Background:  Active Support is a staff practice that aims to increase engagement of people with intellectual disabilities. This study seeks to: (1) identify the outcomes of staff using Active Support and how these are measured; (2) identify how the views of people with intellectual disabilities have been included in Active Support research.

Method:  A scoping review was conducted of peer-reviewed articles about Active Support published between 2009 and 2023.

Results:  Sixteen articles were identified. Outcomes included engagement, the quality of staff support, choice and challenging behaviour. Structured observations were the most frequently used measurement method. Only two studies explored people with intellectual disabilities' perspectives about Active Support.

Conclusions:  Consistent use of similar measures is a strength of Active Support research. Including perspectives of people with intellectual disabilities may provide insight into dimensions of support not been measured and assist in further developing these measures and Active Support practice.

Background: Support from staff plays an important role in quality of life for people with intellectual disability. This study focuses on service users' views of Active Support as good support and whether Active Support increases the quality of everyday support in group homes.

Method: Nine service users were interviewed at baseline and at follow-up one year after staff received Active Support training. Thematic analyses were used to develop themes. Results: Three main themes were created: (1) Home is more than just a place, it is a feeling; (2) Good care is caring with accessible communication; and (3) Time is precious. Participants were more satisfied with most of the support at follow-up, particularly choice-making, control in everyday life, relationships, and emotional support.

Conclusions: Active Support corresponds well with service users’ perceptions of good support. In future studies of Active Support service users' voices should be a part of the follow-up.

Qualitative interviews are generally conducted in person. As the coronavirus pandemic (COVID-19) prevents in-person interviews, methodological studies which investigate the use of the telephone for persons with different illness experiences are needed. The aim was to explore experiences of the use of telephone during semi-structured research interviews, from the perspective of participants and researchers. Data were collected from mobile phone interviews with 32 individuals who had common mental disorders or multimorbidity which were analyzed thematically, as well as field notes reflecting researchers’ experiences. The findings reveal several advantages of conducting interviews using mobile phones: flexibility, balanced anonymity and power relations, as well as a positive effect on self-disclosure and emotional display (leading to less emotional work and social responsibility). Challenges included the loss of human encounter, intense listening, and worries about technology, as well as sounds or disturbances in the environment. However, the positive aspects of not seeing each other were regarded as more important. In addition, we present some strategies before, during, and after conducting telephone interviews. Telephone interviews can be a valuable first option for data collection, allowing more individuals to be given a fair opportunity to share their experiences.

Return-to-work coordinators (RTWC) support people on sickness absence and is a new healthcare occupation in Sweden. Its practitioners represent a variety of professions, there is no common undergraduate training and vague role and competence descriptions. The aim was to explore differences in training and competence according to original professions (occupational therapists, physiotherapists, counselling, and other professions) and coordinators’ views on which professions they believe provide the best competence for the role. All RTWCs (82) in one region were invited to answer a questionnaire (89% response rate). Mixed-methods analyses were applied. The results showed that counselling professions were more likely than other professional groups to have further training, particularly in conversation methods, and a lower proportion of them stated needing more knowledge about gender equality, social problems, insurance/benefit and conversation methods. The analysis of free-text answers identified three competence areas of importance: advice and guidance, a holistic view, and personality over profession. Occupational therapists and social workers were seen as having the best competence for the coordinating role. The results outline some common values, norms and important competences for RTWCs that could help develop the RTW coordination training and pave the way for RTWCs professionalisation process.

Coordinators may play a key role during the return-to-work (RTW) process for people on sickness absence. There are still few studies on the newly implemented rehabilitation coordinators (RECO) within Swedish healthcare, and none focus on their competence. The aim of this study was to explore how persons with multimorbidity and psychosocial difficulties describe the professional competence of the RECO they encountered during their RTW process. The study takes a relational and practical approach in defining professional competence, including both what professionals do and what they possess. Interviews with 12 people with multimorbidity and psychosocial difficulties who had encountered a RECO during their RTW process were analysed using thematic analysis. Six different themes were found: communicative and coordinating skills; advisory and guidance skills; engagement and advocacy skills; being persistent and flexible; being empathic and therapeutic; being professional and trustworthy. Most of these are found in research on RTW coordinators, but being persistent, and having advisory, guidance, advocacy and therapeutic skills have not been recognised as important competences previously. This study adds patients’ views on important professional competence that support the RTW process, which should be regarded in further developments of RECOs’ functions and their competence descriptions.

Background: Receiving support from a return-to-work (RTW) coordinator (RTWC) may be beneficial for people on long-term sick leave. The aim of this study was to investigate whether the number of contacts with an RTWC and their involvement in designing rehabilitation plans for the patients were associated with perceiving support for RTW, emotional response to the RTWC, and healthcare utilization. Methods: In this cross-sectional study, 274 patients who had recently been in contact with an RTWC in Swedish primary or psychiatric care answered questions regarding their interaction with an RTWC, perceived support for RTW, and emotional response to the RTWC. Results: Having more contact with an RTWC was associated with perceiving more support in the RTW process (adjusted OR 4.14, 95% CI 1.49–11.47). RTWC involvement in designing a rehabilitation plan for the patient was associated with perceiving more support in the RTW process from an RTWC and having a more positive emotional response to the RTWC. Conclusions: From the patient’s perspective, this study indicates that the involvement of an RTWC and receiving a rehabilitation plan that an RTWC has helped to design might be perceived as important in the RTW process.

Purpose: Return-to-work coordinators (RTWCs) give people on sick leave individualized support and coordinate between different stakeholders, including physicians.  The aim of this study was to explore physicians’ experience of RTWCs and investigate factors that influence how much physicians collaborate with RTWCs, or refer patients to them, in primary, orthopaedic, and psychiatric care clinics.

Materials and methods: Of the 1229 physicians responding to a questionnaire, 629 physicians who had access to a RTWC in their clinic answered to questions about collaborating with RTWCs.

Results: Among physicians who had access to a RTWC, 29.0% collaborated with a RTWC at least once a week. Physicians with a more favourable experience of RtWcs reported more frequent collaboration (adjusted OR 2.92, 95% CI 2.06–4.15). Physicians also collaborated more often with RTWCs if they reported to often deal with problematic sick-leave cases, patients with multiple diagnoses affecting work ability, and conflicts with patients over sickness certification.

Conclusions: Physicians who had more problematic sick-leave cases to handle and a favourable experience of RTWCs, also reported collaborating more often with RTWCs. The results indicate that RTWCs’ facilitation of contacts with RtW stakeholders and improvements in the sickness certification process may be of importance for physicians.

Vi, 1 620 forskare samt lärare vid universitet och högskolor, är eniga med de unga bakom Auroramålet: De drabbas och riskerar att drabbas allvarligt av klimatkrisen under sin livstid. De klimatåtgärder vi vidtar i närtid avgör deras framtid. Sverige måste ta ansvar och göra sin rättvisa andel av det globala klimatarbetet. 

I strid med Parisavtalet ökar utsläppen av växthusgaser i en takt som gör att 1,5-gradersmålet kan överskridas om några år. De globala effekterna blir allt mer synliga med ständiga temperaturrekord, smältande isar, havshöjning och extremväder som torka, förödande bränder och skyfall med enorma översvämningar, som i Pakistan nyligen. Försörjningen av befolkningen utsätts för allvarliga hot i många länder.

Minskningen av den biologiska mångfalden är extrem. Klimatkrisen är enligt WHO det största hotet mot människors hälsa i hela världen och barn utgör en särskilt sårbar grupp. Med Sveriges nordliga läge sker uppvärmningen här dubbelt så fort som det globala genomsnittet. Det förskjuter utbredningsområden för växtlighet och sjukdomsbärande insekter och ökar förekomsten av extremväder såsom värmeböljor, skogsbränder och översvämningar samt av många olika sorters infektioner och allergier. När extremväder ökar, ökar även stressen och risken för mental ohälsa. Värmeböljor ökar risken för sjukdom och död hos sårbara grupper som äldre, små barn och personer med kroniska sjukdomar. De negativa effekterna på hälsan kommer att öka i takt med klimatkrisen och barn riskerar att drabbas av ackumulerade negativa hälsoeffekter under hela sina liv. Redan i dag är mer än hälften av unga mellan 12 och 18 år i Sverige ganska eller mycket oroliga för klimat och miljö. Detta är förståeligt när våra beslutsfattare inte gör vad som krävs.

Den juridiska och moraliska grunden för arbetet mot klimatförändringarna är att varje land måste göra sin rättvisa andel av det globala klimatarbetet. Centralt i det internationella klimatramverket är att rika länder med höga historiska utsläpp, däribland Sverige, måste gå före resten av världen. Dessa länder måste också bidra till att finansiera klimatomställningen i länderna i det Globala Syd, som är minst ansvariga för klimatkrisen men drabbas hårdast. Denna rättviseprincip är tydlig i Parisavtalet och var en het diskussionsfråga under COP27 i Sharm el-Sheikh, men lyser med sin frånvaro i det svenska klimatarbetet. 

Sverige har satt mål för att minska sina utsläpp. Men de är helt otillräckliga: minskningstakten är för låg och målen tillåter samtidigt att åtgärder skjuts på framtiden. Dessutom exkluderas merparten av Sveriges utsläpp från de svenska nationella utsläppsmålen; bland annat utelämnas utsläpp som svensk konsumtion orsakar utanför Sveriges gränser, utsläpp från utrikes transporter och utsläpp från markanvändning och skogsbruk, exempelvis utsläpp från förbränning av biobränslen eller utsläpp från dikade våtmarker (Prop. 2016/17:146 s.25-28).

Sverige saknar dessutom ett eget mål för att öka upptaget av växthusgaser genom utökat skydd och restaurering av ekosystem, något som krävs för att begränsa de värsta konsekvenserna av klimatkrisen (IPCC s.32). Trots dessa låga ambitioner misslyckas Sverige med att nå sina utsläppsmål, konstaterar både Klimatpolitiska rådet och Naturvårdsverket. En klimatpolitik i linje med Parisavtalet kräver både att alla typer av växthusgasutsläpp minskar samtidigt som – inte i stället för – upptaget av växthusgaser maximeras: i dag misslyckas Sverige på bägge fronter.

Slutsatsen är tydlig. Sverige vidtar inte de åtgärder som krävs för att skydda barns och ungdomars rättigheter enligt Europakonventionen till skydd för de mänskliga rättigheterna. Detta medför allvarliga risker för liv och hälsa för unga generationer, människor i andra länder och särskilt utsatta grupper. Detta kan inte fortsätta. Därför ställer vi oss bakom Auroras krav att Sverige börjar göra sin rättvisa andel och omedelbart sätter igång ett omfattande och långtgående klimatarbete som vilar på vetenskaplig grund och sätter rättvisa i centrum.

Background The COVID-19 pandemic led to vast changes in working life and conditions in which we work. Thesechanges may affect people with multiple sclerosis (PwMS) differently. We aimed to describe the working situation ofPwMS during the COVID-19 pandemic and the pandemic’s impact on their working lives.

Methods All individuals aged 20–50 listed in the Swedish Multiple Sclerosis Registry were invited to participate inan online survey in 2021. Closed and open-ended responses linked to individual-level register data were used in this exploratory mixed-methods study. Differences in the proportions reporting specific impacts were assessed with chisquare tests by sex, MS severity, education, and profession. The open-ended answers were analysed through contentanalysis.

Results Over 8500 PwMS were invited (52% response rate). We included the 3887 respondents who answered questions about the impact of the pandemic on working life. Most (93.7%) reported being in paid work. An impactof the ongoing pandemic to one’s daily occupation was reported by 26.2%, with different characteristics observedacross the impacts. Four categories of type of answers were identified from the open-ended answers: Direct impacton one’s occupation, Disclosing or concealing MS in the workplace, Worry and uncertainty, and Broader impact to lifesituation.

Conclusions PwMS navigated the pandemic by interrupting as well as continuing their working lives. Many PwMSreported that the pandemic did not affect their work situation. However, the reported impacts differed among theparticipants and a sense of uncertainty and worry was often underlying their statements. Lessons from the pandemicmay support future work participation.Keywords SARS-CoV-2, Containment measures, W

Background

The focus in HIV care so far have been to reach good physical conditions and through the UNAIDS 90-90-90 target. However, health also includes mental and social well-being as well as the absence of stigma and discrimination. The overall aim of this study is to explore the association between living as open with HIV as one wants and suicide thoughts among 16-29-year old young people living with HIV in Sweden. A secondary aim is to see how this can be understood in the intersections of gender and sexual identity.

Methods

This study is based on a national survey of young people living with HIV conducted at HIV-clinics in 2018. The survey had 173 respondents, giving a response rate of 36 percent. Logistic regression models were used to calculate odds ratios (OR) using suicide thoughts as the outcome variable and open with HIV status, gender and sexual identity as exposure variables. Gender and sexual identity was combined to investigate intersections.Results: The results show that suicidal thoughts are more common among young people who report that they were not as open as they wanted to be with their HIV status (OR 1.71 95% CI : 0.90 – 3.25). The analysis also indicate that the associations of suicide thoughts intersects with gender, sexual identity and openness with one’s HIV. In general, men had higher odds ratios of suicide thoughts if they reported not being as open as they wanted to with their HIV status, or belonging to a sexual minority, compared to heterosexual men being as open as they wanted. In women, the groups were smaller and the same pattern was not observed.

Conclusions

The findings add to previous knowledge and guide policy and practise as it point not only to the possibilities if being as open as one wants with HIV status but also to how this has different implications depending on the intersection of sex and sexual identity. The results pinpoint the need of larger studies to investigate intersections further.

According to the Swedish Social Services Act, all health personnel are required to report children whom they suspect are subject to maltreatment. This paper describes the organizational and professional conditions in four Swedish children's hospitals regarding the reporting process. Specifically, the study focused on knowledge of risk to children, legal frameworks and the perceptions of organizational support and explored the differences between the hospitals and professional groups. The method used was a quantitative questionnaire, and 295 personnel responded. Hospitals differed in the level of organizational support offered to staff. Importantly, the professional groups showed different levels of knowledge and awareness about structures supporting their reporting obligations, with nurses and nurse assistants showing a lower level of awareness than physicians and hospital social workers. The paper argues that all professional groups need to have equal access to education, with the opportunity to become more involved in the assessment and reporting process and to strengthen multidisciplinary structures. Further, this would reduce risk, dispel the perception that work with children is 'dirty work' and counter strategies of avoidance among some professionals.

I den här boken ges olika exempel på situationer där professionella förväntas ingripa för att skydda barn och unga – alltifrån bristande föräldraomsorg, misshandel, exploatering, väpnade konflikter, socioekonomisk utsatthet, till att skydda barn från ökad utsatthet till följd av sjukdom eller funktionshinder. Men hur långt sträcker sig egentligen ansvaret hos enskilda professionella inom välfärdens institutioner? Med utgångspunkt i min och andras forskning och i egna erfarenheter av att arbeta med dessa frågor som hälso- och sjukvårdskurator, är ambitionen med detta kapitel att bringa lite reda i ett ibland svårnavigerat fält. Kapitlet handlar om de professionellas uppgift, oavsett om det gäller arbete som lärare, sjuksköterska, kurator, psykolog, polis, socionom, barnskötare eller något annat yrke där kontakter med barn är vanliga. Alla dessa utgör tillsammans första linjens försvar i välfärden för barn som riskerar att fara illa. När personal inom verksamheter som berör barn och unga misstänker att ett barn far illa och kan behöva stöd eller skydd, är de skyldiga att göra en så kallad orosanmälan till socialtjänsten. Kapitlet tar ett brett grepp om professionssystemet och anmälningsskyldigheten, och sätter det svenska systemet och definitionerna i ett internationellt perspektiv. Forskning om vad som tenderar att anmälas presenteras, liksom hittills opublicerade forskningsresultat om anmälningsorsaker bland olika kategorier av sjukhuspersonal. Kapitlet fördjupar sig också i orsaker till att professionella inte anmäler sin oro för barn, samt hur bedömningar av barns utsatthet påverkas av sociala normer och känslor.

This thesis explores factors that influence professional discretion in Swedish hospital professionals’ assessment of children who may be at risk of harm. It is based on two data samplings, interviews with fourteen hospital social workers and a questionnaire with 295 responding physicians, nurses, nurse assistants and hospital social workers. The theoretical frame consists of theories of professions, sociology of emotions and normativity. Although all professionals are mandated to report suspicions about children who may be at risk to social services, the findings show that a majority of the participants had never made a report. However, there were major differences between the professions: hospital social workers and physicians made most reports, while it was unusual for nurses and nurse assistants to report. This is explained by children at risk being everyone’s but no single profession’s responsibility within health care – which shapes an informal pattern of jurisdiction, split between physicians and hospital social workers. The professional group to which a person belongs was shown to affect how other factors influence assessment. The lower the status of the group, the less knowledge about the issue and the available organisational support its members have, and the more emotions influenced the decisions not to report. While hospital social workers are less strongly affected by emotions in decisions not to report, the deeper qualitative analysis shows that assessment tended to follow a ‘logic of normativity’ where their worries stuck to ‘warning signs’ associated with gender stereotypes or unprivileged groups of parents. Critical reflexivity could disturb this logic as well as the silence of normality, meaning that children from privileged groups may not be given enough attention. Hospital social workers were also found to take different positions in their inter-professional teams – active, reflective or passive – relating to three institutionalized norms of action – juridical, therapeutic and medical. A small number followed the medical norm, but that had the most dangerous consequences for children who sometimes were not dealt with appropriately despite severe signs of harm. The overall analysis in this thesis suggests that theories of professional discretion should take into account factors such as the context, inter-professional relations, emotions and normativity to enhance the understanding of what influences assessment and decisions.

This article explores the linkage between emotions and social norms, based on gender, nationality/culture, class and (dis)ability, in 14 hospital social workers assessments about parents, in their narratives about children at risk. In various ways, a range of emotions are shown to be linked to normativity. When the feeling of blame was present, other emotions such as worry became stuck to unprivileged groups of parents in a 'logical' way in assessments and shaped certain orientations for actions against the parents. By using the concept of stickiness, an understanding of how emotions and normativity works in assessments is developed.

This article explores hospital social workers' assessment processes for children at risk within the context of inter-professional teams working in child hospital care in Sweden. Based on qualitative interviews, the study discusses how assessment processes for children at risk can be understood from a professionalism perspective. Three institutionalized norms-juridical, therapeutic, and medical, building on different knowledge systems-are analyzed in relation to the three positions taken by hospital social workers as team members-active, reflective, or passive-leading to different kinds of actions in the assessment processes. The outlined norms and the positions taken involve consequences for the children and their families, but also pose questions for the future professionalization efforts of hospital social work.

Detta kapitel behandlar hälso- och sjukvårdskuratorns roll i relation till transnationella och transkulturella frågeställningar. Fokus ligger på kuratorns möte med immigrerade patienter och en diskussion förs kring tidigare forskning och författarens egna studier på området. Kapitlet bidrar med fördjupning i ämnet utifrån perspektiven yrkesetiska principer och teoretiska ramar och lyfter ämnet som ett specifikt kunskapsfält. Kapitlet avslutas med en diskussion om vikten av kritisk reflexivitet för att utveckla en antidiskriminerande praktik och ger förslag på områden för kuratorer att fördjupa sin kompetens inom vad gäller transnationellt och transkulturellt socialt arbete i hälso- och sjukvården.

Under 2016 införde Karolinska Universitetssjukhuset ett specialistteam med asylkuratorer inriktade på asylsökande och papperslösa patienter. Baserat på enkätdata och dokumentation undersöks de ordinarie kuratorernas erfarenheter av asylkuratorerna, om de upplevde att de ökade deras egna kunskaper på migrationsområdet, och i vilka frågor de sökt konsultation. Ju högre grad kuratorerna använde sig av asylkuratorerna, i desto större grad upplevde de att asylkuratorerna haft positiv inverkan på bemötande av patienterna och på de egna arbetsvillkoren och kunskaperna. Även hälften av de som inte involverat asylkuratorerna direkt i patientärenden hade fått ökad kunskap. Resultaten tyder på att specialistkuratorstjänster som formas utifrån sociala problemformuleringar, till skillnad från medicinska uppdelningar, skulle kunna stärka patienters sociala rättigheter och möjligheter till socialt stöd.

Hospital personnel have been shown to report child maltreatment to social services less frequently than other professionals. This quantitative study shows that one-half of the respondents within the four largest Swedish children’s hospitals had never made a report. However, nurses’ and nurse assistants’ odds of being low reporters were significantly high, compared with physicians and hospital social workers. Longer working experience, access to guidelines and routines, and feelings of stress were strongly related to deciding not to report. Insecurity in assessment and ambivalence about how to act also had a strong effect, although different emotions had varying impacts on the different professions; hospital social workers were less strongly influenced by emotions in their decision-making.

Objectives To explore physicians’ experiences of using the national sickness certification guidelines introduced in 2007 and the types of information they used, in general and in different types of clinics.

Design Cross-sectional survey.

Setting Most physicians working in Sweden in 2017.

Participants A questionnaire was sent to 34 718 physicians; 54% responded. Analyses were based on answers from the 13 750 physicians who had sick leave cases.

Outcome measures To what extent the guidelines were used and what type of information from them that was used.

Results Ten years after the sickness certification guidelines were introduced in Sweden, half of the physicians used them at least once a month. About 40% of physicians in primary healthcare and occupational health services used the guidelines every week. The type of information used varied; 53% used recommendations about duration and 29% about degree of sick leave. Using information about function and activity/work capacity, respectively, was more common within primary healthcare (37% and 38%), psychiatry (42% and 42%), and occupational health services (35% and 41%), and less common in surgery and orthopaedic clinics (12% and 12%) who more often used information about duration (48% and 53%). Moreover, 10% stated that the guidelines were very, and 24% fairly problematic to apply. Half (47%) stated that the guidelines facilitated their contacts with patients and 29% that they improved quality in their management of sick leave cases. More non-specialists, compared with specialists, found that the guidelines facilitated contacts with patients (OR 3.28, 95% CI 3.04 to3.55).

Conclusions The majority of the physicians used the sickness certification guidelines, although this varied with type of clinic. Half stated that the guidelines facilitated patient contacts. Yet, some found it problematic to apply the guidelines. Further development of the guidelines is warranted as well as more knowledge about them among physicians.

Background: This study explores how the goals of collaboration in the return-to-work (RTW) process for people with common mental disorders are described by the stakeholders involved, and how they experience stakeholders’ roles and responsibilities in relation to these goals.

Methods: Interviews were conducted with 41 participants from three Swedish regions. Nine of the participants were workers, six employer representatives, four occupational health professionals, four social insurance officers, 18 RTW coordinators and five physicians. Thematic analysis was conducted.

Results: Three main themes and overarching goals when collaborating on RTW were identified. In the first theme, ‘creating an informative environment’, all stakeholders emphasised clear roles and responsibilities. The second theme, ‘striving for consensus in an environment of negotiations’, addressed negotiations about when and how to collaborate, on what and with whom, and reveal different views on stakeholders’ goals, roles and responsibilities in collaboration. The third theme identified goals for ‘creating a supportive environment’ for both workers and other stakeholders. Coordinators are found to have an important role in achieving a supportive environment, and in neutralising power imbalances between workers and their employers and social insurance officers.

Conclusions: Competing goals and priorities were identified as hindering successful collaboration, contributing to a spectrum of complex versus easy RTW collaboration. This study suggests some basic conditions for achieving a collaborative arena that is neutral in terms of power balance, where all stakeholders can share their views.

PURPOSE: In recent decades, many countries have implemented return-to-work coordinators to combat high rates of sickness absence and insufficient collaboration in the return-to-work process. The coordinators should improve communication and collaboration between stakeholders in the return-to-work process for people on sickness absence. How they perform their daily work remains unexplored, and we know little about to what extent they collaborate and perform other work tasks to support people on sickness absence. This study examines which work models return-to-work coordinators use in primary healthcare, psychiatry and orthopaedics in Sweden. METHODS: A questionnaire was sent to all 82 coordinators in one region (89% response rate) with questions about the selection of patients, individual patient support, healthcare collaboration, and external collaboration. Random forest classification analysis was used to identify the models. RESULTS: Three work models were identified. In model A, coordinators were more likely to select certain groups of patients, spend more time in telephone than in face-to-face meetings, and collaborate fairly much. In Model B there was less patient selection and much collaboration and face-to-face meetings. Model C involved little patient selection, much telephone contact and very little collaboration. Model A was more common in primary healthcare, model C in orthopaedics, while model B was distributed equally between primary healthcare and psychiatry. CONCLUSION: The work models correspond differently to the coordinator's assignments of supporting patients and collaborating with healthcare and other stakeholders. The differences lie in how much they actively select patients, how much they collaborate, and with whom. Their different distribution across clinical contexts indicates that organisational demands influence how work models evolve in practice. 

Purpose: People with multimorbidity face a range of barriers in healthcare, and there is little knowledge about their challenges with regard to return-to-work (RTW). Rehabilitation coordinators, a new function in Swedish healthcare, support people in the RTW process. The present study had two aims: to explore what problems and barriers people with multimorbidity experience during their rehabilitation and RTW process and to explore in which domains the coordinators’ support is perceived to be of importance.

Methods: Interviews were conducted with 12 persons with multimorbidity who had contact with a rehabilitation coordinator during their sickness absence. Thematic analysis was guided by the case-management ecological model; this analysis was revised and adapted to the Swedish context.

Results: The participants experienced problems in all domains of the model, namely: “the healthcare system”, “the labor market and the workplace system”, “the sickness insurance system”, and “the personal system”. Rehabilitation programs that did not accommodate combinations of diseases, social complexities and needs were felt to lead to worse symptoms, thus hindering rather than promoting RTW. An overall finding regarding support by coordinators is that interventions, regardless of domain, were felt to be valuable for people with multimorbidity. The coordinator was perceived to give most support by providing advice about and coordination with healthcare and employers. Sometimes the coordinator gave advice and coordination regarding the Social Insurance Agency, very occasionally the Public Employment Services. The coordinator gave least advice and coordination about social difficulties that hindered rehabilitation and RTW processes.

Conclusion: People with multimorbidity perceive rehabilitation coordinator interventions as important in all domains investigated. Lack of advice and coordination, or rehabilitation programs that were not modified to the complexities of individual’s circumstances, were associated with prolonged sickness absence, worse health, or social risk factors not being recognized.

Health social worker as a profession emerged from the urbanization in the early 20th century. Nevertheless, the importance of the urbanization for the profession has not been studied. In this article, we explore how the organizational prerequisites and professional discretion of health social workers is influenced by the urban environment. Individual and focus group interviews collected among health social workers specialised in immigration respectively working in habilitation services within the Stockholm Region. Data was analysed using thematic analysis. Four themes were discovered: 1) Social work with urbanisation processes, 2) Globalization and the city, 3) Efficiency and professional discretion, and 4) the Big city’s many areas of collaboration. The results indicate that the urban environment can involve both a very limited professional discretion, but also provide conditions for increased professional discretion. This depending on whether steering and formation of assignments and tasks are negotiated on the basis of patients’ needs and based on the professions’ own conditions.  

Purpose: The return-to-work (RTW) process for people with multimorbidity and psychosocial difficulties can be complicated. This study explores the organisational prerequisites for coordinating these patients’ RTW processes from the perspective of coordinators in different clinical areas in Sweden.

Material and methods: Six focus group interviews were conducted with 24 coordinators working in primary healthcare (PHC), psychiatric and orthopaedic clinics. The data were analysed thematically, inspiredby organisation theory.

Results: Coordinators described varying approaches to people with multimorbidity and psychosocial difficulties, with more hesitancy among PHC coordinators, who were perceived by other coordinators as hindering patient flows between clinical areas. Most organisational barriers to RTW were identified in the healthcare sector. These were long waiting times, physicians drawing up inadequate RTW plans, coordinators being involved late in the sickness absence process, and lack of rehabilitation programmes for people with multimorbidity. The barriers in relation to organisations such as Social Insurance Agency and Employment Services were caused by regulations and differing perspectives, priorities, and procedures.

Conclusion: Our findings indicate what is needed to improve the RTW process for patients with complex circumstances: better working conditions, steering, and guidelines; shorter waiting times; and a willingness among coordinators from different clinical areas to collaborate around patients. 

In 2016–2017, a large Swedish hospital introduced a mobile team of asylum social workers to work with asylum-seeking and undocumented patients. Based on interviews with the asylum social workers and the theoretical concepts of jurisdiction and professional discretion, this study explores how they experienced their work and developed their specialist competence and strategies for health social work with migrants. The findings show that they not only relieved staff and supported patients and relatives but also systemised the knowledge about health social work with migrants and created a professional specialty with a socially, rather than medically, defined group of patients.

Health social work is often described as a blurred profession, as a work area based on an interdisciplinary field of science with an unclear knowledge foundation of its own. This study describes and analyses the knowledge production in Swedish doctoral dissertations in health social work, authored by social workers, from 2008 to 2019, and focuses on the differences between dissertations published by faculties of health and those in the social sciences. Descriptive statistical and content analysis was carried out on the 52 dissertations identified. Dissertations in the health sciences were often about specific patient groups within adult somatic care. They predominantly used mixed methods and psychological and psychosocial theories and models. Dissertations in the social sciences more often concerned adults in psychiatric or addiction care and the organization of social work. A majority used qualitative research methods, organization and profession theories, as well as interactionist and critical theories. The differences are discussed as being associated with different research ideals and traditions in the scientific disciplines. The findings raise questions about the core components of health social work and how a knowledge foundation and its development can enhance the professional development of social workers and their contribution to healthcare and patients.

Oncologists frequently have sickness certification (SC) consultations, however, little is known about their experiences of such tasks.

OBJECTIVE: To investigate oncologists' experiences of organisational prerequisites for SC tasks, and if lack of resources was related to experiencing SC as problematic.

METHOD: Questionnaire data from 342 oncologists in Sweden were used for descriptive statistics and to calculate odds ratios (OR) with 95% confidence intervals (CI).

RESULTS: The majority (92.2%) had SC consultations weekly; 17.8% of the oncologists experienced such consultations as problematic weekly. About a third appreciated the national guidelines for SC (34.5%) and had joint routines/policies regarding SC at their clinic (29.7%). Experiencing SC consultations as problematic was associated with stating not having enough resources for such work (OR 3.47; 95% CI 1.92-6.25). Lack of resources was associated with: experiencing lack of competence in insurance medicine (3.34; 1.92-5.82), conflicts with patients regarding SC (4.22; 1.96-9.07), finding it problematic to manage the two roles as medical expert and as the patient's treating physician (3.31; 2.04-5.34), or to assess work capacity (2.28; 1.46-3.56).

CONCLUSION: Although oncologists often had SC tasks, most did not experience them as problematic weekly. However, lack of resources for SC tasks was associated with experiencing SC as problematic.

Background: Paid work is one of the most important aspects in life among working-aged women diagnosed withbreast cancer. Despite several attempts, no previous study provides a comprehensive overview from the women’s perspective about factors of importance for being able to work or not. Therefore, the aim of this study was to gainknowledge about factors that women themselves state are of decisive importance for being able to work or not during the frst two years after breast cancer surgery.

Methods: Data was collected in a two-year follow-up questionnaire within the frame of a prospective cohort studyof working-aged women who had undergone breast cancer surgery. 749 were included in the questionnaire studyand of the 616 (82%) responding women, 462 (75%) wrote statements on an open-ended question about factors ofdecisive importance for being able to work or not work during the past two years. The statements were analyzed withcontent analysis.

Results: Five categories of factors of importance for being able to work or not were identifed, each covering severalsub-categories: Health and wellbeing, Contacts and encounters, Flexibility and adjustment possibilities, Socioeconomic consequences from working/not working, and Own motivation and characteristics. A wide variety of factorswere mentioned by the women and the fndings give a multifaceted picture of many single but interrelated factors ofdecisive importance for being able to work/not work. The importance of fexibility in the return-to-work process wasstressed, as well as the importance of supportive encounters from, e.g., colleagues, managers, as well as relatives.

Conclusions: The results give a comprehensive overview over a variety of diferent types of factors for being ableto return to/remain in work or to not work after breast cancer surgery, adding new knowledge about e.g. the importance of colleagues, and the women’s own preferences or characteristics. These are factors that diferent stakeholders, both from healthcare but also from the work place and the insurance ofce, need to be aware of and collaboratearound to support women with breast cancer during the period of treatment, rehabilitation and return to work.