Rationale: Patients in secure forensic psychiatric care have reduced autonomy because of the constraints imposed on them by compulsion laws. Thus, it is vital that nurses enable patient participation whenever possible. Patient participation, and it′s clinical use in forensic psychiatric care, is an understudied field.

Aim: To describe nurses’ experiences of their work with patient participation in forensic psychiatric care. Methods: Managers at different secure forensic psychiatric institutions in the south of Sweden approved the study, and oral consent was retrieved from informants. Interviews guided by a semi-structured interview guide were conducted with nine nurses from five different forensic psychiatric institutions and analysed with content analysis.

Findings: Nurses describe diverse understandings and abilities in an inflexible setting. This indicates that what participation is, and how to achieve it, is not the same for nurses as for patients. Moreover, patients have different abilities to participate, and the secure setting in itself is perceived as hindering participatory work. Still, participation is described as a crucial part of work that requires a caring relationship. Furthermore, nurses pronounce potentially excluding attitudes and strategies that may obstruct patient participation for all, and at the same time, they have a belief that improvement is possible.

Conclusion: Compulsory forensic psychiatric care is a complex care context that requires constant efforts from nurses to balance patients’ rights and needs with mandatory care. The very nature of this caring context appears to be a major obstacle when promoting patient participation. Nevertheless, nurses express that they do aim for patient participation, ‘they try’. From a patient's perspective, trying is not sufficient and a need for improvement is evident. The results can be of clinical interest in similar secure forensic psychiatric nursing settings, and a point of departure in future development of care striving for increased patient participation for all.

Knowledge of sexual and reproductive health and rights (SRHR) by health care, police, legal and social work professionals has been shown to be insufficient. This lack of competence is likely to affect the quality of services. The aim of this study was to describe SRHR indicators in educational programmes in health care, police, legal and social work higher education in Sweden. A text-based analysis was conducted of written material from all educational programmes in law, midwifery, nursing, occupational therapy, physiotherapy, police work, psychology, social work and undergraduate medicine (93 educational programmes at 27 universities and university colleges). Representation of different SRHR indicators varied, but most were poorly covered in the educational programmes. Existing educational programmes lack comprehensiveness in their coverage of SRHR and are unequal both within and between the professions and universities. This situation creates the risk of inequalities in SRHR competence and suggests that needs within this field may be unmet. There is an urgent need therefore to enhance the presence of SRHR in health care, social work and law enforcement education in Sweden.

Objectives 

We aimed to develop and pilot-implement an evidence-informed toolkit (SEXual health Identification Tool; SEXIT) for identifying young people exposed to or at risk of sexual ill health, at Swedish youth clinics, and to investigate SEXIT’s potential to identify young people in need of special care and monitoring.

Methods

The SEXIT toolkit was developed, validated and pilot-implemented at three Swedish youth clinics. Pre-implementation staff readiness was assessed and youth clinic visitors’ responses to SEXIT were analysed.

Results 

All staff perceived a need for screening for sexual risk-taking and exposure. The response rate from 268 youth clinic visitors (aged 15–24 years) was 86%. Half of the visitors had one or no variable associated with sexual ill health, a third had two or three, and 15% reported between four and seven variables. The most common variables were alcohol use, three or more sexual partners in the past year and previous chlamydia. Visitors rated SEXIT as important and not uncomfortable or difficult to answer.

Conclusions

The SEXIT toolkit was found to be feasible and highly acceptable in a clinical setting. The use of SEXIT may facilitate important questions on sexual risk-taking and sexual ill health to be raised with youth clinic visitors. 

This paper describes the implementation of an educational intervention to enhance sexual health among homeless people by including sexual and reproductive health and rights (SRHR) as a part of social work provision with this group. Adult service users in different forms of temporary accommodation were provided with the opportunity to participate in three group sessions. Seventeen sessions, six with women and eleven with men, took place at six different housing facilities in Gothenburg. The intervention implementation process (which involved preparation, creation, realisation and evaluation) is described, and factors of importance are identified. Service users appreciated the opportunity to receive information and discuss sexual health, rights and norms. The success of the work may be related to the fact that the project was anchored both in social services and among service users, constantly adjusted, and delivered using a respectful approach. Social work organisations and professionals have an important role to play in acknowledging and promoting service users? sexual health and rights, especially among disadvantaged and socially excluded groups including homeless people.

Objectives: To describe evaluated sexual health interventions for young people in state care and provide an assessment of the quality of and evidence for these interventions.

Methods: A systematic review of sexual health interventions for young people in state care was conducted. Randomised controlled trials and quasi-experimental designs were eligible, 2051 records were screened, 412 full-text studies retrieved, and 12 publications with low-to-moderate risk of bias included.

Results: Due to substantial heterogeneity in study populations, settings, intervention approaches, outcomes and measures, standard summary measures for intervention outcomes was not used. Instead, data were synthesised across studies and presented narratively.

Conclusion: Without making recommendations, the result suggests that group-based educational interventions in general increase knowledge, attitudes and behaviour compared with standard care. However, these findings need to be further investigated, with a special emphasis on cultural context and the involvement of young people.

Bakgrund

Den här rapporten är en del av Folkhälsomyndighetens uppföljning av arbetet med hivprevention samt sexuell och reproduktiv hälsa och rättigheter (SRHR) bland unga och unga vuxna. Arbetet utgår från regeringens proposition Nationell strategi mot hiv och aids och vissa andra smittsamma sjukdomar och genomfördes inom ramen för Nationell handlingsplan för klamydiaprevention 2009–2014.

Metod

Kartläggningen är en textbaserad granskning av högre utbildning till arbetsterapeut, barnmorska, fysioterapeut, jurist, läkare, polis, psykolog, sjuksköterska och socionom. En gemensam nämnare för de olika utbildningar som ingår är att de alla förbereder den studerande för ett självständigt arbete av människo- eller rättsvårdande karaktär där den professionella möter människor i olika livssituationer. Granskningen omfattade yrkesbeskrivningar, utbildningsplaner och kursplaner på 93 utbildningsprogram vid 27 högskolor och universitet i Sverige. Vid granskningen gjordes en kategorisering av utbildningarnas innehåll utifrån indikatorer som relaterar till SRHR-området. Indikatorerna togs fram med stöd av en referensgrupp.

Resultat och slutsats

Resultatet visar att hivprevention och SRHR sällan förekommer i yrkesbeskrivningar, utbildningsplaner och kursplaner på de utbildningar som undersökts. Detta kan leda till att studenter inte får med sig relevanta kunskaper. Det finns särskilt lite indikatorer för SRHR inom universitets och högskolors professionsutbildningar till: sjuksköterska, socionom, jurist, polis, psykolog samt arbetsterapeut och fysioterapeut. Barnmorska och läkare har fler indikatorer inom SRHR än övriga utbildningar som studerats men trots det är områden som: sex mot sin vilja, hedersrelaterat våld, sex mot ersättning och heteronormen inte alls förekommande samt att området sexuellt våld är mycket lite belyst.

I förlängningen kan detta leda till kompetensbrist kring sexualitetsområdet och dess betydelse för hälsan. Det kan också försvåra förståelsen för klienters och patienters behov och rättigheter. Högskolor och universitet bör se resultaten som underlag för fortsatt utvecklingsarbete av yrkesutbildningarna. Studenter behöver få möjlighet att i sin kommande yrkesroll stödja alla människors rätt att uppnå sexuell och reproduktiv hälsa och rättigheter oavsett kön, ålder, sexuell läggning, könsidentitet, funktionalitet, socioekonomisk position, etnicitet, kulturell bakgrund och juridisk status.

Introduction: Transgender people´s general health and sexual function has previously been studied. However, holistic sexual health—physical, emotional, and relational well-being in relation to sexuality—as both a determinant for and a part of general health is an understudied field in research concerning health among transgender people. There is no research addressing holistic sexual health and sexual health determinants combining quantitative and qualitative data.

Aim: To explore and describe holistic sexual health and sexual health determinants among transgender people in Sweden.

Methods: For the purpose of this paper, descriptive statistics from a previous web-based survey with 796 respondents and quotes from a previous qualitative interview study with 20 transgender people were combined.

Results: Physical, emotional, and relational well-being are all vital aspects for experiencing holistic sexual health; that is, they are all important sexual health determinants, although of different importance to different individuals at different times. Satisfaction with sex life, having an ongoing sexual relationship and having been exposed to disrespectful or discriminatory care are examples of physical, emotional, and relational sexual health determinants that are connected to factors such as condom use, access to respectful STI/HIV-testing and having received reimbursement for sex. Experiences of disrespect and discrimination were reported in both the qualitative and the quantitative data, and in the qualitative data a wish for equity in access to sexual health care is evident.

Conclusion: The results provide a broad and extensive insight into transgender people´s sexual health in Sweden. Furthermore it underlines that access to nondiscriminatory health care services is vital, including access to gender-confirming care and different sexual-health-promoting and preventive services such as testing facilities.