The overall aim of this thesis was to investigate the patients’ and their relatives’ perceived participation in discharge planning after stroke and the patients’ health-related quality of life, depressive symptoms, performance of personal daily activities and social activities in connection with discharge. Another aim was to evaluate the psychometric assumptions of the SF-36 for Swedish stroke patients. Prospective, descriptive and cross-sectional designs were used to study all patients with stroke admitted to the stroke unit at a hospital in southern Sweden from October 1, 2003 to November 30, 2005 each with one close relative. The total sample consisted of 188 patients (mean age=74.0 years) and 152 relatives (mean age=60.1 years). Data were collected during interviews, 2-3 weeks after discharge. The results showed that less depressive symptoms, more outdoor activities and performance of interests are important variables that related to higher HRQoL. SF-36 functions well as a measure of health related quality of life in Swedish stroke patients, but the two summary scales have shortcomings. Compared to a Swedish normal population, scores on all scales/components of the SF-36 were lower among stroke patients especially in the middle-aged group. Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal setting. The relatives perceived that they need more information and they perceived low participation in goal setting and needs assessment. The professionals seem to lack effective practices for involving patients and their relatives to perceive participation in discharge planning. It is essential to develop and to implement methods for discharge planning, including sharing information, needs assessment with goal setting that facilitate patients’ and relatives’ perceived participation. The results suggest that ICF can be used in goal setting and needs assessment in discharge planning after acute stroke.

Women treated for a gynecological cancer report longstanding post-treatment difficulties for which they rarely seek or receive help. Few intervention studies have successfully improved global sexual health within this population. Research in this domain is challenging due to inconsistent measurements of sexuality, low response rates and high attrition rates. The overarching study objectives were: (a) To contribute to the advancement of research on supportive care needs (including sexual health needs), desire for help, and predictors of needs; and, (b) To inform the development of services for gynecological cancer survivors. In Study 1, a qualitative interview study explored the experiences of 15 gynecological cancer survivors. Interviews were conducted and analysed based on the Interpretive Description approach . In Study 2 (for which results were analyzed in two parts), a descriptive, cross-sectional needs assessment was conducted to measure supportive care needs, desire for help, sexual health and vaginal changes, and service format preferences in 113 patients. In Part 1 of Study 2, descriptive and regression analyses explored patient needs, desire for help and potential predictors of these variables. In Part 2, a descriptive analysis explored sexual health needs and vaginal changes, desire for help with sexual health needs, and their associations with sociodemographic and medical variables. Qualitative results from Study 1 suggested that psychological, emotional and relational aspects of sexuality were as important to the participants as physiological sexual response. In the needs assessment, the strongest predictors of greater unmet needs and increased readiness for help were younger age and shorter time since treatment. Moderate to high sexual and social needs were equally prevalent in women recently treated and those treated several years prior to the study, suggesting that sexual and social needs may remain unaddressed over time. Further, many women who reported a need did not desire help, demonstrating the subjectivity of needs and distress, as well as the potential presence of barriers to seeking help. Both studies revealed a common finding, where sexual health needs were a product of the discordance between participants’ current sexual experiences and their perceptions of ideal sexual health. Overall, the two studies indicate that a significant subgroup of patients experience unmet needs in cancer survivorship, most of which are non-physical; also, while some needs were higher following treatment, unmet social and sexual health needs show little relationship with time since treatment. Ambivalence about receiving help with unmet needs is related to beliefs about the role of the health care team in meeting non-physical needs, as well as other perceived barriers. Patient’s perceived sexual health needs and barriers to receiving help should be evaluated within a comprehensive framework of needs and discussed one-on-one. Future research should explore the added predictive value of other groups of medical and psychological variables.

BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.

No description available.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Umeå universitet, 2007. / Härtill 4 uppsatser.

O panorama de desassistência no âmbito da saúde da pessoa com deficiência se mantém, mesmo com alguns avanços trazidos pelo SUS. O conceito de necessidade de saúde como norteador das práticas pode possibilitar a abertura de novos espaços de reflexão e ação para esta população, sendo fundamental a inclusão das próprias pessoas nesta discussão. O objetivo do trabalho aqui descrito é identificar quais são as demandas e necessidades de saúde das pessoas com deficiência, a partir da ótica destes sujeitos. Foi realizado um estudo de metodologia qualitativa, sendo a história de vida a técnica de produção dos dados adotada; foram incluídos na pesquisa pessoas com deficiência física, auditiva e visual, com deficiência congênita e adquirida, e com histórico de atendimento no SUS. Foram realizadas entrevistas em profundidade, baseadas em um roteiro prévio, sendo gravadas e posteriormente transcritas; também foi feito um diário de campo. A análise do material foi feita em três níveis: palavras-chave, temas emergentes e tendências gerais. Produziu-se um texto analítico com os temas emergentes das narrativas, bem como um quadro sintético, elencando os núcleos temáticos sobre necessidades de pessoas com deficiência. Das narrativas, cinco temas principais estiveram presentes: a vivência da deficiência; independência, autonomia e apoio; acesso e direitos; sentidos das intervenções; ações e estratégias. Em relação às necessidades e a atenção em saúde, onze eixos temáticos foram elencados: Acesso; Apoio psicossocial; Aspectos gerais de saúde (para além da deficiência); Autonomia e independência; Dispensação de equipamentos e dispositivos de tecnologia assistiva; Informação / orientação; Prevenção / diagnóstico precoces; Reconhecimento e garantia de direitos; (Re)Encontro com atividades significativas; Validação e ajuda na construção de estratégias próprias de enfrentamento; Vínculo com profissional de saúde. Pôde-se concluir que as necessidades identificadas pelas pessoas com deficiência incluem aspectos específicos da assistência em saúde, mas englobam outras dimensões como o acesso, os direitos, o trabalho, o lazer, indicando a importância de ações integrais e intersetoriais. Ressalta-se também as singularidades que a vivência da deficiência impõe a cada sujeito, bem como os sentidos que cada um encontra em sua história de vida / The lack of assistance panorama in the health of the disabled person still exists, despite some advances brought by SUS. The concept of health needs as a guide for the practices may allow new spaces for reflection and action for this population, and the inclusion of disabled people in this discussion is of extreme importance. The aim of the work described here is to identify demands and health needs of people with disabilities, by the subjects´ perspective. The study was conducted by the use of a qualitative methodology, through the life history method; and people with physical, hearing and visual disabilities, congenital or acquired, with history of assistance by SUS were included. Interviews were conducted based on a previous script, being recorded and later transcribed; and also a field diary was made. The data analysis was done on three levels as follows: keywords, emerging issues and trends. An analytical text with the emerging themes of the narratives, and a summary table have been produced listing the central themes on the people with disabilities needs. Using narratives, five major themes emerged: the experience of disability; independence, autonomy and support; access and rights; meaning of the interventions; actions and strategies. Eleven themes were listed when considering needs and health care: access; psychosocial support; general health issues; autonomy and independence; dispensing of equipment and assistive technology devices; information/guidance; prevention/early diagnosis; recognition and guarantee of rights; recovery of meaningful activities; validation and help in building their own strategies for coping; bonding with health professional. It was concluded that the needs identified by people with disabilities include specific aspects of health care, but also include other dimensions such as access, rights, work, leisure indicating the importance of integrated and intersectoral actions. Singularities that the experience of disability brings to each person are also emphasized, as well as the meanings that each one finds in its life history

M.A. (Social Work) / As a result of the ruling Government's policy, a diverse group of individuals and organisations identified certain critical needs of black people - through their own initiative. In doing so they utilised basic community development principles which forms part of a new approach regarding need satisfaction in the new South Africa. The focus of this particular study is on one such a non-Governmental organisation, which developed from grass roots level to satisfy the needs of black children and their parents with regard to teaching and education. In the light of the growing demand for an educational service and the school's need to effectively address this problem, a need-sassessment was required in order to identify the needs of the children in the context of the school, from the perspective of key-persons and parents. Given the institution's development from grass roots level through community development principles, the institutions requirement of a needs-assessment as well as the fact that implementation of community development will ensure that community needs be addressed, this study will therefore be done in the framework of community development.

The purpose of this study was to understand, by means of Connell’s and Hirdman’s gender theories, whether the older persons’ gender as well as the family situation affect the assessments in elderly care. Previous studies show that social workers do not consciously take gender into consideration, while also showing that gender is important for the assessment and decision. Based on the purpose, we asked the questions how are the assessments of care managers affected by the gender of older persons and in what way are the assessments of care managers affected by older persons family situation? This study was based on eight interviews with care managers in eldery care. The result was divided into the following two main themes assistance management and the older person. Connell’s and Hirdman’s gender theories helped us answer our main questions and analyze our result. The result showed that the unaware subconscious ideas of male and female, older persons’ perceptions of male and female as well as the elderly’s division of different chores in the household are affecting the care managers’ needs assessments in such a way that men and women are granted and apply for different assistance. Depending on who needs help in a couple, if the older person lives alone or with someone as well as other families’ perceptions of what the husband and wife are capable of doing affects the needs assessments of care managers.

The purpose of this study is to understand how eldercare managers, in their assessments of home care, needs to make individual decisions and at the same time keep to municipality’s guidelines. Our research questions deal with how eldercare managers make individual assessments and at the same time consider general municipality’s guidelines in their estimations of need for homecare assistance and how eldercare managers experience that individual assessments and general municipal guidelines relate to each other in estimations of needs for homecare assistance. Nine qualitative, semi-structured interviews were conducted with social workers working with needs assessments within the eldercare. The results were analyzed through Lipsky’s theory on street-level bureaucracy and the concept of discretion. Our main conclusions from this study is that it is a complex work to estimate needs for homecare assistance when considering both individual assessments and general municipal guidelines. Our results showed that the needs of the individual are more important in the cases where guidelines and the person’s needs differ. Our study also showed that the eldercare managers, as a rule, follow the guidelines as long as they coincide with the assessment of individual needs, but the guidelines function as a guidance and not as something definite. The eldercare managers don’t feel that the relation between municipality guidelines and individual decisions is a problem. The complexity was rather evident in the lack of judicial security and justice in the work with the assessment of individual needs.