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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 or ...

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.

The aim of this qualitative study was to understand and explore parents’ experiences of coping with their child's asthma, contextually important mechanisms for coping and parents’ ascribed meaning to their coping strategies. Twenty‐six parents (11 fathers) were interviewed individually (6 subjects) or as a couple. The taped interviews were transcribed verbatim and analysed in line with the grounded theory tradition. Two core categories, describing contextual focus of parental coping with asthma, were identified in the data. These core concepts, “cognitive control” and “locus of confidence in caring”, formed a typology of parental coping with asthma. Combinations of variations in these core concepts were related to six qualitatively different parental coping strategies: “problem‐solving”, “avoiding‐assuring”, “reducing”, “relying on self, “complying” and “enduring”. The core concept “chaos in caring” described the experienced stress in caring for the child's asthma. Six additional categories were related to this core concept: parents’ experience of “lack of control”, “incompetence in caring”, “disease‐focusing”, “existential fear”, “closeness” and “uncertainty due to a non‐understanding environment”. The result gives a deeper understanding of the experienced meaning and context related to parents’ coping efforts and might be of importance in developing and evaluating family therapy/ rehabilitation programs

The aim of this study was to evaluate the effects of a two‐weeks full‐time group‐rehabilitation program designed for hearing‐impaired patients and their close relatives. Seventy‐six consecutive patients in employment age (mean = 51 years; SD = 9 years, R = 22–64 years) with subjective need for audiological rehabilitation were included in the program. Pure tone averages were 46 dB HL and 58 dB HL at the low and high frequencies in the best ear, respectively. The patients responded to visual analogue scales (VAS) and questionnaires, intended to measure “perceived handicap”, “social support”, “perceived negative attitudes”, “acceptance of hearing loss” and “communication strategies”, before and after the last group session. The forms were also sent to the study group by post four and six months after the program was terminated. No significant short‐term effects were found after the last group session, except that self‐rated handicap in family life (VAS) was increased (p = 0.028), probably due to the participants’ increased awareness of hearing‐related problems. Four months later, perceived negative attitudes from others were significantly reduced (p = 0.025), but self‐rated handicap in family life was still increased (p = 0.023). Six months later (long‐term effects), maladaptive strategies (e.g. guessing, pretending to hear and avoiding interactions) were significantly less often used (p = 0.036) and verbal strategies more frequently adopted (p = 0.018). This change of communication strategies might facilitate social participation and should therefore be seen as positive outcomes of a rehabilitation program.

This study examined from the perspective of children with Juvenile Chronic Arthritis, their experiences of coping with chronic pain in daily life. In‐depth interviews were conducted with 22 children (6–17 years). The grounded theory method was applied for analysing the taped and transcribed interviews. Seven descriptive categories were grounded in the data, labelled (1) “controlling strategies”, (2) “avoidance strategies”, (3) “cognitive strategies”, (4) “compliance with the treatment”, (5) “seeking social support”, and (6) “recovering”. A core category was identified and labelled “making me different”. The children seem to be caught in a dilemma. In one way the chosen coping strategy reduces chronic pain and in another way the strategy increases stress and feelings of being different from non‐disabled peers. Our results indicate the great importance of social support from the children's environment.

The aim of this study was to deepen the understanding of female adolescents' daily living with chronic arthritis. Taperecorded open interviews were conducted once with six teenage girls (14_17 years), who also wrote diaries for a 12-month period. In addition, 12 interviews of female adolescents diagnosed with chronic arthritis selected from another sample in an earlier study by the authors were included in the data. The Grounded Theory (GT) method was used for analysing the diaries and the transcribed interviews. A core category, labelled Fitting into the prevailing teenage culture, and four related categories labelled (1) mastering a body in pain; (2) living one day at time; (3) using social support; and (4) fighting for health emerged. The categories formed a substantive theory illuminating living with chronic arthritis during adolescence. The theory explains and provides a deeper understanding of the main concern of these female adolescents and their strategies in managing their situation. Key words: Adolescents, grounded theory, juvenile arthritis, pain, teenage culture

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.

We investigated, in new hearing aid candidates, whether or not the use of coping strategies and the life situation, in terms of activity limitation, participation restriction and psychological well-being, were associated with the outcome of audiological counselling, i.e. the patients’ acceptance or rejection of a hearing aid (HA). The study included 173 consecutive adult patients (104 men and 69 women) with a need for audiological rehabilitation including HA-fitting. Use of communication strategies (Communication Strategies Scale, CSS), experience of activity limitation and participation restriction (Hearing Disability and Handicap Scale, HDHS), and general psychological well-being (Psychological General Well-being scale, PGWB) were assessed by self-report inventories. The hospital records, reviewed 1.5 years after the first consultation, showed that 39 patients (25 men and 14 women, 23%) had not accepted a hearing aid. In crude and adjusted logistic regression analyses a low report (high scores) of malad...

The aim was to describe how bullying was experienced by individuals who had been exposed to bullying at their workplaces. Open interviews were conducted with 22 participants from different professi ...

Little is known of wind turbines' impact on people living in their vicinity. The aim of this study was to gain a deeper understanding of how people perceive and are affected by wind turbines in the ...

The relationship between the reported use of coping strategies and experience of everyday life prior to audiological rehabilitation and the number of rehabilitation consultations needed, were studied in a group of adults. The study took place at St. Olav's University Hospital, Norway and included 132 adult patients (77 men and 55 women) with no previous audiological rehabilitation or experience with hearing aid (HA) use. Hearing impairment was assessed by pure tone audiometry, while use of communication specific coping strategies and daily life situations were obtained using self-report inventories. The latter concerned activity limitation, participation restriction, and psychological well-being. The patients’ hospital records were reviewed approximately 18 months after their first consultation. In total, 41 patients (31%) needed no more than the required minimum number of three consultations to complete rehabilitation including HA fitting, while 91 patients needed more than this. Logistic regression was ...

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.

The consequences of hearing loss in terms of perceived activity limitation and participation restriction were studied in a general population of 343 adults with hearing impairment using the Hearing Disability and Handicap Scale. Coping was measured by the Sense of Humour Questionnaire and the Communication Strategies Scale and combined with objective and subjective audiological variables and demographic factors (age, gender and education). In stepwise linear modelling, several variables contributed significantly to the outcome (adjusted R2=53.3% for activity limitation and 47.2% for participation restriction). Audiological factors explained most of the variance in activity limitation (R2=37.1%), while coping factors were the main predictors for participation restriction (R2=35.2%). Maladaptive behaviour in the Communication Strategies Scale was the strongest predictor and explained 13.7% and 32.4% of the variance in activity limitation and participation restriction, respectively. More frequent use of maladaptive behaviour was related to larger limitation and restriction. This study adds to the understanding of factors that negatively influence daily life in terms of activity limitation and participation restriction. This may in turn have consequences for aural rehabilitation efforts.

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 purpose of this study was to investigate the variables that affect psychological general well-being (quality of life) in patients with cochlear implants (CIs). The study sample consists of 96 adult patients with a CI, aged 24–86 years (Mean = 61.8 yrs; SD = 15.3 yrs). 48 were patients from the Sahlgrenska University Hospital in Sweden and 48 were patients from the University of Florida, USA. The Psychological General Well-being Index and the International Outcome Inventory-Cochlear implants were used in collecting data. Possible independent variables were socioeconomic factors such as age, gender, nationality, living arrangement, education, and social support; as well as length of time since implantation, age when hearing loss became a problem, and subjective benefit of the CI. A stepwise multiple regression analysis showed that 49% of the variance was explained by attitudes from others, restricted social participation, perceived social support and age.SumarioEl proposito de este estudio fue el de inv...

Objectives: To gain a deeper understanding of why women, diagnosed with mental distress, reported good physical and mental health. What could the reason be and how did they feel four to five years later? Method: In-depth interviews were conducted with seven women; age 33 to 52, who worked in a Swedish male-dominated industry. The methodological approach relied on grounded theory. Results: A conceptual model was generated in the analysis, describing a temporal process of change in the women's self-image. Three core concepts illuminated this process: (1) maintaining an ideal self-image, (2) waking up/reappraising health and (3) struggling for a realistic self. The women were moving away from facades of meeting social expectations and pleasing others toward trusting and setting boundaries for themselves. Moving away from symptoms such as asthma, migraine and infections, as well as family problems, they felt and hoped that they had more control over their lives. Conclusions: A conceptual model was proposed to...

The aim of this study was to gain a deeper understanding of the development of burning mouth syndrome (BMS). Eighteen females (43-80 yr old), referred to the Clinic of Oral Medicine, formed the study group. Oral examination did not reveal any mucosal lesion or dental pathology, blood analyses of vitamin B12 and serum iron levels were within normal reference values, and no allergies to dental materials were reported. Reported pain/discomfort was 49.4 (mean) on a 100-mm visual analog scale and duration of symptoms was, on average, 8.1 yr (median = 1.5 yr). Taped semistructured interviews were transcribed and analysed in line with grounded theory methodology. In the analysis, a core category emerged, labeled communicating psychological discomfort. This category indicated musings about the meaning of life and interacted with a personality characterized by a strong need for conscientiousness, a life style including long-standing struggle with psychosocial overload, and external social and cultural influences. The debut of the BMS was then preceded by an acutely stressful event. A psychosocial history, in addition to a detailed dental and medical history, seems to be crucial in diagnosing patients. If a psychological disorder and somatization of anxiety and depression is suggested, as indicated in our study, the patient should be offered counseling by a psychologist.

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.

The aim of this study was to provide increased understanding of what 'feeding the family' means to Somalian women in Sweden. Focus group interviews were carried out with Somalian women, analysed by ...

The process of perceiving symptoms of illness is complex, and many patients delay seeking care when symptoms of acute myocardial infarction occur. However delayed treatment can have great consequences for the prognosis. This article reports on a grounded theory study, the aim of which was to increase our understanding of the individual’s thoughts, feelings and actions at the onset of an acute heart attack. Qualitative analysis of semi-structured interviews revealed four different ways of perceiving the onset of symptoms: understanding, misinterpretation, amazement and disregard. The symptom perception categories were related to two core categories labelled health beliefs and acute reactions. Some persons were aware of risks for coronary heart disease and were ready to seek care immediately. Several others had illusions of invulnerability. Such illusions caused people to delay seeking care at the onset of symptoms of myocardial infarction.

A Women Workplace Culture Questionnaire (WWQ) was developed based on results from a grounded theory study. Respondents were asked: (1) to compare women's general status at work with that of men and (2) to describe their specific experiences in this regard. Answers from 104 White women working in a male-dominated industry were intercorrelated and subjected to principal component analyses, as well as a to varimax rotation. A five-factor solution that explained 56.5% of the total variance was supported by a graphic scree-test. Three factors with coefficient alpha >.70 were identified that concerned areas of perceived burdens on me (the individual woman), perceived burdens on women, and sexual harassment. A fourth factor, social support, also showed modest reliability. Factors I, II, and IV correlated significantly with ill health, distress, and job satisfaction.

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 aim of this qualitative study was to describe, from their own perspective and experiences, how siblings of children with deficits in attention, motor control and perception (DAMP) and Asperger syndrome cope with their life situations in their families. Fifteen adolescent females 12-18 years old, siblings of boys with DAMP (8 subjects) and Asperger syndrome (7 subjects), were interviewed. The method used in sampling and analysis of interview protocols was the constant comparative method for grounded theory. The inductive categorization of data produced two core concepts, one about the siblings' life situations in DAMP and Asperger syndrome ('dilemma of requirements and concerns') and one about the siblings' coping processes ('harmonizing'). Of the six categories identified, four were categories of the processes of coping ('gaining understanding', 'gaining independence', 'following a bonding responsibility' and 'balancing'). The qualitative differences between coping processes were related to the two categories of context to cope within the experienced dilemma 'requirements' and 'concerns'. The findings contribute to a deeper understanding of the siblings' life situations, and may be important for health personnel in encounter families and for identifying siblings with special needs. The findings may also aid in the development of preventive programs for siblings of children with DAMP and Asperger syndrome.

In this study we examined how nursing home staff experienced assisting patients with oral health care. The results of a previous questionnaire indicated that oral health care is a low priority in nursing. The 22 in-depth interviews administered in this study showed that the quality of the oral health care received by the patients depended on several factors. It was found that often there were no specific routines for assisting oral health care in the nursing homes and that other activities were given higher priority. Assisting oral health care was described as passing a barrier, where the main problem was to gain access to the oral cavity. It was concluded that nursing staff working with geriatric patients need to be better educated in oral health care and should be seen by themselves and others as part of a team, where oral health care is clearly defined and included among other daily nursing activities.

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.

The aims of this study were: (1) to compare two groups of patients with chronic pain conditions (work-related muscular pain, mainly low back pain, and fibromyalgia) in general coping and pain-specific coping; (2) to examine the relationship between general and pain-specific coping and, (3) to examine the influence of state-trait anxiety on general and pain-specific coping. The sample included 80 individuals (range=19-70 years; mean=47; SD=9.9), who were patients at two pain management clinics for examination of their physical and psychosocial health conditions and consideration on disability pension. The patients were asked to respond to theStrategies to Handle Stress Questionnaire, theCoping Strategies Questionnaireand theState-Trait Anxiety Inventory. Patients with fibromyalgia scored significantly higher on T-anxiety and adoptedproblem-solving(p0.01) andcatharsis(p0.05) less often andreligionmore often (p0.01) than patients with work-related muscular pain in coping with stressful situations in general. No differences were revealed in pain-related coping between the groups. T-anxiety was positively correlated to pain-relatedcatastrophizing(p0.001) and negatively to abilities to control and reduce pain (p0.05 andp0.01, respectively). The correlation between general and pain-specific coping was weak to moderate. In conclusion, patients with fibromyalgia scored significantly higher on trait-anxiety and seem to interpret stressful situations as more threatening than patients with work-related muscular pain. Anxiety seems to be of central importance for coping with chronic pain. Anxiety-prone patients with fibromyalgia might benefit from psychological support in the process of coping with pain. Copyright 1998 The British Infection Society. All rights reserved.

The aim of this qualitative study was to describe, from the perspective of 22 women (aged 22-60 years) with fibromyalgia, their experiences and beliefs of the pain and its origin and how the pain affects family and social life. Open-ended interviews were analysed via a method influenced by grounded theory. Seven descriptive categories were grounded in the data, forming two higher-order concepts: psychosocial vulnerability and maintaining forces. The first of these core concepts, psychosocial vulnerability, comprises the categories: traumatic life history, over-compensatory perseverance, pessimistic life view, and unsatisfying work situation. In the interviews, there are abundant examples of early loss, high degree of responsibility early in life, and social problems with feelings of helplessness and hoplessness later in life. The second core concept, maintaining forces, consists of the categories professional care, pain benefits and family support, which seem to contribute to the persistence of pain. Our results indicate intrapsychic and psychosocial dimensions, which support the hypothesis that individuals with insecure attachment styles are overrepresented among patients with chronic pain.

A fundamental aim of all qualitative studies is to take the perspective of others and therewith to experience meanings, situations and actions through the eyes of others. This demands data from relatively small strategically selected study groups, in addition to empathy, openness and sensitivity in the researchers. Most qualitative researchers strive to come further than just pure descriptions in their analyses they want to gain an in-depth understanding and explore meanings and processes of everyday life. Interpretation is therefore a basic tool included in all qualitative research. (Published: 6 March 2013) Citation: Int J Qualitative Stud Health Well-being 2013, 8 : 20647 - http://dx.doi.org/10.3402/qhw.v8i0.20647

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 phobia is a widespread problem, which can have significant impact on the individual’s health and daily life. This grounded theory study aims to explore the situation of dental phobic patients: how dental phobia interferes with their normal routines and functioning, social activities and relationships, what factors contribute to the maintenance of dental fear and how they cope with their fear. In the qualitative analysis of thematized in-depth interviews four main categories were developed: threat to self-respect and well-being, avoidance, readiness to act and ambivalence in coping. The results show that several psychological and social factors interact in determining how dental phobic individuals cope with their fear, and demonstrate in what way dental fear affects their daily lives.

The premier issue of International Journal of Qualitative Studies on Health and Well-being was launched in March 2006 and the rest, as they say, is history. Professor Karin Dahlberg and I were the initiators of the journal and Taylor & Francis the first publisher. Two years ago the journal was successfully transferred to the open access publication model and therewith to Co-Action Publishing. This change has contributed hugely to making the journal truly international. Not only is it now included in PubMed Central/PubMed and awaits its first Impact Factor but there has also been a considerable increase in the number of submissions from all over the world. This year, the journal website has so far (November 25, 2011) been visited almost 21,500 times by individuals in 137 countries, and nearly 80,000 full text articles have been downloaded. This is an incredible development - and immensely beneficial to both authors and readers. It also shows the difference open access can make. (Published: 15 November 2011) Citation: Int J Qualitative Stud Health Well-being 2011, 6 : 11289 - DOI: 10.3402/qhw.v6i4.11289

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.

Health, well-being, quality of life, and lifestyle are central concepts within health science, although generally accepted definitions are still lacking. Lifestyle can either be seen as an independent variable and the cause of unhealthy behaviour or as a dependent variable, which is affected by conditions in the society. In the first case, the attention is directed on each individual case: maintaining or improving health requires changes in lifestyle and living habits. In this perspective, diet and physical activity are important features for health promotion. In the second case the attention is rather directed on structural conditions in society, for example the food industry, the lunches for children at school, and the ‘‘fast food’’ industry should be influenced to protect human health. The structural perspective has, so far, received restricted impact when it concerns prevention and promotion of health. Processes of individualisation in the society have to an increasing extent viewed health as an affair for the individual. The benefits of physical activity, healthy food and beverage, social support, and joy are documented scientifically. In general, the trend towards increasing responsibility for one’s lifestyle and health is positive, but might reinforce the inequality in health. With an even harder climate in society there might be a risk that individual health projects undermine the solidarity and the will to accept costs for medical treatment and care for people who risk their health through an unhealthy and risk-taking lifestyle. However, we argue that peoples’ well-being and quality of life presupposes a society that stands up for all people. Key words: Health, well-being, lifestyle, quality of life (Published: 20 May 2011) Citation: Int J Qualitative Stud Health Well-being 2011, 6 : 7137 - DOI: 10.3402/qhw.v6i2.7137

As I am sure most readers will know by now, the International Journal of Qualitative Studies on Health and Well-being (IJQHW) became an Open Access journal at the beginning of 2010. The transition also involved a change of publisher, from Informa Healthcare to Co-Action Publishing. All back volumes (2006-2009) were at the same time made accessible via the ‘‘Archive’’ on the journal’s new website www.ijqhw.net, giving readers and researchers free access to all content published in the journal from the start.(Published: 1 April 2011)Citation: Int J Qualitative Stud Health Well-being 2011, 6: 7090 - DOI: 10.3402/qhw.v6i2.7090

Aim: This study aims at exploring the main concern for elderly individuals with somatic health problems and what they do to manage this. Method: In total, 14 individuals (mean = 74.2 years; range = 68–86 years) of both gender including hospitalized and outpatient persons participated in the study. Open interviews were conducted and analyzed according to grounded theory, an inductive theory-generating method. Results: The main concern for the elderly individuals with somatic health problems was identified as their striving to maintain control and balance in life. The analysis ended up in a substantive theory explaining how elderly individuals with somatic disease were calibrating and adjusting their expectations in life in order to adapt to their reduced energy level, health problems, and aging. By adjusting the expectations to their actual abilities, the elderly can maintain a sense of that they still have the control over their lives and create stability. The ongoing adjustment process is facilitated by different strategies and result despite lower expectations in subjective well-being. The facilitating strategies are utilizing the network of important others, enjoying cultural heritage, being occupied with interests, having a mission to fulfill, improving the situation by limiting boundaries and, finally, creating meaning in everyday life. Conclusion: The main concern of the elderly with somatic health problems was to maintain control and balance in life. The emerging theory explains how elderly people with somatic health problems calibrate their expectations of life in order to adjust to reduced energy, health problems, and aging. This process is facilitated by different strategies and result despite lower expectation in subjective well-being. #2011 A.-S. Helvik et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

The aim of this study was to gain a deeper understanding of the handicap creation process. Twelve hearing-impaired middle-aged subjects were interviewed monthly for 5 months. The interviews focused on the subjects' own descriptions of stressful situations related to their impaired hearing. The analysis of the interviews was influenced by the constant comparative method for grounded theory described by Glaser & Strauss. The primary aim of this inductive method is to generate a theory, models, or concepts from the data rather than to verify an existing theory. Eight categories were grunded in the present data, describing potential situations for a handicap to arise. These formed two higher order categories or concepts: situations related to environmental factors and situations related to life habits. The results of the study fitted in well with the proposed revision of the World Health Organisation definition of handicap, as well as with a Swedish version of an environmentally-related definition. I...

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'.

In a conventional quantitative study, the aim of the literature review mainly is to refine the research question, determine gaps in earlier research and identify a suitable design, and data collection method for a planned study. In qualitative research the literature search—when and how—is of a more ambiguous character. Grounded theory (GT), one qualitative method among many others, is described as a “general inductive method possessed by no discipline or theoretical perspective or data type” (Glaser, 2005, p. 141). In a GT-study, concepts are generated from empirical data rather than from existing literature. Like a detective who strives to explain what is actually happening, the GT-researcher strives to explain the main concern of participants in a specific situation/area and to find out how they resolve or process this main concern. The emerging result is presented either as a hypothesis, a model or as an abstract conceptual theory. The theory is built up around a core category and related categories. In Glaser's words, the aim of GT is to “generate a theory that accounts for a pattern of behavior which is relevant and significant for those involved” (Glaser, 1978, p. 93). Conceptualisation is a core process in GT, which thereby is a theory-generating rather than a descriptive method. Generating theory demands creative and conceptual thinking. Barney Glaser, the originator of the classical GT methodology, has stressed the importance of that a GT-researcher avoids preconceptions and remains open-minded to what actually appears in the research field. He encourages GT-researchers to “just get on and do it.” However, when a hypothesis, model or theory can be discerned in the data, a relevant literature search should be conducted and interwoven into the emerging theory. Glaser argues that an early reading of the literature (i.e., before conducting the study) is problematic. This includes that the researcher is encouraged to ignore the existing literature before entering the research field. This approach rests on the opinion that what is important in the research area will show itself repeatedly, or in other words, what is important will emerge without the “neutral” researcher is doing nothing but listen and look with an open mind. In order to understand the participants’ viewpoint, the researcher must put aside his/her personal perspective and, of course, have knowledge and competence in how to conceptualise data. Unfortunately, many researchers lack competence in conceptualisation. Any researcher has acquired considerable knowledge in the professional and disciplinary literature. To think conceptually requires that the researcher continually follows the cross-disciplinary literature, i.e., they are reading a lot. It is not easy for the researcher to put this knowledge aside when starting a new study but the point is, as I see it, not to be consciously directed by earlier theories and concepts in interpretations and conclusions of the data. One way to stay open and do good GT-studies is to maintain theoretical sensitivity through constant comparisons (e.g., constantly comparing incidents to incidents, incidents to concepts, and concept to concept) and continuous memo writing. There is a fine line between avoiding the use of literature before a study begins and being informed so that a study is focused enough. In my opinion, it is necessary to conduct an early literature review to find out if the planned study, or something similar as the planned study, has been published before. This literature review may also give a background to and motivate the interest for the particular research area. Such a literature review will also be requested by authorities when researchers apply for research grants and/or ethical permission to conduct a study or when a presumptive doctoral student applies for acceptance as a PhD candidate. At least a presumptive researcher has to demonstrate that a problem worthy of research really exists and that he/she has the necessary skill to conduct such a study. This is in line with the view of Glaser (1998) when advocating GT-researchers to do some preliminary reading before the study begins in order to put the study into a context.

Epidemiological research has so far failed to explain the high incidence of occupational disorders among home care workers (HCWs) and the great differences in organizational incidence rate. A qualitative approach may contribute to a deeper understanding of work group reasoning and handling in a more contextual manner. The aim of this grounded theory study was to gain a deeper understanding of the main concern in the processes of recognizing, communicating and reporting occupational disorders among HCWs. Focus group interviews were conducted with 40 HCWs in 9 focus groups. The selected municipalities represented variations in municipality type and incidence rate of occupational disorders. Making it work in the frontline was identified as the core category explaining that the perceived work situation in home care work was the main concern but interacted with work-group socialising processes as well as with the communicability and derivability of the occupational disorder when defining and reporting occupational disorders. Complex problems could be reformulated and agreed within the workgroup to increase communicability. Described significances for reporting/non-reporting were related to financial compensation, to a part of organizational political game or to an existential uncertainty, i.e. questioning if it belonged to their chosen work and life. Our conclusion is that working situation and work group attitudes have importance for reporting of occupational disorders. To support work-related health for HCWs, integrating communication should be developed about work-related challenges in work situation, as well as about attitudes, culture and efficiency within work-group. Key words: Work injury, social environment, home care, social support, collective coping, focus group, grounded theory

The aim of the study was to explore the perceived health consequences of workplace bullying. Open interviews were conducted with 22 informants; 20 bully victims and two persons working with bullying prevention. Data was assessed and analysed simultaneously in line with grounded theory methodology. A conceptual model was grounded in data, describing experiences of deteriorating psychological and physical health following bullying and efforts of returning to a "normal" life. The core category, "remaining marked for life", illuminates the manner in which bullying was perceived as a psychic trauma or a traumatic life event causing the bullied person to be marked forever. The model includes five additional categories: "feeling guilt, shame and diminishing self-esteem", "developing symptoms and reactions", "getting limited space of action", "working through the course of events" and "trying to obtain redress". Bullying included the spreading of rumours and repeated insults aimed at changing the image of the victim and resulting in feelings of guilt, shame and diminishing selfesteem. Physical and psychosomatic symptoms gradually emerge and medical treatment and sick listing follow. The longer the bullying continues, the more limited the possibility to change the situation and the victim has a more limited space of action. Returning to a "normal" life was possible, but presupposed that the victim had worked through of the course of events. The bullied person also tried to obtain redress, such as through monetary compensation or professional confirmation. Despite this, bullying left an internal scar: the bully victim was marked for life. Key words: Workplace, adult bullying, grounded theory, health, self-esteem