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The aim of this study was to identify the consequences related to ethical values in older people’s experiences of using medication-dispensing robots in Swedish home care services. The research material comprised 17 qualitative interviews with people aged 67–90 years. An assemblage perspective was used to analyze the material. The study results showed that medication-dispensing robots contributed to feelings of safety and continuity among older people but that robots could also limit feelings of autonomy for people with more outwardly oriented lifestyles. The introduction of robots changed roles and relations in eldercare, with older people having to actively add and compensate for perceived limitations in robot functionalities. To feel both safe and autonomous, older people had to “craft” ethics by putting different kinds of effort into everyday care involving medication-dispensing robots. In the study, ethics in home care came forth as a cocreational, ongoing, and precarious practice rather than a set of ethical principles embedded in robotic technology. Given that home care services for older people involve several key stakeholders, it would be of interest to identify and compare different perspectives of ethics and what potential benefits could come from using medication-dispensing robots in home care services.

A better understanding of population distributions of capability and inequalities is relevant for public health and social welfare. We surveyed 3639 representatively sampled individuals on background characteristics and on self-reported capability using the capability-adjusted life years Sweden (CALY-SWE) questionnaire, which enables aggregating attribute-level answers into a quality weight score.

We analysed the resulting capability distribution by comparing subgroups. Subgroups were formed along axes of inequality that we selected based on theoretical reasoning and relevance. We stratified into groupings of plurality and disadvantage, based on the human dignity principle and the needs and solidarity principle featured in the Swedish platform for healthcare priority-setting. While disadvantage factors come with inherent need-related disadvantages that explain inequality, such as unemployment, no such normatively acceptable reason exist for plurality factors, such as gender.

The results averaged per individual showed marked inequalities for the disadvantage groups of individuals with poor self-rated health, long-term sick leave unemployment, and payment difficulties. For plurality groups, the largest inequalities occurred in groups with lower education and groups residing in urban areas, but generally inequalities were lower than disadvantage groups.

On the population level, the largest aggregated disability inequalities occurred for self-reported ever NEET (persons who were ever involuntarily not in employment, education or training from age 16 to 29) and payment difficulties groups. Additionally, we assessed the contribution of covariates to these inequalities by counterfactually altering one covariate at a time in a multinomial logistic model of the CALY-SWE attribute-level answers. The most relevant covariates were employment situation, financial difficulties, income, and age group.

For policy-making, this indicates the importance of both plurality and disadvantage inequality axes. Prioritization should adopt nuanced contextualizations of inequality when broadening the perspective beyond healthcare to wider public health and social welfare, for example, elderly care and education.

Purpose: Our aim was to elicit a value set for Capability-Adjusted Life Years Sweden (CALY-SWE); a capability-grounded quality of life instrument intended for use in economic evaluations of social interventions with broad consequences beyond health.

Methods: Building on methods commonly used in the quality-adjusted life years EQ-5D context, we collected time-trade off (TTO) and discrete choice experiment (DCE) data through an online survey from a general population sample of 1697 Swedish participants. We assessed data quality using a score based on the severity of inconsistencies. For generating the value set, we compared different model features, including hybrid modeling of DCE and TTO versus TTO data only, censoring of TTO answers, varying intercept, and accommodating for heteroskedasticity. We also assessed the models’ DCE logit fidelity to measure agreement with potentially less-biased DCE data. To anchor the best capability state to 1 on the 0 to 1 scale, we included a multiplicative scaling factor.

Results: We excluded 20% of the TTO answers of participants with the largest inconsistencies to improve data quality. A hybrid model with an anchor scale and censoring was chosen to generate the value set; models with heteroskedasticity considerations or individually varying intercepts did not offer substantial improvement. The lowest capability weight was 0.114. Health, social relations, and finance and housing attributes contributed the largest capability gains, followed by occupation, security, and political and civil rights.

Conclusion: We elicited a value set for CALY-SWE for use in economic evaluations of interventions with broad social consequences.

Over the past 20 years, the Swedish government and national authorities have organized a structure for knowledge governance in order to implement an evidence-based practice (EBP) for social services. Since the idea of a knowledge governance has not been implemented as expected, it was considered important to develop regional collaboration and support structures (RCSSs) as a link between national and local authorities. In this article, we discuss changes in ideas on knowledge governance at the national level, and also changes in expectations on RCSSs function in knowledge governance of the Swedish social service. Changes in governance also change the prerequisites for implementation of EBP. Therefore, it is important to further examine and analyse ideas on knowledge governance at the national level and whether they change over time. The empirical data consists of official documents and interviews with representatives of key actors at national level. A qualitative content analysis of the interviews was then performed and also an analysis of the official document was used to describe the changes on knowledge governance. This article shows that ideas on knowledge governance has changed over time, from an emphasis on top-down governance towards a more dialogue-based governance. This shift in governance ideals also appears to have had an impact on expectations regarding RCSSs, through an increased emphasis on their collaborative function in relation to both national and local levels. The knowledge governance and the function of the RCSSs appear to be fragile, as this collaboration is based on voluntary partnership and networks.

Robots and AI are increasingly being introduced in organizations to improve efficiency and replace dull and dangerous work. The implementation of robots and AI will change the way work is organized and managed with consequences for both employees and service users. In this chapter, we critically examine the implementation of robots and AI in human service organizations from work design, management, and ethical perspectives. We propose that the implementation of robots and AI introduces several challenges and risks for both employees and users that need to be addressed. However, we also suggest that these challenges may be overcome if knowledge about work design and user involvement is considered.

Small rural municipalities face major challenges in the area of welfare. One of these challenges is about providing knowledge and expertise within social services. As a result of its small scale, social services in rural areas have an integrated organisation where social workers are supposed to work with a wide range of social problems. At the same time, there are expectations that they should have expertise in defined areas. This article focuses on how representatives of social services in eight rural municipalities view the opportunities to provide knowledge and expertise.

Data collection was carried out within an action research project in connection with conferences and workshops. The results show that it can be challenging to develop knowledge and expertise. Since social services mainly have an integrated organisation, it is difficult to keep up-to-date on the state of knowledge in all areas. Another challenge is that it can be difficult to maintain skills in practice because certain types of cases are encountered relatively rarely.

To deal with the challenges, different collaborative solutions are seen as a way to balance expectations on knowledge and expertise, and to balance the expectations of knowledge and expertise with the conditions that prevail in rural environments. The attitude towards different kinds of digital technology – for example web-based education and supervision – as tools for knowledge development and access to expertise is consistently positive. The results also indicate that digital technology has the potential to change the perspectives on the organisation of knowledge development and expertise within social services in rural municipalities.

An overall interpretation of the results is that social services in rural areas must deal with different challenges in terms of knowledge and expertise than social services in larger and more densely populated areas. Therefore, the possible solutions are also different.

Introduction: Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnaire-based measure for quality of life based on the capability approach. CALY-SWE are targeted towards use in cost-effectiveness evaluations of social welfare consequences. Here, we first motivate the measure both from a theoretical and from a Swedish policy-making perspective. Then, we outline the core principles of the measure, namely the relation to the capability approach, embedded equity considerations inspired by the fair-innings approach, and the bases for which capabilities should be considered. The aims were to 1) the most vital capabilities for individuals in Sweden, 2) to define a sufficient level of each identified capability to lead a flourishing life, and to 3) develop a complete questionnaire for the measurement of the identified capabilities.

Material and methods: For the selection of capabilities, we used a Delphi process with Swedish civil society representants. To inform the questionnaire development, we conducted a web survey in three versions, with each Swedish 500 participants, to assess the distribution of capabilities that resulted from the Delphi process in the Swedish population. Each version was formulated with different strictness so that less strict wordings of a capability level would apply to a larger share of participants. All versions also included questions on inequality aversion regarding financial, educational, and health capabilities.

Results: The Delphi process resulted in the following six capabilities: Financial situation & housing, health, social relations, occupations, security, and political & civil rights. We formulated the final phrasing for the questionnaire based on normative reasons and the distribution of capabilities in the population while taking into account inequality aversion.

Conclusion: We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.

Introduction: During the last decade, structures for ‘knowledge governance’ as a means of strengthening the quality of social services has been used by the Swedish government and national authorities. In this process, regional collaboration and support structures (RCSSs) have been identified as a key asset as an intermediary link between national and local actors. The aim of this study was to explore the perspectives of these regional actors on expectations associated with being an intermediary support structure in knowledge governance processes in social services in Sweden. Methods: The study uses an abductive, qualitative approach, mainly with open questions in an empirical-driven manner (inductively) and partly in a theory-driven manner (deductively). Interviews with representatives from the RCSSs were used for data collection. Conventional content analysis with elements of directed content analysis of the data material was used. Results: A variety of expectations on RCSSs was reported from the national and local levels. According to the respondents, the feeling of inadequacy in relation to the perceived expectations was recurrent because the expectations were hard to meet. They also experienced role ambiguity and that their mission was unclear. Conclusions: The findings show that RCSSs seem to handle the situation by considering, assessing, and prioritising different actors’ needs and expectations in relation to their own perception of the intermediary mission. The findings also indicate a lack of a collective sense-making process with other key actors on different levels in the knowledge governance system. To reach the core purpose of knowledge governance, it is necessary to establish a common understanding of the relationship between expectations and prerequisites for facilitation between national, regional, and local actors.

The situation of young people who are neither in employment, education nor training (referred to in political, scientific and public discourses as ‘NEETs’) has received widespread attention during the last decade. However, while policy responses to young people’s work- and school-related marginalisation have been analysed by international scholars in a variety of contexts, to the best of our knowledge, no study to date has scrutinised problem representations of ‘NEET’ young people in youth policies in Sweden. To bridge the current knowledge gap and uncover taken-for-granted assumptions about the otherwise largely unchallenged Nordic welfare model, the aim of this research was to explore how the ‘problem’ of ‘NEET’ young people is represented in Swedish policies and policy proposals. To facilitate this, a discursive approach to policy analysis was adopted, following Bacchi’s ‘What’s the Problem Represented to be?’ (WPR) methodology. By focusing on the solutions that have been proposed to reduce the size of the ‘NEET’ group in two selected policies, four problem representations were developed. These connect the ‘NEET’ problem in Sweden, at the general level, to the ‘vulnerability’ of young people on the margins of education and employment (especially certain sub-groups) and, more specifically, to the failure of a fading welfare system to provide services and support for these ‘vulnerable’ subjects. Beyond representing the ‘problem’ along these lines, the identified problem representations may contribute to silencing young people’s agency and ignoring the consequences of a growing labour-market precarisation in Sweden, while failing to provide a basis for equity and social justice.