Publications by authors named "Maria Wiklund"

29 Publications

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Gender matters in physiotherapy.

Physiother Theory Pract 2021 Sep 1:1-14. Epub 2021 Sep 1.

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.
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http://dx.doi.org/10.1080/09593985.2021.1970867DOI Listing
September 2021

Older Adults' Experiences of Behavior Change Support in a Digital Fall Prevention Exercise Program: Qualitative Study Framed by the Self-determination Theory.

J Med Internet Res 2021 Jul 30;23(7):e26235. Epub 2021 Jul 30.

Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå, Sweden.

Background: Exercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory.

Objective: This study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users.

Methods: The qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers, smartphones, and tablets, and was fully self-managed.

Results: In the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants' competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program.

Conclusions: In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants' experiences, a proposed addition to the classification system used as an analytical matrix has been presented.

Trial Registration: ClinicalTrials.gov NCT02916849; https://clinicaltrials.gov/ct2/show/NCT02916849.
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http://dx.doi.org/10.2196/26235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367180PMC
July 2021

Landscapes of care and despair for rural youth - a qualitative study in the northern Swedish 'periphery'.

Int J Equity Health 2020 10 2;19(1):171. Epub 2020 Oct 2.

Arctic Research Centre (Arcum), Umeå University, Umeå, Sweden.

Background: This study emerges as a response to the lack of youth perspectives when it comes to discussions about access to and experiences of health and social services in rural areas. It subsequently contributes to the literature by positioning young people at the centre of this debate, and by taking a more holistic approach to the topic than is typically the case. Specifically, based on the idea that a good life in proper health for young people may be contingent on notions of care that are bounded up in multi-layered social and spatial environments, the aim of this study was to explore what characterises 'landscapes of care' for rural youth.

Methods: In this qualitative study, the participants included young people and professionals residing in five diverse areas across the northern Swedish 'peripheral' inland. Individual interviews (16 in total) and focus group discussions (26 in total) were conducted with 63 youth aged 14-27 years and with 44 professionals operating across sectors such as health centres, school health, integration units, youth clinics and youth clubs. Following an emergent design and using thematic analysis, we developed one main theme, 'landscapes of care and despair', comprising the two themes: '(dis)connectedness' and 'extended support or troubling gaps'.

Results: The findings illustrate how various health-promoting and potentially harmful aspects acting at structural, organisational and interpersonal levels contributed to dynamic landscapes characterised simultaneously by care and despair. In particular, our study shows how rural youths' feelings of belongingness to people and places coupled with opportunities to participate in society and access practical and emotional support appear to facilitate their care within rural settings. However, although the results indicate that some in the diverse group of rural youth were cared for and about, a negative picture was painted in parallel. These aspects of despair included youths' senses of exclusion and marginalisation, degrading attitudes towards them and their problems, as well as recurrent gaps in the provision and practices of care.

Conclusions: To gain a more comprehensive understanding about the health of rural youth, this study highlights the benefits investigating 'care-ful' and 'uncaring' aspects bounded up in dynamic and multi-layered landscapes.
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http://dx.doi.org/10.1186/s12939-020-01288-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531094PMC
October 2020

Enhancing Confidence and Coping with Stigma in an Ambiguous Interaction with Primary Care: A Qualitative Study of People with COPD.

COPD 2020 10 28;17(5):533-542. Epub 2020 Sep 28.

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

Meaningful and high-quality interactions between people with COPD and healthcare professionals are essential to accomplish effective and efficient self-management.This study's aim was to explore how people with COPD experience COPD-related interactions with healthcare professionals in primary care, and how these interactions influence their self-management and how they cope with their disease.Interviews were performed with eight women and five men with COPD, and grounded theory guided data collection and analysis.The analysis resulted in a theoretical model and the core category , representing a dynamic process in which healthcare and participants' were important for the participants' experiences of interactions, and how they managed and coped with their disease.Mutually respectful and regular relationships with healthcare professionals, along with a personal positive view of life, empowered and facilitated participants to accept and manage their disease. In contrast, experiences of being deprioritized and not taken seriously, along with experiences of fear and stigma, disempowered and inhibited participants in making healthcare contacts or forced them to compensate for experienced insufficiencies in primary care.In order to facilitate meaningful and high-quality interactions and enhance patient-provider partnerships in primary care, there is a need to improve the status of COPD, as well as to increase competence in COPD management among healthcare professionals and support the empowerment of people with COPD. Findings from this study could guide the implementation of improved self-management support in primary care for COPD and other chronic conditions.
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http://dx.doi.org/10.1080/15412555.2020.1824217DOI Listing
October 2020

Enhanced Capacity to Act: Managers' Perspectives When Participating in a Dialogue-Based Workplace Intervention for Employee Return to Work.

J Occup Rehabil 2021 06;31(2):263-274

Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden.

Purpose To explore if and how a dialogue-based workplace intervention with a convergence dialogue meeting can support a return to work process from the managers' perspective. Methods Individual interviews were conducted with 16 managers (10 women and 6 men) who had an employee on sick leave because of stress-induced exhaustion disorder. The manager and employee participated in a dialogue-based workplace intervention with a convergence dialogue meeting that was guided by a healthcare rehabilitation coordinator. The intervention aimed to facilitate dialogue and find concrete solutions to enable return to work. The interviews were analyzed by the Grounded Theory method. Results A theoretical model was developed with the core category enhancing managerial capacity to act in a complex return to work process, where the managers strengthened their agential capacity in three levels (categories). These levels were building competence, making adjustments, and sharing responsibility with the employee. The managers also learned to navigate in multiple systems and by balancing demands, control and support for the employee and themselves. An added value was that the managers began to take preventive measures with other employees. When sick leave was caused only by personal or social issues (not work), workplace actions or interventions were difficult to find. Conclusions From the managers' perspective, dialogue-based workplace interventions with a convergence dialogue meeting and support from a rehabilitation coordinator can strengthen managerial competence and capacity to act in a complex return to work process.
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http://dx.doi.org/10.1007/s10926-020-09914-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172407PMC
June 2021

Co-Creation with Older Adults to Improve User-Experience of a Smartphone Self-Test Application to Assess Balance Function.

Int J Environ Res Public Health 2020 05 26;17(11). Epub 2020 May 26.

Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, 901 87 Umeå, Sweden.

This co-creation study aimed to develop a smartphone self-test application for balance and leg strength in collaboration between older adults and the research team. The paper describes older participants' preferences for, and their contribution to, the application design. Technology to assess movements is available in smartphones with built-in sensors, and one of the challenges is to develop a valuable self-test for older adults. The participants contributed to the design of the application's instructions and user interface. Multiple data collection methods were used: user-test with Think aloud method, mock-ups, homework assignment as co-researcher, audio and video recordings. Qualitative content analysis with a deductive-inductive approach was used, guided by the Optimized Honeycomb model for user experience (UX) as a categorization matrix. The analysis resulted in 17 subcategories within the seven facets of the UX Honeycomb model (findable, accessible, usable, desirable, credible, useful, and valuable), and describes the older participants' preferences and experiences. The main results were participants' desire to know why, to get clear and appropriate information, and expectations of the self-test to be useful. It was feasible and valuable to develop the self-test application in co-creation with the intended user-group, in order to get direct feedback and suggestions for the development.
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http://dx.doi.org/10.3390/ijerph17113768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312460PMC
May 2020

Assessing the youth-friendliness of youth clinics in northern Sweden: a survey analyzing the perspective of the youth.

BMC Health Serv Res 2020 Apr 23;20(1):346. Epub 2020 Apr 23.

Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.

Background: Sweden has nearly 300 youth clinics that have been offering services since the 1970s. However, no evaluation has been done to assess their youth-friendliness. This study aims to assess: i) to what extent youth clinics are perceived as youth-friendly by the young people using them; and ii) if the level of youth friendliness is equally perceived across different sociodemographic groups of users.

Methods: The four northernmost counties of Sweden were included in the study. Of the total identified 22 youth clinics, 20 participated by giving out questionnaires to the youth after their visits to the respective youth clinics. In total 1110 youth participated in the study and answered questions according to the World Health Organization's criteria of accessibility, equity, respect, privacy and confidentiality, no judgement, and quality. Means and frequencies were calculated, and t-test and ANOVA were used to compare means by sociodemographic variables.

Results: Participants perceived the youth clinics as very youth friendly across the measured domains, with scores as high as 4.8 and 4.9 (of a maximum of 5). Youth clinics were perceived in a similar way regardless of gender, but other sociodemographic factors influenced some of the domains, especially ethnic background.

Conclusions: The perception of youth friendliness in youth clinics was very high. Nonetheless, younger users; users who did not categorize themselves as either heterosexual, homosexual, or bisexual; users with trans-experiences; and users with non-Swedish backgrounds gave youth clinics lower scores for certain domains.
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http://dx.doi.org/10.1186/s12913-020-05188-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178958PMC
April 2020

Theorising women's health and health inequalities: shaping processes of the 'gender-biology nexus'.

Glob Health Action 2018 11;11(sup3):1669353

Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.

Since the theoretical frameworks and conceptual tools we employ shape research outcomes by guiding research pathways, it is important that we subject them to ongoing critical reflection. A thoroughgoing analysis of the global production of women's health inequality calls for a comprehensive theorization of how social relations of gender and the biological body mutually interact in local contexts in a nexus with women's health. However, to date, the predominant concern of research has been to identify the biological effects of social relations of gender on the body, to the relative neglect of the co-constitutive role that these biological changes may play in ongoing cycles of gendered health oppressions. Drawing on feminist and gender theoretical approaches, and with the health of women and girls as our focus, we seek to extend our understanding of this recursive process by discussing what we call the 'shaping processes' of the 'gender-biology nexus' which call attention to not only the 'gender-shaping of biology' but also the 'biologic-shaping of gender'. We consider female genital mutilation/cutting as an illustration of this process and conclude by proposing that a framework which attends to the 'gender-shaping of biology' the 'biologic-shaping of gender' as interweaving processes provides a fruitful approach to theorising the wider health inequalities experienced by women and girls.
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http://dx.doi.org/10.1080/16549716.2019.1669353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792043PMC
November 2018

'Managing pieces of a personal puzzle' - Older people's experiences of self-management falls prevention exercise guided by a digital program or a booklet.

BMC Geriatr 2019 02 18;19(1):43. Epub 2019 Feb 18.

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

Background: Exercise is effective in order to prevent falls in community-dwelling older people. Self-management programs have the potential to increase access and reduce costs related to exercise-based fall prevention. However, information regarding older people's views of participating in such programs is needed to support implementation. The aim of this study was to explore older people's experiences of a self-management fall prevention exercise routine guided either by a digital program (web-based or mobile) or a paper booklet.

Methods: This qualitative study was part of a feasibility study exploring two completely self-managed exercise interventions in which the participants tailored their own program, guided either by a digital program or a paper booklet. Individual face-to-face semi-structured interviews were conducted with a purposeful sample of 28 participants (18 women), mean age 76 yrs. Qualitative content analysis was used to analyse the data.

Results: Self-managing and self-tailoring these exercise programs was experienced as 'Managing pieces of a personal puzzle'. To independently being able to create a program and manage exercise was described in the categories 'Finding my own level' and 'Programming it into my life'. The participants experienced the flexibility and independence provided by completely self-managed exercise as positive and constructive although it required discipline. Furthermore, different needs and preferences when managing their exercise were described, as well as varying sources of motivation for doing the exercise, as highlighted in the category 'Defining my source of motivation'. The category 'Evolving my acquired knowledge' captures the participants' views of building their competence and strategies for maintenance of the exercise. It describes a combined process of learning the program and developing reflection, which was more clearly articulated by participants using the digital program.

Conclusions: This study provides new knowledge regarding experiences, preferences and motivations of older people to engage in home-based self-managed fall prevention exercise. They expressed both a capability and willingness to independently manage their exercise. A digital program seems to have strengthened the feeling of support while creating their own exercise program and tailoring it to their preferences and circumstances, which might therefore create better opportunities for adoption and adherence in the long term.
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http://dx.doi.org/10.1186/s12877-019-1063-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378707PMC
February 2019

Accessibility and factors associated with utilization of mental health services in youth health centers. A qualitative comparative analysis in northern Sweden.

Int J Ment Health Syst 2018 14;12:69. Epub 2018 Nov 14.

1Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Background: Youth-friendly health care services can facilitate young people's access to health care services and promote their health, including their mental health. In Sweden, a network of youth health centers exist since the 1970s, incorporated within the public health system. Even if such centers take a holistic approach to youth health, the focus has been in sexual and reproductive health care, and the extent of integrating mental health care services is less developed though it varies notably between different centers. This study aims to analyse the various conditions that are sufficient and/or necessary to make Swedish youth health centers accessible for mental and psychosocial health.

Methods: Multiple case study design, using qualitative comparative analysis to assess the various conditions that makes a youth health center accessible for mental and psychosocial issues and mental health. The cases included 18 youth health centers (from a total of 22) in the four northern counties of Sweden.

Results: In order to enhance accessibility for mental health services, youth health centers need to be trusted by young people. Trust was necessary but not sufficient, meaning that it had to be combined with other conditions: either having a team with a variety of professions represented in the youth health center, or being a youth health center that is both easy to contact and well-staffed with mental health professionals.

Conclusions: Differentiated, first-line services for youth can play an important role in promoting youth mental health if certain conditions are fulfilled. Trust is necessary, but has to be combined with either multidisciplinary teams, or expertise on mental health and easy accessibility.
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http://dx.doi.org/10.1186/s13033-018-0249-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234690PMC
November 2018

Usefulness and Relevance of an eHealth Tool in Supporting the Self-Management of Chronic Obstructive Pulmonary Disease: Explorative Qualitative Study of a Cocreative Process.

JMIR Hum Factors 2018 Oct 26;5(4):e10801. Epub 2018 Oct 26.

Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.

Background: New strategies are urgently needed to support self-management for people with chronic obstructive pulmonary disease (COPD) in primary care. The use of electronic health (eHealth) solutions is promising. However, there is a lack of knowledge about how such eHealth tools should be designed in order to be perceived as relevant and useful and meet the needs and expectations of the health professionals as well as people with COPD and their relatives.

Objective: The objective of this study was to explore the aspects of an eHealth tool design and content that make it relevant and useful for supporting COPD-related self-management strategies from the perspective of health care professionals, people with COPD and their relatives, and external researchers.

Methods: Data were collected during the development of an eHealth tool. A cocreation process was carried out with participants from two primary care units in northern Sweden and external researchers. Individual interviews were performed with health care professionals (n=13) as well as people with COPD (n=6) and their relatives (n=2), and focus group discussions (n=9) were held with all groups of participants. Data were analyzed using qualitative content analysis.

Results: The overarching theme, reinforcing existing support structures, reflects participant views that the eHealth tool needs to be directly applicable and create a sense of commitment in users. Moreover, participants felt that the tool needs to fit with existing routines and contexts and preferably should not challenge existing hierarchies between health care professionals and people with COPD. Important content for health care professionals and people with COPD included knowledge about self-management strategies. Videos were regarded as the most effective method for communicating such knowledge.

Conclusions: The cocreation in the development process enables participant perspectives and priorities to be built into the eHealth tool. This is assumed to contribute to a tool that is useful and relevant and, therefore, adopted into clinical practice and everyday life. Findings from this study can inform the development of eHealth tools for people with COPD in other contexts, as well as the development of eHealth tools for self-management support of other chronic diseases.
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http://dx.doi.org/10.2196/10801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6229513PMC
October 2018

Constructing respectability from disfavoured social positions: exploring young femininities and health as shaped by marginalisation and social context. A qualitative study in Northern Sweden.

Glob Health Action 2018 ;11(sup3):1519960

b Department of Public Health and Caring Sciences, Public Health , Uppsala University , Uppsala , Sweden.

Background: Gender, class and living conditions shape health and illness. However, few studies have investigated constructs of femininity in relation to health and living conditions among young women who are unemployed and marginalised at an early age.

Objective: The aim of this research was to elucidate constructs of femininities in relation to structuring living conditions and expressions of health in Northern Swedish women. The time period of interest was the transition from unemployed teenagers to young adults in a social context of high unemployment and societal change across the critical 'school-to-work-transition' period of the life course.

Methods: Qualitative content analysis was used to analyse data from repeated interviews with unemployed young women, aged 16-33 years, during the 1980s and 1990s. These longitudinal interviews were part of a cohort study in a 'remote' municipality in Northern Sweden that began in 1981. All girls who were not in education, employment, or training were selected for interview. An inductive analysis phase was followed by a theoretically informed phase. The contextual frame is the Nordic welfare-state model and the 'caring state' with its particular focus on basic and secondary education, and women's participation in the labour market. This focus paralleled high rates of youth unemployment in northern Sweden during the study period.

Results: The results are presented as the theme of 'constructing respectability from disfavoured social positions'. Within this theme, and framed by dominant norms of patriarchal femininity, we explored the constructs of normative and altruistic, norm-breaking, and troubled femininity.

Conclusions: Gender-sensitive interventions are needed to strengthen young women's further education and positions in the labour market and to preventing exposure to violence. More research on health experiences related to the multitude of constructs of femininities in various social contexts and across the life course is needed to help design and implement such interventions.
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http://dx.doi.org/10.1080/16549716.2018.1519960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197021PMC
July 2019

Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden.

Int J Equity Health 2018 01 11;17(1). Epub 2018 Jan 11.

Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Background: The purpose of this paper is to propose a protocol for researching the impact of rural youth health service strategies on health care access. There has been no published comprehensive assessment of the effectiveness of youth health strategies in rural areas, and there is no clearly articulated model of how such assessments might be conducted. The protocol described here aims to gather information to; i) Assess rural youth access to health care according to their needs, ii) Identify and understand the strategies developed in rural areas to promote youth access to health care, and iii) Propose actions for further improvement. The protocol is described with particular reference to research being undertaken in the four northernmost counties of Sweden, which contain a widely dispersed and diverse youth population.

Methods: The protocol proposes qualitative and quantitative methodologies sequentially in four phases. First, to map youth access to health care according to their health care needs, including assessing horizontal equity (equal use of health care for equivalent health needs,) and vertical equity (people with greater health needs should receive more health care than those with lesser needs). Second, a multiple case study design investigates strategies developed across the region (youth clinics, internet applications, public health programs) to improve youth access to health care. Third, qualitative comparative analysis of the 24 rural municipalities in the region identifies the best combination of conditions leading to high youth access to health care. Fourth, a concept mapping study involving rural stakeholders, care providers and youth provides recommended actions to improve rural youth access to health care.

Discussion: The implementation of this research protocol will contribute to 1) generating knowledge that could contribute to strengthening rural youth access to health care, as well as to 2) advancing the application of mixed methods to explore access to health care.
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http://dx.doi.org/10.1186/s12939-018-0718-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765630PMC
January 2018

Building COPD care on shaky ground: a mixed methods study from Swedish primary care professional perspective.

BMC Health Serv Res 2017 07 10;17(1):467. Epub 2017 Jul 10.

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 901 87, Umeå, Sweden.

Background: Chronic obstructive pulmonary disease (COPD) is a public health problem. Interprofessional collaboration and health promotion interventions such as exercise training, education, and behaviour change are cost effective, have a good effect on health status, and are recommended in COPD treatment guidelines. There is a gap between the guidelines and the healthcare available to people with COPD. The aim of this study was to increase the understanding of what shapes the provision of primary care services to people with COPD and what healthcare is offered to them from the perspective of healthcare professionals and managers.

Methods: The study was conducted in primary care in a Swedish county council during January to June 2015. A qualitatively driven mixed methods design was applied. Qualitative and quantitative findings were merged into a joint analysis. Interviews for the qualitative component were performed with healthcare professionals (n = 14) from two primary care centres and analysed with qualitative content analysis. Two questionnaires were used for the quantitative component; one was answered by senior managers or COPD nurses at primary care centres (n = 26) in the county council and the other was answered by healthcare professionals (n = 18) at two primary care centres. The questionnaire data were analysed with descriptive statistics.

Results: The analysis gave rise to the overarching theme building COPD care on shaky ground. This represents professionals driven to build a supportive COPD care on 'shaky' organisational ground in a fragmented and non-compliant healthcare organisation. The shaky ground is further represented by uninformed patients with a complex disease, which is surrounded with shame. The professionals are autonomous and pragmatic, used to taking responsibility for their work, and with limited involvement of the management. They wish to provide high quality COPD care with interprofessional collaboration, but they lack competence and are hindered by inadequate routines and lack of resources.

Conclusions: There is a gap between COPD treatment guidelines and the healthcare that is provided in primary care. To facilitate implementation of the guidelines several actions are needed, such as further training for professionals, additional resources, and improved organisational structure for interprofessional collaboration and patient education.
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http://dx.doi.org/10.1186/s12913-017-2393-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504776PMC
July 2017

Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives.

Glob Health Action 2016 Jan - Dec;10(sup2):1272236

a Department of Community Medicine and Rehabilitation, Physiotherapy , Umeå University , Umeå , Sweden.

Background: Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services.

Objectives: To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective.

Methods: A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS).

Results: In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028).

Conclusion: Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions.
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http://dx.doi.org/10.1080/16549716.2017.1272236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645686PMC
November 2017

Challenges and strategies for sustaining youth-friendly health services - a qualitative study from the perspective of professionals at youth clinics in northern Sweden.

Reprod Health 2016 Dec 21;13(1):147. Epub 2016 Dec 21.

Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE-90187, Sweden.

Background: Youth-friendly health-care services - those that are accessible, acceptable, equitable, appropriate and effective for different youth subpopulations - are beneficial for youth health, but not easy to implement and sustain. Sweden is among the few countries where youth-friendly health-care services have been integrated within the public health system and sustained for a long time. This study explores the challenges and strategies in providing sustainable youth-friendly health-care services, from the perspective of professionals working in youth clinics in northern Sweden.

Methods: Eleven semi-structured interviews with various health-care professionals working in youth clinics in northern Sweden were conducted. The interviews were transcribed verbatim, and analysed using thematic analysis in relation to the World Health Organization domains of youth friendliness.

Results: Four themes emerged from the analysis of the data: 1) 'Meeting youths on their own terms - the key to ensuring a holistic and youth-centred care' was related to the acceptability and appropriateness of the services; 2) 'Organizational challenges and strategies in keeping professionals' expertise on youth updated' referred to the domain of effectiveness; 3) 'Youth clinics are accessible for those who know and can reach them' was related to the domains of accessibility and equity, and 4) 'The challenge of combining strong directions and flexibility in diverse local realities' focused on the struggle to sustain the youth clinics organization and their goals within the broader health system.

Conclusions: Professionals working in youth clinics are perceived as motivated, interested and knowledgeable about youth, and the clinics ensure confidentiality and a youth-centred and holistic approach. Challenges remain, especially in terms of ensuring equitable access to different youth subpopulations, improving monitoring routines and ensuring training and competence for all professionals, independently of the location and characteristics of the clinic. Youth clinics are perceived as an indisputable part of the Swedish health system, but organizational challenges are also pointed out in terms of weak clear directives and leadership, heavy workload, local/regional diversity and unequitable distribution of resources.
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http://dx.doi.org/10.1186/s12978-016-0261-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178097PMC
December 2016

Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective.

Glob Health Action 2016;9:31542. Epub 2016 Aug 26.

Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden.

Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain.

Objective: This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic.

Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients' perceptions of important factors for accessing rehabilitation.

Results: One main theme was formulated as Access to rehab - not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted.

Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002397PMC
http://dx.doi.org/10.3402/gha.v9.31542DOI Listing
August 2016

Searching for best practices of youth friendly services - a study protocol using qualitative comparative analysis in Sweden.

BMC Health Serv Res 2016 07 29;16:321. Epub 2016 Jul 29.

Department of Community Medicine and Rehabilitation, Umeå, Sweden.

Background: Swedish youth clinics constitute one of the most comprehensive and consolidated examples of a nationwide network of health care services for young people. However, studies evaluating their 'youth-friendliness' and the combination of factors that makes them more or less 'youth-friendly' have not been conducted. This protocol will scrutinise the current youth-friendliness of youth clinics in northern Sweden and identify the best combination of conditions needed in order to implement the criteria of youth-friendliness within Swedish youth clinics and elsewhere.

Methods/design: In this study, we will use qualitative comparative analysis to analyse the conditions that are sufficient and/or necessary to implement Youth Friendly Health Services in 20 selected youth-clinics (cases). In order to conduct Qualitative Comparative Analysis, we will first identify the outcomes and the conditions to be assessed. The overall outcome - youth-friendliness - will be assessed together with specific outcomes for each of the five domains - accessible, acceptable, equitable, appropriate and effective. This will be done using a questionnaire to be applied to a sample of young people coming to the youth clinics. In terms of conditions, we will first identify what might be the key conditions, to ensure the youth friendliness of health care services, through literature review, interviews with professionals working at youth clinics, and with young people. The combination of conditions and outcomes will form the hypothesis to be further tested later on in the qualitative comparative analysis of the 20 cases. Once information on outcomes and conditions is gathered from each of the 20 clinics, it will be analysed using Qualitative Comparative Analysis.

Discussion: The added value of this study in relation to the findings is twofold: on the one hand it will allow a thorough assessment of the youth-friendliness of northern Swedish youth clinics. On the other hand, it will extract lessons from one of the most consolidated examples of differentiated services for young people. Methodologically, this study can contribute to expanding the use of Qualitative Comparative Analysis in health systems research.
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http://dx.doi.org/10.1186/s12913-016-1570-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966742PMC
July 2016

Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients--A Study of Pain Rehabilitation.

PLoS One 2016 7;11(4):e0152735. Epub 2016 Apr 7.

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

Objective: There is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation.

Methods: In the overarching project named "Equal care in rehabilitation" we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes.

Results: The process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age.

Implications: The clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias.

Conclusions: Thus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152735PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824419PMC
August 2016

Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic - patient and professional perceptions of inequity in rehabilitation of chronic pain.

Scand J Caring Sci 2017 Mar 25;31(1):45-53. Epub 2016 Feb 25.

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

Objective: To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic.

Setting And Methods: This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method.

Results: The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care.

Conclusion: From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation.
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http://dx.doi.org/10.1111/scs.12312DOI Listing
March 2017

Gender-sensitive and youth-friendly physiotherapy: Steps toward a stress management intervention for girls and young women.

Physiother Theory Pract 2016 11;32(1):20-33. Epub 2016 Jan 11.

a Community Medicine and Rehabilitation, Physiotherapy, Umeå University , Umeå , Sweden.

This article describes and evaluates initial steps of a gender-sensitive, youth-friendly group intervention model designed for teenage girls and young women who experience stress-related or psychosomatic problems. Fifty-four young women (16-25 years of age) participated in a gender-sensitive physiotherapy stress management course at a youth health center. Inclusion criteria were self-defined stress-related problems and a wish to participate in the group intervention. Measurements of aspects of body perception, self-image, multiple somatic problems, and mental health symptom areas were assessed both before and after intervention with the Body Perception Questionnaire ad modum Schiöler, social analysis of social behavior, and Adult Self-Report scale. Significant positive changes were found in aspects of body perception, self-image, and mental health and somatic symptoms. The changes were most significant in lower internalization of anxiety and depression symptoms. Symptoms such as headaches and sleeping problems decreased. Participants were more satisfied with their bodies and more able to listen to body signals. Among cognitive issues, significant change occurred in thought problems, but not in attention problems. The intervention model needs further evaluation in controlled trials, but is promising and should be developed further in other physiotherapy settings and subgroups of young people.
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http://dx.doi.org/10.3109/09593985.2015.1075639DOI Listing
November 2016

Health and Masculinities Shaped by Agency within Structures among Young Unemployed Men in a Northern Swedish Context.

PLoS One 2015 8;10(5):e0124785. Epub 2015 May 8.

Dept. Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

Aim: The aim of our paper was to explore expressions of life choices and life chances (aspects of agency within structures) related to power and experiences of health among early unemployed adolescent young men during the transition period to adulthood. These expressions of agency within structure were interpreted in the light of Cockerham's Health Lifestyles Theory. Furthermore, social constructions of masculinities were addressed in our analysis.

Methods: Repeated interviews with ten young men in a cohort of school leavers were analyzed with qualitative content analysis.

Results And Discussion: Cockerham's model was useful for interpreting our findings and we found disposition to act to be a crucial theoretical tool to capture the will and intentions of participants in relation to health. We developed the model in the following ways: structure and socialization were visualized as surrounding the whole model. Analyses of what enhances or restricts power are important. In addition to practices of health lifestyles, we added experiences of health as outcome as well as emotional aspects in disposition to act. We interpret our findings as constructions of masculinities within certain structures, in relation to choices, habitus and practices.

Conclusions: Qualitative research could contribute to develop the understanding of the agency within structure relationships. Future studies need to pay attention to experiences of health among young people at the margin of the labor market in various milieus--and to analyze these in relation to gender constructions and within the frame-work of agency within structure.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124785PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425465PMC
February 2016

Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?

J Rehabil Med 2015 Apr;47(4):365-71

Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Bldg 9A , Umeå University, SE-901 87 Umeå, Sweden.

Objective: To examine potential gender bias in recommendations of further examination and rehabilitation in primary care for patients with chronic musculoskeletal pain after an interdisciplinary team assessment.

Methods: The population consisted of consecutive patients (n = 589 women, 262 men) referred during a 3-year period from primary healthcare for assessment by interdisciplinary teams at a pain specialist rehabilitation clinic. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation. The outcome was defined as the examination or rehabilitation that was specified in the patient's record.

Results: Men had a significantly higher likelihood than women of being recommended physiotherapy and radiological examination, and the gender difference was not explained by confounding variables and covariates (age, marital status, ethnicity, education, working status, pain severity, pain interference, pain sites, anxiety and depression). There was no significant gender difference in recommendations to treatment by specialist physician, occupational therapist, psychologist or social worker.

Conclusion: Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended. The team's choice of recommendations might be influenced by gendered attitudes, but this field of research needs to be studied further.
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http://dx.doi.org/10.2340/16501977-1936DOI Listing
April 2015

Complex symptomatology among young women who present with stress-related problems.

Scand J Caring Sci 2015 Jun 21;29(2):234-47. Epub 2014 Jun 21.

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

Introduction: In Scandinavia and globally, mental health and stress-related problems among adolescent girls and young women are public health concerns that need attention. The aim of this study was to investigate mental health and somatic symptoms with a special focus on internalised problems, self-image and body-mind aspects of body perception in a group of adolescent girls and young women presenting with stress-related problems at a youth-friendly Swedish health centre, and to compare them with normative and clinical reference groups.

Methods: The participants were 47 adolescent girls and young women, aged 17-25 years. The adult self-report (ASR), social analysis of social behaviour (SASB) and body perception questionnaire (BPQ) were used to measure multiple symptom areas.

Results: Compared to reference groups, adolescent girls and young women report complex symptomatology with high levels of internalised problems such as anxiousness, depression and somatic complaints. This manifested in attention problems, negative self-image and perceived bodily discomfort and distrust.

Conclusion: Adolescent girls and young women emerging into adulthood present complex symptomatology of stress-related problems. This study gathered valuable information about their symptoms when they were seeking help. These young women showed higher symptom frequency than normative groups, and similar or higher symptom frequency than other clinical groups. Our findings of internalised and cognitive problems, including impaired self-image and body perceptions, point to the need for preventive strategies and tailored multidisciplinary interventions involving body-based methods to meet this complexity. Using tenets of stress theory, the complex symptomatology may be understood as logical responses to overwhelming stimuli and demands that exceed their ability to cope and disturb their 'equilibrium'. However, the complex gendered interplays between various external/internal stressors and a broad range of stress responses and health outcomes need further study in a long-term perspective.
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http://dx.doi.org/10.1111/scs.12154DOI Listing
June 2015

Low-educated women with chronic pain were less often selected to multidisciplinary rehabilitation programs.

PLoS One 2014 21;9(5):e97134. Epub 2014 May 21.

Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.

Background: There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education.

Methods: The population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS).

Results: Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30-0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high- and low-educated men.

Conclusion: Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0097134PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029603PMC
June 2015

'Girls need to strengthen each other as a group': experiences from a gender-sensitive stress management intervention by youth-friendly Swedish health services--a qualitative study.

BMC Public Health 2013 Oct 1;13:907. Epub 2013 Oct 1.

Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

Background: Mental health problems among young people, and girls and young women in particular, are a well-known health problem. Such gendered mental health patterns are also seen in conjunction with stress-related problems, such as anxiety and depression and psychosomatic complaints. Thus, intervention models tailored to the health care situation experienced by young women within a gendered and sociocultural context are needed. This qualitative study aims to illuminate young women's experiences of participating in a body-based, gender-sensitive stress management group intervention by youth-friendly health services in northern Sweden.

Methods: A physiotherapeutic body-based, health-promoting, gender-sensitive stress management intervention was created by youth-friendly Swedish health services. The stress management courses (n = 7) consisted of eight sessions, each lasting about two hours, and were led by the physiotherapist at the youth centre. The content in the intervention had a gender-sensitive approach, combining reflective discussions; short general lectures on, for example, stress and pressures related to body ideals; and physiotherapeutic methods, including body awareness and relaxation. Follow-up interviews were carried out with 32 young women (17-25 years of age) after they had completed the intervention. The data were analysed with qualitative content analysis.

Results: The overall results of our interview analysis suggest that the stress management course we evaluated facilitated 'a space for gendered and embodied empowerment in a hectic life', implying that it both contributed to a sense of individual growth and allowed participants to unburden themselves of stress problems within a trustful and supportive context. Participants' narrated experiences of 'finding a social oasis to challenge gendered expectations', 'being bodily empowered', and 'altering gendered positions and stance to life' point to empowering processes of change that allowed them to cope with distress, despite sometimes continuously stressful life situations. This intervention also decreased stress-related symptoms such as anxiousness, restlessness, muscle tension, aches and pains, fatigue, and impaired sleep.

Conclusions: The participants' experiences of the intervention as a safe and exploratory space for gendered collective understanding and embodied empowerment further indicates the need to develop gender-sensitive interventions to reduce individualisation of health problems and instead encourage spaces for collective support, action, and change.
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http://dx.doi.org/10.1186/1471-2458-13-907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850732PMC
October 2013

Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender - a cross-sectional school study in Northern Sweden.

BMC Public Health 2012 Nov 16;12:993. Epub 2012 Nov 16.

Umeå Center for Gender Studies, Umeå University, Umeå, Sweden.

Background: Negative trends in adolescent mental and subjective health are a challenge to public health work in Sweden and worldwide. Self-reported mental and subjective health complaints such as pain, sleeping problems, anxiety, and various stress-related problems seem to have increased over time among older adolescents, especially girls. The aim of this study has therefore been to investigate perceived stress, mental and subjective health complaints among older adolescents in Northern Sweden.

Methods: Data were derived from a cross-sectional school-based survey with a sample consisting of 16-18 year olds (n = 1027), boys and girls, in the first two years of upper secondary school, from different vocational and academic programmes in three public upper secondary schools in a university town in northern Sweden. Prevalence of perceived stress, subjective health complaints, general self-rated health, anxiety, and depression were measured using a questionnaire, including the Hospital Anxiety and Depression Scale (HADS).

Results: A large proportion of both girls and boys reported health complaints and perceived stress. There was a clear gender difference: two to three times as many girls as boys reported subjective health complaints, such as headache, tiredness and sleeping difficulties and musculoskeletal pain, as well as sadness and anxiety. High pressure and demands from school were experienced by 63.6% of girls and 38.5% of boys. Perceived stress in the form of pressure and demands correlated strongly with reported health complaints (r = 0.71) and anxiety (r = 0.71).

Conclusions: The results indicate that mental and subjective health complaints are prevalent during adolescence, especially in girls, and furthermore, that perceived stress and demands may be important explanatory factors. Future studies should pay attention to the balance between gender-related demands, perceived control and social support, particularly in the school environment, in order to prevent negative strain and stress-related ill-health. The gender gap in subjective adolescent health needs to be further explored.
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http://dx.doi.org/10.1186/1471-2458-12-993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533931PMC
November 2012

Young women facing multiple and intersecting stressors of modernity, gender orders and youth.

Soc Sci Med 2010 Nov 16;71(9):1567-75. Epub 2010 Sep 16.

Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.

This article aims to explore stressors experienced by Swedish adolescent girls and young women, specifically understood in relation to social context and gender theory. Interviews were conducted with 40 young Swedish women, aged 16-25 years, who had sought help at a youth health centre for stress problems. Using qualitative content analysis we identified three clusters of stressors: "the stressors of modernity", "the stressors of gendered orders", and "the stressors of youth". The results revealed that multiple and intersecting discourse-shaped stressors and demands connected to essential life spheres contribute not only to experiences of distress but also to feelings of constraint. Gendered individualism and healthism proved to be essential in understanding the young women's experienced stress. Failing social support from adults, gendered demands and responsibility taking were also illuminated. This calls for a broad contextualized and gender-sensitive approach to young women's stress and health problems.
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http://dx.doi.org/10.1016/j.socscimed.2010.08.004DOI Listing
November 2010

"He messed me up": Swedish adolescent girls' experiences of gender-related partner violence and its consequences over time.

Violence Against Women 2010 Feb;16(2):207-32

Umeå University, Sweden.

This article illuminates two Swedish adolescent girls' experiences of living in a violent relationship as teenagers and how this has affected their lives and health over time. Interviews were conducted in a youth health center. A combination of qualitative content analysis and narrative analysis describes violation, stress, trauma, coping, and agency during the period of adolescence and transition into adulthood. Despite Swedish progressive public policies on men's violence against women, teenage girls are exposed to male partners' violation, a severe gendered stressor. There is a need for the development of health policy and gender-responsive interventions geared specifically toward adolescent girls.
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http://dx.doi.org/10.1177/1077801209356347DOI Listing
February 2010
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