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Lundman, B., Hammarström, A., Ahlgren, C. & Norberg, A. (2019). Use of the model of Inner Strength for analysing reflective interviews in a group of healthy middle-aged adults. Safety, 7
Open this publication in new window or tab >>Use of the model of Inner Strength for analysing reflective interviews in a group of healthy middle-aged adults
2019 (English)In: Safety, ISSN 0036-3375, E-ISSN 2050-3121, Vol. 7Article in journal (Refereed) Published
Abstract [en]

Objective: Inner Strength has been described as a human resource that promotes well-being linked to health. The aim of this study was to explore how Inner Strength and its four dimensions are manifested in interviews in a group of middle-aged healthy women and men.

Methods: Retrospective reflective interviews with middle-aged healthy women (n = 5) and men (n = 4) selected from a population study were content analysed deductively.

Results: The following themes and their constituents were found in the respective dimensions of the Model of Inner Strength. Firmness: having a drive to act, being purposeful, having trust in one’s competence, and having a positive view of life. Connectedness: being in community, receiving and giving support, and, receiving and giving care. Creativity: changing unsatisfactory life situations, seeing new opportunities, and realizing dreams. Stretchability: balancing between options, and extending oneself.

Conclusions: Expressions that were interpreted as belonging to Inner Strength could be referred the different dimensions of Inner Strength. The Model of Inner Strength is suitable for analysing Inner Strength among middle-aged men and women. The findings indicate that Inner Strength can be identified in human beings’ narratives if asked for.

Place, publisher, year, edition, pages
SAGE Open, 2019
Keywords
Nursing, mental health, psychiatry, Inner Strength, content analysis, deductive
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-161455 (URN)10.1177/2050312119856812 (DOI)000471113000001 ()31217970 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-37
Available from: 2019-07-10 Created: 2019-07-10 Last updated: 2019-09-05Bibliographically approved
Wiklund, M., Ahlgren, C. & Hammarström, A. (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. Global Health Action, 11(sup3), Article ID 1519960.
Open this publication in new window or tab >>Constructing respectability from disfavoured social positions: exploring young femininities and health as shaped by marginalisation and social context. A qualitative study in Northern Sweden
2018 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no sup3, article id 1519960Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
Keywords
youth, adolescence, femininity, gender, femmephobia, respectability, agency within structures, youth unemployment, public health, qualitative interviews, Sweden, ungdom, ungdomshälsa, genus, genusteori, femininitet, respektabilitet, kvalitativ metod, intervjuer, Sverige
National Category
Public Health, Global Health, Social Medicine and Epidemiology Gender Studies
Research subject
Public health; gender studies
Identifiers
urn:nbn:se:umu:diva-152293 (URN)10.1080/16549716.2018.1519960 (DOI)
Funder
Swedish Research Council Formas, 259-2012-37Swedish Research Council, 344-2011-5478
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-01Bibliographically approved
Sandlund, M., Pohl, P., Ahlgren, C., Skelton, D. A., Melander-Wikman, A., Bergvall-Kareborn, B. & Lundin-Olsson, L. (2018). Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention: A Qualitative Study. BioMed Research International, Article ID 6865156.
Open this publication in new window or tab >>Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention: A Qualitative Study
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2018 (English)In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 6865156Article in journal (Refereed) Published
Abstract [en]

Background: Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises.

Aim: To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective.

Methods: Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis.

Results: Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men.

Conclusion: Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women's and men's preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2018
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-150400 (URN)10.1155/2018/6865156 (DOI)000439167500001 ()
Available from: 2018-08-06 Created: 2018-08-06 Last updated: 2018-08-06Bibliographically approved
Sandlund, M., Skelton, D. A., Pohl, P., Ahlgren, C., Melander-Wikman, A. & Lundin-Olsson, L. (2017). Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review. BMC Geriatrics, 17, Article ID 58.
Open this publication in new window or tab >>Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review
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2017 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 58Article in journal (Refereed) Published
Abstract [en]

Background: To offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls. Methods: A review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach. Results: Nine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies. Conclusion: Although there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women's and men's views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Accidental falls, Adherence, Aged, Exercise, Gender identity
National Category
Gender Studies Geriatrics
Identifiers
urn:nbn:se:umu:diva-139587 (URN)10.1186/s12877-017-0451-2 (DOI)000397451900001 ()28212622 (PubMedID)
Available from: 2017-09-20 Created: 2017-09-20 Last updated: 2018-06-09Bibliographically approved
diva2:871971
Open this publication in new window or tab >>Engagement in New Dietary Habits: Obese Women's Experiences from Participating in a 2-Year Diet Intervention
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2016 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 1, p. 84-93Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Dietary weight loss interventions most often result in weight loss, but weight maintenance on a long-term basis is the main problem in obesity treatment. There is a need for an increased understanding of the behaviour patterns involved in adopting a new dietary behavior and to maintain the behaviour over time.

PURPOSE: The purpose of this paper is to explore overweight and obese middle-aged women's experiences of the dietary change processes when participating in a 2-year-long diet intervention.

METHODS: Qualitative semi-structured interviews with 12 overweight and obese women (54-71 years) were made after their participation in a diet intervention programme. The programme was designed as a RCT study comparing a diet according to the Nordic nutrition recommendations (NNR diet) and a Palaeolithic diet (PD). Interviews were analysed according to Grounded Theory principles.

RESULTS: A core category "Engagement phases in the process of a diet intervention" concluded the analysis. Four categories included the informants' experiences during different stages of the process of dietary change: "Honeymoon phase", "Everyday life phase", "It's up to you phase" and "Crossroads phase". The early part of the intervention period was called "Honeymoon phase" and was characterised by positive experiences, including perceived weight loss and extensive support. The next phases, the "Everyday life phase" and "It's up to you phase", contained the largest obstacles to change. The home environment appeared as a crucial factor, which could be decisive for maintenance of the new dietary habits or relapse into old habits in the last phase called "Crossroads phase".

CONCLUSION: We identified various phases of engagement in the process of a long-term dietary intervention among middle-aged women. A clear personal goal and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Gender relations within the household must be considered as a possible obstacle for women engaging in diet intervention.

Place, publisher, year, edition, pages
Springer, 2016
Keywords
Dietary habits, Engagement, Experience, Intervention, Obese, Qualitative study
National Category
Applied Psychology Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-111592 (URN)10.1007/s12529-015-9495-x (DOI)000370243400009 ()26041583 (PubMedID)
Available from: 2015-11-17 Created: 2015-11-17 Last updated: 2018-06-07Bibliographically approved
Mårell, L., Lindgren, M., Ternulf Nyhlin, K., Ahlgren, C. & Berglund, A. (2016). "Struggle to obtain redress": women's experiences of living with symptoms attributed to dental restorative materials and/or electromagnetic fields. International Journal of Qualitative Studies on Health and Well-being, 11(1), Article ID 32820.
Open this publication in new window or tab >>"Struggle to obtain redress": women's experiences of living with symptoms attributed to dental restorative materials and/or electromagnetic fields
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2016 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, no 1, article id 32820Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore the experiences of illness and the encounters with health care professionals among women who attributed their symptoms and illness to either dental restorative materials and/or electromagnetic fields, despite the fact that research on health effects from dental fillings or electricity has failed to substantiate the reported symptoms. Thirteen women (aged 37-63 years) were invited to the study and a qualitative approach was chosen as the study design, and data were collected using semi-structured interviews. The analysis was conducted with a constant comparative method, according to Grounded Theory. The analysis of the results can be described with the core category, "Struggle to obtain redress," the two categories, "Stricken with illness" and "A blot in the protocol," and five subcategories. The core category represents the women's fight for approval and arose in the conflict between their experience of developing a severe illness and the doctors' or dentists' rejection of the symptoms as a disease, which made the women feel like malingerers. The informants experienced better support and confirmation from alternative medicine practitioners. However, sick-leave certificates from alternative medicine practitioners were not approved and this led to a continuous cycle of visits in the health care system. To avoid conflicting encounters, it is important for caregivers to listen to the patient's explanatory models and experience of illness, even if a medical answer cannot be given.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Environmental intolerance, dental restorative materials, encounters, qualitative study
National Category
Dentistry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-128842 (URN)10.3402/qhw.v11.32820 (DOI)000396164400001 ()27938629 (PubMedID)
Available from: 2016-12-16 Created: 2016-12-16 Last updated: 2018-06-09Bibliographically approved
Ahlgren, C., Fjellman-Wiklund, A., Hamberg, K., Johansson, E. E. & Stålnacke, B.-M. (2016). The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain: a literature review. Disability and Rehabilitation, 38(23), 2255-2270
Open this publication in new window or tab >>The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain: a literature review
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2016 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 23, p. 2255-2270Article, review/survey (Refereed) Published
Abstract [en]

Purpose: The purpose of this study is to assess and describe the meanings given to "gender" in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.

Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.

Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: "Gender as a factual difference", "The man is the ideal" and "Gender as a result of social role expectations".

Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.

Implications for rehabilitation

Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs. In rehabilitation for chronic pain the patients' social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

Keywords
Gender, musculoskeletal, pain, review
National Category
Gender Studies General Practice
Identifiers
urn:nbn:se:umu:diva-114094 (URN)10.3109/09638288.2015.1127435 (DOI)000381937400001 ()26730507 (PubMedID)
Available from: 2016-01-13 Created: 2016-01-13 Last updated: 2018-06-07Bibliographically approved
Pohl, P., Sandlund, M., Ahlgren, C., Bergvall-Kårebom, B., Lundin-Olsson, L. & Melander Wikman, A. (2015). Fall risk awareness and safety precautions taken by older community-dwelling women and men: a qualitative study using focus group discussions. PLoS ONE, 10(3), Article ID e0119630.
Open this publication in new window or tab >>Fall risk awareness and safety precautions taken by older community-dwelling women and men: a qualitative study using focus group discussions
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, article id e0119630Article in journal (Refereed) Published
Abstract [en]

Introduction Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women's and men's understanding of fall risk and their experiences with safety precautions taken to prevent falls.

Methods A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively.

Findings Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one's fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was "Safety precautions through fall risk awareness". Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts.

Conclusions The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples' conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.

Keywords
Older people, Fall risk awareness, Safety precautions, Community-dwelling, Qualitative research
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-98404 (URN)10.1371/journal.pone.0119630 (DOI)000351284600078 ()25781181 (PubMedID)
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2018-06-07Bibliographically approved
Pohl, P., Ahlgren, C., Nordin, E., Lundquist, A. & Lundin-Olsson, L. (2015). Gender perspective on fear of falling using the classification of functioning as the model. Disability and Rehabilitation, 37(3), 214-222
Open this publication in new window or tab >>Gender perspective on fear of falling using the classification of functioning as the model
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2015 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 3, p. 214-222Article in journal (Refereed) Published
Abstract [en]

Abstract Purpose: To investigate associations between fear of falling (FOF) and recurrent falls among women and men, and gender differences in FOF with respect to International Classification of Functioning (ICF). Methods: Community-dwelling people (n = 230, 75-93 years, 72% women) were included and followed 1 year regarding falls. Data collection included self-reported demographics, questionnaires, and physical performance-based tests. FOF was assessed with the question "Are you afraid of falling?". Results were discussed with a gender relational approach. Results: At baseline 55% women (n = 92) and 22% men (n = 14) reported FOF. During the follow-up 21% women (n = 35) and 30% men (n = 19) experienced recurrent falls. There was an association between gender and FOF (p = 0.001), but not between FOF and recurrent falls (p = 0.79), or between gender and recurrent falls (p = 0.32). FOF was related to Personal factors and Activity and Participation. The relationship between FOF and Personal factors was in opposite directions for women and men. Conclusions: Results did not support the prevailing paradigm that FOF increases rate of recurrent falls in community-dwelling people, and indicated that the answer to "Are you afraid of falling?" might be highly influenced by gendered patterns.

Implications for Rehabilitation

The question "Are you afraid of falling?" has no predictive value when screening for the risk of falling in independent community-dwelling women or men over 75 years of age.

Gendered patterns might influence the answer to the question "Are you afraid of falling?" Healthcare personnel are recommended to be aware of this when asking older women and men about fear of falling.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
Keywords
Falls, fear, gender, ICF, older people
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-96717 (URN)10.3109/09638288.2014.914584 (DOI)000348789500004 ()24786969 (PubMedID)
Available from: 2014-11-27 Created: 2014-11-27 Last updated: 2018-06-07Bibliographically approved
Hammarström, A., Lundman, B., Ahlgren, C. & Wiklund, M. (2015). Health and masculinities shaped by agency within structures among young unemployed men in a northern Swedish context. PLoS ONE, 10(5), 1-18, Article ID e0124785.
Open this publication in new window or tab >>Health and masculinities shaped by agency within structures among young unemployed men in a northern Swedish context
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, p. 1-18, article id e0124785Article in journal (Refereed) Published
Abstract [en]

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.

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

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.

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.

Keywords
unemployment, youth, agency, structure, gender, masculinity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-103760 (URN)10.1371/journal.pone.0124785 (DOI)000356768100035 ()25954811 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-37Swedish Research Council, 344-2011-5478
Available from: 2015-05-29 Created: 2015-05-29 Last updated: 2018-06-07Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5965-5368

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