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AbstractPurposeMaterials and MethodResultsConclusions\nKEY POINTSReturn to work often requires collaboration between different stakeholders. Rehabilitation coordination is a resource in coordinating efforts during sick leave to facilitate return to work. The purpose of the present study was to describe how people at risk for sick leave or on sick leave with mental health problems experienced rehabilitation coordination.The study had a qualitative approach using qualitative content analysis as described by Graneheim and Lundman. Eleven semi-structured interviews were conducted with persons at risk for sick leave or on sick leave due to mental health problems and with experience of rehabilitation coordination.The participants experience of rehabilitation coordination were described by the overarching theme Building a bridge with many bricks between the person and society. The theme was formed by four categories and eleven subcategories reflecting the complex context of rehabilitation coordination. The categories were Collaboration in a new setting, Unburdened within certain limits, The way back to work is a joint project and Recognising challenges beyond the person.People with mental health problems experienced rehabilitation coordination as a meaningful link between healthcare and work. However, rehabilitation coordination needs to be more recognised within healthcare to increase accessibility. It seems important that interventions are directed not only towards the person, but also include the workplace for a sustainable return to work.It is important to make rehabilitation coordination visible within primary health care and actively inform people on sick leave with mental health problems that it is an option, as they often have difficulties finding information. It will increase their accessibility and enable autonomous decisions.A respectful interplay based on a person-centred care approach seems fundamental for rehabilitation coordination. The interplay with rehabilitation coordinators and with other stakeholders affects the sick leave process and all parties need to collaborate for a sustainable return to work.Three-party meetings with the person on sick leave, the rehabilitation coordinator and the employer, as well as teamwork, may provide better conditions for return to work as this can ensure that all stakeholders are working towards prioritised goals.Targeted interventions at the workplace seem to be important and rehabilitation coordination could be a valuable bridge between healthcare and work for creating sustainable conditions for return to work. [ABSTRACT FROM AUTHOR]

Purpose: Infibulation is the most pervasive form of female genital cutting. Infibulated women face difficulties such as obstruction of urine and menstrual blood flow, sexual problems, and birth complications, and may therefore need medical defibulation. This study explores the lived experiences of young migrant women from Somalia and their views on undergoing medical defibulation in Sweden. Methods: A qualitative study was conducted using phenomenological lifeworld research. Data were collected through in-depth interviews with nine young women originating from Somalia, now resident in Sweden. The interviews were analysed to reveal the meaning of the phenomenon of infibulation. Results: The essential meaning of the phenomenon is characterized by a limbo regarding both infibulation and defibulation. There is a strong desire both to handle the Swedish perspective on infibulation and to stay with the Somalian cultural values. These women are being exposed to a tacit tradition that makes it hard to relate to the possibility of medical defibulation. As a result, the women perceive the possibility to undergo medical defibulation as limited or non-existent. Conclusions: Healthcare professionals can be a support to encourage women in need of medical defibulation to reflect on traditional ideals concerning infibulation and defibulation. [ABSTRACT FROM AUTHOR]

Background: Sick leave due to common mental disorders, encompassing depression and anxiety disorders, is high. Capturing early signs of reduced function could aid adjustments of work tasks and environment and, thus, endorse a pro-active approach to occupational and health care interventions to prevent long-term sick-leave spells. However, few measurements exist to identify early signs of imbalance, and none that is illness-specific. The aim of this study was to develop a work instability scale for people with common mental disorders and to test the fundamental psychometric properties of the scale. Methods: Participants were working adults 18-65 years old with depression or anxiety. The scale development started with qualitative interviews (n = 27) which informed the drafting of a dichotomous, self-report questionnaire. Cognitive debriefing (n = 12) was used to check face validity and modify the draft. Internal construct validity of the draft was tested using Rasch analysis (n = 128). The work ability index was used as a comparator measure. Results: The initial 63-item draft showed poor fit to Rasch model expectations. Items displaying poor fit or local response dependency were stepwise removed, resulting in a unidimensional 34-item scale fitting the model expectations, and with no differential item functioning. Person-item threshold distribution showed that the scale is better suited to measure low to moderate work instability, than to measure high instability. Correlations between the newly developed scale and the work ability index showed a significant, moderately strong correlation. Conclusions: In the initial target sample, the 34-item scale showed acceptable fundamental properties and internal construct validity. Further validation of the scale in a larger sample, including tests for external validity, is warranted. [ABSTRACT FROM AUTHOR]

Few studies describe the development of academic courses with interprofessional perspectives. Therefore, the aim of this study was to describe teachers’ experiences with developing an academic course in person-centred care (PCC). Data collection was divided into three parts: (1) written material/documentation describing the process (text and pictures, 16 meetings), (2) SWOT analysis in relation to being a lecturer (n=7), and (3) interviews with the lecturers (n=4). The data were analysed using mixed methods, descriptive statistics (1) and qualitative content analysis (2-3). The results are presented in three categories (Co-creating a pilot course, Challenges of managing unfamiliar knowledge, and Wanting to understand new educational approach). This study highlights three challenges: (1) unfamiliarity with the field of person-centred care and selected educational activities and teaching skills; (2) unfamiliar colleagues, which delayed partnership efforts; and (3) limited experience working with other lecturers in light of the institute’s structure and routines. However, these challenges served as both barriers and facilitators; the lecturers developed knowledge and experiences from collaborations (educational and/or content skills/knowledge) focusing on resources and skills. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders have a negative impact on work functioning, but less is known about the process when the functioning starts to destabilize. This study explores experiences of work instability in workers with common mental disorders.Methods: A grounded theory study using a theoretical sampling frame, individual in-depth interviews and a constant comparative analysis conducted by a multidisciplinary research team. The sample involved 27 workers with common mental disorders, currently working full or part time, or being on sick leave not more than 6 months. They were women and men of different ages, representing different occupations and illness severity.Results: A general process of work instability was conceptualized by the core category Working in dissonance: captured in a bubble inside the work stream. The workers described that their ordinary fluency at work was disturbed. They distanced themselves from other people at and outside work, which helped them to regain their flow but simultaneously made them feel isolated. Four categories described sub-processes of the dissonance: Working out of rhythm, Working in discomfort, Working disconnected and Working in a no man's land.Conclusions: The experience of work instability in CMDs was conceptualized as "working in dissonance", suggesting a multifaceted dissonance at work, characterized by a sense of being caught up, as if in a bubble. Focusing on how the worker can re-enter their flow at work when experiencing dissonance is a new approach to explore in occupational and clinical settings. [ABSTRACT FROM AUTHOR]

Background. Although the effectiveness of physical exercise for depression has been studied for many years, few studies have described patients' experiences of what exercise means to them, beyond the biological focus. Moreover, exercise as a treatment for depression is rarely explored in a physical therapy context. Objectives. The purpose of this study was to explore a physical therapy exercise intervention, as experienced by people with major depression. Design. This study had an inductive approach and used qualitative content analysis. Methods. Semistructured interviews were conducted with 13 people who participated in physical therapist-guided aerobic exercise in a randomized controlled trial. All participants were diagnosed with major depression according to the Diagnostic and Statistical Manual of Mental Disorders. Data were collected and analyzed in an inductive manner using qualitative content analysis according to Graneheim and Lundman. Results. Pour categories emerged: (1) struggling toward a healthy self, (2) challenging the resistance, (3) feeling alive but not euphoric, and (4) needing someone to be there for you. The participants experienced that although the exercise intervention was hard work, it enhanced the feeling of being alive and made them feel that they were doing something good for themselves. These feelings were a welcome contrast to the numbness and stagnation they experienced during depression. Limitations. The study was conducted in Swedish primary care. Transferability of results must be viewed in relation to context. Conclusions. Exercise in a physical therapy context can improve the patients' perception of their physical ability and create a sense of liveliness, improving their depressed state. The therapeutic relationship is essential for supporting the patient's vulnerability and ambiguity in an empathic and perceptive way. [ABSTRACT FROM AUTHOR]

Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants' experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in one's body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced in depression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression. [ABSTRACT FROM AUTHOR]

Objectives: To explore adolescents' experiences of being diagnosed with Attention deficit hyperactivity disorder (ADHD)., Design: Qualitative interview study, using a phenomenological framework and analysis., Setting: The children's clinic of a specialised out-care hospital located in a multicultural area of a Swedish city., Participants: 13 adolescents, 7 boys and 6 girls between 14 and 19 years old, who had been diagnosed with ADHD., Results: The participants' experience of being diagnosed with ADHD was interpreted as a process of understanding oneself as being different, for better or worse, like many others . The participants sought acceptance and a sense of normality, while developing an understanding of both the positive and the negative sides of their ADHD traits. These two sides of a coin were inter-related parts of themselves and were shared by many others, which increased their acceptance. Three themes described phases of the process: struggling with vulnerability , responding to a label and manoeuvring social life ., Conclusion: The results add to previous research, illuminating that the adolescents tried to make sense of both the uniqueness and the vulnerability of the ADHD diagnosis. The findings can be useful for healthcare professionals, in reflecting on the complexity of ADHD and on the adolescents' expectations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Informal caregivers of patients with chronic obstructive pulmonary disease (COPD) experience a heavy caregiver burden, but few studies have explored what support they need. The aim of this study was to describe perceptions of healthcare support to informal caregivers, both from the family caregiver's and the staff's perspective., Design: A qualitative interview study involving semi-structured interviews and analysed with content analysis., Participants: In total, 54 participated: 36 informal caregivers of patients with severe (stage 3-4) COPD and 17 healthcare staff., Results: Two main themes emerged from the analysis: (1) Ambiguity impedes provision of support. Both caregivers and staff experienced ambiguity. The informal caregivers needed emotional, practical and informational support but talked about unclear expectations, while the staff described an uncertainty about their duties regarding the families. There were no routines to unburden the families. Moreover, language and cultural barriers hampered their efforts. (2) Knowledgeable and perceptive communication is key to support. Both caregivers and staff described positive experiences of dialogue. The dialogue may facilitate means to caregiver support and was a support in itself., Conclusions: Our findings suggest that strategies and routines for caregiver support, including communication skills among the staff, should be developed, to move toward the family perspective advocated in palliative- and nursing family care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)