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  • 1.
    Fhärm, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Rolandsson, Olov
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    ‘Aiming for the stars’—GPs’ dilemmas in the prevention of cardiovascular disease in type 2 diabetes patients: focus group interviews2009Ingår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, nr 26, s. 109-114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Studies have revealed low adherence to guidelines for treatment of diabetes and cardiovascular risk factors.

    Objective

    To explore general practitioners’ experiences regarding treatment practice in type 2 diabetes with specific focus on the prevention of cardiovascular disease.

    Methods

    Fourteen experienced general practitioners from nine health care centres with group practices were interviewed in focus groups. The interviews were digitally recorded, transcribed verbatim and analysed by qualitative content analysis.

    Results

    The overall theme was “dilemmas” in GPs´ treatment practice for type 2 diabetes patients. Five main dilemma categories were identified. First, the GPs were hesitant about labelling someone who feels healthy as ill. Secondly, regarding communicating a diabetes diagnosis and its consequences; should the patient be frightened or comforted? Thirdly, the GPs experienced uncertainty in their role; were they to take responsibility for the care or not? Fourthly, the GPs expressed a conflict between lifestyle changes and drug treatment. Fifthly, the GPs described difficulties in integrating science into reality.

    Conclusions

    The five dilemmas in the general practitioners’ approach to diabetes patients and the treatment of their cardiovascular risk were related to the GPs´ professional role and communication with the patient. To consider these dilemmas in educational efforts is probably essential to achieve improved diabetes care and guideline adherence. 

  • 2.
    Hamberg, Katarina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lindgren, Gerd
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Westman, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Scientific rigor in qualitative research: examples from a study of women´s health1994Ingår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 11, s. 176-181Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The increase in qualitative research in family medicine raises a demand for critical discussions about design, methods and conclusions. This article shows how scientific claims for truthful findings and neutrality can be assessed. Established concepts such as validity, reliability, objectivity and generalization cannot be used in qualitative research. Alternative criteria for scientific rigour, initially introduced by Lincoln and Guba, are presented: credibility, dependability, confirmability and transferability. These criteria have been applied to a research project, a qualitative study with in-depth interviews with female patients suffering from chronic pain in the locomotor system. The interview data were analysed on the basis of grounded theory. The proposed indicators for scientific rigour were shown to be useful when applied to the research project. Several examples are given. Difficulties in the use of the alternative criteria are also discussed.

  • 3.
    Jerdén, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Epidemiologi och folkhälsovetenskap.
    Does a patient-held health record give rise to lifestyle changes? A study in clinical practice.2004Ingår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 21, nr 6, s. 651-653Artikel i tidskrift (Refereegranskat)
  • 4. Johansson, Eva E.
    et al.
    Hamberg, Katarina
    Lindgren, Gerd
    Westman, Göran
    "I've been crying my way": qualitative analysis of a group of female patients' consultation experiences1996Ingår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 13, nr 6, s. 498-503Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and objectives What do women patients, sick-listed for biomedically undefined musculoskeletal disorders, expect and experience when they consult a doctor? With the purpose to learn more about this, a qualitative interview study was conducted.

    Methods Twenty women participated. They were patients at an urban health care centre in northern Sweden. Data were gained through repeated, semi-structured interviews, and analysed according to grounded theory.

    Results The participants described an atmosphere of distrust in the consultation. They had felt ignored, disregarded and rejected by doctors, and had worked out strategies to keep up medical attention in their search for a creditable diagnosis. They were somatizing, claiming under cover, and pleading, to catch the doctor's interest. In addition, they upheld their self-respect by mystifying and martyrizing themselves and their symptoms, and by condemning physicians as ignorant.

    Discussion The patient's consultation experiences are discussed from different aspects; the biomedical framework, the power asymmetry, and the gendered positions of patient and doctor. The findings indicate the importance of making doctors aware of the context behind frustrations in doctor-patient interaction.

  • 5.
    Lehti, Arja
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Mattson, Bengt
    Health, attitude to care and pattern of attendance among gypsy women: a general practice perspective2001Ingår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 18, nr 4, s. 445-448Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is a lack of knowledge about health and attitude to care among gypsies.

    OBJECTIVES: The aim of this study was to explore the reasons for and patterns of attendance among gypsy women in primary health care and to shed light on health problems of gypsies.

    METHODS: Four gypsy women, frequently attending a primary health care centre, were interviewed in depth. Data were analysed according to grounded theory. Additional facts were received from record files.

    RESULTS AND CONCLUSIONS: The gypsy women seldom approached the health centre alone but paid a visit together with relatives or friends. The women usually presented the same type of symptoms, often pain, headache and depression, and obtained the same type of diagnosis and treatment. The symptoms had an acute character and the women wanted immediate access. A collective pattern, a hierarchical order and a strict rule system characterized the gypsy life and coloured the relation to health and illness. Young women were especially vulnerable and could easily end up outside the collective and display symptoms.

  • 6.
    Nilsson, Berit
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Westman, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    The impact of patients' influence on recovery in a group of patients with dyspepsia1999Ingår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 16, nr 5, s. 515-521Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. The approach to health and disease can either be salutogenic (origins of health) or pathogenic (disease causing), which thus makes recovery a concept featuring several different angles. Antonovsky, with his concept of salutogenesis, tried to reach a more complete understanding of its favourable effects on health.

    Objective. We aimed to investigate, understand and learn from the experiences of a small group of patients about factors leading to recovery.

    Methods.A qualitative approach was used to explore patient experiences. One semi-structured interview was conducted by one of the authors (BN) with each of the 18 patients suffering from dyspepsia who had been investigated by means of gastroscopy at a university hospital clinic 12–15 years previously. The interviews were recorded either in written notes composed directly after the interviews or tape-recorded and subsequently transcribed. A modified form of grounded theory according to Strauss-Corbin was used to analyse the data.

    Results. A pattern featuring five types of patients' influence on their lives was discerned, ranging from “a sense of no possibility of having an influence on existence/life” to “having influence”. Strategies used by patients to maintain health could be categorized into four types: “extremists”, “oscillators”, “leapers” and “full-scalers”.

    Conclusions.Listening to patients who had experiences with dyspepsia brought patient influence on their own lives and on the care process into focus. We consider that there might be a link between patients having an influence on their lives and their being healthy today. In clinical practice, patient recovery and health promotion could gain from a perspective where patient influence is treated with esteem and emphasized in the consultation. In the future, research design could benefit from taking patient influence on the care process into consideration. However, no causal linkage between patient influence and patient outcome was established in this study. In order to do that, studies with quantitative design should be undertaken in the future.

  • 7.
    Umefjord, Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Malker, Hans
    Mid-Sweden Research and Development Centre, County Council of Va¨ sternorrland, Sundsvall, Sweden.
    Petersson, Göran
    Health Institute, Department of Health and Behavioural Science, University of Kalmar, Sweden.
    The use of an internet-based ask the doctor service involving family physicians: evaluation by a web survey2006Ingår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 23, nr 2, s. 159-166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Internet consultation without a previous relationship between the doctor and the enquirer seems to be increasing in popularity. However, little is known about the advantages, disadvantages or other differences compared with regular health care when using this kind of service. OBJECTIVE: To investigate how an Internet-based Ask the Doctor service out with any pre-existing doctor-patient relationship was used and evaluated by the enquirers. METHODS: We recruited to a web-based survey users of the non-commercial Swedish Internet-based Ask the Doctor service run by family physicians. The survey was conducted between November 2001 and January 2002. Questions included both multiple choice and free text formats, and the results were analysed quantitatively and qualitatively. RESULTS: The survey was completed by 1223 participants. It was mainly women who submitted questions to the service (29% men, 71% women) and also who participated in the survey (26% men, 74% women). Most participants (77%) wrote their question at home, and 80% asked on their own behalf. Almost half of the enquiries (45%) concerned a medical matter that had not been evaluated by a medical professional before. After reading the answer, 43% of the participants indicated that they would not pursue their question further having received sufficient information in the answer provided. The service was appreciated for its convenience and flexibility, but also for reasons to do with the mode of communication such as the ability to reflect on the written answer without having to hurry and to read it more than once. CONCLUSION: In the present study, we found that an Internet-based Ask the Doctor service run by family physicians on the whole was evaluated positively by the participants both in terms of the answers and the service. Internet-based consultation may act as a complement to regular health care. In future studies, the cost-effectiveness, patient security, responsibilities of the Internet doctor and the role of Ask the Doctor services compared with regular health care should be evaluated.

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