Internetbaserad kognitiv beteendeterapi (IKBT) för olika former av psykisk ohälsa har presenterats som ett alternativ till traditionell samtalsbehandling baserat på forskning från det senaste decenniet. Trots klinisk relevans och flera fördelar för patienter och behandlare går implementeringen långsamt i flera europeiska länder. Syftet med den föreliggande studien var att undersöka behandlares erfarenheter av att implementera IKBT i sina verksamheter. Intervjuer genomfördes med åtta behandlare hos en svensk offentlig vårdgivare, varefter en tematisk analys gjordes. Fyra huvudteman arbetades fram: En ny metod, En ny roll, Premisser och Lärande. Behandlarna har en övergripande samstämmighet och förståelse kring IKBT och dess användning, vilket är en viktig aspekt av implementeringen. Behandlarna beskriver dock också att kollegor som inte arbetar med behandling, men har en roll i implementeringen, ibland har bristande kunskap och negativa fördomar som förhindrar arbetet. Vidare berättar behandlarna att organiserat samarbete mellan aktiva behandlare bortprioriteras i den kliniska vardagen. Resultaten från analysen diskuteras med utgångspunkt i Normalization Process Theory. Vidare forskning kan utforska upplevelsen hos IKBT-utbildade behandlare som inte börjat arbeta med IKBT och hos icke-behandlande kollegor på arbetsplatser där metoden implementeras. / Internet-based Cognitive Behavioral Therapy (ICBT) for different kinds of mental health issues has been presented as an alternative to traditional face-to-face treatment based on research from the last decade. Despite clinical relevance and several advantages for both patients and therapists the implementation of the method is progressing slowly in many European countries. The purpose of this study was to examine therapists’ experiences of implementing ICBT in their everyday work. Interviews were conducted with eight therapists in a Swedish public health care setting, after which a thematic analysis was made. Four main themes were defined: A new method, A new role, Premises and Learning. The therapists have an overarching mutual comprehension of ICBT and its use, which is an important aspect of the implementation. The therapists explained that colleagues that don't work with ICBT, but still have a role in the implementation, sometimes lack knowledge and have negative preconceptions which obstruct the work. Furthermore, therapists talked about organized collaboration between active therapists not being prioritized in the everyday clinical work. Results from the analysis are discussed by applying Normalization Process Theory to the findings. Further research could examine the experiences of ICBT-trained therapists who have not yet started working with ICBT and of colleagues who do not work with treatment in workplaces where ICBT is being implemented.

Domestic violence is a public health and international problem. Previous research outlined the extensivity of the problem internationally and the missing approaches of professionals who work with young children. The study aims to explore the methods and routines used by preschool teachers in approaching suspected cases of domestic violence among preschool children in Sweden. The results show that there are only a few available methods and routines given by governmental agencies in guiding the preschool teachers to approach such cases. As an alternative, the preschool teachers themselves develop individual approaches like observation, documentation, and collaboration with different actors involved. The interviews were conducted with semi-structured interviews with four preschool teachers to give a deeper understanding of their knowledge about the topic and experiences with suspected cases of domestic violence and methods and routines. The normalization process theory (NPT) was used to highlight the complexity of modifying methods and routines for complex problems e.g. domestic violence. The method of deductive thematic analysis provided pre-determined themes connected to the theory and new themes emerged from the data during the analysis process.

Bakgrunden till den här studien har varit ett skolutvecklingsprojekt med syfte att tillsammans med lärare i svenska och lärare i modersmål undersöka vilka erfarenheter ett faktiskt samarbete mellan lärarkategorierna ger upphov till. Pragmatism har som teoretisk ansats influerat projektets utformning. Lärarnas samarbete har varit begränsat till ett temaarbete med utgångspunkt i läsning och bearbetning av ett skönlitterärt verk. Syftet med studien har varit att undersöka möjliga samarbetsformer för lärare i svenska och lärare i modersmål. Studien har genomförts i form av deltagande observation av planerings- och utvärderingsmöten med lärare kopplade till två olika skolor. För att kunna analysera lärarnas handlingar har inspiration hämtats från en aktionsteori som fokuserar hur deltagares handlingar möjliggör respektive hindrar implementeringen av nya praktiker – Normalization Process Theory (NPT). Lärarnas tal om samarbetet och det didaktiska innehåll som de planerar under mötena har spelats in och i efterhand analyserats med hjälp av ett växelspel mellan begrepp inspirerade av NPT och egna kategorier som har skapats med utgångspunkt i det empiriska materialet. Resultatet visar att lärarnas tal om syftet med samarbete mellan lärare i svenska och lärare i modersmål kretsar kring möjligheter att stärka modersmålslärarnas position, att utöka det kollegiala lärandet samt att stötta elevernas lärande och välmående. Vidare visar resultatet att lärarnas tal om den didaktiska planeringen synliggör tre huvudsakliga samarbetsformer som jag har valt att kalla: spegelundervisning, komplementär undervisning och stödämnesfunktion. Dessa olika samarbetsformer har fördelar och nackdelar som bland annat är kopplade till möjligheterna till gemensam planering, utjämnande av ämnenas olika förutsättningar gällande tid samt stöttning av elevernas lärande. Huvudsakliga hinder för ett språkutvecklande samarbete mellan lärare i svenska och lärare i modersmål är enligt resultatet tidsbrist som på olika plan ger upphov till svårigheter att formulera gemensamma mål för undervisningen i de två ämnena. / <p>Svenska</p>

Engaging youth with Type 1 diabetes (T1D) in the self-management of daily tasks and decision- making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. The process of shared decision making (SDM) comprises four key elements – acknowledge, consider, decide, act - and is identified as an optimal approach to making self-management decisions, yet it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision making. Using a sequential two-phased investigation, this dissertation describes how PHRs can be designed to enable SDM and integrated into clinical practice to engage youth with T1D in self-management decision making. Phase 1 proposed an integrated SDM–PHR (e-PHR) functional model justified by youth with T1D (n=7) and providers (n=15) via a user-centered design approach. Located within an interconnected EHR ecosystem, e-PHR integrates 23 PHR functionalities for the SDM process, whereby each SDM element was mapped to PHR functions with a moderate level of agreement between patients and providers (Cohen's kappa 0.60-0.74). The Phase 2 mixed methods, pre-implementation evaluation utilized an online measurement instrument and survey and individual interviews, underpinned by the Normalization Process Theory (NPT), to describe the four cognitive and behavioural processes (coherence, cognitive participation, collective action, reflexive monitoring) known to influence the success of complex socio-technical implementations. Youth with T1D (n=8), providers (n=11), and EHR/clinical leaders (n=8) in British Columbia participated. Reliability tests of NPT-based instrument negated the use of scores for the coherence and reflexive monitoring constructs. Qualitative results indicated that e-PHR made sense as explained by two themes for ‘Coherence’: game changing technology and sensibility of change. Participants strongly agreed (mean score=4.6/5) with ‘Cognitive Participation’ processes requiring an investment in commitment, explained by two themes: sharing ownership of the work and enabling involvement. Weak agreement (mean score=3.6/5) was observed with ‘Collective Action’ processes requiring an investment in effort, explained by one theme, uncovering the challenge of building collective action, and 3 sub-themes, assessing fit, adapting to change together, and investing in the change. Participants appraised e-PHR as explained by two themes for ‘Reflexive Monitoring’: reflecting on value, and monitoring and adapting. Finally, participants strongly agreed (mean score=4.5/5) that e-PHR would positively affect engagement in self-management decision making in two themes: care is efficient and care is person-centred. The establishment of a e-PHR functional model is a precursor to system design requirements. Using the NPT framework, findings from the process evaluation indicated participants invest in sense-making, commitment and appraisal work of this technology. However, successful integration of e-PHR into clinical practice to positively affect engagement in self-management decision making will only be attained when systemic effort is invested to enact it. Further research is needed to explore this gap to inform priorities and approaches for future implementation success. / Graduate

Tidigare forskning om våld i nära relation berör främst mäns våld mot kvinnor. Det finns en kunskapslucka om förekomsten av och kunskapen om mäns våldsutsatthet. Majoriteten av studier om våld mot män omfattas av kvantitativa studier. Den här studien syftar till att genom kvalitativa intervjuer, undersöka hur våldet mot män i heterosexuella relationer tar sig uttryck och hur mannens uppbrottsprocesser kan se ut, för att jämföra det med den kunskap som finns tillgänglig om kvinnors våldsutsatthet. Studien syftar även till att undersöka vilken hjälp och stöd som finns att tillgå. De teoretiska utgångspunkter som används innefattar teorier om våld, normaliseringsprocessen, uppbrottsprocessen, norm- och genusteorier. Urvalet innefattar fem våldsutsatta män som tidigare erfarit våld i heterosexuell relation. Studiens resultat tyder på att samtliga former av våld förekommer i de relationer där män utsätts för våld. Deras uppbrottsprocesser överensstämmer väl med teorier om kvinnors uppbrottsprocesser, vilket antyder att männen upplever samma svårigheter att lämna relationen. Ett utmärkande drag för våldsutsatta män kan kopplas till normer och förväntningar på könsroller, samt att det bidrar till ökade skam- och skuldkänslor. Mörkertalet av våldsutsatta män kan därmed förklaras genom att män inte söker hjälp och stöd på grund av skam, lågt förtroende för rättsväsendet eller okunskap om vart de kan vända sig. De konsekvenser som framkommer till följd av våldet överensstämmer väl med forskningen om kvinnor, där konsekvenserna tenderar att bli långvariga. Genom att normalisera mannen som våldsutövare försvåras möjligheten för våldsutsatta män att få rätt hjälp att hantera eller komma ur den destruktiva relationen. / Previous research on intimate partner violence mainly concerns mens violence against women. There is a knowledge gap about the occurrence and knowledge of mens experience violence, the majority of studies are quantitative studies. This study aims to, through qualitative interviews, examine how the violence against men in heterosexual relationships takes form and how the processes of breakup can be compared with the knowledge available about womens violence, and investigate the available support. The theoretical perspectives include theories of violence, the normalization- and breakup processes, norm- and gender theories. The sample includes five mens experience on intimate partner violence in heterosexual relationships. The results indicate that all forms of violence occur to men subjected to intimate partner violence. The processes of breakup resembles the theories of womens processes, which indicates that men experience the same difficulties in leaving the relationship. A distinctive characteristic of men who are victims of intimate partner violence can be linked to the norms and expectations of gender roles and that contributes to increased shame and guilt feelings. The number of men exposed to violence can thus be explained by the fact that men do not seek help and support because of shame, low confidence in the legal system or lack of knowledge about where they can turn to for help. The consequences that result from the abuse are similar to research on women, where the consequences tend to be prolonged. By normalizing the man as the perpetrator, makes it difficult to get the right help and leave the destructive relationship.

With the unplanned rapid switch to Working from Home (WFH) arrangement due to the COVID-19 pandemic, organisations and their employees were forced to adapt their processes and practices with a huge dependence on digital technologies. When such work reorganization is adopted, all everyday activities including social interactions with colleagues must therefore be taken into account. Existing literature indicates that social interaction with colleagues in the traditional workplace is considered a fundamental feature of employees’ social life and as it shapes their experience of work. Considering that lack of social interaction can lead to social isolation and other negative consequences which in turn affects the whole organization negatively. Currently, little is known about how remote workers engage and maintain social interactions with their colleagues via technology platforms when working remotely. This master’s thesis  study aims to contribute to the existing body of knowledge  on remote working by highlighting remote workers’  experiences around digital social interaction with colleagues when working from home(WFH).  An interpretivist approach utilizing qualitative research was employed by the author of this master’s study. Data was collected using participant observation and semi-structured interviews with a diverse group of remote workers who started and are currently working remotely as a result of the COVID-19 pandemic. The study explored how participants of the study engage in social interactions with their colleagues via technology and how such interactions are embedded in their working lives. The empirical data generated from interviews and observations was subsequently subjected to a thematic analysis for interpretation. Five themes emerged from the thematic analysis method; these themes which constituted the empirical findings of this master’s thesis were then analyzed in connection to the research questions and discussed with the literature review as well as with the four constructs of the Normalization Process Theory(NPT) adopted in this master’s thesis. The results of this study show that social interaction via technology takes place before and after meetings and via chat functions as well. The findings of the study also highlight that most participants do not experience issues in relation to digital social interactions as reported in the previous literature. However, participants reported some negative factors that hinder their social interaction when WFH such as increased workload, overwhelming online social events and reduced support for the new team members. The contribution of this master’s thesis study is to highlight that different perceptions and feelings of how work arrangement has changed via technology exists while working remotely. It is suggested that organizations willing to implement the new work models(Hybrid work or WFH) need to be aware of the existence of these differences and act based on the insights provided by this master’s thesis study. Keywords: Remote Working, Working from home, digital Social interaction, Social support, Social isolation, ICT,  Normalization Process Theory

Objective: The promotion of self-management support for people with LTCs is a health policy priority across the UK (LTCAS 2008; DoH 2012). Self-management support is designed to change and improve care for people with LTCs, who form an increasing proportion of the population requiring healthcare and treatment. For health organisations models of care, which support self-management, require greater emphasis on person-focused rather than disease-focused manifestations of health and represents a new model of care delivery requiring changes in practice. Current research demonstrates that health policies are increasingly complex, involve multiple organisations and often fail to translate into effective practice (Noyles et al. 2014). The deficit between what works and what happens in practice is referred to as the “implementation deficit” (Pressman and Wildasky 1984) and traditionally it has been difficult to breakaway from the idea that the policy process is best viewed from the top-down (Barett and Fudge 1981). However, there remains a need to understand the processes of implementation, which takes account of the variation, the multiple layers and interactions which takes place between policy-maker and -implementer as policy becomes practice (Hupe 2011). Implementation of self-management is a contemporary focus in UK health policy and this thesis explains what processes are used to implement self-management policy for people with LTCs into everyday practice in one health board. Methods: A case study approach was used to investigate the policy process with data collected using thirty-one semi-structured interviews with policy-makers and regional and local policy-implementers plus eight hours of observation of national and regional policy meetings. To provide context to the implementation process data also included thirteen policy documents. Data analysis used the retrospective application of NPT as a theoretical framework with which to explore the implementation processes. NPT is an emerging theory that is being promoted as a means of understanding implementation, embedding and integration of new ideas in healthcare (McEvoy et al. 2014). The application of NPT focuses on four mechanisms, termed work (May and Finch 2009: 547), which promote incorporation of new ideas in practice. These areas of work are coherence, cognitive participation, collective action and reflexive monitoring (Mair et al. 2012). Findings: The findings suggest that there are a number of important influences operating behind or as part of the policy implementation process. These included the need for a shared understanding, getting stakeholders involved to drive forward policy, work promoting collaboration and participation was the most detailed and important in the process of policy implementation; the course of policy was affected by factors which facilitated or inhibited stakeholders acceptance of self-management; and NPT fosters key analytical insights. Conclusion: Understanding the process of policy implementation in healthcare and how practice changes as a result of policy is subject to a wide range of influences. What emerges are five key recommendations relating to understanding policy implementation. (1) understanding the concept of self-management is important in promoting policy implementation. This understanding benefits from dialogue between policy-makers and -implementers. (2) stakeholder involvement supports implementation particularly the role of clinical leadership and leadership through existing networks but also value in establishing new organisational structures to create a receptive context. (3) develop participation and collaboration through use of the patient voice which helped simplify the policy message and motivate change. (4) other resources help policy implementation and where these are evident then policy is implemented and where they are absent then implementation is not embedded. Lack of evidence was a particular area of constraint. (5) NPT has shown that social context is important, and provides for this. But in addition there is evidence that historical perspectives and previous experience are also important influence on receptivity to implementation. This research contributes to the development of theory and practice in the area of implementation science. The exploration of the policy implementation has revealed the action and work which policy-makers and -implementers are engaged in while implementing policy. It has tested the utility of NPT in a real-life setting using all four mechanisms.

Introduction : Le cadre de la gouvernance clinique a été développé afin d’atteindre de hauts standards de qualité de soins et de services, en conjuguant les notions d’amélioration continue de la qualité, d’excellence clinique et d’imputabilité corporative. La présente démarche doctorale avait pour objectif de comprendre le processus d’institutionnalisation de la gouvernance clinique dans un centre de réadaptation. Méthodologie : Une synthèse méta-narrative de 65 documents répertoriés dans 4 bases de données bibliographiques sur la conceptualisation et la mise en œuvre de la gouvernance clinique a été menée. Une étude qualitative de cas unique a été menée dans un centre de réadaptation en déficience intellectuelle et en troubles du spectre de l’autisme, au Québec (Canada). En mobilisant les cinq construits du cadre conceptuel basé sur théorie du processus de normalisation (cohérence, participation cognitive, action collective, suivi réflexif et contexte organisationnel), une analyse thématique des entrevues individuelles auprès de 22 participants (5 administrateurs, 11 gestionnaires et 6 cliniciens) et de 3 groupes de discussion auprès de 8 cliniciens et de 4 proches d’usagers a été menée. Enfin, une analyse d’une centaine de documents administratifs du Centre a été effectuée. Résultats : L’analyse de la littérature a permis de constater que le cadre de la gouvernance clinique est un concept en évolution et encore perçu comme une avenue intéressante pour l’amélioration de la qualité des soins. Toutefois, la confusion autour de sa définition et de sa conceptualisation ainsi que les difficultés de sa mise en œuvre demeurent des enjeux pour les organisations. Par la mobilisation du cadre de gouvernance clinique, la haute direction du centre de réadaptation à l’étude a souhaité systématiser le processus d’amélioration continue de la qualité des services offerts aux usagers et à leurs proches par l’adoption des bonnes pratiques de gouvernance. Ce virage a été bien reçu par les administrateurs et les gestionnaires, résultant sur une participation active et un fort engagement aux activités de leur part. La complexité du cadre et l’absence d’implication des cliniciens dans le processus de mise en œuvre ont créé chez ces derniers une appréhension quant à l’apport de la gouvernance clinique pour la pratique clinique et le bien-être des usagers. Les cliniciens ont dénoncé l’absence d’arrimage entre la théorie et les réalités de la pratique clinique ; la grande vitesse d’implantation et une approche décisionnelle de type top-down comme des enjeux de l’institutionnalisation de la gouvernance clinique. Pour les gestionnaires, les défis ont été la mise en place des moyens de communication efficaces ; l’arrimage des mécanismes de gestion et la disponibilité des ressources humaines. Pour les administrateurs, l’enjeu principal a été l’instabilité des contextes organisationnels interne et externe qui a ralenti la mise en œuvre et freiné l’élaboration d’un processus évaluatif. Conclusion : L’institutionnalisation de la gouvernance clinique dans les établissements non hospitaliers offrant des services sociaux passe par la valorisation de ce concept comme un projet commun au bénéfice de l’usager en vue de renforcer la participation et l’engagement de tous et l’adoption d’une approche de partenariat entre les usagers, leurs proches et les autres acteurs de l’organisation. / Introduction: Clinical governance framework was developed in order to achieve high standards of quality of care and services, by combining the concepts of continuous quality improvement, clinical excellence and corporate accountability. The aim of this doctoral thesis was to understand the implementation process of clinical governance in a rehabilitation center. Methods: A meta-narrative synthesis on the conceptualization and implementation of clinical governance was conducted. 65 tittles screened in 4 international databases were analysing. A qualitative single case study was conducted in a rehabilitation center for intellectual disabilities and autism spectrum disorders, in Quebec (Canada). By mobilizing the five constructs of the conceptual framework based on normalization process theory (coherence, cognitive participation, collective action, reflexive monitoring and organizational context), a thematic analysis of individual interviews with 22 participants (5 administrators, 11 managers and 6 clinicians) and tree focus groups with 8 clinicians and 4 relatives of users were conducted. Finally, an analysis of around hundred administrative documents from the Center was conducted. Results: The literature revealed that the clinical governance framework is an evolving concept and still seen as an interesting avenue for improving the quality of care. However, confusion over its definition and conceptualization, and the difficulties of its implementation remain challenges for organizations. By mobilizing the clinical governance framework, the senior management of the rehabilitation center under study wished to systematize the process of continuous improvement of quality of services offered to users and their families, by adopting good governance practices. This shift was well received by administrators and managers, resulting in active participation and a strong commitment to activities. The complexity of the framework and the absence of involvement of clinicians in the implementation process have created in them an apprehension regarding the contribution of clinical governance to clinical practice and the well-being of users. Clinicians have criticized the lack of alignment between theory and the realities of clinical practice; the high speed of implementation and a top-down decision-making approach as issues of the implementation of clinical governance. For managers, the challenges have been the establishment of effective communications; the alignment of management mechanisms and the availability of human resources. For administrators, the main issue was the instability of the internal and external organizational contexts which slowed down the implementation and the development of an evaluation plan. Conclusion: The implementation of clinical governance in non-hospital facility requires the promotion of this concept as a joint project for the benefit of the user with a view to strengthening the participation and commitment of all and the adoption of a partnership approach between users, caregivers and other actors in the organization.