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Christianson, Monica
Publications (10 of 26) Show all publications
Westergren, A., Edin, K., Walsh, D. & Christianson, M. (2019). Autonomous and dependent–The dichotomy of birth: a feminist analysis of birth plans in Sweden. Midwifery, 68, 56-64
Open this publication in new window or tab >>Autonomous and dependent–The dichotomy of birth: a feminist analysis of birth plans in Sweden
2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 68, p. 56-64Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To elicit pregnant women's perceptions of childbirth as expressed in their birth plans, and through a feminist lens analyse their wishes, fears, values, and beliefs about childbirth, as well as their expectations on partner and midwife.

DESIGN: This study used qualitative content analysis, identifying subcategories, categories, and an overall theme in data gathered from women's written birth plans. A feminist theoretical framework underpinned the research.

SETTING: A middle-sized city in northern Sweden.

PARTICIPANTS: 132 women who gave birth in an obstetrician-led hospital labour ward between March and June 2016 and consented to grant access to their birth plans and antenatal and intrapartum electronic medical records.

FINDINGS: Three categories emerged: 'Keeping integrity intact through specific requests and continuous dialogue with the midwife', 'A preference towards a midwife-supported birth regardless of method of pain relief", and '"Help my partner help me" - Women anticipating partner involvement.' The overall theme linking the categories together was: 'Autonomous and dependent - The dichotomy of birth', portraying women's ambiguity before birth -expressing a wish to remain in control while simultaneously letting go of control by entrusting partner and midwifewith decision-making regarding their own bodies.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women primarily desired a natural, midwife-supported birth and favoured a relationship-based, woman-centred model of care, based on the close interaction between woman, partner, and midwife. Midwives need to be aware of women's ambiguous reliance on them and the power they have to influence women's birth choices and birth experiences. Feminist theory and values in midwifery practice may be useful to inspire a maternity care based on women's wishes and expectations, acknowledging and valuing women's voices, and embracing the sanctity of birth and of the birthing woman's body.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Autonomy, Birth plan, Care, Content analysis, Dichotomy in birth, Feminism, Womancentred
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-152849 (URN)10.1016/j.midw.2018.10.008 (DOI)000450307700008 ()30366225 (PubMedID)2-s2.0-85055191258 (Scopus ID)
Available from: 2018-10-29 Created: 2018-10-29 Last updated: 2019-10-16Bibliographically approved
Goicolea, I., Hultstrand Ahlin, C., Waenerlund, A.-K., Marchal, B., Christianson, M., Wiklund, M., . . . San Sebastian, M. (2018). Accessibility and factors associated with utilization of mental health services in youth health centers: a qualitative comparative analysis in northern Sweden. International Journal of Mental Health Systems, 12, Article ID 69.
Open this publication in new window or tab >>Accessibility and factors associated with utilization of mental health services in youth health centers: a qualitative comparative analysis in northern Sweden
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2018 (English)In: International Journal of Mental Health Systems, ISSN 1752-4458, E-ISSN 1752-4458, Vol. 12, article id 69Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Access, Mental health, Qualitative comparative analysis, Sweden, Youth, Youth health centers
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:umu:diva-154004 (URN)10.1186/s13033-018-0249-4 (DOI)000450477500001 ()30459827 (PubMedID)
Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2019-01-11Bibliographically approved
Goicolea, I., Carson, D., San Sebastian, M., Christianson, M., Wiklund, M. & Hurtig, A.-K. (2018). Health care access for rural youth on equal terms?: A mixed methods study protocol in northern Sweden. International Journal for Equity in Health, 17, Article ID 6.
Open this publication in new window or tab >>Health care access for rural youth on equal terms?: A mixed methods study protocol in northern Sweden
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2018 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 6Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Access, Equity, Health care, Mixed methods, Rural, Youth
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-144569 (URN)10.1186/s12939-018-0718-z (DOI)000422697300001 ()29325552 (PubMedID)2-s2.0-85040462616 (Scopus ID)
Available from: 2018-02-06 Created: 2018-02-06 Last updated: 2018-09-14Bibliographically approved
Lusey, H., San Sebastian, M., Christianson, M. & Edin, K. E. (2018). Prevalence and correlates of gender inequitable norms among young, church-going women and men in Kinshasa, Democratic Republic of Congo. BMC Public Health, 18, Article ID 887.
Open this publication in new window or tab >>Prevalence and correlates of gender inequitable norms among young, church-going women and men in Kinshasa, Democratic Republic of Congo
2018 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 887Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Prolonged political instability may have exacerbated gender inequitable beliefs in the Democratic Republic of Congo (DRC). The aim of this study was to assess attitudes related to gender-equitable norms and its determinants among young, church-going women and men in Kinshasa, DRC.

METHOD: Data were collected through a cross-sectional survey with 291 church-going women and 289 men aged 18-24 years old, residing in three disadvantaged communes of Kinshasa. Variables included sociodemographic characteristics, attitudes towards gender equality, and responses to issues related to the gender-equitable men (GEM) scale. The GEM scale is a 24 item-questionnaire developed to measure attitudes towards gender equitable norms. Logistic regression was applied to discover the associations between the independent variables and the GEM outcome.

RESULTS: Our study reflected the existence of attitudes hampering gender equality that were endorsed by both women and men. For example, 91.4% of women and 83% of men agreed with the statement "a woman's most important role is to take care of her home and cook for her family". Similarly, 88.3% of women and 82.9% of men concurred with the idea that men need more sex than women. These findings coexisted with a few equitable norms, because 93.7% of women and 92.3% of men agreed that a man and a woman should decide together if they want to have children. A positive association was found in both women and men between being educated, being single and separated and having supportive attitudes towards gender equality and a higher GEM scale score. Residency in Camp Luka and Masina was also a significant social determinant associated with equitable gender norms among men whilst job status was only significant among women.

CONCLUSION: While both women and men had high levels of gender inequitable norms, those with more education, single, and with supportive attitudes to gender equality had high GEM scale scores. The results highlight an urgent need for the church to challenge and change gender norms among church youths.

Keywords
Church youths, Cross-sectional survey, DR Congo, Gender equity, Gender inequitable norms, Masculinities
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:umu:diva-150614 (URN)10.1186/s12889-018-5742-9 (DOI)000439346700002 ()30016960 (PubMedID)2-s2.0-85049945949 (Scopus ID)
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2018-08-31Bibliographically approved
Lusey, H., Sebastian, M. S., Christianson, M. & Edin, K. E. (2017). Factors associated with gender equality among church-going young men in Kinshasa, Democratic Republic of Congo: a cross-sectional study. International Journal for Equity in Health, 16, Article ID 213.
Open this publication in new window or tab >>Factors associated with gender equality among church-going young men in Kinshasa, Democratic Republic of Congo: a cross-sectional study
2017 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, article id 213Article in journal (Refereed) Published
Abstract [en]

Background: While women and girls are made vulnerable by inequitable and violent versions of masculinities, there is increasing evidence that gender equality will not be achieved without partnering with men. The aim of this study was to assess gender-equitable norms and their determinants among church-going young men in Kinshasa, the Democratic Republic of Congo.

Method: A cross-sectional study was carried out among 289 church-going young men, aged 18-24 years, residing in three disadvantaged communes of Kinshasa. Variables included sociodemographic characteristics, attitudes towards gender equality and responses to issues related to the Gender-Equitable Men (GEM) scale. Logistic regression was applied to identify the associations between sociodemographic characteristics, attitudes and the GEM scale.

Results: The findings provide evidence of attitudes and beliefs that act as barriers to gender equality. For instance, the majority of church-going young men (83.74%) agreed that a man is the only decision maker in the home and about half (50.87%) of the respondents supported the statement "There are times a woman deserves to be beaten". Similarly, around half of the participants agreed with the idea of men's uncontrollable sex drive (50.87%) and men's toughness (50.17%). Close to half of the participants (44.29%) agreed that it is women's responsibility to prevent pregnancy. These attitudes co-existed with a few gender-equitable norms as 82.70% agreed on the importance of joint decisions concerning family planning. An association between education, certain places of residence, being single or separated, and supportive attitudes towards gender equality was found with higher scores for the GEM.

Conclusion: Our study findings indicate that a high proportion of church-going young men do not endorse gender-equitable norms. Therefore, churches urgently need comprehensive gender equality and masculinity policies and programmes to influence young men's attitudes and behaviours. The promotion of gender equality in schools and the wider community also need to be encouraged.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2017
Keywords
Gender equality, Gender-equitable men scale, Church-going young men, Masculinities, Cross-sectional study, DR Congo
National Category
Gender Studies Nursing
Identifiers
urn:nbn:se:umu:diva-143521 (URN)10.1186/s12939-017-0707-7 (DOI)000417624900001 ()29228996 (PubMedID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-06-09Bibliographically approved
Monica, C., Boman, J. & Essén, B. (2017). Men don’t think that far” – Interviewing men in Sweden aboutchlamydia and HIV testing during pregnancy from a discursivemasculinities construction perspective.. Sexual & Reproductive HealthCare, 12, 107-115
Open this publication in new window or tab >>Men don’t think that far” – Interviewing men in Sweden aboutchlamydia and HIV testing during pregnancy from a discursivemasculinities construction perspective.
2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 12, p. 107-115Article in journal (Refereed) Published
Abstract [en]

Objectives: We used qualitative research design to discursively explore expectant fathers’ perceptions of chlamydia and HIV, and their masculinity constructions about testing, and explored how they talked about their potential resistance towards testing and their pre-test emotions.

Study design: Twenty men were offered chlamydia and HIV testing at the beginning of their partner’s pregnancy. Those who agreed to be tested were interviewed in-depth; those who declined testing were also interviewed. The interviews were tape recorded and transcribed verbatim. The analysis was inspired by discourse analysis on masculinity.

Main outcome: Three discursive themes: Men prefer to suppress their vulnerability to STIs, Body and biology differ between men and women and Men have mixed emotions around STI testing underscore the informants’ conversations and sometimes conflicting thoughts about STI testing.

Conclusion: The majority of men talked about pregnancy as a feminine territory, raised uncertainties about men’s roles in the transmission of STIs, and talked about women’s and men’s essentially different bodies and biology, where few men realised that they could infect both their partner and the unborn child. This knowledge gap that men have must become apparent to healthcare providers, and policy makers must give men equal access to the reproductive arena.

Keywords
Men, Pregnancy, Sexual transmitted infections, Masculinity, Qualitative method, Gender
National Category
Nursing Gender Studies
Identifiers
urn:nbn:se:umu:diva-134027 (URN)10.1016/j.srhc.2017.03.007 (DOI)000401884100018 ()
Available from: 2017-04-25 Created: 2017-04-25 Last updated: 2018-06-09Bibliographically approved
Thomée, S., Malm, D., Christianson, M., Hurtig, A.-K., Wiklund, M., Waenerlund, A.-K. & Goicolea, I. (2016). Challenges and strategies for sustaining youth-friendly health services: a qualitative study from the perspective of professionals at youth clinics in northern Sweden. Reproductive Health, 13, Article ID 147.
Open this publication in new window or tab >>Challenges and strategies for sustaining youth-friendly health services: a qualitative study from the perspective of professionals at youth clinics in northern Sweden
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2016 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 13, article id 147Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Youth-friendly health-care services, Youth clinics, Thematic analysis, Health professionals, Youth health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-129784 (URN)10.1186/s12978-016-0261-6 (DOI)000390956000001 ()28003025 (PubMedID)
Available from: 2017-01-09 Created: 2017-01-09 Last updated: 2018-06-09Bibliographically approved
Lusey, H. G., Christianson, M., San Sebastian, M. & Edin, K. E. (2016). Church representatives' perspectives on masculinities in the context of HIV: the case of the Ecumenical HIV and AIDS Initiative in Africa. African Journal of AIDS Research, 15(3), 273-281
Open this publication in new window or tab >>Church representatives' perspectives on masculinities in the context of HIV: the case of the Ecumenical HIV and AIDS Initiative in Africa
2016 (English)In: African Journal of AIDS Research, ISSN 1608-5906, E-ISSN 1727-9445, Vol. 15, no 3, p. 273-281Article in journal (Refereed) Published
Abstract [en]

Despite a growing body of literature related to church leaders challenging dominant norms of masculinities that may enable the spread of HIV, research on masculinity issues among African church representatives who are policy makers is scarce. The objectives of this study were to explore the perspectives on masculinities held by church representatives within the Ecumenical HIV and AIDS Initiative in Africa (EHAIA) and to identify strategies they used to transform masculinities in their respective churches. Qualitative interviews were carried out with 14 church representatives belonging to the EHAIA International Reference Group. These interviews were analysed using thematic analysis and four themes were identified: "barriers to challenge masculinities" may contribute to the spread of HIV; "counterproductive conservative church leadership" fails to challenge dominant forms of masculinities; "facilitators to challenge masculinities" perceived as slowly changing men and "an evolving hope for gender equality" would be perceived in certain marital relationships. The latter two were viewed as positive approaches resulting from masculinity workshops and male priests disclosing their HIV-positive status. This research highlights strategies that may help male church-goers challenge masculinities, support gender equality and, improve the lives of men and women in the context of HIV.

Place, publisher, year, edition, pages
NISC - National Inquiry Services Centre, 2016
Keywords
church representatives, gender, masculinities, HIV transmission, EHAIA, Africa
National Category
Nursing Gender Studies
Identifiers
urn:nbn:se:umu:diva-127089 (URN)10.2989/16085906.2016.1203341 (DOI)000385553800010 ()27681151 (PubMedID)
Available from: 2016-10-28 Created: 2016-10-28 Last updated: 2018-06-09Bibliographically approved
Goicolea, I., Christianson, M., Hurtig, A.-K., Marchal, B., San Sebastian, M. & Wiklund, M. (2016). Searching for best practices of youth friendly services - a study protocol using qualitative comparative analysis in Sweden. BMC Health Services Research, 16, Article ID 321.
Open this publication in new window or tab >>Searching for best practices of youth friendly services - a study protocol using qualitative comparative analysis in Sweden
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2016 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, article id 321Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Young people, Youth-friendly health services, Youth clinics, Qualitative comparative analysis, Primary alth care, Evaluation
National Category
Other Health Sciences
Identifiers
urn:nbn:se:umu:diva-125587 (URN)10.1186/s12913-016-1570-8 (DOI)000380647500006 ()27473421 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0235
Available from: 2016-09-23 Created: 2016-09-13 Last updated: 2018-06-07Bibliographically approved
Christianson, M. (2015). "Not Used But Almost…"-A Gender and Agency Analysis of the Grey Zone Between Consensual and Nonconsensual Sexual Intercourse. Health Care for Women International, 36(7), 768-783
Open this publication in new window or tab >>"Not Used But Almost…"-A Gender and Agency Analysis of the Grey Zone Between Consensual and Nonconsensual Sexual Intercourse
2015 (English)In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 36, no 7, p. 768-783Article in journal (Refereed) Published
Abstract [en]

Rape is a widespread but underreported problem among women. In this article I explore the complexities surrounding the fine line between consensual and nonconsensual sexual intercourse, by studying a rape through which a young woman was infected with HIV. I provide an analysis of how to understand and interpret this episode by applying a gender perspective based on patriarchy-namely, women's submissive position in heterosexual situations compared with men-and the concept of agency, that is, the individual's own decision-making ability, own choices, and different courses of action available, to outline the frame of action available to the informant. The inclusion of agency and a gender perspective offers new dimensions on how to understand and give meaning to narratives that are seldom told.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:umu:diva-88632 (URN)10.1080/07399332.2014.900063 (DOI)000356423400003 ()24628513 (PubMedID)
Available from: 2014-05-12 Created: 2014-05-12 Last updated: 2018-06-07Bibliographically approved
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