Philosophiae Doctor - PhD / This research explores a poorly understood area of health systems: the nature of managerial decision-making in primary healthcare facilities, and the information that informs decision-making at this level. Located in the emerging field of Health Policy and System Research, this research draws on constructivist and participatory perspectives to understand the role of information and, more broadly, learning and knowledge in decisions that primary healthcare managers make, and the systemic factors influencing this. Using a multiple case study design with iterative cycles of in-depth data collection and analysis over a three year period, it examined the decision-making and information use in three cases of managerial responsibility in 17 primary healthcare facilities in a sub-district in Cape Town. The cases were: improving efficiency of service delivery, implementing programme priorities and managing leave of absence. Using multiple strategies for engaging primary healthcare facility managers, often as co-researchers of their own practice, the research sought to elicit both their explicit and tacit, experience-based knowledge on these phenomena. Key insights gained in the research are that firstly, operational health management at facility level is less linear and simple than policy-makers and planners often assume, and is, instead, characterised by considerable on-the-spot problem solving and people management to meet multiple agendas, which can be surprisingly complex. Secondly, contrary to prevailing views, managers do actively use information in decision-making, but require a wide range of information which is outside of the current, and indeed the globally-advocated, health information system (HIS). Thirdly, they not only use, but generate, information in their management routines and practices, and must learn from experience in order to adapt new interventions for successful implementation in their facilities and communities. This research thus makes explicit the value and use of informal information and knowledge in decision-making. It demonstrates, amongst others, a relationship of functional interdependence between the use of formal information in the HIS, and informal information and knowledge, suggesting that the latter has the potential to improve the use and utility of formal health information by making sense of it within the local context. Furthermore, building on the public policy literature on governance, this research develops a model to understand the multiple contextual influences on decision-making and information use, showing the central role of values and relationships across the health system. It proposes a causal mechanism for strengthening the use of information in decision-making. Finally, in giving priority to the informational needs of facility managers, this research offers a bottom-up perspective which argues for an integrated approach to health system strengthening which moves beyond atomised treatment of HIS strengthening. It suggests the need to re-think how to support facility managers by re-positioning the HIS relative to organisational learning, and leadership and management development.

Socialarbetare använder sig av flera typer av kunskap för att hantera komplexiteten av deras arbete, en del får man via utbildning men en del behöver förkroppsligas utifrån ett eget utforskande. Syftet med denna studie var att undersöka hur fronesis kommer till uttryck bland socialarbetare som jobbar med ungdomar med missbruksproblematik. Med inspiration från hermeneutik har i denna studie utforskat hur socialarbetare översätter deras tidigare erfarenheter till praxis. Empirin består av sex intervjuer med praktiserande socialarbetare som har flera års erfarenhet i behandlande arbete med ungdomar. Datat analyserades utifrån fronesis teori vilket är uppbyggd ur tre subkategorier: praktisk handling, moralen och personlig utveckling. Fronesis i denna studie är förmågan att anpassa sig till sammanhanget hos en situation och förmågan att handla i enlighet med en målsättning. Resultatet visar att subkategorierna gick att identifiera hos informanternas utsagor samt hade påverkan på varandra. Analysen visar att behandlarens målsättning kunde påverka både arbete samt möjligheter till vidare utveckling. / Social workers use several types of knowledge to get about in their complex work, some of which is given through education but some you have to embody on your own. The aim of this study is to use phronesis as a theory and see if this theory can explain some of the nature behind social workers experience-based knowledge. Using an approach inspired by hermeneutics this study aimed to explore how social workers translate their experience into praxis. The data consists of six interviews with practicing social workers with several years of experience in caring work with adolescents. The material was analyzed with phronesis theory which is built up by three subcategories¨: practical action, morals and personal development. Phronesis in this study is the ability to adapt to the context of the situation and the ability work towards a goal. The results show that the subcategories were identifiable in the data and had an influence on one another. Analysis shows that one’s goals could have effect on work and possibilities for further growth.

Wireklint Sundström, Birgitta, 2005. Prepared to be unprepared. A phenomeno-logical study of assessment with a caring approach and how it can be learned in the ambulance services.A focal point in this dissertation is that there is knowledge in the ambulance ser-vice that is experience-based, which has not always been made explicit, and that provides the foundation for the caregivers’ assessment of the patients and their needs for care. The first aim of the study was to describe and analyse the ambu-lance services with a focus on the phenomenon of assessment from the lifeworld perspective in the caring sciences. The second aim of the study was of an educa-tional nature where the object was to be able to draw conclusions about the learning process in the ambulance service in the light of the knowledge generat-ed by the empirical findings. Thus the aim was to create a synthesis consisting of didactic ideas that are based on the caring sciences and describing how assess-ment can be learnt and can support future caregivers in the ambulance services.Assessment in the ambulance service entails, on an overall level, having a natu-ral caring attitude that includes striving in two directions at the same time. These are that on the one hand the caregivers strive to bring order to that which is dis-ordered as soon as possible, to structure the unstructured, and in short define the indefinite in order to provide medical assistance. There is a need to quickly as-sess the patient’s condition and which measures are necessary. On the other hand the caregivers strive to let the indefinite wait a while in order to be able to meet the patient’s suffering. There is thus a desire to listen attentively to the individual patient.The essential meaning of assessment of patients in the ambulance services is that there are conflicting demands on assessment and care, which entails that the caregiver adapts him/herself to the prevailing care situation in a way that means being flexible and adaptable to the patient’s medical condition. The caregivers also have a flexibility and adaptability in relation to their colleague, which leads to a mutual interplay in the assessment. Assessment in the ambulance services also means that the caregivers are paradoxically prepared at the same time as be-ing unprepared, i.e. they are prepared for the unprepared. The assessment thus starts before the caregivers have reached the patient and the actual situation. Even if they “know” what awaits them, they do not really “know”. It becomes a dynamic struggle between on the one side the expectancy that feels certain and on the other the unknown in every new situation. The struggle contains a desire for control and effectiveness in a care practice full of surprises. / Kunskapscentrum PreHospen vid Högskolan i Borås, Institutionen för vårdvetenskap.

Silk-weaving in Sweden during the 19th century. Textiles and texts - An evaluation of the source material. With the rich material available, 19th century silk-weaving invites to studies on industrialisation processes. The purpose of this licentiate thesis is to present and discuss an empirical material regarding silk production in Sweden in the 19th century, to examine the possibilities and problems of different kinds of materials when used as source materials, and to describe how this material can be systematized and analysed in relation to the perspective of a textile scientific interpretation. The introductory sections of the thesis provide a background to textile research and the subject of textile science. This is followed by an overview of previous research on silk-weaving in Sweden and a historical overview of silk-weaving in Sweden, the Jacquard machine, and the K.A. Almgren Sidenväveri, where large parts of the source material have been preserved. After these overviews, the research material is described and systematized: first the main materials, textiles, machines and other objects, and then the various written sources. By way of conclusion, the empirical material is summarized in a critical discussion where the various groups of materials are evaluated in comparison to one another. A discussion on theory and methodology regarding objects as sources and the use of experience-based knowledge in academic research is developed in connection to the critical discussion. Finally, the potential of the material is demonstrated through a textile example. The presentation is an introduction to the cultural-historical analysis that will follow in the PhD thesis. Here, the empirical material will be analysed through the use of knowledge in handicrafts, which may create new dimensions of silk production in Sweden and the complexity of the industrialisation process.

How the world of experience, text-based medicine, and the social world came to interact with each other in a historically situated way is the subject of this doctoral thesis, which studies what I shall call zhang ("miasma") medicine in Song China (960-1279 CE). By the phrase "the world of experience," I refer to the bodily experience of the environment in a given region as well as to experiences of medical practices. "The social world" broadly refers to concomitant social, intellectual, and political events or trends. This thesis proposes a new approach to the study of the environment within the history of medicine in Imperial China (around 202 BCE-1911 CE), an approach which is inspired by anthropological analytical concepts. It highlights individuals' world of experience, treating their knowledge about environmental medicine as the culmination of a dynamic collaboration of their experiential world and existing culture-specific concepts, such as those deriving from scholarly medicine. This new approach dictates a re-examination of the sources that have received intensive attention in the history of medicine in Imperial China: texts up to the thirteenth century on the aetiology, therapies, and prevention methods of zhang as disorders endemic in Lingnan (in Guangdong and Guangxi provinces). Based on this re-examination, I contend that the Song period witnessed the emergence of a pronounced explanatory mode among authors of writings about zhang medicine about how their world of experience informed and affirmed their medical knowledge and practices relating to zhang. This Song explanatory mode embodies, I argue, the endeavor of Song scholar-officials and physicians to extend the proliferation of scholarly medicine at that time to zhang medicine, which lacked widely acknowledged textual references and therapies of medicinal effectiveness. The findings in this thesis firstly broaden our understanding of the development of environmental medicine in Imperial China and, secondly, extend our knowledge of the expansion of scholarly medicine into southern China in Song times.

The aim of this study was to examine how newly qualified social workers from Linnaeus University in Kalmar feel that the school has prepared them with the professional skills to meet the demands that exist within social work. Social work education is a generalist training that will result in a professional qualification. With a qualitative approach eight newly qualified social workers were interviewed.We used the sociology of knowledge as an overall theoretical approach. We also used experience- based knowledge as a theoretical approach. One of the study's conclusion was that the graduates had difficulty linking theory to practice. The graduates also felt that knowledge about the law and dialogue methodology were two useful courses for use in practical work. The results and conclusions can be seen as a reinforcement and extension of previous research in the subject.