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Suicid är ett allvarligt folkhälsoproblem som kräver insatser från flera aktörer samt samverkan på nationell, regional och lokal nivå. I Sverige infördes 2008 ett nationellt handlingsprogram för suicidprevention. Sedan 2020 har suicidförebyggande arbete varit ett särskilt prioriterat område i en överenskommelse mellan staten och SKR. Denna prioritering syftar till att främja och stödja utveckling av suicidförebyggande arbete inom regioner och kommuner.

Syftet med den här utvärderingen var att utvärdera om, och i så fall hur, de länsgemensamma stimulansmedel som avsatts specifikt för suicidförebyggande arbete under åren 2020–2022, har påverkat det suicidförebyggande arbetet i län, regioner och kommuner. Utvärderingen syftade även till att undersöka om det suicidförebyggande arbetet har resulterat i några effekter i form av måluppfyllelse av utvecklingsområden som formulerades i överenskommelser åren 2020–2022.

Utvärderingen genomfördes som en kombination av en kartläggande dokumentstudie, baserad på resultat från handlingsplaner och enkäter, samt en fördjupande intervjustudie. I dokumentstudien samlades data från länsövergripande handlingsplaner för suicidförebyggande arbete. Handlingsplaner från år 2019 eller tidigare (den tidigaste från år 2016) och handlingsplaner från år 2021 och framåt (den senaste från år 2022) samlades in för att möjliggöra en jämförelse mellan situationen före och efter att suicidförebyggande arbete blev ett särskilt prioriterat område år 2020. Vid denna tidpunkt infördes också stimulansmedel direkt riktade mot suicidförebyggande arbete i överenskommelsen mellan staten och SKR. Via enkäter insamlades data om genomförda suicidförebyggande insatser i länen för åren 2019 och 2021. Intervjustudien omfattade intervjuer med nyckelpersoner inom suicidförebyggande arbete i två län, två regioner och fyra kommuner i de utvalda länen. Data analyserades genom en kombination av induktiv (utan förutbestämda teorier) och deduktiv (utifrån åtta utvecklingsområden som angetts i överenskommelsen 2020) kvalitativ innehållsanalys.

Utvärderingens resultat visar att de statliga stimulansmedlen har haft betydelse i organiseringen av det suicidförebyggande arbetet. De statliga stimulansmedlen har bland annat använts till att finansiera samordnare, vilka beskrivs som viktiga för att leda och samordna det suicidförebyggande arbetet. Dock uttrycktes en oro över att stimulansmedlen endast fördelas för ett år i taget, vilket kan skapa osäkerhet kring finansieringen på långt sikt. Resultatet visar vidare att de statliga stimulansmedlen har haft betydelse i arbetet med att ta fram länsövergripande handlingsplaner för det suicidförebyggande arbetet. De statliga stimulansmedlen har även haft betydelse i arbetet med att kontextanpassa de länsövergripande handlingsplanerna till lokala handlingsplaner i regioner och kommuner. Vikten av kontextanpassade handlingsplaner som svarar mot lokala och regionala behov och verksamhetens förutsättningar betonas i utvärderingen. Vidare betonas vikten av att handlingsplanerna för suicidförebyggande arbete integreras i den ordinarie verksamhetsplaneringen för året och att handlingsplanerna följs upp vid verksamhetens delårs- och helårsbokslut. Denna struktur för uppföljning beskrivs vara en viktig faktor för att vidmakthålla det suicidförebyggande arbetet.

De statliga stimulansmedlen har haft betydelse för att förbättra samverkan mellan regioner och kommuner och med civilsamhället. Vad gäller samverkan mellan regioner och kommuner beskrevs medlen ha möjliggjort samverkansgrupper och nätverk, vilka varit viktiga för att diskutera verksamheternas olika perspektiv och ansvar i det suicidförebyggande arbetet. Vad gäller samverkan med civilsamhället visar dock utvärderingens resultat på behov av fortsatt utveckling.

Utvärderingens resultat visar också att de statliga stimulansmedlen i stor utsträckning har använts till olika suicidförebyggande insatser, såsom att erbjuda kompetensutveckling till olika yrkesgrupper som möter suicidnära personer, att förbättra arbetssätt i verksamheter som möter suicidnära personer, samt insatser riktade till anhöriga och andra efterlevande. Resultatet visar att suicidförebyggande arbete är komplext och innefattar förebyggande arbete på befolknings-, grupp- och individnivå, samt att många aktörer behöver samverka inom samtliga nivåer. En tydlig organisationsstruktur för långsiktigt och hållbart suicidförebyggande arbete i län, regioner och kommuner är viktigt, liksom att roller, ansvar och mandat är tydligt definierade.

Utvärderingens slutsats är att de statliga stimulansmedlen riktade specifikt till suicidförebyggande arbete under åren 2020–2022 har haft betydelse i form av ett ökat antal suicidförebyggande insatser i län, regioner och kommuner. Stimulansmedlen har delats ut med relativt kort framförhållning vilket har påverkat hur arbetet planerats och utförts. För att det suicidförebyggande arbetet ska bli hållbart bör långsiktig finansiering av de statliga stimulansmedlen säkerställas. Då de statliga stimulansmedlen bidragit till att utveckla det suicidförebyggande arbetet i län, regioner och kommuner är det viktigt att fortsatt följa det suicidförebyggande arbetet och stimulansmedlens betydelse.

Background: Suicide is a serious public health problem. All 194 member states of the World Health Organization have signed the Comprehensive Mental Health action plan 2013–2030 which tasks governments with implementing evidence-based interventions in community settings to prevent suicide at all stages of life. This study aims to map the priorities in suicide prevention policy in community-settings in Sweden, one of the World Health Organization's member states. Method: A document study, using data from suicide prevention policy documents in the 21 counties in Sweden. Data was analyzed using qualitative content analysis. Results: Suicide prevention interventions at the universal, selective and indicated prevention levels were prioritized. Most of the suicide prevention interventions intended to be implemented at each prevention level was evidence-based. Most of the suicide prevention interventions at all prevention levels did not prioritize any specific age group, however when age groups were targeted there were some emphases on children and adolescents. Conclusion: There is a need to improve suicide prevention interventions prioritizing age-groups who have high suicide rates. As educational interventions that encourage young people to develop their ability to face life challenges related to adolescence are found to be appropriate suicide prevention interventions, so too could educational interventions aimed at other age-groups be developed, to enable them to develop their ability to face life challenges related to their age. © 2023

Purpose – Dignity and well-being are key aspects of the legislation and policies that regulate care of olderpersons worldwide. In addition, care of older persons should be person-centred. Dignity and well-being aredescribed as results of person-centred care (PCC). The purpose of this study was to gain an understanding ofimportant aspects for older persons to experience dignity and well-being in residential care facilities (RCFs).

Design/methodology/approach – This study had a qualitative approach, and individual semi-structuredinterviews were conducted with 20 older persons living in RCFs. Data were analysed using inductive contentanalysis.

Findings – To experience dignity and well-being older persons emphasized the importance ofpreserving their identity. To do this, it was important to be able to manage daily life, to gain support andinfluence and to belong to a social context. However, the findings indicate a need for improvements.

Practical implications – Insights into older persons’ experiences of important aspects for experiencingdignity and well-being in RCFs can be used by first-line managers and registered nurses when designingimprovement strategies to promote PCC.

Originality/value – Dignity and well-being are described as results of PCC. The findings provide anunderstanding of what older persons perceive as important for experiencing dignity and well-being inRCFs. The findings are useful when designing improvement strategies to promote PCC.

Background: Dignity and well-being are central concepts in the care of older people, 65 years and older, world‑wide. The person-centred practice framework identifes dignity and well-being as person-centred outcomes. Older persons living in residential care facilities, residents, have described that they sometimes lack a sense of dignity and well-being, and there is a need to understand which modifable factors to target to improve this. The aim of this study was to examine the associations between perceptions of dignity and wellbeing and the independent variables of the attitudes of staf, the indoor-outdoor-mealtime environments, and individual factors for residents over a three-year period.

Methods: A national retrospective longitudinal mixed cohort study was conducted in all residential care facilities within 290 municipalities in Sweden. All residents aged 65 years and older in 2016, 2017 and 2018 were invited to responded to a survey; including questions regarding self-rated health and mobility, the attitudes of staf, the indooroutdoor-mealtime environments, safety, and social activities. Data regarding age, sex and diagnosed dementia/pre‑scribed medication for dementia were collected from two national databases. Descriptive statistics and ordinal logistic regression models were used to analyse the data.

Results: A total of 13 763 (2016), 13 251 (2017) and 12 620 (2018) residents answered the survey. Most of them (69%) were women and the median age was 88 years. The odds for satisfaction with dignity did not difer over the three-year period, but the odds for satisfaction with well-being decreased over time. Residents who rated their health as good, who were not diagnosed with dementia/had no prescribed medication for dementia, who had not experienced disrespectful attitudes of staf and who found the indoor-outdoor-mealtime environments to be pleasant had higher odds of being satisfed with aspects of dignity and well-being over the three-year period.

Conclusions: The person-centred practice framework, which targets the attitudes of staf and the care environment, can be used as a theoretical framework when designing improvement strategies to promote dignity and well-being. Registered nurses, due to their core competencies, focusing on person-centred care and quality improvement work, should be given an active role as facilitators in such improvement strategies.

The care of older people living in residential care facilities (RCFs) should promote dignity and well-being, but research shows that these aspects are lacking in such facilities. To promote dignity and well-being, it is important to understand which associated factors to target. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to the attitudes of staff, the care environment and individual issues among older people living in RCFs. A national retrospective cross-sectional study was conducted in all RCFs for older people within 290 municipalities in Sweden. All older people 65 years and older (n = 71,696) living in RCFs in 2018 were invited to respond to the survey. The response rate was 49%. The survey included the following areas: self-rated health, indoor-outdoor-mealtime environment, performance of care, attitudes of staff, safety, social activities, availability of staff and care in its entirety. Data were supplemented with additional data from two national databases regarding age, sex and diagnosed dementia. Descriptive statistics and ordinal logistic regression models were used to analyse the data. Respondents who had experienced disrespectful treatment, those who did not thrive in the indoor-outdoor-mealtime environment, those who rated their health as poor and those with dementia had higher odds of being dissatisfied with dignity and well-being. To promote dignity and well-being, there is a need to improve the prerequisites of staff regarding respectful attitudes and to improve the care environment. The person-centred practice framework can be used as a theoretical framework for improvements, as it targets the prerequisites of staff and the care environment. As dignity and well-being are central values in the care of older people worldwide, the results of this study can be generalised to other care settings for older people in countries outside of Sweden.

Objective: The overall aim of this thesis was to increase knowledge regarding the perceptions and experiences of aspects and factors associated with perceived dignity and well-being among older persons living in residential care facilities. Study I describes residents’ perceptions and experiences regarding important aspects of experiencing dignity and well-being. Study II examines the associations between perceptions of dignity and well-being and the attitudes of staff, the indoor-outdoor-mealtime environments and individual factors for residents. Study III examines the same associations as Study II over a three-year period. Study IV examines residents’ perceptions of empowerment, person-centred climate and life satisfaction before and after a caregiver intervention concerning the Swedish national fundamental values of dignity and well-being. 

Methods: The studies were performed in residential care facilities in Sweden. The participants were residents living in these facilities. Study I is a qualitative study that used semi-structured interviews to collect data. Data were analysed using qualitative content analysis. Study II, a cross-sectional study, and Study III, a longitudinal study, are based on national questionnaire data from the Swedish National Board of Health and Welfare. Data from 2016, 2017 and 2018 were used and analysed using descriptive statistics and ordinal logistic regression models. Study IV is a cluster-randomized controlled trial with a pre-and post-test design. Data were collected using the Patient Empowerment Scale, the Person-centred Climate Questionnaire – patient version, the Life Satisfaction Questionnaire and the EQ-5D questionnaire. Data were analysed using descriptive statistics, the Chi-square test, the Wilcoxon signed-rank test, the Mann-Whitney U test and generalized estimating equation models.

Findings: To experience dignity and well-being it was important for residents to feel that they still matter. To feel this, it was vital to be able to manage daily life, to have influence and to belong to a social context (I). Residents who had experienced disrespectful attitudes of staff, who did not thrive in the indoor-outdoor-mealtime environments, who rated their health and mobility as poor, and who were diagnosed with dementia had higher odds of being dissatisfied with aspects of dignity and well-being (II). These associations were persistent over a three-year period (III). After an intervention concerning the Swedish national fundamental values of dignity and well-being, the residents in the intervention group reported higher scores for perceived empowerment, person-centred climate and life satisfaction (IV).

Conclusion: To promote dignity and well-being, the attitudes of staff, the indoor-outdoor-mealtime environments and the individual factors of poor health, poor mobility and a dementia diagnosis need to be targeted. The Person-centred practice framework, targeting the prerequisites of staff and the care environment, could be used as a theoretical framework for designing improvement strategies that aim to promote dignity and well-being. First-line managers and registered nurses in residential care facilities have different knowledge and skills. They therefore need to work together as a team when developing improvement strategies that aim to promote the dignity and well-being of residents. In addition, residents should be included on the team given their knowledge regarding what is important for promoting dignity and well-being.

Dignity and well-being should be promoted in care of older people living at residential care facilities (RCFs). In addition, care should be person-centred. Dignity and well-being can be interpreted as person-centred outcomes. Older people living at RCFs experience a lack of dignity and well-being. To promote this, it is important to understand the associated factors to target. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to attitudes of staff, the care environment and individual issues (age, gender, self-rated health and dementia) among older people living at RCFs. A national cross-sectional study was conducted retrospectively. All older people 65 years and older (n=71,696) living at RCFs in 2018 were invited to respond to the survey. The survey included the areas: self-rated health, indoor-outdoor-mealtime environment, performance of care, treatment from staff, safety, social activities, availability of staff and care in its entirety. Age, gender and diagnosed dementia were collected from two national databases. Data was analysed using ordinal logistic regression models. The result indicated that respondents who had experienced disrespectful treatment, who did not thrive in the indoor-outdoor-mealtime environment, who rated their health as poor and respondents with dementia had higher odds of being dissatisfied with dignity and well-being. There is a need to improve the prerequisites of staff regarding respectful attitudes and to improve the care environment. The Person-centred Practice framework, targeting the prerequisites of staff and the care environment, can be used as a theoretical framework for designing future improvements. 

Background: Dignity and well-being should be promoted in care of older people living in residential care facilities (RCFs). In addition, care in RCFs should also promote person-centred care. According to the person-centred practice (PCP) framework dignity and well-being are being described as the result of person-centred care. Thus, previous research indicate that older people living in RCFs (residents) experience a lack of dignity and well-being and improvements are needed. To know what to target to improve care it is important to understand what factors are associated with residents´experiences of dignity and well-being in RCFs. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to attitudes of staff, the care environment and individual issues (age, gender, self-rated health and dementia) among residents. Our hypothesis was that residents’ perceptions of satisfaction with dignity and well-being are associated with the attitudes of staff, the indoor-outdoor-mealtime environment and individual factors. We suggest that perceptions of a) respectful attitudes of staff, b) supportive indoor-outdoor-mealtime environment and c) good health are associated with higher satisfaction regarding dignity and well-being. Methods: A national cross-sectional study was conducted. All residents 65 years and older (n=71 696) living in RCFs in Sweden in 2018 were included in the study. The response rate was 49%. Data was collected using a national survey by the Swedish National Board of Health and Welfare. The survey questions included the areas: self-rated health, indoor-outdoor-mealtime environment, performance of care and attitudes of staff. Age, gender and diagnosed dementia were collected from two national databases. Data was analysed using descriptive statistics and ordinal logistic regression models. Results: Respondents who had experienced disrespectful attitudes of staff, who did not thrive in the indoor-outdoor-mealtime environment, who rated their health as poor and respondents diagnosed with dementia had higher odds of being dissatisfied with aspects of dignity and well-being. Discussion and conclusion: To improve care regarding dignity and well-being there is a need a) to target the prerequisites of staff regarding respectful attitudes and b) to target the care environment. The Person-centred practice framework, targeting the prerequisites of staff (knowledge, skills and attitudes) and the care environment (physical environment), could be used as a theoretical framework for designing future improvements. Practical research implications: As the result indicate what factors to target to promote dignity and well-being, it can be used by managers and registered nurses when improving care and designing future interventions to promote dignity and well-being in RCFs. 

Dignity and well-being are central values in care of older people living in residential care facilities. In addition, care of older people living in residential care facilities should be person-centred. Dignity and well-being can according to the person-centred practice framework be interpreted as person-centred outcomes. Despite this older people living in residential care facilities have described that they not fully experience dignity and well-being and improvements are needed. To improve care it is important to know what to target. The aim of this qualitative study was therefore to describe residents’ perceptions and experiences of what is needed to live with dignity and a sense of well-being. Interviews were carried out with older people living at residential care facilities (n=20). Inductive content analysis was used to analyse data and one overarching theme and three categories emerged. The result revealed the importance of, and that staff and the care environment supported, to manage daily life by oneself, to be shown respect and to belong to a social context. For older people to experience the person-centred outcomes dignity and well-being managers at residential care facilities need to develop and support the staff prerequisites related to knowledge, skills and attitudes and to improve the care environment. According to the person-centred practice framework, the staff prerequisites and the care environment must be taken into account to achieve the person-centred outcomes dignity and well-being.

Dignity and well-being are central values in the legislation on care of older people living in residential care facilities (RCFs) in Sweden. In addition, care of older people living in RCFs should be person-centred. Dignity and well-being can according to the person-centred practice framework be interpreted as person-centred outcomes. Despite this older people living in RCFs have described that they not fully experience dignity and well-being and improvements are needed. To improve care it is essential to know what to target. The aim of this study was therefore to describe residents’ perceptions and experiences of what is needed to live with dignity and a sense of well-being. A descriptive design with a qualitative approach was used. Open-ended interviews were carried out with 20 older people living at RCFs. Inductive content analysis was used to analyse data and one overarching theme and three categories emerged. The categories revealed the importance of, and that staff and the care environment supported, to manage daily life by oneself, to be shown respect and to belong to a social context. The overarching theme revealed the importance of having a feeling to still matter. For older people to experience the person-centred outcomes dignity and well-being managers at RCFs need to develop and support the staff prerequisites related to knowledge, skills and attitudes and to improve the care environment. According to the person-centred practice framework, the staff prerequisites and the care environment must be taken into account to achieve the person-centred outcomes dignity and well-being. 

This study relates to global sustainability regarding development goal number three – Good health and well-being – implying to promote well-being for all in all ages. This study has a focus on older people and their experiences of what is needed to promote their well-being at RCFs. The results revealed, among other things, that it was important to manage daily life by oneself and this was related to health issues. This implies that this study also deals with health. The results from the study can be used to design improvements to promote older peoples´ health and well-being at RCFs, and in that way sustainability goal number three might be reached.