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Swahnberg, Katarina
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Publications (10 of 62) Show all publications
Simmons, J., Brüggemann, A. J. & Swahnberg, K. (2016). Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence. BMJ Open, 6(6), Article ID e010847.
Open this publication in new window or tab >>Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, article id e010847Article in journal (Refereed) Published
Abstract [en]

Despite associations between being subjected to violence and ill-health being well known, most victims have never told health care professionals about their victimisation. Although both experiences of victimisation and help-seeking behaviour are gendered, male victims’ encounters with the health care system are under-researched. The aim of this study was to develop a theoretical model concerning male victims’ processes of disclosing experiences of being subjected to violence to health care professionals in Sweden. Constructivist grounded theory was used. Twelve men who had reported experiences of emotional, sexual, and/or physical violence by any type of perpetrator in an earlier quantitative study were interviewed. Conflicting thoughts within the men affected their likelihood of disclosing their victimisation. For example, a sense of urgency to seek help increased their likelihood, whereas shame and fear of negative consequences decreased their likelihood. Conformity to hegemonic masculinity had a strong negative influence, and was tipping the men towards a low likelihood of disclosing victimisation. Health care professionals strongly influence the disclosing process. For example, a good patient-provider relationship would help the men disclose, whereas a strong factor hindering disclosure was professionals’ adherence to gender norms, thus neither validating men’s experiences of violence nor acknowledging their psychological suffering.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2016
Keywords
Sweden; Violence; Abuse; Help-seeking; Screening; Gender; Masculinity; Constructivist Grounded Theory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-114678 (URN)10.1136/bmjopen-2015-010847 (DOI)000380237100066 ()
Note

The status of this article was previous manuscript.

Funding agencies: Region Ostergotland, Sweden [LIO-340221, LIO-514621]

Available from: 2015-03-02 Created: 2015-03-02 Last updated: 2018-11-15Bibliographically approved
Zbikowski, A., Zeiler, K. & Swahnberg, K. (2016). Forum Play as a method for learning ethical practice: A qualitative study among Swedish health-care staff. Clinical Ethics, 11(1), 9-18
Open this publication in new window or tab >>Forum Play as a method for learning ethical practice: A qualitative study among Swedish health-care staff
2016 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 11, no 1, p. 9-18Article in journal (Refereed) Published
Abstract [en]

Background: In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care.

Method: Ten health-care workers participating in a Forum Play course took part in this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison.

Results: The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency.

Conclusion: The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Abuse in health care, professional-patient relation, health care, power, Forum Theater, Forum Play, constant comparative method, ethical learning
National Category
Medical Ethics
Identifiers
urn:nbn:se:liu:diva-106233 (URN)10.1177/1477750915622032 (DOI)
Note

At the time for thesis presentation publication was in status: Manuscript

At the time for thesis presentation manuscript was named: Forum Play as a Method for Ethical Learning: A Qualitative Study among Swedish Health Care Staff

Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2017-12-05Bibliographically approved
Brüggemann, J., Swahnberg, K. & Wijma, B. (2015). A first online intervention to increase patients perceived ability to act in situations of abuse in health care: reports of a Swedish pre-post study. BMC Medical Ethics, 16(35)
Open this publication in new window or tab >>A first online intervention to increase patients perceived ability to act in situations of abuse in health care: reports of a Swedish pre-post study
2015 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, no 35Article in journal (Refereed) Published
Abstract [en]

Background: Efforts to counteract abuse in health care, defined as patient-experienced abuse, have mainly focused on interventions among caregivers. This study is the first to test an online intervention focusing on how patients can counteract such abuse. The intervention aimed at increasing patients intention and perceived ability to act in future situations where they risk experiencing abuse. Methods: Participants were recruited through a nephrology clinic in Sweden. The intervention consisted of an online program that aimed to stimulate patients to think of possible actions in situations in which they risk experiencing abuse. The program comprised stories and exercises in text and comic form. The participants filled out a questionnaire immediately before and after going through the program, as well as during follow-up four to eight weeks later. Results: Forty-eight patients (39 %) participated in the study and spent, on average, 41 min responding to questions and going through the program. Both men and women, of various ages and educational backgrounds, participated. An increase in participants self-reported ability to identify opportunities to act in a given situation was seen immediately afterwards, as well as during follow up. Conclusion: The current study suggests that it is feasible and most likely useful to a variety of patients to work with the provided material that has the aim of counteracting abuse in health care. It would be of interest to further develop ways of using comics and to test similar interventions in other health care settings.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Abuse in health care; Patient intervention; Online intervention; Patient empowerment; Comics
National Category
Other Social Sciences Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121147 (URN)10.1186/s12910-015-0027-7 (DOI)000359415300001 ()26003674 (PubMedID)
Note

Funding Agencies|Swedish Research Council [2011-2478]

Available from: 2015-09-08 Created: 2015-09-08 Last updated: 2018-11-15
Simmons, J., Wijma, B. & Swahnberg, K. (2015). Lifetime co-occurrence of violence victimisation and symptoms of psychological ill health: a cross-sectional study of Swedish male and female clinical and population samples. BMC Public Health, 15, Article ID 979.
Open this publication in new window or tab >>Lifetime co-occurrence of violence victimisation and symptoms of psychological ill health: a cross-sectional study of Swedish male and female clinical and population samples
2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 979Article in journal (Refereed) Published
Abstract [en]

Background

Lifetime co-occurrence of violence victimisation is common. A large proportion of victims report being exposed to multiple forms of violence (physical, sexual, emotional violence) and/or violence by multiple kinds of perpetrators (family members, intimate partners, acquaintances/strangers). Yet much research focuses on only one kind of victimisation. The aim of this study was to investigate the association between symptoms of psychological ill health, and A) exposure to multiple forms of violence, and B) violence by multiple perpetrators.

Method

Secondary analysis of cross-sectional data previously collected for prevalence studies on interpersonal violence in Sweden was used. Respondents were recruited at hospital clinics (women n = 2439, men n = 1767) and at random from the general population (women n = 1168, men n  = 2924). Multinomial regression analysis was used to estimate associations between exposure to violence and symptoms of psychological ill health.

Results

Among both men and women and in both clinical and population samples, exposure to multiple forms of violence as well as violence by multiple perpetrators were more strongly associated with symptoms of psychological ill health than reporting one form of violence or violence by one perpetrator. For example, in the female population sample, victims reporting all three forms of violence were four times more likely to report many symptoms of psychological ill health compared to those reporting only one form of violence (adj OR: 3.8, 95 % CI 1.6–8.8). In the male clinical sample, victims reporting two or three kind of perpetrators were three times more likely to report many symptoms of psychological ill health than those reporting violence by one perpetrator (adj OR 3.3 95 % CI 1.9–5.9).

Discussion

The strong association found between lifetime co-occurrence of violence victimisation and symptoms of psychological ill-health is important to consider in both research and clinic work. If only the effect of one form of violence or violence by one kind of perpetrator is considered this may lead to a misinterpretation of the association between violence and psychological ill health. When the effect of unmeasured traumata is ignored, the full burden of violence experienced by victims may be underestimated.

Conclusion

Different kinds of victimisation can work interactively, making exposure to multiple forms of violence as well as violence by multiple perpetrators more strongly associated with symptoms of psychological ill health than any one kind of victimisation alone.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Abuse, Mental health, Stress, Intimate Partner Violence, Revictimization, polyvictimization
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-114676 (URN)10.1186/s12889-015-2311-3 (DOI)000361795600010 ()
Note

On the day of the defence date the status of this article was Manuscript and the original title was Cumulative violence and symptoms of psychological ill-health : importance of the interplay between exposure to different kinds of interpersonal violence in Swedish male and female clinical and population samples.Funding: Nordic Council of Ministers

Available from: 2015-03-02 Created: 2015-03-02 Last updated: 2018-11-15Bibliographically approved
Oscarsson, M., Gottvall, T. & Swahnberg, K. (2015). When fetal hydronephrosis is suspected antenatally: A qualitative study. BMC Pregnancy and Childbirth, 15(349)
Open this publication in new window or tab >>When fetal hydronephrosis is suspected antenatally: A qualitative study
2015 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 349Article in journal (Refereed) Published
Abstract [en]

Background: The information about fetal malformation findings during the ultrasound examination often comes unexpectedly, and the women and their partners may not necessarily receive any conclusive statement on the prognosis. A finding such as fetal hydronephrosis range from being a soft markers or mild anomaly, to a serious condition associated with neonatal morbidity and mortality. The aim of this study was to explore womens reactions to the discovery of fetal hydronephrosis in the context of uncertainty regarding the prognosis. Methods: Ten women were interviewed and the interviews were conducted six to twelve months after the women gave birth. They had experience of suspected fetal hydronephrosis in gestational week 18-20. The interviews were recorded, transcribed verbatim and analysed using constant comparative analysis. Results: The core category, Going through crisis by knowing that you are doing the right thing illustrates the meaning of womens reactions and feelings. It illuminates the four categories: When the unexpected happens-on the one hand, women had positive views that the suspicious malformation could be discovered; however, on the other hand, women questioned the screening. To live in suspense during pregnancy - the suspicious malformation caused anxiety and was a stressful situation. Difficulties in understanding information - the women thought they had limited knowledge and had difficulties in understanding the information. Suppress feelings and hope for the best - the women tried to postpone the problem and thought they should deal with it after delivery. Conclusions: Women are worried irrespective of suspicious or severe malformations, and in need of information and counselling tailored to their individual needs. Other sources of support could be: written information, links to reliable sources on the Internet and possibilities for ongoing follow-ups.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2015
Keywords
Fetal hydronephrosis; Pregnancy; Ultrasound; Qualitative analysis
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-124122 (URN)10.1186/s12884-015-0791-x (DOI)000367044800001 ()26694546 (PubMedID)
Available from: 2016-01-22 Created: 2016-01-19 Last updated: 2017-11-30
Simmons, J., Wijma, B. & Swahnberg, K. (2014). Associations and Experiences Observed for Family and Nonfamily Forms of Violent Behavior in Different Relational Contexts Among Swedish Men and Women. Violence and Victims, 29(1), 152-170
Open this publication in new window or tab >>Associations and Experiences Observed for Family and Nonfamily Forms of Violent Behavior in Different Relational Contexts Among Swedish Men and Women
2014 (English)In: Violence and Victims, ISSN 0886-6708, E-ISSN 1945-7073, Vol. 29, no 1, p. 152-170Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine how lifetime experiences of different types of violent behavior as well as violence by different kinds of perpetrators overlap, and to investigate the co-occurrence of experiences of violent behavior by kind of perpetrator. This was done among both sexes in both a random sample from a county population (women n = 1,168, men n = 2,924) and a clinical sample (women n = 2,439, men, n = 1,767) in Sweden. More than 1 kind of perpetrator was reported by 33%-37% of female and 22%-23% of male victims of some kind of violence, whereas 47%-48% of female and 29%-31% of male victims reported more than 1 kind of violence. The reporting of 2 or 3 kinds of perpetrators was associated with the reporting of experiences of more than 1 kind of violent behavior. Health care providers must be trained to recognize the overlap of violent victimization and help prevent further victimization of those who already have such experiences.

Place, publisher, year, edition, pages
Springer Publishing Co, 2014
Keywords
revictimization; gender; cumulative violence; perpetrator; multiple victimization
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-105043 (URN)10.1891/0886-6708.VV-D-12-00084 (DOI)000330514100010 ()2-s2.0-84899457345 (Scopus ID)
Available from: 2014-03-06 Created: 2014-03-06 Last updated: 2018-11-15
Zbikowski, A., Brüggemann, A. J., Wijma, B. & Swahnberg, K. (2014). Counteracting Abuse in Health Care: A Quantitative Evaluation of an Intervention with Forum Play for Staff.
Open this publication in new window or tab >>Counteracting Abuse in Health Care: A Quantitative Evaluation of an Intervention with Forum Play for Staff
2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: In their lifetime, 13%–28% of female patients in the Nordic countries seeking gynecological health care have reported abuse by staff in a health care setting (AHC). Besides suffering, AHC can cause patients to avoid contacting the health care system. Thus, interventions are clearly needed. In this article, we report a drama intervention method among health care staff and study to what extent the intervention increased the staff’s awareness of AHC and their ability to take action against it.

Design: Pre-/post-test measurement by means of self-reported questionnaires with a longterm follow-up one year after the intervention. Questionnaires were distributed at four measuring times.

Setting: A women’s clinic in Sweden.

Participants: All staff at the target clinic were invited to participate in the intervention and received the questionnaires (n=137). Of those 136 had the possibility to participate in the intervention. A total of 92 staff members (67%) returned at least two questionnaires. 76 (56%) participated in the intervention, of which 61 (80%) returned at least one questionnaire.

Intervention: The drama intervention was based on Forum Play (FP), a form of improvised role-play based on the pedagogy of Augusto Boal. During one year, 2008–2009, 16 half-day FP workshops focusing on AHC were conducted at the target clinic. Participation was voluntary.

Primary outcome measures: 1) The number of reported occasions when staff heard of or were involved in AHC. 2) FP participants’ self-reported ability to act in AHC-related situations.

Results: No change could be seen in the number of occasions of AHC reported by staff between baseline and one year after the intervention. However, an increase of the participants’ ability to act in AHC-related situations was seen.

Conclusions: Health care staff’s participation in FP workshops can increase their ability to take action in AHC situations, but probably does not affect their awareness of AHC.

Keywords
Abuse in health care, interactive theater, Forum Play, Forum Theater, health care staff, professional-patient relation, moral resources
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-106232 (URN)
Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2018-11-15Bibliographically approved
Smirthwaite, G., Lundstrom, M., Albrecht, S. & Swahnberg, K. (2014). Indication criteria for cataract extraction and gender differences in waiting time. Acta Ophthalmologica, 92(5), 432-438
Open this publication in new window or tab >>Indication criteria for cataract extraction and gender differences in waiting time
2014 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 92, no 5, p. 432-438Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this study was to investigate national indication criteria tool for cataract extraction (NIKE), a clinical tool for establishing levels of indications for cataract surgery, in relation to gender differences in waiting times for cataract extraction (CE). Methods: Data were collected by The Swedish National Cataract Register (NCR). Eye clinics report to NCR voluntarily and on regular basis (98% coverage). Comparisons regarding gender difference in waiting times were performed between NIKE-categorized and non-NIKE-categorized patients, as well as between different indication groups within the NIKE-system. All calculations were performed in SPSS version 20. Multivariate analyses were carried out using logistic regression, and single variable analyses were carried out by Students t-test or chi square as appropriate. Results: Gender, age, visual acuity and NIKE-categorization were associated with waiting time. Female patients had a longer waiting time to CE than male, both within and outside the NIKE-system. Gender difference in waiting time was somewhat larger among patients who had not been categorized by NIKE. In the non-NIKE-categorized group, women waited 0.20 months longer than men. In the group which was NIKE-categorized, women waited 0.18 months longer than men. Conclusions: It is reasonable to assume that prioritizing patients by means of NIKE helps to reduce the gender differences in waiting time. Gender differences in waiting time have decreased as NIKE was introduced and there may be a variety of explanations for this. However, with the chosen study design, we could not distinguish between effects related to NIKE and those due to other factors which occurred during the study period.

Place, publisher, year, edition, pages
Wiley, 2014
Keywords
cataract extraction; gender differences; indication; prioritizing tool; priority; waiting time
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-109580 (URN)10.1111/aos.12230 (DOI)000339482700030 ()23981482 (PubMedID)
Available from: 2014-08-21 Created: 2014-08-21 Last updated: 2017-12-05
Brüggemann, J. & Swahnberg, K. (2014). Staff silence about abuse in health care: An exploratory study at a Swedish women’s clinic. Clinical Ethics, 9, 71-76
Open this publication in new window or tab >>Staff silence about abuse in health care: An exploratory study at a Swedish women’s clinic
2014 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 9, p. 71-76Article in journal (Refereed) Published
Abstract [en]

It has been well documented that patients can feel abused in health care and that many patients suffer from these experiences. Insight lacks into contributing factors behind such events. Silence surrounding the abuse has been suggested as a possible mechanism. The present study explores silence surrounding the abuse as a possible contributing factor. We have explored whether this silence is connected with the staff’s hierarchical position and with the staff’s own experiences as patients abused in health care.

Methods During January 2008, a paper questionnaire was sent to all staff members at a Swedish women’s clinic. The questionnaire included questions on sociodemography and profession and multiple questions about abuse in health care. After univariate testing, a binary logistic regression model including variables concerning profession and staff’s own experiences of abuse was built.

Results Our data show that in contrast to midwives and gynaecologists, auxiliary nurses seldom report hearing about cases of abuse in health care. Staff who themselves experienced abuse in health care as patients, so-called wounded healers, were more likely to have heard about abuse in health care during the last 12 months.

Conclusions This study suggests that a form of silence reigns over events of abuse in health care that is not randomly distributed over staff. Professional hierarchies and staff’s own experiences of abuse as patients could be considered in the design of interventions to break the silence surrounding patients’ experiences of abuse in health care.

Place, publisher, year, edition, pages
SAGE Journals, 2014
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-116361 (URN)10.1177/1477750914546760 (DOI)
Available from: 2015-03-26 Created: 2015-03-26 Last updated: 2018-11-15Bibliographically approved
Elmerstig, E., Wijma, B. & Swahnberg, K. (2013). Prioritizing the partners enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse. Journal of Psychosomatic Obstetrics and Gynaecology, 34(2), 82-89
Open this publication in new window or tab >>Prioritizing the partners enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse
2013 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, no 2, p. 82-89Article in journal (Refereed) Published
Abstract [en]

The present study examines the prevalence of women who continue to have vaginal intercourse (VIC) despite pain, avoid telling the partner, and feign enjoyment. It also considers the reasons for this behavior. A sample of 1566 female senior high school students (aged 18-22 years) completed a questionnaire concerning their experiences and attitudes toward their body and sexuality. Forty-seven percent (270/576) of those women who reported pain during VIC continued to have VIC despite the pain. The most common reasons were that they did not want to spoil sex for or hurt the partner by interrupting VIC. Feigning enjoyment and not telling the partner about their pain were reported by 22 and 33%, respectively. Continuing to have VIC despite pain was associated with feelings of being inferior to the partner during sex, dissatisfaction with their own sex lives and feigning enjoyment while having pain. Pain during VIC is reported by every third young Swedish woman, and almost half of those still continue to have VIC. The major reason given is noteworthy - prioritizing the partners enjoyment before their own - and indicates that young women who continue to have VIC despite pain take a subordinate position in sexual interactions.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
Female health; gynecological pain; psychosomatic gynecology; sexual health; womens sexuality
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-96125 (URN)10.3109/0167482X.2013.793665 (DOI)000319748300005 ()
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2018-11-15
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