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  • 1.
    Abbas, Haider
    et al.
    KTH, School of ICT, Electronic Systems.
    Magnusson, Christer
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Yngström, Louise
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Hemani, Ahmed
    ICT/Materialfysik.
    Addressing Dynamic Issues in Information Security Management2011In: Information Management & Computer Security, ISSN 0968-5227, E-ISSN 1758-5805, Vol. 19, no 1, p. 5-24Article in journal (Refereed)
    Abstract [en]

    The paper addresses three main problems resulting from uncertainty in information security management: i)dynamically changing security requirements of an organization ii) externalities caused by a security system and iii)obsolete evaluation of security concerns. A framework based on options reasoning borrowed from corporate finance is proposed and adapted to evaluation of security architecture and decision-making for handling these issues at organizational level. The adaptation as methodology is demonstrated by a large case study validating its efficacy.

  • 2. Abbas, Haider
    et al.
    Magnusson, Christer
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Yngström, Louise
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Hemani, Ahmed
    Architectural Description of an Automated System for Uncertainty Issues Management in Information Security2010In: International Journal of computer Science and Information Security, ISSN 1947-5500, Vol. 8, no 3, p. 59-67Article in journal (Refereed)
    Abstract [en]

    Information technology evolves at a faster pace giving organizations a limited scope to comprehend and effectively react to steady flux nature of its progress. Consequently the rapid technological progression raises various concerns for the IT system of an organization i.e. existing hardware/software obsoleteness, uncertain system behavior, interoperability of various components/method, sudden changes in IT security requirements and expiration of security evaluations. These issues are continuous and critical in their nature that create uncertainty in IT infrastructure and threaten the IT security measures of an organization. In this research, Options theory is devised to address uncertainty issues in IT security management and the concepts have been developed/validated through real cases on SHS (Spridnings-och-Hämtningssystem) and ESAM (E-society) systems. AUMSIS (Automated Uncertainty Management System in Information Security) is the ultimate objective of this research which provides an automated system for uncertainty management in information security. The paper presents the architectural description of AUMSIS, its various components, information flow, storage and information processing details using options valuation techniques. It also presents heterogeneous information retrieval problems and their solution. The architecture is validated with examples from SHS system

  • 3.
    Bakari, Jabiri Kuwe
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Tarimo, Charles N
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Magnusson, Christer
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Yngström, Louise
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences. Säkerhetsinformatik.
    Operationalisiation of ICT Security Policy and Mechanisms in an organisation2007Conference paper (Other academic)
  • 4.
    Berg, M
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University.
    Goldkuhl, L
    Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University.
    Nilsson, Christina
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wijk, H
    Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University.
    Gyllensten, H
    Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University.
    Lindahl, G
    Centre for Healthcare Architecture , CVA, Chalmers University of Technology.
    Uvnäs Moberg, K
    University of Agriculture (SLU).
    Begley, C
    School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin.
    Room 4 Birth - The effect of an adaptable birthing room on labour andbirth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden2019In: TrialsArticle in journal (Refereed)
    Abstract [en]

    Background

    An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden.

    Methods/design

    Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman’s wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7–10 on a scale of 1–10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women’s self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms.

    Discussion

    The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care.

  • 5. Berg, M
    et al.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Värdegrunden har betydelse för vårdandet2007In: Vårdfacket, ISSN 0347-0911, Vol. MarsArticle in journal (Other academic)
  • 6. Dittrich, Yvonne
    et al.
    Ekelin, Annelie
    Elovaara, Pirjo
    Eriksén, Sara
    Hansson, Christina
    Making e-Government Happen. Everyday co-development of services, citizenship and technology.2003Conference paper (Refereed)
    Abstract [en]

    In a joint research project concerning the use and design of IT in public services, we are using a simple figure of on-going, design-oriented interactions to highlight shifting foci on relationships of codevelopment of services, citzenship and technology. We bring together a number of concrete examples of this on-going everyday co-development, presented from the different perspectives that we, as researchers from different disciplines and traditions, represent in the project. The article explores and discusses wokring relations of technology production and use that we see as central to what is actually making e-government happen - or not happen. The main challenge in this area, as we see it, concerns making visible, and developing supportive infrastructures for, the continuing local adaptation, development and design in use of integrated IT and public services.

  • 7. Dittrich, Yvonne
    et al.
    Eriksén, Sara
    Hansson, Christina
    PD in the Wild: Evolving Practices of Design in Use2002Conference paper (Refereed)
    Abstract [en]

    The when and where of participatory design has traditionally been set, primarily, by the software design project. However, modern IT networks with a variety of applications from different software providers, new web-design tools, and the integration of customization processes with on-going version management, are just a few of the developments that are moving participation around IT design issues beyond the traditional software project. Using examples from a research project focusing on existing work practices and IT in use in public service administration, we explore various understandings of design, which challenge some of the assumptions underlying the basic framework of participatory design. If design is seen as continually on-going, and intricately interwoven with use, this raises several important issues for participatory design. It highlights design for change. It points towards the need for reconsidering software design processes. It brings into focus issues of coordination between use, design in use and adaptation and development. Crucially, it raises issues about shop floor IT management, that is, organizational and technical support for local adapting, and continual design and development in use, of IT, and the need for models and methods for sustainable, distributed co-constructive design processes.

  • 8. Dittrich, Yvonne
    et al.
    Rönkkö, Kari
    Eriksson, Jeanette
    Hansson, Christina
    Lindeberg, Olle
    Cooperative method development: Combining qualitative empirical research with method, techniqueand process improvement2008In: Empirical Software Engineering, ISSN 1382-3256, 1573-7616, Vol. 13, no 3, p. 231-260Article in journal (Refereed)
    Abstract [en]

    The development of methods tools and process improvements is best to be based on the understanding of the development practice to be supported. Qualitative research has been proposed as a method for understanding the social and cooperative aspects of software development. However, qualitative research is not easily combined with the improvement orientation of an engineering discipline. During the last 6 years, we have applied an approach we call ‘cooperative method development’, which combines qualitative social science fieldwork, with problem-oriented method, technique and process improvement. The action research based approach focusing on shop floor software development practices allows an understanding of how contextual contingencies influence the deployment and applicability of methods, processes and techniques. This article summarizes the experiences and discusses the further development of this approach based on several research projects in cooperation with industrial partners.

  • 9. Dittrich, Yvonne
    et al.
    Rönkkö, Kari
    Lindeberg, Olle
    Eriksson, Jeanette
    Hansson, Christina
    Co-Operative Method Development revisited2005Conference paper (Refereed)
    Abstract [en]

    During the last five years, we applied a research approach we call 'Co-operative Method Development' formulated on first experience with empirical research focusing especially on the social side of software engineering. This position paper summarizes the experiences and discusses the improvement and further development of this research approach based on our experiences in different research projects in co-operation with industrial partners.

  • 10. Ekelin, Annelie
    et al.
    Elovaara, Pirjo
    Eriksén, Sara
    Dittrich, Yvonne
    Hansson, Christina
    Landén, Sölve
    Larsson, Anita
    Olén, Ida
    Winter, Jeff
    KomInDu: A Small Project about Big Issues2004Conference paper (Refereed)
    Abstract [en]

    In this short paper, we present glimpses from an interdisciplinary research and development project aimed at enhancing local democracy by developing ICT support for the consultation process around the comprehensive plan of a municipality. For the participating researchers, the project offered the opportunity of combining and comparing approaches and methods from two different design traditions that share democratic ideals and ambitions of nurturing citizen/user participation in design processes. This proved to be more challenging than we had originally anticipated. Differences in perspective gave different interpretations of the design context as well as of how participatory the processes actually were.

  • 11.
    Ekstrand, Susanne
    et al.
    Blekinge Institute of Technology, Department of Human Work Science and Media Technology.
    Hansson, Christina
    Blekinge Institute of Technology, Department of Human Work Science and Media Technology.
    Design och utveckling av IT-verktyg: ger ringar på vattnet i en organisation2001Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [en]

    Detta kandidatarbete i datavetenskap och arbetsvetenskap, beskriver design- och utvecklingsprocessen av ett IT-verktyg mellan Ronneby kommun och konsultföretaget TietoEnator, Göteborgskontoret. Rapporten behandlar samarbetet mellan konsult och medutvecklare. I samarbetet förs organisationen in i verktyget och verktyget i organisationen. Begrepp som är centrala i detta samarbete är design, medutveckling och tailoring. En frågeställning som följer rapporten är om distansarbete och medutveckling kan vara ett bra arbetssätt vid design och utveckling av programvara, då organisationen ska föras in i verktyget, samt vilka för- och nackdelar som kan finnas med detta arbetssätt. Våra studier visar att distansarbete är ett bra komplement till personliga möten mellan konsult och medutvecklare. Det finns flera för- och nackdelar med distansarbete. Genom medutvecklingen ges medutvecklaren möjlighet att påverka verktyget genom att komma med designförslag som ger en utökad anpassningsbarhet för framtiden. Förankringen hos medarbetarna i organisationen är betydelsefull för hur de kommer att ta emot verktyget. Långsiktigheten i design- och utvecklingsprocessen har betydelse då organisationer kontinuerligt förändras över tid. Verktyget bör därför vara flexibelt och anpassningsbart. I slutet av rapporten ges förslag på hur en design- och utvecklingsprocess bör genomföras, utifrån författarnas studier under kandidatarbetet.

  • 12. Elovaara, Pirjo
    et al.
    Eriksén, Sara
    Ekelin, Annelie
    Hansson, Christina
    Nilsson, Monica E
    Winter, Jeff
    Educational programs in e-government: An active, practice- and design-oriented network?2004Conference paper (Refereed)
    Abstract [en]

    In the autumn of 2004, two higher educational programs in e-government will be starting up at Blekinge Institute of Technology in Southern Sweden. One of these is a Master’s level program, while the other is a more basic, two-year vocational education. Each will be the first of its kind in Scandinavia, and both will be offered as net-based distance education. The interdisciplinary group of researchers/teachers now developing the courses for these educational programs, in co-operation with several other research groups in Scandinavia, see this co-construction of distance education as the beginning of an active Scandinavian network of competence around higher education and ongoing research and development in the e-government area. We are currently exploring the possibilities of using distance education in this area as a way of networking around on-going e-government research and competence enhancement in Scandinavia. The Scandinavian tradition of Participatory Design, as well as ideas about e-government as constantly ongoing co-construction, have inspired us in our work with developing the new educational programs. A reference group consisting of representatives from a number of municipalities and various government agencies plays an important role in this work.

  • 13. Eriksén, Sara
    et al.
    Ekelin, Annelie
    Elovaara, Pirjo
    Dittrich, Yvonne
    Hansson, Christina
    Winter, Jeff
    What have we learned from the TANGO arena for regional cooperation in Southern Sweden?2004Conference paper (Refereed)
    Abstract [en]

    The TANGO e-government arena is a project in Southern Sweden, funded by the Innovative Actions of the European Regional Development Fund. The project is now nearing its end, and we are thus at the stage of reflectively reviewing what has actually been accomplished and how this relates to the original goals of the project. In July 2002, when the project began, the aim was to establish cooperation between the public sector, private enterprise and university-based research in designing public e-services. In cooperating around development of new, integrated services, catering to various categories of users as well as to a growing diversity of mobile technologies, we have aimed towards es-tablishing feedback channels between practice and theory, between use and design, and between different academic disciplines where we see a need to synchronize the models and methods we work with. Our research questions have focused on exploring and managing multi-perspectivity as a resource for design. In this paper we look at how we organized our cooperation around these goals, and attempt to address those basic summing-up-the-project questions; How well have we succeeded? What have we learned in the process?

  • 14.
    Hansson, Christina
    Blekinge Tekniska Högskola [bth.se], The Library.
    Lärarlärdom Högskolepedagogisk konferens 20142014Collection (editor) (Other academic)
    Abstract [sv]

    Högskolepedagogisk utveckling har under senare år fått en tydligare och mer framträdande roll vid universitet och högskolor. Under senare år har också ett allt större fokus riktats mot utbildningars resultat. Frågor som rör kvaliteten i undervisningen blir därmed centrala. Att utveckla och stödja lärares pedagogiska skicklighet samt belysa villkoren för den undervisning som bedrivs inom högre utbildning är angeläget. Behovet av en gemensam samlingspunkt för pedagogiska och didaktiska diskussioner där BTH:s och Högskolan i Kristianstads lärare kan träffas och föra dessa diskussioner tillsammans och över ämnesgränser är stort. Genom att anordna en årlig högskolepedagogisk konferens vill vi främja ett utbyte av erfarenheter från den dagliga undervisningen och insikter kring det lärande som möjliggörs. Lärarlärdom 2014 gick av stapeln på Blekinge Tekniska Högskola den 20 augusti och samlade ett femtiotal deltagare. Den inledande föreläsningen samt ytterligare fem presentationer finns inspelade och nås via: http://distans.hkr.se/wid/ChristinaHansson/lararlardom_bth2014/

  • 15.
    Hansson, Christina
    Blekinge Institute of Technology, Education Development Unit.
    Lärarlärdom, högskolepedagogisk konferens, 20172017Conference proceedings (editor) (Refereed)
    Abstract [sv]

    Högskolepedagogisk utveckling har under senare år fått en tydligare och mer framträdande roll vid universitet och högskolor. Under senare år har också ett allt större fokus riktats mot utbildningars resultat. Frågor som rör kvaliteten i undervisningen blir därmed centrala. Att utveckla och stödja lärares pedagogiska skicklighet samt belysa villkoren för den undervisning som bedrivs inom högre utbildning är angeläget. Behovet av en gemensam samlingspunkt för pedagogiska och didaktiska diskussioner där lärare och andra yrkeskategorier som är intresserade av av ämnet på BTH, Högskolan i Kristianstads och Linnéuniversitetet kan träffas och föra dessa diskussioner tillsammans och över ämnesgränser är stort. Genom att anordna en årlig högskolepedagogisk konferens vill vi främja ett utbyte av erfarenheter från den dagliga undervisningen och insikter kring det lärande som möjliggörs.

    Lärarlärdom 2017 gick av stapeln på Blekinge Tekniska Högskola, campus Karlshamn den 16 augusti och samlade ett femtiotal deltagare.

  • 16.
    Hansson, Christina
    Blekinge Institute of Technology, Education Development Unit.
    Lärarlärdom: högskolepedagogisk konferens 20192019Collection (editor) (Refereed)
    Abstract [sv]

    Högskolepedagogisk utveckling har under senare år fått en tydligare och mer framträdande roll vid universitet och högskolor. Under senare år har också ett allt större fokus riktats mot utbildningars resultat. Frågor som rör kvaliteten i undervisningen blir därmed centrala. Att utveckla och stödja lärares pedagogiska skicklighet samt belysa villkoren för den undervisning som bedrivs inom högre utbildning är angeläget. Behovet är stort av en gemensam samlingspunkt för pedagogiska och didaktiska diskussioner där lärare och andra yrkeskategorier som är intresserade av av ämnet kan träffas och föra dessa diskussioner tillsammans och över ämnesgränser. Blekinge Tekniska Högskola, Högskolan i Kristianstad och Malmö universitet samarrangerar därför den årliga högskolepedagogiska konferensen Läralärdom.

    Lärarlärdom 2019 gick av stapeln på Blekinge Tekniska Högskola i Karlskrona den 15 augusti och samlade ett sjuttiotal deltagare. Ett urval av konferensens presentationer finns på https://play.bth.se

  • 17.
    Hansson, Christina
    Blekinge Institute of Technology, Department of Human Work Science and Media Technology.
    User Driven Software Development in a Small Company2002Independent thesis Advanced level (degree of Master (One Year))Student thesis
    Abstract [en]

    Field studies, interviews and participative observations have been the main methods in this master thesis where the author has studied, and partially participated, in the development process of a booking system called FRI. Idavall is the small company that develops this suc-cessful software despite small resources. Characteristic for Idavall is in the way they manage to involve their about 1300 users in the development process. The development process is highly flexible which is required when rapidly changes are common. The overall question in this thesis is: How do Idavall manage to develop this software in a flexible way and successfully involve their users in the development process? Idavall arranges FRI-meetings, courses and demonstrations where users meet each other and a representative from Idavall. All participants discuss FRI and have the opportunity to propose changes, improvements and report bugs. One of the most important parts of the busi-ness idea of Idavall is to offer a proper, friendly and professional support. The support is one of the most important possibilities to be informed about the users? needs, wishes and propos-als. This, what I called, user driven development has a lot of common with Participatory De-sign (PD) where users participate in the design of new software. PD implies that users of software should take part in decisions that affect the system and the way it is used and de-signed. Idavall make use of a kind of Customer Relationship Management (CRM), which is a concept used in the marketing arena. The objective of CRM is to create a strong, mutual and trustful relationship between supplier and customer. By using CRM in combination with PD it is possible to enhance the user participation and enable user driven development. The company has a flexible development process, which is built on an informal way of driving the process. Informal meetings are common where decisions about changes and im-provements are taken quickly. New versions are delivered about 20 times a year. The employ-ees meet several times a day in the central located coffee room and discuss problems. The development process has a lot of common with Extreme Programming (XP), which is a software development methodology that aims to make software development more flexi-ble and focus on highly flexible environments with quickly changing requirements. XP is de-scribed briefly and comparisons are made to the development process of FRI as well as short-comings of XP in the context of PD.

  • 18. Hansson, Christina
    et al.
    Dittrich, Yvonne
    Gustavsson, Björn
    Zarnaak, Stefan
    How agile are industrial software development practices?2006In: Journal of Systems and Software, ISSN 0164-1212, E-ISSN 1873-1228, Vol. 79, no 9Article in journal (Refereed)
    Abstract [en]

    Representatives from the agile development movement claim that agile ways of developing software are more fitting to what is actually needed in industrial software development. If this is so, successful industrial software development should already exhibit agile characteristics. This article therefore aims to examine whether that is the case. It presents an analysis of interviews with software developers from five different companies. We asked about concrete projects, both about the project models and the methods used, but also about the real situation in their daily work. Based on the interviews, we describe and then analyze their development practices. The analysis shows that the software providers we interviewed have more agile practices than they might themselves be aware of. However, plans and more formal development models also are well established. The conclusions answer the question posed in the title: It all depends! It depends on which of the different principles you take to judge agility. And it depends on the characteristics not only of the company but also of the individual project.

  • 19. Hansson, Christina
    et al.
    Dittrich, Yvonne
    Randall, Dave
    Agile Processes Enhancing User Participation for Small Providers of Off-the-Shelf Software2004Conference paper (Refereed)
    Abstract [en]

    To survive in todayrsquos competitive software market, software developers must maintain contact with their customers and users and adopt a flexible organization which allows response to feedback and the changing requirements from the use-context. This also requires a software development that enables change proposals and error reports to be acted upon quickly. The present article uses a case study of a flexible development practice which so far has proved to be sustainable and successful to reconsider user involvement and software development practices of small software providers from an agile perspective. Implementing an agile process may allow for competitive flexibility without necessarily jeopardizing quality.

  • 20. Hansson, Christina
    et al.
    Dittrich, Yvonne
    Randall, Dave
    How to include users in the development of off-the-shelf software: A case for complementing participatory design with agile development2006Conference paper (Refereed)
    Abstract [en]

    This paper describes and discusses a non-traditional approach to participatory design, one which is combined with an agile-like software development process. In this case, the size of the company combined with a distributed population of users has a serious impact on the software development process. The small software company in our study resolves this problem with an unconventional amalgam of participatory design and agile processes which seems to suit their situation. By using different kinds of user participation the small software provider is able to keep in contact with users on a daily basis. Users convey requirements for new functionalities, give feedback and report errors. Users' feedback and proposals form the basis for further development. The paper relates our observations to other research on participatory design in unconventional settings and discusses the conditions under which agile software development can complement participatory design.

  • 21. Hansson, Christina
    et al.
    Jedemark, MarieNygren, Åse
    Lärarlärdom, Högskolepedagogisk konferens 2009-20102011Collection (editor) (Other academic)
    Abstract [en]

    Högskolepedagogiska paper som bygger på empiriska undersökningar inom olika ämnesområden On Curriculum, Bildung and the Dialogue Seminar, ”Funkade bra!” – studenters upplevelser av studentstyrt litteraturseminarium, Learning Machine Learning: A Case Study, Stödjande av ett Community Of Practice för studenter, Learning Tools with Pedagogical Standards, Integration av matematik och teknik på ingenjörsutbildningar, Thesis Writing in Business Education – from a Student Perspective, Reflections on Threshold Concepts as Applied to a New E-Learning Tool: A Pilot Study at HKR Spring 2010, Fri tankeprocess och medvetenhet om kreativitet: En studie av studenters kreativa utveckling i kursen Kreativitet, Idéer och Innovation ur ett psykologiskt perspektiv, Notes on Attitudes to Statistics among Swedish Psychology and Education Science Students: The Effects of Self-perception and Anxiety, Från magkänsla till professionell kunskap inom distansutbildning Rapport från ett SoTL-projekt.En kritisk reflektion över didaktik i praktiken

  • 22.
    Hansson, Christina
    et al.
    Blekinge Tekniska Högskola [bth.se], The Library.
    Karlsson, LeifNygren, ÅseBlekinge Tekniska Högskola [bth.se], The Library.
    Lärarlärdom Högskolepedagogisk konferens 20122013Collection (editor) (Other academic)
    Abstract [sv]

    Högskolepedagogisk utveckling har under senare år fått en tydligare och mer framträdande roll vid universitet och högskolor. Under senare år har också ett allt större fokus riktats mot utbildningars resultat. Frågor som rör kvaliteten i undervisningen blir därmed centrala. Att utveckla och stödja lärares pedagogiska skicklighet samt belysa villkoren för den undervisning som bedrivs inom högre utbildning är angeläget. Behovet av en gemensam samlingspunkt för pedagogiska och didaktiska diskussioner där BTH:s och Högskolan i Kristianstads lärare kan träffas och föra dessa diskussioner tillsammans och över ämnesgränser är stort. Genom att anordna en årlig högskolepedagogisk konferens vill vi främja ett utbyte av erfarenheter från den dagliga undervisningen och insikter kring det lärande som möjliggörs. Lärarlärdom 2012 gick av stapeln på Blekinge Tekniska Högskola den 15 augusti och samlade ett femtiotal deltagare. Den inledande föreläsningen samt ytterligare tre presentationer finns inspelade och finns på Medieportalen på Blekinge Tekniska Högskola. http://tuba.bth.se/medieportal/play/510/Lararlardom-pa-BTH

  • 23. Hildingsson, I
    et al.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Karlström, A
    Lundgren, I
    A Longitudinal Survey of Childbirth-Related Fear and Associated Factors2011In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 40, no 5, p. 532-543Article in journal (Refereed)
    Abstract [en]

    To investigate the prevalence of childbirth-related fear from pregnancy to one year after childbirth and to identify factors associated with being cured of childbirth-related fear. Design A longitudinal regional survey. Setting Three hospitals in a northern part of Sweden. Participants Six hundred ninety-seven (697) women who completed four questionnaires. Methods Data were collected by questionnaires in mid and late pregnancy and at 2 months and one year after birth. Childbirth related fear was measured 3 times. Results There was a statistically significant increase in childbirth fear from 12.4% in mid-pregnancy to 15.1% one year after childbirth (p < .001). Women who were cured of childbirth fear reported a better birth experience and would prefer a vaginal birth in a subsequent pregnancy. These women were also more likely to experience a feeling of control during birth and were more satisfied with information about the progress of labor, but there was no difference in prenatal counseling or having an elective cesarean between the groups. Conclusion Women with prenatal fear of childbirth may be cured of this fear by having a better birth experience. If women feel in control of their bodies and are well informed about the progress of labor, the chances of being cured will increase. Prenatal counseling or having an elective cesarean birth does not seem to be a solution for relieving childbirth fear.

  • 24. Johnsson, Pontus
    et al.
    Iacob, Maria Eugenia
    Välja, Margus
    van Sinderen, Marten
    Magnusson, Christer
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Ladhe, Tobias
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Business model risk analysis: predicting the probability of business network profitability2013In: Enterprise Interoperability: 5th International IFIP Working Conference, IWEI 2013. Proceedings / [ed] Marten van Sinderen, Paul Oude Luttighuis, Erwin Folmer, Steven Bosems, Springer Berlin/Heidelberg, 2013, p. 118-130Conference paper (Refereed)
    Abstract [en]

    In the design phase of business collaboration, it is desirable to be able to predict the profitability of the business-to-be. Therefore, techniques to assess qualities such as costs, revenues, risks, and profitability have been previously proposed. However, they do not allow the modeler to properly manage uncertainty with respect to the design of the considered business collaboration. In many real collaboration projects today, uncertainty regarding the business’ present or future characteristics is so significant that ignoring it becomes problematic. In this paper, we propose an approach based on the Predictive, Probabilistic Architecture Modeling Framework (P2AMF), capable of advanced and probabilistically sound reasoning about profitability risks. The P2AMF-based approach for profitability risk prediction is also based on the e3-value modeling language and on the Object Constraint Language (OCL). The paper introduces the prediction and modeling approach, and a supporting software tool. The use of the approach is illustrated by means of a case.

  • 25.
    Lundgren, I
    et al.
    Institute of Health and Care Sciences, The Sahlgrenska Academy.
    Berg, M
    Institute of Health and Care Sciences, The Sahlgrenska Academy.
    Nilsson, Christina
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Olafsdottir, OA
    Faculty of Nursing, School of Health Sciences, University of Iceland.
    Health professionals' perceptions of a Midwifery Model of Woman-Centred Care implemented on a hospital labour ward2019In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article in journal (Refereed)
    Abstract [en]

    Background

    Theoretical models as a basis for midwives’ care have been developed over recent decades. Although there are similarities between these models, their usefulness in practice needs to be researched in specific cultural contexts.

    Aim

    To explore whether, when adopted by midwives on labour wards, a midwifery model of woman-centred care (MiMo) was useful in practice from the viewpoint of a variety of health professionals.

    Methods

    Data were collected from a variety of health professionals before and after an intervention of implementating MiMo at a hospital-based labour ward in Sweden, using nine focus group interviews with a total of 43 participants: midwives (n = 16), obstetricians (n = 8), assistant nurses (n = 11) and managers (n = 8). The text from interviews was analysed using content analysis.

    Findings

    From expressing no explicit need of a midwifery model of woman-centred care before the intervention, there was a shift in midwives, obstetricians and managers perceptions towards identifying advantages of using the MiMo as it gives words to woman-centred midwifery care. Such shift in perception was not found among the assistant nurses.

    Discussion

    Clarification of the various roles of health professionals is needed to develop the model. Heavy workloads and stress were barriers to implementing the model. Thus, more support is needed from organisational management.

    Conclusions

    The model was useful for all professional groups, except for assistant nurses. Further studies are needed in order to clarify the various professional roles and interdisciplinary collaborations in making the MiMo more useful in daily maternity care.

  • 26. Lundgren, I
    et al.
    Morano, S
    Nilsson, Christina
    Sinclair, M
    Begley, C
    Cultural perspectives on vaginal birth after previous caesarean sectionin countries with high and low VBAC rates – a hermeneutic study2019In: Women & BirthArticle in journal (Refereed)
    Abstract [en]

    Background

    Caesarean section (CS) rates are increasing worldwide, an increase that is multifactorial and not well understood. There is considerable variation in the rates of vaginal birth after previous Caesarean section (VBAC). Cultural differences could be one explanation of the varying rates.

    Objective

    To interpret cultural perspectives on VBAC.

    Methods

    A hermeneutic approach for analysing findings from four published qualitative studies that were part of the OptiBIRTH study, focusing on clinicians and women’s views of important factors for improving the rate of VBAC. 115 clinicians and 73 women participated in individual interviews and focus group interviews in countries with low rates (Germany, Italy and Ireland) and countries with high rates (Sweden, Finland and the Netherlands), in the original studies.

    Results

    Three themes demonstrated how the culture differs between the high and low VBAC rate countries; from being an obvious first alternative to an issue dependent on many factors; from something included in the ordinary care to something special; and from obstetrician making the final decision to a choice by the woman. The fourth theme, preparing for a new birth by early follow-up and leaving the last birth behind, reflects coherence between the cultures.

    Discussion

    The findings deepen our understanding of why the VBAC rates vary across countries and healthcare settings, and can be used for improving the care for women.

    Conclusion

    In order to improve VBAC rates both maternity care settings and individual professionals need to reflect on their VBAC culture, and make make changes to develop a ‘pro-VBAC culture’.

  • 27.
    Lundgren, Ingela
    et al.
    Göteborgs Universitet.
    Healy, Patricia
    Carroll, Margaret
    Begley, Cecily
    Matterne, Andrea
    Gross, Mechthild M
    Grylka-Baeschlin, Susanne
    Nicoletti, Jane
    Morano, Sandra
    Nilsson, Christina
    Göteborgs Universitet.
    Lalor, Joan
    Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates.2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, no 1, article id 350Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.

    METHODS: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.

    RESULTS: The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision making - rapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician-woman relationship.

    CONCLUSIONS: The findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.

  • 28.
    Lundgren, Ingela
    et al.
    University of Gothenburg.
    Smith, Valerie
    Trinity College Dublin.
    Nilsson, Christina
    University of Gothenburg.
    Vehvilainen-Julkunen, Katri
    University of Eastern Finland.
    Nicoletti, Jane
    Universita Degli Studi di Genova.
    Devane, Declan
    NUI Galway/West North West Hospital Group.
    Bernloehr, Annette
    Hannover Medical School.
    van Limbeek, Evelien
    Zuyd University.
    Lalor, Joan
    Trinity College Dublin.
    Begley, Cecily
    Trinity College Dublin.
    Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review.2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 16Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC.

    METHODS: The bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, 'Effective Public Health Practice Project'. The primary outcome measure was VBAC rates.

    RESULTS: 238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates.

    CONCLUSIONS: This systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were performed during the late 1980s-1990s. An opinion leader educational strategy confers benefit for increasing VBAC rates. This strategy should be further studied in different maternity care settings and with professionals other than physicians only.

  • 29. Lundgren, Ingela
    et al.
    van Limbeek, Evelien
    Vehvilainen-Julkunen, Katri
    Nilsson, Christina
    Göteborgs Universitet.
    Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a qualitative study from countries with high VBAC rates.2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, article id 196Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of 'OptiBIRTH', an ongoing research project. The study reported here is based on interviews in high VBAC countries. The aim of the study was to investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates.

    METHODS: Individual (face-to-face or telephone) interviews and focus group interviews with clinicians (in different maternity care settings) in three countries with high VBAC rates were conducted during 2012-2013. In total, 44 clinicians participated: 26 midwives and 18 obstetricians. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.

    RESULTS: The findings are presented in four main categories with subcategories. First, a common approach is needed, including: feeling confident with VBAC, considering VBAC as the first alternative, communicating well, working in a team, working in accordance with a model and making agreements with the woman. Second, obstetricians need to make the final decision on the mode of delivery while involving women in counselling towards VBAC. Third, a woman who has a previous CS has a similar need for support as other labouring women, but with some extra precautions and additional recommendations for her care. Finally, clinicians should help strengthen women's trust in VBAC, including building their trust in giving birth vaginally, recognising that giving birth naturally is an empowering experience for women, alleviating fear and offering extra visits to discuss the previous CS, and joining with the woman in a dialogue while leaving the decision about the mode of birth open.

    CONCLUSIONS: This study shows that, according to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are related to the structure of the maternity care system in the country, to the cooperation between midwives and obstetricians, and to the care offered during pregnancy and birth. More research on clinicians' perspectives is needed from countries with low, as well as high, VBAC rates.

  • 30.
    Lyckestam Thelin, I
    et al.
    Institute of Health and Care Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg.
    Lundgren, I
    Institute of Health and Care Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg.
    Nilsson, Christina
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    To challenge oneself as a childbearing woman—the lived experience of vaginal birth after caesarean section in Sweden2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, article id 1605784Article in journal (Refereed)
    Abstract [en]

    Purpose: There is a need to gain deeper knowledge about women’s experience of vaginal birth after caesarean section (VBAC). Considerable research has been conducted on VBAC; however, only a few qualitative studies focus on women’s experiences. Therefore, the aim of this study was to describe the lived experiences of VBAC among women resident in Sweden, a country with a high VBAC rate.

    Method: This studywas performed in accordance with a phenomenological reflective lifeworld approach. Interviews were conducted with nine women in an urban region of Sweden one year after their VBAC birth.

    Results: The essential meaning of the studied phenomenon is “to challenge oneself as a childbearing woman”, which is further described by its four constituents: “striving for support from professionals”, “desiring the experience”, “contrasting and comparing memories of two different births” and “being part of the birthing culture”.

    Conclusions: The experience of VBAC meant regained trust in the ability to give birth vaginally. The women lacked follow-up and support after the caesarean section (CS), during the subsequent pregnancy and the forthcoming VBAC. Enhanced support could be a key factor in helping women meeting the challenge and feel confident about giving birth vaginally despite their previous experiences of CS.

  • 31.
    Magnusson, Christer
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    ICT Pollution and Liability2011In: Computers & society, ISSN 0095-2737, E-ISSN 2167-3055, Vol. 41, no 1, p. 48-53Article in journal (Refereed)
    Abstract [en]

    To a large extent liability for ICT perils is still a grey area, even though an increasing number of information security researchers adopt economic approaches to highlight market mechanisms and externalities. That is why this article focuses on the need for increased awareness of externalities and liability among ICT professionals and their customers. This is critical to achieve in order to promote appropriate ICT technologies and services with comprehensible privacy and security protection.

    What is needed is a better understanding of the consequences of externalities from ICT perils. This would benefit customers and increase trust in ICT products and services which in turn may even increase suppliers' profit margin; customers would be prepared to buy more services and products if contracts and service level agreements would accept more liability. Moreover, suppliers could sell guaranties and insurances on top of their products and services. The result would be a win-win situation and would benefit society at large.

  • 32.
    Magnusson, Christer
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Bakari, Jabiri Kuwe
    Wahlgren, Gunnar
    Yngström, Louise
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    ICT Risk Management Drivers - a Comparative Study of Sweden, USA, India, and Tanzania2007In: Proceedings of the CRiSIS 2007 International Conference on Risk and Security of Internet and Systems, 2007Conference paper (Refereed)
  • 33.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Hogg, Beatrice (Editor)
    Hildingsson, Ingegerd (Editor)
    Lundgren, Ingela (Editor)
    University of Borås, School of Health Science.
    Att möta och vårda kvinnan med förlossningsrädsla2009In: Lärobok för barnmorskor, 3:e upplagan / [ed] Annette Kaplan, Beatrice Hogg, Ingegerd Hildingsson, Ingela Lundgren, Lund: Studentlitteratur AB , 2009, p. 64-68Chapter in book (Other academic)
  • 34.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Att möta och vårda kvinnor med svår förlossningsrädsla2010In: Att stödja och stärka. Vårdande vid barnafödande / [ed] Marie Berg, Ingela Lundgren, Studentlitteratur , 2010, p. 169-191Chapter in book (Other academic)
  • 35.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Föreläsning om förlossningsrädsla2007Conference paper (Other academic)
  • 36.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Förlossningsrädsla med fokus på kvinnors förlossningsupplevelser2012Conference paper (Other academic)
  • 37.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Förlossningsrädsla: med fokus på kvinnors upplevelser av att föda barn2012Doctoral thesis, monograph (Other academic)
  • 38.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Presentation av forskningsområde.2007Conference paper (Other academic)
  • 39.
    Nilsson, Christina
    Göteborgs Universitet.
    The delivery room: is it a safe place? A hermeneutic analysis of women's negative birth experiences.2014In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 4, p. 199-204, article id S1877-5756(14)00063-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Women's negative experiences in the delivery room can have significance for later fear of childbirth. Therefore, it is important to critically evaluate the care during childbirth. The aim was to gain a deeper understanding of women's negative experiences in the delivery room.

    METHODS: This study is based on original data from three qualitative studies on Swedish women's experiences of fear of childbirth. Data were collected from interviews with 21 women; 15 pregnant women (6 + 9) with intense fear of childbirth, and six women who had experienced intense fear of childbirth 7-11 years prior to the interview. The analysis had a hermeneutic approach, with focus on the women's descriptions of their previous negative birth experiences.

    FINDINGS: The interpretation showed that in the delivery room the women were objects of surveillance, and they endured suffering related to the care during childbirth. This involves experiences of midwives as uncaring, feelings of being suppressed, unprotected and lacking safety, of feeling disconnected and of the body as incompetent in giving birth. The birth environments are understood as power structures, containing views of women's birthing bodies as machines, and delivery rooms as surveillance environments, involving interventions such as foetal heart monitoring, induction and augmentation of labour.

    CONCLUSIONS: The delivery room was, for these women, a place creating fear of childbirth. To avoid negative birth experiences and future fear, women must be offered not only medical, but also emotional and existential safety in the delivery room.

  • 40.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Bondas, Terese
    University of Borås, School of Health Science.
    Lundgren, Ingela
    University of Borås, School of Health Science.
    Previous birth experience in women with intense fear of childbirth2011Conference paper (Refereed)
  • 41.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Bondas, Terese
    Lundgren, Ingela
    Previous birth experience in women with intense fear of childbirth2010In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 39, no 3, p. 298-309Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the meaning of previous experiences of childbirth in pregnant women who have exhibited intense fear of childbirth such that it has an impact on their daily lives.

    Design: A descriptive phenomenological study. Setting: A maternity clinic for women with fear of childbirth in the western part of Sweden. Participants: Nine women with intense fear of childbirth who were pregnant with their second child and considered their previous birth experiences negative.

    Methods: Interviews that were transcribed verbatim and analyzed with a reflective life-world approach.

    Results: The essential meanings that emerged were a sense of not being present in the delivery room and an incomplete childbirth experience. The women felt as if they had no place there, that they were unable to take their place, and that even if the midwife was present, she did not provide support. The experience remained etched in the women’s minds and gave rise to feelings of fear, loneliness, and lack of faith in their ability to give birth and diminished trust in maternity care. These experiences contrasted with brief moments that made sense.

    Conclusions: Previous childbirth experiences for pregnant women with intense fear of childbirth have a deep influence and can be related to suffering and birth trauma. The implication is to provide maternity care where the nurse/ midwife is present and supports women during birth in a way that enables them to be present and take their place during birth.

  • 42.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Bondas, Terese
    University of Borås, School of Health Science.
    Lundgren, Ingela
    University of Borås, School of Health Science.
    Previous birth experience in women with intense fear of childbirth2010Conference paper (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the meaning of previous experiences of childbirth in pregnant women who have exhibited intense fear of childbirth such that it has an impact on their daily lives. DESIGN: A descriptive phenomenological study. SETTING: A maternity clinic for women with fear of childbirth in the western part of Sweden. PARTICIPANTS: Nine women with intense fear of childbirth who were pregnant with their second child and considered their previous birth experiences negative. METHODS: Interviews that were transcribed verbatim and analyzed with a reflective life-world approach. RESULTS: The essential meanings that emerged were a sense of not being present in the delivery room and an incomplete childbirth experience. The women felt as if they had no place there, that they were unable to take their place, and that even if the midwife was present, she did not provide support. The experience remained etched in the women's minds and gave rise to feelings of fear, loneliness, and lack of faith in their ability to give birth and diminished trust in maternity care. These experiences contrasted with brief moments that made sense. CONCLUSIONS: Previous childbirth experiences for pregnant women with intense fear of childbirth have a deep influence and can be related to suffering and birth trauma. The implication is to provide maternity care where the nurse/midwife is present and supports women during birth in a way that enables them to be present and take their place during birth.

  • 43.
    Nilsson, Christina
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Dencker, Anna
    Göteborgs Universitet.
    Begley, Cecily
    Trinity University.
    Jangsten, Elisabeth
    Göteborgs Universitet.
    Mollberg, Margareta
    Göteborgs Universitet.
    Patel, Harshida
    Göteborgs Universitet.
    Wigert, Helena
    Göteborgs Universitet.
    Hessman, Eva
    Göteborgs Universitet.
    Sjöblom, Helen
    Göteborgs Universitet.
    Sparud-Lundin, Carina
    Göteborgs Universitet.
    Causes and outcomes in studies of fear of childbirth: A systematic review2018In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article, review/survey (Refereed)
    Abstract [en]

    PROBLEM:

    Fear of childbirth negatively affects women during pregnancy and after birth.

    AIM:

    To summarise the findings of published studies regarding possible causes/predisposing factors and outcomes of fear of childbirth for childbearing women.

    DESIGN:

    A systematic review, searching five databases in March 2015 for studies on causes/predisposing factors and outcomes of fear of childbirth, as measured during pregnancy and postpartum. Quality of included studies was assessed independently by pairs of authors. Data were extracted independently by reviewer pairs and described in a narrative analysis.

    FINDINGS:

    Cross-sectional, register-based and case-control studies were included (n=21). Causes were grouped into population characteristics, mood-related aspects, and pregnancy and birth-related aspects. Outcomes were defined as mood-related or pregnancy and birth-related aspects. Differing definitions of fear of childbirth were found and meta-analysis could only be performed on parity, in a few studies.

    CONCLUSIONS:

    Stress, anxiety, depression and lack of social support are associated with fear during pregnancy. Need for psychiatric care and presence of traumatic stress symptoms are reported outcomes together with prolonged labour, longer labours, use of epidural and obstetric complications. Nulliparous and parous women have similar levels of fear but for different reasons. Since the strongest predictor for fear in parous women is a previous negative birth experience or operative birth, we suggest it is important to distinguish between fear of childbirth and fear after birth. Findings demonstrate the need for creating woman-centred birthing environments where women can feel free and secure with low risk of negative or traumatic birth experiences and consequent fear.

  • 44.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Eriksson, Carola
    Ingegerd, Hildingsson (Editor)
    Hogg, Beatrice (Editor)
    Kaplan, Annette (Editor)
    Förlossningsrädsla2009In: Lärobok för barnmorskor, 3:e upplagan / [ed] Annette Kaplan, Beatrice Hogg, Ingegerd Hildingsson, Ingela Lundgren, Lund: Studentlitteratur AB , 2009, p. 62-64Chapter in book (Other academic)
  • 45.
    Nilsson, Christina
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. University of Gothenburg.
    Hessman, Eva
    University of Gothenburg.
    Sjöblom, Helen
    University of Gothenburg.
    Dencker, Anna
    University of Gothenburg.
    Jangsten, Elisabeth
    University of Gothenburg.
    Mollberg, Margareta
    University of Gothenburg.
    Patel, Harshida
    University of Gothenburg.
    Sparud-Lundin, Carina
    University of Gothenburg.
    Wigert, Helena
    University of Gothenburg.
    Begley, Cecily
    Trinity College Dublin.
    Definitions, measurements and prevalence of fear of childbirth: a systematic review2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 29329526Article in journal (Refereed)
    Abstract [en]

    Background

    Fear of Childbirth (FOC) is a common problem affecting women’s health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings.

    Methods

    Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared.

    Results

    In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with ≥85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, p < 0.0001).

    Conclusions

    Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of ≥85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as ‘Are you afraid about the birth?’ In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required.

  • 46.
    Nilsson, Christina
    et al.
    University of Gothenburg.
    Lalor, Joan
    Trinity College Dublin.
    Begley, Cecily
    Trinity College Dublin.
    Carroll, Margaret
    Trinity College Dublin.
    Gross, Mechthild M
    Hannover Medical School.
    Grylka-Baeschlin, Susanne
    Hannover Medical School.
    Lundgren, Ingela
    University of Gothenburg.
    Matterne, Andrea
    Hannover Medical School.
    Morano, Sandra
    University of Genoa.
    Nicoletti, Jane
    University of Genoa.
    Healy, Patricia
    National University of Ireland.
    Vaginal birth after caesarean: Views of women from countries with low VBAC rates2017In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 6, p. 481-490, article id 28545775Article in journal (Refereed)
    Abstract [en]

    PROBLEM AND BACKGROUND:Vaginal birth after caesarean section is a safe option for the majority of women. Seeking women's views can be of help in understanding factors of importance for achieving vaginal birth in countries where the vaginal birth rates after caesarean is low.AIM:To investigate women's views on important factors to improve the rate of vaginal birth after caesareanin countries where vaginal birth rates after previous caesarean are low.

    METHODS:A qualitative study using content analysis. Data were gathered through focus groups and individual interviews with 51 women, in their native languages, in Germany, Ireland and Italy. The women were asked five questions about vaginal birth after caesarean. Data were translated to English, analysed together and finally validated in each country.

    FINDINGS:Important factors for the women were that all involved in caring for them were of the same opinion about vaginal birth after caesarean, that they experience shared decision-making with clinicians supportive of vaginal birth, receive correct information, are sufficiently prepared for a vaginal birth, and experience a culture that supports vaginal birth after caesarean.DISCUSSION AND

    CONCLUSION:Women's decision-making about vaginal birth after caesarean in these countries involves a complex, multidimensional interplay of medical, psychosocial, cultural, personal and practical considerations. Further research is needed to explore if the information deficit women report negatively affects their ability to make informed choices, and to understand what matters most to women when making decisions about vaginal birth after a previous caesarean as a mode of birth.

  • 47.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Lundgren, I
    Karlström, A
    Hildingsson, I
    Self reported fear of childbirth and its association with women´s birth experience and mode of delivery: a longitudinal population-based study.2012In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 25, no 3, p. 114-121Article in journal (Refereed)
    Abstract [en]

    Objective: To explore fear of childbirth (FOC) during pregnancy and one year after birth and its association to birth experience and mode of delivery. Design: A longitudinal population-based study. Population: Pregnant women who were listed for a routine ultrasound at three hospitals in the middle-north part of Sweden. Method: Differences between women who reported FOC and who did not were calculated using risk ratios with a 95% confidence interval. In order to explain which factors were most strongly associated to suffer from FOC during pregnancy and one year after childbirth, multivariate logistic regression analyses were used. Results: FOC during pregnancy in multiparous women was associated with a previous negative birth experience (RR 5.1, CI 2.5—10.4) and a previous emergency caesarean section (RR 2.5, CI 1.2—5.4). Associated factors for FOC one year after childbirth were: a negative birth experience (RR 10.3, CI 5.1—20.7), fear of childbirth during pregnancy (RR 7.1, CI 4.4—11.7), emergency caesarean section (RR 2.4, CI 1.2—4.5) and primiparity (RR 1.9, CI 1.2—3.1). Conclusion: FOC was associated with negative birth experiences. Women still perceived the birth experience as negative a year after the event. Women’s perception of the overall birth experience as negative seems to be more important for explaining subsequent FOC than mode of delivery. Maternity care should focus on women’s experiences of childbirth. Staff at antenatal clinics should ask multiparous women about their previous experience of childbirth. So that FOC is minimized, research on factors that create a positive birth experience for women is required.

  • 48. Nilsson, Christina
    et al.
    Lundgren, Ingela
    University of Borås, School of Health Science.
    Women's lived experiences of fear of childbirth2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 2, p. 1-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe women's lived experience of fear of childbirth.

    DESIGN: a qualitative study using a phenomenological approach and a lifeworld perspective. Data were collected via tape-recorded interviews. SETTING: Sahlgrenska University Hospital, Göteborg, Sweden in 2003. PARTICIPANTS: eight pregnant women (24-37 gestational weeks) seeking help within an outpatient clinic for women with severe fear of childbirth. Two of the women were primiparous.

    FINDINGS: four constituents were identified: feeling of danger that threatens and appeals; feeling trapped; feeling like an inferior mother-to-be and on your own. The essential structure was described as 'to lose oneself as a woman into loneliness'.

    KEY CONCLUSIONS: fear of childbirth affects women in such a way that they start to doubt themselves and feel uncertain of their ability to bear and give birth to a child. Previous birth experience was central to the multiparous women. They described their experiences of suffering in relation to the care they received during childbirth. This mainly concerned pain and negative experiences with staff.

    IMPLICATIONS FOR PRACTICE: pregnant women who fear childbirth are an exposed group in need of much support during pregnancy and childbirth. The encounter between the woman and the midwife can be a way of breaking down the feeling of loneliness and restoring the woman's trust in herself as a childbearing woman.

  • 49.
    Nilsson, Christina
    et al.
    University of Gothenburg.
    Lundgren, Ingela
    University of Gothenburg.
    Smith, Valerie
    Trinity College Dublin.
    Vehvilainen-Julkunen, Katri
    Kuopio University Hospital.
    Nicoletti, Jane
    Universita Degli Studi di Genova.
    Devane, Declan
    Saolta University Healthcare Group.
    Bernloehr, Annette
    Hannover Medical School.
    van Limbeek, Evelien
    Zuyd University.
    Lalor, Joan
    University of Gothenburg.
    Begley, Cecily
    Trinity College Dublin.
    Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review.2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 7, p. 657-63, article id S0266-6138(15)00118-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to evaluate the effectiveness of women-centred interventions during pregnancy and birth to increase rates of vaginal birth after caesarean.

    DESIGN: we searched bibliographic databases for randomised trials or cluster randomised trials on women-centred interventions during pregnancy and birth designed to increase VBAC rates in women with at least one previous caesarean section. Comparator groups included standard or usual care or an alternative treatment aimed at increasing VBAC rates. The methodological quality of included studies was assessed independently by two authors using the Effective Public Health Practice Project quality assessment tool. Outcome data were extracted independently from each included study by two review authors.

    FINDINGS: in total, 821 citations were identified and screened by title and abstract; 806 were excluded and full text of 15 assessed. Of these, 12 were excluded leaving three papers included in the review. Two studies evaluated the effectiveness of decision aids for mode of birth and one evaluated the effectiveness of an antenatal education programme. The findings demonstrate that neither the use of decision aids nor information/education of women have a significant effect on VBAC rates. Nevertheless, decision-aids significantly decrease women's decisional conflict about mode of birth, and information programmes significantly increase their knowledge about the risks and benefits of possible modes of birth.

    KEY CONCLUSIONS: few studies evaluated women-centred interventions designed to improve VBAC rates, and all interventions were applied in pregnancy only, none during the birth. There is an urgent need to develop and evaluate the effectiveness of all types of women-centred interventions during pregnancy and birth, designed to improve VBAC rates.

    IMPLICATIONS FOR PRACTICE: decision-aids and information programmes during pregnancy should be provided for women as, even though they do not affect the rate of VBAC, they decrease women's decisional conflict and increase their knowledge about possible modes of birth.

  • 50.
    Nilsson, Christina
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Olafsdottir, OA
    Department of Midwifery, School of Health Sciences, University of Iceland.
    Lundgren, I
    Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg.
    Berg, M
    Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg.
    Dellenborg, L
    Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg.
    Midwives’ Care on a Labour Ward Prior to the Introduction of a Midwifery Model of Care: A Field of Tension2019In: International Journal of Qualitative Studies on Health and Well-being, Vol. 14, article id 1593037Article in journal (Refereed)
    Abstract [en]

    Purpose: There is a need to deepen knowledge about midwives’ care in obstetric-led labour wards in which midwives are responsible for normal births. This ethnographic study explores the content and meaning of midwives’ care of women in a hospital-based labour ward in Sweden prior to the introduction of a theoretical midwifery model of care. 

    Methods: Data were gathered through participant observation, analysed through interpretation grounded in reflexivity discussions and are presented in the form of ethnographic descriptions. 

    Results: The midwives’ care was provided in a field of tension in which they had to balance contrasting models of care, described in the themes: The birthing rooms and the office—Different rooms of care, Women giving birth or being delivered—Midwives’ expectations and relationships with women, Old and new caring roles of the midwife—Women giving birth in a “new age”, Being and doing—Different approaches to caring, and Holistic and reductionist care—Guided by contrasting models and guidelines. The midwives’ freedom to act as autonomous professionals was hindered by medical and institutional models of care and this led to uncertainty regarding their roles as midwives. 

    Conclusions: Midwives having to balance their activities in a field of tension require midwifery models that can guide their practice.

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