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Kohi, T. W., von Essen, L., Masika, G. M., Gottvall, M. & Dol, J. (2019). Cancer-related concerns and needs among young adults and children on cancer treatment in Tanzania: a qualitative study. BMC Cancer, 19(1), Article ID 82.
Open this publication in new window or tab >>Cancer-related concerns and needs among young adults and children on cancer treatment in Tanzania: a qualitative study
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2019 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 19, no 1, article id 82Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cancer is one of the leading causes of morbidity and mortality worldwide. Seventy percent of deaths of cancer occur in low or middle-income countries, where the resources to provide cancer treatment and care are minimal. Tanzania currently has very inadequate facilities for cancer treatment as there are only five sites, some with limited services; two are in Dar es Salaam and one each in Mwanza, Kilimanjaro and Mbeya that offer cancer treatment. Despite cancer being a prevalent problem in Tanzania, there is a significant shortage of information on the experiences of young people who receive cancer treatment and care. The aim of this study was to explore cancer-related concerns and needs of care and support among young adults and children who are receiving cancer treatment in Dar es Salaam, Tanzania.

METHODS: Using an explorative, qualitative design, two focus group discussions (FGDs) with young adults (18 to 25 years) and four FGDs with children (9 to 17 years) were held. Data were transcribed into English and analyzed using content analysis.

RESULTS: Identified concerns included physical effects, emotional effects, financial impacts, poor early care, and poor treatment. Identified needs included the need for improved care in hospital by the staff, need for community support, financial needs, needs for improved cancer care and treatment in the hospitals, and the need for increased education about cancer. Resilience was identified, particularly around hope or faith, having hope to be healed, and receiving good care from staff.

CONCLUSION: Young adults and children receiving cancer treatment in Tanzania have many needs and concerns. Improvements with regard to the care provided in hospital by the staff, the cancer care and treatment in the hospital, and population-wide education about cancer are necessary to address the identified needs and concerns. Further studies on specific approaches to address the concerns and needs are also warranted.

Keywords
Cancer, Cancer treatment, Children, Tanzania, Young adults
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2743 (URN)10.1186/s12885-019-5279-z (DOI)30654794 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-05-02Bibliographically approved
Masika, G. M., Gottvall, M., Kohi, T. W., von Essen, L. & Dol, J. S. (2019). Concerns and Needs of Support Among Guardians of Children on Cancer Treatment in Dar es Salaam: A Qualitative Study. Cancer Nursing
Open this publication in new window or tab >>Concerns and Needs of Support Among Guardians of Children on Cancer Treatment in Dar es Salaam: A Qualitative Study
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2019 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Cancer in children in Tanzania is a concerning health issue, yet there is a shortage of information about the experiences of the guardians of children who receive cancer treatment.

OBJECTIVE: To explore concerns and needs of support among guardians of children on cancer treatment in Dar es Salaam, Tanzania.

METHOD: Using a qualitative design, 3 focus group discussions were held with 22 guardians of children aged 9 to 17 years. Guardians were recruited from Muhimbili National Hospital, Dar es Salaam, where their children were receiving cancer treatment. Data were analyzed using thematic content analysis.

RESULTS: Guardians experienced several issues during the initial stages of their child's cancer treatment, including the process of seeking a diagnosis, and experiences with care at the peripheral (regional) hospitals and national hospital. They also shared what they felt would lessen their difficult experiences. Seven themes emerged in this study: financial concerns, emotional concerns, barriers to cancer care, need for improved cancer care, need for information, need for tangible support, and gratitude and hope.

CONCLUSION: Guardians of children with cancer experience challenges during initial stages when seeking a diagnosis and have concerns and needs related to cancer care and treatment.

IMPLICATIONS FOR PRACTICE: Improvements are needed regarding care at regional hospitals, the cancer diagnosis, and the recognition of early signs of cancer and quick referral to diagnostic centers, compassionate caring behaviors by healthcare workers, budgetary support from the government to meet the medication supply demands, and meeting stakeholders' support needs.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2837 (URN)10.1097/NCC.0000000000000722 (DOI)31107702 (PubMedID)
Available from: 2019-06-12 Created: 2019-06-12 Last updated: 2019-06-12Bibliographically approved
Gottvall, M., Sjölund, S., Arwidson, C. & Saboonchi, F. (2019). Health-related quality of life among Syrian refugees resettled in Sweden. Quality of Life Research
Open this publication in new window or tab >>Health-related quality of life among Syrian refugees resettled in Sweden
2019 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose The main purpose of this study was to assess health-related quality of life (HRQoL) among Syrian refugees resettled in Sweden. Further, we wanted to investigate whether sex, age, education, area of residence, cohabitation and social support were associated with HRQoL in this population. Methods This is a cross-sectional study including 1215 Syrian refugees from a randomly selected sample frame resettled in Sweden between the years 2011 and 2013. HRQoL was measured by the EQ-5D-5L descriptive system, and EQ-5D-5L index values were calculated. Associations between sex, age, education, area of residence, cohabitation, social support and EQ-5D-5L were investigated using multiple linear regression analysis. Results Depression/anxiety was the most commonly (61.9%) reported EQ-5D-5L problem among the group of Syrian refugees. The mean EQ-5D-5L index value was found to be 0.754. Male sex, younger age, cohabitation and social support were found associated with a higher EQ-5D-5L index score. Conclusions Our results concerning long-lasting health problems among the study population indicate that there is a profound need for policies and interventions promoting refugees' health. Our results also show that social support, a modifiable factor, is relevant to refugees' overall health, pointing to the importance of public health interventions and policies targeting the facilitation, mobilization and enhancing of refugees' social support.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Quality of life, Refugees, Social support, Syria, Resettlement
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3053 (URN)10.1007/s11136-019-02323-5 (DOI)31617059 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07194Swedish Red Cross
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
Gottvall, M., Vaez, M. & Saboonchi, F. (2019). Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden. BMC International Health and Human Rights, 19(1), Article ID 28.
Open this publication in new window or tab >>Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden
2019 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 19, no 1, article id 28Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender.

METHODS: Data from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011-2013 was analyzed within a Structural Equation Modeling (SEM) framework.

RESULTS: Our results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = -0.22, p < 0.01) and with higher odds ratio (OR) for PTSD (OR 2.52, 95% Confidence interval (CI) 1.83-3.40). Furthermore, higher social support was associated with less likelihood for PTSD (B = -0.56, p < 0.001). Social support partially mediated the effect of torture exposure on PTSD (OR 1.13, 95% bias corrected bootstrap CI 1.06-1.26). Gender did not moderate this pattern.

CONCLUSION: The results indicate that social support attenuates the link between torture exposure and PTSD, and may function as a protective factor for PTSD among both torture-exposed refugee men and women.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Gender, Post-traumatic stress disorders, Protective factors, Refugees, Social support, Torture
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3044 (URN)10.1186/s12914-019-0214-6 (DOI)31488136 (PubMedID)
Available from: 2019-09-26 Created: 2019-09-26 Last updated: 2019-09-26Bibliographically approved
Nilsson, H., Saboonchi, F., Gustavsson, C., Malm, A. & Gottvall, M. (2019). Trauma-afflicted refugees' experiences of participating in physical activity and exercise treatment: a qualitative study based on focus group discussions. European Journal of Psychotraumatology, 10(1), Article ID 1699327.
Open this publication in new window or tab >>Trauma-afflicted refugees' experiences of participating in physical activity and exercise treatment: a qualitative study based on focus group discussions
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2019 (English)In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 10, no 1, article id 1699327Article in journal (Refereed) Published
Abstract [en]

Background: Refugees with prolonged and repeated experiences of trauma, often in combination with post-migration living difficulties, are subjected to severe levels of stress and stress-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever. However, the effect of PA and exercise has received scarce attention in the context of PTSD, and particularly in the field of refugees' health.

Objective: The objective of this study was to explore the experience of participation in PA and exercise as part of the treatment for trauma-afflicted refugees.

Method: An explorative qualitative research design was used. Six focus group discussions were conducted with 33 female and male participants that had experience of group-based PA and exercise treatment. The gathered data was analysed by qualitative content analysis.

Results: The analysis resulted in one over-arching theme reflecting the participants overall experience of PA and exercise as a process of building resilience. Participants experienced improvements in both physical and mental health domains. Increased self-awareness and self-confidence were seen as additional important benefits, and the interruption of daily stressors provided a sense of relief and recovery. The treatment group settings were experienced as becoming a vehicle for overcoming social fear and isolation, which also carried an empowering and strength-building impact over to participants' family life and social relationships. Treatment characteristics were experienced as highly supportive and often referred to as the basis of other positive experiences and perceived health benefits.

Conclusions: The result of this study outlines a detailed account of trauma-afflicted refugees' experiences and preferences of PA and exercise-based treatment from a broad range of perspectives. These findings provide a starting point for future research in this field and indicate a particular need for both research and intervention development to include the real-life impact of participating in such treatments.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
PTSD, Physical activity, exercise, group-based treatment, mental health, physiotherapy, post-migration stress, post-traumatic stress disorder, refugee, trauma
National Category
Psychiatry
Identifiers
urn:nbn:se:rkh:diva-3121 (URN)10.1080/20008198.2019.1699327 (DOI)31853335 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-00426
Available from: 2020-01-03 Created: 2020-01-03 Last updated: 2020-01-07Bibliographically approved
Sigvardsdotter, E., Nilsson, H., Malm, A., Tinghög, P., Gottvall, M., Vaez, M. & Saboonchi, F. (2017). Development and Preliminary Validation of Refugee Trauma History Checklist (RTHC)-A Brief Checklist for Survey Studies. International Journal of Environmental Research and Public Health, 14(10), Article ID 1175.
Open this publication in new window or tab >>Development and Preliminary Validation of Refugee Trauma History Checklist (RTHC)-A Brief Checklist for Survey Studies
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2017 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 10, article id 1175Article in journal (Refereed) Published
Abstract [en]

A high proportion of refugees have been subjected to potentially traumatic experiences (PTEs), including torture. PTEs, and torture in particular, are powerful predictors of mental ill health. This paper reports the development and preliminary validation of a brief refugee trauma checklist applicable for survey studies.

METHODS: A pool of 232 items was generated based on pre-existing instruments. Conceptualization, item selection and item refinement was conducted based on existing literature and in collaboration with experts. Ten cognitive interviews using a Think Aloud Protocol (TAP) were performed in a clinical setting, and field testing of the proposed checklist was performed in a total sample of n = 137 asylum seekers from Syria.

RESULTS: The proposed refugee trauma history checklist (RTHC) consists of 2 × 8 items, concerning PTEs that occurred before and during the respondents' flight, respectively. Results show low item non-response and adequate psychometric properties Conclusion: RTHC is a usable tool for providing self-report data on refugee trauma history surveys of community samples. The core set of included events can be augmented and slight modifications can be applied to RTHC for use also in other refugee populations and settings.

Keywords
population study, refugees, self-report instrument, trauma, trauma checklist
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2450 (URN)10.3390/ijerph14101175 (DOI)28976937 (PubMedID)
Funder
Swedish Red CrossForte, Swedish Research Council for Health, Working Life and Welfare, 2016-07194
Available from: 2017-10-05 Created: 2017-10-05 Last updated: 2018-03-29Bibliographically approved
Gottvall, M., Stenhammar, C. & Grandahl, M. (2017). Parents' views of including young boys in the Swedish national school-based HPV vaccination programme: a qualitative study. BMJ Open, 7(2), Article ID e014255.
Open this publication in new window or tab >>Parents' views of including young boys in the Swedish national school-based HPV vaccination programme: a qualitative study
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, article id e014255Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore parents' views of extending the human papillomavirus (HPV) vaccination programme to also include boys.

DESIGN: Explorative qualitative design using individual, face-to-face, interviews and inductive thematic analysis.

SETTING: 11 strategically chosen municipalities in central Sweden.

PARTICIPANTS: Parents (n=42) who were offered HPV vaccination for their 11-12 years old daughter in the national school-based vaccination programme.

RESULTS: The key themes were: equality from a public health perspective and perception of risk for disease. Parents expressed low knowledge and awareness about the health benefits of male HPV vaccination, and they perceived low risk for boys to get HPV. Some parents could not see any reason for vaccinating boys. However, many parents preferred gender-neutral vaccination, and some of the parents who had not accepted HPV vaccination for their daughter expressed that they would be willing to accept vaccination for their son, if it was offered. It was evident that there was both trust and distrust in authorities' decision to only vaccinate girls. Parents expressed a preference for increased sexual and reproductive health promotion such as more information about condom use. Some parents shared that it was more important to vaccinate girls than boys since they believed girls face a higher risk of deadly diseases associated with HPV, but some also believed girls might be more vulnerable to side effects of the vaccine.

CONCLUSIONS: A vaccine offered only to girls may cause parents to be hesitant to vaccinate, while also including boys in the national vaccination programme might improve parents' trust in the vaccine. More information about the health benefits of HPV vaccination for males is necessary to increase HPV vaccination among boys. This may eventually lead to increased HPV vaccine coverage among both girls and boys.

Keywords
Boys, HPV vaccination, Human papillomavirus, Parents, Vaccination programme, Views
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2343 (URN)10.1136/bmjopen-2016-014255 (DOI)28246143 (PubMedID)
Available from: 2017-03-03 Created: 2017-03-03 Last updated: 2017-11-29Bibliographically approved
Grandahl, M., Tyden, T., Gottvall, M., Westerling, R. & Oscarsson, M. (2015). Immigrant women’s experiences and views on the prevention of cervical cancer: a qualitative study. Health Expectations, 18(3), 344-354
Open this publication in new window or tab >>Immigrant women’s experiences and views on the prevention of cervical cancer: a qualitative study
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2015 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 18, no 3, p. 344-354Article in journal (Refereed) Published
Abstract [en]

Background

Many Western countries have cervical cancer screening programmes and have implemented nation-wide human papillomavirus (HPV) vaccination programmes for preventing cervical cancer.

Objective

To explore immigrant women's experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use.

Design

An exploratory qualitative study. The Health Belief Model (HBM) was used as a theoretical framework.

Setting and participants

Eight focus group interviews, 5–8 women in each group (average number 6,5), were conducted with 50 women aged 18–54, who studied Swedish for immigrants. Data were analysed by latent content analysis.

Results

Four themes emerged: (i) deprioritization of women's health in home countries, (ii) positive attitude towards the availability of women's health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check-ups.

Conclusion

The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health-care providers. Therefore, information needs to be in different languages and provided through different sources. Health-care professionals should also consider immigrant women's difficulties concerning cultural norms and pay attention to their experiences.

National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:rkh:diva-1063 (URN)10.1111/hex.12034 (DOI)23252449 (PubMedID)
Available from: 2012-01-11 Created: 2014-09-26 Last updated: 2017-07-14Bibliographically approved
Gottvall, M., Tydén, T., Larsson, M., Stenhammar, C. & Höglund, A. T. (2015). Informed Consent for HPV Vaccination: A Relational Approach. Health Care Analysis, 23(1), 50-62
Open this publication in new window or tab >>Informed Consent for HPV Vaccination: A Relational Approach
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2015 (English)In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 23, no 1, p. 50-62Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore the relational aspects of the consent process for HPV vaccination as experienced by school nurses, based on the assumption that individuals have interests related to persons close to them, which is not necessarily to be apprehended as a restriction of autonomy; rather as a voluntary and emotionally preferred involvement of their close ones. Thirty Swedish school nurses were interviewed in five focus groups, before the school based vaccination program had started in Sweden. The empirical results were discussed in light of theories on relational autonomy. The school nurses were convinced that parental consent was needed for HPV vaccination of 11-year-old girls, but problems identified were the difficulty to judge when a young person is to be regarded as autonomous and what to do when children and parents do not agree on the decision. A solution suggested was that obtaining informed consent in school nursing is to be seen as a deliberative process, including the child, the parents and the nurse. The nurses described how they were willing strive for a dialogue with the parents and negotiate with them in the consent process. Seeing autonomy as relational might allow for a more dialogical approach towards how consent is obtained in school based vaccination programs. Through such an approach, conflicts of interests can be made visible and become possible to deal with in a negotiating dialogue. If the school nurses do not focus exclusively on accepting the individual parent's choice, but strive to engage in a process of communication and deliberation, the autonomy of the child might increase and power inequalities might be reduced.

National Category
Dermatology and Venereal Diseases
Research subject
Medical Science
Identifiers
urn:nbn:se:rkh:diva-1061 (URN)10.1007/s10728-012-0237-9 (DOI)23275146 (PubMedID)
Available from: 2013-12-16 Created: 2014-09-26 Last updated: 2017-12-05Bibliographically approved
Gottvall, M. (2014). Introduction of School-Based HPV Vaccination in Sweden: Knowledge and Attitudes among Youth, Parents, and Staff. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Introduction of School-Based HPV Vaccination in Sweden: Knowledge and Attitudes among Youth, Parents, and Staff
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to provide a better understanding of knowledge, attitudes, consent, and decision-making regarding Human papillomavirus (HPV) vaccination, seen from the perspectives of concerned parties – high school students, school nurses, and parents.

Two quantitative studies were performed: one descriptive cross-sectional study and one quasi-experimental intervention study. Qualitative studies using focus group interviews and individual interviews were also performed.

High school students’ knowledge about HPV and HPV prevention was low but their attitudes toward HPV vaccination were positive. An educational intervention significantly increased the students’ knowledge regarding HPV and HPV prevention. Their already positive attitudes toward condom use and HPV vaccination remained unchanged. The students wanted to receive more information about HPV from school nurses. The school nurses were also positive to HPV vaccination but identified many challenges concerning e.g. priorities, obtaining informed consent, culture, and gender. They saw an ethical dilemma in conflicting values such as the child’s right to self-determination, the parents’ right to make autonomous choices on behalf of their children, and the nurse’s obligation to promote health. They were also unsure of how, what, and to whom information about HPV should be given. Parents, who had consented to vaccination of their young daughters, reasoned as follows: A vaccine recommended by the authorities is likely to be safe and effective, and the parents were willing to do what they could to decrease the risk of a serious disease for their daughter. Fear of unknown adverse events was overweighed by the benefits of vaccination. Parents also saw the school nurse as an important source of HPV information.

Conclusions: Positive attitudes toward HPV vaccination despite limited knowledge about HPV, are overarching themes in this thesis. School nurses have a crucial role to inform about HPV prevention. It is important that the concerned parties are adequately informed about HPV and its preventive methods, so that they can make an informed decision about vaccination. A short school-based intervention can increase knowledge about HPV among students. From a public health perspective, high vaccination coverage is important as it can lead to a reduced number of HPV-related disease cases. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. p. 62
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 962
Keywords
Human papillomavirus, HPV, cervical cancer, vaccination, condom use, adolescents, school-nurses, parents, knowledge, attitudes, intervention
National Category
Medical Ethics Nursing
Research subject
Medical Science
Identifiers
urn:nbn:se:rkh:diva-1060 (URN)978-91-554-8836-9 (ISBN)
Public defence
2014-02-21, Gustavianum, Auditorium Minus, Akademigatan 3, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-09-26 Created: 2014-09-26 Last updated: 2015-08-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5837-8263

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