Bakgrund: Diabetes typ 2 ökar globalt och är en stor patientgrupp för vården att möta. För att minska risken för komplikationer i form av hjärt- och kärlsjukdomar anses optimering av patientens egenvård vara av stor vikt. Patienter känner en oro över sin sjukdom och vet inte hur de ska hantera de livsförändringar som sjukdomen kräver. Att självständigt kunna hantera diabetes typ 2 är för patienten en förutsättning för att känna livskvalité. Rekommendationerna från socialstyrelsen är att hålla egenvårdsutbildning i grupp. Patienters upplevelse av den egenvårdsutbildning som erbjuds är av vikt att undersöka eftersom de utgör nyckeln i strävandet och utformningen av en god diabetesvård. Syfte: Syftet var att beskriva hur patienter med diabetes typ 2 upplever egenvårdsutbildning i grupp i primärvården. Metod: Litteraturöversikt med tretton artiklar. Resultat: De olika studierna som redovisades i resultatet har gett en klarare bild av hur deltagarna upplevde egenvårdsutbildning i grupp. De flesta upplevde egenvårdsutbildning i grupp som positiv. Deltagarna kunde ställa frågor och dela med sig av tips och råd till varandra. Mötena gav dem chansen att uttrycka sina frågor mer öppet och motiverade till att utföra de livsstilsförändringar de behövde göra. Miljön upplevdes inte lika sträng som under de individuella mötena. Konklusion: De flesta deltagarna upplevde möjligheten att ställa frågor fritt och dela med sig av sina erfarenheter som positiv. Detta är en bidragande faktor till att deltagarna fortsatte att delta i grupperna och på så sätt genomföra de olika livsstilsförändringarna som de behövde göra för en bättre hälsa och livskvalité. / Background: Diabetes type 2 has increased globally which has become a huge patient-group for the healthcare system to face. To minimize the risk of complications such as cardiovascular complication it is therefore of great importance to optimize the self-management care for patient with diabetes type 2. Some patient feel level of uneasiness when it comes to their disease and the lifestyle changes that their disease require them to do. To be able to individually manage their diagnosis is the key for quality of life. The recommendations from Socialstyrelsen is to have self-management care education in groups. Patients experience of self-care management groups are therefore of great importance for the requisite and formation of better diabetes care. Aim: The aim of this study was to examine patient with diabetes type 2 experiences of self-care management education in groups. Method: Literature review consisting of 13 articles. Results: The different studies in this review has given a clearer picture of how the participants experienced the self-care management education in groups. The majority of the participants experienced the self-care management groups as a positive, where they could ask questions and share ideas and experiences with other participants. The meetings in group gave them the chance to express questions more freely. This was experienced by the participants as a positive experience. The meeting in groups motivated them to change their lifestyles changes that were required for a better health and quality of life. The environment of the groupmeetings were not as stern as the individual meetings could be. Conclusion: Most of the participants experienced the possibility of raising questions freely and sharing experiences as something positive. This were a contributing factor that motivated them to continue participate in the groupmeetings to follow through with the lifestyle changes for a better health and quality of life.

<p><strong>Bakgrund</strong>: i Sverige har ungefär fyra procent av befolkningen diabetes. Vid behandling av diabetes (typ-2) är målet att minska risken för komplikationer. Detta kan göras med hjälp av livsstilsförändringar (kost, motion) eller/och farmakologisk behandling. Riskfaktorer för komplikationer är högt blodtryck och höga blodfetter. Komplikationer kan ge mikro- och makrovaskulära förändringar i till exempel ögon, njurar respektive hjärta och blodkärl. Patientutbildning är en central del i behandlingen av typ 2 diabetes.</p><p><strong>Syfte</strong>: vårt syfte med denna studie var att belysa deltagarnas uppfattning av att delta i en grupputbildning om deras diabetessjukdom.</p><p><strong>Metod</strong>: I studien intervjuades sex kvinnor och fyra män (i åldern 65-78 år) som alla deltagit i grupputbildning om diabetes. Intervjuerna analyserades med hjälp av analysmetoden fenomenografi.</p><p><strong>Resultat</strong>: utifrån deltagarnas uppfattningar bildades tre beskrivningskategorier: <em>att lära sig mer</em>, <em>att kommunicera på rätt nivå</em> och <em>livsstilsförändringar.</em><strong></strong></p><p><strong>Konklusion</strong>:<strong> </strong>Vi anser att grupputbildning kan vara både tidsbesparande och kostnadseffektivt. Det kan vara betydelsefullt att informanterna använder ett språk som även icke sjukvårdsutbildade förstår. Vi anser att det vore värdefullt med någon slags uppföljning, vilket skulle kunna ha en motivationshöjande effekt för deltagarna.  För vidare forskning och utveckling i ämnet skulle det vara av intresse att göra intervjuer med ett större urval.</p> / <p><strong>Background</strong>: in Sweden about four percent of the population has diabetes disease. The goal of treatment is to minimize the risk of complications. It can be done with the help of lifestyle changes (diet, exercises) or/and pharmacological treatment. The risk factors for complications are high blood pressures and high blood lipids. The complications can lead to micro- and macro vascular changes, for example in eyes, kidneys, heart and vascular. Patient education plays a central role in type 2 diabetes treatment.</p><p><strong>Aim</strong>: our aim with this study was to elucidate how persons with diabetes considered of attending a group education about their disease.</p><p><strong>Method: </strong>In the study interviewed six women and four men (in the age 65-78 years) that everyone participated in group education about diabetes. The interviews were analyzed with the aid of analysis method phenomenography. <strong></strong></p><p><strong>Results</strong>: on the basis of the participants’ views refined three description categories: to learn more, to communicate on correct level and lifestyle changes.<strong></strong></p><p><strong>Conclusion</strong>: We consider that group education can to be both time-saving and cost-effectively. It can be important to use a language that also non healthcare trained understands. We consider it would be important with some kinds of follow-up, it would to have a motivation increasing effect. For further research and development in the matter would the last of interests to do interviews with a broader selection.</p>

Bakgrund: i Sverige har ungefär fyra procent av befolkningen diabetes. Vid behandling av diabetes (typ-2) är målet att minska risken för komplikationer. Detta kan göras med hjälp av livsstilsförändringar (kost, motion) eller/och farmakologisk behandling. Riskfaktorer för komplikationer är högt blodtryck och höga blodfetter. Komplikationer kan ge mikro- och makrovaskulära förändringar i till exempel ögon, njurar respektive hjärta och blodkärl. Patientutbildning är en central del i behandlingen av typ 2 diabetes. Syfte: vårt syfte med denna studie var att belysa deltagarnas uppfattning av att delta i en grupputbildning om deras diabetessjukdom. Metod: I studien intervjuades sex kvinnor och fyra män (i åldern 65-78 år) som alla deltagit i grupputbildning om diabetes. Intervjuerna analyserades med hjälp av analysmetoden fenomenografi. Resultat: utifrån deltagarnas uppfattningar bildades tre beskrivningskategorier: att lära sig mer, att kommunicera på rätt nivå och livsstilsförändringar. Konklusion: Vi anser att grupputbildning kan vara både tidsbesparande och kostnadseffektivt. Det kan vara betydelsefullt att informanterna använder ett språk som även icke sjukvårdsutbildade förstår. Vi anser att det vore värdefullt med någon slags uppföljning, vilket skulle kunna ha en motivationshöjande effekt för deltagarna.  För vidare forskning och utveckling i ämnet skulle det vara av intresse att göra intervjuer med ett större urval. / Background: in Sweden about four percent of the population has diabetes disease. The goal of treatment is to minimize the risk of complications. It can be done with the help of lifestyle changes (diet, exercises) or/and pharmacological treatment. The risk factors for complications are high blood pressures and high blood lipids. The complications can lead to micro- and macro vascular changes, for example in eyes, kidneys, heart and vascular. Patient education plays a central role in type 2 diabetes treatment. Aim: our aim with this study was to elucidate how persons with diabetes considered of attending a group education about their disease. Method: In the study interviewed six women and four men (in the age 65-78 years) that everyone participated in group education about diabetes. The interviews were analyzed with the aid of analysis method phenomenography. Results: on the basis of the participants’ views refined three description categories: to learn more, to communicate on correct level and lifestyle changes. Conclusion: We consider that group education can to be both time-saving and cost-effectively. It can be important to use a language that also non healthcare trained understands. We consider it would be important with some kinds of follow-up, it would to have a motivation increasing effect. For further research and development in the matter would the last of interests to do interviews with a broader selection.

Bakgrund: Distriktssköterskan har en viktig roll att stödja patienter att leva med långvarig sjukdom som exempelvis diabetes typ 2. Om målet är att stödja lärandet på ett sätt som stärker personen krävs kunskaper om patientens behov och om hur lärandet går till. Syfte: Syftet var att beskriva patienters erfarenheter av gruppundervisning utifrån modellen "Att ta rodret i livet med diabetes typ 2".  Metod: En kvalitativ metod med ett fenomenologiskt livsvärldsperspektiv har använts. Studien bygger på grupp- och enskilda intervjuer samt reflektionsböcker. Resultat: Fenomenet innebär att lära av varandra, genom delande av erfarenheter och att frågor ställs som annars inte skulle blivit ställda. Lärandet som sker med stöd av gruppen bidrar till insikt i komplexiteten i sjukdomen och ökar motivationen till att ta eget ansvar för behandling och genomförande av nödvändiga levnadsvanor. Gruppen bidrar till en känsla av samhörighet och gemenskap som inspirerar till ett fortsatt och aktivt lärande.  Konklusion: Resultatet visar att gruppundervisning är en bra och av patienterna uppskattad undervisningsform som stödjer och underlättar lärandet. Reflektionerna i grupp är givande och leder till ett stort erfarenhetsutbyte mellan patienterna. / "Att ta rodret i livet vid diabetes typ 2 - gruppundervisning i primärvården"

Bakgrund: Då en patient drabbas av långvarig sjukdom som Diabetes typ 2 uppstår ett behov av kunskap för att hantera sin sjukdom. Tidigare forskning visar att gruppundervisning till patienter med diabetes typ 2 sänker HbA1c vilket i sin tur minskar risken för komplikationer. Problemet är att alla inte erbjuds grupputbildning och ett annat problem är att en betydande andel tackar nej till erbjuden utbildning. Syfte: Syftet var att beskriva uppfattningar om gruppundervisning hos patienter med diabetes typ 2 som valt att avstå erbjuden gruppundervisning. Metod: Nio semistruktuerade intervjuer analyserades med en fenomenografisk metod. Intervjuerna analyserades genom sju steg för att få fram uppfattningar om hur patienter med diabetes typ 2 som valt att avstå erbjuden gruppundervisning resonerar. Resultat: Analysen resulterade i två kvalitativt skilda beskrivningskategorier sett ur ett patientperspektiv: en möjlighet att dela erfarenheter med andra i samma situation men med risk att ”blotta” sig själv och sin sjukdom i en grupp med okända samt att formen för lärande och kunskap inte är anpassat till patientens specifika behov och prioriteras inte då sjukdomen inte uppfattas som allvarlig. Konklusion: En möjlig förståelse av resultatet är att gruppundervisning inte passar alla utan en variation av former för undervisning krävs så att patienter kan få den undervisning som de själva uppfattar som kunskapsgivande, i passande tid och form. / Background: When a patient suffers from long-term illness such as type 2 diabetes, there is a need for knowledge to deal with their illness. Earlier research shows that group education for patients with type 2 diabetes is of significance for, among other things, HbA1c, which in turn reduces the risk of complications. However, the main problem with group education is that not all patients are offered to participate and that a significant percentage of those that are invited to group education sessions decline the offer. Aim: The purpose was to describe perceptions of newly diagnosed patients with type 2 diabetes to refrain from offering group instruction. Method: Nine semi-structured interviews have been analysed by using a phenomenographic approach. The interviews were analysed through seven steps to unveil the perceptions of group education in people with type 2 diabetes which chose to renounce the offered group education. Results: The analysis resulted in two different categories of descriptions seen from a patient perspective: an opportunity to share experiences with others in the same situation but with the risk of “exposing” themselves and their illness in a group with unknown and the form of learning and knowledge is not adapted to the person´s specific needs and is not prioritized when the disease is not perceived as serious. Conclusion: A possible understanding of the result is that group education does not suit everyone but a verity of form of education are required so that the patients can get the education that themselves perceive as giving knowledge, in appropriate time and form.

Doctor of Philosophy / Excerpt Chapter 2 - A review of the literature has revealed that asthma management practices in the Australian community are currently suboptimal resulting in significant morbidity and mortality. In adolescent asthma there are added challenges, with problems of self-image, denial and non-adherence to therapy where self-management skills assume a greater importance (Forero et al 1996, Price 1996, Brook and Tepper 1997, Buston and Wood 2000, Kyngäs et al 2000). In rural and remote areas in Australia, asthma management practices have been shown to be poorer and mortality rates from asthma are considerably higher compared to metropolitan areas (AIHW ACAM 2005, AIHW 2006). Limited access and chronic shortages of specialist services in rural areas are shifting the burden more and more towards the primary sector (AIHW 2006). It becomes paramount that people with asthma in rural settings become involved in self-management of their asthma and that community based health care providers be more proactive in facilitating these self-management behaviours by appropriate education and counselling. Health promotion activities, which are a broad range of activities including health education, have been acknowledged as having the potential to improve the health status of rural populations (National Rural Health Alliance 2002). Community pharmacy settings have been shown to be effective sites for the delivery of health promotion, screening and education programs (Anderson 2000, Elliott et al 2002, Cote et al 2003, Hourihan et al 2003, Watson et al 2003, Boyle et al 2004, Goode et al 2004, Paluck et al 2004, Sunderland et al 2004, Chambers et al 2005, Saini et al 2006). In the case of asthma, outreach programs have been shown to have beneficial effects in terms of reducing hospital admissions and emergency visits and improved asthma outcomes (Greineder et al 1995, Stout et al 1998, Kelly et al 2000, Legorreta et al 2000, Lin et al 2004). We proposed to extend the role of the community pharmacist beyond the traditional realm of the “pharmacy” into the community in rural Australia with the first asthma outreach programs designed for community pharmacy. The outreach programs were designed to include two health promotion strategies, the first targeting adolescents in high schools and the second targeting the general community. The project aimed firstly, to assess the feasibility of using community pharmacists to deliver two asthma outreach programs, one targeting adolescents and one for the wider community in a rural area and secondly, to assess the programs’ impact on adolescent asthma knowledge and requests for information at the community pharmacy. Excerpt Chapter 3 - Patient education is one of the six critical elements to successful long-term asthma management included in international and national asthma management guidelines, which have emphasised education as a process underpinning the understanding associated with appropriate medication use, the need for regular review, and self-management on the part of the person with asthma (Boulet et al 1999, National Asthma Council 2002, National Asthma Education and Prevention Program 2002, British Thoracic Society 2003, NHLBI/WHO 2005). The ongoing process of asthma education is considered necessary for helping people with asthma gain the knowledge, skills, confidence and motivation to control their own asthma. Since most health care professionals are key providers of asthma education, their knowledge of asthma and asthma management practices often needs to be updated through continuing education. This is to ensure that the education provided to the patient conforms to best practice guidelines. Moreover, health care professionals need to tailor this education to the patients’ needs and determine if the education provided results in an improvement in asthma knowledge. A review of the literature has revealed that a number of questionnaires have been developed that assess the asthma knowledge of parents of children with asthma (Parcel et al 1980, Fitzclarence and Henry 1990, Brook et al 1993, Moosa and Henley 1997, Ho et al 2003), adults with asthma (Wigal et al 1993, Allen and Jones 1998, Allen et al 2000, Bertolotti et al 2001), children with asthma (Parcel et al 1980, Wade et al 1997), or the general public (Grant et al 1999). However, the existing asthma knowledge questionnaires have several limitations. The only validated asthma knowledge questionnaire was developed in 1990 and hence, out of date with current asthma management guidelines (Fitzclarence and Henry 1990). The shortcomings of the other knowledge questionnaires relate to the lack of evidence of the validity (Wade et al 1997, Grant et al 1999, Bertolotti et al 2001), being outdated 81 with current concepts of asthma (Parcel et al 1980) or having been tested on small or inadequately characterised subject samples e.g. subject samples consisting of mainly middle class and well educated parents (Brook et al 1993, Wigal et al 1993, Moosa and Henley 1997, Allen and Jones 1998, Allen et al 2000, Ho et al 2003). Furthermore, most of the published asthma knowledge questionnaires have been designed to assess the asthma knowledge of the consumer (i.e. a lay person with asthma or a parent/carer of a person with asthma). There is no questionnaire specifically developed to assess the asthma knowledge of health care professionals, who are key providers of asthma education. It is hence important to have a reliable and validated instrument to be able to assess education needs and to measure the impact of training programs on asthma knowledge of health care professionals as well. An asthma knowledge questionnaire for health care professionals might also be used to gauge how successful dissemination and implementation of guidelines have been. Excerpt Chapter 4 - Asthma self-management education for adults that includes information about asthma and self-management, self-monitoring, a written action plan and regular medical review has been shown to be effective in improving asthma outcomes (Gibson et al 1999). These interventions have been delivered mostly in a hospital setting and have utilised individual and/or group formats. Fewer interventions have been delivered in a primary care setting, usually by qualified practice nurses and/or general practitioners or asthma educators and, to date, their success has not been established (Fay et al 2002, Gibson et al 2003). Community pharmacy provides a strategic venue for the provision of patient education about asthma. Traditionally, patient education provided by community pharmacists has been individualised. However, group education has been shown to be as effective as individualised education with the added benefits of being simpler, more cost effective and better received by patients and educators (Wilson et al 1993, Wilson 1997). While small group education has been shown to improve asthma outcomes (Snyder et al 1987, Bailey et al 1990, Wilson et al 1993, Yoon et al 1993, Allen et al 1995, Kotses et al 1995, Berg et al 1997, de Oliveira et al 1999, Marabini et al 2002), to date, no small-group asthma education provided by pharmacists in the community pharmacy setting has been implemented and evaluated.

The major part of care in type 2 diabetes is in the hands of the patient so the focus of educational interventions should be on the person behind the disease. An experience-based group education programme that actively promotes participants’ reflection and understanding has been designed and implemented in cooperation with the Swedish Pharmacy. The regression model presented in Paper I revealed the importance of self-perceived role in diabetes management. Blood glucose control two years after baseline was improved for participants who described themselves as having an active role in their treatment, compared to those taking on a passive or a compliant role. Paper II described the resulting categories from content analysis of three open-ended questions about participants’ role, goal and support needs in diabetes management. The people taking care of diabetes most effectively and needing least support were called Disease Managers; those following the health professionals’ orders and depending on regular controls were categorised as Compliant, whereas the Disheartened had difficulties in achieving good metabolic control and often described both medical and social obstacles. These three self-management profiles were strongly correlated to metabolic outcomes. In Paper III perceptions of diabetes management were reassessed: perceptions were only stable in approximately half of participants, thus providing evidence for a dynamic model of learning self-management in diabetes. The three self-management profiles still correlated with metabolic outcomes. In paper IV the long-term metabolic outcome (HbA1c) of the study population was investigated. Metabolic control was stable up to seven years following the intervention, in contrast to the metabolic deterioration often present in diabetes. The main message of this thesis is that participants’ self-perceived role had a major influence on metabolic outcomes. Assessing self-management profiles both in diabetes and possibly other chronic conditions can help health care providers to tailor their educational efforts accordingly. Furthermore, this experience-based patient education programme outside the framework of routine diabetes care has the potential to stabilise metabolic control on the long run effectively.

Doctor of Philosophy / Excerpt Chapter 2 - A review of the literature has revealed that asthma management practices in the Australian community are currently suboptimal resulting in significant morbidity and mortality. In adolescent asthma there are added challenges, with problems of self-image, denial and non-adherence to therapy where self-management skills assume a greater importance (Forero et al 1996, Price 1996, Brook and Tepper 1997, Buston and Wood 2000, Kyngäs et al 2000). In rural and remote areas in Australia, asthma management practices have been shown to be poorer and mortality rates from asthma are considerably higher compared to metropolitan areas (AIHW ACAM 2005, AIHW 2006). Limited access and chronic shortages of specialist services in rural areas are shifting the burden more and more towards the primary sector (AIHW 2006). It becomes paramount that people with asthma in rural settings become involved in self-management of their asthma and that community based health care providers be more proactive in facilitating these self-management behaviours by appropriate education and counselling. Health promotion activities, which are a broad range of activities including health education, have been acknowledged as having the potential to improve the health status of rural populations (National Rural Health Alliance 2002). Community pharmacy settings have been shown to be effective sites for the delivery of health promotion, screening and education programs (Anderson 2000, Elliott et al 2002, Cote et al 2003, Hourihan et al 2003, Watson et al 2003, Boyle et al 2004, Goode et al 2004, Paluck et al 2004, Sunderland et al 2004, Chambers et al 2005, Saini et al 2006). In the case of asthma, outreach programs have been shown to have beneficial effects in terms of reducing hospital admissions and emergency visits and improved asthma outcomes (Greineder et al 1995, Stout et al 1998, Kelly et al 2000, Legorreta et al 2000, Lin et al 2004). We proposed to extend the role of the community pharmacist beyond the traditional realm of the “pharmacy” into the community in rural Australia with the first asthma outreach programs designed for community pharmacy. The outreach programs were designed to include two health promotion strategies, the first targeting adolescents in high schools and the second targeting the general community. The project aimed firstly, to assess the feasibility of using community pharmacists to deliver two asthma outreach programs, one targeting adolescents and one for the wider community in a rural area and secondly, to assess the programs’ impact on adolescent asthma knowledge and requests for information at the community pharmacy. Excerpt Chapter 3 - Patient education is one of the six critical elements to successful long-term asthma management included in international and national asthma management guidelines, which have emphasised education as a process underpinning the understanding associated with appropriate medication use, the need for regular review, and self-management on the part of the person with asthma (Boulet et al 1999, National Asthma Council 2002, National Asthma Education and Prevention Program 2002, British Thoracic Society 2003, NHLBI/WHO 2005). The ongoing process of asthma education is considered necessary for helping people with asthma gain the knowledge, skills, confidence and motivation to control their own asthma. Since most health care professionals are key providers of asthma education, their knowledge of asthma and asthma management practices often needs to be updated through continuing education. This is to ensure that the education provided to the patient conforms to best practice guidelines. Moreover, health care professionals need to tailor this education to the patients’ needs and determine if the education provided results in an improvement in asthma knowledge. A review of the literature has revealed that a number of questionnaires have been developed that assess the asthma knowledge of parents of children with asthma (Parcel et al 1980, Fitzclarence and Henry 1990, Brook et al 1993, Moosa and Henley 1997, Ho et al 2003), adults with asthma (Wigal et al 1993, Allen and Jones 1998, Allen et al 2000, Bertolotti et al 2001), children with asthma (Parcel et al 1980, Wade et al 1997), or the general public (Grant et al 1999). However, the existing asthma knowledge questionnaires have several limitations. The only validated asthma knowledge questionnaire was developed in 1990 and hence, out of date with current asthma management guidelines (Fitzclarence and Henry 1990). The shortcomings of the other knowledge questionnaires relate to the lack of evidence of the validity (Wade et al 1997, Grant et al 1999, Bertolotti et al 2001), being outdated 81 with current concepts of asthma (Parcel et al 1980) or having been tested on small or inadequately characterised subject samples e.g. subject samples consisting of mainly middle class and well educated parents (Brook et al 1993, Wigal et al 1993, Moosa and Henley 1997, Allen and Jones 1998, Allen et al 2000, Ho et al 2003). Furthermore, most of the published asthma knowledge questionnaires have been designed to assess the asthma knowledge of the consumer (i.e. a lay person with asthma or a parent/carer of a person with asthma). There is no questionnaire specifically developed to assess the asthma knowledge of health care professionals, who are key providers of asthma education. It is hence important to have a reliable and validated instrument to be able to assess education needs and to measure the impact of training programs on asthma knowledge of health care professionals as well. An asthma knowledge questionnaire for health care professionals might also be used to gauge how successful dissemination and implementation of guidelines have been. Excerpt Chapter 4 - Asthma self-management education for adults that includes information about asthma and self-management, self-monitoring, a written action plan and regular medical review has been shown to be effective in improving asthma outcomes (Gibson et al 1999). These interventions have been delivered mostly in a hospital setting and have utilised individual and/or group formats. Fewer interventions have been delivered in a primary care setting, usually by qualified practice nurses and/or general practitioners or asthma educators and, to date, their success has not been established (Fay et al 2002, Gibson et al 2003). Community pharmacy provides a strategic venue for the provision of patient education about asthma. Traditionally, patient education provided by community pharmacists has been individualised. However, group education has been shown to be as effective as individualised education with the added benefits of being simpler, more cost effective and better received by patients and educators (Wilson et al 1993, Wilson 1997). While small group education has been shown to improve asthma outcomes (Snyder et al 1987, Bailey et al 1990, Wilson et al 1993, Yoon et al 1993, Allen et al 1995, Kotses et al 1995, Berg et al 1997, de Oliveira et al 1999, Marabini et al 2002), to date, no small-group asthma education provided by pharmacists in the community pharmacy setting has been implemented and evaluated.

Cehic, A & Meijer, S. Gruppundervisning för individer med diabetes typ 2. En litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö högskola: Hälsa och samhälle, Utbildningsområde omvårdnad, 2009.Syftet med denna litteraturstudie var att undersöka om det finns stöd i vetenskaplig litteratur för att gruppundervisning för individer med typ 2-diabetes stimulerar till livsstilsförändringar. Författarna ville även belysa vilka faktorer i undervisningen som är viktiga. Litteraturstudien är genomförd efter modell av Friberg (2006). Tio kvantitativa artiklar ligger till grund för resultatet. Detta visar på starkt stöd för att gruppundervisning stimulerar typ 2-diabetiker till livsstilsförändringar. Viktiga faktorer i undervisningen var att den som ledde undervisningen hade förtrogenhetskunskap om diabetes, att undervisningen byggde på empowerment och/eller problembaserat lärande och stimulerade till aktiv medverkan av gruppdeltagarna, samt att utbildningen hade långtidsuppföljningar. Ingen skillnad sågs mellan undervisning som leddes av olika yrkeskategorier. Ytterligare forskning med fler studier med långtidsuppföljning samt kvalitativa studier av individernas egna upplevelser är önskvärda. / Cehic, A & Meijer, S. Group education for individuals with type 2 diabetes. A literature review. Degree Project, 15 Credit Points. Malmö University: Health and Society, Department of Nursing, 2009.The aim of this review was to examine if there is support in scientific literature that group education for individuals with type 2 diabetes encourages lifestyle changes. The authors also wished to describe what factors in group education are important. A model of Friberg (2006) was used as method for the review. The result, based on 10 quantitative articles, shows strong support for group education encouraging type 2 diabetics to make lifestyle changes. Important factors in education were familiarity of diabetes in the educators and education based on empowerment and/or problem based learning. Also was long term follow-up of the education groups important. No differences were seen in the results between groups led by different professions. Further research, more long-term studies and qualitative studies of how patients experience group education, is required.

Denna studie bygger på en jämförelse mellan hur pianopedagoger förändrar sina didaktiska val beroende på undervisningsform, i detta fall enskild undervisning eller gruppundervisning. Tre pianopedagoger har intervjuats och sex observationer har genomförts. En då vardera pedagog undervisade i grupp och en då pedagogerna undervisade enskilda elever. Undersökningen har genomförts med hermeneutik och det sociokulturella perspektivet som teori med inslag från Lev. S. Vygotskijs tankar kring kamratlärande och den proximala utvecklingszonen. De visuella, auditiva och kinestetiska lärstilarna valdes ut som särskilt viktiga för undersökningen samt sången och rytmikmetoden som redskap i undervisningen. Dessa redskap valdes ut med grund i dess positiva påverkan på inlärning och kontinuerliga närvaro under min utbildning på Kungl. Musikhögskolan i Stockholm. En koncentration har funnits kring de redskap, enligt den sociokulturella teorin, som pedagogerna använt i sin undervisning och hur faktorer som samspel och kamratlärande har använts och speglats i undervisningen. Resultatet presenteras i två delar. Tre intervjuer med pianopedagoger visar att de inte anser sig göra någon skillnad i sina didaktiska val beroende på undervisningsform. Däremot motsäger resultatet från observationerna detta till viss del. Störst är skillnaden mellan hur informanterna ser på sångens roll i undervisningen och hur de använder den. Undersökningen visar att pedagogernas didaktiska val till större del beror på deras egna preferenser i kombination med individanpassad undervisning än beroende på undervisningsform. I resultatet kan man utläsa att fler moment och redskap användes under gruppundervisningen än under de enskilda lektionerna. Detta kan bero på att pedagogerna behöver anpassa materialet efter fler individers preferenser och möjligheter för inlärning i gruppundervisningen, under de enskilda lektionerna har pedagogerna större möjlighet att individanpassa efter den aktuella eleven. / This study is based on a comparison between how piano teachers change their didactics depending on the teaching method, particularly individual teaching or group teaching. Three piano teachers have been interviewed and six observations have been conducted. One where the teacher taught an individual student and one where the teacher taught a group. The study has been conducted with the sociocultural perspective as overarching theory with elements of Lev. S. Vygotsky’s thoughts about cooperative learning and the Zone of Proximal Development, and with hermeneutics as a method of analysis. Focus was maintained on the tools the teachers use during the lessons and how the cooperative learning is visual during the lessons. Some tools and methods were selected as particularly relevant. These where the three learning styles as tools. That is, visual, auditory and kinesthetic learning. In addition, singing as a tool were chosen as well as the Dalcroze-method. These were chosen because of their continuous presence during my education at the Royal College of Music in Stockholm and their recognition withing the particular scientific field. The results are presented in two parts. The interviews show that the teachers claims to not change their didactics depending on the teaching method, that is individual or group lessons. This is partly contradicted by the result from the observations. The most significant and striking differences is between the teacher’s thoughts about using singing as a tool and how they actually uses it. The study shows that the teacher’s didactic choices largely depend on their own preferences in combinations with the particular needs and abilities of the student. The number of methods and tools used during the group lessons are greater than the ones used during the individual lessons. This could be caused by the fact that the teachers need considerate every students preferences in learning during a group lesson whereas the teacher can concentrate on just one student during a individual lesson.