Introduction: Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to inequalities in health between women and men. Gender equality could therefore be a key element of health equity in working life. Our aim was to analyze what gender (in) equality means for the employees at a woman-dominated workplace and discuss possible implications for health experiences. Methods: All caregiving staff at two workplaces in elder care within a municipality in the north of Sweden were invited to participate in the study. Forty-five employees participated, 38 women and 7 men. Seven focus group discussions were performed and led by a moderator. Qualitative content analysis was used to analyze the focus groups. Results: We identified two themes. "Advocating gender equality in principle" showed how gender (in) equality was seen as a structural issue not connected to the individual health experiences. "Justifying inequality with individualism" showed how the caregivers focused on personalities and interests as a justification of gender inequalities in work division. The justification of gender inequality resulted in a gendered work division which may be related to health inequalities between women and men. Gender inequalities in work division were primarily understood in terms of personality and interests and not in terms of gender. Conclusion: The health experience of the participants was affected by gender (in) equality in terms of a gendered work division. However, the participants did not see the gendered work division as a gender equality issue. Gender perspectives are needed to improve the health of the employees at the workplaces through shifting from individual to structural solutions. A healthy-setting approach considering gender relations is needed to achieve gender equality and fairness in health status between women and men.

Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to gender inequalities in health experiences. The workplace is an important part of the social circumstances under which health opportunities and constraints are shaped. The workplace has also been identified as an important arena for gender constructions. Still, there is a lack of research about the relations between workplace gender equality and health experiences. The aim of this thesis was to explore gender equality and health experiences in a workplace setting. Qualitative and quantitative methods were used. In the qualitative studies all caregiving staff at two establishments providing care for elderly was invited to participate in focus groups (Papers I & II). A moderator led 14 focusgroup discussions. Qualitative content analysis was used to analyse the transcribed discussions. For the quantitative studies questionnaire data from the Northern Swedish Cohort (n=836) were analysed and supplemented with register data about the participants’ workplaces. The register data were used to stratify the workplaces according to gender composition (paper IV) and to create gender equality indicators of the number of women and men at the workplace, education, salary and parental leave (Paper III). Cluster analysis was used to identify patterns of gender equality at the workplaces. Logistic regression analysis, adjusting for individual socio-demographics and previous psychological distress, were used to analyse psychological distress in relation to both clusters and gender compositions. This thesis identifies various workplace patterns of gender equality and how they are related to health experiences. The results from the focus group study showed that workplace stressors had a structural character, often originating from societal processes outside the own organization, whereas health resources had a relational character and were constructed within the organization (paper I). Gender equality was seen as a structural issue not connected to the individual health experiences and gender inequalities were justified through focusing on personalities and interests in work division (paper II). The cluster analysis resulted in six distinctive clusters with different workplace patterns of gender equality (paper III). The most gender-equal cluster was characterized by gender equality in salary and parental leave and was associated with the lowest prevalence of psychological distress, with no significant differences between women and men. The clusters were associated with psychological distress among women only. The highest odds for psychological distress among women were found in a traditional unequal cluster. Analyses of the gender composition at the workplace showed that the highest prevalence of psychological distress was found at workplaces with a mixed gender composition (paper IV). The psychosocial work environment was rather similar independent of the workplace gender composition.The factors most strongly associated with psychological distress were high demands and low control at workplaces with more men, being looked down upon at workplaces with a mixed gender composition, and social support at workplaces with more women. Gender perspectives highlight the importance of gender relations in research on work-related health. Gender inequalities at workplaces can be part of the explanation to women’s worse self-rated health. A multidimensional view of gender equality is necessary to understand health consequences of specific workplace situations. Workplaces are important arenas for health promotion activities and gender equality aspects needs to be taken into account to reach both women and men. Adequate health promotion needs to shift focus from individual health strategies to structural solutions that can challenge the root of the problem. / Ojämställdhet i arbetslivet kan innebära olika hälsokonsekvenser för kvinnor och män. Arbetsplatsen är en viktig del av de sociala omständigheter under vilka hälsomöjligheter och -begränsningar skapas. Arbetsplatsen har också identifierats som en viktig arena för genuskonstruktioner. Trots detta saknas forskning om relationerna mellan jämställdhet på arbetsplatser och hälsoupplevelser. Den här avhandlingen syftar till att studera sambanden mellan jämställdhet på arbetsplatser och de anställdas hälsoupplevelser. Avhandlingen använder både kvalitativa och kvantitativa metoder. I de kvalitativa studierna erbjöds all vårdpersonal på två äldreboenden att delta i fokusgruppsdiskussioner (Artikel I & II). Sammanlagt genomfördes 14 fokusgrupper. Kvalitativ innehållsanalys användes för att analysera de transkriberade fokusgrupperna. I de kvantitativa studierna användes enkätdata från Luleåkohorten(n= 836) som kompletterats med registerdata om deltagarnas arbetsplatser. Registerdata användes för att stratifiera deltagarna utifrån könssammansättningen på deras arbetsplatser (artikel IV) och för att skapa jämställdhetsindikatorer för arbetsplatserna vad gäller andel män och kvinnor, utbildningsnivå, lön och föräldraledighet (artikel III). Klusteranalys användes för att identifiera mönster av jämställhet på arbetsplatserna. Skillnader i psykiska besvär mellan klustren respektive de olika könssammansättningarna analyserades med logistisk regressionsanalys som justerats för sociodemografiska variabler och tidigare psykiska besvär. Avhandlingen identifierar olika jämställdhetsmönster på arbetsplatsenoch hur de är relaterade till hälsoupplevelser. Resultaten från fokusgruppstudierna visade att de hälsorelaterade stressorerna hade en strukturell karaktär som ofta hade sitt ursprung i sociala processer utanför den egna organisationen. Hälsoresurserna var i hög utsträckning av relationell karaktär och skapades inom organisationen. Ojämställdhet sågs som ett strukturellt problem som inte kopplades till individuell hälsa. Ojämställdhet i arbetsfördelningen försvarades genom att fokusera på personligheter och individuella intressen. Kvantitativa analyser resulterade i sex kluster med olika jämställdhetsmönster på arbetsplatserna. Det mest jämställda klustret kännetecknades av arbetsplatser med jämställda löner och föräldraledighet och var relaterat till den lägsta förekomsten av psykiska besvär. I detta kluster hade också män och kvinnor samma förekomst av psykiska besvär. Bland kvinnorna fanns det skillnader mellan klusterna vad gäller psykiska besvär, men inte bland männen. Den högsta förekomsten av psykiska besvär bland kvinnor fanns i det traditionellt mest ojämställda klustret (artikel III) samt på arbetsplatser med en blandad könssammansättning (artikel IV). Variationen i den psykosociala arbetsmiljön var liten mellan arbetsplatser med olika könssammansättning men det fanns skillnader i sambanden mellan den psykosociala arbetsmiljön och psykiska besvär. De faktorer som hade starkast samband med psykiska besvär var höga krav och låg kontroll på arbetsplatser med en majoritet män, att bli ”sedd ner på” på könsblandade arbetsplatser, och socialt stöd på arbetsplatser med en majoritet kvinnor. Genusperspektiv är viktiga för att lyfta fram betydelsen av genusrelationer i forskning om arbetsrelaterad hälsa. Ojämställdhet på arbetsplatser kan vara en del av förklaringen till kvinnors sämre självskattade hälsa. En mångdimensionell syn på jämställdhet är nödvändig för att förstå hälsokonsekvenser av specifika arbetsplatssituationer. Arbetsplatser utgör också viktiga arenor för hälsofrämjande åtgärder och jämställdhetsaspekter måste beaktas för att dessa åtgärder ska nå både kvinnor och män på arbetsplatserna. Hälsofrämjande arbete måste skifta fokus från individuella, beteendeinriktade hälsostrategier till strukturella lösningar som kan utmana grunden till problemen.

In this study similarities and differences in health experiences among urban poor in relation to the forms of capital they possess: economic, social, cultural, and health capital and the different positions they hold in the urban field, are analyzed. The research was conducted in two poor gecekondu neighborhoods in Altindag, Baraj and G&uuml / ltepe, via face to face interviews with 40 individuals. A main finding has been that the different forms of capital, in volume as well as in composition, had an influence on the urban poor&rsquo / s health perceptions, health care access, health seeking strategies and experiences in health institutions. The rural-urban migrants refer to a habitus in relation to health which still strongly relies on their rural practices. Major differences among men and women have been observed, where men seem to be more open to integrate into the urban dispositions. Economic capital plays a crucial role. Regular income earners do tend to emphasize that they have a certain autonomy and control over their health. On the other hand, benefit dependent poor mention that they have less control over their health. Economic capital can be seen as very much the same among the group studied, but the differences in health experiences rely strongly on Cultural capital is understood as their different identities: villager/non-villager / illiterate/ non-illiterate / women/men / healthy/non-healthy. Social capital (formal and informal solidarity networks) is studied as the role in health experiences, access to health care and strategies to use the existing health system / as well as how individuals support each other materially and immaterially. Social capital is important because it converts into economic capital, not as exchange but as use value. An analysis of the different forms of capital allows us to address at the interrelationship of structural conditions in the field and the practices actors experience through their internalized habitus. Health experiences therefore differ even among a socio-economic homogenous group. In addition to the above mentioned forms of capital, it is also argued that health itself should be considered as a form of capital. Health capital (self perceived health/illness and medically diagnosed disease) influences and is influenced by the other forms of capital.

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The overall aim of the present thesis was to explore and describe the health experiences of men and women with musculoskeletal problems. The specific aims of the four papers were: (I) to explore the experience of illness and wellness among ambulance personnel with musculoskeletal symptoms; (II) to explore the experience of illness and wellness among female health care personnel with musculoskeletal symptoms; (III) to explore the experience of bodily illness among people with musculoskeletal problems in the neck-shoulder region, and; (IV) to investigate the symptoms described by people with non-specific neck-shoulder problems, to investigate the method of development of neck-shoulder questionnaires that assesses pain and other symptoms, to analyse the content and items of these questionnaires, and to compare the findings. The overall findings show that the occupationally active men and women with MSDs were “striving for balance” (I-II), that the disease course of chronic neck-shoulder disorders was characterised by “uncontrollable fluctuations” (III), and that most neck-shoulder questionnaires had a low correspondence to the variety of symptoms experienced during this course (IV). In the process of striving for balance (I-II), the informants’ health experiences were not a state of either wellness or illness, but of both, in varying degrees at different times. The balancing started when illness became too intrusive, and was a process of minimising the impact of illness by accepting and handling it, while attaining and maintaining wellness to feel well enough. When striving for balance, the interviewees kept on working to continue being nurtured at the same time as they made different efforts directed at minimising the impact of their illness. For both men and women, illness was characterised by disembodiment, vulnerability, and exhaustion. The illness experiences were counterbalanced by wellness, where some differences could be recognised between the men and the women. Study III further explored the experiences of bodily illness, focusing on people with chronic musculoskeletal disorders in the neck-shoulder region. The course of the disorder was described as characterised by uncontrollable fluctuations, and it usually developed from insidious symptoms to a state of constant discomfort. The participants experienced calmer periods during the course, but intermittent events of increasing illness were always lying in wait, with periodic moments of consuming intensity. In the interviews included in study IV a variety of symptoms were expressed, which indicated a bodily, mental, and emotional engagement, which included more general and more severe symptoms than are usually related to neck-shoulder disorders. Few of the questionnaires were developed using the experiences of the affected. Taken as a whole, did the questionnaires cover many of the symptoms of the interviewees, but each individual questionnaire only included a few. The fluctuations and nuances of symptoms were rarely considered. The correspondence between individual questionnaires and the experiences of those affected was most often low. This thesis reveals other aspects of health than just bodily experiences as important among occupationally active people with MSDs. It also provides a description of the disease course, and an indication of possibilities for improvement of neck-shoulder questionnaires.

Bakgrund: Förekomsten av svårläkta sår förväntas stiga i takt med en åldrande befolkning och ökande bakomliggande sjukdomar. Detta medför stora kostnader för vårdgivarna och behandlingstiderna riskerar att bli långa. Det innebär även mycket lidande och nedsatt livskvalitet för patienten. Svårläkta sår är en stor del av distriktssköterskans arbete, både inom primärvård och hemsjukvård. Motiv: Trots distriktssköterskors stora ansvar inom detta område är forskningsdata kring deras upplevelser samt hur de arbetar för att utveckla sin kunskap bristfällig. Syfte: Syftet med studien är att beskriva distriktssköterskors upplevelser av att behandla svårläkta sår samt undersöka hur de utvecklar sin kunskap.  Metod: Data har inhämtats genom semistrukturerade intervjuer med distriktssköterskor (N=10) inom primärvård och hemsjukvård, från mellersta och norra Sverige. En kvalitativ innehållsanalys med induktiv ansats har använts.  Resultat: Analysen resulterade i fyra kategorier; “Ett känslomässigt arbete”, “Möta människan bakom såret”, “Ett behov av organisation och samverkan” samt “Strävan efter kunskap och utbildning”.  Konklusion: Sårbehandling beskrevs som ett känslomässigt arbete där samarbete och struktur var viktigt. Distriktssköterskorna upplevde bristande organisation, kunskapsluckor samt avsaknad av fortbildningsmöjligheter. Det krävs mer forskning kring distriktssköterskors upplevelse av specialistutbildningen i förhållande till de kunskapskrav som ställs på arbetsplatsen. Resultatet ger även en fingervisning om politiska och organisatoriska förändringar som kan behövas och kan förhoppningsvis leda till en förbättring av arbetet med svårläkta sår. Detta skulle innebära minskat lidande och ökad livskvalitet för patienten. / Background: The prevalence of chronic ulcers is expected to increase in line with an aging population and increasing underlying diseases. This is associated with great costs to care providers and a risk for long treatment times. Chronic ulcers also cause suffering and reduced quality of life for the patient. Within a primary care or home care setting, a major part of a district nurse's assignment involves treating chronic ulcers. Motive: Despite district nurses profound responsibility regarding this subject there is a lack of research touching on the experiences of district nurses and how they develop their knowledge.  Aim: The aim of this study is to describe the experiences of district nurses caring for chronic ulcers including how they develop their knowledge. Methods: Data was collected through semi-structured interviews with district nurses (N=10) working in a primary care or home care setting, in the middle and north of Sweden. The data was analyzed via qualitative content analysis with an inductive approach. Result: The analysis resulted in four categories; “An emotional task”, “Meeting the human behind the ulcer”, “The need for organization and cooperation” and “The pursuit of knowledge and education”. Conclusion: Wound care is an emotional task where teamwork and structure was important. The district nurses experienced a lack in organization, knowledge and education opportunities. Further research is needed in how district nurses experience their education in relation to work related knowledge demands. The result also hints toward political and organizational alterations that could be needed. Hopefully it will lead to an improved way of working with chronic ulcers and in that way also less suffering and a better quality of life for the patient.

No description available.