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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
Tjernström, K., Lindberg, I., Wiklund, M. & Persson, M. (2024). Overlooked by the obstetric gaze - how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study. BMC Health Services Research, 24(1), Article ID 610.
Open this publication in new window or tab >>Overlooked by the obstetric gaze - how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study
2024 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1, article id 610Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.

METHODS: In this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 - February 2022. The data was analysed using inductive qualitative content analysis.

RESULTS: Our results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women's difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a 'key person' in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.

CONCLUSIONS: Our study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Access to care, Empowerment, Healthcare encounters, Key person, Normalisation, Persistent health problems, Postpartum healthcare, Qualitative content analysis, Severe perineal trauma
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-224330 (URN)10.1186/s12913-024-11037-5 (DOI)38724992 (PubMedID)
Available from: 2024-05-14 Created: 2024-05-14 Last updated: 2024-05-15Bibliographically approved
Goicolea, I., Richter Sundberg, L., Wiklund, M., Gotfredsen, A. & Christianson, M. (2024). Widening the scope of mental health with a 'youth centred' approach: a qualitative study involving health care professionals in Sweden’s youth clinics. International Journal of Qualitative Studies on Health and Well-being, 19(1), Article ID 2348879.
Open this publication in new window or tab >>Widening the scope of mental health with a 'youth centred' approach: a qualitative study involving health care professionals in Sweden’s youth clinics
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2024 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 19, no 1, article id 2348879Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of "youth-centeredness".

Methods: Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke.

Results: The three themes were: 1) "youth mission-at the core of the YCs" work and challenged by a stronger involvement in mental ill health'; 2) "YCs" unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization', and 3) "Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users" needs or to refer within an unreliable system'.

Conclusion: This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic "youth-centred" approach while expanding their work with mental health

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
KEYWORDS Youth mental health, youthcentredness, qualitative, reflexive thematic analysis, interviews, youth clinic
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-223982 (URN)10.1080/17482631.2024.2348879 (DOI)38700475 (PubMedID)2-s2.0-85192036204 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00364Public Health Agency of Sweden
Available from: 2024-05-04 Created: 2024-05-04 Last updated: 2024-05-14Bibliographically approved
Åhlander, A., Strömbäck, M., Sandlund, J. & Wiklund, M. (2023). Living (dys)regulated and alienated young masculinity: young men's embodied experiences of mental disorders and suicidality. Counselling and Psychotherapy Research, 23(4), 893-905
Open this publication in new window or tab >>Living (dys)regulated and alienated young masculinity: young men's embodied experiences of mental disorders and suicidality
2023 (English)In: Counselling and Psychotherapy Research, ISSN 1473-3145, E-ISSN 1746-1405, Vol. 23, no 4, p. 893-905Article in journal (Refereed) Published
Abstract [en]

Introduction: Mental disorders, such as depression and anxiety with interlinked suicidality, are the leading cause of health-related disability among young men. Knowledge of the interaction between emotional, bodily, social and gendered mental health processes in young men is limited and therefore needed.

Aim: This study aimed to explore young men's lived embodied experiences of mental disorders and suicidality, and to conceptualise these by integrating affective–emotional, physiological, social and gendered processes.

Methods: Semistructured individual interviews were conducted with 13 young men who had sought professional help for mental disorders and suicidality. Grounded theory (GT) was used with a social constructivist perspective.

Results: The results comprise one core category - Living (dys)regulated and alienated young masculinity - with related categories “battling with the emotional body,” “suffering in social silence” and “balancing embodied darkness and distress.” The GT illustrates how young men navigate and manage their embodied and emotional suffering in a context of “regulative” masculine and social norms alongside insufficient social support.

Conclusion: Our results suggest that young men's lived embodied experiences of mental disorders and suicidality can be understood as a dynamic process of internal and external “(dys)regulation and alienation.” The generated GT provides a broad tentative explanation model, contributing to theory development, and serves as a basis for gender-sensitive interventions - in both psychotherapy and physiotherapy - integrating body, mind and the social context.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
anxiety, depression, emotional regulation, masculinity, self-harm, youth mental health
National Category
Gender Studies Psychiatry
Identifiers
urn:nbn:se:umu:diva-207038 (URN)10.1002/capr.12647 (DOI)000963505600001 ()2-s2.0-85152031835 (Scopus ID)
Funder
Public Health Agency of Sweden
Available from: 2023-04-25 Created: 2023-04-25 Last updated: 2023-12-29Bibliographically approved
Tjernström, K., Lindberg, I., Wiklund, M. & Persson, M. (2023). Negotiating the ambiguity of an (in)authentic working life: a grounded theory study into severe perineal trauma. BMC Women's Health, 23(1), Article ID 47.
Open this publication in new window or tab >>Negotiating the ambiguity of an (in)authentic working life: a grounded theory study into severe perineal trauma
2023 (English)In: BMC Women's Health, E-ISSN 1472-6874, Vol. 23, no 1, article id 47Article in journal (Refereed) Published
Abstract [en]

Background: In Sweden, persistent physical and psychological health problems occur in about three in ten women who sustain severe perineal trauma (SPT) during childbirth. As most Swedish women work outside the home, the question of if and how SPT-related morbidity influences working life needs exploration. This study aims to qualitatively explore how women with persistent SPT-related morbidities experience and conceptualise their problems concerning working life. Further, we theorise the findings by applying Simone de Beauvoir’s feminist framework of immanence and transcendence as well as authentic and inauthentic life.

Methods: Ten interviews with women recruited via a Swedish social media community for perineal trauma were analysed according to Charmaz’s constructivist approach to grounded theory.

Results: The theoretical model and related core category ‘Negotiating the ambiguity of an (in)authentic working life’ reflected the women’s negotiations of immanence as ‘the silent covert object’ versus transcendence as the ‘the resourceful overt subject’. The model also mirrored the conflict of (in)authenticity in working life. An inauthentic working life was experienced when women were denied their subjectivity at work or constructed themselves as subjects in denial of their SPT. On the other hand, women who acknowledged their SPT and were constructed as subjects by ‘others’ achieved an authentic working life despite SPT.

Conclusions: The conflicting gendered process of ‘the silent covert object’ versus ‘the resourceful overt subject’ problematised women’s vulnerability at work. Aspects that enable subjectification and transcendence are essential for policymakers, employers, healthcare services, and society to eradicate the taboo of SPT and create a working environment characterised by understanding, support, and flexibility. Further, access to adequate care, sick leave, and occupational rehabilitation are essential. Such measures support transcendence towards an authentic working life and, consequently, a more gender-equal working environment that does not deprive women of career opportunities due to a physical ailment.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Severe perineal trauma, Maternal morbidity, Workability, Gounded theory, Gender theory, Simone de Beauvoir, Immanence, Transcendence
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-204699 (URN)10.1186/s12905-023-02191-9 (DOI)000928604300001 ()36750837 (PubMedID)2-s2.0-85147562489 (Scopus ID)
Funder
Umeå University
Available from: 2023-02-10 Created: 2023-02-10 Last updated: 2023-09-05Bibliographically approved
Wiklund, E., Wiklund, M. & Hedenborg, S. (2023). Physical activity on prescription “not a quick fix”: school nurses’ experiences of promoting and tailoring physical activity to children in Swedish compulsory school. Journal of School Nursing
Open this publication in new window or tab >>Physical activity on prescription “not a quick fix”: school nurses’ experiences of promoting and tailoring physical activity to children in Swedish compulsory school
2023 (English)In: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364Article in journal (Refereed) Epub ahead of print
Abstract [en]

This study aimed to explore school nurses’ experience of using physical activity on prescription with children in Swedish compulsory school. Semistructured interviews were conducted with 24 school nurses who had the educational qualification to prescribe physical activity. The analysis resulted in one overarching theme, “A delicate process of tailoring physical activity on prescription to a child's social context,” and two categories: “Promoting joyful physical activity through individualization and support” and “Dealing with dilemmas and challenges,” with related subcategories. The results demonstrate the importance of tailoring prescribed physical activity to each individual child, their living conditions, and the school context. In addition, they highlight the nurses’ working conditions and collaborations as important prerequisites when initiating physical activity on prescription. In conclusion, the results suggest that school nurses perceive physical activity on prescription as a useful tool in the school context, but it needs to be tailored to each individual child.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
physical activity, physical activity on prescription, qualitative interviews, school nurses
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-206757 (URN)10.1177/10598405231166124 (DOI)000954645400001 ()36974431 (PubMedID)2-s2.0-85152052018 (Scopus ID)
Available from: 2023-05-02 Created: 2023-05-02 Last updated: 2023-05-02
Einarsson, S., Johansson, A., Kautto, E., Lindberg, V., Ljusbäck, A. M., Rydén, P., . . . Wiklund, M. (2023). Thinking and re-thinking: a qualitative study of university teachers' perspectives on the development process for a new online interprofessional education curriculum in a Swedish higher education institution. Nordic Studies in Education, 43(3), 225-240
Open this publication in new window or tab >>Thinking and re-thinking: a qualitative study of university teachers' perspectives on the development process for a new online interprofessional education curriculum in a Swedish higher education institution
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2023 (English)In: Nordic Studies in Education, ISSN 1891-5914, E-ISSN 1891-5949, Vol. 43, no 3, p. 225-240Article in journal (Refereed) Published
Abstract [en]

The objective was to reflect on the experience of working collaboratively across education programmes, departments, and faculties from the perspective of university teachers at a higher education institution. Nine teachers from five programmes working together to develop a new curriculum for interprofessional education (IPE) participated in a focus group discussion. Data were analysed using thematic analysis. Findings suggest that teacher experiences can be understood in terms of teamwork processes valued from both professional and IPE experiential variations within the group. Since findings illustrate pedagogical collaboration across department and faculty boundaries, they can inspire teachers who are planning a similar process.

Place, publisher, year, edition, pages
Cappelen Damm Akademisk, 2023
Keywords
teacher collaboration, teacher experience, higher education, curriculum development
National Category
Pedagogy
Identifiers
urn:nbn:se:umu:diva-214363 (URN)10.23865/nse.v43.4165 (DOI)2-s2.0-85173957819 (Scopus ID)
Funder
Umeå University
Available from: 2023-09-12 Created: 2023-09-12 Last updated: 2023-10-30Bibliographically approved
Thomson, A., Christensen, E., Wiklund, M. & Christianson, M. (2022). A safe place – Adolescents' and young adults' perceptions of youth clinics in northern Sweden. Sexual & Reproductive HealthCare, 33, Article ID 100752.
Open this publication in new window or tab >>A safe place – Adolescents' and young adults' perceptions of youth clinics in northern Sweden
2022 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 33, article id 100752Article in journal (Refereed) Published
Abstract [en]

Background/objective: Adolescents and young adults are a diverse group with varied health needs. In Sweden, youth clinics are critical for improving their sexual, reproductive, mental, and general health. The aim of this qualitative study was to gain a deeper understanding of key conditions needed for youth friendliness, and to better understand youth-friendly health services from the perspective of adolescents and young adults in northern Sweden.

Methods: Information was collected through focus group discussions and interviews with 23 adolescents and young adults (aged 16 to 25) at youth clinics in each of the four northernmost regions of Sweden. Interviews were analysed inductively using Braun and Clarke's thematic analysis.

Results: Three themes and six sub-themes emerged. A safe, empowering and holistic space, outlines how youth-friendly physical spaces and staff contributed to a sense of safety in contrast to other healthcare facilities. The theme Youth clinics are accessible – but reaching out is challenging, refers to low thresholds for visiting youth clinics and perceived barriers to access. The third theme “You feel a bit vulnerable” – the importance of privacy, highlights privacy dimensions and young people's vulnerability when their privacy is compromised.

Conclusion: Adolescents and young adults perceived youth clinics as being youth-friendly. Key conditions for youth friendliness were safety, respect, a holistic and empowering approach, accessibility, and privacy. Youth-friendly opening hours and outreach to specifically target groups with access barriers are needed. Young people should be involved in the development of equitable youth-friendly health services.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Adolescent health, Qualitative method, Sexual and reproductive health, Swedish youth clinics, Young people, Youth-friendly health services
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:umu:diva-199265 (URN)10.1016/j.srhc.2022.100752 (DOI)000828119700002 ()35803180 (PubMedID)2-s2.0-85133665697 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0235Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00364
Available from: 2022-09-09 Created: 2022-09-09 Last updated: 2023-03-24
Linander, I. & Wiklund, M. (2022). ”Att bara få finnas, utforska eller prata om det”: unga transpersoners egna erfarenheter av stärkande faktorer för den psykiska hälsan. In: "Jag är inte ensam, det finns andra som jag": unga hbtqi-personers levnadsvillkor (pp. 89-113). Växjö: Myndigheten för ungdoms- och civilsamhällesfrågor
Open this publication in new window or tab >>”Att bara få finnas, utforska eller prata om det”: unga transpersoners egna erfarenheter av stärkande faktorer för den psykiska hälsan
2022 (Swedish)In: "Jag är inte ensam, det finns andra som jag": unga hbtqi-personers levnadsvillkor, Växjö: Myndigheten för ungdoms- och civilsamhällesfrågor , 2022, p. 89-113Chapter in book (Other academic)
Place, publisher, year, edition, pages
Växjö: Myndigheten för ungdoms- och civilsamhällesfrågor, 2022
National Category
Public Health, Global Health, Social Medicine and Epidemiology Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Identifiers
urn:nbn:se:umu:diva-196566 (URN)
Available from: 2022-06-15 Created: 2022-06-15 Last updated: 2022-06-20Bibliographically approved
Karlström, J., Wiklund, M. & Tengman, E. (2022). Disrupted knee – disrupted me: a strenuous process of regaining balance in the aftermath of an anterior cruciate ligament injury. BMC Musculoskeletal Disorders, 23(1), Article ID 290.
Open this publication in new window or tab >>Disrupted knee – disrupted me: a strenuous process of regaining balance in the aftermath of an anterior cruciate ligament injury
2022 (English)In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 23, no 1, article id 290Article in journal (Refereed) Published
Abstract [en]

Background: Individuals describe both short and long term consequences after an anterior cruciate ligament (ACL) injury. Functional impairments are well documented while psychological, social and contextual factors need to be further investigated. By the use of a qualitative method incorporating a biopsychosocial lens, we aimed to explore individuals' experiences of living and coping with an ACL rupture with a specific focus on experiences significant to overall life, activity in daily living and physical activity more than one year after injury.

Methods: Twelve participants were chosen strategically by a purposive sampling. Four men and eight women (19–41 years) with an ACL rupture 2–25 years ago, were included. Semi-structured interviews were used and analysed with qualitative content analysis.

Results: The results consisted of one overarching theme: 'A strenuous process towards regaining balance' which built on three categories 'Disrupted knee', 'Disrupted me' and 'Moving forward with new insights'. The overarching theme captures the participants' experiences of a strenuous process towards regaining both physical and mental balance in the aftermath of an ACL injury. The results illuminate how participants were forced to cope with a physically 'disrupted knee', as well as facing mental challenges, identity challenges and a 'disrupted me'. By gradual acceptance and re-orientation they were moving forward with new insights – although still struggling with the consequences of the injury.

Conclusions: Individuals with an ACL injury experience both physical, psychological, and social challenges several years after injury. In addition to the functional impairments, diverse psychological, social and contextual 'disruptions' and struggles may also be present and influence the rehabilitation process. It is important that physiotherapists identify individuals who face such challenges and individually tailor the rehabilitation and support. A biopsychosocial approach is recommended in the clinical practice and future studies focusing on psychosocial processes in the context of ACL rehabilitation are warranted.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
ACL, Coping strategies, Fear of re-injury, Interviews, Physiotherapy, Psychological impairments, Qualitative Research, Rehabilitation
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-193701 (URN)10.1186/s12891-022-05252-6 (DOI)000773936300003 ()35346145 (PubMedID)2-s2.0-85127247809 (Scopus ID)
Available from: 2022-04-28 Created: 2022-04-28 Last updated: 2024-01-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6636-9597

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