Barbro Arvidsson

Research Supervisors' Different Ways of Experiencing Supervision of Doctoral Students.

Research supervisors’ different ways of experiencing their supervision of doctoral students are analysed in terms of the students’ questions and problems as they relate to the supervisor’s research, and what consequences this connection, or non‐connection, to the supervisor’s research has for supervision and the role of supervisor. Thirty supervisors of doctoral students at different faculties at a university in Sweden were interviewed. The results illustrate two supervision structures, called research practice‐oriented and research relation‐oriented supervision. The principal differences between these two ways of structuring supervision consist of whether the supervisor and the doctoral student participate in a common research practice and share objects of research with the same or a related research approach, or whether the doctoral student’s research problems and research objects lack a clear connection with the supervisor’s research.

How do middle-aged patients conceive exercise as a form of treatment for knee osteoarthritis?

Purpose. To describe conceptions, as registered by a semi-structured interview, of exercise as treatment among sixteen middle-aged patients with moderate to severe knee osteoarthritis. Method. Sixteen patients (aged 39 – 64) with symptomatic, radiographic knee osteoarthritis and previous participants in an exercise intervention, were interviewed. The qualitative data obtained were analysed using phenomenographic approach. Results. Four descriptive categories containing 13 conceptions emerged: Category 1) To gain health included five conceptions; to experience coherence, to experience well-being, to be in control, to experience improved physical functioning, to experience symptom relief; 2) To become motivated included three conceptions; to experience inspiration, to be prepared to persevere, to experience the need to exercise; 3) To experience the need for support included three conceptions; to have structure, to receive guidance, to devote time; 4) To experience resistance included two conceptions; to hesitate, to deprecate. Conclusion. Patients with knee osteoarthritis and knee pain, previously participating in exercise intervention, are aware of the health benefits of exercise, but have many doubts and concerns about exercise as treatment. These aspects should be considered when designing patient information and treatment programmes. Furthermore, a hesitative and resistive perception of exercise as a concept could have major influences on the implementation of health programmes.

Health predicting factors in a general population over an eight-year period in subjects with and without chronic musculoskeletal pain

BackgroundMany factors are proposed to be associated with health-related quality of life. Knowledge of health factors associated to development of a good health-related quality of life could be of use in clinical practice and public health work. The aim of this study was to investigate the associations between suggested health factors and health-related quality of life at baseline and in an eight-year follow up in subjects with and without chronic musculoskeletal pain in a cohort from a general population.MethodsThe study was designed as a longitudinal study in a Swedish general population (N = 1 849) with a postal questionnaire at baseline 1995 and at follow up 2003. Subjects were divided into two groups, according to their response about chronic musculoskeletal pain at baseline. Health-related quality of life was assessed by the SF-36 together with suggested health factors. The associations between SF-36 subscales and suggested health factors were estimated by OR and 95% CI calculated by multivariable logistic regressions, with adjustment for all health factors, age, sex and baseline SF-36 values.ResultsAlthough subjects without chronic musculoskeletal pain reported better health-related quality of life than subjects with chronic pain, similar health factors were found to be associated to higher scores in SF-36 at baseline and predicted a better outcome in the eight-year follow up. The most consistent finding was a better health outcome in the eight-year follow up for subjects that were feeling rested after sleep. Other factors that in some aspects predicted a better outcome were belonging to higher socioeconomic group, being a native Swede, having emotional support, having good sleep structure, never being or being a former smoker, and regularly drinking alcohol.ConclusionThe most important health factor in subjects with and without chronic musculoskeletal pain was feeling rested after sleep, but also emotional support, sleep structure, smoking and alcoholic habits appears to be important components. These health factors could be important to address in clinical work with painful musculoskeletal disorders. Since several health factors are common in both subjects with and without pain there could be a common strategy to be formed in public health programmes.

Factors promoting health-related quality of life in people with rheumatic diseases: a 12 month longitudinal study

BackgroundRheumatic diseases have a significant adverse impact on the individual from physical, mental and social aspects, resulting in a low health-related quality of life (HRQL). There is a lack of longitudinal studies on HRQL in people with rheumatic diseases that focus on factors promoting HRQL instead of risk factors. The aim of this study was to investigate the associations between suggested health promoting factors at baseline and outcome in HRQL at a 12 month follow-up in people with rheumatic diseases.MethodsA longitudinal cohort study was conducted in 185 individuals with rheumatic diseases with questionnaires one week and 12 months after rehabilitation in a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors. The associations between SF-36 subscales and the health factors were analysed by multivariable logistic regressions.ResultsFactors predicting better outcome in HRQL in one or several SF-36 subscales were being younger or middle-aged, feeling painless, having good sleep structure, feeling rested after sleep, performing low effort of exercise more than twice per week, having strong sense of coherence (SOC), emotional support and practical assistance, higher educational level and work capacity. The most important factors were having strong SOC, feeling rested after sleep, having work capacity, being younger or middle-aged, and having good sleep structure.ConclusionsThis study identified several factors that promoted a good outcome in HRQL to people with rheumatic diseases. These health factors could be important to address in clinical work with rheumatic diseases in order to optimise treatment strategies.

“Striving for a Good Life” – The Management of Rheumatoid Arthritis as Experienced by Patients

Aim To generate a theoretical model how patients experience their management of rheumatoid arthritis (RA) in everyday life. Method An explorative design with the grounded theory approach was used by interviewing 16 informants with RA. Results The generated theoretical model emerged in a core category- Striving for a good life with two categories; making use of personal resources and grasping for support from others, which formed the base of managing RA. When relating these categories together, four dimensions emerged which characterised patients’ different ways of managing RA: mastering, relying, struggling and being resigned. Discussion The management of RA incorporated the use of personal resources and the grasping for support from others. Both self-management strategies and patients’ need of support were highlighted as aspects that were of importance when managing RA. Patients’ experiences of their need of support to manage RA give extended knowledge that is of importance for nurses and other healthcare providers. The relationship between patients and healthcare providers is always the key to a good encounter. Interventions to increase self-management in RA have to incorporate this knowledge when trying to increase patients’ self-efficacy and with their experience of support.

Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy.

Aim To compare and evaluate the treatment outcomes of a nurse-led rheumatology clinic and a rheumatologist-led clinic in patients with low disease activity or in remission who are undergoing biological therapy. Background Patients with chronic inflammatory arthritis treated with biological therapy are usually monitored by rheumatologists. Nurse-led rheumatology clinics have been proposed in patients with low disease activity or in remission. Design Randomized controlled trial. Methods A 12-month follow-up trial was conducted between October 2009 and August 2011, where 107 patients were randomized into two groups with a 6-month follow-up to a nurse-led rheumatology clinic based on person-centred care (intervention group; n = 53) or to a rheumatologist-led clinic (control group; n = 54). The hypothesis was that the nurse-led clinic outcomes would not be inferior to those obtained from a rheumatologist-led clinic at the 12-month follow-up. The primary outcome was disease activity measured by Disease Activity Score 28. Results A total of 47 patients in the intervention group and 50 in the control group completed the 12-month trial. The trial revealed no statistically significant differences between groups in mean change of Disease Activity Score 28, Visual Analogue Scales for pain, the Health Assessment Questionnaire, satisfaction with or confidence in obtaining rheumatology care. Conclusion Patients with stable chronic inflammatory arthritis undergoing biological therapy could be monitored by a nurse-led rheumatology clinic without difference in outcome as measured by the Disease Activity Score 28.

Cooperation between gatekeepers in sickness insurance - the perspective of social insurance officers. A qualitative study.

BackgroundObjective was to describe variations in how social insurance officers conceive the cooperation with the health care in their daily work with sick leave.MethodsFifteen social insurance officers (SIOs) working with administration of sickness benefits were interviewed. They were purposefully recruited to represent different parts of the social insurance office organization, different ages, gender, education, and work experience. The interviews were audio-recorded, transcribed verbatim and analyzed using phenomenographic approach.Results11 women and 4 men, aged 25–65, with a work experience ranging from 1–40 years were interviewed. Three descriptive categories embracing eleven subcategories emerged: 1) Communication channels included three subcategories; to obtain medical opinions, to hold meetings with actors involved, to experience support functions; 2) Organizational conditions included five subcategories; to experience lack of time, to experience problems of availability, to experience lack of continuity, to experience unclear responsibility, to experience ongoing change; 3) Attitudes included three subcategories; to conceive the attitudes of the physicians, to conceive the attitudes of the patients, to conceive the attitudes of the SIOs.ConclusionPersonal communication was described as crucial to ensure a more efficient working process. The personal contact was obstructed mainly by issues related to work load, lack of continuity, and reorganisations. By enhancing and enabling personal contact between SIOs and health care professionals, the waiting times for the sick-listed might be shortened, resulting in shorter periods of sick-leave. Issues around collaboration and communication between gatekeepers need to be recognized in the ongoing work with new guidelines and education in insurance medicine.

Construct validity of a health questionnaire intended to measure the subjective experience of health among patients in mental health services.

Mental health services have been lacking systematic health-promoting activities, and health is often perceived as the absence of disease from a biomedical perspective. It is vital to develop methods to assess perceived health among patients in a broader perspective. The aim of the study was to investigate construct validity of a newly developed health questionnaire intended to measure subjectively experienced health among patients in mental health services. A cross-sectional study, including a randomly selected sample of 139 outpatients in contact with the mental health services, was performed in order to explore the relationship between perceived health and self-reported levels of self-esteem, symptoms, empowerment, quality of life and experiences of stigmatization. Self-esteem, symptoms, empowerment and quality of life altogether accounted for 70% of the variation in overall perceived health. Overall perceived health showed positive associations to self-esteem, empowerment and quality of life and negative associations to psychiatric symptoms, discrimination and rejection experiences. The findings suggest that perceived health as measured by the health questionnaire can be a meaningful and valid construct that may be useful for measuring health in clinical mental healthcare practice and in mental health services research.

Psychometric Properties of the Swedish Rheumatic Disease Empowerment Scale, SWE-RES-23

INTRODUCTION Empowerment is a central concept in both rheumatology and diabetes care. A Swedish empowerment instrument for patients with rheumatic diseases has not been created before now. The aim of the present study was to determine the psychometric properties of the Swedish Rheumatic Disease Empowerment Scale, SWE-RES-23, such as construct validity, internal consistency reliability, inter-item correlations and discriminant validity. METHODS The already existing instrument, the Swedish Diabetes Empowerment Scale (SWE-DES-23), was adapted for use in patients with rheumatic diseases. The adapted instrument was called the SWE-RES-23. In 2009, 260 patients with rheumatic diseases from a rheumatology unit in Sweden completed the instrument. Construct validity was tested by using exploratory factor analysis. Internal consistency reliability was tested by the use of Cronbachs α-coefficient. In order to determine unidimensionality of the empowerment subscales, inter-item correlations were calculated. To establish discriminant validity, an item about self-perceived health from the Short Form (SF) 36 was used in addition to the SWE-RES-23. RESULTS The exploratory factor analysis resulted in five factors (empowerment subscales) with eigenvalues >1, explaining 64.1% of the total variance: Goal achievement and overcoming barriers to goal achievement; Self-knowledge; Managing stress; Assessing dissatisfaction and readiness to change; and Support for caring. Cronbachs α values ranged from 0.59 to 0.91, and the value for the total score was 0.92. CONCLUSION The results support the possibility of adapting the SWE-DES-23 for use in patients with rheumatic diseases. The SWE-RES-23 shows acceptable psychometric properties, in terms of construct validity and internal consistency reliability. To validate the SWE-RES-23 fully, further studies are needed, with a focus on test-retest correlations.

Experiences of health-promoting self-care in people living with rheumatic diseases

AIM This paper is a report of a study that explores and describes the meaning of the phenomenon of health-promoting self-care as experienced by people living with rheumatic diseases. BACKGROUND People with rheumatic diseases estimate health status as low and health belief and health status influence self-care behaviours. Several self-care behaviours are used in the efforts to mitigate the diseases. METHOD The study had a descriptive phenomenological approach based on a reflective life-world perspective. Data were gathered in 2007 by unstructured open-ended interviews with 12 individuals living with rheumatic diseases. FINDINGS The meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care takes place against a background of continual hope and belief to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three inter-related constituents elucidated their experiences: dialogue, power struggle and choice. Self-care was experienced as dialogues with the body and with the immediate environment. In order to respond to signals from the body, power struggles were required to be entered into when fighting the diseases. Choices were required to be made and things that were beneficial for the body were prioritized. CONCLUSION In this study, the meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care was a way of life. This meant to be ready to understand and respond to signals from the body. Self-care required dialogues, power struggles and choices.