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A general framework for selecting work participation outcomes in intervention studies among persons with health problems: a concept paper. BMC Public Health 2022; 22:2189. [DOI: 10.1186/s12889-022-14564-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Background
Work participation is important for health and can be considered as engagement in a major area of life which is of significance for most people, but it can also be thought of as fulfilling or discharging a role. Currently, academic research lacks a comprehensive classification of work participation outcomes. The International Classification of Functioning is the foremost model in defining work functioning and its counterpart work disability, but it does not provide a critical (core) set of outcomes. Standardizing the definitions and nomenclature used in the research of work participation would ensure that the outcomes of studies are comparable, and practitioners and guideline developers can better decide what works best. As work participation is a broad umbrella term including outcome categories which need unambiguous differentiation, a framework needs to be developed first.
Aim
To propose a framework which can be used to develop a generic core outcome set for work participation.
Methods
First, we performed a systematic literature search on the concept of (work) participation, views on how to measure it, and on existing classifications for outcome measurements. Next, we derived criteria for the framework and proposed a framework based on the criteria. Last, we applied the framework to six case studies as a proof of concept.
Results
Our literature search provided 2106 hits and we selected 59 studies for full-text analysis. Based on the literature and the developed criteria we propose four overarching outcome categories: (1) initiating employment, (2) having employment, (3) increasing or maintaining productivity at work, and (4) return to employment. These categories appeared feasible in our proof-of-concept assessment with six different case studies.
Conclusion
We propose to use the framework for work participation outcomes to develop a core outcome set for intervention studies to improve work participation.
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Thulesius H, Sandén U, Petek D, Hoffman R, Koskela T, Oliva-Fanlo B, Neves AL, Hajdarevic S, Harrysson L, Toftegaard BS, Vedsted P, Harris M. Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective. Scand J Prim Health Care 2021; 39:486-497. [PMID: 34889704 PMCID: PMC8725826 DOI: 10.1080/02813432.2021.2004751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To explore how cancer could be diagnosed in a more timely way. DESIGN Grounded theory analysis of primary care physicians' free text survey responses to: 'How do you think the speed of diagnosis of cancer in primary care could be improved?'. Secondary analysis of primary care physician interviews, survey responses, literature. SETTING Primary care in 20 European Örenäs Research Group countries. SUBJECTS Primary care physicians: 1352 survey respondents (2013-2016), 20 Spanish and 7 Swedish interviewees (2015-2019). MAIN OUTCOME MEASURES Conceptual explanation of how to improve timeliness of cancer diagnosis. RESULTS Pluralistic task shifting is a grounded theory of a composite strategy. It includes task sharing - among nurses, physicians, nurse assistants, secretaries, and patients - and changing tasks with cancer screening when appropriate or cancer fast-tracks to accelerate cancer case finding. A pluralistic dialogue culture of comprehensive collaboration and task redistribution is required for effective pluralistic task shifting. Pluralistic task shifting relies on cognitive task shifting, which includes learning more about slow analytic reasoning and fast automatic thinking initiated by pattern recognition; and digital task shifting, which by use of eHealth and telemedicine bridges time and place and improves power symmetry between patients, caregivers, and clinicians. Financial task shifting that involves cost tracking followed by reallocation of funds is necessary for the restructuring and retraining required for successful pluralistic task shifting. A timely diagnosis reduces expensive investigations and waiting times. Also, late-stage cancers are costlier to treat than early-stage cancers. Timing is central to cancer diagnosis: not too early to avoid overdiagnosis, and never too late. CONCLUSIONS We present pluralistic task shifting as a conceptual summary of strategies needed to optimise the timeliness of cancer diagnosis.Key pointsCancer diagnosis is under-researched in primary care, especially theoretically. Thus, inspired by classic grounded theory, we analysed and conceptualised the field:Pluralistic task shifting is a conceptual explanation of how the timeliness of cancer diagnosis could be improved, with data derived mostly from primary care physicians.This includes task sharing and changing tasks including screening and cancer fast-tracks to accelerate cancer case finding, and requires cognitive task shifting emphasising learning, and digital task shifting involving the use of eHealth and telemedicine.Financial task shifting with cost tracking and reallocation of funds is eventually necessary for successful pluralistic task shifting to happen.
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Affiliation(s)
- Hans Thulesius
- Department of Clinical Sciences Malmö, Family Medicine, Lund University, Lund, Sweden
- Research and Development Centre, Region Kronoberg, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
- CONTACT Hans Thulesius
| | - Ulrika Sandén
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Davorina Petek
- Department of Family Medicine, Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Departments of Family Medicine & Medical Education, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Tuomas Koskela
- Department of General Practice, School of Medicine, University of Tampere, Tampere, Finland
| | | | - Ana Luísa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Lars Harrysson
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
- School of Social Work, Faculty of Social Sciences, Lund University, Lund, Sweden
| | | | - Peter Vedsted
- Department of Clinical Medicine, Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus, Denmark
| | - Michael Harris
- College of Medicine & Health, University of Exeter, Exeter, UK
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Thulesius H. Work incentives, chronic illnesses and how sickness certificates are written affect sickness absence. Scand J Prim Health Care 2019; 37:1-2. [PMID: 30784344 PMCID: PMC6452822 DOI: 10.1080/02813432.2019.1571000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hans Thulesius
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
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Sennehed CP, Holmberg S, Stigmar K, Forsbrand M, Petersson IF, Nyberg A, Grahn B. Referring to multimodal rehabilitation for patients with musculoskeletal disorders - a register study in primary health care. BMC Health Serv Res 2017; 17:15. [PMID: 28061870 PMCID: PMC5219789 DOI: 10.1186/s12913-016-1948-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background In 2008, the Swedish government introduced a National Rehabilitation Program, in which the government financially reimburses the county councils for evidence-based multimodal rehabilitation (MMR) interventions. The target group is patients of working age with musculoskeletal disorders (MSD), expected to return to work or remain at work after rehabilitation. Much attention in the evaluations has been on patient outcomes and on processes. We lack knowledge about how factors related to health care providers and community can have an impact on how patients have access to MMR. The aim of this study was therefore to study the impact of health care provider and community related factors on referrals to MMR in patients with MSD applying for health care in primary health care. Methods This was a primary health care-based cohort study based on prospectively ascertained register data. All primary health care centres (PHCC) contracted in Region Skåne in 2010-2012, referring to MMR were included (n = 153). The health care provider factors studied were: community size, PHCC size, public or private PHCC, whether or not the PHCCs provided their own MMR, burden of illness and the community socioeconomic status among the registered population at the PHCCs. The results are presented with descriptive statistics and for the analysis, non-parametric and multiple linear regression analyses were applied. Results PHCCs located in larger communities sent more referrals/1000 registered population (p = 0.020). Private PHCCs sent more referrals/1000 registered population compared to public units (p = 0.035). Factors related to more MMR referrals/1000 registered population in the multiple regression analyses were PHCCs located in medium and large communities and with above average socioeconomic status among the registered population at the PHCCs, private PHCC and PHCCs providing their own MMR. The explanation degree for the final model was 24.5%. Conclusions We found that referral rates to MMR were positively associated with PHCCs located in medium and large sized communities with higher socioeconomic status among the registered population, private PHCCs and PHCCs providing their own MMR. Patients with MSD are thus facing significant inequities and were thus not offered the same opportunities for referrals to rehabilitation regardless of which PHCC they visited.
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Affiliation(s)
- Charlotte Post Sennehed
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden. .,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.,Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Malin Forsbrand
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.,Blekinge Centre of Competence, Karlskrona, Sweden
| | - Ingemar F Petersson
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden
| | - Anja Nyberg
- Skåne Regional Council, Region Skåne, Department of Healthcare Governance, Malmö, Sweden
| | - Birgitta Grahn
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
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Kisakye AN, Tweheyo R, Ssengooba F, Pariyo GW, Rutebemberwa E, Kiwanuka SN. Regulatory mechanisms for absenteeism in the health sector: a systematic review of strategies and their implementation. J Healthc Leadersh 2016; 8:81-94. [PMID: 29355189 PMCID: PMC5741011 DOI: 10.2147/jhl.s107746] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A systematic review was undertaken to identify regulatory mechanisms aimed at mitigating health care worker absenteeism, to describe where and how they have been implemented as well as their possible effects. The goal was to propose potential policy options for managing the problem of absenteeism among human resources for health in low- and middle-income countries. Mechanisms described in this review are at the local workplace and broader national policy level. METHODS A comprehensive online search was conducted on EMBASE, CINAHL, PubMed, Google Scholar, Google, and Social Science Citation Index using MEDLINE search terms. Retrieved studies were uploaded onto reference manager and screened by two independent reviewers. Only publications in English were included. Data were extracted and synthesized according to the objectives of the review. RESULTS Twenty six of the 4,975 published articles retrieved were included. All were from high-income countries and covered all cadres of health workers. The regulatory mechanisms and possible effects include 1) organizational-level mechanisms being reported as effective in curbing absenteeism in low- and middle-income countries (LMICs); 2) prohibition of private sector activities in LMICs offering benefits but presenting a challenge for the government to monitor the health workforce; 3) contractual changes from temporary to fixed posts having been associated with no reduction in absenteeism and not being appropriate for LMICs; 4) multifaceted work interventions being implemented in most settings; 5) the possibility of using financial and incentive regulatory mechanisms in LMICs; 6) health intervention mechanisms reducing absenteeism when integrated with exercise programs; and 7) attendance by legislation during emergencies being criticized for violating human rights in the United States and not being effective in curbing absenteeism. CONCLUSION Most countries have applied multiple strategies to mitigate health care worker absenteeism. The success of these interventions is heavily influenced by the context within which they are applied.
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Affiliation(s)
- Angela N Kisakye
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Raymond Tweheyo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizeus Rutebemberwa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
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Thulesius HO, Scott H, Helgesson G, Lynöe N. De-tabooing dying control - a grounded theory study. BMC Palliat Care 2013; 12:13. [PMID: 23496849 PMCID: PMC3602181 DOI: 10.1186/1472-684x-12-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 02/26/2013] [Indexed: 11/23/2022] Open
Abstract
Background Dying is inescapable yet remains a neglected issue in modern health care. The research question in this study was “what is going on in the field of dying today?” What emerged was to eventually present a grounded theory of control of dying focusing specifically on how people react in relation to issues about euthanasia and physician-assisted suicide (PAS). Methods Classic grounded theory was used to analyze interviews with 55 laypersons and health care professionals in North America and Europe, surveys on attitudes to PAS among physicians and the Swedish general public, and scientific literature, North American discussion forum websites, and news sites. Results Open awareness of the nature and timing of a patient’s death became common in health care during the 1960s in the Western world. Open dying awareness contexts can be seen as the start of a weakening of a taboo towards controlled dying called de-tabooing. The growth of the hospice movement and palliative care, but also the legalization of euthanasia and PAS in the Benelux countries, and PAS in Montana, Oregon and Washington further represents de-tabooing dying control. An attitude positioning between the taboo of dying control and a growing taboo against questioning patient autonomy and self-determination called de-paternalizing is another aspect of de-tabooing. When confronted with a taboo, people first react emotionally based on “gut feelings” - emotional positioning. This is followed by reasoning and label wrestling using euphemisms and dysphemisms - reflective positioning. Rarely is de-tabooing unconditional but enabled by stipulated positioning as in soft laws (palliative care guidelines) and hard laws (euthanasia/PAS legislation). From a global perspective three shapes of dying control emerge. First, suboptimal palliative care in closed awareness contexts seen in Asian, Islamic and Latin cultures, called closed dying. Second, palliative care and sedation therapy, but not euthanasia or PAS, is seen in Europe and North America, called open dying with reversible medical control. Third, palliative care, sedation therapy, and PAS or euthanasia occurs together in the Benelux countries, Oregon, Washington and Montana, called open dying with irreversible medical control. Conclusions De-tabooing dying control is an assumed secular process starting with open awareness contexts of dying half a century ago, and continuing with the growth of the palliative care movement and later euthanasia and PAS legislation.
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Affiliation(s)
- Hans O Thulesius
- Department of Clinical Sciences Malmö, Division of Family Medicine, Lund University, Lund, Sweden.
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Stigmar K, Ekdahl C, Grahn B. Work ability: Concept and assessment from a physiotherapeutic perspective. An interview study. Physiother Theory Pract 2011; 28:344-54. [DOI: 10.3109/09593985.2011.622835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Vries HJ, Brouwer S, Groothoff JW, Geertzen JHB, Reneman MF. Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers' experiences. BMC Musculoskelet Disord 2011; 12:126. [PMID: 21639884 PMCID: PMC3121659 DOI: 10.1186/1471-2474-12-126] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 06/03/2011] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Many people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators) and how they manage to maintain working (success factors). METHODS A semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?" RESULTS A total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs. CONCLUSIONS Personal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at work are needed to obtain further evidence.
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Affiliation(s)
- Haitze J de Vries
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Johan W Groothoff
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jan HB Geertzen
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, The Netherlands
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Lydell M, Marklund B, Baigi A, Mattsson B, Månsson J. Return or no return--psychosocial factors related to sick leave in persons with musculoskeletal disorders: a prospective cohort study. Disabil Rehabil 2010; 33:661-6. [PMID: 20690859 DOI: 10.3109/09638288.2010.506237] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study was to compare psychosocial factors between healthy persons and sick-listed persons with musculoskeletal disorders (MSD); both groups with MSD 10 years ago. METHODS This cohort study was prospective and 385 persons participated in a rehabilitation program 10 years ago, and 354 persons took part in the follow-up. Of these, 243 persons completed a questionnaire. Two groups were included in the study: a healthy group (not sick-listed) (n = 112) and a sick-listed group (n = 74). Psychosocial factors related to sick leave were compared between the groups. RESULTS In the 10-year follow-up, the healthy group showed a significantly higher quality of life, more control over the working situation, better sense of coherence and unexpectedly more life events. There was no significant difference in social integration and emotional support between the groups. CONCLUSIONS Using the knowledge about the characteristics of the healthy group, adequate rehabilitation for every sick-listed person with a musculoskeletal disorder can be given and therefore facilitate the returning to work process. A multidimensional approach taking into account a person's physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society.
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Affiliation(s)
- Marie Lydell
- Research and Development Unit, Primary Health Care, Halland, Sweden.
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Stigmar K, Grahn B, Ekdahl C. Work ability – experiences and perceptions among physicians. Disabil Rehabil 2010; 32:1780-9. [DOI: 10.3109/09638281003678309] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Grahn B, Gard G. Content and concurrent validity of the motivation for change questionnaire. JOURNAL OF OCCUPATIONAL REHABILITATION 2008; 18:68-78. [PMID: 18286358 DOI: 10.1007/s10926-008-9122-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 01/11/2008] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Musculoskeletal disorders (MSD) are nowadays seen within a biopsychosocial framework, including salutogenic factors, motivation factors, and coping ability. Such a framework recognizes the importance of motivational factors in health promotion and in rehabilitation. The Motivation for Change Questionnaire (MCQ) has been developed to measure the strength of individuals' motivation for change in life, MCQ part 1, and work situation, MCQ part 2. The purpose of the study was to test the content and concurrent validity of the MCQ on patients with prolonged musculoskeletal disorders referred to interdisciplinary rehabilitation as a basis for use in medical and occupational rehabilitation. METHODS Content validity was studied among an expert group of 20 rehabilitation professionals at a rehabilitation centre, and with 10 individuals suffering from prolonged MSD in the south of Sweden. The experts evaluated the clinical relevance of each question in MCQ. Concurrent validity was studied on 58 patients with prolonged MSD at an interdisciplinary rehabilitation centre in the south of Sweden. They answered MCQ, QPS Nordic questionnaire, KASAM and the Action theory questionnaire. Spearman's rank correlation coefficient was used in the analyses. RESULTS The MCQ covered and measured areas of relevance according to content validity. No floor effects in any of the subscales of MCQ part 1 were seen. In MCQ part 2, floor effects were seen in two sub indexes. As for concurrent validity subscales of MCQ correlated significantly with QPS Nordic questionnaire and KASAM. CONCLUSIONS Findings so far indicate the instrument to be valid for use within the present patient group. The questionnaire can be used to identify patient's motivating factors for change in life and work, as a basis for motivational work within rehabilitation.
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Affiliation(s)
- Birgitta Grahn
- R&D Welfare of Southern Småland, P.O. Box 1223, SE-351 12, Vaxjo, Sweden.
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Thulesius HO, Sallin K, Lynoe N, Löfmark R. Proximity morality in medical school--medical students forming physician morality "on the job": grounded theory analysis of a student survey. BMC MEDICAL EDUCATION 2007; 7:27. [PMID: 17683618 PMCID: PMC1964757 DOI: 10.1186/1472-6920-7-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 08/06/2007] [Indexed: 05/16/2023]
Abstract
BACKGROUND The value of ethics education have been questioned. Therefore we did a student survey on attitudes about the teaching of ethics in Swedish medical schools. METHODS Questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed > 8000 words of open-ended responses and multiple-choice questions using classic grounded theory procedures. RESULTS In this paper we suggest that medical students take a proximity morality stance towards their ethics education meaning that they want to form physician morality "on the job". This involves comprehensive ethics courses in which quality lectures provide "ethics grammar" and together with attitude exercises and vignette reflections nurture tutored group discussions. Goals of forming physician morality are to develop a professional identity, handling diversity of religious and existential worldviews, training students described as ethically naive, processing difficult clinical experiences, and desisting negative role modeling from physicians in clinical or teaching situations, some engaging in "ethics suppression" by controlling sensitive topic discussions and serving students politically correct attitudes. CONCLUSION We found that medical students have a proximity morality attitude towards ethics education. Rather than being taught ethics they want to form their own physician morality through tutored group discussions in comprehensive ethics courses.
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Affiliation(s)
- Hans O Thulesius
- Department of Clinical Sciences Malmö, Division of Family Medicine, Lund University, Sweden
- Research and Development Centre, Kronoberg County Council, Box 1223, SE-351 12 Växjö, Sweden
| | - Karl Sallin
- Centre for Bioethics, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Niels Lynoe
- Centre for Bioethics, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Rurik Löfmark
- Centre for Bioethics, LIME, Karolinska Institutet, Stockholm, Sweden
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