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  • 1.
    Almers, Ellen
    et al.
    Jönköping University, School of Education and Communication, HLK, Learning Practices inside and outside School (LPS), Sustainability Education Research (SER).
    Askerlund, Per
    Jönköping University, School of Education and Communication, HLK, Learning Practices inside and outside School (LPS), Sustainability Education Research (SER).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Why forest gardening for children? Swedish forest gardeneducators' ideas, purposes, and experiences2018In: The Journal of Environmental Education, ISSN 0095-8964, E-ISSN 1940-1892, Vol. 49, no 3, p. 242-259Article in journal (Refereed)
    Abstract [en]

    Utilizing forest gardens as urban settings for outdoor environmental education in Sweden is a new practice. These forest gardens combine qualities of a forest, e.g., multi-layered polyculture vegetation, with those of a school garden, such as accessibility and food production. The study explores both the perceived qualities of forest gardens in comparison to other outdoor settings and forest garden educators’ ideas, purposes, and experiences of activities in a three-year forest gardening project with primary school children. The data were collected through interviews and observations and analyzed qualitatively. Four reported ideas were to give children opportunities to: feel a sense of belonging to a whole; experience self-regulation and systemic dependence; experience that they can co-create with non-human organisms; and imagine possible transformation of places. Four pedagogical forest garden features are discussed.

  • 2.
    Andersson Bäck, Monica
    et al.
    University of Gothenburg.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Identity work of successful primary care managers and competing institutional logics2017Conference paper (Refereed)
  • 3.
    Andersson Bäck, Monica
    et al.
    University of Gothenburg.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Medical manager hybrids for handling institutional complexity and change in primary care2017Conference paper (Refereed)
    Abstract [en]

    Introduction: This article deals with hybrid persons combining medical professionalism and management for handling institutional complexity and change in primary care. Primary care and identity are in transition in many western countries, in Sweden emphasized by the 2007 reform for patient choice and competition. Research has shown that embedded hybrid actors, familiar and socialized in a field and to its logics, tend to be influential for handling complexity and change. Yet hydrids and their enactment in primary care is an underexplored area.

    Aim: The aim is to contribute to our understanding of hybrid persons and how they are combining medical professionalism and management in primary care, while managing complexity and change.

    Material and methods: In a case study of six successful primary healthcare centers, public and private, covering 56 interviews and observations with various professions, two medical managers ‘hybrids’ showed to be particularly interesting. These were analyzed in-depth, including analysis of staff’s and colleagues’ experiences and contrasted by other managers and hybrids. For the analysis we draw on institutional logic perspective (Thornton, Occasion & Lounsbury 2012) in order to capture preconditions as well as enactment of such change agents.

    Results/conclusions: The hydrids contributed to innovation, creativity and learning in their primary care centres. At their workplace, coherence and a good ambience coexisted with feelings of high work pace and lacking role clarity among the multidisciplinary staff. Categorized in line with McGivern and colleagues(2015) term as ‘willing hybrids’, the persons studied revealed high ambitions to challenge existing institutional order giving professionalism new forms, while seeking to innovate practices and division of work among healthcare staff in primary care. By doing so the hybrids integrated professionalism and managerialism and were influential in reframing problems and solutions, which aligned several logics at play. However several obstacles related to professional as well as bureaucratic issues appeared along the way.

  • 4.
    Areskoug Josefsson, Kristina
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 4, p. 406-414Article in journal (Refereed)
    Abstract [en]

    Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units.

    Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators.

    Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.

    Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society.

    Key Points

    • Staff at well-functioning primary care units (PCUs) experienced healthy work environments
    • The included PCUs shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges.
    • Staff at the included PCUs were encouraged to work to create and sustain a healthy work environment, but each domain (indicator) also provided challenges that the staff and organisation needed to meet.
    • The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.
  • 5.
    Areskoug Josefsson, Kristina
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Ethics and sexual health: Exploration of the ethical code of conduct for physiotherapists concerning sexual health in clinical practice2018In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Physiotherapists have an important role in sexual health, but there are specific ethical considerations regarding sexuality and the practice of physiotherapy which require serious consideration. This article aims to illustrate how the professional ethical code of physiotherapy can serve as a tool for ethical clinical reasoning regarding sexual health in clinical physiotherapy practice. We analyse the ethical codes for physical therapy, in relation to a definition of sexual health and the declaration of sexual rights. The analysis outlines several ethical considerations crucial in dealing with sexual health, while also acknowledging the critical role of cultural context in any ethical analysis. We conclude that physiotherapists need to practise ethical reasoning and that the ethical code of physiotherapy can act as a point of departure for reflection on thought-provoking ethical dilemmas to improve the practice of physiotherapy and support clients’ overall health. 

  • 6.
    Askerlund, Per
    et al.
    Jönköping University, School of Education and Communication, HLK, School Based Research, Sustainable Development and Science education.
    Almers, Ellen
    Jönköping University, School of Education and Communication, HLK, School Based Research, Sustainable Development and Science education.
    Hyltse-Eckert, Yvonne
    Jönköping University, School of Education and Communication, HLK, School Based Research, Sustainable Development and Science education.
    Avery, Helen
    Jönköping University, School of Education and Communication, HLK, School Based Research, Sustainable Development and Science education.
    Kjellström, Sofia
    Jönköping University, School of Health Science.
    The Nordic forest garden: An educational opportunity for learning about ecological and emotional relationships between organisms2014In: Education for sustainable development: only big words for politicians or a responsibility for education workers?, 2014Conference paper (Refereed)
    Abstract [en]

    Ecosystem services as a perspective on ecological processes is highlighted in the new  curriculum for Biology in years 4-9 in Sweden. The ecosystem service-approach implies  an anthropocentric perspective in education and  an unidirectional view on the purpose and value of other organisms than humans. This study is part of a larger project exploring an educational situation in which 27 seven to eight year-olds participate in creating mini-projects in a forest garden in order to strengthen ecosystem services such as pollination. A forest garden is an edible polyculture landscape with different layers of vegetation. The forest garden is designed to maximise the yield of useful plants while minimizing the input of energy and resources, human labor included (Crawford, 2009). While planning for and establishing a forest garden there is a need to adapt to specific local conditions. The ground must be prepared  in a way that makes best use of the solar energy and waterflow through the area and the plants should be placed so that they promote each another.  This demands reflection and knowledge about relationships between different kinds of plants but also about relationships between plants and animals. The aim of this substudy is to describe how the children perceive their own relationships to other organisms, as well as how they perceive the relationships between different other organisms. This is investigated in focus group interviews  with seven to eight year-olds. Also field notes, video recordings and photos from the children's visits in the forest garden have been collected. The videos and photos have been used for stimulated re-call (Stough, 2001) in a second focus group interview. The data will be analyzed qualitatively (Patton, 2002). In addition to providing insights about the children's perceptions, the project will give examples of  how a Nordic forest garden can be used in an educational context. Preliminary findings show cognitive/emotional/moral/ themes describing how children perceive relationships between organisms.

  • 7.
    Avby, Gunilla
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    LearnOvation: an intervention to foster exploration and exploitation behaviour in health care management in daily practice2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 319Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Innovation has been identified as an important engine for improving the quality, productivity and efficiency of health care. Little is known about how to stimulate innovation capacity in primary health care in general; even less is known about how specific interventions should be designed to support managements' work with practice-based innovations. Research has shown that if managers and teams are excellent at handling the challenges of production (exploitation) and development (exploration), they are better at innovation. The aim of the study is to develop a dynamic management support programme to increase innovation leadership skills in daily practice.

    METHODS: The study has an interactive approach that allows the need for empirical and theoretical knowledge to emerge and merge, and a quasi-experimental cross-over design. Eight primary health care centres will participate in the study. In the first phase, the management teams at four health care centres will participate in the intervention, and the other four centres will serve as a control group. Thereafter, the units will switch places and the control group will experience the intervention. All staff at the 8 units will answer questionnaires at four points in time (before, during, after, 6 months later) to evaluate the effects of the intervention.

    DISCUSSION: The study will contribute to knowledge on how to organize processes of innovation and support exploitation and exploration behaviours by co-producing and testing a tailor-made management support programme for innovation work in primary health care. An expected long-term effect is that the support system will be disseminated to other centres both within and beyond the participating organizations.

  • 8.
    Avby, Gunilla
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Andersson Bäck, Monica
    University of Gothenburg.
    A reform as a lever for innovation and professionalism?2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Consistently with international trends, managerial reforms and incentive systems in Sweden have been introduced to achieve quality improvement and increased efficiency in welfare services. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as service transformations or innovation.

    Aim: In this study we explore how organizational performance are changing within the context of a patient choice reform in primary healthcare.

    Material and Methods: This qualitative study is based on 48 semi-structured interviews with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants) at five PHCCs, conducted as part of a study designed to explore financial incentives and motivation in PHC in Sweden. The PHCCs were purposively selected to ensure the inclusion of both public and private facilities. All centers had a longstanding reputation for good leadership and high quality care. 

    Results: The findings show how professional fields and traits were dissolving and changing, triggering the emergence of innovative solutions in practice. Through ongoing negotiations of professional boundaries new practices unfolded and professionalism increasingly was achieved through contextual conditions. The expanding and changing of professional boundaries as shown in the study are implied to stimulate innovative processes. Thus, the main findings suggest that innovative practices developed as a relationship between contextual conditions and professionalism. E.g. nurses and physical therapists remitted patients directly to the hospital, multiprofessional teams for patient groups with joint needs handled patients that previous needed hospital care, and nurse assistants became responsible for summing patients with minor hypertension for blood pressure controls and consultations.

    Conclusions: The reform seemed to act as a lever for innovation and professionalism under certain conditions. How work is organized and managed is a contextual factor that not only affects work circumstances, but also provides conditions for innovation and professionalism. Impartial to governments’ ambitions to improve their responsiveness to the needs of citizens by altering market rules, new provider models may be of little assistance in achieving the desired effect on health sector reform outcomes if suitable contextual conditions are missing.

  • 9.
    Avby, Gunilla
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Göteborg, Sweden.
    Tending to innovate in Swedish primary health care: a qualitative study2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 42Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Policymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jönköping County Council, as the region's handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.

    METHODS: Five Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.

    RESULTS: This study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.

    CONCLUSIONS: This qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy "push" with professionals' understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals' engagement in the work, that is, their willingness, capability and opportunity to innovate.

  • 10.
    Avby, Gunilla
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Andersson Bäck, Monica
    University of Gothenburg.
    Transforming primary healthcare: Exploring a new provider model as a lever for innovation and professionalism2017Conference paper (Refereed)
  • 11.
    Avby, Gunilla
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Göteborgs universitet.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Sparf, Anette
    Siljehult, Mats
    Samarbete bygger en stark primärvård2017In: Dagens Nyheter 2017-08-17, ISSN 1101-2447Article in journal (Other (popular science, discussion, etc.))
  • 12.
    Boström, Martina
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Björklund, Anita
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Older persons have ambivalent feelings about the use of monitoring technologies2013In: Information Technology and Disabilities, ISSN 1073-5127, E-ISSN 1073-5127, Vol. 25, no 2, p. 117-125Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As they age, older persons prefer to continue to live in their own homes. Sensors in the environment and/or bodily worn systems that monitor people might contribute to an increased sense of safety and security at home, but also raise concerns about the loss of privacy by surveillance. Little is known about how older persons, living at home independently and stating good health, perceive monitoring technology in terms of personal privacy.

    OBJECTIVE: to identify and describe how older persons, perceive monitoring technology in terms of personal privacy.

    METHOD: A qualitative study based on five focus group interviews was used. Concepts of "freedom" and "surveillance" were used as content areas in the data analysis.

    RESULTS: The results comprised three categories of ambivalence; "independence vs. security", "privacy vs. intrusion", and "in the best interest of me vs. in the best interest of others". These three categories merged into the overarching theme "maintaining a sense of self" which illustrates a desire to maintain control of one's life as long as possible.

    CONCLUSIONS: Older persons generally have positive feelings and attitudes toward technology and strive to maintaining a sense of self as long as possible, by having control. They stated high value to privacy, but valued being watched over if it ensured security. To feel good and bad about monitoring technologies, rather than good or does not necessarily lead to feelings of conflict.

  • 13.
    Ericsson, Iréne
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Hellström, Ingrid
    Linköping University, Sweden.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Sliding interactions: An ethnography about how persons with dementia interact in housing with care for the elderly.2011In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 10, no 4, p. 523-538Article in journal (Refereed)
    Abstract [en]

    This ethnography describes how persons with dementia interact with cognitively intact persons in housing with care for the elderly. The results, drawing upon 31 observation sessions and nine interviews, are described under the following themes, which were interpreted from the standpoint of social interaction theory: interaction with expression of satisfaction, disorientation, and dissociation. Interaction provided satisfaction, but did not always reflect a positive experience. Awareness in persons with dementia seemed to be greater than others perceived and, as a result, interaction was adversely affected by frequent well-intentioned corrections and comments. Participation in interaction can be encouraged and feelings of indignation avoided by assuming that persons with dementia are aware of their situation and how others behave toward them. Sensitivity is required to interpret individuals' expressions of desire not to participate, while simultaneously it is important to try to interpret why they want to refrain.

  • 14.
    Ericsson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Hellström, Ingrid
    Linköping University.
    Creating relationships with persons with moderate to severe dementia2013In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 12, no 1, p. 63-79Article in journal (Refereed)
    Abstract [en]

    The study describes how relationships are created with persons with moderate to severe dementia. The material comprises 24 video sequences of Relational Time (RT) sessions, 24 interviews with persons with dementia and eight interviews with professional caregivers. The study method was Constructivist Grounded Theory. The categories of 'Assigning time', 'Establishing security and trust' and 'Communicating equality' were strategies for arriving at the core category, 'Opening up', which was the process that led to creating relationships. Both parties had to contribute to create a relationship; the professional caregiver controlled the process, but the person with dementia permitted the caregiver’s overtures and opened up, thus making the relationship possible. Interpersonal relationships are significant to enhancing the well-being of persons with dementia. Small measures like RT that do not require major resources can open paths to creating relationships.

  • 15. Golino, Hudson
    et al.
    Hamer, Rebecca
    Almers, Ellen
    Jönköping University, School of Education and Communication, HLK, Learning Practices inside and outside School (LPS), Sustainability Education Research (SER).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Measuring epistemological development – a uni- or multidimensional structure?2018Conference paper (Refereed)
  • 16.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Nordström, Erik
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    "We found a solution, sort of”: qualitative interview study with children and parents on their experiences of the coordinated individual plan (CIP) in Sweden2018In: Cogent Medicine, ISSN 2331-205X, Vol. 5, no 1, article id 1428033Article in journal (Refereed)
    Abstract [en]

    Children and adolescents receiving services from two professional parties may obtain support with a coordinated individual plan (CIP). The Swedish law prescribes that CIP must incorporate service user participation. This study aims to explore children and parents’ experiences of participating in CIP-process to generate knowledge with practical implications of how children and parents may be involved in the CIP-process. A descriptive qualitative interview study with 13 service users was conducted during November 2014 to March 2016. Data were audio-recorded and transcribed, and further subjected to qualitative content analysis. Three main descriptive categories with six subcategories emerged. The category “Struggle for coordination” includes service users’ need for participation which are limited by professionals’ lack of consensus. The category “Alliance for coordination” points out the importance of relationship and personal support to accomplish functional coordination. The category “Structure for coordination” shows how the structure facilitate service user involvement on a high level. Service user involvement seemed limited by professionals’ actions, but could be facilitated by support of professionals working in the child’s daily life. Structured coordination seems to relieve the pressure on parents, as well as children, but CIP needs to be individually tailored to reach its full potential.

  • 17.
    Kjellström , Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Idéer om ansvar för hälsa: forskning och metoder utifrån ett vuxenlivsutvecklingsperspektivManuscript (Other scientific)
  • 18.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Ansvar för hälsa och personlig utveckling vid långtidssjukskrivning2007In: Nya vägar till livet, Jönköping: Coompanion Jönköpings län , 2007, p. 36-41Chapter in book (Other academic)
  • 19.
    Kjellström, Sofia
    Linköpings universitet.
    Ansvar, hälsa och människa: en studie av idéer om individens ansvar för sin hälsa2005Doctoral thesis, monograph (Other academic)
  • 20.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Delaktighetens etik och ansvar för delaktighet2012In: Delaktighetens praktik: Det professionella samtalets villkor / [ed] Pia Bülow, Daniel Persson Thunqvist, Inger Sandén,, Malmö: Gleerups Utbildning AB, 2012, 1, p. 31-39Chapter in book (Other academic)
  • 21.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Forskningsetik2012In: Vetenskaplig teori och metod: från idé till examination inom omvårdnad / [ed] Maria Henricson, Lund: Studentlitteratur, 2012, p. 69-94Chapter in book (Other academic)
  • 22. Kjellström, Sofia
    Hälsa i bild2003In: Visuella spår: bilder i kultur- och samhällsanalys, 2003Chapter in book (Other academic)
  • 23.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Kan människor ta ansvar för sin hälsa?2010In: Eget ansvar i vården: ett symposium om medicinsk etik, 16 spetember, Lund, Lund: Medicinsk fakultet, Lunds universitet , 2010, p. 39-46Chapter in book (Other (popular science, discussion, etc.))
  • 24.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Människors olika komplexa förhållningssätt till hälsa och ansvar2008Conference paper (Other academic)
  • 25.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Poor quality of reports on informed consent in dissertation2010Conference paper (Refereed)
    Abstract [en]

    Background: Recent research has indicated that ethical concerns are insufficiently dealt with in dissertations. This study examines how research ethics and informed consent is reported in nurses’ dissertations.

    Methods:  Analyses of ethical content and complexity of ethical reasoning in 64 PhD dissertations published by Swedish nurses in 2007.  

    Results: All dissertations, except one, had a section on ethical considerations; however, these were short, lacking in references, and thin on content. Information and informed consent was discussed in (87% of the dissertations). A third of these dissertations explicitly mention the concept of informed consent. A substantial amount of space described the informing phase of research, including details of form of information (written and/or verbal) and type of information. While many ethical concerns, like informed consent, involve systematic concepts or metasystematic principles, the complexity of ethical reasoning in the dissertations was categorized as abstract (6% of the dissertations), formal (84%) and systematic (10%).

    Conclusions : The concept and practice of informed consent is poorly reported in many dissertations. Important ethical concerns are missing and the complexity of reasoning on ethical principles, motives and implications is insufficient. This is partly due to traditions and norms that discount ethical concerns, but probably also reflect the ability of PhD-students and supervisors to handle complexity in general. It is suggested that the importance of ethical considerations is emphasized in graduate and post-graduate studies, and that individuals with capacity to deal with systematic and meta-systematic concepts are recruited to senior research positions.

  • 26.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Responsibility and Ethics in the Use and Advocacy of Developmental exercises: Response to Zeitler and Reams2010In: Integral Review, ISSN 1553-3069, E-ISSN 1553-3069, Integral Review, Vol. 6, no 2, p. 19-28Article in journal (Refereed)
    Abstract [en]

    In this response I circumscribe the nature and scale of the rejoinder to refocus on the ethical and theoretical implications of utilizing developmental exercises, of which Immunity to Change (ITC) is seen as an example. I welcome Zeitler’s and Reams’ continuation of the ethical discussion, and I want to reclaim and develop some of the delicate points and consequences that were described in my original article. The line of reasoning is based upon the presupposition that developmental methods and techniques are used in the real world with people and consultants with limitations and strengths, in conditions that are neither optimal nor perfect. Among all theoretical and ethical questions, I found the most profound issue to be: does it work?

  • 27.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Samhällets krav – människors förmågor: ett utvecklingsperspektiv?2005Conference paper (Refereed)
  • 28.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    The Ethics of Promoting and Assigning Adult Development Exercises: A Critical Analysis of the Immunity to Change Process2009In: Integral review, ISSN 1553-3069, Vol. 5, no 2, p. 116-132Article in journal (Refereed)
    Abstract [en]

    The Immunity to Change (ITC) process devised by Robert Kegan and Lisa Laskow Lahey is promoted as an influential technique for creating individual and organizational change. A critical analysis of the ITC process applied in university settings and organizational contexts show that an unintended result is the unwillingness and inability of some participants to participate adequately. Significant theoretical and ethical implications arise in the interplay between three interrelated variables (a) the role and competence of the facilitator, (b) expectations and capabilities of the participants, and (c) the mental demands and assumptions of the process. The inquiry illustrate that the ITC process is probably built upon an implicit assumption that change into greater mental complexity is always good and right, and its inherent structure creates demands that can put participants “in over their heads.” The main conclusion is that developmentally-aware, ethical approaches to using transformational practices such as the ITC should meet at least three demands: they should be conducted as voluntary activities on the part of well-informed participants, they should integrate an adult developmental perspective into the process itself, and they should openly allow the possibility that it is the organizations that may also need to change.

  • 29.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    The Model of Hierarchical Complexity and its Application to Phenomenography,2010Conference paper (Refereed)
    Abstract [en]

    Phenomenography is a commonly used qualitative method which aims at revealing the quality of different ways of experiencing various phenomena. It was originally created to examine learning and pedagogical issues, but is used to examine experiences in a variety of domains.

    The aim of this explorative paper is to present the model of hierarchical complexity (MHC) and to discuss how it can be applied to phenomenographic studies. The object of study of phenomenography is the variation and change in capabilities for experiencing particular phenomena. These capabilities can, as a rule, be hierarchically ordered and “seen as more advanced, more complex, or more powerful than other capabilities” (Marton and Booth, 1997, p 111). The analysis is for example performed with the SOLO taxonomy or Werner’s theory of development. MHC is a more generic theory than many developmental theories. MHC is a formal general theory applicable to all occasions in which information is organized. The theory accounts for increases in behavioral complexity and enables measurement of these by a validated scoring procedure. It is also possible to distinguish between two kinds of qualitative differences: horizontal and hierarchical complexity.

  • 30.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Äldres olika sätt att ta ansvar för hälsan2010Conference paper (Other (popular science, discussion, etc.))
  • 31.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Almers, Ellen
    Jönköping University, School of Education and Communication, HLK, School Based Research, Sustainable Development and Science education.
    Ramirez-Pasillas, Marcela
    Jönköping University, Jönköping International Business School, JIBS, Business Administration. Jönköping University, Jönköping International Business School, JIBS, Center for Family Enterprise and Ownership (CeFEO).
    Wagman, Petra
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Stagell, Ulrica
    Jönköping University, School of Education and Communication, HLK, School Based Research, Sustainable Development and Science education.
    Andersson, Ann-Carin
    Jönköping University, School of Engineering, JTH, Civil Engineering.
    Högskoleutbildning för hållbar utveckling: En kartläggning vid Jönköpings högskola2014Report (Refereed)
    Abstract [sv]

    Högre utbildning i Sverige ska enligt Högskolelagens paragraf 5 främja hållbar utveckling (Svensk högskolelag 1992:1434). Hållbar utveckling har definierats som en ”utveckling som tillfredsställer dagens behov utan att kompromissa med kommande generationers möjligheter att tillfredsställa sina behov” (United Nations, 1987). Hållbar utveckling innebär ansvarstagande för kommande generationer och utsträcker sig globalt. När ekologiska gränser överskrids kan människors möjligheter till goda liv undermineras.

    Våren 2013 fick författarna till denna rapport pedagogiska medel för att kartlägga undervisning om och för hållbar utveckling vid Högskolan i Jönköping. Syftet var att undersöka omfattningen av hållbar utveckling i undervisningen på strategisk nivå, programnivå, kursplanenivå och undervisningsnivå. Ett ytterligare syfte var att utifrån en analys av resultatet föreslå åtgärder som kan stärka högskolan i arbetet med utbildning för hållbar utveckling. Kartläggningen började med ett liknande upplägg på samtliga fackhögskolor men fick också anpassas till förutsättningarna på varje skola.

    Resultatet av kartläggningen visar skillnader mellan de olika fackhögskolorna i hur hållbarhetsfrågor inkluderas i undervisningen. Allt från att ingen kursplan innehållande hållbar utveckling identifierats till att undervisningen måste inkludera ett visst antal högskolepoäng. Kartläggningen visar också att tolkningarna av hållbar utveckling och undervisning för/om hållbar utveckling varierar mellan enskilda lärare.

    På Hälsohögskolan är området osynligt i kursplaner och inkluderandet av hållbar utveckling i undervisningen bygger på enskilda lärares engagemang. På Högskolan för lärande och kommunikation skiljer det sig mellan olika program där inslaget av hållbar utveckling varierar från att behandlas ingående till att inte synas explicit. Internationella handelshögskolan har prioriterat arbete med etiska och sociala frågor i utbildning och ekologisk hållbarhet är mindre framträdande. Det finns dock kurser som inkluderar ekologiska, sociala och ekonomiska dimensioner. Jönköpings tekniska högskola har en genomarbetad strategi för hur hållbar utveckling skall finnas med i utbildningarna. Varje utbildning skall integrera minst sex högskolepoäng.

    Sammantaget konstateras fortsatta förbättringsmöjligheter för Högskolan i Jönköping på strategisk nivå, programnivå, kursplanenivå och undervisningsnivå. Skillnader mellan bolagen, programmen och kurserna kan utnyttjas som en tillgång i förbättringsarbetet. En framgångsfaktor verkar vara att som JTH ha med hållbar utveckling i strategidokument med tydliga mål på omfattning samt att kursplaner innehåller moment som förklarar hur hållbar utveckling avhandlas. Vi rekommenderar också att tydliga mål sätts upp på varje fackhögskola och att lärare ges tid och resurser att ta del av de verktygslådor för hållbar utveckling som finns (en lista på sådana finns i rapporten). Ytterligare förslag på hur implementering kan stimuleras ges också, så som skapande av nätverk, införlivande av ämnet i högskolepedagogiska kurser samt högskolegemensamma temadagar för studenter.

  • 32.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Applying adult development theories to improvement science2017In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 30, no 7, p. 617-627Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to address how adult development (AD) theories can contribute to quality improvement (QI).

    Design/methodology/approach

    A theoretical analysis and discussion on how personal development empirical findings can relate to QI and Deming's four improvement knowledge domains.

    Findings

    AD research shows that professionals have qualitatively diverse ways of meaning-making and ways to approach possibilities in improvement efforts. Therefore, professionals with more complex meaning-making capacities are needed to create successful transformational changes and learning, with the recognition that system knowledge is a developmental capacity.

    Practical implications

    In QI and improvement science there is an assumption that professionals have the skills and competence needed for improvement efforts, but AD theories show that this is not always the case, which suggests a need for facilitating improvement initiatives, so that everyone can contribute based on their capacity.

    Originality/value

    This study illustrates that some competences in QI efforts are a developmental challenge to professionals, and should be considered in practice and research.

  • 33.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson Bäck, Monica
    Gothenburg University.
    Financial incentives and motivation: "What we do is the same but how we do it is different"2016Conference paper (Other academic)
    Abstract [en]

    There is an ongoing debate in the scientific community whether financial incentives have unintended consequences, for example less internal motivation and damaged professional autonomy. Little is however known about the views among health care professionals in primary care. Early findings show that financial incentives are no source of motivation, but can act as drivers for innovative quality improvements.

  • 34.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    University of Gothenburg.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Leadership as a driver for work motivation: a study of well-functioning primary healthcare centers in Sweden2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Little is known about how, why, or under which circumstances work motivation is formed and linked to reforms and interventions.

    Aim: The aim of this study is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.

    Material & method: Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. Forty-three interviews were completed with different medical professions and qualitative deductive content analysis was conducted.

    Results: Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of nonhierarchical collaboration, and systematic quality improvement work. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. The units expressed a collective capacity to produce direction, alignment and commitment.

    Conclusions: The design of the reforms and leadership are essential preconditions for work motivation. Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection and quality improvement work. The values of the study consist of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms, and how professionals collectively produce leadership.

  • 35.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    University of Gothenburg.
    Research on successful and well-functioning organizations: The role of qualitative studies for theoretical and practical use. Workshop.2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Organizations strive to handle external and internal demands, and a lot is being written about the struggles and shortages. However, there are organizations that thrive, combining quality of performance and beneficial working conditions. What can we learn from these cases and how are the best studied? Also, how do we move beyond a list of good looking features that we already know are essential, such as leadership and continuous quality improvement work, in order to produce knowledge which is of practical use.

    Goal: This workshop takes point of departure in a study on well function primary care centers. The aim is to share our primary insights from this project and learn from it weaknesses and strengths to inspire to innovative, theoretical and practical meaningful research.

    Method: Six primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private/non-profit and small/large units. In total 56 interviews were completed with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants). At this time, four different qualitative analysis approaches have been used.

    Results/Conclusion: Each center reveals inspiring as well as challenging features. In the workshop, we will discuss how we can learn from studying good practice and design to further our understanding on sustainable healthcare and the use of qualitative methods in this context.

  • 36.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    De komplexa drivkrafterna inom vård och omsorg - en fallstudie av finansiella incitament och dess konsekvenser ur ett arbetsmiljöperspektiv: Slutrapport2017Report (Other academic)
    Abstract [sv]

    Olika ekonomiska drivkrafter och ersättningssystem används för att öka effektiviteten inom vård och omsorg. Forskningen visar dock att de ofta hamnar i konflikt med personalens motivation och normer. Studien har undersökt hur så kallade finansiella instrument påverkar patienters och anställdas upplevelse av arbetsmiljö och vårdkvalitet.

  • 37.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden2017In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, no 4, p. 487-502Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.

    Design/methodology/approach

    Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted.

    Findings

    Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers? positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created.

    Practical implications

    Leaders need to consistently translate and integrate reforms with the professionals? drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work.

    Social implications

    The design of the reforms and leadership are essential preconditions for work motivation.

    Originality/value

    The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

  • 38.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Literature review: Status and trends of research ethics in Swedish nurses' dissertations2010In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 17, no 3, p. 383-392Article, review/survey (Refereed)
    Abstract [en]

    Research ethics are increasingly formally regulated, but we know little about how ethical considerations are reported in dissertations. The aim of this literature study was to describe the status and trends of ethical considerations in Swedish doctoral dissertations written by registered nurses. A total of 77 dissertations from 1987, 1997, and 2007 met the inclusion criteria, and were analyzed by descriptive statistics. Ethical considerations were overlooked in 1987, but ubiquitous by 2007. All dissertations in 2007, except one, had a section on ethical considerations; however, these were short, lacking in references, and thin on content. The most common topic was informed consent and approval from research ethics review boards, followed by confidentiality and ethical aspects of methodological issues. Our results imply that the quantity and quality of ethical considerations must be improved, to assure ethical soundness for participants, patients, researchers, and society.

  • 39.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Status and trends of research ethics in Swedish nurses' dissertations2010In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 17, no 3, p. 383-392Article in journal (Refereed)
    Abstract [en]

    Research ethics is increasingly formally regulated, but little is known about how ethical considerations are reported in dissertations. The aim of this literature study was to describe the status and trends of ethical considerations in Swedish doctoral dissertations written by registerednurses. A total of 77 dissertations from 1987, 1997, and 2007 met the inclusion criteria and were analyzed by descriptive statistics. Ethical considerations were mostly overlooked in 1987, but almost ubiquitous by 2007. All dissertations in 2007, except one, had a section on ethical considerations; however, these were short, lacking in references, and short on content. The most common topic was informed consent and approval from research ethics review boards, followed by confidentiality and ethical aspects of methodological issues. Our results imply that the quantity and quality of ethical considerations must be improved in order to assure ethical soundness for participants, patients, researchers, and society.

  • 40.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Golino, Hudson
    Department of Psychology, University of Virginia, Charlottesville, VA, USA.
    Mining concepts of health responsibility using text mining and exploratory graph analysis2019In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 26, no 6, p. 395-410Article in journal (Refereed)
    Abstract [en]

    Background: Occupational therapists need to know about people’s beliefs about personal responsibility for health to help them pursue everyday activities.

    Aim: The study aims to employ state-of-the-art quantitative approaches to understand people’s views of health and responsibility at different ages.

    Methods: A mixed method approach was adopted, using text mining to extract information from 233 interviews with participants aged 5 to 96 years, and then exploratory graph analysis to estimate the number of latent variables. The fit of the structure estimated via the exploratory graph analysis was verified using confirmatory factor analysis.

    Results: Exploratory graph analysis estimated three dimensions of health responsibility: (1) creating good health habits and feeling good; (2) thinking about one’s own health and wanting to improve it; and 3) adopting explicitly normative attitudes to take care of one’s health. The comparison between the three dimensions among age groups showed, in general, that children and adolescents, as well as the old elderly (>73 years old) expressed ideas about personal responsibility for health less than young adults, adults and young elderly.

    Conclusions: Occupational therapists’ knowledge of the concepts of health responsibility is of value when working with a patient’s health, but an identified challenge is how to engage children and older persons. 

  • 41.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Golino, Hudson
    Universidade Salgado de Oliveira, Brazil.
    Hamer, Rebecca
    International Baccalaureate, The Hague, Netherlands.
    Van Rossum, Erik Jan
    University of Twente, Netherlands.
    Almers, Ellen
    Jönköping University, School of Education and Communication, HLK, School Based Research, Sustainable Development and Science education.
    Psychometric properties of the Epistemological Development in Teaching Learning Questionnaire (EDTLQ): An inventory to measure higher order epistemological development2016In: Frontline Learning Research, ISSN 2295-3159, Vol. 4, no 5, p. 22-54Article in journal (Refereed)
    Abstract [en]

    Qualitative research supports a developmental dimension in views on teaching and learning, but there are currently no quantitative tools to measure the full range of this development. To address this, we developed the Epistemological Development in Teaching and Learning Questionnaire (EDTLQ). In the current study the psychometric properties of the EDTLQ were examined using a sample (N= 232) of teachers from a Swedish University. A confirmatory factor and Rasch analysis showed that the items of the EDTLQ form a unidimensional scale, implying a single latent variable (eg epistemological development). Item and person separation reliability showed satisfactory levels of fit indicating that the response alternatives differentiate appropriately. Endorsement of the statements reflected the preferred constructivist learning-teaching environment of the response group. The EDTLQ is innovative since is the first quantitative survey to measure unidimensional epistemological development and it has a potential to be used as an apt tool for teachers to monitor the development of students as well as to offer professional development opportunities to the teachers.

  • 42.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Larsson, Maria
    Sutter, Silvia
    Självhushållningsfestival och nätverksskapande i Skärstad2015In: Tidningen Åter : forum för självförsörjning och alternativt boende på landsbygden, ISSN 1650-3546, no 4, p. 25-27Article in journal (Other (popular science, discussion, etc.))
  • 43.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Larsson, Maria
    Allmogegården.
    Sutter, Silvia
    Självhushållningsfestivalen i Huskvarna2014In: Åter:Forum för självförsörjning och alternativt boende på landsbygden, ISSN 1650-3546, no 4, p. 23-Article in journal (Other (popular science, discussion, etc.))
  • 44.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Ross, Sara
    Older persons’ reasoning about responsibility for health: variations and predictions2011In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 73, no 2, p. 99-124Article in journal (Refereed)
    Abstract [en]

    With many Western societies structured for adults to live longer and take responsibility for their health, it is valuable to investigate how older persons reason about this demand. Using mixed methods, this pilot studied how older persons reason about responsibility for health and their responsibility as a patient. Interviews with a small Swedish sample of (65-84 years) were analyzed for qualitative characteristics, and quantitative complexity in reasoning. Using adult development theory, we predicted at least three different stages of performance in reasoning. Results indicated four different stages: two where there is no actual reasoning about health and responsibility, and two where reasoning does occur, each qualitatively different. Results suggest a long-standing blind spot in health studies, that older people do not comprehend responsibility issues in the same way. There are significant implications for closing this gap between demand to take responsibility and capabilities to do so.

  • 45.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Ross, Sara N
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Research ethics in dissertations: ethical issues and complexity of reasoning2010In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 36, no 7, p. 425-430Article in journal (Refereed)
  • 46.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Sjölander, Per
    Akademi Norr, Storuman, Sweden.
    The level of development of nursing assistants' value system predicts their views on paternalistic care and personal autonomy2014In: International Journal of Ageing and Later Life, ISSN 1652-8670, E-ISSN 1652-8670, Vol. 9, no 1, p. 35-68Article in journal (Refereed)
    Abstract [en]

    The quality of care is substantially influenced by the staff‘s value priorities. The purpose of this study was to identify and characterize value systems among nursing assistants and nurses’ aides, and to assess relations between their value systems and views on good care. A cross-sectional, quantitative study in a Swedish municipality was performed (N226). Three distinct value systems were identified, and they corresponded to early (n121), middle (n88), and late (n17) conventional stages ofego development. Early conventional value systems emphasized strict rules, routines and working conditions of staff, while middle and, in particularly, late conventional value systems stressed individualization and autonomy of older people. Assessment of value system, socio-demographic, and occupational variables showed that the value systems had a stronger predictive impact on views on care ethics, participation, and autonomy. The results indicate that staff with late conventional value systems prioritized older persons’ exercise of autonomy, while paternalism held priority in staff with early conventional value systems.

  • 47.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Sjölander, Per
    Akademi Norr, Storuman.
    The relationship between nursing staff's value systems and their views on good care2014In: Age Well: Challenges for Individuals and Society. Program, 2014Conference paper (Refereed)
  • 48.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sjölander, Per
    Arctic Research Centre, Umeå University, Umeå, Sweden.
    Almers, Ellen
    Jönköping University, School of Education and Communication, HLK, School Based Research, Sustainable Development and Science education.
    McCall, Mary E.
    Samuel Merritt University, USA.
    Value systems among adolescents: Novel method for assessing level of ego-development2017In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 58, no 2, p. 150-157Article in journal (Refereed)
    Abstract [en]

    Children's value systems develop through youth and influence attitudes and actions. But there is a lack of appropriate measures for children and adolescents. The objective of this study was to construct and validate a questionnaire that reveals distinct value systems among adolescents, and to evaluate the identified value systems’ relationship to degree of ego-development and moral development. A quantitative study in a Swedish School with ages 12 through 16 (grades 6 to 9) was performed (N = 204). A set of pattern recognition statistical analyses has been used to identify different profiles of values systems and demonstrate that these systems can be arranged in a hierarchical order similar to other development. Results revealed three value systems in this sample. The identified value systems reflect different degrees of moral and ego-development among children in the study. Three distinct value systems were identified: the first (n = 9) and the second value systems (n = 35) correspond to pre-conventional stages, and the third value system (n = 155) corresponds to early conventional stages of ego development. Ego development scoring of test statements to assess stages. The value system was significantly related to moral development in the personal interest and the maintaining norms schemas of the Defining Issues Test (DIT). However, many students did not complete the entire DIT, so those results should be looked at with caution. It appears that this new test (Test for Adolescent Value Systems – TAVS) does relate to an established ego development rating scale.

  • 49.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Stålne, Kristian
    Malmö University.
    Adult development as a lens: Applications of adult development theories in research2017In: Behavioral Development Bulletin, ISSN 0934-2575, E-ISSN 1942-0722, Vol. 22, no 2, p. 266-278Article in journal (Refereed)
    Abstract [en]

    Adult development (AD) theories have a great potential for use in providing perspective and create new understanding of societal problems and challenges. The use of AD as a lens provides insights into people’s qualitative, different ways of thinking, talking, and acting. The theories are used by researchers and practitioners with various backgrounds in several different scientific domains. The aim of this article is to provide an overview of different approaches on how theories of AD are applied in research, with a focus on the potential of using it and how to eliminate the possibility of reproducing existing knowledge. The results consist of 6 approaches of how AD is currently presented and used in research: introductory work, creating and refining stages, making comparisons with established models, tracing the dynamics of promoting development, analysis of mismatches in adult life, and societal and organizational development. There are several promising avenues for future research by using a combination of these approaches as a way forward to promote the development of this scientific field.

  • 50.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Stålne, Kristian
    Institutionen för byggvetenskaper, Lunds Tekniska Högskola.
    Komplexitet för kvalitet i lärande och undervisning: bedömning av komplexa problem och studenters resonemang2011In: Högre Utbildning, ISSN 2000-7558, E-ISSN 2000-7558, Vol. 1, no 1, p. 15-26Article in journal (Refereed)
    Abstract [en]

    One of the aims of higher education is to teach students to solve complex problems, but what is the complexity of problems and the reasoning of students? The Model of Hierarchical Complexity (MHC) is a theory applicable to all domains in which information is organized and accounts for increases in behavioral complexity which includes cognitive or reasoning complexity. The paper is a theoretical introduction to MHC as a tool for teaching in higher education. The model clarifies and shows the gap between the complexity in the subject and the students understanding of the same subject. We also discuss how to support the development of more complex reasoning in students.

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