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no / Purpose – Audio-diary methods are under-utilised in contemporary qualitative research. The purpose of this paper is to discuss participants and researchers’ experiences of using audio-diaries alongside semi-structured interviews to explore breastfeeding experiences in a short-term longitudinal study with 22 first-time mothers. Design/methodology/approach – The authors provide a qualitative content analysis of the participants’ feedback about their experiences of the audio-diary method and supplement this with the perspectives of the research team based on fieldwork notes, memos and team discussions. The authors pay particular attention to the ways in which the data attained from diaries compared with those from the interviews. Findings – The diaries produced were highly heterogeneous in terms of data length and quality. Participants’ experiences with the method were varied. Some found the process therapeutic and useful for reflecting upon the development of breastfeeding skills whilst negative aspects related to lack of mobility, self-consciousness and concerns about confidentiality. Researchers were positive about the audio-diary method but raised certain ethical, epistemological and methodological concerns. These include debates around the use of prompts, appropriate support for participants and the potential of the method to influence the behaviour under scrutiny. Interview and diary accounts contrasted and complemented in ways which typically enriched data analysis. Practical implications – The authors conclude that audio-diaries are a flexible and useful tool for qualitative research especially within critical realist and phenomenological paradigms. Originality/value – This appears to be the first paper to evaluate both participants and researchers’ experiences of using audio-diaries in a detailed and systematic fashion.

Sjuksköterskor verksamma på barnavårdscentral (BVC) möter dagligen flyktingbarn och deras föräldrar i sitt arbete och dessa möten ser olika ut beroende på olika faktorer. Syftet med studien var att beskriva BVC- sjuksköterskors arbete med flyktingbarn och deras föräldrar. Semistrukturerade intervjuer genomfördes och analyserades med kvalitativ innehållsanalys. Ur resultatet kom tre kategorier: att skapa trygghet, att vara lyhörd och att ge stöd. I kategorin att skapa trygghet beskrev BVC- sjuksköterskor hur de arbetade för att skapa jämlik vård, öka tillgängligheten samt belyste de vikten av kontinuitet i vården för flyktingbarnen. Kategorin att vara lyhörd innefattade sjuksköterskors sätt att se det enskilda barnets behov. Detta tillämpades med respekt, förståelse och acceptans för kulturella skillnader. Att ge stöd genom behjälplighet vid språk-och kommunikationssvårigheter, rätt anpassad information och samverkan med andra professioner gav flyktingbarnen tryggare och snabbare integrering i det svenska samhället. Svårigheter som BVC- sjuksköterskorna beskrev var kommunikation via tolk, brist på resurser och brist på kontinuitet i arbete med flyktingbarn. Fortsatt forskning behövs för att få ökad kunskap och förståelse kring flyktingbarns behov. Det behövs även fortsatta studier i utveckling, organisation och samordning av verksamheter som bedriver vård och omsorg för flyktingbarn. / Nurses working in Child Health Centers (CHC-nurses) face daily refugee children and their parents in their work and these meetings vary depending on various factors.The aim of this study was to describe CHC-nurses experience of working with refugee children and their parents. Semi-structured interviews were conducted and were analyzed using qualitative content analysis. From the result three categories emerged; to create security, to be responsive and to provide support. In the category to create security the CHC-nurses described how they worked to create equal care, increase accessibility, and highlight the importance of the continuity in the health care of refugee children. Category to be responsive comprised nurses' approach to the individual child's needs which was applied with respect, understanding and acceptance of cultural differences. Providing support through helpfulness with language and communication difficulties, the right customized information and collaboration with other professions gave refugee children safer and faster integration into the Swedish society. Difficulties described by the CHC-nurses were communication through interpreters, lack of resources and lack of continuity in the work with refugee children. Continued research is needed to increase knowledge and understanding of refugee children’s needs. Further studies in development, organization and coordination of activities engaged in health care for refugee children are needed.

This study was funded by a scholarship from the Swedish International Development Cooperation Agency (SIDA) as a Minor Field Study. The social economic development in Tanzania is a major challenge due to a continuing high rate of population growth. A growing   population   puts   increased   strain   on   healthcare,   food   supply   and   the environment.  Early childbearing limits women’s ability to educate themselves and contribute to society. The definition of family planning (FP) is to keep a sustainable population growth through reducing the family size. The government of Tanzania has developed  a  plan  for  FP,  which  includes  a  goal  that  60  percent  of  women  in reproductive age will use contraceptives in 2015. Healthcare professionals have a great potential to encourage lifestyles changes. It is therefore important to investigate the nurses’ experiences of teaching FP to increase the knowledge about their experiences. The aim of the study is to investigate nurses’ experiences of education about FP in the Rufiji district in Tanzania. This is a qualitative study and the data was collected through interviews using a semi structured open-ended question guide. The nurses’ experiences of teaching patients in FP concerns four different areas. Firstly, they have a variety of strategies to execute the education. Secondly, they describe what is necessary to create a meeting with the patient. Thirdly, the patients have needs that have to be met in a learning situation. Finally, even though it’s subtle, they empower the patient, which lays the foundation for making lifestyle changes. The key finding that the nurses spoke of as the  most  important  factor  when  teaching  is  the  importance  of  creating  a  good relationship with the patient.

The study aims to explore different aspects of urban public space. It does so through the case study of the medial debate concerning the planned redevelopment of Heden, an open central publicly owned area in Gothenburg, Sweden. The case study revealed the highly contested meanings of Heden, as well as different understandings of public space. The study also points to the dilemma of making urban public space readable and convivial, while maintaining it inclusive and open for everyone. The medial debate circles around the newly publicized redevelopment plan for Heden. In the plan the local government proposes the addition of more activities and functions to Heden. Thereby, they wish to attract new target groups to Heden. This proposal has met with some approval in the medial debate, but also with harsh critique. Some critics voice the concern of to whom public space is redeveloped. Other critics want to see more extensive redevelopment of Heden, to cover it with “inner city”. Others yet wish a future Heden to have a more explicit focus on sports. The study examines these differing opinions and their possible consequences for the “publicness” of urban public space.

This research presents a comparative case study between the Russian annexation of Crimea in 2014 and the United State’s invasion of Iraq in 2003. It specifically examines how the two interventions were framed by the political executives. Frame theory and a qualitative content analysis served as theoretical­ and methodological benchmarks to assess selected speeches and public statements delivered by president George W. Bush and Vladimir Putin, in order to detect similar motives and justification patterns for the armed occupations. Four distinct war frames emerged from the text material: prevention, common good, state liability and imposed war. The results demonstrate that state leaders are prone to strategically communicate their military ambitions and legitimize their policy agendas through corresponding framing processes.

This thesis focuses mainly on the general ethical considerations of staff and not pre-defined specific ethical problems or dilemmas. The aims of this thesis were: first, to map ethical considerations as described by staff members in their everyday work in child and adolescent psychiatry as well as in adult psychiatry; second, from a normative ethical perspective, examine encounters between staff and patients; and third, to describe staff justification for decisions on coercive care in child and adolescent psychiatry. The material in the three first studies comprised ethical diaries written by staff in 13 inpatient clinics. The fourth study included all the medical records of patients who were admitted to coercive care during one year in child and adolescent psychiatry in Sweden. In a final analysis, combining all the four studies, three staff ideals were identified: being a good carer, respecting the patient’s autonomy and integrity and having good relations with patients and relatives. Staff often felt that the only reasonable way in many situations was to act in a paternalistic way and take responsibility, but they considered it to be problematic. Four main themes were identified as ethical considerations. These were the borders of coercion, the emphasis on order and clarity rather than a more reciprocal relationship with patients, a strong expectation of loyalty within the team, and feelings of powerlessness, mostly in relation to patients. I have identified four challenges for inpatient psychiatry. First, formal and informal coercion in inpatient care raise ethical concerns that also can be emotionally difficult for staff. Second, the professional role and care needs to be redeveloped from providing routinised care to providing more individualised care. Third, staff often worry about how patients manage their life after discharge, indicating that patients need better support. Fourth, staff also need support; they often experience feelings of being alone with their thoughts about ethical difficulties at work. Future research could contribute in the mapping of ethical considerations, in helping to develop, implement and evaluate methods for managing these issues in psychiatric settings, and to develop the normative ethical language so that it is more relevant to the clinic reality.

<p><p><strong>Abstract</strong></p></p><p><strong>Authors:</strong> Mikael Gustafsson & Kristofer von Wachenfeldt</p><p><p><strong>Title:</strong> With help from people and cattle; to recover from mental illness in a rural environment [translated title]</p><p><strong>Supervisor:</strong> Kent-Inge Perseius</p><p><strong>Purpose:</strong> The aim of this study was to examine feelings of recovery from mental illness in the perspective of individuals participating in Nymålen; a rural- situated facility focusing on recreation- and work- related interventions. The study took place outside of Oskarshamn, Sweden. The study focused on if, and in that case how, Nymålen contributes to recovery from mental illness. We were also interested in which factors affecting the recovery-process, as expressed by the participants themselves.</p><p><strong>Method:</strong> Eight individuals from Nymålen participated in individually performed semi- structured interviews. The collected data was then coded and categorized to enable further analysis by using Qualitative content analysis inspired by Graneheim & Lundman (2003). Latent themes that described the underlying meaning of the material were then extracted, using an analysis inspired by Robert K. Merton’s (1967) thesis on manifest and latent functions.</p><p><strong>Results:</strong> The findings of this study suggest that Nymålen in some ways contributes to feelings of recovery from mental illness. Nymålens environment including animals, a feeling of non- demanding chores, perceptive personnel and a positive interaction between the participants were the expressed main factors contributing to recovery from mental illness. Factors interrupting the recovery process were also detected, mainly an unhealthy feeling of competition between the participants, the lack of personnel and feelings of neglect from other psychiatric institutions.</p><p><strong>Keywords:</strong> Recovery, Mental illness, Animals, Rural, Rehabilitation, Qualitative content analysis</p></p>

Bakgrund: Förutsättningarna för sjukgymnasters arbete på särskilt boende ser olika ut beroende på brukarantal, möjlighet att vara tillgänglig samt resurser från kommunen. Flera studier visar på att resursbrist försvårar sjukgymnasters arbete och att det är svårt att tillgodose brukarnas behov när sjukgymnasterna har det medicinska rehabiliteringsansvaret för ett stort antal brukare. Rehabilitering sker på specifik och allmän nivå, och till stor del genom omvårdnadspersonal. Syfte: Syftet med studien var att beskriva sjukgymnasters upplevelser av sitt arbete på särskilt boende för äldre. Metod: Datainsamling skedde genom sju semistrukturerade intervjuer med sjukgymnaster som arbetade på särskilt boende. Data analyserades med kvalitativ innehållsanalys. Resultat: Vid analys framkom fem huvudkategorier: styrande faktorer, prioriteringar, samarbetet runt brukaren, arbetets bredd samt självbild och status. Konklusion: Deltagarna upplevde sitt arbete på särskilt boende för äldre som roligt och varierande, men påverkat av stress och resursbrist. Arbetet upplevdes bestå av mycket prioriteringar men vad de grundade sig på varierade, liksom upplevelsen av stödet från riktlinjer. Deltagarna uppgav att det är önskvärt med ett väl fungerande samarbete med omvårdnadspersonalen eftersom de sjukgymnastiska insatserna i stor utsträckning delegeras till dem. / Background: The conditions for the physiotherapists’ work in housing for the elderly vary depending on number of care recipients, the availability of the physiotherapists and the resources provided at the county level in Sweden. Previous studies have shown that the lack of resources makes the work difficult for the physiotherapists. Moreover, it is hard to meet the needs of individual care recipients when physiotherapists have the medical rehabilitation responsibility for a large number of care recipients. Rehabilitation is carried out on a specific level and a general level and often delegated to care assistants. Purpose: The aim of this study was to examine physiotherapists’ perceptions of their work in housing for the elderly. Method: Seven physiotherapists working in houses for the elderly were interviewed with the help of a semi-structured interview guide. The interviews were analyzed with qualitative content analysis. Results: The analysis revealed five categories: controlling factors, priorities, cooperation around the care recipient, the breadth of the work and self-image and status. Conclusion: The participants’ perceptions of work in housing for the elderly were that the job was fun and varied but influenced by stress and lack of resources. The work was perceived as consisting of a lot of prioritizing; however, the grounds on which the decisions were made varied as did the perception of support from guidelines. The participants reported that they desired a well-functioning working relationship with the care assistants because the physiotherapy inputs were often delegated to them.

Background: As psychosis is often a lifelong disorder, improved health-related quality of life (HRQoL) can be a relevant treatment goal. Persons with psychosis have significantly reduced physical health. Research has demonstrated a great excess of mortality due to cardiovascular diseases, as psychosis may lead to an inactive lifestyle and difficulties making healthy lifestyle choices. Metabolic side effects of second-generation antipsychotics are also common. Many are therefore affected by the metabolic syndrome. The overall situation calls for action by developing health promotion interventions suitable for this group. In recent years, there has been an increased interest in the physical health of persons with psychosis. However, efforts have not been optimally tailored to the needs of this group, and health care services have not done enough, despite being aware of the problem. Aim: The general aim of this thesis was to study HRQoL, and metabolic risk factors in persons with psychosis, and by a health promotion intervention and through the participants’ own perspective contribute to an improvement in lifestyle interventions. Methods: Study 1 had a cross-sectional cohort study design that was carried out in specialised psychiatric outpatient departments in Sweden. The patients (n=903) were diagnosed with a psychotic disorder and invited consecutively to participate. A prospective population-based study of public health in the south-east of Sweden (n=7238) served as reference group. Patients were assessed using psychiatric questionnaires, including the Global Assessment of Functioning (GAF). Health-related quality of life was assessed using the EQ5D, both for patients and the population. Several other health status outcomes relevant to the metabolic syndrome were measured, together with lifestyle habits and clinical characteristics. Study II, III and IV were based on a lifestyle intervention for persons with psychosis. Study II was a longitudinal intervention study with a matched reference sample. The purpose of the lifestyle intervention  was to promote a healthier lifestyle by combining theoretical education with physical activities. The intervention group consisted of 42 participants. A matching procedure was made in which two individuals per participant were matched (n=84) into a reference group. The reference sample was matched for sex, BMI class, and being of as similar an age as possible. Socio-demographics were collected and metabolic risk factors relevant to the metabolic syndrome were measured. Symptom severity was measured using Clinical Global Impression (CGI), and HRQoL was assessed using EQ5D. Measurements were made at baseline and at a one-year follow-up. In study III, a qualitative exploratory study was conducted in order to explore prerequisites for a healthy lifestyle. Data were collected through individual interviews (n=40), using a semi-structured interview guide with participants who had undergone the lifestyle intervention. Data were collected 6–7 months after the intervention had been completed. Conventional content analysis was used. Study IV was also based on these 40 interviews and aimed to describe how persons with psychosis perceive participation in a lifestyle intervention. A phenomenographic analysis approach was used. Results/conclusions: Persons with psychosis are at great additional risk of physical comorbidity. Almost half of the patients met the criteria for metabolic syndrome. In addition, persons with psychosis had significantly lower HRQoL in all dimensions in the EQ5D, except for the pain/discomfort dimension. The only risk factor included in the metabolic syndrome that was associated with lower HRQoL was elevated blood pressure. Raised LDL-cholesterol was also related to lower HRQoL, together with low GAF, older age, high BMI, and female gender. The intervention study demonstrated that HRQoL was significantly improved in the intervention group when comparing EQ-VAS at baseline and at the one-year follow-up. It can be concluded that our intervention was not powerful enough to influence the metabolic factors to any greater extent. The key prerequisite for a healthy lifestyle seemed to be a wish to take part in the society and a longing to live like everybody else. However, many became stuck in a constant state of planning instead of taking action towards achieving a healthy lifestyle. Support by health care professionals is therefore also a prerequisite for a healthy lifestyle. This support should target the transition from thought to action and facilitate the participants’ ability to mirror themselves against healthy people in society by introducing activities they perceive that “common people” do. The challenge for health care professionals is to find a moderate intervention level that does not underestimate or overestimate the person’s capacity. This can facilitate continued participation, and participants can thereby find new social contacts and achieve health benefits.