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Mental health services are increasingly employing peer workers (PWs), individuals who have lived experiences with mental health problems, to support patients and be part of mental health care teams. While the employment of PWs continues to increase, little is known about how the function unfolds in practice. This paper explores the broader context in which the PWs navigate and the concrete outcomes and everyday issues that exist at the individual level. Methodologically, the paper draws on 22 interviews with PWs employed in the mental health services in Denmark. Theoretically, it combines Lipsky's (1980) theory on street-level bureaucrats with sociological discussions concerning the lay-expert divide. The analysis shows that PWs experience both role ambiguity and goal uncertainty and that they use substantial discretion in determining the nature, amount and quality of their peer practices. This – combined with the PWs' diverse lived experiences – calls for a heterogeneous understanding of peer work and therefore the analysis presents three categories of peer workers: PWs as (1) a representative of patients' lifeworld, (2) an interdisciplinary professional and (3) an 'expert by experience'. These categories display PWs different enactments of their lived experiences and reveal ambiguities tied to the lay-expert divide. [ABSTRACT FROM AUTHOR]

In this paper, we view health strategies in the field of personalised medicine as performative actions which articulate the development desired for a given society and demonstrate and affirm values and visions for that society. Based on a qualitative study in Denmark, we show how political actors and policy documents articulate visions for personalised medicine through a distinct sociotechnical imaginary. This sociotechnical imaginary mobilises the distinction between non-profit public and for-profit private organisations, placing personalised medicine in the public domain as the self-evidently desirable future for Danish health care In the Danish case, the issue of implementing personalised medicine becomes an opportunity to revisit the vision for the welfare state and verify public institutions as a shared space for state and citizens. While Danish political actors see personalised medicine as transformative, they articulate this transformation as being steered by public actors, at the same time downplaying the role of private companies. Where public health studies have focused on how political investments into personalised medicine may marginalise specific groups and populations, the Danish case shows that also powerful transnational players may be excluded from political discourse. It teaches us not to treat personalised medicine as one phenomenon, but to pay direct attention to the local contexts in which it operates and shapes what 'public' and 'health' become. [ABSTRACT FROM AUTHOR]

Health care systems around the globe are currently orienting themselves towards 'personalized medicine', a medical care regime aimed at individualizing prevention, diagnosis, and treatment of disease through proliferating amounts and sources of data, including genetic information. In Denmark, national health policies on personalized medicine focus on harnessing the potentials of genomic science and technology to bring knowledge about patient-specific genetic variation into clinical application. A major hope is to improve public health and prevent common diseases by integrating genomic information in health care, yet to act preventively, a temporal path has to be established defining what kind of knowledge to create and to act upon, and when. This paper explores the temporal orderings of medical knowledge in two different areas: health policy and clinical practice. Examining policy papers on personalized medicine issued by Danish governmental and research institutions, and, comparing them with contemporary practices of using genetic information in preventive cardiac health care, we demonstrate that genetic knowledge-making is ordered around two different conceptual views of time: namely the sequential order and the speed with which such knowledge is produced. We argue that the visions of knowledge-making and early intervention through genomic science and technology as conveyed in policy papers on personalized medicine, challenge preexisting practices and understandings of what constitutes timely prevention and actionable knowledge within clinical care. We close the article discussing how prevention through genomics amplifies the significance of the clinical space for public health as a site for sense-making and translation of controversial genetic knowledge. [ABSTRACT FROM AUTHOR]

Medicalisation of hospice care has been discussed simultaneously with the development of palliative care into a medical speciality. However empirical knowledge of the role of medicalisation in hospice practice is underexplored. This paper considers hospice managers' perspectives on hospice care in the complex between values related to hospice philosophy and a specialised medical approach to hospice care. Focus groups and small group interviews were conducted with hospice managers from 16 out of the 19 Danish hospices. Drawing on hope as a theoretical framework, the study contributes to further understanding of the complexity of navigating hospice care in the impasse between an existential hope focused on meaning at the end of life and a medical hope for control of the dying body. Hospice care appeared as pulled between these dimensions of hope. The hospice managers took a pragmatic approach to medicalisation but their emphasis on dying as an existential event also points to a role for hospices as a critical voice against over-medicalisation of dying. [ABSTRACT FROM AUTHOR]

Being in nature and doing nature-based activities has been shown to reduce stress-related illnesses such as trauma and post-traumatic stress disorders. In 2016, the crisis shelter Danner in Denmark decided to implement a programme based on the therapeutic use of nature as a recovery method for their residents: women and children exposed to domestic violence. This was done in collaboration with the research group of University of Copenhagen. This paper describes the objectives of the project, the development of an educational programme and the implementation of nature-based therapy. The Danish model for qualifications in education developed by the Danish Ministry of Education was the overall structural framework for the programme. The education programme contained four overall elements: (1) a theoretical part on the nature–health relationship; (2) performance and development of practical nature activities in collaboration with staff; (3) case stories about the challenges of implementing nature-based therapy for the residents in the crisis shelter; and (4) the implementation phase of nature-based therapy at Danner. Developing qualifications related to the use of nature-activities and the use of nature-environment might be useful for social workers and strengthen their competences in their work with battered women and children. [ABSTRACT FROM AUTHOR]

This paper explores the moral implications of treatment of young people with functional somatic symptoms. Based on an ethnographic field study at a Danish pain clinic for youngsters (age 8 to 18), the paper seeks to unearth the cultural, moral values that clinical practice steers by and upholds, and the implications this has for the assessment and management of ill body-selves. Through an exposition of the general practice of the clinic and an investigation of two specific cases of youngsters, it is found that the assessment of symptoms and selves and the goals of treatment are informed by cultural ideals of 'the good self' and 'the good life' in which agency and work ethic – both pertaining to the notion of individual responsibility – figure as prevalent virtues. The study underpins the findings of other researchers who have found that ideals of individual autonomy and responsibility for own life and health permeate the Western health care system and the discourses of ill individuals. The contribution of this article is to portray in ethnographic detail how such a cultural ethics manifests in practice and what implications this have for the treatment of young people with functional symptoms at a specific location and in specific cases. The two cases illustrate that the underlying norms and values can give rise to very different moral assessments of symptoms and selves within the same diagnostic category. [ABSTRACT FROM AUTHOR]

Health care systems as well as bodies of medical knowledge are dynamic and change as the result of political and social transformations. In recent decades, health care systems have been subjected to a whole assemblage of regulatory practices. The local changes undertaken in Denmark that are being explored here are indicative of a long-term shift that has occurred in many welfare states intended to make public services in the Global North more efficient and transparent. Departing in prolonged field work in Danish general practice and the anthropological literature on audit culture, this paper suggests that the introduction of regulatory practices has enhanced the need for triage as a key organising principle. The term triage literally means separating out and refers to the process of sorting and placing patients in time and space. The paper suggests that an increasing introduction of triage feeds into a reconfiguration of diagnostic work, where the clinical setting is gradually becoming more intertwined with the governing domains of policy, and the work of the secretary is gradually becoming more intertwined with that of the doctor. Finally, the paper argues that an increasing regulation of general practice poses an ethically charged challenge to existing welfare politics of responsibility between the state and the public, as it makes it increasingly difficult to negotiate access to care. [ABSTRACT FROM AUTHOR]

This paper provides an account of young people's experiences of and perspectives on help and support in drug reducing interventions. It is based on interviews with young people age 14–25 who were in contact with the Criminal Justice System (CJS) and, at the same time, participated in a drug reducing intervention. The interview data forms part of the EU funded EPPIC project. Two main themes emerged from the young peoples' accounts that cut across different types of interventions and social systems in both countries. The first revolves around the 'system' of welfare, criminal justice, health and educational services and the barriers young people encountered in navigating the system to find help. The second revolves around the young people's experiences with professionals, including what they appreciated and what they found problematic in professionals' approach to them. Basing our analysis on data from two different countries, we are able to emphasize similarities in the young peoples' perspectives, despite being enrolled in different drug reducing and CJS interventions. The insights gained indicate a need for systems and service changes that can facilitate a better balance between building individual resilience and providing appropriate, timely and adequate support within a 'resilience-building' environment. [ABSTRACT FROM AUTHOR]

The engagement of young people has been a neglected area in youth justice and drug policy and practice. This paper explores the concept of 'engagement' in relation to drug interventions in custodial and community settings in different European countries. Interviews were undertaken with young people (aged 14–25 years) in contact with the criminal justice system who use illegal drugs and with practitioners involved in the delivery of interventions for our target group in Denmark, Italy, Poland, and the UK. The key techniques to engage young people were described in similar terms across the countries. These included forming relationships based on trust, honesty, and empathy, setting goals collaboratively, and employing practitioners with lived experience and understanding. The objectives and activities on offer are often constrained by criminal justice contexts. Despite the differences between the countries in terms of criminal justice systems and the structure of drug interventions, there were remarkable similarities in the ways young people and practitioners described effective engagement. Strong emphasis on operational engagement to ensure positive relationships between young people and practitioners was important in the design and delivery of interventions. Practitioners working in criminal justice contexts need to have flexibility and autonomy to work creatively to find ways to engage, connect, and inspire young people. [ABSTRACT FROM AUTHOR]

Based on research undertaken as part of the EU funded EPPIC project, this paper aims to update and elaborate on the relationship between drug use and offending behaviours by exploring variations within a cross-national sample of drug-experienced young people in touch with criminal justice systems. Adopting a trajectory-based approach, interviews were undertaken with 198 young people aged 15–25 in six European countries (Austria, Denmark, Germany, Italy, Poland, and UK). Data were analysed by applying the Bennett and Holloway categorization of the drugs-crime link, with a focus on the concept of social exclusion as developed by Seddon. Three main types of mechanisms (economic, pharmaceutical, and lifestyles) are used to interpret the data, showing how the relationship between drugs and offending can vary according to type of substances and over time. Furthermore, it can be associated with very different degrees of social exclusion and needs. The results suggest that while economic inequalities still play key roles in explaining drug use and offending, both behaviours can originate from a state of relative deprivation, resulting from the contradictions inherent in 'bulimic societies' that raise aspirations and desires while providing young people scarce opportunities for self-realisation and social recognition. [ABSTRACT FROM AUTHOR]

Based on fieldwork among Danes with a diagnosed risk of type 2 diabetes or cardiovascular disease, this paper investigates how the technological possibilities of diagnosing and monitoring invisible risks shape understandings of health and form subjectivity. It focuses on the experiences of being diagnosed with a risk condition in the form of high blood pressure or elevated blood glucose and the ensuing use of measuring devices. It argues that measurements of these conditions can be seen as ‘formative processes’ that produce and maintain a view of health as something that can best be known through the use of medical technology. The numerical values such measurements yield are seen as true indicators of health, and doing something about risk conditions is felt to be a personal imperative. The formative processes illustrated in this paper are motivational and thought provoking. The informants do not experience new symptoms after being diagnosed; rather they reflect upon their health in a new way and numbers become associated with personal responsibility and morality. However, because numbers influence subjective experiences, they can come to take up too much space in everyday life. Therefore, people have reservations about how often they should measure their values at home. The formative processes of being diagnosed with a risk condition are thus about subjectivity both in the sense of being subject to the demands of living with an illness and of being a subject who acts to keep life from being colonized by concerns about health. [ABSTRACT FROM PUBLISHER]

Transnational Global Health programmes planned and financed in theNorth and executed in the Global South usually involve some transfer ofcapacity between sites or capacity building in place. Capacityinvestment in the form of skills, knowledge, experience and equipmentis often assumed to ‘flow' between countries, laboratories andinstitutions, following the trajectories of mobile subjects in theknowledge economy. Drawing on in-depth interviews with Danish andEast African scientists, this paper considers the mobilities that underpinscientific capacity building, drawing attention to the paradoxical in waysin which these programmes produce stasis and fixity, as well as mobilityand exchange. [ABSTRACT FROM AUTHOR]

This paper, analyzing interviews with men that donate their semen in Denmark, explores what it means to be a sperm donor. Breaking with the assumption that men have a specific and clearly identifiable motivation to become sperm donors, this paper leaves the confinement of such an accountable actor model implied in asking for men's motivations to donate semen. Instead, the author describes the experiences of sperm donors to show how the moral, organizational, and biomedical-technological context of sperm donation in Denmark makes for enactments of moral selves as well as specific embodiments of masculinity. Instead of looking for motivations that can be accounted for, the author engages with the question of how donating semen affords men the experience of moral and gendered selves. [ABSTRACT FROM AUTHOR]

Usability and user experience (UX) methods come from academic environments, where industrial conditions such as time and resources are not of prime importance. Furthermore, usability and UX methods originate from a time when almost all software developments followed a traditional approach, such as the waterfall model. These two facts entail that existing methods often are too resource demanding and complex to apply directly into today’s agile, industrial environments. In this paper we make the claim that methods must be updated and tailored in order to be applicable within the agile, industrial development framework of today. We pursue a solution to simplify well-known methods and to train software developers to perform the UX work. To do this, three methods are modified via an iterative process together with the development of supporting materials. Software developers in three companies are trained in the methods to assess the approach. We find that it indeed is feasible to update and tailor existing usability and UX methods to fit into an agile, industrial environment. Furthermore, we show that it is possible to train developers to perform the usability and UX methods via one-day,in-situsessions using an ‘instructor’-teaching approach. The training is based on hands-on exercises and real-life tasks. This further boosts the developers’ confidence in performing UX work and promises a better consideration of UX in the development phases. We evaluate our approach through observations of the developers performing the UX tasks on their own at a later point in time. [ABSTRACT FROM PUBLISHER]

This qualitative study explores the structural barriers to preventive interventions targeting childhood obesity in the Danish health care system. Based on interviews with relevant health care professionals, the paper reports on the problems which are experienced by general practitioners and health visitors and which complicate implementation of the policies of the Danish health authorities. Findings show that the current system is not well equipped to treat early overweight. A gap in primary preventive health care for children at age 3–5, indistinct lines of responsibility, inadequate cooperation, and lack of resources together make it difficult for health care professionals to initiate interventions and reach the children in need of support. By analyzing the policy implementation process in a theoretical framework that discloses the discursive allocation of responsibilities, the study is able to provide a deeper description and analysis of the problem. The study makes it clear how preventive health care for overweight children rests on the negotiation of formal and performed responsibilities among health practitioners within a framework of scarce resources and communication deficit. [ABSTRACT FROM PUBLISHER]

This paper explores the intersection of gender and class concerning welfare clients with medically unexplained symptoms. The study is conducted in Denmark using qualitative interviews with welfare officers and clients. The paper's focus is on how issues of gender and class intersect in the negotiation of illness among welfare officers and clients. The particular client group in question consists of individuals that are defined by their lack of a bio-medical diagnosis. Their 'lack' of identity accentuates how gender and class become central in the categorisation practices, constructing the ill person as either bio-medically sick or as a person who may be suffering but only from diffuse psychological problems. The paper shows that it is predominantly poorly educated women without a bio-medical diagnosis that welfare officers describe as suffering from psychological problems despite the fact that the women themselves focus on physical ailments in their illness stories. Men and better-educated women are described by the welfare officers as tired and exhausted or truly stressed after a long working life. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study of the onset of acquired hearing impairment. The focus of attention is why a person seeks treatment. The Danish welfare state serves the population 'in need' such as those with an audiological need and gives them guidance on becoming hearing aid wearers in order to rehabilitate them back to 'normalcy'. However, within audiological research, noncompliance has attracted much attention as investigations have shown that more than 20 percent of hearing aids are very seldom, if ever, in use and 19 percent are used only occasionally. As shown in the paper the form a problem takes is in large part a product of micro-political struggles. Hence, at the onset 'need' is often embedded in social pressure from significant others. The paper examines these two discursive frameworks and their constitution of (hearing) problems and concludes that norms of disease are complex and epistemologically contested and can help explain why noncompliance is dominant when it comes to hearing rehabilitation for hearing impaired adults. [ABSTRACT FROM AUTHOR]

Diagnosis constitutes a major categorisation tool in medicine. This paper adds to the paucity of knowledge about part of the work such a tool performs. It examines the ways in which diabetes epidemiology translates into attempts to prevent diabetes from occurring through screening and diagnosing, and then managing those categorised as ‘at high risk’. Using a qualitative design in the context of a small-scale Danish intervention study, the findings suggest that health professionals overinterpreted relative risk reductions and exaggerated treatment effects; simultaneously, prediabetics called into question the scientifically set thresholds. Nonetheless, arguments concerning changed behaviour’s benefits were sought to be incorporated into self-care routines. The data highlight how, by identifying a normatively set threshold, a diagnosis can determine health promotion messages’ impact in ‘high-risk’ prevention strategies. [ABSTRACT FROM PUBLISHER]

Career decisions are amongst the most important we make. Unsurprisingly, much published research exists on this particular aspect of career behaviour. However, the overwhelming majority of studies have been carried out on young people making initial career decisions. This paper extends our understanding by examining how mid-career adults in three European countries (Denmark, France and Italy) actually make career decisions. Characteristic patterns of behaviour recur when individuals approach points of transition or of crisis; each of these transitioning styles is illustrated by an iconic case. Emergent findings support the growing body of evidence that challenges the dominant policy and practice orthodoxy, which places rationality at the centre of the process, by recognising the importance of emotion and context. [ABSTRACT FROM PUBLISHER]

Usability evaluations provide software development teams with insights on the degree to which a software application enables a user to achieve his/her goals, how fast these goals can be achieved, how easy it is to learn and how satisfactory it is in use. Although usability evaluations are crucial in the process of developing software systems with a high level of usability, their use is still limited in the context of small software development companies. Several approaches have been proposed to support software development practitioners (SWPs) in conducting usability evaluations and this paper presents two in-depth empirical studies of supporting SWPs by training them to become barefoot usability evaluators. Findings show that the SWPs after 30 hours of training obtained considerable abilities in identifying usability problems and that this approach revealed a high level of downstream utility. Results also show that the SWPs created relaxed conditions for the test users when acting as test monitors but experienced problems with making users think aloud. Considering the quality of problem descriptions, we found that the SWPs were better at providing clear and precise problem descriptions than at describing the impact, cause, user actions and providing data support for observations. [ABSTRACT FROM PUBLISHER]

More than 25% of the master's degrees in Denmark are taught using English as a medium of instruction (EMI), but not all university lecturers feel they have the appropriate academic English proficiency to meet the standard required. Based on interviews conducted at the Copenhagen Business School (CBS), this article sheds light on the challenges faced by a selection of these lecturers. The interviews formed part of the project Students' Perceptions of the English of Academics, which examines the use of EMI at CBS. Audio recordings were made of 33 lecturers. Questionnaires were distributed to almost 1800 students on a range of issues, including the lecturer's English proficiency. The lecturers themselves also completed a questionnaire. Subsequently, 17 of them were interviewed, five of whom belonged to the group with the weakest skills. Inspired by a categorisation used by Marschan-Piekkari, Welch, and Welch for their recommendations for managing English as a corporate language, the literature review in the present paper discusses university language management under the headings of staff selection, training and development, international assignments and performance appraisal. The insights gained from the interviews address issues such as attitudes to EMI policy, experience with EMI teaching, student evaluations and support. [ABSTRACT FROM AUTHOR]

This paper describes a phenomenological hermeneutic study of experiences of women who were recently diagnosed with osteoporosis. The research objective was to investigate women's experiences of living with osteoporosis during the first 6 months after diagnosis when treatment was first prescribed. Fifteen women were included in the study. The inclusion criteria were a DXA scan at one of the two hospitals showing a T-score below -2.5 (lower back or hip), age 65 years or older; no previous known osteoporotic fracture; at least one of the known risk factors for osteoporosis; and prescription of anti-osteoporotic treatment. Exclusion criteria were previous diagnosis of osteoporosis or previous treatment with anti-osteoporotic medication. Data were collected through in-depth interviews shortly after diagnosis and 6 months later. The performed analyses were inspired by Paul Ricoeur's theory of interpretation of texts comprising three levels: naïve reading, structural analysis, and critical interpretation and discussion. Three key themes emerged: 1) being diagnosed, 2) being prescribed medical treatment, and 3) being on the path of learning to live with osteoporosis. The findings suggest a need for improved support for the patients to gain understanding of their diagnosis and the risk of osteoporotic fracture as well as to learn to live with osteoporosis. The study highlights new health promotion areas for targeting interventions at newly diagnosed patients, helping them accept and interpret the diagnosis, and the medical treatment. [ABSTRACT FROM AUTHOR]

This paper explores the lived experiences of older surgical patients' (aged 74 years and older) experienced challenges during a brief admission to hospital. Age, gender, polypharmacy, and the severity of illness are also factors known to affect the hospitalization process. For an ethnographic study using participant observation and interviews, surgical cancer patients (n=9, aged 74 years and older) were recruited during admission to a Danish teaching hospital. Using ethnographic strategies of participant observation and interviews, each patient was followed through the course of 1 day during their stay at the hospital. Interviews were carried out with all patients during this time. Three areas of concern were identified as prominent in the patients' experiences and challenges during their short hospital stay: teeth and oral cavity, eating in a hospital setting, and medication during hospitalization. Short-term hospitalization requires focused collaboration between staff and patient concerning individual challenges from their teeth and oral cavity as support of nutritional needs during surgical treatment for cancer. [ABSTRACT FROM AUTHOR]

Purpose:Over the past two decades, attempts have been made to describe the nurse’s role and functions in the inpatient stroke rehabilitation; however, the nursing contribution is neither clear nor well-defined. Previous studies have highlighted the need for research aimed at developing interventions in the neuro-nursing area. The objective of this paper was to describe the development of a nursing intervention aimed at optimising the inpatient rehabilitation of stroke patients by strengthening the role and functions of nursing staff. Method:A systematic approach was used, consistent with the framework for developing and evaluating complex interventions by the UK’s Medical Research Council (MRC). Based on qualitative methods and using the Behaviour Change Wheel’s (BCW) stepwise approach, we sought behaviours related to nursing staffs’ roles and functions. Results:We conducted a behavioural analysis to explain why nursing staff were or were not engaged in these behaviours. The nursing staff’s Capability, Opportunity and Motivation were analysed with regard to working systematically with a rehabilitative approach and working deliberately and systematically with the patient’s goals. Conclusion:We developed the educational intervention Rehabilitation 24/7. Following the MRC and the BCW frameworks is resource-consuming, but offers a way of developing a practical, well-structured intervention that is theory- and evidence based. [ABSTRACT FROM PUBLISHER]