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The aim of this grounded theory study was to illuminate the main concern of people suffering from chronic obstructive pulmonary disease (COPD) and how they handle their everyday life. Data were collected through interviews with 23 people with COPD at different stages, from mild to severe. A substantive theory was generated showing that the main concern was feelings of guilt due to self-inflicted disease associated with smoking habits. This core category was related to five managing strategies termed making sense of existence, adjusting to bodily restrictions, surrendering to fate, making excuses for the smoking-related cause and creating compliance with daily medication.

Although many countries offer some publicly funded orthodontic treatment for children, not all conditions receive treatment and some adolescents enter adulthood with persisting poor dental aesthetics or malocclusions. The aim of this study was to generate a theory highlighting the main concerns of young adults, either native-born or of immigrant background, with poor dental aesthetics and the measures they adopt to manage their condition in everyday life.A qualitative method, classic grounded theory, was applied in order to generate a substantive theory highlighting the main concerns and managing mechanisms of 13 strategically selected 19- and 20-year-olds with poor dental aesthetics. Open interviews were conducted with each participant, the topics covering different aspects of social and dental conditions.A core category and three conceptual categories were generated. The core category was labelled "Being under the pressure of social norms" and was related to categories explaining three different ways in which these young adults handle their main concern: (1) avoiding showing their teeth; (2) minimizing the importance of appearance; and (3) seeking orthodontic treatment. The theory offers the potential for improved understanding of young adults who, despite poor dental aesthetics, are managing well with life, and also of those who have not adjusted well.In early adolescence it may be problematic to make decisions about orthodontic treatment. Undisclosed dental fear can be an important barrier. Some of the young adults in the present study would probably benefit from treatment.

This article focuses on one of the interactive processes that parents use to cope with their child's asthma. The concept allowing for the opposite was developed in the course of a clinical project designed to improve consultation methods in pediatric allergy care. We examined material from 67 conversations carried out with 22 heterosexual couples held with two family therapists: one male pediatrician and one female social worker. We found that parents made use of each other's differences in personality and parenting style, allowing each other to take opposing positions on how to cope with their child's asthma. Disagreement should be added to the list of coping mechanisms used by parents in their cooperative efforts to handle their child's asthma.

The purpose of this study was to examine patients’ experiences of daily living with a pacemaker. A total of 13 pacemaker patients (seven women) aged 22-82 (mean = 59.2) years were interviewed. The informants had had a pacemaker from 0.5 to 33 (mean 13.1) years. The grounded theory method was the basis for collection and analysis of the data. The results of the analysis of the semi-structured interviews showed that variations in ‘perceived social participation’ and ‘emotional state’, the two core categories, were related to four qualitatively different ways of experiencing daily living after pacemaker implantation.

This paper reports on an interview study exploring the self-regulation process in women and men, 5 months after a first-time myocardial infarction.Somatic, psychological and social factors affect readjustment after a first-time myocardial infarction, and studies have demonstrated substantial rates of depression in patients after myocardial infarction Women report poorer mental health and physical condition than do men. Reconstruction of the self begins when disease poses novel problems and is more likely to occur in cases of long-lasting and disruptive illnesses. Experiencing myocardial infarction is likely to alter a person's mental representation of self. However, the self-regulation process following first-time myocardial infarction is not yet fully understood.Twenty-one people (11 women, 10 men) were interviewed 5 months after first-time myocardial infarction. The grounded theory method provided the strategies for data collection and analysis.Interviewees' definition of themselves as active was threatened by fatigue and other health problems that kept them from taking part in activities as they had done before the heart attack. Although reorienting the active self was central to the process of recovery from myocardial infarction, reorienting was restricted by illness perception and coping.Participants had not established a stable health condition 5 months after first-time myocardial infarction. They mainly preferred to moderate rather than radically change their daily life activities. They needed more knowledge and support. Nurses can help with information and advice on managing daily life activities, including dialogue about lifestyle changes at this phase of readjustment.

We first aimed to describe demographic and audiological characteristics of adults referred to a university hospital for hearing aid (HA) fitting and rehabilitation. Our second aim was to employ an inventory that assesses life consequences of hearing impairment (HI) in terms of perceived activity limitation and participation restriction for the first time in a Norwegian adult outpatient population. A third aim was to study life consequences by audiological and demographic characteristics.During one year consecutive patients (n = 343) were requested to answer the Hearing Disability and Handicap Scale (HDHS) assessing activity limitation and participation restriction in relation to an audiological examination and medical consultation. The mean threshold of hearing (MTH) was ascertained by pure tone thresholds at 0.5 - 1 - 2 - 4 kHz in the better ear.Activity limitation and participation restriction were both higher for HA experienced than HA naïve subjects ( p0.01). In a multivariable model, the explained adjusted variance of activity limitation (R2) was 43.4% with MTH, perceived duration, and severity of hearing problems as predictor variables. Correspondingly, the explained adjusted variance of participation restriction was 28.4% for a model with MTH, age, gender and perceived severity of hearing problems as predictors.As a standard supplement to audiometric tests, HDHS may be successfully applied as a clinical tool among similar hearing impaired outpatients in order to assess activity limitation and participation restriction as part of audiological rehabilitation.

To study psychological well-being (health-related quality of life) in a population of adults 20 years and over with hearing impairment (HI) and its relation to audiological factors, consequences of the HI, sense of humour, and use of communication strategies.Consecutive adults (n = 343) at the outpatient Unit of Audiology of a Norwegian university hospital answered the Psychological General Well-being inventory (PGWB), Hearing Disability and Handicap Scale (HDHS), Sense of Humour Questionnaire-6 (SHQ-6), and Communication Strategies Scale (CSS) in relation to an audiological examination and medical consultation.Mean PGWB index for the whole sample was 81.4 (SD 14.3) and females reported a significantly lower psychological well-being. In multiple linear regression analyses well-being was negatively associated with high levels of activity limitation and participation restriction. PGWB index was positively associated with high sense of humour, but was neither explained by audiological factors nor use of communication strategies.Psychological well-being was associated with the outcome of a standard HI assessment of activity limitation and participation restriction, but not with degree of HI and use of communication strategies.

The aim of the study was to gain a better understanding of what suffering from hyperacusis means. Twenty-one out-patients referred to a hearing clinic due to persisting hypersensitivity to sounds after an acute head trauma were interviewed. Before the head trauma, they had lived an independent, active and externally oriented life. As a consequence of the trauma, the patients became psychosocially vulnerable and suffered from a variety of symptoms: hypersensitivity to sounds, difficulties with concentrating and remembering, increased anxiety and sensitivity to stress. Structuring everyday life and using a variety of coping strategies was necessary for reducing life stress and symptoms in the process of adjusting to the changed life situation.

Dental phobia is regarded as one of the greatest obstructions to adequate dental care. It has long been established that fearful dental patients are particularly sensitive to dentists' behavior and performance of dental care. There is a need for the establishment of a systematic theory of dentist-patient communication and new methods analyzing how dentists interact with their patients. In this qualitative study, thirty semi-structured interviews were conducted in 1998 and 1999 with five dentists (three male and two female). Dentists consulted on two occasions with 15 newly enrolled, consecutive dental phobic patients (2 male and 13 female) in a Swedish clinic specializing in the treatment of odontophobia. The time interval between consultation one and two was approximately 2-3 weeks. Analysis of the transcribed interviews was based by the principles of Grounded Theory. The study identified one core category, "Holistic perception and understanding of the patient", two categories, "The dentist's positive outlook on people" and "The dentist's positive view of patient contact", and six further subcategories. Findings support previous models of patient-centered medicine and contribute to a better understanding of how patient-centered dentists interact with dental phobic patients.

Oral health care has been shown to have low priority in nursing and has been only partly successful. To create more positive effects than those achieved through traditional oral health care education, this project tested an educational model for nursing staff personnel. In addition to traditional oral health care education, some of the nursing staff members passed an additional dental auscultation period and served as oral care aides. The aides were responsible for the oral health care of the residents at their nursing facilities (intervention group). The intervention nursing facilities were compared with facilities where nursing personnel only received a traditional oral health care education program. Assessments were made at baseline and at a 6-month follow-up. At follow-up it was shown that the nursing staff in the intervention group gave higher priority to the oral health care work than the nursing staff in the control group.

The purpose of this study was to describe the experiences of coping with demanding auditory situations in everyday life from the perspective of individuals with severe-profound hearing impairment. Seventeen individuals (11 women and 6 men), with post-lingual severe-profound hearing impairment participated in the study. All were patients at the Department of Audiology, Sahlgrenska University Hospital in Göteborg, Sweden. Inclusion criteria were a hearing impairment exceeding 70 dB HL at the frequency of 1 kHz in the better ear, and full-time employment. Data were assessed by in-depth interviews lasting about one hour. The interviews were transcribed verbatim and analysed line-by-in line in accordance with the grounded theory tradition. Six theoretical constructs, or categories, were grounded in the data. These categories were labelled 'coaching', 'belonging to two worlds', 'self-efficacy', 'hardiness' and 'directing coping strategies'. In a grounded theory the central phenomenon on which all the other categories are integrated is known as the 'core category'. The core category, which emerged in the present study, was labelled 'finding flow and entering a positive circle'. This was described as a condition necessary for successful coping with the demanding situation of being a profoundly hearing-impaired person working full-time. According to the core category, there is a small 'margin' within the positive circle (a space where smaller mistakes may occur). However, if mistakes are too severe, or too many, individuals will no longer find flow in the positive circle, rather they enter a negative circle. In the present study subjects' personalities were characterized by hardiness. It is suggested that coaching behaviour and the hearing-impaired individuals' personality dispositions of hardiness and self-efficacy function as resistance resources, buffering stressful events in everyday life.

Through the reform entitled "Dental care insurance-dental care at a fixed price", patients are offered a dental insurance, a capitation plan, that ensures that they can visit the dentist regularly during a period of three years at a fixed price per month (Frisktandvård).This insurance may be offered to all patients. The aim of this study was to generate a theory explaining the main concern for the staff at the public dental service when they have to introduce and advocate dental care insurance to patients. Interview data from 17 persons, representing different professions within the public dental service, were collected and analyzed simultaneously in line with guidelines for grounded theory. The results indicated that dentists/dental hygienists experienced several difficult standpoints concerning the implementation of the dental insurance, somewhat of a moral dilemma. The staff generally had a "cautiously positive attitude" to the forthcoming dental care insurance, but had perceptions how and when the patients should be offered the insurance and what that may mean to the clinic.The respondents reflected about the economic aspects for the clinic and how the oral health may be affected over time for the patients.

This study aims at evaluating the short- and long-term effects of a group rehabilitation programme, designed for males with noise-induced hearing loss and their spouses. The rehabilitation programme, including four 3 h group sessions per week, intended to offer adequate information, psychosocial support and training in effective coping strategies. Fifty-three males were consecutively selected and randomly divided into an experimental and a control group. Twenty-seven males were invited to participate in the group sessions together with their spouses. Although an informed consent to participate was given by the males initially, 15 couples (55.6%) refused to participate, and 12 couples agreed to participate in the group sessions. The short-term effects of the programme showed that the couples felt supported by meeting other couples in the same position. Further, the spouses' awareness of the effects of the hearing impairment was increased, which facilitated the understanding of problems related to their husbands' hearing disability. A reduction in perceived handicap, measured by the handicap sections of the Hearing Measurement Scale (P = 0.017) and by the disability/handicap factor of the Hearing Handicap and Support scale (P = 0.054), was found immediately after the rehabilitation programme in the participants compared to the controls. Four months later, no significant difference in any of the variables measured was found. Interestingly, both from a short-term and a long-term perspective, the drop-outs from the experimental group (n = 15) scored significantly higher on perceived handicap (P = 0.034 and P = 0.031, respectively) compared to the participants in the group rehabilitation programme.

Dental fear is a common and widespread problem, which can cause severe stress. Even so, most patients with dental fear undergo regular dental treatment in spite of their fear and many enjoy good oral health. The aim of this study was to obtain a deeper understanding of how patients with dental fear manage to undergo dental treatment. Fourteen patients with dental fear, who undergo regular dental care, were interviewed. Qualitative analysis of the transcribed interviews was performed according to the principles of grounded theory. A conceptual framework was generated, and the main concern was identified as 'making dental care possible - a mutual affair'. Four additional categories explained how patients handled their dental fear and how dental care became possible. The strategies were labelled 'taking part in a mental wrestling match', 'trust-filled interaction with dental staff', 'striving for control' and 'seeking and/or receiving social support'. The results showed that making dental care possible for patients with dental fear is a mutual challenge that requires interplay between dental staff and patients, involving verbal and non-verbal communication reflecting respect, attention, and empathy. Moreover, a balance between nearness and distance and between professional and personal treatment is required.

By using a modified stepwise regression analysis technique, the structure of self-perceived handicap and tinnitus annoyance in 89 males with noise-induced hearing loss was described. Handicap was related to three clusters of variables, reflecting individual, environmental, and socioeconomic aspects, and 60% of the variance in self-perceived handicap was explained by the representatives of these clusters: i.e. 'acceptance of hearing problems', 'social support related to tinnitus' and 'years of education'. Tinnitus had no impact of its own on self-perceived handicap and only a modest portion (36%) of the variance in tinnitus annoyance was explained by 'sleep disturbance' and 'auditory perceptual difficulties'.

The hearing measurement scale (HMS), targeting the experience of being hearing impaired, was translated into Swedish and answered by 122 patients with slight to moderate hearing losses. According to the item analysis the test construction of the HMS functions well with a relevant division of the sections. In all sections there were individuals utilizing all response possibilities and the homogeneity (alpha) of the test was high. One exception was section II (hearing non-verbal sounds), which may be due to lack of awareness, indicating that it might not be possible to pursue this dimension by a questionnaire approach. Normative descriptions were given for two age groups: 40 to 60 and 61 to 74 years, including both sexes. The groups had a similar outcome on the HMS, even though the older subjects, on average, had worse hearing problems, measured by pure-tone audiometry. The section covering speech perception had the strongest correlation with hearing loss, while the section covering emotional response entirely lacked such correlations for the younger group.

Beliefs and attitudes towards tinnitus have been found to play an important role in the process of rehabilitation. The relationship between audiological, psychological and psychosomatic factors (self-assessment of vertigo and headache and the perceived severity of tinnitus) was investigated in a clinical population of 163 subjects. Audiological descriptives comprised pure-tone average (dB HL), etiology of hearing loss, duration of tinnitus and tinnitus localisation. Perceived severity of tinnitus was assessed with a questionnaire focusing on tinnitus impact on aspects of quality of life, concentration and sleep. A 28-item handicap and support questionnaire was used and factor analysed, resulting in three factors: perceived attitudes, social support and disability/handicap. Tinnitus severity was significantly related to perceived attitudes. The influence of social support on tinnitus severity did not seem to be crucial. The results showed that significantly more women than men complained about vertigo. Unilateral tinnitus localisation was also more prevalent in females. The subjects with multiple tinnitus localisations were older and had significantly more sleep disturbance than subjects with tinnitus localized to the ears only. In accordance with previously reported observations, the frequency of headaches was strongly correlated with the severity of tinnitus.

Coping strategies are presumed to be modifying factors between a hearing impairment and the perceived handicap. The focus of this investigation was to explore audiological and psychological factors affecting the perceived handicap in hearing-impaired middle-aged subjects. The Hearing Measurement Scale, supplemented by a subjective estimation of the perceived handicap, was used as the dependent variable in a study of 62 subjects, heterogeneous as to type and severity of hearing loss and to hearing aid use. In a stepwise regression analysis, maladaptive communication strategies as well as active and constructive coping behaviours were found to increase the self-perception of hearing handicap. Other significant variables were severity of hearing loss and years of education. Tinnitus symptoms did not contribute to the explained variance in the perceived handicap, which was an unexpected finding. A conclusion that may be drawn from the present study is that active coping strategies tend to focus attention on disability and thereby increase perceived handicap.

The aim of this study was to gain a deeper understanding of what hearing-impaired people are doing to deal with demanding auditory situations in everyday life. Twelve middle-aged subjects with clinical hearing impairments were interviewed monthly during 5 months. The interviews focused on the subjects' own descriptions of demanding auditory situations and what they did, thought and felt in these situations. Verbatim transcribed protocols were content-analysed according to Grounded Theory. Fourteen categories were grounded in the data, forming a model for dealing with demanding auditory situations, including two qualitatively different management patterns: 'to control the social scene' and 'to avoid the social scene'. The emerging core variable was socio-psychological: the hearing-impaired individuals strive to maintain the normal identity and to prevent their definition as deviant in interactions with hearing people. The result of the inductive study was verified in a deductive study of 50 hearing-impaired subjects.

Aim.This paper is a report of a study to explore what it means for children to attend hospital for day surgery. Background.Hospitalization is a major stressor for children. Fear of separation, unfamiliar routines, anaesthetic/operation expectations/experiences and pain and needles are sources of children's negative reactions. Method.A grounded theory study was carried out during 2005–2006 with 15 boys and five girls (aged 6–9 years) scheduled for elective day surgery. Data were collected using tape-recorded interviews that included a perioperative dialogue, participant observations and pre- and postoperative drawings. Findings.A conceptual model was generated on the basis of the core category 'enduring inflicted hospital distress', showing that the main problem for children having day surgery is that they are forced into an unpredictable and distressful situation. Pre-operatively, the children do not know what to expect, as described in the category 'facing an unknown reality'. Additional categories show that they perceive a 'breaking away from daily routines' and that they are 'trying to gain control' over the situation. During the perioperative period, the categories 'losing control' and 'co-operating despite fear and pain' are present and intertwined. Post-operatively, the categories 'breathing a sigh of relief' and 'regaining normality in life' emerged. Conclusion.The perioperative dialogue used in our study, if translated into clinical practice, might therefore minimize distress and prepare children for the 'unknown' stressor that hospital care often presents. Further research is needed to compare anxiety and stress levels in children undergoing day surgery involving the perioperative dialogue and those having 'traditional' anaesthetic care.

The aims were to (i) translate the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) into Swedish and evalute its usefulness, (ii) describe hearing difficulties and psychological well-being (quality of life) and (iii) explore variables related to psychological well-being in a Swedish population.Seventy-nine consecutive patients, referred to the hearing clinic for hearing examination and audiological rehabilitation, formed the study sample. Along with pure-tone audiometry, the AIADH, the Psychological General Well-being index and the Communication Strategies Scale were used.Men had significantly worse hearing on the high frequencies (2, 3, 4 and 6 kHz) than women but their quality of life was significantly higher than for women. Men scored significantly lower on 'auditory localization' and adopted non-verbal communication strategies less often than women. A stepwise regression analysis showed that 'maladaptive behaviours' and 'intelligibility in quiet' explained 48% of the variance in quality of life.Psychosocial consequences of hearing loss, such as lowered quality of life, cannot be predicted from audiometric data alone. The adverse relationship between maladaptive behaviour and quality of life emphasizes the relevance of developing training programs aiming to improve coping with the consequences of a hearing impairment. The AIADH may be useful in assessing self-reported difficulties among patients with hearing problems, but needs to be further developed in terms of psychometric evaluations and reliability testings based on a larger representative sample.

Background Workplace bullying has attracted increased attention during the last decade due to its severe consequences on health. However, the origin of bullying has, so far, been insufficiently described. Aim This study investigates the manner in which bullying is initiated at workplaces in the public service sector. Method Twenty-two bully victims were interviewed in-depth and data were analysed according to grounded theory methodology. Results The findings of this study demonstrated that bullying was preceded by a long-standing struggle for power. This power struggle emanated from conflicts of values caused by organizational conditions, leadership styles and the involved parties’ work expectations. In particular, individuals who perceived themselves as strong and competent or as vulnerable and sensitive persons were targeted in these types of power struggles. Conclusions In these cases, if values conflicts were solved, the power struggle ebbed. When values conflicts remained unsolved, the gap widened between the targeted individual and that person's opponents. Thereby, the conflict escalated and grew into one characterized by systematic and persistent bullying.

Aim. This paper reports a study to assess stress, well-being and supportive resources experienced by mothers and fathers of children with rare disabilities, and how these variables were affected by an intensive family competence intervention. Background. Despite diagnosis-specific studies, little overall knowledge exists about life-consequences for families of children with rare disorders. Method. We used a prospective design with baseline data and two follow-ups (at 6 and 12 months) after an intervention. The intervention aimed at empowering parents in managing their child's disability. Parents from all parts of Sweden visiting a national centre for families of children with rare disabilities were consecutively selected (n = 136 mothers, 108 fathers). Instruments of parental stress, social support, self-rated health, optimism and life satisfaction and perceived physical or psychological strain were used. Stratified analyses were carried out for mothers and fathers, and related to parental demands: single mothers, full-time employment, participation in a parent association, child's age and type of disability. Results. We found high parental stress, physical and emotional strain among mothers, especially among single mothers. Fathers showed high stress related to incompetence, which decreased after the intervention. Decreased strain was found among full-time working mothers and fathers after the intervention. Parents’ perceived knowledge and active coping and mothers’ perceived social support were increased at follow-up. Factors related to parents’ overall life satisfaction (57–70% explained variance) changed after the intervention, from being more related to internal demands (perceived strain, incompetence and social isolation) to other conditions, such as problems related to spouse, paid work and social network. Conclusion. Parents, especially fathers and full-time working parents, may benefit from an intensive family competence programme.

The purpose of this research was to psychometrically evaluate the Dyadic Adjustment Scale (DAS), modified for use with new, first-time parents by extending the items of communication, sensuality, and sexuality. A total of 820 Swedish respondents, 6 months after the birth of their first child, participated in the study. Psychometric evaluation was conducted with factor analysis. The obtained factor structure was tested with multitrait analysis program. Thirty-three itemswere found to fit into a five-factor solution, explaining 50% of the total variance. Descriptive data revealed thatmost new parentswere satisfied with their intimate relationship in general, but dissatisfied with their sexual lives. Themodified DAS, now called the Quality of Dyadic Relationship Instrument includes 33 items and seems to be a useful, updated measurement for assessing quality of the intimate relationship in new first-time parents.

The present article is a descriptive survey assessing nurses' knowledge, training, and practices regarding the care of abused women. A self-administered questionnaire was sent to all nurses working within the government health organization on the Aland Islands, Finland. The response rate was 57%. Most nurses had no formal training in domestic violence and were less likely than the in-service-trained nurses to intervene with abused women. Nurses' knowledge, beliefs, and practices were found to be unsystematic and had drawbacks. Nurses were not familiar with the formal structure provided by the health administration. The results suggest that in order to meet the urgent need for training among nurses, an in-service training program needs to be set up. This program would help the nurses in identifying survivors of abuse and make them prepared to intervene more effectively to promote the health of these women.

This study aimed to describe the quality of the intimate relationship among parents six months after the birth of their first child. The Dyadic Adjustment Scale (DAS) has been modified and used on 820 responding first-time parents, of which 768 were couples. The results reveal that most parents were happy in their relationship, but both mothers and fathers were discontented with the dyadic sexuality. "Being too tired for sexual activity" was a problem, especially for the mothers, and the most common frequency of intercourse was once or twice per month. The result does not support the assumption that the couples compensate the lacking sexuality with sensuality. Good communication within the couple was associated with higher levels of several dimensions of the intimate relationship, especially dyadic consensus and satisfaction. Thus, one way to stabilize and strengthen a relationship when dyadic sexual activity is low would be to emphasize dyadic communication and sexual activity.

The purpose of the present study was, first, to detect possible changes in health-related quality of life (HRQL) over time and, second, to predict HRQL at 1 year based on measures made 1 week and 5 months after a first-time acute myocardial infarction. There was an improvement in HRQL at 1 year, as measured by the questionnaire 36-item Medical Outcomes Study Short-Form (SF-36), for both men and women as compared with the assessment 5 months after the acute myocardial infarction. However, the pattern was somewhat different for women and men. Women mainly reported increased scores on scales reflecting better mental health, whereas men, on the whole, demonstrated higher scores in the physical health domain. Depression (HAD) and fatigue were identified as early predictors of lower HRQL at the 1-year follow-up. Our conclusion is that early assessment of fatigue and depression is worthwhile, as they may indicate decreased HRQL in men and women 1 year after first-time myocardial infarction.

PCI has been established as an effective treatment for coronary artery disease. Restenosis is a recurrence of a significant narrowing in the treated vessel. Although a part of the investigative and research funding is invested in the prevention and resolving the restenosis problem, little is known about its clinical significance apart from further revascularisation.The intention of this study was to clarify the patients perspective of what it means to suffer from documented restenosis after PCI.Patients interviewed had undergone PCI. Data collection and analysis was done simultaneously according to Grounded Theory methodology and continued until new interviews provided no additional information."Living with uncertainty" was identified as the core category, and the central focus in the data explains what it means to patients' to suffer from restenosis. The core category was further illuminated in four additional categories labelled "fighting for access to care", "moderating health threats", "trying to understand" and "controlling relatives anxiety".Patients' perceptions of illness and illness-related events, such as symptoms, diagnosis, treatment and prognosis, are considerably affected by uncertainty. This infiltrates their struggle to acquire the care needed, their endeavour to comprehend and moderate health threats, and caring for their family.

The aim of this grounded theory study was to gain a deeper understanding of what it means to profoundly deaf adults to undergo cochlear implantation and their experience of living with it daily. The aim of grounded theory is theorizing, i.e. constructing from data an explanatory scheme that systematically integrates various concepts and their relationships. The study group consisted of 10 women and seven men (age 29-78 years; mean age 56.5 years), who had had their cochlear implant (CI) for between 1 and 12 years (mean 4.1 years). Open taped interviews were carried out and analysed. The core category, coming back to life, defines a psychological process basic to existence, elucidating the existential value of hearing, including perceived harmony in life and becoming a part of the living world as important dimensions. This core concept is related to four additional emerging categories in a temporal order. Preventing disappointment concerns the decision to undergo the operation governed by the conception of having nothing to lose combined with low expectations of successful outcomes. Waiting in silence relates to experiences during the postoperative period such as sensations from the head and uncertainty about the outcome of surgery. The 'switch-on' was experienced as a significant revelation and the emotionally loaded starting point for their coming back to life. Retraining the brain concerns the lengthy audiovisual learning process. finally resulting in 'a car sounding like a car'. Strengthening of self-worth concerns psychosocial outcomes of cochlear implantation, in terms of less dependency and increased social participation. CIs provide a substantial improvement in the quality of life, as identified in the emerging generic process of coming back to life, fundamental for psychological existence.

Dental phobic patients' view of dental anxiety and experiences in dental care: a qualitative study The aim of this study was to explore and describe dental phobic patients' perceptions of their dental fear and experiences in dental care. The study sample consisted of 18 participants (12 women), with a mean age of 39.4 years, selected consecutively from patients applying for treatment at a specialized dental fear clinic in Goteborg, Sweden. Dental fear, assessed by the Dental Anxiety Scale, showed score levels well over established levels for severe dental fear. The method for sampling and analysis was inspired by the constant comparative method for Grounded Theory (GT). The thematized in-depth interviews took place outside the clinic and lasted for 1-1.5 h. All the interviews were conducted by the first author (KHA), audiotaped and transcribed verbatim. Three higher-order categories were developed and labelled existential threat, vulnerability and unsupportive dentist. Existential threat was identified as the core category, describing the central meaning of the subjects' experiences in dental care. The core category included two dimensions, labelled threat of violation and threat of loss of autonomy and independence. The core category and the descriptive categories are integrated in a model framing the process of dental fear, as described by the informants. In conclusion, the onset of dental fear was commonly related to individual vulnerability and to traumatic dental care experiences, where perceived negative dentist behaviour played a significant role. The patient was caught in a 'vicious circle' that was difficult to break, and where fear and anxiety were maintained by negative expectations about treatment and about patient's own ability to cope in dental care situations.

Thirty semi-structured interviews were conducted with 5 dentists (3 male and 2 female) after first and second consultations with 15 newly enrolled dental phobic patients (2 male and 13 female) in a clinic specializing in the treatment of odontophobia. Analysis of the transcribed interviews was influenced by the principles of grounded theory. Five concepts/higher-order categories were grounded in the data: 1 core category: 'Relatedness, based on affective resonance and concordant roles' and 4 additional higher-order categories: 'the dental phobic patient's emotions'; 'the patient's verbal and non-verbal cues'; 'the dentist's role as a clinician: professional interpersonal skills'; and 'the dentist's role as a fellow-being: general interpersonal skills'. The model developed describes the dynamics of the dentist-patient interaction and has a theoretical application.

The aim of this study was to evaluate, in terms of descriptive statistics, factor analysis, corrected item-total correlations, and internal consistency reliability, a Swedish translation of the Hearing Disabilities and Handicaps Scale (HDHS). The HDHS is shortened and modified version of the Hearing Measurement Scale. Data from 101 men having noise-induced hearing loss, with the pure-tone audiometric data showing a median value of 53.3 dBHL (R = 81.6; Q = 12.5) over the frequencies 3, 4, and 6 kHz better ear, were assessed at the Department of Audiology, Sahlgrenska University Hospital, Göteborg. A principal component analysis followed by a varimax rotation was conducted giving four emerging factors, accounting for 64.6% of the variance. Two of the factors, "speech perception" (alpha = 0.89) and "non-speech sounds" (alpha = 0.85), appear to measure perceived disability, whereas two factors, "interpersonal distress" (alpha = 0.79) and "threat to self-image" (alpha = 0.84), appear to measure dimensions related to the process of creating a handicap. The four-factor HDHS needs to be further tested in order to find out its usefulness for clinical assessment of perceived disability and handicap.

The primary aim of this study was to describe coping with noise-induced hearing loss (NIHL) from the perspective of middle-aged men. An additional aim was to gain a deeper insight in their experiences of suffering from NIHL. Taped interviews were conducted with 53 consecutive patients. The interviews focused on the subjects' own descriptions of demanding auditory situations and what they did, thought and felt in these situations. The verbatim transcribed interview protocols were analysed by a method influenced by the tradition of grounded theory (Glaser and Strauss, 1967). The first important finding was that the coping model, consisting of controlling and avoiding strategies, described by Hallberg and Carlsson (1991), was validated by the present data. Second, it was shown that avoiding strategies dominated among men with NIHL, although situational circumstances, interactional conditions, social closeness and degrees of priority, awareness and acceptance sometimes changed the behaviour towards the more controlling strategies. Identification of these five factors should be regarded as an extension of the original model of coping, a third important contribution of this study. The driving force for coping was the hearing impaired person's striving to avoid definition as a deviant in social interactions in order to maintain a positive (normal) self-image. Health professionals are requested to encourage men with NIHL to recognize, confirm and actively seek solutions to problems caused by their hearing loss rather than to reinforce their denial of hearing difficulties.

The aim of this inductive study was to describe, from the perspective of the spouses, their experiences of living close to a male with severe noise-induced hearing loss. An additional aim was to generate the first step of a theory of how these spouses managed their daily life. The study sample consisted of 10 strategically selected females who differed in age, educational status, number of children and years of marital relationship. Verbatim transcribed thematized interviews were analysed according to a method influenced by the constant comparative method for grounded theory. Two main variables, or core concepts, were identified: the husband's reluctance to acknowledge hearing difficulties and the impact of hearing loss on the intimate relationship. Combinations of these main variables were related to four qualitatively different strategies used by the spouses: co-acting, minimizing, mediating and distancing strategies. It is suggested that the type of strategy chosen by the spouse influences the outcome of the audiological rehabilitation.

The aim of this study was to describe the characteristics of tinnitus in 87 patients (mean age = 53.7 years); 43 patients seeking professional help (complainers) and 44 patients who do not seek help for their tinnitus (noncomplainers). 'Left-sided or mostly left-sided' tinnitus was reported by 42% of complainers and 30% of noncomplainers, whereas 'right-sided or mostly right-sided' tinnitus was equally prevalent in the two groups (26 v. 25%); the differences between groups were not significant. Tinnitus 'in the head' was reported by 14% of the complainers and 6% of the noncomplainers, a nonsignificant difference, whereas noncomplainers perceived tinnitus in 'both ears equally' significantly more frequently than complainers. Complainers had significantly more often 'combined' (tonal plus buzzing) tinnitus sounds (51 v. 30%) and 'non-fluctuating tinnitus' (49 v. 25%) than had noncomplainers, whereas 'tonal' tinnitus was significantly more frequent in noncomplainers than in complainers (43 v. 16%). Further, noncomplainers had worse hearing than complainers: pure-tone averages over vocal as well as high frequencies were significantly higher. Complainers scored significantly higher than noncomplainers on the psychological variables concentration difficulties, irritability and sleep disturbance. Patients with 'combined' tinnitus sounds scored significantly higher on irritability and sleep disturbance than subjects with 'tonal' tinnitus. Patients with 'non-fluctuating tinnitus' scored significantly higher on the three psychological variables than patients with 'fluctuating tinnitus'. A conclusion to be drawn is that 'combined' tinnitus sounds and 'non-fluctuating tinnitus' might be determinants of psychological problems.

The Communication Strategies scale of the Communication Profile for the Hearing Impaired (CPHI) was translated into Swedish and used in several studies of people with hearing impairment (Hallberg & Carisson, in press; Hallberg, Erlandsson, & Carlsson, 1991) In this study the scale was evaluated in terms of descriptive statistics, corrected item-total correlations, principal component analysis, and internal consistency reliability. Agreement with results from American studies is surprisingly good Normative data based on three samples are presented a general Swedish hearing-impaired sample with predominantly sensorineural hearing loss ( N =199), a subgroup of 105 younger subjects with noise-induced hearing loss, and a subgroup of 39 older subjects with sensorineural hearing loss due to heredity and/or old age. A significantly more frequent use of maladaptive behaviors ( p < .001) and verbal communication strategies ( p < .01) was reported by older subjects with age-related and/or hereditary hearing loss than by younger subjects with noise-induced hearing loss. The Communication Strategies scale seems to be an adequately reliable and clinically useful instrument for assessing adaptive and maladaptive strategies In hearing-impaired subjects.