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I ALL FORTROLIGHET: En undersøkelse av meldinger ompsykisk helse på internett i Norge og Sverige
Nordic Council of Ministers, Nordic School of Public Health NHV.
2012 (Norwegian)Doctoral thesis, comprehensive summary (Other academic)
Abstract [no]

Denne undersøkelsen retter oppmerksomheten mot forbindelsen mellom et økende folkehelseproblem og nyere teknologiske kommunikasjonsmidler, og har analysert kommunikasjonom psykisk helse på internett. Doktorgradsarbeidet hadde til hensikt å undersøke hvordan psykisk helse ble fremstilt på nettbaserte tjenester i Norge og Sverige, og på denne bakgrunn løfte frem og diskutere utfordringer for psykisk helsearbeid i et folkehelseperspektiv. Undersøkelsen hadde eksplorative, deskriptive og analytiske siktemål, og ble forankret i kvalitative forsknings-metoder. Totalt 60 nettjenester ble identifisert og kartlagt i 2009, og avdekket likhet i opphav, målgrupper, innhold og svarere mellom de to landene. Kommunikasjon på offentlige tilgjengelige spørsmål-og-svar tjenester ble undersøkt ved hjelp av kvalitativ innholdsanalyse. Innsendernes bekymringer og forventninger til tjenestene ble analysert. Det samme ble tjenestenes gjensvar. Undersøkelsen viste variasjon i tjenesteprofil, forventninger fra innsenderne og i meldingsinnhold. Psykisk helse ble samlet sett fremstilt som et relasjonelt anliggende i meldingene fra innsenderne, mens individuelle forståelser dominerte gjensvarene fra tjenestene. Sammenholdt med at innsendernes meldinger utviste stor tiltro til tjenestenes kompetanse, og at tjenestene rimelig konsekvent anbefalte kontakt med helsepersonell, så skapte det et inntrykk av at nettbaserte tjenester bidro til å individualisere spørsmål om psykisk helse i Norge og Sverige.Variasjonen som fremkom i analysen utfordrer folkehelsevitenskapen til å ivareta mangetydigheten og samtidigheten i spørsmål omkring psykisk helse. Det gir støtte til en bred forståelse av folkehelse, og gjør det særskilt viktig å anerkjenne og likestille ulike fagfelt i arbeidet med å fremme psykisk helse og forebygge sykdom. Undersøkelsen utfordrer folkehelsearbeidet til å unngå visjoner om en form for menneskelig perfeksjonisme, og antyder muligheten for å utvikle et psykisk helsearbeid forankret i en erkjennelse av menneskelig sårbarhet og avhengighet. Studien utfordrer folkehelsearbeidet til å anerkjenne nettbaserte tjenester ikke bare som fangarmer for eksisterende tjenester, men også som selvstendige kommunikasjonskanaler for psykisk helse og «virtuelle prøverom» i psykisk helsearbeid. For å unngå at slike tekstbaserte og anonyme meldinger om psykisk helse forblir utenfor den etiske sfæren, peker avhandlingen mot den forpliktelse som påhviler tjenestene i å bringe folks erfaringer tilbake til samfunnet. På den måten kan tjenestene fungere som samfunnets «lytteposter» og bidra til å gi styrke til marginaliserte stemmer i de skandinaviske velferdssamfunn.

Abstract [en]

This thesis draws attention to the field of “e-mental health” and offers an analysis of messages about mental health on the Internet. The aim is to examine how mental health was presented on Internet-based mental health services in Norway and Sweden and to discuss challenges for community mental health services in a public health perspective. The study relies on qualitative methodology with exploratory, descriptive, and analytic objectives. In 2009 atotal of 60 Internet-based mental health services were identified and mapped and they revealed similarities of origin, target-groups, content, and respondents. Communications on publicly accessible question-and-answer services were examined using qualitative content analysis. Service users’ concerns and expectations of services were analyzed as well as the services’ responses. The study showed variations in the service profiles, expectations of service users, and the message contents. Mental health was portrayed overall as a relationalconcern in messages from applicants while individualinterpretations dominated the answers from the services. Given that service users had great confidence in the services’ expertise, and services rather consistently recommended them to seek help from healthcare providers, the study creates the impression that online services contribute to individualizing questions about mental health in Norway and Sweden. The variations that emerged in the analysis challenge the public health field to respect the ambiguous complexity of issues surrounding mental health. It provides support for a broad understanding of public health, and makes it particularly important to bring together different disciplines in efforts to promote mental health and prevent illness. The study challenges public health actors to refrain from visions of individual human perfection, and suggests the possibility of developing a community mental health focus grounded on the recognition of human vulnerability and dependency. The study challenges the public health field to recognize online services not only as extensions of existing services, but also as independent communication channels for mental health “consumers” and an opportunity for them to test the waters of community mental health services. The thesis stresses the obligations incumbent upon services to bring people’s experiences back to the community by making anonymous messages available in the public sphere. In this way the services might work as society’s “listening posts,” helping to provide strength to the marginalized voices of the Scandinavian welfare states

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2012. , 87 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2012:10
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3774ISBN: 978-91-86739-46-1 (print)OAI: oai:DiVA.org:norden-3774DiVA: diva2:787198
Public defence
2012-12-12, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Norwegian)
Opponent
Supervisors
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-09Bibliographically approved
List of papers
1. The dialogical bricoleur?: Expectations towards internet-based services in Norway and Sweden
Open this publication in new window or tab >>The dialogical bricoleur?: Expectations towards internet-based services in Norway and Sweden
2012 (English)In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 2, no 2, 137-152 p.Article in journal (Refereed) Published
Abstract [en]

Mental health is a multifaceted concept that has been described and understood differently throughout history. The emergence of internet-based services has signalled changes in both the delivery of services and the understanding of mental health that could alter expectations towards professionals. This study explores the implicit images of answerers online culled from messages by individuals who use internet-based mental health services (henceforth, submitters) and discusses the possible implications of the answerers. An internet search identified Norwegian and Swedish websites, and 444 messages from 13 of those services were included in our study and analysed via qualitative content analysis. Ten images of the answerers were constructed in this process and they were gathered into four main images named ‘the specialist’, ‘the counsellor’, ‘the therapist’ and ‘the master of discourse’. These four images form the structural element in our presentation of the empirical interpretations and serve as the main expectations towards the services. This article discusses these empirical interpretations in the context of both the scientific ‘bricoleur’ and the Open Dialogue Approach. Our results suggest that the ‘dialogical bricoleur’ is a unifying image in submitters’ expectations towards answerers online. Our study argues for strengthening sensitivity towards submitters and increasing the capacity to encompass human variation on the internet.

Keyword
mental health, public health, open dialogue approach, professionals
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3769 (URN)10.1080/2156857X.2012.707620 (DOI)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-09Bibliographically approved
2. Internet-based mental health services in Norway and Sweden: characteristics and consequences.
Open this publication in new window or tab >>Internet-based mental health services in Norway and Sweden: characteristics and consequences.
2013 (English)In: Administration and Policy in Mental Health, ISSN 0894-587X, E-ISSN 1573-3289, Vol. 40, no 2, 145-53 p.Article in journal (Refereed) Published
Abstract [en]

Internet-based mental health services increase rapidly. However, national surveys are incomplete and the consequences for such services are poorly discussed. This study describes characteristics of 60 Internet-based mental health services in Norway and Sweden and discusses their social consequences. More than half of the services were offered by voluntary organisations and targeted towards young people. Professionals answered service users' questions in 60% of the services. Eight major themes were identified. These characteristics may indicate a shift in the delivery of mental health services in both countries, and imply changes in the understanding of mental health.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3771 (URN)10.1007/s10488-011-0388-2 (DOI)22109838 (PubMedID)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-09Bibliographically approved
3. Struggles for recognition: a content analysis of messages posted on the Internet.
Open this publication in new window or tab >>Struggles for recognition: a content analysis of messages posted on the Internet.
2012 (English)In: Journal of multidisciplinary healthcare, ISSN 1178-2390, Vol. 5, 153-62 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Internet has enlarged the possibilities of human communication and opened new ways of exploring perceptions of mental health. This study is part of a research project aiming to explore, describe, and analyze different discourses of mental health in Norway and Sweden, using material from Internet-based services.

AIM: To examine messages posed by users of publicly available question-and-answer services and to describe their content.

METHODS: A Web search was used to identify Norwegian and Swedish Websites offering mental health services by email or posted messages. A total of 601 messages from 20 services, 10 Norwegian and 10 Swedish, were analyzed by means of qualitative content analysis and further interpreted in light of the social theory of recognition by Honneth.

RESULTS: EIGHT CATEGORIES EMERGED FROM THE ANALYSIS: family life, couples, others, violence, the ungovernable, self-image, negotiating normality, and life struggles. These categories were then grouped into three themes: (1) relationship to significant others, (2) relationship to self, and (3) relationship to the social community. The themes promoted an understanding of mental health as closely connected to political and social factors.

CONCLUSIONS: The results showed a variety of concerns from various parts of life and empowered the view that mental health should be understood broadly, at a conceptual level. Mental health emerged as a deeply relational concept that emphasized the equal distribution of chances in life. It strengthened the moral grammar of social inclusion and the acceptance of plurality in social life.

Keyword
Internet-based services, mental health, public health, social theory
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3772 (URN)10.2147/JMDH.S33418 (DOI)22888257 (PubMedID)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-09Bibliographically approved
4. Reaching out to people struggling with their lives: a discourse analysis of answers from Internet-based services in Norway and Sweden.
Open this publication in new window or tab >>Reaching out to people struggling with their lives: a discourse analysis of answers from Internet-based services in Norway and Sweden.
2012 (English)In: Psychology research and behavior management, ISSN 1179-1578, Vol. 5, 113-21 p.Article in journal (Refereed) Published
Abstract [en]

The Internet has enlarged the scope of human communication, opening new avenues for connecting with people who are struggling with their lives. This article presents a discourse analysis of 101 responses to 98 questions that were posted on 14 different Internet-based mental health services in Norway and Sweden. We aimed to examine and describe the dominant understandings and favored recommendations in the services' answers, and we reflected upon the social consequences of those answers. The services generally understood life struggles as an abnormal state of mind, life rhythms, or self-reinforcing loops. Internet-based mental health services primarily counsel service users to seek help, talk to health care professionals face-to-face, and discuss their life struggles openly and honestly. They also urge service users to take better care of themselves and socialize with other people. However, such answers might enhance the individualization of life problems, masking social origin and construction. Consequently, the services are challenged to include social explanations in their answers and strengthen their responsibility to amplify peoples' messages at a societal level. Potentially, such answers could strengthen democratic structures and put pressure on social equity.

Keyword
Internet; depression; e-mental health; health psychology; public health
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3773 (URN)10.2147/PRBM.S34524 (DOI)23049282 (PubMedID)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-09Bibliographically approved

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