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The purpose of this study is to study how a specific assistive technology, namely wash toilet systems, are used and which values they enact for their users. The study is primarily based on ten semi-structured interviews conducted with older adults who were offered a wash toilet as an element in the welfare service of a large Danish municipality. The study shows how, in various ways, specific aspects of wash toilet systems are associated with specific aspects of human physiology. Essential challenges to older adults that implicate the use of wash toilet systems either relate to 'arms that cannot reach behind', or the leakage of urine and eventually faeces. Furthermore the study shows that values enacted by wash toilet systems differ in the various arrangements, e.g., enabling social relations, being a part of something, being self-reliant or independent, preserving intimacy limits, or just 'be pleased with'. The wash toilet systems are woven into several different arrangements of the ageing body, wheelchairs, walkers, care personnel, spouses, diapers, etc. being situated in differently spaced bathrooms in different homes and different municipalities. We propose that the abandonment of focus on abstract policy values in favour of an emphasis on the actual arrangements of technology and the human body in old age will, in fact, be beneficial to our understanding of how welfare technology can contribute to enhanced citizenship. An implication of this study for rehabilitation is not to take for granted how a wash toilet system will interact in arrangements with older adults, but attend to the potentially various/many ways the system can create value for the user in the actual arrangement it is part of. Another implication of the study is that it is always an empirical question whether self-reliance – which is often an aim of implementing assistive technologies - is an effect of a specific arrangement of a wash toilet system and the human body in old age. [ABSTRACT FROM AUTHOR]

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Background: This study evaluated an attempt to implement video consultations through a novel education intervention in telehealth training and implementation in two middle-sized hospitals in Denmark. Three units tested the education intervention along with a regional decision to strengthen multidisciplinary and cross-sectoral collaboration through technology to improve service delivery by making the process more coherent and saving time and resources. This study aims to identify what contextual factors enable workplace learning, skills acquisition, and utilization of new digital skills to use and routinize video consultations in workplace practice. Methods: This qualitative case study draws on the principles of the realist evaluation framework using cross-case comparisons to test and refine program theories by exploring the complex and dynamic interaction among context, mechanism, and outcome. The methods in this study include participant observations, document analysis, semi-structured individual interviews, and focus groups. We performed an interpretive cross-case analysis, which explored the context-mechanism-outcome relationship using the guiding question, "What works, for whom, under what circumstances, and why?". Results: Two broad mechanisms appeared to enable skills acquisition and routinization of video consultations: informal workplace learning and adjusting video consultations to professional judgment. The three units had different approaches to the implementation and training and, as such, had different outcomes. First, the skills acquired in the units differed; therefore, how and with whom they used video consultations varied. Second, video consultation use was more likely to be adjusted to workflows if unit managers were responsive to staff's professional judgments regarding patients, as was evident in all three units. Conclusion: Our study shows that a formal training course alone is insufficient to provide healthcare professionals with the skills needed to use video consultations in workplace practice. Informal workplace learning with support on the spot and continuous follow-up seems to equip healthcare professionals with the skills to use video consultations. Video consultations are more likely to be used confidently if novel workflows are adjusted to health care professionals' knowledge, skills, and judgment and their concerns regarding patient soundness. [ABSTRACT FROM AUTHOR]

Although it is often recognised that testing has unintended effects, not enough intellectual curiosity has been invested in a deeper questioning of what "unintended" means. While this concept often remains dependent on an image of good, underlying, rational intentions, it underestimates the contested, controversial and socially productive nature of testing. A conceptual alternative is offered, termed "constitutive effects" as well as a theoretical framework in which this concept makes sense. Four domains in which constitutive effects are likely to unfold are carved out. A qualitative case study of how a national testing system of Danish for immigrants influences practices in one school in Denmark is offered as an illustration of such constitutive effects. Finally, a discussion unfolds concerning in what sense constitutive effects of testing can be seen as political (in a way that is not captured by the more conventional conceptualisation of "unintended effects".

One way to understand the context of evaluation is in terms of its interaction with political culture. That culture includes citizens' views of the role of government and of evaluation and the history of the polity. This chapter illustrates the relationship of political culture and evaluation by means of two accounts of Danish political culture. The chapter also draws on this analysis to stimulate our thinking on the very idea of how context can be studied.

In recent years, international comparisons have become a powerful lever for change in educational policies. Quality assurance and evaluation (QAE) in many forms is being incorporated in the steering and management of schools. However, the Danish use of QAE is a dynamic result of ongoing tensions and struggles both around and within QAE initiatives. Romantic and communitarian tenets in the traditional Danish view of enlightenment continue to influence the way QAE is used. However, the recent waves of QAE initiatives--comprising "transparency", goal-setting, tests and a number of new comprehensive and mandatory reporting mechanisms--restructure the world of schools and teachers in important ways.

What can be said about effect of an intervention without a control group? The lack of evaluative evidence is a long-standing problem for regulatory policies against work-related health and safety risks. The European Union Occupational Safety and Health Framework has been in operation for three decades and covers more than 200 million workers, but the most recent evaluation was inconclusive about the benefits generated by this framework. A theory-based evaluation focusing on mechanisms in combination with a design capturing within-intervention variations offers a way forward. The idea is to measure the prevalence of most likely mechanisms and their correlation with outcomes. This approach is illustrated in a large- N evaluation of the use of workplace assessments in the public sector in Denmark. The strengths and weakness of the workplace assessment legislation are assessed. It is shown how findings based on the presented approach contribute to the public debate about workplace assessments. [ABSTRACT FROM AUTHOR]

Contemporary policy strategies frame welfare technologies as a solution for welfare states facing the challenges of demographic change. Technologies are supposed to reduce or substitute the work of care workers and thereby reduce attrition among their ranks, reduce costs, and at the same make elderly people self-reliant and independent. In this paper, it is suggested that this way of framing how welfare technologies work with elderly people holds an instrumental view of technologies as well as of bodies and needs to be challenged. Drawing on an STS (Science Technology Studies) understanding of the constituting role of technology in people’s lives, the guiding question in this study is how autonomy is practised in the lives of elderly people using welfare technologies. The study is based on interviews with eight elderly citizens in a Danish municipality who have been provided with a wash toilet and often also other technologies as part of their welfare service package. The study shows how autonomy is practised in various ways, how autonomy is practised in specific areas of life linked to the specific life story and body of the elderly citizen, how autonomy is situational as it is practised in specific situations during the day/week, and how autonomy is relational as it is practised in relation to specific persons and things and with specific persons and things. Implications of these findings are discussed in relation to the implementation of welfare technology as well as forms of governance appropriate for embodied elderly citizens and technologies. [ABSTRACT FROM AUTHOR]

Objective - To describe the use and level of HbA1c in a large unselected Type 2 diabetic population in Denmark. In addition, to describe the characteristics of the patients and the general practitioners in relation to the monitoring of HbA1c. Design - Data were collected from public data files for the period January 1993 to December 1997. Setting - The County of Vejle with a background population of 342597 citizens, 303 250 of whom were listed with participating general practitioners. Patients - The Type 2 diabetic population alive and resident in the county on 1 January 1997. Results - In a population of 4438 Type 2 diabetics, 73% had a minimum of one annual HbA1c measurement in 1997. No HbA1c measurement was associated with a long history of diabetes, diet treatment or old age. Poor glycaemic regulation was found in 65% of the Type 2 diabetics in 1997. Poor glycaemic regulation was associated with tablet or insulin treatment, age under 70 years and long history of diabetes. The interpractice variation was huge. Conclusion - The quality of HbA1c monitoring of Type 2 diabetics needs to be improved. Possibilities for improvement seem to be present. [ABSTRACT FROM AUTHOR]

Students of evaluation have found many examples of reports gathering dust on the shelf, as well as politically hired outsiders with an ax who relentlessly cut public programs. These images indicate that evaluation often does not fulfill its genuine democratic potential. A study of the Danish municipal sector shows that out of 600 evaluations, less than 1% led to termination of the evaluated activities, whereas 78% of the evaluations led to adjustments of program activities. On this basis, an alternative view of evaluation is proposed: a managerial support system. This requires a new understanding of the utilization problem in evaluation and its democratic ramifications. [ABSTRACT FROM AUTHOR]

• OHSMS factors such as management support and employee influence predict action against risks at the workplace. • OHSMS factors explain 25.2% of variations in action-taking against psychosocial risks. • OHSMS factors explain 20.3% of variations in action-taking against physical risks. • Integration of risk assessment into organizational processes is conducive to action taken against psychosocial risks. The increasing prevalence of psychosocial risk factors at work poses new challenges to occupational health and safety management systems (OHSMSs) such as those taking place under EU Framework Directive 89/391. Due to the wicked nature of psychosocial risks, management of these risks allegedly lag behind management of other kinds of occupational safety and health risks. Data describing the use of workplace assessments (WPAs) in public workplaces in Denmark (N = 2221) show that variations in OHSMS components predict actions taken against psychosocial risks even better than they predict actions taken against physical risks. Two factors predict actions taken against psychosocial risks in particular: The use of anonymous data in WPAs and the integration of WPAs into organizational processes such as strategy-making and HR. These findings enforce a sustained belief in systematic organizational approaches to the management of psychosocial risk factors. [ABSTRACT FROM AUTHOR]