Implementation of evidence-based interventions: analyzing critical components for sustainability in community mental health services

This study analyses the implementation and sustainability of evidence-based community mental health services in the form of publicly financed Individual Placement and Support programs. Critical implementation components and program fidelity were assessed after one year. After two years, program fidelity was assessed once again. After three years, the programs’ sustainability was assessed and semi-structured interviews performed, in order to deepen the understanding of implementation. Interviews and documents provided the quantitative and qualitative data, which were analyzed by the use of the Supported Employment Fidelity Scale, the Sustainable Implementation Scale (which was developed in a connecting study), and qualitative content analysis. Despite promising fidelity results after one year, eight out of 14 programs were terminated within three years. Implementation of integrated evidence-based programs in community-based settings is a delicate undertaking. Implementing agencies can benefit from rigorous preparation before program start, especially concerning the circumstances at the organizational level, such as making plans for collaboration, financing and assessments of program fidelity.     

Target groups for prevention of neck/shoulder and low back disorders: an exploratory cluster analysis of working and living conditions

Musculoskeletal disorders (MSDs) have a multifactorial etiology. Therefore, a holistic approach to identifying target groups for primary/secondary prevention is essential. In this study, an exploratory person-oriented approach was applied, using cluster analysis of variables related to physical and psychosocial work conditions, and conditions in the private sphere, on a data set of 1,341 Swedish women and men who had not sought care for MSDs the 6 months preceding enrollment in the study. Three groups at risk and five "healthy" groups regarding MSDs were identified. Two of the risk groups had a strained situation regarding psychosocial work conditions or domestic/family conditions, respectively. The majority of individuals in these groups were women. The third risk group had a strained situation regarding both physical and psychosocial work conditions. This group consisted largely of men working in male-dominated jobs. The five healthy groups had low/moderate metabolic demands at work, and all of them having high proportions of subjects with moderate to high education, and fairly even distributions of men and women. In conclusion, the results indicate that gender-specific working and living conditions are associated with an increased risk for MSDs. The identification of these subgroups in the population may facilitate a selective prevention approach.     

On Strategy and Management Control: The Importance of Classifying the Strategy of the Business

The point of departure for this paper is a number of contingency-theory studies on the relationship between business strategy and the design and use of management control. In these studies strategy has been operationalized in different ways – a major reason why the findings are ambiguous and difficult to integrate. Thus there is a strong need for a common frame of reference for classifying business strategy. In view of the multifaceted nature of the concept of strategy, however, it is neither desirable nor possible to arrive at a single method of classification that would be appropriate in all situations. Rather, the task is to integrate different strategic variables such as strategic pattern, strategic position and strategic mission. In this paper we show how these three variables may be assumed to influence, and be influenced by, what characterizes changes in strategy and how business units manage their product offerings. Unlike most previous studies in the field, this paper discusses how the strategic variables taken together may be assumed to influence the classification of strategy and thus the design and use of the management-control system. Our deductive analysis, and the hypotheses used in connection with it, show that studies which consider only one strategic variable may lead to erroneous conclusions about the relationship between strategy and management control.     

An asymptotically distribution-free test of symmetry

A procedure, based on sample spacings, is proposed for testing whether a univariate distribution is symmetric about some unknown value. The proposed test is a modification of a sign test suggested by Antille and Kersting [1977. Tests for symmetry. Z. Wahrscheinlichkeitstheorie verw. Gebiete 39, 235–255], but unlike Antille and Kersting's test, our modified test is asymptotically distribution-free and is usable in practice. A simulation study indicates that the proposed test maintains the nominal level of significance, α$\alpha$ fairly accurately even for samples of size as small as 20, and a comparison with the classical test based on sample coefficient of skewness, shows that our test has good power for detecting different asymmetric distributions.     

Can job insecurity be managed? Evaluating an organizational-level intervention addressing the negative effects of restructuring

Although downsizing and reorganisation are recognised as serious threats to the psychological well-being of employees, intervention strategies for addressing these events are limited. This study evaluated the effects of a participatory organisational-level intervention in which employees and managers chose to address the psychosocial consequences, specifically job insecurity, of restructuring. The intervention was conducted among postal service letter carriers in Denmark and was evaluated based on quantitative and qualitative data. Using interviews (N?=?24) and observations, the programme theory of the intervention and to what extent the intervention had been implemented were assessed. Using survey data (N?=?238), repeated measures ANOVAs were conducted to test for differences in the development of job insecurity between the intervention group and a comparison group. The results indicate that the intervention group had a significantly smaller increase in one dimension of job insecurity as compared to the comparison group. Therefore, we conclude that employees’ experiencing of job insecurity, which typically follows in the wake of restructuring, can be addressed by planned efforts at the workplace level.     

‘We are just ordinary people working hard to reach our goals!’ Disabled students’ participation in Norwegian higher education

In this article we shed light on the experiences of disabled students attending professional courses in higher education in Norway. The findings from this empirical study are based on interviews with 14 students with diverse impairments, ranging from the visible to the invisible. They faced barriers that they resolved to address on their own, using their capabilities and working ‘in silence’ to meet the expectations of normal students in academia as strong and independent. In addition to their own motivation and self-determination, what facilitated their progress in their studies was that some of the staff and fellow students met them respectfully as ordinary students, while recognizing their strain and providing support without calling attention to it. Leaning on the Nordic Relational Model of Disability, we call for greater awareness of the complex interactional processes between the disabled students and people in their social environment.     

Gender,Parenthood and Wage Differences: The Importance of Time-Consuming Job Characteristics

Using data from the Swedish Level of Living Survey (2000, 2010), we investigate how the gender wage gap varies with occupational prestige and family status and also examine the extent to which this gap is explained by time-consuming working conditions. In addition, we investigate whether there is an association between parenthood, job characteristics and wage (as differentiated by gender). The analyses indicate that there are gender differences regarding prestige-based pay-offs among parents that are partly explained by fathers’ greater access to employment characterized by time-consuming conditions. Separate analyses for men and women demonstrate the presence of a marriage wage premium for both genders, although only men have a parenthood wage premium. This fatherhood premium is however only present in high-prestigious occupations. Compared with childless men, fathers are also more advantaged in terms of access to jobs with time-consuming working conditions, but the wage gap between fathers and childless men is not explained by differences in access to such working conditions.     

Policy Changes in Community Mental Health: Interventions and Strategies Used in Sweden over 20 Years

The deinstitutionalization of mental health care has changed the responsibilities of involved authorities and has led to a continuous need for new treatment forms and interventions. This article describes this development in Europe, and in particular how these new conditions have been handled in Sweden over the past 20 years at the level of governmental policy‐making. Three major policy documents from 1994, 2009 and 2012 were included in this study. To increase our understanding of the policies' contents, we have used theoretical concepts concerning governance, implementation and political risk management. Although our main interest was to find out how the government handles interventions for users of the mental health care system, we found that the policy work is progressing stepwise. The first document, from the deinstitutionalization era, did not discuss interventions clearly. Instead, it was mainly concerned with both practical and economical areas of responsibility. The second document, from the post‐deinstitutionalization era, was more focused on what services should be delivered to the users, while the most recently published document to a greater extent addressed the question of how the support is supposed to be designed. The trend in European community mental health policy has been to advocate services in open forms that are integrated into the society's other care systems. This is also the case in Sweden, and continuous work is being done by the government to find strategies to support the development, and to meet the needs at both political and local levels.