Background: In ‘workplace health promotion’, empowerment is assumed to promote health. Nevertheless, few studies have examined the relationship between empowerment in working life, and health.

Aim: To study the impact of empowerment in working life on health, with special focus on gender differences.

Material and methods: Paper I is a review of the scientific literature, examining instruments intended to measure empowerment in working life. The second study (paper II) was a cross-sectional survey, assessing the relationship between psychological empowerment, and self-rated health and burnout among employees. Papers III and IV encompass a two-year longitudinal survey study of the gender-specific relationships between baseline levels of psychological empowerment, and the combination of psychological support and social support, and self-rated health and burnout two years later among employees. Study five (paper V) is a qualitative study, using focus-group interviews and phenomenography to evaluate a theory-based intervention method, problem-based learning, for workplace health promotion with regard to possible facilitation of empowerment processes.

Results: In paper I, nine questionnaires were found and analysed. Most of the questionnaires focused on intra-individual issues, while a smaller number dealt with the interaction between individual and organisation. Control and competence were frequently used dimensions. The Psychological Empowerment Instrument had undergone the most comprehensive investigation, showing satisfactory validity and reliability. In paper II, men reported a greater degree of psychological empowerment than women in terms of self-determination and impact. Associations were found between psychological empowerment, and self-rated health and burnout (p<0.05). Men and women with higher levels of empowerment reported significantly better health, compared with those who had lower levels of empowerment. Papers III and IV show that for women, increasing levels of psychological empowerment at work at baseline were associated with better self-rated health as measured by the SF-36 scales physical role function, bodily pain, and mental health at the 2-year follow-up (p<0.05). Also for women, a combination of high psychological empowerment and high social support at the workplace was associated (p<0.05) with better self-rated health (bodily pain, general health, vitality, social functioning, emotional role, mental health, EQ-5D VAS, and EQ-5D index) and lower levels of work-related burnout at the 2-year follow-up. For men, psychological empowerment at baseline, and a combination of psychological empowerment and social support at the workplace, were associated with self-rated health at follow-up as measured by the EQ-5D VAS (p<0.05). Combinations of psychological empowerment and social support were associated with work-related burnout at the two-year follow-up for women only (p=0.002). The differences between men and women were confirmed in the gender×empowerment and social support interaction analysis for the measures bodily pain, social function, and work-related burnout (p<0.05). The phenomenographic analysis in paper V resulted in six descriptive categories: reflection, awareness and insight, self-direction and self-management, group coherence, social support and action. The results correspond to established theories on components of empowerment processes. The method “problem-based learning” initiated processes of change at organisational, workplace and individual levels. Social support and group coherence were expressed as essential in order to transform challenging strategies into action and goal realisation.

Conclusions: This thesis demonstrates that psychological empowerment is associated with self-rated health and burnout. Psychological empowerment also impacts mental and somatic health after two years. The impact on health becomes more extensive when psychological empowerment is combined with social support at the workplace. Empowerment and social support are crucial core characteristics in ‘workplace health promotion’, but effects may differ for men and women. Empowerment processes can be facilitated by implementation of the participative intervention method known as “problem-based learning”. Practitioners and researchers who are active in health enhancement in working life should gain from implementing these findings, whether the focus is on health promotion, disease prevention, or rehabilitation back to work.

The aim of this study was to evaluate a theory-based method for workplace health promotion (WHP) with regard to possible facilitation of empowerment processes. The intervention tool was the pedagogic method known as problem-based learning (PBL). The aim of the intervention was to promote empowerment and health among the employees. The intervention was implemented in three organizations within the public sector in Sweden, in a bottom-up approach. All employees, including management, in each organization, were offered the opportunity to participate (n = 113) and 87% (n = 97) participated. The intervention was implemented in 13 groups of six to eight participants who met once a week over a period of 4 months. The predetermined overall goal of the intervention was to promote employee health within the organizational setting. A facilitator in each group and a group-specific mutual agreement guided the intervention, as did the problem solving process. The participants set goals and developed strategies to reach their goals between the meetings. Thirty informants were interviewed in seven focus groups after the intervention about the intervention method and the process, following a semi-structured theme guide. The phenomenographic analysis resulted in six descriptive categories: reflection, awareness and insight, self-direction and self-management, group coherence, social support and actions. The results correspond to established theories of components of empowerment processes. The method initiated processes of change at organizational, workplace and individual levels as the participants examined their work situation, determined problems and initiated solutions. Social support and group coherence were expressed as essential in order to transform challenging strategies into action and goal realization. The findings indicate that systematic improvements of social support and group coherence among employees ought to be facilitated by the organization as a health-promoting arena. PBL appears to be a profitable and powerful instrument with the potential to enable empowerment.

This study identifies and describes questionnaires that measure empowerment in working life. Theoretical bases and empirical examination of the questionnaires are also reported. Nine questionnaires emerged from a database search including AMED, CINAHL, ERIC, MEDLINE and PSYCINFO. The main target groups were employees in general. Most authors share the same theoretical basis. Most of the questionnaires focus on intra- individual issues, while a smaller number deal with the interaction between individual and organization. Control and competence are frequently used dimensions. Cronbach's alpha for complete questionnaires ranged between 0.62 and 0.96. No comparisons with outcome of health were reported. Spreitzer's questionnaire [54] has undergone the most comprehensive investigation. Research is required to achieve better understanding of the interplay between conditions at work and empowerment and health.

PURPOSE: To explore the gender-specific longitudinal association between psychological empowerment at the workplace and self-rated health and burnout in a working population.

MATERIAL AND METHOD: The participants were employees working in the public service sector in central Sweden. The baseline survey was carried out in 2001 and the follow-up in 2003. The questionnaire was answered by 715 respondents at both points in time (overall response rate 67%). Measures used were Psychological Empowerment Instrument by Spreitzer, the SF-36, the EQ-5D, and the Copenhagen Burnout Inventory. Gender specific differences in average score for self-rated health and burnout at follow-up were assessed using multiple linear regression adjusted for age, education, study cohort and self-rated health and burnout at baseline. An analysis on interactional effects due to gender was also performed.

RESULTS: For women, increasing levels of psychological empowerment at work at baseline are associated with less bodily pain, better physical role function and mental health in the multivariate analysis at follow-up two years later. For men, increased psychological empowerment at baseline is significantly associated with better self-rated health as measured by the EQ-5D VAS at follow-up in the multivariatc analysis. Higher levels of psychological empowerment at baseline show a statistically significant association with a lower degree of burnout at follow-up in the univariate analysis for men and women. However, the associations diminished after adjustments in the multivariate analyses. No significant gender x empowerment interaction appeared.

CONCLUSION: Psychological empowerment in working life was associated with somatic and mental aspects of SRH two years later for women. Men seem to be less affected by psychological empowerment, yet an association with the EQ-5D V AS appeared. Psychological empowerment did not predict burnout two years later for either men or women.

PURPOSE: To explore the gender-specific association between psychological empowerment and self-rated health and burnout in a working population.

MATERIAL AND METHOD: A cross-sectional survey was carried out among 1,243 employees (response rate 81% (n=1007), 65 % females). Psychological empowerment was measured by the Spreitzer questionnaire, developed for a working life context. The questionnaire includes the subscales: meaning, competence, self-determination and impact. Self-rated health was evaluated with EQ-5D and SF-36 and the Copenhagen Burnout Inventory was used to measure burnout.

RESULTS: Men reported a greater degree of empowerment than women in terms of self-determination and impact. Significant associations (p<0.05) were found between psychological empowerment and self-rated health and burnout. Men and women with higher levels of empowerment reported significantly better health compared to those with lower levels of empowerment. In multivitriate analyses, all four subscales of empowerment were associated with burnout among both men and women. The most pronounced association with self-rated health was seen for the subscale impact. These associations were particularly strong among women.

CONCLUSION: Psychological empowerment in working life is associated with self-rated health and burnout. Interventions aiming to promote health at work or aiming to prevent burnout may therefore benefit if they comprise empowerment in terms of impact, self-determination, meaning and competence. Also, workplace health promotion that includes empowerment processes should be gender conscious.

PURPOSE: To explore the gender-specific longitudinal association between a combination of psychological empowerment and social support at the workplace and self-rated health and burnout in a working population.

MATERIAL AND METHOD: The participants were employees working in the public service sector in central Sweden. The baseline survey in two cohorts was carried out in 2001 and the follow-up in 2003. The questionnaire was answered by 715 respondents at both points in time (overall response rate 67%). Measures used were the Psychological Empowerment Instrument by Spreitzer, the social support dimension in the Demand-Control-Support Questionnaire, the SF-36, the EQ-5D, and the Copenhagen Burnout Inventory. Based on empirical medians, psychological empowerment and social support at baseline were combined into four categories. Mlltivariate comparisons adjusted for age, education, study cohort and SRH and burnout at baseline were performed using multiple linear regression analysis. The genderxempowerment and social support interaction effect was assessed in the multiple linear regression analysis. All analyses were performed for men and women separately.

RESULTS: For women, a combination of high psychological empowerment and high social support at the workplace, in comparison with a combination of low psychological empowerment and low social support, is strongly associated with better SRH (bodily pain, general health, vitality, social functioning, emotional role, mental health, the EQ-5D VAS, and EQ-5D index) and lower levels of work-related burnout at the 2-year follow-up after adjusting for demographics and baseline SRH and burnout. For men, there are univariate associations with burnout and some associations with SRH. After adjustments for demographics and baseline SRH and burnout, psychological empowerment and social support is associated with SRH as measured by the EQ-5D VAS for men. The gender x empowerment and social support interaction analyses confirm gender differences regarding bodily pain, social function, and work-related burnout.

CONCLUSION: A combination of psychological empowerment and social support in working life strongly affects SRH and work-related burnout two years later for women, but only in part for men.

  Tid, tidsanvändning och tidsbrist i arbetet är i fokus i debatten om de krav som det nya arbetslivet ställer. Vilka konsekvenser får sättet att organisera och rationalisera arbete för lärande, hälsa, jämställdhet och arbetsförhållanden? Forskare från fyra discipliner granskar och jämför skeenden i fyra offentliga organisationer som genomför organisationsförändringar. Boken vänder sig till alla, såväl studerande som yrkesverksamma, som hanterar arbetslivs-, organisations- och ledarskapsfrågor.

Under hösten 2002-hösten 2003 genomfördes ett interventionsprojekt vid akutkliniken, Universitetssjukhuset i Linköping. Projektet syftade till att utveckla förutsättningarna och kompetensen inom organisationen att hantera frågor som främjar hälsa.

Alla medarbetare på kliniken har träffats i arbetsgrupper och under handledning arbetat enligt problembaserat lärande med frågor som berör hälsa i arbetet. Grupperna dokumenterade sitt arbete i s.k. loggböcker, samt i rapporteringar från två heldagar då alla medarbetare samlades. Ett strategiskt urval av medarbetarna har intervjuats vid interventionens början, samt efter avslutad interventionstid. Personalen har även följts med landstingets personalenkät och sjukfrånvarostatistik.

Interventionsprojektet har lett fram till en mängd förbättringsförslag och genomförda åtgärder på alla nivåer i organisationen, såsom t.ex. ökad medicinsk-teknisk kompetens, förbättrat socialt klimat, ökad regelbundenhet i personalutvecklingssamtal, ökade förutsättningar för patientflödet i verksamheten och utveckling av strategier för att hantera långtidssjukskrivna. PB-gruppernas rangordning av prioriterade områden för hälsofrämjande utvecklingsarbete var ledarskap, organisation, kompetens, information och kommunikation, samt vårdkvalitet.

Interventionen har bidragit till ett ökat erfarenhetsutbyte mellan personalen, vilket har inneburit både ett individuellt och ett kollektivt lärande. Personalen har också under interventionsprojektet ökat sin kompetens att hantera verksamhetsförändringar.

Medarbetarna har utvecklat synen på hälsa, och vad som påverkar den arbetsrelaterade hälsan. Interventionsprojektet har belyst vikten av reflektion under arbetstid, samt betydelsen av delaktighet under förändringsprocesser.

Resultaten visar på tre framträdande faktorer av betydelse för genomförandet och utfallet av interventionsprojektet. För det första har ledningen en väsentlig roll i utvecklingen av hälsofrämjande processer på arbetsplatsen. Ledningen behöver stötta och legitimera  utvecklingsarbetet. Ett sådant hälsofrämjande ledarskap ställer krav på kompetens hos ledningen. Ledare behöver därför extra stöd och utvidgad kompetens i hälsofrämjande utvecklingsarbete.

För det andra är det viktigt att organisera för lärande och kollektiv reflektion. Det kräver en medveten strategi. Det problembaserade arbetssättet under interventionsprojektet har fungerat som ett forum där medarbetarna kontinuerligt har fått utrymme att tänka i nya banor. Resultatet av en sådan organisering för lärande har givit utslag i verksamheten i form av olika åtgärder och förändringar.

För det tredje har de problembaserade grupperna fungerat som en buffert i organisationen, där medarbetarna har lärt en handlings- och förändringsberedskap. De har ökat sin kompetens i att hantera inre och  yttre krav på förändring, liksom att påverka sin egen organisation i riktning mot en hälsofrämjande arbetsplats.

Background: Previous reports have suggested left hemispheric dominance for maintaining consciousness, although there is controversy over this claim. Objective: To compare early impairment of level of consciousness between patients with right and left hemispheric stroke. Methods: Data from 564 patients with ischaemic stroke enrolled in the placebo arm of a trial of a putative neuroprotectant were analysed. All patients had major hemispheric stroke with cortical dysfunction, visual field deficit, and limb weakness, with symptom onset within 12 hours of enrolment. Patients were prospectively evaluated on a predefined scale (1-6, 1 = fully awake, higher scores representing greater impairment) to measure level of consciousness at multiple time points over the initial 24 hours after presentation. The National Institutes of Health (NIH) stroke scale score at presentation and infarct volume at 30 days were determined. Results: Some degree of impairment in level of consciousness was observed in 409 of the 564 patients (73%). Median maximum sedation score was 2 for both right and left hemispheric stroke (p = 0.91). Mean sedation score over 24 hours was 1.5 for both right and left stroke (p = 0.75). There was no difference between level of consciousness scores in right and left stroke at any individual time point during the 24 hour monitoring period. No association between side and impairment in level of consciousness was seen after adjustment for stroke severity and infarct volume. Conclusions: In contrast to previous reports, there was no evidence for hemispheric dominance for consciousness in the setting of a major hemispheric stroke.

Den här antologin presenterar aktuell forskning kring hälsa och ohälsa inom svenskt arbetsliv under de senaste åren.Läs merBoken, som till stor del skrivits av forskare på Arbetslivsinstitutet, ger en bred analys av arbetslivets villkor och dess utvecklingsmöjligheter. Några exempel på områden som tas upp är sjukskrivningar, förtidspensioneringar, inflytande på arbetsplatsen och nedskärningar inom skola, vård och omsorg

  Tid, tidsanvändning och tidsbrist i arbetet är i fokus i debatten om de krav som det nya arbetslivet ställer. Vilka konsekvenser får sättet att organisera och rationalisera arbete för lärande, hälsa, jämställdhet och arbetsförhållanden? Forskare från fyra discipliner granskar och jämför skeenden i fyra offentliga organisationer som genomför organisationsförändringar. Boken vänder sig till alla, såväl studerande som yrkesverksamma, som hanterar arbetslivs-, organisations- och ledarskapsfrågor

Tid, tidsanvändning och tidsbrist i arbetet är i fokus i debatten om de krav som det nya arbetslivet ställer. Vilka konsekvenser får sättet att organisera och rationalisera arbete för lärande, hälsa, jämställdhet och arbetsförhållanden? Forskare från fyra discipliner granskar och jämför skeenden i fyra offentliga organisationer som genomför organisationsförändringar. Boken vänder sig till alla, såväl studerande som yrkesverksamma, som hanterar arbetslivs-, organisations- och ledarskapsfrågor

Föreliggande rapport är en tredje delrapport i utvärderingen av Arbetsmarknadsverkets, AMV:s, ”Projekt Hälsa”. Syftet med delrapporten är att genomföra och redovisa en resultatutvärdering av det aktuella projektet.  Av särskild vikt är det att ställa projektets resultat mot dess målsättningar och att försöka klarlägga effekten av den interventionsmetod som projektet bygger på.

Projektet har genomfört de aktiviteter som det avsåg att göra och ambitionsnivån har varit hög. När det gäller effekten av projektet saknas vissa mättal, som exempelvis på hälsa, vilket gör att det är svårt att skatta effekten på det genomförda projektet i vissa avseenden. Interventionen har dock inte haft någon nämnvärd effekt på den positiva utvecklingen inom AMV utan orsakerna till den utvecklingen ligger utanför projektet.  

Abstract ID: 98  

Objective. To analyse the variation between primary care centres (PCCs) with regard to prescribing antibiotics and to investigate whether the variation can be explained by factors related to patient satisfaction and to socio-demographic characteristics of the populations in the catchment areas of the PCCs. Methods. The frequency of prescription of antibiotics by GPs at the PCCs was used as the dependent variable in a multivariate regression analysis. Questionnaire data for patient satisfaction and register data for socio-demographic characteristics were used as explanatory variables. The study was set in a county in south-east Sweden, and 6734 patients consulting GPs at 39 out of the 41 PCCs in the county participated. Variables correlating with the frequency of antibiotics prescription at PCC level and with patient satisfaction were the main outcome measures. Results. A seven-fold variation in the extent of the prescription of antibiotics between the PCCs was observed. In the multivariate analysis, a high antibiotic prescription rate relates to high overall patient satisfaction with GP consultation as well as to the share of males in the listed population but to low satisfaction with the time spent by the GP on listening to the patient. Conclusion. A high frequency of prescription of antibiotics at a PCC may reflect a general disposition among GPs to give priority to maintaining good relations with the patients. However, a low level of prescription may be consistent with patient satisfaction if more time is spent on listening to and informing the patients. Thus more time spent on listening to the patients may reduce the prescription of antibiotics without reducing patient satisfaction.

Background: Stroke is a major cause of serious disability and death. In Sweden approximately 30,000 people suffer from stroke each year, and 20% of them are under 65 years of age.

Aim: The aim of this thesis was to study stroke among people aged 30-65 years. Specific aims were: a) to compare the incidence of stroke in Sweden between the periods 1989-1991 and 1998-2000 in persons aged 30-65 years, b) to explore sick leave, disability pension and health-care-seeking behaviour among people 30-65 years of age prior to their stroke in year 2001 in the county of Östergötland, Sweden, c) to explore whether organisational change and work-related stress, as measured by the Job Content Questionnaire, was associated with first-ever stroke among working people aged 30-65, d) to describe the experience of return to work (RTW) after stroke from the patient’s perspective in comparison with experiences of patients on long-term sick leave.

Material and methods: Studies I and II are based on retrospective register data. Study I is based on data from the SHDR and the CDR during 1989-2000, and NSR Östergötland during the period 1989-2000. Study II is based on data from the HCDWÖ and the social insurance office. Study III is a case–control study where the cases are obtained from four hospitals in the south-east of Sweden and the controls come from the base populations at each respective hospital. Studies IV and V are qualitative studies and the informants in study IV are cases from Linköping and Norrköping included in study III. Study V is a case study based upon a focus group interview with 7 women who had undergone a problem-based rehabilitation.

Results: Stroke incidence increased in Sweden for both men and women between 1989 and 2000, especially for women. Future stroke patients showed more sick leave compared with the general population. For men, accumulated sick leave of more than 29 days was associated with an increased risk of later stroke. Frequent health-care-seeking behaviour is not a tool for identifying women who develop stroke, while it may be an indicator for men. We found partial support for an association between organisational change, work-related stress and stroke. The likelihood of stroke was significantly lower for people in active job situations. The individual stroke patient’s capacity and ability to return to work was perceived as enhanced by motivation or ‘will’ and self-efficacy, in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. When the more medically oriented rehabilitation is finished, other aspects of the individual’s abilities should be in focus. There seem to be similarities between the RTW process and processes of health promotion.

Conclusion: Stroke among younger people in regard to work related risk factors and work related rehabilitation is a field where few studies have been carried out, and further research is needed in order to investigate risk factors and planning for prevention, health promotion and rehabilitation. The thesis also indicates the need for gender-specific studies.

Begreppen hälsa och hälsofrämjande används alltmer i olika måldokument på lokal, nationell och internationell nivå. Det är dock sällan som begreppen definieras. Detta har inneburit en stor osäkerhet kring vad som egentligen avses med dessa begrepp och denna osäkerhet har ibland skapat irritation över vad som uppfattats som ”flummigt” och vagt kring hälsa.Denna bok är en litteraturgenomgång av olika teorier om och definitioner av hälsa och hälsofrämjande. Teorier och definitioner förklaras och klassificeras utifrån termer som holistisk, biostatistisk, teleologisk, strategi, handling o.s.v. Vi belyser frågor som: Är hälsa motsatsen till sjukdom? Är hälsa något annat än frånvaro av sjukdom? Går den att förklara med termer som handlingsförmåga, välbefinnande eller mening? Finns det någon skillnad mellan hälsofrämjande och prevention? Vad kan olika hälsosyner ha för inverkan på mötet med patienter, klienter etc.Målgruppen omfattar blivande och praktiserande läkare, sköterskor, folkhälsovetare, arbetsterapeuter, socionomer och andra yrkesgrupper som professionellt arbetar med hälsa och hälsofrämjande.