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  • 1. Abma, Tineke
    et al.
    Cook, Tina
    Rämgård, Margareta
    Kleba, Elisabeth
    Harris, Janet
    Wallerstein, Nina
    Social impact of participatory health research: collaborative none- linear processes of knowledge mobilization2017In: Educational action research, ISSN 0965-0792, E-ISSN 1747-5074, Vol. 25, no 4, p. 489-505Article in journal (Refereed)
    Abstract [en]

    Social impact, defined as an effect on society, culture, quality of life, community services, or public policy beyond academia, is widely considered as a relevant requirement for scientific research, especially in the field of health care. Traditionally, in health research, the process of knowledge transfer is rather linear and one-sided and has not recognized and integrated the expertise of practitioners and those who use services. This can lead to discrimination or disqualification of knowledge and epistemic injustice. Epidemic injustice is a situation wherein certain kinds of knowers and knowledge are not taken seriously into account to define a situation. The purpose of our article is to explore how health researchers can achieve social impact for a wide audience, involving them in a non-linear process of joint learning on urgent problems recognized by the various stakeholders in public health. In participatory health research impact is not preordained by one group of stakeholders, but the result of a process of reflection and dialog with multiple stakeholders on what counts as valuable outcomes. This knowledge mobilization and winding pathway embarked upon during such research have the potential for impact along the way as opposed to the expectation that impact will occur merely at the end of a research project. We will discuss and illustrate the merits of taking a negotiated, discursive and flexible pathway in the area of community-based health promotion.

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  • 2.
    Al Musawi, Ahmed
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Hellström, Lina
    Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Kalmar; Pharmaceutical Department, Region Kalmar County, Kalmar.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Midlöv, Patrik
    Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University.
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Cheng, Yuanji
    Malmö University, Faculty of Technology and Society (TS), Department of Materials Science and Applied Mathematics (MTM).
    Eriksson, Tommy
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University, Biofilms Research Center for Biointerfaces.
    Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions2024In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711Article in journal (Refereed)
    Abstract [en]

    Background Medication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient’s medication use at home.

    Aim In preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients and data collection to reduce medication discrepancies at discharge and improve medication adherence and (2) to explore the outcomes of the interventions.

    Method Participants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed.

    Results Of 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores.

    Conclusion Based on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.

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  • 3.
    Annersten Gershater, Magdalena
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Holmberg, C. Nagorny
    Novo Nordisk Scandinavia AB, Malmö, Sweden..
    Grahn, M.
    Malmö City, Malmö.
    Andersson, M.
    Hlth & Med Care Management, Grp Off, Reg Skane, Malmö, Sweden..
    Diabetes prevalence is rising among young residents in Malmö, Sweden2021In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 64, no SUPPL 1, p. 161-161Article in journal (Other academic)
  • 4.
    Avery, Helen
    et al.
    Center for Middle Eastern studies, Lund University, Lund, Sweden.
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Empowering communities with health promotion labs: result from a CBPR programme in Malmö, Sweden2022In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, no 1, p. 1-15, article id daab069Article in journal (Refereed)
    Abstract [en]

    Health promotion is thus not only a participatory practice, but a practice forempowerment and social justice. The study describes findings from a community-basedparticipatory and challenge-driven research program. that aimed to improve health through healthpromotion platform in an ethnically diverse low-income neighbourhood of Malmö, Sweden. Localresidents together with lay health promoters living in the area were actively involved in theplanning phase and decided on the structure and content of the program. Academic, public sectorand commercial actors were involved, as well as NGOs and residents. Empowerment was usedas a lens to analyse focus group interviews with participants (n=322) in six co-creative healthpromotinglabs on three occasions in the period 2017-2019. The CBP R interview guide focusedon the dimensions of participation, collaboration and experience of the activities. The CBP Rapproach driven by community member contributed to empowerment processes within the healthpromotion labs: Health promotors building trust in social places for integration, Participantsmotivate each other by social support and Participants acting for community health in widercircle. CBP R Health promotion program should be followed up longitudielly with communityparticipants to be able to see the processes of change and empowerment on the community level.

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  • 5.
    Awad, Eman
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Ramji, Rathi
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Cirovic, Stefan
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Shleev, Sergey
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University.
    Developing and evaluating non-invasive healthcare technologies for a group of female participants from a socioeconomically disadvantaged area2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 23896Article in journal (Refereed)
    Abstract [en]

    When compared to the general population, socioeconomically disadvantaged communitiesfrequently experience compromised health. Monitoring the divide is challenging since standardizedbiomedical tests are linguistically and culturally inappropriate. The aim of this study was to developand test a unique mobile biomedical testbed based on non-invasive analysis, as well as to explorethe relationships between the objective health measures and subjective health outcomes, asevaluated with the World Health Organization Quality of Life survey. The testbed was evaluated in asocioeconomically disadvantaged neighborhood in Malmö, which has been listed as one of the twelvemost vulnerable districts in Sweden. The study revealed that compared to conventional protocolsthe less intrusive biomedical approach was highly appreciated by the participants. Surprisingly, thecollected biomedical data illustrated that the apparent health of the participants from the ethnicallydiverse low-income neighborhood was comparable to the general Swedish population. Statisticallysignificant correlations between perceived health and biomedical data were disclosed, even thoughthe dependences found were complex, and recognition of the manifest complexity needs to beincluded in further research. Our results validate the potential of non-invasive technologies incombination with advanced statistical analysis, especially when combined with linguistically andculturally appropriate healthcare methodologies, allowing participants to appreciate the significanceof the different parameters to evaluate and monitor aspects of health.

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  • 6.
    Bolmsjö, Ingrid
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Johansson, Mats
    Existential Loneliness: A Multidimensional Approach2014In: Journal of Palliative Care, ISSN 0825-8597, Vol. 30, no 3, p. 207-207Article in journal (Other academic)
  • 7.
    Bolmsjö, Ingrid
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Tengland, Per-Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Existential loneliness: An attempt at an analysis of the concept and the phenomen2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 5, p. 1310-1325Article in journal (Refereed)
    Abstract [en]

    Abstract Background: According to ethical guidelines, healthcare professionals should be able to provide care that allows for the patients’ values, customs and beliefs, and the existential issues that are communicated through them. One widely discussed issue is existential loneliness. However, much of the debate dealing with existential loneliness concludes that both the phenomenon and the concept are quite vague. Aim: To clarify what constitutes existential loneliness, and to describe its lived experiences. A further aim was to provide a definition of existential loneliness that can function as a tool for identifying the phenomenon and for differentiating it from other kinds of loneliness. Method: A literature review including theoretical and empirical studies. Different search strategies were used to gather the articles included in the study. The analysis of the empirical studies had an interpretative approach. The articles were also analysed with the aim of providing a definition of existential loneliness. This was done by means of criteria such as language, uniqueness, theory and usefulness. This study is not empirical and does therefore not require an ethics review. Results: The analysis resulted in two main characteristics. The first one was perceiving oneself as inherently separated (disconnected) from others and from the universe. The second one brings out emotional aspects of EL, such as isolation, alienation, emptiness and a feeling of being abandoned. The empirical findings were divided into two categories: experiences of EL and circumstances in which EL arises. A definition of EL is also suggested, based on the two main characteristics identified. Conclusion: In order to meet patients’ needs, it is an ethical duty for healthcare staff to be able to recognise experiences of EL, that is, to communicate with the patients about these experiences in an appropriate manner. This in turn demands knowledge about existential issues and skills to deal with them.

  • 8.
    Carlson, Elisabeth
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bolmsjö, Ingrid
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bengtsson, Mariette
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Registered nurses' perceptions of their professional work in nursing homes and home-based care: A focus group study2014In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 5, p. 761-767Article in journal (Refereed)
    Abstract [en]

    Background: In Sweden, as well as in most industrialized countries, an increasing older population is expected to create a growing demand for health care staff. Previous studies have pointed to lack of proficient medical and nursing staff specialized in geriatric care, which poses serious threats to the care of a vulnerable population. At the same time, there are studies describing elderly care as a low-status career choice, attracting neither nurses nor student nurses. Judging from previous research it was deemed important to explore how nurses in elderly care perceive their work, thus possibly provide vital knowledge that can guide nurse educators and unit managers as a means to promote a career in elderly care. Objective: The aim of the present study was to illuminate how nurses, working in nursing homes and home-based care, perceived their professional work. Method: This was a qualitative study using focus groups. 30 registered nurses in seven focus groups were interviewed. The participants worked in nursing homes and home-based care for the elderly in rural areas and in a larger city in southern Sweden. The interviews were analyzed in line with the tradition of naturalistic inquiry. Results: Our findings illustrate how nurses working in elderly care perceived their professional work as holistic and respectful nursing with the older person at its centre. Three categories emerged during analysis: (1) establishing long-term relationships, (2) nursing beyond technical skills, and (3) balancing independence and a sense of loneliness. Conclusions: We suggest that nurse educators and nurse managers promote continuity and long term relationships with patients, as well as independence and the opportunity to provide holistic care as key aspects of elderly care. These key aspects can be used to attract and retain nurses to a much needed area as well as be used as positive examples that can influence values and attitudes towards a career in elderly care.

  • 9. Chung, B P M
    et al.
    Olofsson, Jonas
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Wong, F K Y
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Overcoming existential loneliness: a cross-cultural study2020In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, no 1, article id 347Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Moving into a long-term care facility (LTCF) can reduce the ability for older adults to engage in meaningful roles and activities and the size of their social network. These changes and losses can lead them to experience existential loneliness (EL)-the intolerable emptiness and lack of meaningful existence resulted from the losses they have experienced. While EL has often been understood as a universal human experience, it has primarily been studied in people from Western cultures; little is known about how EL may be experienced by and manifested in people from Eastern cultures. Hence, this qualitative study aimed to describe the experience and coping of EL in Hong Kong Chinese and Swedish older adults living in LTCFs.

    METHODS: A qualitative study using Thorne's (2004) interpretive description was conducted. Thirteen Chinese and 9 Swedes living in LTCFs in Hong Kong, China and Malmo, Sweden, respectively were interviewed about their experience of EL in two series of semi-structured interviews. Data were analyzed using thematic analysis.

    RESULTS: The core theme of "overcoming EL" described the participants' experience of EL, which came about through the combined process of "Feeling EL" and "Self-Regulating". Both Chinese and Swedish participants had similar experience with EL. Realizing that they did not want to living with EL anymore, they coped by reframing their experience and identifying new meaning in their life.

    CONCLUSIONS: The study findings suggested that early and clear counselling support that help older adults to define new meaning in life may help them cope. In addition, more opportunities should be available at the LTCFs to promote quality relationships, enable older adults to reflect on their lives with pride, and support their ability to do the things they enjoy.

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  • 10. Cuesta, Marta
    et al.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Intersectional perspective in elderly care2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, no 1, article id 30544Article in journal (Refereed)
    Abstract [en]

    Abstract Earlier research has shown that power relationships at workplaces are constructed by power structures. Processes related to power always influence the working conditions for (in this study in elderly care) the working groups involved. Power structures are central for intersectional analysis, in the sense that the intersectional perspective highlights aspects such as gender and ethnicity (subjective dimensions) and interrelates them to processes of power (objective dimension). This qualitative study aims to explore in what way an intersectional perspective could contribute to increased knowledge of power structures in a nursing home where the employees were mostly immigrants from different countries. By using reflexive dialogues related to an intersectional perspective, new knowledge which contributes to the employees’ well-being could develop. Narrative analysis was the method used to conduct this study. Through a multi-stage focus group on six occasions over 6 months, the staff were engaged in intersectional and critical reflections about power relationship with the researchers, by identifying patterns in their professional activities that could be connected to their subjectivities (gender, ethnicity, etc.). The result of this study presents three themes that express the staff’s experiences and connect these experiences to structural discrimination. 1) Intersectionality, knowledge, and experiences of professionalism; 2) Intersectionality, knowledge, and experiences of collaboration; and 3) Intersectionality, knowledge, and experiences of discrimination. The result demonstrates that an intersectional perspective reinforces the involved abilities, during the conversations, into being clear about, for example, their experiences of discrimination, and consequently developing a better understanding of their professionalism and collaboration. Such deeper reflections became possible through a process of consciousness raising, strengthening the employee’s self-confidence, in a positive way. Key words: Power, intersectionality, focus group, elderly care, ethnicity, gender

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  • 11.
    Enskär, Karin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Isma, Gabriella E
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Safe environments: Through the eyes of nine-year-old schoolchildren from a socially vulnerable area in Sweden2021In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 47, no 1, p. 57-69Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Children are more vulnerable than adults to environmental risks. Also, children have little control over their environment. Unlike adults, they may be both unaware of risks and unable to make choices to protect their health. Children living in especially vulnerable areas might be even more at risk due to socioeconomic factors, immigration, and high crime rates. Therefore, the aim of this study was to describe the perceptions that schoolchildren from a socially vulnerable area have of safe environments.

    METHODS: 52 nine-year-old schoolchildren from a socially vulnerable area participated in this study. The data collection consisted of an environmental walk with photovoicing, followed by rating of the photos, and a focus-group discussion elaborating on the photos and ratings. Six focus groups, with 6-8 children in each group, were conducted and analyzed using an inductive content analysis.

    RESULTS: The results show that, according to the children, places that they think are bright and beautiful, where they can do fun things with others and do not risk being exposed to danger, create safety. To increase safety, the children suggested cleaning up, making the environment beautiful with grass and flowers, and painting it in nice colours. Furthermore, they suggested that building features that increase the opportunities to play and engage in activities together with others, would improve safety and enhance protection and surveillance.

    CONCLUSIONS: All children have the right to protection and safety. Therefore, it is important to create safe environments for all children by listening to children's own voices.

  • 12. Holmberg, Anna
    et al.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS).
    Esbjörnsson, Mattias
    Jämlik hälsa: en agenda för att främja innovationer för en bättre och mer jämlik hälsa2015Report (Other academic)
    Abstract [sv]

    Agendan syftar till att möta Sveriges utmaning med att uppnå en jämlik hälsa i befolkningen. För att ta sig an denna utmaning behövs en kraftsamling från alla berörda aktörer. Agendan är därför framtagen i samverkan mellan offentlig sektor, idéburen sektor, näringsliv, akademi och medborgare.

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  • 13.
    Isma, Gabriella E
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Enskär, Karin
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Perceptions of health among school-aged children living in socially vulnerable areas in Sweden2023In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1136832Article in journal (Refereed)
    Abstract [en]

    Introduction: According to the Convention on the Rights of the Child, all children have the right to health. Since good health is a decisive factor for children's future, investing in children's health is important, especially children from vulnerable areas. The purpose of this study was to investigate the perceptions of health among school-aged children from socially vulnerable areas.

    Methods: The study has an explorative mixed-method design with a participatory and inductive approach based on focus group interviews with children and youth leaders, respectively, at Multi-activity Centers in three of the vulnerable areas in Malmö Municipality, as well as results from the Multi-activity Centers' own questionnaire. The data has been analyzed with inductive and deductive content analysis.

    Results: The children and the youth leaders described health in terms of well-being, participation, and activity. Well-being included feeling good and safe, having a healthy body, and having fun by doing things together with friends and leaders. Participating in activities was described as having a feeling of involvement, being able to have an influence on the organization of the activities and participating on one's own terms.

    Discussion: The result of this study shows that participating in activities increases the child's sense of well-being.

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  • 14.
    Kronkvist, Maria Bendtsen
    et al.
    Umea Univ, Dept Clin Sci, Umea, Sweden..
    Forsberg, Karl-Anton
    Umea Univ, Dept Clin Sci, Umea, Sweden..
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sandlund, Mikael
    Umea Univ, Dept Clin Sci, Umea, Sweden..
    Janarv, Tove
    Umea Univ, Dept Clin Sci, Umea, Sweden..
    Dahlqvist Jonsson, Patrik
    Region Halland, Halmstad, Sweden..
    User participation in decision-making - a qualitative intervention study on mental health professionals' experiences2022In: Journal of Public Mental Health, ISSN 1746-5729, E-ISSN 2042-8731, Vol. 21, no 3, p. 250-261Article in journal (Refereed)
    Abstract [en]

    Purpose The purpose of this study was to describe mental health professionals' experiences of changes in attitudes towards, and knowledge about, users of mental health-care recovery and decisional participation in clinical practice after an educational intervention.

    Design/methodology/approach Users of mental health care want to participate in decisions regarding their own mental health care. Shared decision-making as a method is coherent with recovery orientation in mental health services and results in better-informed patients and fewer conflicts regarding decisions. A qualitative intervention study was designed to evaluate changes in attitudes and knowledge about mental health recovery in Sweden. Nine participants were interviewed, and the data were analysed by content analysis.

    Findings Three categories were generated from the analysis: Increased theoretical knowledge, changing attitudes about practical approaches and the significance of social factors in recovery.

    Originality/value When shared decision-making is to be implemented in mental health, professionals need to gain knowledge about recovery and need to adopt changed roles as health professionals. Educational interventions therefore seem necessary if such changes are to happen.

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  • 15.
    Larsson, Helena
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Edberg, Anna- Karin
    Bolmsjö, Ingrid
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Contrasts in older persons’ experiences and significant others’ perceptions of existential loneliness2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 6, p. 1623-1637Article in journal (Refereed)
    Abstract [en]

    Background: As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in what way, the views of frail older persons and their significant others concerning existential loneliness are in concordance. Objective: To contrast frail older (>75) persons’ experiences with their significant others’ perceptions of existential loneliness. Methods: A case study design was chosen for this study. Individual interviews with frail older persons (n ¼ 15) and interviews with their significant others (n ¼ 19), as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. Ethical considerations: This study was conducted in accordance with the principles of research ethics. Findings: The findings showed three themes: (1) Meaningless waiting in contrast to lack of activities, (2) Longing for a deeper connectedness in contrast to not participating in a social environment and (3) Restricted freedom in contrast to given up on life. Discussion: Knowledge about the tensions between older persons’ and their significant others’ views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. Conclusion: It is of importance that health care professionals listen to both the frail older person and their significant other(s) and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person. Keywords case study, existential loneliness, frail older person, significant other, thematic analysis

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  • 16.
    Larsson, Helena
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bolmsjö, Ingrid
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Older persons’ existential loneliness, as interpreted by their significant others - an interview study study2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, no 138Article in journal (Refereed)
    Abstract [en]

    Background: In order to better understand people in demanding medical situations, an awareness of existential concerns is important. Studies performed over the last twenty years conclude that when dying and death come closer, as in the case with older people who are stricken by infirmity and diseases, existential concerns will come to the fore. However, studies concerning experiences of existential loneliness (EL) are sparse and, in addition, there is no clear definition of EL. EL is described as a complex phenomenon and referred to as a condition of life, an experience, and a process of inner growth. Listening to someone who knows the older person well, as significant others often do, may be one way of learning more about EL. Methods: This study is part of a larger research project on EL, the LONE study, where EL is explored through interviews with frail older people, their significant others and health care professionals. The aim of this study was to explore frail older (>75) persons’ EL, as interpreted by their significant others. The study is qualitative and based on eighteen narrative interviews with nineteen significant others of older persons. The data was analysed using Hsieh and Shannon’s conventional content analysis. Results: According to the interpretation of significant others, the older persons experience EL (1) when they are increasingly limited in body and space, (2) when they are in a process of disconnecting, and (3) when they are disconnected from the outside world. Conclusion: The result can be understood as if the frail older person is in a process of letting go of life. This process involves the body, in that the older person is increasingly limited in his/her physical abilities. The older person’s long-term relationships are gradually lost, and finally the process entails the older person’s increasingly withdrawing into him- or herself and turning off the outside world. The result of this study is consistent with previous research that has shown that EL is a complex phenomenon, but the implications of this research include a deepened understanding of EL. In addition, the study highlights the interpretations of significant others.

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  • 17.
    Larsson, Helena
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Blomqvist, Kerstin
    Spouses' existential loneliness when caring for a frail partner late in life: a hermeneutical approach2020In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 15, no 1, article id 1734166Article in journal (Refereed)
    Abstract [en]

    Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs. Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner. Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other. Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses' existential needs visible and to provide support based on their needs.

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  • 18.
    Lill, Linda
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Intersektionalitet i vården2016In: Praktiska grunder för omvårdnad / [ed] Nina Jahren Kristoffersen, Finn Nortvedt, Eli-Anne Skaug, Janeth Leksell, IngaLill Källström Karlsson, Liber, 2016, p. 465-478Chapter in book (Other academic)
    Abstract [sv]

    Syftet med följande kapitel är att introducera begreppet intersektionalitet och att med utgångspunkt i ett antal beskrivande fall illustrera betydelsen av ett intersektionellt perspektiv i möten inom vården. Intersektionalitet är ett sätt att förstå världen utifrån hur föreställningar om klass, genus och etnicitet får betydelse för möten mellan människor. Globalisering och förändrad könsuppdelning i samhälle och familj gör att vi ständigt måste reflektera över hur överlappningen av olika faktorer påverkar orättvisor, hälsa och ohälsa.

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  • 19.
    Lindsjö, Cecilia
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Migrant women's engagement in health-promotive activities through a women's health collaboration2023In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1106972Article in journal (Refereed)
    Abstract [en]

    Introduction: Social determinants of health impact health, and migrants are exposed to an inequitable distribution of resources that may impact their health negatively, leading to health inequality and social injustice. Migrant women are difficult to engage in health-promotional activities because of language barriers, socioeconomic circumstances, and other social determinants. Based on the framework of Paulo Freire, a community health promotion program was established in a community-academic partnership with a community-based participatory research approach.

    Aim: The aim of this study was to describe how a collaborative women's health initiative contributed to migrant women's engagement in health promotion activities.

    Materials and methods: This study was part of a larger program, carried out in a disadvantaged city area in Sweden. It had a qualitative design with a participatory approach, following up on actions taken to promote health. Health-promotional activities were developed in collaboration with a women's health group, facilitated by a lay health promoter. The study population was formed by 17 mainly Middle Eastern migrant women. Data was collected using the story-dialog method and the material was analyzed using thematic analysis.

    Result: Three important contributors to engagement in health promotion were identified at an early stage of the analysis process, namely, the group forming a social network, the local facilitator from the community, and the use of social places close to home. Later in the analysis process, a connection was made between these contributors and the rationale behind their importance, that is, how they motivated and supported the women and how the dialog was conducted. This therefore became the designated themes and were connected to all contributors, forming three main themes and nine sub-themes.

    Conclusion: The key implication was that the women made use of their health knowledge and put it into practice. Thus, a progression from functional health literacy to a level of critical health literacy may be said to have occurred.

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  • 20.
    Lindsjö, Cecilia
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Health promotion focusing on migrant women through a community based participatory research approach2021In: BMC Women's Health, E-ISSN 1472-6874, Vol. 21, article id 365Article in journal (Refereed)
    Abstract [en]

    Background Migrants are often more vulnerable to health issues compared to host populations, and particularly the women. Therefore, migrant women's health is important in promoting health equity in society. Participation and empowerment are central concepts in health promotion and in community-based participatory research aimed at enhancing health. The aim of this study was to identify conditions for health promotion together with women migrants through a community-based participatory research approach. Methods A community-based participatory research approach was applied in the programme Collaborative Innovations for Health Promotion in a socially disadvantaged area in Malmo, Sweden, where this study was conducted. Residents in the area were invited to participate in the research process on health promotion. Health promoters were recruited to the programme to encourage participation and a group of 21 migrant women participating in the programme were included in this study. A qualitative method was used for the data collection, namely, the story-dialogue method, where a process involving issue, reflections and actions guided the dialogues. The material was partly analysed together with the women, inspired by the second-level synthesis. Results Two main health issues, mental health and long-term pain, were reflected upon during the dialogues, and two main themes were elaborated in the process of analysis: Prioritising spare time to promote mental health and Collaboration to address healthcare dissatisfaction related to long-term pain. The women shared that they wanted to learn more about the healthcare system, and how to complain about it, and they also saw the togetherness as a strategy along the way. A decision was made to start a health circle in the community to continue collaboration on health promotion. Conclusions The community-based participatory research approach and the story dialogues constituted an essential foundation for the empowerment process. The health circle provides a forum for further work on conditions for health promotion, as a tool to support migrant women's health.

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  • 21.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Enskär, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Uppsala Universitet.
    Ramji, Rathi
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Tengland, Per-Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Theodoridis, Kyriakos
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The Need for Parental Support for Migrant Parents in Transition Into Sweden: A Perspective2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 680767Article in journal (Refereed)
    Abstract [en]

    Migration is a stressful experience and research shows that newly arrived migrants in Sweden suffer from different challenges and struggle to relate to parenting in a new culture that is different from their own. The Swedish Child Health Services (CHS) focuses on promoting health among children, as well as supporting parents in parenting. Although this is a goal, migrant parents participate at lower rates in parental support groups. This paper aims to discuss how the Swedish CHS can support these families and address the need for improvement in the parental support offered to migrant parents during transition into their host country. In addition, this paper also aims to review and discuss the advantages of using a community-based participatory research approach together with the Swedish CHS to identify and apply culturally appropriate support programs to increase health literacy among migrant parents.  

    The Swedish government decided to place greater emphasis and resources on supporting parents and promoting equal health among families in Sweden, with special emphasis on migrants and other vulnerable groups. This report from the Swedish government indicates the importance of creating knowledge about new ways, methods, and actions that may be needed to increase this support. One suggestion of this paper is to provide culturally appropriate healthcare work using a community-based participatory research approach, where migrant parents themselves are actively involved in the development of support programs. This approach will not only provide migrant families knowledge and support, it will also build on their needs and the challenges they can share, and receive support to overcome.

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  • 22.
    Olofsson, Jonas
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bramhagen, Ann-Cathrine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Older migrants' experience of existential loneliness2021In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 28, no 7-8, p. 1183-1193, article id 969733021994167Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: With rapidly ageing population worldwide, loneliness among older adults is becoming a global issue. Older migrants are considered being a vulnerable population and ethical issues are often raised in care for elderly. A deeper sense of loneliness, existential loneliness is one aspect of loneliness also described as the ultimate loneliness. Making oneself understood or expressing emotions, have shown to be particularly challenging for older migrants which could lead to experience of existential loneliness. Ageing and being a migrant are potential triggers for experiencing existential loneliness. There appears to be, however, little known about being a migrant experiencing existential loneliness in old age.

    AIM: This study explored older migrants' experience of existential loneliness.

    RESEARCH DESIGN: Qualitative study.

    PARTICIPANTS AND RESEARCH CONTEXT: Data were collected through interviews (n = 15) with older (>65) migrants' in Swedish nursing homes or senior citizen centres. A thematic analysis was performed to analyse the data.

    ETHICAL CONSIDERATIONS: The study was conducted in accordance with the principles of research ethics.

    FINDINGS: The result was described in terms of three themes: (1) Choices made in life, (2) seeking reconciliation with life and (3) thoughts about death and dying in a foreign country.

    DISCUSSION: Ethical reflection and knowledge about how older migrants' life story can lead to experiencing existential loneliness, could be of use in care for older migrants'.

    CONCLUSION: This study indicates that the experience of existential loneliness derived from being a migrant is a long-term and significant process. Migration was a hope of creating a meaningful life, the experience of existential loneliness occurred as migrants sought reconciliation with life, reflected upon their past choices, and thought about death and dying in a foreign country.

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  • 23.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Brogårdh-Roth, Susanne
    Malmö University, Faculty of Odontology (OD).
    Olofsson, Anna Nilvéus
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in Southern Sweden.2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 4, article id e035732Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Inequalities in oral health have been on the rise globally. In Sweden, these differences exist not between regions, but among subgroups living in vulnerable situations. This study aims at understanding behavioural change after taking part in participatory oral health promotional activity among families living in socially disadvantaged neighbourhoods in Southern Sweden.

    SETTING: The current study involved citizens from a socially disadvantaged neighbourhood in Malmö, together with actors from the academic, public and private sectors. These neighbourhoods were characterised by high rates of unemployment, crime, low education levels and, most importantly, poor health.

    PARTICIPANTS: Families with children aged 7-14 years from the neighbourhood were invited to participate in the health promotional activities by a community representative, known as a health promoter, using snowball sampling. Between 8 and 12 families participated in the multistage focus groups over 6 months. Data were analysed using qualitative content analysis.

    RESULTS: Three main themes emerged from the analysis, providing an understanding of the determinants for behavioural change, including meaningful social interactions, family dynamics and health trajectories. The mothers in the study valued the social aspects of their participation; however, they believed that gaining knowledge in combination with social interaction made their presence also meaningful. Further, the participants recognised the role of family dynamics primarily the interactions within the family, family structure and traditional practices as influencing oral health-related behaviour among children. Participants reported having experienced a change in general health owing to changed behaviour. They started to understand the association between general health and oral health that further motivated them to follow healthier behavioural routines.

    CONCLUSIONS: The results from this study show that oral health promotion through reflection and dialogue with the communities, together with other stakeholders, may have the potential to influence behavioural change and empower participants to be future ambassadors for change.

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  • 24.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Impact of a CBPR-informed physical activity intervention before and during COVID-19 among women from a disadvantaged neighborhood in Sweden.2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 997329Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Public health practitioners have been striving to reduce the social gradient and promote physical activity among citizens living in disadvantaged neighborhoods. The emergence of the COVID-19 pandemic, which has affected these citizens extensively, has posed a significant challenge to efforts to maintain a physically active lifestyle. Thus, the aim of this study was to explore the impact of a CBPR-informed physical activity intervention before and during the COVID-19 pandemic from the perspective of women from a socially disadvantaged neighborhood.

    METHODS: A total of 34 women participated in a CBPR-informed physical activity intervention previously developed in collaboration with lay health promoters and other citizens from the same neighborhood. Focus group discussions were conducted at four time points, namely, at baseline prior to the intervention, post-intervention, 6 months after the intervention ended, and during the COVID-19 pandemic. The data were analyzed using qualitative content analysis following an inductive approach.

    RESULTS: In total, four themes emerged from the discussions: "Wavering between frustration and action," "Shifting from prioritizing family needs to taking control of self," "Between isolation and social support," and "Restricted access to health-related knowledge vs. utilizing internalized knowledge".

    CONCLUSION: The results of this study reveal that building on CBPR-informed health promotion initiatives has the potential to foster individual empowerment and assist during acute situations like the COVID-19 pandemic through mobilizing communities and their resources, which leads to increased community resilience and health. This study is regarded as unique in that it involves evaluation of a CBPR intervention that was initiated ahead of the pandemic and followed even during the pandemic.

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  • 25.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Shleev, Sergey
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University, Biofilms Research Center for Biointerfaces.
    Awad, Eman
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Development and evaluation of a physical activity intervention informed by participatory research: a feasibility study2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, article id 112Article in journal (Refereed)
    Abstract [en]

    Background: Despite numerous interventions aiming to improve physical activity in socially disadvantagedpopulations, physical inactivity remains to be a rising challenge to public health globally, as well as, in Sweden. Inan effort to address this challenge, a community-based participatory intervention was developed through activecommunity engagement and implemented in a socially disadvantaged neighborhood in Sweden. The current studyaims to present the development and initial evaluation of a participatory research driven physical activityintervention.Methods: Fifteen participants (11 females and 4 males) aged 17–59 years volunteered to participate in the physicalactivity intervention program. The intervention program was evaluated using a longitudinal mixed methods designmeasuring health impact changes over time through focus group discussions and quality of life surveys. Furtheradditional biomedical health parameters such as levels of glycosylated hemoglobin, blood pressure, levels ofoxygen saturation and body mass index were monitored before and after the intervention. Focus group data wereanalyzed using content analysis with an inductive approach. The pre-and post-test scores from the survey-basedquality of life domains, as well as the health parameters were compared using non-parametric and parametricstatistics.Results: Four themes emerged from the analysis of the focus group discussions including sense of fellowship,striving for inclusion and equity, changing the learner perspective and health beyond illness. The scores for thedomains Physical Health, Psychological Health, Social Relationships and Health Satisfaction where significantlyhigher after participation in the physical activity intervention program compared to the pre-test scores (p < .05)s.There were however, no significant changes in the scores for the environmental domain and overall quality of lifeafter intervention compared to that prior to intervention start. Overall, the biomedical health parameters remainedstable within the normal ranges during intervention.Conclusion: The focus group discussions and results from the surveys and biomedical measures reveal importantfindings to understand and further develop the intervention program to promote health equity among citizens indisadvantaged areas. Evaluating the feasibility of such an intervention using multiple approaches contributes toeffective implementation of it for larger communities in need.

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  • 26.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Shleev, Sergey
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Awad, Eman
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Cirovic, Stefan
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Health and quality of life among women after participation in a CBPR-informed physical activity intervention: with a pandemic perspective.2023In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 17972Article in journal (Refereed)
    Abstract [en]

    The lack of culturally and contextually oriented interventions promoting physical activity (PA) has led to increased physical inactivity among women living in disadvantaged neighbourhoods in Sweden. In this study one such intervention informed by community-based participatory research (CBPR) has been evaluated among 34 women from a disadvantaged neighbourhood before and during COVID-19. Health-related quality of life (HRQOL), behavioural and biomedical outcomes were assessed directly prior and post-intervention, followed by evaluations at 6-months and 18-months follow-up during COVID-19. The results revealed that HRQOL, particularly psychological, social, and environmental health significantly increased post-intervention compared to prior to intervention but reversed back at 6-months follow-up. Perceived health satisfaction and environmental health increased at 18-months follow-up during COVID-19. Participation in PA improved post-intervention and at 6-months follow-up. Everyday activities and fruit and vegetable intake continued to increase through all timepoints. Systolic blood pressure significantly decreased post-intervention and 6-months follow-up; blood flow rate increased significantly at all timepoints. Overall, the findings underscores the potential effectiveness of CBPR approaches in promoting and sustaining healthy lifestyles, even during acute situations such as the COVID-19. It may even serve as a future model for promoting health and addressing health disparities in similar groups.

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  • 27.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Psychometric properties of the WHOQOL-BREF in citizens from a disadvantaged neighborhood in Southern Sweden2023In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 14Article in journal (Refereed)
    Abstract [en]

    Background: Citizens living in disadvantaged neighborhoods experience poorer health than the majority, and this inequality is a public health problem even in a welfare state such as Sweden. Numerous initiatives aimed at improving health and quality of life in these populations are being implemented and evaluated. Given that these populations are predominantly multicultural and multilingual, an instrument such as the WHOQOL-BREF, which is cross-culturally validated and available in multiple languages, may be appropriate. However, this cannot be ascertained since the psychometric properties of WHOQOL-BREF have never been assessed in the Swedish context. Thus, the current study aimed at assessing the psychometric properties of the WHOQOL-BREF questionnaire in citizens from a disadvantaged neighborhood in Southern Sweden.

    Methods: The respondents in this study were 103 citizens who participated in the health promotional activities of a Health promotional program and also responded to the 26-item, WHOQOL-BREF questionnaire as a part of an evaluation to assess the impact of the activities on the health-related quality of life of citizens. A Rasch model using WINSTEP 4.5.1 was used to assess the psychometric properties in this study.

    Results: Five of the 26 items, including pain and discomfort, dependence on medical substances, physical environment, social support, and negative feelings did not display acceptable goodness-of-fit to the Rasch model. On removing these items, the 21-item WHOQOL-BREF scale had an improved internal scale validity and person-separation reliability than the original 26-item version for this group of citizens from the neighborhood. When assessing the individual domains, three of the five items that were misfits on analyzing the full model also showed misfits in relation to two respective domains. When these items were removed, the internal scale validity of the domains also improved.

    Conclusion: WHOQOL-BREF seemed to be psychometrically inadequate when used in the original form due to internal scale validity problems, while the modified 21-item scale seemed better at measuring the health-related quality of life of citizens living in socially disadvantaged neighborhoods in Sweden. Omission of items shall be done but with caution. Alternatively, future studies may also consider rephrasing the items with misfits and further testing the instrument with larger samples exploring the associations between subsamples and specific item misfit responses.

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  • 28.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Det sexuella rummet: en kunskapsverkstad om sexualitet och samliv i äldreomsorgen2010Report (Other academic)
    Abstract [sv]

    Ett aktionsforskningprojekt i form av en kunskapsverkstad där personal inom äldreomsorgen samlats i en forskningscirkel för att diskutera sitautioner runt sexualitet och samliv i deras arbete. Rapporten presenterar tidigare forskning inom området samt påvisar hur bristande kunskap och föreställningar om sexualitet och samliv bland de allra äldsta konstruerar ett sexuellt rum - som exkluderar snarare än inkluderar sexualitet och intimitet för äldre i den kommunala äldreomsorgen. Kunskapsbrister och outtalade föreställningar påverkar även personalens arbetsmiljö eftersom de har svårta att hantera dessa situationer.Dialogen i forskningscirkeln påvisar även skillnader mellan att arbeta i de egna hemmen kontra på kommunens särskilda boende, vilket antyder en sorts moralgeografi dör olika förhållningsätt råder till äldre människors integritet beroende på vilken plats omsorgen bedrivs.

  • 29.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Geography of the elderly2014In: Geography and health: a Nordic outlook / [ed] Anders Schærström, Stig H Jørgensen, Thomas Kistemann, Åke Sivertun, Universität Bonn, Institute for Hygiene and Public Health. Bonn, Germany , 2014, p. 88-90Chapter in book (Other academic)
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  • 30.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    INSATS MITHRA: ger stöd och möjlighet att närma sig arbetsmarknaden för den som varit utsatt för våld i nära relationer2016Report (Other academic)
    Abstract [sv]

    Insatsen MITRA i Hörby Kommun startades av Finsam MittSkåne för att det finns ett behov av riktade stödinsatser till personer som varit utsatta för våld i nära relationer. MITRA betyder skydd och vänskap och har sitt namn efter en beskyddande gudinna. Insatsen riktar sig mot de personer som varit utsatta för relationsrelaterat våld efter det akuta skedet när utredningsprocesser, krisbearbetning och missbruk är avslutade. Avsikten med insatsen är således inte att utreda själva våldshandlingen utan snarare att öka social inkludering och möjliggöra för personer som varit utsatta för våld i nära relationer att bli självförsörjande. Det övergripande syftet med insatsen är att deltagare genom MITRA skall närma sig arbetsmarknaden genom arbetsträning, praktik eller studier. Deltagarens delaktighet och det salutogena arbetssättet står i fokus i insatsen eftersom den riktas mot ett promotivt förebyggande arbete där deltagarnas egna resurser skall stärkas och tas tillvara. Samtidigt skall myndigheter och hälso- och sjukvård erbjuda olika former av stöd. Genom att detta arbete sker i samverkan med lokala myndigheter och hälso- och sjukvård i Hörby förväntas kommunen åter bli en trygg plats för dessa personer.

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  • 31.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kulturbegreppet och personal i äldreomsorgen2016In: Omsorg: Nordisk tidsskrift for Palliativ Medisin, ISSN 0800-7489, no 3, p. 17-21Article in journal (Refereed)
    Abstract [sv]

    Artikeln problematiserar först olika perspektiv på kulturell identitet i relation till personalens berättelser om att vårda i livets slut i den kommunala äldreomsorgen. Därefter presenteras ett tredje kulturgeografiskt perspektiv som kan berika en multikulturell ansats i den palliativa vården

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  • 32.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Närsjukvård: samverkan mellan olika professioner i hemsjukvården2010Report (Other academic)
    Abstract [sv]

    Boken är den första i en serie om närsjukvård i samverkan. Forskningen tar utgångspunkt i den kommunala verksamheten och de vårdteam som består av biståndshandläggare, distriktssköterskor, sjukgymnaster och arbetsterapeuter. Syftet är att genom aktionsforskning bidra till en kunskapsöverföring som skapar förutsättningar för bättre relationer mellan olika professio­ner i närsjukvården. Avsikten är att stärka samspelet i hela det kommunala teamet, så att det förbättrar vården för den enskilde vårdtagaren, oavsett personalens professionstillhörighet. Aktionen i projektet utgörs utav casemetoden samt dialog samtal i fokusgrupper. Teoretiskt tar studien utgångspunkt i Bourdieus begrepp habitus och sociala rum. Resultatet visar att de olika professionerna angriper de situa­tioner och vårdbehov de ska ta ställning till utifrån sina professionella habitus på ett sådant sätt att det innebär att det kan uppstå intressekonflikter i vårdteamen. Samtidigt söker de konsensus mellan sig i vårdteamet som ofta bygger på för givet tagande i tolk­ningen av olika vårdsituationer. Genom aktionen så belyses deras habitus och ger dem möljighet att beakta vårdsituationerna från andra aspekter som förstärker samarbetet och som ger en bättre omvårdnad. En viktig sak att ta i beaktande i det sammanhanget är att det råder olika kulturella före­ställningar, som färgar vårdsammanhangen utifrån profesionella habitus beroende på i vilken plats omsorgen bedrivs.

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  • 33.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS).
    Omvårdnadens geografi och dess betydelse för familjen2012In: Att möta familjer inom vård och omsorg; / [ed] Eva Benzein, Margareta Hagberg, Britt- Inger Saveman, Studentlitteratur AB, 2012, p. 235-246Chapter in book (Other academic)
    Abstract [en]

    The chapter is linked to two concepts that are essential in geography of caring. The first concerns social space, which is about the family and family members' social networks, inequalities in society and how these are affected by proximity and distance. The second concept is place. People are place-bound creatures. Places are a part of our existence and identity, and family relationships are connected to places and the physical environment as well as to social relations.

  • 34.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Platsens betydelse för dementa: en studie av demensvården i tre skånska kommuner2009Report (Other academic)
    Abstract [sv]

    Projektet har genomförts i tre kommunla boende för dementa och berör platsers betydelse för dementa boendes sociala välbefinnande. Några av frågeställningarna i projektet är: Kan socialt välmående för de dementa boende relateras till specifika platser? Har förändringar i den fysiska miljön någon påverkan på de dementa boende? Materialet består av fokusgrupper tillsammans med personalen i de tre särskilda boendena, djupintervjuer med anhöriga samt dagböcker som följer trettio dementa boende under tre månader. Förutom de spatiala frågorna tar rapporten upp behovet av kontinuitet i arbetet med de dementa boende och hur det kan minska oro och därmed reducera medicinförbrukningen. Den pekar även på att om de dementa boende skall uppleva mening i boendet så måste de utveckla sociala aktiviteter i mindre grupper, olika konstellationer och miljöer som de känner igen sedan tidigare. Rapporten visar att när dementa boende får komma till platser där de utövat sociala aktiviteter (och som är förknippade med stark positiva känsloupplevelser) förstärks deras kognition och minnesfunktion.

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  • 35.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Spaces of Birth in Greenland2014In: Geography and health: a Nordic outlook / [ed] Anders Schærström, Stig. H Jørgensen, Thomas Kirsteman, Åke Sivertun, Universität Bonn, Institute for Hygiene and Public Health. Bonn, Germany , 2014, p. 95-101Chapter in book (Other academic)
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  • 36.
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Teamets lärande främjar personcentrerad vård2018In: Bar liv för äldre: forskning ger möjligheter / [ed] Birgit Rösblad, Elisabeth Strandberg, Carita Nygren, Svensk sjuksköterskeförening , 2018, p. 21-22Chapter in book (Other academic)
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  • 37.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Terapeutiska landskap i samhällsplaneringen- hållbar utveckling i praktiken2011Report (Other academic)
    Abstract [sv]

    Rapporten berör ett aktionsforskningsprojekt bland samhällsplanerare i skånska kommuner. Kommunerna har arbetat med olika case/ fall för att påvisa hur de kan skapa en långsiktig hållbarhet som främjar hälsa för kommande generationer. Forskaren har studerat processen i det arbetet. Resultatet visar att kommunernas tjänstemän arbetar med en defintion av hållbar utveckling som bevarar naturvärden, främja social inkludering över generationerna och arbeta hälsofrämjande i relation till att skapa rekreation och minska hälsofarliga miljöer. De fokuserar mer på miljöaspekter än en generell social hållbarhet och är begränsade i att tänka på mer marginaliserade grupper i samhällsplaneringen. I miljöfrågor så har de ett djupare engagemang som försätter dem i en sorts etisk stress när de måste frångå sina principer pågrund utav politiskt fattade beslut. Rapporten kritiserar det politiska besluten om att snabba upp planprocessen och påvisar att en systematiserad reflekterande dialog mellan olika yrkesfunktioner tidigt i planeringsarbete bidrar till en mer långsiktig hållbar utveckling i praktiken.

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  • 38.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    The power of place in the context of pregnancy2014In: Geography and health: a Nordic outlook / [ed] Anders Schærström, Stig. H Jørgensen, Thomas Kistemann, Åke Sivertun, Universität Bonn, Institute for Hygiene and Public Health. Bonn, Germany , 2014, p. 47-59Chapter in book (Other academic)
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  • 39.
    Rämgård, Margareta
    Lund University.
    The power of place: Place security in the context of pregnancy2006Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The study explores the importance of place attachment for women’s sense of security during pregnancy. Coping strategies of pregnant women are analysed, focusing on how the prospect of giving birth affects their relationship to place. Anthony Giddens’ concept of ontological security is critically examined and used to investigate the connection between place and ontological security – what I call place security –through a set of empirical data drawn from in-depth interviews with pregnant women.   Two studies were carried out, one in Sweden and the other in northern Norway. A qualitative analysis was made of the interview material, using the three basic elements of ontological security, self-identity, continuity and ritualisation, as a grid of analysis. Earlier psychological research indicates that the prospect of giving birth and raising a family brings the issue of ontological security to the surface. The data confirms such findings, demonstrating the particular importance of place. During pregnancy, the women came to consider issues of identity related to their own childhood experience. A sense of security connected to place was essential for their well-being in this vulnerable period of transition, and places procuring this security were consciously sought to alleviate anxiety. Both women who had previously lived very mobile lives and those who had been more sedentary exhibit the need for place security. A typical coping strategy was to return to childhood places. In other cases, the women tried to achieve place security for their children by recreating an environment similar to the place their own sense of identity was rooted in. Social institutions, such as schools, day-care facilities and jobs, largely determine in which places a sense of security can be achieved from a practical point of view. Deeper ontological security, however, relates to the individual’s life history, and to places that represent continuity, daily routines and the constitution of identity for that individual. The study investigates the significance of childhood experiences of place with respect to the women’s experience of security during pregnancy

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  • 40.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Utvägen: ett salutogent samverkansprojekt finansierat av Finsam Mitt Skåne - slutrapport2015Report (Other academic)
    Abstract [sv]

    Rapporten berör forskningen runt en salutogen insats (utvägen) hos socialtjänsten i Höörs kommun. Insatsen är implementerad i ordinarie verksamhet och har resulterat i att 40% långtidsarbetslösa deltagare i insatsen, många med hälsoproblem, har uppnått självförsörjning. Rapporten fokuserar på deltagarnas egna upplevelser, och en samverkan i ett deltagarbaserat perspektiv samt en ekonomisk utvärdering av insatsen.

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  • 41.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Utvägen: ett salutogent samverkansprojekt finansierat av Finsam MittSkåne: Rapport 1: deltagarnas upplevelser2013Report (Other academic)
    Abstract [sv]

    En utvärderingsrapport om ett deltagarbaserat salutogent samverkansprojekt för långtidsarbetslösa med hälsoproblem. Rapporten visar att arbetsättet påverkat deltagarna positivt men påvisar också hur myndigheternas tidigare bemötande påverkat deltagarnas kognition.

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  • 42.
    Rämgård, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Utvägen: ett salutogent samverkansprojekt: rapport 2: samverkan i Utvägen2014Report (Other academic)
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  • 43.
    Rämgård, Margareta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Avery, Helen
    Lund Univ, Ctr Adv Middle Eastern Studies, Lund, Sweden.;Linnaeus Univ, Dept Languages, Växjö, Sweden..
    Lay Health Promoters Empower Neighbourhoods-Results From a Community-Based Research Programme in Southern Sweden2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, p. 1-13, article id 703423Article in journal (Refereed)
    Abstract [en]

    This article focuses on the role of lay health promoters in the Lindangen initiative, a community-based participatory research (CBPR) programme for health promotion that started 2016 in a low-income neighbourhood in the outskirts of Malmo, southern Sweden. The programme aimed to support equitable health and develop an innovative model for community health promotion. The purpose of this article is to describe the role of the lay health promoters in the initiative and discuss the challenges of their position mediating between residents of the neighbourhood and the established institutions, using interviews, meeting notes and focus groups sessions with the health promoters and local stakeholders. Lay health promoters' role and function developed in a collaborative process of networking with local stakeholders and citizens in local meeting places. Their work was based on their credibility in their role, in combination with the use of a CBPR model that was open to innovation, with a strong focus on actively engaging members of the community. This allowed the lay health promoters to take political and social stances towards various issues, and to start to concretely address the social determinants of health in the community, as well as express recommendations to policymakers. Based on these experiences, the lay health promoters gained clearer insights into the institutional and structural conditions that impact their community. The position they had in the process of the programme resulted in empowerment and a new local association for health promotion; LindangenKraft (LindangenPower) driven by the health promotors and community members.

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  • 44.
    Rämgård, Margareta
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Blomkvist, Kerstin
    Petersson, Pia
    Developing health and social care planning in collaboration2015In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 29, no 4, p. 354-358Article in journal (Refereed)
    Abstract [en]

    Collaboration between different professions in community care for older people is often both difficult and complex. In this project, a participatory action research (PAR) was conducted in order to support the professions involved in the care for older people to develop individualized health and social care plans. Cases from daily work were discussed in different professional groups over a period of one year. A key finding was that lack of knowledge regarding the other professions’ field of expertise and their underlying professional culture and values was a barrier in their collaboration. However, as the continuous reflective dialogue process progressed,the participants began to reflect more about the importance of collaboration as a prerequisite to achieve the best possible care for the recipient. This process of reflection led to the often complex needs of the care recipients being given a more central position and thus care plans being better tailored to each person’s needs.

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  • 45.
    Rämgård, Margareta
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Strategies for diversity: medical clowns in dementia care: an ethnographic study2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, no 16, article id 152Article in journal (Refereed)
    Abstract [en]

    Background: As nursing homes become increasingly diverse, dementia care needs a wider range of culturally responsive strategies for individual and collective social interactions. While previous studies conclude that medical clowns have positive effects on verbal and non verbal social interactions, research is lacking from the perspective of residents’ cultural background. Aim: The aim of this study was to identify interaction strategies employed by medical clowns in culturally diverse dementia care settings Method: An ethnographic approach was used and data were collected through observation of interactions between medical clowns and residents with dementia in two nursing homes during a ten week period. Results: The observations showed that the medical clowns interacted with residents by being tuned in and attentive to the residents as individuals with a unique life-history, confirming each person´s sense of self. The clowns used sensory triggers, encouragement and confirmation in culturally responsive ways to bond socially with the residents in their personal spaces. The clowns involved objects in the daily environment that were meaningful for the residents, and paid attention to significant places and habits in the past. The clowns further contributed to joint interaction in the common spaces in the nursing homes, using music and drama Conclusion: The strategies employed by medical clowns in activities with older people with dementia appear to support social interaction. The medical clowns used the social and material environment in culturally responsive ways to strengthen individuals’ sense of self, while contributing to a sense of togetherness and interaction among residents in the common spaces. Findings suggest that both verbal and non-verbal cultural content affected social interaction. The non-demanding encouraging way the clowns tuned in to the residents as individuals could help nurses and staff members improve ways of communication in social activities inside the nursing home.

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  • 46.
    Rämgård, Margareta
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Forsgren, Annika
    Avery, Helen
    PHR in health and social care for older people: regional development whitin and across organisations2017In: Educational action research, ISSN 0965-0792, E-ISSN 1747-5074, Vol. 25, no 4, p. 506-524Article in journal (Refereed)
    Abstract [en]

    The study draws on findings from a series of seven participatory action research projects in community care for older people carried out over a period of eight years in 20 municipalities in southern Sweden. The analysis here looks at social impact across administrative levels and geographical scales. Different professional groups and care workers in community care participated, crossing divides between social work and health care. The participatory methods all involved a phase of individual reflection, a phase of reflection in practice with colleagues and mixed groups at the regional level, including unit managers and directors in some stages. Impacts concerned interprofessional learning and improved conditions for collaboration in care for older people across institutional boundaries as well as organisational learning across the municipalities. The action research approach was characterised by intensive work with values, empowering low-status professional groups. Social impacts were achieved beyond each project by benefitting from the multi-stakeholder design, using the structure of the organisations and the regional R&D department of the Association of Local Authorities. Over time, the different projects thus contributed to regional development ‘from below’. Nevertheless, employer perspectives tended to determine which conclusions from the projects were eventually implemented and prioritised. Continued reflective dialogue meetings between professional groups are therefore, needed as part of regular work processes. Local and regional structures need forms of autonomy that allow them to implement recommendations from participatory projects. Finally, employee perspectives need to be reflected in decision-making at all levels, particularly including low-status groups of care staff.

  • 47.
    Rämgård, Margareta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Håkansson, Peter
    Malmö University, Faculty of Education and Society (LS), Department of Society, Culture and Identity (SKI).
    Björk, Josefin
    Malmö University, Faculty of Culture and Society (KS), Department of Urban Studies (US).
    Det sociala sammanhanget: om Finsam MittSkånes arbete mot utanförskap2018Book (Other academic)
    Abstract [sv]

    Finsam MittSkåne (där kommunerna Eslöv, Hörby och Höör ingår) har mellan åren 2012–2017 initierat och drivit ett flertal stora samverkansinsatser. I denna bok beskrivs tre av dessa insatser. Det som dessa tre insatser haft gemensamt är dels att de syftat till att öka graden av självförsörjning bland deltagarna, dels att de alla utgått från ett salutogent perspektiv. I detta perspektiv har det sociala sammanhanget och känslan av sammanhang haft särskilt stor betydelse. Malmö universitet har under flera år haft olika uppdrag för Finsam MittSkåne att studera, kartlägga och följa upp dessa insatser. Denna bok sammanfattar de erfarenheter som de olika rapporterna beskriver, men den ger även en djupare teoretisk bakgrund som inte beskrivits i rapporterna.

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  • 48.
    Rämgård, Margareta
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Neimenen Kristofersson, Tuija
    "Låt inte spindelväven växa i ditt hjärta": en forskningscirkel om poesins verkan för sjuksköterskor i palliativ vård2010Report (Other academic)
    Abstract [sv]

    Den här rapporten presenterar ett aktionsforskningsprojekt i form av en forskningscirkel om poesi med sjuksköterskor som arbetar med svårt sjuka och döende människor. Med hjälp av dikten så bearbetar de sina existentiella tankar och upplevelser, i det som författarna benämner det existentiella rummet. Sjuksköterskor upplever ofta att de saknar ord att beskriva svåra känslor av existentiell karaktär. Men med hjälp av poesin får känslorna ett språk, som personalen sedan kan reflektera över tillsammans i grupp och med sina patienter. I den aktionsinriktade processen ger sjuksköterskorna uttryck för att poesin hjälper dem att få ihop det professionella och det med mänskliga i omvårdnaden om sina patienter såväl som i sitt eget existentiella rum. Vilket lägger grunden för en ett bättre bemötande. Resutatet av forskningen påvisar bland annat att reflekterande samtal i grupp bör föranledas av en känslomässig förankring utöver det erfanhetsbeskrivande för att uppnå en känsla av mening i själva reflektionen. Det påvisar också vikten av gestaltande aktiviteter i palliativ vård.

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  • 49.
    Rämgård, Margareta
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Peterson, Pia
    Vården som system2017In: Omvårdnad & Äldre / [ed] Kerstin Blomqvist, Anna-Karin Edberg, Marie Ernsth Bravell, Helle Wijk, Studentlitteratur AB, 2017, p. 551-566Chapter in book (Other academic)
  • 50.
    Rämgård, Margareta
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Petersson, Pia
    Blomqvist, Kerstin
    Att vårda i blindo - en forskningsrapport om professioners samverkan i närsjukvården2012Report (Other academic)
    Abstract [sv]

    Projektet berör långsiktig vårdplanering i samverkan (VOPS) mellan olika professioner i vårdkedjan. Projektet är upplagt som ett utvecklingsarbete och ett forskningsprojekt. I projektet deltar de kommunala vårdteamen, primärvårdsläkare samt överläkare på sjukhuset i fokusgrupper där de presenterar olika case. Dessa har som uppgift att forma ett gemensamt VOPS-dokument som kan följa personen i primär- och sjukhusvård såväl som i det egna hemmet. Forskarna följer processen i grupperna och resultatet påvisar att en god vårdplanering i det egna hemmet förutsätter en vårdplanering i grupp där flera professioner deltar tillsammans med vårdtagare och närstående. Genom gruppens dialog och reflektion i en mer grupporienterad vårdplanering så överbryggas olika synsätt mellan professionerna vilket resulterar i en personcentrerad vård som tar hänsyn till vårdtagarens egna preferenser och önskningar.

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