'Overjoyed that I can go outside': Using walking interviews to learn about the lived experience and meaning of neighbourhood for people living with dementia

This study explores the relationships between people living with dementia and their neighbourhood as they venture out from home on a regular and often routine basis. Here, we report findings from the Swedish field site of an international 5-year project: Neighbourhoods: our people, our places. The aims of this study were to investigate the lived experience of the neighbourhood for people with dementia and through this to better understand the meaning that neighbourhood held for the participants. In this study, we focus on the walking interviews which were conducted with 14 community-dwelling people with dementia (11 men and 3 women) and were analysed using an interpretative phenomenological method. Four themes were revealed from these interviews: life narratives embedded within neighbourhood; the support of selfhood and wellbeing through movement; the neighbourhood as an immediate social context; and restorative connections to nature. These themes were distilled into the ‘essence’ of what neighbourhood meant for the people we interviewed: A walkable area of subjective significance and social opportunity in which to move freely and feel rejuvenated. We have found that the neighbourhood for community-dwelling people with dementia holds a sense of attachment and offers the potential for freedom of movement. Our research indicates that a dementia diagnosis doesn’t necessarily reduce this freedom of movement. The implications for practice and policy are considered: future research should explore and pay closer attention to the diverse living conditions of people living with dementia, and not least the particular challenges faced by people living alone with dementia

Taking time: the temporal politics of dementia, care and support in the neighbourhood

Dementia is a global health challenge and currently the focus of a coordinated international response articulated through the notion of ‘dementia-friendly communities and initiatives’ (DFCIs). Yet, while increasing research attention has been paid to the social and spatial dimensions to life with dementia in a neighbourhood setting, the temporalities of dementia have been largely overlooked. This article sets out different aspects of the lived experience of time for people with dementia and unpaid carers, before exploring the temporal politics of formal dementia care and support. The authors show that time is a site for material struggle and a marker of unequal relations of power. People with dementia and unpaid carers are disempowered through access to formal care, and this is illustrated in their loss of (temporal) autonomy and limited options for changing the conditions of the care received. The authors advocate for a time-space configured understanding of the relationship with neighbourhood and foreground a tempo-material understanding of dementia. Set against the backdrop of austerity policy in the UK, the findings reveal that ongoing budgetary restrictions have diminished the capacity for social care to mediate in questions of social justice and inequality, at times even compounding inequity

Experiences and contributions of people living with dementia to the social life of everyday places

This chapter focusses on work programme 4 of the Neighbourhoods study entitled ‘Neighbourhoods: Our People, Our Places’ (N:OPOP). We used a creative mix of qualitative methods, including network mapping, mobile interviews, and home tours with people living with dementia and their care partners in England, Scotland, and Sweden. We focused explicitly on the subjective meaning of neighbourhoods for people living with dementia with a view to understand how people could be better supported to live in community settings. Neighbourhoods matter to people with dementia because of the type of support they can offer, and this chapter presents insights into how and why this might be the case. Neighbourhoods can enable people living with dementia to develop and sustain connections, maintain a sense of belonging, and contribute to the diversity and inclusivity of local places. Neighbourhoods are not simply fixed locations within which activities happen but are an amalgamation of connections to people and other places over time, understood and experienced in the context of other locations and times. Drawing on our published work (Ward et al., 2021 a, b, c) , this chapter considers how people living with dementia are not passive observers of neighbourhood life but, instead, engage in the social rhythms of neighbourhoods and, with support, actively shape them as neighbourhoods of choice, though with such choices are often restrained by contexts and circumstances. The chapter is presented as follows. First, we provide a brief overview of some of allied research that has explored the importance of neighbourhoods spaces as sites for social interaction for people living with dementia.. Next, it outlines the ways in which we gathered and analysed our data. It then presents three interconnected ‘snapshots’ of our findings exploring: i) neighbourhoods as assemblages of connections; ii) neighbourhoods as real and symbolic sites of support; and iii) understanding neighbourhoods and change in the context of living with dementia. The chapter then outlines how our findings might influence thinking about: neighbourhoods as relational places; how neighbourhoods might contribute to social health; and how people living with dementia can, with support, engage in neighbourhoods of choice. Collectively, these themes point to the relevance of understanding the ‘lived neighbourhood’ for people living with dementia

Being in want of control: Experiences of being on the road to, and making, a suicide attempt

Attempted suicide is a risk factor for future suicidal behaviour, but understanding suicidality from the perspective of people who have experienced attempted suicide is limited. The aim of the study was to explore the lived experience of being suicidal and having made a suicide attempt, in order to identify possible implications for health care professionals. Semi-structured individual interviews were held with 10 persons shortly after they attempted suicide and were analysed through qualitative content analysis. The participants’ experience of being suicidal and of having attempted suicide could be described as “Being on the road towards suicidal action”, which culminated in an experience of either chaos or turned off emotions, “Making sense of the suicide attempt”, and “Opening the door to possible life lines”. An overall theme, “Being in want of control”, captured their all-embracing lack of sense of control and was seen in relation to different aspects of oneself, overall life-situation, the immediate suicide attempt situation and in the outlook on the future. Being in want of control may be a relevant and general feature of being suicidal. People who have attempted suicide need more adequate help to break vicious circles before they reach a point of no return and enter an acute suicidal state of mind. Patients’ experience-based knowledge is highly important to listen to and use clinically as well as theoretically when constructing suicide prevention programs

The lived neighbourhood : understanding how people with dementia engage with their local environment

In this paper, we report progress on “Neighborhoods: our people, our places” an international study about how people living with dementia interact with their neighborhoods. The ideas of social health and citizenship are drawn upon to contextualize the data and make a case for recognizing and understanding the strengths and agency of people with dementia. In particular, we address the lived experience of the environment as a route to better understanding the capabilities, capacities, and competencies of people living with dementia. In doing this, our aim is to demonstrate the contribution of social engagement and environmental support to social health. The study aims to “map” local spaces and networks across three field sites (Manchester, Central Scotland and Linkoping, Sweden). It employs a mix of qualitative and participatory approaches that include mobile and visual methods intended to create knowledge that will inform the design and piloting of a neighborhood-based intervention. Our research shows that the neighborhood plays an active role in the lives of people with dementia, setting limits, and constraints but also offering significant opportunities, encompassing forms of help and support as yet rarely discussed in the field of dementia studies. The paper presents new and distinctive insights into the relationship between neighborhoods and everyday life for people with dementia that have important implications for the debate on social health and policy concerning dementia friendly communities. We end by reflecting on the messages for policy and practice that are beginning to emerge from this on-going study

My Home is my Castle : Residential Well being and Perceived Safety in Different Types of Housing Areas in Sweden

Background: Safety in the housing environment is a basic human need and may be a prerequisite for health but studies from the perspective of the residents are limited in the literature. Although historically public health research has recognized the housing environment as an important determinant of health, there is a need for more research on how housing conditions influence residential well-being. Aim: The overall aim of this thesis was to examine factors and conditions associated with residential well-being and perceived safety in different types of housing areas and to compare safety promotion intervention designs based on residents self-expressed safety needs with corresponding designs developed by local government professionals. Materials and methods: A postal survey (response rate 56%, n=2476) and 11 focus groups (57 participants) were conducted among the residents in 3 small-scale housing areas with detached houses and 3 housing areas with blocks of flats in a Swedish municipality. The areas were geographically contiguous as each of the small-scale areas bordered on an area with blocks of flats. The study municipality is a designated member of WHO Safe Community network that have signed up to work in line with the indicators developed by WHO Collaborating Centre on Community Safety Promotion. Narrative data from a postal questionnaire were used to analyze the lay perspective and identify features perceived to be necessary to feel safe by residents in areas with blocks of flats and small-scale housing areas. Quantitative data were used to examine correlates of local safety-related concerns through a factor analysis. Logistic regression analysis examined associations between high-level scores of the safetyrelated dimensions found and area-level crime rate and being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. To examine how self-assessed area reputation is associated with social trust and residential well-being, a multilevel logistic regression analysis was performed using quantitative data, controlling for the random effect of neighbourhood- and individual-level socio-demographic factors. Data from focus group interviews were analyzed to identify mechanisms of how neighbourhood reputation was established. The quality function deployment (QFD) technique was used in a case study to integrate residents’ demands into the design of safety promotion interventions in housing areas. The resulting design was then compared with the safety intervention programme designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community programme. Results: The residents’ narratives showed that a stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in small-scale housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. The crime rates were lower and safety-related concerns were less in small-scale housing areas. Three composite dimensions (CD) of perceived residential safety were identified: structural indicators of social disorder (CD 1); contact with disorderly behaviour (CD 2); and existential insecurity (CD 3). Area-level crime rates and individual-level variables were associated with dimensions (CD 1) and (CD 3), but only individuallevel variables were associated with dimension (CD 2). The level of residential well-being and social trust was higher in small-scale areas. The housing area reputation was found to be strongly associated with safety-related concerns, residential well-being and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order. The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups. The Safe Community programme designed by professionals did not address the social integrative processes, but did cover the vulnerable groups. Conclusions: Area reputation is an important and probably underestimated dimension in the development of residential well-being and perceived safety. The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particular suitable for providing a quality orientation from the lay perspective on safety promotion in local residential areas. The current Safe Homes concept in the Safe Community programme would benefit from being widened to Safe Housing

Folkhälsovetenskap – ett integrerat ämne, och en inriktning i det interprofessionella masterprogrammet vid Medicinsk fakultet, Linköpings universitet

 Hälsoorientering med interprofessionellt och problembaserat lärande har en lång tradition vid den medicinska fakulteten vid Linköpings universitet. Detta utgör också grunden för det interprofessionella masterprogram som startade 2008. Detta har utgångspunkt i behovet av att utveckla en mer hälsofrämjande hälso- och sjukvård för att möta framtidens behov samt utveckla vårdens kvalitet och resultat. Teori och metod för hälsofrämjande, prevention och förbättringskunskap är därför centrala delar för alla professioner på masternivå och inte enbart för folkhälsovetaren. Alla studenter får därmed ett folkhälsovetenskapligt perspektiv i sin ämnesspecifika examen, med möjlighet till fördjupning. Alumni bekräftar att de fått verktyg för att utveckla kvalitet och hälsoorientering av hälso- och sjukvården som de tidigare saknat

Stereology: a novel technique for rapid assessment of liver volume

Abstract Background The purpose of this study was to test the stereology method using several grid sizes for measuring liver volume and to find which grid provides an accurate estimate of liver volume. Materials and methods Liver volume was measured by volumetry in 41 sets of liver MRI. MRI was performed before and after different weight-reducing regimens. Grids of 3, 4, 5, and 6 cm were used to measure liver volume on different occasions by stereology. The liver volume and the changes in volume before and after treatment were compared between stereology and volumetry. Results There was no significant difference in measurements between stereology methods and volumetry (p > 0.05). The mean differences in liver volume between stereology based on 3-, 4-, 5-, and 6-cm grids and volumetry were 37, 3, 132, and 23 mL, respectively, and the differences in measurement of liver volume change were 21, 2, 19, and 76 mL, respectively. The mean time required for measurement by stereology was 59–190 s. Conclusion Stereology employing 3- and 4-cm grids can rapidly provide accurate results for measuring liver volume and changes in liver volume. Main Messages • Statistical methods can be used for measuring area/volume in radiology. • Measuring liver volume by stereology by 4-cm grids can be done in less than two minutes. • Follow-up of liver volume is highly accurate with stereological methods

'Overjoyed that I can go outside' : Using walking interviews to learn about the lived experience and meaning of neighbourhood for people living with dementia.

This study explores the relationships between people living with dementia and their neighbourhood as they venture out from home on a regular and often routine basis. Here, we report findings from the Swedish field site of an international 5-year project: Neighbourhoods: our people, our places. The aims of this study were to investigate the lived experience of the neighbourhood for people with dementia and through this to better understand the meaning that neighbourhood held for the participants. In this study, we focus on the walking interviews which were conducted with 14 community-dwelling people with dementia (11 men and 3 women) and were analysed using an interpretative phenomenological method. Four themes were revealed from these interviews: life narratives embedded within neighbourhood; the support of selfhood and wellbeing through movement; the neighbourhood as an immediate social context; and restorative connections to nature. These themes were distilled into the 'essence' of what neighbourhood meant for the people we interviewed: A walkable area of subjective significance and social opportunity in which to move freely and feel rejuvenated. We have found that the neighbourhood for community-dwelling people with dementia holds a sense of attachment and offers the potential for freedom of movement. Our research indicates that a dementia diagnosis doesn't necessarily reduce this freedom of movement. The implications for practice and policy are considered: future research should explore and pay closer attention to the diverse living conditions of people living with dementia, and not least the particular challenges faced by people living alone with dementia