Malmö University Publications
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  • Public defence: 2024-05-31 09:00 Aula HS, Malmö
    Striberger, Rebecka
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Secondary prevention in patients with intermittent claudication and evaluation of e-health support.2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Intermittent claudication is the most common symptom of peripheral arterial disease, with impaired walking ability due to pain in the legs and with negative effects on quality of life as well as a high risk for cardiovascular events. The first line of treatment is secondary prevention, including smoking cessation, walking exercise and best medical therapy with the purpose of reducing claudication symptoms, of slowing down the progression of the atherosclerotic process and of preventing cardiovascular events. However, there is a deficiency in evidence-based systematic care regarding secondary prevention for these patients. Accordingly, new ways to support patients with intermittent claudication to adhere to treatment is needed. Further, knowledge about patients’ requisite resources for managing their disease are important to be able to improve the care of patients with intermittent claudication. Therefore, the overall aim of this thesis is to explore illness perception and associated factors for adherence to secondary prevention treatment for patients with IC. A further aim is to test and evaluate a web-based application as support for secondary prevention in patients with IC.

    Methods: Study I was a systematic review of current research in illness perception. The data were analysed deductively using the common-sense model, as well as inductively with conventional content analysis. In study II, health literacy was evaluated in patients with intermittent claudication regarding clinical characteristics, demographics, self-efficacy and quality of life. The method was a cross-sectional multicentre questionnaire study. In total, 158 patients were included. Study III aimed to compare illness perceptions, health literacy, self efficacy, adherence to treatment, and quality of life in patients with intermittent claudication. It was a longitudinal cohort multicentre questionnaire study where the participants from study II (n=158) were followed up after 6 (n=133) and 12 months (n=128). Descriptive and inferential statistics were used in studies II-IV. Study IV was a randomised controlled pilot trial which aimed to evaluate the usability of a web-based application and its effect on secondary prevention outcomes. Patients’ experiences of using the application were collected through focus group interviews and analysed with thematic analysis. In total, 34 patients were included. For three months, the intervention group (n=18) reported information in the application about physical activity, smoking, medication therapy, blood pressure, pain after activity, and quality of life.

    Results: In study I, the findings showed a lack of understanding of the symptoms, the cause and the chronic nature of the disease. The beliefs about control and cures varied from awareness of the positive effects of physical activity to the belief that walking would not have any effect, but instead make patients’ situations worse. There was fear that the disease would progress, leading to increased dependency and a lack of control. The experienced consequences showed that living with the disease meant a process of adaptation to patients’ new situations. According to study II, 52.5 % of the participants had insufficient levels of health literacy. Insufficient levels were more frequent among patients living alone compared to co-habitants. Patients with a university degree reported a significantly higher ability to access and understand health-related information. Further, patients with sufficient health literacy reported significantly higher selfefficacy and quality of life, and were more physically active than patients with insufficient health literacy. According to study III, women reported higher illness coherence and higher emotional representations compared to men. The believed cause for one’s disease reported most often was smoking, followed by age, genetics and “no idea”. Patients with sufficient health literacy reported less consequences and lower emotional representations of the disease. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. Quality of life increased between baseline and 12 months, but there were no differences in self-efficacy. In study IV, the results showed a non-significant trend towards increased walking distance and an improved mean change in ankle-brachial index in the intervention group compared to the control group. Patients in the intervention group also had an improved quality of life between baseline and follow-up, and reported higher levels than in the control group, in which no improvement was found. The focus group interviews identified three major themes, focussed on describing a process whereby the usability factors of the application led to the feeling of having a helping hand which further worked as a promoter of self-care and control.

    Conclusion: Illness perception, health literacy and self-efficacy are factors influencing self-management in patients with IC and should be addressed to beable to improve adherence to secondary prevention. The positive results from the pilot study indicate that the web-based application might be beneficial for patients with IC in giving support to adherence to secondary prevention treatment and that a further study at a larger scale could be valuable.

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  • Public defence: 2024-06-05 10:15 Niagara, hörsal C (NI:C0E11), Malmö
    Holeksa, Julie
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Sweden has a history of a restrictive drug policy, with a national policy focus on achieving a “drug free society.” This has led to a relatively slow development of “harm reduction” services, those services which aim to reduce risk and vulnerability for people who use drugs (PWUD), without requiring drug abstention. The harm reduction services which do exist are inequitably distributed across the country. In this context, this project aims to explore the attitudes of social work professionals (SWP) towards harm reduction, and the experiences of Swedish PWUD. The data consist of a survey of SWP (208 responses), interviews with PWUD in an area of limited harm reduction (11), and interviews with PWUD who had travelled to Denmark, a country with a less restrictive drug policy approach (17). 

    Article I utilizes survey data to explore the perspectives of Swedish SWP regarding the philosophy of harm reduction and specific harm reduction initiatives. The study reveals a generally positive attitude towards harm reduction, albeit with significant geographical variances. There were low levels of support concerning the adoption of newer harm reduction strategies. Less positive attitudes and negativity regarding new interventions were significantly associated with SWP in areas with lesser exposure to harm reduction practices. 

    Article II examines how PWUD in a small urban center handle the absence of local harm reduction services. The participants’ experiences are interpreted using the theoretical concept of “risk environment” which highlights how various environmental factors interact to produce risk of drug-related harm. Strategies ranged from traveling to external needle exchange programs, relying on unofficial secondary distribution, to risk behaviours such as stealing, reusing, or sharing injection equipment. Many were homeless, articulating a continuous struggle to find temporary shelter. They injected drugs in unsafe places, such as public toilets, increasing risk of overdose or infection. They also expressed 10 feeling stigmatized and excluded from society which compounded their stress, risk of disease transmission and overdose, and poor overall wellbeing. 

    Article III explores the motivations behind the mobility of PWUD from Sweden to Denmark. The “risk environment” framework was used to contextualize decision-making and risks, based on the physical, social, policy, and economic environments. The study identifies harm reduction service availability, stigma, social networks, the drug scene, and policing practices, as key drivers for relocation. Despite the perceived benefits of moving, such as improved access to harm reduction services, participants also reported exposure to new risks, including violence, potential exclusion from a range of services, and exposure to new drugs. 

    Article IV analyzes the reflections of PWUD on their experiences in Sweden and Denmark in the context of each nation’s drug policy. The analysis explored experiences of stigma and coupled these to concepts of identity and social exclusion. In daily interactions, participants felt ignored and dehumanized in Sweden’s zero-tolerance environment, whereas in Denmark, a country with a harm reduction approach, they felt visible and valued as individuals. This, combined with more developed services and a less punitive policing approach, led participants to feel included in society in Denmark. Contrasts between experiences in the two countries were also echoed in participants’ interactions with the healthcare system, relating to feeling controlled in Sweden, or being given autonomy and trust over their care in Denmark. 

    Collectively, this thesis highlights the interplay between drug policies, care formats, policing practices, social interactions, the attitudes of SWP, and the lived experiences of PWUD. While overall positive, the attitudes towards care goals and interventions differ between different areas, among professionals who provide care to PWUD. PWUDs’ movement to and experiences in different settings can be used to offer an insight into their own policy preferences. The project demonstrates the role of constructions, and resulting drug policy, in how they influence PWUDs’ experiences of stigma and exclusion, and their risk environments. 

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  • Public defence: 2024-06-05 13:15 NI:B0E15, Malmö
    Söderberg, Rebecka
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS).
    Displacing Diversity: How Social Mix Interventions are Legitimised, Experienced and Resisted in a Danish Neighbourhood2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This doctoral thesis explores residents’ experiences of and resistance to social mix interventions, as well as how these interventions are legitimised in policies. This is studied through an ethnographic approach to policies combined with ethnographic fieldwork in a neighbourhood targeted by social mix interventions. In its empirical scope, the thesis is limited to a Scandinavian context, highlighting the perspectives of residents in a Danish neighbourhood targeted by the so-called ghetto legislation and comparing Danish and Swedish policies. 

    The first article of this compilation thesis explores problematisations of urban diversity in Danish and Swedish urban and integration policies. It highlights processes of ‘selfing/othering’, showing how Danish policies construct the figure of ’the non-Western’ and myths of national sameness based on assumptions about cultural homogeneity, while Swedish policies construct the figure of ‘the unproductive’ based on assumptions about sameness as productiveness. The second article explores residents’ experiences of ongoing interventions for social mix. The analysis shows how residents live in conditions of evictability and how they are subjected to the discursive, material, and psychological violence of un-homing, i.e., residents are deprived of their home on multiple scales, even before relocation. The third article highlights how residents engage in various forms of resistance against displacement and commodification. The analysis emphasises how residents’ resistance is both individual and collective, material and discursive, discreet and confrontational. In addition, it shows how residents’ resistance is productive and ambiguous, producing new discourses, (dis)alliances, and places.

    Researching experiences of social mix interventions while they occur, this thesis adds new aspects to previous research, which is mainly concerned with whether social mix policies ‘work’. The analysis shows how social mix interventions have immediate, wide-reaching and unintended consequences, and highlights mundane and productive dimensions of processes of resistance.

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