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A health-promotive approach to maintain and sustain health in women-dominated work in Nepal and Sweden
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Jönköping University, Hälsohögskolan, HHJ, ADULT, Sweden. (Family-Centred Health (FamCeH))ORCID iD: 0000-0002-6596-5837
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The characteristics of women-dominated work differ in Nepal compared to Sweden. Women in Nepal perform household and other low-income work, including nursing, which is a women-dominated occupation in both Nepal and Sweden. Work-related adverse health outcomes, such as burnout, fatigue, depression, sleep disturbances, and long-term sickness absence, are evident in women-dominated work, especially within nursing. These challenges are accompanied by an increasing elderly population and a shortage of nursing personnel. Good health and well-being for all, improvingworking conditions and working environment, and providing adequate health and safety at work are the targets of sustainable development goals. Healthpromotive actions and interventions are needed to maintain and sustain health in women-dominated work.

Aims: The overall aim of this thesis was to identify means for promoting and sustaining health in women-dominated work in Nepal and Sweden through the evaluation and exploration of sense of coherence (SOC), work-related health, job demands, job resources, and health outcomes.

Methods: This thesis includes five individual papers. Paper I is a community-based intervention study with a quantitative design conducted in Nepal. The participants were 857 women before and 1268 women after health educationintervention in Nepal, who responded to a translated version of the SOC-13 questionnaire in Nepali. Papers II and III have a qualitative design and are based on 19 individual interviews with nurses in Nepal. Paper IV is also a qualitative study, based on 13 individual interviews with midwives and nurses in Sweden. Paper V is derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH). Data were collected in 2016–2019 for all papers. The quantitative studies were analyzed through descriptive statistics, chisquared tests, one-way analyses of variance (ANOVAs), multivariable oneway ANOVAs, and logistic regression analyses. The qualitative studies werebased on individual interviews, and the data were analyzed through qualitative content analysis and thematic analysis.

Results: Women in semi-urban Nepal exhibited total SOC mean values between 51.1 and 57.4, which are comparable to India within a similar context. Qualitative validation of the SOC-13 questionnaire in Nepali was found to be general and not specific, and some translations were confusing. The SOC-13 items needed to undergo further editing in translation to increase theircomprehensions. Nurses in Nepal and nurses and midwives in Sweden described their work experience as meaningful, and several experiences were partially similar; their work and health were reported to be strengthened through collegial support, teamwork, and opportunities for skills and competence development. Shift work, lack of rewards and appreciation from managers, low staff-patient ratios, and high workload affected their work-related health negatively. In particular, nurses in Nepal experienced a lack of a safe physical work environment and insufficient managerial support. Results from SLOSH-data showed that the nursing professionals’ job demands were associated with lower self-rated health, higher burnout, and higher sickness absence. Job resources were associated with higher self-rated health and lower burnout.

Conclusion: This thesis shows that the SOC-13 questionnaire is useful and qualitatively validated for future use in the Nepalese context, to explore individuals’ overall life orientation and abilities to cope with various life events. Health education can be useful in strengthening SOC among women. To maintain, promote, and sustain health in women-dominated work, a health-promotive approach should be fostered. Nursing professionals’ health can be strengthened and sustained through the development of a positive work environment through good collegial, organizational, and managerial support, offering skills and competence development opportunities, and creating a safe physical and psychosocial work environment. Increasing job resources and minimizing job demands are important to increase positive health outcomes and decrease adverse health outcomes. Nursing professionals in Nepal and Sweden can also adopt strategies that support recovery and stress-management at work

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2022. , p. 146
Series
Dissertation Series. School of Health and Welfare, ISSN 1654-3602 ; 115
Keywords [en]
experiences, health promotion, nursing professionals, resources, salutogenesis
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family-Centred Health
Identifiers
URN: urn:nbn:se:his:diva-21085ISBN: 978-91-88669-14-8 (print)OAI: oai:DiVA.org:his-21085DiVA, id: diva2:1654660
Public defence
2022-06-01, G110, Högskolevägen 3, Skövde, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2022-04-28 Created: 2022-04-28 Last updated: 2022-12-20Bibliographically approved
List of papers
1. Determination and Evaluation of Sense of Coherence in Women in Semi-urban Nepal: A part of the Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) Trial
Open this publication in new window or tab >>Determination and Evaluation of Sense of Coherence in Women in Semi-urban Nepal: A part of the Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) Trial
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2021 (English)In: Kathmandu University Medical Journal, ISSN 1812-2027, E-ISSN 1812-2078, Vol. 19, no 73, p. 69-75Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Kathmandu University, 2021
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family-Centred Health; Research on Citizen Centered Health, University of Skövde (Reacch US)
Identifiers
urn:nbn:se:his:diva-19769 (URN)34812161 (PubMedID)2-s2.0-85110696122 (Scopus ID)
Note

VOL. 19 | NO. 1 | ISSUE 73 | JAN.-MARCH 2021

Available from: 2021-06-09 Created: 2021-06-09 Last updated: 2022-05-31Bibliographically approved
2. A qualitative validation of Nepali version of Antonovsky’s sense of coherence-life orientation 13-item questionnaire among nurses working in the hospitals of Kathmandu Valley in Nepal
Open this publication in new window or tab >>A qualitative validation of Nepali version of Antonovsky’s sense of coherence-life orientation 13-item questionnaire among nurses working in the hospitals of Kathmandu Valley in Nepal
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(English)Manuscript (preprint) (Other academic)
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family-Centred Health; Research on Citizen Centered Health, University of Skövde (Reacch US)
Identifiers
urn:nbn:se:his:diva-21086 (URN)
Available from: 2022-04-28 Created: 2022-04-28 Last updated: 2022-04-29Bibliographically approved
3. Facilitators for and barriers to nurses’ work-related health – A qualitative study
Open this publication in new window or tab >>Facilitators for and barriers to nurses’ work-related health – A qualitative study
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2022 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, article id 218Article in journal (Refereed) Published
Abstract [en]

Background

Work-related health problems, such as work stress, fatigue, and burnout constitute a global challenge within the nursing profession. Work-related health among nurses is not yet a prioritized phenomenon in Nepal. Health-promoting approaches to maintaining and sustaining nurses’ health are therefore essential. The aim of this study was to explore and thereby gain a deeper understanding of how nurses in Nepal’s hospitals experience their everyday work, with a focus on promoting and sustaining their work-related health.

Methods

A qualitative design with semi-structured individual interviews were used. Nineteen registered nurses working at hospitals in Kathmandu Valley, Nepal, were individually interviewed between October 6 and December 5, 2018. Transcribed interviews were analyzed through thematic analysis.

Results

Four main themes with belonging eight subthemes were constructed from the analysis: (1) “Sense of meaningfulness and belongingness in work culture” with subthemes; “Open environment” and “Sharing attitude and cooperating for the entire team” (2) “Support and rewards from the management team” with subthemes; “Lacking managerial support” and “Fair evaluation and job promotion opportunities”(3) “Workload and protection against work-related hazards” with subthemes; “Stressful and multitasking in workload” and “Lacking equipment for own health and caring”, and (4) “Motivation through opportunities and activities” with subthemes; “Employment benefits that motivate work”, and “Activities outside of work needed to recover”. These main themes and subthemes described nurses’ facilitators for and barriers to their work environment and health.

Conclusion

Our study highlighted nurses’ experiences with facilitators and barriers to their work-related health. Nurses’ work-related health was positively affected by support from colleagues, managers, and the organization. Conversely, less support from managers, lack of equipment, and unfair judgment were barriers to nurses’ work-related health. This study adds new knowledge about nurses’ work-related health from the context of Nepal. Hospital organizations and nursing managers in similar cultural and healthcare settings can apply the results of our study to develop strategies to promote and sustain nurses’ health and prevent work-related illness.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Health promotion, Managerial support, Job resources, Nurses, Stress, Teamwork, Work environment, Work‑related health
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family-Centred Health; Research on Citizen Centered Health, University of Skövde (Reacch US)
Identifiers
urn:nbn:se:his:diva-21088 (URN)10.1186/s12912-022-01003-z (DOI)000836600400001 ()35931988 (PubMedID)2-s2.0-85135440648 (Scopus ID)
Note

CC BY 4.0

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Available from: 2022-04-28 Created: 2022-04-28 Last updated: 2022-10-17Bibliographically approved
4. Support and resources to promote and sustain health among nurses and midwives in the workplace: A qualitative study
Open this publication in new window or tab >>Support and resources to promote and sustain health among nurses and midwives in the workplace: A qualitative study
2021 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 41, no 3, p. 166-174Article in journal (Refereed) Published
Abstract [en]

Registered nurses and midwives are in short supply and have among the highest rates of sick leave in the global workforce. The aim of this study was therefore to explore and gain a deeper understanding of how nurses and midwives experience their everyday work, with a view toward promoting and sustaining their work-related health. Nine registered nurses and four registered midwives working in hospitals and community healthcare facilities in Sweden were interviewed. The interviews were analyzed using content analysis. This study is reported in accordance with COREQ. One main category emerged: ‘Quality of organizational and collegial support and opportunities to facilitate recovery, health, and patient care’. From this category, four generic categories describing the overall experiences of registered nurses and midwives could be discerned. Based on these results, it is recommended that employers adopt a systematic health-promotive approach to foster and maintain the workplace health of registered nurses and midwives.

Place, publisher, year, edition, pages
Sage Publications, 2021
Keywords
health promotion, occupational health, organization, stress, support, teamwork
National Category
Nursing Occupational Health and Environmental Health Occupational Therapy
Research subject
Woman, Child and Family (WomFam); Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-19456 (URN)10.1177/2057158520988452 (DOI)2-s2.0-85131317291 (Scopus ID)
Note

CC BY 4.0

First Published February 9, 2021

Available from: 2021-02-10 Created: 2021-02-10 Last updated: 2022-08-31Bibliographically approved
5. Job demands, job resources, and health outcomes among nursing professionals in private and public healthcare sectors in Sweden – A prospective study
Open this publication in new window or tab >>Job demands, job resources, and health outcomes among nursing professionals in private and public healthcare sectors in Sweden – A prospective study
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2022 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, article id 140Article in journal (Refereed) Published
Abstract [en]

Background

Nursing professionals exhibit high prevalence of stress-related health problems. Job demands and job resources are parallel drivers of health and well-being among employees. Better job resources associate with better job satisfaction, job motivation and engagement even when job demands are high. To date, there is limited research which explores the association between job demands, job resources and health outcomes among nursing professionals in the Swedish context. The aim of this study was therefore to investigate Swedish nursing professionals’ job demands and job resources in relation to health outcomes, with comparisons between the private and public healthcare sectors. The specific research questions were as follows: (1) Are there differences between private and public healthcare regarding job demands, job resources, and health outcomes? and (2) Are there prospective associations between job demands and job resources in relation to health outcomes?

Methods

Data were drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2016 and 2018, including 520 nurses and 544 assistant nurses working in the private and public healthcare sectors from 2016 (baseline). Data were analyzed using binary logistic regression.

Results

Nursing professionals reported higher threats, lower bullying, lower control, lower social support, and lower cohesion in the public healthcare units compared to the private healthcare units. The prospective analyses showed that job resources in terms of social support and rewards were associated with higher self-rated health and lower burnout. Cohesion was associated with higher self-rated health. Job demands in terms of psychological demands and job efforts were associated with lower self-rated health, higher burnout, and higher sickness absence, while emotional demands were associated with higher burnout.

Conclusions

Nursing professionals’ job resources are deficient in public healthcare units. Job resources are associated with positive health outcomes, whereas job demands are associated with negative health outcomes, among nursing professionals. Strengthening job resources among nursing professionals in the private and public healthcare sectors can promote and sustain their work-related health.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Demands, Employment sectors, Healthcare, JD-R model, Occupational health, Resources
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family-Centred Health; Research on Citizen Centered Health, University of Skövde (Reacch US)
Identifiers
urn:nbn:se:his:diva-21089 (URN)10.1186/s12912-022-00924-z (DOI)000806789700005 ()35668404 (PubMedID)2-s2.0-85131327268 (Scopus ID)
Funder
AFA Insurance, 150474Forte, Swedish Research Council for Health, Working Life and Welfare, 2009–1758Swedish Research Council, 2013–0164Swedish Research Council, 2013–01646
Note

CC BY 4.0

Correspondence: dip.raj.thapa@his.se

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

© 2022 BioMed Central Ltd unless otherwise stated. Part of Springer Nature.

Open access funding provided by University of Skövde. This work was supported by AFA Insurance (grant 150474), the Swedish Research Council for Health, Working Life and Welfare (FORTE) through the Stockholm Stress Center (grant 2009–1758), the Swedish Research Council (VR; grant 2013–0164 and 2013–01646) and the School of Health Sciences at the University of Skövde, Sweden. The funders had no role in the study design, data analysis, the preparation of the manuscript or decision to publish the manuscript.

Available from: 2022-04-28 Created: 2022-04-28 Last updated: 2022-07-13Bibliographically approved

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