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Genom genuslinser: Om patienters jämställdhet i tillgång till operation av gråstarr i Sverige
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
2016 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Gendered Visions : Gender Differences among Patients regarding Access to Cataract Extractions in Sweden (English)
Abstract [en]

Aim: The aim was to examine waiting times for cataract extraction in Sweden from an intersectional gender perspective; quantitative with regard to waiting times for different patient groups, and qualitative in order to identify factors that might contribute to gender differences in waiting time. Furthermore, the aim was to examine implications of critical realism and situated knowledges for studies of gender differences among patients regarding access to cataract extraction and more generally as grounds for studies of (in)equity in care.

 

Methods: Studies I and II were register studies, and linear regression was performed in Study I and logistic regression in Study II. Mean waiting times for female and male patients were calculated in both studies. In Study III, focus group interviews were conducted at two eye clinics with differences in gender-related waiting times. The analysis method used was constructivist grounded theory, and text analyses were performed in Study IV.

 

Main findings: Longer waiting times were associated with patients who were female, retired, of higher age, born outside the Nordic countries, having lower income, lacking education at university level and not being categorized by means of NIKE. Female patients had longer waiting time in all categories.

The following factors might contribute to why female patients have longer waiting times: Traditional male occupations were constructed as being more demanding for visual acuity, while the need for good visual acuity in women’s work life was questioned; Assertive behaviour among men was explained in legitimizing ways; Behaviour among men with poor vision was constructed as safety risks in relation to driving and hunting. Concerning meta-theoretical aspects, both critical realism and situated knowledges can be fruitful for studies of (in)equity in care but are to some degree incompatible with each other.

 

Conclusions: Differences in waiting times at eye clinics can be related to gender constructions. The prevailing pattern of female cataract patients systematically having longer waiting time than male patients that emerges in this thesis is noteworthy in relation to the principle of equity in care. Furthermore, it is noteworthy that waiting times were related to age, retirement, and native country as well as income and education levels.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2016. , 189 p.
Series
Linnaeus University Dissertations, 251/2016
Keyword [en]
equity in care, waiting time, cataract extraction, doing gender, intersectionality, situated knowledges, critical realism
National Category
Other Medical Sciences
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-52881Libris ID: 19482528ISBN: 978-9188357-17-5 OAI: oai:DiVA.org:lnu-52881DiVA: diva2:932455
Public defence
2016-05-24, V159, Storken, Kalmar, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2016-06-01 Created: 2016-06-01 Last updated: 2017-04-19Bibliographically approved
List of papers
1. Indication criteria for cataract extraction and gender differences in waiting time
Open this publication in new window or tab >>Indication criteria for cataract extraction and gender differences in waiting time
2014 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 92, no 5, 432-438 p.Article in journal (Refereed) Published
Abstract [en]

Purpose:  The purpose of this study was to investigate national indication criteria tool for cataract extraction (NIKE), a clinical tool for establishing levels of indications for cataract surgery, in relation to gender differences in waiting times for cataract extraction (CE).

Methods:  Data were collected by The Swedish National Cataract Register (NCR). Eye clinics report to NCR voluntarily and on regular basis (98% coverage). Comparisons regarding gender difference in waiting times were performed between NIKE-categorized and non-NIKE-categorized patients, as well as between different indication groups within the NIKE-system. All calculations were performed in spssversion 20. Multivariate analyses were carried out using logistic regression, and single variable analyses were carried out by Student’s t-test or chi square as appropriate.

Results:  Gender, age, visual acuity and NIKE-categorization were associated with waiting time. Female patients had a longer waiting time to CE than male, both within and outside the NIKE-system. Gender difference in waiting time was somewhat larger among patients who had not been categorized by NIKE. In the non-NIKE-categorized group, women waited 0.20 months longer than men. In the group which was NIKE-categorized, women waited 0.18 months longer than men.

Conclusions:  It is reasonable to assume that prioritizing patients by means of NIKE helps to reduce the gender differences in waiting time. Gender differences in waiting time have decreased as NIKE was introduced and there may be a variety of explanations for this. However, with the chosen study design, we could not distinguish between effects related to NIKE and those due to other factors which occurred during the study period.

National Category
Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-32085 (URN)10.1111/aos.12230 (DOI)000339482700030 ()2-s2.0-84904748843 (Scopus ID)
Funder
Swedish Research Council
Available from: 2014-02-05 Created: 2014-02-05 Last updated: 2017-12-06Bibliographically approved
2. Inequity in access to care in the Swedish welfare state – the example cataract extraction
Open this publication in new window or tab >>Inequity in access to care in the Swedish welfare state – the example cataract extraction
2014 (English)In: Voices In Nordic Gender Research: Book Of Abstracts: Roskilde University, November 5-7, 2014, Roskilde University , 2014, 17-19 p.Conference paper, Oral presentation with published abstract (Other academic)
Place, publisher, year, edition, pages
Roskilde University, 2014
Keyword
Gender, Acces to care
National Category
Other Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-44775 (URN)
Conference
NORA Conference 2014: Voices In Nordic Gender Research, Roskilde, Denmark, November 5-7, 2014
Funder
Swedish Research Council
Available from: 2015-06-18 Created: 2015-06-18 Last updated: 2016-06-01Bibliographically approved

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