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  • 1.
    Aalto, Maarit
    et al.
    Nordic Council of Ministers, Nordic Centre for Welfare and Social Issues.
    Stankovic, Nenad
    Sällsynt samverkan för nordisk välfärd: Kartläggning av möjliga nordiska samarbetsområden anknutna till små och sällsynta diagnosgrupper2010Other (Other (popular science, discussion, etc.))
  • 2.
    Aas, Sigrid
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Foreldreerfaringer med barnehabilitering.: En brukerundersøkelse i Nord-Trøndelag med The Measure of Processes of Care.2008Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: To explore experiences with professional services among parents of disabled children in contact with Childrens Habilitation Department in Nord-Trøndelag, Norway.

    Method: A descriptive cross-sectional survey among parents, who’s children received services from the Childrens Habilitation Department during one year, was done. MPOC-20 NO, a questionnaire developed for this target group and translated into norwegian, was used. It consists of five factors: enabling/partnership, general information, spesific information, co-ordinated/comprehensive care and respectful/supportive care. Each factor consists of 3 – 5 questions.

    Results: The respons rate was 54,5%, parents of children with severe disabilities were overrepresented. Thus the results should be interpreted with care. The mean score on general information was lower than on other factors. The mean scores in Nord-Trøndelag was generally lower than in Canada, but about the same as results from Uppsala, Sweden.

    Parents of children under 6 years had better experiences than parents with older children. Parents with children with minor disabilities were more satisfied than others. Parents under 36 years and mothers had better experiences than older parents and fathers. Parents living together with their child less than 11 days/month were less satisfied than others. Having a key worker and/or an individual service plan made a positive difference on information factors, but not on the other factors.

    Conclusion: The answers showed that certain areas and qualities of the departments service should be better developed and some groups of parents should get a service delivery more fitted to their needs. Other methods should be considered to recruite parents and collect anwers to ensure a higher response rate.

  • 3.
    Abrahamsson, Mariette
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Kreftpasienters behov for og opplevelse av informasjon ved strålebehandling2011Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study aimed to increase understanding the information needs of cancer patients before and during radiation therapy. We also explored how cancer patients adapt such information to their new life situations.

    Method: Among 10 participants in our qualitative interview survey, eight individuals were interviewed before radiation therapy commenced, one was interviewed during treatment and one was interviewed following CT examination. We used grounded theory to analyse our data.Results: Our study identified one core category: small things matter. Other categories included information synergy (desire for information and manner of delivery), vulnerability (emotions and lack of knowledge), and coping skills (comprehension and security).

    Conclusions: This study identified the importance of answering patients´ questions. Providing accurate information, minimizing vulnerability, and enhancing coping skills all play an important role in optimizing patient preparation for radiation therapy. However, the process of developing a variety of communication methods (e.g., improved patient dialogue, printed information, and video presentations) will increase demands on the healthcare system.

  • 4.
    Ahlborg, Tone
    Nordic Council of Ministers, Nordic School of Public Health NHV. Nordic School of Public Health NHV.
    Experienced quality of the intimate relationship in first-time parents: Qualitative and quantitative studies2004Doctoral thesis, comprehensive summary (Other academic)
  • 5.
    Ahlborg, Tone
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Nordic School of Public Health NHV.
    Dahlöf, Lars-Gösta
    Nordic School of Public Health NHV.
    Hallberg, Lillemor R-M
    Nordic School of Public Health NHV.
    Quality of intimate and sexual relationship in first-time parents six months after delivery.2005In: Journal of Sex Research, ISSN 0022-4499, E-ISSN 1559-8519, Vol. 42, no 2, 167-74 p.Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe the quality of the intimate relationship among parents six months after the birth of their first child. The Dyadic Adjustment Scale (DAS) has been modified and used on 820 responding first-time parents, of which 768 were couples. The results reveal that most parents were happy in their relationship, but both mothers and fathers were discontented with the dyadic sexuality. "Being too tired for sexual activity" was a problem, especially for the mothers, and the most common frequency of intercourse was once or twice per month. The result does not support the assumption that the couples compensate the lacking sexuality with sensuality. Good communication within the couple was associated with higher levels of several dimensions of the intimate relationship, especially dyadic consensus and satisfaction. Thus, one way to stabilize and strengthen a relationship when dyadic sexual activity is low would be to emphasize dyadic communication and sexual activity.

  • 6.
    Ahlborg, Tone
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Nordic School of Public Health NHV.
    Persson, Lars-Olof
    Nordic School of Public Health NHV.
    Hallberg, Lillemor R-M
    Nordic School of Public Health NHV.
    Assessing the quality of the dyadic relationship in first-time parents: development of a new instrument.2005In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 11, no 1, 19-37 p.Article in journal (Refereed)
    Abstract [en]

    The purpose of this research was to psychometrically evaluate the Dyadic Adjustment Scale (DAS), modified for use with new, first-time parents by extending the items of communication, sensuality, and sexuality. A total of 820 Swedish respondents, 6 months after the birth of their first child, participated in the study. Psychometric evaluation was conducted with factor analysis. The obtained factor structure was tested with multitrait analysis program. Thirty-three items were found to fit into a five-factor solution, explaining 50% of the total variance. Descriptive data revealed that most new parents were satisfied with their intimate relationship in general, but dissatisfied with their sexual lives. The modified DAS, now called the Quality of Dyadic Relationship Instrument includes 33 items and seems to be a useful, updated measurement for assessing quality of the intimate relationship in new first-time parents.

  • 7.
    Ahlborg, Tone
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Nordic School of Public Health NHV.
    Strandmark, Margareta
    Nordic School of Public Health NHV.
    The baby was the focus of attention - first-time parents' experiences of their intimate relationship.2001In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 15, no 4, 318-25 p.Article in journal (Refereed)
    Abstract [en]

    The baby was the focus of attention - first-time parents' experience of their intimate relationship. The purpose of this study was to describe the phenomenon of 'first-time parents' intimate relationship', to focus on their mental health, and the ability to support them professionally. Ten Swedish parents (five couples) were interviewed on two occasions, when the first baby was 6 and 18 months old, respectively. A descriptive phenomenological method was used. The findings show that the essence of the phenomenon is 'The baby was the focus of attention'. This had different meanings for the couples, putting them in two categories. For the first category, the essence was that the baby was the focus of mutual concern, which implied a fostered relationship. The strain of parenthood in this category was mild. In the second category, the baby was focused on at the expense of the father, who felt rejected emotionally. This impaired the relationship and parenthood involved a severe strain. The way the spouses communicated differed between the two categories. This study shows that mental health can be affected, especially among first-time fathers, and this could jeopardize the relationship and family health. An awareness of this fact is needed among the health professionals giving care to first-time parents.

  • 8.
    Ahlborg, Tone
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Nordic School of Public Health NHV.
    Strandmark, Margaretha
    Nordic School of Public Health NHV.
    Factors influencing the quality of intimate relationships six months after delivery--first-time parents' own views and coping strategies.2006In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 27, no 3, 163-72 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe and analyze first-time parents' experiences of factors that affect the quality of their intimate relationship and the way they cope with their situation six months after delivery. The method used was inductive qualitative content analysis of two open questions in a larger questionnaire. The data is based on 535 respondents' statements. The factors affecting the quality of the intimate relationship were available or missing and could be classified into four categories. 1. 'Coping by adjustment to parental role', e.g., mutual support as new parents, 2. 'The couple's 'intimacy', i.e., togetherness and love, 3. 'Coping by communication', i.e., verbal and non-verbal mutual confirmation, and 4. 'Coping with external conditions', e.g., by seeking social support. The results are described in a model, which could constitute a basis for the promotion of health in family health care, with the aim, if possible, of preventing unnecessary separations/divorces after couples become parents.

  • 9.
    Ahlborg, Tone
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Strandmark,, Margaretha
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Dahlöf, L-G
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    First-time parents' sexual relationships.2000In: Scandinavian Journal of Sexology, ISSN 1398-2966, Vol. 3, no 4, 127-139 p.Article in journal (Refereed)
    Abstract [en]

    Describes the phenomenon termed, "First-time parents' sexual relationship". The qualitative descriptive phenomenological method was applied for the material from the interviews. Ten couples (aged 24–42 yrs) were interviewed separately and undisturbed on a single occasion, when the first baby was nine-months-old. The results indicated that the essence of the phenomenon described in this study pertained to sexual desire. The significance of the concept differed among parents. Some couples lacked the time and energy for each other due to the presence of the baby but compensated for their desires with reciprocal tenderness alternating with that shown to the baby. Some couples assigned time actively for each other which enabled them to enjoy their sexual desire. One couple was forced to control their sexual desires due to severe mucus infection. However, this couple compensated with caressing and thereby confirmed each other emotionally and sexually. Certain mothers longed for desire or emotional confirmation. These couples lacked the ability to assign time and show interest reciprocally, as well as an ineffective communication. Their relationships were characterized by misunderstandings and unarticulated demands.

  • 10.
    Alieu Sanyang, Famara
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Are patient satisfaction surveys tools for quality improvement or mere symbolism?: The case of Østfold Hospital Trust in Norway2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    In 1997 and 2002 the Østfold Hospital Trust conducted patient satisfaction surveys. This study presented the results of the 2002 survey and compares them with the 1997 results. This is done to ascertain if there are any changes with regards to the dimensions the hospital scored poorly on in 1997. The purpose of this study is to find out if the patient satisfaction survey conducted at the Østfold Hospital Trust in 1997 was a serious attempt to improve the quality of the health care provided or only a symbolic act. The concepts of innovation, rational choice and institutional theory were used as spectacles to analyse how the Østfold Hospital Trust acted on the results of the 1997 patient satisfaction survey. The choice of study design is not an "either / or" situation between the quantitative and qualitative approach, since both methods can strengthen each other. This study has therefore employed a form of methodological triangulation. The finding of the study showed that the Østfold Hospital Trust can be termed as innovative, when they implemented the patient satisfaction survey in 1997. This because there was no coercive forces from the hospital owners to implement such surveys. There were only signals in the form of strategy documents. In spite of the hospitals innovative action in implementing the non-mandatory survey in 1997, the hospital leadership did not use the results to improve quality. Based on the findings, the study can conclude that the implementation of the patient satisfaction survey in 1997 was more symbolic, rather than a quality improvement act. Looking further than 1997, it’s important to remark that the hospital leadership resolved a number measures to improve quality, based on the 2002 patient survey. At the time of writing the issue of patient feedback as a quality improvement tool is high on the agenda at the Østfold Hospital Trust. The development point in the direction of a paradigm shift

  • 11.
    Alquist, Ragnhild
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Mødre som strever med amming2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    AIM: The study describes mothers and children who strived with the breastfeeding dyad. The aim was to see if information, help and close support increase duration of breastfeeding and to gather information of mothers’ experience of breastfeeding problems and breastfeeding support in practise.

    METHOD: The study had a descriptive, retrospective design. Data were gathered through a postal questionnaire with 37 questions. The informants were Norwegian speaking mothers who had received extra breastfeeding help and support at a well-baby clinic in Oslo.

    RESULTS: The majority of children were under a week old when discharged from hospital. There were no differences in gender. The children’s most reported problems were suckling problems, and failure to thrive. 75 % of the breastfeeding problems among mothers occurred during the first two weeks. More than half of the mothers reported the reason for breastfeeding problems to be sore, cracked and/or infected nipples. The majority of the mothers coped with breastfeeding in spite of huge breastfeeding problems, and breastfed for a long period. Knowledge of how mothers milk protects the baby was the most important motivation for coping with breastfeeding problems. To succeed with breastfeeding was related to the feeling of being a good mother. Support from the child’s father was important for the mother’s decision to continue or to stop breastfeeding. The mothers described that to be given knowledge, counselling and support from competent health workers increased their self confidence and motivation to continue breastfeeding.

    CONCLUSION: The time of breastfeeding initiation was an indicator for mothers who needed breastfeeding support both in maternity ward and in the well-baby clinic. The use of supplements in addition to breastfeeding at an early stage was a marker for shorter duration of breastfeeding. It is important to ensure that mothers get breastfeeding support before discharge from hospital and that the support is individual and based on knowledge. Mothers’ need of breastfeeding support after discharge from hospital is a central part of health promotion at the well-baby clinic as it concerns the baby’s nutrition and the mothers mastering.

  • 12.
    Amtsbiller, Helle
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hvordan oplever og håndterer de danske infektionshygiejniske enheder risikoen for udvikling af antibiotikaresistente mikroorganismer?2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Antimicrobial resistance is a serious threat to present and future patients. Despite several interventions, the increase in multidrug-resistant microorganisms is a global challenge in public health.

    Aim: This study describes and analyzesthe viewpoint of infection control specialists (physicians and infection control nurses) regarding the threat of antimicrobial resistance. It was also evaluated whether specialists perceive a need to improve the match between individual specialist and decision makers.

    Methods: Qualitative content theory was used to analyze empirical data based upon semi-structured interviews with infection control specialists. Management, inter-and cross-sector cooperation, and quality improvement and evaluationformed the theoretical framework for this thesis.

    Results: Interviewees reported thatDenmark’s efforts to prevent the spread of infection and the development of new resistant micro-organisms have been insufficient. The interviewees viewed current national and international guidelines as sufficient but the interviewees expressed that there is in adequate compliance withvarious elements of the infection control program, including vocational training, guidelines, information and education, monitoring, and a national antibiotic strategy. However, there is a need for more focus and emphasis on implementation and information to all involved personnel.

    Conclusion: Antimicrobial resistance requires greaterinter-and cross-sector cooperationin Denmark, regarding the overuse of antibiotics. This effort will require the participation of general practitioners, healthcare professionals, veterinarian specialists, as well as the involvement of leaders and relevant organizations and ministries

  • 13.
    Andersen, Anders Johan W
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    I ALL FORTROLIGHET: En undersøkelse av meldinger ompsykisk helse på internett i Norge og Sverige2012Doctoral thesis, comprehensive summary (Other academic)
    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

  • 14.
    Andersen, Anders Johan W
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Svensson, Tommy
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden .
    Reaching out to people struggling with their lives: a discourse analysis of answers from Internet-based services in Norway and Sweden.2012In: Psychology research and behavior management, ISSN 1179-1578, Vol. 5, 113-21 p.Article in journal (Refereed)
    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.

  • 15.
    Andersen, Anders Johan W
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Svensson, Tommy
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden .
    Internet-based mental health services in Norway and Sweden: characteristics and consequences.2013In: Administration and Policy in Mental Health, ISSN 0894-587X, E-ISSN 1573-3289, Vol. 40, no 2, 145-53 p.Article in journal (Refereed)
    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.

  • 16.
    Andersen, Anders Johan W
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Svensson, Tommy
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden .
    The dialogical bricoleur?: Expectations towards internet-based services in Norway and Sweden2012In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 2, no 2, 137-152 p.Article in journal (Refereed)
    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.

  • 17.
    Andersen, Anders Johan W
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Svensson, Tommy
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden .
    Struggles for recognition: a content analysis of messages posted on the Internet.2012In: Journal of multidisciplinary healthcare, ISSN 1178-2390, Vol. 5, 153-62 p.Article in journal (Refereed)
    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.

  • 18.
    Andersen, Astrid Elisabeth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Metoden som kan forandre praksis: en grounded theory studie av Marte Meo terapeuter i demensomsorgen2009Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Purpose

    This qualitative study aimed to increase understanding of  what the consequences have been

    for Marte Meo therapists in dementia health care to have learned the method.

     

    Method

    We used grounded theory to analyze eight open interviews.

     

    Results

    The informants, all Marte Meo therapists reported that they gained a method they long have missed for dementia health care. The Marte Meo method helps them detect tacit knowledge, support and enforce known knowledge, and strengthen their self-confidence. They also gained increased awareness and a common language leading to an improved working environment and the individual needs of the patients are better seen and met.

     

    Conclusion

    The study shows that Marte Meo method has positive influence both because the staff have an improved working environment and because the staff experience that they are better able to detect the patients needs after having learned the method.

  • 19.
    Andreassen, Grete
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Pasienttilfredshet blant pasienter med et ”ikke – skandinavisk morsmål”: Hvilke faktorer er viktige? Del II av en bruker- og kvalitetsutviklingsstudie om pasienttilfredshet2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: This study is a follow up of a patient survey study done in the Physiotherapy outpatient clinic, Department of Physical Medicine andRehabilitation, Ullevaal university hospital, 2003. The previous study showed that patients with a non- Scandinavian mother tongue were less overall satisfied with the treatment than other patients.

    Purpose: of this study was to find out why patients with a non- Scandinavian mother tongue were less overall satisfied with the treatment than other patients, and to assess with which factors the patients were most dissatisfied and how the patients had experienced the treatment.

    Methods: The material consisted of patients who had finished their physiotherapy treatment for muscle skeleton diseases. Most of them came from Asia. Both quantitative and qualitative (phenomenography) research methods were used. In the patient survey 30 patients were included. Another four patients were included in focus group interviews.

    Results: Older patients were more satisfied than younger. There was no significant association between gender and satisfaction. The main dissatisfaction factor was no improvement following treatment. However, many patients were satisfied despite that there had not been any improvement. Other factors that had impact on the overall satisfaction were communication, professional skills, information, enough time and expectations. Facilities and equipment were of less importance.

    Conclusion: The results indicate that in addition to improved condition, communication, information and enough time were of great importance for patient satisfaction. These factors should be taken into consideration while treating patients with foreign culture and language

  • 20.
    Angeloff, Line Ø.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Miljørettet helseverns tilsyn i norske asylmottak - de profesjonelles syn på dagens praksis, kompetanse og måloppnåelse2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background and objectives: This study focuses on the supervision of environmental andpsychosocial conditions in Norwegian accommodation centers for asylum seekers with long-term residence. We aimed to examine how professionals from the communities view current practice andto what extent they consider it compliant with legislative intentions. We further aimed to explore the sufficiency of available resources, guidelines, and conditions, and to determine their effect on the quality of the supervision.

    Methods: This cross-sectional study used structured telephone interviews with 82 persons, a number that corresponds to 48.8% of the total number of professionals in Norwegian communities, based ona questionnaire comprising 28 closed and 2 open questions. Data was analyzed using descriptive statistics and qualitative content analysis.

    Results: Employees who currently oversee regulations for environmental health reported too muchdiscretion-based supervision. They called for better policies and clearer requirements in laws an dsupervisors, respectively. Furthermore they announced more knowledge directly aimed at psychosocial factors in reception, and more focus from central government on courses and trainingand better facilities to carry out a proper inspection. Respondents viewed closer and more interdisciplinary collaboration with health professionals and immigration authorities, as well as intermunicipal organizations, as a force for improving the quality of inspections.

    Conclusions: Evidence suggests that poor housing conditions, long-term residence, andidleness/pacification comprise the largest challenges for the psychosocial environment in asylum centers. The most important measures for improving the quality of supervision likely requireincreased knowledge in the field, especially regarding psychosocial factors; clearer requirements;legal and regulatory guidelines; and greater cross-discipline collaboration to fulfill the needs of a vulnerable group of people/residents in reception

  • 21.
    Anker-Rasch, Celina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Kvinner med fødselsdepresjon – finner vi dem?: En intervjustudie av helsesøstres opplevelser på helsestasjoner i Oslo.2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The aim of this study was to understand how public health nurses work to trace women with postnatal depression, how effective they find their work and their attitude towards new knowledge and methods. Postnatal depression is common in the postnatal period and studies show that the conditionoften is not detected. Postnatal depression may lead to disturbances in the bonding between mother and child which can have a negative influence on the child’s development and health. Help and support given to these women will have a positive impact on both the mothers’ and the children’s future health. In a qualitative study 14 public health nurses wereinterviewed and asked how they trace these women, whether they miss some and their attitude towards using Edinburgh Postnatal Depression Scale (EPDS), which is aquestionnaire validated for use in primary health care to detect women with postnataldepression. The design had a hermeneutical/phenomenological approach. The results showed that the public health nurses do not have a method to trace women with postnatal depression. They rely on their experience, personality and intuition and are aware that they do not trace all.They are positive towards getting more knowledge about postnatal depression and to start using EPDS. Further research should include discussions about whether screening for postnatal depression is desired and how the follow-up for the women should be organized

  • 22. Arbelaez, Maria Patricia
    et al.
    Gaviria, Marta Beatriz
    Franco, Alvaro
    Restrepo, Roman
    Hincapié, Doracelly
    Blas, Erik
    Nordic Council of Ministers, Nordic School of Public Health NHV. UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), The World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
    Tuberculosis control and managed competition in Colombia.2004In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 19 Suppl 1, S25-43 p.Article in journal (Refereed)
    Abstract [en]

    Law 100 introduced the Health Sector Reform in Colombia, a model of managed competition. This article addresses the effects of this model in terms of output and outcomes of TB control. Trends in main TB control indicators were analysed using secondary data sources, and 25 interviews were done with key informants from public and private insurers and provider institutions, and from the health directorate level. We found a deterioration in the performance of TB control: a decreasing number of BCG vaccine doses applied, a reduction in case finding and contacts identification, low cure rates and an increasing loss of follow up, which mainly affects poor people. Fragmentation occurred as the atomization and discontinuity of the technical processes took place, there was a lack of coordination, as well as a breakdown between individual and collective interventions, and the health information system began to disintegrate. The introduction of the Managed Competition (MC) in Colombia appeared to have adverse effects on TB control due to the dominance of the economic rationality in the health system and the weak state stewardship. Our recommendations are to restructure the reform's public health component, strengthen the technical capacity in public health of the state, mainly at the local and departmental levels, and to improve the health information system by reorienting its objectives to public health goals.

  • 23.
    Arnesen, Audhild
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Eldres opplevelse av eget hjelpebehov2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Demografic development points to a significant increase in elderly people, creating challenges in how health care services are shaped in correspondence with user needs and resources. The aim of this study was to describe and analyse, how elderly people, experienced their own need for help. Qualitative research interviews were chosen as a method of collecting the material for this survey. Grounded theory was used for analysis of the gathered information. The interviews were based on the experience of nine elderly people living at home by themselves. All nine selected interviewees were dependent upon regularly daily help from the communal health care and home help services. “A user related service” was defined as a superior core category. Three categories were related to the core category: Resources and needs among the elderly people, the encounter with the “helper” and outer boundaries of the service provided. Conclusion: The major results of this study points to the lack of individual response, flexibility and predictability of the help provided. Despite of this the elderly seem to cope with their situation, and preferred to live in their own homes as long as possible.The results may lead to a closer look on the necessity of a more thorough survey related to the elderly population and their coping needs, before help and care services are provided. The focus has to be aimed on health assesment to prevent dysfunctional services from developing even further.

  • 24. Ask Larsen, Flemming
    et al.
    Damen, Saskia
    Frölander, Hans-Erik
    Boers, Erika
    Nicholas, Jude
    Johannessen, Anna Maria
    Tuomi, Emmi
    Varran, Anne
    Hunsperger-Ehrlich, Henriette
    Andersen, Vivi
    Okbøl, Henrik
    Ask Larsen, Flemming (Editor)
    Damen, Saskia (Editor)
    Guidelines for Assessment of Cognition in Relation to Congenital Deafblindness2014 (ed. 500)Book (Other (popular science, discussion, etc.))
    Abstract [en]

    The aim of this booklet is to discuss assessment of cognition in relation to deafblindness. Cognitive ability is manifested in moments of shared attention. Expressions reveal capacity, but also give us possibilities to estimate schematic ability and comprehension of reality.

    The Guidelines are structured in three parts. Part I gives an introduction to the theoretical foundation of the work of the network and of the guidelines in the present booklet. Part II is an analysis of textbooks and introductions to assessment in general, that aim at teasing out general guidelines that need specific CDB focus. This part ends up in a set of recommenda­tions for assessment of cognition in relation to CDB. Part III is a series of examples from our own work that present different attempts at applying the presented guidelines and theoretical foundation, in combination with more specific assessment targets and procedures.

    All authors are professionals within the deafblind-field working practically in different disciplines or with research.

  • 25.
    Askeland Winje, Brita
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Comparison of QuantiFERON®TB Gold with tuberculin skin test to improve diagnostics and routine screening for tuberculosis infection among newly arrived asylum seekers to Norway2008Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Introduksjon: QuantiFERON®TB Gold (QFT) er en ny blodtest for påvisning av tuberkulosesmitte, men med få data så langt fra undersøkelse av immigranter. Målet med studien var å sammenligne resultat av QFT og tuberkulin hudtest blant nyankomne asylsøkere i Norge og å vurdere hvilken rolle QFT bør ha i screening for latent tuberkulose.

    Metode: Alle asylsøkere, 18 år eller eldre, som ankom Tanum asylmottak fra september 2005 ble invitert til å delta og ble inkludert etter informert samtykke. Inkludering pågikk inntil et forhåndsbestemt antall på 1000 inkluderte ble nådd. Siste deltager ble inkludert i juni 2006. Deltagelse innebar en QFT test og standardiserte spørsmål, i tillegg til den lovpålagte tuberkulintesten og lungerøntgen.

    Resultat: Totalt 2813 asylsøkere ankom Tanum asylmottak i inkluderingsperioden (sept 05-juni 06).  Blant de 1000 deltagerne hadde 912 gyldige testresultater og ble inkludert i analysen, 29 % (264) hadde positiv QFT, mens 50 % (460) hadde positiv tuberkulintest (indurasjon > 6mm). Det indikerer en høy andel smittede personer i denne gruppen. Blant deltagere med positiv tuberkulintest hadde 50 % negativ QFT, mens 7 % av dem med negativ tuberkulintest hadde positiv QFT. Det var en signifikant sammenheng mellom økning i tuberkulinutslag og sannsynligheten for å ha positiv QFT. Samsvar mellom testene var 71-79%, avhengig av grenseverdi for tuberkulin. Det var bedre samsvar mellom testene for ikke-vaksinerte personer.

    Konklusjon: Ved å implementere QFT som rutine kan videre oppfølging avsluttes for 42% av dem som ville ha blitt henvist basert kun på tuberkulinresultat (> 6mm). Andelen som henvises vil være den samme enten QFT implementeres som erstatning for eller som supplement for å bekrefte en positiv tuberkulinreaksjon, men antallet som testes vil variere mye. Ulike tilnærminger vil identifisere samme andel (88-89%) av asylsøkere med positiv QFT og/eller sterkt positiv tuberkulinutslag (>15mm), men ulike grupper vil mistes.

  • 26.
    Assmundson, Åsa
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Cancersmärta – ett folkhälsoproblem?2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Cancer is one of the most common diseases in the West World. Cancer is also a disease that accounts for much pain and decreases in quality of life in the suffering individuals. The assessment of dimensions of pain is very important for the individual treatment in the palliative care to increase quality of life in patients with cancer. The aim of this study was to describe the incidence and intensity, quality, location and duration of the present or “just now” and the usual or “every-day” cancer pain. An other aim was to describe the differences of factors, even deference of age and gender. Pain experiences were assessed with Pain-O-Meter (POM): The POM combines the qualities of McGill Pain Questionnaire and the Visual Analogue Scale into one tool, and is therefore useful for evaluation of different dimensions of the pain experience. POM also makes it possible to assess the location and duration of the pain. The result showed that all subjects experienced moderate to severe usual pain even though they were patients at a clinic specialized in palliative care for individuals suffering from cancer. The most interesting finding was that the patients in the assessment situation experienced their present pain to be more intensive then the usual or “every day” pain. These finding have implications for how to ask the patients about their pain. The results also indicated that the individuals experienced more intense pain during physical activities compared to the pain during rest. This will increase incidences of complications and decrease quality of life in this group of patients

  • 27.
    Atladóttir, Ósk Rebekka
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Influenza vaccination in emergency department workers: Knowledge, attitudes, and practices2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: Thisstudy aimedto investigatethe knowledge and attitudes of healthcareworkers regardinginfluenza, influenza vaccination,and vaccination practicesin emergency departments in Gothenburg, Sweden.

    Method: This cross-sectional studyuseda self-administered questionnaire distributed tonurses, assistant nurses,and physiciansin three emergency departments atThe Sahlgrenska University Hospital in January–February2014.

    Results: Among214 participants, 56% were nurses, 27% assistant nurses,and 17% physicians. The response ratewas 77%. A total of 66 participants (31%)werevaccinated against influenza during the previous12 months.The highest vaccination coverage occurredin the oldestage group(56%;P<0.05).Past vaccinationstrongly predicted future vaccinationbehavior (P<0.001). Ourdata revealed nosignificant difference invaccination coverage betweenprofession, work experience, hospital,or gender. The mean knowledge score was higher among vaccinated vs. unvaccinated health care workers (17.9 ± 2.7vs.16.8 ± 2.6, respectively; P< 0.05). Moreover, influenza risk perception was higher among participants who were vaccinated during the previous12 months compared to unvaccinated participants (P< 0.001). Interestingly, more un vaccinated health care workers believed that personal behavior determines health (higher internal locus of control) compared to vaccinated workers(P< 0.05). More than half of vaccinated health care workers stated that they got vaccinated to avoid influenza. Almost half of the unvaccinated workers voiced concern about vaccine side effects. Fourteen percent of all respondents mentioned patient protection as an important factor in their decision to receive influenza vaccination.

    Conclusion:This study demonstrates a need for improved knowledge about influenza and influenza vaccinationin health care workers. Increased risk perception of influenza can increase vaccination coverage in emergency department personnel,and may reduce the incidence of healthcare-associated influenza.

  • 28.
    Augustsson, Hanna
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hagquist, Curt
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Kartläggning av studier om nordiska ungdomars psykiska hälsa2011Report (Other academic)
    Abstract [sv]

    I denna forskningsrapport redovisas en kartläggning av studier om nordiska ungdomars psykiska hälsa.Kartläggningen har genomförts av Centrum för forskning om barns och ungdomars psykiska hälsa vid Karlstads universitet på uppdrag av Nordiska högskolan för folkhälsovetenskap (NHV). Kartläggningen har finansierats av Nordiska ministerrådet och ingår som ett delprojekt inom ramen för ministerrådets handlingsplan för psykisk hälsa. Samtliga projekt som ingår i handlingsplanen har initierats av Nordiska Akademin för forskning om psykisk hälsa vid NHV under ledning av docent Lars Fredén.Barns och ungdomars psykiska hälsa är en viktig folkhälsofråga, såväl i de nordiska länderna som i de vidare internationella sammanhangen. Under senare år har området fått en ökad uppmärksamhet. Nordiska ministerrådets handlingsplan för psykisk hälsa är ett uttryck för detta. Ett annat exempel kan hämtas från Sverige. Inspirerade av ett projekt i Kungl. Vetenskapsakademiens regi har de statliga forskningsfinansiärerna riktat totalt 300 miljoner kronor under sex år till forskning om barns och ungdomars psykiska hälsa.Kartläggningen i denna forskningsrapport är gjord med ett systematiskt och vetenskapligt arbetssätt, men kan inte likställas med de systematiska kunskapsöversikter som Kungl. Vetenskapsakademien producerade i tidigare nämnda projekt, eller med de rapporter som Statens beredning för medicinsk utvärdering utarbetar. Föreliggande rapport är gjord med väsentligt mindre resurser och med förenklade arbetsmetoder. En preliminär version av rapporten presenterades vid konferensen Ung och utsatt som den 5-6 maj 2011 anordnades vid NHV

  • 29.
    Aune, Ingvald
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Risikovurdering for kromosomavvik: En kvalitativ studie om gravide kvinners tanker og erfaringer rundt denne problemstillingen2008Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Purpose: This qualitative study aimed to increase understanding of how pregnant women experience early ultrasound examination that includes risk assessment for chromosomal anomalies. Moreover, this study examined how such women rationalize test results.

    Method: I conducted pre- and post-examination interviews of ten pregnant women undergoing risk assessment for chromosomal anomolies, and used grounded theory to analyze the results.

    Results: The study generated a core category (I want a choice, but I don’t want to decide) and five main categories (existential choices, feeling of safety, anxiety, guilt, and counselling and care). Factors contributing to choice difficulty included anxiety, loss of control or coping, emotional connection to the fetus, feelings of guilt, and social pressures. The core category describes the conflict between choice and decision. Since the women sought independent choices without external influence, they also felt greater responsibility. The women’s understanding of actual risk varied, and they used different logic and methods to evaluate risk and reach a decision.

    Conclusion: Pregnant women need for prenatal diagnostic information and want easy access to specialty services. This study shows the complex feelings pregnant women experience regarding early ultrasound examination that includes risk assessment for chromosomal defects. Stress, non-transparent information about actual and perceived risks, and personal moral judgments further complicate the decision-making process. Therefore, improved distribution of information and frequent contact with health professionals will help women to make informed choices in accordance with their values and beliefs.

  • 30.
    Austberg, Sissel
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Skolens oppfatning av tverrprofesjonelt samarbeid: en utforskende studie innen en norsk ungdomsskole2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Purpose: This study aimed to increase knowledge about teachers' and management's perceptions of, and experiences with, the concept of interprofessional collaboration. The study also sought to determine perceptions about the need and opportunity for implementing interprofessional collaboration in their work environment. Finally, the studie investigated whether past experiences influence motivation for structured cooperation.

    Method: This study used a fenomenografic approach and interviewed 15 employees of a Norwegian junior high school. Study participants were divided into three focus groups; participants from the management, teachers with experience from structured interprofessional collaboration and teachers without such experience.

    Results: Data analysis identified three categories and six subcategories. All participants described interprofessional collaboration as not well known and collaboration with other professions is described as rare, sometimes difficult, and random. They perceived the school's role in committed cooperation as difficult because it increases demands on the school. The study participants find prioritization between vocational training and topics that fall under the social skills difficult. Motivation for cooperation is based on a need for increased knowledge about the factors that influence students' individual and overall experience of school. Focus groups having greater experience with a structured interprofessional collaboratio, showed a more positive attitude toward cooperate with other professions. Participants perceived formal frameworks as a limiting factor for collaboration.

    Conclusions: This study showed a need to clarify the meaning of the term interprofessional collaboration. The school should work to develop a good psychosocial environment in an interprofessional perspective. A positive experience with structured interprofessional collaboration, increases motivation for further cooperation.

  • 31. Autti-Rämö, Ilona
    et al.
    Holmila, Marja
    Raitasalo, Kirsimarja
    Kosola, Mikko
    Ask Torvik, Fartein
    Laslett, Anne-Marie
    Kronbæk, Mette
    Asmussen Frank, Vibeke
    Skårner, Anette
    Svenson, Bengt
    Kuuluvainen, Venla
    Isotalus, Pekka
    Purshouse, Robin C
    Angus, Colin
    Holmes, John
    Mäkelä, Klaus
    Rosén, Måns
    Järvinen-Tassopoulos, Johanna
    Tigerstedt, Christoffer
    Nordic Studies on Alcohol and Drugs NAD 5/13 Volume 302013Book (Refereed)
  • 32.
    Averlid, Getrud
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Helsefremmende samarbeid – en viktig triveselfaktor i anestesisykepleierfaget.: En kvalitativ studie av anestesisykepleieres opplevelse av sitt arbeidsmiljø2009Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: The 2006 employee survey from Anaesthesia Unit 2, at Oslo’s Rikshospital, revealedlow scores regarding anaesthesia nurses` opportunity to influence their own work situation.

    Purpose: This study aimed to examine work factors that anaesthesia nurses perceive health promoting and to analyze how hospital leadership could initiate a healthier work environment. The value of this assessment is that factors that promote a healthy work environment for anaesthesia nurses will become visible to department management.

    Method: A qualitative method was used, which included interviews with fourteen anaesthesianurses, working in six different departments. A modified Grounded Theory was applied as a methodfor analysis.

    Result: Analysis of the interviews yielded a core category: Cooperation for Better or Worse-Anaesthesia Nurses` “Ticket” in the Workplace, and three categories: Leadership, An Organizer of Conditions; Well-being in an Operations Environment and Clarity of Roles.The core category illustrates the coordinated entirety that anaesthesia nurses consider a safeguard inrelation to the patients and other professions. Nurses described great satisfaction in their work aswell as an inkling that differences can occur. Leadership was crystallized as an important factor infacilitating a healthy working environment that satisfies basic personal and professional needs. The respondents perceived production pressure and communication difficulties with close collaborators,as demotivators that sometimes caused lack of trust. Collegial support was a crucial factor in creatingthe perception of a good working environment. A model was developed, which illustrates the basic conditions of practicing the profession, obstacles and restrictions, how nurses experience optimal patient care and fundamental and potential influence of department leadership on both positive and negative factors.

    Conclusions: The study shows that several important factors contribute to a healthy working environment for the anaesthesia nurses. Leadership should work more actively toward developing ajustifiable framework of management and initiating health promoting efforts that motivate better cooperation between team members. Other important factors for well-being in the workplace included independent work and interdisciplinary collaboration around patient care.

  • 33.
    Bak, Pia
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Mødet mellem eksplicitte og ”tavse” kundskaber i praksisfællesskaber.: Fokusgruppeinterview med tværfaglige teami social- og sundhedssektoren med forebyg-gende og sundhedsfremmende opgaver.2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Situations of life characterised by numerous complex psychosocial and health problems demand another extent in interprofessional co-operation in social and health service. At the same timeincreased focus on prevention and health promotion have raised the necessity of knowledge andcompetence creation that is able to deal with these complex challenges. The aim of this study is to identify possible patterns of experience with creation of shared knowledgeand competence in interprofessional co-operation with focus on prevention and health promotion.The studyis based on qualitative interviews in focus groups and memorized theme guide was used.The analyzing process was based on grounded theory. 25 professionals represented eight occupationgroups from nine social and health service teams. The overall core categories emerge as: ”social cultural organization sets the agenda for creation of knowledge and competence”. Three additional overall categories related to the core category definedas: ”the needful professional foundation”, “the discourse of prevention and health promotion” and“the tacit knowledge and competence”. Conclusions: The overall findings pointed out the essential influence of the social culturalorganization on the possibility of the interprofessional co-operation to create shared knowledge in the prevention and health promotion. If space for learning and reflection in community of practice is not created the feasibility of meetings between tacit and explicit knowledge will be reduced

  • 34.
    Beck, Frank
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Kommuneplanlegging og folkehelse.: Norske kommuneplanleggeres vurdering avhelse-fremmende innspil2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Municipal planning sets important conditions for a population's personal choices and lack of choices. Well-planned communities can help motivate people to adopt a more activedailylifestyle.

    Purpose: This thesis aimed to illuminate city planners’ viewof concepts such as community and public health. It also sought to identify city planners’ most relevant experience.

    Method:Fourteen municipal planners responded to 20 questionnaires, and six municipal planners in three municipalities participated in interviews.I used content analysis to evaluate all responses.

    Results:Many respondents mentioned the value of physical improvements, such asreduced sound levels,more cycle paths,and safe pedestrian walkways. Other suggestions includedimproving the visual quality of our surroundings, well-being, and affiliating with relevant factorsin urban planning.

    Conclusion:Multidisciplinary cooperation between planners and health sectors couldcontribute to a common understanding of the challenges connected to municipal planning for health promotion

  • 35.
    Beillon, Lena Marie
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Att värdera vårdbehov- ett kliniskt dilemma: En studie av nyttjandet av ambulanssjukvård i olika geografiska områden2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The health care system in the Nordic countries’ are based on that those individuals who have urgent need of health care should have access to it without unnecessary delay. But regarded to limited resources prioritisation has to be made. The reason for prioritising is to deliver an appropriate and rapid response to those with the most urgent needs and to guarantee the public a qualitative good and effective health care. The health care system has an important role for creating safety, especially the emergency medical service. When someone become acute ill or injured, there are expectations for immediately rapid response from the health care system. The prioritisation and allocation of the ambulance service is performed from an emergency medical centre by the emergency number 112. Several Emergency Medical Systems use a criteria based prioritizing system for ambulance response. In such a system the operators at the medical emergency dispatch centres have to assess patients’ symptoms and needs for ambulance response. The prioritizing of the ambulance response is based on the seriousness of the patient’s symptoms, on the patient’s current condition and in the case of trauma, on the trauma mechanism. The priority system is supposed to optimize the use of the ambulance service and to match up and meet the patients’ needs with adequate responses of the ambulances. The aim of this thesis is to evaluate if the prioritising of patients medical status leads to appropriate use of the health care service and the emergency medical service. The thesis is based on five parts, including six studies (I-VI) and the methods used have a quantitative approach. Part 1 (study I-II), evaluates the settings of priorities and patients need for prehospital care. Part 2 (study III), describes how patients with chest pain in different geographical areas uses the ambulance service. Part 3 (study IV), analyses the differences in use of the ambulance service between densely and sparsely populated areas. Part 4 (study IV), describes the use of the ambulance service in Finland. Part 5 (study IV), reviews the ambulance patients and the need of care at emergency department or similar level of care. The results show that the initial priority of ambulance response from the dispatch centre was consistent with patients' current status as assessed by ambulance staff in half of the missions, and as assessed retrospectively by an expert panel at one third of cases. According to the assessment of the ambulance personnel and the review from an expert panel there was extensive use of both ”overtriage” and ”undertriage” in the emergency medical dispatching of ambulance missions. The result also shows that decisions lead to sub optimal use of the ambulance service and other health care resources. One of the major findings is the occurrence of undertriage. A triage system has to identify those patients with the most urgent health needs, and give these patients access to care in order to avoid unnecessary deterioration in health status. At the same time must safety margins be maintained and overuse of resources minimised. Another major finding is that a high safety margins and high amount of overtriage leads to that a big part of the ambulance missions are transportation of patients with no need of today’s high tech ambulances or the professional competence of ambulance nurses

  • 36.
    Beillon, Lena Marie
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Suserud, Björn-Ove
    Karlberg, Ingvar
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Herlitz, Johan
    Does ambulance use differ between geographic areas? A survey of ambulance use in sparsely and densely populated areas.2009In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 27, no 2, 202-11 p.Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to analyze possible differences in the use of ambulance service between densely and sparsely populated areas.

    METHODS: This study was designed as a 2-step consecutive study that included the ambulance service in 4 different areas with different geographical characteristics. A specific questionnaire was distributed to the enrolled ambulance services. Completion of one questionnaire was required for each ambulance mission, that is, 1 per patient, during the study periods. For calculations of P values, geographic area was treated as a 4-graded ordered variable, from the most densely populated to the most sparsely populated (ie, urban-suburban-rural-remote rural area). Statistical tests used were Mann-Whitney U test and Spearman rank statistic, when appropriate. All P values are 2 tailed and considered significant if below .01.

    RESULTS: The medical status of the patients in the prehospital care situation was more often severe in the sparsely populated areas. In addition, drugs were more often used in the ambulances in these areas. In the sparsely populated areas, ambulance use was more frequently judged as the appropriate mode of transportation compared with the more densely populated areas.

    CONCLUSIONS: Our study suggests that the appropriateness of the use of ambulance is not optimal. Furthermore, our data suggest that geographical factors, that is, population density, is related to inappropriate use. Thus, strategies to improve the appropriateness of ambulance use should probably take geographical aspects into consideration.

  • 37.
    Berg, Christian
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    The ever increasing use of acid suppressive therapy: Descriptive analysis of data from the national wholesale and prescription databases on the consumption of proton pump inhibitor in Norway2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Pharmacoepidemiological analyses are needed as a background for evaluation of drug use and for making cost-effective priorities. Drug sales and prescription databases provide useful tools for analysis of drug consumption and expenditures. In this essay, an analysis of the sales and prescribing of proton pump inhibitors (PPIs), drugs used for acid related gastric disorders, are presented. Since 1996, the consumption of PPIs in Norway has increased by approximately 10 % per year, with esomeprazole as the most commonly used drug. An increasing number of individuals are using these drugs with considerable costs for the reimbursement schemes, e.g., in 2006 more than 450 million NOK. Verified reflux oesophagitis is the predominant indication for reimbursement prescribing. There are, however, indications of an overprescribing of PPIs. The prescribing in Norway is different from Denmark and Sweden, both regarding choice of drug and level of consumption. The prevalence of PPI use increased with age, reaching a maximum of nearly 12 % in the age groups 70-79 and 80-89 years of age. A considerable proportion is long-term users (> 2 years). These groups have a high risk of polypharmacy treatment. Even though the PPIs have been on the market for many years, negative effects associated with long term use are being discussed and need to be further explored. Attention should be focused on the rational use of PPIs and not only on the reduction of costs for PPI therapy.

  • 38.
    Berg, Geir V
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Å fremme den eldre sykehuspasientens helse i lys av et folkehelse- og et holistisk-eksistensielt sykepleieperspektiv2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aim: The number of elderly hospital patients is increasing in line with tidisciplinary eriatric approach reduces illness, re-hospitalization and costs as well as improving dge about health and health erly hospital patients from a public health and nursing erspective. ploys a combination between different data collection methods, data urces and analytical techniques in order to investigate health and health promotion . Study three illustrated and explored the life world of empowerment, health and health promotion were introduced to nurses in the advancing age of the population. Old people are a heterogeneous group when itcomes to health status and sickness. Research findings suggest that a mulgsurvival rates and functional level. The aim of this thesis was to describe and develop knowlepromotion related to eldpData sources and methods: The thesis, which comprises four studies, has a qualitative approach that emsoamong elderly hospital patients. Study one was conducted as a theoretical conceptual analysis and synthesis of the concepts of man, health, nursing and illness/disease based on description of the concepts in three nursing theories. Study two described and explored health and health promotion from the perspectives of ten elderly hospital patients using qualitative interviewsfive nurses and their understanding of health promotive nursing related to the elderly hospital patient by means of participant observation. Study four was an explorative study. The conceptsorder to give a mutual theoretical platform before participating in reflection group dialogues. Two groups of nurses participated in three dialogues that were conducted by a moderator and an assistant. The dialogues were tape-recorded and transcribed verbatim. Each dialogue was analysed with qualitative content analysis. Findings: The thesis proposes a stipulative definition of health promotive nursing with a holistic-existential approach based on five necessary preconditions. The definition and preconditions may serve as a theoretical basis for health promotion in nursing. The elderly hospital patients reported that health was being able to be the person I am, to do what I want, to feel well and have strength. Health promotion was described as being enabled by being seen as the person I am, through information and knowledge as well as hope and motivation. The nurses’ attitude to health and health promotion was influenced by two different views; the biomedical and the holistic nursing view, between which they moved. In their work the nurses were masters at balancing on a tightrope and interacting with a professional competence that makes it possible to manage a constantly changing work situation. Reflection group dialogues revealed a dual relation among the about participating nurses to empowerment and power. The nurses highlighted the importance of using an individualised approach in order to promote the health of elderly hospital patients with focus on respect for the individual and normalization of the situation. Conclusion: The thesis proposes a stipulative definition of health promotion as well as five preconditions that may serve as guidance and offer a health promotive nursing approach for elderly hospital patients. How health promotion and health are understood depends on one’s scientific and professional background as well as the experience of caring for the individuals in one’s charge. The understanding of health promotion on the part of both nurses and elderly hospital patients was somewhat vague, but improved as a result of dialogue and discussions. Empowerment may be a suitable strategy, as it helps both nurses and elderly patients to acknowledge the necessity of controlling and influencing their situation. However, empowerment implies a consciousness of one’s own power. According to the elderly hospital patients in this study, health is promoted when they are seen as a person, when they receive adequate information and knowledge their condition and when they feel motivated. Reflection group dialogues may be a strategy to increase the professional consciousness of nurses to implement research findings and to focus on promoting the health of elderly hospital patients.

  • 39.
    Berg, Geir V
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hedelin, Birgitta
    Sarvimäki, Anneli
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    A holistic approach to the promotion of older hospital patients' health.2005In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 52, no 1, 73-80 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe how nurses interpreted health promotion related to older patients in a medical hospital ward and the presuppositions for this work.

    METHODS: The study had a descriptive and explorative design. Data were created through participant observation of five nurses and informal dialogues with four nurses working in an infection unit in a small hospital in Norway. The nurses where followed during a period of 6 months. The observations and dialogues were interpreted and transformed into text. This text was analysed with qualitative content analysis and interpreted hermeneutically on three levels: (1) reading the text to get an overview of the themes; (2) systematically separating central patterns; and (3) highlighting the patterns with examples.

    FINDINGS: The nurses' interpretation of health promotion was closely connected to their interpretation of health and holistic nursing. Two main aspects were uncovered in the informal dialogues: a biomedically oriented nursing view and a holistically oriented nursing view. The observations showed that presuppositions, such as waiting for something or somebody, constantly changing situations, complexity and diversity in patient cases, influenced the nurses' work in general and also their focus on health promotion. The nurses balanced between the biomedical and the holistic approach. It seemed to be important for the nurses to be the masters of walking on a tightrope and to have professional clinical competence.

    CONCLUSION: It was difficult to find a clear focus on health promotion. The most visible focus was on diagnosis and treatment, while the more complex and comprehensive situations related to health promotion of older patients seemed to be underprioritized. The phenomenon of 'waiting' may be an important issue for further research.

  • 40.
    Berg, Geir V
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    A holistic-existential approach to health promotion.2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 4, 384-91 p.Article in journal (Refereed)
    Abstract [en]

    Health promotion seems to be implicit in many nursing theories, but the theoretical and philosophical basis of health promotion in nursing is not always explicitly stated. The interpretation of health promotion is closely related to the interpretation of man, health, illness and nursing. There is a need to clarify, refine and redefine health promotion in nursing because the concept is partly nonspecific and has not been used to identify a distinctive nursing focus. The aim of this study was to formulate a stipulative definition of health promotive nursing with a holistic-existential approach. A philosophical frame of reference in combination with conceptual analysis and theoretical synthesis were used as the methodological approach. The philosophical framework served as a basis in selecting the nursing theories and influenced the analysis. Two nursing theories and one nursing model were selected due to their influence on Norwegian nursing and because of their philosophical basis. Through analysis and synthesis of the selected nursing theories, the concepts man, health, illness/disease and nursing were analysed. The paper proposes a stipulative definition of health promotion in nursing based on a holistic-existential approach, supported by five necessary conditions. The definition and conditions needs to be further investigated by both empirical studies and by comparing with other relevant nursing theories, in order to formulate theoretical statements. The proposed definition may be the first step in a process of developing a theoretical framework of health promotive nursing with a holistic-existential approach.

  • 41.
    Berg, Geir V
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hedelin, Birgitta
    Hospitalized older peoples' views of health and health promotion.2006In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 1, no 1, 25-33 p.Article in journal (Refereed)
    Abstract [en]

    Older peoples' health varies considerably and the number of older people who need hospital care will increase in the future. Traditionally, the focus of nursing care in hospitals is oriented towards diagnosis and treatment of disease, although health and health promotion are inherent in theories and definitions of nursing. This is an important issue in health politics, in new laws and regulations in Norway. However, it was difficult to find research-based knowledge about how nurses work with health promotion and health related to older hospitalized patients. This study aimed at describing older hospitalized patients' experiences of health and health promotion. The study used a descriptive and explorative qualitative design, with an interpretative-phenomenological approach. Ten older hospitalized patients, recruited through purposeful sampling, were interviewed during their hospital stay. The informants described health as Being able to be the person I am, to do what I want to do, and feel well and have strength. Health promotion was described as Being enabled through being the person I am, through information and knowledge and through hope and motivation. The findings may be applied to nursing practice in order to focus on promotion of health as an individual process built upon the unique person's life and situation, supported by nursing care and medical treatment.

  • 42. Bian, Ying
    et al.
    Sun, Qiang
    Zhao, Zhengyan
    Blas, Erik
    Nordic Council of Ministers, Nordic School of Public Health NHV. UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), The World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
    Market reform: a challenge to public health--the case of schistosomiasis control in China.2004In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 19 Suppl 1, S79-94 p.Article in journal (Refereed)
    Abstract [en]

    This study examines how the provision of schistosomiasis control has adapted to increased exposure to market forces which has occurred in China over the past decades with the main emphasis on contemporary performance of the services. Financial and service data were collected and analysed from ten schistosomiasis stations in the Hunan province. A document and literature review, key informant interviews, as well as two focus group discussions were conducted to establish their context. The study found that the schistosomiasis control stations had shifted their emphasis from prevention to clinical services and that 62% of the stations' total income now comes from charging for individual clinical services, while 90% of the total costs was related to providing these services. The study found that revenue generation had become the primary motive, and that over-treatment and prescription had become an accepted practice for all the stations. The study concludes that a combination of lax supervision and accountability, and a greater reliance on user-payment and market mechanisms has severely compromised the provision of the public goods elements of the schistosomiasis control programme.

  • 43.
    Biong, Stian
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Between death as escape and the dream of life: Psychosocial dimensions of health in young menliving with substance abuse and suicidal behaviour2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Substance abuse and suicidal behaviour are major challenges to public health. These phenomena are mainly studied by quantitative designs. This qualitative thesis aims at gaining a deeper understanding of substance abuse and suicidal behaviour, as experienced by young men in different types of treatment. By describing, exploring and interpreting lived experiences, in this thesis I try to give a more nuanced language of both substance abuse and suicidal behaviour, also in young migrating men. I also focus on the system of services related to the prevention and follow-up of life-threatening overdoses by describing and exploring how this phenomenon is experienced by individuals and professionals in Oslo. By researching the lived experiences of substance abuse and suicidal behaviour, combined with researching the phenomenon of life-threatening overdoses, a deeper insight is gained and this can be an important source to both prevention and health promotion for the group in question. The first three papers are based on descriptive, explorative and interpretative studies. How meaning is constructed is the core research question. In the fourth study I describe and explore life-threatening overdoses as a contemporary phenomenon in its context. The research questions are on a descriptive level. In the first three papers, the research object is the personal narratives from in-depth interviews, which are analysed using a phenomenological hermeneutic method. The case study is composed of data collected from different sources, and analysed by triangulation. The main finding in the first paper is that substance abuse and suicidal behaviour can be understood as goal-oriented, communicative and meaning-making activities about the individuals’ balance between death as an escape from pain and the hope of a life. In the second study, metaphorical expressions about a shifting sense of self is understood as balancing being an agent or a victim. In migrating young men these phenomena are interpreted as goal-oriented, communicative and meanig-making activities about existing in a maze that is perceived as closed. The findings of the case study show that different forms of life-threatening overdoses in Oslo are experienced in a state of existential and material stress. A wish of follow-up might not be expressed by the individual. Due to structural problems, such as lack of goals, professionals do not prevent such events in a planned way, nor do they cooperate between different levels. Professionals decide what is good quality in prevention and follow-up of life-threatening overdoses

  • 44.
    Biong, Stian
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Karlsson, Bengt
    Svensson, Tommy
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Metaphors of a shifting sense of self in men recovering from substance abuse and suicidal behavior.2008In: Journal of Psychosocial Nursing and Mental Health Services, ISSN 0279-3695, Vol. 46, no 4, 35-41 p.Article in journal (Refereed)
    Abstract [en]

    The purpose of this descriptive study was to explore and interpret men's experience of sense of self within the context of recovery from substance abuse and suicidal behavior. A secondary analysis of data from a previous study of four young Norwegian men revealed how a shifting sense of self was constructed through the use of metaphors. The analysis identified three themes related to the participants' sense of self: The Meaning of Being Isolated, The Meaning of Being Close to the Point of No Return, and The Meaning of Still Being on the Edge. By acknowledging metaphorical expressions as a source of important knowledge, this study reflects on how mental health professionals can use metaphors in the recovery process. As part of the' treatment alliance and therapeutic communication, we suggest that metaphors may aid the assessment of suicidal ideation, promote a sense of a more active self, and signal acceptance and recognition of subjectivity.

  • 45.
    Biong, Stian
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ravndal, Edle
    National Institute of Alcohol and Drug Research, Oslo, Norway.
    Living in a maze: Health, well-being and coping in young non-western men in Scandinavia experiencing substance abuse and suicidal behaviour2008In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 4, no 1, 4-16 p.Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to illuminate and interpret the lived experiences of emigration, substance abuse and suicidal behaviour in young non-western men in Scandinavia. The research questions were formulated as: (1) How is meaning constructed in the narratives? (2) What impact do these experiences have on health, well-being and coping? Data were collected using open-ended in-depth interviews. A phenomenological-hermeneutic approach, inspired by the philosophy of Ricoeur, was used to analyse the data. The naïve reading involved awareness of the participants’ perceived sense of insecurity in life. The structural analysis identified three themes: (1) the meaning of getting in a tight spot, (2) the meaning of being in a fog and (3) the meaning of the burning bed. A comprehensive understanding of the data was formulated as “living in a maze”. Ill health involved having a sense of liminality, which impaired one's possibilities to define and re-define goals. Substance abuse and suicidal behaviour were explicit expressions of not being well, when living in a maze that was perceived as closed. Both problem-focused and emotion-focused coping were used by the participants. These provided the motivation for substance abuse and suicidal behaviour.

  • 46.
    Biong, Stian
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ravndal, Edle
    National Institute of Alcohol and Drug Research, Oslo, Norway.
    Young men's experiences of living with substance abuse and suicidal behaviour: Between death as an escape from pain and the hope of a life2007In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 2, no 4, 246-259 p.Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to illuminate the experiences of suicidal behaviour in young Norwegian men with long-term substance abuse and to interpret their narratives with regard to meaning. Data were collected using open-ended, in-depth interviews. A phenomenological hermeneutic approach, inspired by the philosophy of Ricoeur, was used to analyse the data. The naïve reading involved awareness of the perceived sense of pain and hope in the participants. In the structural analysis, three themes were identified: (1) the meaning of relating, (2) the meaning of reflecting and (3) the meaning of acting. A comprehensive understanding of data indicated that the meaning of living with suicidal behaviour could be understood as a movement between different positions of wanting death as an escape from pain and hope for a better life. Our conclusion is that suicidal behaviour in men with substance abuse is a communicative activity about the individual's lived experience of pain and hope. How the participants experienced and constructed masculinity influenced the suicidal behaviour. To reduce pain and create hope by being seen and confirmed in social relationships, and being helped to verbalize existential thoughts and openly discuss possible solutions, are of importance.

  • 47. Birch Christiansen, Lena
    et al.
    Zierau Kudsk, Mette
    Пилотный проект «Психологическое здоровье2011Book (Other (popular science, discussion, etc.))
  • 48.
    Bjerkeli Grøvda, Lillian
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Evaluering av bruken av egenjournal i helsestasjon: et empowermentprosjekt2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background:Research has shown that insufficient communication skills and lacking continuity has led to poor quality of the children's health services. In some cases this has caused incorrect diagnosis and treatment and insufficient information to the parents. The Norwegian Board of Health appointed a working group that created a parent-held child health record. The group proposed the record to betried out in a selected population and evaluated before introducing it for the whole country.

    Aim: Tostudy parents use of the PHCHR, and to evaluate participation in decisionmaking and communication with the professionals. We also wanted to determine the PHCHR’s influence on health care utilisation, knowledge about child health and self-care.

    Setting: Maternal child health centres in ten municipalities in the North-west of Norway between October 2001 and January2003.

    Method: A sample of 309 children born between Jan 8. 2000 (00.08.01) and Oct 1. 2001 (01.10.01) was recruited successively at routine health surveillance visits and randomised into an intervention ora control group. First-born children were excluded. We used self-completed questionnaires, which had standardised, specific and closed questions. Both groups answered part one before and after the intervention, and the intervention group also answered part two after the intervention. It was 289(94%) parents who answered the questionnaires before the intervention, and 260 (84%) after. Public health nurses introduced both the PHCHR and the questionnaires. The nurses were interviewed to validate the interpretation of the results.

    Results: 3/4 of the parents used the PHCHR when visiting the maternal child health centres, 3/4 reported that the record had been helpful to them and 3/4 had entered information in the PHCHR themselves. Half of the parents claimed that the PHCHR led to better view of the child's health and development, and that they got more involved in decisions. The PHCHR was less used visiting other health professionals. The use of PHCHR did not influence the utilisation of health care services, parents’ knowledge of child's health, or the parents' satisfaction of information and communication with professionals.

    Conclusions: The PHCHR was well acceptedand frequentlyused in this randomised controlled trial, but the survey does not support the positive results using PHCHR shown in earlier descriptive follow up studies. Still, the public health nurses taking part in the study believe that an earlier introduction of the parent-held child record – at the first home visit, and more training would alter the results. Further studies are needed before one is to decide what to do about PHCHR in health promotion in children

  • 49.
    Björklund, Margereth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    LIVING WITH HEAD AND NECK CANCER: AHEALTH PROMOTION PERSPECTIVE: A Qualitative Study2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aim: In society there is a growing awareness that a vital factor for patientswith chronic diseases, such as head and neck cancer (HNC), is how well they are able tofunction in their everyday lives – a common, but often overlooked, public health issue. Theoverall aim of this thesis is to reach a deeper understanding of living with HNC and toidentify the experiences that patients felt promoted their health and well-being. It alsoexplores the patients’ experiences of contact and care from health professionals and whetherthese encounters could increase their feelings of health and well-being; salutogenic approach.

    Methods: This thesis engages a qualitative data design. On three occasions, 35 purposivelyselected patients were interviewed (31 from Sweden and one from Denmark, Finland, Island,and Norway). The first study was conducted in the Nordic counties (I), and the remainingstudies were conducted in Sweden (II, III, IV). Interviews were performed on a single basis(I, II, III) and then repeated (IV). The individual, semi-structured qualitative interviews usedopen-ended questions (n=53). Three different forms of analyses were used: critical incidenttechnique (I), thematic content analysis (II), latent content analysis (III), and interpretativedescriptive analysis (paper IV).

    Findings: Living with head and neck cancer was expressed as living in captivity, in the sensethat patients’ sometimes life-threatening symptoms were constant reminders of the disease.The patients experienced a threat against identity and existence. Patients struggled to findpower and control over everyday life, and if successful this appeared to offer them better health and well-being along with spiritual growth. The general understanding was that these patients had strong beliefs in the future despite living on a virtual rollercoaster. The patients went through a process of interplay of internal and external enabling that helped them acquire strength and feelings of better health and well-being. Consequently, they found power and control from inner strength and other health resources, e.g. social networks, nature, hobbies,activity, and health professionals. However, the findings also revealed the opposite; that somepatients were more vulnerable and felt powerless and faced everyday life with emotional andexistential loneliness. They were dependent on next of kin and health professionals. Having good interpersonal relationships and emotional support 24 hours a day from next of kin were crucial, as were health promoting contacts and care from health professionals. This healthpromoting contact and care built on working relationships with competent healthprofessionals that were available, engaged, respectful, validating, and, above all experiencedin the treatment phase. But many patients experienced not health promoting contact and care –and a sense of not being respected, or even believed. Added were the patients’ experiences ofinadequate coordination between phases of their lengthy illness trajectory. They felt lost andabandoned by health services, especially before and after treatment.

    Conclusions: Inner strength, good relationships with next of kin, nature, hobbies, andactivities could create strength and a sense of better health and well-being. Patientsexperienced a mutual working relationship during dialoguing and sensed co-operation andequality in encounters with competent health professionals. This could lead to enhancedpower and control i.e. empowerment in a patient’s everyday life. The findings highlightpsychosocial rehabilitation in a patient-centred organisation when health professionals supportpatients’ inner strength and health resources, and also offer long-term support to next of kin.Finally, this research suggests that if health professionals could gain a deeper understandingof the psychosocial, existential, social, and economic questions on patients’ minds, they couldbetter sense how patients feel and would be better equipped not only to offer greater support,but to raise their voices to improve health policy and health care for these patients.

  • 50.
    Björklund, Margereth
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Fridlund, B
    Centre for Health Promotion Research, Halmstad University, Halmstad, Sweden .
    Cancer patients' experiences of nurses' behaviour and health promotion activities: a critical incident analysis.1999In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 8, no 4, 204-12 p.Article in journal (Refereed)
    Abstract [en]

    Patients with head and neck cancer report several disease- and health-related problems before, during and a long time after completed treatment. Nurses have an important role in educating/supporting these patients about/through the disease and treatment so that they can attain well-being. This study describes the cancer patients' experiences of nurses' behaviour in terms of critical incidents after nurses had given them care to promote health. The study had a qualitative, descriptive design and the method used was the critical incident technique. Twenty-one informants from the Nordic countries diagnosed with head and neck cancer were strategically selected. It was explained to the informants what a critical incident implies before the interviews took place; this was defined as a major event of great importance, an incident, which the informants still remember, due to its great importance for the outcome of their health and well-being. The nurses' behaviour was examined, and critical incidents were involved in 208 cases-150 positive and 58 negative ones-the number of incidents varying between three and 20 per informant. The nurses' health promotion activities or lack of such activities based on the patients' disease, treatment and symptoms, consisted of informing and instructing the patients as well as enabling their participation. Personal consideration and the nurses' cognisance, knowledge, competence, solicitude, demeanour and statements of understanding were found to be important. Continuous health promotion nursing interventions were of considerable value for the majority of this group of cancer patients. Oncology nurses could reconfirm and update the care of head and neck cancer patients by including health promotion activities in individual care plans. By more frequent use of health promotion models, such as the empowerment model, the nurses could identify and focus on those individuals who needed to alter their life-style as well as tailor their approach towards these patient by setting goals for well-being and a healthy life-style.

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