Learning to live with diabetes - as experiencing an expanding life world

Introduction: Chronic illness, such as diabetes, results in a transition process involving a variety of changes in both bodily function and conditions for living, and requiring broad knowledge and understanding in order to meet new demands. The outcomes of a healthy transition are described as well-being and mastery, in contrast to vulnerability and dependency. Little is known about how time for experience contributes to the transition of living with a chronic illness. Aim: The overall aim of the thesis was to illuminate the transition of living with diabetes during the first three years after diagnosis, in order to reach an understanding of how better to create more person-centred care. Design: The study has a life world phenomenological approach with a longitudinal, descriptive and interpretive design. Thirteen participants were interviewed within two months after diagnosis and again after three years. A selected sample approach was used. For study I a qualitative inductive content analysis was used and for study II a phenomenological-hermeneutic method. Findings: In study I four themes were found; ‘taken over by a new reality,’ ‘the body plays a role in life’, ‘different ways of learning’ and ‘the health care service as a necessary partner’ and in study II one overall theme; Experience for understanding the individual meaning of freedom and control in living with diabetes and two themes ´Solving the life-puzzle – a delicate balance to create the desired life´ and ´The need for being in control of your own health´. Discussion: For a healthy transition when living with diabetes, the ability to interact with others in order to share their experiences was crucial and contributed towards participants understanding themselves and their life world. In order to be able to interact, participants had to understand their body as a subject, interlaced with the self and the life, the lived body. Being able to listen to the body and interpret body cues and circumstantial information also contributed to a healthy transition. When the body with diabetes was objectified, a struggle ensued where incompatible needs were experienced and contradictory information created insecurity. The person then preferred not to interact with others but to be dependent on advice and information from the health care service. Conclusion: This study showed that duration of illness was not of importance for the understanding of living with diabetes. Three years after being diagnosed, living with diabetes meant an experience both of overall balance in one’s existence and of a daily struggle. Health care personnel are open to the unique experience of the person living with diabetes as well as to where the person is in the transition. Patient education in a group setting, with the goal of sharing experiences in a learning process, will be meaningful only if the person has the ability to interact with others

Living with diabetes : a lifelong learning process

Living with diabetes, as a lifelong illness, is interlaced with learning and to face continual changes. However, the role of time in this learning process is not yet well understood. The overall aim of the thesis was to gain a deepened understanding of learning to live with diabetes for those recently diagnosed and over a three year period. The thesis, involving four studies where qualitative inductive content analysis (I, III) and phenomenological hermeneutical interpretation (II, IV) were used, has a lifeworld approach and a qualitative and longitudinal design. Thirteen persons, recently diagnosed with diabetes (type I or II), were interviewed on three different occasions over a three year period. All interviews focused on the experience of living with diabetes and situations where diabetes had to be taken into account. The aim of study I was to reach an understanding of how learning to live with diabetes is experienced in the first 2 months after diagnosis. The findings revealed to be taken over by a new reality, with a body that played a role in life with the health care service as a necessary partner. The aim of study II was to illuminate the meaning of learning to live with diabetes three years after being diagnosed. The findings revealed learning as making decisions through use of different sources of information and as solving the life-puzzle – a delicate balance to create a desired life. The aim of study III was to identify patterns in learning when living with diabetes, from recently being diagnosed, and over a 3-year period. In the findings five patterns were identified illuminating different learning processes emerging over time. A longer time living with diabetes did not per se mean increased satisfaction in living well with illness or increased confidence in understanding one’s own needs. The aim of the IV study was to illuminate the meanings of trigger situations in learning to live with diabetes. The findings revealed trigger situations, such as being encumbered by vulnerability and temporality in unsustainable situations with an unpredictable body and a life involving new concerns for the future. The thesis conducted that learning was an informal and ongoing everyday process in life. Time living with diabetes meant both an increased mastery of a changed life situation, but also increased difficulties in achieving well-being and with a dependency on health care. Hence, health care interventions must adhere to the individual’s needs and not be based on duration of illness. Understanding the body and the role of health care, as well as what facilitates and hampers learning, changed with time. It is therefore important that health care personnel illuminate the individual understanding and experiences of those living with diabetes as this was found to be important for the learning process as well as for their sense of well-being

Living with diabetes - development of learning patterns over a 3-year period

Background: Learning involves acquiring new knowledge and skills, and changing our ways of thinking, acting, and feeling. Learning in relation to living with diabetes is a lifelong process where there is limited knowledge of how it is experienced and established over time. It was considered important to explore how learning was developed over time for persons living with diabetes. Aim: The aim of the study was to identify patterns in learning when living with diabetes, from recently being diagnosed, and over a 3-year period. Materials and methods: A longitudinal qualitative descriptive design was used. Thirteen participants, with both type I and type II diabetes, were interviewed at three different occasions during a 3-year period. Qualitative content analysis was used in different steps in order to distinguish patterns. Findings: Five main patterns of learning were identified. Two of the patterns (I and II) were characterized by gradually becoming comfortable living with diabetes, whereas for one pattern (IV) living with diabetes became gradually more difficult. For pattern V living with diabetes was making only a limited impact on life, whereas for Pattern III there was a constant management of obstacles related to illness. The different patterns in the present study showed common and different ways of learning and using different learning strategies at different timespans. Conclusion: The present study showed that duration of illness is not of importance for how far a person has come in his own learning process. A person-centered care is needed to meet the different and changing needs of persons living with diabetes in relation to learning to live with a lifelong illness

Time and change: A typology for presenting research findings in qualitative longitudinal research

Background: Qualitative longitudinal research (QLR) is an emerging methodology used in health research. The method literature states that the change in a phenomenon through time should be the focus of any QLR study, but in empirical studies, the analysis of changes through time is often poorly described, and the emphasis on time/change in the findings varies greatly. This inconsistency might depend on limitations in the existing method literature in terms of describing how QLR studies can present findings. The aim of this study was to develop and describe a typology of alternative approaches for integrating time and/or change in QLR findings. Methods: In this method study, we used an adapted scoping review design. Articles were identified using EBSCOhost. In total, methods and results sections from 299 QLR articles in the field of health research were analyzed with inspiration from content analysis. Results: We constructed a typology of three types and seven subtypes. The types were based on the underlying structural principles of how time/change was presented: Type A) Findings have a low utilization of longitudinal data, Type B) Findings are structured according to chronological time, and Type C) Findings focus on changes through time. These types differed in 1) the way the main focus was on time, change or neither; 2) the level of interpretation in the findings; and 3) how theoretical understandings of time/change were articulated in the articles. Each type encompassed two or three subtypes that represented distinct approaches to the aim and results presentation of QLR findings. Conclusions: This method study is the first to describe a coherent and comprehensive typology of alternative approaches for integrating time/change into QLR findings in health research. By providing examples of various subtypes that can be used for results presentations, it can help researchers make informed decisions suitable to their research intent.publishedVersio

Encumbered by vulnerability and temporality - the meanings of trigger situations when learning to live with diabetes

AIMS AND OBJECTIVES: The aim of the study was to illuminate the meanings of trigger situations experienced in everyday life when learning to live with diabetes. BACKGROUND: Adults become active learners when faced with situations they do not know how to manage, triggering a need to understand something in a different way than before. Knowing more about experiential learning for persons living with diabetes is important for understanding how learning can be supported by health care. DESIGN: A life-world approach with a phenomenological hermeneutical method, inspired by the philosophy of Paul Ricoeur. METHODS: This method was used for interpreting transcriptions of interviews and consists of three stages: naïve understanding, structural analysis and a comprehensive understanding. Participants (n = 13), with either type I or type II diabetes, were interviewed on three different occasions over a three-year period after being diagnosed with diabetes. RESULTS: When learning to live with diabetes, the meanings of trigger situations were described as 'the unpredictable body heightens insecurity with awareness of one's own dependability', 'losing control in unsustainable situations' and 'encumbered by vulnerability and temporality in earlier familiar situations'. CONCLUSION: The meanings of trigger situations were to lose the smooth, unreflected way of managing an everyday life situation, interlaced with feelings of lost control of how to live with new insights of being vulnerable. Trigger situations meant an opportunity for learning, as well as being demanding, unplanned and with limited freedom of choice. Trigger situations presented life and body as unpredictable. RELEVANCE TO CLINICAL PRACTICE: If healthcare professionals can identify the worries and questions raised in trigger situations, knowledge gaps can be identified and reflected on to stimulate learning

Säger en bild verkligen mer än tusen ord? : En studie av hur millenniegenerationen upplever kommunikation av hållbara varumärken på sociala medier

Den ökade miljömedvetenheten samt oron för framtiden har medfört att både företag och konsumenter känner ett starkt behov för mer miljövänliga alternativ. Konsumenterna suktar efter mer ekologiska varor samtidigt som företagen insett potentialen i denna efterfrågan. Samtidigt har företagen varit tvungna att skapa nya marknadsföringsstrategier på grund av att konsumenterna till allt högre grad befinner sig i sociala medier. Det finns mycket tidigare forskning om hållbarhet ur både konsumenternas och företagens perspektiv, men inte lika mycket vad gäller varumärkeskommunikation på sociala medier i form av bilder och text. Eftersom varumärkeskommunikation är en faktor som skapar varumärkesassociationer, vilka hjälper varumärkena att positionera och differentiera sig, är det av stor betydelse att kommunikationen är effektiv och välfungerande. Syftet med studien var att undersöka hur millenniegenerationen upplever kommunikation av hållbara varumärken på sociala medier. För detta har en empirisk undersökning genomförts i form av semistrukturerade intervjuer med sammanlagt åtta stycken personer vilka alla tillhör millenniegenerationen. I den empiriska undersökningen fick deltagarna ta del av en portfolio med Instagraminlägg i form av bilder av hållbara varumärken inom klädindustrin, samt diskutera sina egna upplevelser angående hållbara varumärken. Resultaten från den empiriska undersökningen visar att kommunikationen av hållbara varumärken inte fungerar så som önskat. Konsumenterna tycks inte uppfatta hållbarhetsaspekten som varumärken försöker förmedla med hjälp av bilder på exempelvis natur. Det krävs av varumärkena att bilderna är mer informativa än så. Eftersom kommunikationen på sociala medier sker i form av bild och text, och det allt som oftast är bilden som fångar mottagaren intresse, bör de bilder som används vara mer informativa. Konsumenterna tycks i allmänhet fästa uppmärksamhet vid bilder som innehåller informativ text. Speciellt välfungerande verkade varumärkeskommunikationen vara i sådana fall då varumärket lyfte fram branschspecifika problem, så som miljöföroreningar, vilket påvisar medvetenhet om de existerande problemen

Medverkan i europabolagen : En förstärkning, bevaring eller förminskning av den nationella rätten?

Denna avhandling utgör en rättsdogmatisk forskning och avhandlingens syfte är att undersöka huruvida tillämpningen av bestämmelserna i direktivet om europabolag innebär att den nationella rätten till medverkan kan bevaras, förstärkas eller förminskas i det europabolag som bildas, i jämförelse med den nationella rätten i de olika medlemsstaterna. I och med att den nationella rätten till medverkan ser så olika ut i de olika medlemsstaterna har man i direktivet om europabolag infört en bestämmelse om att rätten till medverkan enbart måste införas i europabolaget om denna rätt sedan tidigare förekommer i något av de deltagande bolagen. Direktivets uttalade syfte är således att säkerställa arbetstagarnas förvärvade rätt till medverkan i enlighet med den så kallade före- och efterprincipen, samtidigt som utgångspunkten i direktivet är ett förhandlingsförfarande genom vilket förhandlingsparterna ska fastställa det arbetstagarinflytandet som de anser lämpa sig bäst i europabolaget ifråga. Den så kallade före- och efterprincipen genomsyrar hela direktivet och utgör den grundläggande tanken bakom bestämmelserna i direktivet. Ifall förhandlingsförfarandet inte resulterar i ett avtal för arbetstagarinflytandet i europabolaget har man i direktivet infört en rad referensbestämmelser som ska komma att tillämpas i andra hand. Referensbestämmelserna föreskriver att den högsta grad av medverkan som förekommer i ett deltagande bolag även ska införas i europabolaget. Direktivets bestämmelser kan vid en första anblick verka utgöra en välfungerande helhet som ger ett effektivt skydd för den nationella rätten till medverkan. Trots direktivets uttalade syfte att säkerställa arbetstagarnas förvärvade rätt till medverkan har det visat sig att det förekommer bristfälligheter i direktivet som kunde leda till att rätten till medverkan i enlighet med den nationella rätten ändå inte bevaras då ett europabolag bildas. I denna avhandling undersöks därmed vilka de olika bristfälligheterna i direktivet är som kan leda till att den nationella rätten till medverkan kringgås då ett europabolag bildas. I avhandlingen undersöks därmed de specifika bestämmelserna beträffande förhandlingsförfarandet i direktivet för att analysera huruvida det förekommer oklarheter eller otydligheter som kunde försvåra att medverkan kan bevaras i europabolaget, på grund av att medverkan ser så olika ut i de olika medlemsstaterna. Därtill tas fasta även på utomstående omständigheter som inverkar på hur medverkan kan utformas i europabolaget, samt till en viss mån även huruvida det förekommer bristfälligheter i medlemsstaterna implementering av vissa av direktivets bestämmelser. Direktivets olika bestämmelser har inte som syfte att förstärka rätten till medverkan i europabolaget utan har främst som uppgift att bevara den nationella rätten. Det finns dock dem som förespråkar att medverkan i europabolagen kunde leda till att denna rätt förstärks och sprids i medlemsstaterna och man pratar om en europeisering av denna rätt i den mening arbetstagarrepresentanterna i bolagens styrelse bör representera och ta i beaktande hela arbetskraften i de olika medlemsstaterna. I avhandlingen undersöks därmed även i hur stor mån denna europeisering av medverkan har skett samt vilka de olika faktorerna är för att europeiseringen av denna rätt ska kunna ske. Direktivet främjar således inte aktivt att rätten till medverkan förstärks i europabolaget och det är svårt att förutspå hur utvecklingen av denna rätt i framtiden kommer att ske. Det förefaller självklart att en revidering av direktivet är på sin plats för att hantera de olika bristfälligheterna som förekommer i direktivet, och det förekommer ett behov för en lösning som bättre kunde ta i beaktande den dynamiska karaktär som ett företagen har, vilket den nuvarande före- och efterprincipen dessvärre inte gör. Det existerar fortsättningsvis skeptiska förhållningssätt till denna rätt i de olika medlemsstaterna, och något större skifte i attityderna och fördomarna gentemot denna rätt verkar inte förekomma trots att medverkan antas ha en positiv inverkan på företagens verksamhet. Huruvida kommissionen i framtiden enbart kommer att anta minimistandardregler eller allt striktare kommer att harmonisera denna rätt i medlemsstaterna förblir därmed att se

A pattern-oriented approach : Practical advice about longitudinal qualitative analysis procedures

Background: The number of published longitudinal qualitative studies has increased over the last couple of years. However, there is no consensus in how longitudinal analysis should be conducted or presented. Overall, little literature about the procedures of doing qualitative longitudinal analysis has been published. The aim of this presentation is to describe a procedure for conducting longitudinal qualitative analysis (e.g., a pattern oriented approach). Method: Independently of each other the two authors have developed a similar approach to analyze interview data over time. The two individual analyses have been compared and common features identified. Results: A pattern-oriented analysis focuses upon how individuals (or phenomena) move through a process/time in identifiable patterns. When other longitudinal analysis approaches might emphasize a main process, a pattern-oriented approach accounts for the individual variance in the context of time and change. The key features of the analysis procedure include; ‘identifying the process’, ‘summarized description’ and ‘using matrixes’. Conclusion: A pattern-oriented analysis is a fruitful way of viewing ways of changing over time and thus understanding complex life processes