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  • 1.
    Ayoub, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Udo, Camilla
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Randell, Eva
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Promoting social engagement for young adults living in social isolation: Social workers and health care professionals' perceptions of success factors2019Conference paper (Other academic)
    Abstract [en]

    Background: Today the global number of young adults not in employment, education or training seem to increase. A large proportion of the group are unemployed and disengaged and have not been in contact with any authority. Thus, they are invisible to many community services and official agencies. The situation standing outside the society may have negative long-term health effects and statistics shows that more than a third of the target group after ten years still not work or study. Socially withdrawn youth is a complex phenomenon and very few young adults seek help, often due to their lack of motivation. For this reason, unemployed and inactive young people are often described as being a difficult group to support and engage. Further, there is currently limited evidence on the effects of interventions directed to socially withdrawn youth not in employment or education and the use of evidence-based practice has to be improved.

    Aim: The aim of this study was to investigate social workers and health care professionals’ experiences of working with young adults living in social isolation, and to identify which interventions the professionals find most successful in supporting the young adults’ engagement in society.

    Methods: In this study a qualitative method was used. Ten semi-structured interviews were conducted that included thirteen employees from social services and outpatient psychiatric clinics in a Swedish county. Data were analyzed using thematic network analysis.

    Results: Analysis resulted in two general thematic networks: ”barriers of the transition into adulthood” and ”to manage complex needs”. Participants tended to associate the issues of young adults with difficulties related to transition into adulthood. Mental health problems, low self-esteem, school related problems and limited social networks also came out in the interviews as factors that characterized unemployed and disengaged socially withdrawn youths. Participants described that successful work to re-engage these young adults included an empowerment-oriented perspective with a focus on the individual strengths, integrated and coordinated interventions and a flexible working approach.

    Conclusion: Today the societal changes and the process of individualization place greater demands on individual resources and capabilities which might increase the risk of social exclusion. Participants indicated that the complex problems of socially isolated young adults and experiences of long-term disengagement may contribute to stable and persistent withdrawal from society. Early identification and support for youths at risk of social withdrawal, a holistic approach, multifaceted interventions and tailored and flexible activities is deemed crucial to help reintegrate these young people. Further investigation is required to examine the effects of interventions targeting socially withdrawn and inactive young adults.

     

  • 2.
    Joffer, Junia
    et al.
    Department of Epidemiology and Global Health, Umeå University. Center for Clinical Research Dalarna-Uppsala University, Falun.
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Bergström, Erik
    Department of Clinical Sciences, Pediatrics, Umeå University.
    Randell, Eva
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Jerdén, Lars
    Department of Epidemiology and Global Health, Umeå University. Center for Clinical Research Dalarna-Uppsala University, Falun.
    Self-rated health, subjective social status in school and socioeconomic status in adolescents: a cross-sectional study2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 785Article in journal (Refereed)
    Abstract [en]

    Background: Social position, traditionally measured by objective data on socioeconomic status (SES), is linked to health status in adults. In adolescents, the association is more uncertain and there are some studies suggesting that subjective social status (SSS) might be more adequate in relation to health. This study aimed to examine associations between SSS in school, SES and self-rated health (SRH) in adolescent boys and girls.

    Methods: A descriptive cross-sectional research design with quantitative survey data was used. The study involved 705 Swedish adolescents in upper secondary school (17–18-year-olds). SRH was measured with a single-item question and SSS by a question where adolescents were asked to assess their social position within their school. Formal education level of the parents was used as a proxy for objective SES. Univariable and multivariable ordinal regression analyses were conducted to assess the associations between SRH and SSS in school and SES.

    Results: In the multivariable analysis, SSS in school was positively associated with SRH, whereas no significant association between SES and SRH was found. The proportion of adolescents with high SRH increased with higher steps on the SSS ladder. Significant gender differences were found in that boys rated their SRH and SSS in school higher than girls did.

    Conclusions: The study shows that self-rated health in adolescents is related to perceived social position in school. Subjective social status in school seems to be a useful health-related measure of social position in adolescents.

  • 3.
    Randell, Eva
    Dalarna University, School of Education, Health and Social Studies, Social Work. Umeå Universitet.
    Adolescent boys’ health: managing emotions, masculinities and subjective social status2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The health of adolescent boys is complex and surprisingly little is known about how adolescent boys perceive, conceptualise and experience their health. Thus, the overall aim of this thesis was to explore adolescent boys’ perceptions and experiences of health, emotions, masculinity and subjective social status (SSS).

    This thesis consists of a qualitative, a quantitative and a mixed methods study. The qualitative study aimed to explore how adolescent boys understand the concept of health and what they find important for its achievement. Furthermore, the adolescent boys’ views of masculinity, emotion management and their potential effects on wellbeing were explored. For this purpose, individual interviews were conducted with 33 adolescent boys aged 16-17 years. The quantitative study aimed to investigate the associations between pride, shame and health in adolescence. Data were collected through a cross-sectional postal survey with 705 adolescents. The purpose of the mixed methods study was to investigate associations between SSS in school, socioeconomic status (SES) and self-rated health (SRH), and to explore the concept of SSS in school. Cross-sectional data were combined with interview data in which the meaning of SSS was further explored. Individual interviews with 35 adolescents aged 17-18 years were conducted.

    In the qualitative study, data were analysed using Grounded Theory. In the quantitative study, statistical analyses (e.g., chi-square test and uni- and multivariable logistic regression analyses) were performed. In the mixed method study, a combination of statistical analyses and thematic network analysis was applied.

    The results showed that there was a complexity in how the adolescent boys viewed, experienced, dealt with and valued health. On a conceptual level, they perceived health as holistic but when dealing with difficult emotions, they were prone to separate the body from the mind. Thus, the adolescent boys experienced a difference between health as a concept and health as an experience (paper I). Concerning emotional orientation in masculinity, two main categories of masculine conceptions were identified: a gender-normative masculinity and a non-gender-normative masculinity (paper II). Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite that their expressions are in contrast to each other. Non-gender-normative masculinity included an orientation towards sincerity, emphasising the personal values of the boys. Emotions were expressed more independently of peer group norms. The findings suggest that different masculinities and the expression of emotions are intricately intertwined and that managing emotions is vital for wellbeing. The present findings also showed that both shame and pride were significantly associated with SRH, and furthermore, that there seems to be a protective effect of experiencing pride for health (paper III). The results also demonstrated that SSS is strongly related to SRH, and high SRH is related to high SSS, and further that the positioning was done in a gendered space (paper IV).

    Results from all studies suggest that the emotional and relational aspects, as well as perceived SSS, were strongly related to SRH. Positive emotions, trustful relationships and having a sense of belonging were important factors for health and pride was an important emotion protecting health. Physical health, on the other hand, had a more subordinated value, but the body was experienced as an important tool to achieve health. Even though health was mainly perceived in a holistic manner by the boys, there were boys who were prone to dichotomise the health experience into a mind-body dualism when having to deal with difficult emotions.

    In conclusion, this thesis demonstrates that young, masculine health is largely experienced through emotions and relationships between individuals and their contexts affected by gendered practices. Health is to feel and function well in mind and body and to have trusting relationships. The results support theories on health as a social construction of interconnected processes. Having confidence in self-esteem, access to trustful relationships and the courage to resist traditional masculine norms while still reinforcing and maintaining social status are all conducive to good health. Researchers as well as professionals need to consider the complexity of adolescent boys’ health in which norms, values, relationships and gender form its social determinants. Those working with young boys should encourage them to integrate physical, social and emotional aspects of health into an interconnected and holistic experience.

  • 4.
    Randell, Eva
    Dalarna University, School of Education, Health and Social Studies, Social Work. Umeå Universitet.
    Living in the shadow of political decisions: Former refugees’ experiences of supporting newly arrived minors2019Conference paper (Other academic)
    Abstract [en]

    Living in the shadow of political decisions: Former refugees’ experiences of supporting newly arrived minors

    Background and aim: Steady streams of refugees and unaccompanied minors, of which the great majority are boys, come to Sweden, mostly from Afghanistan, Syria and Somalia. Among the arrivals, there are boys with traumatic experiences. It is a challenging task for the society to promote health, empowerment and integration of these minors. With the intention to support their integration in the society, the organisation Save the Children formed special meeting places for unaccompanied minors in 2018 in three municipalities in Sweden. There, the minors had the opportunity to engage in different activities. In addition, psychosocial support was offered. The leaders for the activities at these meeting places were recruited among former refugees who themselves had arrived in Sweden as unaccompanied minors. Research is sparse concerning how foreign-born leaders’ experience how it is to support the integration of the newly arrived minors. Thus, the aim of the study was to explore the perceptions of the meeting place leaders, also former refugees, when supporting newly arrived minors’ integration in society.

    Methods: This is a qualitative study in which interviews were conducted with leaders, also former refugees, at the meeting places for unaccompanied minors in municipalities. Data were analysed using network analysis.

    Results: Based on the preliminary analyses of the interviews, a thematic network was developed. Basic themes were identified, which in turn generated four organising themes and one global theme. The organising themes were ‘integrating together’, ‘keep going’, ‘living in no man’s land’ and ‘being proud helping others’. The four organising themes were then clustered into the global theme of ‘living in the shadow of political decisions’. Although they all expressed a frustration concerning the migration politics, they all perceived the helping role as very important and connected to positive emotions.

    Conclusion and implications: The findings show the massive impact from the national political decisions concerning the right to stay permanently or temporary, which affected the daily lives of the newly arrived at the meeting places and demanded an attitude of never-ending hope in leaders. Despite being forced to deal with difficult emotions - such as despair - the results underscored the important role of feeling proud to help others. Furthermore, the own experiences of being a refugee were valued and shared in meeting the unaccompanied minors. The integration process is generally complex, and further studies of what is helpful in the integration process are needed.

  • 5.
    Randell, Eva
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Janeslätt, Gunnel
    Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, SUF Resource center, Uppsala, Center for Clinical Research in Dalarna .
    Höglund, Berit
    Department of Women's and Children's Health, International Sexual and Reproductive Health, Akademiska Hospital, Sweden.
    How can an intervention with knowledge and care-taking prepare youth with ID for future decisions to parenthood?2019In: IASSID 2019, The world congress of the international association for the scientific study of intellectual and developmental disabilities, 2019, Glasgow, Scottland, 2019Conference paper (Other academic)
    Abstract [en]

    Introduction

    There is limited knowledge about how young people with intellectual disability (ID) can be facilitated in their process of deciding about parenthood in future. This study aimed to explore an intervention using the Toolkit “Children – what does it involve? and the “Real Care Baby” (RCB) simulator among pupils with ID.

    Methods

    Pupils (n=15) with ID participated in an intervention with 12 educational sessions and a three-day caring session with the RCB simulator. Data were collected with individual in-depth interviews. Content analysis was used.

    Results

    Preliminary results showed that the intervention gave knowledge and experiences, which promoted insights in parenthood among these pupils. They described both basic and more specific needs of the child and the complexity of caring a child and being a responsible parent. Parent´s relationship was emphasised as well as to be an autonomously adult. Final results are pending.

    Implications

    By receiving adapted knowledge and experiences, pupils with ID became more suited to make informed decisions about parenthood in future.

  • 6.
    Randell, Eva
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Jerdén, L.
    Öhman, A.
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    What is health and what is important for its achievement?: A qualitative study on adolescent boys’ perceptions and experiences of health2016In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 10, p. 26-35Article in journal (Refereed)
    Abstract [en]

    Few qualitative studies have explored adolescent boys’ perceptions of health.

    Aim: The aim of this study was therefore to explore how adolescent boys understand the concept of health and what they find important for its achievement

    Methods: Grounded theory was used as a method to analyse interviews with 33 adolescent boys aged 16 to 17 years attending three upper secondary schools in a relatively small town in Sweden.

    Results: There was a complexity in how health was perceived, experienced, dealt with, and valued. Although health on a conceptual level was described as ‘holistic’, health was experienced and dealt with in a more dualistic manner, one in which the boys were prone to differentiate between mind and body. Health was experienced as mainly emotional and relational, whereas the body had a subordinate value. The presence of positive emotions, experiencing self-esteem, balance in life, trustful relationships, and having a sense of belonging were important factors for health while the body was experienced as a tool to achieve health, as energy, and as a condition.

    Conclusion: Our findings indicate that young, masculine health is largely experienced through emotions and relationships and thus support theories on health as a social construction of interconnected processes. 

  • 7.
    Randell, Eva
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Jerdén, Lars
    Öhman, Ann
    Starrin, Bengt
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Tough, sensitive and sincere: how adolescent boys manage masculinities and emotions2015In: International Journal of Adolescence and Youth, ISSN 0267-3843, E-ISSN 2164-4527, Vol. 21, no 4, p. 486-498Article in journal (Refereed)
    Abstract [en]

    This study aimed to explore adolescent boys’ views of masculinity and emotion management and their potential effects on well-being. Interviews with 33 adolescent boys aged 16–17 years in Sweden were analysed using grounded theory. We found two main categories of masculine conceptions in adolescent boys: gender-normative masculinity with emphasis on group-based values, and non-gender-normative masculinity based on personal values. Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite their expressions contrasting each other. Non-gender-normative masculinity included an orientation towards sincerity emphasising the personal values of the boys; emotions were expressed more independently of peer group norms. Our findings suggest that different masculinities and the expression of emotions are strongly intertwined and that managing emotions is vital for well-being.

  • 8.
    Randell, Eva
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work. Umeå Universitet.
    joffer, Junia
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Starrin, Bengt
    Jerdén, Lars
    Associations between pride, shame and self-rated health in adolescence2016Conference paper (Other academic)
  • 9.
    Randell, Eva
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work. Umeå Universitet.
    Joffer, Junia
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Starrin, Bengt
    Jerdén, Lars
    Umeå universitet; Uppsala universitet.
    Pride, shame and health among adolescents – a cross-sectional survey2018In: International Journal of Adolescent Medicine and Health, ISSN 0334-0139, E-ISSN 2191-0278, Vol. 30, no 6, article id 20160107Article in journal (Refereed)
    Abstract [en]

    Background

    Pride and shame are important emotions known to influence identity development and psychological well-being in adolescence. Research evidence indicates that self-rated health (SRH) is a strong predictor of future health. This cross-sectional study, conducted during 2008–2009, aimed to investigate the associations between pride, shame and SRH among adolescent boys and girls.

    Methods

    The study sample comprised 705 adolescents in Sweden aged 17–18 years (318 boys and 387 girls) who completed a questionnaire that included items on SRH, shame and pride (participation rate 67%). Logistic regression analyses (univariable and multivariable) were used to investigate the associations between pride and shame as separate and combined constructs on SRH, adjusting for potential confounders (country of birth, parental educational level, school experience, having enough friends, mood in family and being active in associations).

    Results

    Pride and shame separately were significantly associated with SRH in both genders. Logistic regression analysis of the pride-shame model showed that the odds of having lower SRH were highest in boys and girls with lower pride-higher shame. In a multivariable logistic regression analysis of the pride-shame model the odds of having lower SRH remained significant in boys and girls with lower pride-higher shame [boys: odds ratio (OR) 3.51, confidence interval (CI) 1.40–8.81; girls: OR 2.70, CI 1.22–5.96] and in girls with lower pride-lower shame (OR 2.16, CI 1.02–4.56).

    Conclusion

    The emotions of shame and pride are associated with SRH in adolescence. Experiencing pride seems to serve as a protective mechanism in SRH in adolescents exposed to shame. We believe that this knowledge should be useful in adolescent health promotion.

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