The evidence that treatment of life-threatening arrhythmia (LTA) with an Implantable Cardioverter Defibrillator (ICD) can prolong life is convincing. Living with a lifelong heart disease will gradually influence the everyday life and encompasses some or all aspects of life. In order to influence health outcomes, the impact of the ICD must be considered in a broader context including not only the physical, but also the psychological and social functioning of the individual. The general aim of this thesis was to describe everyday life in recipients living with an ICD in a longterm perspective. The aim in Paper I was to describe changes in the life situation of recipients’ with an ICD over a period of 1 year. The aim in Paper II was to describe quality of life (QOL) and uncertainty in recipients who have an ICD and to predict QOL at long-term follow-up. Fifty-six recipients participated (I) and 35 of these recipients, who had survived at least five years, were further included (II). The Quality of Life Index-Cardiac version (I, II), Mishel Uncertainty in Illness Scale-Community version (I, II), Patient ICD Questionnaire (I) and multiple regression analysis (II) were used. Higher scores indicate higher QOL and uncertainty. The questionnaires were completed before implantation, three and twelve months after implantation (I) and also five years after implantation i.e. long-term follow up (II). At the long-term follow up, the average ICD recipient had lived with an ICD for six years and nine months (6.9 years). The results showed the overall QOL and QOL in the health/functioning domain were unchanged over time. QOL in the socio-economic (p= .002) and psychological/spiritual domains (p= .012) decreased in the first year. From baseline to long-term follow up, the QOL in the family domain (p= .011) and overall uncertainty (p= .002) decreased. Uncertainty related to the information decreased at year 1 in relation to baseline (p= .001). The aim in Paper III was to illuminate the main concern of recipients living with an ICD and how they handle this in their daily life. Sixteen recipients who had lived with an ICD between six to twenty-four months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classical grounded theory. In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command”, illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life. The aim in Paper IV was to explore relationships between OQL, coping strategies, anxiety, depression and perceived control in recipients living with an ICD and to compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication. A cross-sectional, correlational, multicenter design was used, and 147 recipients who had lived with an ICD between six to twenty-four months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale. The results showed that anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of coping with optimistic coping being the most used coping strategy. There was no relationship between QOL and coping. No differences were found in QOL, coping, anxiety, depression and perceived control between recipients implanted either on a primary or secondary preventive indication or having the device less or more than one year. In this thesis, it was concluded that the ICD recipients strived to resume command over their life (III) and the more control the recipients perceived the more satisfied they were with their QOL (IV) and the more symptoms of anxiety, depression and uncertainty they experienced the less satisfied they were with their QOL (II, IV). Coping strategies were used more frequently by ICD recipient perceiving more anxiety (IV). QOL was fairly good 6,9 years after implantation and ICD recipients felt less uncertain once they had passed the first year of their illness.

Policy-makers, research funders, and practitioners acknowledge the need for theories about the uptake of scientific evidence into policy and programs to reduce population-wide risk factors for the major avoidable chronic non-communicable diseases. Models of evidence-informed practice in public health settings have not been developed through systematic scientific inquiry. This study explores and develops a realistic account of evidence-informed tobacco control practice in Ontario public health agencies. In-depth, intensive, semi-structured qualitative interviews were conducted with twelve local public health agency senior executives and other key tobacco control staff in three diverse public health agencies in Ontario, Canada. Interviews explored aspects of tobacco control related decision-making and practice, as well as supports from regional, provincial, and national levels that might enhance tobacco control practice. Interview data were supplemented by field notes and other documentation provided by interviewees, as well as unobtrusive sources. A grounded theory approach to the analysis of textual data identified six major and many subcategories and dimensions implicated in evidence-informed tobacco control practice in local public health agencies. The major category structure includes: information and evidence, interpretation and decision-making, organizational aspects, organizational environment, practice integration, and time. An overall model and five sub-models were developed describing the relations among core category and sub-category factors. Propositions were developed a priori based on an extensive review of the literature. Potentially relevant social theories and concepts were also identified based on a selective review of the literature, including critical realist and other perspectives pertaining to agency-structure issues. Theories and propositions were reviewed, which resulted in a minor modification to the subcategory structure of one branch. Public health agency tobacco control case descriptions were developed based on a final category structure, including six branches, 27 sub-branches, and 98 twigs, and verified (subject to some adjustments) through a member check. Working knowledge is seen to be complex and socially constructed, incorporating aspects of social cognitive and planned behavior theories and Aristotelian intellectual virtues. Realist social theory offers insights into potential change processes. Contributions of the study of theory, practice and methods are discussed, as are strengths and limitations, and areas of needed future research.

While meanings of leisure have been widely studied from Western perspectives, to date, few researchers have explored the meanings of leisure in non-Western cultural contexts. However, in an era of globalization, it is particularly significant to explore leisure experiences of people from non-Western cultures. This study is then designed to investigate the role leisure plays in a Chinese culture context. Specifically, Chinese university students’ leisure experience and the values they ascribe to leisure in relation to their lives as a whole is examined. Their ideology of work and its impact on leisure participation is addressed in particular. In a Chinese university, criterion sampling method was first applied to recruit Chinese students who could provide information-rich stories about their leisure participation. Snowball sampling method was also used to find more information-rich cases for this exploratory study. 11 participants were engaged in this study. Semi-structured, in-depth interviews were conducted to discover leisure experience of these students. Data analysis was guided by a constructivist grounded theory approach to understand the participants’ perceptions and meanings of their leisure experience. The data analysis resulted in three major themes. The first theme “Valuations of Work” addressed that the students placed high valuation on work and their life was ruled by work. The second theme “Two Spheres of Leisure” illustrated the students’ ideology of leisure and its impact on their leisure experience. The last theme “Causes for the Subordinate Role of Leisure”revealed two underlying causes that shaped the subservient role of leisure in the students’ daily lives. The emerged themes reflected that the students’ lives were centered around work; and they gave little consideration to their leisure participation. Holding such work-leisure ideology, the students’ leisure participation cannot always contribute to their well being. Therefore, this study advocates the implementation of leisure education in China, which may facilitate the Chinese people to build a balanced and healthy life style.

Disclosure of sexual assault is a complicated process which depends upon a host of factors, such as assault characteristics, the victim’s interpretation, and the level of distress she experiences. Comprehensive theories of adult sexual assault disclosure have not been proposed. Most studies concentrate on a particular aspect of disclosure, such as outcomes of disclosure and reasons for disclosing versus not disclosing. A number of gaps exist in the current literature on adult sexual assault disclosure. These include the conceptualization of disclosure as a discrete or continuous variable; how it may evolve during stages of recovery; the progression of disclosure (e.g., observable patterns to disclosing); the potential variety of motivations for disclosing beyond help-seeking; and the role of culture (e.g., how one’s cultural and familial upbringing influences comfort and acceptance of disclosure as a viable option). The present study aimed to clarify and expand our previous knowledge about disclosure of sexual assault by investigating the overall process. A qualitative study, using a grounded theory approach, was conducted with a diverse sample of women who were sexually victimized after age 12. Findings from the study reveal the complex nature of disclosure and expand on previous conceptions of its process and behavioral manifestations, such as evidence supporting a disclosure continuum, a variety of motivations for disclosing and not disclosing, the roles of culture and parenting practices that may influence disclosure, and the interactive nature of disclosure and recovery. The results suggest that the disclosure process consists of the factors that contribute to whether a disclosure is made, the disclosure itself, and the aftereffects of the disclosure, a process which could be conceived as occurring in circular manner. Thus, decisions of disclosure appear to be very complex, and all of these factors potentially interact with one another and collectively influence whether a woman discloses and how much. A number of research and practical implications are discussed including examining the relationship between motivations and current recovery stages, modifying our conceptualization of disclosure (as continuous rather than dichotomous), and recognizing the needs and concerns of diverse cultural groups in their decisions to disclose.

The purpose of this study is to explore cultural identity within African Americans. The primary construct of interest is African centered identity, which is comprised of two parts: 1) cultural values with origins in African cultures that have been unintentionally retained, and 2) a social and political ideology that intentionally incorporates elements of an African worldview. This study utilizes qualitative research methodology to investigate the lived experience of African centered identity, and incorporates a developmental perspective. Semi-structured interviews of 14 adults are analyzed using a grounded theory approach. The results reveal many themes in the participants’ lived experience of their cultural identity that are consistent with prominent descriptions of African centered worldview. Less consistent results regarding participants’ development of their cultural identity are discussed within the framework of racial and ethnic identity stage models. Finally, respondents’ narratives are discussed with regards to their implications for identity measurement, the social construction of identity, and the influence of environment on identity development.

Denna studie undersöker hur polisvåld och polisvåld i media tolkas av polisen själv. Studien genomfördes med metodvalet grundad teori, för att säkerhetsställa att fakta talar och att inte undersökarens åsikter påverkar utgången. Våldets tolkning blev kärnkategorin med åtta underkategorier. Data påvisade ett flertal problem gällande hur våldet tolkas och polisens problematik kring detta. Media har ett stort inflytande på polisen vilket påverkar hur allmänheten skapar sin bild av dem. Media och polisen har nytta av varandra i ett ömsesidigt utbyte av information och för att allmänheten inte ska bilda sig felaktiga uppfattningar. Det ges även kritik till media från polisen för hur media beskriver att polisen arbetar. Polisen har även en moralisk konflikt mot lagstiftarna gällande hur insatser ska hanteras, lagens tolkning är på många sätt hämmande för att minska våldet och istället ökar det. Poliser kan i det stadiet välja det som är bäst för sig själva eller tolka lagen rent bokstavligt. Konsekvent kan handlingen uppfattas som övervåld, medan lagen syftar på att ingripandet skett proportionerligt. Media publicerar denna nyhet till allmänheten och polisen kan stämplas av media att skydda de som är lagbrytare bland de sina. / This study investigates how police violence is interpreted by the Swedish own police force in the perspectives the media raises about it. The study was done with the methodological tool of grounded theory, to make sure the data is coming to light and not the researcher’s subjective perspectives. The interpreted violence became the main category together with eight minor categories. The data showed several problems how violence is interpreted and the troubles arise from the Swedish national police standpoint. The media influence how society creates its picture of the police. Media and police have to work towards a symbiosis for the greater good of the society and minimizing the risk of misinterpretations. The media has also been criticized by the police in the fashion they do their investigations and the lacking of subject of law the Swedish police must attain to while doing their work. The police are also caught in a moral dispute with the lawmakers; the subject of matter is how they dictate the police should work, while the police view is that violence increases with the lawmaker’s rules. The officers are then caught in a dilemma between doing what they seem right or following blindly the print in the book. The consequences are that actions are interpreted as overly done violence, something media are quick to raise questions about and to judging the police as protecting their own criminal behavior.

Information exchange is an essential component for all involved in the paediatric care encounter. Despite this, most of the research about information exchange concerns adults and the significance of the child’s existence in the encounter have not been given sufficient attention. Therefore, the overall aims of this thesis were twofold. Firstly, the aim was to identify, describe and generate concepts in information exchange between minors, parents/guardians and health care professionals in paediatric care situations. Secondly, the intention was to formulate a theoretical construction, a theory, of the phenomenon of information exchange in paediatric care situations. This thesis is based on four studies. In studies I, II and III grounded theory was used according to Glaser and data have been analyzed using the constant comparative analysis method. Data have been collected through observations and medical records (I, II and III) and also with additional follow-up interviews (III). In study IV, at first a qualitative content analysis of Løgstrup’s ethical demand was conducted and, second, a simultaneous concept analysis of the findings from studies I, II and III and the findings from the qualitative content analysis was carried out. There were a total of 67 participants in the three observational studies: 28 minors (I), 24 parents/guardians (II) and 15 health care professionals (III), who exchanged information in different paediatric care encounters. The information exchange interaction process was resolved by the minors “balancing the circumstances” (I), the parents/guardians used “firm handling” (II) and the health care professionals were “sharing and contributing the responsibility” (III). The qualitative content analysis of Løgstrup’s ethical demand provided the mediation and the social norms. The simultaneous concept analysis finally gave the advanced outcome to intergrade, which means to merge gradually with another through a continuous series of intermediates. At the same time as we intergrade in paediatric care, we protect the totality of minors, recognize the dependency of the parents/guardians and the social interplay by the health care professionals, the information exchange is improved. This thesis emphasizes the importance of health care professionals’ communication skills and the need for education and practice in this topic, in order to improve the information exchange with minors and their parents/guardians from an ethical viewpoint. The theory intergrade explains how this could be applied and implemented.

Background: It is debated whether temporary employment compared to permanent employment entails an elevated risk of illness or not, as the empirical studies have not shown a unified picture. Since a significant part of the Swedish workforce is currently working under temporary employment contracts, it is important for public health research to pay close attention to what the implications in terms of illness might be. Therefore the aim of this thesis was to explore the relationship between temporary employment and illness. Methods: This thesis was based on data from the Northern Swedish Cohort, consisting of all pupils in grade 9 in Luleå in 1981 (n=1083). The cohort was followed with extensive questionnaires. The latest follow-up was performed in year 2007, when 94% participated. To analyse the quantitative questionnaire data, logistic regression and trajectory analysis were used. A qualitative method, Grounded Theory, was also applied in this thesis to analyse interviews performed in 2011, with a strategic selection of 12 participants from the cohort. Results: Quantitative data showed that temporary employees had overall higher odds ratios for illness in terms of psychological distress and non-optimal self-rated health compared to permanent employees. This general difference in odds ratios was evident irrespective of how temporary employment was measured as well as after control for earlier health status and confounders. The qualitative analysis gained insight into temporary employment as social processes of: underling the driving force for employment; working hard for a job. The structural conditions emerged in terms of, being used and exploited on the labour market and these conditions were related to the individual strategies of adaptation and coping. In the intersection of agency, structural conditions and adaption, emotional and bodily reactions emerged, such as being worn out, worried and wrathful. Conclusion: Illness is unevenly distributed between temporary and permanent employees, with temporary employees being the unfavourable group. Striving for good and evenly distributed health conditions in the population, policy makers should aim at reducing the number of employees working in temporary contracts. In addition, there is a need to improve surveillance of the health situation among temporary employees and to reduce unfavourable conditions, such as job and financial insecurity and unemployment, among temporary employees.

Vi har genomfört en undersökning på miljökontoret i Linköping som ansåg sig ha vissa problem med ECOS, ett databassystem som används för ärendehantering. Syftet med vår undersökning är att presentera en teori kring användandet av ECOS på miljökontoret i Linköping samtidigt kommer vi att genomföra denna undersökning med grundad teori så som Glaser beskriver den. Vi har valt att arbeta med grundad teori (GT) enligt Barney Glaser. Vi bestämde oss för att ha följande öppna frågeställning när vi inledde vår undersökning: Hur använder sig de anställda på miljökontoret i Linköping av ECOS? Det datamaterial som vi har analyserat har bestått av anteckningar över det som vi ansett vara väsentligt i intervjuer, observationer och dokument. Slutresultatet i en undersökning genomförd med GT blir en teori. En sådan teori beskriver inte data, den är grundad i data. Beskrivningen av problemområdet och resultatet som kommit ur de data vi insamlat ligger till grund för den teori som vi anser kan fungera på området.

Today the ISO 14001 system is used within a rather wide spectrum of firms and industries, even if the early adopters of the standard mainly where organizations in the heavy industry and manufacturing sectors (Peglaue and Baxter, 2007). Many of those early adopters have now been certified for over 10 years, and during the years several surveys and case studies have been conducted to pinpoint the motives, benefits and challenges for why organizations chose to implement and maintain the system (Massoud, 2010; Jiang and Bansal, 2003). However, one issue with research about ISO 14001 up until now is that most studies have focused upon a managerial perspective where the managers´ attitudes have been in focus rather than the employees (Boiral, 2007). Therefore, this case study set out to explore how the employees, the production operators, inside one certified organization are involved in ISO 14001 through a Grounded Theory approach. The results of the study showed that the production operators relied upon different strategies in order to legitimize their involvement in ISO 14001. Further on, the study shows that the production operators where involved in ISO 14001 at a level which was required in order to keep the certification. However, they could not obtain enough legitimacy to motivate an involvement in ISO 14001 which extended what was required in order to keep the certification. Grounded in the discovery of the different strategies used by the employees, this study argues that environmental awareness could be seen as an internal barrier and as a source for unsatisfied employees. Something which risks emphasizes a feeling of being involved in a rational myth (Boiral, 2007).