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  • 1.
    Thapa, Dip Raj
    Jönköping University, School of Health and Welfare, HHJ. ADULT. University of Skövde, Skövde, Sweden.
    A health-promotive approach to maintain and sustain health in women-dominated work in Nepal and Sweden2022Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The characteristics of women-dominated work differ in Nepal compared to Sweden. Women in Nepal perform household and other low-income work, including nursing, which is a women-dominated occupation in both Nepal and Sweden. Work-related adverse health outcomes, such as burnout, fatigue, depression, sleep disturbances, and long-term sickness absence, are evident in women-dominated work, especially within nursing. These challenges are accompanied by an increasing elderly population and a shortage of nursing personnel. Good health and well-being for all, improving working conditions and working environment, and providing adequate health and safety at work are the targets of sustainable development goals. Health-promotive actions and interventions are needed to maintain and sustain health in women-dominated work.

    Aims: The overall aim of this thesis was to identify means for promoting and sustaining health in women-dominated work in Nepal and Sweden through the evaluation and exploration of sense of coherence (SOC), work-related health, job demands, job resources, and health outcomes.

    Methods: This thesis includes five individual papers. Paper I is a community-based intervention study with a quantitative design conducted in Nepal. The participants were 857 women before and 1268 women after health education intervention in Nepal, who responded to a translated version of the SOC-13 questionnaire in Nepali. Papers II and III have a qualitative design and are based on 19 individual interviews with nurses in Nepal. Paper IV is also a qualitative study, based on 13 individual interviews with midwives and nurses in Sweden. Paper V is derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH). Data were collected in 2016–2019 for all papers. The quantitative studies were analyzed through descriptive statistics, chi-squared tests, one-way analyses of variance (ANOVAs), multivariable one-way ANOVAs, and logistic regression analyses. The qualitative studies were based on individual interviews, and the data were analyzed through qualitative content analysis and thematic analysis.

    Results: Women in semi-urban Nepal exhibited total SOC mean values between 51.1 and 57.4, which are comparable to India within a similar context. Qualitative validation of the SOC-13 questionnaire in Nepali was found to begeneral and not specific, and some translations were confusing. The SOC-13 items needed to undergo further editing in translation to increase their comprehensions. Nurses in Nepal and nurses and midwives in Sweden described their work experience as meaningful, and several experiences were partially similar; their work and health were reported to be strengthened through collegial support, teamwork, and opportunities for skills and competence development. Shift work, lack of rewards and appreciation from managers, low staff-patient ratios, and high workload affected their work-related health negatively. In particular, nurses in Nepal experienced a lack of a safe physical work environment and insufficient managerial support. Results from SLOSH-data showed that the nursing professionals’ job demands were associated with lower self-rated health, higher burnout, and higher sickness absence. Job resources were associated with higher self-rated health and lower burnout.

    Conclusion: This thesis shows that the SOC-13 questionnaire is useful and qualitatively validated for future use in the Nepalese context, to explore individuals’ overall life orientation and abilities to cope with various life events. Health education can be useful in strengthening SOC among women. To maintain, promote, and sustain health in women-dominated work, a health-promotive approach should be fostered. Nursing professionals’ health can be strengthened and sustained through the development of a positive work environment through good collegial, organizational, and managerial support, offering skills and competence development opportunities, and creating a safe physical and psychosocial work environment. Increasing job resources and minimizing job demands are important to increase positive health outcomes and decrease adverse health outcomes. Nursing professionals in Nepal and Sweden can also adopt strategies that support recovery and stress-management at work.

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  • 2.
    Thapa, Dip Raj
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, Skövde, Sweden.
    Ekström-Bergström, Anette
    Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, Skövde, Sweden; Department of Health Sciences, University West, Trollhättan, Sweden.
    Krettek, Alexandra
    Department of Public Health, School of Health Sciences, University of Skövde, Skövde, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    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). Faculty of Health Sciences, VID Specialized University, Sandnes, Norway; Department of Behavioural Sciences, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway .
    Support and resources to promote and sustain health among nurses and midwives in the workplace: A qualitative study2021In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 41, no 3, p. 166-174Article in journal (Refereed)
    Abstract [en]

    Registered nurses and midwives are in short supply and have among the highest rates of sick leave in the global workforce. The aim of this study was therefore to explore and gain a deeper understanding of how nurses and midwives experience their everyday work, with a view toward promoting and sustaining their work-related health. Nine registered nurses and four registered midwives working in hospitals and community healthcare facilities in Sweden were interviewed. The interviews were analyzed using content analysis. This study is reported in accordance with COREQ. One main category emerged: ‘Quality of organizational and collegial support and opportunities to facilitate recovery, health, and patient care’. From this category, four generic categories describing the overall experiences of registered nurses and midwives could be discerned. Based on these results, it is recommended that employers adopt a systematic health-promotive approach to foster and maintain the workplace health of registered nurses and midwives.

  • 3.
    Thapa, Dip Raj
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Krettek, Alexandra
    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).
    Ekström- Bergström, Anette
    Exploring nurses’ experiences of their work-related health in a Swedish context – A qualitative study2019Conference paper (Refereed)
  • 4.
    Thapa, Dip Raj
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Högskolan i Skövde, Institutionen för hälsovetenskaper; Forskningsmiljön hälsa, hållbarhet och digitalisering.
    Oli, N.
    Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal.
    Vaidya, A.
    Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal.
    Suominen, Sakari
    Högskolan i Skövde, Institutionen för hälsovetenskaper.
    Ekström-Bergström, Anette
    Högskolan i Skövde, Institutionen för hälsovetenskaper.
    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). Department of Behavioural Sciences, Faculty of Health Sciences, Oslo Metropolitan University, Norway; Faculty of Health Sciences, VID Specialized University, Sandnes, Norway.
    Krettek, Alexandra
    Högskolan i Skövde, Institutionen för hälsovetenskaper.
    Determination and Evaluation of Sense of Coherence in Women in Semi-urban Nepal: A part of the Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) Trial2021In: Kathmandu University Medical Journal, ISSN 1812-2027, E-ISSN 1812-2078, Vol. 19, no 1, p. 69-75Article in journal (Refereed)
    Abstract [en]

    Background

    Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals’ overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal.

    Objective

    To determine and evaluate women’s SOC before and after a health education intervention.

    Method

    This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban Jhaukhel-Duwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1-7 years. Eight hundred and fifty-seven women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests and one-way uni-variate ANOVA.

    Result

    Women’s total SOC mean values at baseline were 51.1-57.4 and at follow up 54.4-54.9 in the intervention and control area, respectively. At baseline, SOC was significantly weaker in the intervention area compared to the control area (p < 0.001). At follow-up three months later, SOC was significantly stronger in the intervention area than in the control area (p < 0.001).

    Conclusion

    Nepalese women had weaker SOC than women in high-income countries, but comparable to neighboring country India with similar cultural features. Empowerment of women through community participation and health education strengthened SOC. The SOC-13-questionnaire in its Nepali version is recommended to be further evaluated.

  • 5.
    Thapa, Dip Raj
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, Skövde, Sweden.
    Stengård, Johanna
    Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Ekström-Bergström, Anette
    Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University West, Trollhättan, Sweden.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Behavioural Sciences, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Faculty of Health Studies, VID Specialized University, Sandnes, Norway.
    Krettek, Alexandra
    Department of Public Health, School of Health Sciences, University of Skövde, Skövde, Sweden.
    Nyberg, Anna
    Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Job demands, job resources, and health outcomes among nursing professionals in private and public healthcare sectors in Sweden: A prospective study2022In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, no 1, article id 140Article in journal (Refereed)
    Abstract [en]

    Background

    Nursing professionals exhibit high prevalence of stress-related health problems. Job demands and job resources are parallel drivers of health and well-being among employees. Better job resources associate with better job satisfaction, job motivation and engagement even when job demands are high. To date, there is limited research which explores the association between job demands, job resources and health outcomes among nursing professionals in the Swedish context. The aim of this study was therefore to investigate Swedish nursing professionals’ job demands and job resources in relation to health outcomes, with comparisons between the private and public healthcare sectors. The specific research questions were as follows: (1) Are there differences between private and public healthcare regarding job demands, job resources, and health outcomes? and (2) Are there prospective associations between job demands and job resources in relation to health outcomes?

    Methods

    Data were drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2016 and 2018, including 520 nurses and 544 assistant nurses working in the private and public healthcare sectors from 2016 (baseline). Data were analyzed using binary logistic regression.

    Results

    Nursing professionals reported higher threats, lower bullying, lower control, lower social support, and lower cohesion in the public healthcare units compared to the private healthcare units. The prospective analyses showed that job resources in terms of social support and rewards were associated with higher self-rated health and lower burnout. Cohesion was associated with higher self-rated health. Job demands in terms of psychological demands and job efforts were associated with lower self-rated health, higher burnout, and higher sickness absence, while emotional demands were associated with higher burnout.

    Conclusions

    Nursing professionals’ job resources are deficient in public healthcare units. Job resources are associated with positive health outcomes, whereas job demands are associated with negative health outcomes, among nursing professionals. Strengthening job resources among nursing professionals in the private and public healthcare sectors can promote and sustain their work-related health.

  • 6.
    Thapa, Dip Raj
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, Skövde, Sweden.
    Subedi, Madhusudan
    School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal.
    Ekström-Bergström, Anette
    Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University West, Trollhättan, Sweden.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Behavioural Sciences, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Faculty of Health Studies, VID Specialized University, Sandnes, Norway.
    Krettek, Alexandra
    Department of Public Health, School of Health Sciences, University of Skövde, Skövde, Sweden.
    A qualitative validation of Nepali version of Antonovsky’s sense of coherence-life orientation 13-item questionnaire among nurses working in the hospitals of Kathmandu Valley in NepalManuscript (preprint) (Other academic)
  • 7.
    Thapa, Dip Raj
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, PO Box 408, Skövde, 541 28, Sweden.
    Subedi, Madhusudan
    School of Public Health, Patan Academy of Health Sciences, GPO Box 26500, Lalitpur, Nepal.
    Ekström-Bergström, Anette
    Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, PO Box 408, Skövde, 541 28, Sweden.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Behavioural Sciences, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, Oslo, 0130, Norway.
    Krettek, Alexandra
    Department of Public Health, School of Health Sciences, University of Skövde, PO Box 408, Skövde, 541 28, Sweden.
    Facilitators for and barriers to nurses’ work-related health: a qualitative study2022In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, no 1, article id 218Article in journal (Refereed)
    Abstract [en]

    Background: Work-related health problems, such as work stress, fatigue, and burnout constitute a global challenge within the nursing profession. Work-related health among nurses is not yet a prioritized phenomenon in Nepal. Health-promoting approaches to maintaining and sustaining nurses’ health are therefore essential. The aim of this study was to explore and thereby gain a deeper understanding of how nurses in Nepal’s hospitals experience their everyday work, with a focus on promoting and sustaining their work-related health.

    Methods: A qualitative design with semi-structured individual interviews were used. Nineteen registered nurses working at hospitals in Kathmandu Valley, Nepal, were individually interviewed between October 6 and December 5, 2018. Transcribed interviews were analyzed through thematic analysis.

    Results: Four main themes with belonging eight subthemes were constructed from the analysis: (1) “Sense of meaningfulness and belongingness in work culture” with subthemes; “Open environment” and “Sharing attitude and cooperating for the entire team” (2) “Support and rewards from the management team” with subthemes; “Lacking managerial support” and “Fair evaluation and job promotion opportunities”(3) “Workload and protection against work-related hazards” with subthemes; “Stressful and multitasking in workload” and “Lacking equipment for own health and caring”, and (4) “Motivation through opportunities and activities” with subthemes; “Employment benefits that motivate work”, and “Activities outside of work needed to recover”. These main themes and subthemes described nurses’ facilitators for and barriers to their work environment and health.

    Conclusion: Our study highlighted nurses’ experiences with facilitators and barriers to their work-related health. Nurses’ work-related health was positively affected by support from colleagues, managers, and the organization. Conversely, less support from managers, lack of equipment, and unfair judgment were barriers to nurses’ work-related health. This study adds new knowledge about nurses’ work-related health from the context of Nepal. Hospital organizations and nursing managers in similar cultural and healthcare settings can apply the results of our study to develop strategies to promote and sustain nurses’ health and prevent work-related illness.

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