Universal parenting courses are increasingly being offered in child health clinics, yet instructors’ experiences of universal implementation remain under-studied. Circle of Security Parenting (COS-P) is a widely used attachment-based programme designed to strengthen parent–child interaction. This qualitative study explored instructors’ experiences of delivering COS-P as a universal offering in a Norwegian municipality, using focus-group interviews and reflexive thematic analysis. The knowledge claims concern instructors’ experiences and interpretations rather than programme effects. Instructors described universal COS-P as less stigmatising than selective provision, as participation signals access to a general resource, fosters diversity, and normalises help-seeking. They experienced COS-P as a learning and support framework that enhances parental reflection, provides a shared language for relationships, and facilitates peer networks within and beyond the course. At the same time, they reported limitations for parents with substantial or complex difficulties, who often require more concrete, individualised and intensive support than a universal group can offer. No harms were reported, though the offering was sometimes insufficient. Overall, universal COS-P may reduce stigma and support reflection and networking in child health clinics, but should be embedded within stepped care with clear pathways to targeted interventions for families with greater needs.
Nordic integration policies emphasize refugees’ rapid integration into the labour market, operationalized in Norway through the mandatory Introduction Program (IP). However, refugees with health challenges often struggle to meet the program’s requirements, making interprofessional collaboration across health and welfare services essential. This article examines how such collaboration unfolds when supporting refugees with health challenges in Norway’s IP. Drawing on Hartmut Rosa’s concepts of social acceleration, desynchronization, and uncontrollability, we analyse 23 semi-structured interviews with employees from welfare, health, and education services in three municipalities in Northern Norway. The analysis reveals temporal tensions across three levels, organized into three themes. First, we examine how the unpredictable and slow nature of refugees’ individual health trajectories can clash with the policy-imposed urgency to rapidly address health challenges. Second, we show how collaboration across services was experienced as slow and frequently ineffective, a dynamic compounded by structural constraints such as limited healthcare capacity, poor information exchange, and misaligned legal frameworks that local actors could not always resolve alone. Third, we show that while concentrating resources in specialized refugee (health) services may help overcome some collaboration challenges, it risks creating “a system within the system” that can mask rather than resolve underlying structural gaps and potentially generate new dilemmas concerning long-term service continuity. We argue that interprofessional collaboration, though necessary, cannot fully compensate for insufficient healthcare capacity, misaligned legislation, or policy timelines that conflict with health and resettlement trajectories. These insights call for greater flexibility in program duration and stronger institutional continuity across welfare systems.
Patient involvement (PI) has become a central focus within Nordic healthcare systems. However, the concept remains ambiguous and is interpreted differently across disciplines, which poses challenges for both research and practice. This study explores how PI is conceptualized in Danish academic literature published between 1990 and 2024. Using a scoping review and a meta-narrative approach, we identified three disciplinary storylines: Health Care; Organizational and Management; and Society. These storylines represent distinct yet overlapping logics concerning the roles of patients, professionals, and institutions, and operate at different analytical levels (micro, meso, and macro). By unpacking these narratives, the study contributes to a more nuanced understanding of the assumptions and tensions embedded in the concept of PI. Our findings underline the importance of engaging critically with the theoretical foundations of PI and suggest directions for future empirical research that can explore how these divergent logics play out in practice.
In the Nordic welfare state, user involvement is a fundamental political and population right that healthcare managers must adhere to. Thus, the aim of this study is to investigate what opportunities healthcare managers in a small municipality in Norway experience in terms of user involvement in the health and care services. A total of six focus-group interviews were conducted with 12 participants, all of whom were employed as department heads or unit managers. Reflexive thematic analysis (RTA) was selected as the method of analysis. Two themes were identified: (1) The municipal framework makes user involvement demanding, and (2) Communication skills are a prerequisite for user involvement. Overall, the research underscores the significance of proficien t communication as the basis for user involvement in healthcare services. The study provides valuable insights into healthcare managers' perspectives on user involvement in municipal health and care services. It highlights that communication is challenged not only by conflicts of priorities, such as lack of time, but also by uncertainty or a lack of professional skills.
This study explores the experiences of young people involved in a municipal mentoring program in Tromso, Norway. The initiative was developed as a preventive measure against youth exclusion, substance abuse, and crime. Based on qualitative in-depth interviews with fifteen adolescents aged 15-17, the analysis draws on theories of belonging, resilience, and Bourdieu's concepts of social, cultural, and economic capital. Findings highlight the mentor as a stable and trusted support figure in an otherwise unpredictable everyday life. The adolescents emphasize the importance of trust and continuity in the mentoring relationship and contrast this with experiences of fragmented and inconsistent support from formal services. Mentors are described as key bridges between youth, families, schools, and public services, enhancing motivation, structure, and a sense of mastery across life domains. Several participants also view their mentors as guides in navigating complex service systems-a role referred to here as a "bureaucratic interpreter." The study also reveals that the conclusion of the mentoring relationship may be experienced as a vulnerable phase. Youth express a need for more predictable and gradual transitions when the mentorship ends. The findings suggest that Tromso's mentoring model may serve as a promising, relationship-based approach to reducing social exclusion among youth. Further research is recommended on long-term mentoring outcomes and comparative studies across Nordic and multicultural contexts to deepen understanding of effective mentoring structures.
Adults with disabilities often rent or own their own homes but may still rely on support from both professionals and family members. In the collaboration between family members and professionals, ethical challenges may arise. In a large Norwegian municipality, ethical reflection groups were initiated to improve cooperation with family caregivers, involving both employees and relatives of people with disabilities. Following this project, a research project was carried out, where the purpose was to uncover ethical challenges that employees and family caregivers experience in caring for people with disabilities. Furthermore, the aim was to highlight the significance of ethical reflection when collaborating. Focus group interviews were conducted with employees, and in-depth interviews with relatives. The interviews were then analyzed thematically. The study revealed that the challenges encountered revolved around a tension between familial values and institutional values. Through ethics reflection, both employees and family caregivers felt they gained a greater understanding of each other's perspectives, which in turn helped reduce the tension. The findings are discussed in light of different institutional logics and a discourse ethical approach.
Purpose: The report Indicators for Health Inequality in the Nordic Countries was written at the Norwegian Institute of Public Health and published by the Nordic Welfare Centre in 2019. It recommended seven indicators for social inequalities in health, including the Gini coefficient, as important to alleviate social health disparities. This article updates the findings from the report and describes developments over time. Methodology: The indicator sources that were used in 2019 were searched for updates, and data were downloaded. When the exact indicators were unavailable, we contacted the data owners to ask for updates. Findings: The majority of data were available from the original data sources with the same definitions. Two indicators had to be redefined, and we chose to use the “new” definitions to retrieve the older data points again. With one exception, there do not seem to have been any momentous changes over time, either within the countries or between the countries, and the socioeconomic gradients remain clear in all the countries. Conclusion: The proportion of everyday smokers decreased for almost all groups in all countries, while the patterns for other indicators were less clear. Nevertheless, monitoring social inequalities in health is important for policy reasons.
This study explores the hybrid sensemaking of data among professionals engaged in data-driven cooperation across municipalities in Denmark. In the context of digital transformation, the use of data has become integral to decision-making processes in the public sector, raising concerns about biases, privacy, and ethical dilemmas. This research focuses on the backstage setting, examining how professionals navigate the interplay of technology, human agency, and welfare state principles. Drawing on Harrits’s (2016) framework of sensemaking, the study highlights how professionals blend formal knowledge with personal, relational, and emotion-based logics in their work. The analysis identifies three key themes: identities, roles, and practices. Professionals act as “creative data literates”, “knowledge brokers”, and “translators”, bridging the gap between data and practical knowledge. The findings underscore the importance of ethical considerations and the need for a nuanced understanding of data’s role in public service. This study provides a framework to conceptualize how professionals assess and make sense of data, offering insights into the evolving nature of professional discretion in a digitized public sector. The implications of this research are particularly relevant for understanding the future of public-sector work in increasingly data-driven environments in the Nordic countries.
This study critically interrogates the “welfare technology as a solution” discourse in Norwegian national health and care policy, focusing on how it comes to be in relation to the framing of the care crisis as a particular kind of problem and the discursive constitution of elderly people as policy subjects. The research contributes to ongoing discussion about the impact of neoliberal governance in shaping the Norwegian welfare state, with a specific focus on investigating how welfare technology policy facilitates this shift. Employing Carol Bacchi’s post-structural “What’s the Problem Represented to Be” analytical framework to analyze six national healthcare policy documents, this study reveals a “technofix” logic that consolidates and mobilizes the illusion that technological solutions can solve the care crisis, which is peculiarly framed as the result of a conservative, inadequate care sector and passive care recipients. The care sector of tomorrow is discursively constructed as inevitably transformed through digital solutions that will compensate for traditional inefficiencies. The new elderly generation is invested with greater responsibilities for self-care, independence, and active aging, supported by welfare technology. Altogether, these findings reveal how technofix discursive frames present both overromanticized and silenced perspectives, ultimately shaping the understanding of care (including care agents, arrangements, practices, and relationships) and the role of the welfare state.
Voksne personer med utviklingshemming leier eller eier ofte egen bolig, men vil samtidig være avhengig av støtte fra både profesjonelle og pårørende. I samarbeidet mellom pårørende og profesjonelle kan det oppstå etiske utfordringer. For å bedre samarbeidet med pårørende ble det i en større norsk kommune startet opp refleksjonsgrupper der ansatte og pårørende til personer med utviklingshemming deltok. I etterkant av dette prosjektet ble det gjennomført et forskningsprosjekt der hensikten var å avdekke etiske utfordringer ansatte og pårørende opplever i samarbeidet om omsorgen for personer med utviklingshemming. Videre har hensikten vært å synliggjøre hvilken betydning etikkrefleksjon kan ha for samarbeidet. Det ble gjennomført fokusgruppeintervjuer med ansatte og dybdeintervjuer med pårørende. Intervjuene ble så analysert tematisk. Studien viste at utfordringene som oppsto, handlet om en spenning mellom familiære verdier og institusjonelle verdier. Gjennom etikkrefleksjon opplevde både ansatte og pårørende at de fikk en større forståelse av hverandres perspektiver, som igjen bidro til å minske spenningen. Funnene blir diskutert i lys av ulike omsorgslogikker og en diskursetisk tilnærming.
I denne studien undersøker vi ungdommers erfaringer med en kommunal mentorordning i Tromsø etablert som et forebyggende tiltak mot utenforskap, rus og kriminalitet. Studien bygger på kvalitative, individuelle dybdeintervjuer med 15 ungdommer i alderen 15–17 år og blir analysert med utgangspunkt i teori om tilhørighet, resiliens og sosial, kulturell og økonomisk kapital. Funnene sier oss at mentoren oppfattes som en kontinuerlig og trygg støttespiller i en ellers uforutsigbar hverdag. Ungdommene omtaler særlig tillit og stabilitet i relasjonen som avgjørende og kontrasterer dette med erfaringer fra hjelpeapparatet preget av lite forutsigbarhet, hyppige personaleskifter og lav tillit. Mentorene fungerer som bindeledd mellom ungdom, familie, skole og offentlige tjenester og bidrar til økt tillit, motivasjon, struktur og mestring i skole- og fritidshverdagen. Enkelte ungdommer peker også på mentorens rolle som veiviser i møte med systemet, en funksjon som kan omtales som «byråkratitolk». Samtidig synliggjør studien sårbarheten ved avslutning av relasjonen og behovet for mer forutsigbar og gradvis avvikling. Funnene peker mot at mentorordningen, slik den er organisert i Tromsø kommune, kan være et virkningsfullt og relasjonelt forankret tiltak for å forebygge utenforskap blant unge. Det anbefales videre forskning på mentorrelasjoner over tid samt komparative studier på tvers av nordiske og flerkulturelle kontekster.
This article investigates how street-level bureaucrats (SLBs) in Sweden manage cross-cultural challenges in their everyday interactions with migrants. While Swedish integration policy promotes both respect for cultural diversity and adherence to core national values such as gender equality and secularism, SLBs are often tasked with navigating the tensions between these potentially conflicting goals in practice. Drawing on 49 semi-structured interviews with SLBs across education, healthcare, labour market and social services, the study explores how cultural value dilemmas are interpreted and addressed at the frontline of the welfare state. The findings show that SLBs frequently perceive cultural diversity as a challenge to effective service delivery. Although they adopt culturally sensitive strategies, such as dialogue, adaptation, and contextual understanding, these are often employed to guide migrant clients toward alignment with dominant societal norms. Cultural sensitivity and assimilation thus emerge not as oppositional, but as coexisting logics that shape SLB practice. The article argues that culturally sensitive engagement may function as a method for advancing assimilationist goals, particularly in relation to gender roles, parenting, and religion. By highlighting these dynamics, the study contributes to a more nuanced understanding of how diversity is governed within Swedish welfare institutions.
The article examines the experiences of Syrian and Ukrainian refugees in their encounters with municipal integration workers in Norway and Denmark. The empirical analysis takes its point of departure in street-level bureaucracy (SLB) theory on how informal practices of frontline workers are crucial for the delivery of welfare policies. It also departs from the more classical focus within the SLB literature by focusing more explicitly on the experiences of the claimants and how these experiences vary across groups and policy regimes. Thus, it examines whether the differences between Norwegian and Danish integration policies at the national level - the latter being refugees' experiences of service quality, in this article measured as communication difficulties, whether they get the help they need, and changes in experienced self-worth following encounters with integration workers. The article finds that, overall, experiences of service quality are positive, but that differences exist across refugee groups and country of residence. The Syrian refugees in Denmark report the least positive experience with the municipal integration workers. We also find that a remarkable number of refugees report experiences of lower self-worth and communication problems. These negative experiences are more prevalent among refugees from Syria than Ukraine and more prevalent in Denmark than in Norway. Finally, the article finds that experiences of service quality are shaped by the individual resources that refugees are in possession of.
Although the literature on resettlement-the movement of refugees from their first country of asylum to a third country that can offer permanent residency and protection-is growing, we still know relatively little about how categories and criteria for the selection of refugees for resettlement are implemented in practice. We propose that to understand how refugees are selected for resettlement, it is useful to study the interorganizational encounters of national agencies involved in implementing the selection criteria of receiving states. Resettlement workers operate in a larger system of bureaucracies. In this paper we will focus on Norwegian practices of resettlement and the three Norwegian agencies involved-the Norwegian Directorate of Immigration, the Norwegian Directorate of Integration, and the Immigration Police. Drawing on street-level bureaucracy theory and ethnographic fieldwork among resettlement officers selecting refugees for resettlement to Norway, we ask how the different mandates and discretionary responsibilities influence how cooperating agencies implement the available criteria to select refugees for resettlement. We explore their division of labour, as well as distinct operational perspectives that sometimes produce contrasting reviews of the same cases, and how they resolve disagreement over resettlement decisions. In the context of the selection missions, the three agencies come to embody the multiple and sometimes conflicting aims and norms that guide Norwegian resettlement practices. Through an exploration of "trouble cases", we provide insight into how epistemic perspectives and discretionary reasoning differ between the agencies and how these factors shape inter-agency collaboration and ultimately resettlement decisions.
This article is concerned with how migrant students who arrive in the Danish school system during their compulsory school years are placed in different reception programs by street-level bureaucrats. The national political framework is indeterminate with regards to integration programs in education, meaning the local level can create multiple coexisting programs where the placement of migrant students depends upon how street-level bureaucrats apply their discretion. Street-level bureaucrats must decide migrant students’ placement considering students’ temporal conditions, namely their potential permanent integration, but in recent years also their potential non-permanence as posited by the 2019 immigrant policy “paradigm shift” espousing repatriation. The article is therefore guided by the question: How do street-level bureaucrats navigate temporal conditions in their integration work of referring migrant students to reception programs in a Danish municipality? The theoretical framework consists of street-level theory regarding discretion, but read with an emphasis on migrant students’ temporal conditions (Griffiths, 2024; Lipsky, 2010). The empirical material consists of 17 interviews in a Danish municipality supplemented by municipal policy documents. The article finds that three groups of migrant students are identified by street-level bureaucrats as referred to different reception programs based on temporariness as a temporal condition. These are respectively “international students,” “aging-out students,” and “Ukrainian students.” The referral leads to disparities in provision within the heterogeneous group of migrant students. This has potential ramifications for migrant students’ access to their educational rights and the Danish welfare state’s posits of educational egalitarianism.
This article investigates the broader landscape of trust in institutional encounters between forced migrants and the welfare state. It foregrounds different actors who are positioned at differing proximities to the actual encounter and have more direct and indirect influence on the street-level bureaucratic process. The paper advances the need to study the ambiguous role of third-party actors in order to understand the broader trust landscape beyond the dyadic service user and street-level bureaucrat (dis)trusting relations. Empirically, the analysis draws on fieldwork conducted in Finland and Sweden, building on 24 interviews with street-level bureaucrats in two key sectors of integration work—employment and social service institutions—and 27 interviews with forced migration background service users. The analysis shows how actors outside the core institutional encounter function in different ways as enablers and preventers of trust, and thereby ultimately reinforce or counteract structural disadvantage in a forced migration setting. Hence, they influence service users’ and street-level bureaucrats‘ trusting relations and consequently how service users are included in bureaucratic processes that support their integration.
This study investigates career counsellors working in the Finnish integration training programme, and as street-level integrators. In this study, their work is considered as emotional labour (Hochschild, 2012), requiring the street-level workers to manage their feelings for the sake of their duties. The study is based on two datasets, collected in 2019-2020. The first dataset includes video-recorded career counselling discussions between the career counsellors and migrants, and the second includes semi-structured interviews with the same counsellors and applying stimulated recall interview method. The counsellors verbalise very little emotional labour in the first dataset. In the second, they volunteer to describe various emotions involved in their work, which in this study are interpreted as cues for emotional labour. The descriptions by the counsellors involve either issues related to their counselling relationship with the migrants or directly to the migrants themselves. The results suggest there are various emotions involved in the counsellors' work, but they manage and regulate them when meeting the migrants. However, when presented with a situation to deal with this side of their work, they use it willingly. This indicates that there is an emotional gap present in their work: the emotions are not discussed in their daily duties, but the counsellors would benefit from receiving structured support to address them. The emotional gap burdens these street-level workers and indirectly informs the way they do integration policy. Additionally, due to this situation, the integration policy outcomes are neither optimal nor adequate.
Employers play a key role in the inclusion of vulnerable groups in the workforce. In this article, we examine Danish employers' recruitment practices across three vulnerable groups: people with physical disabilities, refugee backgrounds and individuals assigned to flexjobs. We explore the relationship between employers' recruitment and their attitude towards social responsibility through an employer typology and investigate what characterises employers who recruit employees from vulnerable groups and have a positive attitude. The results are based on three surveys and show that far more employers can be characterised as inclusive towards individuals granted a flexjob than towards individuals with mobility impairments and a refugee background. Furthermore, the results indicate that the proportion of employees from vulnerable groups is higher in small and private workplaces compared to large and public workplaces. The results also suggest that companies collaborating with a jobcenter more often employ an individual from a vulnerable group and have a positive attitude towards social responsibility. The results are interpreted with theories on stigma and inclusion and compared to existing research.
The Linde veterans are a group of surviving children who contracted polio shortly before, during, and after the Second World War. The veterans were all students at the Linde Boarding School for Disabled Children during various periods from 1947 to 1974. In this article, we highlight how their experiences at Linde and the political engagement they have developed since then have contributed to the emergence of a collective identity as disabled people. The veterans' participation in community and local political arenas in the 1970s and 1980s helped to create particularly favorable conditions for successfully struggling for the realization of their rights. Today, however, such local arenas have lost much of their former importance, and the people with disabilities' encounters with public institutions are leading to new defeats. In this situation, the question of individual and collective identity becomes central. We show that the relative lack of a strong collective identity with an accompanying narrative about the minority's historical relationship to the majority society (as in the case of the Sami) makes the struggle of interests of the Linde veterans and other disabled people much more vulnerable than before, not least because injustice can be individualized. This may require a reassessment of the disability struggle in a new era with new conditions. The material on which our article is based is drawn from interviews with nine former students at Linde and observations of conversations among Linde veterans.
