OBJECTIVE:To explore experiences and challenges faced by regional and municipal health care leaders during the COVID-19 pandemic, with a focus on primary health care and care of older adults. DESIGN:A longitudinal qualitative study based on two rounds of semi-structured interviews 2-3 months apart. SETTING AND PARTICIPANTS:Fifteen health care leaders strategically recruited from regions and municipalities across Sweden. The first interviews took place in November-December 2020, the second in January-March 2021. RESULTS:Four themes were identified. The first captured the challenge of navigating uncharted territory during an unprecedented crisis. The second addressed ethical dilemmas arising from public health priorities. The third highlighted the growing significance and evolving role of infection prevention and control. Finally, the fourth illustrated how initially productive and solution-oriented local collaboration and communication gradually gave way to tensions and conflicting responsibilities. CONCLUSIONS:In the early phases of the pandemic, the Swedish Public Health Agency's leadership and measures were generally appreciated, although the initial response was widely perceived as slow and insufficient. The high mortality among older adults was regarded as a major failure, raising ethical concerns and exposing tensions in collaboration between actors. Pandemic work was experienced as exhausting yet meaningful, and the field of infection prevention and control gained increased recognition and status. Some distinctive features of Sweden's pandemic response - such as decentralised decision-making and an emphasis on individual responsibility - may have been shaped by the constitutional prohibition of ministerial rule and the substantial autonomy granted to regional and local authorities.

Urinary tract infections (UTIs) are highly prevalent, affecting up to 50

We explore how Norwegian students understand and cope with mental health and well-being challenges in higher education. We use innovative visual collaborative methodology with a critical approach to well-being, drawing on a sociology of world relations. Our findings add insights into students' perspectives in a field largely informed by quantitative data. They illustrate the extent of students' active self-management of emotional, temporal and relational aspects. They also reveal everyday challenges of self-judgment and shame. We find, to improve a sense of health and well-being in a university context, students' perceptions of personal productivity are significant but more so supportive relationships.

Introduction Multidose drug dispensing (MDD) provides machine-packed, patient-specific dose pouches to improve medication safety and adherence, streamline medication management, and reduce pressure on healthcare systems. Despite the benefits, uptake in Denmark remains lower than in neighbouring countries, even after MDD prescriptions were integrated into the national electronic Shared Medication Record (SMR). This study explores general practitioners’ (GPs) and hospital physicians’ experiences with MDD following SMR integration.Methods A qualitative study was conducted through semi-structured interviews with 15 physicians (8 GPs, 7 hospital physicians) from the Capital Region and the North Region in Denmark between November 2022 and May 2023. Data was analysed using systematic text condensation.Results Two main code groups with six subgroups were constructed. “A Multi-layered Burden for Physicians”, reflects an experience of an increased workload and added complexity resulting from IT challenges, dosing period calculations, and inconsistent communication with pharmacies. “Finding the Right Fit”, highlights uncertainty about which patients and medications are suitable for MDD, together with the differentiated roles of healthcare professionals in managing the MDD system. While some physicians considered MDD beneficial for patients with complex needs, others found it unsuitable for those with fluctuating conditions, especially during hospitalisations.Conclusion Although MDD offers potential benefits, its practical implementation is constrained by digital, organisational, and interprofessional challenges. Assessing patient suitability is essential, but rather than excluding patients, the findings suggest reconceptualising MDD as a flexible, adaptable system, capable of meeting individual care needs and responding to changing clinical situations.

This article explores the introduction of the internet-based self-help programme "My Symptoms" into Danish general practice. The programme aims to assist patients and general practitioners (GPs) in managing persistent physical symptoms (PPS) such as pain, fatigue, gut trouble, and dizziness. These symptoms affect a significant part of the population, yet they are rarely explained by a pathophysiological diagnosis. The article is based on ethnographic fieldwork in four general practice clinics in the Central Denmark Region and 31 semi-structured interviews with GPs and patients engaged in the programme. Inspired by work emphasizing technologies-in-practice as multidirectional, that is, shaped through reciprocal interactions across actors and settings, we examine how this programme subtly co-constitutes symptoms, practices, and relationships between patients and GPs. Rather than taking either a patient or a clinician perspective, we analyse engagement across both groups and across of both home and clinic. Through this lens, we explore three interrelated themes in the making of PPS: primary care, everyday life, and the redistribution of responsibilities. By attending to the fluidity and adaptability of PPS and programme engagements, we show the sensemaking and reconfiguring practices required to transform digital health programmes into meaningful care practices. The analysis, therefore, complicates the dominant promises of a digital transformation of healthcare by showing how technologies define and constrain specific care practices as possible. This raises critical questions about shifting responsibilities and the distributed work of self-help technologies in contemporary healthcare.

Background:Understanding patients' expectations of health care is central to providing patient-centered care and improving patient satisfaction. However, the current literature is primarily focused on single disease-specific patient expectations. Aim:To develop an in-depth understanding of the expectations patients with musculoskeletal conditions and comorbidities have towards physiotherapists working in private physiotherapy practice. Methods:35 observations with patients with musculoskeletal conditions and comorbidities receiving treatment in a Danish private physiotherapy setting were conducted. Of these, nine patients participated in interviews. A Grounded Theory analysis was undertaken, and categories were formed and agreed upon through an inductive approach grounded in the data. Results:Three major themes emerged from the data 1) Professional expertise is needed but will not be enough if enthusiasm fades in a long treatment course 2) Being able to laugh about life when you have many health problems 3) The balance of involvement and the sharing of power and responsibility. Patients express a desire for a strong bond with their physiotherapists, fostering intimacy and mutual understanding. They seek light-hearted interactions and wish to share personal aspects like family dynamics and hobbies. The study also underscores their expectations for sharing power and care tailored to their specific needs. Conclusion:Our findings reveal that patients with musculoskeletal conditions and comorbidities have clear expectations of treatment and collaboration with their physiotherapists in private physiotherapy practice. Underscoring personal relationships over physical results and demonstrating that this patient group has resources to support treatment and is clear about levels of involvement and collaboration.

People on long-term sickness absence in Denmark experience the help and support they receive from professionals as problematic. To understand these issues, this study, through interviews with eight interlocutors, investigated how people on long-term sickness absence perceive and experience professionals from both the vocational and health care sectors involved in their situation. Our study led to two main findings: Firstly, the roles of professionals often transcended their formal boundaries, with caseworkers frequently becoming involved in the sick absentees' health-related issues, and health care professionals frequently becoming involved in the sick absentees' vocational issues. Secondly, professionals from both sectors were perceived as enacting one of two positions: A "position of togetherness," where professionals were perceived as someone helping the sick absentee in managing their situation, and a "position of otherness," where the professionals were perceived as an additional uncertainty in the sick absentee's situation. These positions were situational and could change depending on the context and over time. The research highlights the importance of meaningful relationships between professionals and sick absentees, suggesting that fostering a position of togetherness can lead to better outcomes. We believe our findings can help professionals better understand and support people on sickness absence.

BACKGROUND:In chronic care, patient-GP collaboration is essential, but might be challenging if patients have complex health problems because of multimorbidity, psychosocial predicaments, and addiction problems. To understand and manage these challenges, it is important to explore how patients and GPs attempt to collaborate, to maintain and achieve an alliance in order to gain good quality of care. AIM:To explore how dyads of GPs and patients, who GPs deem have complex health problems and difficulties following treatment, perceive and manage challenges in their chronic care partnership. DESIGN & SETTING:This was a qualitative study from Danish general practice in deprived, rural areas. METHOD:Semi-structured interviews were conducted with 12 dyads of GPs and patients with doctor-assessed complex chronic conditions and difficulties following treatment. The principles of systematic text condensation were used in the analysis. RESULTS:Overall, the patient-GP collaboration could be characterised as either 'stuck' or 'unstable'. In both types, the challenges were identified as pointless consultations, conflicts about lifestyle, resignation, concealment of information, and hopelessness. These challenges could be managed by solving conflicts, adjusting to the patient's needs, accommodating the challenges in the relationship, and offering continued emotional support even with unsolved medical problems. CONCLUSION:Care of patients with complex health problems may present several challenges. In this study, patients and GPs experienced the relational dimension as crucial for collaboration. A robust therapeutic alliance, incorporating the patient's agenda, offers an essential foundation for enhancing care in individuals with complex health problems.

Background Understanding patients’ expectations of health care is central to providing patient-centered care and improving patient satisfaction. However, the current literature is primarily focused on single disease-specific patient expectations. Aim To develop an in-depth understanding of the expectations patients with musculoskeletal conditions and comorbidities have towards physiotherapists working in private physiotherapy practice. Methods 35 observations with patients with musculoskeletal conditions and comorbidities receiving treatment in a Danish private physiotherapy setting were conducted. Of these, nine patients participated in interviews. A Grounded Theory analysis was undertaken, and categories were formed and agreed upon through an inductive approach grounded in the data. Results Three major themes emerged from the data 1) Professional expertise is needed but will not be enough if enthusiasm fades in a long treatment course 2) Being able to laugh about life when you have many health problems 3) The balance of involvement and the sharing of power and responsibility. Patients express a desire for a strong bond with their physiotherapists, fostering intimacy and mutual understanding. They seek light-hearted interactions and wish to share personal aspects like family dynamics and hobbies. The study also underscores their expectations for sharing power and care tailored to their specific needs. Conclusion Our findings reveal that patients with musculoskeletal conditions and comorbidities have clear expectations of treatment and collaboration with their physiotherapists in private physiotherapy practice. Underscoring personal relationships over physical results and demonstrating that this patient group has resources to support treatment and is clear about levels of involvement and collaboration.

BackgroundPatients with multiple chronic conditions, for example, musculoskeletal conditions and comorbidities, often receive inadequate and sometimes even contradictory care. Physiotherapists are well qualified to manage patients with musculoskeletal conditions and comorbidities due to their education and experience with rehabilitation; however, it is unknown which challenges they face when treating these patients.AimTo identify challenges, treatment strategies, and delineations of areas of responsibility among physiotherapists working in private physiotherapy practice when treating people with musculoskeletal conditions and comorbidities.MethodsQualitative study using focus group discussions and participant observations of 13 physiotherapists working in Danish private physiotherapy clinics. Grounded theory was applied to guide the analysis.ResultsTwo major themes emerged from the focus groups and the observations (1) The necessity of adapting management to the patients and their treatment trajectory; (2) The dilemma of overall responsibility for coordinating care. The physiotherapists described different elements of adapting their management, including being challenged on time, taking extra care of the patient, and having to adjust to a fluctuating course of treatment. The dilemma in coordinating care concerned whether the responsibility should lie with the physiotherapist, other healthcare professionals, or the patients, and whether to treat only the condition on the referral or to treat all the conditions the patient had.ConclusionPhysiotherapists use adapted strategies for diagnosing and treating patients with musculoskeletal conditions and comorbidities and are uncertain about the overall responsibility for coordinating care and whether they should focus on the index condition alone or also the other comorbidities the patient has.

(note til redaktion: publiceres uden resumé)

For people with mental and somatic illnesses, the interpretive process of attending to a multitude of bodily sensations and recognising them as potential symptoms represents daily and ‘chronic homework’. Based on 16 months of ethnographic fieldwork in Denmark, this study explores diagnostic work and healthcare seeking among people with severe mental and somatic illnesses. As multiple studies have shown, the transformation process for a perceived sensation to become a symptom is a socially constructed interpretative process highly dependent on social legitimisation and shaped by prior cultural knowledge. We found that people with severe mental and somatic illnesses often struggle to ‘read’ the body and its boundaries and to define and distinguish when a symptom becomes a potential sign of illness. Furthermore, they often lack opportunities for social recognition of symptoms due to the absence of social relations. Finally, lifelong experiences with the healthcare system have taught them that they must distinguish between ‘mental’ and ‘somatic’ symptoms to fit the systemic organisation of the healthcare system. This deeply rooted mind-body dualism in the organisation of healthcare services and the daily struggles of diagnostic work to comply with this organisation impacted the interlocutors’ healthcare seeking strategies. Moreover, even though they ‘make up their minds’ to seek healthcare, they risk being met with diagnostic overshadowing and reductionist clinical approaches.

ObjectiveTo explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.DesignLongitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.ResultsThrough the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.ConclusionsThe Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience. The Norwegian Infection Control Act gave comprehensive responsibility and authority for local COVID-19 pandemic management to the municipalities and the Municipality Chief Medical Officers (MCMOs).The MCMOs highlighted several challenges and shortcomings of the municipal crisis preparedness, of which lack of detailed organizational plans was the most prominent.Teamwork, digital networking and collective sensemaking seemed to enhance pandemic collaboration and resilience within and across municipalities.Most MCMOs gained a leading role at a higher organizational level within the municipality through the COVID-19 pandemic.To strengthen future crisis management, arrangements must be made, both organizationally and financially, for preparedness to remain on the agenda even between epidemics and pandemics.

Purpose: Chronic pelvic pain (CPP) is a multifaceted condition, and many women live with CPP without receiving any explanation for their complex symptoms. A multimodal approach including physiotherapy is the recommended treatment. To increase the limited knowledge of what is beneficial in physiotherapy, this article aims to explore women's experiences of Norwegian psychomotor physiotherapy (NPMP) as treatment for CPP. Method: This qualitative study is based on in-depth interviews with eight women undergoing CPP. The concept of embodiment underpins the entire research project, and the analysis of the participants' experiences builds on a phenomenological approach. Results and conclusion: Three final themes embrace the participants' experiences of change after NPMP treatment: experiencing their body in new ways, letting go of tension, and understanding their symptoms. Through treatment, the participants moved from keeping bodily sensations at a distance towards increased bodily self-awareness. They realised that their state of tension was linked to their emotional life and stress was revealed as a trigger of bodily reactions they related to their symptoms. Positive bodily sensations were essential for the participants to let signals from their body guide their actions in a change process.

Background Adverse childhood experiences can have immediate effects on a child’s wellbeing and health and may also result in disorders and illness in adult life. General practitioners are in a good position to identify and support vulnerable children and parents and to collaborate with other agencies such as child welfare services. There is a need for better integration of relevant services. The aim of this study is to explore GPs’ experiences of the collaboration process with child welfare services. Method This is a qualitative grounded theory study, with data consisting of ten semi-structured interviews with general practitioners across Norway. Results The doctors’ main concern was: ‘There’s a will, but not a way’. Three subordinate stages of the collaboration process were identified: (I) Familiar territory, with a whole-person approach to care by the doctor. (II) Unfamiliar territory, when child welfare becomes involved. Here, a one-way window of information and a closed door to dialogue perpetuate the doctors’ lack of knowledge about child welfare services and uncertainty about what is happening to their patients. (III) Fragmented territory, where doctors experience lost opportunities to help and missing pieces in the patient’s history. Conclusion General practitioners are willing to contribute to a collaborative process with child welfare, but this is hampered by factors such as poor information flow and opportunities for dialogue, and limited knowledge of the partner. This implies lost opportunities for doctors to help families and contribute their knowledge and potential actions to a child welfare case. It can also impede whole-person care and lead to fragmentation of patient pathways. To counteract this, electronic two-way communication could enable a collaborative process and relationships that enhance coordination between the parties. Making space for all parties and their individual roles was considered important to create a positive collaborative environment.

To reduce morbidity and mortality of cancer, more countries have implemented strategies to detect cancer, based on the logic of 'the sooner the better'. Time is thereby an essential component in how cancer research, policies, and prevention are practiced today. Where the logic of early diagnosis benefits some, the logic also produces harms. In this article, we use a cross-disciplinary case-study design to discuss how different notions of time and linearity are essential in today's research ontology of cancer, describe the individual and societal consequences of such ontology, and invite a rethinking of time in cancer. Drawing on theoretical concepts of time together with cancer epidemiological, historical and ethnographical data, we analyse how the logic of early diagnosis has been established as a stable concept. Although evidence supporting the logic points in different directions, the message 'the sooner the better' is currently not being challenged by research, policy or society. This at least partly, can be explained by a linear perception of time and societal traces of neoliberalism and acceleration in our society together with cancer still being a somewhat enigmatic disease that requires acute action. To support a sustainable healthcare sector, we argue there is a need to nuance the logic of early diagnosis. Continuing the linear perception of symptoms and cancer, risks doing more harm than good by making more people patients unnecessarily and by spending health resources on those with the least need.

In Denmark, due to the implementation of the Non-specific Symptoms and Signs of Cancer-Cancer Patient Pathway (NSSC-CPP), more people with symptoms such as fatigue and weight loss are informed that their symptoms might indicate cancer and they are referred to the pathway. But what do patients in the NSSC-CPP experience, in particular, with respect to being in an affective state of anticipation of a cancer diagnosis? We conducted participant observation and semi-structured interviews with patients to investigate their experience of the NSSC-CPP with a specific focus on their perception of symptoms and their thoughts on worrying about cancer. We found that the phrase 'worried about cancer' was not recognised by the participants, but worry was visible in their increased healthcare use and their interpretation of bodily sensations. Our study indicates the need to explore the impact of anticipation and potential cancer worries in participants' everyday lives, as this context mediates their moral roles and responsibilities and restructures their social lives, while keeping uncertainty and probabilities on the table.

Abstract Objective When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change. Design Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September–December 2020, the second round from January–April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2–4 months apart. To analyze the data, we used thematic analysis. Results The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. Conclusions Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response. Key Points Facing the COVID-19 pandemic, the primary health care service in Norway had to reorganize to ensure safe patient treatment and maintain infection control. Several GPs experienced challenges in collaboration with the municipalities. There is a need for clarification of responsibilities between GPs and the municipality.

Chronic pelvic pain (CPP) is highly prevalent among women and the condition is poorly understood. In addition to multiple symptoms from the pelvis, CPP patients frequently suffer bodily distress like musculoskeletal pain and negative emotional, behavioral, and sexual implications. This paper is based on a qualitative study including semi-structured interviews with eight women with CPP. Our project has been conducted within the framework of phenomenology, particularly shaped by the concept of embodiment. We discuss the link between the lived body and CPP and address the value of making the life experiences of the patient relevant to understand this complex condition.