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Müssener, U., Andersson, E. K., Linderoth, C., Leijon, M. E. & Bendtsen, M. (2018). A Text Message-Based Intervention Targeting Alcohol Consumption Among University Students: User Satisfaction and Acceptability Study.. JMIR Human Factors, 5(3), Article ID e23.
Open this publication in new window or tab >>A Text Message-Based Intervention Targeting Alcohol Consumption Among University Students: User Satisfaction and Acceptability Study.
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2018 (English)In: JMIR Human Factors, E-ISSN 2292-9495, Vol. 5, no 3, article id e23Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Heavy consumption of alcohol among university students is a global problem, with excessive drinking being the social norm. Students can be a difficult target group to reach, and only a minority seek alcohol-related support. It is important to develop interventions that can reach university students in a way that does not further stretch the resources of the health services. Text messaging (short message service, SMS)-based interventions can enable continuous, real-time, cost-effective, brief support in a real-world setting, but there is a limited amount of evidence for effective interventions on alcohol consumption among young people based on text messaging. To address this, a text messaging-based alcohol consumption intervention, the Amadeus 3 intervention, was developed.

OBJECTIVE: This study explored self-reported changes in drinking habits in an intervention group and a control group. Additionally, user satisfaction among the intervention group and the experience of being allocated to a control group were explored.

METHODS: Students allocated to the intervention group (n=460) were asked about their drinking habits and offered the opportunity to give their opinion on the structure and content of the intervention. Students in the control group (n=436) were asked about their drinking habits and their experience in being allocated to the control group. Participants received an email containing an electronic link to a short questionnaire. Descriptive analyses of the distribution of the responses to the 12 questions for the intervention group and 5 questions for the control group were performed.

RESULTS: The response rate for the user feedback questionnaire of the intervention group was 38% (176/460) and of the control group was 30% (129/436). The variation in the content of the text messages from facts to motivational and practical advice was appreciated by 77% (135/176) participants, and 55% (97/176) found the number of messages per week to be adequate. Overall, 81% (142/176) participants stated that they had read all or nearly all the messages, and 52% (91/176) participants stated that they were drinking less, and increased awareness regarding negative consequences was expressed as the main reason for reduced alcohol consumption. Among the participants in the control group, 40% (52/129) stated that it did not matter that they had to wait for access to the intervention. Regarding actions taken while waiting for access, 48% (62/129) participants claimed that they continued to drink as before, whereas 35% (45/129) tried to reduce their consumption without any support.

CONCLUSIONS: Although the main randomized controlled trial was not able to detect a statistically significant effect of the intervention, most participants in this qualitative follow-up study stated that participation in the study helped them reflect upon their consumption, leading to altered drinking habits and reduced alcohol consumption.

TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/705putNZT).

Place, publisher, year, edition, pages
Toronto, Canada: J M I R Publications, Inc., 2018
Keywords
SMS, alcohol consumption intervention, mobile phones, students, text messages
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-153600 (URN)10.2196/humanfactors.9641 (DOI)29991469 (PubMedID)2-s2.0-85052017018 (Scopus ID)
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2019-05-02Bibliographically approved
Thomas, K., Müssener, U., Linderoth, C., Karlsson, N., Bendtsen, P. & Bendtsen, M. (2018). Effectiveness of a Text Messaging-Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial. JMIR mhealth and uhealth, 6(6), Article ID e146.
Open this publication in new window or tab >>Effectiveness of a Text Messaging-Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial
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2018 (English)In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 6, no 6, article id e146Article in journal (Refereed) Published
Abstract [en]

Background: Excessive drinking among university students is a global challenge, leading to significant health risks. However, heavy drinking among students is widely accepted and socially normalized. Mobile phone interventions have attempted to reach students who engage in excessive drinking. A growing number of studies suggest that text message-based interventions could potentially reach many students and, if effective, such an intervention might help reduce heavy drinking in the student community. Objective: The objective of this study was to test the effectiveness of a behavior change theory-based 6-week text message intervention among university students. Methods: This study was a two-arm, randomized controlled trial with an intervention group receiving a 6-week text message intervention and a control group that was referred to treatment as usual at the local student health care center. Outcome measures were collected at baseline and at 3 months after the initial invitation to participate in the intervention. The primary outcome was total weekly alcohol consumption. Secondary outcomes were frequency of heavy episodic drinking, highest estimated blood alcohol concentration, and number of negative consequences attributable to excessive drinking. Results: A total of 896 students were randomized to either the intervention or control group. The primary outcome analysis included 92.0% of the participants in the intervention group and 90.1% of the control group. At follow-up, total weekly alcohol consumption decreased in both groups, but no significant between-group difference was seen. Data on the secondary outcomes included 49.1% of the participants in the intervention group and 41.3% of the control group. No significant between-group difference was seen for any of the secondary outcomes. Conclusions: The present study was under-powered, which could partly explain the lack of significance. However, the intervention, although theory-based, needs to be re-assessed and refined to better support the target group. Apart from establishing which content forms an effective intervention, the optimal length of an alcohol intervention targeting students also needs to be addressed in future studies.

Place, publisher, year, edition, pages
JMIR PUBLICATIONS, INC, 2018
Keywords
alcohol consumption intervention; text message-based intervention; university students; brief intervention
National Category
Substance Abuse
Identifiers
urn:nbn:se:liu:diva-149731 (URN)10.2196/mhealth.9642 (DOI)000436207100005 ()29941417 (PubMedID)
Note

Funding Agencies|Public Health Agency in Sweden [05670-2014-6.2]

Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2019-04-03
Müssener, U., Bendtsen, M., Karlsson, N., White, I. R., Mccambridge, J. & Bendtsen, P. (2016). Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students A Randomized Clinical Trial. JAMA Internal Medicine, 176(3), 321-328
Open this publication in new window or tab >>Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students A Randomized Clinical Trial
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2016 (English)In: JAMA Internal Medicine, ISSN 2168-6106, E-ISSN 2168-6114, Vol. 176, no 3, p. 321-328Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Smoking is globally the most important preventable cause of ill health and death. Mobile telephone interventions and, in particular, short message service (SMS) text messaging, have the potential to overcome access barriers to traditional health services, not least among young people. OBJECTIVE To determine the effectiveness of a text-based smoking cessation intervention among young people. DESIGN, SETTING, AND PARTICIPANTS A single-blind, 2-arm, randomized clinical trial (Nicotine Exit [NEXit]) was conducted from October 23, 2014, to April 17, 2015; data analysis was performed from April 23, 2014, to May 22, 2015. Participants included daily or weekly smokers willing to set a quit date within 1 month of enrollment. The study used email to invite all college and university students throughout Sweden to participate. INTERVENTIONS The NEXit core program is initiated with a 1- to 4-week motivational phase during which participants can choose to set a stop date. The intervention group then received 157 text messages based on components of effective smoking cessation interventions for 12 weeks. The control group received 1 text every 2 weeks thanking them for participating in the study, with delayed access to the intervention. MAIN OUTCOMES AND MEASURES The primary outcomes were self-reported prolonged abstinence (not having smoked >5 cigarettes over the past 8 weeks) and 4-week point prevalence of complete smoking cessation shortly after the completion of the intervention (approximately 4 months after the quit date). RESULTS A total of 1590 participants, mainly between 21 and 30 years of age, were randomized into the study; 827 (573 [69.3%] women) were allocated to the intervention group and 763 (522 [68.4%] women) were included in the control group. Primary outcome data were available for 783 (94.7%) of the intervention group and 719 (94.2%) of the control group. At baseline, participants were smoking a median (range) of 63 (1-238) and 70 (2-280) cigarettes per week, respectively. Eight-week prolonged abstinence was reported by 203 participants (25.9%) in the intervention group and 105 (14.6%) in the control group; 4-week point prevalence of complete cessation was reported by 161 (20.6%) and 102 (14.2%) participants, respectively, a mean (SD) of 3.9 (0.37) months after the quit date. The adjusted odds ratios (95% CIs) for these findings were 2.05 (1.57-2.67) and 1.56 (1.19-2.05), respectively. CONCLUSIONS AND RELEVANCE With the limitation of assessing only the short-term effect of the intervention, the effects observed in this trial are comparable with those for traditional smoking cessation interventions. The simple NEXit intervention has the potential to improve the uptake of effective smoking cessation interventions.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2016
National Category
Basic Medicine Computer and Information Sciences
Identifiers
urn:nbn:se:liu:diva-127282 (URN)10.1001/jamainternmed.2015.8260 (DOI)000372302500008 ()26903176 (PubMedID)
Note

Funding Agencies|Swedish Research Council [521-2012-2865]; Swedish Medical Research Council [U105260558]

Available from: 2016-04-20 Created: 2016-04-19 Last updated: 2018-01-10
Keurhorst, M., Heinen, M., Colom, J., Linderoth, C., Müssener, U., Okulicz-Kozaryn, K., . . . Wensing, M. (2016). Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study. BMC Family Practice, 17(70)
Open this publication in new window or tab >>Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study
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2016 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, no 70Article in journal (Refereed) Published
Abstract [en]

Background: Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI. Methods: Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method. Results: Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important Tamp;S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro-level such as societal and political culture the effects risks to get nullified. Conclusions: Essential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2016
Keywords
Screening and brief intervention; Alcohol prevention; Primary healthcare; Implementation; Qualitative evaluation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-129661 (URN)10.1186/s12875-016-0461-8 (DOI)000377164500001 ()27267887 (PubMedID)
Note

Funding Agencies|European Union [259268]; Netherlands Organization for Health Research and Development (ZonMW, Prevention Program), under - ODHIN - Optimizing delivery of healthcare interventions in the Netherlands FP7 EC Grant Agreement [200310017]

Available from: 2016-06-27 Created: 2016-06-23 Last updated: 2018-08-14
Müssener, U., Ståhl, C. & Söderberg, E. (2015). Does the quality of encounters affect return to work? Lay people describe their experiences of meeting various professionals during their rehabilitation process. Work: A journal of Prevention, Assesment and rehabilitation, 52(2), 447-455
Open this publication in new window or tab >>Does the quality of encounters affect return to work? Lay people describe their experiences of meeting various professionals during their rehabilitation process
2015 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 52, no 2, p. 447-455Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Among the many aspects of the rehabilitation process that may be relevant for its outcome, the impact of encounters with various professionals has received little attention. OBJECTIVE: The objective was to gain a deeper understanding of how individuals with experiences of being on sick leave perceive their encounters with professionals, and how such encounters affected their ability to return to work, as well as their attitudes towards the sickness insurance system. METHODS: An inductive qualitative approach was used to analyze data from 20 interviews with men and women, aged 33-59, in Sweden who had experience of being on sick leave for at least 28 days. RESULTS: The study shows how interviewees encounters with professionals affected their self-confidence and perception of their ability to return to work. Professionals treatment of people on sick leave seems to be affected by the structural prerequisites for offering support, where sickness insurance regulations are suggested to have a large impact. CONCLUSIONS: An encouraging and supportive attitude on the part of the professionals is essential for empowering people to handle obstacles during the rehabilitation process; whereas feeling rejected and belittled in the return to work process may lead to disempowerment, and/or delays in measures and longer periods on sick leave.

Place, publisher, year, edition, pages
IOS PRESS, 2015
Keywords
Sickness absence; rehabilitation; lay person; sick leave; professionals
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-123175 (URN)10.3233/WOR-152121 (DOI)000364411700022 ()26409366 (PubMedID)
Note

Funding Agencies|Swedish Council for Working Life and Social Research

Available from: 2015-12-06 Created: 2015-12-04 Last updated: 2018-01-10
Bendtsen, P., Anderson, P., Wojnar, M., Newbury-Birch, D., Müssener, U., Colom, J., . . . Gual, A. (2015). Professionals Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study. Alcohol and Alcoholism, 50(4), 430-437
Open this publication in new window or tab >>Professionals Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study
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2015 (English)In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 50, no 4, p. 430-437Article in journal (Refereed) Published
Abstract [en]

To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy B - Oxford Open Option D, 2015
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-120454 (URN)10.1093/alcalc/agv020 (DOI)000357867100009 ()25787012 (PubMedID)
Note

Funding Agencies|Netherlands Organization for Health Research and Development (ZonMW) [200310017]

Available from: 2015-08-12 Created: 2015-08-11 Last updated: 2018-01-11
Müssener, U., Bendtsen, M., Karlsson, N., White, I. R., McCambridge, J. & Bendtsen, P. (2015). SMS-based smoking cessation intervention among university students: study protocol for a randomised controlled trial (NEXit trial). Trials, 16, Article ID 140.
Open this publication in new window or tab >>SMS-based smoking cessation intervention among university students: study protocol for a randomised controlled trial (NEXit trial)
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2015 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 16, article id 140Article in journal (Refereed) Published
Abstract [en]

Background: Most smoking efforts targeting young people have so far been focused on prevention of initiation, whereas smoking cessation interventions have largely been targeted towards adult populations. Thus, there is limited evidence for effective smoking cessation interventions in young people, even though many young people want to quit smoking. Mobile communication technology has the potential to reach large numbers of young people and recent text-based smoking cessation interventions using phones have shown promising results. Methods/design: The study aims to evaluate a newly developed text-based smoking cessation intervention for students in colleges and universities in Sweden. The design is a randomised controlled trial (RCT) with a delayed/waiting list intervention control condition. The trial will be performed simultaneously in all colleges and universities served by 25 student health care centres in Sweden. Outcomes will be evaluated after 4 months, with 2 cessation primary outcomes and 4 secondary outcomes. After outcome evaluation the control group will be given access to the intervention. Discussion: The study will examine the effectiveness of a stand-alone SMS text-based intervention. The intervention starts with a motivational phase in which the participants are given an opportunity to set a quit date within 4 weeks of randomisation. This first phase and the subsequent core intervention phase of 12 weeks are totally automated in order to easily integrate the intervention into the daily routines of student and other health care settings. As well as providing data for the effectiveness of the intervention, the study will also provide data for methodological analyses addressing a number issues commonly challenging in Internet-based RCTs. For example, an extensive follow-up strategy will be used in order to evaluate the use of repeated attempts in the analysis, and in particular to explore the validity of a possible missing not at random assumption that the odds ratio between the primary outcome and response is the same at every attempt.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
: Tobacco, Smoking cessation, Students, Text messages, Mobile phones, SMS
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-117550 (URN)10.1186/s13063-015-0640-2 (DOI)000353116200001 ()25872503 (PubMedID)
Available from: 2015-05-04 Created: 2015-05-04 Last updated: 2017-12-04
Müssener, U. (2012). Det goda mötet - en viktig del i sjukskrivnings- och rehabiliteringsprocessen. Socialmedicinsk Tidskrift, 89(2), 169-177
Open this publication in new window or tab >>Det goda mötet - en viktig del i sjukskrivnings- och rehabiliteringsprocessen
2012 (Swedish)In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 89, no 2, p. 169-177Article in journal (Refereed) Published
Abstract [sv]

Ansvaret för att stötta individer vid återgång i arbete delas mellan flera offentliga aktörer såsom Försäkringskassan, hälso- och sjukvården, Arbetsförmedlingen, arbetsgivaren och den sjukskrivne själv. Studien visar att bemötandet från dessa aktörer påverkar hur personer som varit sjukskrivna hanterar sin situation relaterat till de förändringar som genomförts i sjukförsäkringen samt deras möjlighet att återgå till arbete. Möten där individens styrkor och förmågor på olika sätt lyfts fram tycks påverka självförtroendet och synen på den egna arbetsförmågan. Kritik riktas mot sjukförsäkringssystemet, t.ex. regler och bestämmelser, snarare än mot aktörerna som arbetar i det. I intervjuerna framkommer att systemets utformning i sig bidrar till att de professionella har svårt att se och beakta individuella behov vilket bidrar till orättvisa bedömningar och beslut.

Abstract [en]

The responsibility to support individuals to return to work is shared between different public organizations such as the healthcare services, the employment- and the social insurance authorities, and the individual on sick leave. This study shows that encounters from these professionals affect sickness absentees' self-confidence and perception of work ability as well as their abilities to handle obstacles during the sick-leave and rehabilitation process. How professionals encounter people on sick leave seem to be affected by the professionals' working conditions, which in its turn are highly influenced by the context in which they operate. Most respondents were critical to the system rather than of the professionals working in it.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80107 (URN)
Funder
FAS, Swedish Council for Working Life and Social Research
Available from: 2012-08-20 Created: 2012-08-20 Last updated: 2017-12-07
Ståhl, C., Müssener, U. & Svensson, T. (2012). Implementation of standardized time limits in sickness insurance and return-to-work: Experiences of four actors. Disability and Rehabilitation, 34(16), 1404-1411
Open this publication in new window or tab >>Implementation of standardized time limits in sickness insurance and return-to-work: Experiences of four actors
2012 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 16, p. 1404-1411Article in journal (Refereed) Published
Abstract [en]

Purpose: In 2008, time limits were introduced in Swedish sickness insurance, comprising a pre-defined schedule for return-to-work. The purpose of this study was to explore experienced consequences of these time limits. Sick-listed persons, physicians, insurance officials and employers were interviewed regarding the process of sick-listing, rehabilitation and return-to-work in relation to the reform.

Method: The study comprises qualitative interviews with 11 sick-listed persons, 4 insurance officials, 5 employers and 4 physicians (n = 24). Results: Physicians, employers, and sick-listed persons described insurance officials as increasingly passive, and that responsibility for the process was placed on the sick-listed. Several ethical dilemmas were identified, where officials were forced to act against their ethical principles. Insurance officials' principle of care often clashed with the standardization of the process, that is based on principles of egalitarianism and equal treatment.

Conclusions: The cases reported in this study suggest that a policy for activation and early return-to-work in some cases has had the opposite effect: central actors remain passive and the responsibility is placed on the sick-listed, who lacks the strength and knowledge to understand and navigate through the system. The standardized insurance system here promoted experiences of procedural injustice, for both officials and sick-listed persons.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keywords
Work disability, return-to-work, ethics, Sweden
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-73393 (URN)10.3109/09638288.2011.641667 (DOI)000305421700008 ()22200168 (PubMedID)
Available from: 2012-01-02 Created: 2012-01-02 Last updated: 2017-12-08Bibliographically approved
Ståhl, C., Müssener, U. & Svensson, T. (2011). Sjukskrivningssystemet och dess aktörer: Efter införandet av rehabiliteringskedjan. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Sjukskrivningssystemet och dess aktörer: Efter införandet av rehabiliteringskedjan
2011 (Swedish)Report (Other academic)
Abstract [sv]

Sedan 2008 har ett antal större förändringar gjorts i sjukförsäkringen. Främst har rehabiliteringskedjan, dvs. införandet av fasta tidsgränser för bedömning av arbetsförmåga och rätt till ersättning, stått i fokus för debatten. Med tidsgränserna sattes en slutgräns för hur länge sjukpenning betalas ut, vilket tidigare inte fanns i försäkringen. I denna studie undersöks hur sjukskrivna, arbetsgivare, försäkringskassehandläggare och läkare resonerar kring dessa tidsgränser, arbetsförmågebedömningar, rehabilitering och återgång i arbete.

Studien omfattar kvalitativa intervjuer med sjukskrivna, arbetsgivare, handläggare på Försäkringskassan samt primärvårds- och företagsläkare. Totalt intervjuades 24 personer.

Sjukskrivna, arbetsgivare och läkare upplever att Försäkringskassans handläggare blivit mindre tillgängliga, och generellt uppfattas handläggarna som alltmer passiva i rehabiliteringsprocessen. Handläggare på Försäkringskassan menar att de senaste årens regeländringar har medfört en mer administrativ handläggarroll, där mer tid läggs på att hålla tidsgränser än att arbeta med faktisk rehabilitering. Handläggare upplever också att etiska dilemman uppstår när individuella bedömningar kommer i konflikt med tidsgränserna, vilket upplevs som stressande.

De sjukskrivna upplever att Försäkringskassan borde ta ett större ansvar för att driva sjukskrivnings- och rehabiliteringsprocessen framåt, eftersom de själva har svårt att överblicka och navigera i sjukförsäkringssystemet. Även arbetsgivarna i studien förväntar sig att Försäkringskassan ska ta större ansvar för sjukskrivningsprocessen. Handläggarna på Försäkringskassan har å sin sida blivit alltmer benägna att lägga detta ansvar på de sjukskrivna.

Studien identifierar också flera brister i samverkan mellan arbetsgivare, sjukvård och Försäkringskassan kring bedömningen av sjukskrivnas arbetsförmåga. Försäkringskassans handläggare lägger stor vikt vid de medicinska underlagen i bedömningarna, och ger uttryck för en tveksamhet inför att använda andra informationskällor (såsom SASSAMkartläggningar), då det upplevs som avsteg från rådande riktlinjer.

Ett av syftena med rehabiliteringskedjan var att skapa en mer enhetlig och standardiserad sjukskrivningsprocess. Dock upplever såväl handläggare som sjukskrivna att systemet är oflexibelt och inte tar hänsyn till individers olikheter och skilda behov, och att de fasta tidsgränserna därmed medfört en ökad orättvisa för de sjukskrivna. Även om bemötandet från handläggare på Försäkringskassan i många fall upplevs som bra, uppfattas sjukförsäkringssystemet som orättvist; studien ger därmed i första hand exempel på upplevd proceduriell orättvisa, snarare än upplevelser av orättvist bemötande.

Studien visar på ett ytterligare behov av att studera etik, rättvisa och kvalitet i sjukskrivningsprocessen. 

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. p. 49
Series
HELIX working papers, ISSN 1654-8213 ; 7
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-72618 (URN)
Available from: 2011-11-30 Created: 2011-11-30 Last updated: 2015-06-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5173-5419

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