| 1. |
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| 2. |
- Andersson, Lisa, 1983-
(author)
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Addressing youth unemployment: what role for social work? : Policy responses to youth unemployment in Sweden and Europe
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Unemployed youth are a heterogenous group facing varying and sometimes complex problems. Being young and unemployed can have a negative impact on future life chances and quality of life. Studies on youth unemployment have mostly focused on education and labour market responses, leaving the involvement of social work aside. This thesis aims to explore policies for unemployed youth in three key policy areas: social work, education and labour market, in Europe and Sweden. The thesis consists of four separate studies highlighting how policy ideas are translated into agendas, and how responses are administered and organized at national and local level. Applying an institutionalist theoretic framework, the results are analysed with consideration to the structure of state and welfare state. Study I explored the ideas inherent to the social policy concept ‘social investment’, outlining three central dimensions of the concept: temporal-perspective, principles of distribution and policy coherence. A key result of study I is that social investment ideas are nuanced, and that social investments can take different forms. In the following three studies, the dimensions of social investment are used as heuristic tools to examine policy responses for unemployed youth. Study II examined how the EU recommendation on establishing a youth guarantee (YG), was translated in national YG plans. The results were analysed using tentative regime-types based on the structure of social work, the education system, and the social insurance system. The results showed that outreach as an early intervention was marginal across countries and regime types, and the involvement of social work was largely absent. In study III, the coordination within and between policy areas was analysed between Sweden and the UK, over time. Policy documents on national labour market programs in both countries between 1998-2011, were analysed. The results showed that coordination between labour market programs and social security benefits/social assistance had strengthened over time in both countries. How authority to regulate and administer different policy areas, was also linked to the occurrence of coordination between different policy areas. Study IV examined if and how specialization and coordination were part of organizing local level work with NEETs in Sweden. This was explored through structured interviews with local professionals in social work, education and labour market. The results showed a pattern of coordination and specialization among education and labour market actors. The involvement of social work was instead marginal, and primarily concerned social assistance. In conclusion, the results of this thesis show that the agenda, content and administration of policy responses to youth unemployment consists mainly of wide, universal and reactive responses. They are also characterized by coordination between labour market measures and social insurance/assistance, in line with an activation trend. An important finding is also the very limited involvement of social work, as noted in national policy agendas and programs, and in local level work. Both activation and social work involvement did however vary somewhat with administrative levels and between different policy areas. The results thereby indicate that institutional aspects such as organizational structure and administration, matter for the involvement of different policy areas in responses to youth unemployment.
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| 3. |
- Batljan, Ilija, 1967-
(author)
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Demographics and Future Needs for Public Long Term Care and Services among the Elderly in Sweden : The Need for Planning
- 2007
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Doctoral thesis (other academic/artistic)abstract
- Long term care and social services (LTCaS) for older people are an important part of the Scandinavian welfare state. The fast growing number of elderly people in Sweden has caused many concerns about increases in future needs (and particularly costs) of age-related social programs such as LTCaS. The general aim of this dissertation is to examine how projected demographic changes may affect future needs for long-term care and services in Sweden assuming different trends in morbidity and mortality. The following data sources are used: national population registers, register data on inpatient/outpatient health care from region Skåne, the Swedish National Survey on Living Conditions (SNSLC) for the period 1975-1999. Three alternative methods to inform simple demographic extrapolations of needs for health and social care for the elderly are presented. Furthermore, a new method for demographic projections has been developed. According to our studies, the health of older people (measured as the prevalence of severe ill-health) has improved during the study period. Taking into account health status, when projecting future needs for LTCaS, will result in a fairly substantial reduction of the rate of the demographically influenced increase in projected LTCaS needs. The changes in population composition regarding education and mortality differentials per educational level may have a significant impact on the number of the elderly in the future. On the other hand, the projected increase in the number of older people suffering from severe ill-health, as a consequence of population ageing, may be counterbalanced to a large extent by changes in the educational composition towards a higher proportion of the population having a high educational level and lower prevalence of severe ill-health. We need to improve our planning tools in order to support policy-makers to plan for uncertainty concerning future needs and demand for LTCaS.
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| 4. |
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| 5. |
- Blomqvist, Jan, 1946-
(author)
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Beyond treatment? : widening the approach to alcohol problems and solutions
- 1998
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Doctoral thesis (other academic/artistic)abstract
- The dissertation includes four different studies which, from different points of departure, aim to illuminate problems and prospects of social work with alcohol problems in contemporary Sweden.Paper 1 analyses the historical succession of predominant public images of, and societal responses to, alcohol problems in Sweden during the past century. The analysis distinguishes between a moral, an enlightenment, a medical and a compensatory approach to these problems. The main development in society's handling of alcohol problems is described to have been a gradual shift from the moral to the medical approach, despite the fact that the compensatory approach is in many respects the one most akin to the general social policy ideal of Sweden. The paper concludes by discussing the future prospects of community-based approaches to alcohol problems, relying on the assumptions of the latter approach.Paper 2 scrutinises, based on reanalyses of a variety of empirical sources, developments within residential care for substance misusers in Sweden during the past three decades. The results of these analyses belie several popular notions about the role of institutions in social work with alcohol problems. Thus they show, in contrast to claims in some public reports, that the annual number of alcohol misusers cared for decreased during most of the 1980s, already before the major decrease in the beginning of the 1990s. Further, they show that residential care has - despite a growing "treatment rhetoric" over the years - been primarily utilised for a rather small group of long-term misusers with severe social problems, and with a pattern of repeated - and often prematurely interrupted - admissions and readmissions over a long succession of years.Paper 3 reviews and discusses the significance of research on "spontaneous recovery" from substance misuse and treatment outcome research. The paper outlines and develops further the notion that there may be "common elements" or mechanisms in all successful change processes, whether these include professional interventions or not. Formal treatment is further discussed in terms of temporary interventions in the client's life course, which may, if successful, facilitate and accelerate "naturally" occurring rehabilitation processes. The paper concludes by proposing a closer integration of research on "spontaneous recovery" and treatment outcome research, as a way of learning more about the potential interplay between life events, formal interventions and change of lifestyle.Paper 4 is an account of an attempt to put the ideas of Paper 3 into practice, by comparing subjects who recovered from severe alcohol problems without formal assistance, with subjects who were assisted in doing so. Comparisons were made with regard to drinking patterns and occurrences of significant life events during a period of time, encapsulating four years before and two years after the resolution, and with regard to subjects' attributions as to what initiated and maintained recovery. As regards drinking patterns and event occurrences, comparisons were further made with assisted and unassisted subjects with current alcohol problems. The results indicate that initial attempts to solve the drinking problem and initial help-seeking, as well as long-term maintenance of the resolution, are influenced by environmental factors, operating outside the context of formal treatment. Unassisted remitters showed greater social stability before the resolution than assisted remitters, more often stated positive incentives for trying to change their lifestyle, and more often tapered their drinking gradually. The results underline the need to consider and try to harness contextual factors when planning individually directed and preventive measures.In an introductory chapter, the four papers are linked together by an examination of prevailing theoretical models of alcohol problems, and the outlining of an overarching perspective that accounts for habitual ex-cessive drinking as a "central activity" in the drinker's way of life. Finally, some joint implications of the four papers, with regard to social work with alcohol problems, and with regard to future research, are discussed.
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| 6. |
- Bromark, Kristina, 1973-
(author)
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The user as a key actor in user participation : Exploring knowledge production in personal social services with a participatory approach
- 2024
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Doctoral thesis (other academic/artistic)abstract
- The concept of user participation in social work is frequently debated. In Sweden, users are supposed to be active and involved in matters concerning them, a stance which is regulated in policy and law. The involvement of users in practice can be considered a form of knowledge production that can strengthen and develop users as well as the organizations. In practice, however, research shows that actual engagement, education or activation of users is difficult to attain and can be understood as a devaluation of user knowledge. The aim of this dissertation is to increase knowledge of how to understand and enhance the conditions for user participation in personal social services. To study this question, the dissertation focuses especially on young people’s participation in the context of out-of-home care. To explore user participation in personal social services, a participatory approach was applied. Data was gathered with young people and staff using participatory techniques as well as qualitative interviews. To explore challenges and possibilities with user participation, a future workshop was held with staff in personal social services (study I). This was followed by a co-design process in which staff, young people, and researchers collaborated on a support tool (study II), later to be implemented in practice (study III). The implementation process was explored by interviewing both staff and managers as well as a user representative (from a youth council). The co-design and implementation processes are problematized and discussed in the dissertation from a researcher’s perspective (study IV). The theoretical framework for understanding how users can be devalued as knowers is epistemic injustice. The assumption is that the role of a knower can shift, depending on social power and the structures in a context. The findings in this dissertation show that user participation is contingent on the distribution of power and responsibility and on perceptions of knowers and knowledge in practice. Although the general attitude towards user participation is positive, a reluctance in practice is revealed. It appears to be a challenge for staff to acknowledge the expertise of users, despite the fact that the users’ have the capacity and are willing to contribute with their knowledge. Work with user participation is identified as a team effort that requires actions at all levels of the organization as well as increased resources, leadership and a coherent understanding and agreement of the concept. A participatory approach to knowledge production with users is identified as a possible way to enhance epistemic justice and the inclusion of all relevant actors in activities and processes. The dimensions important to user participation can be acknowledged. For the dynamics to be maintained in a wider sense, however, an organizational infrastructure, with routines and methods, is necessary. To sustain epistemic justice in the implementation of user participation, a participatory culture with a solid and coherent understanding of user participation in practice is encouraged. A realization of user participation in practice requires a critical exploration of power and positions, systematic changes to infrastructure and transparency about roles and responsibility.
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| 7. |
- Fors, Stefan, 1976-
(author)
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Blood on the tracks : Life-course perspectives on health inequalities in later life
- 2010
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of the thesis was to explore social inequalities in: a) mortality during mid-life, b) health in later life, and c) old-age mortality, from a life-course perspective. The studies are based on longitudinal Swedish survey and registry data. The results from Study I showed substantial inequalities in health, based on social class and gender, among older adults (aged 55+). Moreover, the magnitude of these inequalities did not change during the period 1991-2002. The results from Study II revealed social inequalities in cognitive functioning among the oldest old (aged 77+). Social turbulence and social class during childhood, education and social class in adulthood were all independently associated with level of cognitive functioning in later life. In Study III, social inequalities in mortality during mid-life (i.e., between ages 25 and 69) were explored. The results showed that childhood living conditions were associated with marital status and social class in adulthood and that, in turn, these conditions were associated with mid-life mortality. Thus, the results suggested that childhood disadvantage may serve as a stepping stone to a hazardous life-course trajectory. Study IV explored the association between income in mid-life, income during retirement and old-age mortality (i.e., mortality during retirement). The results showed that both income during mid-life and income during retirement were associated with old-age mortality. Mutually adjusted models showed that income in mid-life was more important for women’s mortality and that income during retirement was more important for men’s. Thus, the results of the present thesis suggest that there are substantial social inequalities in the likelihood of reaching old age, as well as in health and mortality among older adults. These inequalities are shaped by differential exposures throughout the life-course that affect health in later life both through direct effects and through processes of accumulation.
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| 8. |
- Forsman, Hilma, 1985-
(author)
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Addressing poor educational outcomes among children with out-of-home care experience : Studies on impact, pathways, and interventions
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Children with out-of-home care (OHC; foster family/residential care) experience is a high-risk group for future adverse outcomes. With an ambition of supporting the design of effective preventive child welfare measures targeting children in OHC, the overall aim of this thesis is to examine education as a possible intervention path for improving their development and overall life chances.The thesis consists of four interrelated empirical studies that address different aspects of poor educational outcomes among children with OHC experience by means of analyses of longitudinal survey and register data, and evaluations of two interventions aimed at improving their basic academic skills.Study I examined the hypothesized causal effect of poor school performance on adverse outcomes in young adulthood among children with OHC experience. The results showed that poor school performance has an impact on later psychosocial problems net of observed and unobserved factors, suggesting that the estimated effects allow for causal interpretations.Study II explored educational outcomes at different stages in the educational career, and pathways to varied educational outcomes for children with OHC experience and their peers. The results showed that the OHC group had lower educational outcomes across the life course. Yet, by large, their educational pathways did not differ significantly from their peers – cognitive ability and previous school performance had the largest associations with the outcomes in both groups. However, the influence of these factors were weaker in the OHC group whilst the influence of the birth family’s attitude towards higher education was stronger.Study III aimed at furthering our understanding of the book-gifting program the Letterbox Club’s potential impact on foster family children’s reading skills. The results showed that participation in the program was associated with small improvements. In general, the program was well received by children and carers, and could result in increased reading. The study furthermore suggested that promotion of carer involvement may improve its potential impact.Study IV explored the process of conducting a structured paired reading intervention involving foster family children and their carers. Findings showed that it is possible to engage carers in interventions targeting the education of children in OHC, but that this is no automatic process – carers need a rationale for getting involved, and support in delivering the intervention.In sum, this thesis shows that improving the educational outcomes of children in OHC may be a viable intervention path in supporting their life course development, a path that historically has been overlooked. The thesis furthermore shows examples of promising interventions which may improve the basic academic skills of children in OHC. The results also point out that the child welfare system should provide early and continuous educational support, and highlight the importance of addressing adults’ attitudes, expectations, and involvement in these children’s education.
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| 9. |
- Heap, Josephine, 1980-
(author)
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Living conditions in old age: Coexisting disadvantages across life domains
- 2016
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to analyse coexisting disadvantages in the older Swedish population. Coexisting disadvantages are those that occur simultaneously in various life domains. A person who simultaneously experiences several disadvantages may be particularly vulnerable and less well-equipped to manage daily life and may also need support from several different welfare service providers. Concerted actions may be needed for older people who experience not only physical health problems and functional limitations, but also other problems. Research that encompasses a wide range of living conditions provides a basis for setting political priorities and making political decisions.The studies in this thesis used data from two Swedish nationally representative surveys: the Level of Living Survey, which includes people aged 18 through 75, and the Swedish Panel Study of Living Conditions of the Oldest Old, which includes people aged 77 and older.Study I showed that the probability of experiencing coexisting disadvantages was higher in people 77 and older than in those aged 18 through 76. These age differences were partly driven by a high prevalence of physical health problems in older people. In all age groups, coexisting disadvantages were more common in women than men.The longitudinal analyses in Study II indicated that coexisting disadvantages in old age persist in some people but are temporary in others. Moreover, the results suggested a pattern of accumulating disadvantages: reporting one disadvantage in young old age (in particular, psychological health problems) increased the probability of reporting coexisting disadvantages in late old age. Study III showed that physical health problems were a central component of coexisting disadvantages. The results also showed that being older; female; previously employed as a manual labourer; and divorced/separated, widowed or never married were associated with an increased probability of experiencing coexisting disadvantages. However, the experience of coexisting disadvantages differed: the groups associated with coexisting disadvantages tended to report different combinations of disadvantage.Study IV showed that the prevalence of coexisting disadvantages in those 77 and older increased slightly between 1992 and 2011. Physical health problems became more common over time, whereas limited ability to manage daily activities (ADL limitations), limited financial resources and limited political resources became less common. Associations between different disadvantages were found in all survey years, but certain associations changed over time. The results suggest that in general, the composition of coexisting disadvantages in the older population may have altered over time.In sum, results showed that coexisting disadvantages were associated with specific demographic and socio-economic groups. Physical health problems and psychological health problems were of particular importance to the accumulation and coexistence of disadvantages in old age.
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| 10. |
- Heimdahl Vepsä, Karin, 1983-
(author)
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Substance use, pregnancy, and parenthood : A study on problematizations and solutions
- 2021
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Doctoral thesis (other academic/artistic)abstract
- With the starting point in the view that how we interpret a problem is decisive for how we think this problem should be dealt with, the overall aim of this dissertation is to explore problematizations of substance use in relation to pregnancy and parenthood within different settings. The dissertation consists of four studies, based on different empirical materials, that analyze problematizations of substance use, pregnancy, and parenthood from different perspectives. Elucidating how these constructions are made in social work related settings can in the long run contribute to improve the ways that pregnant women and parents with substance use problems are approached.Study I analyzes the Swedish discussion on the diagnosing of Fetal alcohol spectrum disorders (FASD). The data consists of a report from a Swedish authority and webpage material from an FASD interest organization. The results show that the interest organization and the authority have different views on whether FASD diagnoses should be used. The analysis suggests that the discussion on FASD is structured by three main discourses; a scientific discourse, a pragmatic discourse, and an ethical discourse.Study II analyzes professional accounts of substance-using pregnant women’s transitions into parenthood. Professionals within maternity care were interviewed in focus groups. The results show that the professionals related to two, sometimes contradictory, ideals of, on the one hand, “believing in the patient” and on the other hand “being realistic” when reflecting on the patients’ prospects to function well as parents.Study III is carried out as a scoping review aimed to give an overview of research on psychosocial interventions targeting parents with substance use problems. It has a focus on underlying assumptions motivating these interventions. The results show that all studies but one focused on women as parents. Most of the interventions were primarily concerned with the psychological deficits of these mothers, while only seldom addressing broader social and structural factors.Study IV aims to explore how parents with previous substance use problems narrated their experiences of becoming and being parents. The study participants were all active in the 12-step movement. The results show that the way they narrated their experiences of substance use problems, recovery, and parenthood was structured by a classic 12-step storyline. The participants described how their recovery processes had made them more emotionally present and skilled in handling their own feelings – competences they described as important resources for them as parents. The four studies, taken together, show some patterns in how substance use, pregnancy, and parenthood were problematized in relation to each other. The problematizations tended to portray parents, and especially mothers, with substance use problems as posing risks towards their children’s psychological and physical wellbeing. Furthermore, there was a tendency to define these parents solely based on their substance use problems, without acknowledging potential individual variation in parenting capacity. Finally, the solutions presented had a clear individualistic focus, emphasizing, for example, the importance of individual motivation and the willingness to comply with treatment, but only occasionally taking contextual and structural factors into account.
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| 11. |
- Hussénius, Klara, 1988-
(author)
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Differentiating the Poor : Patterns of Discrimination in Decision-Making on Social Assistance Eligibility
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Access to the Swedish welfare state’s last safety net, social assistance, is ultimately determined through discretionary decision-making by social workers. This dissertation examines intersectional patterns and discriminatory bias in social workers’ assessments about social assistance eligibility. Focusing on factors related to applicants’ gender, family and ethnicity, the project comprises four studies, all of which highlight patterns regarding which applicants assessed as being eligible for support. Altogether, the project contributes to an expanded understanding of discriminatory tendencies in how social assistance policies are given practical meaning by the professionals that bring them into force.The first study builds on data covering all social assistance eligibility decisions implemented in 25 municipalities during one calendar month in 2012 (n=472). The remaining three studies build on data from a vignette experiment conducted in 2018, in which just over 1,000 social workers from 19 municipalities, including Sweden’s three largest cities, participated. Results from both sources of data confirm the impression left by previous research that social assistance assessments are gendered. They show that the likelihood of granting assistance is determined through different standards for men and women. In the view of current knowledge gaps, an important contribution lies in bringing the issue of ethnicity bias to light. The results from the vignette experiment indicate that applicants with Arabic-sounding names are responded to with more conditionality than applicants with Swedish-sounding names, and that discriminatory biases related ethnicity are highly intertwined with gender biases.By raising much-needed questions about the assessment of couples, the project also draws attention to the dissonance between the Swedish welfare state’s gender equality regime and the conditions for accessing social assistance. The results indicate that moral judgments about applicants’ gendered family roles affect social workers’ propensity to grant support to couples, and that such judgments take form through ethnicity bias. In terms of theory, the dissertation draws upon feminist and postcolonial perspectives on social policy as well as a street-level bureaucracy perspective on frontline work. Social assistance is understood as part of the welfare state’s wider politics of redistribution, and the quantitative patterns formed by social workers’ individual acts are seen in the light of structural inequalities. The dissertation presents a conceptual model for thinking about social assistance eligibility, emphasising uncertainty as an inescapable dimension of means-testing. A central argument is that eligibility issues decided at the street level cannot be separated from ongoing discretionary processes of policy implementation. While the risk of discrimination in social assistance assessments is inevitable, it tends to be concealed by the administrative arrangements through which policy comes to matter.
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| 12. |
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| 13. |
- Härd, Sofia, 1992-
(author)
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Knowledge in practice : The feasibility of recovery capital in Swedish alcohol and other drug treatment
- 2024
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Doctoral thesis (other academic/artistic)abstract
- The recovery model, endorsed by various governmental bodies, emphasises the integration of a recovery perspective into alcohol and drug policy, with a focus on post-treatment interventions such as housing, employment and education needs. In an effort to enhance the utility of the recovery perspective in treatment, the concept of recovery capital (RC) has been used as a foundation for operationalisations used to measure treatment needs and progress. While other countries have embraced the recovery model and RC in alcohol and other drug (AOD)-related policy and treatment, the treatment setting in Sweden has not undergone a comparable transformation. This dissertation aims to explore the feasibility of implementing RC in Swedish AOD treatment. It examines the transferability and applicability of assessment tools and considers the challenges of translating research into practice. This involves delving into the complexities of knowledge transfers, production and use in order to bridge the gap between research findings and practical implementation. The feasibility study involved qualitative interviews with AOD treatment professionals to gather their perspectives on the applicability of an RC-based assessment tool (Papers II and III). Insights into feasibility were also obtained from a quantitative study assessing treatment progress in individuals residing in a recovery residence in Florida, USA, using an established RC-based assessment tool (Paper I). To further evaluate the target setting for the feasibility study, the use of a locally developed assessment tool was explored through a deviant case analysis (Paper IV). The dissertation’s theoretical framework is built upon conceptualisations of standardisations and professions that emphasise their interconnected nature and thereby underscore the significance of their relationship in the analysis of knowledge production and use, thus situating the study within a broader theoretical discourse on the interplay between standardisation and professionalism.The findings confirm the applicability of the RC concept in Swedish AOD treatment by highlighting its unique benefits in exploring diverse recovery pathways to address individual challenges and strengths. However, it is evident that certain elements of its conceptual framework are already implemented in the treatment facilities visited in the study. Furthermore, whether or not to use standardised assessment tools to implement RC in Swedish AOD treatment remains unclear. The dissertation also emphasises the importance of collaborating with professionals during the development of assessment tools as a way of ensuring that these tools align with the cultures and structures of the social work profession, presenting this collaboration as an approach to bridging the gap between research and practice. It also identifies a significant knowledge gap in locally produced knowledge, urging further research to map its extent and evaluate its impact on current and future knowledge production and use in social work. Lastly, the absence of client participation is acknowledged. The need for future research to explore the client perspective is emphasised, given the potential adverse effects of recovery-oriented interventions on clients.
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| 14. |
- Jegermalm, Magnus
(author)
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Carers in the Welfare State : On Informal Care and Support for Carers in Sweden
- 2005
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Doctoral thesis (other academic/artistic)abstract
- The general aim of this dissertation is to describe and analyse patterns of informal care and support for carers in Sweden. One specific aim is to study patterns of informal care from a broad population perspective in terms of types of care and types of carer. A typology of four different care categories based on what carers do revealed that women were much more likely than men to be involved at the ‘heavy end’ of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely than women to provide some kind of practical help (Study I).Another aim is to investigate which support services are received by which types of informal caregiver. Relatively few informal caregivers in any care category were found to be receiving any kind of support from municipalities or voluntary organizations, for example training or financial assistance (Study II).The same study also examines which kinds of help care recipients receive in addition to that provided by informal carers. It appears that people in receipt of personal care from an informal caregiver quite often also receive help from the public care system, in this case mostly municipal services. However, the majority of those receiving personal, informal care did not receive any help from the public care system or from voluntary organizations or for-profit agencies (Study II).The empirical material in studies I and II comprises survey data from telephone interviews with a random sample of residents in the County of Stockholm aged between 18 and 84.In a number of countries there is a growing interest among social scientists and social policymakers in examining the types of support services that might be needed by people who provide informal care for older people and others. A further aim of the present dissertation is therefore to describe and analyse the carer support that is provided by municipalities and voluntary organizations in Sweden. The dissertation examines whether this support is aimed directly or indirectly at caregivers and discusses whether the Swedish government’s special financial investment in help for carers actually led to any changes in the support provided by municipalities and voluntary organisations. The main types of carer support offered by the municipalities were payment for care-giving, relief services and day care. The chief forms of carer support provided by the voluntary organizations were support groups, training groups, and a number of services aimed primarily at the elderly care recipients (Study III).Patterns of change in municipal carer support could be discerned fairly soon. The Swedish government’s special allocation to municipalities and voluntary organisations appears to have led to an increase in the number of municipalities providing direct support for carers, such as training, information material and professional caregiver consultants. On the other hand, only minor changes could be discerned in the pattern of carer support services provided by the voluntary organizations. This demonstrates stability and the relatively low impact that policy initiatives seem to have on voluntary organizations as providers (Study IV).In studies III and IV the empirical material consists of survey data from mail questionnaires sent to municipalities and voluntary organizations in the County of Stockholm.In the fields of social planning and social work there appears to be a need to clarify the aims of support services for informal carers. Should the support be direct or indirect? Should it be used to supplement or substitute caregivers? In this process of reappraisal it will be important to take the needs of both caregivers and care recipients into account when developing existing and new forms of support. How informal caregivers and care recipients interact with the care system as a whole is undeniably a fertile field for further research.
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| 15. |
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| 16. |
- Karlsson, Patrik, 1977-
(author)
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Margins of Prevention : - On Older Adolescents' Positive and Negative Beliefs about Illicit Drug Use
- 2006
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Doctoral thesis (other academic/artistic)abstract
- This study explores older adolescents’ positive and negative beliefs about illicit drug use from a preventive perspective. By positive beliefs is meant positive expectancies and benefit perceptions. By negative beliefs is meant negative expectancies and risk perceptions. The choice of studying beliefs originates from the assumption that there is much to gain for prevention in considering the target audience’s starting point. An appraisal of the extent to which positive and negative beliefs are held suggests the margins for change.The data used for the study derive from a survey conducted among a sample of third-year students in upper secondary school in the greater Stockholm area (n=2104). Overall, findings demonstrate that high negative beliefs are held and that positive beliefs to some extent are held. While this being the general trend, marked differences emerge between individuals who have used illicit drugs and individuals who have not. By and large, experienced individuals rate the negative sides as lower and the positive sides as higher than the other group. Substantial differences are found among lifetime users of illicit drugs as well. Those who have used illicit drugs more frequently during the last 12 months differ in particular from those who have refrained during this period. The differences are dramatic in some cases. In addition, consistent differences are documented between the sexes. Males are found to hold lower negative beliefs and higher positive beliefs across most measures employed. Few systematic relationships are found between other variables and outcomes.Plausible explanations for the findings are discussed theoretically and potential implications for drug prevention are highlighted. A saturation hypothesis is introduced in order to accentuate that the overall room for change in negative beliefs probably is limited. Conversely, the fact that positive beliefs are held to a certain degree suggests a belief domain with change potential.
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| 17. |
- Kejerfors, Johan
(author)
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Parenting in urban slum areas : families with children in a shantytown of Rio de Janeiro
- 2007
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Book (other academic/artistic)abstract
- This is a study of parenting and child development in a slum area in a developing part of the world. The aims of the study were threefold. The first aim was to explore the physical and social contexts for parenting in a shantytown in Rio de Janeiro using an ecological perspective. The second aim was to examine parenting and subsequent child outcomes among a sample of families living in the shantytown. The third aim was to explore what factors contribute to differences among parents in how they nurture and protect their children. The theoretical framework of the study was an updated version of Bronfenbrenner’s bioecological model of human development. Using self-report questionnaires developed by Rohner, data on perceived parental acceptance–rejection were collected from 72 families with adolescents 12–14 years old, representing approx. 75% of all households with children in this age group in the shantytown. Besides self-report questionnaires, each adolescent’s main caregiver replied to several standardized questionnaires developed by Garbarino et al., eliciting demographic and social-situational data about the family, neighborhood, and wider community. The results of the study paint a complex portrait of the social living conditions of the parents and children. Despite many difficulties, most parents seemed to raise their children with loving care. The results from the self-report questionnaires indicate that the majority of the adolescents perceived substantial parental acceptance. The adolescents’ experience of greater or lesser parental acceptance–rejection seems to influence their emotional and behavioral functioning; it also seems to be related to their school attendance. Much of the variation in degree of perceived acceptance–rejection seems to be related both to characteristics of the individual adolescents and their main caregiver(s) and to influences from the social and environmental context in which they and their caregivers interact and live their lives.
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| 18. |
- Korkmaz, Sibel, 1987-
(author)
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Youth Intimate Partner Violence in Sweden : Prevalence and Young People’s Experiences of Violence and Abuse in Romantic Relationships
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Swedish studies on intimate partner violence (IPV) among young people are virtually non-existent, and the European research field on this phenomenon has not been specifically overviewed. This thesis aims to review European research on youth IPV, investigate the extent and characteristics of youth IPV victimization in a sample of Swedish high school students, and explore the dynamics of this victimization.The dissertation consists of four sub-studies employing different kinds of methods and using different sets of data. Analyses are underpinned by a rather extensive theoretical framework, permitting an examination of youth IPV from different perspectives and angles.Study I gives an overview of existing European research, pointing out trends and challenges within the field and providing a frame of reference for the Swedish study. One conclusion of this overview is that an intersectional approach is needed when researching violence among youth, and that gender, especially, is a key variable to explore in research on youth IPV.Study II presents IPV prevalence rates in a regional sample of Swedish young people. Drawing upon survey data, the study shows that over half of participating youth reported experiences of some form of IPV, and that girls experience more repeated IPV compared to boys. Furthermore, the study places youth IPV in a physical context, suggesting that it takes place in different arenas, such as the parents’ house, the partner’s house, and at school.Study III uses data consisting of “teller-focused” interviews with 18 IPV victimized youth (aged 17-23) in Sweden, and illustrates the dynamics of IPV victimization, establishing it as a social phenomenon and emphasizing the agency of young people in the midst of abusive relationships. It shows varying responses (including a lack of response) from three different actors: parents, school, and young people themselves, all from the young person’s perspective. Overall, the data show that youth-specific factors (e.g. parental dependency, attending school) have a meaningful bearing on both responses and resilience to IPV.Lastly, study IV draws upon data consisting of “teller-focused” interviews with 18 IPV victimized youth (aged 17-23) in Sweden, and shows how young people’s abusive relationships come to an end. It shows that the ending process for youth may be different than for adults, since youth-specific factors create unique barriers (e.g. the desire to be a girlfriend) and bridges (e.g. parental responsibilities) for young people seeking to end abusive relationships.Overall, this dissertation shows that many Swedish youth experience violence within a romantic intimate relationship, and that such violence, many times, is repeated and severe. The results indicate a gendered dimension to youth IPV—compared to boys, girls report more repeated violence and also describe how gendered norms affect their victimization. Moreover, regarding the physical context of youth IPV, the results show that this social problem takes place in arenas where adults dwell and how they can respond. Hence, it is not possible for the adult world to dismiss youth IPV as something undetectable.In sum, this dissertation shows that IPV does happen “when you’re young too.” Thus, it seems apparent that a wide-ranging response is called for: one that involves parents, schools, social workers, and policy makers alike. Only then will youth IPV as a social problem receive the attention it needs and deserves.
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| 19. |
- Larsson, Kristina, 1951-
(author)
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According to need? : Predicting use of formal and informal care in a Swedish urban elderly population
- 2004
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Doctoral thesis (other academic/artistic)abstract
- This dissertation studies factors that predict use of public eldercare, informal care, and purchase of private services in relation to an individual’s needs, social network characteristics, and sociodemographic factors. A further purpose is to examine whether use of public eldercare is correlated to receipt of informal care and purchase of private services in the Swedish welfare state. The dissertation is based on the Kungsholmen Study, a population-based longitudinal study. Studies I–III used cross-sectional data from community-dwelling people aged 81-100 and examined (I) gender, (II) marital and parental status, and (III) dementia and depressive symptoms as predictors of use of home help. Study IV analyzed factors related to moving into institutional care and receipt of home help from 1994/96 to 2000. The majority of support provided to elders living in the community comes from informal sources, even among people living alone. There was considerable overlap between home help and informal care. When all sources of care were considered, childless individuals had comparatively lower odds of receiving care. Factors predicting use of public eldercare and informal care differed depending on whether or not elders coresided. No gender differences in use of formal and informal care were found when controlling for household composition. Living alone, dementia, need of help with household chores, and walking limitations increased the likelihood of using public eldercare. Coresidence, informal care from outside the household, and use of private services decreased the likelihood. Depressive symptoms increased the likelihood of receiving home help and institutionalization when using longitudinal data, but not in the cross-sectional studies. Educational level was of importance and interacted with several factors; persons with higher levels of education were advantaged. Very few people moved into institutional care without previously having received home help services. Essentially the same factors that predicted receipt of home help services also predicted institutionalization.
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| 20. |
- Linell, Hanna, 1975-
(author)
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Child protection through an abuse-focused lens : Adolescent victimization and Swedish social services responses
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Knowledge concerning the social services’ use of the Care of Young Persons (Special Provisions) Act 1990:52 (CYPA) is relatively scarce, especially when it comes to the protection of adolescents victimized by abuse. The overall aim of this thesis is to investigate and discuss different conceptualisations of abuse, adolescents’ agency regarding abuse, victimization and social intervention, and how abuse and adolescent victimization are responded to, primarily by the social services. This is done from a stance influenced by critical realism as well as victim- and child-centred responses. The dissertation consists of four papers and examines these themes in two samples of judgments and related documents concerning applications for care of adolescents aged 13-17 under the CYPA. The findings from the total study of all judgments in the selected year clearly confirm § 2 CYPA as a rare intervention to protect adolescents. In only 85 of Sweden's 290 municipalities was a CYPA application made, but a main finding is that such care to a large extent was used to protect adolescents from various forms of abuse. In the total study, the applications of § 2 CYPA concerned 196 adolescents, for 70 per cent of whom abuse was described, and where more girls (96) than boys (41) were being considered for care based on abuse. Of all the girls, 79 per cent were described as subjected to abuse and of the boys 55 per cent. Also in the smaller sample consisting of judgments for 37 girls in care under § 2 CYPA and §§ 2 and 3 CYPA, abuse was described for many. For several adolescents in both samples abuse was described as having been exerted to maintain standards of honour, shame and virginity, and/ or to enable a forced marriage. The initiative and agency of the adolescents themselves in both the disclosure of abuse as well as the decision on alternative care is one of the most striking findings in the thesis. The majority of the adolescents, 71 per cent, were categorized as having intentionally disclosed the abuse. The aftermath of the disclosure was for many of the adolescents described as intensely challenging. For the majority the abuse was denied during the investigation, not only by the alleged abusers but also by non-abusing parents and other relatives. The findings relating to the social services responses suggest that the initial response to a high degree could be understood as parent-oriented. For 33 per cent, the judgment also revealed that the abuse had been disclosed to authorities one or several times prior to the investigation leading to the application for care under the CYPA. That the abuse in these cases had been known to the social services for on average 5 years can from a child-centred position be seen as a major failure regarding the system’s ability to reach children and stop abuse. A central conclusion is that the various forms of abuse described seem more connected to domination, fear, power and control than to conflict; to some extent mirroring the kind of systematic oppression described for victimized adults seeking the protection of NGOs and public authorities. The findings imply that interventions under the CYPA may enable more child-centred, safe and stable protection of children subjected to this kind of abuse. Given the findings in the present thesis it is argued that it may be important to differentiate the concept of abuse as well as to acknowledge the agency of children in both research and in practice.
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| 21. |
- Ljungwald, Carina, 1975-
(author)
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The Emergence of the Crime Victim in the Swedish Social Services Act
- 2011
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Doctoral thesis (other academic/artistic)abstract
- This study sought to explain how crime victims emerged as a target group in the Swedish Social Services Act in 2001. The findings, derived from legislative documents, a literature review, and focus group interviews with social workers, showed that the 2001 provisions both duplicated and undermined pre-existing provisions of the Social Services Act. The explicit aim of the reform was to improve services to crime victims. The provisions did not, however, change the legal responsibility of the social services, nor did they strengthen the social rights of crime victims. The social services already assumed responsibility for crime victims according to other provisions of the act. To some degree, the reform can be explained symbolically. Support for crime victims was a complicated issue for the social democratic government. The economic crisis of the early 1990s ruled out reforms that might bring high increased costs. Yet expanding crime victims’ rights at the expense of the offender (e.g. toughening penal law and promoting victim impact statements) was not in line with social democratic ideology. By enacting the 2001 provisions, the government showed its commitment to providing support to crime victims. At the same time, the provisions did not increase costs or strengthen crime victims’ rights. In this way, the provisions solved a political dilemma for the government. Incorporating the 2001 provisions in the Social Services Act may seem to have been a modest reform. Symbolic politics, however, are not empty; rather, they reflect attitudes and beliefs. This study proposed that the reform revealed the state’s increasing concern with violence against women and individual responsibility. Furthermore, the provisions may have constituted a normative reorientation of the Social Services Act, in which individual responsibility increasingly replaced solidarity, the holistic view, and a right to assistance according to need.
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| 22. |
- Meinow, Bettina, 1972-
(author)
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Capturing health in the elderly population : Complex health problems, mortality, and allocation of home-help services
- 2008
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Doctoral thesis (other academic/artistic)abstract
- This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+).Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up.Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults.Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment.The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.
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| 23. |
- Meiss, Kathleen Ann, 1947-1993
(author)
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Work, welfare & social work practice
- 1991
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Doctoral thesis (other academic/artistic)abstract
- This is a study of the search for the essential nature of social work practice. The text is divided into two parts. The first part presents a theoretical analysis of the intraprofessional discourse in search of a generic study-object for social work practice. Part 2 follows with an empirical application of the theoretical findings for the field of occupational social work. Placed within a framework that seeks to identify fundamental contextual issues, practice traditions and prevailing dilemmas of current practice theory, this study examines social work practice in Sweden and the USA today. The project is built upon a qualitative research method based upon the social work tradition of the use-of-self as the instrument of practice and a complex triangulation design which builds upon a practitioner-researcher perspective. In part 1, social work practice is defined by its practice focus, the internal dynamics of practice, and its external societal relations, the external dynamics of practice. The intra-professional struggle to define a generic study-object is plagued historically by the polarization between micro and macro practice traditions. The central problem for the development of social work practice theory is formulated as an embarrassing void. Clues are identified within the professional debates gradually marking the route for the identification of the embarrassing void and a generic studyobject of social work practice as a concept of victimization. Victimization is defined as a process concept of relationship-in-action, the contradiction of which is the function of practice, the advocacy of basic human rights. The relevance of a concept of victimization for social work practice is examined against the societal context in Sweden and the USA where underlying philosophical similarities are found to depend upon the citizen's relationship to the employment market for determining the quality of their personal welfare protections. In part 2, the concept of victimization is tested, with the application of an "extreme example" research method, against the boundary practice of occupational social work, and finds that it offers an unrecognized significance for western, democratic welfare states today. Empirical case-studies of occupational social work practices in Sweden and the USA are reported, examined and compared. The numerous and penetrating consequences of this study call for a re-examination of social work practice with relationship to the centrality of victimization processes and the relevance of employment for social work clients. The study concludes with a proposal for a new Social Justice Model for social work practice to be founded upon basic human rights in the private (family) and public (employment) spheres of everyday life as the concrete manifestation of the practice of social work with issues of victimization.
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| 24. |
- Minas, Renate, 1962-
(author)
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Administrating poverty : Studies of intake organization and social assistance in Sweden
- 2005
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Doctoral thesis (other academic/artistic)abstract
- The general purpose of this dissertation is to study the causes and the consequences of the formal structure of intake of potential social assistance clients at Swedish social welfare offices. The focus lies on the social welfare offices, their organizational framework and routines concerning intake. A focus on the formal structure of the intake may provide information about the importance of organization for people seeking help but also for the municipalities themselves. The data used in the analyses comes from two surveys of welfare offices augmented with register data.Study 1 examines the very first contact between social assistance inquirers and the social welfare offices. Telephone intake and first personal visits are documented and a considerable variation in the share of inquirers who received an appointment for further assessment was found. Considerable variation was also found in the share who were granted social assistance after the assessment during the personal visit. An examination of the offices’ intake routines and organization provided some indications that the unequal priority given to intake is an important explanation behind the variation.Study 2 analyzes the link between intake organization and the degree of selection taken place at telephone intakes by focusing on those inquirers not becoming clients. The relationship between intake organization and the social workers’ reasons for selection is examined and several selection strategies could be found. The results confirm the fact that Swedish municipalities have great autonomy in designing the social services and in addition show that offices within the same municipality may choose different organizational solutions.The aim of study 3 is to investigate how intake of social assistance inquirers is organized in Swedish municipalities and what factors determine intake organization. The results show that there are three different intake types. One of them, called special intake units, is distinct from the other two in that the intake staff has relatively high qualifications. Examining factors likely to affect the creation of special intake units, the results show that mainly professional and organizational factors related to the organization of work within the whole social assistance unit are important.The purpose of study 4 is to examine the connection between organizational factors and local social assistance expenditures in Swedish municipalities. The organization of the social assistance unit, in particular to the intake of social assistance inquirers, and its potential implication for local social assistance costs are emphasized. The results show a cost reducing effect of special intake units first when analyzed together with additional specialization and taking account for staff resources. Thus, specialized intake organization by itself does not play a cost reducing role, but in combination with certain other factors describing internal organization.In an introductory part the studies are located in a broader framework starting with a historical description of different strategies and classification systems traditionally used when distributing poor aid. The expansion of the welfare state changed the importance of a last safety net. Specific characteristics of public organizations administering social assistance are described and the legal framework is outlined focusing on the right to apply for social assistance is outlined. Different aspects of intake are then discussed: stages of the intake process, the organization of intake in Sweden and elsewhere, intake organization as a fashion, and possible functions of the intake. Finally, implications of the four studies with regard to access to benefit and the issue of specialization as well as further research are discussed.
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| 25. |
- Månsson, Josefin, 1982-
(author)
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Cannabis discourses in contemporary Sweden : Continuity and change
- 2017
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis is to study how cannabis is constructed in contemporary Sweden, which policy responses are promoted as rational, and how international cannabis trends are received in this context. The four papers are the result of analyzing empirical material from three different sub-studies: 1) a qualitative study of online discussions about cannabis and drug policy, 2) a qualitative and comparative study of print media articles from 2002 and 2012, and 3) a qualitative study of oral presentations from cannabis information symposia. All papers are based on a social constructionist approach.A point of departure is that attitudes and regulations on cannabis have changed in large parts of the Western world. In Sweden, however, strict prohibition of cannabis is still central in the national drug laws. Some of the main findings can thus be gathered in discussions on continuity and change. In Swedish online discussions, there seems to be a strong desire to change the national cannabis policy in line with international developments. This discussion propagates alternative views on cannabis, in which comparisons to alcohol become vital and more liberal cannabis policies become logical. These discussions are also characterized by continuity, as many arguments for liberal cannabis policies seem to be based on traditional social democratic values and prohibitionist “scaremongering” arguments. Continuity is also what seems to characterize traditional print media, where cannabis is generally portrayed as a potent and illegal drug producing social problems. However, this arena also shows signs of change, as the material from 2012 includes stories on cannabis as an economic asset as well as a recreational substance. Both traditional print media and cannabis information symposia focus on youth consumers, who are seen as particularly vulnerable to cannabis effects. Such constructions seem important for protecting prohibition from international influences and for a continuous discourse centered on the dangers of cannabis.It is concluded that cannabis appears to be able to represent almost anything. As such it can be “used” for any purpose to promote a whole set of ideas related to policy often based on what is considered as scientific evidence. Depending on the context, it thus seems possible that cannabis is medicinal, recreational, harmful, and addictive. If so, and if all of these constructions are in some way “real,” then it is suggested that cannabis necessitates a much more tailored and nuanced response than that which prohibition can offer.
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| 26. |
- Pålsson, David, 1986-
(author)
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The Prerequisites and Practices of Auditing Residential Care : On the Licensing and Inspection of Residential Homes for Children in Sweden
- 2018
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Doctoral thesis (other academic/artistic)abstract
- The aim of this dissertation is to describe and analyse the prerequisites and practices of auditing Swedish residential care for children. Residential care is a complex intervention provided to children in vulnerable life situations. The care is extensively delivered by private providers and shows difficulties in demonstrating clearly positive treatment effects. Licensing and inspections are policy instruments to address alleged quality problems in decentralised and marketised welfare services. However, in research there are mixed opinions on the ability of audits to generate improved service quality.The dissertation consists of four papers exploring central facets of the audit system. The empirical material is based on interviews (n=50) with inspectors and residential staff, documentation (n=286) in terms of guidelines and license/inspection decisions and observations (n=12) at inspection-related events. Each paper includes a unique set of data.Paper I analyses the controls that private residential homes undergo prior to their entry into the market. The results show that a majority of applicants are granted a license and that the controls do not reduce the need for ex post control. There is limited guidance on care content and research evidence is weakly incorporated in the controls. Overall, the state exerts limited influence over the composition and professional development of the care market.Paper II explores the operationalisation process of care quality in inspections. The results show that the standards display a marked variation and there is no differentiation between different residential homes. In general, the standards focus on reducing malpractice and not maximising care quality. In practice, the inspections are often discussion-based and standards relating to work with children are often indistinct.Paper III analyses how inspections are perceived by representatives from residential homes. The results show that inspections induce reflection and to some extent shape the administrative parts of care, but also that it is difficult to discern the actual impact of the inspections on the work. The inspections appear to bring a degree of stability and legitimacy to the work, but there are sometimes tensions between standards and professional judgment.Paper IV studies the influence the inspection process grants children in care. The results suggest that different inspectorial rationales (regulative, supportive and protective) may influence the agency children exert and that it is difficult to allow children’s views to have a substantial impact on the process. Overall, there tends to be a gap between what the children find important and what the audits can address in concrete terms.The theoretical ideas used to analyse the results are derived from institutional organisational theory and the thesis on the audit society. The overall analysis shows that 1) making certain core care aspects auditable and ensuring their impact is difficult (e.g., children-staff relationships, children’s views and use of research knowledge), 2) the system has a restrained character and is in many senses associated with inconclusive formative effects, 3) the use of uniform goals does not necessarily equal a more suitable care provision and 4) the audits signify strong symbolic values. Despite the limitations, the audits may help to discipline care providers, secure a minimum level relative to the audited care aspects and induce reflection among auditees.
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| 27. |
- Schön, Pär, 1971-
(author)
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Gender Matters : Differences and change in disability and health among our oldest women and men
- 2011
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Doctoral thesis (other academic/artistic)abstract
- This thesis investigates gender differences in health and how they have changed between 1992 and 2002 among very old people. It explores gender differences in the association between disability and health, and gender differences in care utilization among our oldest old people. The studies are based on nationally representative data of the population in Sweden aged 77 and older (SWEOLD). Results from Study I showed that women generally had more health problems than men. Analyses of change between 1992 and 2002 showed increased prevalence rates for both sexes, especially women. However, women’s reporting of poor global self-rated health did not increase. There were no gender differences and there was no change over time in activities of daily living (ADL). Several health indicators seem to be developing differently for women and men. Study II showed that associations between ADL disability and other health indicators changed between 1992 and 2002, with several health problems and functional limitations becoming less disabling over time. This trend was especially true for women, while for men, the findings were mixed. Study III found no gender differences in physician visits and dental visits, despite women’s worse health and dental status. Marriage was associated with more physician visits for men and dentist visits for women. Results imply that women and unmarried older adults may have unmet health-care needs. Study IV examined whether the increase in life expectancy at age 65 observed between 1992 and 2002 consisted of years with or without musculoskeletal pain. Results showed that total years without pain decreased for both women and men, but more so for women. Women also had more years with pain added to life. The results of this thesis suggest an increase of health problems, but not disability, in the oldest Swedish population. However, gender variations in the findings highlight the importance of analyzing health trends separately for women and men.
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| 28. |
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| 29. |
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| 30. |
- Topor, Alain, 1952-
(author)
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Managing the contradictions : Recovery from severe mental disorders
- 2001
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Doctoral thesis (other academic/artistic)abstract
- One of the assumptions made when mental problems are defined as a medical problem is that certain problems, certain diagnoses, are chronic. Nevertheless, a substantial number of follow-up studies have shown that the course of development in patients with these diagnoses is neither uniform nor chronic. The aim of this dissertation is to summarise the state of the art in the knowledge about recovery from severe mental disorders and to examine in depth which factors people who have recovered regard as having helped them in their recovery, and in which ways. These two aims have resulted in two separate but complementary presentations of results. The review of the state of the art, which focuses on the diagnosis schizophrenia, shows that some two-thirds of the patients who received this diagnosis have recovered, either totally or socially. The variation in the percentage of persons who have recovered is explained in the study by such factors as fluctuations in national and local unemployment rates, in definitions of the diagnoses and in access to psychiatric care. On the other hand, the introduction of various treatment interventions seems to have had no noticeable effect on the recovery rate, although it has affected the relapse frequency. There is still a long way to go towards understanding the recovery process and how it can be facilitated. The interview study with persons who have been treated for severe mental disorders and recovered show the patients themselves to be a crucial factor in their own recovery. Throughout the whole course of the disorder, they struggle to find ways to manage both their symptoms and the factors that cause them. What appears to others as symptoms might instead be theperson’s unsuccessful attempts to manage existential problems. Entering into and maintaining relationships with other people is another crucial factor in recovery work. Professionals from a variety of backgrounds as well as family members and other laypersons can contribute to recovery, first and foremost in that they represent continuity between diverse facets of the person’s life; they engage with the person in his/her full complexity, not as someone reduced to a diagnosis and a given patient role, nor by denying the fact of the person’s suffering. Still another factor in recovery work is material conditions which impact on the person’s possibility to regain an identity as a full member of the community. Lastly, the descriptions that the respondents give of their recovery practice have certain constructed meanings in common. These meanings can be categorised as medical, therapeutic, spiritual and interactional. In many of the life stories collected in this study, several of these categories of meaning appear in unison, co-existing in one and the same life story. There is a recurrent theme running through these practice stories of recovery: that people in their everyday lives are not reducible to their problems, but at the same time these problems must not be denied. That people have both weaknesses and strengths, sometimes existing within the same spheres of life and occurring simultaneously; but that in relationships with other people they are given scope to manage and live with these contradictions is of central importance for recovery practice.
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| 31. |
- Trydegård, Gun-Britt, 1937-
(author)
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Tradition, change and variation : past and present trends in public old-age care
- 2000
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Doctoral thesis (other academic/artistic)abstract
- The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services.Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation.Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings.Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics.In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed.
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| 32. |
- von Braun, Therese, 1982-
(author)
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Theorizing the therapeutic process in substance use-related dependency treatment
- 2018
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Doctoral thesis (other academic/artistic)abstract
- The aim of the thesis was to increase knowledge on how to understand the therapeutic process highlighting the importance of the therapeutic relationship as described by therapists and clients in substance use-related dependency treatment. The research questions were related to how the therapeutic process can contribute to a positive outcome considering the therapists’, the clients’ and close co-dependent relatives’ perspectives. The thesis followed a qualitative and narrative research design and consists of six studies (I-VI). Study I contributed a description of a multidimensional interactional model for the analysis of substance use-related dependency. The study revealed how a multidimensional interactional model can provide holistic and detailed knowledge about the complex processes involved in the use or misuse of alcohol and drugs. The interactional model was illustrated by a narrative analysis of qualitative empirical data. This model seemed to support a person-by-situation interactional analysis of substance use-related dependency. Study II revealed the possibilities and limitations of using a self-theoretical perspective in the analysis of the use or misuse of alcohol and drugs. The self-theoretical perspective was related to empirical case illustrations based on qualitative or narrative data. The implications of studies I and II were that a self-theoretical perspective can be integrated within a multidimensional model and can be a fruitful theoretical framework for the analysis of treatment processes of dependency. Study III presented conceptual contributions for understanding treatment of substance use-related dependency, focusing on the importance of the therapeutic process and the therapeutic relationship and the use of narrative methods. Study IV presented a structural perspective on clients’ narrative descriptions of different phases of the use or misuse of alcohol and drugs including phases of treatment. Study V contributed an in-depth analysis of three therapists’ narratives of therapeutic relationships in the treatment of drug-dependent clients. The analysis pointed out the multidimensional aspects of the treatment and focused on three phases of therapy; starting the therapeutic process and building a therapeutic relationship, the ongoing therapeutic process, and the closing phase of therapy. The study also presented an in-depth analysis of two narrative case histories on dependency treatment. Study VI focused on a qualitative in-depth analysis based on narrative data from a group of 10 clients that had undergone treatment for alcohol and drug use or misuse. The study also included qualitative and narrative data from four co-dependent clients and six therapists about their views on the treatment process and the therapeutic relationship. The results of the study described how to understand the experiential world of the clients and their cognitive, emotional and behavioral changes associated with the treatment process. The thesis’ contributions relate to an outline of a self-theoretical perspective integrated within a multidimensional interactional model for the analysis of the therapeutic process and the therapeutic relationship in substance use-related dependency treatment. The theoretical analysis sheds new light on the complexity of the treatment process and the clients’ struggle with their personal identity and sense of self, especially their drug self.
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