En kvalitativ studie pågår med syfte att belysa rehabiliteringsprocessen för långtidssjukskrivna kvinnor, med nacksmärta, för att möjliggöra återgång i arbete. Resultaten kan användas för preventivt och promotivt arbete inom ex. primärvården, företagshälsovården, försäkringskassan och arbetsförmedlingen.

Purpose To investigate the impact of rehabilitation measures on work ability and return to work (RTW), specifically the association between workplace rehabilitation/supportive conditions at work and work ability and RTW over time, among women on long-term sick leave. Methods Questionnaire data were collected (baseline, 6 and 12 months) from a cohort of women (n = 324). Linear mixed models were used for longitudinal analysis of the repeated measurements of work ability index (WAI), work ability score and working degree. These analyses were performed with different models; the explanatory variables for each model were workplace rehabilitation, supportive conditions at work and time. Results The individuals provided with workplace rehabilitation and supportive conditions (e.g. influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community and work satisfaction) had significantly increased WAI and work ability score over time. These individuals scored higher work ability compared to those individuals having workplace rehabilitation without supportive conditions, or neither. Additionally, among the individuals provided with workplace rehabilitation and supportive conditions, working degree increased significantly more over time compared to those individuals with no workplace rehabilitation and no supportive conditions. Conclusion The results highlight the importance of integrating workplace rehabilitation with supportive conditions at work in order to increase work ability and improve the RTW process for women on long-term sick leave.

AIM: To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes.

BACKGROUND: In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome.

METHOD: In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory.

RESULTS: 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work.

CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.

Background: Healthcare managers are expected to lead and manage planned organizational change intended to improve healthcare process quality. However, their complex working conditions offer limited decision control, and healthcare managers often feel ill prepared and inadequately supported to perform their duties. Healthcare managers have previously described their need for organizational support, but we lack knowledge of the preconditions and resources that help managers implement planned change.

Methods: This prospective cohort study examined healthcare managers at three Swedish hospitals implementing lean production and two Swedish hospitals implementing their own improvement model. Questionnaire data from 2012, 2103, and 2014 were used in following up. We used t-tests and a linear mixed model design in analysing the data.

Results: Healthcare managers who perceived strong support from managers, employees, colleagues, and the organization and managers with the longest managerial experience had the least negative appraisal of change. Managers who perceived strong support from employees, management, and the organizational structure perceived higher levels of healthcare process quality.

Conclusions: Long managerial experience and strong support from managers, employees, and the organization are important formanagers’ appraisal of, work on, and successful implementation of planned change. Top management must therefore ensure that the healthcare managers have sufficient managerial experience and support before they delegate to them the responsibility to implement planned change

To increase efficiency and quality, process development has been implemented in many Swedish hospitals. These hospitals are usually organized as professional bureaucracies in which health care managers have limited decision control. The new governance principles has been implemented without removing bureaucratic elements. This study analyzes how managers implement planned change in these professional bureaucracies, considering if managers coaching style, organizational preconditions, implementation strategy, appraisal of change and clinic autonomy, is associated with health care process quality (HPQ). The study is based on interviews with health care managers and longitudinal assessments of HPQ. The results revealed significant differences between coaching style, organizational preconditions, and HPQ over time. The conclusion is that leadership and preconditions is of importance for the health care manager’s ability to work with planned change, as that the health care managers understand how management methods, governance principles, and professional bureaucracies work in practice.

Comprehensive overview of research in the field Includes contributions from leading researchers on managers Combines theory, evidence, and reflection Detailed literature review of 21 of the most important previous studies Managers are significant actors in contemporary organizations and yet there is very little deep-level analysis of what managers do, and how they understand their managerial selves and social situations. Instead of evaluating management techniques according to their internal logic and systematic qualities, this book advances the 'practice perspective', using behaviour and activities of successful, experienced, and skilled managers as the primary data for theorizing good management. In this book, academics review classic literature on managerial work, discuss methodological and theoretical approaches, and present empirical studies on various kinds of managers at different levels of organizations, in different roles, and different sectors, from construction site managers and CEOs of large companies to university vice chancellors and front-line health care managers. It makes the case for studies of managerial work that look beyond the rational and ordered world to the challenges presented by, inter alia, work and information overload, complexity, performance pressures, unintended consequences, and irreconcilable expectations. Readership: Academics, researchers, and graduate students in Management and Organization Studies

Aim The aim of the present study was to explore and describe what characterizes first- and second-line health care managers' use of time. Background Many Swedish health care managers experience difficulties managing their time. Methods Structured and unstructured observations were used. Ten first- and second-line managers in different health care settings were studied in detail from 3.5 and 4 days each. Duration and frequency of different types of work activities were analysed. Results The individual variation was considerable. The managers' days consisted to a large degree of short activities (<9 minutes). On average, nearly half of the managers' time was spent in meetings. Most of the managers' time was spent with subordinates and <1% was spent alone with their superiors. Sixteen per cent of their time was spent on administration and only a small fraction on explicit strategic work. Conclusions The individual variations in time use patterns suggest the possibility of interventions to support changes in time use patterns. Implications for nursing management A reliable description of what managers do paves the way for analyses of what they should do to be effective.

The aim of this article is to describe and analyse observed managerial communication. The research questions concerned: What characterizes managerial communication practices and the organizational consequences? We make use of structuration theory and view communication as a social interaction process in which temporary structures are negotiated. Ten first- and second-line managers were shadowed. The managers used a combination of structuration of caring, interdependency and accountability typical of health care organizations. The communication practices were related to how new norms of reputation management were institutionalized through structuration. The types of structuration were sometimes contradictory and productive communication was rare or non-existent. The managerial communication practices had consequences for the power and domination and for which issues were signified as part of the agenda. The conclusions can be generalizable to other professional organizations.

Ageing population is becoming a major concern because of its economic, political and social impact. Trusted eldercare service is an important issue for a matured nation. The paper addresses the preconditions of healthy ageing and sustainable value integrated eldercare in a developing and a developed society. In India, professional eldercare is about a decade old and is still emerging to get a foothold in the health care system. The aim is to explore understanding and values of home-based eldercare (HBEC) in India from a multiple stakeholder’s perspective and to understand the value related challenges and issues in developments with HBEC in Sweden which has a century old experience of professional and public organised eldercare. The study included 210 in-depth interviews, 105 each from India and Sweden. The in-depth interviews of various stakeholders including older individuals, their relatives, caregivers, managers and doctors. Interviews and focused group discussions were carried out across six cities in India and 10 municipalities in Sweden. The qualitative data were analysed to conceptualise the stakeholders understanding of HBEC, the values associated with care giving, perceived challenges and issues in the emerging HBEC sector in India. The findings highlight the changing values in the societies with relation to the needs and context of eldercare in both countries. These preconditions for compassion and work engagement in care giving as well as competence development in caregivers need to be strengthened in the contexts of care and in alignment with sociocultural values

This study prospectively assessed the importance of individual conditions and computer use during school or work and leisure time as risk factors for self-reported generally reduced productivity due to musculoskeletal complaints among young adults with musculoskeletal symptoms in the neck or upper extremities. METHODS: A cohort of 2914 young adults (18-25 years, vocational school and college or university students) responded to an internet-based questionnaire concerning musculoskeletal symptoms related to individual conditions and computer use during school or work and leisure time that possibly affected general productivity. Prevalence ratios (PR) were used to assess prospective risk factors for generally reduced productivity. RESULTS: The selected study sample (N=1051) had reported neck or upper-extremity symptoms. At baseline, 280 of them reported reduced productivity. A follow-up of the 771 who reported no reduced productivity was carried out after 1 year. Risk factors for self-reported generally reduced productivity for those followed-up were symptoms in two or three locations or dimensions for the upper back or neck and the shoulders, arms, wrists, or hands [PR 2.30, 95% confidence interval (95% CI) 1.40-3.78], symptoms persisting longer than 90 days in the shoulders, arms, wrists, or hands (PR 2.50, 95% CI 1.12-5.58), current symptoms in the shoulders, arms, wrists, or hands (PR 1.78, 95% CI 1.10-2.90) and computer use 8-14 hours/week during leisure time (PR 2.32, 95% CI 1.20-4.47). A stronger relationship was found if three or four risk factors were present. For women, a relationship was found between generally reduced productivity and widespread and current symptoms in the upper extremities. CONCLUSIONS: The main risk factors for generally reduced productivity due to musculoskeletal symptoms among young adults in this study were chronic symptoms in the upper extremities and widespread symptoms in the neck and upper extremities.

Det övergripande syftet med denna rapport är att beskriva chefers etiska värderingar, dilemman och organisatoriska förutsättningar för att bedriva ett värdebaserat ledarskap i såväl kommunal som privat äldreomsorg.

Det empiriska materialet består av en omfattande enkätstudie till nästan 500 studerande inom ramen för den nationella ledarutbildningen för chefer inom äldreomsorgen vid Högskolan i Borås under perioden 2013 till 2015. Utbildningen gavs på uppdrag av Socialstyrelsen och omfattade 30 högskolepoäng med två års studier på kvartsfart. Samtliga studerande var yrkesverksamma som chefer och ledare inom kommunal eller privat äldreomsorg i södra Sverige. Metoder som använts i bearbetning och analys av materialet är deskriptiva, jämförande och analytiska med regressionsmodeller och SEM-analys.

Resultatet visar på att cheferna – oavsett utbildningsbakgrund, värderade följande etiska värden högst: att inte skada, respekt för individen och rätten till konfidentialitet. Värdedilemman i chefsarbetet är dock vanligt och sammanlänkat med andra utmaningar i arbetet, särskilt med utmaningar som rör hantering över organisationsnivåer (buffertproblem och containerproblem) och av olika ansvarsområden (logikkonflikter). Inom privat verksamhet skattade de medverkande cheferna värdekonflikter och andra utmaningar i lägre grad än chefer inom kommunal verksamhet.

De flesta chefer var nöjda med hur de kunde fullfölja sitt ansvar för utveckling av verksamheten avseende värdegrund, kvalitet, processer, dagligt arbete, brukarmedverkan, brukarsäkerhet och arbetsmiljö. De flesta skattade också att de arbetade i mycket hög grad med strukturering och utveckling av dessa frågor.

Stödresurser minskade upplevelsen av värdekonflikter, men det fanns skillnad i betydelsen relaterat till chefers grundprofession. Det organisatoriska stödet var också tydligare för chefer inom privat verksamhet. Organiserade stödresurser hade stor betydelse för hållbart integrerat och värdeskapande ledarskap samt för aktiva ledningsstrategier. Även sambandet mellan hållbart ledarskap och aktiva ledarstrategier modererades av grundprofession, där sambandet var moderat negativt för chefer med social grundutbildning. Det tycks således finnas ett utbildningsbehov bland äldreomsorgens chefer och behov av ett utvecklat stöd från arbets- HÖGSKOLAN BORÅS HÖGSKOLAN BORÅS 15 givaren då det varierar avseende omfattning, inriktning och nivå mellan kommunal och privat verksamhet.

Sammanfattningsvis har chefer i äldreomsorgen många olika värden, på olika nivåer och utifrån olika perspektiv att förhålla sig till i sitt ledarskap. Att hantera och utveckla förståelse för dessa är utmanande i chefskapet och värdedilemman är vanliga. Majoriteten av cheferna i denna studie beskriver dock generellt en aktiv och god hantering och organisering av dessa. Konstateras att en integrerad förståelse och hantering, samt goda organisatoriska stödresurser tycks bidra till mer hållbart och värdeskapande ledarskap.

AbstractAim To investigate the relationships between return to work and social support outside work among women on long-term sick leave from human service organizations. Background Work is an important part of life and is, in general, considered to be supportive of health and wellbeing. Few studies have thoroughly investigated the importance of aspects of social support outside work for return to work. Methods A cohort of women on long-term sick leave was followed with questionnaires from 2005 to 2012. Results The availability of social attachment increased the women's work ability, return to work, and vitality significantly more over time. There were positive relationships between return to work and seeking support in terms of emotional support and comfort and expressing unpleasant feelings. Conclusions Important resources to increase return to work can be found in factors outside work, such as close social relationships and support seeking. Thus, it is important to take the woman's whole life situation into account and not focus solely on aspects related to the workplace.

FoU-programmet ”Ledarutveckling i hälsofrämjande ledarskap” genomfördes under 2007 i tre företag. Syftet var att stärka ledares kunskap och handlingsberedskap i ett hälsofrämjande förhållningssätt i ledarskapet – och att ett sådant även skulle avspegla sig i medarbetares hälsa och hälsosamma arbetsvillkor. Samtalsledare var företagens interna företagshälsovård och/eller personalfunktion vilka fick kunskaps- och processtöd av forskare. Programmet utvärderades med intervjuer och enkäter före och efter. Resultaten från enkätundersökningarna visade att ledarna har fått förbättrade förhållningssätt vad det gäller att ha ett hälsofrämjande ledarskap. Detta avspeglades i ledarnas egen stress , egna beskrivna strategier samt i medarbetarnas skattning av dem. Flera chefer skattade att de hade stärkt sin handlingsförmåga att hantera problem som rörde medarbetare och tillvarata resurser hos medarbetare. Ledarna angav ett antal olika aktiviteter de genomfört som ett resultat av programmet: aktiviteter för ökad måltydlighet, trivsel, hälsomedvetenhet bland medarbetare och för att stärka arbetsgruppen samt åtgärder för att stärka egen hållbarhet och ett fortsatt hälsofrämjande ledarskap i företaget. Deras upplevelse av stöd inom organisationen kan sammanfattas som ”att ha fått stöd till själv-hjälp” vilket också var programmets intention.

Few efforts have been made to prospectively identify resources and obstacles outside work that may predict regained work ability and return to work when workers are on sick leave. This study investigates the association between partner relationships and sick leave. Our research questions were as follows: (i) What is the influence of sick leave, pain, stress and domestic strain on the quality of the dyadic partner relationship?, and (ii) What is the influence of the partner and social relationship on pain, stress, work ability, self-rated health and return to work? A cohort of female workers (n = 225) on long-term sick leave (>60 days), all in a partner relationship, at 6-month intervals completed a questionnaire based on the Quality of Dyadic Relationship (QDR) instrument, the Interview Schedule of Social Interaction (ISSI), the Work Ability Index (WAI) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Univariate and multivariate analyses of baseline and prospective data were performed. The results showed that decreased partner relationship quality was related to having major responsibility for household work despite being on sick leave, having pain and having decreased social integration. Among younger individuals on sick leave, a reduction in the quality of the partner relationship was shown already at the first (6-month) follow-up, while among middle-aged women, such a reduction was seen only at the 12-month follow-up. No dimensions of partner relationship quality at baseline were related to dimensions of return to work, either as a resource or as an obstacle. Consequently, our results show that a good relationship does not keep the woman from returning to work. Having main responsibility for household work, which implies domestic strain while on sick leave, predicts lower partner relationship quality. The practical implications are that healthcare professionals treating women on sick leave should emphasize the importance of keeping a social network as well as making sufficient adjustments at home for the relationship quality to be safeguarded. Special attention should be given to the young woman on sick leave as being on sick leave seems to influence her partner relationship considerably.

The theoretical framework is that muscle tension in the neck is related to insufficient muscular rest and is a risk factor for chronic pain and reduced work ability. Promoting muscle strength and muscle rest may increase work ability and reduce neck pain. OBJECTIVES: To test whether myofeedback training or intensive strength training leads to decreased pain and increased work ability in women on long-term sick leave. METHODS: This is a randomized controlled trial of two 1-month interventions with myofeedback or muscular strength training in the home environment. Female human service organization workers (n = 60) on long-term (>60 days) sick leave and with chronic neck pain were followed with self-reported and laboratory-observed data of health, pain, muscular activation, and work ability, at baseline, immediately after the intervention and 3 months after baseline. RESULTS: For both intervention groups, pain was lowered over time compared with the control group. Decreased pain and muscular activity was associated with increased self-rated work ability and with laboratory-observed work ability at 3-month follow-up. Decreased pain was also associated with increased self-rated work ability at 1-month follow-up. Muscular strength training was associated with increased self-rated work ability and mental health. Myofeedback was associated with increased observed work ability and self- rated vitality. CONCLUSIONS: The two interventions showed positive results, suggesting that they could be developed for use in health care practice to address pain and work ability. The intensive muscular strength training program, which is both easy to conduct at home and easy to coach, was associated with increased work ability.

Chefer kan ha stor betydelse för anställdas hälsa, stress, engagemang i arbetet och prestation. Få tidigare studier har undersökt vilket stöd chefer behöver för ett hållbart och bra ledarskap. Artikeln presenterar resultat från en prospektiv studie om betydelsen av chefers stödresurser för hållbart ledarskap. I studien, som är en del av Chefios-projektet, ingår chefer i kommunal vård och omsorg (n=344). Data från enkätstudier med instrumentet ”Gothenburg Manager Stress Inventory” har analyserats. Resultatet visar att ett stödjande privatliv och en personlig inställning till chefsuppdrag har stor betydelse för chefers hållbarhet över tid. Chefens kontrollspann och erfarenhet som chef påverkade betydelsen av stödresurser. För chefer med kortare chefserfarenhet eller fler underställda (>30) har även stöd från ledning, chefskollegor och externt stöd betydelse.

The aim of this qualitative study was to describe, from their own perspective and experiences, how siblings of children with deficits in attention, motor control and perception (DAMP) and Asperger syndrome cope with their life situations in their families. Fifteen adolescent females 12-18 years old, siblings of boys with DAMP (8 subjects) and Asperger syndrome (7 subjects), were interviewed. The method used in sampling and analysis of interview protocols was the constant comparative method for grounded theory. The inductive categorization of data produced two core concepts, one about the siblings' life situations in DAMP and Asperger syndrome ('dilemma of requirements and concerns') and one about the siblings' coping processes ('harmonizing'). Of the six categories identified, four were categories of the processes of coping ('gaining understanding', 'gaining independence', 'following a bonding responsibility' and 'balancing'). The qualitative differences between coping processes were related to the two categories of context to cope within the experienced dilemma 'requirements' and 'concerns'. The findings contribute to a deeper understanding of the siblings' life situations, and may be important for health personnel in encounter families and for identifying siblings with special needs. The findings may also aid in the development of preventive programs for siblings of children with DAMP and Asperger syndrome.

Rapporten sammanfattar aktuella studier om hållbar och hälsofrämjande arbetsmiljö och hur en sådan miljö kan skapas genom ledarskap. De mest betydelsefulla aspekter som rör hur chefer genom ledarskap och organisering av arbete och arbetsförhållanden kan ha en avgörande betydelse för medarbetares hälsa och hållbarhet i vardagsarbete och under utvecklingsarbeten tas upp. Rapporten inleds med en genomgång av allmänna teorier och forskning om välbefinnande och hälsosamt arbetsengagemang. Därefter beskrivs forskning om hur ledarskap och chefskap påverkar välbefinnande och engagemang. Förhållanden i chefers arbete som kan vara stödjande för att hantera utmaningar i ledarskapet lyfts också. Rapporten fokuserar därutöver förutsättningar i arbetet som visat samband med hälsa samt hur hälsa och hållbarhet kan stärkas genom medarbetarskap, socialt kapital och team. Aspekter på förändringsledning som visat samband med hållbarhet beskrivs också. Rapporten avslutas med att belysa basstrukturer som ger förutsättningar för delaktighet, kontroll, inflytande, handlingsutrymme och socialt stöd bland så många som möjligt vid arbetsplatsen.

This paper reports result from one-year follow up in a research program with the overall aim to investigate how implementations of lean in health care affect working conditions, health, and performance of employees at five Swedish hospitals. This paper summarizes the implementation approaches, and their importance at short-term follow up for performance (with regard to active work with improvements), perceived working conditions and stress-related health among the healthcare workers. The implementation strategies and pace varied between the hospitals and between the strategic and operative levels. This short-term follow up showed that physical stress-related symptoms had increased overall but the cognitive stress had increased only in hospitals implementing lean. In hospitals with high implementation pace, there were more improvement work among the employees, but higher quantitative demands and lower job satisfaction.

BACKGROUND: Although health inequality between young adult women and men has been strikingly evident in symptoms of ill health, we found no studies examining these inequalities with a focus on positive health and performance. OBJECTIVE: The aim of the present study was to examine possible inequalities between young adult women and men in a combined assessment of positive health and health-related performance. METHODS: Women and men aged 18 to 25 years studying medicine or computer science at 6 colleges/universities in 5 cities in Sweden were recruited for this study. All respondents answered a Web-based questionnaire regarding health, health-related performance, information and communication technology exposure, mood, and individual factors. A combined assessment of excellent health and health-related performance (EHHP) was defined and tested. Prevalence ratios (PRs) with 95% CIs of EHHP were calculated separately for female and male respondents. To assess potential determinants of EHHP, differences in the relationships between EHHP and the explanatory factors were compared for both sexes. Results: In a study group of young adult students consisting of 1046 women and 1312 men, women were less likely than men to have EHHP (PR 0.90 [95% CI, 0.83-0.98]). This inequality was even stronger within each course of study (medicine or computer science). Health-related factors showed similar patterns of relationship to EHHP for women and men; however, the strength of these relationships differed between the sexes. Logical relationships were observed between EHHP and almost all of the symptoms as well as between EHHP, the mood index, and health-related behavior. CONCLUSIONS: The well-known inequality in symptoms of ill health between young adult women and men was prevalent even in a combined assessment of positive health and health-related performance. That this inequality was prevalent in a relatively homogeneous sample of young adults indicates the importance of gender-based psychological and psychosocial factors beyond the more well-known structural gender-differentiating factors of vertical and horizontal segregation and disproportional responsibilities for domestic work. It may therefore be essential to emphasize these gender-based psychological and psychosocial factors when designing future studies and health promotion programs.

Terms and theories of work attendance vary according to their use and focus. This paper analyzes long-term work attendance in relation to social, psychosocial, and health-related factors. Register-based and questionnaire-based data covering 3,804 human service organisation workers over a three-year period were analyzed at individual and work-unit level. The results showed positive relationships between work attendance and male gender, high income, work commitment, job satisfaction, and having positive feelings towards work. High work attendance combined with work commitment, stress, or pain did not show any negative long-term effects upon short-term or long-term sick leave. Instead, work attendance seemed to be more associated with stable patterns of behaviour. Register-based measures of work attendance (at most 4–7 days of sick leave per worker per year) may be a useful tool in managing psychosocial work environment and related behaviour, but their inability to encompass information regarding individual health and disease must be borne in mind.

Låg sjukfrånvaro mäts ofta på olika sätt och framförallt när nationell statistik eller statistik från arbetsgivarens personalregister används. Därmed har resultaten varierat och få sjukdagar kan indikera både goda arbetsförhållanden och krav på sjuknärvaro. Syftet var att undersöka utvecklingen av låg sjukfrånvaron bland sjuk- och undersköterskor och utforska om enhetsvis utveckling samvarierade med stödjande arbetsförhållanden, ledarstrategier och organisering av social och organisatorisk arbetsmiljö. Mått på få sjukfrånvarodagar undersöktes med data från arbetsgivarens personalregister. Förklaringar till trender undersöktes på enhetsnivå genom chefsenkät under de två första åren. Resultaten visade att majoriteten av anställda på enheter (93 %) inte hade en sjukdag under ett år och att 2 % var sjukskrivna 1-7 dagar. Samvariationerna var svaga men visade betydelser av stödjande ledning, strukturerande ledarstrategi och god samverkan mellan chef och medarbetare för mer balanserad närvaro. Stödjande ledning, närvarande ledarstrategi och stödjande organisatoriska strukturer visade samband med enhetsvis hög förekomst av ingen sjukdag alls.

PURPOSE: The aim was to investigate the long-term importance of adjustment latitude for increased work ability and return to work among female human service workers on long-term sick leave.

METHODS: A cohort of female human service workers on long-term sick leave (>60 days) was given a questionnaire four times (0, 6, 12, 60 months). Linear mixed models were used for longitudinal analysis of the repeated measurements of work ability and return to work.

RESULTS: Having a higher level of adjustment latitude was associated with both increased work ability and return to work. Adjustments related to work pace were strongly associated with increased work ability, as were adjustments to the work place. Having individual opportunities for taking short breaks and a general acceptance of taking short breaks were associated with increased work ability. At home, a higher level of responsibility for household work was related to increased work ability and return to work. Individuals with possibilities for adjustment latitude, especially pace and place at work, and an acceptance of taking breaks had greater increased work ability over time and a greater work ability compared with individuals who did not have such opportunities.

CONCLUSIONS: This study highlights the importance of opportunities for adjustment latitude at work to increase work ability and return to work among female human service workers who have been on long-term sick leave. The results support push and pull theories for individual decision-making on return to work.

Aim.  This paper is a report of a cohort study of healthcare workers’ work attendance, and its long-term consequences’ on health, burnout, work ability and performance. Background.  Concepts and measures of work attendance have varied in the scientific literature. Attending work in spite of being sick can have serious consequences on health. There is little knowledge on which individual and work-related conditions that increase work attendance and the long-term impact on health and performance. Method.  Prospective analyses of three measures of work attendance i.e. sickness attendance, uninterrupted long-term attendance and balanced attendance (≤7 days of sick leave per year and no sickness attendance) were done using questionnaire data from a 2-year cohort study (2004–2006) of randomly selected healthcare workers (n = 2624). Incentives (e.g. effort-reward balance, social support, meaningfulness) and requirements (e.g. time-pressure, dutifulness, high responsibility) to attend work as well as general health, burnout, sick leave, work ability and performance were assessed. Results.  There was a positive relation between balanced work attendance and incentives, whereas high sickness attendance was associated with requirements. Follow up after 2 years showed that balanced attendance was associated with sustained health and performance while sickness attendance was associated with poor health, burnout, sick-leave and decreased performance. Conclusion.  It is important to distinguish between measures of work attendance as they differ in relation to incentives, and health- and performance-related consequences. Sickness attendance seems to be an important risk indicator. A balanced work attendance should be promoted for sustained health and performance in healthcare organisations.

Epidemiological research has so far failed to explain the high incidence of occupational disorders among home care workers (HCWs) and the great differences in organizational incidence rate. A qualitative approach may contribute to a deeper understanding of work group reasoning and handling in a more contextual manner. The aim of this grounded theory study was to gain a deeper understanding of the main concern in the processes of recognizing, communicating and reporting occupational disorders among HCWs. Focus group interviews were conducted with 40 HCWs in 9 focus groups. The selected municipalities represented variations in municipality type and incidence rate of occupational disorders. Making it work in the frontline was identified as the core category explaining that the perceived work situation in home care work was the main concern but interacted with work-group socialising processes as well as with the communicability and derivability of the occupational disorder when defining and reporting occupational disorders. Complex problems could be reformulated and agreed within the workgroup to increase communicability. Described significances for reporting/non-reporting were related to financial compensation, to a part of organizational political game or to an existential uncertainty, i.e. questioning if it belonged to their chosen work and life. Our conclusion is that working situation and work group attitudes have importance for reporting of occupational disorders. To support work-related health for HCWs, integrating communication should be developed about work-related challenges in work situation, as well as about attitudes, culture and efficiency within work-group.

The 2nd Nordic Interdisciplinary Conference on Qualitative Methods in the Service of Health, held in Göteborg in August 2001, was the starting-point for this book. Researchers from different disciplines contribute knowledge and research experience to this anthology. The main aim of the book is to point at the value of diversity in public health research and the challenge of using qualitative methods complementary to traditional epidemiological methods. The book gives the reader an analysis of the uniqueness and the theoretical foundations for qualitative methods and a discussion of the nature of qualitative research in general. Different qualitative methods appropriate to different research questions in the public health area are practically illustrated as well as the nature of knowledge obtained through these methods. The present book especially highlights phenomenology, phenomenography, grounded theory and narrative research. In sum, the aim of the book is to provide students with theoretical understanding and practical knowledge of qualitative research. This anthology targets students in health care and public health as well as doctoral students and practicing researchers with an interest in qualitative methods.

The purpose of this study was to identify macro-socioeconomic determinants for the incidence of occupational injuries and diseases among home care workers. The study base was the total workforce of home care workers in Sweden during 1994-1998. In an ecological study design, data from three national databases were combined by record linkage. Descriptive and analytical statistics were used to estimate and interpret macro-socioeconomic determinants (economic resources, age structures of inhabitants and home care workers, unemployment, type of employment, size and location of municipality) for the incidence of occupational disorders among home care workers.

The purpose of this study was to identify macro-socioeconomic determinants for the incidence of occupational injuries and diseases among home care workers. The study base was the total workforce of home care workers in Sweden during 1994-1998. In an ecological study design, data from three national databases were combined by record linkage. Descriptive and analytical statistics were used to estimate and interpret macro-socioeconomic determinants (economic resources, age structures of inhabitants and home care workers, unemployment, type of employment, size and location of municipality) for the incidence of occupational disorders among home care workers. A great variation in municipal incidence of occupational disorders was found when comparing various municipalities (10-184 occupational disorders/1000 full-time equivalent workers per year and municipality). The relation between the incidence of occupational disorders and macro-socioeconomic factors is complex. The investigated socioeconomic factors together explained 12-19 % of the differences in mean municipal occupational disorders but there were different explanations related to metropolitan regions and sparsely populated areas. The factors that had a potential to explain the differences were the age structure of inhabitants and home care workers, and unemployment. The economic resources, e.g. the gross expenses for the care of the elderly and handicapped, and the average income, or the employment conditions among the home care workers did not give any explanation for differences in occupational disorders. The group of privately employed home care workers (1-3 %) had a lower incidence of occupational disorders and were younger. The great difference in incidence of occupational disorders which appears when municipalities in Sweden are compared indicates a preventive potential. However, the relation between the incidence and macro-socioeconomic factors is complex. In order to better understand socio-environment phenomena related to occupational injuries, further studies are needed to explore the possible influence of the work system at the macro-, organisational- and micro-level.

The capability approach is relevant to gaining a conceptual understanding of individuals’ abilities and motivation to work and to explore the potential consequences that various working conditions have for people when they reach old age. Here, the capability concept is complemented with system theory to understand the multi-component key resources for capability to work among older workers, and also the conversion factors – capability through work – at individual, micro, meso, macro and chrono-levels. The theoretical approach is exemplified by studies from the interdisciplinary field of work sciences. The chapter describes central working-life conditions, conversion factors for crafting capability to work and examples of patterns of interactions between capability to work and capability through work. To support practical applications, we suggest important conversion factors and patterns of interaction between capability to work and capability through working-life resources. In sum, having a reasonable degree of control and influence (freedom of choice) at work and opportunities to make individual deals and adjustments that match one’s values, abilities, competence and experience are important for individual preference of a long working life. This requires an organisation that focuses on the value of work and promotes a general learning climate through broad participation.

Aim to assess the importance of managerial support from superior, colleagues, external, employees and private life and its importance for managers’ health- related sustainability Background. Managers and leadership can have a great importance for employees’ health related sustainability. Few published studies, have investigate what kind of support managers need to sustain in their position with preserved health. Design. A prospective cohort study with data collection 2009 and 2011. Methods. All first and second line managers for public health care in seven Swedish municipalities were included (n=344). Managers’ health related sustainability and support resources were measured with Gothenburg Manager Stress Inventory. Analysis with structured equation modeling with a crossed-lagged panel design. Results. All of the studied sources of support were cross-sectional associated with sustainable health, but only support from private life predicted health related sustainability across time. Stratified analyses revealed further prospective associations. First, among less experienced managers, all of the studied sources of support predicted at least some aspect of health-related sustainability. Second, among managers with a large span of control (>30 subordinates), external support and support through good cooperation with subordinates predicted health-related sustainability. Conclusion. It is important to provide health care mangers with adequate support, but only support through private life predicted health-related sustainability. Socializing as well as organisational support was strongly predicting sustainable health among managers new in their role and managers with a large span of control.

The aim of this study was to retrospectively explore the prevalence of rehabilitation actions, supportive factors, and obstacles for rehabilitation among home care workers with musculoskeletal disorders, especially focusing on aspects related to occupational rehabilitation. All home care workers in Sweden whose disability pension was approved in 1997 and 1998 because of a musculoskeletal disorder, were selected (n = 373). Data, covering aspects of the rehabilitation process and conditions in working life 5 and 15 years prior to their disability pension, were collected from a questionnaire. The majority considered that the disorder leading to a disability pension was caused by their work, but only one-third of them had their occupational disorder formally approved. Only one-third of the study group received occupational rehabilitation. However, an approved occupational disorder was related to higher prevalence of occupational rehabilitation. In the age group 60–65, few home care workers received rehabilitation. The majority perceived good support from their supervisor and working team, but no support with regard to lowering physical demands. Modification and reduction of physical demands might improve both sustained work ability in home care work and the outcome of the rehabilitation.

OBJECTIVE: There is a growing need for home-care services in western societies. As home-care workers show high levels of absence related to poor health it is important that we broaden our knowledge about what factors in the work system contribute to this. The aim of this study was to explore and estimate the impact of the work system on permanent work disability and its relative importance compared with home-life risks among home-care workers. METHODS: The cases (617 subjects) were all home-care workers in Sweden, whose disability pension was approved in 1997 or 1998. The controls (771 subjects) were home-care workers still working. We used a questionnaire to gain situation-specific information on working life and home life 5 and 15 years before disability pension entitlement. RESULTS: The most important risk factors in the work system were poor ergonomic/lifting conditions, time pressure and lack of professional caring technique. Fifteen years prior to disability pension entitlement, insufficient management (odds ratio (OR) 95%, CI 2.6[1.6;4.2]) and relational problems at work were also risk factors. Five years before disability pension entitlement, poor organisational support (4.1 [2.5;6.7]), opportunities for co-working and working climate (3.5 [2.4;5.2]) were also strongly related to a persisting work ability. The magnitude of exposure to a number of risk factors had an increased effect (highest 13.8 [5.6-33.8]). The strongest risk factor in home life was little opportunity to rest from work (4.9 [3.0;8.0]). The risk factors in working life were robust to the inclusion of the grouped risk factors of home life. CONCLUSIONS: The conclusion was that risk factors related to the work system are, alone, strongly related to permanent work disability among home-care workers. Also, exposure to several of the risk factors constitutes a notably strong risk for permanent work disability.

Aim  To gain a deeper understanding of how Swedish head school nurses perceive their leadership in developing school health care. Background  A well-functioning school health care is important for promoting the health of children and young people. Method  Constructivist-grounded theory was used to analyse 11 individual interviews with nine head school nurses. Results  Head school nurses strive to find a balance between what they experience as vague formal goals and strong informal goals which leads to creating local goals in order to develop school health care. Conclusion  The head school nurse’s job is experienced as a divided and pioneering job in which there is uncertainty about the leadership role. They provide individual support to school nurses, are the link between school nurses and decision makers and highlight the importance of school nurses’ work to organizational leaders. Implications for nursing management  This study shows that school health care needs to be founded on evidence-based methods. Therefore, a structured plan for education and training in school health care management, based on research and in cooperation with the academic world, would develop the head school nurses’ profession, strengthen the position of school health care and advance the school nurses’ work.

Aim.  This paper reports a study to assess stress, well-being and supportive resources experienced by mothers and fathers of children with rare disabilities, and how these variables were affected by an intensive family competence intervention. Background.  Despite diagnosis-specific studies, little overall knowledge exists about life-consequences for families of children with rare disorders. Method.  We used a prospective design with baseline data and two follow-ups (at 6 and 12 months) after an intervention. The intervention aimed at empowering parents in managing their child's disability. Parents from all parts of Sweden visiting a national centre for families of children with rare disabilities were consecutively selected (n = 136 mothers, 108 fathers). Instruments of parental stress, social support, self-rated health, optimism and life satisfaction and perceived physical or psychological strain were used. Stratified analyses were carried out for mothers and fathers, and related to parental demands: single mothers, full-time employment, participation in a parent association, child's age and type of disability. Results.  We found high parental stress, physical and emotional strain among mothers, especially among single mothers. Fathers showed high stress related to incompetence, which decreased after the intervention. Decreased strain was found among full-time working mothers and fathers after the intervention. Parents’ perceived knowledge and active coping and mothers’ perceived social support were increased at follow-up. Factors related to parents’ overall life satisfaction (57–70% explained variance) changed after the intervention, from being more related to internal demands (perceived strain, incompetence and social isolation) to other conditions, such as problems related to spouse, paid work and social network. Conclusion.  Parents, especially fathers and full-time working parents, may benefit from an intensive family competence programme.

Bland personal inom kommunal vård- och omsorgsverksamhet finns en hög förekomst av arbetsskador och sjukskrivning och låg förekomst av långtidsfriska. Ett flertal tidigare studier visar att förhållanden och villkor i organisationen är relaterade till arbetshälsa och arbetsskador. Tidigare litteratur har beskrivit delaktighet och lärandestrategier som mer önskvärda strategier i förändringsarbetet för bättre arbetsmiljö. Men det finns begränsad kunskap om hur struktur och delaktighetsprocesser i systematiskt arbetsmiljöarbete påverkar arbetsskador och arbetshälsa. Denna rapport integrerar ett hälsoperspektiv med ett organisatoriskt perspektiv med fokus på struktur, organisering och delaktighetsprocesser avseende systematiskt arbetsmiljöarbete.

Despite several years of conducting formalized systematic occupational health and safety management (SOHSM), as required by law in Sweden and most other industrialized countries, there is still little evidence on how SOHSM should be approached to have an impact on employees' health. The aim of this study was to investigate the importance of SOHSM, considering structured routines and participation processes, for the incidence of occupational disorders and the prevalence of long-term work attendance among home care workers (HCWs). Municipal human service organizations were compared concerning (a) their structured routines and participation processes for SOHSM and (b) employee health, i.e. the municipal five-year incidence of occupational disorders and prevalence of work attendance among HCWs. National register-based data from the whole population of HCWs (n = 154 773) were linked to register-data of occupational disorders and prevalence of long-term work attendance. The top managers and safety representatives in selected high- and low-incidence organizations (n = 60) answered a questionnaire about structure and participation process of SOHSM. The results showed that prevalence of long-term work attendance was higher where structure and routines for SOHSM (policy, goals and plans for action) were well organized. Highly structured SOHSM and human resource management were also related to high organizational incidence of reported occupational disorders. Allocated budget and routines related to HCWs' influence in decisions concerning performance of care were also related to long-term work attendance. The participation processes had a weak effect on occupational disorders and work attendance among HCWs. Reporting occupational disorders may be a functional tool to stimulate the development of effective SOHSM, to improve the work environment and sustainable work ability.

Den under 90-talet ökande sjukfrånvaron, framförallt bland kvinnor inom den offentliga och kommunala sektorn, är ett välkänt samhällsproblem. Stat och arbetsgivare har med olika insatser försökt vända trenden. I Göteborg avsatte Göteborgs Stad 2002 kommuncentrala medel för att möjliggöra hälsofrämjande satsningar inom enheter och arbetsgrupper i kommunen. För ett ökat utbyte mellan teori och praktik samarbetar Göteborgs Stad och Yrkes- och miljömedicin i ett forsknings- och utvecklingsprojekt om hälsofrämjande arbete i social service. Projektet, som döptes till SAMS (Systematiskt salutogent arbetsmiljöarbete inom social service i Göteborgs Stad), har som syfte att öka kunskapen om förhållanden på individ-, grupp-, organisations- eller samhällsnivå som har betydelse för genomförande, effekt och utvärdering av hälsofrämjande satsningar för minskad sjukfrånvaro bland kommunal personal inom social service. Detta för att på sikt bidra till ökade förutsättningar för medvetenhet och handlingsberedskap avseende systematiskt arbetsmiljöarbete. Projektledare för de hälsofrämjande satsningarna är Helen Torstensson från stadskansliet, Göteborgs Stad och undertecknad är projektledare för forsknings- och utvecklingsprojektet. SAMS-projektet finansieras av Vinnovas program ”Utveckling för hållbar hälsa”. Ett program där ett ökat samspel mellan forskning och politisk/offentlig verksamhet prioriteras. Denna rapport är en första delstudie i SAMS-projektet och syftar till att få en fördjupad kunskap om ledares föreställningar om möjligheter och vägar att påverka anställdas hälsa för att minska ohälsan och sjukskrivningarna.

Titeln Projektliv - villkor för uthållig projektverksamhet anspelar på en insikt förmedlad av en av Volvo Personvagnars erfarna projektledare: Utmaningen i en projektorienterad verksamhet är inte bara att bedriva det enskilda projektet framgångsrikt, utan att också skapa sådana villkor för projekten att både projektledare och projektmedarbetare utvecklas och lockas att använda sina erfarenheter i nya utmanande projekt. Det handlar om mer än att behärska och utveckla projektplanering och projektverktyg. Uthållig projektverksamhet ställer krav på förmågan att förstå källor till komplexitet och stress, att skapa motiverande villkor, att stödja projektverksamheten med ledarskap och personalstrategier som utvecklar kompetens hos enskilda projektdeltagare såväl som hos organisationen som helhet. I denna bok förmedlar ledande projektforskare erfarenheter och resultat som belyser dessa frågor. "Beställningen" var att skriva både läsvärt och läsvänligt - läsvärt i meningen att den kunskap som förmedlas innehåller översikter över relevanta teorier och forskningsresultat och samtidigt bygger på egen aktuell forskning, och läsvänligt i meningen att vi alla i vårt skrivande anpassat oss till en stil som skall göra boken lättläst för såväl praktiker som forskare.

Background: Despite the acknowledged role of leadership in the psychosocial work environment, few studies focus on how leadership qualities and strategies may act as key processes of importance to positive effects of workplace health promotion (WHP). The aim of this study was to increase knowledge about how leadership qualities and strategies in WHP projects influence employees’ long-term work attendance. Method: The 1- and 2-year effect of leadership on the prevalence of long-term work attendance among municipal human service workers (n = 3 275) was analysed using 3-year register-based data on sick leave, questionnaires and a qualitative categorization of each unit. Result: Increased leadership qualities, especially where leaders used rewards, recognition and respect, were associated with higher prevalence of work attendance at follow-up [PR 1.42 (1.20–1.69)]. Leaders’ strategies and views on work-related health had a significant impact on increased work attendance in projects that had goals clearly focusing on changeable factors [1.36 (1.11–1.67)], in multi-focused projects [1.60 (1.24–2.04)] and in projects aimed to increase employees’ awareness of their health. Workplace health promotion strategies with a single focus on strengthening individual, professional or organizational resources were negatively associated with work attendance. A higher proportion of employee work attendance was also seen in units whose leaders viewed the organization or the society (rather than individual workers) as responsible for the high rate of sick leave. Conclusion: Leadership, WHP strategies and leaders’ attitudes towards employee work-related health have importance for implementation processes, as well as affecting employee work attendance. In this study, multi-focused WHP interventions had the largest effect on work attendance.