Managing adversity : qualitative studies of long-term social assistance recipiency in Sweden in a resilience perspective

This thesis is based on four qualitative studies and aimed to explore the experiences of living long term on social assistance, and to increase knowledge on how social workers providing social assistance perceive their possibilities to support their clients. The findings were reflected from a resilience perspective, focusing on processes and features that help (or hinder), the positive functioning of individuals and families in adverse situations. Data consisted of interviews with 33 social assistance recipients (Study I-III), interviews with 23 social workers and observations in one of the study sites (Study IV). Interviews were carried out in Stockholm County during 2005-2006. Four research questions were explored. The first concerned consequences for well-being of living long term on social assistance (Study I-III). It was described as possible to manage to live on social assistance for a short time, but it allowed for nothing extra. In the long run, difficulties with money were unavoidable, resulting in financial stress. Psychosocial consequences of living on social assistance included feelings of powerlessness, exclusion, hopelessness, shame, stigma and dependency on authorities which adversely affected their perceived well-being. Among those with chronic illness (Study II) and those who had long lasting difficulties and adversity (Study III), the consequences for well-being were modified by their interaction with health and social services and how they as clients and patients were treated, in combination with the support available through the welfare system. The negative consequences of long lasting adversity included limited possibilities to make choices in their lives, increased isolation, feelings of hopelessness and not finding a way out. The second research question concerned the responses and strategies of social assistance recipients (Study II and III) to maintain or improve their well-being, including living one day at a time, taking steps forwards and backwards and making attempts to find ways out of the situation (Study II). Benefit levels, access to and quality of services as well as the overall construct of the welfare system, the quality of the neighbourhood and social networks all influenced the level of well-being. Strategies to manage long lasting adversity (Study III) included to focus on the well-being of the children and the family and to put one’s own needs behind. Another strategy concerned searching for balance in life, especially among those who reported mental ill-health. Those who reported addiction and struggled to “start a new life” focused day by day on staying away from drugs/alcohol, to find and keep a flat and try to create a new social life. The third research question was about ways out of social assistance (Study I-III), which required help from the society and professionals. Employment and education were common aspirations, but often beyond reach. Getting other benefits like unemployment benefit or sickness benefit was seen as “a better alternative” to enable improved access to rehabilitation and labour market activities. To be recognised as individuals, getting help and continuous support based on their individual needs were key aspects. The fourth research question concerned dilemmas in providing social services to long-term recipients (Study IV). Dilemmas related to the interaction between social workers and their clients, and to the societal context in which they operated. Benefit levels and cooperation between different public agencies further influenced the daily practice of social workers. Social workers balanced in a dual role between supporting clients and making demands on them as an authority. The importance of treating clients as individuals instead of seeing them as “categories” was highlighted. Resilience in the conducted studies, was about keeping going, managing adversity and resisting difficulties, and facilitated by supportive social contacts, access to adequate interventions with good quality and professionals who recognised them as individuals. As emphasised by social workers, structural measures such as improvements in co-operation between public agencies and in the overall construction of the benefit system combined with increase in labour market opportunities for different groups, would facilitate resilience among the clients. The thesis underlines the importance of developing strategies that prevent social exclusion and poverty in the society, combined with long-term targeted, individually tailored interventions

Perceptions of health and wellbeing among employees in a work integration social enterprise in Sweden

Background: Work Integration Social Enterprises (WISEs) constitute an important vehiclefor providing employment opportunities for disadvantaged groups.Objective: The goal of this qualitative case study is to explore perceptions of health andwellbeing among employees working in a WISE located in the Gävleborg region, in eastcentral Sweden.Methods: Data were gathered using 16 in-depth, semi-structured interviews with thesocial enterprise employees.Results: Findings were categorized into three main categories: the importance of financialindependence and societal benefits; team spirit and a sense of belonging; and improvedquality of life and wellbeing.Conclusion: The participants perceived that working in the WISE gave them a feeling offreedom and increased their self-esteem because of the possibility to earn an income.Also, they were satisfied with their job (e.g., with regard to work quality and flexibility)and believed that their work contributed to society. Moreover, through working in a WISE,the participants felt a sense of belonging and togetherness through interaction with coworkersand managers, and an improved quality of life for themselves and their families

Die Rolle des Freibergerpferdes im Pferdemarkt Schweiz

Das Freiberger Pferd hat wie viele andere vergleichbare lokale, ursprüngliche europäische Pferderassen mit rückläufigen Bestandes- und Geburtenzahlen sowie einer fehlenden Rentabilität auf Stufe Produktion zu kämpfen. Agroscope, Schweizer Nationalgestüt SNG, untersuchte im Zuge der Erarbeitung eines Strategierapportes zur Erhaltung der Freibergerrasse die Marktkonformität des Freibergerpferdes (FM: franches-montagnes) mittels einer Umfrage bei Pferdeeigentümern sowie ergänzenden Experteninterviews. Die Ergebnisse lassen den Schluss zu, dass bei einer Mehrheit der befragten Pferdeeigentümer die persönlichen Erwartungen an ein Pferd mit der Beurteilung der Qualitäten und der generellen Wahrnehmung des Freibergerpferdes deckungsgleich sind. Daraus lässt sich ableiten, dass der FM über Qualitäten verfügt, die im Grundsatz im Freizeitpferdemarkt nachgefragt werden (einfacher Charakter, Polyvalenz, Robustheit, Gesundheit). Das Image des Markenbildes FM ist bei den nicht FM-Besitzern deutlich weniger positiv als bei den FM-Besitzern. Die Ergebnisse der Umfrage sowie der Experteninterviews zeigten, dass vor allem Anstrengungen zur Verbesserung der Vermarktung und des Images notwendig sind, um einen besseren Absatz von Freibergerpferden zu gewährleisten und damit auch langfristig einen Anstieg der Geburten zu erreichen

Living on social assistance with chronic illness: Buffering and undermining features to well-being

<p>Abstract</p> <p>Background</p> <p>In Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living, with either sickness benefits or disability pension. Some, however, are not entitled to these benefits or receive social insurance benefits at a level too low for subsistence, and are referred to social assistance. The purpose of this study was to explore in depth how social assistance recipients with chronic illness perceive and respond to the experience of living on social assistance.</p> <p>Methods</p> <p>Seventeen in-depth interviews were carried out with chronically ill people who had received social assistance for several years. Grounded theory informed the design of the study.</p> <p>Results</p> <p>The study showed that different strategies (living one day at a time, taking steps forwards and backwards and making attempts to find ways out of the situation) were employed by social assistance recipients to maintain or improve their well-being. Contextual features like the prevailing welfare system, public services and the local neighbourhood could buffer or undermine these strategies and their overall well-being. These features together influenced how interviewees perceived their situation, the possible ways out of the situation and the consequences for their well-being.</p> <p>Conclusion</p> <p>From this study it is evident that the way in which individuals on social assistance interact with services and how they are treated by professionals plays an important role in their well-being, in combination with what kind of help and support is available for recipients through the welfare system. In this respect, persons living on social assistance with chronic illness are particularly vulnerable. This study suggests that more effort should be made to find long term solutions concerning income support, rehabilitation and other services provided to this group.</p

Experiences of involuntary job loss and health during the economic crisis in Portugal

Background: The economic recession that started in 2008 left many unemployed across several European countries. Many studies have analyzed the relationship between job loss, health, and well-being in other contexts. This study aimed to explore experiences of involuntary unemployment during the economic recession and their relationship with health, conceptualized as a state of physical, mental, and social well-being among unemployed individuals. Methods: Semistructured qualitative interviews were carried out among a convenience sample of participants who became unemployed during the economic recession. The analysis was conducted to identify patterns and themes. Results: Participants (n=22; 8 men and 14 women; 23–51years) experienced feelings of loss of identity, stress, and a sense of powerlessness due to unemployment, as well as a lack of purpose and structure in their daily lives. Six themes were identified: work as the basis for life structure and personal fulfillment; response to unemployment and the importance of its duration; unemployment leading to isolation and loss of a role in society; impact of a change in financial situation on social life and consumption patterns; the physical and psychological health consequences of unemployment; and searching for ways to cope with unemployment and to feel well. Conclusions: Losing a job is an adverse experience that impairs an individual’s perception of overall health and well-being. From a public health perspective, the results of this study highlight the need for policymakers’ awareness to help mitigate the potential consequences of involuntary job loss in the short- and long-term

Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden

Background: Understanding the mechanisms of implementation of public health interventions in community settings is a key aspect of programme assessments. To determine core components and establish a programme theory are important tools to improve functioning and support dissemination of programme models to new locations. An extended early childhood home visiting intervention has been developed on-site in a socioeconomically disadvantaged area of Sweden since 2013 with the aim of reducing persisting health inequities in the population. This study aimed at investigating the core programme components and how the intervention was perceived to contribute towards health equity from early childhood. Methods: Qualitative framework method was applied in a document analysis and subsequent semi-structured interviews with 15 key actors involved in the programme. Results: The intervention was found to be constituted of five core components centred around the situation-based, parental strengthening work method delivered by a qualified team of child health care nurse and social worker. The programme theory foresaw positive effects on child and parental health, responsive parenting practices, families' use of welfare services according to need and increased integration and participation in society. The principles of Proportionate Universalism were recognised in the programme theory and the intervention was perceived as an important contribution to creating conditions for improved health equity for the families. Still, barriers to health equity were identified on the structural level which limit the potential impact of the programme. Conclusions: The core components of the Extended home visiting programme in Rinkeby correspond well to those of similar evidence-based home visiting interventions. Combining focus on early childhood development and responsive parenting with promoting access to the universal welfare services and integration into society are considered important steppingstones towards health equity. However, a favourable macro-political environment is required in the endeavour to balance the structural determinants' influence on health inequities. Improved availability and accessibility to welfare services that respond to the needs of the families regarding housing, education and employment are priorities. Trial registration: The study was retrospectively registered on 11/08/2016 in the ISRCTN registry ( ISRCTN11832097 )

A better start for health equity? Qualitative content analysis of implementation of extended postnatal home visiting in a disadvantaged area in Sweden

Abstract Background Health inequities among children in Sweden persist despite the country’s well-developed welfare system and near universal access to the national child health care programme. A multisectoral extended home visiting intervention, based on the principles of proportionate universalism, has been carried out in a disadvantaged area since 2013. The present study investigates the content of the meetings between families and professionals during the home visits to gain a deeper understanding of how it relates to a health equity perspective on early childhood development. Methods Three child health care nurses documented 501 visits to the families of 98 children between 2013 and 2016. A qualitative data-driven conventional content analysis was performed on all data from the cycle of six visits per child, and a general content model was developed. Additional content analysis was carried out on the data from visits to families who experienced adverse situations or greater needs. Results The analysis revealed that the home visits covered three main categories of content related to the health, care and development of the child; the strengthening of roles and relations within the new family unit; and the influence and support located in the broader external context around the family. The model of categories and sub-categories proved stable over all six visits. Families with extra needs received continuous attention to their additional issues during the visits, as well as the standard content described in the content model. Conclusions This study on home visiting implementation indicates that the participating families received programme content which covered all the domains of nurturing care as recommended by the WHO Commission on Social Determinants of Health and recent research. The content of the home visits can be understood to create enabling conditions for health equity effects. The intervention can be seen to represent a practical example of proportionate universalism

Keep going in adversity – using a resilience perspective to understand the narratives of long-term social assistance recipients in Sweden

Abstract Introduction In Sweden, means-tested social assistance serves as a temporary, last resort safety net. However, increasing numbers of people are receiving it for longer periods and about a third has assistance for more than a year. The aim of this study was to explore the ways social assistance recipients manage long lasting adversity and their roles as active, rather than passive, agents in this process, using a resilience perspective. Method The study is based on thirteen in-depth interviews with long-term social assistance recipients from diverse areas in Stockholm County. The interviews were guided by narrative inquiry to interpret and construct stories of experiences and are part of a larger qualitative study exploring experiences of living on social assistance in Sweden. Results Experiences of cumulative adversity during many years compounded recipients’ difficulties in finding ways out of hardship. They had different strategies to deal with adversities, and many had underlying “core problems”, including mental health problems, which had not been properly resolved. Recipients’ showed resistance in adverse situations. Some made attempts to find ways out of hardship, whereas others struggled mainly to achieve a sense of mastering life. They received important support from individual professionals in different authorities, but mostly the help from the welfare system was fragmented. Conclusions Social assistance recipients in this study demonstrated agency in ways of managing long lasting difficulties, sometimes caused by “core problems”, which were often accumulated into complex difficulties. Resilience was about keeping going and resisting these difficulties. To find ways out of social assistance required help from different welfare agencies and professionals and was hindered by the fragmentation of services. This study shows that there is a need for more long-term personalised, comprehensive support, including interventions both to increase individual well-being and self-esteem and to open up opportunities for education and employment. Adequate benefit levels and overall quality of welfare services such as health and social care, day care and schools, are of major importance for those in greatest need.</p