Mina publikationer i diva

  • Small children’s engagement in care procedure involving venepuncture
  • Being a child in the family : Young children describe themselves and their parents who have participated in universal parenting training
  • Förhållandet teori och praktik inom omvårdnadsverksamhet : Att tillägna sig personlig yrkeskunskap och praktisk erfarenhet och konsekvenser för handledning under klinisk praktik inom sjuksköterskeutbildning
  • Nurses' empowering of Parents in Pediatric settings : A conceptual analysis
  • Encountering Parents : Professional Action Styles among Nurses in Pediatric care
  • Families Participation in Paediatric care challenge nurses differently – Transcultural studies.
  • Lyssnar vi på barnen inom hälso- och sjukvården? : Barns bästa - Barns röst
  • Mozambican Nurses’ Beliefs and Practice regarding Family Involvement in Hospital Care.

    This study describes nurses’ beliefs and practice regarding family involvement in the care of hospitalised children in Mozambique. Cultural circumstances influence nurses’ everyday practice that is shaped by community culture, organisational hospital culture, nursing culture with a personal view of generic care captured by traditions in families and a professional view of care learned through nursing training. Influences of the institutional culture of a workplace and values inherent in medical science complicate relations in health care settings. The social understanding within a specific workplace with its special characteristics implies that staff share beliefs and ideas as ‘common thinking,’ which then influences the way they understand and act in everyday situations. In order to address social-cultural conditions and shared thinking we investigated Mozambican nurses’ beliefs and practice regarding family involvement in the care of hospitalised children. Ethnographic fieldwork was used to explore nurses’ involvement of family members in their everyday work. The data production consisted of field descriptions from observations and interviews with 36 nurses. Qualitative content analysis was used. The findings show that nurses’ practice of family involvement reflects a society that is poor, hierarchical, family-oriented but at the same time still adaptive. Four themes were identified: family members’ presence in order to assist the nurses in the caring, nurses’ support and education of family members to be involved in the caring, nurses’ shielding of family members from family involvement and difficulties and conditional dilemmas in the nurses’ involvement of families. In conclusion the authors state that emphasising culturally congruent nursing care is necessary if Mozambican families’ way of life is to be accommodated. However, to empower family involvement, the nurses themselves need to be empowered. The desired opportunity for nurses to develop culturally congruent family involvement is also closely connected to community awareness and empowerment of children’s rights.

  • Using video-technique to capture preschool children's participation


    Exploring preschool children’s actions to reveal the way they participate in health care situations is a methodological challenge. This challenge lays in capturing children’s expressions, spoken words and body language. Using video technique during observation offers an opportunity to reveal small changes in children’s expressions that might be failed to secure when using the human eye solely. However, video observation is not only about pushing the ‘rec-button’. It requires both methodological and ethical considerations in advance: What is to be in focus during the video observation? What decides when each observation begins and ends? How much time must be devoted for fieldwork and complementary work? Further, the researcher needs to get informed consent from everyone involved. Constant reflexivity during the initial phase, video observations, transcriptions and analysis is also important as the researcher’s presence will influence the final outcome. When transcribing, the researcher’s predetermined focus guides the selection about what to transcribe. To accomplish a selection when transcribing is necessarily to not get lost in the gathered data. The opportunities to see the same sequence several times and to share the observations with a more experienced researcher can contribute to trustworthiness. Therefore, to describe and discuss video observation as a methodological issue is important. Video observations provide rich and thick information that can bring understanding to children’s participation in a detailed and varied way.

  • Care of hospitalized children in Mozambique : nurses' beliefs and practice regarding family involvement

    This study aims to describe nurses' beliefs and practice regarding family involvement in the care of hospitalized children in Mozambique. Ethnographic fieldwork was used. The data production consisted of field descriptions from observations and interviews with 36 nurses. Through qualitative content analysis the findings show that nurses' practice of family involvement reflects a society that is poor, hierarchical, family-oriented but at the same time still adaptive. Four themes are identified: family members' presence in order to assist the nurses in care; nurses' support and education of family members to be involved in care; nurses' shielding of family members from family involvement; difficulties and conditional dilemmas in the nurses' involvement of families. It is concluded that emphasizing culturally congruent nursing care is necessary if families' way of life is to be accommodated. However, to empower family involvement in everyday practice, the Mozambican nurses themselves need to be empowered.

  • Empowerment and empowering skills
  • Family centred care: illusion, rhetoric or reality?

    Overview of symposium

    Family centred care has been promoted as the ideal way to structure the nursing care of sick children and their families and is seen as a key principle in children’s health care provision globally. The involvement of parents in the delivery of care is seen as leading to positive outcomes both for the child and family. Although parent participation has been promoted for several decades, been formalised in numerous government policy documents, and embraced by health professionals in hospital and community, it remains a difficult concept to operationalise. There is discrepancy between what is espoused and what is actually practiced. There is confusion about the concept and inconsistent application in practice in hospital and community healthcare settings. The purpose of this symposium is to present a considered critique of family centred care which will be of use to practitioners and educators and which will provide a forum for debate and collegiality. The key objectives are:

    1. To highlight the idealised notion of FCC and challenge current assumptions of FCC.

    2. To contrast the idealised version with reality, drawing on our research (experiences from England, Sweden, Mozambique, Australia, Indonesia, Thailand) to substantiate the content

    3. To discuss how FCC is about survival, obligation or choice.

    4. To suggest ways in which FCC may be implemented to provide a firmer basis for development and evaluation of practice.

    The symposium will consist of four related presentations that focus on family centred care and with the opportunity for participants to make both written feedback/response to the papers and to join in a discussion with the presenters.

    Presentation 1: ‘The elephant in the room?’ Professor Bernie Carter

    Family centred care is part of our psyche, part of our professional raison d’être. Children’s nurses are not actually born hard-wired to believe in family-centred care but the wiring is laid down early in our education and its centrality to our way of working and being with families continues to be emphasised. However, there is a paradox at the heart of FCC: we all believe that it is good but there is no ‘hard’ evidence (and not much ‘soft’ evidence) that demonstrates that it is effective. Despite this we ‘know’ that it is good, we promulgate it as a way of working – perhaps because we can’t think of anything else that’s better. In this paper, Bernie intends to problematise and question our faith in FCC and provide a stepping off point for my fellow presenters’ papers.

    Presentation 2. Professor Imelda Coyne

    The pendulum of parent participation has swung from excluding parents in the past to making parents feel total responsibility for their child in hospital. Imelda will illustrate how parents want to stay with their hospitalised child (in varying ways) primarily because of concern for their child’s welfare but then feel compelled to be there because of nurses’ expectations. Nurses controlled the nature of parents’ participation and parents had to ‘toe the line’. Although participation was presented as optional, parents were presented with no course other than acceptance. Parents were expected to stay with their child, behave properly and be involved in care. When certain parents did not adhere to these norms, they caused disruption to the order and routine of the ward. The dominant process appeared to be the socialisation of parents to their role on the ward through inclusionary and exclusionary tactics. The results from this research (from UK & Ireland) indicate that the current models or theories on parent participation/ partnership are inappropriate or inadequate because they do not address important elements of children and parents’ experiences in hospital. The impact of the burden of caring and providing a consistent presence on parents and their families could be considerable and adversely affect parents’ welfare in the long term.

    Presentation 3 Dr Maja Soderback

    Maja will illustrate how participation or mutuality are co-created by nurses and the involved family caregivers during a child’s hospitalization. The situated actions are culture bound and different professional cultures struggle with tradition of family caregivers’ involvement as well as different work conditions. Maja will draw on data from two studies (from Sweden and Mozambique) to provide insights into the nurses’ mastering of their everyday encounters with family caregivers during a child’s hospitalization. The studies used ethnography with participant observations and interviews. The fieldwork in Sweden occurred at three paediatric wards. One or more caregivers from a family were living-in with their children 0-18 years with various illnesses. Five paediatric wards were included in Mozambique. The age of the hospitalized children varied between 0-7 years, with various illnesses. All children mostly had one family caregiver living-in with them. The conclusions demonstrate how a nurse interacts with family caregivers, and how he or she must be focused on intention and action in a specific situation, context and culture of life, and work conditions. Also important are the nurse’s beliefs about what constitutes both nursing and parenting, and the rights of children.

    Presentation 4. Professor Linda Shields and Dr Jan Pratt

    There are myths and misconceptions about family-centred care, and Linda and Jan will “bust” some of these based on work in developing countries. Also, they will describe the Cochrane systematic review of FCC that they undertook, explaining the inclusion and exclusion criteria for studies and the rationale behind them. The aim was to find studies that might show whether or not FCC really works. The results showed that at this stage, there is no evidence either way. From this, they will postulate that families' experiences of FCC are driven by survival, obligation or choice, and add this to the mix of discussion that will be an important part of this seminar.

    Conclusion and Discussion. Professor Bernie Carter

    In conclusion, Bernie will synthesise the core concepts presented in each of the four papers. These concepts will act as triggers for the discussion with the symposium participants with the aim of trying to further our understanding of FCC.

  • Let me give my own expressions for participation! : Small Children’s Expressions of Engagement in Procedures at a Day Care Unit in Sweden

    In Sweden the Health and Medical Services Act emphasises that patients’ knowledge should be respected and patients should participate and have influence over what happens to them. For hospitalized children we have standards in order to safeguard their needs. There is an adult interest in children’s safety during hospitalizations. Parents play an important and significant role in their child’s recovery and healthy development. Likewise nurses find it important to inform and prepare children and work in trustful relationships with parents. With the best of intentions adults want to advocate for the small child and consider themselves as competent to convey the child’s perspective. But, having a child-focus in situations is not the same thing as obtaining the child’s perspective. According to the Child Convention, even small children have the right in every situation to voice their needs and to be listened to from their own competence and experience. This study aimed to research small children’s (3-6 years old) expressions of activities (action and voice) as participation in situations on a paediatric day care ward.

    The method was qualitative using the video technique. After informed consent was obtained from the parents and the children (n=10) they were followed by the video camera while they interacted with the nurses in a variety of situations. The transcribed material was analyzed through qualitative latent content analysis.

    The analysis is still in process, but a preliminary result shows that the small children express their wish to participate with activities in a prolonged time consuming process.

  • Preschool children's expression of participation in Primary Child Health Care

    Preschool children's expression of participation in primary child health care


    According to The Convention on the Rights of Child children have the right to have their voice heard and to participate in situations that involve them.

    Aim of the study

    The aim of this study was to explore and describe the expression of participation of 3-year old children during their annual primary health care visit.


    The study employed qualitative research design using video-observation, and focused on the actions of twenty-nine 3-year olds in their interaction with the nurse. The varying expressions of the children were captured using hermeneutic analysis.


    The findings demonstrate how 3-year old children prepare themselves for particiaption prior to their health care visit. They arrange their bodies in different positions, ask questions, seek contact with their parent or are absorbed in their thoughts. The children then direct their attention towards the health care activity, by using bodily and/or spoken expressions they respond to the nurse´s invitations. When the children have replyed to the invitation they confirm them self. Findings also show children´s expressions of unpreparedness and reluctance in the health care situation.

    Conclusion / discussion

    Children’s participation occupies either all or part of the body and bodily expressions replace each other in a rapid progression. Children´s spoken expression strengthens their bodily expression.

    Practical relevance

    Studying pre-school children’s expressions in the child health care environment can contribute to promote their participation in their interaction with nursing staff.

    Research implications

    This research project will continue by studying the expression of perceived participation of children at 4 and 5,5 years of age during their annual primary health care visit.


    Allmark, P. (2002). The ethics of research with children. Nurse researcher, 10 (2), 7-20.

    Bronfenbrenner, U. (1979). The ecology of Human Development. Cambridge, Mass. Harward university press.

    FA, Ministry for Foreign Affairs, (1989). The Convention on the Rights of the Child.

    Fraser, S., Lewis, V., Ding, S., Kellet, M. & Robinsson, C. (2004). Doing research with children and young people. London: Sage Publications.

    Hammersley, M. & Atkinson, P. (1995). Ethnography. Principles in Practice. London: Routledge

    Ministry for Health and Social Affairs. (2005). Mötet med barnet. Barnkompetens inom hälso-och sjukvården. 2005.031

    National Board of Health and Welfare. (1991). Allmänna råd från socialstyrelsen 1991:8. Hälsoundersökningar inom barnhälsovården. Stockholm: Allmänna förlaget.

    Schutz, A. (1967). The phenomenology of the Social World. Evanston: North-western Univ. Press.

  • Family involvement in the care of a hospitalised child : a questionnaire survey of Mozambican family caregivers.

    BACKGROUND: Previous research from Western and Eastern countries shows that parents of a sick child want to be involved and to participate during a child's hospitalisation. However, the stay can be stressful and parents have their own needs. Conditions and cultural constructs are different among countries. No published study on parents' or close family caregivers' involvement and participation during paediatric hospitalization has been found for an African population. OBJECTIVE: The aim of this study was to articulate Mozambican family caregivers' expressed needs, expectations and experiences of hospital care and hospital staff. SETTING AND PARTICIPANTS: The study was conducted at the Paediatric Clinic at the Central Hospital in Maputo, Mozambique. A sample of 100 family caregivers was chosen, representing one third of all family caregivers of hospitalised children over a one-month period. DESIGN AND METHOD: A cross-sectional study was conducted, using a questionnaire. RESULTS: Participating Mozambican family caregivers have, for the most part, a low level of education and reduced socio-economic conditions. This made the admission to and the time in hospital hard to cope with, and difficult for them to understand. The study showed that they were badly informed of anything to do with hospitalisation. They needed explanation and support to make the hospital situation less intimidating. Hospital staff's behaviour was to some extent characterised by attentiveness, kindness, and sympathy, but it was also shown that the family caregivers had experiences of communication difficulties and of being neglected. CONCLUSION: The result, in this Sub-Saharan African context, shows that parents or family caregivers have a desire to be involved in the care of their hospitalised child, much the same as has been shown in studies in Western and Eastern countries. But Mozambican family caregivers' expectations, needs and experiences are rooted not only in poverty, their household situation and the health system, but also in the hierarchical construct of their culture. All these factors influence their communication and relationships. Hospital staff is perceived to be superior. To empower the family caregivers to take part in the caring process in a cultural sensitive way is therefore of great importance.

  • We are the First Doctors Here at Home: : Women’s Perspectives on Sanitary Conditions in Mozambique

    Lack of sanitation is an important public health issue in low-income countries. Globally, the lack of sanitation affects some 2.8 billion people, mainly the poor, women and children. The people affected are deprived of their dignity and at risk for several severe diarrheal diseases. However, improvements are often hindered by the fact that human excrement is a sensitive issue, and feasible solutions fail to consider cultural and gender issues.

    With this background, this chapter focuses on women’s sanitary conditions in a rural African village (Mozambique). An ethnographic approach was used to investigate the everyday sanitary conditions, understood through a theoretical framework of equity in health, and gender was used for understanding. During a two-month stay in the village, women in three households were followed and observed in their everyday work to explore the sanitary prerequisites. Furthermore, official and traditional leaders in the village were interviewed about their perceptions of the women’s sanitary situation.

    The findings show that every woman and her family members are obligated to deal with their human waste on an individual basis, creating solutions mostly from what could be obtained free within the confinements of their yard. This unhygienic situation rendered the women fearful of disease and accidents, especially for their children, resulting in both psychological and physiological discomfort. Maintaining sanitation was female work. However, only men were allowed to build new latrines, causing difficulties for the many women without husbands. Several positive forces also existed: openness, interest, knowledge and an already existing net of community development. Improvements are instead held back by poverty and gender disparities, depriving women of control over their own home and health.

  • Mälardalen encontra-se com Maciene : - 9 estudos universatarios
  • Four year old Children’s strategies of negotiation when they are holding a Primary Child Health Care situation

    Four year old Children’s strategies of negotiation when they are holding a Primary Child Health Care situation

    The Swedish Primary Child Health Care (PCHC) is assigned to promote children’s (age 0-5) health and development through regular health visits. A child’s first year involves several health checkups, then planned health visits take place at 3, 4 and 5,5 years of age. These health visits is a part of a monitory program to examine the child’s speech development, motor and cognitive functions. During the health visit the child and the parent will meet a PCHC nurse. Recently, the child’s perspective as an actor in the health visit was explored. The result demonstrated how three year old children exhibit various actions in a progression of states. The child progress from a state of getting ready to a state of being ready and further to a state where the child strengthens the own self. This progression is dynamic and coloured with the states of not being ready or of being adverse. The aim of present study is to describe the four year old children’s strategies when they are holding a PCHC situation. The study has an explorative design with a hermeneutic approach and video-observations are used. Twenty-nine children participate and the selection is strategically. Informed consent was gained in writing from all children, parents and nurses. The findings exhibit how the children use various strategies of negotiation when they are holding a PCHC situation. Illuminating children’s perspective by conceptualizing their expressions and strategies may contribute towards encouraging the PCHC nurse’s sensitivity when inviting and guiding children in the health visit.

  • Hur uttrycker små barn sin delaktighet vid hälsobesök och i vårdsituationer?

    Hur uttrycker små barn sin delaktighet vid hälsobesök och i vårdsituationer?

    Att ha möjlighet att ge uttryck för sitt perspektiv i alla situationer innebär att få vara delaktig vilket hör till ett barns rättigheter. Att fånga barns perspektiv vid ett hälsobesök inom Barnhälsovården eller i en vårdsituation är att ge barnet möjlighet att uttrycka sin kompetens och att göra sin röst hörd. Barn uttrycker sitt perspektiv med kropp (gester, ansiktsuttryck och kroppsrörelser) och röst (tal, ljud). För små barn som ännu inte utvecklat språkets förmåga fullt ut är kroppen viktigt redskap i interaktion med andra. Med sin kropp visar barnet sina intentioner och handlar därefter vilket också påverkar andra i samma situation. Barnets mognad och erfarenheter avgör med vilka uttryck barnet agerar situationsanpassat.


    Vi har använt videoobservationer för att upptäcka barns uttryck när de deltar i aktiviteter inom hälsobesök eller i vårdsituationer. Dessa har analyserats för att söka förståelse utifrån barnets perspektiv.


    De varierande uttryck som treåriga barn visade i en hälsobesöksituation formade deras handlingar i en progress av olika tillstånd. När barnet inbjuds av sjuksköterskan att delta i en aktivitet rörde det sig från ett tillstånd att göra sig redo, till att vara beredvillig, och vidare till ett tillstånd där det bekräftade sig självt. I denna progress visade sig även tillstånd då barnet inte var redo eller var avogt inställd.


    I vårdsituationer med treåriga barn visade barnen uttryck som formade en progress av engagemang på varierande sätt. Efter att ha fått någon form av inbjudan till en aktivitet visade barnen vaksamhet. Denna vaksamhet övergick vidare antingen till ett nyfiket engagemang eller till ett engagemang av följsamhet.  Efter inbjudan och visad vaksamhet med fortsatt misstro mot aktiviteten kunde dock sjuksköterskan och/eller förälder påtvinga barnet till att visa ett motsträvigt engagemang vilket ibland övergick till att barnet visade resignation. 

    Att tydliggöra barns uttryck, handlingar, tillstånd och engagemang i olika situationer inom hälso- och sjukvård kan medverka till att utveckla vårdpersonalens lyhördhet för vad som är barnets perspektiv i sitt arbete för att se till barnets bästa, vilket är intentionen för hur konventionen om barns rättigheter förverkligas och implementeras.

  • Empowering skills to improve Family Nursing in Children's care : - Innovation in a global perspective

    A family interest all over the world is their child’s safety. Family caregivers play a significant role in their child’s recovery. Family involvement has been promoted for decades and been formalized in numerous policy documents. These documents have been embraced by health professionals. Current research demonstrates that nurses find it important to work in trustful relationships with families. Nevertheless, involvement on behalf of a family’s needs and wishes still remains difficult to realize in everyday care. Research demonstrates a discrepancy between what family involvement is supposed to contain and what is actually practiced and experienced by families. Ethnographic research at pediatric wards with different conditions and cultures (Sweden and Mozambique), describe family’s needs and experiences as well as nurses’ beliefs and everyday practice of family involvement. Even though nurses use different tactics or action styles, the dominant process in both Swedish and Mozambican nursing care is a socialization of family caregiver to an expected role on the ward. However, some nurses used skills with empowerment characteristics. The objective is to challenge the skill pool for quality of care in children’s nursing in a global perspective. Different action styles among nurses encountering parents will be described and compared with emphasis on the concept of empowerment and what empowering skills mean in nurses’ actions of family involvement. I will illustrate how involvement and participation is co-created in encounters, in interaction between nurses who use empowering skills and families in need of support. Empowering skills will improve family involvement in children’s nursing.

  • Exploring three-year-old children in a primary child health care situation

    In the Swedish Primary Child Health Care (PCHC) children participate in regular health visits. In these visits children as actors demonstrate their subjective maturity through bodily and verbal expressions. The aim of this study was to explore three-year-old children's expressions when they take part as actors in a PCHC situation. An explorative design with a hermeneutic approach and video observations was used. Twenty-nine children participated. The findings exhibit a variation of expressions in the situation conceptualized as actions in a progression of states: from a state of getting ready to a state of being ready and further to a state where the child strengthens their own self. This progression is dynamic and coloured with the states of not being ready or of being adverse. The conceptualization of children's expressions can contribute towards encouraging nurses' sensitivity when inviting and guiding children in PCHC situations.

  • Barns och ungas rätt i vården
  • Barnperspektiv eller Barnets perspektiv
  • Methodological issues when conducting research with children and adolescents : i The use of videotechnique in observing children's expressions of actionsii The use of drawings and pictures as participatory methods to encourage children to tell about their perceptions on a specific theme.iii The use of focusgroup interviews with children and adolescents.

    Methodological issues when conducting research with children and adolescents

    Maja Söderbäck, Marie Golsäter, Maria Harder,

    CHILD Research Group, Sweden

    This symposium will focus on methodological issues and challenges using different techniques in qualitative research when conducting research with children and adolescents in health care. The session will consist of three linked presentations that:

    1. Provide experiences of using video technique in observing children’s expressions of actions.  
    2. Provide experiences of using participatory methods such as drawings and pictures to encourage children to tell about their perceptions on a specific theme.
    3. Provide experiences from focus group interviews with children and adolescents.


    The concluding discussion will focus on methodological issues related to children´s competence to bodily and verbally express their wish, experiences, motivation and feelings, when using these techniques. Also, research findings from these techniques will be discussed. Furthermore, ethical considerations and the researchers’ interpretation of the children´s perspectives are issues demanding reflections.

    i  The use of video technique in observing children’s expressions of actions  


    Maja Söderbäck

    School of Health, Care and Social welfare, Mälardalen University, Sweden

    Maria Harder

    School of Health, Care and Social welfare, Mälardalen University and Department of Women’s and Children’s Health, Karolinska Institutet, Sweden


    Video technique is found to be useful in qualitative research when the interest is to explore young children’s expressions of actions in situations where they participate as actors with parents and health care professionals. Through this technique the whole situation and the child´s varying and detailed expressions are captured. Thus the use of video provides the opportunity to capture the child’s subjective perspective. The researcher’s role is to be objective and follow the child in the course of the situation without interference.

    Further, the video technique allows the researcher to study a child’s expressions several times during the analysis, and to reflect and validate with co-researchers. However, the interpretation of the children's expressions of actions needs to be guided by the intention to understand the children’s perspectives.

    This presentation will demonstrate issues related to the use of video technique when observing children three to five years of age during health visits in a Primary Child Health Care situation and in a care procedure involving venepuncture. Further, discussion concerning analysis of the gathered data with respect for children´s competence to bodily and verbally express their wish, experiences, motivation and feelings will be brought up.


    1. ii.                  The use of drawings and pictures as participatory methods to encourage children to tell about their perceptions on a specific theme

    Maria Harder

    School of Health, Care and Social welfare, Mälardalen University and Department of Women’s and Children’s Health, Karolinska Institutet, Sweden

    Maja Söderbäck

    School of Health, Care and Social welfare, Mälardalen University, Sweden

    The movement from doing research on children to do research with children within the health care area challenges researchers to use participatory methods. The use of drawings and pictures are such participatory methods which allow children to share their perceptions and experiences of a situation. Drawings and pictures are familiar from children’s every-day-lives and suit their competence. Furthermore, the use of drawings and pictures facilitate the interaction between the child and the researcher. To let children make drawings about a specific theme and tell about them announce the children as experts and that their perceptions and experiences are valuable. The use of pictures makes a theme well-defined for the children and will make it easier for them to associate and talk unconstrained. The combination of various participatory methods in one data-collection might contribute to detailed descriptions of children’s perceptions about a phenomenon. This presentation will demonstrate a combination of participatory methods which have contributed to grasp children’s perceptions of various situations as for example going through a vaccination. The presentation will further bring up methodological issues related to the use of participatory methods and the analysis of grasping children’s perceptions with respect to their competence.



    1. iii.                The use of  focus group interviews with children and adolescents

    Marie Golsäter

    School of Health Sciences, Jönköping University, Sweden.

    Karin Enskär

    School of Health Sciences, Jönköping University, Sweden.


    According the Convention on the Rights of the Child, children and adolescents have the right to be heard in matters concerning them. Focus group interviews is a useful way to voice children's and adolescent's perspectives. The interaction that occurs in a focus group can contribute to new dimensions of a topic from the participant’s perspective and contributes to the exploration of perspectives that might remain undetected in one to-one interviews.

    Focus group interviews might also encourage children and adolescents to express their own view instead of answering in a way they believe the interviewer wants them to answer. One disadvantage could be that those not comfortable taking part in groups may choose not to participate or might have no chance to express their experiences.

    This presentation will demonstrate the methodological issues revealed during focus group interviews with children and adolescents regarding their experiences of health and life style dialogues with the school nurse. Issues such as performing focus groups interviews with participants in various age groups, the size of the group and the use of mixed or unisexual groups will be brought up.


  • Ethnographic research to get understanding beyond family involvement of hospitalized children – Sweden and Mozambique


    This study assumes that all human interaction is fundamentally social and that nurses, on the basis of their knowledge, organize their professional work and interact in sense that is meaningful to them in different situations. Current research shows that nurses find it important to work in trustful relationships with family caregivers during their child’s hospitalization. Family involvement is formalized according to cultural circumstances that is shaped by community culture, organisational hospital culture, nursing culture and view of generic care captured by traditions in families and a professional view of care learned through nursing training. The social understanding implies that  staff share beliefs and ideas as ‘common thinking,’ which influences the way they act in everyday situations.


    To explore nurses’ beliefs and practice regarding family involvement in the care of hospitalised children in Sweden and Mozambique.


    Ethnographic fieldwork was used, with a combination of participant observation, reflective talks and interviews. The subjects in Sweden were 30 nurses and in in Mozambique 36 nurses. The observations of each nurse in their daily interaction with family caregivers and their children were followed by an interview. Constant comparative analyses were used to construct themes of action strategies and beliefs.


    The findings show that nurses’ practice of family involvement reflects the conditions in the society. However there are similarities in nurses’ beliefs and strategies in everyday practice. Even though the nurses use different action styles when encountering family caregivers, the dominant process in both Sweden and Mozambique was a socialization of the family caregivers to an expected role on the hospital ward. However some nurses used skills which revealed empowerment characteristics. The opportunity for nurses to develop culturally congruent family involvement is closely connected to community awareness, nurses’ empowerment and children’s rights.


  • The Use of Drawings and Pictures as Participatory Methods to Encourage Children to Tell About Their Perceptions on a Specific Theme
  • The Use of Video Technique in Observing Children's Expressions of Actions
  • Mälardalen möter Moçambique : fältstudier som processorienterat kunskapsarbete
  • Nurses' experiences of managing sick listing issues in telephone advisory services.
  • Drivers' and conductors' views of causes and prevention of workplace violence in the road passenger transport sector in Maputo city, Mozambique


    Workplace violence (WPV) is an occupational health hazard in both low and high income countries. To design WPV prevention programs, prior knowledge and understanding of conditions in the targeted population are essential. This study explores and describes the views of drivers and conductors on the causes of WPV and ways of preventing it in the road passenger transport sector in Maputo City, Mozambique.


    The design was qualitative. Participants were purposefully selected from among transport workers identified as victims of WPV in an earlier quantitative study, and with six or more years of experience in the transport sector. Data were collected in semi-structured interviews. Seven open questions covered individual views on causes of WPV and its prevention, based on the interviewees' experiences of violence while on duty. Thirty-two transport professionals were interviewed. The data were analyzed by means of qualitative content analysis.


    The triggers and causes of violence included fare evasion, disputes over revenue owing to owners, alcohol abuse, overcrowded vehicles, and unfair competition for passengers. Failures to meet passenger expectations, e.g. by-passing parts of a bus route or missing stops, were also important. There was disrespect on the part of transport workers, e.g. being rude to passengers and jumping of queues at taxi ranks, and there were also robberies. Proposals for prevention included: training for workers on conflict resolution, and for employers on passenger-transport administration; and, promoting learning among passengers and workers on how to behave when traveling collectively. Regarding control and supervision, there were expressed needs for the recording of mileage, and for the sanctioning of workers who transgress queuing rules at taxi ranks. The police or supervisors should prevent drunken passengers from getting into vehicles, and drivers should refuse to go to dangerous, secluded neighborhoods. Finally, there is a need for an institution to judge alleged cases of employees not handing over demanded revenues to their employer.


    The causes of WPV lie in problems regarding money, behavior, environment, organization and crime. Suggestions for prevention include education, control to avoid critical situations, and a judicial system to assess malpractices. Further research in the road passenger transport sector in Maputo City, Mozambique and similar settings is warranted.

  • The importance of including both a Child perspective and the Child's perspective within Health Care settings to provide truly Child centred care.

    The UN Convention on the Rights of the Child (1989) asserts the right of every child to self-determination, dignity, respect, non-interference, and the right to make informed decisions. The provision of quality care in health services tailored to children's preferences means that health professionals have a responsibility to ensure children's rights, and that the child is encouraged and enabled to make his or her view known on issues that affect them. This paper will help illuminate and differentiate between a child perspective and the child's perspective in health care settings. The issues are supported with research which illustrates the different perspectives. Both perspectives are required to perceive and encounter children as equal human beings in child-centred health care settings.

  • Five-year-old Children's Tuning-in and Negotiation Staregies in an Immunization Situation

    In this article, we have explored 5-year-old children's expressions when they as actors took part in an immunization situation in the Primary Child Health Care (PCHC) service in Sweden. Although children's health and development are the main concern in the PCHC service, their perspectives in such a setting have not been explored fully. To capture children's perspectives we used a hermeneutic design and video observations. The findings revealed children as competent and active participants, contributing to the construction of the PCHC situation in mutuality with the nurse and the parent. The conceptualization of children's expressions and actions revealed how they influenced and dealt with a PCHC situation by using strategies of tuning-in, affirmative negotiation, and delaying negotiation. Understanding children's actions will assist nurses to act with sensitivity when they encounter and support children.

  • Perceptions of the use of khat among Somali immigrants living in Swedish society

    Aims: The aim of this study was to gain a better understanding of Somali immigrants’ perceptions of the use of khat living in Swedish society. Using khat is illegal in Sweden

    Methods: A phenomenographic design was used to capture different perception of using khat. Fourteen interviews were conducted with both men and women. The information was subjected to phenomenographic analysis.

    Findings: Perceptions of the habit of chewing khat among Somalis living in Sweden vary. The use of khat is perceived as a kind of food or as a drug. To use khat is perceived as having a physical impact on individual health, as well as an impact on social and family life. Using khat also has an impact on people’s time, because time is needed to indulge the habit. Furthermore, using khat is perceived as a medium for cultural and community cohesiveness. The Somalis prefered preventive measures in place to counter the use of khat in Sweden

    Conclusions: The use of a phenomenographic design which captured the variation in perceptions of the habit of using khat among Somali immigrants’ living in Swedish society is helpful in guiding individual strategies in health promotion activities.

  • Kangaroo Mother Care in a Mozambican Perinatal ward : A Clinical Case study

    Kangaroo mother care (KMC) was first introduced in Mozambiquein 1984. The aim of this study was to describe Mozambicanmothers’ experiences of going through admission, passing froman intensive care ward to a nursery ward with their prematurebaby, undergoing KMC training before early discharge. A clinicalcase study was conducted, involving naturalistic observationsand a face-to-face interview with 41 mothers participating tocomplete a questionnaire. Descriptive statistics and manifestcontent analysis were used in this study. The results show thatthe mothers were of low socio-economic standing and felt thatthey did not have enough information on KMC. The hierarchicalorganization within the hospital setting as well as communalisticbehaviours influenced the mothers’ support of KMC, includinginformation, communication, relationships and actions. Theconclusion is that there is an important challenge for trainedneonatal nurses to improve the guidelines for KMC and toempower mothers and their families to adopt KMC.

  • Caring for addicted Clients by Swedish Community Social workers, Sweden

    The aim of this study was to explore and describe the Swedish social workers’ experiences in caring for addicted clients in the middle-sized municipality with a population of about 130,000 inhabitants. Qualitative descriptive study was applied. Purposive sampling was used to recruit the participants. Seven Swedish social workers participated in the study. These participants had extensive experiences and were able to communicate in English. The structured interviews, field notes, and the tape recorder were used during data collection process during February 21 st to March 23rd 2011. Content analysis was used for data analysis. The results disclose that two themes emerged including ways of encountering and ways of caring. The first theme way of encountering, social workers encourage their drug addicted clients to sustain abstinence by using motivation talk and showing respect for human rights. In another theme, way of caring, social workers applied standardize methods in the caring process and collaboration between the health care and social welfare systems.

  • Older Women’s descriptions of how they activate themselves in their everyday living and what will promote their activity abilities.
  • Older women´s daily rhythm of activities in a supporting environment, Living with persistent musculoskeletal pain.
  • Providing School-based Health Care : Comparison in Sweden and Thailand
  • Absence and reliance : Liberian women's experience of vaginal fistula

    Childbirth entails considerable risk in developing countries. A prolonged labour process can cause the woman sustained injuries and lead to the death of the unborn child. Many women in Africa suffer from vaginal fistulas, causing a constant leakage of urine and/or faeces. The aim of this study was to explore and describe women's experiences of living with fistulas and how the condition affects their daily life. An ethnographic-inspired design involving observation, group- and individual conversations, was carried out at a gynaecological ward at a rural hospital in Liberia with 14 women. The reflexive analysis during fieldwork revealed two main themes in the women's experiences: absence and reliance. The results demonstrate that the women felt a loss of control over a perceived traumatic birth, loss of the dead child, loss of status as a woman and wife and loss of social fellowship. They also felt a loss of self-confidence. In contrast, the women relied on their belief and trust in God to help them with the difficult situation.

  • A Comparative study of Actions and Beliefs involving Family caregivers of hospitalized children among nurses in Sweden and Mozambique

    This comparative study of Swedish and Mozambican nurses' beließ and actions in encounters with family caregivers was conducted by analyzing ethnographic fieldwork in pédiatrie hospital settings. The aim was to reveal similarities and diversities in their culturally embedded contexts. A total of 65 nurses were studied working in their daily practice. The analysis was guided by a theoretical framework of actions, such as social modes, and of common thinking in a professional group. The comparative findings, with cultural variations, revealed similarities in the nurses' organizing and demanding actions, as well as diversity in their eliciting actions. The nurses' beliefs concerned types of family caregivers and their activities. The findings refiect the diversity aligned to culturally embedded conditions.

  • A capacity building PBL-course module for health promotion strategies.
  • Young children´s (aged 3-5 years) experiences of being in care procedures including medical investigations

    Introduction The Convention of children's rights focuses on protection, promotion as well as participation. Research show that young children's active

    participation in matters affecting them is underrated. Further it is known that improving participation in care procedures enhances both motivation and

    engagement. To achieve active participation in care procedures, the variation of experiences and perceptions, need to be explored and described. Purpose To

    explore and describe children's variations of experiences, perceptions, thoughts and wishes in care procedures including a medical investigation. It is a first

    study in a project aiming to develop and test an IT based interactive communication tool (IACT) for younger children. Material Younger children (3-5 years) in a

    preschool, visiting a health care center and a pediatric day care ward. Methods A phenomenographic approach searching the children's variations of

    experiences, perceptions, thoughts and wishes, in verbally and non-verbally expressions. Semi structured interviews, combined with talks based on vignettes,

    observations and drawings are used. Results The result is still preliminary. However the children studied so long describe experiences and thoughts of varied

    content. There are descriptions how they wished the care procedures to be carried out, as well as what scared them and what they wanted to avoid. The

    descriptions of experiences and perceptions will be contrasted and demonstrated in a hierarchy of variations according to a phenomenographic analyses.

    Conclusions The result will be the starting point to develop an IT-based interactive communication tool (IACT) for younger children, aged 3-5, to improve their

    active participation in care procedures based on their experiences, needs and wishes.


  • Nurses' experiences of managing sick-listing issues in telephone advisory services at primary health care centres

    Objective. To describe Swedish nurses’ experience of managing sick-listing issues in telephone advisory services in a primary health care setting.

    Design. The study was a qualitative focus group study.

    Setting. Data collection was conducted in three focus group conversations in a county in central Sweden in 2009. The conversations were recorded, transcribed and analyzed using qualitative content analysis.

    Subjects. The study included fourteen nurses, purposively sampled as having current experience of telephone advisory services at primary health care centers.

    Main outcome measures. How nurses experience and handle sick-listing issues in telephone advisory services.

    Results. Nurses’ management of sick-listing issues was described in three themes: the Nurses Actions which are affected by Enabling conditions and Obstructing conditions. The Nurses’ Actions included making an assessment for appropriate action, making an appointment and/or giving information and guidance to the patient and/or monitoring patient’s rights. Enabling conditions included documentation, routines, supportive co-operation and training in insurance medicine. The obstructing conditions were related to patients’ expectations, co-operation with other professionals, lack of training and the nurses’ professional role.

    Conclusion. The nurses demonstrated difficulties to find themselves as active care-givers in health care of sick-listed patients. They also experienced difficulties due to lack of training and the need to balance demands from the organisation and the patient. By engaging nurses more consciously in the sick-listing process a new perspective will be added in care of sick-listed patients.

  • Young (3-5 year-old) children's ways of engagement in care procedures involving venepuncture

    A fear of medical examination and of pain in care procedures is common among children. Young children are particularly sensitive to the way a procedure is carried out. The children will engage and act in the way they understand the situation and what is meaningful for them, which will depend on their experiences, interests and motivation. This study describes the qualitative differences in the complexity of how young children, aged 3–5 years, demonstrated the way they engaged in care procedures involving venepuncture. Video observation captured the young children as social actors in the procedure, and interpretive descriptive analysis was used to seek an understanding of the children’s demonstrated expressions and actions. The identified ways of engagement among the children were as follows: watchful engagement, curious engagement and adaptive engagement, as well as avoidance, forced engagement and resigned engagement. The children could fluctuate between the different ways of engagement during the course of the procedure. The results call attention to the sensitivity and responsiveness shown by the adults, nurses and parents in guiding the young children’s engagement and their ability to become integrated and act through active participation in a sometimes frightening care procedure.

  • Four year old children's negotiation strategies to influence and deal with a Primary Health Care situation

    In Sweden, children’s health and development are promoted through Primary Child Health Care (PCHC) visits. The children participate in these visits from their own perspective through bodily and verbal expressions. This study explores four-year-old children’s expressions when they as actors take part in a PCHC situation. The conceptualisation of the children’s expressions reveals various actions that exhibit their affirmative and delaying negotiation strategies to influence and deal with these situations. For PCHC nurses, these findings may encourage to view children as negotiating participants and inspire to sensitivity when inviting children and guiding them through health visits

  • Co-production by scientific papers in the field of Health and Welfare among Scientists / Institutions in Thailand and Sweden


    The aim of this study is to examine to what extent there is a co-production in research in the field of health and welfare between scientific institutions and universities in Thailand and Sweden.



    At the School of Health, Care and Social Welfare at Mälardalen University the cooperation with Thailand includes both education and research. The cooperation has went on since 2009 including the Ministry of Health and their nursing and public health colleges as well as two universities, Mahidol university and Rangsit university. The latest agreement of cooperation covers the years 2013 - 2017. The cooperation takes place mainly through student exchange and training on graduate and advanced in the field of health and welfare, but also by some research contacts.



    The study is based on a systematic literature review in three multidisciplinary databases; Scopus, Web of Science and PubMed databases. The scoping has been limited to scientific articles. Three different search strategies have been used. To elaborate on the precision of the search it has been carried out in three steps. The initial search was based on the keywords ‘Health and Welfare’ as well as ‘Thailand and Sweden’ in the title as well as abstract. The second search was focused on ‘affiliation/address, author, Thailand and Sweden’. For PubMed the search included only 2013, because it was from this year it was possible to search for more than one affiliation/address. The third search was a deepening search by a concretization of ‘Health and Welfare’ based on other keywords related to disciplines, as specific concepts such as ‘caring, nursing, sociology, physiotherapy, public health, social work, psychology’ or appropriate disciplines. A limitation was made by including only studies between the two countries, not multicenter studies from more countries in which the two countries have signed. Further, duplicates were excluded in the analysis. Regarding the reliability of the articles the quality of the articles will be more analyzed in a final step of the process.


    The first conceptual search resulted in 210 articles, distributed by the keywords Health and Welfare (4), Health (199) and Welfare (7). The second search resulted in 422 articles that showed that most of these items were not at all in the area of ​​health and welfare, but other fields as engineering, physics, medical chemistry, biomedicine and animal studies. In the third search 56 articles in all three databases were identified. For the aim of this study 17 were considered relevant.



    This study demonstrates that there is a research collaboration and joint scientific publishing in many scientific disciplines and areas between the two countries, Thailand and Sweden. The co-production occurred primarily during the last 10 years. However there is a limited degree in the area of Health and Welfare. Only one of the identified articles were written by a cooperation with researchers in Thailand and at Mälardalen University.

    Recurring annual systematic literature reviews in the area of Health and Welfare will be a way to track the progress of co-production between universities in Thailand and Mälardalen University. This study can function as baseline study for such reviewing.

  • Thailand and Sweden as welfare regimes : examples from the healthcare sector

    The characteristics of a welfare state is largely related to social justice and welfare reforms. This is mainly in the form of legislation, economic transfers and services that help to ensure that all citizens receive a basic economic security and access to services such as health care and nursing. A key factor for this is a country's economy and political will. In Thailand, there was a strong economic growth during the 1970s. The corresponding development in Sweden took place in the mid 1940's. Health and welfare is the main area of collaboration between the Ministry of Health in Thailand and Mälardalen University. The aim of this study is from a welfare perspective, a comparison of the similarities and differences in the basic elements of the health care systems in Thailand and Sweden.

    The study is based on analysis of national policy documents from Thailand and Sweden as well as from United Nations Agency.

    Both countries emphasize health and welfare from a social rights perspective in constitutions and other laws. E.g. the Thailand Constitution of 2007 states that a person shall enjoy an equal right to receive standard public health service, and the indigent shall have the right to receive free medical treatment from State's infirmary. The Swedish Constitution recognizes that the personal, economic and cultural welfare should be the fundamental goal of public activity through, among other things promote social care and social security, and good conditions for health. In the Swedish Health Care Act of 1982, the goal is a good health and care on equal terms for the entire population.

    Both Thailand and Sweden have a national system of Universal Health Coverage (UHC), which is defined according to World Health Organization (WHO) as ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

    In terms of selected indicators shows for the year 2012 that the Total health expenditure (THE) % of Gross Domestic Product (GDP) amounts in Thailand 4% and 10% in Sweden, general government expenditure on health as % of GDP are 3% resp. 8%, prevention and public health services are 9 resp. 4%, physician density per 1,000 population 0.3 resp. 3.9. The proportion of beds at public/private hospitals are 78/21% resp. 99/1%.

    The example from the health care system shows that the two countries have legislation that emphasizes health as a social right and a public financing of health care. In terms of specific indicators, there are wide variations in terms of costs to society and the individual including prevention and public health services, access to doctors and proportion of beds in public and private hospitals.

  • Kommunikativ utveckling och miljöns betydelse
  • Kommunikation med barn och unga i vården
  • Parents health literacy and their experiences of participation in their child's care during hospitalization.

     Background. Parents’ health literacy is an important key factor that influences how they are able to understand their child’s health status and needs, and how to participate in the care when their child needs to be in hospital.  Parents are the most important care givers, who facilitate ongoing growth and development of their children, giving protection and support. How well parents are able to care and support their child’s care will be influenced by their health literacy. Further, parents’ experiences of participation in their hospitalized child’s care are not investigated in Thailand, comparing with other international studies.

    The aim. The aim of this study is to explore parents’ health literacy and their experiences of participation in their child’s care during hospitalization.  The study will be conducted in four pediatric units at Phrapokklao Hospital, a central hospital in Chanthaburi, Thailand.

    Method. A descriptive qualitative research design will be used. Thirty biological Thai parents, whose children stay in the pediatric units, will be interviewed. A demographic data sheet will be used to obtain background information on characteristics of the parents.  A semi-structured interview guide with open-ended questions will be used.  The questions include general questions to grasp parents’ health literacy, to specific questions experiences of participation in the child’s care. A content analysis, developed by Graneheim and Lundman, will be used.  Ethical considerations have to be made according to informed consent and voluntarism. Consent is given by the Ethical committee in Chanthaburi Province, Thailand.

    Findings. During the conference preliminary results will be presented as generated concepts of understanding of the Thai parents’ health literacy, as well as generated categories of parents’ experiences of participation in the child’s care.

    Clinical implications. Health literacy and experiences of participation is cultural sensitive. Health care providers in different cultures need to understand parents’ health literacy to develop strategies to facilitate and improve their participation in the care of their children according to the rights in the Child convention.


  • Barn och unga i vårdmiljöer
  • Barns och ungas delaktighet
  • Facilitating young children's participation in health care situations

    Facilitating young children’s participation in health care situations Background An initiative was given to perform a collaborative research project with health practices in Sörmland on facilitating young children’s participation in health care situations. Departing from workshop with healthcare professionals conveyed that it is an ambiguous challenge to be in care situations with children since each situation depends on its participants; the child, the parents and the professionals. These findings were used in reflective forums to integrate theory and practice to broaden the professionals’ awareness of the child’s perspective in care situations. The project is inspired by a clinical application research (CAR) design, where scientifically trained researchers work with health care professionals, building a team to exchange experiences related to data collection, interpretations and the applicability of the results.

    The use of research involves a process of learning as well as engaging beliefs and actions, and these questions are foundational for the practice of clinical care. Such approach aims at facilitating the use of research in clinical practice, to reduce the eventual gap between theory and its practical application.


    The overall aim of the project is to facilitate young children’s participation in their health care situations Method and Material The CAR design involves understanding, interpretation and application. This means reflecting on care situations and being confronted with assumptions from theoretical perspectives as well as training an openness and awareness in caring encounters. The team work is in a continued progress and will last during 2014. The data analysis will then proceed.

    Result :Some preliminary result will be presented about the process and outcome of the clinical application research Clinical implications: This study may contribute to the stock of knowledge regarding the implementation of an interactive communicative device with the purpose to facilitate young children’s participation in their health care situations.

  • Hälsovägledning med Somaliska föräldrar inom Svensk Barnhälsovård : En kvalitativ studie

    Background: Difficulties in intercultural encounters and communication in health care is well known. Swedish primary child health nurses' have daily encounter with Somali parents for health counseling of their young children. Little is known about their experiences of the intercultural understanding of the health counseling encounters.

    Aim:  To describe Swedish primary child health nurses' experiences of health counseling Somali parents.

    Methods: A qualitative design was used. Five child health nurses were strategic selected for interviews. A content analysis was used in the analysis.

    Findings: The primary child health nurses' experienced both facilitators and barriers in the encounters of health counseling, as well as within their profession and in the Somali parenting.

    Conclusion: Health counseling as an educational process. Time is important in intercultural encounters with health counseling in primary child health care to identify and show an interest in the Somali family's life history and perceived needs.

  • The importance of a daily rhythm in a supportive environment-  promoting ability in daily activities among older women livingalone with chronic pain

    Purpose: The aim of this study was to explore how older women living alone with chronic musculoskeletal pain, describe their ability in performing activities in everyday life and what could promote their ability in activities in everyday life as well as their perceived meaning of a changed ability to perform activities in everyday life. Method: Qualitative interviews were conducted with 12 women, and an inductive content analysis was used. Results: The results showed the importance of a daily rhythm of activities. Activities included in the daily rhythm were socializing with family and friends, physical activities, doing own activities as well as activities supported by relatives and the community. The activities described by the women also promoted their ability in activities in everyday life. Other findings were the women's perceived meaning of being independent and maintaining that independency, along with the meaning of accepting and adapting to a changed life situation. Conclusion: This paper concludes that it is important to be sensitive of individual needs regarding the daily rhythm of activities when health-care professionals intervene in the activities in everyday life of older women living alone, promote the women's independency, and enable them to participate in the community. 

  • Being in care situations with young children presents ambigious challenges.
  • Undergoing an immunization is effortlessly, manageable or difficult according to five-year-old children

    Background: To prevent diseases among children they regularly undergo immunizations. Previous research show different approaches available to facilitate immunization-procedures for children to protect them from harm. To complement this research and provide care suited for children, research recognizing their perceptions of undergoing such a procedure is needed. Aim: The aim of this study was to describe 5-year-old children's perceptions of undergoing an immunization. Method: A phenomenographic approach and analysis was used to describe the children's (n = 21) various perceptions. The data-collection was accomplished directly after the immunization to grasp the children's immediate perceptions. Drawings and reflective talks were used as they are considered as suitable methods when involving young children in research. The right to conduct research with children was approved by the appropriate research ethics committee and also by each child and the parents. Results: The findings show that children's perceptions of an immunization-procedure may vary from effortlessly, to manageable or difficult. Regardless of how the child perceive the immunization-procedure each perception embrace the children's descriptions of actors and articles in the situation, their feelings in the situation and also their actions to deal with the immunization. Nevertheless, these descriptions vary according to how the children perceive the immunization as effortlessly, manageable or difficult. Conclusion: Children's and adults' perceptions of medical procedures may differ and children need guidance, time and space to deal with them. Recognizing children's perceptions of undergoing an immunization contributes to the promotion of their right to be involved in their own health care and towards the development of child-centred care. 

  • The child’s perspective as a guiding principle : Young children as co-designers in the design of an interactive application meant to facilitate participation in healthcare situations

    During the last decade, interactive technology has entered mainstream society. Its many users also include children, even the youngest ones, who use the technology in different situations for both fun and learning. When designing technology for children, it is crucial to involve children in the process in order to arrive at an age-appropriate end product. In this study we describe the specific iterative process by which an interactive application was developed. This application is intended to facilitate young children's, three-to five years old, participation in healthcare situations. We also describe the specific contributions of the children, who tested the prototypes in a preschool, a primary health care clinic and an outpatient unit at a hospital, during the development process. The iterative phases enabled the children to be involved at different stages of the process and to evaluate modifications and improvements made after each prior iteration. The children contributed their own perspectives(the child's perspective) on the usability, content and graphic design of the application, substantially improving the software and resulting in an age-appropriate product.

  • The child’s perspective as the guiding principle: young children as co-designers of an application used for enabling participation in healthcare situations

    Introduction: To facilitate child´s rights in healthcare situations, professionals need to be aware of, and use, their child perspective and the child´s perspective in the situation. A child´s rights approach requires that the caring culture and ways of working are adapted to the interactive communication tool, based on children´s perceptions of being in healthcare situations, prerequisites of children.

    Aim: To develop an interactive communication tool, based on children´s perceptions of being in healthcare situations, meant to facilitate children´s participation and understanding in these specific situations.

    Method: Children, 3-5 years, in a preschool, a primary health care clinic and a pediatric outpatient unit at a hospital were encountered in interviews which focused the children´s perceptions of being in healthcare situations. Non-verbal perceptions were elicited through drawings. These perceptions were used in the development of the communication tool. In iterative phases the children, as co-designers, tested and evaluated evolving prototypes of the tool. Their feedback were analyzed and used in the ongoing development and improvement of the prototype.

    Result: an iterative, co-designing process of the interactive communication tool transformed children´s verbal and non-verbal perceptions of being in a healthcare situation into an age appropriate and likeable application regarding content, usability and graphic design.

    Conclusion: an interactive communication tool involving visual guidance of healthcare situations facilitates younger children to elicit their perspective in these situations. Children´s participation in healthcare situations is enabled by professionals who use the child´s perspective, expressed with help of the communication tool, combined with their verbal guidance.

  • Reframing the focus from a Family-centred to a child-centred care approach for children's healthcare

    In this article, we argue for a conceptual move from family-centred care (FCC) to a child-centred care approach and the implications for clinical nursing practice. Firstly, we argue that the parents and professional dominance constructs an asymmetric relationship towards the child, which may take away the focus from the child; Secondly, we need to renew efforts to promote the fundamental principles of protection, promotion and participation rights for children and young people according to the United Nations Convention on the Rights of the Child declaration and thirdly, we need to strengthen the child’s perspective and to view the child as an agent representing own experiences and wishes to be respected and negotiated.

  • Thai district Leaders' perceptions of managing the direct observation treatment program in Trang Province, Thailand

    Background: Thailand is 18th out of the 22 countries with the highest tuberculosis (TB) burden. It will be a challenge for Thailand to achieve the UN Millennium Development target for TB, as well as the new WHO targets for eliminating TB by 2035. More knowledge and a new approach are needed to tackle the complex challenges of managing the DOT program in Thailand. Contextual factors strongly influence the local implementation of evidence in practice. Using the PARIHS model, the aim has been to explore district leaders' perceptions of the management of the DOT program in Trang province, Thailand. Methods: A phenomenographic approach was used to explore the perceptions among district DOT program leaders in Trang province. We conducted semi-structured interviews with district leaders responsible for managing the DOT program in five districts. The analysis of the data transcriptions was done by grouping similarities and differences of perceptions, which were constructed in a hierarchical outcome space that shows a set of descriptive categories. Results: The first descriptive category revealed a common perception of the leaders' duty and wish to comply with the NTP guidelines when managing and implementing the DOT program in their districts. More varied perceptions among the leaders concerned how to achieve successful treatment. Other perceptions concerned practical dilemmas, which included fear of infection, mutual distrust, and inadequate knowledge about TB. Further, the leaders perceived a need for improved management practices in implementing the TB guidelines. Conclusion: Using the PARIHS framework to gain a retrospective perspective on the district-level policy implementation of the DOT program and studying the leadership's perceptions about applying the guidelines to practice, has brought new knowledge about management practices. Additional support and resources from the regional level are needed to manage the challenges.

  • Younger children's (three to five years) perceptions of being in a health-care situation

    Younger children are common users of health-care services. Their perspective on a health-care situation and their ways of communication differ from that of adults. There is a shortness of research of younger children's perceptions of health-care situations. The knowledge that exists indicates the importance of involving the child's perspective to enable understanding and to offer appropriate support. This paper aimed to describe how younger children perceive to be in a health-care situation. Semi-structured interviews, analysed phenomenographically, were used. The main findings revealed that children view themselves as actors, as either main or co-actors, in a health-care situation. Parents and professionals are also understood as actors. The children's perceptions enable professionals to create a mutual understanding which will give openings for increased involvement of the children and an improved level of the children's health literacy.

  • Thai people living with tuberculosis and how they adhere to treatment : A grounded theory study

    To develop a conceptual framework of adherence to treatment among Thai people living with tuberculosis, a grounded theory approach was used. A purposive sample of 20 Thai people living with tuberculosis, aged from 23 to 85years, was interviewed. From the participants' perspective, a core category of social belonging was highlighted, with three categories of conditions connected: personal barriers, personal resilience, and social facilitation. Personal barriers encompassed fear of stigma, concealing the illness, and lack of knowledge and motivation to complete the treatment regime. Personal resilience encompassed positive thinking and self-awareness. Social facilitation encompassed the ease of access to health services, continuity in the health service's ability to choose a directly-observed therapy observer, and social support. This study contributes a deeper understanding of the perspective of Thai people living with tuberculosis with regards to adherence to tuberculosis treatment. It might improve how local healthcare workers provide tuberculosis care, and inspire them to tailor care to people living with tuberculosis in a local community to increase personal resilience and reduce stigma.

  • Curious, Thoughtful and Affirmative – Young Children’s Meanings of Participation in Healthcare Situations when using an Interactive Communication Tool
  • An Assessment of Two Parenting Training Manuals Used in Swedish Parenting Interventions

    In Sweden, all parents of children aged 0–18 years are entitled to attend free parenting courses as part of a national strategy presented by the Government in 2009. This broad parental support welfare strategy is expected to fulfil the intentions of the UN Convention on the Rights of the Child. In this study, two parenting training manuals were analysed: the Canadian Connect program, based on attachment theory, and the Swedish ABC program, based on social learning theory. The results indicate that the manuals use strategies that can both hinder and support children's rights, regardless of rhetoric of children's best interests. © 2017 John Wiley & Sons Ltd and National Children's Bureau

  • The intention – action gap when using a behavioral medicine approach in physiotherapy for patients with persistent musculoskeletal pain.
  • Centeredness in Healthcare : A Concept Synthesis of Family-centered Care, Person-centered Care and Child-centered Care

    Background: Increasingly within healthcare, different kind of ‘centeredness’ are used to denote the focus of care which can create confusion for practitioners. Methods: A concept analysis was undertaken to identify the antecedents, attributes and relationship between family-, person-, and child-centered care. PubMed and CINAHL were searched from 2012 to 2017 and thirty-five papers were reviewed. Results: Both person- and child-centered care are focused on individuals, a symmetric relationship and the tailoring of care to individual needs while family- centered care is focused on the family as a unit of which the child is included. Person-centered care focuses on an adult person with autonomy, while the focus in child-centered care is the individual child as an own actor with rights but still close to a family. Conclusion: It appears at a conceptual level that the concepts of centeredness contain both similarities and differences. Finding ways to structure nursing and focus the care that respects a person's dignity and humanity is essential in healthcare and should be a major goal of health policy and health systems worldwide. Implications: The identification of the antecedents and attributes embedded in the concepts may help raise professionals’ awareness of the different foci and how this will influence one's practice. There is a need to recognize strengths and weaknesses of the centeredness in different settings and environments. Furthermore, it is important to know which approach to apply within different situations so that quality care is enabled for every person, child and family.

  • Competent parents with natural children : Parent and child identities in manual-based parenting courses in Sweden

    This article analyses identity constructions in two manual-based universal parenting training programmes in Sweden, Connect (U) and All Children in Focus (ABC). The analysis was performed with discourse analysis of oral messages during parent training courses. The findings revealed that the parents' subject positions altered between troubled and good while the children's subject positions altered between ambiguous and natural in a confessional discourse of uncertainty and competence. Conclusively, pastoral power operated to support parental self-reflexivity and adult control in a process to improve parenting skills.

  • Child-centred Care : Health Professionals' Perceptions of What Aspects are Meaningful When Using Interactive Technology as a Facilitator in Healthcare Situations

    Purpose: A prerequisite for child-centred care is children's participation, which in paediatrics can partly be enhanced by using interactive technology solutions, for instance tablet or smartphone-based applications. These applications, however, mainly target older children. In a research project, a tablet-based application, i.e. a communication tool, was developed, meant to facilitate young children's participation in healthcare situations. This study explored health professionals' perceptions of what aspects are meaningful when jointly using such an application in healthcare situations. 

    Design/Methods: Using the critical incident technique, 18 qualitative, semi-structured interviews focusing on critical incidents were performed with four health professionals who had used the interactive communication tool together with children in various healthcare situations. The data were analysed according to inductive content analysis. 

    Results: Results showed that the health professionals described the use of the tool as meaningful because it provided information that helped the children increase their participation, modify their understanding of the situations, and reduce their fear. The tool was also perceived to contribute to a common language between the children and the professionals, which improved their overall communication. 

    Conclusion: The introduction of an interactive communication tool in healthcare situations seemed to be beneficial for both the children and the health professionals.

    Practice Implications: An interactive communication tool, facilitating both verbal and non-verbal communication, can reinforce children's participation in healthcare situations and contribute to positive outcomes in the childprofessional relationship, as well as in the situation itself. 

  • Health care professionals’ perspective on children’s participation in health care situations : encounters in mutuality and alienation

    Purpose: Encounters between health care professionals, parents and children in health care services for children are complex as these encounters involve the various perspective and understanding of each person involved. The aim of the study is to describe health care professionals’ understanding of significant encounters with children and parents to uncover the meaning of participation. Method: A qualitative descriptive design was applied. The health care professionals’ narratives (n = 35) of their significant encounters with children were interpreted from the perspective of participation. A phenomenological-hermeneutical approach was used in the analysis. Results: The findings show children’s participation as a dynamic movement in mutuality and alienation which can vary within a situation or between different situations involving the same persons. The movement can occur in mutuality and or in alienation depending on what or towards whom the persons direct themselves. Understanding participation as a movement in health care situations is useful in supporting children’s opportunities to participate from their own perspective and deal with health care examinations. Conclusion: The outcome of a situation can never be predicted. Still, professionals can be aware of their actions in encounters with children.

  • The complexity of integrating a behavioral medicine approach into physiotherapy clinical practice

    Introduction and Aim: The implementation of a behavioral medicine (BM) approach in physiotherapy is challenging, and studies regarding the determinants are sparse. Thus, the aim of this study was to explore determinants of applying a BM approach in physiotherapy for patients with persistent pain across the micro-, meso-, and macro-levels. Methods: A qualitative multiple-case study design was used. Data were collected from four cases through semi-structured interviews with physiotherapists (PTs), patients, and managers; observations of video-recorded treatment sessions; and reviews of local directives and regulations. Data were analyzed with inductive content analysis and cross-case analysis, followed by mapping to the domains of determinants at the micro-, meso-, and macro-levels within the Implementation of Change Model. Results: Similar determinants were found across the cases. At the micro-level, these determinants concerned the PTs’ ambivalence toward a BM approach, a biomedical focus, embarrassment asking about psychosocial factors, BM knowledge, skills for applying the approach, and self-awareness. Others concerned the patients’ role expectations of the PT, patients as active or passive agents in the treatment process, patients’ focus on biomedical aspects, and confidence in the PT. At the meso-level, support from managers and peers, allocation of time, and expectations from the organization were identified as determinants. No determinants were identified at the macro-level. Conclusion: The complexity of integrating a BM approach into physiotherapy clinical practice arises from multiple determinants functioning as both facilitators and barriers. By selecting strategies to address these determinants, the implementation of a BM approach could be supported.

  • Trusted and doubted : Discourses of parenting training in two Swedish official inquiries, 1947 and 2008

    Aim: The aim of this study was to analyse discourses of parenting training in official inquires in Sweden that explicitly deal with the bringing up of children and parental education and how the representations of the problems and their solutions affect parental subject positions in the early welfare state and at the onset of the 21st century. Method: We carried out a discourse analysis of two public inquiries of 1947 and 2008, drawing on theories about governmentality and power regimes. Tools from political discourse analysis were used to investigate the objectives of political discourse practices. Results: Both inquiries referred to a context of change and new life demands as a problem. Concerning suggestions for solutions, there were discrepancies in parents’ estimated need of expert knowledge and in descriptions of parental capacity. In a discourse of trust and doubt, the parents in 1947 were positioned as trusted welfare partners and secure raisers of future generations, and in 2008, as doubted adults, feared to be faltering in their child-rearing tasks. Conclusions: The analysis revealed how governmental problem descriptions, reasoning about causes and suggestions of solutions influenced parents’ subject positions in a discourse of trust and doubt, and made way for governmental interventions with universal parenting training in the 21st century. 

  • Using an interactive communication tool in healthcare situations : Patterns in young children's use of participation cues

    This study forms part of a larger project about developing and using interactive technology to facilitate young children's participation in healthcare situations. Children's participation in these situations improves their motivation and situated understanding. Likewise, their participation helps professionals to more fully understand the child's perspective. In the project, an interactive communication tool, that is, an application suitable for tablet use, was developed with children, aged three to five, in two clinical settings. When tested, the children's participation cues, identified from video recordings of healthcare situations, were understood as having curious, thoughtful or affirmative meanings. This study aimed to investigate the similarities and differences in the young children's use of participation cues when using an interactive communication tool in healthcare situations. A secondary analysis of the identified cues was performed focusing on age, setting and examination or procedure. In total, 2167 cues were identified representing either curious, thoughtful or affirmative cues. The curious cues were mainly used (66%), followed by thoughtful (28%) and affirmative (6%) cues. Differences in cue usage were seen in relation to the children's age and setting. Knowing how children may react to common healthcare procedures may help increase healthcare professionals' awareness of the need to support children in an individual and situational way.