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Bakgrund: Under Covid-19-pandemin använde skolsköterskor på gymnasiet videosamtal för att kommunicera med sina elever. Enligt kompetensbeskrivningen ska skolsköterskan kunna ta ny teknik i anspråk och använda informations- och kommunikationsteknik för att kommunicera. Syfte: Syftet med studien var att beskriva skolsköterskors upplevelser av videosamtal med gymnasieelever under Covid19-pandemin. Metod: En kvalitativ metod med induktiv ansats användes. Data samlades in genom en webbenkät med öppna frågor. Fritextsvar från totalt 24 respondenter analyserades genom kvalitativ innehållsanalys. Resultat: Analysen resulterade i två huvudkategorier: Videosamtal inverkar på kommunikationen mellan skolsköterska och elev; samt Olika praktiska aspekter av att erbjuda eleven videosamtal. I de två huvudkategorier framkom sex underkategorier. Konklusion: Videosamtal ökar tillgängligheten till elevhälsan och medverkar till att skolsköterskankan arbeta mer flexibelt. Elever som av olika anledningar inte kan vara i skolan kan speciellt främjas av videosamtal som mötesform. / Background: During the Covid-19 pandemic school nurses in high school used video calls to communicate with their students. According to the skills description, the school nurse must be able to use modern technology, information, and communication technology to communicate. Aim: The aim of the study was to describe school nurses' experiences of video calls with high school students during the Covid-19 pandemic. Method: The study uses a qualitative method with an inductive approach. Data were collected through an online survey with open-ended questions. Free text responses from a total of 24 respondents were analysed through qualitative content analysis. Results: The analysis resulted in two main categories: Video calls affect communication between school nurse and student; Several practical aspects of offering the student video calls. In the two main categories, six subcategories emerged. Conclusion: Video calls increase accessibility to student health and contribute to the school nurse being able to work more flexibly. Students who cannot attend school for various reasons can particularly benefit from video calls.

There is extensive research over the decades around health care services utilization trends, however, limited data and research exists around student utilization of campus health centers. Furthermore, there is very minimal data on student utilization trends of campus health services since the onset of the Covid-19 pandemic. Since a crucial component to fostering healthy and safe college campuses is through campus health services, it clearly indicates a need for further research on the trends and perceptions of students’ campus health services utilization. This study examines utilization rates of students through exploring key demographic characteristics of students, including their perceptions toward utilization of campus health services, for their physical well-being and medical care. This dissertation is a secondary data analysis of the American College Health Association-National College Health Assessment. This study’s specific aims were to examine if key characteristics exist of students utilizing campus health centers, and if those trends still exist or had shifted after the Covid-19 pandemic. The data was used to evaluate if there are significant relationships between student demographics and their respective perceptions of campus health services. Drawing on a nationally representative sample of undergraduate students, data analysis found various statistical significance based on the various steps in the Andersen Behavioral Model of Health Services Use. The results confirmed there are barriers to college student utilization of health services, specifically for certain race/ethnicity, international students, having an active health insurance policy, and how they perceive health being a priority on campus. Given the vital role that student health services have on college campuses, efforts to increase campus health service utilization should be considered through targeted programming and more inclusive staffing and service offerings.

Till största delen anlitas företagshälsan för efterhjälpande insatser på individnivå. Alla arbetsgivare ska enligt arbetsmiljölagen bedriva ett förebyggande systematiskt arbetsmiljöarbete (SAM). Företagshälsans kompetens utnyttjas sällan i SAM, även om arbetsmiljölagen föreskriver att det ska göras om kompetensen saknas i den egna organisationen. Vid Arbetsmiljöenheten, som är Region Jönköpings läns inbyggda företagshälsa, har en metod arbetats fram för att användas i företagshälsans förebyggande arbetsmiljöarbete. Den kallas SMAK (Strukturerad Multidisciplinär Arbetsmiljökartläggning). Den bygger på nära samarbete med arbetsgivarorganisationen och dess anställda och den ligger till grund för arbetsmiljöarbete och utvärdering av effekten av olika interventioner insatta i syfte att förbättra arbetsmiljön. Arbetssättet har testats i liten skala med goda erfarenheter och syftet med förbättringsarbetet var att skala upp användningen och att fler av medarbetarna på Arbetsmiljöenheten skulle vara involverade. Förbättringsidén var att ett utbildningskoncept utformades och genomfördes för medarbetarna vid Arbetsmiljöenheten och som avslutades med att möjligheter och hinder identifierades tillsammans för den fortsatta utvecklingen av arbetssättet. För att studera vilken påverkan utbildningskonceptet haft för de anställda på Arbetsmiljöenheten användes flermetodsperspektiv. Förbättringsarbetet ledde inte till att SMAK användningen skalades upp eller att fler involverades i det under projekttiden. Däremot ökade uppfattningen om användbarheten för SMAK i företagshälsans arbete och för egen del. De möjligheter och hinder som identifierades ligger till grund för fortsatt arbete. Studien visade att förbättringsarbetet har stärkt det interna samarbetet och bidragit med entusiasm inför en fortsatt gemensam utveckling av användningen av SMAK i förebyggande arbetsmiljöarbete. Studien visade också att även om initiativet till det utvidgade arbetssättet kom från företagshälsans ledning så har förbättringsarbetet lett till en grund för fortsatt utveckling som utgår från medarbetarna på företagshälsan, vilket är en viktig faktor för att lyckas med förbättringsarbete. / The Occupational Health Service (OHS) mostly work with aftercare for the individual. There are general demands for every employer to work with the occupational environment in a planned and systematic way. The competence in OHS is rarely used in the proactive work environment management. The Swedish Work Environment Act tells us to involve the OHS if knowledge and capabilities in your organization is not sufficient. At Arbetsmiljöenheten, which is Region Jönköping County built in OHS, has a tool developed to be used in the OHS involvement in proactive work environment management. It is called SMET (Structured Multidisciplinary Work Evaluation Tool). It depends on close cooperation with the employer and the employees and is the basis for work environment management and evaluation of interventions done to improve the work environment. SMET has been tested with good experiences in a small scale and the aim of the improvement work was to scale up the use and let it be possible for more of the coworkers at Arbetsmiljöenheten to use the tool. The idea to test in the improvement work was to construct an educational program for the coworker at the OHS and then together identify possibilities and obstacles for future work. A multi perspective approach was used to study the effect for the coworkers. There was no increase in the usage of SMET, neither were more coworkers involved during the project. However, coworkers thought SMET was usable both for them as individuals and for the OHS. The possibilities and the obstacles identified after the education became the base for the future work. The result from the study tells that the improvement work has strengthen the cooperation at the occupational health service and there is an enthusiasm for the future codevelopment of the way to work with SMET in preventive and proactive work environment management. The result from the study also says that even if the initiative for an extended way of working initially come from the management, the improvement work has led to a foundation on which to build on where the coworkers are central, which is important for successful improvement work.

Abstract: Aim: This study aimed at getting an understanding and critical analyses of the Ethiopian government empowerment strategy in improving maternal and child health in Ethiopia.Method: This is an ethnographic study, in which mainly un-structured interviews, focus group discussions and participant observation were conducted to collect data for the study. Results: The study concluded that the empowerment intiative has been promising to some extent in addressing the health concerns of women and children in Ethiopia. However, lack of bottom up health promotion strategies such as geniune community participation in the designing and implementation of the health program has greatly hindered the health promotion program from effectively improving the health status of women in the studied community.

While there is a large body of research demonstrating that Asian-Americans underutilize mental health services compared to other ethnic groups, little is known about how Vietnamese-Americans use formal mental health services. The traumatic war, post-war and refugee journey contributed to incidences of PTSD and other mental disorders. This mixed-method study aims to understand how multigenerational Vietnamese-Americans view their serious mental illness and how past experiences, family structure, and social networks influence mental health and use of mental health services. The theories that guided the research were the Network-Episode Model and Social Network Orientation Theory. Quantitative analyses using data from the National Latino and Asian-American Study (NLAAS) examined the relationship of variables assessing acculturation, social support, cultural identity, and health/mental health status with formal mental health service use for the Vietnamese-American subsample (N=520). The qualitative study explored how Vietnamese-Americans in multigenerational households experience severe mental illness and the reasons that influenced their mental health help-seeking and service use. Semi-structured interviews with 17 members of six multigenerational Vietnamese families from the greater Boston and Los Angeles area were conducted in English, transcribed, and analyzed using thematic analysis. Findings from the study highlight the differences between 1st and 2nd generation Vietnamese respondents and provide insight into how generational culture – the prevailing attitudes, values, and beliefs of each generation – influences the social network support of Vietnamese-Americans and affects their mental health help-seeking behavior. The forced migration severed social networks, restricting 1st generation respondents to rely on small family networks for information and support. The traditional matriarchal hierarchy limited access to treatment as younger 2nd generation Vietnamese-Americans were unable to convince their parents to seek help for serious mental health problems or to get their approval to seek treatment. Cultural values such as belief in spiritual healers and self-reliance also insulated families from seeking professional help. The study found that the types of interactions respondents had with their social networks—whether positive or negative in orientation—shaped their beliefs about who and where they could go to for help with serious mental health problems and was instrumental in creating pathways to mental health service use.

In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing ¿outcome¿ data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of ¿feminine carer¿ offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders¿ stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a ¿space¿ for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the ¿other¿, offenders were able to re-author a more ¿moral¿ and ¿worthy¿ self. Moreover, the ATR has been found to be successful in enabling the offenders¿ hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.

Prenatal care (PNC) is an essential health service that can reduce adverse health and social outcomes through prevention, detection and treatment of abnormalities of pregnancy. It offers an opportunity to mitigate the impact of the Social Determinants of Health (SDoH) on individual patients through advocacy and referral to social services. Despite a publicly funded health care system in Canada, disparities in access to PNC persist. Much is known about the barriers to PNC and client experiences of inadequate PNC (IPNC). Very little is known about care provider perspectives of IPNC, what should be done about it and are the barriers to doing it. The goal of this project was to address this gap in knowledge to inform the development of novel care delivery models that could reduce disparities in access to PNC in Hamilton. Using a Critical Theory lens, I conducted an interpretive descriptive study using individual interviews and focus groups with health and social service providers in Hamilton to explore their understandings of IPNC. Participants viewed IPNC as a small but important phenomenon disproportionately impacting people who are marginalized. The experience of IPNC is chaotic, worrisome and joyful for providers. An interdisciplinary, midwifery-led outreach PNC model would better meet the needs of the client population and providers alike. A Community Centred Care model of PNC embodies and enhances participant suggestions for addressing IPNC. Access to abortion, postpartum care and newborn apprehension require special attention. Peer participation and the impacts of patriarchy and racism must be addressed in the development of future PNC models. The ways in which participants described and proposed intervening in IPNC revealed an individualized understanding of the SDoH that is paralleled in existing research on IPNC. This conceptualization of the problem obscures the root causes of disparities in access and warrants future consideration. / Thesis / Master of Science (MSc) / Prenatal care (PNC) can help to reduce complications of pregnancy and birth and connect expecting families with other support services. Even though health care is free in Canada, people who are marginalized struggle to access enough PNC. We know the complexities of people’s lives and their negative experiences with the health care system prevent them from getting PNC. We know little about what PNC for people who don’t access it is like for the providers or why they can’t make their care easier to access. Mindful of systems of power, the goal of this research is to explore how health and social service providers understand inadequate PNC (IPNC), to inform accessible PNC models. Participants proposed an interdisciplinary outreach PNC model responsive to needs of the community. The Social Determinants of Health were an important part of how participants understood IPNC which shaped the way that they proposed to address it.

Background: The impact children with complex healthcare needs have on the healthcare system is significant and requires a multidisciplinary response. Congenital anomaly (CA) is a group of conditions requiring complex and variable input from primary and secondary healthcare. This thesis explores the literature on health system preparedness for children with complex healthcare needs and quantitatively describes healthcare use for a population of children with CA, an exemplar for children with complex healthcare needs. Methods: Routine health data from primary care was explored to identify children with CA and linked to secondary care data, outpatient records, and questionnaire data from a multi-ethnic prospective birth cohort over a five-year period. Rates of CA were calculated and healthcare use for children with and without CA was analysed. Results: Out of a birth cohort of 13,857 children, 860 had a CA. Using primary care data for children aged 0 to 5 years, the number of children with CA was found to be 620.6 per 10,000 live births, above the national rate of 226.5 per 10,000 live births. Healthcare use was higher for children with CA than those without CA. Demand for use of hospital services for children with CA was higher (Incident rate ratio (IRR) 4.38, 95% confidence interval (CI) 3.90 to 4.92) than demand for primary care services (IRR, 1.27, 95% CI 1.20 to 1.35). Conclusion: These results suggest that using primary care data as a source of CA case ascertainment reveals more children with CA than previously thought. These results have significant implications for commissioning healthcare services for children with complex healthcare needs.

Bakgrund: Arbetsgivaren har det övergripande ansvaret för att arbetsmiljön är tillfredställande på arbetsplatsen - bruksskedet. Flertalet av de fysiska arbetsmiljöfaktorerna som arbetsgivaren har att ansvara för bestäms tidigt i byggprocessen, i planerings- och projekteringsstadiet. Arbetsmiljölagen beskriver vilka uppgifter och ansvar som åligger byggherre och projektörer som låter utföra ett byggnads- eller anläggningsarbete. Litteraturen beskriver en utveckling där arkitekter och andra projektörers ansvar för att beakta arbetsmiljöaspekten har ökat. Ett ansvar där deras insatser ofta är begränsade. Syfte: Syftet med uppsatsen är att undersöka vilken roll arbetsmiljö­ingenjören kan ha i att beakta arbetsmiljön gällande bruksskedet vid planering och projektering av nya kontorsarbetsplatser. Metod: Uppsatsen bygger på litteraturgenomgång samt intervjuer med huvudsakligen arbetsmiljöingenjörer och arkitekter. Resultat: Litteratur och intervjuer visar att arbetsmiljöingenjörer engageras sent i processen vilket resulterar i brister i arbetsmiljön och ombyggnationer som åtgärd. Här framträder också en situation där kunskapsläget runt arbetsmiljöfrågor hos arkitekter upplevs som svagt, vilket bekräftas av de intervjuade. Respondenterna menar att checklista som arbetsverktyg används i mer eller mindre stor utsträckning. Befintliga checklistor från Arbetsmiljöverket presenteras i uppsatsen, dessa rekommenderas som arbetsverktyg. Slutsats: Av intervjuerna framkommer att respondenterna menar att arbetsmiljöingenjören kan agera sakkunnig, utifrån sin kunskap och erfarenhet, i projekteringsprocessen. Arbetsmiljöingenjören utgör därmed med sin sakkunskap runt arbetsmiljöfrågor ett stöd för byggherre och projektör. Den ansvarsroll som Arbetsmiljölagen beskriver, Byggarbets­miljösamordnare - planering och projektering (BAS-P), torde utgöra en naturlig roll för arbetsmiljöingenjören. I och med detta får arbetsmiljöingenjören en naturlig roll tidigt i byggprocessen.   Nyckelord: Byggprojektering, arkitekt, arbetsmiljö, företagshälsa, checklista. / Abstract Background: The employer has the overall responsibility that the work environment is satisfactory in the work place, the usage stage. Most of the physical working environment factors which the employer has the responsibility for are determined early in the construction process, in the planning and design stage. Work environment legislation describes the tasks and responsibilities for the property developer and design engineers, how the work environment should be considered and who is responsible for the construction process from design to operation stage. The literature describes a development in which architects and other property developers responsibility to take into account the working environment aspect has increased. A responsibility where their efforts are often limited. Purpose: The purpose of this thesis is to examine which role the occupational health and safetey (OHS) engineer may have to take into account in the planning and design of new office workplaces. Method: The thesis is based on literature review and interviews with mainly working engineers and architects. Results: The literature and interviews shows that the OHS engineer is involved late in the process, resulting in shortages and rebuilding as a measure. It also emerges a situation where the knowledge of work environment legislation of architects are perceived as weak, which is confirmed by those interviewed. Respondents believe that checklist as a tool is used more or less often. Existing checklists from the Swedish Work Environment Authority (Arbetsmiljöverket) are presented in the thesis and are recommended as tool to be used. Conclusion: The interviews reveal that respondents believe that the OHS engineer can act as an expert, based on their knowledge and experience in the planning process. The OHS engineer thus constitutes its expertise and supports the property developer and the design engineer. The role, described in Swedish Work Environment Legislation (Arbetsmiljöverket), construction work environmental coordinator - planning and design (BAS-P) would be a natural role for the OHS engineer. The OHS engineer is given a natural role early in the construction process. Keywords: Construction planning, Architect, Work Environment, Occupational Health Service, Checklist