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Dahlblom, Kjerstin
Publications (10 of 22) Show all publications
Eriksson, M. & Dahlblom, K. (2017). What constitute health promoting living environments from children's perspectives?. Paper presented at 10th European Public Health Conference Sustaining resilient and healthy communities Stockholm, Sweden 1–4 November 2017. European Journal of Public Health, 27(Suppl_3), 508
Open this publication in new window or tab >>What constitute health promoting living environments from children's perspectives?
2017 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 508-Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Swedish research on the effects of living environment on children's health is limited, and very few studies bring up children’s own views and experiences from their everyday lives. The overall aim of this study is to explore what constitutes health promoting living environments from children’s own perspectives.

Methods: This is an ongoing qualitative exploratory study, building on children’s active involvement using Photovoice method. Schoolchildren in grade five, living in a medium sized Swedish municipality were equipped with digital cameras to document places of importance for their well-being. These photographs were discussed in sex-stratified focus groups. By discussing their photos, the children could identify and portray their choices of places, which gave valuable insights of how they view their worlds and what they perceive as health promoting in their living environments. Data were initially analyzed thematically.

Results: Children presented photos from their homes showing mostly their own rooms and their computers, sports- and other facilities for leisure activities as well as photos from playgrounds, forests and neighborhood venues. These places were all perceived as important for their wellbeing. Preliminary analyzes reveal how these places in different ways are characterized as; Places allowing Socializing; Places for Activities; Places for Relaxation, and Places providing a sense of Freedom. Having a Space of one’s own was also perceived as important for well-being.

Conclusions: A safe environment, allowing positive activities, relaxation, togetherness as well as freedom and a space of one’s own, characterizes health-promoting places for Children in a Swedish context.

Key messages:

  • Children are active actors in their living environments and are well aware of aspects in their living environments of importance for their well-being.
  • Children’s voices and experiences needs to be taken into account in the planning and design of health promoting living environments.
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143071 (URN)10.1093/eurpub/ckx186.301 (DOI)000414389805207 ()
Conference
10th European Public Health Conference Sustaining resilient and healthy communities Stockholm, Sweden 1–4 November 2017
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2018-06-09Bibliographically approved
Melander, M., Dahlblom, K., Jegannathan, B. & Kullgren, G. (2016). Exploring communication of traumatic experiences from Khmer Rouge genocide survivors to their offspring: In-depth interviews with both generations. International Journal of Social Psychiatry, 62(4), 327-333
Open this publication in new window or tab >>Exploring communication of traumatic experiences from Khmer Rouge genocide survivors to their offspring: In-depth interviews with both generations
2016 (English)In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 62, no 4, p. 327-333Article in journal (Refereed) Published
Abstract [en]

Background: Traumatic events experienced by parents who have survived genocide influence mental health among their offspring. This study aims at exploring how the communication of traumatic events between Khmer Rouge survivors and their offspring was perceived by both generations.

Methods: Qualitative interviews were performed with six Khmer Rouge survivors and with six young people representing the second generation and were analysed using a content analysis approach.

Discussion: Parents felt that informing their children was important to instill gratitude for living a better life and to empower them. Among children, this was met with empathy but sometimes also disbelief and at times they blamed their parents for being too submissive.

Conclusion: The study discloses the complexity, pros and cons of intergenerational sharing of trauma.

Keywords
Trauma, genocide, second generation, communication, qualitative analysis
National Category
Social Psychology
Identifiers
urn:nbn:se:umu:diva-124191 (URN)10.1177/0020764016631364 (DOI)000378423200003 ()26896030 (PubMedID)
Available from: 2016-08-05 Created: 2016-07-28 Last updated: 2018-06-07Bibliographically approved
Jegannathan, B., Kullgren, G. & Dahlblom, K. (2016). How do young people in Cambodia perceive the impact of societal attitudes, media and religion on suicidal behaviour?. International Journal of Social Psychiatry, 62(2), 114-122
Open this publication in new window or tab >>How do young people in Cambodia perceive the impact of societal attitudes, media and religion on suicidal behaviour?
2016 (English)In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 62, no 2, p. 114-122Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Young people in low and middle income countries (LMICs) in societal transitions with rapidly changing norms face an increased risk of suicide. This study explores how young people in Cambodia understand the impact on suicidal behaviour from societal attitudes, media and religion.

MATERIAL: Focus group discussions were held with school students from a suburban area. Thematic analysis was used to interpret the data.

DISCUSSION: Participants perceived the prevailing suicide-stigmatizing societal attitudes, the double-edged media and suicide-ambiguity in Buddhist religion as challenging. Globalization was recognized as contradicting with traditional Cambodian norms and values.

CONCLUSION: Suicide prevention programmes should take into consideration the complex picture of suicide that young people are exposed to.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Societal attitudes, media, religion, suicide, young people, Cambodia
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-106859 (URN)10.1177/0020764015597952 (DOI)000370422200003 ()26238990 (PubMedID)
Available from: 2015-08-11 Created: 2015-08-11 Last updated: 2018-06-07Bibliographically approved
Hernández, A. R., Hurtig, A.-K., Dahlblom, K. & San Sebastián, M. (2015). Integrating views on support for mid-level health worker performance: a concept mapping study with regional health system actors in rural Guatemala. International Journal for Equity in Health, 14, Article ID 91.
Open this publication in new window or tab >>Integrating views on support for mid-level health worker performance: a concept mapping study with regional health system actors in rural Guatemala
2015 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 14, article id 91Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Mid-level health workers are on the front-lines in underserved areas in many LMICs, and their performance is critical for improving the health of vulnerable populations. However, improving performance in low-resource settings is complex and highly dependent on the organizational context of local health systems. This study aims to examine the views of actors from different levels of a regional health system in Guatemala on actions to support the performance of auxiliary nurses, a cadre of mid-level health workers with a prominent role in public sector service delivery. A concept mapping study was carried out to develop an integrated view on organizational support and identify locally relevant strategies for strengthening performance.

METHODS: A total of 93 regional and district managers, and primary and secondary care health workers participated in generating ideas on actions needed to support auxiliary nurses' performance. Ideas were consolidated into 30 action items, which were structured through sorting and rating exercises, involving a total of 135 of managers and health workers. Maps depicting participants' integrated views on domains of action and dynamics in sub-groups' interests were generated using a sequence of multivariate statistical analyses, and interpreted by regional managers.

RESULTS: The combined input of health system actors provided a multi-faceted view of actions needed to support performance, which were organized in six domains, including: Communication and coordination, Tools to orient work, Organizational climate of support, Motivation through recognition, Professional development and Skills development. The nature of relationships across hierarchical levels was identified as a cross-cutting theme. Pattern matching and go-zone maps indicated directions for action based on areas of consensus and difference across sub-groups of actors.

CONCLUSIONS: This study indicates that auxiliary nurses' performance is interconnected with the performance of other health system actors who require support, including managers and community-level collaborators. Organizational climate is critical for making auxiliary nurses feel supported, and greater attention to improving the quality of hierarchical relationships is needed in LMIC settings. The participatory nature of the concept-mapping process enabled health system actors to collaborate in co-production of context-specific knowledge needed to guide efforts to strengthen performance in a vulnerable region.

Keywords
Health worker, Nursing, Performance, Relationships, Health services management, Health system, Concept mapping
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-110309 (URN)10.1186/s12939-015-0225-4 (DOI)000362408600001 ()26449232 (PubMedID)
Available from: 2015-10-20 Created: 2015-10-20 Last updated: 2018-06-07Bibliographically approved
Obando Medina, C., Kullgren, G. & Dahlblom, K. (2014). A qualitative study on primary health care professionals' perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua. BMC Family Practice, 15, 129
Open this publication in new window or tab >>A qualitative study on primary health care professionals' perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua
2014 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 15, p. 129-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mental health problems among young peoples are a growing public health issue around the world. In low- income countries health systems are characterized by lack of facilities, human resources and primary health care is rarely an integrated part of overall health care services. This study aims at exploring how primary health care professionals in Nicaragua perceive young people's mental health problems, suicidal problems and help-seeking behaviour.

METHODS: Twelve in-depth interviews were conducted with nurses and doctors working in primary health care services in León, Nicaragua. A qualitative research design was applied. Data was analysed using thematic analysis approach.

RESULTS: This study revealed that doctors and nurses were reluctant to deal with young people presenting with suicidal problems at the primary health care. This was more likely to stem from feelings of incompetence rather than from negative attitudes. Other barriers in providing appropriate care to young people with mental health problems were identified such as lack of time, lack of privacy, lack of human resources, lack of trained professionals and difficulties in communicating with young people. The primary health care (PHC) professionals suggested different solutions to improve care for young people with suicidal problems.

CONCLUSION: PHC doctors and nurses in Nicaragua felt that providing skilled mental health services to young people was a priority for them but they also identified a number of barriers to be able to do so. They discussed ways to improve young people's willingness to share sensitive issues with them and suggested ways to make PHC more appreciated by young people.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
young people, focus-group discussion, suicidal behaviour, Cambodia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-91945 (URN)10.1186/1471-2296-15-129 (DOI)000339513900001 ()24989871 (PubMedID)
Available from: 2014-08-18 Created: 2014-08-18 Last updated: 2018-06-07Bibliographically approved
Mosquera Mendez, P. A., Hernández, J., Vega, R., Labonte, R., Sanders, D., Dahlblom, K. & San Sebastián, M. (2014). Challenges of implementing a primary health care strategy in a context of a market-oriented health care system: the experience of Bogota, Colombia. International Journal of Health Planning and Management, 29(4), E347-E367
Open this publication in new window or tab >>Challenges of implementing a primary health care strategy in a context of a market-oriented health care system: the experience of Bogota, Colombia
Show others...
2014 (English)In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 29, no 4, p. E347-E367Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. METHODS: The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. RESULTS: The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. CONCLUSION: Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
primary health care; barriers and enablers; qualitative study; Bogota
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-83481 (URN)10.1002/hpm.2228 (DOI)000344783200003 ()24254649 (PubMedID)
Available from: 2013-11-27 Created: 2013-11-27 Last updated: 2018-06-08Bibliographically approved
Salazar, M., Dahlblom, K., Solórzano, L. & Herrera, A. (2014). Exposure to intimate partner violence reduces the protective effect that women's high education has on children's corporal punishment: a population-based study. Global Health Action, 7, 24774
Open this publication in new window or tab >>Exposure to intimate partner violence reduces the protective effect that women's high education has on children's corporal punishment: a population-based study
2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 24774-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Previous studies have shown that women's education is protective against corporal punishment (CP) of children. However, the effect that women's exposure to intimate partner violence (IPV) has on the association between women's education and children's CP has not been studied.

OBJECTIVE: To understand how the interaction between women's exposure to IPV and their education level influences the occurrence of children's CP at the household level.

METHODS: We selected 10,156 women who had at least one child less than 16 years old from cross-sectional data from the 2006-2007 Nicaraguan Demographic and Health Survey. Children's CP was defined as the punishment of children by slapping them, hitting them with a fist, or hitting them with a rope, belt, stick, or other object. IPV was measured by using a conflict tactic scale. The WHO Self-Reporting Questionnaire 20 (SRQ-20) was used to assess the women's mental health. We computed adjusted risk ratios (ARR) and 95% confidence intervals (CI) using Poisson regression with a robust variance estimator.

RESULTS: Women's exposure to IPV was associated with a 10-17% increase in the risk of children's CP. IPV and children's CP were associated with impaired women's mental health. Women's lifetime exposure to emotional IPV and controlling behavior by a partner significantly decreased the protective effect from women's high education level on children's CP. When women were exposed to emotional IPV, the protective effect from having a college education decreased from ARR=0.61 (95% CI 0.47-0.80) to ARR=0.98 (95% CI 0.80-1.19). A similar pattern was found among women exposed to controlling behavior by a partner, the protective effect decreased from ARR=0.71 (95% CI 0.53-0.90) to ARR=0.86 (95% CI 0.70-1.06).

CONCLUSION: This study shows how significant gains in one positive social determinant of children's well-being can be undermined when it interacts with men's violence toward women. Policies that aim to end children's CP must include actions to end women's exposure to IPV.

Keywords
children's corporal punishment, education, interaction, IPV, women
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-93536 (URN)10.3402/gha.v7.24774 (DOI)000341766300001 ()25226419 (PubMedID)
Available from: 2014-09-24 Created: 2014-09-24 Last updated: 2018-06-07Bibliographically approved
Hernández, A. R., Hurtig, A.-K., Dahlblom, K. & San Sebastián, M. (2014). More than a checklist: a realist evaluation of supervision of mid-level health workers in rural Guatemala. BMC Health Services Research, 14(1), 112
Open this publication in new window or tab >>More than a checklist: a realist evaluation of supervision of mid-level health workers in rural Guatemala
2014 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, no 1, p. 112-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mid-level health workers (MLHWs) form the front-line of service delivery in many low- and middle-income countries. Supervision is a critical institutional intervention linking their work to the health system, and it consists of activities intended to support health workers' motivation and enable them to perform. However its impact depends not only on the frequency of these activities but also how they are carried out and received. This study aims to deepen understanding of the mechanisms through which supervision activities support the performance of auxiliary nurses, a cadre of MLHWs, in rural Guatemala.

METHODS: A multiple case study was conducted to examine the operation of supervision of five health posts using a realist evaluation approach. A program theory was formulated describing local understanding of how supervision activities are intended to work. Data was collected through interviews and document review to test the theory. Analysis focused on comparison of activities, outcomes, mechanisms and the influence of context across cases, leading to revision of the program theory.

RESULTS: The supervisor's orientation was identified as the main mechanism contributing to variation observed in activities and their outcomes. Managerial control was the dominant orientation, reflecting the influence of standardized performance criteria and institutional culture. Humanized support was present in one case where the auxiliary nurse was motivated by the sense that the full scope of her work was valued. This orientation reflected the supervisor's integration of her professional identity as a nurse.

CONCLUSIONS: The nature of the support health workers received was shaped by supervisors' orientation, and in this study, nursing principles were central to humanized support. Efforts to strengthen the support that supervision provides to MLHWs should promote professional ethos as a means of developing shared performance goals and orient supervisors to a more holistic view of the health worker and their work.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Mid-level health worker, Supervision, Performance, Motivation, Realist evaluation, Guatemala
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-87000 (URN)10.1186/1472-6963-14-112 (DOI)000332617800002 ()24602196 (PubMedID)
Available from: 2014-03-17 Created: 2014-03-17 Last updated: 2018-06-08Bibliographically approved
Jegannathan, B., Dahlblom, K. & Kullgren, G. (2014). Outcome of a school-based intervention to promote life-skills amongyoung people in Cambodia. Asian Journal of Psychiatry
Open this publication in new window or tab >>Outcome of a school-based intervention to promote life-skills amongyoung people in Cambodia
2014 (English)In: Asian Journal of Psychiatry, ISSN 1876-2018Article in journal (Refereed) In press
Abstract [en]

Background Most of the school-based interventions to prevent suicide are from high income countries and there is a need for evidence based interventions in resource-poor settings. The aim of this study is to evaluate the outcome of a school based intervention to reduce risk factors for suicide among young people in Cambodia by promoting life skills.

Method Six classes were randomly selected from two schools each, one designated as experimental and the other as control school, respectively. In experimental school 168 young people (M = 92, F = 76) received 6 sessions of life skills education and in the control school 131 students (M = 53, F = 78) received three general sessions on health. We looked at the pre-post differences on Life-Skills Development Scale Adolescent Form (LSDS-AF)- and Youth Self-Report (YSR) questionnaire to measure the effect size (ES) from the intervention after 6 months. We analyzed the data by stratifying for gender and for those who reported more severe suicidal expressions at baseline (high-risk group).

Results The girls showed improvement in Human Relationship (ES = 0.57), Health Maintenance (ES = 0.20) and the Total Life Skills Dimensions (ES = 0.24), whereas boys with high-risk behavior improved on Human Relationship (ES = 0.48), Purpose in Life (ES = 0.26) and Total Life Skills Dimensions (ES = 0.22). Effect size for YSR-syndrome scores among all individuals showed no improvement for either gender. Among high-risk individuals boys had a small to moderate effect size from intervention on Withdrawn/Depressed (ES = 0.40), Attention problems (ES = 0.46), Rule breaking behavior (ES = 0.36), Aggressive behavior (ES = 0.48) and Externalizing syndrome (ES = 0.64).

Conclusion Promoting life skills in schools may enhance the overall mental health of young people, indirectly influencing suicide, particularly among boys with high-risk behavior in Cambodia.

Keywords
Outcome; School based intervention; Life skills; Cambodia
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-88194 (URN)10.1016/j.ajp.2014.01.011 (DOI)
Available from: 2014-04-25 Created: 2014-04-25 Last updated: 2018-06-07Bibliographically approved
Jegannathan, B., Dahlblom, K. & Kullgren, G. (2014). ‘Plue plun’ male, ‘kath klei’ female: gender differences in suicidal behavior as expressed by young people in Cambodia. International Journal of Culture and Mental Health, 7(3), 326-338
Open this publication in new window or tab >>‘Plue plun’ male, ‘kath klei’ female: gender differences in suicidal behavior as expressed by young people in Cambodia
2014 (English)In: International Journal of Culture and Mental Health, ISSN 1754-2863, E-ISSN 1754-2871, Vol. 7, no 3, p. 326-338Article in journal (Refereed) Published
Abstract [en]

Few studies from low- and middle-income countries use qualitative methodologyto explore suicidal behavior among young people. In Cambodia, young peopleface the challenge of rapidly changing times and are vulnerable for suicidalbehavior as revealed by research in transitional economies. This study seeks togain a deeper understanding of the suicidal phenomena from a gender, psychosocialand cultural perspective. Six focus-group discussions were conductedamong boys and girls, aged 15–19 years, in two secondary schools in a suburbanarea close to Phnom Penh, the capital city. The data was analyzed using thematicanalysis approach. The participants highlighted the gender difference in suicidalbehavior by describing the suicide-prone, acting-out male as ‘plue plun’, whilesuicide-prone females were described as caught in constricted, tunneled-thinkingbehavior, expressed as ‘kath klei’. Parental attitude and family environment werealso pointed out as the chief causes of discontent and there was a strong wish onthe part of young people to find space for modern values within the traditionalfamily. The young people’s awareness of their challenges in everyday life suggeststhat school-based programs to prevent suicidal behavior ought to be gendersensitiveand peer-focused.

Place, publisher, year, edition, pages
Taylor & Francis, 2014
Keywords
young people, focus-group discussion, suicidal behaviour, Cambodia
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-83539 (URN)10.1080/17542863.2013.800568 (DOI)
Available from: 2013-12-02 Created: 2013-12-02 Last updated: 2018-06-08Bibliographically approved
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