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  • 1.
    Alex, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Experiences of Well-Being Among Sami and Roma Women in a Swedish Context2013Ingår i: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 34, nr 8, s. 707-726Artikel i tidskrift (Refereegranskat)
    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.)

  • 2.
    Bengs, Carita
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Johansson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Danielsson, Ulla EB
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Gendered portraits of depression in Swedish newspapers2008Ingår i: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 18, nr 7, s. 962-973Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Mass media are influential mediators of information, knowledge, and narratives of health and illness. In this article, we report on an examination of personal accounts of illness as presented in three Swedish newspapers, focusing on the gendered representation of laypersons' experiences of depression. A database search identified all articles mentioning depression during the year 2002. Twenty six articles focusing on personal experiences of depression were then subjected to a qualitative content analysis. We identified four themes: displaying a successful facade, experiencing a cracking facade, losing and regaining control, and explaining the illness. We found both similarities and differences with regard to gendered experiences. The mediated accounts of depression both upheld and challenged traditional gender stereotypes. The women's stories were more detailed, relational, emotionally oriented, and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression, reflecting hegemonic patterns of masculinity.

  • 3.
    Danielsson, Ulla EB
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Bengs, Carita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hammarström, Anne
    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.
    Struck by lightning or slowly suffocating: gendered trajectories into depression2009Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 10, nr 1, s. 56-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In family practice depression is a common mental health problem and one with marked gender differences; women are diagnosed as depressed twice as often as men. A more comprehensive explanatory model of depression that can give an understanding of, and tools for changing, this gender difference is called for. This study explores how primary care patients experience, understand and explain their depression.

    Methods: Twenty men and women of varying ages and socioeconomic backgrounds diagnosed with depression according to ICD-10 were interviewed in-depth. Data were assessed and analyzed using Grounded Theory.

    Results: The core category that emerged from analysis was "Gendered trajectories into depression". Thereto, four categories were identified – "Struck by lightning", "Nagging darkness", "Blackout" and "Slowly suffocating" – and presented as symbolic illness narratives that showed gendered patterns. Most of the men in our study considered that their bodies were suddenly "struck" by external circumstances beyond their control. The stories of study women were more diverse, reflecting all four illness narratives. However, the dominant pattern was that women thought that their depression emanated from internal factors, from their own personality or ways of handling life. The women were more preoccupied with shame and guilt, and conveyed a greater sense of personal responsibility and concern with relationships.

    Conclusion: Recognizing gendered narratives of illness in clinical consultation may have a salutary potential, making more visible depression among men while relieving self-blame among women, and thereby encouraging the development of healthier practices of how to be a man or a woman.

  • 4.
    Eskilsson, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Stressrehabilitering, Västerbottens läns landsting.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap.
    Sturesson, Marine
    Västerbottens läns landsting.
    Ståhlnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Metodstöd ADA+: ArbetsplatsDialog för Arbetsåtergång : planering, uppföljning och stöd2017Bok (Övrigt vetenskapligt)
  • 5.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Haukenes, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Fjellman Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Evengard, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Low-Educated Women with Chronic Pain Were Less Often Selected to Multidisciplinary Rehabilitation Programs2014Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 5, artikel-id e97134Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Klara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Annandale, Ellen
    Ahlgren, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Christianson, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Elwer, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Eriksson, Carola
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Gilenstam, Kajsa
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Harryson, Lisa
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Stenberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Verdonk, Petra
    Central gender theoretical concepts in health research: the state of the art2014Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, nr 2, s. 185-190Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Danielsson, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Bengs, Carita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Johansson, E.E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Gender-related explanatory models of depression: a critical evaluation of medical articles2009Ingår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, nr 10, s. 689-693Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Although research has consistently shown a higher prevalence of depression among women compared with men, there is a lack of consensus regarding explanatory factors for these gender-related differences. The aim of this paper was to analyse the scientific quality of different gender-related explanatory models of depression in the medical database PubMed.

    Study design: Qualitative and quantitative analyses of PubMed articles.

    Methods: In a database search in PubMed for 2002, 82 articles on gender and depression were selected and analysed with qualitative and quantitative content analyses. In total, 10 explanatory factors and four explanatory models were found. The ISI Web of Science database was searched in order to obtain the citation number and journal impact factor for each article.

    Results: The most commonly used gender-related explanatory model for depression was the biomedical model (especially gonadal hormones), followed by the sociocultural and psychological models. Compared with the other models, the biomedical model scored highest on bibliometric measures but lowest on measures of multifactorial dimensions and differences within the group of men/women.

    Conclusion: The biomedical model for explaining gender-related aspects of depression had the highest quality when bibliometric methods were used. However, the sociocultural and psychological models had higher quality than the biomedical model when multifactoriality and intersectionality were analysed. There is a need for the development of new methods in order to evaluate the scientific quality of research.

  • 8.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Haukenes, Inger
    Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health; Research Unit for General Practice, Uni Research Health, Kalfarveien 31, Bergen, Norway.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients: A Study of Pain Rehabilitation2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 4, artikel-id e0152735Artikel i tidskrift (Refereegranskat)
    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.

  • 9.
    Johansson, Eva E
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Bengs, Carita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Danielsson, Ulla EB
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Gaps between patients, media and academic medicine in discourses on gender and depression: a metasynthesis2009Ingår i: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, nr 5, s. 633-644Artikel i tidskrift (Refereegranskat)
  • 10.
    Lehti, Arja
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Struggling for clarity: cultural context, gender and a concept of depression in general practice2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Many depressed patients attend primary health care, and minority-group patients often see general practitioners for depressive symptoms. The diagnosis and classification criteria of depression and guidelines for management are based on symptoms. However,expressions of depression can vary with culture and gender but the diagnostic tools and guidelines are not adapted to gendered or cultural context and have shown to be poorly applicable in clinical practice. The purpose of this thesis was to analyse how socio-cultural factorswith focus on gender and ethnicity and their intersections- could influence the concept of depression from the perspectives of the patient and patient descriptions, of medical experts as well as general practitioners. By viewing these different perspectives I have tried to illustrate how depressive symptoms are expressed and interpreted in different gendered socio-cultural contexts and how they become a disease entity. Furthermore, I want, in particular, to illustrate a variety of difficulties that GPs may face during the process of care when meeting and treating men and women from different countries showing symptoms which may indicate depression.

    Study I. The aim of the study was to explore the reasons for and patterns of attendance among Roma women in primary health care and to shed light on health problems of the Roma. Four Roma women were interviewed in-depth. The data were audiotaped and analysed according to Grounded Theory. The resuIts showed that the daily life of women was characterized by marked hierarchical order and rules formed by gender, age and the collective culture. Young women had most rules to follow and if the rules were broken it was easy to end up outside the collective and display depressive symptoms or pain. The gendered, collective culture could both construct and/or form the concept of illness among the Roma women.

    Study II. The aim of the study was to highlight the gendered representations of lay persons´ experiences of depression by drawing on personal stories of depression that appeared in Swedish newspapers. The data were then subjected to a Qualitative Content Analysis. The mediated accounts of depression both upheld and challenged traditional gender stereotypes. The women’s stories were more detailed, relational, emotionally oriented, and embodied. The portrayal of men was less emotional and expressive, reflecting hegemonic patterns of masculinity. The media representations of gendered healthrelated beliefs and behaviours may influence the way patients, physicians and other health care professionals understand and communicate about issues of mental health and depression.

    Study III. The aim of the study was to explore how authors of medical articles wrote about different symptoms and expressions of depression in men and woman from various ethnic groups as well as to analyse the meaning of gender and ethnicity for expressions of depression. Through a search in the medical database PubMed 30 scientific articles were identified and included in the analysis. The result and the discussion section of each article was analysed with Qualitative Content Analysis. The analysis showed that culture and gender formed the expressions of depression, how depression was interpreted and the diagnosis of depression. The analysis of the articles identified a western point of view, which could lead to “cultural or gender gaps” and which could also influence the diagnosis of depression.

    Study IV. The aim of the study was to make a qualitative analysis of medical research articles in order to get a broader view of explanations of depression in men and women in various ethnic groups. Through a search in the medical database PubMed 60 scientific articles were identified and included in the analysis. The result and the discussion section of each article was analysed with Qualitative Content Analysis. The explanations for depression in our study have a strong emphasis on socio-cultural causes with focus on depressed persons from non-western minority groups. Even so, discussion about cultural or gendered explanations for depression was almost missing. We interpreted that the view of minority groups in the articles could be described as a view of “others”. The view of “othering” increases risks for cultural and gender gaps, such as biased scientific knowledge, medicalization of social problems, cultural stereotypes, risk for misdiagnosis of men´s depression, and affects the quality and care of depressed patients.

    Studv V. The aim of the study was to explore and analyse how GPs think and deliberate when seeing and treating patients from foreign countries who display potential depressive symptoms. The data were collected in focus group and individual interviews with GPs in northern Sweden and analysed by Qualitative Content Analysis. The study showed that patients’ early life events of importance were often unknown which blurred the accuracy. Reactions to trauma, cultural frictions and conflicts between the new and old gender norms made the diagnostic process difficult. The patient-doctor encounter comprised misconceptions, and social roles in meetings were sometimes confused. GPs based their judgement mainly on clinical intuition. Tools for management and adequate action were diffuse. There is a need for tools for multicultural, general practice care. It is also essential to be aware of the GPs’ own conceptions to avoid stereotypes and not to under-or overestimate the occurrence of depressive symptoms.

    Conclusion: The concept of depression is always situated. The gendered socio-cultural norms, beliefs and behaviours can both construct the concept of illness and influence patients’ experiences and expressions of depression as well as form the patient-doctor encounter. The knowledge of medical “experts” is based on a dominating, western view of knowledge, which defines diagnosis and classification criteria of depression as well as guidelines for management. GPs are struggling for clarity between the medical and the clinical practice. The multicultural appearances of depressive symptoms are a challenge for GPs but it is a challenge for society to improve the life circumstances which can lead to a depressed mood and suffering.

  • 11.
    Lehti, Arja
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic: patient and professional perceptions of inequity in rehabilitation of chronic pain2017Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, nr 1, s. 45-53Artikel i tidskrift (Refereegranskat)
    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.

  • 12.
    Lehti, Arja
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Mattsson, Bengt
    Göteborgs universitet.
    Recognition of depression in people of different cultures: a qualitative study2009Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 10, s. 53-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Many minority group patients who attend primary health care are depressed. To identify a depressive state when GPs see patients from other cultures than their own can be difficult because of cultural and gender differences in expressions and problems of communication. The aim of this study was to explore and analyse how GPs think and deliberate when seeing and treating patients from foreign countries who display potential depressive features.

    METHODS: The data were collected in focus groups and through individual interviews with GPs in northern Sweden and analysed by qualitative content analysis.

    RESULTS: In the analysis three themes, based on various categories, emerged; "Realizing the background", "Struggling for clarity" and "Optimizing management". Patients' early life events of importance were often unknown which blurred the accuracy. Reactions to trauma, cultural frictions and conflicts between the new and old gender norms made the diagnostic process difficult. The patient-doctor encounter comprised misconceptions, and social roles in the meetings were sometimes confused. GPs based their judgement mainly on clinical intuition and the established classification of depressive disorders was discussed. Tools for management and adequate action were diffuse.

    CONCLUSION: Dialogue about patients' illness narratives and social context are crucial. There is a need for tools for multicultural, general practice care in the depressive spectrum. It is also essential to be aware of GPs' own conceptions in order to avoid stereotypes and not to under- or overestimate the occurrence of depressive symptoms.

  • 13.
    Lehti, Arja
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva E
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Bengs, Carita
    Umeå universitet, Samhällsvetenskaplig fakultet, Sociologi.
    Danielsson, Ulla
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    "The others": a qualitative analysis of explanations of depression in research publications focusing on ehtnicity and genderArtikel i tidskrift (Övrigt vetenskapligt)
  • 14.
    Lehti, Arja
    et al.
    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.
    Bengs, Carita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Danielsson, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    "The Western gaze": An analysis of medical research publications concerning the expressions of depression, focusing on ethnicity and gender2010Ingår i: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 31, nr 2, s. 100-112Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Our aim of this study was to explore how authors of medical articles wrote about different symptoms and expressions of depression in men and women from various ethnic groups as well as to analyze the meaning of gender and ethnicity for expressions of depression. A database search was carried out using PubMed. Thirty articles were identified and analyzed using qualitative content analysis. Approaches differ with regard to how depression is described and interpreted in different cultures in relation to illness complaints, illness meaning, and diagnosis of depression. Articles often present issues based on a Western point of view. This may lead to “cultural or gender gaps,” which we refer to as “the Western gaze,” which may in turn influence the diagnosis of depression.

  • 15.
    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.

  • 16.
    Lilja, Aina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    DeMarinis, Valerie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Department of Theology, Psychology of Religion and Cultural Psychology, Uppsala University, Uppsala, Sweden; Mental Health Division, Innlandet Hospital Trust, Hamar, Norway.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Forssén, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Experiences and explanations of mental ill health in a group of devout Christians from the ethnic majority population in secular Sweden: a qualitative study2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 10, artikel-id e011647Artikel i tidskrift (Refereegranskat)
    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.

  • 17.
    Stålnacke, Britt-Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Haukenes, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Bergen, Norway.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Wiklund, Anncristine Fjellman
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?2015Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 4, s. 365-371Artikel i tidskrift (Refereegranskat)
    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.

  • 18.
    von Knorring, Johanna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Semb, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Martin, Fahlström
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    "It is through body language and looks, but it is also a feeling"-a qualitative study on medical interns' experience of empathy2019Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 19, artikel-id 333Artikel i tidskrift (Refereegranskat)
    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.

  • 19.
    Wiklund, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective2016Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, artikel-id 31542Artikel i tidskrift (Refereegranskat)
    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.

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