Eva Ladekjær Larsen

Attitudes towards sickness absence and sickness presenteeism in health and care sectors in Norway and Denmark: a qualitative study

BackgroundIn the health and care sector, sickness absence and sickness presenteeism are frequent phenomena and constitute a field in need of exploration. Attitudes towards sickness absence involve also attitudes towards sickness presenteeism, i.e. going to work while sick, confirmed by previous studies. Sickness behavior, reflecting attitudes on work absence, could differ between countries and influence absence rates. But little is known about attitudes towards sickness absence and sickness presenteeism in the health and care sectors in Norway and Denmark. The aim of the present paper is therefore to explore attitudes towards sickness absence and sickness presenteeism among nursing home employees in both countries.MethodsEight focus group discussions (FGDs) were conducted using a semi-structured interview guide, the main attention of which was attitudes towards sickness absence and sickness presenteeism. FGDs were conducted in two nursing homes in Norway and two in Denmark, with different geographic locations: one in a rural area and one in an urban area in each country. FGDs were recorded, transcribed and analyzed using framework analysis to identify major themes and explanatory patterns.ResultsFour major significant themes were identified from the FGDs: a) sickness absence and sickness presenteeism, b) acceptable causes of sickness absence, c) job identity, and d) organization of work and physical aspects of the workplace. Our analyses showed that social commitment and loyalty to residents and colleagues was important for sickness absence and sickness presenteeism, as were perceived acceptable and non-acceptable reasons for sickness absence. Organization of work and physical aspects of the workplace were also found to have an influence on attitudes towards sickness absence.ConclusionsThe general interpretation of the findings was that attitudes towards sickness absence and sickness presenteeism among nursing home employees were embedded in situational patterns of moral relationships and were connected to a specific job identity. These patterns were constituted by the perception of colleagues, the social commitment to residents, and they influence on what was deemed as acceptable and non-acceptable reasons for sickness absence. In other words, attitudes towards sickness absence and sickness presenteeism were socially and morally determined at personal levels by an overall concept of work, independent of country.

Getting the pain right: how low back pain patients manage and express their pain experiences

Purpose: Biopsychosocial interventions in low back pain (LBP) rehabilitation aim at preparing patients to accept and manage their pain conditions and to encourage them to maintain their everyday life routines. Although such approaches have demonstrated a positive effect, for example, in relation to return to work (RTW), few studies have explored how social contexts influence how pain is being managed. Using a theoretical approach that addresses pain as social performance, we illustrate how pain is expressed and managed in three different contexts: at the clinic, at home and at work. Methods: Qualitative in-depth interviews were conducted with eight patients who had followed a hospital-based RTW intervention. Results: Low back patients experience dilemmas of how to express their pain sensations and constantly evaluate whether the activities they participate in will ease or worsen their pain sensations. In this process, their behavior is guided by how they think their social role will be affected by their decision to abstain from or undertake the activities in question. Conclusions: Interventions in rehabilitation may benefit from knowledge of the social processes at play when LBP patients articulate, express and suppress their symptoms in their interaction with health professionals, workmates, families and friends. Implications for Rehabilitation Low back pain In order to manage pain, patients with low back pain are encouraged to exercise and to maintain their everyday activities. Choosing to become physically active, although in pain, is related to those social roles one wishes to maintain or support. Future interventions could offer support so that patients will be able both to maintain their social roles and to retire from social activities without their social roles being threatened.

“A good spot”: Health promotion discourse, healthy cities and heterogeneity in contemporary Denmark

Health promotion at a community level has gained popularity in recent decades within and outside academic environments. The health promotion discourse is part of a wider political discourse, aimed at empowering individuals to take control of their own lives and enabling them to be engaged, responsible and active citizens in their own communities. Key values of the discourse, deriving from a democratic and individualistic culture, are evident in how local authorities develop and implement policies aimed at promoting population health and wellbeing. In this article, we draw on data from a relatively poor multicultural Danish community incorporated in the WHO Healthy Cities Programme. We explore how key terms of the health promoting discourse are constructed, operationalized and resisted by different subgroups. The contradictions that emerge challenge how we comprehend communities in relation to safety and harmony, and how people within defined communities are involved in common community life.

Students’ drinking behavior and perceptions towards introducing alcohol policies on university campus in Denmark: a focus group study

BackgroundHigh alcohol consumption among university students is a well-researched health concern in many countries. At universities in Denmark, policies of alcohol consumption are a new phenomenon if existing at all. However, little is known of how students perceive campus alcohol policies. The aim of this study is to explore students’ perceptions of alcohol policies on campus in relation to attitudes and practices of alcohol consumption.MethodsWe conducted six focus group interviews with students from the University of Southern Denmark at two different campuses. The interviews discussed topics such as experiences and attitudes towards alcohol consumption among students, regulations, and norms of alcohol use on campus. The analysis followed a pre-determined codebook.ResultsAlcohol consumption is an integrated practice on campus. Most of the participants found it unnecessary to make major restrictions. Instead, regulations were socially controlled by students themselves and related to what was considered to be appropriate behavior. However students were open minded towards smaller limitations of alcohol availability. These included banning the sale of alcohol in vending machines and limiting consumption during the introduction week primarily due to avoiding social exclusion of students who do not drink. Some international students perceived the level of consumption as too high and distinguished between situations where they perceived drinking as unusual.ConclusionThe study showed that alcohol is a central part of students’ lives. When developing and implementing alcohol policies on campus, seeking student input in the process and addressing alcohol policies in the larger community will likely improve the success of the policies.

Betwixt and between: workplace perspectives on work reintegration in the eldercare sector in Denmark

Abstract Purpose: Contemporary return-to-work (RTW) policies in Denmark and other welfare nations recommend employees on long-term sick leave, due to physical or mental health problems, to RTW gradually. Factors that influence the process of work reintegration (WR) is well documented, however, co-workers experiences of this process are a rather new research topic. Moreover, in the context of the present research, no studies have so far explored the workplace as an arena for social interaction. The aim of this study was to explore co-workers’ experiences of the reintegration process and how these experiences are related to social positions at the workplace. Methods: Ethnographic fieldwork was conducted at two nursing homes that were in a process WR after long-term sick leave. The data consist of field notes, policy documents, individual interviews, and focus group interviews. Data were organized by use of NVivo. A theoretical framework was adopted which enabled us to approach and interpret the reintegration process as one that changed the social position of the returning employee. Results: The dataset demonstrates how the returnee is in a state of being betwixt and between the social positions of a co-worker and a non-co-worker. This is illustrated in three cases which show that this state prevents the returnee from taking on the role as a co-worker, excludes the returnee from the workplace, and creates uncertainty for all workplace actors. Conclusion: The study highlighted that WR creates a social position for the returnee that complicates the working routine and causes uncertainty in social interactions. Implications for Rehabilitation Work reintegration (WR) after long-term sick leave is commonly characterized by reduced working hours and modified working tasks. The WR process influences the whole work place including co-workers’ everyday working life and complicates work situations where work tasks and roles are negotiated between the returning worker and co-workers. Future WR policies and guidelines could benefit from integrating co-workers’ perspective to ensure that the returning worker is not socially excluded as well as ensuring that co-workers are not overburdened in the process.

Work reintegration after long-term sick leave: domains of influence on co-workers’ ability to be supportive

Abstract Purpose: The purpose of the study is to identify domains of influence on co-workers’ ability to be supportive of returning worker during the work reintegration (WR) process. Methods: An ethnographic study design was chosen involving fieldwork at four different workplaces, at an emergency care service, a waste disposal company and at two nursing homes. Qualitative methods for inquiry were used including participant observation, individual- and group interviews of 30 participants. Data were coded and analysed according to a grounded theory approach. Results: Four themes were identified related to domains of influence on co-workers’ ability to be supportive of returning worker during the WR process: (1) organisation of work and level of interaction; (2) disruption of work routines, (3) relationship with returning worker and (4) attitudes towards sick leave. Conclusion: The WR process after long-term sick leave is not only influenced by the WR’s arrangements made, but also by the co-workers’ responses to the process. Work arrangements not only affect the returning worker’s ability to return-to-work (RTW) successfully, but also the co-workers’ ability to be supportive and their ability to take active part in the process. Implications for Rehabilitation The process of WR after long-term sick leave involves interaction with co-workers. Domains of influence is in the co-workers’ perspective influencing their ability to be supportive during reintegration of a returning worker. Future WR management could benefit from integrating the conditions for co-worker support. We encourage co-workers to be involved in the RTW planning, monitoring and evaluation with particular focus on how the WR arrangements are influencing their work and their ability to be supportive.

More questions regarding the Danish health puzzle

We have read with interest the paper of Bakah and Raphael on the “Danish health puzzle” [1]. We want to thank the authors for their engagement and work on this subject. Yet, we have some issues to raise, which may lead to a broader discussion or even to new research. The authors start their analysis by presenting differences in life expectancy for Denmark and the other Nordic countries. The authors lacked a country-specific comparative perspective, which made it difficult to follow their argumentation. In fact, Finnish males have the same low life expectancies compared to Danes (FI 78.4 and DK 78.8, Sweden (SE) 80.4 and Norway (NO) 80.1 in 2015); however, among females there are different life expectancies between Denmark and the other Nordic countries (DK 82.8, FI 84.1, Sweden (SE) 84.2 and Norway (NO) 84.2 in 2015). These overall gender differences as well as the similarity between the life expectancies of Danish and Finnish men could be used to find potential reasons for the low Danish life expectancy. We suggest, therefore, that research explaining the low life expectancy in Denmark should be gender-specific. Furthermore, life expectancy is in actuality a statistical construct, depending on age-specific mortality and early life mortality. Overall infant mortality is very low in Denmark, but it is still higher than in other Nordic countries. Further research should point out age-specific mortality rates to clarify the population under risk when comparing Denmark’s low life expectancy with other Nordic countries. Such research should take into account the difficult task of establishing a causal relation between policy and life expectancy, between macro level indicators and life expectancy. Additionally, we would like to point out the role of healthcare systems. The authors are concerned with developments in the Danish system. We are aware that health expenditure is not the only measure to assess differences in healthcare. However, in comparing health expenditures in Denmark with the other Nordic countries, Danish per capita health expenditures in EURO purchase power parity (PPP) were placed in the middle of the five Nordic countries after Norway and Sweden [2]; in terms of health expenditures as a percentage of GDP, Denmark was second [2]. Of course, this is only one year and a trend analysis would provide more information. Yet, according to these data, the difference is unlikely to be due to healthcare systems and expenditures. More analytical, welldesigned studies are needed to clarify the role of different determinants of health on life expectancy differences including the role of health systems. Decentralization in the field of healthcare systems has, until the structural reform of 2007, influenced freedom of choice and local differences in health services. It has been hard to standardize health services across the country. Until the beginning of the 2000s large regional differences existed and made it more difficult to develop a common priority and standard. One reason might be a lack of organization of inter-institutional cooperation between the three levels; the state, region and municipalities. Therefore, it is important to compare life expectancies between different regions taking into account differences in regional healthcare More questions regarding the Danish health puzzle?

Use of information communication technology and stress, burnout, and mental health in older, middle-aged, and younger workers - results from a systematic review

Abstract The aim of this systematic review is to summarise quantitative studies in occupational settings observing the association between Information communication technology (ICT) and stress, and burnout, considering age as an effect modifier. A systematic review using PRISMA guidelines was conducted through the following bibliographic databases: PubMed, Web of Science, Psycinfo, and the Cochrane Library. Inclusion criteria were occupational settings and content relevant to our research question. Risk of bias was assessed using the Newcastle–Ottawa scale. Two interventional, 4 cohorts, and 29 cross-sectional studies were found. ICT use in occupational settings was associated with stress seen in cross-sectional studies, but not in interventional studies. There was a concordant association with ICT and burnout in different study designs. Overall, there were no linear trends between age and technostress. We suggest that the observed associations were mostly present in the middle-aged working population and that these associations need to be supported in further studies.

Perceptions and Practices of Physical Activity Among Colombian Overweight/Obese Schoolchildren

The purpose of this study was to explore the contexts that shape obese children’s engagement in physical activity (PA) focusing on children’s perceptions. The qualitative design consisted of non-participant observations, and unstructured and semi-structured focus group and individual interviews. Data were analyzed by use of conventional content analysis. Participants were overweight/obese children from a public school in Colombia. The findings show that the main context where PA took place was during physical education (PE) classes at school and in the children’s neighborhoods. The participants perceived the PE classes to be too competitive and demotivating. PA taking place outside school was associated with fun, but occurred only on an infrequent basis and was challenged by living in insecure neighborhoods. Adapting a health promotion approach that emphasizes participation and social environments might motivate obese children to become physically active at school as well as during leisure time.

People and Place: The Interrelated Connections Between Interactions, Perceptions and Space

The main purpose of this chapter is to provide a theoretical overview of the interaction between people and place. Drawing on sociological and anthropological theory and case studies, the chapter addresses three key issues: How people culturally construct meanings of places, how social relationships are practised in public places and how public places shape human behaviour. The dialectic relationship between people and place is a relevant perspective for understanding how people relate to their neighbourhood and how neighbourhood architecture invites residents to socially interact.