Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

A Discussion of Globalization Theories - Through International Consumer Perceptions

Globalization has developed more and more within the business world as well as private life during the last decades. Globalization has influenced the way companies are conducting business and their approach towards the consumers which can have an influence on their way of purchasing. Consumers nowadays have more than ever the possibility to get involved and gather experiences from abroad, as well as companies are taking advantage of this globalization. Within this thesis the following question will be discussed: Do consumers see the value companies try to create for them with an identical offer the same way in different markets? This idea is based on Theodore Levitt’s theory of globalization which comprises standardization of an offer since consumer needs are homogenizing globally. Douglas & Wind instead state that segmentation with adaptations is necessary to fulfill all consumer needs. Within this elaboration the question whether standardization is accepted and liked by the consumers is discussed and analyzed by including an empirical research. This research is based on Zeithaml’s model of the Perceived Quality Components, which was the fundamental base behind formulating the survey questions. These were submitted in Germany, the Republic of Ireland and Sweden to be able to discuss and visualize how the consumers of these different markets perceive different aspects of a company’s offer. One particular company, which is seen as doing business globally, was chosen as a test object. Based on the test object Lidl - which consumers were questioned about in the survey - it was possible to conduct a comparison of consumers’ general expectations against components of Lidl’s offer such as price, weekly specials, product range, etc. where differences and similarities between the three countries of Lidl’s fulfillment of these expectations were achieved. They were analyzed to discover to which extent globalization is present. Resulting from the comparison it was concluded that nowadays segmentation is important but developing with time globalization seems to increase in significance. Recommendations for further research about topics which were omitted due to limited resources are presented.

Brand Awareness among Customers : A case study of ICA-Kvantum

This research paper has been prepared by Bachelor students from Dalarna University in Borlänge. The project is centered on a case study of ICA – Kvantum and its brand awareness among customers. The purpose of this study is to find out that which measures can help ICA-Kvantum to create brand awareness among its current and potential customers by looking in to the importance of information of its offerings and use of effective communication tools to convey this information. Further, to recommend them what they need to do, to increase brand awareness among their customers with the help of managerial implications. The research question was formulated as what actions could be seen effective for ICA-Kvantum to maintain or improve brand awareness among its current and potential customers.The project was created with the help of theoretical concepts of brand awareness, brand loyalty, perceived quality, consumer decision model, integrated marketing communication approach and strategic planning process. These theories were applied in this thesis in order to find out the most effective communication measures to maintain or improve brand awareness among current and potential customers of ICA-Kvantum.The primary and secondary data was collected. Primary data was gathered through the survey among ICA-Kvantum customers in the front of the store in Borlänge. The personal interview with manager was conducted in the office of ICA-Kvantum store located in Borlänge. Secondary data was gathered from textbooks, academic journals, theses and websites.The empirical findings have been presented in detail and then analyzed with the help of theoretical concepts. The analysis and further results from survey and interview focused on importance of information, marketing communication tools, brand awareness and loyalty, perceived quality and implementation of strategic planning process. Moreover, the main weaknesses and strengths of ICA-Kvantun have been evaluated. The conclusion including short summary of analysis and its results have been provided at the end. Each weakness of issues related to brand awareness i.e. importance of information, effectiveness of marketing communication tools and strengths and weaknesses of ICA-Kvantum discussed in the paper, has been pointed out along with solutions and managerial implications.

Push or pull? : The relationship between quality of care and use of complementary and alternative medicine among patients with lung cancer in Sweden

Little is known about relationships between quality of care (QoC) and use of complementary and alternative medicine (CAM) among patients with lung cancer (LC). Purpose: This study examines CAM-use among patients with LC in Sweden, associations between QoC and CAM-use among these patients, and reported aspects of LC-care perceived as particularly positive and negative by patients, as well as suggestions for improving QoC. Methods: Survey data from 94 patient members of the Swedish LC patient organization about CAM-use and QoC as measured by the instrument “Quality from the patient’s perspective” were analyzed. Results: Fifty (53%) LC-patients used CAM, with 40 of the CAM-users reporting that CAM helped them. The most common CAMs used were dietary supplements and natural remedies, followed by prayer. Significantly more patients reported using prayer and meditation for cure than was the case for other types of CAM used. Less than half the CAM-users reported having spoken with staff from the biomedical health care system about their CAM-use. Patients provided numerous suggestions for improving LC-care in a variety of areas, aiming at a more effective and cohesive care trajectory. No differences in QoC were found between CAM-users and non-CAM-users, but differences in CAM-use i.e. type of CAM, reasons for using CAM, and CAM-provider consulted could be associated with different experiences of care. Conclusions: It is important to recognize that CAM-users are not a homogeneous group but might seek different types of CAMs and CAM-providers in different situations depending on experiences of care.

Formal caregivers' perceptions of quality of care for older people : associating factors

Background: Despite the growing number of studies concerning quality of care for older people, there is a lack of studies depicting factors associated with good quality of care from the formal caregivers' perspective. The aim was to describe formal caregivers' perceptions of quality of care for older people in the community and explore factors associated with these perceptions. In total, 70 nursing assistants, 163 enrolled nurses and 198 registered nurses from 14 communities in central Sweden participated in the study. They filled out the following questionnaires: a modified version of Quality from the Patient's Perspective, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items regarding education and competence, Health Index and Sense of coherence questionnaire. The overall response rate was 57 % (n = 431). Results: In the perceived reality of quality of care respondents assessed the highest mean value in the dimension medical-technical competence and physical technical conditions and lower values in the dimensions; identity-oriented approach, socio-cultural atmosphere and in the context specific dimension. The caregivers estimated their competence and health rather high, had lower average values in sense of coherence and organizational climate and low values in stress of conscience. Conculsions: The PR of quality of care were estimated higher among NA/ENs compared to RNs. Occupation, organizational climate and stress of conscience were factors associated with quality of care that explained 42 % of the variance. Competence, general health and sense of coherence were not significantly associated to quality of care. The mentioned factors explaining quality of care might be intertwined and showed that formal caregivers' working conditions are of great importance for quality of care.

Visual functioning and health-related quality of life in diabetic patients about to undergo anti-vascular endothelial growth factor treatment for sight-threatening macular edema

Purpose To examine patient-reported outcome (PRO) in a selected group of Swedish patients about to receive anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME). Material and methods In this cross-sectional study, 59 patients with diabetes mellitus, who regularly visited the outpatient eye-clinics, were included. Sociodemographic and clinical data were collected and the patients completed PRO measures before starting anti-VEGF treatment. PRO measures assessed eye-specific outcomes (NEI-VFQ-25) and generic health-related quality of life (SF-36). Results The participants consisted of 30 men and 29 women (mean age, 68.5 years); 54 (92 %) patients had type 2 diabetes; Five (9%) patients had moderate or severe visual impairment; 28 (47 %) were classified as having mild visual impairment. Some of the patients reported overall problems in their daily lives, such as with social relationships, as well as problems with impaired sight as a result of reduced distance vision. Conclusions Further studies are needed to investigate PRO factors related to low perceived general health in this patient population. It is important to increase our understanding of such underlying mechanisms to promote improvements in the quality of patient care.