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Lehti, Arja
Publications (10 of 19) Show all publications
von Knorring, J., Semb, O., Martin, F. & Lehti, A. (2019). "It is through body language and looks, but it is also a feeling"-a qualitative study on medical interns' experience of empathy. BMC Medical Education, 19, Article ID 333.
Open this publication in new window or tab >>"It is through body language and looks, but it is also a feeling"-a qualitative study on medical interns' experience of empathy
2019 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 19, article id 333Article in journal (Refereed) Published
Abstract [en]

Background: Empathy has long been recognized as a fundamental part of the professionalism of doctors and is considered to be both necessary and beneficial to doctor-patient relationships, although empathy is notoriously difficult to define and measure. Previous research on empathy has mostly consisted of quantitative studies measuring and evaluating empathy levels in students or medical residents. The aim of our qualitative study was to explore the lived experience of empathy among medical interns in Sweden.

Method: We interviewed 16 medical interns, using semi-structured interviews. Content analysis was used to analyse the interviews.

Results: The analysis led to the emergence of a main theme of empathy as being multifaceted and conflictual, consisting of descriptions (subthemes) of “being” and “doing”; of being uncontrollable and contextual; biased and situated and essential and conflictual. Since the components of empathy were also found to be interwoven, to provide a more holistic presentation of the results, we applied a socio-ecological model to the results inspired by Bronfenbrenner.

Conclusions: We concluded that empathy is situated and contextual. By using the socioecological model empathy can be described as a systemic interaction between doctor and patient. Based on this we propose a more holistic approach to empathy in medical education to better prepare students for clinical practice.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Empathy, Medical education, Professionalism
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-164626 (URN)10.1186/s12909-019-1770-0 (DOI)000485283800003 ()31484525 (PubMedID)2-s2.0-85071737175 (Scopus ID)
Available from: 2019-11-12 Created: 2019-11-12 Last updated: 2019-11-12Bibliographically approved
Eskilsson, T., Lehti, A., Sturesson, M. & Ståhlnacke, B.-M. (2017). Metodstöd ADA+: ArbetsplatsDialog för Arbetsåtergång : planering, uppföljning och stöd. Umeå: Umeå universitet
Open this publication in new window or tab >>Metodstöd ADA+: ArbetsplatsDialog för Arbetsåtergång : planering, uppföljning och stöd
2017 (Swedish)Book (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. p. 48
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-148200 (URN)9789176018125 (ISBN)
Projects
Strukturerad metod för hälso- och sjukvård, som främjar dialog mellan arbetsgivare och patient för att förbättra återgång i arbete vid psykisk ohälsa
Funder
AFA Insurance, 150274
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2019-08-26Bibliographically approved
Lehti, A., Fjellman-Wiklund, A., Stålnacke, B.-M., Hammarström, A. & Wiklund, M. (2017). Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic: patient and professional perceptions of inequity in rehabilitation of chronic pain. Scandinavian Journal of Caring Sciences, 31(1), 45-53
Open this publication in new window or tab >>Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic: patient and professional perceptions of inequity in rehabilitation of chronic pain
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2017 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 45-53Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
gender, intersectionality, ethnicity, pain, rehabilitation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-119190 (URN)10.1111/scs.12312 (DOI)000394988700005 ()26917442 (PubMedID)
Projects
Jämlik vård
Funder
Swedish Research Council, 344-2009- 5839Swedish Research Council, 344-2011-5478
Available from: 2016-04-12 Created: 2016-04-12 Last updated: 2018-06-07Bibliographically approved
Wiklund, M., Fjellman-Wiklund, A., Stålnacke, B.-M., Hammarström, A. & Lehti, A. (2016). Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective. Global Health Action, 9, Article ID 31542.
Open this publication in new window or tab >>Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective
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2016 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31542Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
chronic pain, treatment of pain, multimodal rehabilitation, gender bias, equity in health, intersectionality, qualitative interviews, Sweden, smärta, rehabilitering, jämlik vård, genus, genusbias, intersektionalitet, kvalitativ metod, intervjuer, Sverige
National Category
Public Health, Global Health, Social Medicine and Epidemiology Physiotherapy
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-124847 (URN)10.3402/gha.v9.31542 (DOI)000395813700001 ()28156868 (PubMedID)
Projects
Jämlik vård
Funder
Swedish Research Council, 344-2009-5839Swedish Research Council, 344-2011-5478
Note

This paper is part of the Special Issue: Gender and Health Inequality - intersections with other relevant axes of oppression. 

Available from: 2016-08-26 Created: 2016-08-26 Last updated: 2018-06-07Bibliographically approved
Hammarström, A., Wiklund, M., Stålnacke, B.-M., Lehti, A., Haukenes, I. & Fjellman-Wiklund, A. (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, 11(4), Article ID e0152735.
Open this publication in new window or tab >>Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients: A Study of Pain Rehabilitation
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 4, article id e0152735Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Gender Studies
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-119116 (URN)10.1371/journal.pone.0152735 (DOI)000373608000039 ()27055029 (PubMedID)
Funder
Swedish Research Council, 344-2009- 5839Swedish Research Council, 344-2011-5478
Available from: 2016-04-11 Created: 2016-04-11 Last updated: 2018-06-07Bibliographically approved
Lilja, A., DeMarinis, V., Lehti, A. & Forssén, A. (2016). Experiences and explanations of mental ill health in a group of devout Christians from the ethnic majority population in secular Sweden: a qualitative study. BMJ Open, 6(10), Article ID e011647.
Open this publication in new window or tab >>Experiences and explanations of mental ill health in a group of devout Christians from the ethnic majority population in secular Sweden: a qualitative study
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 10, article id e011647Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore existential meaning-making in an ethnic-majority subgroup with mental ill health and to increase knowledge about the importance of gaining access to such information in mental healthcare.

DESIGN: Qualitative study using in-depth interviews and systematic text condensation analysis.

PARTICIPANTS: 17 devote Christians with an ethnic-Swedish background, 12 women and 5 men, 30-73 years old, from different congregations across Sweden, having sought medical care for mental ill health of any kind.

SETTING: The secular Swedish society.

RESULTS: A living, although asymmetric, relationship with God often was seen as the most important relationship, giving hope and support when ill, but creating feelings of abandonment and fear if perceived as threatened. Symptoms were interpreted through an existential framework influenced by their view of God. A perceived judging God increased feelings of guilt, sinfulness and shame. A perceived merciful God soothed symptoms and promoted recovery. Existential consequences, such as being unable to pray or participate in congregational rituals, caused feelings of 'spiritual homelessness'. Participants gave biopsychosocial explanations of their mental ill health, consonant with and sometimes painfully conflicting with existential explanations, such as being attacked by demons. Three different patterns of interaction among biopsychosocial and existential dimensions in their explanatory systems of illness causation were identified: (a) comprehensive thinking and consensus; (b) division and parallel functions and (c) division and competitive functions.

CONCLUSIONS: Prevailing medical models for understanding mental ill health do not include the individual's existential experiences, which are important for identifying risk and protective factors as well as possible resources for recovery. The various expressions of existential meaning-making identified in this devout religious subgroup illustrate that existential information cannot be generalised, even within a small, seemingly homogenous group. The three identified patterns of interactions formed a typology that may be of use in clinical settings.

National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-129024 (URN)10.1136/bmjopen-2016-011647 (DOI)000391303200091 ()27797991 (PubMedID)
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2019-11-13Bibliographically approved
Stålnacke, B.-M., Haukenes, I., Lehti, A., Wiklund, A. F., Wiklund, M. & Hammarström, A. (2015). Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?. Journal of Rehabilitation Medicine, 47(4), 365-371
Open this publication in new window or tab >>Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?
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2015 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 4, p. 365-371Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Foundation of Rehabilitation Information, 2015
Keywords
chronic pain, rehabilitation, assessment, gender
National Category
Public Health, Global Health, Social Medicine and Epidemiology Physiotherapy
Identifiers
urn:nbn:se:umu:diva-103159 (URN)10.2340/16501977-1936 (DOI)000352753900011 ()25587848 (PubMedID)
Available from: 2015-05-29 Created: 2015-05-18 Last updated: 2018-06-07Bibliographically approved
Hammarström, A., Johansson, K., Annandale, E., Ahlgren, C., Aléx, L., Christianson, M., . . . Verdonk, P. (2014). Central gender theoretical concepts in health research: the state of the art. Journal of Epidemiology and Community Health, 68(2), 185-190
Open this publication in new window or tab >>Central gender theoretical concepts in health research: the state of the art
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2014 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 2, p. 185-190Article in journal (Refereed) Published
Abstract [en]

Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (ie, a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2014
Keywords
Gender, public health, social inequalities
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-84828 (URN)10.1136/jech-2013-202572 (DOI)000329487900007 ()24265394 (PubMedID)
Funder
Swedish Research Council, 344-2006-7280, 344-2011-5478
Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2018-06-08Bibliographically approved
Hammarström, A., Haukenes, I., Fjellman Wiklund, A., Lehti, A., Wiklund, M., Evengard, B. & Stålnacke, B.-M. (2014). Low-Educated Women with Chronic Pain Were Less Often Selected to Multidisciplinary Rehabilitation Programs. PLoS ONE, 9(5), Article ID e97134.
Open this publication in new window or tab >>Low-Educated Women with Chronic Pain Were Less Often Selected to Multidisciplinary Rehabilitation Programs
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2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5, article id e97134Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-90849 (URN)10.1371/journal.pone.0097134 (DOI)000336730600022 ()
Available from: 2014-07-22 Created: 2014-07-01 Last updated: 2018-06-07Bibliographically approved
Alex, L. & Lehti, A. (2013). Experiences of Well-Being Among Sami and Roma Women in a Swedish Context. Health Care for Women International, 34(8), 707-726
Open this publication in new window or tab >>Experiences of Well-Being Among Sami and Roma Women in a Swedish Context
2013 (English)In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 34, no 8, p. 707-726Article in journal (Refereed) Published
Abstract [en]

Our aim was to explore the experiences of well-being and lack of well-being among middle-aged and older women belonging to two national minority groups in Sweden. Interviews from nine older Sami women and four middle-aged Roma women were analyzed using grounded theory with the following categories identified: contributing to well-being (with the subcategories belonging to a healthy family, being spiritual, cultural norms as health promoting, and having had a life of one's own); and contributing to lack of well-being (with the subcategories living subordinate to the dominant society, living in a hierarchical family, and living in the shadow of tuberculosis.)

Keywords
Sami, health
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-79418 (URN)10.1080/07399332.2012.740110 (DOI)000321731700006 ()
Available from: 2013-09-04 Created: 2013-08-19 Last updated: 2018-06-08Bibliographically approved
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