Tine Mechlenborg Kristiansen

Experiences with Recruitment of Marginalized Groups in a Danish Health Promotion Program: A Document Evaluation Study

Background Studies have found that marginalized groups living in deprived neighborhoods are less likely to participate in health programs compared to the majority of society. This study evaluates recruitment approaches conducted during a national government-funded project in 12 deprived neighborhoods across Denmark between 2010 and 2014. The aim of this study was to understand how recruitment approaches could promote participation in health programs within deprived neighborhoods to reach marginalized groups. Method Documents from all 12 of the included municipalities were collected to conduct a document evaluation. The collected documents consisted of 1,500 pages of written material with 12 project descriptions, three midterm and 10 final evaluations. The collected data were analyzed through a qualitative content analysis. Results The results are based on the fact that only 10 municipalities have developed evaluations related to recruitment, and only three evaluations provided a description of which marginalized groups were recruited. Challenges related to recruitment consist of difficulties involving the target group, including general distrust, language barriers and a lack of ability to cope with new situations and strangers. Additional geographical challenges emerged, especially in rural areas. Positive experiences with recruitment approaches were mainly related to relationship building and trust building, especially through face-to-face contact and the project employees’ presence in the neighborhood. Additionally, adjusting some of the interventions and the recruitment strategy increased participation. Conclusion This study found that relation and trust between the residents and the project employees is an important factor in the recruitment of marginalized groups in deprived neighborhoods as well as adjusting the health interventions or recruitment strategy to the target groups. In future research, it is necessary to examine which recruitment approaches are effective under which circumstances to increase participation among marginalized groups.

Reasons for women’s non-participation in follow-up screening after gestational diabetes

BACKGROUND Due to the increased risk of type 2 diabetes, follow-up screening after birth is recommended to women with previous gestational diabetes. Low participation in such screening has been shown to delay detection of diabetes with potentially serious consequences for the womens future health. The womens experiences of treatment and care during their pregnancies may affect participation. AIM This study aimed at understanding the womens experiences with treatment and care during pregnancy and to understand how these experiences influence participation in follow-up screening. METHODS A qualitative study was undertaken drawing on a phenomenological methodology. Seven women treated for gestational diabetes at a university hospital in the North Denmark Region participated in interviews. FINDINGS The women experienced lack of continuity in care between hospital departments and health sectors. We identified the following causes for low participation in follow-up screening: poor coordination, little elaboration of information, a lack of clear coordination of responsibility for follow-up screening among health care professionals and absence of focus and inclusion of their individual needs and preferences. CONCLUSION The women wished to be reminded of screening to increase their sense of safety. The womens experiences seem to reflect a lack of patient-centeredness during the pregnancy, which may be remedied by increasing the focus on the womens need for improved continuity in treatment and care. Participation in follow-up screening after gestational diabetes may be increased by sending reminders to the women. Raised awareness of the womens individual needs and preferences for treatment and care offers potential for improvement.

Construction of meaningful identities in the context of rheumatoid arthritis, motherhood and paid work: a meta-ethnography

AIMS AND OBJECTIVES To derive new conceptual understanding about how women with rheumatoid arthritis manage their illness, motherhood and paid work, based on a comprehensive overview of existing knowledge, gained from qualitative studies. BACKGROUND Rheumatoid arthritis affects several social aspects of life; however, little is known about how women with rheumatoid arthritis simultaneously manage their illness, motherhood and paid work. DESIGN Qualitative metasynthesis. METHODS A qualitative metasynthesis informed by Noblit and Hares meta-ethnography was carried out, based on studies identified by a systematic search in nine databases. RESULTS Six studies were included. Social interactions in the performance of three interdependent subidentities emerged as an overarching category, with three subcategories: subidentities associated with (1) paid work, (2) motherhood and (3) rheumatoid arthritis. Pressure in managing one of the subidentities could restrict the fulfilment of the others. The subidentities were interpreted as being flexible, situational, contextual and competing. The women strove to construct meaningful subidentities by taking into account feedback obtained in social interactions. CONCLUSIONS The subidentities associated with paid work and motherhood are competing subidentities. Paid work is given the highest priority, followed by motherhood and illness is the least attractive subidentity. Because of the fluctuating nature of the illness, the women constantly reconstruct the three interdependent subidentities. RELEVANCE TO CLINICAL PRACTICE When healthcare professionals meet a woman with rheumatoid arthritis, they should consider that she might not accept the subidentity as an ill person. Health professionals should not expect that women will prioritise their illness in their everyday life. This could be included in clinical conversation with the women.

Patient education as a status passage in life – An ethnographic study exploring participation in a Danish group based patient education programme

In this paper, we apply the theory of status passage to the empirical field of group-based patient education. On the basis of ethnographic fieldwork carried out in the context of a local Danish patient education programme aimed at people diagnosed with rheumatoid arthritis, we illustrate how participation in the programme for the recently diagnosed is a regularised status passage symbolising a transition in life from a novice to a more experienced person with chronic illness. We demonstrate how central properties of status passage are at play and how they are shaped by interactions among the different agents: participants, lay experts and health professionals. We highlight how the unique biographical situation of the individual and the individual timing of participation is an important factor affecting whether the patient education programme succeeds in regularising the status passage. We highlight the ambiguity of the role of the health professionals in directing the status passage of the recently diagnosed. On one hand, health professionals empowered the participants by giving them access to professional knowledge and guidance and thereby supporting the status passage. On the other hand, the effort to direct responsibility back to the participants did not consider individual biographical situations, and thereby risked leaving the participants frustrated and unable to pass. Further, we point to the special significance of the socialising process between the participants, with the recently diagnosed being the novices asking questions and seeking guidance and the lay experts and the experienced participants taking the role of coaches, guiding the recently diagnosed managing the status passage into chronic illness.

Focus Groups as Social Arenas for the Negotiation of Normativity

Aim: This article aims to demonstrate how focus group discussions act as a social arena for the negotiation of social norms and normativity and to discuss the implications for the analysis of focus group discussions. Participants and methods: We have used sequences of group interactions from a focus group study on everyday life and chronic illness to demonstrate how methodological tools from conversation analysis and discursive psychology can be used to facilitate a systematic analysis of the negotiation and legitimization of social norms and normativity in focus groups. The empirical data consisted of six focus groups with a total of 32 participants. Results: The analysis demonstrated negotiations on normativity concerning four central aspects related to living with chronic illness: negotiating normativity about adjustment to the disease, negotiating normativity about being a dutiful employee, negotiating normativity about responsibility for the illness, and negotiating normativity about carrying on. Conclusion: Although the role of interaction in focus group data analysis and its impact on the content of the data should always be viewed in relation to the specific study and study focus, based on the analyses, we argue that adding different epistemological and analytical lenses to a data set may produce different, additional, and more complex insights into the research field.

Juggling identities of rheumatoid arthritis, motherhood and paid work – a grounded theory study

Abstract Purpose: To explore how women with rheumatoid arthritis manage their illness, motherhood, and work life. Methods: A constructivist, grounded theory approach based on individual interviews and participant observations with 20 women with rheumatoid arthritis who participated in work life and had children living at home or were pregnant. After initial and focused coding Goffman’s concepts of social identity were applied. Results: A core category: “Juggling meaningful identities” and three conceptual categories were developed: (1) Work life as the strongest identity marker; (2) Motherhood: a two-sided act; (3) Living with rheumatoid arthritis as an identity? Paid work, motherhood, and illness are linked to the women’s social identities. The women construct and change their identities in interactions with children, partners, other parents, colleagues, and employers. Conclusion: The women attribute the highest priority to their professional identity, spending the majority of their time and energy in an effort to appear as “good stable workers”. The disease is seen as a hindrance in this regard, and the illness identity is almost completely rejected. In motherhood, the women prioritize close interaction with their children, and deprioritize external activities. Extended outbreaks of the disease and issues regarding the children force the women to deprioritize working life. Implications for rehabilitation Juggling meaningful identities of rheumatoid arthritis, motherhood, and paid work challenge women in managing their everyday lives. Therefore, rehabilitation professionals should support individuals to develop new strategies to manage the challenges they experience regarding juggling motherhood and work ability. Work is a dominant identity marker for women with rheumatoid arthritis therefore, rehabilitation professionals have an important role to play in investigating possible ways for the individual to maintain employment or return to work. Living with rheumatoid arthritis and being a paid worker challenge women’s role performance and thereby their identification as mothers. Therefore, rehabilitation professionals have to support the women and their families.

Interactions between women with rheumatoid arthritis and nurses in nursing consultations – balancing illness, motherhood and work life

Background Patients with rheumatoid arthritis (RA) are offered outpatient follow-up in nurse-led consultations.1 RA affects almost every aspect of daily life,.2 Many women with rheumatoid arthritis find it challenging to be mothers and simultaneously participate in paid work.3 Objectives To investigate how women’s understanding of RA, motherhood and working life are parts of the interactions with nurses during nursing consultations. Methods Participant observations were conducted during 10 women’s attendance in nursing consultations and subsequently the women were interviewed about their experiences. Data generation and analysis were carried out according to the principles of constructivist grounded theory.4 Results A core category was developed: “Cooperation through mutual recognition” which describes how women and nurses through verbal and non-verbal communication confirm their common understanding of the content and form of nursing consulting. Furthermore, three sub-categories were identified: 1) “On safe ground” illuminates, that biomedical aspects of the disease such as blood tests results, examination of the joints and pharmacological treatments represent the foundation of the dialogue. This interaction has elements that may be characterised as ritualised behaviour. 2) “Taking risks” documents how both parties are more aware of the counterparts’ reaction when it comes to dialogue concerning how the women manage illness in everyday life along with motherhood and paid work. 3) “Gentle correction” shows how the nurses gently express when they find the women’s talk is too far out. Conclusions The biomedical aspects of the disease (disease perspective) constitute the starting point for a discussion and allow both parts to initiate conversations on the women’s subjective understanding (illness perspective) of how illness, motherhood, and work are managed. References [1] de Thurah, A., et al., Efficacy of embedded nurse-led versus conventional physician-led follow-up in rheumatoid arthritis: a systematic review and meta-analysis. RMD Open, 2017. 3(2): p. e000481. [2] Kristiansen, T.M., et al., It means everything: continuing normality of everyday life for people with rheumatoid arthritis in early remission. Musculoskeletal Care, 2012. 10(3): p. 162–70. [3] Feddersen, H., et al., Construction of meaningful identities in the context of rheumatoid arthritis, motherhood and paid work: A meta-ethnography. Journal of Clinical Nursing, 2017. 26(23–24): p. 4117–4128. [4] Charmaz, K., Constructing Grounded Theory. 2nd ed. 2014, Los Angeles: Sage. Disclosure of Interest None declared

An ethnographic field study of the influence of social interactions during the school day for children diagnosed with ADHD

Abstract The aim of this ethnographic field study was to investigate the influence of school-day social interactions on the well-being and social inclusion of children diagnosed with ADHD. The empirical data consisted of participant observations and informal interviews over a three-month period at a Danish primary school. Two ADHD-diagnosed 11-year-old boys in the fourth and fifth grades were followed on an alternating basis. The field notes were analysed using a qualitative content analysis that incorporated Etienne Wenger’s concepts of social identity and participation. The results revealed that the effects of school-day social interactions are complex and situation dependent. Medication, friendships and relationships with teachers and other adults strongly influence how children diagnosed with ADHD participate in social interactions and, consequently, how they thrive. We argue that it is important to emphasise the mediation of these children’s participation in the classroom community throughout an entire school day to ensure their social inclusion and well-being.