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INTERNATIONAL CONFERENCE ON HEALTH AND SOCIAL WELFARE AND COPRODUCTION ABSTRACT BOOK 9-10TH SEPTEMBER 2014 TABLE OF CONTENTS THE INTERNATIONAL CONFERENCE AT MÄLARDALEN UNIVERSITY.....................................................4 PROGRAMME.........................................................................................................................................5 PARALLEL SEMINARS AUTHORS .............................................................................................................6 PARALLEL SEMINARS SCHEDULE............................................................................................................7 KEY NOTE SPEAKERS.............................................................................................................................10 ORAL PRESENTATIONS...........................................................................................................................13 POSTER PRESENTATIONS........................................................................................................................57 SPONSORS.............................................................................................................................................80 the international conference at Mälardalen University THE INTERNATIONAL CONFERENCE AT MÄLARDALEN UNIVERSITY The School of Health, Care and Social Welfare at Mälardalen University welcomes our national and international collaboration partners and all participants to the conference ‘Health and Social Welfare and Coproduction’. Health and Social welfare is one of six research fields at Mälardalen University. Health and social welfare is defined as a field of knowledge in which health research and social welfare research will meet. The definition of social welfare entails a focus on health-related aspects of social welfare. The definition of health entails primarily a corresponding focus on social welfare-related aspects of health. The research in health and social welfare has a patient/person, user or professional affiliation. The research in health and social welfare is multifaceted and implemented by using various scientific methods. Collaboration with neighboring communities, county councils, municipalities, private operators, patient organizations and other universities (both national and international) is important. Apart from this collaboration, a number of researchers from other schools at Mälardalen University are affiliated. Further, an overall university venture called Collaboration arena of health and welfare technology started in January 2014. The health and social welfare research clusters encompass interdisciplinary and multidisciplinary fields, based on caring science, nursing science, public health, physiotherapy, medical science, health care education, social work, psychology, sociology and work life studies. The school of Health, Care and Social Welfare involve 12 Full Professors, 52 Senior lecturers, including 21 Associate Professors, and approximately 40 doctoral students enrolled in Ph. D. programs. THE RESEARCH IS DISTRIBUTED WITHIN FIVE RESEARCH CLUSTERS Older people’s health and welfare Children and youth research: ICU CHILD Health and welfare in multicultural working life Individual centered research milieu Innovation and implementation research GREETINGS We wish to extend a particularly warm welcome and honor the guests involved in the opening ceremony: Govenor Liselott Hagberg, County Council Sörmland Municipal Manager, Pär Eriksson, Eskilstuna municipality Director of Research Dr. Jureerat Kijsomporn, (PIHWD) Ministry of Public Health, Thailand Vice Chancellor Karin Röding, Mälardalen University Associate professor Maria Müllersdorf, Dean of the School of Health, Care and Social Welfare, Mälardalen University Thanks to the editorial board for reviewing all 90 abstracts which were submitted to the conference: Associate Professor Margareta Asp Professor Inger K. Holmström Associate Professor Elisabet Häggström-Nordin Senior lecturer Ann-Christin Johansson Professor Lene Martin Associate Professor Maja Söderbäck Professor Per Tillgren Associate Professor Gunnel Östlund Thanks to our sponsors making it possible to exclude registration fees. Please see the full list of sponsors on the last page in the abstract book. Some of the sponsors will also be present in the health and social welfare technology exhibition area, on September 10th. Thanks to Eskilstuna Municipality allowing us to hold the conference dinner in the Eskilstuna City hall. 4 ProgramME PROGRAMME International conference on Health, Social Welfare and Coproduction at Mälardalen University in Eskilstuna 9-10th September, 2014. We reserve the right to make alterations to the published programme. TUESDAY SEPTEMBER 9TH 09.00-10.00 Registration and coffee 10.00-10.45 Opening Ceremony [Filharmonin] Vice chancellor: Karin Röding, Mälardalen University, Govenor Liselott Hagberg, County of Sörmland, Municipal Manager, Pär Eriksson, Eskilstuna municipal, Director of Research Dr Jureerat Kijsomporn, (PIHWD) Ministry of Public Health, Thailand, Dean Dr Maria Müllersdorf, School of Health, Care and Social Welfare, Mälardalen University. 10.45-11.45 Key-note [Filharmonin] Putting the Health Agenda First: Mobilizing the Multi-sectorial Coordinated Implementation Model Professor Elizabeth Dean, University of British Colombia, Canada. 11.45-12.45 Lunch [Studion] 12.45-14.40 Parallel seminars [Various lecture halls] See next page for more information. 14.40-15.15 Coffee break [Studion] 15.15-17.10 Parallel seminars [Various lecture halls] See next page for more information. 18.30- Conference dinner [Eskilstuna City hall] WEDNESDAY SEPTEMBER 10TH 09.00-09.30 Coffee and health and social welfare technology exhibition [Studio] 09.30-10.00 Key note [Filharmonin] Co-production with Industry – a different perspective Dr Damir Isovic, Dean School of Innovation, Design and Technology, Mälardalen University 10.00-10.30 Key note [Filharmonin] Lessons learned from world’s largest test-bed for Technologies for Independent Life Adam Hagman, Business Developer Technology for Independent Life, Robotdalen 10.45-11.30 Key note [Filharmonin] How culture impact exclusive breastfeeding: local wisdom, ritual practice, and nutrition. Dr Chularat Howharn, Research Division, Praboromrajchanok Institute for Health Workforce Development, Ministry of Public Health Thailand. 11.45-12.45 Lunch [Studion] 12.45-14.40 Parallel seminars [Various lecture halls] See next page for more information. 14.40-15.15 Coffee break [Studion] 15.15-15.45 Closing Ceremony [Filharmonin] 5 Parallel seminars authors - in alphabetic order PARALLEL SEMINARS AUTHORS - IN ALPHABETIC ORDER SEMINAR MAIN AUTHOR C5 Kumpula Esa E1 Akhavan Sharareh & Aytar Osman A5 Manasatchakun Pornpun C9 Almqvist Anna-Lena A6 Martin Lene B2 Almqvist Lena E9 Nongnuch Wongsawang A1 Anbäcken Els-Marie D5 Norfjord Zidar Maria B3 Andersson Anna Karin C6 Pittard Benjawan D1 Arkkukangas Marina E6 Ramsten Camilla E2 Avelin Pernilla & Beijer Ulla E7 Ranheim Albertine E3 Chachvara Pannathorn A7 Ruangdej Kannika Chaosuansreecharoen C1 Chaowiang Kanok-on D6 Sandelius Susanna C2 Choowong Jiraporn D2 Sellin Linda C3 Chotiga Pleumjit B6 Sitanon Thongsouy B4 Dhanawan Wilawan B7 Sjöman Madeleine D7 Eklund Caroline B8 Sriyasak Atcharawadee D3 Elvén Maria C7 Stier Jonas A2 Gusdal Annelie B9 Stålberg Anna E4 Hanpaichaiyakul Somkaun D9 Sundler Annelie J D4 Hanpatchaiyakul Kulnaree D8 Suriya Chutikarn A3 Högqvist Pia A8 Söderman Mirkka C4 Isaksson Kerstin A9 Thunborg Charlotta A4 Johansson-Pajala Rose-Marie B1 Wojnar Danuta E5 Kanaskar Mukesh C8 Wojnar Danuta & Bowie Bonnie B5 Khumsaen Natawan E8 Åkerlind Charlotta 6 parallel seminars schedule PARALLEL SEMINARS SCHEDULE TUESDAY 12.45-14.40 LOCATION: H121 MODERATOR OLDER PEOPLE’S HEALTH AND WELFARE 1. 12.45-13.20 TBA A1 - A story in retrospect of a co-production study: Crosscultural comparisons on ageing, daily life and care in Japan and Sweden 2. 13.25-14.00 TBA A2 - Informal caregivers’ experiences and needs when caring for a near one with chronic heart failure in ordinary homes: An interview study 3. 14.05-14.40 TBA A3 Older female assistant nurses’ experiences of importance for sustained work ability LOCATION: H122 MODERATOR CHILDREN AND YOUTH RESEARCH 1. 12.45-13.20 TBA B1 - Effects of Miscarriage on Lesbian Couples: a Prospective Mixed Methods Study 2. 13.25-14.00 TBA B2 - Children’s behaviour problems as a predictor of staff implemented intervention in preschool and engagement outcomes 3. 14.05-14.40 TBA B3 - Born too soon – a project about everyday functioning, health and welfare LOCATION: L249 MODERATOR HEALTH AND WELFARE IN MULTICULTURAL WORKING LIFE 1. 12.45-13.20 TBA C1 - Cooperation of Boromarajonani College of nursing, Praputhabat, and Networks to Decrease Depressive Symptoms and Promote Quality of Life Among Caregivers of Patients with Chronic Illness: Strengthen Health and Social Welfare in Praputhabat Municipality, Saraburi, Thailand 2. 13.25-14.00 TBA C2 - Public Health Officers Perceptions of the DOT Program Management System for TB Control in Trang Province, Thailand 3. 14.05-14.40 TBA C3 - The experiences of health care workers in transcultural nursing along Thailand-Myanmar border LOCATION: L3115 MODERATOR INDIVIDUAL CENTERED RESEARCH 1. 12.45-13.20 TBA D1 - Fall prevention through exercise with or without behavior change in older community living people – a feasibility study of a randomized controlled trial 2. 13.25-14.00 TBA D2 - Development of suicide prevention based on a lifeworld perspective 3. 14.05-14.40 TBA D3 - A clinical reasoning model focused on clients’ behaviour change with reference to physiotherapists: Its multiphase development and validation LOCATION: L327 MODERATOR INNOVATION AND IMPLEMENTATION RESEARCH 1. 12.45-13.20 TBA E1 - The inter-sectorial and disciplinary dimensions of collaboration and coproduction. The example: Learning Project Health on Equal Terms 2. 13.25-14.00 TBA E2 - To develop and implement plans of action about children’s rights as next of kin in adult palliative care 3. 14.05-14.40 TBA E3 - Participatory Learning Process to Build Capacity of Family in Solving Alcohol Problems in Ban San Pa Bong , San Pa Muang Sub-Distric, Muang Distric, Phayao Province 7 parallel seminars schedule TUESDAY 15.15-17.10 LOCATION: H121 MODERATOR OLDER PEOPLE’S HEALTH AND WELFARE 1. 15.15-15.50 TBA A4 - Nurses’ self-reported medication competence in relation to their pharmacovigilant activities 2. 15.55-16.30 TBA A5 - The relations between factors to healthy aging among the elderly in the northeast of Thailand 3. 16.35-17.10 TBA A6 - Screening for age-related eye diseases in the ageing population LOCATION: H122 MODERATOR CHILDREN AND YOUTH RESEARCH 1. 15.15-15.50 TBA B4 - Breastfeeding Experiences in a group of Prison mothers in Suphanburi Province 2. 15.55-16.30 TBA B5 - Health risk behaviors among adolescents in Suphanburi Province, Thailand 3. 16.35-17.10 TBA B6 - Parents’ health literacy and their experiences of participation in their child’s care during hospitalization LOCATION: L249 SELANDER MODERATOR HEALTH AND WELFARE IN MULTICULTURAL WORKING LIFE 1. 15.15-15.50 TBA C4 - REwarding and SUstainable health-promoting LEADership (RE-SU-LEAD) 2. 15.55-16.30 TBA C5 - “It depends on us” - Construction of gender, health and health promoting activities among Caregivers in forensic psychiatric care 3. 16.35-17.10 TBA C6 - Being Nurse Managers: Reflective Practice in Nursing Administration Praxis LOCATION: L3115 MODERATOR INDIVIDUAL CENTERED RESEARCH 1. 15.15-15.50 TBA D4 - Barriers to accessing alcohol treatment a multidisciplinary perspective 2. 15.55-16.30 TBA D5 - Non-Participation in mammographic screening related to area-level socio-demographic factors - Mapping, describing and analyzing - area specific data on municipality level, in a county in Mälardalen 3. 16.35-17.10 TBA D6 - The “Rolls Royce” of telephone nursing. Telephone nurses‘experiences of monitoring calls in children with gastroenteritis LOCATION: L327 MODERATOR INNOVATION AND IMPLEMENTATION RESEARCH 1. 15.15-15.50 TBA E4 - The Development of Well-beings under the Innovation of Simulated Family System (One College One Community) 2. 15.55-16.30 TBA E5 - Participatory Tools for Interactive Research into Heath & Social Welfare of Vulnerable Population in India and Developing Countries’ 3. 16.35-17.10 TBA E6 - ICT and intellectual disability: A survey of the organizational support on municipality level in Sweden 8 parallel seminars schedule WEDNESDAY 12.45-14.40 LOCATION: H121 MODERATOR OLDER PEOPLE’S HEALTH AND WELFARE 1. 12.45-13.20 TBA A7 - Impact of the Elderly Club on Quality of Life of Elderly in Three Southern Border Provinces of Thailand 2. 13.25-14.00 TBA A8 - Caring for the ethnic elders suffering from dementia – experiences of nursing staff 3. 14.05-14.40 TBA A9 - Development of a new assessment scale measuring interactional transfer related behavior in dementia care dyads LOCATION: H122 MODERATOR CHILDREN AND YOUTH RESEARCH 1. 12.45-13.20 TBA B7 - Teachers and children's interactions in Swedish preschool settings as mediating factor between engagement and children´s externalizing behavior 2. 13.25-14.00 TBA B8 - The father role: A comparison between Thai teenage and adult first time fathers 3. 14.05-14.40 TBA B9 - Young children´s (3-6 years) perceptions of care situations including medical examinations and needle procedures LOCATION: L249 SELANDER MODERATOR HEALTH AND WELFARE IN MULTICULTURAL WORKING LIFE 1. 12.45-13.20 TBA C7 - Co-producing a social problem: abusive leadership in Swedish national level gymnastics 2. 13.25-14.00 TBA C8 - Understanding first generation Somali immigrants’ barriers to effective parenting and resource utilization in the USA 3. 14.05-14.40 TBA C9 - Fathers, Work and Family in Sweden and the US LOCATION: L3115 MODERATOR INDIVIDUAL CENTERED RESEARCH 1. 12.45-13.20 TBA D7 - Development of an e-health program for behavioural change in stress related problems 2. 13.25-14.00 TBA D8 - Development of a simplified diagnostic indicator scoring system and validation for peptic ulcer perforation in a developing country 3. 14.05-14.40 TBA D9 - P-C-old: Person-centered communication in the care of the elderly – a research based international platform for education, research and practice LOCATION: L3117 MODERATOR INNOVATION AND IMPLEMENTATION RESEARCH 1. 12.45-13.20 TBA E7 - Facilitating young children’s participation in health care situations 2. 13.25-14.00 TBA E8 - Information and communication technology [ICT] in everyday life of older people and their relatives in home care 3. 14.05-14.40 TBA E9 - Performing Family Care for Dependent Older Persons in Thai Families * We reserve the right to make alterations to the published schedule. 9 key note speakers KEY NOTE SPEAKERS ELIZABETH DEAN, PROFESSOR Affiliation: Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Canada Coproduction partner/s: Anne Söderlund Title: Putting the Health Agenda First: Mobilizing the Multi-sectorial Coordinated Implementation Model Aim: This keynote first describes the global meaning of health and its environmental, psychosocial and physical underpinnings, and the critical importance of differentiating health care and illness care to maximize the health outcomes of a country’s people. The Coordinated Implementation Model has been proposed as one means of mobilizing multiple sectors in society to effect population as well as individual health. Partners include the public, and the breadth of urban and community planners, politicians, policy makers, engineers, environmentalists, religious leaders, farmers, educators, and the market place, as well as established health professionals, their educators and researchers. Background: The mark of a healthy country is that its people are well; not simply free of disease and troubling complaints. Many factors have contributed to an illness care vs. health care system. Scandinavia is one region that has demonstrated a commitment to the health of its societies with the implementation of healthy living initiatives at a systematic organization level. A new radically-distinct framework of health care based on such initiatives is indicated in contemporary society, based on epidemiological indicators and the evidence-based literature. Method/s: Key international and national health documents are reviewed and their data synthesized to describe a true partner-driven health-based framework for health promotion including inter-professional core health-based activities and competencies. Findings: The non-communicable diseases related to lifestyle behaviors are well known to be not only prevalent globally, but also unsustainable economically. Some authorities have questioned the ethics of a primary focus on illness care when the evidence is clear about the health behaviors that are associated with health, and those associated with ill health. Biomedical approaches have been described as providing patchwork care as they focus on remediation of signs and symptoms, and little on causative and contributing factors. In addition, illness care is enormously expensive compared with health care. The literature supports partner-driven health-based initiatives that are implemented systematically, and that core health-based competencies warrant being taught inter-professionally and practiced systematically as a means of improving population as well as individual health. Health professionals also have a responsibility to advance the health of societies as well as of the individuals they treat. Implications: Inter-professional health-based activities and core competencies hold the promise of maximizing population and individual health even when people are living with chronic conditions, reducing illness care costs, maximizing health-related quality of life, and maximizing the human resource capital of nations. Scandinavia can do even more to lead by example through partnerships including inter-professional practice and shared core health based activities and competencies. 10 key note speakers DAMIR ISOVIC, PHD, DEAN Affiliation: School of School of Innovation, Design and Technology, Mälardalen University Title: Coproduction with Industry – a different perspective Mälardalen University has a long history of a successful cooperation and coproduction with the industry and public sector in Sweden. The aim of the university is to produce, with its partners, outputs for societal benefit and value for all. This ambition covers all the different layers and activities within the university from basic and advanced education to doctorial education and research. This has eventually led it to become one of the leading higher education institutes in Sweden for excellent coproduction with different societal actors, both internationally and nationally. The university has through its coproduction activities become convinced of its value and of the wide range of opportunities it can bring to all parties involved. In this talk, we will share our experience through some good examples both from research and education and discuss what is needed for successful and sustainable coproduction. We will describe our coproduction model mostly between industry and university, as the one with the longest history, highlighting a number of initiatives that illustrates how Mälardalen University continuously have been elaborating the coproduction concept at different levels, from leading management positions, via research and education activities, ending with initiatives driven by research groups and individual employees. Furthermore, we will discuss some differences between the coproduction with the different actors, industry and public sector, and emphasise the key success factors for long-term partnerships. ADAM HAGMAN, BUSINESS DEVELOPER Affiliation: Technologies for independent Life, Robotdalen, Mälardalen University The human race has always relied on technology to overcome major challenges. Many believe, that technology will help us with the coming demographic challenge. Governments and EU are plunging billions into development of robotic devices that will take care of our future seniors. Japan is working with humanoids and androids. But are we on the right track? What are the users say today? The elderly care industry has so far shown great scepticism to robotic solutions. Why? What are the differences between Europe Asia and US? What about the etics? This presentation will answer these questions and highlight important aspects that should not be forgotten when we develop and implement robotic technologies for this industry. Robotdalen is an initiative financed by the Swedish Government and European Union that focuses on development, implementation and commercial success of robotic innovations for the health- and elderly care. 11 key note speakers CHULARAT HOWHARN, CO- AUTHOR SITARA MAYUKHACHOTE, PHD Affiliation: Praboromrajchanok Institute for Health Workforce Development Title: Beliefs and Local Wisdom Practices among Women in three ethnic groups, Surin Province, Thailand Aim: To determine beliefs and local wisdom practices among women in three ethnic groups, Surin province Background: Surin is one of the oldest historical province in Thailand. There are three major ethic groups which are the Kui, Khmer, and Laotians living around Surin. Among these, they have the way of health practice during pregnancy, labor, and postpartum period which some of these practices are oppose to the recommendation for health practice. Data from home visit showing that women were not rely on the information from health care providers. Method/s: This study was a descriptive study. Participants were 374 postpartum women. Self-administered questionnaire and semi-structure interview were used for collect the belief and local wisdom practices during pregnancy and postpartum period. Questionnaires were developed from the qualitative study. Psychometric properties of the questionnaire were approved. Findings: The majority of the participants were Buddhist (99.4%), multiparous (79.4%), has a vaginal delivery (83.2%). Their beliefs and local wisdom practices were transferred from their mother. Nearly 94% has the beliefs about lie by fire after childbirth but only 60% practiced with the short period. Around 92% has the beliefs about Herbal sauna using steam from boiling herbs but only few practiced. Regarding to the nutrition, they have protein less than recommend because they did not want to have a big baby. Moreover, they would have egg since they know they got pregnant until the last month of pregnancy. There was a similarity and different on dietary behaviors among three ethnic group. Khmer and Laotian were preferred egg while Kui were preferred pork. Considered vegetable, Khmer have more cucumber followed by Ivy gourd while Kui preferred sponge gourd followed by cucumber. Laotian preferred morning glory followed by ivy gourd. Considered the fruit consumption, They all preferred papaya followed by rose apple and apple, consecutively. They were similarity in having banana more frequently. They also preferred natural meal that they believed they are high benefit for their baby. However, there were some different ways of cooking. Khmer preferred grilled while Kui preferred hot and spicy meal and Laotians preferred spicy minced meat salad and fish-and-bean curry. Although they have different ways of cooking they have using the similarity ingredients. Tthey stated that they avoided spicy food and some kinds of vegetable during pregnancy because they believed these kinds of food are harmful for their baby. More than 80% used a specific kind of herbs as ingredient of their meals, bath, and planted around their house. There were 44%-70% practiced ritual activities with the beliefs on protecting the spiritual of mother and the baby. Conclusion: Postpartum women in Surin province pursued their beliefs and practices from their ancestors. The practices have something different than their ancestors did. Implications: Health care provider can utilized the findings from this study in developing health interventions that related to their beliefs and practices in promoting sustainable health. 12 Oral presentations ORAL PRESENTATIONS AKHAVAN SHARAREH & AYTAR OSMAN Coauthor/s: Lennart Bogg, Anne Söderlund, Per Tillgren E1 Affiliation: Mälardalen University Title: The inter-sectorial and disciplinary dimensions of collaboration and coproduction. The example: Learning Project Health on Equal Terms Background: Equity in health and providing care on equal terms is one of the most important aspects of a welfare society. Under the Health Act, the goal of health care in Sweden, good health and care on equal terms for the entire population. At the same time, several scientific studies and reports from e.g. government, state governments and The Swedish Association of Local Authorities and Regions (SALAR) shows the Swedish health care system is not equitable. Health care has among other shortages in availability and is not offered on equal terms, based on people's different needs and circumstances. The Swedish government made an agreement with the SALAR to develop way of work and methods of a more equitable health care in the years 2011-2014. The National Learning Project - Health on equal terms was conducted in seven Primary Health Care center’s with responsibility for first-line treatment in four county councils/ regions in Sweden. Mälardalen University (MDH) has the responsibility to evaluate and be scientific support for SALAR and project. Aim: The aim for this presentation is to use this project as a case study to describe, analyze and reflect on coproduction and cooperation based on two dimensions: (1) between SALAR and MDH in the implementation of the project and (2) the cross-disciplinary within the Academy of Health and Welfare and the subjects physiotherapy, social work and public health sciences who participated in the project. Method/s: A program theory is developed to obtain an integrated approach to the evaluation and a broader perspective on the project. SALAR and MDH are stakeholders and the collaboration is included in the perspective of goals and resources. The material for this study is based on surveys to the participated Primary Health Care centers and their final reports, and interviews with their operations managers and supervisors. Other documentation in the form of progress reports and final reports from the evaluation are also included. The analysis of the documents is in the final phase. Result and discussion: The project will be completed and reported in the month of May 2014. At the conference in September, the results of the analysis will be presented and discussed. Keywords: Case study, collaboration, co-production, evaluation, mixed methods. 13 Oral presentations ALMQVIST ANNA-LENA Coauthor/s: Gayle Kaufman Affiliation: Mälardalen University and Sociology, Davidson College, Davidson, North Carolina, US Title: Fathers, Work and Family in Sweden and the US C9 Aim: This paper investigated Swedish and US fathers’ experiences of work-family conflict, possible solutions, and actual changes to their work situation in relation to becoming a parent. Background: The family policy systems are very different in Sweden and the US. Therefore, it is important to analyze if there are possible similarities as well as differences in the fathers' reasoning concerning work and family. Method/s: The Swedish data were drawn from interviews completed in 2008 with 16 fathers with a child born in 2005 or 2006. The US data came from interviews conducted between 2005 and 2007 with 26 fathers with at least one child age five or younger. Findings: In terms of conflicts, half of the Swedish fathers mention time pressures or stress, with some reference to work-life balance as a puzzle. Findings indicate that the US fathers think that they work too much overtime as well as shift hours, and they also mention arguments with their partner about responsibility at home. At the same time, a majority of both US and Swedish fathers emphasize family as a priority over work. In terms of possible solutions, a common theme among Swedish fathers is to mention that ideal work hours would be less than their current hours, with some wishing for a shorter work week (e.g., 4 days) and others a shorter work day (e.g., 6 hours). US fathers most commonly wish for a more flexible work-life situation. In terms of actual changes, several fathers adjust their work lives in response to their family life. Among Swedish fathers, the most common changes involve working fewer hours, adjusting their start and end times, and taking advantage of flexible hours. Swedish fathers also emphasize trading off with their partners, including ‘shift parenting.’ As for US fathers, some have changed their job to be more at home, some changed from working three shifts and some fathers solved the situation by intense work during a limited time. Implications: US policy needs to be more supportive towards fathers' needs to combine work and family. The norm of full-time working in Sweden, particularly for fathers, needs to be more flexible, to make shorter working hours more possible. 14 Oral presentations ALMQVIST LENA Coauthor/s: Sjöman, M. Golsäter, M.,Granlund, M Affiliation: Mälardalen University and Jönköping University Title: Children’s behaviour problems as a predictor of staff implemented intervention in preschool and engagement outcomes B2 Coproduction partner/s: Västerås stad, Högskolan i Jönköping/CHILD/Jönköpings Läns Landsting Aim: The aim of this study was to investigate what factors predict the likelihood that children with behaviour problems will receive teacher-implemented support in preschool with or without supervision and to what degree teacher-implemented support influence children's functioning in preschool. Background: Not all children perceived by preschool staff to be in need of special support in Swedish preschools receive individualized support for functioning in preschool. The odds that a child receives individualized support is much higher if he/she is formally identified as a child in need of special support. However, preschool staff report that they provide support to several children that are not formally identified. For what reasons support is given to these children and if the factors influencing the odds for providing special support vary dependent on if the child is formally identified or not is not well known. Method/s: Teacher ratings of 202 preschool children aged 15 to 71 months (110 boys) in 81 Swedish preschool units in 6 municipalities were obtained. Behavior problems were measured by Strenghts and Difficulties Questionnaire (SDQ), impact of behaviour problems on child and preschool unit were measured by SDQ impact supplement, and staff implemented interventions for individual children due to behavioural problems were reported by staff. Children's functioning in preschool was operationalized as engagement in everyday activities and measured by Children's Engagement Questionnaire (CEQ). Logistic regression models were performed to assess the influence of behaviour problems (emotional problems, conduct problems, hyperactivity, and peer-relation problems), impact of behaviour problems (to be a burden in the group, to disturb free play, routine situations and organized activities) on the likelihood that children will receive staff-implemented support, with or without supervision. Further, univariate analyses were performed to analyse differences in engagement between children with behaviour problems not receiving staff-implemented support in preschool (n=39) from those receiving support with (n=9; all formally identified in need of special support) or without supervision (n=46) controlling for demographic variables (age, gender and mother tongue). Findings: Preliminary results indicate that the presence of conduct problems and the right to receive mother tongue education significantly predict the likelihood that children will receive staff-implemented support without supervision. To be formally identified and to disturb free play predicts the likelihood to receive support with supervision. Results also indicate that children with behaviour problems receiving support without supervision is significantly more engaged in preschool activities that children with behaviour problems receiving support with supervision or those who do not receive support at all, independent of age, gender and mother tongue. Qualitative descriptions of the type of staff-implemented support will be added to the results when presented. Implications: Support initiated by staff seems to be targeted to and succeed on promoting everyday functioning for children with behaviour problems. 15 Oral presentations ANBÄCKEN ELS-MARIE Affiliation: Linköping University & Mälardalen University A1 Title: A story in retrospect of a co-production study : Crosscultural comparisons on ageing, daily life and care in Japan and Sweden Coproduction partner/s: Håkan Karp (Mälardalen University), Yasuhito Kinoshita (Rikkyo University, Tokyo, Japan) & Masako Nitta (Sapporo Gakuin University, Japan). Aim: The overarching aim was to study the views expressed by older people themselves on ageing, life and care. Another aim was to study the welfare societal contexts for citizens in both countries. Background: A comparative study initiated by Håkan Karp, Els-Marie Anbäcken and Yasuhito Kinoshita resulted in a joint project between Mälardalen, Linköping and Rikkyo Universities. Two important features were that it focused the perspectives of older persons themselves on the same time as it involved local communities and municipalities. Between 2001 and 2005 intensive substudies were planned and carried out. Method/s: Studies were of basically three different kinds and therefore different methods: 1. Descriptive and analytical on welfare policy and services on national and local levels, with profiles of the municipalities in which the empirical studies took place. 2. Interview studies with older people both in the community and in care institutions 3. Participant observations in activities for older community residents. To carry out the comparative study with visits to each other´s fields, we found added qualitatively to our study. "The joint comparative model" helped us to not fall into the trap of easy culturalizing. The close discussions on case studies gave room for nuances in both similarities and differences that were found and analysed. Findings: The whole project resulted in an anthology with 12 chapters, co-authored, several of them with Japanese and Swedish authors. The paper will take its point of departure in a discussion on this specific method in cross-cultural comparative studies. It will then present and discuss some of the substudies more closely regarding some aspects of ageing, life and care in Japan and Sweden. A special focus will be on the study focusing older couples who experience a kind of separation process when one of them enters institutional care. In doing this we also elaborate on the results from a methodological perspective. Implications: The paper concludes with reflections on how research methods can be developed in international co-production. For example an intersectional approach in terms of analyzing taken for granted cultural assumptions can be a valuable research tool. 16 Oral presentations ANDERSSON ANNA KARIN Coauthor/s: Almqvist Lena, Martin Lene, Strand-Brodd Katarina Affiliation: Mälardalen University, Mälarsjukhuset in Södermanland County Council B3 Title: Born too soon – a project about everyday functioning, health and welfare Aim: The aim of the study was to identify strengths and weaknesses in everyday functioning in preschool preterm born children in relation to gestational age, birth weight, Apgar score, parity and morbidity at birth corrected for differences in socio-economic status, compared to term born children at the same age Background: For everyday functioning children need skills to develop their capacity for communication, social skills and behavior, in addition to motor and cognitive skills. These skills grow in a mutual interaction between the child and its context. Everyday functioning, that is interaction, behavior and performance skills in daily activities, measured as participation has been strongly related to health and well-being. The preterm born children perform poorer in motor-, social and emotional functioning, already in pre-school. To the best of our knowledge it is not known if or how these difficulties affect the children’s everyday functioning, thereby creating barriers to participate in situations typical for their age and environment. The aim of the study was to identify strengths and weaknesses in everyday functioning in preschool preterm born children in relation to gestational age, birth weight, Apgar score, parity and morbidity at birth corrected for differences in socioeconomic status, compared to term born children at the same age. Method/s: All children born preterm (n=351) in 2008, living in two Swedish county councils were asked to participate in the project. The preterm born children and a group of matched term born children were identified in the Swedish Medical birth register. Data were collected from the Medical Birth Register, Statistics Sweden and the Swedish Neonatal Quality Register concerning gestational age, weight and length at birth, Apgar score, head circumference, morbidity in the new born period and child's birth order in family. Data concerning the mother’s age, marital status, occupation and employment during pregnancy were also obtained as well as data concerning socioeconomic status. Three questionnaires regarding everyday functioning were answered by parents of the children. Register data were linked to the questionnaires through each child's unique personal identification number. Bivariate analysis, descriptive analysis and ANOVA were used to describe group differences and correlations between birth related variables and everyday functioning. Regression analysis was used to investigate the predictive value of birth related factors and socioeconomic status for everyday functioning Findings: Data collection is currently in progress. Results will be presented shortly. Implications: The current study with its systematic data collection strategy may increase the knowledge of how birth related factors separately and combined influence preterm born children’s everyday functioning. To detect factors vital for everyday functioning in preschool ages may enable early intervention intended to prevent difficulties later on in for instance school, leisure activities and play. The current study is expected to provide an empirical base to design a future intervention study with the aim of promoting the everyday functioning of preterm born children. 17 Oral presentations ARKKUKANGAS MARINA Coauthor/s: Marina Arkkukangas, Susanna Tuvemo Johnson, Karin Hellström, Anne Söderlund, Staffan Eriksson, Ann-Christin Johansson Affiliation: Mälardalen University, Uppsala University and Center for Clinical Research, Sörmland Title: Fall prevention through exercise with or without behavior change in older community living people – a feasibility study of a randomized controlled trial D1 Aim: To study feasibility of a randomized controlled study (RCT) based on a multicenter fall prevention intervention study including exercise (Otago Exercise Program, OEP) with or without behavioral modifying actions (Motivational Interviewing, MI) compared to standard care, for older community living people. Background: Falls are common in older people. It is important to increase understanding of how intervention programs for elderly should be formed and how they should be presented to maximize the acceptance and participation. Method/s: There were two intervention groups and one control group. Feasibility of the assessment and interventions from the participating physiotherapists’ perspective was evaluated after inclusion of a pilot sample (n=45) in the underlying RCT. Eleven physiotherapists conducted the interventions. Forty-five community living people, over 75 years was included. Feasibility was measured by a questionnaire to the participating physiotherapists regarding assessment and treatment. A positive response rate of 80% or a median of 8 (0-10 scale) was estimated to be feasible. Fall frequencies were analyzed for the whole group and between groups. Effect measures within groups and between groups were analyzed for balance, physical performance, falls self-efficacy and falls measured by Mini-BESTest, Short Physical Performance Battery (SPPB) and Falls Efficacy scale, Swedish version (FES-S) . Findings: The preliminary results imply feasibility and over time effects within groups of this RCT. Some difficulties in performing the exercise according to the protocol were discovered. The MI communication method was requested by the physiotherapist to be supported regularly. The fall frequency was 20 (38%). The Mini-BESTest showed no significant effect over time in any of the three different groups. Significant effect over time in SPPB was shown in the MI group (p=0,05) and in the control group (p=0,02). There was a significant effect over time in the MI group (p=0,02) regarding falls self-efficacy. There were no differences between groups for falls and effect measures. Implications: The experiences and adjustments are taken in consideration to improve the ongoing RCT. Keywords: Fall prevention, feasibility, motivational interviewing, exercise, older population. 18 Oral presentations AVELIN PERNILLA & BEIJER ULLA Coauthor/s: Ulla Beijer Maja Söderbäck Hans Eriksson Margareta Asp Affiliation: Mälardalen University, Research and development in Sörmland, Karolinska Institutet Title: To develop and implement plans of action about children’s rights as next of kin in adult palliative care. E2 Coproduction partner/s: County Consul Sörmland Aim: The aim is to study the process of developing evidence based action plans and implementations in a pilot project in Sörmland County Council that aims to develop and implement plans of action regarding how children of patients in palliative care should be more involved and informed about the care of the next of kin. Background: Every year many children experience that someone in their nearness gets a severe illness and dies. These children have their rights to be informed and have support according to their needs and level of development. Recent research show that children’s perspectives and rights as next of kin are often overlooked in health and welfare. When children experience that their relatives are severe ill and become influenced by the circumstances in the family, their own health are at-risk. Recently, the children’s situations in health and welfare have been considered in Swedish national legislations and with local guidelines in county consuls. In Sörmland, the county consul has started a pilot project to develop and implement plans of action regarding how to let the children participate in the care of next of kin and how they can be informed and get their needs satisfied. Method/s: A quasi experimental study, with an intervention (learning situations in team) is performed on two settings with palliative care. Further two settings are control. Qualitative and quantitative methods will be used to study the implementation process and results. Findings: Preliminary data shows that, 96 persons (55%) of 175 staff in four multi professional teams of palliative care for adults answered a questionnaire at the baseline. Half of them informed usually or always the children, while the other half informed children only sometimes, rarely, or never. Implications: The project is an implementation project, where evidence will be transformed to practice and action. The intervention is to arrange several learning situations for two multi professional teams on two units for adult palliative care. Keywords: Children, next-of kin, implementation research, knowledge transformation, learning, palliative care. 19 Oral presentations CHACHVARA PANNATHORN Affiliation: Boromarajonnani College of Nursing, Phayao Title: Participatory Learning Process to Build Capacity of Family in Solving Alcohol Problems in Ban San Pa Bong, San Pa Muang Sub-Distric, Muang Distric, Phayao Province Aim: Assess drinking situation among people in a community and Promote participatory learning in order to empower families to solve alcohol problems in a community. E3 Background: It has been increasing of alcohol consumption among Thai people. Alcohol consumption can cause major health and family problems. Family members believe that it is difficult to stop drinking among their member. Therefore, family empowerment activities are requires. Method/s: There were 5 steps of research processes: 1) assessing a drinking pattern among villagers, 2) priority setting about drinking problems 3) identifying the problem solving method of drinking problems 4) implementing for figure out drinking problems and 5) evaluating the result of participatory leaning for empowering families in order to resolve drinking problems. Participants were villagers who residing in Moo 6, Sunpamuang sub district, Muang district, Phayao province voluntary to participate in this research. Findings: There were 89.7% of participants consumed alcohol over last six months. Drinkers knew that alcohol effected to both health and caused of accident. Family members who participated in the process of participatory learning reported that they had initial drinking since teenage. The cause of drinking was learning from families, peers and communities. The main reason for drinking was social drinking. And types of alcohol beverage preference were local brew, spirit, beer and wine. Mostly of them drank in the evening after finish working because the villagers always feed them food and white spirit for giving them the rewards after working. Participants set the priority of alcohol problems consisting of health problems, family problems and social problems. Participants provided the guideline to solve alcohol problems as follows: promoting concern of health consequences among drinkers, promoting concern of negative effect of alcohol by family’s members, community’s members and health workers. After implementation according to the plan for resolving alcohol problems, there were 3 level of positive impacts 1) drinkers: drinkers reported the reduction of alcohol consumption, 2) family: family’s member and drinkers had chance to discuss about alcohol problems and 3) community: there was community’s policy for reducing alcohol drinking such as no drinking at a funerals and no drinking during making merit activities. Implications: there was the increasing of the number of abstinence alcohol drinking during Buddha lend. In addition, there were a leading group working for reducing of alcohol consumption in a community. 20 Oral presentations CHAOWIANG KANOK-ON Coauthor/s: Kanok-on Chaowiang, Yaowadee Suwannaka, Boonsurb Sosome C1 Affiliation: Boromarajonani College of Nursing, Praputhabat (BCNPB), Thailand Title: Cooperation of Boromarajonani College of nursing, Praputhabat, and Networks to Decrease Depressive Symptoms and Promote Quality of Life Among Caregivers of Patients with Chronic Illness: Strengthen Health and Social Welfare in Praputhabat Municipality, Saraburi, Thailand Aim: The purposes were to assess prevalence of depressive symptoms and compare 1) depressive symptoms scores, 2) quality of life scores before and after promoting the program. Background: BCNPB has one of crucial responsibilities to strengthen community health. Based on an initial study, the caregivers expressed that health care providers concerned only taking care of patients, but did not concern any caregivers’ needs. Group support is one of the ways to help them decrease their tension, increase their quality of life, and obtain equal health care. In addition, collaboration between multidisciplinary teams was needs in order to continually strengthen health and social welfare. Method/s: BCNPB, Praputhabat Municipality, and Village Health Volunteer were participated as an investigative team. The National Health Security Office Thailand was also in the team and supported grant for some part of this project. The study, including 2 parts, was from January 2011 – March 2012. The first part was a mixed method, qualitative and quantitative study. The purpose of this study was to investigate prevalence of depressive symptoms and quality of life among care givers and patients with chronic illness in Praputhabat community. The participants, 30 caregivers and 30 patients with chronic illness, were interviewed and examined. The depressive symptoms questionnaire and the quality of life questionnaire were administered among 200 caregivers. The second part was a quasi experimental study. The purposes were to assess prevalence of depressive symptoms and compare 1) depressive symptoms scores, 2) quality of life scores before and after promoting the program. Sample consisted of 60 caregivers. Thirty samples participating in the program were in an experimental group. The program consisted of 5 steps including engagement, recognition of background and psychological needs, dealing with bio-psycho-social needs, adopting positive roles and challenges for care-giving, and termination of session. Another 30 participants were in a standard health care group. Findings: Prevalence of high depressive symptoms was 15%. Mean score of depressive symptoms after promoting the program was lower and than before promoting the program and mean score of quality of life after promoting the program was higher than before promoting the program at the level of .05. Finally, the program for increasing quality of life and decreasing depressive symptoms among caregivers was established. The guide books for taking care of people with chronic illness were provided. In addition, a caregiver-group support was launched. Furthermore, collaborative team furthered next projects to strengthen social welfare in this community. Implication: Because of the shortage of health care providers worldwide, a policy to decrease health care service cost, and enhancing health and social welfare, multidisciplinary cooperation and group support are the way to allow people in communities reach health care service and social welfare. Keywords: Supportive Group, Caregivers, Network, Social Welfare. 21 Oral presentations CHOOWONG JIRAPORN Coauthor/s: Per Tillgren, Maja Söderbäck, Suwatta Kumsuk C2 Affiliation: HVV/MDH och Boromarajonani College of Nursing Trang, Praboromarajchanok Institute for Health Workforce Development (PIHWD), Thailand. Title: Public Health Officers Perceptions of the DOT Program Management System for TB Control in Trang Province, Thailand Background: Tuberculosis is a global health emergence problem as can be seen by the unequal distribution in the world. Thailand is in the 18 of the 22 high tuberculosis burden countries. In Thailand, Public health officers (PHOs) are responsible for implementing the district TB control program, as well as management of the Directly Observed Treatment (DOT) program. There are some incidents that affect the DOT program management system. The main reason for the DOTS strategy’s failure is lack of proper implementation. However, there is still a lack of comprehensive evidence particularly regarding the perceptions of DOT program management in Thailand. Aim: The aim of the study was to explore and describe perceptions among PHOs on district level about the DOT program management system in Trang province, Thailand. Method/s: A phenomenographic approach was used to explore perceptions of PHOs of DOT program management in Trang province. Ten PHOs, including five TB coordinators in a district level and five TB clinic staffs from a TB clinic in Trang province, were recruited to participant in semi-structure interviews. A purposeful sampling strategy by including both men and women of different area and length of services was used aiming to get a variety of perceptions. Findings: The PHOs had in common a perception of a duty and a wish to comply with the TB guideline to manage the DOT treatment and stop TB in their district/province. Other perceptions identified among the PHOs were about; to get success of cure; practical dilemmas and further a need for improvement of the DOT program management system. Implications: We found the PHOs need to improve and reduce dilemmas of DOT program management by providing a new guideline to improve their knowledge to empower TB patients and also get social support for improving their performance. Keywords: DOT program management system, Thailand, Tuberculosis. 22 Oral presentations CHOTIGA PLEUMJIT Coauthor/s: Waraporn Wanchaitanawong and Pleumjit Chotiga C3 Affiliation: Boromarajonani College of Nursing Chiangmai, Chiangmai, Thailand Title: The experiences of health care workers in transcultural nursing along Thailand-Myanmar border Aim: The aims of this study were to explore and describe the experiences of transcultural nursing among health care workers and how they interpret the current healthcare needs situation along ThailandMyanmar border. Method/s: Individual interviews were conducted among 23 health care workers who provide health care for Myanmar and hill tribes people who are living in a Thai district close to Thailand-Myanmar border in the northern parts of Thailand. A focus group was also conducted among health care workers. Data were analysed manually using thematic analysis. Findings: The study found that caring for multicultural people along the border meant that health care workers faced various difficulties and encountered many barriers. The findings also demonstrated the factors that influenced the effectiveness of transcultural nursing including the clients' ability to pay health service fee, the type of health insurance scheme, communication difficulties, ability to read Thai or Myanmarese language, influence of family and lack of health care workers. Implications: Health care workers should be recommended ways to develop awareness of health, increase networks for the promotion of health, awareness of and respect for cultural practices and increase policies to increase the quality of transcultural nursing. Keywords: Hard-to-reach group, transcultural nursing, accessing health services. 23 Oral presentations DHANAWAN WILAWAN Coauthor/s: Jintana Pethmani, Pichaya Sangpeag Affiliation: Boromarajonani College of Nursing Suphanburi Title: Breastfeeding Experiences in a group of Prison mothers in Suphanburi Province B4 Aim: The purpose of this study was to explore breastfeeding experiences in a group of Prison mothers in Suphanburi Prison Province Background: Breastfeeding is the best thing to promote children’s health. The incarcerated women who are the mothers in prison who have breastfeeding their babies were vulnerable group that health care providers should deepen the understanding. Method/s: Design: A Descriptive Qualitative Study , The purposive of 12 prison mothers in Suphanburi Prison Province who had had experiences of breastfeeding with in the past 3 years participated. Data were collected by 3 groups each group was interviewed by focus group. The data were analyzed by content analysis. Findings: Two mains themes with three categories and eight subcategories emerged from the text. The two main themes are: The individual experience of the mother and the important of the environment. Three categories are: aspect and practice of Breastfeeding, facility of breastfeeding and supporting of breastfeeding. Implication: The prison mothers are feeling positive about the breastfeeding for their baby, but restrictions and regulations, as well as many facilities as a problem to the success of breastfeeding mothers with differences of mother outside the prison. The findings of the research is a great guide for those involved in improving the quality of life of service to mothers and babies in prison anyway. Keywords: Breastfeeding, Experiences, Prison mothers, Qualitative research. 24 Oral presentations EKLUND CAROLINE Coauthor/s: Yvonne Eriksson, Magnus Elfström, Anne Söderlund Affiliation: Mälardalen University Title: Development of an e-health program for behavioural change in stress related problems D7 Aim: The aim is to develop an evidence based and interactive platform for e-health including an evidence based and tailored self-management program for behavioral change in stress related problems. Background: Stress can be defined as internal or external demands that are appraised as exceeding the individual’s perceived resources. Persons who report high work related stress have higher odds for poor selfrated health, psychological distress and musculoskeletal pain and perceived dissatisfaction with work and high psychological and physical strain are associated with sick-listing and long-term sick leave. Persons on long-term sick leave are also less able to cope with work related stress. Health related problems due to stress are a major cause for increased costs for community and for individuals. Stress related problems can be reduced by behavioral change through interventions delivered face-to-face or through the web. In order to change behavior permanently there is a need for more advanced e-health and self-management programs than existing possibilities. Existing programs do not always take current evidence regarding design, content and ways of delivering program into account. Neither are these programs rigorously evaluated. Method/s: The development started with a review of the evidence in the fields of pedagogic design, behavior change and stress-management techniques and continued with consulting experts in the field of innovation, design and engineering at the school of innovation, design and engineering at Mälardalen University. When consulting experts focus was on the meaning of the graphic design, interfaces and pedagogical design. Screening process- and outcome measurements have been selected and will be integrated in the program. The start of the program will be based on screening of the individual’s stress level and stress related behaviors and thus, individualize the program to each person. Findings: For the theoretical framework of the self-management program there are several useful health psychological theories. Regarding behavioral change in stress context three theories arise as more important; The Transactional Theory of Stress and Coping, Social Cognitive Theory and the Trans-theoretical Model and Stages of Change. Five central techniques for behavior change have been identified: self-monitoring, formulation of intention to change, specific goal setting, feedback and reevaluation of goals. These techniques are included in the program together with other techniques such as for example providing information of consequences, and identification of barriers and facilitators. A system for the tailored interactive feedback will be developed. Implications: The United Nations has identified elements for the right to health. Interventions should be available, accessible, acceptable and of god quality. With a tailored, evidence based self-management program it is possible to meet these demands. To be acceptable for a greater extent of user’s visual elements and text included in the program and platform need to be considered from a gender perspective as well as be relevant to persons with different ethnicity, age and socioeconomic status. Next step will be a feasibility study. 25 Oral presentations ELVÉN MARIA Coauthor/s: Jacek Hochwälder, Elizabeth Dean, Anne Söderlund D3 Affiliation: Mälardalen University and University of British Columbia, Vancouver, Canada. Title: A clinical reasoning model focused on clients’ behaviour change with reference to physio- therapists: Its multiphase development and validation Background and aim: Biopsychosocial approaches and strategies that promote behaviour change have long been proposed to facilitate client participation and to serve as a basis for addressing the current multifaceted health problems. This emphasis has implications for the clinical reasoning of health professionals. The aim of this study was to develop and validate a conceptual model to guide clinical reasoning focused on clients’ behaviour change specifically related to the physiotherapy context. Method/s: A two-phase study was conducted to develop and validate the conceptual model. Phase 1 consisted of the exploration of existing research and the research team’s experiences and knowledge. Phase 2 consisted of validation and refinement of the model based on the input of physiotherapy students in two focus groups (n=5 per group) (Phase 2a) and of experts in behavioural medicine (n=9) (Phase 2b). Findings: Phase 1 generated the theoretical and evidence base for the first version of a clinical reasoning model. Phases 2a and 2b established the validity and value of the model according to the inputs of the students and experts, and minor refinements were suggested. The experts, for example, suggested that greater emphasis should be placed on the attributes of behaviour change. The final model described clinical reasoning focused on clients’ behaviour change as a cognitive, reflective, collaborative, and iterative process with multiple levels that included input from the client and physiotherapist, a functional behavioural analysis of the activity-related target behaviour, and the selection of strategies for a specific behaviour change. In summary, biological and psychosocial factors related to the client and physiotherapist are reflected in the clinical reasoning process. Implications: This unique model highlights the concepts and corresponding relationships that may assist physiotherapy students’ and practitioners’ learning and implementation of efficient clinical reasoning in integration with strategies for promoting behaviour change. Physiotherapists with such clinical reasoning competence could have an impact on health equity and well-being in the society through a focus on the intermediary determinants of health including clients’ biological, behavioural, and psychological factors and social circumstances. Finally, the clinical reasoning model may provide a foundation for general research in clinical reasoning. 26 Oral presentations GUSDAL ANNELIE Coauthor/s: Karin Josefsson, Eva Thors Adolfsson, Lene Martin Affiliations: Mälardalen University, Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västerås, Sweden. Department of Primary Health Care, Västmanland, City University, London, UK A2 Title: Informal caregivers’ experiences and needs when caring for a relative with heart failure: an interview study Coproduction partner/s: Västmanlands läns landsting Aim: To explore informal caregivers’ experiences and needs when caring for a relative with heart failure in their homes. Background: Heart failure (HF) is a complex and progressive condition that results in substantial morbidity and mortality. The prognosis is poor with a five-year survival of 50 % after the first recorded diagnosis which compares unfavourably with the most common cancer diagnoses. HF is the single most frequent cause of hospitalizations and re-hospitalizations for older persons and its societal costs are high, thus representing a large public health problem. Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care and identifying deterioration in health status. Caring for a relative with HF may affect informal caregivers' quality of life, well-being and cause a burden for the informal caregiver. Research has been limited on informal caregivers' perspectives in the field of HF. Few studies have specifically focused on informal caregivers' needs and recommendations to address unmet needs for support is scarce. Method/s: The study has a qualitative, descriptive design with an inductive approach. Interviews were held with 14 informal caregivers - eight female spouses, three male spouses, three daughters - of relatives with HF recently discharged from hospital. Data were analyzed using qualitative content analysis. Findings: Two themes emerged: "Living in a changed existence" and "Struggling and sharing with health care". The first theme describes the demands on life adjustments and new challenges. Informal caregivers were responsible for the functioning of everyday life which challenged earlier established roles. Informal caregivers experienced an ever-present uncertainty related to the relative’s impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative’s understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes the informal caregivers' experiences with health care. They felt counted upon but not accounted for as their care was taken for granted while their need to be seen and acknowledged was not met. They were not invited to share information with health care professionals and their specific expertise was not requested. Health care professionals had neither provided them with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by health care professionals. Implications: Informal caregivers handled their new situations using different strategies in order to preserve a sense of "self" and of "us". Informal caregivers express a need for more involvement with health care professionals which may facilitate the situation for informal caregivers and improve the dyadic congruence between the informal caregivers and their relatives. It is essential for health care professionals to meet the informal caregivers' need to be seen and acknowledged as the informal caregivers felt counted upon but not accounted for by the health care professionals. 27 Oral presentations HANPAICHAIYAKUL SOMKAUN Coauthor/s: Charoensuk Sukjai, Makarapan Jutarasaga, Lily Siriporn, Jiraporn Wattanasrisilp, Watcharee Amornroteworawut, et.al. E4 Affiliation: Praboromarajchanok institute (PBRI) Title: The Development of Well-beings under the Innovation of Simulated Family System (One College One Community) Background: The Praboromarajchanok Institute of Health Workforce Development (PBRI) is an institute that responsible for producing and developing health personnel employed through the Ministry of Public Health, Thailand. There are 30 nursing colleges, 7 public health colleges, and one college of medical and public health technology under the PBRI. To upgrade the health service and promote the well-beings of Thai people, the PBRI declares “Humanized Health Care” as its graduate identity. This identity characterizes the healthcare workforce that should provide health service to Thai people like their relatives. Consequently, the innovative integrated education model namely ‘Simulated Family System’ has been adopted to be a mean to achieve such identity. Broadening outside the context of colleges, the ‘Simulated Family System’ has also been applied to upgrade the well-beings of local community. Therefore, the varied models that the selected nursing colleges used to promote the development of well-beings needs to be explored in order to propose the policy related to the production of nurses in response to the community need. Method: The descriptive research and content analysis were used to investigate each of the models developed by the selected nursing colleges including Boromarajonani College of Nursing: Khon Kaen, Boromarajonani College of Nursing: Chakriraj, Boromarajonani College of Nursing: Nakhon Sri Thammarat. The analysis focused on existing models that have been developed to encourage the participation between colleges and their communities in order to attain the desirable well-beings as follows: 1) the betterment of physical wellbeings of human resources within the colleges and those in local communities, 2) the formation of learning community between colleges and their local communities, 3) the nurture of ‘Humanized Health Care’ as desirable mental quality for both groups and 4) the integrated development of holistic well-beings. Findings: To attain the desirable well-beings of local communities, the result revealed that all 3 colleges have developed the family-like relationship with communities. In sum, the study showed that the physical and mental well-beings of human resources within the 3 colleges and their local communities were improved. The health care projects taking care of local people were co-planned and co-created by the nursing colleges and local communities, also leading to participatory learning in both groups. Nevertheless, it is found that the created healthcare activities in the 3 colleges were varied based on the contexts of each college and its local community i.e. the need of local community, the resource constraints and the nature of contact between the nursing college and the community. Here, the capability to adjust to its context revealed that all selected nursing colleges have a similar characteristic of ‘Humanized Health Care Learning Organization’. Implications: The application of ‘Simulated Family System’ and humanistic learning process encouraged the participation between the nursing colleges and their communities to attain the desirable well-beings. Yet, the policy to promote well-beings of the community through the participation between the nursing colleges and their community should be flexible for the application based on diverse contexts. 28 Oral presentations HANPATCHAIYAKUL KULNAREE Coauthor/s: Henrik Eriksson, Jureerat Kijsompon, Gunnel Östlund D4 Affiliation: Mälardalen University, Boromarajonani College of Nursing Changwat Nonthaburi, Thailand, Swedish Red Cross University College, Praboromarajchanok Institute for Health Workforce Development (PIHWD), Ministry of Public health, Thailand Title: Barriers to accessing alcohol treatment a multidisciplinary perspective Coproduction partner/s: Henrik Eriksson, Jureerat Kijsompon and Gunnel Östlund Aim: The aim of this study was to provide knowledge through professionals’ multidisciplinary experiences of alcohol treatment in a hospital. Moreover we looked for identifying the barriers in entering in or remaining in alcohol treatment through different professionals’ perspective. Background: Although, Thailand provides universal care for all people, treatment for alcohol addiction is not widespread and the knowledge of alcohol treatment and barriers in accessing such is particular scarce. Only a few of clients were found in the hospital population and treated by physicians specifically for alcohol addiction. Method/s: Qualitative descriptive method was applied in this study. The sample comprised of 32 multidisciplinary members who have experiences from working with caring alcohol treatment for more than 5 years each. Data was collected by five focus groups and a semi-structure interview guide was used to explore similar themes among nurses (3 groups) and paramedical professionals (2 groups). Content analysis was applied to analyze the data. Findings: Two main categories emerged in the study that comprised of components of alcohol treatment and collaborative practice. In addition, the component of alcohol treatment included three subcategories such as the fit of the program, competence to care and care chain. The category of collaborative practice comprised of two subcategories, vertical and horizontal team collaboration and patient and family engagement. The different professions identified the barriers in how the treatment was carried out and there was no consistency in the way of professionals dealt with the treatment process. A recurrent theme was lack of confidence in professional way of treating alcohol addiction, and also a general problem described was that Thailand health care did not provide care chain that function properly. Implications: In the study ideas based on universalism, health care gender structures, narrow focus on “addiction” health care hierarchy structures and care based on coercive measures have been highlighted as barriers discussed from a multidisciplinary perspective. The barrier understanding alcohol treatment from a multidisciplinary perspective is important especially when further developing alcohol treatment. Moreover health care in Thailand need to agree on a suitable referral system that open up doors into treatment for clients with addiction and to find out ways to involve the family in the process. Keywords: Universalism, gender structures, narrowly, hierarchy, repression. 29 Oral presentations HÖGQVIST PIA Coauthor/s: Maria Sandborgh, A3 Affiliation: AktivaRe, Primärvårdsrehab, Åkersberga, Stockholms läns landsting, Mälardalen University Title: Older female assistant nurses’ experiences of importance for sustained work ability Co-production partner/s: Municipality of Katrineholm Aim: To explore older female assistant nurses’ experiences of importance for sustained work ability in municipal elderly care, from a behavioural medicine and salutogenic perspective. Background: The Swedish Work Environment Authority has received a comprehensive commission from the Swedish Government to make visible and increase women’s health in work life. Assistant Nurse is a female dominated profession with high sickness absence, occupational related illnesses and accidents. Hence, it is of importance to increase our understanding of assistant nurses perceptions, of importance for work attendance and work ability. A behavioural medicine and salutogenic perspective on these perceptions could increase our understanding of how bio-psycho-social factors, including cognitive processes, influence individuals’ health promoting behaviours. Method/s: A descriptive qualitative interview study was conducted in a Swedish municipality. Data were analysed with qualitative manifest content analysis. Six healthy assistant nurses between 55-58 years in municipal elderly care were selected through purposive sampling for semi-structured in-depth interviews. The participants had worked between 8 to 37 years as assistant nurses. Findings: Mainly aspects of psychosocial nature, with elements of physical activity, are perceived to promote work ability by the female assistant nurses. The assistant nurses are able to identify and fulfil needs of their own. They adapt, mainly in the private life, and achieve well-being through a meaningful existence. Their behaviours can be linked to sense of coherence, empowerment and internal locus of control. Nine categories were identified: Health and physical activity, Physical work environment, Organisation, Collaboration and communication, Intentional adaptions, Work satisfaction, Meaningful existence, Preference and attitude and Societal level. Implications: The findings can contribute to form a basis for promotional work. A behavioural medicine and salutogenic perspective can be of value in the understanding of how bio-psycho-social factors interact in the maintenance of work ability. Clinical implications for health care givers are to pay attention to the client’s life situation, sense of coherence, empowerment and locus of control. Thus, health promoting interventions for sustained work ability could be directed to support the client in an appropriate way. 30 Oral presentations ISAKSSON KERSTIN Coauthor/s: Kerstin Isaksson & Gisela Mohr Affiliation: Mälardalen University, Leipzig University, REwarding and SUstainable health-promoting LEADership (RE-SU-LEAD) Coproduction partner/s: Västerås stad, Eskilstuna kommun C4 Title: Rewarding, Sustainable, Health-promoting Leadership (RE-SU-LEAD) Aim: Investigate change over time in health promoting leadership. Furthermore to identify predictors of health promoting leadership after the intervention and the role of satisfaction with the intervention workshops. The aim was to investigate whether group level indicators from the evaluation of the intervention seemed to affect individual perceptions of their leaders in terms of health promoting leadership behavior. Background: A three year intervention study with three nations collaborating (Finland, Germany and Sweden). Swedish partner is MDH (Psychology) was conducted in collaboration with two Swedish municipalities. The intervention, a training program with focus on health-promoting leadership and duration of 12 months was conducted in Germany and Sweden. Method/s: Questionnaire data were collected on three occasions mostly from the public sector. Total number of respondents was 1143, 124 in Sweden and 797 from Germany. The dependent variable was employees’ perceptions of health promoting leadership measured by questionnaires at T2. Level 1 variables (individual level) entered were: working conditions (role clarity, work load and team climate). Individual control variables were age and level of education. On the group level we entered, Goal attainment Satisfaction with workshop 2 and Number of subordinates of leader (Team size). Findings: Summative evaluation indicated that the training appeared to have a positive impact on leadership behavior (transparency, conflict management, self-awareness, fairness) and on follower well-being (work engagement, occupational self-efficacy, team climate, somatic symptoms). Moreover, we found positive effects on sickness absence and sickness presence. However, significant changes in perceptions of health promoting leadership and wellbeing of employees after the intervention were found only in Germany. Throughout the study Swedish employees tended to have more positive perceptions of their leaders and higher levels of wellbeing than their German counterparts. Generally the evaluation revealed relatively small changes over time. Satisfaction with the intervention workshop appeared to have had no significant effect on the perception of health promoting leadership. Instead, a decisive factor was the size of the teams and larger groups generally reported lower levels of health promoting leadership. In summary results based on team member’s evaluations indicated that the project managed to reach the goal to change leadership in positive direction at least in Germany whereas results in Sweden showed no difference over time. There were also positive effects on some health indicators in Germany but not in Sweden. Reasons for the differences in countries could be a “ceiling effect” in Sweden with higher values from the outset. Furthermore, team size was considerably larger in Sweden. Implications: Results showing large differences between the two countries indicate that interventions cannot easily be transferred between countries. It seems critical to adapt both objectives and content to the local situation in the participating organizations in order to achieve positive outcomes. 31 Oral presentations JOHANSSON-PAJALA ROSE-MARIE Coauthor/s: Martin, L. Fastbom, Johan. Jorsäter-Blomgren, Kerstin A4 Affiliation: Mälardalen University, City University, London, United Kingdom, Karolinska Institutet and Stockholm University Title: Nurses’ self-reported medication competence in relation to their pharmacovigilant activities. Aim: To describe and evaluate nurses’ self-reported competence and activities in pharmacovigilance and the impact of a university course in relation to age, education, work place and nursing experience. Background: Prescription of potentially inappropriate drugs is highly prevalent and the issue of optimizing drug prescribing has become an important worldwide public health concern. To ensure safe use of medicines, the area of pharmacovigilance has been increasingly recognized. The World Health Organization states that education of health professionals is one action that must be taken, to improve safety in relation to utilization of medicines. Medication management constitutes a substantial part of nurses’ daily work and they are wellplaced to monitor and reduce drug-related morbidity. The importance of nurses’ pharmacovigilant activities in Sweden can be expected to increase due to newly launched regulations, imposing health care providers to offer a medication review to all patients 75 years or older, who are prescribed at least five drugs, or when drug-related problems may be suspected. Nurses are also imposed to report suspected adverse effects to the Swedish Medical Product Agency (MPA). Method/s: This cross-sectional study was based on questionnaires covering areas related to nurses’ medication competence and performance of pharmacovigilant activities, including detection, assessment, understanding and prevention of drug-related problems. A 45 item questionnaire was sent to 296 nurses working in different settings and counties in Sweden in 2013. They were selected on the basis of having applied to a university course including pharmacovigilance, during 2008-2011. 124 nurses (exposed) had participated in the courses and 172 (unexposed) had applied to the courses but not participated due to limitation in number of course participants or declining for other reasons. Findings: Completed questionnaires were obtained from 75 exposed (60%) and 93 unexposed (54%) nurses. Nurses rated themselves high in medication competence but low in pharmacovigilant activities. Significant (p≤0.001) differences between the two groups were observed in subjectively evaluated knowledge regarding pharmacokinetics, drug interactions, the meaning of pharmacovigilance and adherence. Significant differences were also found regarding assessment of drug interactions, to report adverse drug reactions to the MPA and to use drug interaction database. All differences was in favor of the exposed group. Age, work place, specialist nursing degree and additional courses in medicine/pharmacology did not change the significant association between exposure and self-reported medication competence. No significant differences were found between the groups regarding the number of performed pharmacovigilant activities during the last six months prior to answering the questionnaire. Implications: The results implies that dedicated academic education improved nurses subjectively experienced competence in pharmacovigilance up to at least 2-5 years after completed course, but did not increase the number of related activities. Education alone seems not be sufficient to generate pharmacovigilant activities among nurses. Nurses’ medication competence and activities are essential in detecting health changes and drug-related problems. Further studies are needed to explore elements affecting nurses’ pharmacovigilant activities in their daily meetings with the patients, such as interdisciplinary collaboration, organizational aspects, standardised reporting procedures and computer-aided support. 32 Oral presentations E5 KANASKAR MUKESH Coauthor/s: Mukesh Kanaskar Affiliation: Director- International, All India Institute of Local Self-Government Title: ‘Participatory Tools for Interactive Research into Heath & Social Welfare of Vulnerable Population in India and Developing Countries’ Coproduction partner/s: Primary stakeholders the subjects of researches, United Nations Population Fund (UNFPA), Government of India Aim: Discuss ‘participation’ as a key concept in interactive research related to vulnerable populations, understand ‘interactive research’ as a catalyst for transformation and generate inputs for research and policy. Background: This paper discusses ‘participation’ as a key concept vis-à-vis interactive research related to vulnerable populations referring to 3 diverse examples of researches conducted by the author as the Principal Investigator. It highlights ‘interactive research’ with vulnerable population as a catalyst for transformation. It narrates wide applications of participatory research tools (PRTs) through synthesizing Author’s learnings of developing customized PRTs as innovations. The paper traverses coproduction and mutuality as key features of research in multi-ethnic multi-stakeholder contexts. Method/s: The paper synthesizes methods in customized PRTs developed for following researches: 1. Impact assessment conducted for UNFPA of a government health program supported by UNFPA titled ‘Rapid Assessment of Adolescent Friendly Health Clinics in Maharashtra’. A key feature is gender segregated analysis conducted with adolescent girls and boys of 1) impacts and 2) future needs. 2. Policy facilitation study for Support to National Policies for Urban Poverty Reduction (SNPUPR), an initiative of Government of India supported by DFID: ‘Barriers to Urban Poor in Accessing Urban Services’. It assessed access of urban poor to relevant social welfare services vital for their health and survival. 3. Another policy facilitation study for SNPUPR: ‘Management and Maintenance of Tenements’ (MMT) in the context of slum redevelopment as among pioneering efforts to develop MMT as scientific body of knowledge. Findings: The customized development and administering of innovative PRTs could be effectively done in diverse research contexts: 1)impact assessment of a government health programme, 2)assessing access to social services of urban poor and 3)developing a new scientific body of knowledge. Use of PRTs enabled generate policy implications of significance for adolescent population of 253.2 mn in India and 1.056 bn in developing countries, urban poor population of 115.86 mn in India and 291.44mn globally, and slum population of 65.4 mn in India and more than 1 bn globally. The third study developed a global innovation of two methodologies for Self-Assessment and Planning by Community and Community Representatives. It received recognition of inclusion in the policy document published by Government of India and Oxford University Press titled ‘State of the Urban Poor Report 2013’. Implications: Regarding vulnerable, the paper discusses implications vis-à-vis: • Developing new customized PRTs e.g. visual tools for less literate communities • Crucial role of PRTs in identifying: ‘real’ vulnerable, ‘real’ issues, empowerment strategies and actions. • Ownership of findings among primary stakeholders they being participant to the study • Ensuring participation of deprived women and girls, gender segregated analysis unearthing gender inequities. • Do’s, don’ts pertaining to PRTs. • Generating inputs for research, policy and capacity building 33 Oral presentations KHUMSAEN NATAWAN Coauthor/s: Wassana Aoup-por, Darin Panasant, Purin Srisa-salak Affiliation: Boromarajonani College of Nursing, Suphanburi, Thailand Title: Health risk behaviors among adolescents in Suphanburi Province, Thailand B5 Background: Nowadays, health risk behaviors among adolescents have dramatically increased worldwide. In addition, adolescents initiate health risk behaviors earlier than last decade. Health risk behaviors among adolescents, including smoking behavior, aggression and violent behavior, and sexual risk behavior, are of interest of health care providers. Aim: This study aimed to investigate health risk behaviors among early adolescents in Suphanburi province, Thailand. Method/s: This study is a school-based survey. Public school students in ninth grade of randomly selected schools were recruited. A total of 555 students were obtained using a multistage cluster-sampling method. Data was collected using a set of questionnaires. Descriptive statistics were employed to analyse data. Findings: The results revealed that the students were 14-16 years of age. A mean age was 14.34 (SD=0.49). A majority of participants were male (56.90%). Approximately 12.1% of the respondents reported smoking behavior. Of them, 68.65 % reported daily smoke. The smoking place was in school (34.32%). The expense of smoking was less than 100 Bahts per month (22.6%). About one-third of the sample reported having been violated by peers (37.4%) using non-weapon (smack and punch 92.2%). The violence always took place in classroom (33.9%). About 13% of the participants reported having ever hurt others, including peers (36.1%) using non-weapon (smack and punch 83.3%). The violence always took place at the isolated place nearby schools (23.6%). The main cause of violence was ever been hurt and violated (27.8%). With regards to sexual risk behavior, approximately 9.2% of the sample reported having had sexual experience. The majority of sexually active participants reported that they initiated their first sexual intercourse at the age of 14. Among them, the youngest age of first sexual intercourse experience was 11 years. The major cause of engaging in sexual experience was to be curious about sex. The majority of first sexual partner was lover. During their sexual relationship, the participants always used condom. More than half of the sexually active participants (54.9%) usually and correctly used condom. Furthermore, most of the participants expressed that engaging in sexual relationship during their school age was unacceptable. Implications: The empirical knowledge obtained from this study provides a rationale for nursing practice to conduct nursing interventions to achieve a change in health risk behaviors among Thai adolescents. Moreover, this study makes the contributions to health policy, nursing research, and community-based practice. Keywords: Early adolescents, health risk behaviors, Suphanburi province, Thailand. 34 Oral presentations KUMPULA ESA Coauthor/s: Henrik Eriksson, Per Ekstrand, Maja Söderbäck C5 Affiliation: Mälardalen University, The Red Cross University College Title: “It depends on us” - Construction of gender, health and health promoting activities among Caregivers in forensic psychiatric care Aim: The overall aim of this project is to explore and describe the interaction between construction of health and gender in caregiver’s everyday work in Forensic psychiatric care. Background: Questions of health as a matter of equality is related to all settings of health care. An overlooked research question concerns the interplay between women and men as caregivers and the influence on health and activities of health promotion. Forensic psychiatric care in Sweden is a specialized field with a focus on safety and constitutes a specific institutional environment in health care in terms of gender and power relationships. Method/s: An ethnographic approach is used. Data collection was carried out from fieldwork of a period of approximately 250 hours, in two different settings in Forensic Psychiatric care. The fieldwork has offered a variety of sources for data collection: observations, field notes, diary notes, reflective conversations, pictures, focus group interviews, formal interviews and written material such as policy document or notes from staff meetings. Observations have been made by following caregivers in their everyday work in order to observe construction of health and of gender. Findings: Constructing of health and health promotion activities in forensic psychiatric care are explored not to be single issues that can be separated from patterns and structures in an environment influencing caregivers’ everyday life. The preliminary findings indicate that caregivers construct health in relation to rules and safety in a complexity of intersectional relations like gender, age, and class. An initial interpretation could be made that the view of health is involved with different power dimensions and carried out in this environment. As forensic psychiatric care is encircled by rules and regulations caregivers’ definitions of health and health promotion activities will be of practical importance for caring work. 35 Oral presentations MANASATCHAKUN PORNPUN Coauthor/s: Maria Sandborgh, Åsa Roxberg, Pluemjit Chotiga, Magareta Asp A5 Affiliations: Mälardalen University, Sweden Boromarajonani College of Nursing Udon Thani, and Chiang Mai Thailand Title: The relations between factors to healthy aging among the elderly in the northeast of Thailand Aim: The aims were to compare subgroups regarding perceptions of health related factors and to examine the factors associated with healthy aging. Background: Method The increasing in number of the aging population has been recognized worldwide as an important issue. Healthy aging is a key for improving health and preserving health in older people. In Thailand which is a developing country there are few studies about healthy aging. In a cross sectional study healthy aging among Thai elderly were described and explored in both rural and urban areas in the northeast of Thailand. 453 senior citizens aged 60 years old and over, who live in Udon Thani province participated. Datawas collected by using the questionnaire with two parts, the individual factors such as socio-demographic factors and the Healthy ageing instrument(HAI). The Mann Whitney U test, the Kruskal-Wallis test and the Multiple regression were used to analyze data in this study. Findings: The findings showed significant differences in healthy aging between the districts, levels of income, marital status, disability, and the meaningful in life. Elderly persons living in the city had a significantly lower score on HAI. Elderly who are single had the lowest score on HAI than other persons. The low income participants had the lowest score on HAI. The elderly who has the highest score on the meaningful in life had the highest score on HAI. The districts, levels of income, marital status, disability, and the meaningful in life were selected to be the predictors of healthy aging among elderly in this study. These 5 predictors can explain 23.4% of the variance of perceived healthy aging (Adjusted R2 = 0.234). Implications: In health promotion program strategies need to focus on the importance of these factors. Moreover, the future intervention targeting should cover the area where the elderly live, the marital status, the income level, and the meaning in their life. 36 Oral presentations MARTIN LENE Coauthor/s: John G Lawrenson A6 Affiliation: Mälardalen University, City University London, UK Title: Screening for age-related eye diseases in the ageing population Aim: To compare three models for large-scale screening for common age-related eye diseases, i.e. macular degeneration, glaucoma and diabetic retinopathy with regard to sensitivity, specificity and the different welfare systems in three countries. Background: According to the WHO, the main causes of visual impairment in industrial countries are agerelated macular degeneration, diabetic retinopathy and glaucoma. Even though these diseases are all, more or less preventable and can be treated, within a few years more than 200 million people worldwide will be bilaterally blind from these diseases. In relation to this we can foresee great challenges including an increasing number of old people, an increasing awareness in the population about the importance of good vision and eye diseases, and a strain on resources since chronic diseases means life-long management. Health care professionals, such as community optometrists/opticians can screen for age-related eye disorders using modern non-mydriatic fundus cameras and automated perimeters. Such screening is performed in England, Scotland and Sweden, with different principles regarding organization, cost for the patient and evaluation of examination results. The Swedish screened subjects pay for the service, in Scotland the screening examination is subsidized by the NHS and in England it is subsidized for subjects over 60 years of age and groups at higher risk of disease. Hence, there are differences between the three countries regarding cost for the patient, evaluation of the test results and access to conventional eye health care. Method/s: In Sweden, data sets are available from more than 35 000 screening procedures in more than 25 000 subjects. In England an on-going study has gathered data from 800 subjects. Data from a similar set-up in Scotland will also be analysed. Findings: In Sweden ICD-10 codes were recorded in all 35 000 examinations. The most common code (56%) was “Examination of eye and vision”. The second most common diagnosis (21%) was “Suspected disease, but no diagnosis confirmed”. More than every fifth patient has undergone repeated screening(s). 6.5% of all examined subjects were referred to conventional eye care. The most common codes among these were “chorioidal and retinal diseases” (which includes diabetic retinopathy and age-related macular degeneration) and “glaucoma”. A survey was performed of 123 randomly selected referral responses. In 121 (98.4%) cases the subjects had been recommended treatment or follow-up at the clinic. Similar analyses are under way from England and Scotland. Implications: The Swedish screening system, paid for by the examined subject, with examinations performed in optician’s shops and findings evaluated by ophthalmologists, detected the expected proportion of agerelated diseases with high sensitivity. The comparison with screening systems in England and Scotland will provide information about the influence of different welfare systems, organization, access to conventional eye health, and examination methods on the outcome of screening. 37 Oral presentations SUSANNA SANDELIUS Coauthor/s: Anne-Cathrine Mattiasson, Anna Carin Wahlberg D6 Affiliation: Karolinska Institute, Department of Neurobiology, Care Sciences and Society Title: The “Rolls Royce” of telephone nursing. Telephone nurses‘ experiences of monitoring calls in children with gastroenteritis Aim: The aim of this study was to describe telephone nurses’ experiences of monitoring calls in telephone advice nursing, in children with gastroenteritis. Background: Several studies show that a common reason for calling a telephone nurse is gastroenteritis symptoms in children. In these kinds of calls clinical experience shows that monitoring calls are regularly used by telephone nurses. A monitoring call is a follow-up call from the telephone nurse to the care-seeker in order to follow up given advice and make a new assessment. Swedish Health Care Direct (SHD) measurement for patient satisfaction 2013 describes monitoring calls as the most appreciated action, but under what circumstances monitoring calls are used is not explored. Method/s: Sixteen telephone nurses were interviewed in April and May 2013. Since the area is unexplored, a qualitative interview method with an inductive content analysis was used. Findings: Preliminary results in this study show that telephone nurses experience monitoring calls as a way to make parents feel safe while caring for their sick child at home. The call mitigates the sense of anxiety that some parents experience while performing self-care. The telephone nurses also want provide a convenient service to parents, to relive them from calling again and ending up in a telephone queue, and to be able to stay at home instead of going to the hospital, especially when they live far away from the hospital. The telephone nurses also expressed that monitoring calls were about patient safety, to check that the given advice was correct and that the parents understood it correctly. The monitoring call was also perceived as a learning situation, both for the parent and for the telephone nurse. The parents became empowered to perform selfcare in the future and for the telephone nurse receiving feedback on the advice given and thereby assuring the quality of the advice. The telephone nurses thought that performing monitoring calls was a way to be cost effective, and preventing unnecessary health care visits. But the same time the services was perceived as expensive since the call center does not receive cost recovery or payment for outgoing calls. 38 Oral presentations NORFJORD ZIDAR MARIA Coauthor/s: Per Tillgren, Peter Larm, Sharareh Akhavan D5 Affiliation: Mälardalen University Title: Non-Participation in mammographic screening related to area-level socio-demographic factors Mapping, describing and analyzing - area specific data on municipality level, in a county in Mälardalen Author/s: Maria Norfjord Zidar, Sharareh Akhavan, Peter Larm and Per Tillgren Aim: Analyze the non-participation in relation to the area-level socio-demographic variables, by using a register for invitation to mammographic screening. Background: Breast Cancer is the most common type of cancer in women and studies have shown a decrease in mortality for the women participating in screening. The participation rate in mammographic screening for year 2012 in a county of Mälardalen was approximately 82 %, and aligned with the national target of a participation rate of at least 80 %, however the participation rate within the county may differ, and is of interest to investigate as research has found that Health Care seeking and utilizing is influenced by socio-demographic factors (foreign-born, marital status, educational level, occupation, social status and geographical location). By using register data for invitation to mammographic screening factors such as age, participation rate and geographical residence can be investigated and further explored in relation to areaspecific socio-demographic data for instance unemployment rate, share of foreign-born persons, income, and level of education. This corresponds to the aim in Study I of the project Inequity in Health Care Accessibility and Participation in Mammographic Screening. Based on these results and in collaboration with the practitioners at the mammographic screening unit, more targeted interventions may further be designed. Method/s: Conduct a cross-sectional and a longitudinal register study covering the years from 2001 to 2012. The procedure of analysis: Step 1. Analyzing the variables non-participation, years, age, postal code. Step 2. Further scrutinizing the data with relation to socio-demographic variables at area level. Findings: Preliminary indications show variation in non-participation rate in mammographic screening over the years, indicating that age and geographical location may explain non-participation in screening. For the municipalities with the highest participation rate (84,7%), and in comparison with the lowest rate (71,8%), the mean age between these two municipalities differed by approximately three years, where the older age was more inclined to participate in mammographic screening. The mean age for the municipality with the highest participation rate was 58, 6 years where as for the municipality with the lowest rate displayed a mean age of 55 years. In addition to age, preliminary indications also showed that the distance to the mammographic screening unit may also be a factor for non-participation, however further investigations will explore these questions. Specific socio-demographic characteristics for the municipalities which display the highest and lowest participation will be examined as well as the trend of participation in mammographic screening within different municipalities. Implications: The findings will contribute to knowledge in regard to area-related socio-demographic factors connected to participation in mammographic screening and will serve as a basis to develop approaches and interventions, in collaboration with practitioners on the field, to further reach potential participant in mammographic screening. 39 Oral presentations PITTARD BENJAWAN Coauthor/s: Pitchawee Sinsawad C6 Affiliation: Boromarajonani College of Nursing, Ratchaburi, Thailand Title: Being Nurse Managers: Reflective Practice in Nursing Administration Praxis Aim: This qualitative study aimed to explore with nursing students their reflections on "being nurse manager" within the nursing administration praxis environment. Background: Nursing is a complex profession requiring careful attention on many aspects. Additionally, globalization and rapid changes around the world in the 21st century also affect nurse managers to think critically and provide their clients appropriate nursing service. Therefore, training nursing students to be competent nurse managers of the future needs reflective practice to assist them identifying their management issues and working through them. Method/s: Grounded theory was used as the methodology. Data were collected from 32 4th year nursing students who were training on nursing administration praxis at 16 different wards nearly the end of semester 2, 2012. Participants were divided into four small groups which composed of eight participants from four different wards. Each group joined an hour focus group reflecting their experiences of being nurse manager while having nursing administration praxis. Taylor's reflection model (REFLECT model: practical reflection) was taken to run those focus groups. The focus groups were audiotaped for verbatim transcription. A manual method of thematic analysis was used to find codes, categories, and to generate a grounded theory. Findings: The results showed that nursing students reflected "Being nurse manager" practically in terms of selecting knowledge, framing essential characteristics, emerging obstacles and blooming ways of achievement. As nurse managers, they chose the best knowledge carefully to work ordinarily and solve the problems specially. During that time, they framed essential characteristics of nurse managers and classified into joint and additional characteristics. Surprisingly, those characteristics related to Thai Qualifications Framework for Nursing Science programme. They acknowledged inner and outer obstacles which emerged and delayed their achievement. Furthermore, they reported that their ways of achievements bloomed gradually from the strong supports of gaining knowledge, attitude and skills after two week of administration praxis. Implications: The findings make recommendations for faculties and nurses for any co-operations related to training nursing students and help them to reach the graduates' competencies within the environment of nursing administration praxis. Faculties should re-arrange their teaching methods and encourage students to make a proper knowledge bridge for crossing the gap between theory and practice confidentially. In addition, they should reflect students frequently during the praxis period which will help the students to handle the learning obstacles. Moreover, those findings increase student awareness and promote the creation of personal meaning of one's reactions, values, and premises in the context of being better nurse manager in the future. 40 Oral presentations RAMSTEN CAMILLA Coauthor/s: Christine Gustafsson, Ingrid Snellman, Kerstin Göransson E6 Affiliation: Mälardalen University Title: ICT and intellectual disability: A survey of the organizational support on municipality level in Sweden Coproduction partner/s: Nyköping municipality Aim: The aim was to map how municipal organizations in Sweden organized the support for use of information and communication technology in social care for young adults with a mild to moderate intellectual disability from a social participation perspective. Background Social participation among young adults with a mild to moderate intellectual disability is markedly lower than in the general population. A small social network, low participation in cultural, recreational and societal life increases the risk for social isolation. Information and communication technology (ICT) can be a tool for social participation as it creates possibilities for maintaining social relations, deepen own interest and get information about the surrounding society. Inaccessibility to ICT also creates a new social welfare inequality, the digital divide. Young adults with a mild to moderate intellectual disability is a neglected group in research, especially outside the school or occupational context and therefore, need to be acknowledged. The project is conducted in collaboration with Nyköping municipality. Method/s: A survey including all municipalities in Sweden (n=290) was conducted. A questionnaire was designed to cover several aspects of support for use of ICT and social participation. The questionnaire originally entailed 22 questions. The questionnaire was sent per e-mail to one person working with development or manager within municipal social care for people with disabilities. The respondents were chosen based on previous contact with each organization where a respondent were identified. Questions were asked about which prerequisites existed for use of ICT for young adults with a mild to moderate intellectual disability. The response rate was 51 percent (n=147). Findings: Preliminary results indicate that support for use of ICT for young adult with a mild to moderate intellectual disability is a low-prioritized question in municipal social care in Sweden. The majority has no specific strategy for this and ICT tools are only offered in a few municipalities. Of those municipalities who had participated in a project to promote use of ICT, most projects were conducted in day care services rather than in residential care. Overall, there seem to be a more conscious work with ICT in day care service than in any other activities. Implications: The survey indicates that knowledge about ICT for young adults with a mild to moderate intellectual disability is needed. There is also a requested need for information about projects in other municipalities, new ideas and environment that show different kind of ICT tools. 41 Oral presentations RANHEIM ALBERTINE Coauthor/s: Maria Harder, Maja E7 Söderbäck Affiliation: Mälardalen University Title: Facilitating young children’s participation in health care situations Aim: The overall aim of the project is to facilitate young children’s participation in their health care situations Background: An initiative was given to perform a collaborative research project with health practices in Sörmland on facilitating young children’s participation in health care situations. Departing from workshop with healthcare professionals conveyed that it is an ambiguous challenge to be in care situations with children since each situation depends on its participants; the child, the parents and the professionals. These findings were used in reflective forums to integrate theory and practice to broaden the professionals’ awareness of the child’s perspective in care situations. The project is inspired by a clinical application research (CAR) design, where scientifically trained researchers work with health care professionals, building a team to exchange experiences related to data collection, interpretations and the applicability of the results. The use of research involves a process of learning as well as engaging beliefs and actions, and these questions are foundational for the practice of clinical care. Such approach aims at facilitating the use of research in clinical practice, to reduce the eventual gap between theory and its practical application. Method/s: The CAR design involves understanding, interpretation and application. This means reflecting on care situations and being confronted with assumptions from theoretical perspectives as well as training an openness and awareness in caring encounters. The team work is in a continued progress and will last during 2014. The data analysis will then proceed. Findings: Some preliminary result will be presented about the process and outcome of the clinical application research. Implications: This study may contribute to the stock of knowledge regarding the implementation of an interactive communicative device with the purpose to facilitate young children’s participation in their health care situations. 42 Oral presentations RUANGDEJ KANNIKA CHAOSUANSREECHAROEN Coauthor/s: Paiboon Chaosuansreecharoen A7 Affiliation: Sirindhorn College of Public Health, Trang Title: Impact of the Elderly Club on Quality of Life of Elderly in Three Southern Border Provinces of Thailand Aim: This study aimed to measure the quality of life (QoL) among elderly in elderly club of three southern border provinces and to identify its some determinant factors. Background: The insurgence of violence in three southern border provinces of Thailand that began in January 2004 is directly or indirectly affecting the lives of up to a million elderly living in Narathiwat, Pattani, and Yala. The violence included bomb attacks and daily killings of state officials and local villagers. Currently, the violence has increased in complexity, frequency and severity. Thai Government is concerned with providing for sustained social welfare for the aging population. The government implemented a policy of elderly club in all sub-districts, places where older persons in the local area can gather and enjoy social activities. Thus, it is believed that the elderly club is one strategy to improve well-being among elderly living in three southern border provinces. Method/s: This was cross-sectional survey of a random sample of members of active elderly club in three southern border provinces. The constructively QoL was measured on economic, social, environmental, health, and attitudinal domain. The study participants were interviewed at their elderly clubs. Descriptive statistics were used in this study. Uni-variate analysis was performed for group comparison and Pearson product-moment correlation coefficient was utilized to determine the existed correlation between the dependent variable and the following independent variables. The analytical procedure of stepwise multiple regressions were conducted to predict QoL determinant. Findings: The results revealed that elderly who were member of an activity elderly club in three southern border provinces showed high level of QoL (Economic domain = 54.4%, Social domain = 76.8%, Environmental domain = 97.6%, Health domain = 69.6%, Attitudinal domain = 94.4% and Total QoL = 86.8%). The stepwise multiple regression analysis indicated that the best fit model included six predictors of frequency elderly club participation, having money saving, social capital on social network domain, life satisfaction and happiness, age and feeling of safety from violence. All six predictors could explain 54.5% of the variance of QoL. Of the six predictor variables, a stepwise multiple regression analysis indicated that frequency elderly club participation was most strongly related to QoL. The feeling of safety from violence was the most weakness related to QoL. Implications: The result has shown that active members have higher QoL than non-active members. Thus, the community must recognize the value of nurturing the well-being of the elderly in order to maintain an active club that enhances the quality of life of the elderly in the three southern border provinces. Keywords: Quality of Life, Elderly Club, Three Southern Border Provinces of Thailand. 43 Oral presentations SELLIN LINDA Coauthor/s: Tuula Wallsten, Lene Martin,Lena Wiklund-Gustin D2 Affiliation: Mälardalen University, County Council of Västmanland Title: Development of suicide prevention based on a lifeworld perspective Coproduction partner/s: Västmanland County Council Aim: This study aims at describing what suicidal patients experience as promoting health, and thereby creating a base for development of nursing care. Background: The prevalence of suicide indicates that people can experience life as too unbearable to deal with. Studies have shown that the majority of suicidal patients who have survived, don´t regret afterwards to still being alive. Suicide based research has in high degree focused on security issues and risk assessment. In contrast, research concerning what promotes health and well-being is sparse. A one-sided focus on risks in the patient´s care, can increase suicidal patients´ experience of stigma and powerlessness. Accordingly, it is necessary to outline understanding of suicidal patients´ health processes, as a profound way to emphasize patients´ perspective in suicide prevention. Indeed, suicide prevention needs to be able to support vulnerable peoples´ experience of being valuable and capable. Method/s: A lifeworld phenomenological approach intends to describe the essence of phenomenon related to human existence. Emphasis on peoples´ lived experience of being within the world is here of significance. The approach can benefit knowledge development on how suicidal patients understand their situation, and which factors that may facilitate the understanding of life as worth living. Data is collected through meaningoriented interviews with suicidal patients, who are recruited from a psychiatric emergency department. Open questions encourage reflection and support participants’ narrative about their experiences. On the basis of a phenomenological analysis, the essence of the phenomenon, and thus what is experienced as health promoting, can be illuminated. Findings: Analysis of the interviews will be conducted during summer 2014. Preliminary results will be presented at the conference. The method’s contribution for vulnerable peoples´ experience will be exemplified. The ethical considerations in sensitive research will be made explicit. Implications: Suicidal patients´ experiences are expected to be a resource for knowledge development regarding suicide prevention. This refers to an epistemology that intends to uncover the world the way it is experienced by people, and consequently, the question of meaning is vital. The method´s capacity to honour the complexities of suicidal patients´ experience will be discussed. The possibility to use the results as a basis for nursing interventions will be problematized. 44 Oral presentations SITANON THONGSOUY Coauthor/s: Maja Söderbäck B6 Affiliations: Phrapokklao Nursing College Chantaburi, BNC Title: Parents’ health literacy and their experiences of participation in their child’s care during hospitalization Background: Parents’ health literacy is an important key factor that influences how they are able to understand their child’s health status and needs, and how to participate in the care when their child needs to be in hospital. Parents are the most important care givers, who facilitate ongoing growth and development of their children, giving protection and support. How well parents are able to care and support their child’s care will be influenced by their health literacy. Health literacy and experiences of participation is cultural sensitive. Parents’ experiences of participation in their hospitalized child’s care are not earlier investigated in Thailand, as in other international studies. Aim: The aim of this study is to explore parents’ health literacy and their experiences of participation in their child’s care during hospitalization. Method/s: A descriptive qualitative research design is used. The study is conducted in four pediatric units at Phrapokklao Hospital, a central hospital in Chanthaburi, Thailand. Thirty Thai parents, whose children stay in the pediatric units, were invited to participate.. A demographic data sheet was used to obtain background information on the characteristics of the parents. A semi-structured interview guide with open-ended questions were used in the interview. The questions included general questions to grasp parents’ health literacy, and specific questions experiences of participation in the child’s care. A content analysis, developed by Graneheim and Lundman, was used. Consent was given by the Ethical committee in Chanthaburi Province, Thailand. Findings: The study is ongoing but preliminary findings will be presented as generated concepts of the Thai parents’ health literacy, as well as generated categories of parents’ experiences of participation in the child’s care. Clinical implications. Health care providers need to understand parents’ health literacy to improve strategies to facilitate the parents’ rights of participating in the care of their children. 45 Oral presentations SJÖMAN MADELEINE Coauthor/s: Lena Almqvist, Mats Granlund B7 Affiliation: Jonkopings University, Mälardalen University Title: Teachers and children's interactions in Swedish preschool settings as mediating factor between engagement and children´s externalizing behavior Coproduction partner/s: Jönköping Municipality, Sweden Aim: The aim was to investigate positive interaction processes in preschool as a mediator factor between behavior problems (hyperactivity and conduct problems) and the two types of engagement, core and developmental engagement. Background: Studies have shown that children who are positively engaged in preschool activities gain in cognitive self-regulation skills and academic achievement (Corapci, 2010; Fuhs, Farran, & Nesbitt, 2013; Williford, Whittaker, Vitiello, & Downer, 2013). Nevertheless, behavior problems may refrain the child from being engaged in learning activities in preschool and can work as a barrier for children’s possibility to participate in social situations (Buhs, Ladd, & Herald, 2006; Nurmi, 2012). Children´s engagement and behavior problem need to be defined in relationship to the context and depends both on the individual child´s characteristics i.e. behavior, temperament, gender, biological age, cognitive level, and on social processes i.e. interaction with peers and teachers (Birch & Ladd, 1997; Beijers, Riksen – Walraven, Putman, De Jong & De Weerth, 2013; Ewon, Olson, and Sameroff, 2013) and the child´s earlier experiences. It also depends on the time spent in proximal processes, more precisely how often the child is actively engaging in activities in the environment e.g. preschool environment (Bronfenbrenner & Evans, 2000). However, studies designed to explicate the interrelationships among these child behaviors is lacking. This research focuses on children’s engagement behavior and externalizing behavior problems (e.g. conduct problems and hyperactivity) and interaction processes in preschool settings. Method/s: The present study use a non – experimental design with questionnaires, responded by the preschool teacher, about children´s engagement, behavior problems (e.g. conduct problems and hyperactivity) and interactions processes (e.g. teacher - child interactions and peer group – child interactions). The sample is based on 663 children (340 boys) at age of 18 – 64 month, in 81 preschool units in six different municipalities in Sweden, includes metropolitan and urban areas. The study has a variable oriented approach (Bergman & Trost, 2006) and use a path analysis to investigate the relationship between behavior problems and engagement, and how interaction processes can work as mediating factor between behavior problem and engagement. Findings: The preliminary results shown negative relationship between hyperactivity and both core and developmentally engagement. Moreover, conduct behavior problems were not significantly related to the different types of engagement. Mediational analyses, however, showed a significant indirect effect of behavior problems (hyperactivity and conduct problems) through both positive teacher-child and child-child interaction to core and developmental engagement. The result indicate how positive interaction processes can promote engagement of children with behavior problems. Implications: The study indicate that especially hyperactivity behavior could be a barrier for children´s possibility to be positively engaged in preschool activities. Nevertheless, positive peer interactions and teacher responsiveness will encourage the amount of time the child will be engage in different activities in preschool and behavior problems will consequently decrease. This implicate the need to attend to positive interactions in preschool rather than disapprove children´s behavior problems. More research is needed, however, about different teaching strategies to support children's positive interactions and engagement in preschool. 46 Oral presentations SRIYASAK ATCHARAWADEE Coauthor/s: Elisabet Häggström-Nordin Anna-Lena Almqvist, Chaweewan Sridawruang B8 Affiliation: Mälardalen University, Prachomklao College of Nursing, Phetchaburi province, Thailand and Boromarajonani College of Nursing Udon Thani, Thailand Title: The father role: A comparison between Thai teenage and adult first time fathers Aim: This study aimed at comparing the perceived father role among teenage and adult first-time fathers in a West region of Thailand. Background: The transition to the father role is a significant change impacting on physical and psychological health for a first time father. Fathers must make major psychosocial changes in order to adapt to their new role. Teenagers face double doses of stress as they are confronted with not only the transitions and challenges associated with fatherhood, but also with those associated with a normal teenage development. Thailand is facing an increased birth rate among teenagers, from 13.4% in 2007 to 14.3% in 2011 (Ministry of Social Development and Human Security [MOSDHS], Thailand, 2011), which reversed the national campaign to reduce the birth rate to less than 10% (MOPH, 2012). Knowledge and understanding about differences between how teenage and adult first time fathers construct their roles is limited in the existing literature, therefore this study intends to make a contribution. Method/s: The design was cross sectional and comparative, the sample involved seventy teenage and seventy adult fathers, whose infants were 2-6 months old. The fathers were recruited from 32 Primary Health Care Centers in one province of the west region in Thailand. Three validated self-reported questionnaires with multiple-choice questions were used for data collection. Differences between the two groups were analysed using Chi-square and Mann Whitney U- test. Findings: The results revealed differences between teenage and adult fathers concerning their income, educational level, and their intention to have a baby. The teenage father group had a lower sense of competence, scored lower on the childrearing behavior-, and the relationship father and child questionnaires, compared to the adult father group. Implications: To prepare teenage first-time fathers, it is important that health care providers include fathers during both antepartum and postpartum periods to discuss and promote childrearing skills in order to have a smoother transition into fatherhood. Strengthening skills of male teenagers to negotiate to safe sex, in order to prevent unintended pregnancies and accomplish changed attitudes towards teenage parenthood, are also important areas to develop. 47 Oral presentations STIER JONAS Coauthor/s: Helena Blomberg C7 Affiliation: Mälardalen University Västerås and Eskilstuna Title: Co-producing a social problem: abusive leadership in Swedish national level gymnastics Aim: This study problematizes and discusses the heated media-debate during the year 2012 of what was depicted as abusive leadership at the national team level of gymnastics in Sweden. Empirical data are made up by articles published between January 14th 2012 and January 23rd 2013 in the largest Swedish daily newspapers, Dagens Nyheter. Theoretically and methodologically the study takes a discursive approach as its point of departure. Thus, it is presumed that media influences and sustains our notion of the world, other people and ourselves – but also produces versions of reality and unavoidably exclude alternative versions. Method/s: Moreover, the study analyses how language is utilized to pursue social actions and how different actors express their views on the leadership in national level gymnastics. Focus is on what the media conveys and how different truth statement are constructed and legitimized by different actors – e.g. gymnasts, coaches and parents. Findings: Results show how actors involved in the debate put forward accusations and defensive arguments in terms of the classical discursive dichotomy of perpetrator and victim. It is concluded that the predominant media dramaturgy is instrumental in co-producing something as a social problem. Apart from victims, perpetrators and experts, it is also concluded that media is a crucial actor in the co-production of social problems. 48 Oral presentations STÅLBERG ANNA Coauthor/s: Anette Sandberg, Thomas Larsson, Maja Söderbäck B9 Affiliation: Mälardalen University Title: Young children´s (3-6 years) perceptions of care situations including medical examinations and needle procedures Co-productions partners: Nobab, County council of Sörmland, Quicksearch, the Swedish Heritage Fund Aim: To explore and describe young children´s perceptions of being in care situations, including medical examinations and needle procedures. Background: Research shows that children express a wish of active involvement in care situations. Barriers for involvement are found to concern weak health literacy among the young children. Young children have limited opportunities to access, comprehend and communicate information on health issues. Further there is a lack of knowledge of the child´s own perspective in perceiving the care situations. Method/s: A phenomenographic inspired approach with interviews and observations was conducted to explore children´s perceptions through their verbal and non-verbal expressions. Findings: The outcome space describe four areas of the children’s perceptions: about myself, about parents, about professionals and about the specific care situation. Myself was understood as being both as main and co-actor. Feelings evoked by the situation were described. Parents were perceived as being present and close. The professionals were understood as actors in care procedures and as different types. The specific care situation was perceived by the body in focus, by being in a different environment and by receiving a benefit. Implications: The young children´s perspective, by describing their varied perceptions in a care situation, will improve and support the professionals’ interactive communication and enable joint understanding in a care situation. 49 Oral presentations SUNDLER ANNELIE J Coauthor/s: Jessica Höglander. Hilde Eide, Inger K Holmström D9 Affiliation: Mälardalen University, University of Skövde, Buskerud University Collage, Norway. Title: P-C-old: Person-centered communication in the care of the elderly – a research based inter national platform for education, research and practice Aims: This project includes three phases, and the research aims in these phases are to: • Analyze authentic communication in home care services from a person-centered perspective • Develop and evaluate interactive simulated educational training for person-centered communication • Develop an international platform for research and education on person-centered communication. Background: The focus of this research project is the communication in encounters between care providers and elderly persons in home care services. Central challenges for health care providers in home care are the complexity of the care and communication situations. To increase older peoples’ participation and to improve the care of older people in home care more knowledge is needed on how to facilitate person-centered care and communication. Communication is regarded as a basic competence in health care and it is a cornerstone of caring encounters. High quality care has also been closely linked to person-centered care. Care providers use communication to explore a patient’s situation, and patients express symptoms and health concerns through communication. Little is to date known about the communication of the caring encounters that take place in the homes of elderly people, what the communication is about, and whether it is person-centered and effective. In this presentation we will present the research program that still is in an initial stage. Design and method: The first phase of the project has a descriptive and comparative design. Verbal and nonverbal communication, communication patterns and challenging communication situations, will be investigated. The second phase has a quasi-experimental design with a mixed method approach. In this phase, an interactive simulated educational intervention will be developed and tested. The third phase contains the development of an international research-based platform for person-centered communication with elderly persons. The program is part of the international project on “Person centered communication with older persons in need of health care. Development of a research based education platform”, led by Professor Hilde Eide, Buskerud University Collage, Norway, and based on collaboration between educators and researchers in Norway (Buskerud University Collage and Ahus), Sweden (Mälardalen University), Netherlands (NIVEL) and the United States (Johns Hopkins University and the University of Chicago). 50 Oral presentations SURIYA CHUTIKARN Coauthor/s: Nongyao Kasatpibal, Wipada Kunaviktikul, Toranee Kayee D8 Affiliation: Chiang Mai University Nakornping Hospital, Chiang Mai, Thailand Title: Development of a simplified diagnostic indicator scoring system and validation for peptic ulcer perforation in a developing country Aim: To perform and confirm a simplified diagnostic indicators scoring system for predicting peptic ulcer perforation (PUP). Method/s: A case–control study was conducted including 812 consecutive patients with PUP from retrospective medical records. Each diagnostic indicator measurable at the time of admittance was analyzed by a multiple regression. Stepwise logistic regression was applied with backward elimination of statistically significant predictors from the full model, with P $ 0.05 for exclusion. The item scores were transformed from regression coefficients and computed to a total score. The risk of PUP was interpreted using total scores as a simple predictor. This system was internally validated in 218 consecutive patients and compared to existing systems. Findings: A PUP risk score was determined from the diagnostic indicators associated with PUP: gender, age, nonsteroidal anti-inflammatory drugs used, history of peptic ulcer, intense abdominal pain, guarding, X-ray free air positive, and referral from other hospitals. Item scores ranged from 0–6.0 and the total score ranged from 0–34.0. The area under the receiver operating characteristic curve shows that there was 91.73% accuracy in the total scores predicting the likelihood of PUP. The likelihood of PUP among low risk (scores ,10.5), moderate risk (scores 11–21), and high risk (scores ≥ 21.5) patients was 0.13, 11.44, and 1.95, respectively. Conclusion: This scoring system is an effective diagnostic indicator for identifying the complex cases of PUP. It is a simple system and can help guide clinicians, providing them with a more efficient way to accurately subgroup patients while also reducing potential biases. Keywords: Peptic ulcer perforation, risk scoring, prediction. 51 Oral presentations SÖDERMAN MIRKKA Coauthor/s: Sirpa Pietilä Rosendahl A8 Affiliation: Mälardalen University Titel: Caring for the ethnic elders suffering from dementia – experiences of nursing staff Aim: The aim of this study was to describe and compare the experiences of nursing staff caring for ethnic elderly persons suffering from dementia in an ethnic care setting and a Swedish-speaking care setting. Background: The numbers of ethnic elderly persons who speaks only their native language and are suffering from dementia are growing. As the dementia progresses into its´ advanced stage the person suffering from dementia first loses the second language and later the native language and needs to be admitted to institutional care. In some municipalities in Sweden ethnic elders suffering from dementia receives care in an ethnic care setting where the persons` native language is spoken, but most ethnic elders suffering from dementia receives care in Swedish-speaking institutions. In terms of communication this may be a challenge for the nursing staff. Method/s: The study has a qualitative approach with 27 semi-structured interviews. Data consist of 12 interviews with Finnish-speaking nursing staff working in a Finnish-speaking group home for persons suffering from dementia in Sweden and of 15 interviews with nursing staff working in Swedish-speaking group homes caring for non-Swedish older persons with dementia. The material is analysed with qualitative analysis. Findings: The experiences of the nursing staff showed that caring for the patients in a Finnish-speaking environment meant that they could communicate with the patients in their native language, which in turn stimulated the cognitive, physiological and social abilities of the person with dementia. Besides the language, the Finnish-speaking nursing staff also included cultural aspects such as Finnish music, food and media into the daily life in the care. The nursing staff in the Swedish-speaking group homes, perceived that all patients received equal basic care, but as they did not speak the patients` language communication was limited The language barrier resulted in behavioural disturbances at times in the non-Swedish patients with dementia. Implications: The two types of care settings were compared and besides a mutual language, the bilingual staff in the Finnish-speaking group home were able to include more of the cultural aspects which all together contributed to a sense of homeness for the Finnish elders with dementia. The care in the Swedish-speaking group homes was considered good and equal, but was also experienced as limited and frustrating by the Swedish-speaking nursing staff. Other strategies to communicate with the patients had were used and which will be further discussed. Keywords: Bilingual nursing, dementia, ethnic elders, qualitative. 52 Oral presentations THUNBORG CHARLOTTA Coauthor/s: Von Heideken Wågert Petra, Götell, Eva, Ivarsson, Ann-Britt, Söderlund, Anne A9 Affiliation: Mälardalen University, Västerås, Sweden and Örebro University, Sweden Title: Development of a new assessment scale measuring interactional transfer related behavior in dementia care dyads Coproduction partner/s: Attendo Care Aim: The overarching aim of the study was to develop a new assessment scale for the measurement of interactional transfer related behavior involving dementia care dyads at special care units. The ultimate purpose for the assessment scale was to be able to identify problematic person- and environment-related biopsychosocial factors related to daily person transfers, which could then be positively influenced by treatment strategies in these daily transfer situations. Background: Interactional transfer related behavior in dementia care dyads can be seen as complex integration of physical abilities, environmental conditions, and personal factors. Understanding of these daily person transfers imposes need of an observational assessment scale by proxy reporting the daily person transfers. Method/s: A conceptual framework for the new assessment scale was developed based on the literature, expert opinions video observations and feasibility test of dementia care dyads performing daily person transfers at a special care unit. Classification of behavior in dementia care dyads was based on key domains from the biopsychosocial model. Items should therefore cover the whole range of aspects that could be of importance when performing interactional transfer related behavior in special care units. Findings: The initial list of 92 items was reduced to17 items covering biopsychosocial aspects of interactional behavior in daily person transfers at dementia special care units. In the final outline of the assessment scale, eight items reflected the person with dementia’s transfer related behavior and nine items reflected the caregiver’s transfer related behavior. The items are rated between 1 and 7 with anchor points on a numeric rating scale. The score range of the person with dementia area can be 8-56 and the caregiver area can be 9-63 points. Lower scores indicate higher ability to perform interactional transfer related behavior in both areas. Implications: Daily person transfers are one of the most critical daily activities at dementia special care units. In order to investigate problematic daily person transfers and introduce measures, assessment scales with good psychometric characteristics are needed. The new assessment scale pinpoint critical biopsychosocial aspects of interactional transfer related behavior involving dementia care dyads and will be further tested for psychometric preferences. 53 Oral presentations WOJNAR DANUTA Affiliation: Seattle University, College of Nursing, USA B1 Title: Effects of Miscarriage on Lesbian Couples: a Prospective Mixed Methods Study Coproduction partner/s: Funding of $25,000.00 US was obtained from J. Sinegal Foundation Aim: The aim of this presentation is to share findings from a prospective mixed methods study that investigated effects of miscarriage on lesbian couples’ grief and depression in the first six months after pregnancy loss. Background: In recent decades between 1.5 and 5 million women who self-identify as lesbian have become mothers in the USA. Approximately 30-50% of lesbian versus 25% heterosexual women conceptions end in miscarriage, an unexpected pregnancy loss prior to the point of fetal viability. Qualitative studies conducted with lesbians who miscarried suggest that they may be at increased risk for emotional disturbances because their experience of loss is compounded by the complexities of planning and achieving pregnancy, uncertainty surrounding pregnancy outcomes, and overall low social support for their choice to become parents. National Institutes of health (NIH) in the USA are committed to addressing the unique health care needs of lesbian population by increasing research in this area. There is no published research that investigated the effects of miscarriage on lesbian mothers and their partners. For lesbians, health care to be appropriate, the scope and nature of their health issues must be better understood. Method/s: Ethical approval for protection of human subjects was obtained from the IRB at the investigator’s study site. This was a prospective mixed methods design study. To attain a statistical power of 0.80, significance criterion alpha =.05 and moderate effect size (r=0.3), and to allow for 25% attrition, the researcher attempted to recruit a non-random sample of 86 lesbian couples (172 individuals). After two years of recruitment a sample of 69 couples (138 women) was obtained and included in the analysis. Wojnar, Swanson, and Adolfsson (2011) Miscarriage Model provided theoretical framework for the investigation. At 12, 16, 24 weeks post loss participants completed and electronically returned to the study: Qualitative, narrative description of feelings about pregnancy loss; Supportive Behavior Inventory (SBI); Caring Other Scale (COS); Caring Professional Scale (CPS); Impact of Miscarriage Scale (IMS); Miscarriage Grief Inventory (MGI); The Center for Epidemiological Studies Depression Scale (CES-D), and Ways of Coping Scale. Inductive Content Analysis is used to analyze qualitative data. Repeated measures analysis of co-variance, controlling for age, ethnicity, education, and income and T-tests is used to analyze quantitative data. Findings: Data analysis is in progress and findings will be presented at the conference. Implications: This is the first investigation to examine the effects of miscarriage on lesbian couples’ grief, depression, and couple relationships over time. Findings will inform clinical practice and future research. 54 Oral presentations WOJNAR DANUTA & BOWIE BONNIE Affiliation: Seattle University, College of Nursing, USA C8 Title: Understanding first generation Somali immigrants’ barriers to effective parenting and resource utilization in the USA Aim: To gain an understanding of the challenges to resource utilization and effective parenting of the first generation immigrants from Somalia during the transition from kindergarten to school. Background: U.S. Homeland Security (2008) estimates that over 100,000 Somali refugees have resettled in the United States over the past decade. There is evidence that children, who do not assimilate successfully into school, are at risk for poverty, homelessness, and gang membership. Based on the initial needs assessment in partnership with the Head Start preschool and local public kindergarten staffs and Somali community informants associated with the agency, a need for better school readiness was identified for many of the Head Start children born to first generation Somali immigrant families. It was therefore imperative to better understand the barriers to school readiness for these children. Method/s: This study is part of a larger Community Based Research Project involving an interdisciplinary team of faculty from a private, urban university. The community partner is an inter-city Head Start preschool, with 77% of families served originally from East Africa. Following IRB approval, interviews with Somali mothers and fathers were conducted using a descriptive phenomenological method. Inclusion criteria were: first generation Somali immigrants with a child enrolled in the Head Start program. Recruitment of subjects occurred by word of mouth through the Family Support Workers and participant referrals. Parents participated in in-person interviews about the challenges of entering school and parenting in general as a recent immigrant. Interviews were transcribed verbatim for analysis. Qualified interpreter was used for all interviews. In appreciation for their participation, participants were given a $50 gift certificate to a local store. Coliazzi’s (1978) method guided the analysis. Results: Twenty families that met the inclusion criteria participated. The following themes were identified from data analysis: 1) Balancing Family Values and Traditional Childrearing Practices with New Reality; 2) Grieving the Loss and Longing for the Old Culture and Support Systems; 3) Having Difficulties Accessing Family Resources in the USA; 4) Acknowledging the Importance of Parent-Teacher Partnerships; 5) Belief in the Shared Responsibility of Parents and School in Childrearing; 6) Balancing Fears and Suspicions about the New System with Hopes and Dreams for the Children in the New World. Implications: Parenting and accessing family support resources in the USA is difficult for the first generation Somali immigrants. The process is compounded by the differences in childrearing approaches, language barriers, and fears and suspicions families may have about the resources that may be punitive and not understanding of the cultural values and traditions of Somali families. Building bridges between the two entities is imperative. Findings from this study will be used to design culturally relevant programs aimed at improving understanding of Somali parents’ approaches to childrearing, improving the access to family services in the USA, and providing preschool education with cultural competence to ease the transition from preschool to kindergarten for children of first generation immigrants from Somalia. 55 Oral presentations ÅKERLIND CHARLOTTA Coauthor/s: Lene Martin, Christine Gustafsson E8 Affiliation: Mälardalen University Title: Information and communication technology [ICT] in everyday life of older people and their relatives in home care. Coproduction partner/s: City of Västerås Aim: The overall purpose of this project is to investigate whether and how various ICT tools affect daily life, with a focus on self-perceived health, communication, quality of life, safety and security, for older users and their relatives in home care. Background: The rapid development of ICT in recent years has created new areas for its use and engages new groups of users. At the same time, the need for home care for older people has increased along with the increasing proportion of older people in the population. ICT have shown to be a valuable tool in this context. Development projects and research in this area has mostly focused on identifying technical development and to test the products in practice. Previous studies, describing the use from a user perspective, have mostly emphasized ICT in home care as a support for the chronically ill in communication with health care. Hence, there is a need for an increased knowledge of older people and their relatives experiences of using and living with an ICT support in daily life. Method/s: The project’s four studies have an intervention design. The intervention comprises the implementation of the ICT tool, information, resources and services related to this. The informants included in the studies are ≥65 years, with granted e-home care consisting of an ICT tool, and their relatives. Study I and II have a qualitative approach to highlight what communication, safety and security mean for the individuals living with ICT support. The data collection method is interviews and the analysis is a qualitative content analysis. Study III and IV have a quantitative approach to detect correlations and explore if and how the individual's health and quality of life are affected by living with an ICT support. The data collection method is questionnaires and data will be analyzed with descriptive statistics. Findings: The results are expected to highlight what communication, safety and security means for individuals living with ICT support, and also if and how living with an ICT support can affect the individual's health and quality of life. Preliminary results will be presented in autumn 2014. Implications: The experiences of older people and their families, together with previous knowledge gained from technical research, are expected to provide more comprehensive information on how ICT affects the daily life. This can lead to the development of ICT tools, based on the user's needs and experiences, as well as provide guidance on how already existing tools can be used in a better way. 56 Oral presentations NONGNUCH WONGSAWANG Coauthor/s: Nongnuch Wongsawang, Barbara J Bowers, Punyarat Lapvongwattana and E9 Sunee Lagampan Affiliation: Boromarajonani College of Nursing,Ratchaburi, Thailand Title: Performing Family Care for Dependent Older Persons in Thai Families Coproduction partner/s: City of Västerås Aim: To identify strategies for performing care by Thai family members who care for dependent older adults. Background: Demographic and cultural changes pose new challenges for families regarding caring for dependent older adults in Thailand. With a strong sense of family obligation, Thai families continue to provide most of the care. Unfortunately, there are some limitations in knowledge regarding ways to support and prepare Thai families for providing care to dependent older adults. Method/s: A Grounded dimensional analysis, a version of grounded theory was applied with 30 adult caregivers from 15 families who represent family members involved in caregiving. A total of 46 interviews were conducted in-person and telephone interviews. Dimensional analysis was applied within three phases: 1) calling up dimensions, 2) assigning relative value to each of the dimension considers, and 3) inferring. Findings: The finding revealed three difference caregiving approaches: ‘Focusing on care needs’, ‘Focusing on caregivers’ self’ and ‘Focusing on family unit’. These approaches differ primarily in the attitude of family members on caregiving which resulted in different consequences on both caregivers and older adults. Implications: The results provide a basis for future studies of the relationships between caregiving approaches and ensuring consequences for caregivers, older adults and their family relationship. Monitoring quality of care in relation to caregiving approaches by nurses and health personnel will be benefit for them. Keywords: family caregiving, family caregiving, dependent older person 57 POSTER presentations POSTER PRESENTATIONS M1 AHMADI FERESHTEH Coauthor/s: Mehrdad Darvishpour Affiliation: University of Gävle and Mälardalen University Title: Stabilities and changes in attitudes to diversity in Sweden Coproduction partner/s: Orlando Mella, professor Emeritus in sociology, Department of sociology, Uppsala university; Irving Palm, emeritus associate professor in sociology, Department of sociology, Uppsala university) Aim: To measure the attitudes toward ethnic diversity in Sweden Background: The attitude of Sweden people towards cultural manifold and immigrants Several patterns in the Swedes' attitudes toward immigrants and immigration can be proposed. They are generally more positive than negative in their approach to ethnic diversity according to measurements made by the Ethnic Diversity Survey from Uppsala University and University of Gävle (Mella and Palm, 2010; Ahmadi, Darvishpoor, Mella and Palm, forthcoming 2014). Method/s: The study is based on a survey of a random sample of the adult Swedish population. The sample was consisted, year 2013, of 762 individuals. Findings: This annual survey that took place between 2005 and 2013 show a stable picture without any dramatic changes. Attitudes towards ethnic diversity are therefore relatively constant over this period despite the economic crisis in 2008. However, some statistical differences have been established: diverse attitudes between men and women, as well as among high and low educated individuals. Women are more positive than men, a pattern that has followed all 9 measurements. Implications: The purpose of this article is to contribute to better understanding of the Swede’s attitude towards cultural manifold and migrants. 58 POSTER presentations CHAIDACHATORN SUPAWADEE Coauthor/s: Kotchakorn Kaewprom and Tassanee Thipseungneuan Affiliation: Nakhon Ratchasima, Boromarajonani nursing College Thailand Title: Mental health status of the Elderly leaders in Nakhon Ratchasima O1 Aim: This research aims are to study mental health status and factors associated with mental health status of the Elderly leaders in Nakhon Ratchasima province. Background: Elderly leaders are the key person who that influenced to operating elderly clubs or social groups. If Elderly leaders have sanity, club activities are carried out effectively. There has been no study directly focusing on the mental health of the Elderly leader. Thus, the present study aimed to explore the mental health and factors influencing mental health in the Elderly leaders. Method/s: A cross-sectional survey research was conducted among 422 Elderly leaders aged 60-90 years, using multi-stage random sampling. The data were collected through interviewing the Elderly leaders using questionnaire and Thai mental health indicator (TMHI-15) and thereafter analyzed by frequency, percentage, means, standard deviations and chi-square tests. Findings: The results showed that 48.3 percent of the Elderly leaders had a fair level of mental health status; 37 percent had a good level of mental health status and only 14.7 percent with a poor mental health status. Mental health status was significantly associated with various factors such as gender, living with a spouse, income, occupation, residential area and education. Other factors such as age and marital status were not significantly associated with mental health status. Implications: This study indicated that most of the Elderly leaders have good level mental health or higher than the general population. However, there are some of those who have a higher risk of mental health problems are also included and there are many factors that influenced the mental health status of the Elderly leaders in Nakhon Ratchasima province. Therefore, activities in the community still needs to focus on promoting mental health for these individuals with no less than to improve quality of life on the other side as well. 59 POSTER presentations CHANTARANOTHAI NATTINEEPORN Coauthor/s: Chatthong Jarupisitpaiboon, Sinsakchon Aunprom-me, I1 Affiliation: Borommarajonani College of Nursing Nakhonratchasima. Pakatip Singkhom Title: The situations of food contamination and factors of seller's food selection at the Red Cross Fair in NakhonRatchasima, Thailand Aim: 1. To study the situation of food contamination at the Red Cross fair in Nakhonratchasima. 2. To study the factors of sellers’ food selection to sell at the Red Cross fair in Nakhonratchasima. Background: Eating unsafe foods is cause of increasing of non-infection disease of population. Especially cancers, the top of causes of death in Thailand is caused by unsafe foods that up to 30-40% of cancers patients. Diet is one factor that is important to public health. Safety foods must be free from pathogenic like poison, germs and chemicals. Operating by the Provincial Health Office, Health Sciences Center and The unit cell for Food Safety (Mobile Unit) that sampling to detect foods contaminants and residues in foods found that there are many more contaminants steadily from 0.69 percent in the year 2008 to 0.83 in 2009 and increased to 1.91 in the year 2010. The most common contaminants are pathogens followed by aflatoxin, beta-agonist, insecticides, formalin and sodium hydrosulfide. Method/s: 1. Randomly buy sold foods at the fair which risk to contaminated by Formalin, Borax, Sodium hydrosulfide, and Salicylic acid. 2. Test 68 collected foods by the preliminary kit test of the Department of Medical Science, Ministry of Public health. 3. Ask foods sellers for resource of which they sell, understanding the basics of food safety and general information of sellers. 4. Analyze data by frequency and percentage. Findings: 1. The contamination of formalin in squid was 4.76% 2. Salicylic acid in fruits and vegetables preserved was 25%. 3. There was no contamination of borax and sodium hydrosulfide. 4. Most sellers lack understanding of food contaminants. 5. The food sellers usually used contaminants to preserve food in order to store for longer, more colorful and better quality: crispy, bounce, and flavorful which helped them make a good profit. 6. Fifty percent of sellers wash the precook food before cooking. Implication: Some of foods sold in public area is contaminate by health harmful agents. Therefore, providing the knowledge and attitude and understanding of the contaminants in food that should promote appropriate behavior for foods sellers and avoiding the risk of contamination are important way to safety from foods hazard. 60 POSTER presentations CHATCHUMNI MANAPORN Coauthor/s: Henrik Eriksson, Ampaporn Namvongprom, Monir Mazaheri ID1 Affiliation: Mälardalen University, Rangsit University, Thailand. The Red Cross University College Title: Pain Management by Nurses as co-production in a Functional ward: A post-post response to discomfort and pain Aim: This study aimed to describe pain management practice of a surgical ward within Thai context. Background: Nurses play an important role in the effectiveness and outcomes of pain management. Therefore, the cultural context of practices of managing pain effectively is crucial and of importance to understand. There is a need for further research about nurses’ pain manage practices in a Thai-context. Method/s: A focused ethnographic methodology was used. First author conducted 98.30 hours of field observation and conducted 12 informal interviews at the surgical ward. Data was analyzed using Spradleys’ steps for focused ethnography Findings: The findings revealed that the nurses managed pain and nurses responded to patients’ pain in three themes: (i) mutual relapsed in communication, (ii) Thais’ tradition of nursing care, and (iii) Nursing approach for pain management practices. Implications: The study recommended that the nurses should be setting priorities in relation to political ambitions to improve postoperative care. For this to be successful this study recommends a shift moving from functional to patient centered care. This also implies a shift from a post-post response to a post-pre response to discomfort and pain, to close the gap between ambitions and practice in postoperative pain management. Keywords: Functional ward, pain management practice, postoperative pain. 61 POSTER presentations CLAESSON ANNIKA Coauthor/s: Anders Bruhn, Elinor Brunnberg, Kari Jess, M2 Affiliation: Eskilstuna Municipality, Mälardalen University, Örebro University Title: Evaluation as a tool of continued skills development – A study of learning and use of know ledge among healthcare and eldercare staff Aim: This licentiate thesis focuses on evaluating continued professional development in healthcare and eldercare and how the evaluation itself can support the transfer process from training to knowledge use in practice. Background: Health and social care needs are expected to rise in Europe and worldwide. The number of people older than 65, and young people with various disabilities, is expected to increase (Centre for European Social and Economic Policy, 2005; Eurostat, 2013; Swedish National Board of Health and Welfare, 2013). Strategic professional development (capacity building) is a key issue for social welfare organisations to ensure the continued quality of social care and services. The transfer problem faced by organisations is that learning (through courses) often stops on an individual level after training, rather than progressing to the level of collective and organisational learning that can promote professional and organisational development. For transfer to occur, learned behaviour must be transformed into practice, leading to improved quality in daily work. A common organisational routine at training is that evaluation takes place immediately afterwards. Evaluation is thus used primarily as a tool to assess whether learning goals were met, rather than acting as a tool to help participants transfer learning into practice. Method/s: These issues are examined in relation to an evaluation of the 2006–2008 training programme “Steps for Skills”, for eldercare staff in a municipality in Sweden. After finishing the training programme, 339 eldercare staff completed a questionnaire. Caregivers for the elderly were also included in four focus group interviews. The evaluation was based on Mezirow’s transformation theory (1991, 2000), with instrumental, communicative, emancipatory and transformative learning, and through critical reflection and self-reflection, where the student reconsiders any ingrained ideas she may have. In the thesis, this evaluation is examined from a metaperspective and analysed based on research and theories about continued professional development, learning and the transfer process, summative and formative evaluation approaches, programme theory evaluation and the complexity of these issues. Findings: Findings focus on the evaluation’s strengths and weaknesses and the limitations of the applied evaluation model. The discussion will concern how evaluation can support individual and collective learning, from training to use of knowledge in daily work, and how evaluation can support organisational development. Finally, it discusses how opportunities and obstacles in summative and alternative evaluation contribute to the process of transfer of learning. The role of the evaluator is also reviewed. Keywords: critical reflection, evaluation, programme theory, skills development in eldercare, transfer of learning. 62 POSTER presentations APIRADEE SOOKSANGDOW Coauthor/s: Sriwan Emratch, Srisaowalak Aunprom-me, Wichitra Nawanantawong O5 Affiliation: Boromarajonani College of Nursing Nakhon Ratchasima, Thailand Title: Exploring Desirable Health Status among Elderly from a Rural Northeast Region of Thailand Aim: This study aimed to explore desired health among elderly resided in Tambon Khok Krachai Khon Buri District Nakhon Ratchasima Province. Background: Thailand’s elderly population in 2010 was 11.9 % that means Thailand is becoming an elderly society. The elderly suffer from chronic illness and disabilities more as their age increases. Health promotion is one of the several strategic plans of the Thai public health service to keep the elderly healthy without complications and take care of themselves properly. The authors realized that an understanding of the desirable health status among the elderly should be applied to determine the health promotion activities that are consistent with the best health status for them. Method/s: Thailand. Participants of this study were 318 elderly who were randomly selected using simple random sampling method. Instruments used in this study are comprised of 5 parts. Part 1 contained questions asking in 2 areas. Physical health was measured using question asking about results in blood pressure and blood sugar. Mental health was measured using 15-item Thai Happiness Indicators developed by the Department of Mental Health, Ministry of Public Health of Thailand and the depression screening Questionnaires include 2 Questions (2Q) and 9 Questions (9Q) of Prasrimahaphodi psychiatric Hospital. Part 2 contained questions asking whether elderly have at least 20 teeth or at least 4 pairs of tooth occlusion. Part 3 collected body mass index (BMI) or abdominal circumference of the elderly. Part 4 contained questions asking about ability of the elderly to assist themselves and others. Part 5 asked whether elderly exercise at least 3 times a week for at least 15-30 minutes. The reliability of Thai Happiness Indicators and the depression screening Questionnaires using Cronbach’s alpha coefficient were 0.87 and 0.78 respectively. The data were analyzed using frequencies and percentages. Findings: Results showed that 45 elderly (14.2 %) from the samples met the desirable health. There were 273 elderly (85.8 %) who did not meet the desirable health. The sample with blood pressure equal to or higher than 140/90 mmHg were consisted of 118 persons (37.1 %) while 111 persons (34.9 %) had blood sugar higher than 125 mg./dl. Regarding happiness level, there were 135 elderly (42.5 %) with a ‘good level’ of happiness, 127 elderly (39.9 %) with a ‘fair level’ of happiness, and 56 elderly (17.6 %) with a ‘poor level’ of happiness. There were 49 persons (15.4 %) with depression. There were 136 elderly (42.8 %) who did not have at least 20 teeth or at least 4 pairs of tooth occlusion. There were 100 elderly (31.4 %) with exceeding standard BMI or abdominal circumference. There were 11 elderly (3.5 %) who could not assist themselves or others. Finally, there were 73 elderly (22.9 %) who did not exercise regularly. Implications: Results from the study were helpful in understanding the elderly health status in a rural area of Thailand and can be used to develop health promotion programs that meet their conditions and needs. 63 POSTER presentations FONGKERD SURIYA Coauthor/s: Pookisana, S C1P Affiliation: Boromarajonani College of Nursing Chon Buri, Thailand Title: Attitudes towards the premature sex and adolescent pregnancy of students at expands educational opportunity school in Chon Buri province, Thailand. Aim: This descriptive study aims to attitudes towards the premature sex and adolescent pregnancy of students and compare to personal factors of students to attitudes towards the premature sex and adolescents pregnancy. Method/s: Subjects consisted of 172 students in expands educational opportunity school in Chon Buri Province, Thailand. Research instruments were the questionnaires of personal factors, attitudes towards the premature sex and attitudes towards to adolescent pregnancy which were tested for content validity. The reliability of the questionnaires which were tested using Cronbach’s alpha coefficient were .89 and .90 respectively. Data were analyzed by percentage, mean, standard deviation, Mann-Whitney U test, & Kruskal – Wallis test. Results: The students attitude towards premature sex and pregnancy in adolescents at high level (x = 3.78, S.D.= .636, & x = 4.15, S.D.= .808) respectively. It was found that male and female attitudes towards premature sex and pregnancy in adolescents did not differ (Z = - .775, p = .438, & Z = - .008, p = .994) respectively. The Students living with their parents' attitude towards premature sex is no different with students living with relatives. (Z = -1.725, p = .084), students living with parents' attitudes towards pregnancy in adolescents difference to students living with relatives (Z = -2.391, p = .017). And found that students in each grade are attitudes to premature sex were not significantly different (X2 = 4.055, p = .132 ). But the attitude towards pregnancy in adolescents different (X2 = 12.52, p =. 002) Conclusion: Classification by personal factors that most students have positive attitudes towards premature sex no different and their attitudes toward pregnancy in adolescents in different. Keywords: Attitude, premature sex, pregnant in adolescents. 64 POSTER presentations FRITZ JOHANNA Coauthor/s: Maria Sandborgh, Maja Söderbäck Title: Facilitators and barriers for implementation of a behavioral medicine approach in physical therapy. Study protocol and preliminary results ID2 Affiliation: Mälardalen University Coproduction partners: County Council of Västmanland and Sörmland Aim: Explore and describe possible facilitators and barriers for a behavioral medicine approach in physical therapy for patients with persistent musculoskeletal pain. Background: A behavioral medicine (BM) approach in physical therapy (PT) for patients with persistent pain is recommended by the Swedish Council on Health Technology Assessment. However, translation of clinical research on BM into clinical behaviors in PT is challenging. Previous studies show that PT:s don’t change their traditional ways of working, even after taking a course on BM methods. According to previous research, an important step in implementation is to explore facilitators and barriers for the implementation intervention. This study will explore facilitators and barriers, as an important background for tailoring implementation of complex interventions to individuals and organizations. Method/s: The design is a qualitative case study. Participants: Strategic and purposive sampling of four to six clinically working PT:s, graduated from advanced courses in PT or the undergraduate PT program at Mälardalen University, one to two years postgraduation. Further, the selected PT:s represent different types of clinics. For each PT one of their patients with persistent musculoskeletal pain and the head of the clinic are asked to participate. Number of participants is dependening on achieved saturation, which refers to the repetition of discovered information and confirmation of previously collected data. Data collection and analyses: Semi structured interviews of PT:s, patients and head of clinic, video recordings of treatment sessions, and local regulations and directives. Data collection takes place in the following order for each clinic: 1) interview of the PT before the treatment session, video recording of treatment session, 3) telephone interview of the patient the day after the recorded treatment session, 4) interview of the PT based on joint observation of selected sequences from the recorded treatment session, 5) formal local regulations and directives will be collected, 6) interview of head of clinic. Qualitative content analyses are used in an abductive process and data is triangulated concerning core concepts, regarding a BM approach in PT treatment, found in video recordings, interviews, directives and regulations. At the time of this poster presentation, data collection and analyses of three cases are completed. Findings: Preliminary results show that the PT has intentions to work with a behavioural medicine approach, but have problems to integrate and apply it. The PT needs support and resources (time) from the organization to implement BM in clinical practice. Expectations are contradictory regarding the PT as well as the patient in a treatment session. Implications: The findings will support the identification of barriers and facilitators for a BM approach in PT, and construct a topic list for factors to target in implementation of BM. 65 POSTER presentations GUSTAFSSON LENA-KARIN Coauthor/s: Karin Mattsson, Åsa Snöljung O2 Affiliation: Mälardalen University Title: The Equalhs’-study - Nurses perceived aspects of working with evidence when nursing frail older adults Coproduction partner/s: Municipalities of Eskilstuna and Västerås, Attendo Care Company, Västerås Aim: To identify and describe the different ways municipal care nurses perceive aspects of working with evidence when nursing frail older adults. Background Evidence based nursing and practices have during the last decade been highlighted and of great concern in all healthcare settings. Still, the concept of evidence is multi-faceted and might not be understood and used in the same way by different professionals. As frailty, chronic diseases and long term health conditions in aging populations are major challenges for the future, the importance of evidence based decision making and actions are urgent not only to prevent suffering within the aging individuals. The conscientious, explicit and judicious use of current best research and evidence in making decisions about the care of individual patients is also needed to prevent cost consuming malpractices in times of limitations regarding financial funding in the health care sector. Method/s: An explorative design with phenomenographic approach, based on interviews with community nurses working with home based care. Findings: The findings of the Equalhs’-study reveal it is a challenge to implement evidence based nursing and practice both on an individual and organizational level in municipal care of older adults. Factors hindering are lack of confidence, meaning a disbelief in own ability to apply evidence in caring/nursing. There is also a lack of support in form of availability where evidence is seen as something externally brought to the nurses, as opposed to an internal approach integrated into their nursing skills. Another factor hindering is a lack of time and confidence in own capacity to apply evidence, others were often perceived as more competent in applying the “right” method in the search for evidence. Implications: Understanding the contextual perceptions of evidence by nurses can cast light on the barriers as well as the prerequisites of working with evidence while caring for frail older adults in municipal care. 66 POSTER presentations BOGG LENNART, SÖDERBÄCK MAJA & TILLGREN PER Affiliation: Mälaradalen University, Eskilstuna and Västerås I3Title: Thailand and Sweden as welfare regimes - examples from the healthcare sector Background and aim: The characteristics of a welfare state is largely related to social justice and welfare reforms. This is mainly in the form of legislation, economic transfers and services that help to ensure that all citizens receive a basic economic security and access to services such as health care and nursing. A key factor for this is a country's economy and political will. In Thailand, there was a strong economic growth during the 1970s. The corresponding development in Sweden took place in the mid 1940's. Health and welfare is the main area of collaboration between the Ministry of Health in Thailand and Mälardalen University. The aim of this study is from a welfare perspective, a comparison of the similarities and differences in the basic elements of the health care systems in Thailand and Sweden. Both countries emphasize health and welfare from a social rights perspective in constitutions and other laws. E.g. the Thailand Constitution of 2007 states that a person shall enjoy an equal right to receive standard public health service, and the indigent shall have the right to receive free medical treatment from State's infirmary. The Swedish Constitution recognizes that the personal, economic and cultural welfare should be the fundamental goal of public activity through, among other things promote social care and social security, and good conditions for health. In the Swedish Health Care Act of 1982, the goal is a good health and care on equal terms for the entire population. Method/s: The study is based on analysis of national policy documents from Thailand and Sweden as well as from United Nations Agency. Findings: In terms of selected indicators shows for the year 2012 that the Total health expenditure (THE) % of Gross Domestic Product (GDP) amounts in Thailand 4% and 10% in Sweden, general government expenditure on health as % of GDP are 3% resp. 8%, prevention and public health services are 9 resp. 4%, physician density per 1,000 population 0.3 resp. 3.9. The proportion of beds at public/private hospitals are 78/21% resp. 99/1%. Both Thailand and Sweden have a national system of Universal Health Coverage (UHC), which is defined according to World Health Organization (WHO) as ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. Implications: The example from the health care system shows that the two countries have legislation that emphasizes health as a social right and a public financing of health care. In terms of specific indicators, there are wide variations in terms of costs to society and the individual including prevention and public health services, access to doctors and proportion of beds in public and private hospitals. Keywords: health policy, health, welfare, Thailand, Sweden. 67 POSTER presentations KATHALAE DUANGRAT Affiliation: Boromarajonani College of Nursing, Nakhonratchasima, Thailand of Thailand Background: The terrifying situations in Southern Thailand caused the troubling shortage of nursing staffs. The muslim students from 5 Southern provinces were recruited to attend nursing program for being the local registered nurse. M3 Title: Stress and Mental Health of Undergraduate Nursing Students From 5 Southern Provinces Aim: The purposes of this survey study were to explore the influencing factors and coping behaviors on mental health and stress, and to determine the relationship between coping behaviors and mental health and stress of nursing students from 5 Southern provinces of Thailand. Method/s: Participants were the first year undergraduate nursing students. The Thai Mental Health Indicator and Stress Test questionnaires were used to interview 191 participants. The Cronbach's alpha coefficients of those two questionnaires were .81 and .86, respectively. Data were obtained in February, 2007. Descriptive statistics and Chi-square test were used for data analysis. Findings: The majority of participants were single Islamic females, aged 21-25 years old from the middle socio-economic level whose monthly income was lower than 5,000 baht. Most participants came from Pathanie province where their families own lands and houses.The average score of mental health was in the normal to higher than normal level. The average score of stress was in the normal to mild level. Changing jobs/schools, terrifying situations in Southern Thailand, sickness, death in the family, and family income were the influencing factors on mental health. Study, adaptation, social/environment, and friends were major influencing factors on stress. Activities such as watching TV, reading books, listening to music, using their own ideas for personal situations, and talking to family members and friends were their coping mechanisms. Accepting terrifying situations, consulting an advisor, and taking minor tranquillizers were significantly related to their mental health (p < .05). Students used mechanisms like crying, damaging things to release tension, taking minor tranquilizers, and hurting themselves as coping behaviors which significantly related to stress (p < .05). Implications: The numbers of students should be divided into two or three small numbers of each sub-class. Counseling system should have a practical schedule. Repeating measures on mental health and stress levels need to be done every year until graduation. Increasing relationships among family members also including many different activities need to be promoted for improving and maintaining mental health of these participants. Using many different kinds of activities and projects between nursing school and their family members will help increasing mental health level and reducing stress level. Keywords: Stress, mental health, nursing student. 68 POSTER presentations KETIN VARUNEE Coauthor/s: Varunee Ketin, Kitsana Hongthong, Atcharawadee Sriyasak C2P Affiliation: Prachomklao College of Nursing, Phetchaburi province, Thailand Title: The perspective of health and infant development among Thai first-time mothers. Aim: The study aimed to explore the perspective of health and infant development among the first time teenage mothers. Background: The survey of child development found that the developmental decline from 71 percent to 67 percent in 2007. The studied about growth and development of children among teenage mother, whose infants were 1-2 years old found that 8.54 percent has impaired language, 9 percent has problem solving and fine motor (Phramongkutklao hospital, 2004). The infantile is the most important to develop physically, mentally and emotionally. They need love and taking care of the parent to be strong and healthy with the right personality. An understanding the perception of teenage mother is limited. Therefore, it is a significant gap in the knowledge base and the rationale for undertaking this study. Method/s: The qualitative approach was taken with nine teenage mothers between the ages of 14 and 19 years, having a baby younger than 6 months of age, residing in Phetchaburi province, Thailand were interviewed. Content analysis was used to analyze interview transcripts. Findings: The results found that health and infant development of infant was described as healthy and ability to do activities. Support from family and previous childrearing experiences were important factors contributing infant development. Doing physical care, developmental care and protective care helped them to bonding and attachment with their infant. Implications: Promoting childrearing skills for teenage mothers should be addressed by health care providers. It is important to provide clinical counseling for teenage parents and promote her husband and family to participate during pregnancy childbirth and postpartum. This will help to improve the quality of the family. 69 POSTER presentations LOEB CARINA Affiliation: Mälardalen University Title: Simple is boring: About the relationship between self-efficacy, level of difficulty, interest, control and performance M4 Aim: The aim was to examine the relationship between interest, self-efficacy, level of difficulty, control and performance. Background: Several studies have shown that if an individual's self-efficacy increases so does the interest in the task and there often also is an improvement in performance. There are also studies that have shown that a moderately difficult task allows the individual both to feel sufficiently competent to make a qualified performance and at the same time feel that the task is challenging enough to create an interest. Method/s: The relationship between interest, self-efficacy, level of difficulty, control and performance were examined with 91 students in two anagram tasks in a 2 (control: controlled / free) x 3 (level of difficulty: easy / moderate / hard) experimental design. Findings: The hypothesis was that interest of the task would be highest at a moderate level of difficulty but result showed that interest increased as the task got tougher and self-efficacy lower. General self-efficacy was found to be unrelated to performance, while task specific self-efficacy predicted performance - the higher the specific self-efficacy, the better the performance. How interesting and difficult a new task is experienced proved to be influenced by what the individual did before. To first perform an easy task and then making a more difficult, gave an increase of interest, while first performing a difficult task and then an easier resulted in reduction of interest. The second task, which was exactly the same for all participants, was also perceived more difficult if it was preceded by an easy task than when it was preceded by a moderately difficult or difficult task. Implications: This study contributes with knowledge about that a gradual increase in level of task difficulty over time can be beneficial for both self-efficacy and interest. A plausible explanation could be that the individual is given space and time to feel competent enough to continuously move forward with new and more challenging tasks. The study also highlights the importance of earlier experiences in how future tasks will be perceived. 70 POSTER presentations OUNGSAKUL LAORWAN & SUCHADA KLAIMANEE Coauthor/s: Wanna Thananuphapphisan Supawadee Chaidejathorn Chiranuch Somchok Somporn Prasertsil Affiliation: Boromarajonani College of Nursing Nakhonratchasima Title: Relationship between bone mineral density with the menopause and BMI of the women who work in Boromarajonani College of Nursing Nakhonratchasima, Thailand M5 Aim: 1. To study bone mineral density of women who work in the College of NursingNakhonratchasima. 2. To study the relationship between bone mineral density with menopausal of women who work in the College of Nursing Nakhonratchasima 3. To study the relationship between bone density with body mass index of the women who work in the College of Nursing Nakhonratchasima . Background: Osteoporosis has increased dramatically. Women aged 70 years or above are found osteoporosis more than 50 percent and that are 15.7 to 24.7 percent of them have osteoporosis at lumbar spine and 9.5 to 19.3 percent at femoral neck. The incidence of femoral neck fractures of Thai postmenopausal women aged 50 years or more is 289 per hundred thousand of population per year. A study by the International Osteoporosis Foundation of Thailand also found mortality after femoral neck fracture within 5 years is as many as 1 in 3 of both male and female. Most of women who are at high risk to fractures were palliative cared at home. They also do not diagnose the cause by examining the density of the bone (Bone Mineral Density or BMD) with a Dual Energy X-ray Absorptiometry (DEXA), and also found that the population of Thailand is a lack of calcium and vitamin D as well. Method/s: 1. Select volunteer 72 women aged 40 years or above working in a Nursing College Nakhonratchasima in year 2012 and consent. 2. Examine of bone mineral density by Nuclear medicine department of Maharaj Nakhonratchasima Hospital with Dual Energy X-ray Absorptiometry (DEXA) Scan for the BMD of the lumbar spine and femoral neck. 3. Volunteer Respondents to evaluate the factors that affect bone mass before entering examine 4. The data was analyzed by using descriptive statistics, chi - square. Findings: 1. Forty two percent of women are menopausal women and 62 percent of women have over body mass index (BMI). 2. Twenty six percent of women have osteopenia at lumbar spine and 28 percent at femoral neck. 3. Menopausal is relations with osteopenia at lumbar spine and femoral neck by statistically significant at .05 level. 4. Body mass index relations with osteopenia at lumbar spine but non-relations with osteopenia at femoral neck by statistically significant at the .05 level. Implications: The results of this research demonstrate bone mineral density is relation with menstruation and body mass index. Menopausal and less BMI may lead to the occurrence of osteopenia until osteoporosis. Therefore, we should find ways to promote and protect women's health by providing awareness of the importance of getting calcium and vitamin D in all forms, including appropriate self care to prevent or reduce the risk of bone mass such as prevention of fractures. 71 POSTER presentations PHISAIPHANTH SUPARAT Coauthor/s: Nuntareeya Lohapaiboonkul O4 Affiliation: Boromarajonani College of Nursing Sanpasithiprasong Title: Health Factors and Social Welfare Need of the Elderly in Ubonratchathani Province Aim: To investigate the elderly's social welfare needs, and to determine what health factors affect social welfare needs of the elderly in Ubonratchathani province. Background: The number of elderly is rapidly increasing in Thailand. The establishment of social welfare services served this population has become an important concern. However, the services for the elderly on socio-economic issues are mainly focused rather than health issues. Social welfare services regarding health needs of elderly are inadequate even though the welfare services help them regain their health and improve quality of life. Method/s: A cross-sectional correlational study was conducted, between April and May 2014. A purposive sampling was used to select 80 elderly. Data was collected by using the Demographic Interview, the Social Welfare Needs Questionnaire, the Activities of Daily Living Profile, the Thai Mental State Examination, and the Thai Depression Scale. Multiple regression analysis was used to determine what health factors contribute social welfare needs of the elderly in Ubonratchathani province. Findings: Results showed that found that the social welfare needs of the elderly in Ubonratchathani province are high. However, physical health, dementia and depression are not significant determinants of social welfare needs in the elderly. Implications: The results were hampered by samples, measures, and setting of the study. However, the findings of this study emphasize the significance of social welfare needs to elderly in Ubonratchathani. Suggestions for future research are provided. Keywords: Social welfare needs, health, elderly. 72 POSTER presentations SRIWICHAI PREMRUDEE Coauthor/s: Pimpimon Wongchaiya ID3 Affiliation: Boromarajonani College of Nursing, Phayao Title: A Sense of Belonging, Stress and Depression amongst First - Year Nursing Science Students at Boromrajonnani College of Nursing, Phayao Aim: To examine the degree of students’ sense of belonging, stress and depression, to compare the average levels of their sense of belonging, stress and depression and to investigate the relationship between their sense of belonging, stress and depression. Background: First year nursing students often experience stress and depression. Sense of belonging has been recognized as a predictor of psychological and academic well being of students. Sense of belonging may influence person factors including stress or depression. Method/s: This descriptive study was conducted on first - year nursing students at Boromrajonnani College of Nursing, Phayao. The study population was 88 first - year nursing students. The research instruments consisted of (1) the sense of belonging test develop by Pimpimon Wongchaiya, et. al. (2) The stress evaluation form developed by the Department of Mental Health, and (3) The teenagers' depression scale (CES-D) developed by Umaporn Trungkasombut et. al. The self- report response was conducted three times at the first, fourth and seventh month of the 2010 academic year. The data were analyzed based on mean, percentage, Pearson`s co-efficient and a Repeated Measure design. Findings: The study revealed the following results. After one month of the academic year 55.68% of the subjects displayed a high degree of sense of belonging, 45.45% showed a normal degree of stress, and 81.81% reported an absence of depression. After four months of study, 83.72 % reported a high degree of sense of belonging, 75.58% showed a normal degree of stress and as high 98.80% being depression-free. However, after seven months of study, only about half of the subjects (52.38%) maintained a very high sense of belonging, while 69.05% displayed a normal degree of stress, and almost all (81.81%) showed no sign of depression. Moreover, based on three measurements, the average scores of each variable differed significantly at p =.01. The average scores of sense of belonging increased slightly at the second measurement and decreased slightly at the third (1=3.88, 2= 4.26, 3=4.02, respectively). The average scores of stress rose highest at the first measurement before dropping sharply at the second and rising slightly at the third (1=1.90, 2=0.46, 3=0.54, respectively); so did the average scores of depression (1=0.80, 2=0.42, 3=0.59). Finally, a Pearson product moment showed low to moderate negative relationships between the sense of belonging and stress (r= -.327 to -.328, p< .01) and between the sense of belonging and depression (r= -.229 to -.534, p< .01 ). Implications: A sense of belonging might be one of the factors that prevent students’ stress and depression. Therefore, activities enhancing student sense of belonging should be conducted for the first - year nursing students. Also it could be included in a mental health orientation and counseling program. 73 POSTER presentations SUTTINEAM UBOL Coauthor/s: Jintana Buathongjun, Samerchan Teerawatskul ID4 Affiliation: Boromarajonani Nursing College Bangkok, Thailand Title: Effectiveness of Self-management Program on Health Beliefs, Health Behaviors, and Health Indicators of Supporting Staffs Aim: The purpose of this quasi-experimental study was to study the effects of Self-management Program on health beliefs, health behaviors, and health indicators, including the body weight, body mass index, waist circumference, fasting blood sugar, and lipid profiles of 40 supporting staffs of the Boromarajonani College of Nursing, Bangkok who were risk for metabolic syndrome. All health beliefs, health behaviors, and health indicators were measured twice as baseline at the first and twelfth week. Then, the self-management program, including eating, exercise, and stress management, was implemented for 8 weeks. After that, the participants were reevaluated twice at the first and fifth week after the end of the program by using the same instrument. Data were analyzed by using descriptive statistics and repeated measure one-way ANOVA. Findings: The results showed that the health beliefs and health behaviors at 1 and 5 weeks after the implementation were statistically significant higher than at 1 and 12 weeks before the implementation (p<.001). The health indicators, including body weight, body mass index, and waist circumference after the implementation at 1 week and 5 weeks were significantly lower than those of before the implementation (p<.01). Other health indicators, including blood sugar, total cholesterol, and LDL after the implementation at 1 week and 5 weeks were also significantly lower (p <.01). In conclusion, the self-management program is effective in changing health beliefs and health behaviors, and reducing body mass index, waist circumference, blood sugar, and lipid profiles. Keywords: Self-management, Health beliefs, Health behaviors, Health indicators. 74 POSTER presentations OLSSON SYLVIA Coauthor/s: Munir Dag ID5 Affiliation: Mälardalen University Title: Social isolation and loneliness as a child - how does it look like 20 years later? Aim: The purpose of the study is to make a knowledgeable briefing on deaf children's psychosocial situation and if they felt isolated as a child are they still isolated as an adult? We also want to know if it´s possible to predict antisocial behavior as abuse of alcohol or drugs? Background: Hard of Hearing is a group that is midway between hearing and deaf, in that they usually is bi-lingual with both spoken Swedish and sign. They can identify with and feel connected to both or either of these groups. At a hearing impairment, attention must be paid to the psychosocial consequences that may arise in the workplace and marriage and lead to isolation and thus become a threat to the identity (Carlsson, Hjelmquist & Lundberg, 2000). Hearing impairment may also affect a person socially since he or she can sometimes be perceived as arrogant and unsociable of environment, depending on the person in question did not hear what was being said and thus fails to acknowledge the message through verbal or nonverbal communication. It may also be a tendency to be more dependent on other people due to they must repeat or speak louder than normal and independence is threatened because of the hard of hearing person. This can lead to a choice to withdraw instead of being apart (Eriksson & Erlandsson-Mangold, 1993). Many deaf and hard of hearing students also feel that they are subject to bullying at school and often feel outside (Hindley, 2000). Method/s: The existing study is one longitudinally study where data earlier been collected in 1994 and 1996 with all hard-of-hearing (HH) children that attended HH classes in a regional area in Sweden. Interviews from 1994 and 1996 will be compared with interviews from today. Findings: No findnings yet. Implications: Prediction of antisocial behavior The aim in the current study is to describe, analyze and understand psycho-social aspects of living with an innate hearing impairment. The aim of this presentation is to examin the feeling of group belonging and participation in social environments. The existing study is one longitudinally study where data earlier been collected in 1994 and 1996 with all hard-of-hearing (HH) children that attended HH classes in a regional area in Sweden . When the study started all children were integrated into a hearing environment. In the autumn 1994 the HH classes moved to a special school and a sign language environment. So the students got deaf schoolmates instead for hearing. The HH children are today young adults in the age 24 - 30 years old, both women and men. They have implemented or started their establishment in the society like adults. Seventeen in depth interviews were conducted with them in the fall of 2011. This presentation will be based on the possibility of prediction of social functionality or dysfunctionality. If you were isolated as a child are you then isolated as an adult? With regard to antisocial behavior, focus will be on alcohol or drug abuse. Preliminary results show that high proportions of respondents have tested marijuana. 75 POSTER presentations SÖDERBÄCK MAJA & TILLGREN PER Affiliation: Mälardalen University Title: Co-production by scientific papers in the field of Health and Welfare among Scientists / Institutions in Thailand and Sweden Aim: The aim of this study is to examine to what extent there is a co-production in research in the field of health and welfare between scientific institutions and universities in Thailand and Sweden. M6 Background: At the School of Health, Care and Social Welfare at Mälardalen University the cooperation with Thailand includes both education and research. The cooperation has went on since 2009 including the Ministry of Health and their nursing and public health colleges as well as two universities, Mahidol university and Rangsit university. The latest agreement of cooperation covers the years 2013 - 2017. The cooperation takes place mainly through student exchange and training on graduate and advanced in the field of health and welfare, but also by some research contacts. Method/s: The study is based on a systematic literature review in three multidisciplinary databases; Scopus, Web of Science and PubMed databases. The scoping has been limited to scientific articles. Three different search strategies have been used. To elaborate on the precision of the search it has been carried out in three steps. The initial search was based on the keywords ‘Health and Welfare’ as well as ‘Thailand and Sweden’ in the title as well as abstract. The second search was focused on ‘affiliation/address, author, Thailand and Sweden’. For PubMed the search included only 2013, because it was from this year it was possible to search for more than one affiliation/address. The third search was a deepening search by a concretization of ‘Health and Welfare’ based on other keywords related to disciplines, as specific concepts such as ‘caring, nursing, sociology, physiotherapy, public health, social work, psychology’ or appropriate disciplines. A limitation was made by including only studies between the two countries, not multicenter studies from more countries in which the two countries have signed. Further, duplicates were excluded in the analysis. Regarding the reliability of the articles the quality of the articles will be more analyzed in a final step of the process. Findings: The first conceptual search resulted in 210 articles, distributed by the keywords Health and Welfare (4), Health (199) and Welfare (7). The second search resulted in 422 articles that showed that most of these items were not at all in the area of health and welfare, but other fields as engineering, physics, medical chemistry, biomedicine and animal studies. In the third search 56 articles in all three databases were identified. For the aim of this study 17 were considered relevant. Implications: This study demonstrates that there is a research collaboration and joint scientific publishing in many scientific disciplines and areas between the two countries, Thailand and Sweden. The co-production occurred primarily during the last 10 years. However there is a limited degree in the area of Health and Welfare. Only one of the identified articles were written by a cooperation with researchers in Thailand and at Mälardalen University. Recurring annual systematic literature reviews in the area of Health and Welfare will be a way to track the progress of co-production between universities in Thailand and Mälardalen University. This study can function as baseline study for such reviewing. Keywords: Health and Welfare, systematic literature review, scientific articles, cooperation, Thailand, Sweden. 76 POSTER presentations THITASAN ANCHALEE Coauthor/s: Elinor Brunberg, Marianne Velandia Chularat Howharn Affiliation: Mälardalen University, Boromarajonani College of Nursing, Sanpasithiprasong, Ubon Ratchathani, Thailand Title: Sexual health of adolescents: A review of Sweden and Thailand C3P Aim: The review is to provide an overview of similarities and disparities of attitude and sexual behaviors between Swedish and Thai adolescents. The finding will be use as a preliminary data before conducting a survey on adolescent living conditions, life styles, risk behaviors and sexuality. Background: Sexuality is an important aspect of human life and health. In Sweden, sexuality matter and reproduction of individual is respected. All people have the right to their own body and sexuality. Sexual activity is permitted and acceptable, including in adolescents, if they are in love and matured. In the contrary, in Thailand, sexually active is considered as cultural taboo and inappropriate for adolescents. A cross cultural comparison on attitude and sexual behavior will be benefit for better understanding sexuality health in international level. Method/s: The studies on attitude, sexual heath, and heterosexual behaviors of Thai and Swedish adolescents conducted in 2000 to 2014 were reviewed to address similarity and disparity of adolescents’ sexuality. Eighteen reviewed studies, written in English and retrievable, were chosen. Findings: There were more similarities of attitudes and sexual behaviors than disparities despite cultural differences. Premarital sex was common among Thai and Swedish adolescents. The majority of the first sexual partner was boy/girlfriend. Unintended pregnancy and sexual transmitted infections (STIs) were the common negative consequences of sexual active among adolescents in both countries. Sexually active adolescents aware of getting pregnant more than getting STIs. Both male and female adolescents had negative attitude toward teenage pregnancy. However, using contraceptive was inconsistent relied on a type of relationship. A male partner was likely to dominate a condom used. Gender disparity was presented in both countries mostly put male adolescents being superior to female adolescents when they were in a sexual relationship. Some Thai and Swedish female adolescents reported a feeling of having forced sex. If having unintended pregnancy, adolescents in both countries considered on not carrying pregnancy to term. Self-induced abortion was reported by Thai adolescents using abortifacients. Implications: It is important to understanding the variation and variability in sexual behaviors and attitudes in adolescents. This issue should be a great concern in both countries. The study of sexual behaviors and related factors is necessary for getting better understanding of adolescents' sexual health. To enhance sexual health in both genders, male adolescents should be empowered to take more responsibility for the sexual relationship. 77 POSTER presentations THONGTANUNAM YUPAWAN Coauthor/s: Rangsima Wongsutin Narumol Loakosin, Christine Gustafsson Affiliation: Boromarajonani College of Nursing, Changwat Nonthaburi, Talad-Khan Health Promoting Hospital, Ministry of Public Health, Mälardalen University Title: Needs of Older adult and their Care giver for Providing Elderly Care at Home O3 Coproduction/partner: Praboromarajchanok Institute, Ministry of Public Health Thailand Aim: The study aim was to explore the needs of older adults and their care giver in order to providing elderly care management at home. Background: Thailand is going to be considered as an elderly society in the period of 2020 to 2030. The national statistics also revealed that the prevalent rate of the chronic diseases among midlife and elderly population were dramatically increased. Thus, Thailand health system is at need to prepare for dealing with these rising elderly population, especially elderly with chronic illness. Based on the systematic reviews, persons with more chronic conditions become more functionally impaired sooner than persons with fewer chronic conditions. Additionally, having multiple chronic conditions also makes their living more challenging to participate effectively in their own care. Understanding the needs of older adults and their caregivers could impact on the quality of care and health care system improvement as results in older adult quality of life. Method/s: Thirty older adults and their care givers in the urban area of Thailand were purposively selected to participate in the study. The open-ended questions were used to collect data regarding physical changes, health condition, and prescribed treatment. The activity of daily life, instrumental activity of daily life, ability of using technology, and needed information were collected using questionnaire. The functional health were also evaluated by using Berg’s balance and Time get up and go test. The need for elderly care of the elderly and their caregiver were collected using semi-construct interview. The descriptive statistics were used to describe characteristics of participants. Thematic analysis was used on the qualitative data. Findings: Older adults participated in this study mostly had more than one chronic disease. Majority of them are at risk of falls. Approximately fifty percent of participants need help for their basic daily living. Twenty percent of the participants need help for independent living. The qualitative data revealed that elder and their care giver needs information regarding nutrition, alternative medicine, medication, and health behavior promoting regarding chronic disease as well as health care service. Implications: Coordinating care of the elderly at home is very importance. To meet long term care needs for elderly, health care provider should understand needs of older adult and their care giver. Finding from this study could be useful data for helping health care providers to improve quality of life of older adults and their caregiver as well as maintain independence of them for long as possible. 78 POSTER presentations YUWANICH NUTTAPOL Coauthor/s: Waliaporn Nantsupawatb, Sharareh Akhavan, Lene Martin M7 Affiliations: Mälardalen University, Rangsit University, Thailand. City University, London, UK Title: Experiences of occupational stress among emergency department nurses at private hospitals, Bangkok, Thailand Aim: The aim of the study is to explore nurses’ experiences of stress in emergency departments (ED) in private hospitals in Bangkok, Thailand. Background: Occupational stress affects employees’ health and organizational productivity. Nurses in EDs are exposed to specific stressors including trauma, injuries, acute life-threatening of patient, violence and sudden death of the patients and since they are largely unpredictable the ED nurses are of higher risk for stress than nurses in other departments. This stress may lead to a low quality of nursing care performance at the ED. Method/s: A descriptive qualitative design was applied in this study. Qualitative approaches enable the researcher to explore the phenomenon through the individual’s experiences within their daily life. Semi-structured interviews were used in order to explore emergency department nurses’ experiences regarding occupational stress. The participants consisted of 15 emergency department nurses in two private hospitals in Bangkok, Thailand. Transcribed interviews were analyzed using content analysis. Findings: Three themes were identified; “causes of stress”, “responses to stress”, and “stress handling”. The stressors were associated with work characteristics, inadequate nursing staffs, and issues related to patients and their relatives. The participants believed that occupational stress influenced their health; both physical and psychological health, and was also related to incomplete nursing care. However, the findings also showed a positive response to occupational stress, perceived as a challenge to overcome, which proved the individual’s competency. Implication: ED nurses frequently experience occupational stress. This possibly affects the organization and ultimately it might lead to a shortage amongst nurses. The findings in this study may be beneficial in order to develop and implement policies and guideline procedures related to prevention and management of occupational stress in an ED. 79 POSTER presentations ÅKERBERG ANNA Coauthor/s: Anne Söderlund, Maria Lindén ID6 Affiliations: Mälardalen University Title: Evaluation of a Selected Pedometer Cell Phone Application for iPhone Coproduction partner/s: Supported by: NovaMedTech and ESS-H Aim: to evaluate accuracy of a selected Pedometer Cell Phone Application in two different positions measuring walking steps in different walking environments compared to manual measure. Background: The overall most common technique to measure physical activity is with a pedometer, which today can be integrated in other devices, like smartphones. However, integrated pedometers needs to be evaluated regarding step accuracy and the most appropriate position to use. When encouraging the population to increase the physical activity level, which may affect the public health positively, it’s important to use psychometrically sound measures. Method/s: 20 randomly selected test persons (9 male/11 female, mean age 40 years, mean BMI 25.4), walked in their normal walking speed using the same Pedometer Cell Phone Application in two positions. The steps were also measured manually (M) by a mechanical hand clicker. Walking environments: Uphill, Downhill, Straight road, Flat lawn, Up in stairs and Down in stairs. Cell Phone Positions: the right chest pocket (Chest) and the left lower pocket (Pants) of a measuring-west. Equipment: iPhone 4S (Apple Inc., California, USA), with 3-axis accelerometer, software v. iOS6.1.3, and Pedometer FREE GPS+ (Sport.com, Minks, Belarus) v.14. Approval by the Ethical Board, Uppsala, Sweden (Ref; 2013/072). Findings: Cell phone position in Chest’ and Pants’ pockets performed reasonable accurate measurements with similar SD, on plain surfaces and in slope (e.g. Uphill: 190±13 (M), 178±12 (Chest), 188±14 (Pants), Straight road: 188±14 (M), 189±22 (Chest), 196±21 and Up in stairs: 59±2 (M), 55±10 (Chest), 59±16 (Pants)). Repeated Measurements ANOVA for Uphill and Downhill data showed significant results. Pairwise comparisons for Uphill showed that Chest differs significantly from M (p=0.002), and for Downhill differs Pants significantly (p=0.001) from M. ANOVA showed significant differences for Flat lawn, and comparisons revealed that Chest differs (p=0.048) from M. Also Down in stairs revealed significant differences; however the pairwise comparison were not significant. No significant differences in Straight road or Up in stairs were shown. Implications: This study showed that the selected Pedometer Cell Phone Application performed reasonable good accuracy, but higher accuracy on plain surfaces compared to in slope. Both positions performed accurate measurements on Straight road and Up in stairs, although the result from the remaining walking environments differed, and therefore it is not possible to conclude which position is the most appropriate. 80 Sponsors SPONSORS ARENAN FÖR HÄLSOOCH VÄLFÄRDSTEKNIK 81 Address: P.O. Box 883, SE-721 23 Västerås. Sweden Address: P.O. Box 325, SE-631 05 Eskilstuna. Sweden E-mail: [email protected] Web: www.mdh.se
