Annika Jakobsson

Frail Elders’ Experiences With and Perceptions of Health

In this study we explored frail elders’ experiences with and perceptions of the phenomenon of health so as to develop a deeper understanding of living with diseases and disorders in old age. Frail elders participated in qualitative interviews that explored the meaning of the phenomenon of health for them. Eleven men and 11 women, who had diverse ratings of self-perceived health ranging from poor to excellent, were selected by means of a purposeful strategic sampling of frail elders taken from a broader sample that participated in a larger quantitative study on health. In total, 22 individual interviews were analyzed using Giorgi’s descriptive phenomenology. We found that frail elders described health as being in harmony and balance in everyday life, and this occurred when participants were able to adjust to the demands of their daily lives in the context of their resources and capabilities.

The role of gendered conceptions in treatment seeking for alcohol problems.

The aim of this study was to explore the inducements for treatment-seeking for alcohol problems in women and men. Specifically we wanted to identify what promoted or hindered treatment-seeking in women and men, respectively, and to what extent femininity and masculinity was reflected in the context of treatment seeking. Data was obtained from open interviews with five women and seven men within a month after their first entry into alcohol treatment. A content analysis was performed using gender as the sorting factor. Promoting factors for treatment seeking in men were characterized by belief in their own capability, and looking to the future; whereas the women placed importance on pressure from someone significant, and sharing the problem with others. Hindrances for both women and men were feelings of shame and the significant role alcohol had in their lives. The women perceived alcohol problems as incompatible with femininity, and this made them avoid talking openly about their problems, which hence hindered treatment seeking. These findings showed that the value of alcohol as a gendered symbol still exists, which could be perceptible in promoting and hindering factors for treatment seeking in women and men. These factors could be useful to consider by professionals both in the primary healthcare system and in the social services. Future research should address treatment seeking in relation to both cultural and gendered constructions and their influence on the perceptions and behaviour of women and men with alcohol problems.

Holding on to the indispensable medication -A grounded theory on medication use from the perspective of persons with medication overuse headache

BackgroundMedication overuse headache (MOH) is a chronic headache disorder, caused by overuse of acute medication. To date, it remains unclear why some people overuse these medications. The aim of this qualitative study was to explore how individuals with MOH use medications and other strategies to manage headaches in their daily lives, and their thoughts about their own use of acute medication. Our intention was to develop a theoretical model about the development of MOH, from the perspective of those with MOH.MethodsData collection and analysis were conducted according to grounded theory methodology. The participants were recruited via newspaper advertisements. Fourteen persons with MOH were interviewed in individual qualitative interviews.ResultsThe basic process leading to medication overuse was holding on to the indispensable medication. The acute medication was indispensable to the participants because they perceived it as the only thing that could prevent headaches from ruining their lives. The participants perceived headaches as something that threatened to ruin their lives. As a result, they went to great lengths trying to find ways to manage it. They tried numerous strategies. However, the only strategy actually perceived as effective was the use of acute medication and they eventually became resigned to the idea that it was the only effective aid. The acute medication thus became indispensable. Their general intention was to use as little medication as possible but they found themselves compelled to medicate frequently to cope with their headaches. They did not like to think about their medication use and sometimes avoided keeping track of the amount used.ConclusionsThis qualitative study adds understanding to the process via which MOH develops from the perspective of those having MOH. Such knowledge may help bridge the gap between the perspectives of patients and health-care professionals.

Possibilities and Hindrances for Prevention of Intimate Partner Violence: Perceptions Among Professionals and Decision Makers in a Swedish Medium-Sized Town

BackgroundIntimate partner violence (IPV) is a major public health problem, but few evidence-based prevention programs have yet been implemented.PurposeThis study explored the perceptions and beliefs of local-level decision makers, social and health-care professionals, and representatives from the police force regarding the possibilities and hindrances for prevention of IPV.MethodAn explorative qualitative approach was used, and participants were strategically selected for focus group discussions. The participants, 19 men and 23 women, were professionals or decision makers within health-care services, social welfare, municipal administration, the police force, local industry, and local politicians in a Swedish town of 54,000 inhabitants. The focus group discussions were audio recorded, transcribed verbatim, and thematically analyzed. A manifest content analysis was performed on the text.ResultsPreschools, schools, sports associations, workplaces, and the mass media were suggested as possible arenas for prevention measures. The proposed activities included norm building and improved social support structures. Hindrances were conceptualized as societal beliefs and attitudes, shame, silence, gender inequality, the counteracting influence of the media, and lack of resources. The participants demonstrated closeness and distance to IPV, expressed as acceptance or referral of responsibility to others regarding where and by whom prevention measures should be executed.ConclusionThis study gave new insights in the prevailing perceptions of professionals and decision makers of a medium-sized Swedish town, which can be a useful knowledge in future preventive work and contribute to bridge the gap between research and practice.

Drinking context and problematic alcohol consumption in young Swedish women

Previous research has indicated that a variety of contextual factors are involved in the development of drinking behavior. An integrated perspective can extend our understanding of the context and circumstances in which individuals drink. In this study, a person-oriented approach, cluster analysis, was used to identify drinking context clusters in a population of 20- and 25-year-old Swedish women. A further aim was to analyze how these clusters were associated with problematic alcohol consumption (high episodic drinking (HED) and alcohol use disorder (AUD)). A total of 760 respondents were interviewed, some in 1996 and some in 2001. Self-reported effects of drinking and situational factors associated with drinking alcohol were used in the cluster analysis procedure. Logistic regression models were used to analyze the associations with problematic alcohol consumption. The results revealed four distinct clusters of drinking patterns: coping drinkers, social drinkers, controlled drinkers, and moderate drinkers. Differences between clusters concerning problematic alcohol consumption were found. HED was significantly more common among the social drinkers and alcohol use disorder was more prevalent among the coping drinkers. Age differences and to a lesser extent secular trends in drinking pattern could be observed. The findings suggest that information on drinking context can help to explain differences in patterns of risky drinking and AUD. This highlights the importance of identifying groups of individuals with potentially harmful drinking patterns, which could be the target of specific preventive actions.

A cross-sectional study of personality traits in women previously treated or untreated for alcohol use disorders.

BackgroundA better understanding of the relationship between treatment-seeking for alcohol problems and personality traits could give useful insight in factors promoting or hindering treatment for alcohol use disorders (AUD). The aim of this study was to analyze the associations between treatment-seeking for AUD, personality traits, and psychiatric co-morbidity in women. The study was based on pooled cross-sectional data from three population based samples and one clinical sample (n = 1,339). Comparisons were made between treated and untreated women with AUD, and between those with resolved and unresolved AUD.ResultsA stepwise logistic regression model showed that treatment-seeking for AUD was not associated with personality traits. Among women with lifetime AUD (n = 217), those who had been treated (n = 42) had significantly higher scores than untreated women (n = 175) on three personality traits of the Karolinska Scales of Personality (KSP); somatic anxiety, muscular tension, and guilt. Women with resolved AUD, who had received treatment (n = 23) had significantly higher scores on scales measuring somatic anxiety, psychic anxiety, muscular tension, irritability, and guilt than untreated women with resolved AUD. The latter group resembled women without AUD on most personality traits. There were no differences in occurrence of lifetime psychiatric disorders between the treated and the untreated women, whereas treated women with current AUD had increased risk of lifetime anxiety (OR: 3.1, 95% CI: 1.1–8.7).ConclusionTreatment-seeking was not associated with personality traits in this study. Still, it can be concluded that women with resolved AUD who had received treatment had high scores on the KSP-scales measuring psychic and somatic anxiety, tension, irritability, and feelings of guilt. This suggests that personality assessment might be a useful tool in tailoring individual treatment programs for women with AUD. Future studies need to explore if women who do not seek treatment have special needs which are not met in usual treatment settings.

Effects of a continuum of care intervention on frail elders’ self-rated health, experiences of security/safety and symptoms: A randomised controlled trial

We aimed to evaluate effects of the intervention on self-rated health, experiences of security/safety and symptoms. A non-blinded controlled trial was performed with participants randomised to either the intervention group or a control group, with follow-ups at 3, 6 and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of older adults, with a case manager from the municipality as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the Mölndal municipality were asked to participate. Inclusion criteria were age 80 years and older, or 65 to 79 years with at least one chronic disease and dependency in at least one activity of daily living. Analyses were conducted on the basis of the intention-to-treat principle. Outcome measures were self-rated health, experiences of security/safety and symptoms. These were analysed using Svensson’s method. Of 161 participants, 76 were allocated to the control group and 85 to the intervention group. Positive effects of the intervention were observed for frail older adult’s symptoms and self-rated health.