Pia Bülow

Who's Talking : Drawing Conclusions from Focus Groups - Some Methodological Considerations

The central argument of this article is that participants in focus groups may talk and interact in many capacities. As a consequence a central methodological question in analysing focus group material is whos talking—that is, in what way are the utterances of individual members of the focus group to be interpreted. This problem is discussed by using material from three focus groups discussing the phenomenon ‘burnout’. We suggest that the participants of focus groups may constitute themselves in various ways, even just as an array of individuals talking together, without being a group and that they may shift between these different modes of interacting. Two interactive problems seem to be particularly important in the establishment of a focus group. A first interactive problem for the participants is to establish a common ground; a second is to add their contributions to the common ground. This has implications in the way the researcher is able to attribute attitudes and opinions to persons in focus groups.

Sharing Experiences of Contested Illness by Storytelling

Based on audiotaped conversations from a patient school for adults suffering from chronic fatigue syndrome, this article examines sharing experiences of illness as a mutual activity. The analysis shows that sharing experiences in this context is primarily of the narrative kind. Three main types of narratives were found: self-contained personal stories, orchestrated chained personal stories, and co-narrated collectivized stories. Through sharing three things seem to happen: (1) the participants jointly created experiential knowledge and a mutual image of the illness, (2) the individual sufferers could compare themselves to the jointly constructed image, (3) the active sharing of experience bestows a mutual confirmation of suffering irrespective of whether the individual’s experiences correspond or deviate from the common picture. Two parallel transitions seemed to occur: the transformation of personal experience into shared collectivized experiences and the transition when the individual sufferer perceives his/her private suffering through sharing experiences with co-sufferers.

Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work

Purpose In welfare policy and practical work it is unclear what the concept of work ability involves and assessments may be different among involved actors, partly due to a lack of theoretical research in relation to regulations and practice. Based on theoretical and legal aspects of work ability the aim of the study is to analyze stakeholders’ perspectives on work ability in local practice by studying multi-stakeholder meetings. Methods The material comprises nine digitally recorded multi-stakeholder meetings. Apart from the sick-listed individual, representatives from the public Social Insurance Agency, health care, employers, public employment service and the union participated in the meeting. The material was analyzed using qualitative content analysis. Results Three perspectives on work ability were identified: a medical perspective, a workplace perspective and a regulatory perspective. The meetings developed into negotiations of responsibility concerning workplace adjustments, rehabilitation efforts and financial support. Medical assessments served as objective expert statements to legitimize stakeholders’ perspectives on work ability and return to work. Conclusions Although the formal goal of the status meeting was to facilitate stakeholder collaboration, the results demonstrates an unequal distribution of power among cooperating actors where the employers had the “trump card” due to their possibilities to offer workplace adjustments. The employer perspective often determined whether or not persons could return to work and if they had work ability.

Patient School as a Way of Creating Meaning in a Contested Illness: The Case of CFS

Creating meaning in a situation of contested illness like Chronic Fatigue Syndrome (CFS) is an interactive process. As an example of how meaning is created, a CFS patient school organized by a hospital clinic in Sweden is discussed. This school can be seen as both a school and a medically oriented activity. The presence of different frameworks provides an opportunity to use different perspectives to understand CFS. It makes it possible for the participating men and women to regard the illness both from the outside as a social object, from the inside through personal experiences and to put the diagnosis and suffering in a larger ‘sickness’ perspective. Consequently, a number of different interpretations are brought up and used to create meaning in a situation of illness. The patients/students are thus learning discursively to manage the illness at the same time as they examine different ways to interpret their experiences through this discursive activity.

Problem-solving in physiotherapy – physiotherapists’ talk about encounters with patients with non-specific low back pain

Purpose: To investigate how physiotherapists talk about the choice of intervention for patients with NSLBP, particularly how professionals manage clinical encounters that may be experienced as challenging. Method: Discourse analysis was performed of four focus groups’ talk. Twenty-one experienced physiotherapists working in primary health care in southern Sweden participated. Results: Four focal themes appeared: Responsibility for health and health-related problems; Normalization – what counts as a normal back pain problem in relation to living an ordinary life; Change process – how to lead one’s life; and Individualization of the intervention in relation to the individual patient but also from the physiotherapists’ point of view. The themes shape an over-arching pattern of Problem-solving – which concerned both the professional task and the back pain problem, and was related to varying case complexity. This may have implications for the intervention the individual patient will be offered and on outcome. Conclusions: Physiotherapists’ attitudes and approaches seem to entail components of professional and personal values which may influence patients’ access to health care, with a risk for unequal assessment and intervention as a consequence. We argue that enhanced physiotherapist-patient collaboration, including patient-led problem-investigation, is a prerequisite for improved outcome in terms of patient satisfaction, and for physiotherapy development. Future investigations of patients’ roles in specific face-to-face encounters are needed. Implications for Rehabilitation Varying attitudes among professionals regarding responsibility for health and health-related problems may influence patients’ access to rehabilitation, with a risk for unequal assessment and intervention as a consequence. Professionals’ use of personal approaches indicates that interventions may be based on professional instead of patient preferences, with consequences on patient satisfaction and outcome. Enhanced professional-patient collaboration which thoroughly includes patient preferences seems to be a prerequisite for improved clinical outcome in terms of patient satisfaction, and for professional development.

Mindful sustainable aging: Advancing a comprehensive approach to the challenges and opportunities of old age

The primary aim of this article is to present a new concept called mindful sustainable aging (MSA), which is informed by mindfulness practices that support the physical, the mental, and especially, the social and the existential dimensions of old life. The concept of MSA is discussed and compared with four influential psychosocial theories in the field of gerontology, i.e., activity theory, disengagement theory, successful aging theory and gerotranscendence theory. The article ends with reviewing research on how mindfulness practice can help to manage, diminish and/or improve a number of serious physical conditions that are common among older people. The potential of mindfulness when it comes to facilitating for older adults in their quest for spiritual and existential meaning is discussed extensively throughout the article.

'We are not as alike, as you think' sense of individuality within the co-twin relationship along the life course

We have explored how older twins experience and describe themselves in relation to their co-twin. The life stories of 20 older twins were analyzed with narrative analysis. Results showed that the twins described themselves from the point of differences in relation to the co-twin. This was based on experiences of how other people viewed them as alike, as well as on life events along the life course, which contributed to the perception of oneself as an individual in relation to the co-twin. The emphasis on unlikeness was therefore interpreted as a way of trying to establish a position as an individual within the co-twin relationship and to assert ones individuality to the rest of the social environment. To claim oneself as an individual was an ongoing identity work along the life course.

In Sweden work is more important than the culture, actually! : The care leaving process for unaccompanied youths from the perspective of social workers

In 2014 about 7000 unaccompanied minors applied for asylum in Sweden and a great part of them were allowed to stay. Thus Sweden is one of the countries receiving the highest number of unaccompanied children in Europe. Previous research has shown that individuals with out-of-home care experiences belong to a vulnerable group. Besides that, young people with a migrant background sometimes experienced exclusion and discrimination. This study aims to explore social workers’ understanding of the unaccompanied youths’ minority backgrounds in relation to the process of leaving care. With a qualitative approach, data have been collected through focus groups at two residential care units. Within this kind of human service organizations (HSO), the staff struggle with meeting the perceived needs of the youths based on their minority background. Alongside, they are trying to teach what they consider as being good Swedish practices claimed to be necessary when facing life outside care. A transnational perspective prevents an understanding of the unaccompanied youths’ context as static, but rather promotes a way of relating to the youths in past and present times in order to be prepared for the future.