Empirical studies focusing on the subjective experience of health among patients in contact with the mental health services are rare and most questionnaires are based on a medical model that emphasizes objectively observed disease-oriented health indicators. In studies I and II perceptions of the concept of health among patients and nurses in mental health services were explored and described using a phenomenographic approach. The perceptions and description categories that emerged from these studies were transformed into a number of items forming a questionnaire intended to measure subjectively experienced health among patients in mental health services. In study III, a randomly selected sample was used to test the psychometric properties of the new Health Questionnaire. A factor analysis revealed three factors labelled Autonomy, Social Involvement and Comprehensibility. The purpose of study IV was to examine the construct validity of the Health Questionnaire. The hypothesis was that subjectively experienced health would be positively associated to self-esteem, empowerment and quality of life, and negatively associated to psychiatric symptoms, perceived stigmatization experiences and perceived attitudes of devaluation and discrimination. This hypothesis was mainly confirmed insofar that overall health was positively correlated to self-esteem, empowerment and quality of life and negatively correlated to symptoms, attitudes of devaluation and discrimination and rejection experiences. The results of this thesis show that health is more than just an absence of disease and support a focus on health promotion interventions in mental health care. / <p>Medicine doktorsexamen</p>

This dissertation presents a phenomenographic case study of a senior physics professor during and beyond an extended collaboration with a science education professor from a College of Education. The context for the collaboration is the co-teaching of a physics course for graduate students in a Masters of Teaching program at a research university in the southeastern US. The course was focused on physics content and the pedagogy of teaching for conceptual change. The purpose of this study is to investigate from a physics professor’s perspective the progression of his conceptions and practices regarding teaching for conceptual change over the duration of the collaboration and beyond. Prior research indicates that such change is a difficult and complex process requiring a transformative, personal experience. Collaboration between science departments and Colleges of Education has been identified as a key opportunity for transformative experiences, but research on the resulting changes is limited. Questions addressed by this study include (a) what is the evidence of change in a physics professor’s conceptions of teaching for conceptual change, (b) what is the evidence of change in a physics professor’s practices of teaching for conceptual change, (c) what are the learning environment characteristics identified by the physics professor that either facilitated or hindered changes in his conceptions and/or practices in teaching for conceptual change. The primary data were interviews with the physics professor integrated with direct classroom observations. Emergent categories of how the physics professor conceived and practiced teaching for conceptual change showed a progression over time toward a more expert view on teaching for conceptual change. Key factors identified in the physics professor’s progression are: 1) his motivation to become a more effective teacher, 2) the expertise of the science education professor, and 3) the way the collaboration developed. Limiting factors identified include: 1) time pressure for content coverage, 2) difficulty in translating change to other contexts, and 3) unsupportive external environments.

Syftet med den här studien är att undersöka pedagogers varierande förståelser av begreppet hållbar utveckling i förskolan. Tidigare forskning har visat på en stor variation av olika utbildningsformer och innehåll i undervisningen för hållbar utveckling. Studien har en fenomengrafisk ansats och för att få svar på studiens frågor har jag använt kvalitativa intervjuer. Sex pedagoger har svarat på frågor om vad de anser att hållbar utveckling är och vad för sorts verksamhet det leder till med barnen i förskolan. Resultatet visar en variation av olika uppfattningar där olika syn på innehåll, arbetssätt och förhållningssätt till barnen har kommit fram. Tydligast är att en grupp pedagoger arbetade för att skapa miljövänliga vanor hos barnen medan den andra gruppen arbetade för att ge barnen kunskap genom förståelse och insikt. Vidare visar studien att olika pedagoger har olika fokus i miljöarbetet med barnen så som odling, vetenskapliga experiment eller kreativ verksamhet. / The aim of this study is to investigate pedagogues varying conceptions of the term sustainable development in preschool. Previous research has shown a great variety of different forms and contents of education for sustainable development. The study is phenomenographical and to answer the questions of the study I have used qualitative interviews. Six pedagogues have answered questions about what they think sustainable development is and what sort of teaching activities it leads to with children in preschool. The results show a variation of different conceptions where different views on the content, methods and approaches to children were revealed. The most significant part of the result is that one group of pedagogues worked to create sustainable habits in the children while the other group worked on giving the children knowledge by understanding and insight. The study shows further that different pedagogues have various focus in the environmental work with the children, such as farming, science experiments or creative activities.

This study describes some teacher´s perceptions of how problems with reading and writing difficulties are desciribed in reading and writing analyses. It shows the understanding as it is today, but also the need of further training in the field of reading and writing difficulties. The study is a semi structured interview study with eight high school teachers in two high schools in Sweden and it has a phenomengrafic approach. The teachers in this study are familiar to working with students with reading and writing difficulties and support their students in the classroom. Allthough the study shows some misconceptions of the same type that have previously been shown in international research. There is a lot of intuitive skills in the sense that the teachers interviewed, know that adjustments are needed and, that the students abilities can differ. The formal knowledge of disabilitie effects and what it means for teaching, as expressed in the reading and writing analysis are not complete and the study shows some misconceptions and, in some cases, the lack of basic knowledge. An effect of this is that in some cases, support become meaningless or had an opposite effect.

Intensivvårdspatienter är ofta sederade och intuberade och kan därmed ej vara delaktiga i sin vård. Närstående har enligt svensk lag rätt att delta i planering och utförande av vården för patienter som inte kan tala för sig. Studier har undersökt och belyst närståendes behov vid vård av intensivvårdspatienter. Få studier har fokuserat på närståendes uppfattning om delaktighet i vården av intensivvårdspatienter. Syfte  Att undersöka hur närstående upplever sin delaktighet i beslutsfattande och omvårdnad av intensivvårdspatienter. Metod  En deskriptiv kvalitativ design med semistrukturerade intervjuer användes, med en fenomenografisk ansats. Nio närstående intervjuades. Resultat Fem kvalitativt skilda beskrivningskategorier framkom och ordnades hierarkiskt; Beslutsfattandets betydelse – medicinska beslut överlämnas, Delta i omvårdnad – både positivt och skrämmande, Positivt bemötande avdramatiserar, Viktigt att vara fysiskt nära och Tydlig information underlättar delaktighet. Beskrivningskategorin Tydlig information underlättar delaktighet placerades högst i hierarkin eftersom informanterna angav att informationen hade störst betydelse för upplevelsen av delaktighet i vården. Slutsats Kännedom om närståendes olika upplevelser av delaktighet, i synnerhet vikten av rak och tydlig information kan möjliggöra för personalen att bättre inkludera närstående och därigenom öka deras upplevelse av delaktighet i vården av intensivvårdspatienter. / Intensive care patients are often sedated and intubated and can not participate in their care. Swedish law states that when a patient can not participate in care, relatives should be invited to participate in his/her place. Many studies have been conducted focusing on relatives’ needs, but very few focus on their perception of participation in care of intensive care patients.  Aim This study was conducted to explore how relatives perceive their participation in care of intensive care patients, with regards to decision making and participating in physical care. Method A descriptive, qualitative design was used, with semi-structured interviews and with a phenomenographic approach. Nine relatives were interviewed. Results Five qualitatively differing categories of description appeared and were organized in a hierarchy; The importance of decision making – medical decisions are handed over, Participating in physical care – both positive and scary, A welcoming atmosphere helps ease the mood, Important to be physically near, Clear information helps the perceived participation. The category Clear information helps the perceived participation was placed the highest in the hierarchy because the informants described information as the most important for the perceived participation in care. Conclusion Knowledge about relatives’ different perceptions of participation in care, especially the importance of straight forward and direct information, may enable the nursing staff to better include relatives and increase their satisfaction and perceived participation in care of the intensive care patients.

The purpose of this essay called is to examine how preschool teachers understand planned and spontaneous physical activities in preschool. We also search to elucidate if there is some difference between a preschool with a pedagogical orientation based on outdoor physical activities and a traditional preschool in which outdoor physical activities are not a part of their pedagogical orientation. We want even to examine how teachers understand their own role in children's physical development. The study draws on a phenomenographic approach and we apply a qualitative method to collect our data. The data is mainly based on interviews with preschool teachers from preschools with the two forms of pedagogical orientation that we mentioned earlier. We interviewed a total of six preschool teachers, three from each preschool. The results of the study showed that the informants from both preschools understand planned physical activities as an activity that is initiated and organised by the teachers. On the contrary they understand spontaneous physical activities as an activity initiated by the children, often in the form of games. Another important result is that the informants in our study agree in that spontaneous physical activities are given quite more time in the preschool’s everyday than planned activities. Finally, the study shows that the informants in the study feel confident as leaders in physical activities, regardless of the preschools pedagogical orientation. It is rather a question of education and personal interests than pedagogical focus.

Bakgrund: Statistik visar på ökat antal elektiva kejsarsnitt internationellt och nationellt. Ett kejsarsnitt kan rädda liv på mor och barn om komplikationer uppstår, elektivt kejsarsnitt är även liksom andra stora operationer förenat med risker för komplikationer. Antalet elektiva kejsarsnitt på humanitär indikation har ökat i Sverige och cirka 17 % av alla förlossningar sker via kejsarsnitt. Att vårda och stödja kvinnor före, under och efter en förlossning med kejsarsnitt hör till barnmorskans arbete. Syftet med studien var att beskriva barnmorskors uppfattning om indikationer och effekter av förlossning med elektiva kejsarsnitt på humanitär indikation belyst utifrån arbetslivserfarenheter. Metod: kvalitativ metod: semistrukturella intervjuer med nio barnmorskor. Materialet analyserades via fenomenografisk analys i sju steg. Resultat: Fyra beskrivningskategorier framkom, Elektivt kejsarsnitt på humanitär indikation är ett etiskt dilemma, Elektivt kejsarsnitt på humanitär indikation är en stor operation, Elektivt kejsarsnitt på humanitär indikation påverkar organisation och barnmorskans arbetsmiljö och Elektivt kejsarsnitt på humanitär indikation påverkar kvinnans förlossningsupplevelse. Vidare framkom nio kategorier som beskriver barnmorskors uppfattningar. Slutsats Barnmorskor uppfattar elektiva kejsarsnitt som något komplext, att de med sina yrkeskunskaper värnar det naturliga vid kejsarsnitt på humanitär indikation och att de har brist på mandat att stödja och stärka kvinnors informerade val om elektivt kejsarsnitt på humanitär indikation. Klinisk tillämpbarhet: Resultatet kan användas vid undervisning kring barnmorskans stödjande och vårdande arbete i samband med förlossning via kejsarsnitt. Vidare kan resultatet vara underlag till diskussioner inom mödrahälsovård och förlossning i syfte att ge barnmorskor stärkt mandat till sina stödjande och informativa uppgifter. / Background: Statistics show an increased number of elective caesarean section internationally and nationally. A caesarean section can save the life of mother and child if complications arise, elective caesarean section in common with other major surgeries involve risk of complications. The number of elective caesarean sections on humanitarian indication has increased in Sweden and about 17% of all deliveries via caesarean section. To care and support women before, during and after a cesarean is an essential part of midwifery work. Objective: The aim of the study is to describe midwives' perception of indications and effects of childbirth by elective caesarean section on humanitarian indication illuminated on the basis of work experience. Method: A qualitative approach: semi structural interviews with nine midwives, phenomenographic analysis in seven steps was used for analysis of data. Results: Four descriptive categories emerged, elective Caesarean section on humanitarian indication is an ethical dilemma, elective Caesarean section on humanitarian indication is major surgery, elective Caesarean section on humanitarian indication affect the organization and midwives working environment and elective Caesarean section on humanitarian indication affect the woman's birth experience. Further nine categories that describe midwive´s perceptions emerged. Conclusion: Midwives perceived elective ceaserean section as something complex, that with their professional skills they support the natural part in caesarean sections on humanitarian indication and they lacked mandate to support and strengthen women's informed choice regarding elective Caesarean section on humanitarian indication. Clinical applicability: The result can be used in education regarding midwives supportive and caring role in deliveries with caesarean section. In addition the result can be used in discussions at delivery wards and antenatal care units regarding improving midwives mandate for their supportive and informative tasks.

<p>There is no common understanding on what constitutes good sick-listing, a frequent and problematic task for many physicians, especially general practitioners (GPs) and orthopaedic surgeons. Aiming to achieve a deeper understanding of sick-listing practices, 19 GPs (I, III) and 18 orthopaedic surgeons (II) in four counties were interviewed, and data analysed qualitatively for views on good sickness certification and barriers to desired practice. Data from a survey of all 7665 physicians in two counties on emotionally straining problems in sickness certification (IV) was analysed quantitatively. </p><p>Some GPs exposed narrow views of sick-listing, where their responsibility was limited to issuing a certificate, while GPs with the most inclusive view had a perspective of the patient’s total life-situation and aimed to help patients shoulder their own responsibility (I). The orthopaedic surgeons´ perceptions of good sick-listing were mainly related to their views on their role in the health-care system. Some perceived their responsibility as confined to the orthopaedic clinic only, while others had the ultimate goal of helping the patient to become well functioning in life with regained work capacity – by means of surgery <i>and</i> proper management of sick-listing (II). </p><p>Difficulty handling conflicting opinions was a barrier to good sickness certification for GPs (III), and problematic for about 50% of all physicians and about 80% of GPs (IV). Orthopaedic surgeons’ handling of such situations varied from being directed by the patient, via compromising, to being directed by professional judgement (II). Other barriers included poor stakeholder collaboration (III). GPs with a workplace-policy on sickness certification reported fewer conflicts and less worry of getting reported to the disciplinary board in relation to sick-listing (IV).</p><p>Understanding physicians’ underlying views on and barriers to practicing “good sick-listing” can inform efforts to change physician practice. Communications skills training in handling sick-listing situations with conflicting opinions is recommended.</p>

Background and aims: Many adults with congenitally malformed hearts are at risk for complications such as decreased function and capacity of the heart due to the heart defect and previously surgery. This advocates self-management behaviours related to medical treatments, physical activity, preventions of endocarditis, some restrictions regarding suitable employment and spare time activities, birth control and pregnancy, but also lifestyle concerns such as refraining from smoking and healthy eating. Sufficient knowledge and support are requirements for successful self-management. The overall aim of this thesis was to describe educational needs, develop a tool for assessing knowledge and to evaluate the effects of a follow-up model providing education and psychosocial support to adults with congenitally malformed hearts. Subjects and methods: Adults (≥18 years of age) with the ten most common heart defects namely ventricular septal defect, atrial septal defect, coarctation of the aortae, aortic valve stenosis (defined as uncomplicated heart defects) and tetralogy of Fallot, complete transposition of the great arteries, congenitally corrected transposition of the great arteries, Ebstein anomaly and Eisenmenger syndrome (defined as complicated heart defects) were included in the studies. To apprehend the educational needs (I), sixteen adults with heart malformations, ranging from 19-55 years of age, were interviewed and data were analysed qualitatively using phenomenographic method. As a tool to evaluate knowledge, an instrument named Knowledge scale for adults with Congenital Malformed Hearts (KnoCoMH) was developed and psychometrically evaluated (II) in 19 + 114 adults with the ten most common heart defects average age 34 ± 13.5. A model for follow-up was described and initially evaluated (III) by 55 adults with the most common heart defects and finally tested in a randomised controlled trial (IV) with a total of 114 adults with congenitally malformed hearts (56 participants in intervention group and 58 in control group with average age 34 ± 13.5). The intervention group recived a model for follow-up with individualise and computer-based eduction and psychosocial support by a multidisciplinary team. Results: Two-way communication when given information was found to be crucial in order to enhance knowledge (I). Knowledge was seen as a tool for managing important areas in life. The KnoCoMH (II) was found to be a valid and reliable scale and can now be used to estimate knowledge in adults with congenitally malformed hearts. The model for follow-up (III) was effective in improving and maintaining knowledge (IV) about self-management in adults with heart malformation.

Hensikt: Hensikten med undersøkelsen var å beskrive, og å oppnå større forståelse for, hvordan ventelistepasienter ved Klinikk for ortopedi og revmatologi og pasientrepresentanter fra Brukerutvalget ved St. Olavs Hospital i Trondheim oppfattet ventetiden og kontakten med sykehuset i påvente av undersøkelse og behandling. Kunnskapen skal brukes til å forbedre informasjonen til og kommunikasjonen med ventelistepasientene. Metode: Datainnsamling ble gjort ved 24 individuelle intervju med pasienter fra ventelistene og et gruppeintervju med pasienter i en offisiell rolle som medlemmer av sykehusets Brukerutvalg. Analysen av intervjuene ble gjort med fenomenografisk tilnærming. Resultat: To sammenhengende hovedtema fremkom, der tema om Daglig liv som ventelistepasient dominerte over tema om Informasjon og kommunikasjon i ventetiden. De to tema ble belyst med seks hovedkategorier med til sammen 20 underkategorier som viste at ventelistepasientene opplevde en hverdag med mye smerter og hindringer i forhold til tidligere funksjonsnivå. De var lite opptatt av generell informasjon og hvordan den skriftlige informasjonen så ut. Den informasjon de hadde fått ble oppfattet som grei nok, men inneholdt ikke de opplysninger de hadde behov for. Det viktige var å få personlig, lett forståelig og forklarende informasjon av legen ved den polikliniske undersøkelsen der de eventuelt ble søkt til innleggelse og operasjon; på et tidlig tidspunkt i ventetiden få en konkret operasjonsdato å forholde seg til; få målrettet informasjon om hvordan de kunne forberede seg på operasjonen og tilrettlegge for seg selv etter operasjonen; at det var noen å komme i kontakt med hvis de ønsket det. I tillegg til samsvarende oppfatninger med ventelistepasientene var deltakerne fra Brukerutvalget mer opptatt av og kritisk til informasjonens innhold og form enn pasientene i de 24 individuelle intervjuene. Konklusjon: Pasientene ønsket kontroll over livet i ventetiden ved å få konkret og personlig informasjon om operasjonsdato, hensiktsmessige forberedelser, hva og hvordan i forhold til operasjon og rekonvalesens. Først når dette var oppfylt kunne de vise en begrenset interesse for informasjonens utforming / Aim: The aim of the study was to describe and achieve a greater understanding of how patients on the waiting list for surgery at the Department of Orthopaedic Surgery and Rheumatology and the group of patient representatives (Brukerutvalget) at St. Olav’s University Hospital in Trondheim experienced the waiting time and the contact with the hospital. The knowledge shall be used to improve the information to and the communication with patients on waiting list. Method: The data collection was done through 24 individual interviews with patients on waiting lists and one group interview with four of the patients having an official role as members of the hospital’s group of user representatives. The analysis of the interviews was done by a phenomenographic approach. Results: Two related main subjects appeared of which the subject of the daily life as a waiting list patient dominated over the subject of the information and communication received during the waiting time. These two subjects were illustrated by six main categories and 20 subcategories which showed that the waiting list patients experienced a daily life with much pain and hindrances compared to their earlier level of functionality. They were to a small degree interested in any general information and how the general information was presented. The information they had received was conceived as satisfactory, but did not contain the information they needed. The important thing was to get personal, easy to understand and well explained information from the doctor during the visit at the outpatient clinic, when they were eventually sought referred to the hospital for admission and operation, to get a fixed time for the operation early in the waiting time, to get systematic information about how to prepare for the operation and how to organize themselves after the operation, and finally that there should be a person to contact if they needed to. In addition to perceptions common with the waitinglist patients the participants from the group of user representatives were more concerned with and critical to the contents and presentation of the information than the patients from the 24 individual interviews. Conclutions: Personal and relevant information was needed to cope with the daily life. Not till the patients knew about a fixed time for the operation, appropriate preparations, the surgery and convalescence they could show a limited interest for the shaping of the information / <p>ISBN 978-91-85721-15-3</p>