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Richter Sundberg, L., Gotfredsen, A., Christianson, M., Wiklund, M., Hurtig, A.-K. & Goicolea, I. (2024). Exploring cross-boundary collaborationfor youth mental health in Sweden: a qualitative study using the integrativeframework for collaborative governance. BMC Health Services Research, 24, Article ID 322.
Open this publication in new window or tab >>Exploring cross-boundary collaborationfor youth mental health in Sweden: a qualitative study using the integrativeframework for collaborative governance
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2024 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, article id 322Article in journal (Refereed) Published
Abstract [en]

Background: Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.

Methods: We conducted 42 interviews (November 2020 to March 2022) with health and social care professionalsand managers in the youth mental health system in Sweden. Interviews explored participants’ experience andunderstanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergentstudy design using reflexive thematic analysis.

Results: The analysis produced three themes. The first shows that collaboration is considered as essential andimportant, and that it serves diverse purposes and holds multiple meanings in relation to professionals’ roles andresponsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, andtarget levels, and the third captures the challenges and criticisms in collaborating across the youth mental healthlandscape, but also in growing possibilities for future development.

Conclusion: We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Youth mental health, Youth mental health services, Mental health system, Collaboratio, Governance
National Category
Medical and Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Public health; Public health
Identifiers
urn:nbn:se:umu:diva-221945 (URN)10.1186/s12913-024-10757-y (DOI)38468279 (PubMedID)2-s2.0-85187412932 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00364
Available from: 2024-03-11 Created: 2024-03-11 Last updated: 2024-04-22Bibliographically approved
Goicolea, I., Bäckström, H., Lauri, M., Carbin, M. & Linander, I. (2023). Daring to ask about violence?: a critical examination of social services’ policies on asking about gender-based violence. Journal of Gender-Based Violence, 7(3), 467-482
Open this publication in new window or tab >>Daring to ask about violence?: a critical examination of social services’ policies on asking about gender-based violence
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2023 (English)In: Journal of Gender-Based Violence, ISSN 2398-6808, Vol. 7, no 3, p. 467-482Article in journal (Refereed) Published
Abstract [en]

This article critically analyses the assumptions and effects of the ‘daring to ask approach’ to gender based violence (GBV), as expressed in the policies that govern social services’ work in Sweden. We show how GBV is constituted as a sensitive issue connected with shame and as something that will not be brought up spontaneously; GBV is something that women who had experienced it carry with them as an ‘untouched truth’ waiting to be discovered by social workers while women’s worries about the consequences of telling are not made intelligible. The very speaking as such is seen as emancipatory, and the social worker is understood as a facilitator. With this approach follows standardised questions, aiming for neutrality and equity. However, these are so wide and unspecific, that the risk is that no one thinks the questions are directed to her. By making the assumptions and effects of a seemingly self-evident strategy visible, we demonstrate areas in need of further research and policy development, such as barriers to help-seeking (beyond stigmatisation) and effects of standardisation. This is an important undertaking since without critical scrutiny of the policies there is a risk that stakeholders assume that merely asking will resolve the problem of GBV.

Place, publisher, year, edition, pages
Bristol University Press, 2023
Keywords
intimate partner violence, violence against women, violence in close relationships, social work, standardisation, problematisation
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-214789 (URN)10.1332/239868021x16903817520612 (DOI)001054983800001 ()2-s2.0-85174310009 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2021-01373
Available from: 2023-09-29 Created: 2023-09-29 Last updated: 2023-10-27Bibliographically approved
Amani, P. J., San Sebastian, M., Hurtig, A.-K., Kiwara, A. D. & Goicolea, I. (2023). Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study. BMC Public Health, 23(1), Article ID 459.
Open this publication in new window or tab >>Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study
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2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 459Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Healthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers' experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania.

METHODS: An exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data.

RESULTS: Three categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement.

CONCLUSION: While health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Elderly, Health insurance, Healthcare workers, Qualitative, Rural, Tanzania
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-205785 (URN)10.1186/s12889-023-15297-4 (DOI)000946288900009 ()36890474 (PubMedID)2-s2.0-85149684611 (Scopus ID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2023-03-28 Created: 2023-03-28 Last updated: 2023-09-05Bibliographically approved
Bäckström Olofsson, H. & Goicolea, I. (2023). Sisterhood at a distance: doing feminist support work online. Affilia
Open this publication in new window or tab >>Sisterhood at a distance: doing feminist support work online
2023 (English)In: Affilia, ISSN 0886-1099, E-ISSN 1552-3020Article in journal (Refereed) Epub ahead of print
Abstract [en]

The aim of this study is to analyze the characteristics of feminist peer support in the context of online chat counseling. Based on 15 interviews with female lay supporters associated with a branch of the Swedish women's shelter movement targeting young women, we explore how the digital setting—characterized by distance and anonymity—affects the meaning and doing of feminist support. Our results show that core principles of feminist support—striving for equality and trust, the crafting of safe spaces, and sharing experiences—are all renegotiated and/or accentuated by the digital setting. The chat is experienced as enabling a more equal relationship and a high level of safety. The meaning of safety has largely shifted, however, from being associated with a feminist community to safety associated with solitude and distance. We further show a tension in the respondents’ understanding of shared experiences, stressing both the importance of situated knowledges and the value of not knowing who is seeking or offering support. By combining research and material on feminist support and online youth counseling, the article offers novel perspectives on feminist counseling and social work, the power dimensions of online counseling, and the virtual space as an arena for feminist activism.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
online youth counseling, feminist peer support, digital social work, safe space, digital feminism
National Category
Gender Studies Social Work
Identifiers
urn:nbn:se:umu:diva-211030 (URN)10.1177/08861099231181583 (DOI)001016332900001 ()2-s2.0-85163306997 (Scopus ID)
Available from: 2023-06-28 Created: 2023-06-28 Last updated: 2023-07-17
Baroudi, M., Goicolea, I. & Hurtig, A.-K. (2023). The good, the bad, and the why: How do Arabic-speaking migrant men perceive and experience information and services related to sexual and reproductive health in Sweden?. Journal of Migration and Health, 7, Article ID 100153.
Open this publication in new window or tab >>The good, the bad, and the why: How do Arabic-speaking migrant men perceive and experience information and services related to sexual and reproductive health in Sweden?
2023 (English)In: Journal of Migration and Health, ISSN 2666-6235, Vol. 7, article id 100153Article in journal (Refereed) Published
Abstract [en]

Although migrant men constitute a large and growing proportion of men in Sweden, literature exploring migrant men's experiences in sexual and reproductive health (SRH) services is scarce. We aimed to explore how Arabic-speaking migrant men perceive and experience information and services related to SRH in Sweden. We conducted 13 semi-structured interviews with Arabic-speaking migrant men and analysed the data using reflexive thematic analysis. We developed four themes: 1) SRH is ‘something essential in life’; 2) the good: a transition to a ‘new open society’; 3) the bad: barriers to sexual education and health services; and 4) the why: blaming oneself or the system. SRH services and sexual education/information were perceived as needs and rights, and the participants were content with the new possibilities and the ‘new open society’. However, sexual education was not provided to most migrants, and SRH services provided to men had shortcomings that deprived some migrant men from fulfilling their needs. Moreover, internalised and cultural racism created a challenge to receive adequate/acceptable SRH services. There is a need to provide comprehensive sexual education for all, strengthen SRH services provided to men, and develop an action plan to reinforce the anti-discrimination/racism policies in healthcare and society.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Sexual and reproductive health, Cultural racism, Internalised racism, Arabic-speaking, Men
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-204319 (URN)10.1016/j.jmh.2023.100153 (DOI)000967407100001 ()2-s2.0-85147102590 (Scopus ID)
Available from: 2023-02-01 Created: 2023-02-01 Last updated: 2023-09-05Bibliographically approved
Goicolea, I., Gotfredsen, A., Jonsson, F. & Wernesjö, U. (2023). The Promise of Belonging: Racialized Youth Subject Positions in the Swedish Rural North. Journal of International Migration and Integration, 24, 695-713
Open this publication in new window or tab >>The Promise of Belonging: Racialized Youth Subject Positions in the Swedish Rural North
2023 (English)In: Journal of International Migration and Integration, ISSN 1488-3473, E-ISSN 1874-6365, Vol. 24, p. 695-713Article in journal (Refereed) Published
Abstract [en]

This article analyses how youth subject positions of the ‘racialized other’ are produced, and how these positions interconnect with the concept of belonging to the rural community. We do this by analysing 15 group discussions with 63 young people living in rural areas in northern Sweden taking a discursive psychology approach, and focusing on how discourses produce certain subject positions of ‘the racialized other’. Drawing on the concepts of the politics of belonging and the ‘stranger’, we argue that discourses on belonging to the (rural) community create boundaries that exclude ‘other’ youth, as well as resistance and contestation. The subject positions that such discourses produce represent racialized youth in stereotypical ways and imply a promise of belonging for certain ‘others’ based on their fulfilment of particular norms. However, such a depoliticized promise of belonging that places the responsibility for becoming integrated on the ‘others’ was also challenged. Firstly, in relation to criticisms of the welfare system, and secondly, in relation to racism as an unwelcome threat in rural communities.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Subject positions, Politics of belonging, ‘Othering’, Racialization, Rural
National Category
Public Health, Global Health, Social Medicine and Epidemiology Social Psychology
Identifiers
urn:nbn:se:umu:diva-197433 (URN)10.1007/s12134-022-00973-y (DOI)000810804700001 ()2-s2.0-85131796904 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-00434
Available from: 2022-06-28 Created: 2022-06-28 Last updated: 2023-07-14Bibliographically approved
Malizgani, C. P., Zulu, J. M., Goicolea, I. & Hurtig, A.-K. (2023). Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis. Health Research Policy and Systems, 21(1), Article ID 97.
Open this publication in new window or tab >>Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis
2023 (English)In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 21, no 1, article id 97Article in journal (Refereed) Published
Abstract [en]

Background: Comprehensive sexuality education (CSE) has recently become salient, but adolescent sexual reproductive health and rights (ASRHR) challenges are still a global health problem. Studying policies which have implications for CSE implementation is a crucial but neglected issue, especially in low and middle-income countries (LMICs) like Zambia. We analyzed policy synergies, challenges and contradictions influencing implementation of CSE framework in Zambia.

Methods: We conducted a document review and qualitative interviews with key stakeholders from Non-Governmental Organizations, as well as health and education ministries at the National and all (10) provincial headquarters. Our methods allowed us to capture valuable insights into the synergies, challenges and contradictions that exist in promoting CSE framework in Zambia.

Results: The study highlighted the synergies between policies that create opportunities for implementation of CSE through the policy window for adoption of sexual reproductive health and rights (SRHR) that opened around the 1990s in Zambia, promotion of inclusive development via education, adoption of an integrated approach in dealing with SRHR problems, and criminalization of gender-based violence (GBV). This analysis also identified the policy challenges and contradictions including restricted delivery of education on contraception in schools; defining childhood: dual legal controversies and implications for children, grey zones on the minimum age to access SRHR services; inadequate disability inclusiveness in SRHR legal frameworks; policy silences/contentious topics: LGBTQI + rights, abortion, and grey zones on the minimum age to access SRHR services.

Conclusion: While many policies support the implementation of CSE in schools, the existence of policy silences and challenges are among the barriers affecting CSE implementation. Thus, policy reformulation is required to address policy silences and challenges to enhance effective promotion and integration of the CSE framework.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Adolescents, Challenges, Comprehensive sexuality education, Facilitators, Policy analysis, Sexual reproductive health rights
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-214679 (URN)10.1186/s12961-023-01037-y (DOI)2-s2.0-85171368855 (Scopus ID)
Funder
Swedish Research Council, 2019-04448
Available from: 2023-09-28 Created: 2023-09-28 Last updated: 2023-09-28Bibliographically approved
Goicolea, I. (2023). What a critical public health perspective can add to the analysis of healthcare responses to gender-based violence that focus on asking. BMC Public Health, 23(1), Article ID 1738.
Open this publication in new window or tab >>What a critical public health perspective can add to the analysis of healthcare responses to gender-based violence that focus on asking
2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 1738Article in journal (Refereed) Published
Abstract [en]

In this comment I analyze the effects of approaching gender-based violence as a public health problem, that the health system should address through ‘daring to ask’. I acknowledge the potential of the ‘daring to ask’ strategy, but I also argue that asking has effects, and that we should be aware of them.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Asking, Gender-based violence, Health-care, Public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-214416 (URN)10.1186/s12889-023-16641-4 (DOI)37674212 (PubMedID)2-s2.0-85169998645 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2021–01373
Available from: 2023-09-18 Created: 2023-09-18 Last updated: 2023-09-18Bibliographically approved
Anyango, C., Goicolea, I. & Namatovu, F. (2023). Women with disabilities’ experiences of intimate partner violence: a qualitative study from Sweden. BMC Women's Health, 23(1), Article ID 381.
Open this publication in new window or tab >>Women with disabilities’ experiences of intimate partner violence: a qualitative study from Sweden
2023 (English)In: BMC Women's Health, E-ISSN 1472-6874, Vol. 23, no 1, article id 381Article in journal (Refereed) Published
Abstract [en]

Background: Intimate Partner Violence (IPV) is a prevalent form of gender-based violence affecting one in three women globally. It is also a preventable cause of ill-health, disability, and death. Current research suggests that women with disabilities are at a significantly higher risk of experiencing violence throughout their lifetime. They are almost twice as likely to experience violence compared to men with disabilities or men and women without disabilities. Additionally, they experience higher rates of all types of violence. This increased vulnerability may be due to factors related to disability such as dependence on others for support, mistrust, and social and physical isolation. Although there is existing research on IPV against women in general, there is limited knowledge on IPV against women with disabilities. To address this gap in knowledge, this study aimed to explore women with disabilities’ perceptions and experiences of being victims/survivors of IPV in Sweden.

Methods: This was a qualitative study conducted through in-depth interviews with eleven women with disabilities. The participants were aged eighteen years upwards. The collected data was analyzed using reflexive thematic analysis with a constructivist epistemological standpoint.

Results: We developed four themes. Theme one: “multiple abuse by multiple abusers, over time,” describes the participants’ experiences of various types of violence from different perpetrators for prolonged periods. Theme two: “psychological abuse—harmful, but neglected and difficult to prove,” explains how women with disabilities’ perceive psychological abuse as harmful, but not given the same level of seriousness as physical violence. It also expresses the difficulties they encountered in providing tangible evidence to prove instances of psychological abuse. Theme three: “abuse does not end with separation,” highlights how abuse can continue beyond separation/divorce. Theme four: “surviving abusive relationships” describes the different and evolving ways the participants used to navigate their abusive relationships.

Conclusions: Women with disabilities face all forms of abuse. They find it challenging to prove psychological abuse, and the system is inadequate in addressing its harm. The abuse also continues after separation or divorce. The support system should consider the needs of women with disabilities who experience violence, both during and after the abusive relationship. Service providers should be better equipped to detect and handle all types of IPV, especially psychological abuse.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
In-depth interviews, Intimate partner violence, Reflexive thematic analysis, Women with disabilities
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-212466 (URN)10.1186/s12905-023-02524-8 (DOI)37474929 (PubMedID)2-s2.0-85165318152 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, STYB-2019/0005
Available from: 2023-08-04 Created: 2023-08-04 Last updated: 2023-08-28Bibliographically approved
Baroudi, M., Nkulu Kalengayi, F., Goicolea, I., Jonzon, R., San Sebastian, M. & Hurtig, A.-K. (2022). Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare: A Cross-sectional Survey. International Journal of Health Policy and Management, 11(3), 287-298
Open this publication in new window or tab >>Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare: A Cross-sectional Survey
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2022 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 11, no 3, p. 287-298Article in journal (Refereed) Published
Abstract [en]

Background: This study aims to assess migrant youths’ access to sexual and reproductive healthcare (SRHC) in Sweden, to examine the socioeconomic differences in their access, and to explore the reasons behind not seeking SRHC. 

Methods: A cross-sectional survey was conducted for 1739 migrant youths 16 to 29 years-old during 2018. The survey was self-administered through: ordinary post, web survey and visits to schools and other venues. We measured access as a 4-stage process including: healthcare needs, perception of needs, utilisation of services and met needs. 

Results: Migrant youths faced difficulties in accessing SRHC services. Around 30% of the participants needed SRHC last year, but only one-third of them fulfilled their needs. Men and women had the same need (27.4% of men [95% CI: 24.2, 30.7] vs. 32.7% of women [95% CI: 28.2, 37.1]), but men faced more difficulties in access. Those who did not categorise themselves as men or women (50.9% [95% CI: 34.0, 67.9]), born in South Asia (SA) (39% [95% CI: 31.7, 46.4]), were waiting for residence permit (45.1% [95% CI: 36.2, 54.0]) or experienced economic stress (34.5% [95% CI: 30.7, 38.3]) had a greater need and found more difficulties in access. The main difficulties were in the step between the perception of needs and utilisation of services. The most commonly reported reasons for refraining from seeking SRHC were the lack of knowledge about the Swedish health system and available SRHC services (23%), long waiting times (7.8%), language difficulties (7.4%) and unable to afford the costs (6.4%). 

Conclusion: There is an urgent need to improve migrant youths’ access to SRHC in Sweden. Interventions could include: increasing migrant youths’ knowledge about their rights and the available SRHC services; improving the acceptability and cultural responsiveness of available services, especially youth clinics; and improving the quality of language assistance services.

Place, publisher, year, edition, pages
Kerman University of Medical Sciences, 2022
Keywords
Migrants, Youth, Access to Healthcare, Sexual Health, Reproductive Health, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-173748 (URN)10.34172/ijhpm.2020.123 (DOI)000719952400001 ()32729283 (PubMedID)2-s2.0-85108111651 (Scopus ID)
Funder
Public Health Agency of Sweden
Available from: 2020-07-30 Created: 2020-07-30 Last updated: 2023-03-24Bibliographically approved
Projects
How, why and under what circumstances are Swedish Youth Clinics youth friendly? A realist evaluation [2014-00235_Forte]; Umeå University Health care access for rural youth on equal terms? Identifying needs and proposing actions using mixed-methods research [2016-00434_Forte]; Umeå University Stärka ungdomars motståndskraft (resilience) och mentala hälsa i norra Indien [2017-05421_VR]; Umeå UniversityHow can mental health care services be integrated in youth clinics? A health policy and systems study [2018-00364_Forte]; Umeå University; Publications
Richter Sundberg, L., Gotfredsen, A., Christianson, M., Wiklund, M., Hurtig, A.-K. & Goicolea, I. (2024). Exploring cross-boundary collaborationfor youth mental health in Sweden: a qualitative study using the integrativeframework for collaborative governance. BMC Health Services Research, 24, Article ID 322. Richter Sundberg, L., Christianson, M., Wiklund, M., Hurtig, A.-K. & Goicolea, I. (2021). How can we strengthen mental health services in Swedish youth clinics? A health policy and systems study protocol. BMJ Open, 11(10), e048922-e048922
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8114-4705

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