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  • 201.
    Kullberg, Agneta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    My Home is my Castle: Residential Well being and Perceived Safety in Different Types of Housing Areas in Sweden2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Safety in the housing environment is a basic human need and may be a prerequisite for health but studies from the perspective of the residents are limited in the literature. Although historically public health research has recognized the housing environment as an important determinant of health, there is a need for more research on how housing conditions influence residential well-being.

    Aim: The overall aim of this thesis was to examine factors and conditions associated with residential well-being and perceived safety in different types of housing areas and to compare safety promotion intervention designs based on residents self-expressed safety needs with corresponding designs developed by local government professionals.

    Materials and methods: A postal survey (response rate 56%, n=2476) and 11 focus groups (57 participants) were conducted among the residents in 3 small-scale housing areas with detached houses and 3 housing areas with blocks of flats in a Swedish municipality. The areas were geographically contiguous as each of the small-scale areas bordered on an area with blocks of flats. The study municipality is a designated member of WHO Safe Community network that have signed up to work in line with the indicators developed by WHO Collaborating Centre on Community Safety Promotion. Narrative data from a postal questionnaire were used to analyze the lay perspective and identify features perceived to be necessary to feel safe by residents in areas with blocks of flats and small-scale housing areas. Quantitative data were used to examine correlates of local safety-related concerns through a factor analysis. Logistic regression analysis examined associations between high-level scores of the safetyrelated dimensions found and area-level crime rate and being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. To examine how self-assessed area reputation is associated with social trust and residential well-being, a multilevel logistic regression analysis was performed using quantitative data, controlling for the random effect of neighbourhood- and individual-level socio-demographic factors. Data from focus group interviews were analyzed to identify mechanisms of how neighbourhood reputation was established. The quality function deployment (QFD) technique was used in a case study to integrate residents’ demands into the design of safety promotion interventions in housing areas. The resulting design was then compared with the safety intervention programme designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community programme.

    Results: The residents’ narratives showed that a stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in small-scale housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. The crime rates were lower and safety-related concerns were less in small-scale housing areas. Three composite dimensions (CD) of perceived residential safety were identified: structural indicators of social disorder (CD 1); contact with disorderly behaviour (CD 2); and existential insecurity (CD 3). Area-level crime rates and individual-level variables were associated with dimensions (CD 1) and (CD 3), but only individuallevel variables were associated with dimension (CD 2). The level of residential well-being and social trust was higher in small-scale areas. The housing area reputation was found to be strongly associated with safety-related concerns, residential well-being and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order. The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups. The Safe Community programme designed by professionals did not address the social integrative processes, but did cover the vulnerable groups.

    Conclusions: Area reputation is an important and probably underestimated dimension in the development of residential well-being and perceived safety. The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particular suitable for providing a quality orientation from the lay perspective on safety promotion in local residential areas. The current Safe Homes concept in the Safe Community programme would benefit from being widened to Safe Housing.

    List of papers
    1. Residents’ perspectives on safety support needs in different types of housing areas
    Open this publication in new window or tab >>Residents’ perspectives on safety support needs in different types of housing areas
    2011 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 6, p. 590-597Article in journal (Refereed) Published
    Abstract [en]

    Background: Knowledge about conditions that are understood to support safety is important for planning residential safety promotion in interactions with residents. How residents themselves perceive and reason about their own safety needs has seldom been investigated in Scandinavia. Aim: To identify factors perceived to be necessary to feel safe by residents in areas with blocks of flats and detached houses.

    Methods: Residents in a Swedish municipality were asked an open-ended question on the research topic by a mail survey; 787 residents provided narrative data that were fed into a summative qualitative and quantitative content analysis.

    Results: A stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in detached housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. This finding emphasizes the need to reduce the differential exposure to safety-related factors in the living environment.

    Conclusions: The results of our study encourage the continued use of a setting-orientated safety promotion approach in which residents and other stakeholders are involved. The policy recommendation that can be drawn from the study is that both the subjective and objective dimensions of safety should be identified and considered when developing local safety promotion interventions in community contexts.

    Place, publisher, year, edition, pages
    Sage, 2011
    Keywords
    Safety promotion; resident perspective; housing; neighbourhoods; safety inequalities, content analysis
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-60158 (URN)10.1177/1403494810395988 (DOI)000293249400005 ()
    Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2017-12-12Bibliographically approved
    2. Correlates of local safety-related concerns in a Swedish Community: a cross-sectional study
    Open this publication in new window or tab >>Correlates of local safety-related concerns in a Swedish Community: a cross-sectional study
    2009 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, no 221Article in journal (Refereed) Published
    Abstract [en]

    Background: Crime in a neighbourhood has been recognized as a key stressor in the residential environment. Fear of crime is related to risk assessment, which depends on the concentration of objective risk in time and space, and on the presence of subjective perceived early signs of imminent hazard. The aim of the study was to examine environmental, socio-demographic, and personal correlates of safety-related concerns at the local level in urban communities. The specific aim was to investigate such correlates in contiguous neighbourhoods in a Swedish urban municipality. Methods: A cross-sectional study design was used to investigate three neighbourhood settings with two pair-wise conterminous but socially contrasting areas within each setting. Crime data were retrieved from police records. Study data were collected through a postal questionnaire distributed to adult residents (n = 2476) (response rate 56%). Composite dimensions of perceived residential safety were derived through a factor analysis. Logistic regression analysis was used to examine associations between high-level scores of the three safety-related dimensions and area-level crime rate, being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. Results: Three composite dimensions of perceived residential safety were identified: (I) structural indicators of social disorder; (II) contact with disorderly behavior; and (III) existential insecurity. We found that area-level crime rates and individual-level variables were associated with the dimensions structural indicators of social disorder and existential insecurity, but only individual-level variables were associated with the dimension contact with disorderly behavior. Self-assessed less favorable area reputation was found to be strongly associated with all three factors. Being female accorded existential insecurity more than being a victim of crime. Conclusion: We have identified environmental, socio-demographic, and personal correlates of safety-related concerns in contiguous neighbourhoods in a Swedish community. The results of this study suggest that residents self-assessed area reputation is an important underlying mechanism of perceived safety. We also found a difference in crime rates and safety-related concerns between areas with blocks of flats compared with small-scale areas although the neighbourhoods were close geographically.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20757 (URN)10.1186/1471-2458-9-221 (DOI)
    Note
    Original Publication: Agneta Kullberg, Nadine Karlsson, Toomas Timpka and Kent Lindqvist, Correlates of local safety-related concerns in a Swedish Community: a cross-sectional study, 2009, BMC PUBLIC HEALTH, (9), 221. http://dx.doi.org/10.1186/1471-2458-9-221 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2009-09-19 Created: 2009-09-18 Last updated: 2017-12-13
    3. Does the perceived neighborhood reputation contribute to neighborhood differences in social trust and residential wellbeing?
    Open this publication in new window or tab >>Does the perceived neighborhood reputation contribute to neighborhood differences in social trust and residential wellbeing?
    Show others...
    2010 (English)In: Journal of community psychology (Print), ISSN 0090-4392, E-ISSN 1520-6629, Vol. 38, no 5, p. 591-606Article in journal (Refereed) Published
    Abstract [en]

    The authors used a mixed methods approach to examine if the reputation of a housing area has bearing on residential wellbeing and social trust in three pairs of socioeconomically contrasting neighborhoods in a Swedish urban municipality. Multilevel logistic regression analyses were performed to examine associations between area reputation and residential wellbeing and social trust, controlling for the random effect of neighborhood and individual level sociodemographic factors. Qualitative data were analyzed to identify mechanisms of how neighborhood reputations were established. The housing area reputation was found to be strongly associated with wellbeing and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order The results suggest that area reputation is an important and probably underestimated dimension in the development of residential wellbeing and social trust in housing.

    Place, publisher, year, edition, pages
    John Wiley and Sons, Ltd, 2010
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-58346 (URN)10.1002/jcop.20383 (DOI)000278776400004 ()
    Available from: 2010-08-13 Created: 2010-08-11 Last updated: 2017-12-12
    4. Integrating residents’ demands into the design of safety promotion interventions in housing areas: a case study application of quality function deployment in a Safe Community program
    Open this publication in new window or tab >>Integrating residents’ demands into the design of safety promotion interventions in housing areas: a case study application of quality function deployment in a Safe Community program
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The needs and demands of the residents are rarely considered in community-based design of safety services and planning in housing areas. We therefore set out to compare safety promotion intervention design based on residents’ self-expressed safety needs with interventions designed by local government professionals. A secondary aim was to use the results to suggest improvements for the safety promotion indicators targeting Safe Homes within the Safe Community movement.

    Methods: Case study research methods based on a nested single-case design were used for the study. Data collected from 787 residents in a case study community were analyzed using the quality function deployment (QFD) technique. Quantitative and qualitative data on residents’ self-expressed safety needs were transformed into an intervention design. The resulting design was then compared with the safety intervention program designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community program.

    Results: The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups (e.g. the old elderly, infants, and persons with disabilities). The Safe Community program designed by professionals did not address the social integrative processes, but did cover the vulnerable groups. Our results indicate that the current Safe Homes concept in the Safe Community program would benefit from being widened to Safe Housing.

    Conclusions: The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particularly suitable for providing a quality orientation from the lay perspective of residents. Residents and professionals can contribute with different perspectives on safety promotion and injury prevention in local residential areas. In developing safe housing, these different views should be identified and considered. Socio-economic differences and social inequalities in safety-related housing conditions between areas also need to be considered in the programs.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-60159 (URN)
    Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2013-09-05
  • 202.
    Kullberg, Agneta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Correlates of local safety-related concerns in a Swedish Community: a cross-sectional study2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, no 221Article in journal (Refereed)
    Abstract [en]

    Background: Crime in a neighbourhood has been recognized as a key stressor in the residential environment. Fear of crime is related to risk assessment, which depends on the concentration of objective risk in time and space, and on the presence of subjective perceived early signs of imminent hazard. The aim of the study was to examine environmental, socio-demographic, and personal correlates of safety-related concerns at the local level in urban communities. The specific aim was to investigate such correlates in contiguous neighbourhoods in a Swedish urban municipality. Methods: A cross-sectional study design was used to investigate three neighbourhood settings with two pair-wise conterminous but socially contrasting areas within each setting. Crime data were retrieved from police records. Study data were collected through a postal questionnaire distributed to adult residents (n = 2476) (response rate 56%). Composite dimensions of perceived residential safety were derived through a factor analysis. Logistic regression analysis was used to examine associations between high-level scores of the three safety-related dimensions and area-level crime rate, being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. Results: Three composite dimensions of perceived residential safety were identified: (I) structural indicators of social disorder; (II) contact with disorderly behavior; and (III) existential insecurity. We found that area-level crime rates and individual-level variables were associated with the dimensions structural indicators of social disorder and existential insecurity, but only individual-level variables were associated with the dimension contact with disorderly behavior. Self-assessed less favorable area reputation was found to be strongly associated with all three factors. Being female accorded existential insecurity more than being a victim of crime. Conclusion: We have identified environmental, socio-demographic, and personal correlates of safety-related concerns in contiguous neighbourhoods in a Swedish community. The results of this study suggest that residents self-assessed area reputation is an important underlying mechanism of perceived safety. We also found a difference in crime rates and safety-related concerns between areas with blocks of flats compared with small-scale areas although the neighbourhoods were close geographically.

  • 203.
    Kullberg, Agneta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Integrating residents’ demands into the design of safety promotion interventions in housing areas: a case study application of quality function deployment in a Safe Community programManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The needs and demands of the residents are rarely considered in community-based design of safety services and planning in housing areas. We therefore set out to compare safety promotion intervention design based on residents’ self-expressed safety needs with interventions designed by local government professionals. A secondary aim was to use the results to suggest improvements for the safety promotion indicators targeting Safe Homes within the Safe Community movement.

    Methods: Case study research methods based on a nested single-case design were used for the study. Data collected from 787 residents in a case study community were analyzed using the quality function deployment (QFD) technique. Quantitative and qualitative data on residents’ self-expressed safety needs were transformed into an intervention design. The resulting design was then compared with the safety intervention program designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community program.

    Results: The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups (e.g. the old elderly, infants, and persons with disabilities). The Safe Community program designed by professionals did not address the social integrative processes, but did cover the vulnerable groups. Our results indicate that the current Safe Homes concept in the Safe Community program would benefit from being widened to Safe Housing.

    Conclusions: The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particularly suitable for providing a quality orientation from the lay perspective of residents. Residents and professionals can contribute with different perspectives on safety promotion and injury prevention in local residential areas. In developing safe housing, these different views should be identified and considered. Socio-economic differences and social inequalities in safety-related housing conditions between areas also need to be considered in the programs.

  • 204.
    Kullberg, Agneta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Residents’ perspectives on safety support needs in different types of housing areas2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 6, p. 590-597Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge about conditions that are understood to support safety is important for planning residential safety promotion in interactions with residents. How residents themselves perceive and reason about their own safety needs has seldom been investigated in Scandinavia. Aim: To identify factors perceived to be necessary to feel safe by residents in areas with blocks of flats and detached houses.

    Methods: Residents in a Swedish municipality were asked an open-ended question on the research topic by a mail survey; 787 residents provided narrative data that were fed into a summative qualitative and quantitative content analysis.

    Results: A stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in detached housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. This finding emphasizes the need to reduce the differential exposure to safety-related factors in the living environment.

    Conclusions: The results of our study encourage the continued use of a setting-orientated safety promotion approach in which residents and other stakeholders are involved. The policy recommendation that can be drawn from the study is that both the subjective and objective dimensions of safety should be identified and considered when developing local safety promotion interventions in community contexts.

  • 205.
    Kullberg, Agneta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Karlsson, Nadine
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Does the perceived neighborhood reputation contribute to neighborhood differences in social trust and residential wellbeing?2010In: Journal of community psychology (Print), ISSN 0090-4392, E-ISSN 1520-6629, Vol. 38, no 5, p. 591-606Article in journal (Refereed)
    Abstract [en]

    The authors used a mixed methods approach to examine if the reputation of a housing area has bearing on residential wellbeing and social trust in three pairs of socioeconomically contrasting neighborhoods in a Swedish urban municipality. Multilevel logistic regression analyses were performed to examine associations between area reputation and residential wellbeing and social trust, controlling for the random effect of neighborhood and individual level sociodemographic factors. Qualitative data were analyzed to identify mechanisms of how neighborhood reputations were established. The housing area reputation was found to be strongly associated with wellbeing and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order The results suggest that area reputation is an important and probably underestimated dimension in the development of residential wellbeing and social trust in housing.

  • 206.
    Kvarnström, Susanne
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, The Institute of Technology.
    Difficulties in collaboration: a critical incident study of interprofessional healthcare teamwork2008In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 22, no 2, p. 191-203Article in journal (Refereed)
    Abstract [en]

    The challenge for members of interprofessional teams is to manage the team processes that occur in all teamwork while simultaneously managing their individual professional identities. The aim of this study was to identify and describe difficulties perceived by health professionals in interprofessional teamwork. Utterances on verbal actions and resolutions were also explored to enable a discussion of the implications for interprofessional learning. Individual interviews using a Critical Incident Technique were performed with 18 Swedish professionals working in healthcare teams, and examined with qualitative content analysis. The main findings show difficulties related to the team dynamic that arose when team members acted towards one another as representatives of their professions, difficulties that occurred when the members' various knowledge contributions interacted in the team, and difficulties related to the influence of the surrounding organization. The perceived consequences of the difficulties, beyond individual consequences, were restrictions on the use of collaborative resources to arrive at a holistic view of the patient's problem, and barriers to providing patient care and service in the desired manner. This paper also discusses how experiences of managing difficulties entailed various forms of interprofessional learning situations.

  • 207.
    Kvarnström, Susanne
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Interprofessionella team i vården: En studie om samarbete mellan hälsoprofessioner2007Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    There are great expectations that collaboration among professions and various sectors will further develop health care and thus lead to improved public health. In the World Health Organization’s declaration “Health 21” the designated goal for health professions in the member nations in Europe by the year 2010 is to have developed health promotional competence, including teamwork and cooperation based on mutual respect for the expertise of various professions. The challenges faced by the interprofessional teams are, however, multifaceted, and these challenges place demands upon society, which, in turn, determines the fundamental conditions for collaboration among the health professions within the health care organizations.

    This licentiate dissertation contains discourse and content analyses of interprofessional teamwork in health care. The major objective of this dissertation is to study and describe how the team members construct and create the content and significance of teams and teamwork among health professions. One specific goal has been to study how the members of a multi-professional health care team refer to their team, especially the discursive patterns that emerge and the function that these patterns has (I). The second specific goal has been to identify and describe the difficulties that the health professionals have experienced within their interprofessional teamwork. One purpose has been to enable discussions of the implications for interprofessional learning (II).

    Focused group interviews with team members (n=32) from six teams were studied using discursive social psychological research approach. The analysis concentrated on the use of the pronouns “I”, “we” and “them”. The results were then analyzed in relation to theories on discursive membership and discursive communities (I). Individual semi-structured interviews with team members (n=18) from four of the six teams were carried out using critical incident techniques. The interviews were analysed via latent qualitative content analysis and the results were interpreted in the light of theories on sociology of professions and learning at work (II).

    The findings showed that two discursive patterns emerged in the team members’ constructions of “we the team”. These patterns were designated knowledge synergy and trustful support (I). The following three themes that touched upon the difficulties of interprofessional teamwork were identified in the personal interviews: (A) difficulties concerning the teams’ dynamics that arose when the team members acted as representatives for their respective professions; (B) difficulties when the various contributions of knowledge interacted in the team; and (C) difficulties that were related to the surrounding organisation’s influence on the team (II).

    The conclusion was reached that the discursive pattern provided rhetorical resources for the team members, both in order to reaffirm membership in the team and to promote their views with other care providers, but also to deal with difficulties regarding, for example, lack of unity in outlook. The conclusion was also drawn that, in addition to the individual consequences, one outcome of the perceived difficulties was that they caused limitations of the use of collaborative resources to arrive at a holistic view of the patient’s problems. Thus the patients could not be met in the desired manner.

    The practical implications of the research project concern the development of teams in which various forms of interprofessional learning can influence the continued development of the team and the management of health care in regard to the importance of implementation processes and organisational learning.

    List of papers
    1. Discursive patterns in multiprofessional healthcare teams
    Open this publication in new window or tab >>Discursive patterns in multiprofessional healthcare teams
    2006 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 53, no 2, p. 244-252Article in journal (Refereed) Published
    Abstract [en]

    Aim. The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions.

    Background. Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self-presentations of a multiprofessional healthcare team.

    Methods. A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south-east Sweden. The analysis focused on the participants' discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I.

    Findings. The constructions of 'we' by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus.

    Conclusion. These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration.

    Keywords
    discourse analysis, inter-professional practice, membership, nursing, self-presentations, teamwork
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14668 (URN)10.1111/j.1365-2648.2006.03719.x (DOI)
    Available from: 2007-10-12 Created: 2007-10-12 Last updated: 2015-01-19
    2. Difficulties in collaboration: a critical incident study of interprofessional healthcare teamwork
    Open this publication in new window or tab >>Difficulties in collaboration: a critical incident study of interprofessional healthcare teamwork
    2008 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 22, no 2, p. 191-203Article in journal (Refereed) Published
    Abstract [en]

    The challenge for members of interprofessional teams is to manage the team processes that occur in all teamwork while simultaneously managing their individual professional identities. The aim of this study was to identify and describe difficulties perceived by health professionals in interprofessional teamwork. Utterances on verbal actions and resolutions were also explored to enable a discussion of the implications for interprofessional learning. Individual interviews using a Critical Incident Technique were performed with 18 Swedish professionals working in healthcare teams, and examined with qualitative content analysis. The main findings show difficulties related to the team dynamic that arose when team members acted towards one another as representatives of their professions, difficulties that occurred when the members' various knowledge contributions interacted in the team, and difficulties related to the influence of the surrounding organization. The perceived consequences of the difficulties, beyond individual consequences, were restrictions on the use of collaborative resources to arrive at a holistic view of the patient's problem, and barriers to providing patient care and service in the desired manner. This paper also discusses how experiences of managing difficulties entailed various forms of interprofessional learning situations.

    Keywords
    Critical incident technique; interdisciplinary health team; interprofessional learning; interprofessional relations; sociology of professions
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14669 (URN)10.1080/13561820701760600 (DOI)
    Available from: 2007-10-12 Created: 2007-10-12 Last updated: 2017-12-13
  • 208.
    Kvarnström, Susanne
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Cedersund, Elisabet
    Linköping University, Department of Social and Welfare Studies, Äldre - vård - civilsamhälle (ÄVC) . Linköping University, Faculty of Arts and Sciences.
    Discursive patterns in multiprofessional healthcare teams2006In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 53, no 2, p. 244-252Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions.

    Background. Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self-presentations of a multiprofessional healthcare team.

    Methods. A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south-east Sweden. The analysis focused on the participants' discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I.

    Findings. The constructions of 'we' by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus.

    Conclusion. These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration.

  • 209.
    Kälvegren, Hanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    Fridfeldt (Berggren), Jonna
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    Garvin, Peter
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wind, Lena
    Leanderson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences.
    Kristenson, Margaretha
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kihlström, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Bengtsson, Torbjörn
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    Richter, Arina
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Correlation between rises in Chlamydia pneumoniae-specific antibodies, platelet activation and lipid peroxidation after percutaneous coronary intervention.2008In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 27, no 7, p. 503-511Article in journal (Refereed)
    Abstract [en]

    We recently showed that Chlamydia pneumoniae activates platelets in vitro, with an associated oxidation of low-density lipoproteins. The aim of this study was to investigate whether C. pneumoniae is released during percutaneous coronary intervention (PCI) and, thereby, causes platelet activation and lipid peroxidation. Seventy-three patients undergoing coronary angiography and following PCI or coronary artery bypass graft (CABG) and 57 controls were included in the study. C. pneumoniae antibodies, serotonin and lipid peroxidation were measured before and 24 h, 1 month and 6 months after angiography. The results show that serum C. pneumoniae IgA concentrations were significantly higher in patients than in the controls. Furthermore, in 38% of the C. pneumoniae IgG positive patients, the C. pneumoniae IgG concentration increased 1 month after PCI. The levels of C. pneumoniae IgG antibodies 1 month after PCI correlated with plasma-lipid peroxidation (r = 0.91, P < 0.0001) and platelet-derived serotonin (r = 0.62, P = 0.02). There was no elevation in the total serum IgG 1 month after PCI. In conclusion, the present results suggest that PCI treatment of coronary stenosis releases C. pneumoniae from the atherosclerotic lesions, which leads to platelet activation and lipid peroxidation.

  • 210.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Göransson, Anne
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Conceptions on treatment and lifestyle in patients with coronary heart disease: a phenomenographic analysis2002In: Patient Education and Counseling, ISSN 0738-3991, Vol. 47, no 2, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Twenty-three patients with an acute event of coronary heart disease (CHD) received routine care including information about medication and lifestyle changes. They were interviewed after 1 year about their conceptions concerning drug treatment and lifestyle changes. The interviews were taped, transcribed and analysed using the phenomenographic approach. Conceptions were hierarchically categorised with regard to level of understanding. The results showed that the patients’ understanding of the effects and health benefits of their treatment was superficial as judged on an informed layman level. The knowledge was fragmentary and mechanistic. Several misconceptions were revealed. Few answers related to prognostic benefits. However, a conception about effects of stopping drug intake was risk of relapse. Some patients considered fate and heredity as the main causes of CHD. Thus, our patients had not achieved an adequate understanding of CHD treatment. The level of knowledge was lower than anticipated.

  • 211.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wodlin, Peter
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Hjelmfors, Lisa
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    The effect of problem-based learning in patient education after an event of CORONARY heart disease - a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study2012In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, no 110Article in journal (Refereed)
    Abstract [en]

    Background

    Even though there is convincing evidence that self-care, such as regular exercise         and/or stopping smoking, alters the outcomes after an event of coronary heart disease         (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention         programmes are structurally and pedagogically applied using adult learning principles         e.g. problem-based learning (PBL). Until now, most education programs for patients         with CHD have not been based on such principles. The basic aim is to discover whether         PBL provided in primary health care (PHC) has long-term effects on empowerment and         self-care after an event of CHD.     

    Methods/Design

    A randomised controlled study is planned for patients with CHD. The primary outcome         is empowerment to reach self-care goals. Data collection will be performed at baseline         at hospital and after one, three and five years in PHC using quantitative and qualitative         methodologies involving questionnaires, medical assessments, interviews, diaries and         observations. Randomisation of 165 patients will take place when they are stable in         their cardiac condition and have optimised cardiac medication that has not substantially         changed during the last month. All patients will receive conventional care from their         general practitioner and other care providers. The intervention consists of a patient         education program in PHC by trained district nurses (tutors) who will apply PBL to         groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients         in the control group will not attend a PBL group but will receive home-sent patient         information on 11 occasions during the year.     

    Discussion

    We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy         and empowerment to achieve self-care goals significantly more than one year of standardised         home-sent patient information. The assumption is that PBL will reduce cardiovascular         events in the long-term and will also be cost-effective compared to controls. Further,         the knowledge obtained from this study may contribute to improving patients’ ability         to handle self-care, and furthermore, may reduce the number of patients having subsequent         CHD events in Sweden.

  • 212.
    Leijon, Margareta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hensing, Gunnel
    Linköping University, Faculty of Health Sciences.
    Alexanderson, Kristina
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Sickness absence due to musculoskeletal diagnoses: association with occupational gender segregation2004In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 32, no 2, p. 94-101Article in journal (Refereed)
    Abstract [en]

    Background: Musculoskeletal disorders represent a considerable public health problem and the most common diagnoses behind sickness absence and disability pensions. However, little is known about how sickness absence with these diagnoses varies with the strong gender segregation of the labour market.

    Aims: A study was undertaken to investigate the association between musculoskeletal-related sickness absence and occupational gender segregation.

    Methods: The study was population based, and included all new sick-leave spells exceeding seven days due to musculoskeletal diagnoses, comprising neck/ shoulder pain, low back pain, and osteoarthritis in Östergötland county, Sweden, which has 393,000 inhabitants (5% of the national population). The participants were all sick-leave insured employed persons in Östergötland (n=182,663) in 1985.

    Results: Cumulative incidence of musculoskeletal-related sickness absence (>7 days) was higher for women (7.5%, 95% confidence interval [C.I.] 7.3-7.7) than for men, (5.8%, C.I. 5.6-5.9), and the same was true for the mean number of sick-leave days (women 81, C.I. 78-83; men 65, C.I. 63-68). Grouping occupations according to degree of numerical gender segregation revealed the highest incidence and duration of sickness absence for women in male-dominated occupations. For both genders, the lowest cumulative incidence and duration occurred in gender-integrated occupations.

    Conclusions: Our results indicate a strong association between occupational gender segregation and musculoskeletal-related sickness absence. Further studies are needed to elucidate gender segregation of the labour market in relation to health and rehabilitation measures.

  • 213.
    Leijon, Margareta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Mikaelsson, Bo
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Repeated short-term sick-leave as a possible symptom of psycho-social problems1984In: Scandinavian Journal of Social Medicine, ISSN 1403-4948, Vol. 12, no 4, p. 165-169Article in journal (Refereed)
    Abstract [en]

    As part of a research project concerning repeated short-term sick-leave an intensive study has been performed aiming at estimating the frequency and character of psycho-social problems in a population with a minimum of six short sick spells during a 12-month period, in comparison with an age- and sex-matched sample of patients who went to the local general practitioner in the same area. The results show that psycho-social problems are twice as common in the group with repeated short-term sick-leave.

  • 214.
    Leijon, Matti
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Activating People: Physical activity in the general population and referral schemes among primary health care patients in a Swedish county2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In this thesis the need for physical activity interventions is investigated in a general adult population, the characteristics of physical activity referral (PAR) scheme recipients and referral practitioners, and the effectiveness of PAR in a routine primary health-care (PHC) setting in the county of Östergötland, Sweden. The thesis consists of four papers: three papers are based on a quantitative, uncontrolled prospective PAR study and one paper is based on a population survey in the county of Östergötland, Sweden.

    In 2006, only one in four of the adult population, aged 18–84 years, in Östergötland was considered sufficiently active to meet the Swedish national public health recommendations, stated as “30 minutes of moderate physical activity a day”. More than one-third (37%) reported that they hade no intentions to change their physical activity levels, while 36% had thought about change, and 27% were determined to change. Although the individuals felt a large responsibility for their own physical activity, they also believed that this responsibility is partly shared by health-care providers. Among those who wanted to increase their physical activity level, almost one in seven of the total population and one in four among those reporting poor general health, with a BMI over 30 and those who were inactive reported that they wanted support to bring about this change. More than half of them wanted this support from their health-care provider.

    During 2004 and 2005, a total of 6300 patients received PARs as part of the Östergötland PAR scheme. Two-thirds of the patients were female and half of the patients were 45–64 years old. The PAR scheme reached a relatively high proportion of physically inactive people. PARrelated statistics, including the numbers of referrals made at individual PHC centres and by different professional categories, showed large differences in prescribing activities, both by patient categories, and by prescribing professionals, indicating great potential for further improvements of this scheme in the future.

    Half of the patients (51%) who received PARs were recommended home-based activities, such as walking. Patient follow-up showed that an increase in self-reported physical activity level was achieved by 52% of the patients at the 12-month follow-up. The proportion of inactive patients decreased from 33% at baseline to 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 32% at 12 months. Neither patient age, diagnosis/PAR reason nor the profession of the prescriber were associated with differences in effectiveness. Low activity levels at baseline and homebased activities were significantly associated with increased physical activity at 12 months. Half of the patients (50%) achieved adherence to PARs at the 12-month follow-up, with adherence assessed by simply asking the patients about their adherence to prescribed activity. Patients’ activity levels at baseline (being at least somewhat physically active) and being issued home-based activities were significantly associated with higher adherence at 12 months.

    List of papers
    1. Is there a demand for physical activity interventions from health care providers?: Findings from a population survey
    Open this publication in new window or tab >>Is there a demand for physical activity interventions from health care providers?: Findings from a population survey
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    2010 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 34Article in journal (Refereed) Published
    Abstract [en]

    Background: Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity.

    Methods: A regional public health survey was mailed to 13 440 adults (aged 18-84 years) living in Östergötland County (Sweden) in 2006. The survey was part of the regular effort by the regional Health Authorities.

    Results: About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37%) had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity) more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support.

    Conclusion: These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for their own physical activity levels, but also attribute responsibility for promoting increased physical activity to health care practitioners.

    Keywords
    Exercise, public health, health survey, health behaviour, lifestyle
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
    Identifiers
    urn:nbn:se:liu:diva-16816 (URN)10.1186/1471-2458-10-34 (DOI)000275405700002 ()
    Note

    Original Publication:Matti Leijon, Diana Stark-Ekman, Per Nilsen, Kerstin Ekberg, Lars Walter, Agneta Stahle and Preben Bendtsen, Is there a demand for physical activity interventions provided by the health care sector? Findings from a population survey, 2010, BMC PUBLIC HEALTH, (10), 34.http://dx.doi.org/10.1186/1471-2458-10-34Licensee: BioMed Centralhttp://www.biomedcentral.com/

    Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2018-01-13Bibliographically approved
    2. Physical activity referrals in Swedish primary health care: prescriber and patient characteristics, reasons for prescriptions, and prescribed activities
    Open this publication in new window or tab >>Physical activity referrals in Swedish primary health care: prescriber and patient characteristics, reasons for prescriptions, and prescribed activities
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    2008 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 8, no 201Article in journal (Refereed) Published
    Abstract [en]

    Background: Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Östergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries.

    Methods: Prospective prescription data were obtained for 90% of the primary health care centres in Östergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff.

    Results: During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45–64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1–2 days per week.

    The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%).

    Conclusion: Östergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16823 (URN)10.1186/1472-6963-8-201 (DOI)
    Available from: 2009-02-22 Created: 2009-02-20 Last updated: 2017-12-13Bibliographically approved
    3. Does a physical activity referral scheme improve the physical activity among routine primary health care patients?
    Open this publication in new window or tab >>Does a physical activity referral scheme improve the physical activity among routine primary health care patients?
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    2009 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 5, p. 627-636Article in journal (Refereed) Published
    Abstract [en]

    Physical activity referral (PAR) schemes or concepts occur in varying forms. Because few physical activity intervention studies have been carried out in routine health care settings, it is difficult to translate research findings into daily practice. The aim of this study was to analyze the effectiveness of a PAR scheme implemented in routine primary health care. The study did not include a control group and was based on the ordinary staff's work efforts and follow-up measures. During a 2-year period, 6300 PARs were issued. Effectiveness was measured by an increase in self-reported physical activity. Half of the patients reached reported increased physical activity both at 3 months (49%) and at 12 months (52%). The proportion of inactive patients decreased from 33% at baseline to 17% at 3 months and 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 33% at 3 months and 32% at 12 months. Neither the patient's age nor the profession of the prescriber was associated with differences in effectiveness. The patient's activity level at baseline, the type of physical activity as well as the reason for the prescription were associated with increased physical activity.

    Keywords
    Exercise, prescription, lifestyle, primary prevention, health promotion, health education, interpersonal relations, health service research
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-15609 (URN)10.1111/j.1600-0838.2008.00820.x (DOI)
    Note
    The definitive version is available at www.blackwell-synergy.com: M. E. Leijon, P. Bendtsen, P. Nilsen, K. Festin, A. Ståhle, Does a physical activity referral scheme improve the physical activity among routine primary health care patients?, 2008, Scandinavian Journal of Medicine and Science in Sports.http://dx.doi.org/10.1111/j.1600-0838.2008.00820.x. Copyright: Blackwell Publishing www.blackwell-synergy.comAvailable from: 2008-11-21 Created: 2008-11-21 Last updated: 2017-12-14Bibliographically approved
    4. Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care
    Open this publication in new window or tab >>Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care
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    2010 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 11, no 38Article in journal (Refereed) Published
    Abstract [en]

    Background: Written prescriptions of physical activity, so‐called physical activity referral (PAR) schemes, have increased in popularity in recent years. Such schemes have mostly been evaluated in terms of efficacy. This study reports on a Swedish PAR scheme implemented in routine primary health care (PHC) measuring patients’ self‐reported adherence to physical activity prescriptions. The aim of this study was to evaluate adherence to physical activity prescriptions issued in everyday PHC at 3 and 12 months and to analyse the different characteristics associated with adherence to these prescriptions.

    Methods: Prospective prescription data were obtained for 37 of the 42 PHC centres in Östergötland County, Sweden, during 2004. The study population consisted of 3300 patients issued PARs by ordinary PHC staff members. Odds ratios were calculated to identify the factors associated with adherence.

    Results: The average adherence rate was 56% at 3 months and 50% at 12 months. In the descriptive analyses, higher adherence was associated with increased age, higher activity level at baseline, home‐based activities, prescriptions issued by professional groups other than physicians, and among patients issued PARs due to diabetes, high blood pressure and “other PAR reasons”. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline, and to prescriptions including home‐based activities, both at 3 and 12 months.

    Conclusions: Prescriptions from ordinary staff in routine PHC yielded adherence in 50% of the patients in this routine care PAR scheme follow‐up. Patients’ activity level at baseline (being at least somewhat physically inactive) and being issued homebased activities were associated with higher adherence at both 3 and 12 months.

    Place, publisher, year, edition, pages
    London, UK: BioMed Central, 2010
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16824 (URN)10.1186/1471-2296-11-38 (DOI)000279851800001 ()
    Note

    Original Publication:Matti E. Leijon, Preben Bendtsen, Agneta Stahle, Kerstin Ekberg, Karin Festin and Per Nilsen, Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care, 2010, BMC Family Practice, (11), 38.http://dx.doi.org/10.1186/1471-2296-11-38Licensee: BioMed Centralhttp://www.biomedcentral.com/

    Available from: 2009-02-20 Created: 2009-02-20 Last updated: 2017-12-13Bibliographically approved
  • 215.
    Leijon, Matti
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Arvidsson, Daniel
    Lund University/Region Skåne, Malmö.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Stark Ekman, Diana
    University West, Trollhättan.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Anne Lie
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Improvement of Physical Activity by a Kiosk-based Electronic Screening and Brief Intervention in Routine Primary Health Care: Patient-Initiated Versus Staff-Referred2011In: Journal of medical Internet research, ISSN 1438-8871, Vol. 13, no 4, p. e99-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Interactive behavior change technology (eg, computer programs, Internet websites, and mobile phones) may facilitate the implementation of lifestyle behavior interventions in routine primary health care. Effective, fully automated solutions not involving primary health care staff may offer low-cost support for behavior change.

    OBJECTIVES: We explored the effectiveness of an electronic screening and brief intervention (e-SBI) deployed through a stand-alone information kiosk for promoting physical activity among sedentary patients in routine primary health care. We further tested whether its effectiveness differed between patients performing the e-SBI on their own initiative and those referred to it by primary health care staff.

    METHODS: The e-SBI screens for the physical activity level, motivation to change, attitudes toward performing the test, and physical characteristics and provides tailored feedback supporting behavior change. A total of 7863 patients performed the e-SBI from 2007 through 2009 in routine primary health care in Östergötland County, Sweden. Of these, 2509 were considered not sufficiently physically active, and 311 of these 2509 patients agreed to participate in an optional 3-month follow-up. These 311 patients were included in the analysis and were further divided into two groups based on whether the e-SBI was performed on the patient´s own initiative (informed by posters in the waiting room) or if the patient was referred to it by staff. A physical activity score representing the number of days being physically active was compared between baseline e-SBI and the 3-month follow-up. Based on physical activity recommendations, a score of 5 was considered the cutoff for being sufficiently physically active.

    RESULTS: In all, 137 of 311 patients (44%) were sufficiently physically active at the 3-month follow-up. The proportion becoming sufficiently physically active was 16/55 (29%), 40/101 (40%), and 81/155 (52%) for patients with a physical activity score at baseline of 0, 1 to 2, and 3 to 4, respectively. The patient-initiated group and staff-referred group had similar mean physical activity scores at baseline (2.1, 95% confidence interval [CI] 1.8-2.3, versus 2.3, 95% CI 2.1-2.5) and at follow-up, (4.1, 95% CI 3.4-4.7, vs 4.2, 95% CI 3.7-4.8).

    CONCLUSIONS: Among the sedentary patients in primary health care who participated in the follow-up, the e-SBI appeared effective at promoting short-term improvement of physical activity for about half of them. The results were similar when the e-SBI was patient-initiated or staff-referred. The e-SBI may be a low-cost complement to lifestyle behavior interventions in routine primary health care and could work as a stand-alone technique not requiring the involvment of primary health care staff.

  • 216.
    Leijon, Matti E.
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Ståhle, Agneta
    Department of Neurobiology, Health Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden and Department of Medicine, Division of Cardiology, Karolinska Institutet, and Department of Physiotherapy, Karolinska Hospital, Stockholm, Sweden.
    Physical activity referrals in Swedish primary health care: prescriber and patient characteristics, reasons for prescriptions, and prescribed activities2008In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 8, no 201Article in journal (Refereed)
    Abstract [en]

    Background: Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Östergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries.

    Methods: Prospective prescription data were obtained for 90% of the primary health care centres in Östergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff.

    Results: During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45–64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1–2 days per week.

    The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%).

    Conclusion: Östergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals.

  • 217.
    Leijon, Matti E.
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Festin, Karin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ståhle, A.
    Karolinska Institutet, Sweden .
    Does a physical activity referral scheme improve the physical activity among routine primary health care patients?2009In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 5, p. 627-636Article in journal (Refereed)
    Abstract [en]

    Physical activity referral (PAR) schemes or concepts occur in varying forms. Because few physical activity intervention studies have been carried out in routine health care settings, it is difficult to translate research findings into daily practice. The aim of this study was to analyze the effectiveness of a PAR scheme implemented in routine primary health care. The study did not include a control group and was based on the ordinary staff's work efforts and follow-up measures. During a 2-year period, 6300 PARs were issued. Effectiveness was measured by an increase in self-reported physical activity. Half of the patients reached reported increased physical activity both at 3 months (49%) and at 12 months (52%). The proportion of inactive patients decreased from 33% at baseline to 17% at 3 months and 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 33% at 3 months and 32% at 12 months. Neither the patient's age nor the profession of the prescriber was associated with differences in effectiveness. The patient's activity level at baseline, the type of physical activity as well as the reason for the prescription were associated with increased physical activity.

  • 218.
    Leijon, Matti E.
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Ståhle, Agneta
    Department of Neurobiology, Health Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care2010In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 11, no 38Article in journal (Refereed)
    Abstract [en]

    Background: Written prescriptions of physical activity, so‐called physical activity referral (PAR) schemes, have increased in popularity in recent years. Such schemes have mostly been evaluated in terms of efficacy. This study reports on a Swedish PAR scheme implemented in routine primary health care (PHC) measuring patients’ self‐reported adherence to physical activity prescriptions. The aim of this study was to evaluate adherence to physical activity prescriptions issued in everyday PHC at 3 and 12 months and to analyse the different characteristics associated with adherence to these prescriptions.

    Methods: Prospective prescription data were obtained for 37 of the 42 PHC centres in Östergötland County, Sweden, during 2004. The study population consisted of 3300 patients issued PARs by ordinary PHC staff members. Odds ratios were calculated to identify the factors associated with adherence.

    Results: The average adherence rate was 56% at 3 months and 50% at 12 months. In the descriptive analyses, higher adherence was associated with increased age, higher activity level at baseline, home‐based activities, prescriptions issued by professional groups other than physicians, and among patients issued PARs due to diabetes, high blood pressure and “other PAR reasons”. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline, and to prescriptions including home‐based activities, both at 3 and 12 months.

    Conclusions: Prescriptions from ordinary staff in routine PHC yielded adherence in 50% of the patients in this routine care PAR scheme follow‐up. Patients’ activity level at baseline (being at least somewhat physically inactive) and being issued homebased activities were associated with higher adherence at both 3 and 12 months.

  • 219.
    Leijon, Matti E.
    et al.
    Center for Primary Health Care Research, Lund University .
    Faskunger, Johan
    Swedish National Institute of Public Health.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Who is not adhering to physical activity referrals, and why?2011In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 29, no 4, p. 234-240Article in journal (Refereed)
    Abstract [en]

    Objective. To analyse patients self-reported reasons for not adhering to physical activity referrals (PARs). Design and setting. Data on 1358 patients who did not adhere to PARs were collected at 38 primary health care (PHC) centres in Sweden. Intervention. PHC providers issued formal physical activity prescriptions for home-based activities or referrals for facility-based activities. Subjects. Ordinary PHC patients whom regular staff believed would benefit from increased physical activity. Main outcome measure: Reasons for non-adherence to PARs: "sickness", "pain", "low motivation", "no time", "economic factors", and "other". Results. Sickness and pain were the most common motives for non-adherence among older patients. The youngest patients blamed economic factors and lack of time more frequently than those in the oldest age group. Economic factors was a more common reason for non-adherence among those referred for facility-based activities compared with those prescribed home-based activities. Low motivation was a more frequent cause of non-adherence among those prescribed home-based activities compared with those referred for facility-based activities. Furthermore, lack of time was a more common reason for non-adherence among patients issued with PARs due to high blood pressure than other patients, while low motivation was a more common reason among patients issued with PARs because of a BMI of greater than 25. Conclusion. The reasons for non-adherence differ between patients prescribed home-based activities and referred for facility-based activities, as well as between patients with different specific characteristics. The information obtained may be valuable not only for the professionals working in PHC, but also for those who work to develop PARs for use in different contexts.

  • 220.
    Leijon, Matti
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Stark Ekman, Diana
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Walter, Lars
    Landstinget i Östergötland; Centre for Public Health Sciences; Folkhälsovetenskapligt centrum.
    Ståhle, Agneta
    Department of Neurobiology, Health Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Is there a demand for physical activity interventions from health care providers?: Findings from a population survey2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 34Article in journal (Refereed)
    Abstract [en]

    Background: Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity.

    Methods: A regional public health survey was mailed to 13 440 adults (aged 18-84 years) living in Östergötland County (Sweden) in 2006. The survey was part of the regular effort by the regional Health Authorities.

    Results: About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37%) had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity) more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support.

    Conclusion: These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for their own physical activity levels, but also attribute responsibility for promoting increased physical activity to health care practitioners.

  • 221.
    Lindblom, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    No effect on performance tests from a neuromuscular warm-up programme in youth female football: a randomised controlled trial2012In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 20, no 10, p. 2112-2119Article in journal (Refereed)
    Abstract [en]

    The objective of the present randomised controlled trial was to study the effect of a neuromuscular warm-up programme on performance tests in youth female football. less thanbrgreater than less thanbrgreater thanFour youth female football teams with players aged 12-16 years were randomised into an intervention group and control group. The intervention was a 15-min neuromuscular warm-up programme carried out twice a week during the 11-week study period. Baseline and follow-up measurements of performance were made indoors and included the star excursion balance test, a countermovement jump test, a triple-hop for distance test, a modified Illinois agility test, and 10- and 20-m sprint tests. less thanbrgreater than less thanbrgreater thanFifty-two players (intervention 28; control 24) took part in baseline measurements, and after dropout, 41 players (intervention 23; control 18) were included for analysis. Minor positive changes were seen in the control group compared to the intervention group for a sub-score of the star excursion balance test (P andlt; 0.05) and in the modified Illinois agility test (P andlt; 0.05). No improvement was seen in the intervention group from baseline to follow-up. less thanbrgreater than less thanbrgreater thanThe study showed that a neuromuscular warm-up programme carried out during 11 weeks did not improve performance in youth female football. This could indicate that the programme does not contain sufficient stimulus to improve performance. A low player attendance at training sessions, and low specificity between exercises in the warm-up programme and the evaluated performance tests may also contribute to the lack of effect. less thanbrgreater than less thanbrgreater thanI.

  • 222.
    Lindhe Söderlund, Lena
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Challenges of learning and practicing motivational interviewing2009Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings.

    Aims: The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies.

    Methods: Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective.

    Results: In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations.

    Conclusions: Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.

    List of papers
    1. Feasibility of using motivational interviewing in a Swedish pharmacy setting
    Open this publication in new window or tab >>Feasibility of using motivational interviewing in a Swedish pharmacy setting
    2009 (English)In: International Journal of Pharmacy Practice, ISSN 0961-7671, E-ISSN 2042-7174, Vol. 17, no 3, p. 143-149Article in journal (Refereed) Published
    Abstract [en]

    Aims: Motivational interviewing (MI) is widely established as an effective counselling approach for many lifestyle issues, but is largely untested in pharmacy settings. The aim of this study was to identify factors that impact on the feasibility of using MI with pharmacy clients in routine community pharmacy work in Sweden.

    Methods: Interviews were conducted with 15 pharmacists at two pharmacies after they had participated in a manualbased MI skills training and used MI with clients for 6 months. The pharmacists were offered hands-on training from “pilot pharmacists” who had received more MI training and were involved in assembling the manual that adapted MI for use in pharmacies. Three focus groups with the pharmacists and five individual interviews with pharmacists in leading positions were conducted. Data were interpreted from a phenomenological perspective.

    Results/conclusions: Pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. Pharmacists experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations. The opportunity to decide on appropriate clients and/or health-related behaviours for counselling was an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. The organizational context in which MI was applied affected the pharmacists’ attitudes to using MI.

    Keywords
    Counselling; Health promotion; Pharmacist
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-17314 (URN)10.1211/ijpp/17.03.0004 (DOI)
    Available from: 2009-03-19 Created: 2009-03-17 Last updated: 2017-12-13Bibliographically approved
    2. Applying motivational interviewing to counselling overweight and obese children
    Open this publication in new window or tab >>Applying motivational interviewing to counselling overweight and obese children
    2009 (English)In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 24, no 3, p. 442-449Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to identify barriers and facilitators to nurses’ application of motivational interviewing (MI) to counselling overweight and obese children aged 5 and 7 years, accompanied by their parents. Ten welfare centre and school health service nurses trained and practiced MI for 6 months, then participated in focus group interviews concerning their experiences with applying MI to counselling overweight and obese children. Important barriers were nurses’ lack of recognition that overweight and obesity among children constitute a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem and working with obese children rather than those who were overweight.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-17312 (URN)10.1093/her/cyn039 (DOI)
    Available from: 2009-03-19 Created: 2009-03-17 Last updated: 2017-12-13Bibliographically approved
  • 223.
    Lindhe Söderlund, Lena
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Motivational Interviewing in Theory and Practice2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    An estimated 50% of mortality from the 10 leading causes of death is due to behaviour. Individuals can make important contributions to their own health by adopting health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a counselling approach for behavioural change that builds on a patient empowerment perspective by supporting autonomy and self-efficacy.

    The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on general health care professionals’ learning and practice of MI. Specific aims are; study I was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies; study II was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services; study III was to evaluate the attitudes towards MI and clinical use of MI with children´s weight issues one year after child health care nurses’ participation in MI training; study IV was to systematically review studies that have evaluated the contents and outcomes of MI training for general health care professionals.

    Participants in study I were 15 community pharmacy pharmacists in Östergötland, Sweden. Participants in study II were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Data for both studies were obtained through focus group interviews. Study III, participants were 76 nurses from child health care centres in Östergötland, Sweden. 1-year after MI training they answered a survey. Study IV, the material was 10 empirical studies that have evaluated different aspects of MI training.

    MI training for general health care providers is generally of short duration and tends to focus on specific topics such as diabetes, smoking, and alcohol. The training seems to contain more training on phase I elements, such as clients’ inner motivation, than on phase II, which involves strengthening clients’ commitment to change. MI is seen as practical and useful in work with lifestyle and health promotion issues, especially with issues that may be perceived as sensitive, such as alcohol and obesity. General health care providers have positive attitudes to MI and view MI as being compatible with their values and norms about how they want to work. Clients’ resistance reactions are difficult to handle in the first stages of learning MI, and may lead to frustration. Strategies to avoid resistance are including in the final stages of learning MI. Learning and clinical use of MI for general health care providers is influenced by interactions with their environment (colleagues, staff and organization). Unlearning of old knowledge can be a problem for general health care providers in the learning and clinical use of MI.

    List of papers
    1. Feasibility of using motivational interviewing in a Swedish pharmacy setting
    Open this publication in new window or tab >>Feasibility of using motivational interviewing in a Swedish pharmacy setting
    2009 (English)In: International Journal of Pharmacy Practice, ISSN 0961-7671, E-ISSN 2042-7174, Vol. 17, no 3, p. 143-149Article in journal (Refereed) Published
    Abstract [en]

    Aims: Motivational interviewing (MI) is widely established as an effective counselling approach for many lifestyle issues, but is largely untested in pharmacy settings. The aim of this study was to identify factors that impact on the feasibility of using MI with pharmacy clients in routine community pharmacy work in Sweden.

    Methods: Interviews were conducted with 15 pharmacists at two pharmacies after they had participated in a manualbased MI skills training and used MI with clients for 6 months. The pharmacists were offered hands-on training from “pilot pharmacists” who had received more MI training and were involved in assembling the manual that adapted MI for use in pharmacies. Three focus groups with the pharmacists and five individual interviews with pharmacists in leading positions were conducted. Data were interpreted from a phenomenological perspective.

    Results/conclusions: Pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. Pharmacists experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations. The opportunity to decide on appropriate clients and/or health-related behaviours for counselling was an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. The organizational context in which MI was applied affected the pharmacists’ attitudes to using MI.

    Keywords
    Counselling; Health promotion; Pharmacist
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-17314 (URN)10.1211/ijpp/17.03.0004 (DOI)
    Available from: 2009-03-19 Created: 2009-03-17 Last updated: 2017-12-13Bibliographically approved
    2. Applying motivational interviewing to counselling overweight and obese children
    Open this publication in new window or tab >>Applying motivational interviewing to counselling overweight and obese children
    2009 (English)In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 24, no 3, p. 442-449Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to identify barriers and facilitators to nurses’ application of motivational interviewing (MI) to counselling overweight and obese children aged 5 and 7 years, accompanied by their parents. Ten welfare centre and school health service nurses trained and practiced MI for 6 months, then participated in focus group interviews concerning their experiences with applying MI to counselling overweight and obese children. Important barriers were nurses’ lack of recognition that overweight and obesity among children constitute a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem and working with obese children rather than those who were overweight.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-17312 (URN)10.1093/her/cyn039 (DOI)
    Available from: 2009-03-19 Created: 2009-03-17 Last updated: 2017-12-13Bibliographically approved
    3. Applying motivational interviewing (MI) in counselling obese and overweight children and parents in Swedish child health care
    Open this publication in new window or tab >>Applying motivational interviewing (MI) in counselling obese and overweight children and parents in Swedish child health care
    2010 (English)In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 69, no 4, p. 390-400Article in journal (Refereed) Published
    Abstract [en]

    Objective: To evaluate how a motivational interviewing (MI) training course for child healthcare nurses in Sweden affected their work with children’s weight issues and their attitudes to MI.

    Design: Cross-sectional survey, descriptive design.

    Setting: Nurses were recruited from 33 different child healthcare centres in Östergötland, Sweden.

    Method: Seventy-six nurses who had participated in an MI training course (held in 2008) were approached one year later to answer a questionnaire by telephone. Most questions concerned the respondents’ routine use of MI in clinical practice and their attitudes towards MI as a method.

    Results: The response rate was 82 per cent. Nearly half of the nurses had changed the content and structure of their discussions regarding weight issues. Three-quarters of the nurses stated that they had sufficient time to use MI and that they had support from leadership and colleagues to use MI in their routine practice. The nurses’ attitudes to MI were positive, especially their perception that MI was consistent with their values and was better than traditional advice-giving approaches. Most MI techniques were found to be simple to use: 78 per cent found it very or quite simple to listen actively, 63 per cent believed it was very or quite simple to summarize parents’ opinions, 63 per cent found it very or quite simple to pay attention to parents’ change talk, and 60 per cent said that it was very or quite simple to ask permission before providing information.

    Conclusion: MI training can have a substantial effect on child healthcare nurses’ clinical work on paediatric weight issues.

    Place, publisher, year, edition, pages
    London, UK: Sage Publications, 2010
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60327 (URN)10.1177/0017896910373136 (DOI)000285087600004 ()
    Available from: 2010-10-11 Created: 2010-10-11 Last updated: 2018-07-03Bibliographically approved
    4. A systematic review of motivational interviewing training for general health care practitioners
    Open this publication in new window or tab >>A systematic review of motivational interviewing training for general health care practitioners
    2011 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 84, no 1, p. 16-26Article in journal (Refereed) Published
    Abstract [en]

    Objectiv: This article systematically reviews empirical studies that have evaluated different aspects of motivational interviewing (MI) training for general health care professionals.

    Method: Studies were obtained from several databases. To be included, the MI training had to be provided specifically for general health care practitioners for use in their regular face-to-face counselling. The training outcomes had to be linked to the MI training.

    Result: Ten studies were found. The median length of the training was 9 h. The most commonly addressed training elements were basic MI skills, the MI spirit, recognizing and reinforcing change talk, and rolling with resistance. Most studies involved follow-up training sessions. The study quality varied considerably. Five studies assessed training outcomes at a single point in time, which yields low internal validity. Four studies used random assignment of practitioners to the MI training and comparison conditions. The training generated positive outcomes overall and had a significant effect on many aspects of the participants’ daily practice, but the results must be interpreted with caution due to the inconsistent study quality.

    Conclusion: The generally favourable training outcomes suggest that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care. However, the results must be interpreted with caution due to inconsistent methodological quality of the studies.

    Practice implication: This review suggests that MI training outcomes are generally favourable, but more high-quality research is needed to help identify the best practices for training in MI.

    Place, publisher, year, edition, pages
    Shannon, Co. Clare Ireland: Elsevier, 2011
    Keywords
    Motivational interviewing; Education; Behaviour change; Counselling
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60329 (URN)10.1016/j.pec.2010.06.025 (DOI)000292674000004 ()20667432 (PubMedID)
    Available from: 2010-10-11 Created: 2010-10-11 Last updated: 2018-07-03Bibliographically approved
  • 224.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Madson, Michael B.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Rubak, Sune
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A systematic review of motivational interviewing training for general health care practitioners2011In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 84, no 1, p. 16-26Article in journal (Refereed)
    Abstract [en]

    Objectiv: This article systematically reviews empirical studies that have evaluated different aspects of motivational interviewing (MI) training for general health care professionals.

    Method: Studies were obtained from several databases. To be included, the MI training had to be provided specifically for general health care practitioners for use in their regular face-to-face counselling. The training outcomes had to be linked to the MI training.

    Result: Ten studies were found. The median length of the training was 9 h. The most commonly addressed training elements were basic MI skills, the MI spirit, recognizing and reinforcing change talk, and rolling with resistance. Most studies involved follow-up training sessions. The study quality varied considerably. Five studies assessed training outcomes at a single point in time, which yields low internal validity. Four studies used random assignment of practitioners to the MI training and comparison conditions. The training generated positive outcomes overall and had a significant effect on many aspects of the participants’ daily practice, but the results must be interpreted with caution due to the inconsistent study quality.

    Conclusion: The generally favourable training outcomes suggest that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care. However, the results must be interpreted with caution due to inconsistent methodological quality of the studies.

    Practice implication: This review suggests that MI training outcomes are generally favourable, but more high-quality research is needed to help identify the best practices for training in MI.

  • 225.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Malmsten, Janna
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Applying motivational interviewing (MI) in counselling obese and overweight children and parents in Swedish child health care2010In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 69, no 4, p. 390-400Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate how a motivational interviewing (MI) training course for child healthcare nurses in Sweden affected their work with children’s weight issues and their attitudes to MI.

    Design: Cross-sectional survey, descriptive design.

    Setting: Nurses were recruited from 33 different child healthcare centres in Östergötland, Sweden.

    Method: Seventy-six nurses who had participated in an MI training course (held in 2008) were approached one year later to answer a questionnaire by telephone. Most questions concerned the respondents’ routine use of MI in clinical practice and their attitudes towards MI as a method.

    Results: The response rate was 82 per cent. Nearly half of the nurses had changed the content and structure of their discussions regarding weight issues. Three-quarters of the nurses stated that they had sufficient time to use MI and that they had support from leadership and colleagues to use MI in their routine practice. The nurses’ attitudes to MI were positive, especially their perception that MI was consistent with their values and was better than traditional advice-giving approaches. Most MI techniques were found to be simple to use: 78 per cent found it very or quite simple to listen actively, 63 per cent believed it was very or quite simple to summarize parents’ opinions, 63 per cent found it very or quite simple to pay attention to parents’ change talk, and 60 per cent said that it was very or quite simple to ask permission before providing information.

    Conclusion: MI training can have a substantial effect on child healthcare nurses’ clinical work on paediatric weight issues.

  • 226.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Feasibility of using motivational interviewing in a Swedish pharmacy setting2009In: International Journal of Pharmacy Practice, ISSN 0961-7671, E-ISSN 2042-7174, Vol. 17, no 3, p. 143-149Article in journal (Refereed)
    Abstract [en]

    Aims: Motivational interviewing (MI) is widely established as an effective counselling approach for many lifestyle issues, but is largely untested in pharmacy settings. The aim of this study was to identify factors that impact on the feasibility of using MI with pharmacy clients in routine community pharmacy work in Sweden.

    Methods: Interviews were conducted with 15 pharmacists at two pharmacies after they had participated in a manualbased MI skills training and used MI with clients for 6 months. The pharmacists were offered hands-on training from “pilot pharmacists” who had received more MI training and were involved in assembling the manual that adapted MI for use in pharmacies. Three focus groups with the pharmacists and five individual interviews with pharmacists in leading positions were conducted. Data were interpreted from a phenomenological perspective.

    Results/conclusions: Pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. Pharmacists experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations. The opportunity to decide on appropriate clients and/or health-related behaviours for counselling was an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. The organizational context in which MI was applied affected the pharmacists’ attitudes to using MI.

  • 227.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Angbratt, Marianne
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Applying motivational interviewing to counselling overweight and obese children2009In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 24, no 3, p. 442-449Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify barriers and facilitators to nurses’ application of motivational interviewing (MI) to counselling overweight and obese children aged 5 and 7 years, accompanied by their parents. Ten welfare centre and school health service nurses trained and practiced MI for 6 months, then participated in focus group interviews concerning their experiences with applying MI to counselling overweight and obese children. Important barriers were nurses’ lack of recognition that overweight and obesity among children constitute a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem and working with obese children rather than those who were overweight.

  • 228.
    Lindmark, Ulrika
    et al.
    Jönköping University.
    Stenström, Ulf
    Växjö University.
    Wärnberg-Gerdin, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hugoson, Anders
    Jönköping University.
    The distribution of ‘‘sense of coherence’’ among Swedish adults: A quantitative cross-sectional population study2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: Antonovskys concept of "sense of coherence (SOC) has been shown to be related to health. The aim of this study was to describe the distribution of SOC scores and their components in an adult Swedish population aged 20-80 years. Methods: A random sample of 910 individuals from Jonkoping, Sweden, aged 20, 30, 40, 50, 60, 70 and 80 years, of which 589 agreed to participate in an oral health examination. The participants answered Antonovskys 13-item version of "the life orientation questionnaire scale. The response to the items and the distribution of the three components of comprehensibility, manageability and meaningfulness were analyzed for different age groups and genders using mean values and standard deviations, Students t-test and ANOVA. Results: A total of 526 individuals, 263 men and 263 women, answered all 13 questions and constituted the final material for the study (response rate 89%). The individual SOC score increased with age. The 20 year olds had a statistically significantly lower SOC score compared with the other age groups and 55% of them had a low SOC (andlt;= 66 points) compared with 17% of the 80 year olds. Men in the 60 and 70 year age groups had a statistically significantly higher SOC score compared with women of the same age. Conclusions: The individual distribution of SOC varied with age and gender. Twenty year olds had a significantly lower SOC score compared with elderly age groups. Elderly men had a statistically significantly higher SOC score compared with women of the same age.

  • 229.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Motala Municipality - a sustainable Safe Community in Sweden2012In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 19, no 3, p. 249-259Article in journal (Refereed)
    Abstract [en]

    An extensive research project concerning injury prevention was planned and initiated in Motala Municipality in the early 1980s. This article summarises 25 years of work for injury prevention and safety promotion in Motala. Evaluation of both process and effect were conducted based on a quasi-experimental study design, as well as cost-effectiveness and cost-benefit analyses of interventions. Initial evaluations results showed an annual incidence of injuries of 118.9/1000 citizens in 1983/1984 consisting of injuries at home (35%), sports injuries (18.9%), injuries at work (13.7%), traffic-related injuries (12.8%) and other injuries (19.5%). The annual social economic costs of injuries were estimated at 116 million Swedish crowns (SEK). By 1989, after two years of preventive work, the incidence of injuries was reduced by 13%. The greatest decrease was among the moderate severity category of injuries (41%). The social economic costs were thereby reduced by 21 million SEK per year. Since then, work with injury prevention has continued and annual evaluations have shown that the incidence of injuries, with some fluctuation, has continued to decrease up to the latest evaluation in 2008. The total decrease during the study period was 37%. This study shows that community-based injury prevention work according to the Safe Community model is a successful and cost-effective way of reducing injuries in the local community.

  • 230.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    School of Health & Medical Sciences, Department of Public Health Science, Örebro University, Örebro, Sweden.
    Impact of social standing on traffic injury prevention in a WHO safe community2012In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 4, no 4, p. 216-221Article in journal (Other academic)
    Abstract [en]

    The objective of the current study was to evalu- ate outcomes of a program to prevent traffic injuries among the different social strata under WHO Safe Community Program. A quasi-experi- mental design was used, with pre- and post- implementation registrations in the program im- plementation area (population 41,000) and in a neighbouring control municipality (population 26,000) in Östergötland County, Sweden. The traffic injury rate in the not vocationally active households was twice than employed or self- employed households in the intervention area. In the employed and not vocationally active households, males showed higher injury rates than females in both areas. In the self-employed households females exhibited higher injury rates than males in the intervention area. Males from not vocationally active households displayed the highest post-intervention injury rate in both the intervention and control areas. After 6 years of Safe Community program activity, the injury rates for males in employed category, injury rates for females in self-employed category, and males/females in non- vocationally active cate- gory displayed a decreasing trend in the inter- vention area. However, in the control area injury rate decreased only for males of employed households. The study indicated that there was almost no change in injury rates in the control area. Reduction of traffic injuries in the inter- vention area between 1983 and 1989 was likely to be attributable to the success of safety pro- motion program. Therefore, the current study concludes that Safe Community program seems to be successful for reducing traffic injuries in different social strata.

  • 231.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The impact of child safety promotion on different social strata in a WHO Safe Community2012In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 4, no 1, p. 20-25Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The objective of the current study was to evaluate outcomes of a program to prevent severe and less severe unintentional child injuries among the different social strata under WHO Safe Community program. Specifically, the aim was to study effectiveness of Safe Community program for reducing child injury.

    METHODS: A quasi-experimental design was used, with pre- and post-implementation registrations covering the children (0 -15 years) in the program implementation area (population 41,000) and in a neighboring control municipality (population 26,000) in Ostergotland County, Sweden.

    RESULTS: Boys from not vocationally active households displayed the highest pre-intervention injury rate in both the control and intervention areas. Also in households in which the vocationally significant member was employed, boys showed higher injury rates than girls. Households in which the vocationally significant member was self-employed, girls exhibited higher injury rates than boys in the intervention area. After 6 years of program activity, the injury rates for boys and girls in employed category and injury rates for girls in self-employed category displayed a decreasing trend in the intervention area. However, in the control area injury rate decreased only for boys of employed families.

    CONCLUSIONS: The study indicated that almost no changes in injury rates in the control area suggested that the reduction of child injuries in the intervention area between 1983 and 1989 was likely to be attributable to the safety promotion program. Therefore, the current study indicates that Safe Community program seems to be successful for reducing child injuries.

  • 232.
    Lindqvist, Kent
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Karlsson, Nadine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Impact of social standing on injury prevention in a World Health Organization Safe Community - Intervention outcome by household employment contract2004In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 33, no 3, p. 605-611Article in journal (Refereed)
    Abstract [en]

    Background. Although social inequality in health has been an argument for community-based injury prevention programmes, intervention outcomes with regard to differences in social standing have not been analysed. The objective of this study was to investigate rates of injuries treated in health-care among members of households at different levels of labour market integration before and after the implementation of a WHO Safe Community programme. Methods. A quasi-experimental design was used with pre- and post-implementation data collection covering the total populations <65 years of age during one year in the programme implementation municipality (population 41 000) and in a control municipality (population 26 000). Changes in injury rates were studied using prospective registration of all acute care episodes with regard to social standing in both areas during the study periods. Results. Male members of households categorized as not vocationally active displayed the highest pre-intervention injury rates. Also after the intervention, males in households classified as not vocationally active displayed notably elevated injury rates in both the control and study areas. Households in the study area in which the significant member was employed showed a post-intervention decrease in injury rate among both men (P < 0.001) and women (P < 0.01). No statistically significant change was observed in households in which the significant member was self-employed or not vocationally active. In the control area, only an aggregate-level decrease (P < 0.05) among members of households in which the significant member was employed was observed. Conclusions. The study displayed areas for improvement in the civic network-based WHO Safe Community model. Even though members of non-vocationally active households, in particular men, were at higher pre-intervention injury risk, they were not affected by the interventions. This fact has to be addressed when planning future community-based injury prevention programmes. © International Epidemiological Association 2004, all rights reserved.

  • 233.
    Lorefelt, Birgitta
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Wilhelmsson, Susan
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nutritional status and health care costs for the elderly living in municipal residential homes — An intervention study2011In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 15, no 2, p. 92-97Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The aim was to study the effect of individualised meals on nutritional status among older people living in municipal residential homes and to compare the results with a control group. An additional aim was to estimate direct health care costs for both groups.

    SETTING:

    Six different municipal residential homes in the south-east of Sweden.

    PARTICIPANTS:

    Older people living in three residential homes constituted the intervention group n=42 and the rest constituted the control group n=67.

    INTERVENTION:

    A multifaceted intervention design was used. Based on an interview with staff a tailored education programme about nutritional care, including both theoretical and practical issues, was carried through to staff in the intervention group. Nutritional status among the elderly was measured by Mini Nutritional Assessment (MNA), individualised meals were offered to the residents based on the results of the MNA. Staff in the control group only received education on how to measure MNA and the residents followed the usual meal routines.

    MEASUREMENTS:

    Nutritional status was measured by MNA at baseline and after 3 months. Cost data on health care visits during 2007 were collected from the Cost Per Patient database.

    RESULTS:

    Nutritional status improved and body weight increased after 3 months in the intervention group. Thus, primary health care costs constituted about 80% of the total median cost in the intervention group and about 55% in the control group.

    CONCLUSION:

    With improved knowledge the staff could offer the elderly more individualised meals. One of their future challenges is to recognise and assess nutritional status among this group. If malnutrition could be prevented health care costs should be reduced.

  • 234.
    Lundberg, Johanna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Social status: a state of mind?2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis is concerned with social stratification of psychosocial factors and social position measurement in population samples collected in mid-Sweden 2000-2006. Traditional resource-based measures of social position (occupation, education) and so far less explored prestige-based measures (subjective status, status incongruence) are tested with respect to their associations with psychosocial factors, emotions, and selfrated health. Three papers in this thesis are based on data from the Life Conditions, Stress, and Health (LSH) study, using a randomly selected population sample. Data for the fourth paper is a regional sample drawn from the health-related survey “Liv och Hälsa 2000”. Statistical methods range from correlation analysis to logistic regression and repeated measures analyses.

    Results from studies I and IV show that psychosocial factors are unequally distributed within the population in a linear manner, so that the lower the socioeconomic position (SEP), the more unfavourable levels. This is independent of whether we study this in a highly unequal setting such as Russia, or in a more egalitarian society such as Sweden. The stability of psychometric instruments over two years tend to be lower for all instruments among low SEP groups, and differ significantly for self-esteem and perceived control among groups with high and low education, and for cynicism among groups with high and low occupational status. Results from studies II and III point to the relevance of individuals’ own thoughts about themselves, and the potential impact on the self by normative judgements of social position in a certain hierarchical setting. In paper II, the prestige-based measure of subjective status was influenced by resource-based measures, such as self-rated economy and education, but also by life satisfaction and psychosocial factors. The importance of self-evaluation was especially obvious from the study on status incongruence (study III) where the traditionally protective effecs of a high education seem to disappear when combined with a lowstatus occupation. Shaming experiences may play an important role here for our understanding of self-perception.

    List of papers
    1. Adverse health effects of low levels of perceived control in Swedish and Russian community samples
    Open this publication in new window or tab >>Adverse health effects of low levels of perceived control in Swedish and Russian community samples
    Show others...
    2007 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, no 314Article in journal (Refereed) Published
    Abstract [en]

    Background: This cross-sectional study of two middle-aged community samples from Sweden and Russia examined the distribution of perceived control scores in the two populations, investigated differences in individual control items between the populations, and assessed the association between perceived control and self-rated health.

    Methods: The samples consisted of men and women aged 45–69 years, randomly selected from national and local population registers in southeast Sweden (n = 1007) and in Novosibirsk, Russia (n = 9231). Data were collected by structured questionnaires and clinical measures at a visit to a clinic. The questionnaire covered socioeconomic and lifestyle factors, societal circumstances, and psychosocial measures. Self-rated health was assessed by standard single question with five possible answers, with a cut-off point at the top two alternatives.

    Results: 32.2 % of Swedish men and women reported good health, compared to 10.3 % of Russian men and women. Levels of perceived control were also significantly lower in Russia than in Sweden and varied by socio-demographic parameters in both populations. Sub-item analysis of the control questionnaire revealed substantial differences between the populations both in the perception of control over life and over health. Logistic regression analysis revealed that the odds ratios (OR) of poor self-rated health were significantly increased in men and women with low perceived control in both countries (OR between 2.61 and 4.26).

    Conclusions: Although the cross-sectional design does not allow causal inference, these results support the view that perceived control influences health, and that it may mediate the link between socioeconomic hardship and health.

    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-15548 (URN)10.1186/1471-2458-7-314 (DOI)
    Note
    Original Publication: Johanna Lundberg, Martin Bobak, Sofia Malyutina, Margareta Kristenson and Hynek Pikhart, Adverse health effects of low levels of perceived control in Swedish and Russian community samples, 2007, BMC Public Health, (7), 314. http://dx.doi.org/10.1186/1471-2458-7-314 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2008-12-21 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
    2. Is Subjective Status Influenced by Psychosocial Factors?
    Open this publication in new window or tab >>Is Subjective Status Influenced by Psychosocial Factors?
    2008 (English)In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 89, no 3, p. 375-390Article in journal (Refereed) Published
    Abstract [en]

    Objective Associations between subjective status and health are still relatively unexplored. This study aimed at testing whether subjective status is uniquely confounded by psychosocial factors compared to objective status, and what factors that may predict subjective status. Design A cross-sectional analysis of a population-based, random sample of 795 middle-aged men and women from the southeast of Sweden. Questionnaires included subjective status, objective measures of socioeconomic status, life satisfaction, and a battery of psychosocial factors. Associations were controlled for effects of age and sex. Results Both subjective status and occupation were significantly associated with self-rated health also after control for psychosocial factors. Stepwise regression showed that subjective status was significantly influenced by self-rated economy, education, life satisfaction, self-esteem, trust, perceived control, and mastery. Conclusion The association between subjective status and self-rated health does not seem to be uniquely confounded by psychosocial factors. Both resource-based measures and psychological dimensions seem to influence subjective status ratings. Comparative studies are required to study whether predictors of subjective status vary between countries with different socio-political profiles.

    Keywords
    Subjective status, Social status, Socioeconomic status, Psychosocial factors, Life satisfaction, Self-anchored ladder, Self-perceived status, Self-rated health, Psychological resources, Psychological risk factors
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-15549 (URN)10.1007/s11205-008-9238-3 (DOI)
    Note
    The original publication is available at www.springerlink.com: Johanna Lundberg and Margareta Kristenson, Is Subjective Status Influenced by Psychosocial Factors?, 2008, Social Indicators Research, (89), 3, 375-390. http://dx.doi.org/10.1007/s11205-008-9238-3 Copyright: Springer Science Business Media http://www.springerlink.com/ Available from: 2008-12-17 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
    3. Status incongruence revisited - associations with shame and mental well-being (GHQ)
    Open this publication in new window or tab >>Status incongruence revisited - associations with shame and mental well-being (GHQ)
    2009 (English)In: Sociology of Health and Illness, ISSN 0141-9889, E-ISSN 1467-9566, Vol. 31, no 4, p. 478-493Article in journal (Refereed) Published
    Abstract [en]

    Study purpose: Status incongruence has been related to poor health and all-cause mortality, and could be a growing public health problem due to changes in the labour market in later decades. Shaming experiences have been suggested as playing a part in the aetiology. Our aim was to study the risk for shaming experiences, pessimism, anxiety, depressive feelings, and poor mental well-being (GHQ) with a special focus on shame, in four status categories: negatively and positively incongruent individuals, and low-status and high-status congruent individuals.

    Method: Data comprised 14 854 working men and women from a regional sample of randomly selected respondents, 18-79 years. Logistic regression was used to study differences in risk for negative emotional outcomes. Results: The negative incongruent category persisted as the group most at risk for all negative emotional outcomes (OR 1.5-1.9; p<0.05-<0.001). When testing the risk for poor mental well-being among the status categories with and without shaming experiences, OR for all groups with shaming experiences were elevated. Among groups without shame, only the negative incongruent category remained at risk (OR 2.7; p<0.05) after adjustment.

    Conclusion: Negative incongruent status is associated with adverse emotional outcomes, among them shame, which is a previously unappreciated aspect of status incongruence.

    Keywords
    social status • public health • status incongruence • GHQ • shame • mental wellbeing
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-15550 (URN)10.1111/j.1467-9566.2008.01148.x (DOI)
    Note
    This is the author version of the following article: Johanna Lundberg, Margareta Kristenson and Bengt Starrin, Status incongruence revisited: associations with shame and mental wellbeing, 2009, SOCIOLOGY OF HEALTH and ILLNESS, (31), 4, 478-493. which has been published in final form at: http://dx.doi.org/10.1111/j.1467-9566.2008.01148.x Copyright: Blackwell Publishing Ltd http://www.blackwellpublishing.com/ Available from: 2009-06-10 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
    4. Does two-year stability for scale scores of psychosocial factors differ by socioeconomic position?
    Open this publication in new window or tab >>Does two-year stability for scale scores of psychosocial factors differ by socioeconomic position?
    2009 (English)In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 105, no 3, p. 1009-1022Article in journal (Refereed) Published
    Abstract [en]

    Previous longitudinal studies have demonstrated the importance of measuring stability of risk factors over time to correct for attenuation bias. The present aim was to assess the stability of scores for eight psychometric scales over a 2-yr. period and whether stability differed by socioeconomic position. Baseline data were collected during 2003–2004 from 1,007 men and women ages 45 to 69 years. Follow-up data were collected in 2006 from a total of 795 men and women. Analysis showed that stability over 2 yr. was moderate and tended to be lower in groups of low socioeconomic position. It is suggested that correction of attenuation bias is relevant in longitudinal studies for psychosocial factors, especially for groups of low socioeconomic position.

    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-15551 (URN)10.2466/PR0.105.F.1009-1022 (DOI)000274967100002 ()20229904 (PubMedID)
    Note

    Tidigare titel: Does 2-year stability of psychosocial factors differ by socioeconomic position? Original Publication: Johanna Lundberg, Nadine Karlsson and Margareta Kristenson, DOES TWO-YEAR STABILITY FOR SCALE SCORES OF PSYCHOSOCIAL FACTORS DIFFER BY SOCIOECONOMIC POSITION?, 2009, PSYCHOLOGICAL REPORTS, (105), 3, 1009-1022. http://dx.doi.org/10.2466/PR0.105.F.1009-1022 Copyright: Perceptual and Motor Skills http://www.ammonsscientific.com/ :Test-retest correlations of self-esteem, mastery, perceived control, sense of coherence, cynicism, hopelessness, vital exhaustion and depression in a middle-aged Swedish normal population

    Available from: 2008-11-17 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
  • 235.
    Lundberg, Johanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bobak, Martin
    International Institute for Society and Health, Department of Epidemiology and Public Health, UCL, London, UK.
    Malyutina, Sofia
    Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Pikhart, Hynek
    International Institute for Society and Health, Department of Epidemiology and Public Health, UCL, London, UK.
    Adverse health effects of low levels of perceived control in Swedish and Russian community samples2007In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, no 314Article in journal (Refereed)
    Abstract [en]

    Background: This cross-sectional study of two middle-aged community samples from Sweden and Russia examined the distribution of perceived control scores in the two populations, investigated differences in individual control items between the populations, and assessed the association between perceived control and self-rated health.

    Methods: The samples consisted of men and women aged 45–69 years, randomly selected from national and local population registers in southeast Sweden (n = 1007) and in Novosibirsk, Russia (n = 9231). Data were collected by structured questionnaires and clinical measures at a visit to a clinic. The questionnaire covered socioeconomic and lifestyle factors, societal circumstances, and psychosocial measures. Self-rated health was assessed by standard single question with five possible answers, with a cut-off point at the top two alternatives.

    Results: 32.2 % of Swedish men and women reported good health, compared to 10.3 % of Russian men and women. Levels of perceived control were also significantly lower in Russia than in Sweden and varied by socio-demographic parameters in both populations. Sub-item analysis of the control questionnaire revealed substantial differences between the populations both in the perception of control over life and over health. Logistic regression analysis revealed that the odds ratios (OR) of poor self-rated health were significantly increased in men and women with low perceived control in both countries (OR between 2.61 and 4.26).

    Conclusions: Although the cross-sectional design does not allow causal inference, these results support the view that perceived control influences health, and that it may mediate the link between socioeconomic hardship and health.

  • 236.
    Lundberg, Johanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Does two-year stability for scale scores of psychosocial factors differ by socioeconomic position?2009In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 105, no 3, p. 1009-1022Article in journal (Refereed)
    Abstract [en]

    Previous longitudinal studies have demonstrated the importance of measuring stability of risk factors over time to correct for attenuation bias. The present aim was to assess the stability of scores for eight psychometric scales over a 2-yr. period and whether stability differed by socioeconomic position. Baseline data were collected during 2003–2004 from 1,007 men and women ages 45 to 69 years. Follow-up data were collected in 2006 from a total of 795 men and women. Analysis showed that stability over 2 yr. was moderate and tended to be lower in groups of low socioeconomic position. It is suggested that correction of attenuation bias is relevant in longitudinal studies for psychosocial factors, especially for groups of low socioeconomic position.

  • 237.
    Lundberg, Johanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Is Subjective Status Influenced by Psychosocial Factors?2008In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 89, no 3, p. 375-390Article in journal (Refereed)
    Abstract [en]

    Objective Associations between subjective status and health are still relatively unexplored. This study aimed at testing whether subjective status is uniquely confounded by psychosocial factors compared to objective status, and what factors that may predict subjective status. Design A cross-sectional analysis of a population-based, random sample of 795 middle-aged men and women from the southeast of Sweden. Questionnaires included subjective status, objective measures of socioeconomic status, life satisfaction, and a battery of psychosocial factors. Associations were controlled for effects of age and sex. Results Both subjective status and occupation were significantly associated with self-rated health also after control for psychosocial factors. Stepwise regression showed that subjective status was significantly influenced by self-rated economy, education, life satisfaction, self-esteem, trust, perceived control, and mastery. Conclusion The association between subjective status and self-rated health does not seem to be uniquely confounded by psychosocial factors. Both resource-based measures and psychological dimensions seem to influence subjective status ratings. Comparative studies are required to study whether predictors of subjective status vary between countries with different socio-political profiles.

  • 238.
    Lundberg, Johanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Starrin, Bengt
    Department of Social Sciences, Karlstad University, Sweden.
    Status incongruence revisited - associations with shame and mental well-being (GHQ)2009In: Sociology of Health and Illness, ISSN 0141-9889, E-ISSN 1467-9566, Vol. 31, no 4, p. 478-493Article in journal (Refereed)
    Abstract [en]

    Study purpose: Status incongruence has been related to poor health and all-cause mortality, and could be a growing public health problem due to changes in the labour market in later decades. Shaming experiences have been suggested as playing a part in the aetiology. Our aim was to study the risk for shaming experiences, pessimism, anxiety, depressive feelings, and poor mental well-being (GHQ) with a special focus on shame, in four status categories: negatively and positively incongruent individuals, and low-status and high-status congruent individuals.

    Method: Data comprised 14 854 working men and women from a regional sample of randomly selected respondents, 18-79 years. Logistic regression was used to study differences in risk for negative emotional outcomes. Results: The negative incongruent category persisted as the group most at risk for all negative emotional outcomes (OR 1.5-1.9; p<0.05-<0.001). When testing the risk for poor mental well-being among the status categories with and without shaming experiences, OR for all groups with shaming experiences were elevated. Among groups without shame, only the negative incongruent category remained at risk (OR 2.7; p<0.05) after adjustment.

    Conclusion: Negative incongruent status is associated with adverse emotional outcomes, among them shame, which is a previously unappreciated aspect of status incongruence.

  • 239.
    Lönn, J.
    et al.
    Division of Clinical Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Starkhammar Johansson, Carin
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Kälvegren, Hanna
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Skoglund, Caroline
    Linköping University, Department of Physics, Chemistry and Biology, Molecular Surface Physics and Nano Science. Linköping University, The Institute of Technology.
    Garvin, Peter
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Särndahl, E.
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Ravald, Nils
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Richter, Arina
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Bengtsson, T.
    Division of Clinical Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nayeri, Fariba
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Hepatocyte growth factor in patients with coronary artery disease and its relation to periodontal condition2012In: Results in Immunology, ISSN 2211-2839, Vol. 2, p. 7-12Article in journal (Refereed)
    Abstract [en]

    Hepatocyte growth factor (HGF) is an angiogenic, cardioprotective factor important for tissue and vascular repair. High levels of HGF are associated with chronic inflammatory diseases, such as coronary artery disease (CAD) and periodontitis, and are suggested as a marker of the ongoing atherosclerotic event in patients with CAD. Periodontal disease is more prevalent among patients with CAD than among healthy people. Recent studies indicate a reduced biological activity of HGF in different chronic inflammatory conditions. Biologically active HGF has high affinity to heparan sulfate proteoglycan (HSPG) on cell-membrane and extracellular matrix. The aim of the study was to investigate the serum concentration and the biological activity of HGF with ELISA and surface plasmon resonance (SPR), respectively, before and at various time points after percutaneous coronary intervention (PCI) in patients with CAD, and to examine the relationship with periodontal condition. The periodontal status of the CAD patients was examined, and the presence of P. gingivalis in periodontal pockets was analyzed with PCR. The HGF concentration was significantly higher, at all time-points, in patients with CAD compared to the age-matched controls (P< 0.001), but was independent of periodontal status. The HGF concentration and the affinity to HSPG adversely fluctuated over time, and the biological activity increased one month after intervention in patients without periodontitis. We conclude that elevated concentration of HGF but with reduced biological activity might indicate a chronic inflammatory profile in patients with CAD and periodontitis.

  • 240.
    Magunacelaya, Macarena B
    et al.
    Distriktstandvarden Tulegatan.
    Glendor, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Surfing for mouth guards: assessing quality of online information2011In: Dental Traumatology, ISSN 1600-4469, E-ISSN 1600-9657, Vol. 27, no 5, p. 334-343Article in journal (Refereed)
    Abstract [en]

    Introduction: The Internet is an easily accessible and commonly used source of health-related information, but evaluations of the quality of this information within the dental trauma field are still lacking. Aim: The aims of this study are (i) to present the most current scientific knowledge regarding mouth guards used in sport activities, (ii) to suggest a scoring system to evaluate the quality of information pertaining to mouth guard protection related to World Wide Web sites and (iii) to employ this scoring system when seeking reliable mouth guard-related websites. Materials and methods: First, an Internet search using the keywords athletic injuries/prevention and control and mouth protector or mouth guards in English was performed on PubMed, Cochrane, SvedMed+ and Web of Science to identify scientific knowledge about mouth guards. Second, an Internet search using the keywords consumer health information Internet, Internet information public health and web usage-seeking behaviour was performed on PubMed and Web of Science to obtain scientific articles seeking to evaluate the quality of health information on the Web. Based on the articles found in the second search, two scoring systems were selected. Then, an Internet search using the keywords mouth protector, mouth guards and gum shields in English was performed on the search engines Google, MSN and Yahoo. The websites selected were evaluated for reliability and accuracy. Results: Of the 223 websites retrieved, 39 were designated valid and evaluated. Nine sites scored 22 or higher. The mean total score of the 39 websites was 14.2. Fourteen websites scored higher than the mean total score, and 25 websites scored less. The highest total score, presented by a Public Institution Web site (Health Canada), was 31 from a maximum possible score of 34, and the lowest score was 0. Conclusion: This study shows that there is a high amount of information about mouth guards on the Internet but that the quality of this information varies. It should be the responsibility of health care professionals to suggest and provide reliable Internet URL addresses to patients. In addition, an appropriate search terminology and search strategy should be made available to persons who want to search beyond the recommended sites.

  • 241.
    Malmsten, Janna
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Chang, G
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A SYSTEMATIC REVIEW OF STUDIES INVESTIGATING PREDICTORS FOR DRINKING DURING PREGNANCY in ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH, vol 34, issue 8, pp 23A-23A2010In: ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH, Blackwell Publishing Ltd. , 2010, Vol. 34, no 8, p. 23A-23AConference paper (Refereed)
    Abstract [en]

    n/a

  • 242.
    Malmsten, Janna
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    THE EPIDEMIOLOGY OF ALCOHOL USE PRIOR TO AND DURING PREGNANCY IN SWEDEN in ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH, vol 34, issue 8, pp 23A-23A2010In: ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH, Blackwell Publishing Ltd. , 2010, Vol. 34, no 8, p. 23A-23AConference paper (Refereed)
    Abstract [en]

    n/a

  • 243.
    Malmsten, Janna
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Chang, Grace
    Brigham and Womens Hospital.
    Predicting Drinking During Pregnancy - A Systematic Review in JOURNAL OF WOMENS HEALTH, vol 19, issue 3, pp 624-6242010In: JOURNAL OF WOMENS HEALTH, Mary Ann Liebert, Inc. , 2010, Vol. 19, no 3, p. 624-624Conference paper (Refereed)
    Abstract [en]

    n/a

  • 244.
    McCambridge, Jim
    et al.
    London School Hyg and Tropical Medicine, England .
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care.
    Bendtsen, Marcus
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Alcohol email assessment and feedback study dismantling effectiveness for university students (AMADEUS-1): study protocol for a randomized controlled trial2012In: TRIALS, ISSN 1745-6215, Vol. 13, no 49Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol causes huge problems for population health and for society, which require interventions with individuals as well as populations to prevent and reduce harms. Brief interventions can be effective and increasingly take advantage of the internet to reach high-risk groups such as students. The research literature on the effectiveness of online interventions is developing rapidly and is confronted by methodological challenges common to other areas of e-health including attrition and assessment reactivity and in the design of control conditions. less thanbrgreater than less thanbrgreater thanMethods/design: The study aim is to evaluate the effectiveness of a brief online intervention, employing a randomized controlled trial (RCT) design that takes account of baseline assessment reactivity, and other possible effects of the research process. Outcomes will be evaluated after 3 months both among student populations as a whole including for a randomized no contact control group and among those who are risky drinkers randomized to brief assessment and feedback (routine practice) or to brief assessment only. A three-arm parallel groups trial will also allow exploration of the magnitude of the feedback and assessment component effects. The trial will be undertaken simultaneously in 2 universities randomizing approximately 15,300 students who will all be blinded to trial participation. All participants will be offered routine practice intervention at the end of the study. less thanbrgreater than less thanbrgreater thanDiscussion: This trial informs the development of routine service delivery in Swedish universities and more broadly contributes a new approach to the study of the effectiveness of online interventions in student populations, with relevance to behaviors other than alcohol consumption. The use of blinding and deception in this study raise ethical issues that warrant further attention.

  • 245.
    McClure, Roderick John
    et al.
    Monash University.
    Davis, Elizabeth
    Injury Prevention and Control Australia Ltd.
    Yorkston, Emily
    ARTD Consultants.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Schluter, Philip
    Auckland University of Technology.
    Bugeja, Lyndal
    Monash University.
    Special issues in injury prevention research: Developing the science of program implementation2010In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 41, p. 16-19Article in journal (Refereed)
    Abstract [en]

    Introduction: Despite widespread application of the public health approach to injury prevention, there is an acknowledged limitation in the extent to which it facilitates translation of research evidence to injury prevention practice. Aim: In this paper we clarify the ecoepidemiological principles that underpin the public health approach to injury control in order to support explicit efforts to address the multilevel component causes and improve the evidence base on which effective program implementation depends. Keypoints: If injury causation is understood in terms of the ecoepidemiological model rather than the proximal risk factor model, then quantification of the context in which the event occurs is evidently as important as quantification of the energy exchange event itself. The ecoepidemiological model of injury causation recognises barriers and facilitators to injury prevention as component causes of population burden of injury and thus delineates these factors as legitimate targets for intervention. Injury prevention programs that are designed to specifically address the factors causally related to the programs implementation, as well as the contextual factors that determine the characteristics of the energy exchange event, are more likely to be implemented and more likely to result in effective uptake of recommended energy exchange countermeasures. Conclusion: Interventions to reduce the burden of injury in the population should address the individual level factors that increase the risk of injury, but also the upstream factors that influence the extent to which there is widespread adoption by individuals of the recommended countermeasures.

  • 246.
    Medeiros, S E
    et al.
    Charles R Drew University of Medicine and Science,.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Mohammadi, R
    Karolinska Institute.
    Bazargan-Hejazi, S
    Charles R Drew University of Medicine and Science.
    JUSTIFYING PHYSICAL VIOLENCE AGAINST MEN AND WOMEN: A STUDY OF FEMALE INTIMATE PARTNER VIOLENCE VICTIMS IN MALAWI in JOURNAL OF INVESTIGATIVE MEDICINE, vol 58, issue 1, pp 112-1122010In: JOURNAL OF INVESTIGATIVE MEDICINE, Slack Incorporated , 2010, Vol. 58, no 1, p. 112-112Conference paper (Refereed)
    Abstract [en]

    n/a

  • 247.
    Moller, M.
    et al.
    Møller, M., Danish Transport Research Institute (DTF), Knuth-Winterfeldts Allé, DK-2800 Kgs. Lyngby, Denmark.
    Gregersen, Nils-Petter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Psychosocial function of driving as predictor of risk-taking behaviour2008In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 40, no 1, p. 209-215Article in journal (Refereed)
    Abstract [en]

    This study examined the relation between risk-taking behaviour while driving, the psychosocial function of driving, leisure time activities, car oriented peer group interaction and educational attainment. Two thousand four hundred seventeen drivers aged 18-25, randomly selected from the Danish Driving Licence Register, participated in the study. Data was collected through a mail survey. The response rate was 60.4%. A positive significant effect on risk-taking behaviour based on the score on the psychosocial function of driving was found (p < 0.001). A positive significant effect on risk-taking behaviour was also found based on driving related interaction with friends. Low structure/high impulsivity leisure time activities such as playing PC-games, doing body building and partying with friends were found to be related to increased risk-taking behaviour (p < 0.01). Although risk-taking behaviour is generally condemned by society results show that risk-taking behaviour while driving can also be functional in the lives of the young drivers. Consequently, other motives than safety motives are at stake when engaging in risk-taking behaviour. Implications for preventive efforts are discussed. © 2007 Elsevier Ltd. All rights reserved.

  • 248.
    Mueller-Wohlfahrt, Hans-Wilhelm
    et al.
    Munich and Football Club FC Bayern Munich, Germany .
    Haensel, Lutz
    Munich and Football Club FC Bayern Munich, Germany .
    Mithoefer, Kai
    Harvard University, MA USA .
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    English, Bryan
    Football Club Chelsea, England .
    McNally, Steven
    Football Club Manchester United, England .
    Orchard, John
    University of Sydney, Australia .
    van Dijk, C Niek
    University of Amsterdam, Netherlands .
    Kerkhoffs, Gino M.
    University of Amsterdam, Netherlands .
    Schamasch, Patrick
    Int Olymp Comm, Switzerland .
    Blottner, Dieter
    Charite, Germany .
    Swaerd, Leif
    University of Gothenburg, Sweden .
    Goedhart, Edwin
    Football Club Ajax Amsterdam, Netherlands .
    Ueblacker, Peter
    Munich and Football Club FC Bayern Munich, Germany .
    Terminology and classification of muscle injuries in sport: The Munich consensus statement2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 6, p. 342-U17Article in journal (Refereed)
    Abstract [en]

    Objective To provide a clear terminology and classification of muscle injuries in order to facilitate effective communication among medical practitioners and development of systematic treatment strategies. less thanbrgreater than less thanbrgreater thanMethods Thirty native English-speaking scientists and team doctors of national and first division professional sports teams were asked to complete a questionnaire on muscle injuries to evaluate the currently used terminology of athletic muscle injury. In addition, a consensus meeting of international sports medicine experts was established to develop practical and scientific definitions of muscle injuries as well as a new and comprehensive classification system. less thanbrgreater than less thanbrgreater thanResults The response rate of the survey was 63%. The responses confirmed the marked variability in the use of the terminology relating to muscle injury, with the most obvious inconsistencies for the term strain. In the consensus meeting, practical and systematic terms were defined and established. In addition, a new comprehensive classification system was developed, which differentiates between four types: functional muscle disorders (type 1: overexertion-related and type 2: neuromuscular muscle disorders) describing disorders without macroscopic evidence of fibre tear and structural muscle injuries (type 3: partial tears and type 4: (sub) total tears/tendinous avulsions) with macroscopic evidence of fibre tear, that is, structural damage. Subclassifications are presented for each type. less thanbrgreater than less thanbrgreater thanConclusions A consistent English terminology as well as a comprehensive classification system for athletic muscle injuries which is proven in the daily practice are presented. This will help to improve clarity of communication for diagnostic and therapeutic purposes and can serve as the basis for future comparative studies to address the continued lack of systematic information on muscle injuries in the literature. less thanbrgreater than less thanbrgreater thanWhat are the new things Consensus definitions of the terminology which is used in the field of muscle injuries as well as a new comprehensive classification system which clearly defines types of athletic muscle injuries.

  • 249.
    Müssener, Ulrika
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Encouraging Encounters: Experiences of People on Sick Leave in Their Meetings with Professionals2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The recent increase in long-term sickness absence both in Sweden and many other countries has been met with various attempts to intensify the use of rehabilitation measures in order to prevent people from remaining long-term sickness absent. Several actors, among them professionals in healthcare, occupational health services, and social insurance are involved in handling issues related to the sick leave of an individual, and in providing measures to promote return to work (RTW). Identification of the factors that are related to RTW of the individual is a multifaceted task; therefore to meet the individual in this process is an essential challenge for many actors involved. Knowledge is needed about factors that might promote RTW in order to facilitate future research aimed at designing effective rehabilitation programs. Such information is of great importance to improve the work situations of the professionals, to decrease the cost for society, and to improve the situations for people on sick leave by facilitating RTW.

    Objectives: The overall aim of the work underlying this thesis was to ascertain whether contacts between professionals and sickness absentees might a factor that can promote RTW, and also to identify different aspects of how such positive encounters are experienced by those who are sick listed.

    Material and methods: Five investigations were conducted using different study designs, data, and methods of data analyses. The first two (papers I and II) concerned interviews with people on sick leave about positive experiences of their encounters with professionals. The third study (paper III) was based on four questions about encounters, which were included in a questionnaire that was administrated to people who were on sick leave. The fourth study (paper IV) used a broad questionnaire to examine experiences of positive encounters, and the final study (paper V) proposed a model of possible effects of the encounters on RTW.

    Results: In paper I and II different aspects of sick-listed person’s experiences of positive encounters were identified. For example, it seemed that important qualities included being treated with respect, feeling supported, establishing a personal relationship, and participating in decisions regarding RTW measures. Several of the interviewees stated that RTW might be promoted by positive encounters. Paper III showed that perceptions of interactions varied with the type of professionals, as well as with demographics. The respondents perceived their encounters with professionals within healthcare as most positive, followed by social insurance, and lastly occupational health services. In general, females, people born in Sweden, and those who were older, or had a higher education rated their encounters with professionals as more positive. The main finding reported in paper IV was that the majority of the participants had experienced being positive encountered by professionals. Three aspects of such encounters were stressed, namely being treated with ”competence”, ”personal attention”, and ”competence and trust”. The results related in paper V indicated that theories about empowerment and on social emotions could be successfully applied in this area, after they were specifically adapted to some unique features of the contacts between sickness absentees and rehabilitation professionals.

    Conclusions: This thesis emphasizes that being positively encountered by professionals can have a beneficial impact on RTW after a period of sickness absence. More research is required to elucidate the interaction between sick-listed persons and professionals who are involved in their cases. Further studies should focus on how methods for professionals can be provided to increase sick-listed persons’ own ability to mobilize and develop their resources. Moreover, additional knowledge is needed to extend professional treatment strategies that enhance self-confidence and empowerment of individuals during sickness absence.

    List of papers
    1. Positive encounters with rehabilitation professionals reported by persons with experience of sickness absence
    Open this publication in new window or tab >>Positive encounters with rehabilitation professionals reported by persons with experience of sickness absence
    2004 (English)In: Work: A Journal of Prevention, Assessment & Rehabilitation, ISSN 1051-9815, Vol. 22, no 3, p. 247-254Article in journal (Refereed) Published
    Abstract [en]

    More knowledge is needed on different factors that can promote return to work among sick-listed persons. One such factor might be by their interactions with the rehabilitation professionals they encounter. The aim of the present study was to identify and analyze statements about positive encounters with rehabilitation staff, reported by persons who had been absent from work with back, neck, or shoulder diagnoses. A descriptive and explorative qualitative approach was used to analyze data from five focus-group interviews. There were few statements on positive encounters, and they were frequently attributed to sheer luck. Experiences of positive encounters were assigned to two major categories: respectful treatment and supportive treatment. Receiving adequate medical examination or treatment was also mentioned as being positive. Further efforts are needed to study and develop methods for investigating interactions with rehabilitation professionals that laypersons experience as positive and that may contribute to empowerment and influence return to work when sickness absent.

    Keywords
    sickness absence, sick leave, rehabilitation, encounter, return to work
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14286 (URN)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2015-06-02
    2. Encouraging encounters: sick-listed persons’ experiences of interactions with rehabilitation professionals
    Open this publication in new window or tab >>Encouraging encounters: sick-listed persons’ experiences of interactions with rehabilitation professionals
    2007 (English)In: Social work in health care, ISSN 0098-1389, E-ISSN 1541-034X, Vol. 46, no 2, p. 71-87Article in journal (Refereed) Published
    Abstract [en]

    Long-term sickness-absence has increased in many countries and more knowledge is warranted on factors that can promote return-to-work (RTW). Interactions with professionals might be one such factor and especially experiences of positive encounters. The purpose of the study was to identify and analyze sick-listed persons' experiences of positive encounters with professionals within social insurance and healthcare. An inductive and descriptive qualitative approach was used to analyze ttanscripts from 11 semi-structured interviews with persons with experience of long-term sickness absence.

    The following five categories of qualities of encounters were found to be of importance: being treated with respect, feeling supported, establishing a personal relationship, perceiving demands as well-balanced, and participating in decisions regarding rehabilitation measures. Several interviewees expressed the opinion that positive encounters with professionals can promote RTW.

    Further research is needed to elucidate the aspects of interactions that enhance empowerment and self-confidence in persons on sick leave, in order to develop professional treatment strategies that facilitate RTW.

    Keywords
    Sickness-absence, sick leave, encounter, return-to-work, professionals
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14287 (URN)10.1300/J010v46n02_05 (DOI)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2017-12-13
    3. A population-based questionnaire study of how people on sick leave perceive contacts with professionals in healthcare, occupational health services, and social insurance
    Open this publication in new window or tab >>A population-based questionnaire study of how people on sick leave perceive contacts with professionals in healthcare, occupational health services, and social insurance
    2007 (English)In: Article in journal (Refereed) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14288 (URN)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2015-06-02
    4. Positive experiences of encounters with professionals among people on long-term sick leave
    Open this publication in new window or tab >>Positive experiences of encounters with professionals among people on long-term sick leave
    2007 (English)In: Article in journal (Refereed) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14289 (URN)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2015-06-02
    5. Pride, empowerment and return to work: On the significance of positive social emotions in the rehabilitation of sickness absentees
    Open this publication in new window or tab >>Pride, empowerment and return to work: On the significance of positive social emotions in the rehabilitation of sickness absentees
    2006 (English)In: Work: A Journal of Prevention, Assessment & Rehabilitation, ISSN 1051-9815, Vol. 27, no 1, p. 57-65Article in journal (Refereed) Published
    Abstract [en]

    Sickness absence is a great public health problem and there is a lack of knowledge concerning the hows and whys of success or failure in promoting return to work of sick-listed persons. Discussions of and research into social and psychological aspects of this problem area are in need of theoretical contextualisation. In this paper it is suggested that theories of social emotions may be useful, and that the concept of empowerment can be applied provided that it is reasonably well defined. The notions of pride/shame and empowerment are elucidated and discussed, and it is shown that they can be related in the context of research into emotional dimensions of sickness absentees' experiences of the rehabilitation process in a way that may help to guide empirical studies. A simple model of hypothetical relations between pride/shame, empowerment/disempowerment, work ability, health, and return to work is sketched.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-14290 (URN)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2015-06-02
  • 250.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Upmark, Marianne
    Karolinska Institutet.
    Alexanderson, Kristina
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Positive experiences of encounters with healthcare and social insurance professionals among people on long-term sick leave2008In: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine, ISSN 1651-2081, Vol. 40, no 10, p. 805-811Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse different aspects of positive experiences of people on long-term sick leave with regard to their interactions with healthcare and social insurance professionals.

    Methods: A random population-based questionnaire survey among 10,042 long-term sick-listed people in Sweden. Statements related to positive encounters with the professionals were analysed. Factor analysis and logistic regression was used to identify possible associations with gender, age, marital status, country of birth, level of education, part- or full-time sickness absence, self-rated health, depression during the past year, and reasons for sick leave.

    Results: Ninety-two percent of respondents had experienced positive encounters with healthcare and 73% had experienced positive encounters with social insurance. The mean rating was higher for healthcare. The respondents agreed most with the items "treated me with respect", "listened to me", and "was nice to me". Three aspects of interactions were identified: competence, personal attention, and confidence and trust. Women, people born in Sweden, and individuals with good self-rated health experienced the inter-actions as most positive.

    Conclusion: The majority of the respondents on long-term sickness absence have had positive interactions with healthcare and social insurance. More research is required to determine the impact that such experiences might have on return to work, and how such interactions might be promoted.

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