Pregnant Adolescents in Vietnam : Social context and health care needs

Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and prevalence of STIs including HIV among youth indicate a need to improve services and counselling for these groups. Midwives are key persons in the promotion of young people’s sexual and reproductive health in Vietnam. Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV). Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents’ experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers’ perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care was explored in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV). Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20 % of all births, higher than previous findings from Vietnam. About 2 % of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of self-confidence emerged as themes from the interviews; and experience of ‘being in the hands of others’ in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV). Conclusion: Cultural norms and gender inequity make pregnant adolescent women in Vietnam vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas while counselling unmarried adolescents who come for abortion and this has a negative impact on the quality of care. Integrated ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services in Vietnam.

Game Audio in Audio Games : Towards a Theory on the Roles and Functions of Sound in Audio Games

For the past few decades, researchers have increased our understanding of how sound functions within various audio–visual media formats. With a different focus in mind, this study aims to identify the roles and functions of sound in relation to the game form Audio Games, in order to explore the potential of sound when acting as an autonomous narrative form. Because this is still a relatively unexplored research field, the main purpose of this study is to help establish a theoretical ground and stimulate further research within the field of audio games. By adopting an interdisciplinary approach to the topic, this research relies on theoretical studies, examinations of audio games and contact with the audio game community. In order to reveal the roles of sound, the gathered data is analyzed according to both a contextual and a functional perspective. The research shows that a distinction between the terms ‘function’ and ‘role’ is important when analyzing sound in digital games. The analysis therefore results in the identification of two analytical levels that help define the functions and roles of an entity within a social context, named the Functional and the Interfunctional levels. In addition to successfully identifying three main roles of sound within audio games—each describing the relationship between sound and the entities game system, player and virtual environment—many other issues are also addressed. Consequently, and in accordance with its purpose, this study provides a broad foundation for further research of sound in both audio games and video games.

Motståndets betydelse : Ett bidrag till aktör-strukturdebatten

The significance of inhibition: a contribution to the agency-structure debate A central problem in social theory today is how to integrate agency and structure. The vital question is how to explain social reality by proceeding from both the notion of people doing things which affect the social relationships in which they are embedded (agency) and the idea of the social context moulding social activity (structure). Sociologists as Pierre Bourdieu, Anthony Giddens and Jürgen Habermas call attention to social practices as the ”missing link” between agency and structure. In accentuating social practices, the aim is to explain how people in their daily encounters actively contribute to the production and reproduction of social structures. This article puts forth the posthumous contribution of George Herbert Mead to the agency-structure debate. I argue that his social pragmatist theory gives us a compound and thorough– but not fully recognized – explanation of the dynamics and the course of events in structurally framed encounters. By especially emphasizing the importance Mead ascribes to the inhibited social act, I examine how his theory deepens the understanding of social practices as a bridge between agency and structure.

Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

Struggling with daily life and enduring pain : a qualitative study of women's experiences with pelvic girdle pain during pregnancy

Background. Few studies have investigated the experiences of living with pelvic girdle pain (PGP) and its impact on pregnant women’s lives. To address this gap in knowledge, this study investigates the experiences of women living with PGP during pregnancy. Methods. A purposive sample, of nine pregnant women with diagnosed PGP, were interviewed about their experiences. Interviews were recorded, transcribed to text and analysed using a Grounded Theory approach. Results. The core category that evolved from the analysis of experiences of living with PGP in pregnancy was “struggling with daily life and enduring pain”. Three properties addressing the actions caused by PGP were identified: i) grasping the incomprehensible; ii) balancing support and dependence and iii) managing the losses. These experiences expressed by the informants constitute a basis for the consequences of PGP: iv) enduring pain; v) being a burden; vi) calculating the risks and the experiences of the informants as vii) abdicating as a mother. Finally, the informants’ experiences of the consequences regarding the current pregnancy and any potential future pregnancies is presented in viii) paying the price and reconsidering the future. A conceptual model of the actions and consequences experienced by the pregnant informants living with PGP is presented. Conclusions. PGP during pregnancy greatly affects the informant’s experiences of her pregnancy, her roles in relationships, and her social context. For informants with young children, PGP negatively affects the role of being a mother, a situation that further strains the experience. As the constant pain disturbs most aspects of the lives of the informants, improvements in the treatment of PGP is of importance as to increase the quality of life. This pregnancy-related condition is prevalent and must be considered a major public health concern during pregnancy.

Det ideella tränaruppdraget : En studie om ideella tränares ledarskap inom gymnastik.

Volunteer coaches are critical for the existence of youth sports organizations. They are both leading the activity and are expected to develop the athletes in a technical, psychological, social and cultural way. The mission as a coach requires skills and knowledge from a wide range of fields and the mission as a coach appears complex. Stakeholders like Riksidrottsförbundet, Gymnastikförbundet and the sport organization have certain requirements on how to design the activities. Coaches have to follow those guidelines and implement them in practice. The social context is one important factor for understanding the driving force. It affects how coaches perceive their assignment as a volunteer coach. This study aims to contribute to increased understanding of the fenomen volunteer coach mission and increase understanding for the drivers of volunteer coaches in gymnastics. In order to clarify this, 6 interviews with volunteer coaches from gymnastics organizations linked to Riksidrottsförbundet were conducted. This study indicates that the motive behind the coaching mission is grounded in an intrinsic value of being a coach. The coaching mission itself appears partly contradictory when trying to combine the sport related and the social dimensions. Seeing progress from practice and to follow the development of gymnasts are aspects that drives coaches. That combined with the social interaction is important for understanding the drivers of being a coach.

Elvaåringars skriftbruk till vardags och i skolan

The written word ‘surrounds us round the clock’. Consequently, it is difficult to determine the border between children’s school literacy and their vernacular literacy outside school. The aim of this article is therefore to describe some everyday literacy events and their relation to literacy events in grade 5 in school.  The concept literacy covers broader ways of reading and writing and is understood in the social context in which it is used and acquired. Children use different written modes of communication outside school, for example, Facebook and blogs, but seldom books. In school, on the other hand, they usually write with a pen and read books made of paper. The children’s vernacular literacy practices and school literacy practices meet during school breaks, where students’ texting and typing are visible. The different use of modes, tools and literacy events among students are something that probably should be problematized and discussed within schools with the aim of drawing on everyday practices to enhance educational development.

Skolan i livet - livet i skolan : Några illitterata invandrarkvinnor lär sig tala, läsa och skriva på svenska som andraspråk

Many immigrants in Sweden have not had the chance to learn to read and write, for various reasons. In Sweden, literacy is a prerequisite to being able to function in the cultural community, and for many immigrants this is the first time that they experience their inability to read and write as a handicap or see themselves as “illiterate”. The aim of this study is to use a socio-cultural, second language and gender approach to describe, analyse and understand how a number of adult, illiterate, immigrant women experience their situation when they are expected to simultaneously learn to speak, read and write Swedish. The study focuses on two literacy groups in two Swedish municipalities. In one of the groups I act as both teacher and researcher. The thesis is a case study of the learning process of five illiterate immigrant women in Sweden. The results are based on interviews, carried out with the help of an interpreter, and observation of teaching and texts ritten by the students. The study is based on the assumption that human learning is an activity that takes place in a cultural community in a social context. When learning a language, the language is simultaneously the tool that facilitates social communication and the object of the learning process. The study shows that cultural communities influence the women in different ways. Gender structures are firmly planted in a patriarchal value system, which means that women are seen as inferior to men, and women are expected to “meet the demands of others”. The women have no time to study at home, as their household duties are prioritised. However, there are subtle indications that there is a wish to change the situation in accordance with Swedish values and norms. This can be seen in the Swedish for Immigrants (SFI) lessons. As they have little contact with Swedes, school is the only arena in which they have a chance to use Swedish. They are positive towards teaching and school as an institution. Here they are able to develop an alternative identity. The study also shows that teaching in the literacy groups is to a great extent based on a technical approach, in which the teacher tries to elicit a correct answer from the students. Social interaction involving contemplation and negotiation is either not included or not prioritised. the women’s experience and knowledge is not made use of. There are,however, occasions when collaborative discussions take place between the teacher and students. On these occasions an exchange of experiences takes place. Learning is based on the students’ own experiences and thoughts. Linguistic concepts gain meaning in the collaborative discussion. Initially the concepts may be unclear, but the group works on them together, adapting and adjusting them until they finally make sense. Finally, I conclude that women immigrants bring their own socio-cultural values and experience to the school situation, which affects their learning process to varying degrees. Furthermore, immigrant women need more time at school, as it is the only arena in which they can spend time on studying and personal development. another conclusion is that the school must become a learning community that recognises the immigrants’ cultures, makes use of the students’ experience and allows the students to participate in collaborative discussions, so that they can develop their ability to speak, read and write Swedish.

Older people's experience of utilisation and administration of medicines in a health- and social care context

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care. AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care. DESIGN: A qualitative descriptive study. METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used. FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process. CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine. RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.