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Project type/Form of grant
Other
Title [sv]
Jämlik vård till kvinnor som lever i hemlöshet - utveckling, genomförbarhet och implementering av interventioner
Title [en]
Inclusion health for women in homelessness - development, feasibility and implementation of interventions
Abstract [sv]
Vårt bidrag till att omsätta målen i Agenda 2030 till verklighet är att fokusera på människor i välfärdssamhället som lever med svår ohälsa, marginaliserade och i fattigdom. I höginkomstländer som Sverige, drabbas kvinnor i hemlöshet av extrema ohälsoklyftor, vilket resulterar i ett förkortat liv. Projektets övergripande mål är att utveckla och implementera interventioner för jämlik vård och hälsa till kvinnor i hemlöshet; i nära samarbete med kvinnor, avnämare från hälso- och sjukvård, sjuksköterskeutbildningar, civilsamhället och Nationellt Centrum för Kvinnofrid. Projektet omfattar tre områden: Förhindra stigma och diskriminering inom hälso- och sjukvård: hinder/möjligheter till jämlik vård före och under COVID-19 pandemin; vad som upplevs som god vård;  sjuksköterskors vårdande, kliniska-demografiska variabler, attityder kring hemlöshet, hälsa, våldsutsatthet och hälsolitteracitet; använda en kunskap/utbildningsintervention för sjuksköterskor och sjuksköterskestudenter. Använda digitalisering för ökad tillgång till hälso- och sjukvård: hinder/möjligheter och attityder till användande av informationsteknologi (IT) i sjukvård, samt användande av eHälsa för att främja jämlik vård till kvinnor i hemlöshet. Öka kunskapen om genusspecifika skillnader: genom att följa en kohort av personer med beroendeproblematik som lever i hemlöshet och undersöka huruvida män jämfört med kvinnor erhåller vård utifrån nationella riktlinjer vid missbruk samt vård under COVID-19 pandemin. Vidare att utveckla en nationell handlingsplan för kvinnor i hemlöshet som utsatts för våld i nära relationer. Interventionerna avser att (1) öka kunskapen hos sjuksköterskor och sjuksköterskestudenter om jämlik vård till kvinnor i hemlöshet; (2) Utveckla eHälsa för kvinnor i hemlöshet; och (3) utveckla vården till kvinnor i hemlöshet som utsatts för trauma, våld och övergrepp. Projektet fokuserar på mål 3 God hälsa och välbefinnande, mål 5 Jämställdhet och mål 10 Minskad ojämlikhet i Sverige. Projekt id: 2019-01095_VR
Abstract [en]
Our contribution to implementing Agenda 2030 is focusing health efforts on people in extremely poor health due to marginalization, multi-morbidity, and poverty. Women in homelessness in high-income countries face extreme health inequities, resulting in considerably shortened lives. The goal is to develop and implement healthcare interventions for inclusion health among homeless women in Sweden; in collaboration with the women, stakeholders from healthcare services, nurse education, civil society and the Centre for Knowledge on Men´s Violence against Women. Three work packages form the project: End stigmatisation and discrimination in healthcare: exploring barriers/facilitators for inclusion health before and during COVID-19 pandemic, caring behaviors in RNs, clinical- and demographic variables, attitudes toward homelessness, health, exposure to violence, health literacy and use of IT; using a knowledge intervention/education for RNs and nursing students. Use digitalization to increase access to healthcare services: to describe the barriers and facilitators of IT; the attitudes towards eHealth to promote inclusion health among women in homelessness. Increase knowledge about gender-specific differences: through a cohort of persons with addiction in homelessness; to investigate if men receive care in line with national guidelines for addiction care as compared to women and in the same cohort explore COVID-19 related care. Further to develop a National Action Plan for Women in Homelessness who have been exposed to violence. The interventions focus on: (1) Increase knowledge about inclusion health for women in homelessness for RNs and nursing students; (2) Develop eHealth for women in homelessness; and (3) Develop and implement a National Action Plan for Care of Homeless Women with Experiences of Abuse, Assault and Trauma. This project targets Goal 3 Good health and wellbeing, 5 Achieving gender equality, and 10 Reducing inequality within Sweden.
Publications (10 of 25) Show all publications
Bockgård, G., Mattsson, E., von Essen, L. & Klarare, A. (2024). Collaborative Interpretation of Researcher-Generated Photo-Elicitation Findings: Insights From Women With Lived Experience of Homelessness. Qualitative Health Research
Open this publication in new window or tab >>Collaborative Interpretation of Researcher-Generated Photo-Elicitation Findings: Insights From Women With Lived Experience of Homelessness
2024 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557Article in journal (Refereed) Epub ahead of print
Abstract [en]

Interviews with individuals experiencing homelessness can be challenging for various reasons, including mental and physical health issues, substance use, and negative experiences with authority figures. Researchers have used photos to facilitate communication and empower participants during data collection. We analyzed data from a previous study to explore the use of researcher-generated photos during interviews about health with 13 women experiencing homelessness. Conversation analysis revealed clear patterns regarding the use of the photos during the interviews. The photos were referred to 118 times over the total interview length, 6 hours and 23 minutes, with the interviewer making 62% of the referrals and the women accounting for 38%. Fifty-nine percent of the referrals occurred within the first 5 minutes of the interviews. The women used the photos to trigger associations and emotions, to describe photo content, or in a minor role during the interview. Interpretations from an advisory board of six women with lived experiences of homelessness suggested that the photos did not engage participants as intended, highlighting the importance of considering participants’ perspectives when designing photo-elicitation methods. The feedback also provided valuable insights into interview locations and incentives in research that may have influenced the women’s willingness to use the photos. This study emphasizes the importance of understanding the complexity of choosing researcher-generated photos in interviews with underserved, hard-to-reach populations.

Keywords
Homelessness, Photo-elicitation, Researcher-generated photos, Women, Qualitative
National Category
Health Sciences
Identifiers
urn:nbn:se:esh:diva-10629 (URN)10.1177/10497323231224330 (DOI)38235734 (PubMedID)
Available from: 2024-01-18 Created: 2024-01-18 Last updated: 2024-01-19Bibliographically approved
Klarare, A., Ekström, V., Godskesen, T., Westman, J., Mattsson, E. & Kneck, Å. (2024). Treatment of trauma-related conditions for people in homelessness: A scoping review. Journal of social distress and the homeless
Open this publication in new window or tab >>Treatment of trauma-related conditions for people in homelessness: A scoping review
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2024 (English)In: Journal of social distress and the homeless, ISSN 1053-0789, E-ISSN 1573-658XArticle, review/survey (Refereed) Epub ahead of print
Abstract [en]

People in homelessness face significant health inequities, with tri-morbidity, exposure to violence, substance use- and post-traumatic stress disorder. The aim of this scoping review was to describe treatments for trauma-related conditions for persons in homelessness. Systematic searches were performed in three databases: PubMed, PsycInfo and Scopus, guided by the PRISMA checklist. Nine studies fulfilled the criteria and were included in the review. Results show no randomized studies specifically focusing on treatment of trauma-related conditions for people in homelessness. Studies described interventions or programs that focused on consolidating and developing participants’ own strengths and skills to better navigate life with the challenges of homelessness, trauma, and PTSD. Treatment of trauma-related conditions may have positive effects for people in homelessness, as for others. Multimodal treatments, developing personal strengths and skills for people in homelessness, show potential to decrease trauma symptoms, however, more robust studies are needed for inferences and recommendations. 

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Homelessness, Scoping review, Therapies, Trauma, Treatment
National Category
Health Sciences
Identifiers
urn:nbn:se:esh:diva-10708 (URN)10.1080/10530789.2024.2310948 (DOI)
Funder
Swedish Research Council, 2019-01095Forte, Swedish Research Council for Health, Working Life and Welfare, 2020-169
Available from: 2024-02-13 Created: 2024-02-13 Last updated: 2024-02-13Bibliographically approved
Anonymous, . (2024). When the wounds heal but the soul bleeds: A lived experience narrative. Journal of Psychiatric and Mental Health Nursing
Open this publication in new window or tab >>When the wounds heal but the soul bleeds: A lived experience narrative
2024 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850Article in journal (Other academic) Epub ahead of print
Abstract [en]

Accessible Summary

What is known on the subject?

  • This paper acknowledges the profound and lasting impact of childhood abuse on substance use and homelessness.

What this paper adds to existing knowledge?

  • It underscores the inherent value and humanity of every individual, regardless of their struggles.
  • That a comprehensive approach to mental health care, encompassing medication, therapy and a secure environment, is imperative.

What are the implications for mental health nursing?

  • Early intervention and recognising individuals who suffer in silence are paramount. Mental health nurses must have the courage to ask uncomfortable questions and truly hear the unspoken words.
  • Mental health nurses should never underestimate the power of simply being present with someone during their darkest moments. This simple act can wield significant influence.
Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2024
Keywords
Addiction, Adult survivors of abuse, Child abuse, Mental health
National Category
Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:esh:diva-10630 (URN)10.1111/jpm.13022 (DOI)38234235 (PubMedID)
Available from: 2024-01-19 Created: 2024-01-19 Last updated: 2024-02-05Bibliographically approved
Gaber, S., Klarare, A., Mattsson, E. & Karlsson Rosenblad, A. (2023). A comparison of perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students. Scandinavian Journal of Caring Sciences, 37(4), 959-969
Open this publication in new window or tab >>A comparison of perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students
2023 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, no 4, p. 959-969Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The population of women in homelessness in Europe is increasing and women in homelessness experience multiple healthcare needs. However, there is insufficient understanding about how perceptions of caring behaviours compare between women in homelessness as patients and nurses in their clinical practice.

AIM: This study aimed to investigate perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students.

METHODS: A cross-sectional design was used with convenience sampling to recruit groups of women in homelessness (n = 37), Registered Nurses (n = 92) and nursing students (n = 142) in Stockholm, Sweden. Between August 2019 and December 2020, data were collected through face-to-face interviews or online, using the Caring Behaviours Inventory-24 instrument. Data were analysed using descriptive statistics and group-comparing hypothesis tests.

RESULTS: Overall, women in homelessness' perceptions of caring behaviours were significantly lower than nursing students (p < 0.001), who in turn scored significantly lower than Registered Nurses (p < 0.001). The Knowledge and Skill domain had the highest score, and the Connectedness domain had the lowest score in all three groups. The ranking of the individual items according to score varied between the groups. However, all three groups had the highest score for the Knowing how to give shots, IVs, etc., item and the lowest score for the Helping the patient to grow item.

CONCLUSION: Healthcare providers and nurse educators should consider incongruences and congruences in caring behaviours to better prepare Registered Nurses and nursing students to contribute to increased health equity, and more targeted clinical practice for women in homelessness.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2023
Keywords
Caring behaviours, Homelessness, Nurse-patient relations, Nursing students, Registered nurses, Women
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-9426 (URN)10.1111/scs.13071 (DOI)000758136400001 ()35187681 (PubMedID)
Funder
Swedish Research Council, 2019-01095Forte, Swedish Research Council for Health, Working Life and Welfare, 2020-00169
Available from: 2022-02-28 Created: 2022-02-28 Last updated: 2023-12-13Bibliographically approved
Kneck, Å. (2023). Fungerande, behovsstyrd och resursstärkande samverkan: Avgörande för att den våldsutsatta kvinnan i hemlöshet ska kunna erbjudas traumavård. In: : . Paper presented at NaPSa, Nationell paper-konferens i socialt arbete, Södertörns högskola, Stockholm, 22-23 mars 2023..
Open this publication in new window or tab >>Fungerande, behovsstyrd och resursstärkande samverkan: Avgörande för att den våldsutsatta kvinnan i hemlöshet ska kunna erbjudas traumavård
2023 (Swedish)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [sv]

Det övergripande syftet för projektet är att öka möjligheten för våldsutsatta kvinnor i hemlöshet att kunna erbjudas traumavård vilket förutsätter att våldet identifieras och fungerande samverkan inom och mellan ett antal välfärdsinstitutioner. För kvinnor är våld både en orsak till, och en konsekvens av hemlöshet, där kvinnan sällan erbjuds traumavård och behandling pga. drogmissbruk, samsjuklighet och avsaknad av stabila levnadsförhållanden. Att kvinnan lämnas ensam att hantera sina trauman bidrar till psykisk och fysisk ohälsa, ökad droganvändning och begränsade möjligheter att ta sig ur hemlösheten. Fungerande samverkan mellan och inom socialtjänsten – samt med hälso-och sjukvården är avgörande för att kvinnas komplexa behov ska tillgodoses och för att våldet inte ska förbises eller normaliseras.

Strukturella, organisatoriska och individuella hinder för samverkan utmanar en fungerande samordning där kvinnas möjlighet och förmåga att vara delaktig och beslutskompetent är begränsad. Krav på hälsosjukvård och socialtjänstpersonal att skapa förutsättningar för delaktig är omfattande men svåruppnåeliga. Kvinnor i hemlöshet har länge betraktats som passiva, beroendet av andras agerande, stöd och omsorg dära utonomi, värdighet eller integritet är hotad. Utan att förbise denna utsatthet behöver kvinnan även ses som aktiv, kompetenta och ansvarstagande med möjlighet att påverka sin situation. Planerat projekt har en explorativ och samskapande design där våldsutsatta kvinnor i hemlöshet och olika personalkategorier medverkar i forskningsprocessen. Data utgörs främst av kvalitativt material. Ingående studier belyser både professions- och brukar/patientperspektiv och rör identifiering av våldsutsatthet, samspel och handlingsutrymme vid samordnad individuell plan samt utveckling av intervention för ökad samverkan.

National Category
Nursing Social Work
Identifiers
urn:nbn:se:esh:diva-10720 (URN)
Conference
NaPSa, Nationell paper-konferens i socialt arbete, Södertörns högskola, Stockholm, 22-23 mars 2023.
Available from: 2024-02-15 Created: 2024-02-15 Last updated: 2024-02-22Bibliographically approved
Mattsson, E. & Klarare, A. (2023). Kvinnor far illa inom ramen för samhällets institutioner. Dagens arena (2023-04-14)
Open this publication in new window or tab >>Kvinnor far illa inom ramen för samhällets institutioner
2023 (Swedish)In: Dagens arena, no 2023-04-14, p. 1Article in journal, News item (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Vårdprogram, journalsystem och arbetsrutiner bör ändras för att öka säkerheten för kvinnor med skyddade personuppgifter. 

Place, publisher, year, edition, pages
Stockholm: , 2023. p. 1
National Category
Health Sciences
Identifiers
urn:nbn:se:esh:diva-10172 (URN)
Available from: 2023-04-24 Created: 2023-04-24 Last updated: 2023-04-28Bibliographically approved
Stobin, R., Björling, A. & Kneck, Å. (2023). Orimliga krav på den som är sjuk och hemlös att ensam försöka navigera i ett svårtolkat strukturellt system: Erfarenheter hos personer i hemlöshet kring samverkan av vård- och omsorgsinsatser. Vårdmagasinet Hälsa : medlemstidning för distriktssköterskor (1), 28-29
Open this publication in new window or tab >>Orimliga krav på den som är sjuk och hemlös att ensam försöka navigera i ett svårtolkat strukturellt system: Erfarenheter hos personer i hemlöshet kring samverkan av vård- och omsorgsinsatser
2023 (Swedish)In: Vårdmagasinet Hälsa : medlemstidning för distriktssköterskor, ISSN 2003-1165, no 1, p. 28-29Article in journal (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Personer som lever i hemlöshet är sjukare, både fysiskt och psykiskt och har kortare livslängd än genomsnittsbefolkningen, ändå söker denna patientgrupp vård i mindre utsträckning än andra. Ofta har personen komplexa behov som kräver insatser från hälso-sjukvården samt socialtjänsten. Problem med ohälsa till följd av missbruk, trauma, våldsutsatthet i kombination med avsaknad av fast bostad gör personer i hemlöshet särskilt sårbara och samverkan mellan olika aktörer avgörande för att säkerställa adekvata åtgärder.

Place, publisher, year, edition, pages
Sigtuna: Distriktssköterskeföreningen i Sverige, 2023
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-10138 (URN)
Available from: 2023-04-05 Created: 2023-04-05 Last updated: 2023-04-05Bibliographically approved
Agius, J., Klarare, A., Mattsson, E., Vamstad, J., Eriksson Lundström, J. & Vahlman, S. (2023). Vilket stöd våldsutsatta får blir ett lotteri: Ge kommuner ett särskilt bostadsförsörjningskrav för våldsutsatta. Dagens Samhälle, Article ID 2023-06-08.
Open this publication in new window or tab >>Vilket stöd våldsutsatta får blir ett lotteri: Ge kommuner ett särskilt bostadsförsörjningskrav för våldsutsatta
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2023 (Swedish)In: Dagens Samhälle, article id 2023-06-08Article in journal, News item (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Inrätta en nationell handlingsplan som säkerställer skydd, stöd och stadigvarande boende för våldsutsatta oavsett kommun, föreslår forskare i ett projekt om kvinnor i hemlöshet.

National Category
Health Sciences
Identifiers
urn:nbn:se:esh:diva-10310 (URN)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2023-06-17 Created: 2023-06-17 Last updated: 2023-06-19Bibliographically approved
Mattsson, E., Lindblad, M., Kneck, Å., Salzmann-Eriksson, M. & Klarare, A. (2023). Voices of women in homelessness during the outbreak of the COVID-19 pandemic: A co-created qualitative study. BMC Women's Health, 23(11)
Open this publication in new window or tab >>Voices of women in homelessness during the outbreak of the COVID-19 pandemic: A co-created qualitative study
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2023 (English)In: BMC Women's Health, E-ISSN 1472-6874, Vol. 23, no 11Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Women in homelessness face extreme health- and social inequities. It could be postulated that during societal crises, they become even more vulnerable. Thus, the aim was to explore experiences related to the COVID-19 pandemic among women in homelessness.

METHODS: Ten interviews were conducted with women in homelessness, in Stockholm, Sweden, using researcher-driven photo elicitation. The data analysis was guided by the DEPICT model for collaborative data analysis and a qualitative content analysis was performed. A collaborative reference group of women with lived experience of homelessness contributed to the research process through designing the data collection, performing the data analysis, and providing feedback during report writing.

RESULTS: For women in homelessness, the COVID-19 pandemic was adding insult to injury, as it significantly affected everyday life and permeated most aspects of existence, leading to diminished interactions with others and reduced societal support. Thus, in an already dire situation, the virus amplified health- and social issues to another level. The women strived to find their balance on the shifting sands of guidelines and restrictions due to the pandemic. Adhering to the new social distancing rules and guidelines in line with the rest of society, was simply impossible when experiencing homelessness. However, for some women the pandemic was nothing but a storm in a teacup. The harsh reality continued irrespectively, living one day at a time and prioritizing provision for basic human needs.

CONCLUSIONS: The COVID-19 pandemic and homelessness can be viewed as two intersecting crises. However, the women's aggregated experiences were greater than the sum of experiencing homelessness and meeting the threat of the virus. Gender, exposure to violence, poverty, social isolation, and substance use were additional factors that further marginalized the women during the pandemic. To rebuild a better and more sustainable post-pandemic future for all, global commitment to ending homelessness is crucial. In addition, addressing social determinants of health must be the number one health intervention.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
COVID-19 pandemic, Homelessness, Inclusion health, Public involvement, Qualitative, Women
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:esh:diva-10001 (URN)10.1186/s12905-023-02157-x (DOI)000912027800003 ()36627642 (PubMedID)
Note

In collaboration with: Women Advisory Board for Inclusion Health. Ersta Möjlighet, Stockholm, Sweden.

Available from: 2023-01-11 Created: 2023-01-11 Last updated: 2024-02-09Bibliographically approved
Kneck, Å., Klarare, A., Mattsson, E. & Salzmann‐Erikson, M. (2022). Reflections on health among women in homelessness: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 29(5), 709-720
Open this publication in new window or tab >>Reflections on health among women in homelessness: A qualitative study
2022 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 29, no 5, p. 709-720Article in journal (Refereed) Published
Abstract [en]

Introduction: Mental health issues are common among women in homelessness, alongside undertreated chronic physical conditions leading to serious and unnecessary complications. Even though homelessness and risks of impaired health have been researched, broader perspectives of health are absent.

Aim: To describe reflections on health among women with experiences of homelessness.

Method: We conducted thirteen interviews with women in homelessness using researcher-driven photo elicitation. Together with an advisory board of women with lived experience of homelessness, researchers were guided by the DEPICT model for collaborative data analysis and performed a thematic analysis.

Findings: Women with experiences of homelessness emphasized three main resources for achieving health and well-being: feelings of having a home, being involved in authentic relationships and experiences of preserved dignity.

Implication for practice: Healthcare needs to integrate the perceived resources for health and well-being when caring for women in homelessness. It is imperative since women will return to the healthcare setting only if they feel safe and secure, and only if dignity is preserved or restored. The results promote utilization of an integrative nursing approach; understanding that the health of women in homelessness is inseparable from their environment and social determinants for health, such as housing and social integration.

Keywords
Health, Health equity, Homeless persons, Photo-elicitation, Women’s health
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-9683 (URN)10.1111/jpm.12859 (DOI)000840714500001 ()35861352 (PubMedID)
Note

In collaboration with: Women Advisory Board for Inclusion Health. Ersta Möjlighet, Stockholm, Sweden.

Available from: 2022-08-02 Created: 2022-08-02 Last updated: 2023-03-21Bibliographically approved
Principal InvestigatorMattsson, Elisabet
Co-InvestigatorBockgård, Gustav
Co-InvestigatorKlarare, Anna
Co-InvestigatorWestman, Jeanette
Co-InvestigatorVamstad, Johan
Co-InvestigatorKneck, Åsa
Co-InvestigatorSalzmann, Martin
Co-InvestigatorRosenblad, Andreas
Co-InvestigatorOlsson, Malin
Coordinating organisation
Marie Cederschiöld University
Funder
Period
2021-01-01 - 2023-12-31
National Category
Other Health Sciences
Identifiers
DiVA, id: project:2924Project, id: 2020-00169_Forte

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