Rural Sweden Research Articles

Church funds used for credit in eighteenth- and nineteenth-century rural Sweden

ABSTRACT Private lenders are still considered to have been the dominant lenders in the eighteenth and nineteenth centuries, although various types of institutional lenders appeared from the late 1700s onwards. This paper analyses one of the earlier and probably underestimated institutional lenders in northern Europe, the Church, using Sweden as a case study. As late as 1834, the Swedish church lent about the same amount of money as all other credit institutions combined. Using a government survey from 1857 with data from 400 parishes, and accounts from 14 parishes 1770–1890, we can show that all parishes had funds, with about 80–90 per cent of the capital in loans. The funds were growing in size and lending was extensive, primarily for constructing new church buildings. However, the funds also played an important role in the local economy. The largest funds and most extensive lending were found in areas with landed estates and high levels of urbanisation, while funds in poorer areas were considered to be poor relief funds. Lending from church funds declined after the 1860s, but not rapidly. The church was probably seen as an attractive option when money was needed, located close by and controlled by the parishioners.

The Collateral Damage of Policy Reform: Low-Income Women Retirees, State Feminism, and the Pension System in Sweden

In 2014, the Swedish government declared itself the first feminist government in the world. Indeed, the country has been successful in promoting gender equality, yet many retired women, particularly in rural areas, live on an income below the EU poverty line. Based on analysis of Sweden’s pension system, the country’s commitment to gender equality, and interviews with low-income women pensioners in rural Sweden, this article explores why some women end up living in poverty in later life. The article demonstrates how the Swedish pension reform of the 1990s has generated a structural lag; today’s older women have lived during times that were radically different from the world nowadays, yet their pensions are based on forward-looking ideals. Consequently, today’s older women have become “collateral damage” (Bauman 2011) of securing a new form of pension system, and seemingly also neglected in the state’s promise of ensuring gender equality.

Exploring the effect of telemedicine on the control of blood pressure and lipid measurements in cardiovascular patients from rural Sweden: a before-and-after intervention study

Exploring the effect of telemedicine on the control of blood pressure and lipid measurements in cardiovascular patients from rural Sweden: a before-and-after intervention study

Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams – an observational study with a randomized cross-over design

BackgroundIn northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the physicians to the rest of the team – creating ‘distributed teams’. Patient participation is a core competency for healthcare professionals. Knowledge about how distributed teamwork affects patient participation is missing.The aim was to investigate if and how teamwork affecting patient participation, as well as clinicians’ perceptions regarding shared decision-making differ between co-located and distributed emergency teams.MethodsIn an observational study with a randomized cross-over design, healthcare professionals (n = 51) participated in authentic teams (n = 17) in two scripted simulated emergency scenarios with a standardized patient: one as a co-located team and the other as a distributed team. Team performances were filmed and observed by independent raters using the PIC-ET tool to rate patient participation behavior. The participants individually filled out the Dyadic OPTION questionnaire after the respective scenarios to measure perceptions of shared decision-making. Scores in both instruments were translated to percentage of a maximum score. The observational data between the two settings were compared using linear mixed-effects regression models and the self-reported questionnaire data were compared using one-way ANOVA. Neither the participants nor the observers were blinded to the allocations.ResultsA significant difference in observer rated overall patient participation behavior was found, mean 51.1 (± 11.5) % for the co-located teams vs 44.7 (± 8.6) % for the distributed teams (p = 0.02). In the PIC-ET tool category ‘Sharing power’, the scores decreased from 14.4 (± 12.4) % in the co-located teams to 2 (± 4.4) % in the distributed teams (p = 0.001). Co-located teams scored in mean 60.5% (± 14.4) when self-assessing shared decision-making, vs 55.8% (± 15.1) in the distributed teams (p = 0.03).ConclusionsTeam behavior enabling patient participation was found decreased in distributed teams, especially regarding sharing power with the patient. This finding was also mirrored in the self-assessments of the healthcare professionals. This study highlights the risk of an increased power asymmetry between patients and distributed emergency teams and can serve as a basis for further research, education, and quality improvement.

“I am a very active person”: Disability organizations as platforms for participation in rural Sweden

The aim of the text is to discuss the role of disability organizations for participation in rural municipalities in Sweden. Disability organizations are places for social interactions and for the accumulation of knowledge about disabilities as lived experiences. They also form a platform for dialogues and political influence work in the local community. With help of Nancy Fraser's theory of social justice, the importance of disability organizations as respected contexts is emphasized. Participation means being included in societal activities in a way that suits the individual's capacities and ambitions. The redistributive role of the public sector also enables participation, as it both supports disability organizations and opens up for influence in local planning. Conclusions that can be drawn are that if more support is given and more disability-specific arenas are created, there will be more open arenas for possible participation, and that what counts as participation must take a starting point in individuals' own experiences and values of what they appreciate and need in their daily lives.

Effectiveness of internet-delivered cognitive behavioural therapy for anxiety and obsessive-compulsive disorders within routine clinical care in rural Sweden

Few studies have evaluated the implementation of ICBT in regular child and adolescent mental health services (CAMHS). This study aimed to explore the acceptability, feasibility, and effectiveness of ICBT for children and adolescents with anxiety disorders and obsessive-compulsive disorder (OCD) within a rural CAMHS. The study also explored outcome predictors and long-term outcomes.Eighty-three participants were consecutively recruited from a non-specialized CAMHS in Region Jämtland Härjedalen in northern Sweden. Therapist-guided ICBT was offered during 12 weeks to children aged 8–17 with an anxiety disorder or OCD. Acceptability and feasibility measures included treatment adherence, treatment satisfaction, and adverse events. The primary outcome measure was the Clinical Global Impression–Severity. Secondary measures of effectiveness included clinician-, self-, and parent-ratings of symptom severity and functional impairment. Assessments were completed at baseline, post-treatment, and three-month follow-up (primary endpoint). A two-year follow up was conducted using medical records. Potential predictors included both patient characteristics and treatment variables.Results indicated that ICBT was both acceptable and feasible according to study measures. Statistically significant improvements were found from baseline to the three-month follow-up on clinician rated severity (B [SE] = −0.92 [0.09]; p < .001), as well as on all secondary measures. Forty-three percent of participants no longer fulfilled criteria for their principal disorder at the three-month follow-up. No serious adverse events were reported. Clinical improvement was highest among children with higher functioning at baseline (B [SE] = −0.05 [0.02]; p < .05). Forty-six percent of participants had been in contact with CAMHS during the two-year follow-up period, mainly for reasons other than their initial diagnosis. Findings suggest that ICBT could be an acceptable and feasible treatment option for young people with anxiety disorders and OCD in rural non-specialized CAMHS settings. Further studies are needed to confirm treatment effectiveness in this setting. Trial registration: NCT02926365.

Place and Youth Political Action: How Place Shapes Political Action in Rural Sweden

There are important gaps in the research on youth political action due to a lack of attention to the roles of place and the experiences of young people in rural places. To address these gaps, this article presents findings from intensive interviews with 15 young people (aged between 16 and 29 years) who identified as politically/socially engaged and lived or had recently lived in a rural place in Sweden. Analysis of their responses, based on constructivist-grounded theory, shows that place dimensions shaped three social processes of young people’s political action: engaging in politics in (rural) places, finding recognition as political actors in (rural) places and negotiating political belonging in relation to (urban) places. By linking these processes with Agnew’s three-dimensional understanding of place, the analysis provides novel insights into how various dimensions of place shape crucial social processes of youth political action.

Identifying pivotal factors that influence the ability of main employers in rural Sweden to have employees who are part-time firefighters: a modified Delphi study

Identifying pivotal factors that influence the ability of main employers in rural Sweden to have employees who are part-time firefighters: a modified Delphi study

Women's contributions to rural development: implications for entrepreneurship policy

PurposePolicy for women's entrepreneurship is designed to promote economic growth, not least in depleted rural areas, but very little is known about the contributions of rural women entrepreneurs, their needs or how the existing policy is received by them. Using a theoretical framework developed by Korsgaard et al. (2015), the authors analyse how rural women entrepreneurs contribute to rural development and discuss the implications for entrepreneurship policy. This paper aims to focus on the aforementioned objectives.Design/methodology/approachThe authors interviewed 32 women entrepreneurs in rural Sweden representing the variety of businesses in which rural Swedish women are engaged. The authors analysed their contributions to rural development by analysing their motives, strategies and outcomes using Korsgaard et al.’s framework of “entrepreneurship in the rural” and “rural entrepreneurship” as a heuristic, interpretative device.FindingsIrrespective of industry, the respondents were deeply embedded in family and local social structures. Their contributions were substantial, multidimensional and indispensable for rural viability, but the policy tended to bypass most women-owned businesses. Support in terms of business training, counselling and financing are important, but programmes especially for women tend to miss the mark, and so does rural development policy. More important for rural women entrepreneurs in Sweden is the provision of good public services, including for example, schools and social care, that make rural life possible.Research limitations/implicationsTheoretically, the findings question the individualist and a-contextual focus of much entrepreneurship research, as well as the taken-for-granted work–family divide. How gender and how the public and the private are configured varies greatly between contexts and needs contextual assessment. Moreover, the results call for theorising place as an entrepreneurial actor.Practical implicationsBased on the findings, the authors advise future policymakers to gender mainstream entrepreneurship policy and to integrate entrepreneurship and rural development policy with family and welfare state policy.Originality/valueThe paper highlights how rural women respond to policy, and the results are contextualised, making it possible to compare them to other contexts. The authors widen the discussion on contributions beyond economic growth, and the authors show that policy for public and commercial services and infrastructure is indeed also policy for entrepreneurship.

Tourists’ perceptions of wind turbines: conceptualizations of rural space in sustainability transitions

Concerns about the effects of climate change have led to an interest in identifying ways to foster sustainability transitions. In the Global North, a key approach is to eventually eliminate dependence on carbon emitting energy while moving towards renewable sources, including wind power. Since wind farms require vast amounts of land, inevitably this explains the presence of such installations in many rural regions. This situation has alarmed various stakeholders, including those involved in tourism, who see such developments as threats to idyllic notions of rurality and, by default, to the transformation of the countryside for visitor experiences. Through a series of case studies in rural Sweden, we explore the attitudes of tourists towards the presence of wind farms in the landscape. Overall, study respondents recognize the need for such installations since most accept the necessity to embark on sustainable energy transitions. In this way, they understand that many parts of rural Sweden are transforming into spaces where sustainable energy future must be negotiated. Ultimately, sustainability transitions lead to the rethinking of conventional perceptions around rural space and tourism. We suggest that geographical research on sustainability transitions in tourism should account for conceptions of rurality that involve assemblages of imagination, place framing, and power relations in sustainability transitions. This conceptualization is necessary for achieving just and sustainable energy futures.

Perceived fairness of intra-municipal cohesion politics: Does place of residence affect party preferences?

This paper examines whether beliefs that local decision-makers are perceived to favour certain groups or districts over others, are linked to anti-establishment party preferences, and whether living in an urban or rural area affects this relationship. By taking stock of an original survey of Swedish respondents stratified into densely (urban) and sparsely (rural) populated districts, our results reveal geographical polarisation even within municipalities based on perceptions of how resources are distributed, as well as perceptions of opportunities to influence policy. Individuals who live in densely populated rural areas and believe that groups have unequal influence within the municipality depending on their geographical location tend to be far left. Individuals who have similar grievances about bias in decision-making but live in rural areas tend to be far right. Furthermore, Left Party supporters living in densely populated areas are more likely to perceive bias against poor districts, while rural Sweden Democrat supporters are more likely to believe that urban residents disregard rural concerns. We conclude that local decision-makers are perceived to favour certain groups or districts over others, are linked to an increased likelihood to prefer anti-establishment parties.

Governing resettlement beyond safety: Multilevel governance as a model for sustainable resettlement of unaccompanied refugee children in rural Sweden?

AbstractThis article explores the sustainability of the resettlement of unaccompanied refugee children from their perspective. Against the backdrop of a critical assessment of the multilevel governance of resettlement, it compares two rural municipalities. Unaccompanied refugee children in the municipality with a disempowering local governance model were hindered to engage with civil society, while in the municipality with an enabling model, their integration was enhanced. Achieving safety by legal residency does not by itself resolve the liminalities of belonging to unaccompanied refugee children. Beyond positive engagement by professionals, supporting encounters with civil society were found to enhance integration and belonging, while the lack of these strengthened marginalities. Unaccompanied refugee children resettlement is largely influenced by the benevolence of local actors when the state vacates its responsibility to co‐ordinate efforts. While civil society has an important role to play, a helping civil society cannot be assumed. Tensions rose also due to the collision between institutional styles. The marketisation of refugee reception at the national level led to loss of ability to plan schooling in rural municipalities, reinforcing practices of physical and symbolic segregation of children in the refugee context education. These accounts shed also light on the resilience of unaccompanied refugee children encountering local resettlement efforts emerging in the context of increasingly securitised asylum policies.

In Memoriam: Mats Morell

In Memoriam: Mats Morell

The past and the present: Following in the footsteps of a neo-Nazi movement in a rural Sweden school

This case study aimed to describe and analyse how students and staff at a school in a geographical area with a tradition of high neo-Nazi activism perceived and talked about racism and sexism in particular, and the ‘school climate’ in general. The case consists of 10 school professionals and 14 students. The selected school was located in a traditional mill town, once built around a dominating industry, but over the last decades it has been characterised by deindustrialisation and economic decline. The town became the founding area of the Swedish National Socialist movement during the interwar period and has since hosted vital parts of the movement, which is ongoing. Today, the local movement comprises middle-aged former skinheads who have children attending the local school. The study scrutinised the encounter between the mill town’s ingrained racism and the school’s duty to prevent racism and promote tolerance. The outcome shows how Nazi movement has generationally reproduced itself in Shortfield for a century, in the midst of the municipality and indeed also within the roams of the school’s professional work – with the teachers well aware of the continuous history – but with only people from the outside realising the problem of racism in Shortfield.

Use of CAM among cancer patients

BackgroundThe use of complementary and alternative medicine (CAM) by patients is widespread. However, there is a lack of knowledge regarding the extent and details of patient CAM use in Sweden, especially in rural Sweden. The aim of this study was to estimate the extent and characteristics of CAM use among cancer patients in Region Gävleborg.MethodsA total of 631 questionnaires were distributed to which 376 responses were registered, yielding a response rate of 59.6%. Questionnaires were distributed to oncology patients at their first visit for curative treatment at the Department of Oncology, Gävle Hospital. Palliative patients were recruited at their first visit and during enrollment in palliative outpatient care in their own homes. The characteristics of the respondents were presented with standard descriptive statistics. A multivariable logistic model was fitted to calculate odds ratios (ORs) and identify potential predictors (Age, Gender, Education, Diagnosis) of CAM use post-cancer diagnosis.Results54% of all participants reported lifetime CAM use, 34% reported CAM use post-diagnosis. The most common CAM methods used after diagnosis are vitamins, health food preparations, herbal teas, prayer and dietary methods. The most common source of information reported is family and friends. Almost 70% of those who used CAM after their diagnosis stated that they did not discuss their use with healthcare professionals. Most patients reported that they would like some CAM modalities to be offered within conventional care regardless of their own CAM use.ConclusionsThe use of CAM is common among patients with cancer in the region of Gävleborg, and previous studies show a similar use in Sweden in general. Based on the widespread use of CAM and patient interest in discussing CAM use with healthcare professionals, greater attention and focus should be placed on creating a basis for this dialogue. If we, as healthcare professionals, are to emphasise our commitment to providing patient-centred care, we must acknowledge that patients use CAM and are seeking a dialogue about CAM use in their care.

Patient participation in tele-emergencies - experiences from healthcare professionals in northern rural Sweden.

Telemedicine provides opportunities for access to health care in remote and underserved areas. In parts of northern rural Sweden telemedicine is used to connect a remote physician by a video-conference system to an emergency room, staffed by nurses during on-call hours. This can be called 'tele-emergency'. Patient participation, often described as mutual information exchange, a trustful relationship and involvement in decision-making, is challenged in emergency care by short encounters, deteriorating patients and a stressful work situation. Nevertheless, patient participation may be important for the patients' experience. Healthcare professionals (HCPs) have been identified as 'gatekeepers' for patient participation, therefore putting their perspective in focus is important. As emergency care in rural areas is increasingly turning toward telemedicine, patient participation in tele-emergencies needs to be better understood. The aim of this study was to explore and characterise HCPs' perspectives of patient participation in tele-emergencies in northern rural Sweden. A qualitative design based on interviews was used. HCPs working in cottage hospitals in northern rural Sweden were included. Semi-structured interviews were performed, first, in multidisciplinary groups of three informants. Later, because of limited experience of tele-emergencies in the groups, individual interviews with HCPs with substantial experience were added. A qualitative content analysis of the interview transcripts was conducted. A total of 44 HCPs from northern inland Sweden participated in the interviews. The content analysis resulted in two themes, six categories and 19 subcategories. Theme 1, 'To see, understand, and to build trust through the digital barrier', contains descriptions of the interpersonal relationship between the patient and the HCPs, and the challenges when interacting with the patient during a tele-emergency. The informants also described a need for boundaries between the professional team and the patient. The categories in theme 1 are 'understanding the patient's point of view', 'building a trustful relationship', and 'needing a private space without the patient'. Theme 2, 'The (im)balance of power - tele-emergency reinforces the positions', mirrors the power asymmetry in the patient-professional relationship, and the potential impact of the tele-emergency on the different roles. Tele-emergencies were described as a risk that potentially could weaken the patient's position, but also as providing an opportunity to share power. Categories in theme 2 are 'medical conditions limit patient participation', 'patient involvement in decision-making requires understanding' and 'the inferior patient and the superior professionals'. This study sheds light on patient participation in tele-emergencies in a remote rural setting from the HCP's perspective. The tele-emergency set-up affected patient participation by interfering with familiar patient-HCP relationships and changing group dynamics in interactions with the patient. Due to the extensive changes of the conditions for patient participation imposed in tele-emergencies, suggestions for actions improving patient participation are made.

Conceptualising feminist resistance in the postfeminist terrain

PurposeIn this paper, women entrepreneurs are seen as leaders and women leaders as entrepreneurial, making both groups an easy target of postfeminist expectations, governed by calls to embody the entrepreneurial self. Acknowledging that the entrepreneurial self has its roots in the universal, rational and autonomous subject, which was shaped in a male form during the Enlightenment, the purpose of this study is to conceptualise feminist resistance as a process through which the autonomous subject can be de-stabilised.Design/methodology/approachEmpirically, this study draws on an extensive research project on women’s rural entrepreneurship that includes 32 in-depth interviews with women entrepreneurs in rural Sweden. This study interpreted expressions of resistance from the women by using an analytical framework the authors developed based on Jonna Bornemark’s philosophical treatise.FindingsFeminist resistance unfolds as an interactive and iterative learning process where the subject recognises their voice, strengthens their voice and beliefs in a relational process and finally sees themselves as a fully fledged actor who finds ways to overcome obstacles that get in their way. Conceptualising resistance as a learning process stands in sharp contrast to the idea of resistance as enacted by the autonomous self.Research limitations/implicationsThis study helps researchers to understand that what they may have seen as a sign of weakness among women, is instead a sign of strength: it is a first step in learning resistance that may help women create a life different from that prescribed by the postfeminist discourse. In this way, researchers can avoid reproducing women as “weak and inadequate”.Originality/valueThrough the re-writing of feminist resistance, the masculine entrepreneurship discourse including the notion of the autonomous self is challenged, and a counternarrative to the postfeminist entrepreneurial woman is developed. Theorising resistance as a learning practice enables a more transforming research agenda, making it possible to see women as resisting postfeminist expectations of endless competition with themselves and others.

Local Places Ruling Life: Compromises and Restricted Career Choices in Rural Sweden

In this article, we explore the theme of choice in relation to education and work by discussing the notion of “compromise” within career guidance. In particular, we analyse compromises related to career choice in regard to groups and individuals who are restricted — or belong — to a particular geographical place and how this spatial limitation is managed and discussed by career guidance counsellors who work with unemployed individuals. The article is based on the following questions: How are compromises and restricted choices considered in relation to place and belonging? How do career guidance counsellors and other professionals discuss compromises of choice? The qualitative interviews have been conducted with career counsellors working with unemployed individuals in rural Sweden. Four themes emerge: location as a given/non-issue, location as opposed to interest, location as personal life and location as an obstacle. We argue that belonging can be seen as more available to certain groups. For example, career counsellors view the claims of belonging by young people as less valid than for individuals who can present caring and family obligations as reasons for not being mobile.

EPA (aka A-Traktor) Girl Greasers in Sweden: Girlhood in Motion?

This article focuses on girlhood in one of the youth subcultures of rural Sweden, EPA greasers. The EPA, a car that Swedes aged 15 and older can legally drive, is at the centre of EPA culture. In this uniquely and previously male Swedish youth greaser culture, there has been a recent increase in the number of Swedish girls driving EPAs. Previous research has shown how EPA culture and EPA girlhood are shaped through distancing from hegemonic urban and middle-class norms and ideology. In this article, we seek to develop an understanding of EPA culture, specifically the ways in which it has been adopted by girls. Starting out from their online performances, we will explore how place, femininity and resistance intersect. The findings demonstrate how EPA girls use a playful way of troubling norms in their online performances, understood here as space and outlet to resist and mess around with dominant discourses and prejudice. This can also be understood as a way of talking back to masculinity, the majority society and urbanity.

‘A longing for a sense of security’ – Women’s experiences of continuity of midwifery care in rural Sweden: A qualitative study

BackgroundThere is evidence that continuity models of midwifery care benefit women and babies in terms of less birth interventions and higher maternal satisfaction. Studies about continuity models in a Swedish context are lacking. ObjectiveThe aim of this study was to describe how women experience continuity of midwifery care in a Swedish rural area, and thereby provide a deeper understanding of what this care entails for women. MethodsA qualitative interview study using thematic analysis was carried out. Telephone interviews were conducted with 33 women who participated in a continuity of midwifery care project in a rural area of Sweden. ResultsThe overarching theme ‘a longing for a sense of security’, pervaded the three main themes: ‘The importance of professional midwifery care’, ‘Continuity of midwifery – fulfilled expectations or full of disappointments’ and ‘New prerequisites – acceptable to some, but not a substitute for everyone’, which explains different aspects affecting the feeling of security. The endeavour to feel secure during pregnancy, birth and postpartum was a continually recurring subject that cannot be overstated. ConclusionContinuity of midwifery care strengthened women’s feelings of security during pregnancy, birth and postpartum. The deepened relationship developed over time was a central part of the positive aspects of the experience of continuity in midwifery care. Expectations and prerequisite circumstances are important to consider when developing and introducing new care models. Service providers and decision makers should pay attention to and prioritise this relational aspect when planning care for women during the childbearing period.