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Vad betyder känsla av sammanhang i våra liv?: aspekter på stabilitet, kön, hälsa och psykosociala faktorer
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2002 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Känsla av sammanhang (KASAM) är ett sätt att studera hälsa och välbefinnande ur ett salutogent perspektiv. Med denna infallsvinkel kan såväl avgränsade sjukdomsgrupper i små populationer, som en större normalbefolkning undersökas. Det är väsentligt att studier också kan ske över tid för att ha möjlighet att fånga en utveckling. Syftet med denna studie var, att med magbesvär som infallsvinkel, studera KASAM och den salutogena modellens relation till hälsa, kön, psyko- sociala faktorer och stabilitet.

Vid en klassifikation av patientens sjukdomstillstånd, gjord separat av patient, läkare och kurator, visade jämförelsen full överensstämmelse i hälften av fallen. En motsvarande jämförelse gällande patientens allmänna hälsotillstånd visade full överensstämmelse i en tredjedel av fallen. Synliggörandet av dessa skillnader antyder behovet av reflektion, över såväl den egna bedömningen som andras, i den kliniska vardagen.

En grupp personer med magbesvär intervjuades 16-18 år efter en gastroskopiundersökning. Fynden i en kvalitativ studie visade att patientens inflytande på sitt liv, direkt eller indirekt, tycktes vara relaterat till om han/hon var frisk vid uppföljningen. Att ha inflytande över sitt liv kan också innebära att vara i stånd till att ha inflytande i mötet med vårdgivare och över adekvat behandling.

I en tvärsnittsstudie av en normalbefolkning (WHO MONICA Project) visade sig medelvärdena för KASAM, efter uppdelning i tre olika diagnosgrupper, vara signifikant lägre i en grupp med magbesvär (n=309) i jämförelse med såväl en grupp med identifierad sjukdom (n=198) som en grupp utan de efterfrågade symtomen/sjukdomarna (n=1212).

I en panelstudie med en uppföljning efter fem år visades att det förelåg en statistiskt signifikant minskning av KASAM i totalpopulationen (n=1254) och att män och kvinnor hade en likartad minskning. Studien visade också KASAM endast var stabil hos personer med höga ingångsvärden. Personer i åldersgruppen 45-74 år och personer med en identifierad sjukdom hade den största sänkningen. Nedgången är i linje med samhällsutvecklingen under den studerade perioden under 1990-talet, med en nedmontering av delar i det tidigare välfärdssamhället.

En studie, som jämförde två tvärsnitt i en normalbefolkning med fem års mellanrum, visade en statistiskt signifikant nedgång av KASAM. Sänkningen var mest uttalad bland kvinnor, i den yngre åldersgruppen (25-44 år) och bland dem med en identifierad sjukdom. Personer med mångåriga magbesvär hade det lägsta medelvärdet i båda tvärsnitten.

Att kartlägga hur olika faktorer relaterar till KASAM kan utgöra en väg både vad gäller att förstå hur politiska beslut påverkar skilda sektorer i samhället, och var enskilda människor befinner sig i olika processer vid hälsa och sjukdom. Patienter med mångåriga magbesvär rapporterade en låg känsla av sammanhang och är till synes en grupp som borde uppmärksammas i vården. Det är väsentligt att inte bara mäta KASAM som en personlig variabel utan också se hur strukturförändringar påverkar den enskilda människan. Olika vårdgivare kan tillsammans med patienten vara öppna för att inte enbart det medicinska perspektivet utan att även patientens inflytande och sociala situation lyfts fram.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2002. , 76 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 806
Keyword [sv]
Patient, KASAM, hälsa, kön, patientinflytande, magbesvär, psykosociala faktorer, vårdgivare, stabilitet, samhällsförändringar, WHO MONICA Project
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-94110ISBN: 91-7305-308-2 (print)OAI: oai:DiVA.org:umu-94110DiVA: diva2:763812
Public defence
2002-10-11, Tandläkarhögskolan, Rosa salen, plan 9, Umeå universitet, Umeå, 13:00
Opponent
Supervisors
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 2002

Available from: 2014-11-17 Created: 2014-10-03 Last updated: 2015-04-10Bibliographically approved
List of papers
1. The salutogenic model as a joint venture: assessment of indigestion by social workers, physicians and patients
Open this publication in new window or tab >>The salutogenic model as a joint venture: assessment of indigestion by social workers, physicians and patients
1997 (English)In: Scandinavian Journal of Social Welfare, ISSN 0907-2055, Vol. 6, no 4, 286-291 p.Article in journal (Refereed) Published
Abstract [en]

The medical perspective often is the dominant interpretation in diagnosing people who are ill. The authors have compared the assessments of health and disease made by patients, physicians and social workers of patients with non-ulcer indigestion, based on the salutogenic model. Complete agreement on the classification of disease occurred in half the cases. With the introduction of the health concept, disparity seemed to increase. All three participants tended to overlook the problems and opportunities seen by others. The aspirations of care providers and patients seemed to account for the differences. Recovering from disease as well as improving health can be considered as a joint venture of care providers and patients. A medical approach to identify deficiencies can lead to a blind and partial assessment of problems. The introduction of a salutogenic perspective opened for treatment alternatives and enhanced goal-setting negotiations if the health perspective was shared.

Place, publisher, year, edition, pages
Munksgaard Forlag, 1997
Keyword
patient, clinical competence, family physician, social worker, indigestion, health, slautogenic model
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-96293 (URN)
Projects
digitalisering@umu
Available from: 2014-11-17 Created: 2014-11-17 Last updated: 2017-12-05Bibliographically approved
2. The impact of patients' influence on recovery in a group of patients with dyspepsia
Open this publication in new window or tab >>The impact of patients' influence on recovery in a group of patients with dyspepsia
1999 (English)In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 16, no 5, 515-521 p.Article in journal (Refereed) Published
Abstract [en]

Background. The approach to health and disease can either be salutogenic (origins of health) or pathogenic (disease causing), which thus makes recovery a concept featuring several different angles. Antonovsky, with his concept of salutogenesis, tried to reach a more complete understanding of its favourable effects on health.

Objective. We aimed to investigate, understand and learn from the experiences of a small group of patients about factors leading to recovery.

Methods.A qualitative approach was used to explore patient experiences. One semi-structured interview was conducted by one of the authors (BN) with each of the 18 patients suffering from dyspepsia who had been investigated by means of gastroscopy at a university hospital clinic 12–15 years previously. The interviews were recorded either in written notes composed directly after the interviews or tape-recorded and subsequently transcribed. A modified form of grounded theory according to Strauss-Corbin was used to analyse the data.

Results. A pattern featuring five types of patients' influence on their lives was discerned, ranging from “a sense of no possibility of having an influence on existence/life” to “having influence”. Strategies used by patients to maintain health could be categorized into four types: “extremists”, “oscillators”, “leapers” and “full-scalers”.

Conclusions.Listening to patients who had experiences with dyspepsia brought patient influence on their own lives and on the care process into focus. We consider that there might be a link between patients having an influence on their lives and their being healthy today. In clinical practice, patient recovery and health promotion could gain from a perspective where patient influence is treated with esteem and emphasized in the consultation. In the future, research design could benefit from taking patient influence on the care process into consideration. However, no causal linkage between patient influence and patient outcome was established in this study. In order to do that, studies with quantitative design should be undertaken in the future.

Place, publisher, year, edition, pages
Oxford University Press, 1999
Keyword
Background. The approach to health and disease can either be salutogenic (origins of health) or pathogenic (disease causing), which thus makes recovery a concept featuring several different angles. Antonovsky, with his concept of salutogenesis, tried to reach a more complete understanding of its favourable effects on health
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-96288 (URN)10.1093/fampra/16.5.515 (DOI)
Projects
digitalisering@umu
Available from: 2014-11-17 Created: 2014-11-17 Last updated: 2017-12-05Bibliographically approved
3. Sense of coherence in different stages of health and disease in northern Sweden: Gender and psychosocial differences
Open this publication in new window or tab >>Sense of coherence in different stages of health and disease in northern Sweden: Gender and psychosocial differences
2000 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 18, no 1, 14-20 p.Article in journal (Refereed) Published
Abstract [en]

Objective - To investigate ?Sense of Coherence? (SOC) and its relation to perceived health, different stages of disease, and different psychosocial factors in a population-based study. Design - Postal survey of a population-based sample, the MONICA study (1994). Setting - Norrbotten and Västerbotten, the two northernmost counties in Sweden, with a total population of 510,000 inhabitants. Subjects - 837 men and 882 women in three mutually-exclusive groups: stomach trouble of many years' standing, identified disease (stroke, cardiac infarction, diabetes, anti-hypertension treatment) and no reported disease. Main outcome measures - SOC scores in relation to sociodemographic variables and perceived health. Results - We found a relationship between low SOC scores and poor perceived health, low social support and low emotional support on a population level. When comparing persons with stomach trouble with those without disease, or with established diseases, we found similar relationships between low mean SOC scores in all strata for both women and men. ?Perceived health?, however, was only significantly correlated for women, and women had an overall stronger relationship. Conclusions - In a study in northern Sweden, female patients with stomach trouble comprise a vulnerable group. The concept of SOC introduces a new dimension for perceiving health and disease. In clinical practice, care providers can identify and elaborate on the relationship between SOC scores and sociodemographic data.

Place, publisher, year, edition, pages
Informa Healthcare, 2000
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-96289 (URN)10.1080/02813430050202497 (DOI)
Projects
digitalisring@umu.se
Available from: 2014-11-17 Created: 2014-11-17 Last updated: 2017-12-05Bibliographically approved
4. Sense of coherence - stability over time and relation to health, disease, and psychosocial changes in a general population: a longitudinal study
Open this publication in new window or tab >>Sense of coherence - stability over time and relation to health, disease, and psychosocial changes in a general population: a longitudinal study
2003 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no 4, 297-304 p.Article in journal (Refereed) Published
Abstract [en]

Aims: To explore the stability of sense of coherence (SOC) over time in a normal population and to examine its relation to gender and psychosocial factors. Methods: The Northern Sweden MONICA Project population surveys were performed in 1994 and 1999. A cohort of 1,254 subjects participating in both surveys answered questions about experiences of disease, perceived health, marital status, psychosocial factors, and Antonovsky's SOC scale with 13 items. Results: The mean SOC score showed a decrease in the five-year follow-up and those with identified disease and the oldest age group (45 - 74 years) had the largest decrease of the SOC score. People with the lowest SOC scores in 1994 had the largest decrease during the period. Men and women shared a similar pattern regarding the decrease in SOC over time. The impact of individual social changes during the study period showed that both men and women who had experienced loss of perceived good health and high social support had the largest decrease. Furthermore, women seemed to be more affected by changes than men. Conclusions: We found that SOC was only stable for those with initially high levels of SOC. For other people, individual conditions and societal changes influenced their SOC. Further longitudinal studies in normal populations are needed to investigate the stability of SOC scores.

Place, publisher, year, edition, pages
Sage Publications, 2003
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-22817 (URN)10.1080/14034940210164920 (DOI)
Available from: 2009-05-19 Created: 2009-05-19 Last updated: 2017-12-13Bibliographically approved
5. Sense of coherence in two cross-sectional studies in northern Sweden 1994 and 1999: Patterns among men and women
Open this publication in new window or tab >>Sense of coherence in two cross-sectional studies in northern Sweden 1994 and 1999: Patterns among men and women
(English)Manuscript (preprint) (Other academic)
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-96294 (URN)
Projects
digitaliserilng@umu.se
Available from: 2014-11-17 Created: 2014-11-17 Last updated: 2014-11-17Bibliographically approved

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