This study aimed to describe the quality of the intimate relationship among parents six months after the birth of their first child. The Dyadic Adjustment Scale (DAS) has been modified and used on 820 responding first-time parents, of which 768 were couples. The results reveal that most parents were happy in their relationship, but both mothers and fathers were discontented with the dyadic sexuality. "Being too tired for sexual activity" was a problem, especially for the mothers, and the most common frequency of intercourse was once or twice per month. The result does not support the assumption that the couples compensate the lacking sexuality with sensuality. Good communication within the couple was associated with higher levels of several dimensions of the intimate relationship, especially dyadic consensus and satisfaction. Thus, one way to stabilize and strengthen a relationship when dyadic sexual activity is low would be to emphasize dyadic communication and sensual activity.

The purpose of this research was to psychometrically evaluate the Dyadic Adjustment Scale (DAS), modified for use with new, first-time parents by extending the items of communication, sensuality, and sexuality. A total of 820 Swedish respondents, 6 months after the birth of their first child, participated in the study. Psychometric evaluation was conducted with factor analysis. The obtained factor structure was tested with multitrait analysis program. Thirty-three itemswere found to fit into a five-factor solution, explaining 50% of the total variance. Descriptive data revealed thatmost new parentswere satisfied with their intimate relationship in general, but dissatisfied with their sexual lives. Themodified DAS, now called the Quality of Dyadic Relationship Instrument includes 33 items and seems to be a useful, updated measurement for assessing quality of the intimate relationship in new first-time parents.

Objectives:

To gain a deeper understanding of why women, diagnosed with mental distress, reported good physical and mental health. What could the reason be and how did they feel four to five years later?

Method:

In-depth interviews were conducted with seven women; age 33 to 52, who worked in a Swedish male-dominated industry. The methodological approach relied on grounded theory.

Results:

A conceptual model was generated in the analysis, describing a temporal process of change in the women's self-image. Three core concepts illuminated this process:(1) maintaining an ideal self-image, (2) waking up/reappraising health and (3) struggling for a realistic self. The women were moving away from facades of meeting social expectations and pleasing others toward trusting and setting boundaries for themselves. Moving away from symptoms such asasthma, migraine and infections, as well as family problems, they felt and hoped that they had more control over their lives.

Conclusions:

A conceptual model was proposed to illustrate a temporal change in women's self-image related to their changing perception of health. Women's newway of life challenges the support system within organizations and society.

Dental fear is a common and widespread problem, which can cause severe stress. Even so, most patients with dental fear undergo regular dental treatment in spite of their fear and many enjoy good oral health. The aim of this study was to obtain a deeper understanding of how patients with dental fear manage to undergo dental treatment. Fourteen patients with dental fear, who undergo regular dental care, were interviewed. Qualitative analysis of the transcribed interviews was performed according to the principles of grounded theory. A conceptual framework was generated, and the main concern was identified as 'making dental care possible - a mutual affair'. Four additional categories explained how patients handled their dental fear and how dental care became possible. The strategies were labelled 'taking part in a mental wrestling match', 'trust-filled interaction with dental staff', 'striving for control' and 'seeking and/or receiving social support'. The results showed that making dental care possible for patients with dental fear is a mutual challenge that requires interplay between dental staff and patients, involving verbal and non-verbal communication reflecting respect, attention, and empathy. Moreover, a balance between nearness and distance and between professional and personal treatment is required.

The purpose of the present study was, first, to detect possible changes in health-related quality of life (HRQL) over time and, second, to predict HRQL at 1year based on measures made 1 week and 5 months after a first-time acute myocardial infarction. There was an improvement in HRQL at 1year, as measured by the questionnaire 36-item Medical Outcomes Study Short-Form (SF-36), for both men and women as compared with the assessment 5 months after the acute myocardial infarction. However, the pattern was somewhat different for women and men. Women mainly reported increased scores on scales reflecting better mental health, whereas men, on the whole, demonstrated higher scores in the physical health domain. Depression (HAD) and fatigue were identified as early predictors of lower HRQL at the 1-year follow-up. Our conclusion is that early assessment of fatigue and depression is worthwhile, as they may indicate decreased HRQL in men and women 1year after first-time myocardial infarction.

Aim

This paper reports on an interview study exploring the self-regulation process in women and men, 5 months after a first-time myocardial infarction.

Background

Somatic, psychological and social factors affect readjustment after a first-time myocardial infarction, and studies have demonstrated substantial rates of depression in patients after myocardial infarction Women report poorer mental health and physical condition than do men. Reconstruction of the self begins when disease poses novel problems and is more likely to occur in cases of long-lasting and disruptive illnesses. Experiencing myocardial infarction is likely to alter a person's mental representation of self. However, the self-regulation process following first-time myocardial infarction is not yet fully understood.

Method

Twenty-one people (11 women, 10 men) were interviewed 5 months after first-time myocardial infarction. The grounded theory method provided the strategies for data collection and analysis.

Findings

Interviewees' definition of themselves as active was threatened by fatigue and other health problems that kept them from taking part in activities as they had done before the heart attack. Although reorienting the active self was central to the process of recovery from myocardial infarction, reorienting was restricted by illness perception and coping.

Conclusion

Participants had not established a stable health condition 5 months after first-time myocardial infarction. They mainly preferred to moderate rather than radically change their daily life activities. They needed more knowledge and support. Nurses can help with information and advice on managing daily life activities, including dialogue about lifestyle changes at this phase of readjustment.

Objective: to gain a deeper understanding of how women who seek care at an early stage experience the latent phase of labour.

Design: a qualitative interview study using the grounded theory approach.

Setting: the study was conducted at a hospital in the southwestern part of Sweden with a range of 1600-1700 deliveries per year. The interviews took place in the women's homes two to six weeks after birth.

Participant: eighteen Swedish women, aged 22-36, who were admitted to the tabour ward while they were stilt in the latent phase of tabour.

Findings: 'Handing over responsibility' to professional caregivers emerged as the core category or the central theme in the data. The core category and five additional categories formed a conceptual model explaining what it meant to women being admitted in the early stage of tabour and their experiences of the Latent phase of tabour. The categories, which all related to the core category, were labelled: (1) 'longing to complete the pregnancy,' (2) 'having difficulty managing the uncertainty,' (3) 'having difficulty enduring the stow progress,' (4) 'suffering from pain to no avail' and (5) 'oscillating between powerfulness and powerlessness.'

Conclusions and implications for practice: findings indicate that women being admitted to the tabour ward in the latent phase of tabour experienced a need for handing over responsibility for the tabour, the welt-being of the unborn baby, and for themselves. Midwives have an important role in assisting women with coping during the latent phase of tabour, and in giving the women opportunity to hand over responsibility. This care should include validation of experienced pain and confirmation of the normality of the slow process, information and support. © 2007 Elsevier Ltd. All rights reserved.

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.

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.

Through the reform entitled "Dental care insurance dental care at a fixed price", patients are offered a dental insurance, a capitation plan, that ensures that they can visit the dentist regularly during a period of three years at a fixed price per month (Frisktandvard). This insurance may be offered to all patients. The aim of this study was to generate a theory explaining the main concern for the staff at the public dental service when they have to introduce and advocate dental care insurance to patients. Interview data from 17 persons, representing different professions within the public dental service, were collected and analyzed simultaneously in line with guidelines for grounded theory. The results indicated that dentists/dental hygienists experienced several difficult standpoints concerning the implementation of the dental insurance, somewhat of a moral dilemma. The staff generally had a "cautiously positive attitude" to the forthcoming dental care insurance, but had perceptions how and when the patients should be offered the insurance and what that may mean to the clinic. The respondents reflected about the economic aspects for the clinic and how the oral health may be affected over time for the patients.

Approximately 40 years ago, Barney Glaser and Anselm Strauss and their joint research approach, the constant comparative method of grounded theory, were at the forefront of what can be called a qualitative revolution. The publication of their book, The discovery of grounded theory (1967), was a breakthrough because of the systematic procedures for qualitative research that were presented. Prior to this publication, qualitative research methodology was traditionally most often taught orally. Through their book, Glaser and Strauss defended the method of qualitative research and countered the prevailing opinion that quantitative research provided the one and only approach to scientific inquiry. They argued that qualitative research is a field of inquiry in its own right, not merely to be used for pre-studies to “real” statistically based studies. The grounded theory method fits in with life world research, because the emphasis is on individuals as unique living wholes and the researcher focuses on the world as it is experienced by the individual. The researcher does not formulate any hypothesis in advance and tries to approach the research area with as few preconceptions as possible. Preconceptions, taken-for-granted assumptions, and interpretations must be handled by reflexive strategies in line with what Dahlberg (2006) has labelled “bridling”. Grounded theory offers the researcher a set of guidelines for building conceptual frameworks that specify the relationships among categories. The guidelines should be used as flexible tools rather than being seen as rigid rules. Grounded theory is a broad method with distinct procedures that work in practice and that are suitable to pragmatic researchers. The “core category” in grounded theory is, as I see it, the constant comparative method. The grounded theory method has been modified by the era within which it exists and by new ideas encountered in the world of inquiry (Annells, 1997). Varying views of what reality is and how it can be known affect the modes of the grounded theory method.

The aim of this study was to generate a substantive theory, based on interviews with women with fibromyalgia, explaining how they manage their main concerns in daily life. The study has an inductive approach in line with classic grounded theory (Glaser, 1992). Twenty-three women living in the southwest region of Sweden were interviewed in-depth about their daily living with fibromyalgia and problems related to this. Probing and follow-up questions were asked by the interviewers when relevant. The interviews were transcribed verbatim and consecutively analysed in line with guidelines for grounded theory. The results showed that the main concern for women with fibromyalgia was to reach a balance in daily life. This concern was resolved by them using different strategies aimed at minimizing the dysfunctional interplay between activity and recovery (core category). This imbalance includes that the women are forcing themselves to live a fast-paced life and thereby tax or exceed their physical and psychological abilities and limits. Generally, the fibromyalgia symptoms vary and are most often unpredictable to the women. Pain and fatigue are the most prominent symptoms. However, pain-free periods occur, often related to intense engagement in some activity, relaxation or joy, but mainly the "pain gaps" are unpredictable. To reach a balance in daily life and manage the dysfunctional interplay between activity and recovery the women use several strategies. They are avoiding unnecessary stress, utilizing good days, paying the price for allowing oneself too much activity, planning activities in advance, distracting oneself from the pain, engaging in alleviating physical activities, and ignoring pain sensations. Distracting from the pain seems to be an especially helpful strategy as it may lead to "pain gaps". This strategy, meaning to divert attention from the pain, is possible to learn, or improve, in health promoting courses based on principles of cognitive behavioural therapy (CBT). We suggest that such courses are offered in primary care for patients with fibromyalgia or other types of longstanding pain. The courses should be led by registered nurses or psychologists, who are experienced in CBT and have extensive knowledge about theories on longstanding pain, stress and coping. Such courses would increase well-being and quality of life in women suffering from fibromyalgia. © 2011 L. R.-M. Hallberg & S. Bergman.

The aim of this study was to gain a deeper understanding of the quality of daily living of persons with hyperacusis after a traumatic head injury 1 year after these persons had participated in a treatment programme at a Swedish hearing clinic. The study group consisted of 21 patients with a mean age of 36 years. In-depth interviews, conducted 1 year after the treatment programme, were analysed using the grounded theory method. Five emergent categories were labelled moderating vulnerability, awareness of restrictions, conditioned participation, structuring daily life and controlling mood changes. The core category, moderating vulnerability, describes the necessary balancing act between activity and recovery. The informants were aware of their new restrictions and managed daily life by structuring and planning each day in detail to minimize exposure to sensory stimuli. They had learned to prioritize their activities and, thereby, rationed their time. The evaluated programme appears to have positive effects and facilitates patients' adjustment process to hyperacusis with relatively restricted costs for the society.

PURPOSE. The aims were to (i) translate the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) into Swedish and evalute its usefulness, (ii) describe hearing difficulties and psychological well-being (quality of life) and (iii) explore variables related to psychological well-being in a Swedish population. METHOD. Seventy-nine consecutive patients, referred to the hearing clinic for hearing examination and audiological rehabilitation, formed the study sample. Along with pure-tone audiometry, the AIADH, the Psychological General Well-being index and the Communication Strategies Scale were used. RESULTS. Men had significantly worse hearing on the high frequencies (2, 3, 4 and 6 kHz) than women but their quality of life was significantly higher than for women. Men scored significantly lower on 'auditory localization' and adopted non-verbal communication strategies less often than women. A stepwise regression analysis showed that 'maladaptive behaviours' and 'intelligibility in quiet' explained 48% of the variance in quality of life. CONCLUSION. Psychosocial consequences of hearing loss, such as lowered quality of life, cannot be predicted from audiometric data alone. The adverse relationship between maladaptive behaviour and quality of life emphasizes the relevance of developing training programs aiming to improve coping with the consequences of a hearing impairment.The AIADH may be useful in assessing self-reported difficulties among patients with hearing problems, but needs to be further developed in terms of psychometric evaluations and reliability testings based on a larger representative sample.

This article focuses on one of the interactive processes that parents use to cope with their child's asthma. The concept allowing for the opposite was developed in the course of a clinical project designed to improve consultation methods in pediatric allergy care. We examined material from 67 conversations carried out with 22 heterosexual couples held with two family therapists: one male pediatrician and one female social worker. We found that parents made use of each other's differences in personality and parenting style, allowing each other to take opposing positions on how to cope with their child's asthma. Disagreement should be added to the list of coping mechanisms used by parents in their cooperative efforts to handle their child's asthma.

The aim of this grounded theory study was to gain a deeper understanding of what it means to profoundly deaf adults to undergo cochlear implantation and their experience of living with it daily. The aim of grounded theory is theorizing, i.e. constructing from data an explanatory scheme that systematically integrates various concepts and their relationships. The study group consisted of 10 women and seven men (age 29-78 years; mean age 56.5 years), who had had their cochlear implant (CI) for between 1 and 12 years (mean 4.1 years). Open taped interviews were carried out and analysed. The core category, coming back to life , defines a psychological process basic to existence, elucidating the existential value of hearing, including perceived harmony in life and becoming a part of the living world as important dimensions. This core concept is related to four additional emerging categories in a temporal order. Preventing disappointment concerns the decision to undergo the operation governed by the conception of having nothing to lose combined with low expectations of successful outcomes. Waiting in silence relates to experiences during the postoperative period such as sensations from the head and uncertainty about the outcome of surgery. The `switch-on' was experienced as a significant revelation and the emotionally loaded starting point for their coming back to life. Retraining the brain concerns the lengthy audiovisual learning process, finally resulting in `a car sounding like a car'. Strengthening of self-worth concerns psychosocial outcomes of cochlear implantation, in terms of less dependency and increased social participation. CIs provide a substantial improvement in the quality of life, as identi- fied in the emerging generic process of coming back to life, fundamental for psychological existence.

Cochlea implantat (CI) ordineras numera allt oftare som rehabilitativt hjälpmedel till personer med allt bättre ”resthörsel” och omkring 40 nya operationer genomförs för närvarande per år på Hörselvårdsavdelningen, SUS i Göteborg. För att förstå vad det innebär för patienter med grav hörselnedsättning/vuxendövhet att leva med CI och hur deras livskvalitet påverkas, krävs både traditionellt kvantitativa studier på slumpmässigt utvalda grupper ur populationen och mer inträngande kvalitativa studier på strategiskt utvalda grupper. Två av våra studier, en med kvalitativ och en med kvantitativ ansats, kommer kortfattat att beskrivas i denna artikel och belyser hur metodologisk mångfald bidrar till önskvärd kunskapstillväxt på ett komplicerat område.

The purpose of this study was to investigate the variables that affect psychological general well-being (quality of life) in patients with cochlear implants (CIs). The study sample consists of 96 adult patients with a CI, aged 24–86 years (Mean = 61.8 yrs; SD = 15.3 yrs). 48 were patients from the Sahlgrenska University Hospital in Sweden and 48 were patients from the University of Florida, USA. The Psychological General Well-being Index and the International Outcome Inventory-Cochlear implants were used in collecting data. Possible independent variables were socioeconomic factors such as age, gender, nationality, living arrangement, education, and social support; as well as length of time since implantation, age when hearing loss became a problem, and subjective benefit of the CI. A stepwise multiple regression analysis showed that 49% of the variance was explained by attitudes from others, restricted social participation, perceived social support and age.

The aim of the study was to explore the perceived health consequences of workplace bullying. Open interviews were conducted with 22 informants; 20 bully victims and two persons working with bullying prevention. Data was assessed and analysed simultaneously in line with grounded theory methodology. A conceptual model was grounded in data, describing experiences of deteriorating psychological and physical health following bullying and efforts of returning to a “normal” life. The core category, “remaining marked for life”, illuminates the manner in which bullying was perceived as a psychic trauma or a traumatic life event causing the bullied person to be marked forever. The model includes five additional categories: “feeling guilt, shame and diminishing self-esteem”, “developing symptoms and reactions”, “getting limited space of action”, “working through the course of events” and “trying to obtain redress”. Bullying included the spreading of rumours and repeated insults aimed at changing the image of the victim and resulting in feelings of guilt, shame and diminishing self-esteem. Physical and psychosomatic symptoms gradually emerge and medical treatment and sick listing follow. The longer the bullying continues, the more limited the possibility to change the situation and the victim has a more limited space of action. Returning to a “normal” life was possible, but presupposed that the victim had worked through of the course of events. The bullied person also tried to obtain redress, such as through monetary compensation or professional confirmation. Despite this, bullying left an internal scar: the bully victim was marked for life.

Aim: This study aims at exploring the main concern for elderly individuals with somatic health problems and what they do to manage this.

Method: In total, 14 individuals (mean-74.2 years; range-68-86 years) of both gender including hospitalized and outpatient persons participated in the study. Open interviews were conducted and analyzed according to grounded theory, an inductive theory-generating method.

Results: The main concern for the elderly individuals with somatic health problems was identified as their striving to maintain control and balance in life. The analysis ended up in a substantive theory explaining how elderly individuals with somatic disease were calibrating and adjusting their expectations in life in order to adapt to their reduced energy level, health problems, and aging. By adjusting the expectations to their actual abilities, the elderly can maintain a sense of that they still have the control over their lives and create stability. The ongoing adjustment process is facilitated by different strategies and result despite lower expectations in subjective well-being. The facilitating strategies are utilizing the network of important others, enjoying cultural heritage, being occupied with interests, having a mission to fulfill, improving the situation by limiting boundaries and, finally, creating meaning in everyday life.

Conclusion: The main concern of the elderly with somatic health problems was to maintain control and balance in life. The emerging theory explains how elderly people with somatic health problems calibrate their expectations of life in order to adjust to reduced energy, health problems, and aging. This process is facilitated by different strategies and result despite lower expectation in subjective well-being. © 2011 A.-S. Helvik et al.

Aim: To study psychological well-being (health-related quality of life) in a population of adults 20 years and over with hearing impairment (HI) and its relation to audiological factors, consequences of the HI, sense of humour, and use of communication strategies.

Subjects and methods: Consecutive adults (n = 343) at the outpatient Unit of Audiology of a Norwegian university hospital answered the Psychological General Well-being inventory (PGWB), Hearing Disability and Handicap Scale (HDHS), Sense of Humour Questionnaire-6 (SHQ-6), and Communication Strategies Scale (CSS) in relation to an audiological examination and medical consultation.

Results: Mean PGWB index for the whole sample was 81.4 (SD 14.3) and females reported a significantly lower psychological well-being. In multiple linear regression analyses well-being was negatively associated with high levels of activity limitation and participation restriction. PGWB index was positively associated with high sense of humour, but was neither explained by audiological factors nor use of communication strategies.

Conclusions: Psychological well-being was associated with the outcome of a standard HI assessment of activity limitation and participation restriction, but not with degree of HI and use of communication strategies.

One purpose of this study was to describe sense of humour and communication strategies in a general population of adults who needed hearing aid (HA) fitting or refitting. Another purpose was to explore the correlation between characteristics of hearing impairment (HI), sense of humour, and other participant characteristics and the communication strategies as outcome. Consecutive patients (n=343) at the Department of Audiology during 1 year completed the Sense of Humour Questionnaire-6 (SHQ-6) and the Communication Strategies Scale (CSS with maladaptive behaviour, verbal and non-verbal strategies). It was found that a high sense of humour was related to female gender and younger age. In multiple regression analyses, use of non-verbal communication strategies was more prevalent among females and increased with younger age, longer duration of HI, and previous HA experience. Use of verbal communication strategies and maladaptive communication behaviour increased with increasing HI. Use of verbal strategies was further associated with younger age and previous HA experience. Frequent use of maladaptive behaviour was related to younger age, longer duration of HI and less sense of humour. Maladaptive behaviour, alternatively expressed as negative reactions to stressful events in communication, was negatively associated with sense of humour. This study may indicate a role for sense of humour in prevention of maladaptive behaviour. It may also improve our understanding of what factors influence the use of communication strategies.

The aim of this study was to determine the association between level of hearing loss (HL) and perceived health and life situation. A population sample of 343 outpatient adults who consulted a university hospital in Norway for hearing aids and rehabilitation was studied. Health and life situation was assessed by self-reported measures of general health, anxiety, participation in social activities, and life satisfaction. Level of HL was estimated by mean hearing threshold in the better ear, and categorized according to international standards. Subjects with normal hearing in the better ear were used as reference. Explanatory health and life situation variables were dichotomized and analysed using logistic regression models. The results showed that perception of good health was negatively affected by increasing HL before and after adjustment for potential confounders (p for trend <0.05). Compared with non-impaired individuals, the odds of perceiving their health as “not good”, were four times higher for the most severely affected subjects (p < 0.05). The odds for reporting anxiety, of abstaining from participation in social activities, and of being generally dissatisfied increased for patients with moderate and higher levels of HL. In conclusion, perception of health was negatively associated with increasing HL, while anxiety, participation in social activities, and perceived life satisfaction did not significantly correlate with the level of loss. Thus, degree of HL seems to be of quite limited importance when consequences of HL are judged.

The consequences of hearing loss in terms of perceived activity limitation and participation restriction were studied in a general population of 343 adults with hearing impairment using the Hearing Disability and Handicap Scale. Coping was measured by the Sense of Humour Questionnaire and the Communication Strategies Scale and combined with objective and subjective audiological variables and demographic factors (age, gender and education). In stepwise linear modelling, several variables contributed significantly to the outcome (adjusted R2=53.3% for activity limitation and 47.2% for participation restriction). Audiological factors explained most of the variance in activity limitation (R2=37.1%), while coping factors were the main predictors for participation restriction (R2=35.2%). Maladaptive behaviour in the Communication Strategies Scale was the strongest predictor and explained 13.7% and 32.4% of the variance in activity limitation and participation restriction, respectively. More frequent use of maladaptive behaviour was related to larger limitation and restriction. This study adds to the understanding of factors that negatively influence daily life in terms of activity limitation and participation restriction. This may in turn have consequences for aural rehabilitation efforts.

Purposes: We first aimed to describe demographic and audiological characteristics of adults referred to a university hospital for hearing aid (HA) fitting and rehabilitation. Our second aim was to employ an inventory that assesses life consequences of hearing impairment (HI) in terms of perceived activity limitation and participation restriction for the first time in a Norwegian adult outpatient population. A third aim was to study life consequences by audiological and demographic characteristics.

Subjects and methods: During one year consecutive patients (n?=?343) were requested to answer the Hearing Disability and Handicap Scale (HDHS) assessing activity limitation and participation restriction in relation to an audiological examination and medical consultation. The mean threshold of hearing (MTH) was ascertained by pure tone thresholds at 0.5?–?1?–?2?–?4 kHz in the better ear.

Results: Activity limitation and participation restriction were both higher for HA experienced than HA naïve subjects ( p < 0.01). In a multivariable model, the explained adjusted variance of activity limitation (R²) was 43.4% with MTH, perceived duration, and severity of hearing problems as predictor variables. Correspondingly, the explained adjusted variance of participation restriction was 28.4% for a model with MTH, age, gender and perceived severity of hearing problems as predictors.

Conclusions: As a standard supplement to audiometric tests, HDHS may be successfully applied as a clinical tool among similar hearing impaired outpatients in order to assess activity limitation and participation restriction as part of audiological rehabilitation.

Aim.

To evaluate the Communication Strategies Scale (CSS) in an adult Norwegian sample with hearing loss.

Subjects and methods.

Of 474 invited patients, a total of 337 consecutive adults admitted to the outpatient Unit of Audiology, ENT Department of a university hospital answered the CSS of the Communication Profile for the Hearing Impaired. The inventory assesses the use of three specific coping strategies; Maladaptive Behaviour, Verbal and Nonverbal Communication Strategies. The psychometric evaluation included construct validity by corrected item-total correlation, the internal consistency reliability by coefficient alpha (Cronbach's) and standard error of the measurement (SEM). Internal structure was evaluated by factor analyses using principal factors followed by a varimax rotation.

Results.

CSS showed good psychometric properties with acceptable and good internal consistency reliability for the subscales. The internal structure of the entire scale gave main loadings at 24 of 25 items at the same factor as the original one.

Conclusion.

CSS may well be used as a clinical tool in the routine assessment of maladaptive and adaptive communication strategies in an unselected adult population of hearing impaired outpatients.

Aim:

To evaluate the Hearing Disability and Handicap Scale (HDHS) in an unselected population of adults with hearing impairment.

Subjects and methods:

A total of 342 consecutive adults who consulted the outpatient unit of audiology in the ENT department of a Norwegian university hospital answered HDHS, which intends to assess the negative consequences of hearing loss. The psychometric evaluation included internal structure analyses and made use of principal factors followed by varimax rotation, construct validity by corrected item-total correlation, and internal consistency reliability by Cronbach's alpha coefficient.

Results:

HDHS showed good psychometric properties with three factors, i.e. speech perception (five items), non-speech sound (five items) and participation restriction (10 items). All had good internal consistency reliability. The inventory distinguished between activity limitations and other problems related to social life participation.

Conclusion:

HDHS was found to be adequate for research and clinical purposes in an unselected adult population with a quite different cultural background and language than the original one.

We investigated, in new hearing aid candidates, whether or not the use of coping strategies and the life situation, in terms of activity limitation, participation restriction and psychological well-being, were associated with the outcome of audiological counselling, i.e. the patients’ acceptance or rejection of a hearing aid (HA). The study included 173 consecutive adult patients (104 men and 69 women) with a need for audiological rehabilitation including HA-fitting. Use of communication strategies (Communication Strategies Scale, CSS), experience of activity limitation and participation restriction (Hearing Disability and Handicap Scale, HDHS), and general psychological well-being (Psychological General Well-being scale, PGWB) were assessed by self-report inventories. The hospital records, reviewed 1.5years after the first consultation, showed that 39 patients (25 men and 14 women, 23%) had not accepted a hearing aid. In crude and adjusted logistic regression analyses a low report (high scores) of maladaptive behaviour in communication was associated with a three-times higher odds for rejecting a hearing aid, while a highly perceived activity limitation and participation restriction were related to lower odds for rejection. Patients who felt they had few problems with their hearing or overlooked or repressed their shortcomings, rejected HAs more often.

The relationship between the reported use of coping strategies and experience of everyday life prior to audiological rehabilitation and the number of rehabilitation consultations needed, were studied in a group of adults. The study took place at St. Olav's University Hospital, Norway and included 132 adult patients (77 men and 55 women) with no previous audiological rehabilitation or experience with hearing aid (HA) use. Hearing impairment was assessed by pure tone audiometry, while use of communication specific coping strategies and daily life situations were obtained using self-report inventories. The latter concerned activity limitation, participation restriction, and psychological well-being. The patients' hospital records were reviewed approximately 18 months after their first consultation. In total, 41 patients (31%) needed no more than the required minimum number of three consultations to complete rehabilitation including HA fitting, while 91 patients needed more than this. Logistic regression was used to study coping and everyday life in relation to the need for three versus more consultations. Little experienced participation restriction was related to the need for only three consultations. Use of communication specific coping strategies, activity limitation, or psychological well-being was not associated with the number of consultations needed. © 2007 Taylor & Francis.

The present article is a descriptive survey assessing nurses' knowledge, training, and practices regarding the care of abused women. A self-administered questionnaire was sent to all nurses working within the government health organization on the Åland Islands, Finland. The response rate was 57%. Most nurses had no formal training in domestic violence and were less likely than the in-service-trained nurses to intervene with abused women. Nurses' knowledge, beliefs, and practices were found to be unsystematic and had drawbacks. Nurses were not familiar with the formal structure provided by the health administration. The results suggest that in order to meet the urgent need for training among nurses, an in-service training program needs to be set up. This program would help the nurses in identifying survivors of abuse and make them prepared to intervene more effectively to promote the health of these women.

Objective

Although many countries offer some publicly funded orthodontic treatment for children, not all conditions receive treatment and some adolescents enter adulthood with persisting poor dental aesthetics or malocclusions. The aim of this study was to generate a theory highlighting the main concerns of young adults, either native-born or of immigrant background, with poor dental aesthetics and the measures they adopt to manage their condition in everyday life.

Material and methods

A qualitative method, classic grounded theory, was applied in order to generate a substantive theory highlighting the main concerns and managing mechanisms of 13 strategically selected 19- and 20-year-olds with poor dental aesthetics. Open interviews were conducted with each participant, the topics covering different aspects of social and dental conditions.

Results

A core category and three conceptual categories were generated. The core category was labelled "Being under the pressure of social norms" and was related to categories explaining three different ways in which these young adults handle their main concern: (1) avoiding showing their teeth; (2) minimizing the importance of appearance; and (3) seeking orthodontic treatment. The theory offers the potential for improved understanding of young adults who, despite poor dental aesthetics, are managing well with life, and also of those who have not adjusted well.

Conclusions

In early adolescence it may be problematic to make decisions about orthodontic treatment. Undisclosed dental fear can be an important barrier. Some of the young adults in the present study would probably benefit from treatment.

The aim of this grounded theory study was to illuminate the main concern of people suffering from chronic obstructive pulmonary disease (COPD) and how they handle their everyday life. Data were collected through interviews with 23 people with COPD at different stages, from mild to severe. A substantive theory was generated showing that the main concern was feelings of guilt due to self-inflicted disease associated with smoking habits. This core category was related to five managing strategies termed making sense of existence, adjusting to bodily restrictions, surrendering to fate, making excuses for the smoking-related cause and creating compliance with daily medication.

The purpose of this study was to examine patients’ experiences of daily living with a pacemaker. A total of 13 pacemaker patients (seven women) aged 22-82 (mean = 59.2) years were interviewed. The informants had had a pacemaker from 0.5 to 33 (mean 13.1) years. The grounded theory method was the basis for collection and analysis of the data. The results of the analysis of the semi-structured interviews showed that variations in ‘perceived social participation’ and ‘emotional state’, the two core categories, were related to four qualitatively different ways of experiencing daily living after pacemaker implantation.

Background:

PCI has been established as an effective treatment for coronary artery disease. Restenosis is a recurrence of a significant narrowing in the treated vessel. Although a part of the investigative and research funding is invested in the prevention and resolving the restenosis problem, little is known about its clinical significance apart from further revascularisation.

Aim:

The intention of this study was to clarify the patients perspective of what it means to suffer from documented restenosis after PCI.

Method:

Patients interviewed had undergone PCI. Data collection and analysis was done simultaneously according to Grounded Theory methodology and continued until new interviews provided no additional information.

Results:

“Living with uncertainty” was identified as the core category, and the central focus in the data explains what it means to patients' to suffer from restenosis. The core category was further illuminated in four additional categories labelled “fighting for access to care”, “moderating health threats”, “trying to understand” and “controlling relatives anxiety”.

Conclusion:

Patients' perceptions of illness and illness-related events, such as symptoms, diagnosis, treatment and prognosis, are considerably affected by uncertainty. This infiltrates their struggle to acquire the care needed, their endeavour to comprehend and moderate health threats, and caring for their family.

Little is known of wind turbines' impact on people living in their vicinity. The aim of this study was to gain a deeper understanding of how people perceive and are affected by wind turbines in their living environment. In-depth interviews with 15 informants, strategically chosen to form a heterogeneous group, were analyzed using the constant comparative method of grounded theory. The informants were to different extents affected by the swishing noise, flickering light, and constant movement of the turbines' rotor blades. Some informants perceived the exposures as outside their territory while others perceived them as intrusion into privacy; a divergence partly determined by the informants' personal values about the living environment. The feeling of intrusion was associated with feeling a lack of control, subjected to injustice, a lack of influence, and not being believed. Informants used various coping strategies, such as rebuilding their houses or complaining, but mainly tried to ignore exposures from the wind turbines. The findings can help us to better understand the severe reactions wind turbines sometimes evoke and contribute to the knowledge base used when planning for new wind farms.

In Sweden, snuff-use is an established and accepted phenomenon in society, especially in connection with certain sports. The aim of this qualitative study was to analyze and describe the psychosocial environment influencing young male ice-hockey players into starting to use snuff. The study sample comprised 16 male participants between 15 and 32 years of age strategically selected for being active or having been active as ice-hockey players-snuff-users and non-users alike. A grounded theory design, including in-depth interviews, was used to generate a theory from data and thereby create theoretical concepts explaining social phenomena, human behavior, and process. An interview guide containing different themes was used to cover the study area. Five higher-order categories were developed and labeled: having a role model, residing in a consenting environment, experiencing performance demands, experiencing a sense of community and creating an image. Socialization in and through psychosocial norms of the ice-hockey environment was identified as a core category describing the central meaning of the informants' experiences of snuff in the ice-hockey environment. In the present study, the identified categories that integrate within the environment in which the young people reside and pursue their sports activities have been interpreted as factors enhancing the commencement of snuff-use. We suggest health promotion activities within the ice-hockey environment based on a health psychology model of planned behavior.

Background: Nursing students are expected to deliver holistic care in their upcoming career. Developing spirituality during nursing training is poorly understood.

Objectives: The current study aimed to explore the process of developing spirituality among Iranian nursing undergraduates.

Patients and Methods: The study employed Grounded theory approach and purposive sampling with maximum variation to select the participants among undergraduate nursing students in their fourth-year of study in the nursing school of Tehran University of Medical Sciences. Data were gathered through semi structured interviews with nineteen nursing students and one faculty member (n = 20). Corbin and Strauss approach was selected for data analysis.

Results: Data analysis revealed that developing spirituality during nursing education is an intuitive development including three stages: early frustration, intuitive development through hardship and seeking meaning and fulfilment. This process is influenced by educational/caring environment as well as role models.

Conclusions: Upbringing capable nurses to deliver spiritual care require supportive environment and influential role models to encourage students’ spiritual development. Developing spiritually may end in delivering spiritual care and provide nursing students with inner strength for better confrontation with serious situations common in their upcoming career.

The aim was to describe how bullying was experienced by individuals who had been exposed to bullying at their workplaces. Open interviews were conducted with 22 participants from different professional and organizational status groups in the public service sector, who had experienced bullying at their workplaces. The interviews were analyzed according to guidelines for grounded theory. The core category illuminated a social process of “being rejected and expelled from the workplace.” Based on the informantś descriptions, the meaning of bullying seemed to be conflict resolution through rejection of a threatening workmate. Additional categories described assumed intentions of indirect aggressive behaviors; “changing a person's image by means of slander,” “betraying a person through deceit,” “devaluing a person through insults,” and “legitimizing bullying through unjust treatment.” The category “mobilizing power through support” showed that the informants perceived temporary relief from suffering through support from others. Often support from those other than family and close friends was sparse. All categories formed a conceptual model describing a process of workplace bullying, as experienced and described by the informants. A conceptual model is proposed to illustrate a social process of rejection and expulsion from the workplace, based on interview data from informants who have experiences of bullying at the workplace. Bullying seemed to hold meaning in that it was perceived by the informants to solve values conflicts in the workplace.

BACKGROUND:

Workplace bullying has attracted increased attention during the last decade due to its severe consequences on health. However, the origin of bullying has, so far, been insufficiently described.

AIM:

This study investigates the manner in which bullying is initiated at workplaces in the public service sector.

METHOD:

Twenty-two bully victims were interviewed in-depth and data were analysed according to grounded theory methodology.

RESULTS:

The findings of this study demonstrated that bullying was preceded by a long-standing struggle for power. This power struggle emanated from conflicts of values caused by organizational conditions, leadership styles and the involved parties' work expectations. In particular, individuals who perceived themselves as strong and competent or as vulnerable and sensitive persons were targeted in these types of power struggles.

CONCLUSIONS:

In these cases, if values conflicts were solved, the power struggle ebbed. When values conflicts remained unsolved, the gap widened between the targeted individual and that person's opponents. Thereby, the conflict escalated and grew into one characterized by systematic and persistent bullying.

The aim was to describe bullying at the workplace. In-depth interviews with 22 individuals were analysed according to the Grounded Theory method. The findings showed that the origin of bullying was a struggle for power, initiated by value conflicts at the workplace, which is a potential arena for bullying, where the targeted individuals were either strong or vulnerable. This power struggle was transformed into bullying, and the bullies' goal was to reject and expel the victims from the workplace. The process of bullying consisted of slander, deceit, insults and injustice, although sometimes the victims also received social support.

The burden of diabetes and obesity is increasing worldwide, indicating a need to find the best standard for diabetes care. The aim of this study was to generate a theory grounded in empirical data derived from a deeper understanding of health care professionals’ main concerns when they consult with individuals with diabetes and obesity and how they handle these concerns. Tape-recorded interviews were conducted with seven groups and three individual members of a diabetes team in an area of western Sweden. The grounded theory (GT) method was used to analyse the transcribed interviews. A core category, labelled Balancing coaching and caution and three categories (Coaching and supporting, Ambivalence and uncertainty, and Adjusting intentions) emerged. The core category and the three categories formed a substantive theory that explained and illuminated how health care professionals manage their main concern; their ambition to give professional individualised care; and find the right strategy for each individual with diabetes and obesity. The theory generated by this study can improve our understanding of how a lack of workable strategies limits caregivers’ abilities to reach their goals. It also helps identify the factors that contribute to the complexity of meetings between caregivers and individuals with diabetes. © 2011 I. Svenningsson et al.