njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2010 inaugural editorial we have the great pleasure to publish the inaugural issue of the nordic journal of social research. the njsr is an open-access, net-based journal that publishes peer-reviewed articles shortly after they are accepted following the review process. in this issue, we present three original, peer-reviewed articles. among these is a contribution from thomas scheff of the university of california, santa barbara, whose works have had a lasting impact on sociological theory worldwide. professor scheff has generously offered us his latest article as a sign of his close cooperation with nordic scholarship on social research. the other two originate from sweden, with one by björn blom and lennart nygren of umeå university and the other by carolina jernbro, ulla-britt eriksson, and staffan janson of karlstad university. the nordic countries, with their unique historical development and social conditions and their distinctive traditions of social welfare, offer a rich basis for social research. accordingly, the main purpose of the njsr is to establish an arena for presenting nordic social research, and research where nordic cases or contexts are seen in a comparative perspective. there have been calls for a journal with this focus, and a net-based, open-access journal is a solution suited both for this purpose and for the future academic journals. this format makes it possible for the njsr to publish manuscripts of high quality that address topics within with the journal’s scope, and to do so on an ongoing basis, unhindered by the restrictions inherent to its printed counterparts. as a net-based journal has no limits to the number of pages or issues, we shall publish papers shortly after they are accepted. researchers thus have the opportunity to present their material without any delay. moreover, the immediate, open access to the material will facilitate the dissemination of the material, and therewith a greater number of citations. although there are a growing number of journals in the social sciences, many researchers still lack a suitable arena for testing their material up against rigorous publishing standards. the njsr can serve as such an arena for both nordic and international scholars. in our statements about focus and scope, we have expressed the ambition of being a window into nordic social science for readers beyond our borders. this aim implies that accepted articles should have a nordic connection, empirically or theoretically. we do not think this will be a difficult limitation, since comparative works including the nordic countries also will be accepted. the ‘nordic-window’ approach is also our reason for inviting scholars to offer critical reviews in english of important works written in the nordic languages for an international audience. the responses to our efforts to establish this journal have been most encouraging. we have been fortunate to have highly qualified researchers willing to be reviewers. we also hope we can develop the journal in collaboration with our readers. we hope readers will contribute to the journal’s continuous improvement by giving us comments and proposals. the njsr is a non-profit journal. for the start-up period we have received a grant from lillehammer university college. our aim is to run the journal with contributions from a number of colleges and institutes in order to avoid the need to impose publication fees onto the authors. njsr – the nordic journal of social research 2010 2 as the njsr is a new journal, we welcome article submissions, critical reviews of scholarly works, and letters. moreover, we hope readers will inform their colleagues and prospective writers about the njsr. njsr editorial board njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 7 (2016): special issue guest editorial: special education and the deviant child in the nordic countries – the impact of foucault julie allan* school of education university of birmingham email: j.allan.1@bham.ac.uk *corresponding author bjørn hamre danish school of education aarhus university email: bjha@edu.au.dk keywords: foucault, disability studies, disability history, special-needs education, nordic countries this special issue considers the impact of the work of foucault on special education and on constructions of the ‘deviant child’ within the nordic countries, and it comes at a point at which we are seeing a global expansion of what sally tomlinson (2012) has called a ‘special educational needs industry’, accompanied by rapidly growing assessment and accountability systems (stiggins, 2002; sahlberg, 2007). these systems are validated and maintained by an educational testing profession (ydesen, 2011; ydesen et al., 2013) that promotes a scientific taxonomic discourse over teachers’ subjective judgements to the point that, as axelsson, writing in this issue, notes, ‘the tests live their own life’. the ‘deviant child’ appears currently to be a valuable commodity and more and more children seem to be captured through diagnostic practices such as ‘psychopathologization’ (harwood & allan, 2014), whereby children’s behavioural problems are becoming increasingly reassigned to categories of mental disorders and institutional gaming practices (waitoller, artiles & cheney, 2010; artiles et al., 2010) that encourage professionals to mark individual children in ways that guarantee a continuity of heterogeneity (bogard, 2000). inherent learner differences associated with race and poverty are also caught within the web of deviance through practices of genetic determinism (gillborn, forthcoming; lópez, 2014) and a ‘new eugenics’ of assessment (gillborn, 2010). these cultural practices are more covert but are presented and taken up by politicians and others as part of a scientific discourse. in such a context, it seems mailto:j.allan.1@bham.ac.uk mailto:bjha@edu.au.dk njsr – nordic journal of social research vol. 7 (2016): special issue 2 all the more important to interrogate and revisit current understandings and to acquire new conceptual tools to do so. the work of the philosopher michel foucault has already proved invaluable to many education scholars for analysing how practices of subjectification and disciplinary regimes (foucault, 1977) create the ‘fleshless passive body’ (hughes, 2005, p. 84), complicit, but also capable of resistance. foucault’s incitement to question what we think we know and to realize that we are freer than we feel (foucault, in martin et al., 1988) has encouraged a search for ‘unforeseen untried possibilities in our history’ (rajchman, 1995, p. 14). as mcwhorter (2005) explains, the point here, i think, is not to feel bad about the injustice or the suffering in the world … the point is to pull up short before the possibility that what you thought was true might not be, that what you thought was normal or natural might be the product of political struggle, and to start – from just that place – to think, which means to question, to critique, to experiment, to wonder, to imagine, to try. (p. xvii) many scandinavian scholars have taken inspiration from foucault. in particular, the danish historian birgit kirkebæk’s historical analysis of the normalization ideology has especially been influenced by foucault’s archaeology and genealogy. her analysis of the institutionalization of the feebleminded has, in turn, influenced the norwegian way of interpreting disability studies and foucault has been subsequently applied to fight the case of the feebleminded and other institutionalized groups during the twentieth century. the nordic orientation to foucault’s work has been in relation to issues of emancipation of the institutionalized, rather than on the issues of subjectification related to questions of ethics and rights of disabled people. these studies of the constructions and accommodations of the deviant child have been quite separate from foucauldian analyses of education in general, the latter having tended to examine how subjects have been governed in education. the discourses associated with disabled people have been shifting over the last 20 years from concerns with normalization to issues of rights and inclusion, but this does not seem the have affected the ways in which foucault’s ideas have been taken up. there are, however, some exceptions and some of the contributions in this special issue offer analyses that position the disabled subject as being capable of acting and of challenging forms of subjectivization and control. the articles that make up this special issue offer a strong and coherent narrative on time, place, and personhood. time is addressed through an historical and foucauldian reading of past educational and diagnostic practices which gives us an opportunity to explore the ways of speaking about pathologies and of how psychology and medicine have made it possible to ‘tell the truth’ (foucault, 1976, p. 74) about these pathologies because he understood that they possess the truth about medicine and psychology. foucault, in his analyses, offers some substantial theoretical tools that could enable us to understand current contexts more fully. the particularity of the space of the nordic countries is elaborated within the articles covering denmark, norway, sweden, finland, and iceland, and the differences between countries provides a mirror with which to reflect upon other european contexts as well as back on the nordic countries themselves. the changing nature of the space of the school is also a feature of the articles and is an extremely important consideration. sjöberg (2014), reflecting on the radically changed space of the school, notes an increasing imperative on the student for visualization and documentation of learning and indeed engagement within school. the physical space, thus, becomes subordinate to visual and documentary representation. the subject of the child njsr – nordic journal of social research vol. 7 (2016): special issue 3 is consequently radically affected by an altered symmetry between adults and children, leading to an intensification of individualization and the development of a self-regulated child (beach & dovemark, 2011). we see, then, the emergence of the ‘regulated child’ (vallberg roth & månsson, 2009). the contributions consider personhood and constructions of the human subject through the exploration of themes of empowerment, transgression, and subjectification. the first of the articles reflects on the danish context and considers ‘the subject of exemption through discourses of normalization and individualization’. here, bjorn hamre, tine fristrup, and gerd christensen trace the changes over time in the conception of the deviant subject and highlight the lack of convergence, until relatively recently, between discourses of special-needs education and of education more generally within denmark. hamre and colleagues’ analysis shows how much the former has to learn from the latter, especially where foucauldian research is concerned. thom axelsson’s contribution, ‘intelligence testing, ethnicity and construction of the deviant child: foucault and special education’, shows how iq testing was used in sweden as a tool for controlling social behaviour. axelsson illustrates the devastating consequences of this through the proliferation of discourses, initiated by ohlander, about the deviance of children considered to be ‘tattare’ (i.e., scandinavian travellers) and the subsequent considerations, associated with eugenics, of how such populations might be controlled. in ‘why michel foucault in special education research?’ hege knudsmoen and eva simonsen take up foucault’s later work on ethics to trace ways in which constructions of the deviant child were validated in norway and in other parts of scandinavia. in so doing, they highlight the fruitfulness of such a perspective even though it is one that is pursued to only a limited degree within special education. lauri siisiäinen tells of the competing rivalries over the construction of the deaf child fought by oralism and manualism in ‘foucault and deaf education in finland’. these respective german and french traditions spread across scandinavia, but in finland, siisiäinen notes, oralist practices prevailed together with the idea of the deaf child as a sensual and perceiving subject. manualism, oralism’s opposite, was constructed as a dangerous and desubjectivizing force, with the eye represented as the animalistic and unstable subject. bjørn hamre, in his article, ‘diagnosing, special education and ‘learnification’ in danish schools’, uses foucault to document the twin tracks within the danish educational system of learning and diagnosis, and demonstrates this specifically in the discourses of educational psychologists. hamre depicts the diagnosed or deviant child as an entity that lives in the shadow of the ideal type of the learner, governed by the ‘maybe-ability’ imperatives of the school. finally, a broader perspective on the incursion of democratic and inclusive education is given by ólafur páll jónsson, drawing on foucault’s notion of the gaze and referring specifically to iceland. páll jónsson reminds us of the powerful role of ideology in the consolidation of the powerful concept of abnormality. he also, however, makes a convincing call for a different kind of education which allows for, and even privileges, an active subject through inclusion and democracy and, citing bell hooks (1994), promotes the notion of the school as a site of ecstasy. it is indeed salutary to be reminded by hooks of the potential for education to be a ‘practice of freedom’ (hooks, 1994, p. 13) while the authors in this special issue help us to understand how and why we have lost sight of this. the articles in this special issue offer some powerful provocations. they incite a renewed interest in foucault’s work in its entirety and encourage us to make use of it, and even to re-read it (golder, 2013), not just to revisit our understandings of our history, but as axelsson points out, in order to see that the present is just as strange as the past. they draw attention to the particular njsr – nordic journal of social research vol. 7 (2016): special issue 4 contribution of the nordic countries to the debates about normality and abnormality that, although reflecting differences between countries, is both significant and valuable as a whole. they add sophistication to understandings of constructions of the deviant child and the ‘knowledge monopoly’ (ydesen et al., 2013, p. 120) of these constructions and of their validation through testing and diagnosis. finally, and perhaps most importantly, these contributions help us to recognize that a different kind of education could possibly help us to realize the freedoms for which foucault exhorted us to strive. references artiles, a., kozleski, e., trent, s., osher, d. & ortiz, a. (2010). justifying and explaining disproportionality, 1968-2008: a critique of underlying views of culture. exceptional children, 76(3), 279-299. beach, d. & dovemark, m. (2011). twelve years of upper-secondary education in sweden: the beginnings of a public neoliberal hegemony? educational review, 63(3), 313-327. bogard, w. (2000). smoothing machines and the constitution of society. cultural studies, 14(2), 269-294. foucault, m. (1976). mental illness and psychology. berkeley/los angeles, ca: university of california press. foucault, m. (1977). discipline and punish: the birth of the prison. london: penguin. gillborn, d. (2010). reform, racism and the centrality of whiteness: assessment, ability and the ‘new eugenics’. irish educational studies, 29(3), 231-252. gillborn, d. (forthcoming). genetics, race, intelligence & education: the hidden racism of the new geneism. golder, b (ed.) (2013). rereading foucault: on law, power and rights. abingdon, uk: routledge. harwood, v. & allan, j. (2014). psychopathology at school: theorising mental disorders in education. london: routledge. hooks, b. (1994). teaching to transgress. new york/london: routledge. hughes, b. (2005). what can a foucauldian theory contribute? in s. tremain (ed.) foucault and the government of disability (pp. 78-92). ann arbor, mi: university of michigan press. lópez, i. (2014). dog whistle politics: how coded racial appeals have reinvented racism & wrecked the middle class. oxford: oxford university press. martin, l., gutman, l. & hutton, p. (1988). technologies of the self: a seminar with michel foucault. amherst, ma: university of massachusetts press mcwhorter, l. (2005). foreword. in s. tremain (ed.) foucault and the government of disability (pp. xiii-xvii). ann arbor, mi: university of michigan press. rajchman, j. (1995). foucault ten years after. michel foucault: j’accuse. a journal of culture/theory/politics, 25, 14-20. sahlberg, p. (2007). education policies for raising student learning: the finnish approach. journal of educational policy, 22(2), 173-197. njsr – nordic journal of social research vol. 7 (2016): special issue 5 sjöberg, l. (2014). the construction of the ideal pupil – teacher training as a discursive and governing practice. education inquiry, 5(4), 517-533. stiggins, r. j. (2002). assessment crisis: the absence of assessment for learning. phi delta kappan, 83(10), 758-765. doi: 10.1177/003172170208301010 tomlinson, s. (2012). the irresistible rise of the sen industry. oxford review of education, 38(3), 267-286. vallberg roth, a. & månsson, a. (2011) regulated childhood equivalence with variation. early years. an international research journal, 29(2), 177-190. waitoller, f., artiles, a. & cheney, d. (2010). the miner’s canary: a review of overrepresentation research and explanations. the journal of special education, 44(1), 29-49. ydesen, c. (2011). the rise of high stakes testing in denmark, 1920-1970. frankfurt: peter lang verlag. ydesen, c., ludvigsen, k. & lundahl, c. (2013). creating an educational testing profession in norway, sweden and denmark, 1910-1960. european educational research journal, 12(1), 120-138. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2010 updating labelling theory: normalizing but not enabling professor emeritus thomas scheff department of sociology university of california, santa barbara email: scheftj@cox.net abstract in modern societies we often make judgements of certain kinds of behaviour that are virtually automatic: delusions show that one is crazy, wrong answers show that one is ignorant, and so on. the theory of labelling/normalization suggests caution in making these judgements because of the effect they are likely to have on the social relationship, feelings of rejection and embarrassment. there is a social-emotional component in all human contact that can be managed independently of the content. equal care is needed to avoid both labelling and enabling. two extended and three brief concrete examples of normalizing are discussed. the social-emotional component seems to be critical in most relationships, both in psychotherapy and education, as suggested by the examples. keywords: labelling theory, normalization, psychotherapy, education, symbolic interactionism introduction this essay begins with the labelling theory of mental illness (scheff, 1999 [1966]) because it came first. it was accepted by most sociologists, but had little impact in other disciplines and even less on the public at large. it sought to challenge the medical model of what is called mental illness with a social model. in this model, symptoms of mental illness are recast as violations of residual rules: social norms so taken for granted that they go without saying. most social rules, perhaps, are largely invisible. for example, in modern societies at least, when one is conversing, one’s gaze should be on the other’s eyes, rather than forehead or ear. yet asking anyone to explain the rules of conversation is impracticable; this idea is so taken for granted as to be unthinkable. after all the rules in awareness are named, there is still a universe of other rules that are taken for granted, a huge residue of unconscious rules. this is the territory that erving goffman explored in behavior in public places (1964) and in many of his other studies as well. to find one’s ear or forehead the subject of attention might be upsetting. we would be apt to think that the person is not merely rude, but in another world than ours. in our society we call that world insanity, but there may be a better approach. in modern societies, those who are thought to be depressed or njsr – the nordic journal of social research 2010 2 deluded are usually drugged with little consideration of the details of their particular case. the average dispenser of psychotropic drugs has little incentive to sift through the details. (for a film that makes this point extravagantly, see numb). drugging often carries with it labelling and rejection in the sense that such a person is not one of us. rejection may not be obvious and outright, but subtle in varying degrees. labelling theory suggests that in some cases a better way might be normalizing those who break the residual (unstated) rules, rather than labelling, ridiculing or rejecting them. this is not to say that one should always normalize. automatic responses, whether labelling or normalizing, are equally undesirable. labelling/normalization theory suggests that we need to decrease automatic responses of both kinds. automatic normalizing can result in enabling, and automatic labelling can result in social rejection. the main effect of labelling of any kind is implied by goffman’s treatment of what he called facework, saving and losing face. when one is labelled, one loses face and gains embarrassment, shame, or humiliation. there is a socialemotional element in all human contact. this point is made more directly in fuller’s study (2003) of somebody and nobody feelings. we feel like a somebody when we are accepted, and like a nobody when we are not. what is the percentage of time in 12 or 16 years of school do students feel like nobodies? what does a high percentage of nobody feelings do to students and to our society? feeling like a nobody can obviously result from flagrant rejection. however, it can also occur when rejection is subtle. this is a difficult point to make because feeling accepted (connected) is not only hard to achieve in real life, but it is even difficult to describe. there are many terms that are used to describe this state: attunement, shared or mutual awareness, and so on. we take it for granted because we do it, or at least try to do it, for our entire lives. as indicated above, labelling theory has had little impact in the real world. perhaps one of the problems was that the opposite of labelling, normalizing, was not spelled out concretely enough to be understandable. many examples of labelling were provided, but few of normalizing. below are some concrete examples in mental illness and in education. one of the examples is fictional, a film, the other four factual, to try to remedy my earlier omissions. normalizing in a film and in real life the film, lars and the real girl (kimmel & gillespie 2007), although a comedy, also teaches a powerful lesson: how a community might manage mental illness without the social side effects (‘it takes a village…’). the crucial moments occur early in the film. because lars has been treating a life-size doll as a real person, his brother, gus, and sister-in-law, karin, bring him to their family doctor. early in the session, the doctor asks: has lars been functional? does he go to work, wash, dress himself? gus: so far. doctor: has he had any violent episodes? karin: oh no, no never. he’s a sweetheart—he never even raises his voice. njsr – the nordic journal of social research 2010 3 this dialogue establishes limits the film sets to normalizing: able to take care of self, unlikely to harm self or others. however, there are many other limits that must be set in order to avoid enabling. for example, does he take drugs? in the educational context, to be discussed below, the teacher must take care to accept the student without confirming their mistakes. gus: okay, we got to fix him. can you fix him? dr. dagmar: i don’t know, gus. i don’t believe he’s psychotic or schizophrenic. i don’t think this is caused by genes or faulty wiring in the brain. (preliminary normalizing statement, rejecting diagnosis) gus: so then what the hell is going on then? doctor: he appears to have a delusion. gus: a delusion? what the hell is he doing with a delusion for christ’s sake? (gus’s manner implies that lars’s behaviour is abnormal) doctor: you know, this isn’t necessarily a bad thing. what we call mental illness isn’t always just an illness. it can be a communication, it can be a way to work something out. (this is the doctor’s central normalizing statement: lars is not abnormal, he is just communicating.) gus: fantastic, when will it be over? doctor: when he doesn’t need it anymore. in this fable, lars has been scripted to find an extraordinarily unconventional doctor. not prescribing psychiatric drugs for symptomatic patients now amounts to heresy, or at least is not acceptable practice. i have a psychiatrist friend (i shall call her dr. d) who is a real-life dr. dagmar. she left her first and only full-time job under pressure because she normalized rather than prescribed psychiatric drugs. for example, dr. d treated a young man who was unable to keep still, complained of restlessness, fidgeted, rocked from foot to foot, and paced. she told him and his employer that he was not mentally ill, but drugged by the antidepressant he was taking (prozac), which proved to be correct. lest this instance seem too obvious, i know of many similar cases where the presiding physician decided that the problem was not too much drug, but too little. a vast difference of outlook separates the great majority of labelling physicians from the few normalizing ones. dr. d has had nothing but trouble from the establishment because of her normalizing approach. seven years after leaving her full-time job, she has been unable to find a regular position as a psychiatrist, even though she is recognized as an authority in her psychiatric specialty. a much more likely response to lars in real life would have been for the doctor to say, ‘ok. let’s start him on an anti-psychotic medication, since we don’t want his symptoms to get worse.’ if karin had said, ‘but what about side njsr – the nordic journal of social research 2010 4 effects? aren’t they sometimes more dangerous than the illness?’ the doctor would have replied, ‘karin, i’m sure you realize that he could become much more ill, or even violent.’ for drama and comedy, the film enlists the whole community to help lars. but in real life, perhaps fewer people would be needed; even one person might be enough. jay neugeboren (1999) has investigated many cases in which there was great improvement or complete recovery from what had been diagnosed as ‘serious mental illness’. the common thread he has found was that at least one person treated the afflicted one with respect, sticking by him or her through thick or thin. 1 until recently, i had not realized that in the actual dialogue, in order to normalize suspect behaviour, the healer must specifically translate the discourse out of the labelling mode into the normalizing mode, and be prepared to accept the consequences from the world of automatic labelling. in the fictional case, the doctor said, in effect, you are not mentally ill, you are just communicating. in the real case, the psychiatrist said, you are not mentally ill, you are just drugged. inadvertent normalizing ironically, because i didn’t understand the actual look of normalization, i didn’t recognize it occurring in my own next study. at the time that my book was being first published (1966), i observed a series of very brief recoveries from depression. as a visiting researcher at shenley hospital (uk) in 1965, i was present for all intake interviews of male patients for six months: 83 patients in all. of this number 70 patients were 60 or older. the comments that follow concern the older men. every one of them was presented as deeply depressed in their speech and manner. however, to my surprise, there were moments in some of the interviews that seemed to be miracles of recovery. it took many years for me to understand what i had observed in terms of labelling theory. many of the patients were virtually silent, or gave one-word answers. long before i came, some of the interviewing psychiatrists had found a way of getting more responses to their questions. in the interviews i observed, 41 of the patients were asked about their activity during world war ii. for 20 of those asked this question, the responses shocked me. as they began to describe their activities during the war, their behaviour and appearance underwent a transformation. those who changed in the greatest degree sat up, raised their voice to a normal level instead of whispering, held their head up, and looked directly at the psychiatrist, usually for the first time in the interview. the speed of their speech picked up, often to a normal rate, and became clear and coherent, virtually free of long pauses. their facial expression became lively and showed more colour. each of them seemed like a different, younger, person. 1 the biography (nasar, 1998) of john nash, a nobel prize winner, is similar. although nash is not included in neugeboren’s book, the biography shows that nash’s mother and wife aided his recovery, since they never gave up on him. however, a beautiful mind, a film purportedly based on nash’s biography, is misleading on the drug issue. nash, played by russell crowe, attributes his complete recovery to ‘the newer antipsychotic drugs’. but the biography states that nash refused to take drugs after 1970, long before the newer antipsychotics. indeed, the biographer states that his refusal may have been fortunate, making possible his complete recovery (nasar, 1998, p. 353). njsr – the nordic journal of social research 2010 5 ‘ the majority changed to a lesser extent, but in the same direction. i witnessed 20 awakenings, some very pronounced, however temporary. the psychiatrists told me that they had seen it happen many times. after witnessing the phenomenon many times, i, like the psychiatrists, also lost interest. many years later, because of my work on shame, i proposed a partial explanation (2001): depression involves the complete repression of painful emotions (such as shame, grief, fear, and anger), and lack of a single secure bond. the memory of the patients’ earlier acceptance as valued members of a nation at war relived the feeling of acceptance. this feeling generated pride that counteracted the shame part of their depression. telling the psychiatrist about belonging to a community during wwii had been enough to remove the shame of being outcasts. conveying to the psychiatrist that ‘once, we were kings’ had momentarily relieved their shame and therefore their depressive mood. when the psychiatrists asked the depressed outcast men about their experience during wwii, they were inadvertently normalizing the patients, returning them, for just a few moments, to what it felt like to be an accepted member of society, rather than labelled and rejected. my recent article on depression (2009) explained some of the implications for social, rather than medical, treatment of mental illness. however, because i had not used enough concrete instances in my theory, i still had not recognized the way the psychiatrists’ question could be interpreted in terms of labelling theory. the psychiatrists’ intentions were to continue to label the patients: ‘you are mentally ill, so i need more information to assist me with your diagnosis.’ however, 20 of the patients understood the meaning as normalizing: ‘you are socially acceptable now if you were ever accepted even once as a valuable member of a community.’ perhaps a longterm therapy based on this and other social ideas might do better than just temporary recoveries. two examples from other fields a psychotherapist who was in bereavement and in end-of-life care told me this story. the first time she met a new patient with dementia from brain cancer, the patient said to her: ‘o, my! what have you done to your hair?’ at this point a relative might have argued: ‘oh mom, i’m not jenny, i’m victoria.’ the therapist, instead of arguing, made a gesture of absent-mindedly straightening her hair with her hand, saying: ‘i haven’t been able to do a thing with it!’ they both laughed, and proceeded to have a lively session, punctuated with laughing and crying. (for an argument that catharsis lives, see scheff, 2007.) the final example comes from the field of education. my colleague at the university of california, santa barbara, also teaches mathematics in an elementary school for underprivileged children. he explains his method: i ask students leading questions about mathematical situations in order to help them discover, understand, and become proficient in mathematics. the basic principle is that when asked to explain a wrong answer, students will discover their mistakes, and by working together as a group, develop their understanding. a key aspect is not quite described; the teacher usually tries to save students from the automatic embarrassment of a wrong answer. one question: how njsr – the nordic journal of social research 2010 6 many sides does this milk carton have? he is prepared to normalize many of the different answers by having thought ahead: your answer is about the visible side, outside, flat, and so on. his method seeks to avoid automatic judgements: students are not always wrong, just as teachers are not always right. more importantly, in the long run, social acceptance, rather than automatic rejection, might improve our schools and our society. teachers can learn to give corrective responses without putting the students down: normalizing without enabling. i have an example from my own student days. as a senior in physics, i had one professor whom i particularly respected, and i thought that he respected me as well. however, one day when i went to the blackboard prepared to grind out the answer to the problem he had given me, i thought of an intuitive answer that was correct. my professor was so astounded that he said, ‘did jim (the star student) tell you that?’ that was the beginning of the end of my love affair with physics: he had labelled me as a plodder, and embarrassed me in front of the class. conclusion this essay has suggested an idea that might help us individually be better therapists or teachers, and in the long run, change our medical, psychotherapeutic, and educational institutions. the theory of labelling/normalizing alerts us to the dangers of automatic reactions of labelling as well as enabling, and it gives us examples of how both extremes might be avoided. these ideas might help both individuals and societies to grow and to prosper. acknowledgements this essay has greatly benefitted from comments on an earlier draft by robert fuller and suzanne retzinger. references fuller, r. w. (2003) somebodies and nobodies. gabriola island, bc: new society. goffman, e. (1964). behavior in public places. new york: free press. kimmel, s. (producer), & gillespie c. (director) (2007). lars and the real girl [motion picture]. united states: mgm. nasar, s. (1998). a beautiful mind. new york: simon & schuster. neugeboren, j. (1999). transforming madness. new york: william morrow. scheff, t. (1999). being mentally ill (3rd ed.). hawthorne, new york: aldine transaction. ——— (2001). social components in depression. psychiatry. 64(3), 212-224. njsr – the nordic journal of social research 2010 7 ——— (2007). catharsis and other heresies. journal of social, evolutionary and cultural psychology. 1(3), 98-113. ——— (2009). a social theory and treatment of depression. journal of ethical and human psychiatry, 11(1), 37-49. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2011 – special issue guest editorial welfare-state change, the strengthening of economic principles, and new tensions in relation to care birgit pfau-effinger institut für soziologie university of hamburg email: pfau-effinger@wiso.uni-hamburg.de tine rostgaard sfi – the danish national centre for social research email: tr@sfi.dk outline of the concept of the special issue changes in family structures, a massive increase in labour-market participation of women, and an ageing population have led to changes in the traditional organization of care work. european governments are being forced to find new solutions for managing what is called „the emerging care deficit‟. this volume of the njsf addresses the new forms of care emerging across european countries. care work is still to a substantial degree provided in private households in unpaid or paid informal forms of care work, but many welfare states in europe have extended financial support and public provisions in the field of childcare and elderly care, and have established new social rights for care recipients (anttonen & sipilä 2005; kröger & sipilä 2005; rostgaard 2002). pay for family care in the framework of parental-leave schemes and elderly care has been introduced (pfau-effinger 2007). this measure implies that care work produced within the private household by family members or relatives is to an increasing extent organized as semi-formal care. such policies have contributed to diminishing the tensions between family and employment that had been developing as a consequence of the increase in labour-force participation rates of women. however, in many european countries, these tensions between care responsibility and employment still exist. this restructuring of the organization of care work has overlapped with another major change in european welfare states, namely, the substantial modification of the main principle of the provision of care. as long as care was provided in the family, its production was based on principles of mutual support. however, this notion of family care was contested beginning in the 1970s. feminists argued that care provided in the family excluded women – the main providers of family care – from the labour market and social security mailto:pfau-effinger@wiso.uni-hamburg.de mailto:tr@sfi.dk njsr – nordic journal of social research 2011 – special issue 2 (anttonen & zechner 2011; england 2005). as far as care was formalized, with the state taking the main responsibility, it was usually organized in the form of a broad public sector of social services. care provision was based on social rights connected to needs. but state care based on public-sector social services was also contested, even in the nordic countries. in the discourses of the early 2000s, people described it as rigid, uniform, and inhumane (vabø 2006). the new type of welfare-state policies now in place following the reforms aim instead to empower people in need of care (or their relatives in the case of small children), and to give them the option to act as „consumers‟ on the basis of „free choice‟ between the different types of care provision on offer. according to mia vabø (2006), „consumerism‟ was a major driving force behind the reforms of the nordic welfare states. these reforms have been subject of a great deal of empirical research and a broad debate in the social sciences. however, these reforms have turned out to be even more farreaching than many observers had expected and the introduction of „consumerism‟ was part of a much larger phenomenon. in the new world of care provision, welfare states now tend to treat care as a good that people can sell and buy on markets under the conditions of competition between providers. moreover, the organization of care on the basis of the principle of „need‟ was to some extent substituted by the principle of „efficiency‟, and it became legitimate for firms to use the production of care to make profits. we call this development the „strengthening of economic principles‟ in relation to care. the new policies include such elements as the introduction of fordist principles into care work, the outsourcing of parts of what was formerly stateprovided services to the market or the non-profit sector, the establishment of welfare markets and competition among the providing organizations, the introduction of cash-for-care schemes, the replacement of the concept of clients or patients holding rights with the concept „consumers‟ making „free choices‟ on the emerging social-care market (bode 2005; budäus 2003; clarke & fink 2008; daly 2002; knijn & verhagen 2007; kremer 2004; lewis & al. 2008; lundsgaard 2006; rostgaard 2002; ungerson 2005; vabø 2006). these reforms have to a considerable degree been influenced by neoliberal ideas and principles (e.g., esping-andersen 1999; jæger & kvist 2003; vabø 2006). the introduction of these new policies has in part offered new solutions to budgetary problems and the lack of efficiency in care provision. however, it has also created substantial new tensions and contradictions in the care arrangements, because the new principles of care provision contradict other principles (eichler & pfau-effinger 2009). it is plausible to assume, however, that different welfare states have implemented these new principles to different degrees and in different forms. so far, there have been relatively few comparative studies on the strengthening of economic principles in care provision (for an exception, see for example bode 2005; da roit & le bihan 2011). there are also open questions concerning which cases such policies lead to tensions and which particular elements of these policies produce tensions. aims of the special issue the aims of this special issue of the njsr are 1) to analyse policies that strengthen economic principles and their outcomes in the field of childcare and elderly care in european welfare states; 2) to analyse tensions and njsr – nordic journal of social research 2011 – special issue 3 contradictions which have emerged as a consequence of such policies; and 3) to contribute to the further development of the theoretical and conceptual frameworks for this line of research. the authors analyse and explain the specific ways in which different welfare states have introduced and strengthened new economic principles in their care policies. moreover, they analyse the outcomes of these policies, their potential tensions and contradictions, and the conditions under which such policies can lead to tensions in relation to care. in this regard, the volume will add new elements both to the debate and to the scientific analyses of the strengthening of economic principles in care policies of european welfare states. the special issue is a mixture of comparative analyses from different welfare states in europe, as well as case studies of single welfare states. the main bulk of the articles addresses the organization and policies of childcare and care of the elderly. several of the articles analyse the change towards the client or user as a consumer in a service „market‟, the new choice between „cash or care‟, as with childcare, or between for-profit, non-profit or publicservice delivery, as with care for the elderly. the articles in this special issue are the result of the international research collaboration in the eu network of excellence „reconciling work and welfare in european societies‟ (recwowe). the editors are the convenors of the task group, „tensions in care between work and welfare‟ under recwowe. the contributions as a central part of the strengthening of economic principles in the field of long-term care in european welfare states, the figure of the old person in need of care, who was previously regarded as the client or patient, has been replaced by the figure of a „consumer‟ who makes „free choices‟. in most countries these choices include offers by different providers of home care who compete on the care market and care performed by family members. the focus of the first article by birgit pfau-effinger, per h. jensen, and ralf och is on the effects of these policies on caring family members. it aims to give an answer to two different research questions. first, how do different welfare states legally construct the work situation of caring family members and their relationship with the elderly „care consumers‟? secondly, to what degree does this construction cause tensions? to answer these questions, the authors compare the legal construction of the work conditions of family care givers in germany and denmark, as well as the effects on their relationship with the older relatives who receive care. the findings show that the degree to which „consumerism‟ in long-term care causes tensions in the situation of the caring family member and in the care relationship depends on the ways in which it is embedded in a „family care regime‟. in this regard, the tensions are clearly greater in the semi-formal family care regime of germany compared to the formal family care regime in denmark. the following article by barbara fersch and per h. jensen investigates politics of „choice‟ for senior citizens in the danish welfare state. the strengthening of economic principles in elderly home care in denmark has primarily taken the form of outsourcing public care provision. the content and quality of services have remained the same, but the providers of services have njsr – nordic journal of social research 2011 – special issue 4 changed. the welfare state has continued to bear the major responsibility for the provision of elderly care, while outsourcing has allowed clients to choose freely between a public and private provider of care. the major aim of outsourcing has been to empower the frail elderly by providing them with exiting and choice opportunities and to construct them as consumers of welfare-state provision. though denmark‟s central government introduced the public service reform, the municipalities bear the administrative and financial responsibilities for the care of seniors. in other words, national policy-makers have imposed on the local authorities (municipalities) the duty to provide the opportunities for choice to individuals in need of care. against this background and drawing on the case studies of two danish municipalities, this article analyses how nationally imposed ideas and the „politics of choice‟ have created tensions locally in the form of municipal resistance and blockages. ingela naumann investigates the development of „childcare markets‟ in both great britain and sweden. the findings are that there are trends not only towards the marketization but also towards the universalization of childcare, which suggest a complex picture of competing policy logics and goals in the restructuring of welfare states. these similar ideas and trends have, however, played out differently in different national contexts. while market mechanisms have developed slowly over time and have so far had a limited effect in sweden, in the uk ideas about universal early childhood education became influential as part of a new social-investment agenda in the 1990s, though their restricted implementation has not fundamentally altered the existing childcare market. the author finds that historical policy trajectories thus continue to matter; however, tensions and incoherencies among existing policies can open spaces for change. with the article by tine rostgaard, we again investigate the case of free choice of home care in denmark. the article discusses the overall premises underlying the introduction of the free choice in home care as a panacea to the crisis of the welfare state, and continues with a discussion of the assumptions behind the free choice with regard to the role and responsibilities of the home-care user, the older person. with free choice, the user is expected to become active in seeking information about providers and changing the home care they receive when the quality is poor. this emphasis on free choice overlooks the fact that care is not a commodity like others, for it requires trust and established relationships. in reality, most users do not desire the opportunity to change providers, but they do need continuity in care provision and care staff. although users are generally appreciative of the opportunity to choose between providers, they do not rate the quality of the care to be any higher in the private sector than in the public. the article concludes that consumerism is now part of the logic of governance, and this has changed the relationship between the welfare state and its subjects. consequently, new forms of risks, responsibility, and dependencies have been created. anneli anttonen and liisa häikiö in their article scrutinize social care by investigating recent trends and changes towards marketization and marketlike mechanisms within the social-policy field of social care in finland. they find that public-sector service provision is being redefined and reorganized in such a way that the state and municipalities are taking less responsibility for producing care services-in-kind. universalism, which the nordic welfare states are so renowned for, is being challenged by neoliberalism, market-friendly social-policy doctrines, and demands for the development of user-friendly service systems that make choice possible. the authors find that the transformation of public administration into public management and the njsr – nordic journal of social research 2011 – special issue 5 influence of managerialism and new public management (npm) on recent public-sector reforms have accelerated welfare-state change. as a result, a very extensive and deep reform of social-care service provision is taking place in finland. these changes mean that the mixed governance mode will be reinforced and the earlier, state-centred welfare production mode is at least partly withering away. in this respect finland is approaching the liberal welfare states. it is remarkable that there are today few critics of the new market-like mechanisms and operational practices. the final article by teppo kröger investigates whether the introduction of market-based practices linked to npm has affected the work satisfaction of care workers in care systems for the elderly in denmark, finland, norway, and sweden. this question is highly relevant because most countries are struggling to hire and retain workers in this sector. the work is often of low pay and of low status, and can be both mentally and physically strenuous. using comparable survey data from denmark, finland, norway, and sweden, the author finds many variations between the four nordic countries concerning both the adoption of market-inspired practices – which denmark has been the most and norway the least eager to introduce – and their implications. employees of for-profit and public employers have similar levels of work satisfaction. in contrast, the implementation of a purchaser-provider model, whereby care assessment and care provision are separated administratively and physically, is associated with weaker levels of work satisfaction. the introduction of other npm-based practices does not display similar negative associations. in particular, quality-control mechanisms are associated with higher levels of work satisfaction among care workers. acknowledgements we would like to thank the anonymous reviewer for her or his very useful comments and franz zurbrugg for copy-editing this editorial. references anttonen, a. & sipilä, j. (2005). comparative approaches to social care: diversity in care production modes. in b. pfau-effinger & b. geissler (eds), care arrangements in europe – variations and change, bristol: policy press. bode, i. (2005). einbettung und kontingenz. wohlfahrtsmärkte und ihre effekte im spiegel der neueren wirtschaftssoziologie [embedment and contingency. welfare markets and their effects as reflected in recent economic sociology], zeitschrift für soziologie, 34(3), 250-269. daly, m. (2002). care as a good for social policy. journal of social policy, 31(2), 251270. daly, m. & lewis, j. (1998). introduction: conceptualising social care in the context of welfare state restructuring. in j. lewis (ed.), gender, social care and welfare state restructuring in europe. aldershot: ashgate, 1-24. eichler, m. & pfau-effinger, b. (2009). the “consumer principle” in the care of elderly people free choice and actual choice in the german welfare state, social policy and administration, 43(6) 617-644. knijn, t. & verhagen, s. (2007). contested professionalism: payments for care and the quality of home care, administration and society, 39(4), 451-475. njsr – nordic journal of social research 2011 – special issue 6 knijn, t. & kremer, m. (1997). gender and the caring dimension of welfare states: toward inclusive citizenship. social politics, 4(3), 328-361. kremer, m. (2004). consumers in charge of care: the dutch personal budget and its impact on the market, professionals and the family, european societies, 8(3), 385-401. kröger, t. & sipilä, j. (eds) (2005). overstretched: european families up against the demands of work and care. malden: blackwell. lewis, j., knijn, t., martin, c., & ostner, i. (2008). patterns of development in work/family reconciliation policies for parents in france, germany, the netherlands, and the uk in the 2000s. social politics 15(3), 261-286. lundsgaard, j. (2006). 'choice and long-term care in oecd countries: care outcomes, employment and fiscal sustainability', european societies, 8(3), 361383. pfau-effinger, b. (2005). welfare state policies and development of care arrangements. european societies, 7(3), 321-347. rostgaard, t. (2002). caring for children and older people in europe: a comparison of european policies and practice. policy studies 23(1), 51-68. ungerson, c. (2004). whose empowerment and independence? a cross-national perspective on “cash for care” schemes. ageing & society, 24(2), 189-212. vabø, m. (2006). caring for people or caring for proxy consumers? european societies, 8(3), 403-422. ../../../../../fsktine/lokale%20indstillinger/dokumente%20und%20einstellungen/admin/lokale%20einstellungen/documents%20and%20settings/fsktine/documents%20and%20settings/fsktine/local%20settings/temporary%20internet%20files/olk1/title~db=all~content=t713685208~tab=issueslist~branches=8#v8 microsoft word johansen risk factors of long-term sickness absence in norway and sweden.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 4, 2013 risk factors of long-term sickness absence in norway and sweden vegard johansen eastern norway research institute email: vj@ostforsk.no abstract aims: this paper examines the level of long-term sickness absence (ltsa) in norway and sweden. it also investigates whether risk factors of ltsa are the same in norway and sweden. methods: more than 2500 norwegian and swedish workers between 20 and 60 years of age answered a postal questionnaire. the norwegian and swedish samples are weighted and representative with regard to regional background variables and demographic background variables, but the response rate was low. ltsa is defined as 15 days or more sickness absence in the previous year. binary logistic regression is used to detect which factors influence ltsa. the analyses of ltsa include demographic factors, socioeconomic position, and occupational characteristics. results: nineteen per cent of respondents in norway and 11 per cent of respondents in sweden experienced ltsa in the previous year. many respondents from sweden report mental problems and many norwegian respondents report pain in back, neck, knuckles, and muscles. income level is the most important predictor of ltsa in both countries. the direct impacts of gender, age, and physical work conditions are stronger in norway than sweden. discussion: in accordance with official statistics and previous studies, the proportion of norwegian respondents with ltsa is much higher than the proportion of swedish respondents. the different levels of ltsa could be linked to differences in social policy. in line with previous studies, respondents with low income are overrepresented with ltsa, and gender, age, and physical work also matter. in contrast to previous studies, there is not any evidence of higher levels of ltsa among non-western immigrants, people with less education, and non-managers. these results reflect the control for ‘income level’, but they could also be related to limits with the survey (nonresponse, response bias, etc.). keywords: long-term sickness absence, risk factors, survey, norway, sweden, logistic regression njsr – nordic journal of social research vol. 4, 2013 72 introduction this article discusses long-term sickness absence (ltsa) in norway and sweden. there are many studies on sickness absence and ltsa (lidwall, 2010), but fewer studies with a comparative approach. comparative studies can potentially contribute to the knowledge about societal, cultural and legislative effects on outcomes such as ltsa. the two countries examined may look alike from distance: norway and sweden are neighbours, exchange labour extensively, and have robust job protection, high levels of work participation, and healthy populations (bonato & lusinyan, 2004; markussen, 2007). both countries are vast welfare states, but sickness benefits in norway are more generous than they are in sweden: a sick-listed person in norway receives full compensation of the loss of income from the first day for a maximum of 364 days, whilst in sweden the employees themselves pay for the starting day and receive 80 per cent compensation of the loss of income for a maximum of 364 days within a frame of 450 days (government proposition no.136, 2008; ministry of labour and social inclusion, 2011). moreover, the level of sickness absence is much higher in norway compared with sweden (berge, 2012). in the last decade, the mean rate of doctorcertified sickness absence in norway was more than six per cent and four per cent in sweden (statistics norway 2013; statistics sweden, 2013). moreover, a survey a few years ago provided indications of profound differences between respondents from the two countries in attitudes towards sickness absence (dahl et al., 2007). this article examines the level of ltsa in norway and sweden, and investigates whether a selection of risk factors of ltsa are the same in norway and sweden. the investigation of risk factors of ltsa includes demographic factors, socio-economic position, and occupational characteristics. there are two reasons for focusing on ltsa and not sickness absence in general. first, short-term sickness absence does not require sickness certification from a doctor, and it is therefore often used to respond to common and minor problems. secondly, workers with ltsa account for much of the total sickness absence in both countries, and they must be the target group for a reduction of the total levels to take place (mykletun et al., 2007). the data is from a questionnaire answered by more than 2500 norwegian and swedish workers between 20 and 60 years of age. scandinavian studies of ltsa the high levels of sickness absence and ltsa in norway and sweden constitute an important research topic from both a public-health and an economic perspective. sickness absence is caused by a variety of factors. since labour-market conditions and social conditions vary, who is at risk of ltsa may vary significantly from country to country. therefore, i shall now discuss the factors that previous scandinavian studies of ltsa have found to be relevant. first, a review of sickness absence in norway discusses many factors relevant to ltsa (ose, 2010). it is shown that women run a higher risk of ltsa than men. several hypotheses have been put forward to explain gender differences with regard to ltsa, such as women’s reproductive role, women’s responsibilities for the family, and the fact that men and women have different working conditions. income is an important measure of socio-economic njsr – nordic journal of social research vol. 4, 2013 73 position, and there is a strong and negative correlation between income and ltsa. moreover, the review also refers to cross-country studies that have shown that sickness benefits have a robust and positive impact on absence. the association between economic incentives in the social-insurance system and sickness absence is also found in swedish studies (andren, 2005). secondly, a swedish study of changes over time in factors associated with ltsa used data from studies conducted in 1992 (2600 respondents) and 2002 (3900 respondents). the results showed that both weak social support and high ergonomic exposure had consistent influence on ltsa, whilst having a high-strain job was associated with ltsa in 2002 but not in 1992. in 2002, women ran a higher risk of ltsa than men, but not in 1992. for the women, daily smoking, being overweight, permanent employment, public employment, active jobs, and working more than 45 hours a week were all associated with ltsa in the 2002 study, but not in the 1992 study. age and education seem to matter for ltsa, whilst the family situation had less influence (lidwall et al., 2009). thirdly, a danish study with more than 5000 respondents identified that higher risks of ltsa was associated with gender, age, educational level, the municipal employment sector, and work-environment exposures, such as ergonomic conditions and physically demanding work. uncomfortable working positions, lifting or carrying loads, and pushing or pulling loads are factors increasing the risk of ltsa. moreover, ltsa among females was associated with role conflict, low reward, and poor management, whilst high emotional demands predicted ltsa among men (lund et al., 2006; 2007). the association between physical working conditions and sickness absence is also found in a study among employees in the swedish public sector, and this study also indicates interactions between ergonomic working conditions and the psychosocial work environment (fjell et al., 2007). substantial attention has also been paid to psychosocial conditions in the workplace and sickness absence, and the relation between health and the psychosocial work environment has been well illustrated by the demand-control model (karasek & theorell, 1990). fourthly, 15 per cent of the swedish population and nine per cent of the norwegian population are immigrants. non-western immigrants have poorer health than others, and in many european countries non-western immigrants are characterized by low employment rates and precarious employment in low-paid jobs. swedish studies have shown that there are differences in sickness absence among natives and non-western immigrants (nilsson, 2005; bengtsson & scott, 2006). similarly, a norwegian study concludes that absence rates are higher among some groups of non-western immigrants than among ethnic norwegians: after controlling for demographic factors, labourmarket factors, and socio-economic differences, workers from africa and asia (men) still have higher propensity for ltsa (dahl et al., 2010). fifthly, position at the workplace and type of work might also have an impact on ltsa. in norway, self-employed men seem to have lower sicknessabsence levels compared with employed men, but self-employed women had higher sickness absence levels compared with employed women (nossen & thune, 2010). in sweden, a study indicates vast differences between employees with and without managerial responsibilities with regard to sickness absence: managers have less sickness absence periods compared with other njsr – nordic journal of social research vol. 4, 2013 74 groups of employees (mulder, 2011). type of occupation matters to ltsa, and one might distinguish between different occupational classes with divergent levels of ltsa, such as white collar, blue collar, self-employed, and so on (lidwall, 2010). sixthly, various studies have investigated relations between socio-economic position and sickness absence, and have found that people with less education face a higher risk of ltsa than those highly educated do (labriola et al., 2007). similarly, those with low income are overrepresented among those with high levels of sickness absence (ose, 2010). there is also a growing literature on the effects of family relations and sickness absence. some studies indicate that workers struggling to combine their work and family life have a higher risk of ltsa (lidwall, 2010), whilst other studies do not find such correlations (lidwall et al., 2009). cohabitation and the presence of children may constitute higher demands at home (for women), and sickness absence could be an adverse outcome of this double work-home burden. in particular, single parenthood is associated with sickness absence. finally, there are also studies that have looked into the association between lifestyle factors and ltsa. following a nation-wide cohort of more than 40 000 swedish men between 1986 and 2005 regarding sick-leave, it was found that lifestyle factors such as being overweight or obesity influenced ltsa (neovious et al., 2012). using data from three cross-sectional samples of the working population, another swedish study examined work-related sleep disturbances and their association with ltsa (westerlund et al., 2008). in a swedish study with 1700 respondents between 20 and 52 years, a consistent pattern of increased sickness absence was seen for high consumers and for those with indications of a drinking problem (upmark et al., 1999). method this study uses data from a survey in norway and sweden from 2011. the data collection took two months; it began in the beginning of march and ended in the beginning of may. the data collection was funded by the research council of norway. the research council of norway had no role in the following: study design; the collection, analysis and interpretation of the data; in the writing of the article; and the decision to submit for publication. the research was done in accordance with the rules set by the committees for medical research ethics in both norway and sweden, and it was approved by the norwegian social science data services. in both countries, the process of selecting the gross sample was simple random sampling from the population of workers between 20 and 60 years of age. the net samples included 1600 norwegians and 1250 swedes. the data are weighed according to country of origin, so that the norwegian and swedish samples have the same influence. the response rate was low (33 per cent in both countries), but this is similar to other levels of living surveys in norway and sweden. response rates tend to be very low for postal questionnaires (edwards et al., 2002), but it was the only financially viable option for this cross-country study. to increase the response rate, the length of the questionnaire was kept quite short (four pages and 60 questions), a postal follow-up including questionnaire was sent, the njsr – nordic journal of social research vol. 4, 2013 75 return envelope was pre-paid, and the information letter stressed the benefits of the study to society. to test for non-response bias, known values from the population of workers between 20 and 60 years of age and the potential participants were compared with the values that prevail in the subgroup that answered the questionnaire. it is positive that the norwegian and swedish net samples were representative with regard to ethnic background, as well as representative of regional dimensions like the size of municipality, county, and centrality/peripherality. the norwegian net sample is representative with regard to gender, whilst there is an overrepresentation of women in the swedish sample. in the net samples for norway and sweden, those in the age group 40-60 are overrepresented and those between 20 to 39 years are underrepresented. the data were weighed according to age and gender in order to remedy the underrepresentation of young workers and men. questions about work, including sickness absence, were answered by 2533 respondents who were either working, on parental leave, or on leave of absence. there are five basic ways of assessing sickness absence: frequency refers to sickness absence episodes, incidence rate refers to estimates of frequency per person-time, duration refers to mean or median days spent away during each episode of sickness absence, length is often measured as number of days of sickness absence, and cumulative incidence is used to assess the proportion of individuals absent during a specified period (hensing, 2009). the chosen question was formulated like this: ‘how many days did you take sick leave the last 12 months?’ it allows for an investigation of the proportion of individuals with sickness absence in the prior year (cumulative incidence) and the distribution of absent days per worker (length). respondents were given six alternatives: 0 days, 1-7 days, 8-14 days, 15-30 days, 31-90 days, and 91-365 days. ltsa is a phenomenon defined very differently in the literature, and a review of the literature reveals that cut-off points such as seven days (kivimäki et al., 2003), 15 days (lidwall et al., 2009), 28 days (vingård et al., 2005), 56 days (lund et al., 2007), 60 days, and 90 days (lidwall, 2010) are used. the choice of cut-off point seems to be rather arbitrary, and divergent cut-off points also pose a problem for comparisons between studies: it is unreasonable to match up studies referring to ltsa as seven days and those referring to three months. the current study defines ltsa as 15 days or more. the available data also allows sensitivity analysis, and this defines ltsa as 31 days or more. answers to questions about the past can be imperfect and thereby affect the validity of the results of the survey. ninety-eight per cent of the potential respondents answered the question about sickness absence in the prior year. it could be that the choice of six alternatives (closed question) made it easier to answer about sickness absence than it would have been if the respondents were asked to remember the exact number of days (open question). it is, however, hard to make conclusions about the accuracy of their answers. response bias refers to instances when a respondent intentionally responds incorrectly to a question about their personal history. some former studies have shown that employees tend to under-report their sickness absence (van poppel et al., 2002). this study does not control for overor underreporting with regard to ltsa. it must be noted, though, that response bias is particularly problematic with interviews face-to-face or over the phone; there is njsr – nordic journal of social research vol. 4, 2013 76 less of an interview effect in this study, where respondents wrote down their answers in an anonymous survey. binary logistic regression has been used to detect which factors influence ltsa. binary logistic regression is suitable for predicting the outcome of a categorical criterion variable that can take on only two possible outcomes. nagelkerke r2 indicates how accurate the models are in terms of how much of the total variation the factors included in the model are able to explain. the independent variables include demographic characteristics, socio-economic position, and work-related factors. • gender: male (reference category, 50 per cent of the sample) and female (50 per cent); • age in years; • ethnic background: divided between natives and western immigrants (comprising western europe, canada, usa, australia, and new zealand (reference category, 94 per cent of the sample), and nonwestern immigrants (comprising persons born in other countries, six per cent); • education: divided between high educational attainment (bachelor degree or higher, 36 per cent of the sample) (reference category) and low educational attainment (64 per cent); • income: divided between low income (0-299,000 nok/sek, 40 per cent of the sample), and medium income (300,000-499,000 sek/nok, 43 per cent), and high income (500,000+ nok/sek, 17 per cent); • type of employment: divided between employee in the public sector (reference category, 37 per cent), employee in the private sector (51 per cent) and self-employee (12 per cent); • employment position: divided between those that do not have a managerial position (reference category, 71 per cent of the sample), and middle management/executives (29 per cent). although the models for ltsa in norway and sweden are quite complex, they still consist of a limited selection of potential risk factors. important factors are missing that could have changed the results. most significantly, i do not have information about respondents' health, which is arguably an important determinant of ltsa. there is also extensive research on the relationship between the psycho-social conditions in working life and sickness absence, but the data does not cover that topic. in addition, i cannot investigate the possible correlations between lifestyle factors and ltsa. results i begin with a descriptive analysis of ltsa in the two samples. according to table 1, 21 per cent of the norwegian sample and 11 per cent of the swedish sample experienced ltsa (15 days or more sickness absence). using a more narrow definition (31 days or more sickness absence), i have found that 12 per cent of the norwegian sample and six per cent of the swedish sample had ltsa. on a minor note, a higher proportion of respondents in norway than sweden did not experience any sickness absence (53 per cent versus 46 per cent). if we use the narrow definition of ltsa (31 days or more), the main njsr – nordic journal of social research vol. 4, 2013 77 cause for the norwegian sample is pain in back, neck, knuckles, and muscles, and the swedish sample most often reported mental problems (25 per cent) and injury/accident (21 per cent). table 1. distribution of sickness absence in norway and sweden, in percentage norway sweden 0 days 53 46 1-7 days 21 35 8-14 days 7 8 15-30 days 7 5 31-90 days 6 3 91-365 days 6 3 sum 100 100 table 2 and table 3 presents the unstandardized coefficients and p-values from regression analyses of ltsa in norway and sweden. in table 2 ltsa is defined as 15 days or more sickness absence. there are statistically significant effects for ‘low income’ and ‘medium income’ in both norway and sweden. in the norwegian model, ‘female’, ‘age’, and ‘physical work’ are also significant. in the swedish model, a closer examination shows that gender for the most part has an indirect effect on ltsa: women are overrepresented in the category ‘low income’, which in turn affects ltsa. the remaining variables are non-significant. table 2. binary logistic regression of the factors influencing sp in norway and sweden, ltsa defined as 15 days or more. variables norway sweden b or b or constant -3.56** 0.03 -3.60** 0.03 female 0.48** 1.61 -0.07 0.94 age 0.014* 1.01 0.00 1.00 non-western immigrant -0.03 0.97 -0.05 0.95 low education 0.25 1.28 0.23 1.34 low income 1.04** 2.84 1.95** 6.99 medium income 0.70** 2.02 1.03* 2.80 self-employed -0.20 0.82 -0.23 0.79 employee in private sector 0.31 1.36 -0.17 0.84 management -0.14 0.86 -0.08 0.92 physical work 0.61** 1.84 -0.06 0.94 ** = significant at 0.01, * = significant at 0.05 reference categories: male; native or western immigrant; high education; high income; employee in public sector; non-management; sedentary work nagelkerke r2: 0.10 (norway) and 0.06 (sweden) njsr – nordic journal of social research vol. 4, 2013 78 table 3. binary logistic regression of the factors influencing sp in norway and sweden, ltsa defined as 31 days or more. variables norway sweden b or b or constant -3.82** 0.02 -3.67** 0.03 female 0.32 1.38 -0.09 0.91 age 0.011 1.01 0.006 1.01 non-western immigrant -0.62 0.54 -0.37 0.69 low education 0.27 1.31 0.22 1.25 low income 1.16** 3.19 1.45* 4.25 medium income 0.65** 1.92 0.17 1.19 self-employed -0.12 0.89 -0.49 0.61 employee in private sector 0.32 1.37 -0.42 0.66 management -0.15 0.86 -0.02 0.98 physical work 0.49* 1.63 -0.20 0.82 ** = significant at 0.01, * = significant at 0.05 reference categories: male; native or western immigrant; high education; high income; employee in public sector; non-management; sedentary work nagelkerke r2: 0.07 (norway) and 0.06 (sweden) in most cases, the results in table 3 are parallel to those in table 2. when ltsa is defined as 31 days or more, there are statistical significant effects for ‘low income’ and ‘medium income’. whilst physical work is significant in the norwegian model, neither ‘female’ nor ‘age’ is significant. this illustrates the importance of the choice of cut-off point. discussion tables 1-3 have shown similarities and differences in ltsa in norway and sweden. a major difference is that the level of ltsa is twice as high in norway as in sweden. a second difference concerns the causes for ltsa: many respondents from sweden report mental problems and many norwegian respondents report pain in back, neck, knuckles, and muscles. this finding reflects the national statistics: musculoskeletal problems are the most typical diagnoses in norway, and mental problems are the most typical diagnoses in sweden. norway and sweden should be comparable nations with regard to the health situation, and the different levels of ltsa could be linked to differences in social policy. the structure and administration of the sickness-insurance scheme in each country is a fundamental factor affecting ltsa. previous cross-country studies have shown that sickness benefits have a robust and positive impact on absence (bonato & lusinyan, 2004; ose, 2010), and the association between economic incentives in the sickness-insurance scheme is particularly strong with regard to ‘shorter’ sickness absence (andren, 2005; lidwall, 2010). it seems plausible to interpret part of the cross-country difference in ltsa as a result of the more generous sickness benefits in norway. another reason for differences in ltsa could be that the swedish labour market is in a tougher situation than the norwegian labour market: sweden has higher unemployment rates and is more affected by the european sovereign-debt crisis than norway. an earlier swedish study indicates that the njsr – nordic journal of social research vol. 4, 2013 79 rate of sickness absence decreases in times of recession and increases during economic prosperity (lidwall & marklund, 2011). the idea of an association between increased unemployment and decreased sickness absence is based on the notion that employees have less absence because they are afraid of losing their jobs if they are absent too often, and that people with extensive absence are designated to unemployment (shapiro & stiglitz, 1984; leigh, 1985). some of the decline in sickness absence in sweden in the past decade could also be credited the development of tighter standards for sick leave at different diagnoses (mykletun et al., 2010). most results regarding risk factors for ltsa are the same in norway and sweden. level of income is the most important predictor for ltsa in both countries, and the strong correlation between low income and high level of ltsa is also found in previous studies (ose, 2010). in both countries, the impact of educational level was less strong than expected. an important reason for the low impact of education on ltsa is the adjustment for income level and managerial position. former studies conclude that rates of absence are higher among non-western immigrants than among natives (nilsson, 2005; bengtsson & scott, 2006; dahl et al., 2010), but significant correlations are not found in this study. there are few non-western immigrants in the sample. also, non-western immigrants are overrepresented with short-term absence in both countries, and this is not covered in the discussion about ltsa. there are no significant effects for type of employment or employment position. the data includes few respondents that are executive managers, and so middle managers were included in the managerial group. this partly explains the missing correlation, but the most important factor is the control for level of income. with regard to type of employment, a closer investigation of the data shows that self-employed women have higher ltsa compared with employed women, but that self-employed men have lower ltsa compared with employed men. this finding is parallel to nossen and thune’s result (2010). some results differ between the two countries. the direct impact of gender is strong in norway, but less strong in sweden. in sweden, gender has more of an indirect impact: gender affects income which in turn affects ltsa. age also seem to have stronger direct impact in norway than in sweden. the reason for expecting a higher rate of sickness absence from the older part of the workforce is that people will accumulate health problems during their (working) life and that they get tired and exhausted. ltsa is more frequent for the elderly part of the job stock than the younger in norway. also, a high physical workload increases the risk of ltsa in norway, but not in sweden. the impact of physical work conditions on ltsa has also previously been documented in danish studies (lund et al., 2006; 2007). final comments in norway and sweden, a small group of workers with ltsa account for most of the total sickness absence. the identification of risk factors of ltsa is therefore necessary for the choice of correct policies for the reduction of the total level of sickness absence. because this study used self-reported and cross-sectional data, the results are tentative. njsr – nordic journal of social research vol. 4, 2013 80 the main strength and contribution of this article is that it compares ltsa between workers in norway and sweden, and this is something that few studies have done before. a major difference between norway and sweden is the proportion of workers with ltsa: 19 per cent of the norwegian respondents compared with 11 per cent of the swedes experienced 15 or more days of absence in the previous year. with regard to risk factors for ltsa, the direct impacts of gender, age, and physical work conditions are stronger in norway than sweden. still, income level is the most important predictor of ltsa in both countries. in contrast to previous studies, there is not any evidence of higher levels of ltsa among non-western immigrants, people with less education, and nonmanagers. a main reason for the divergent results could be that the current study controls for the impact of income level, a variable that correlate strongly with ethnic background, education, and position. still, given that previous studies use population data from public registers, one could argue that the results in this study are less reliable. there are four potential reasons that might explain why this study has not found statistical effects with regard to ethnic background, education, and employment position: i) the classification of groups is broader in this study than in the previous studies (e.g., executives and managers together); ii) some groups of respondents are quite small (e.g., non-western immigrants); iii) the response rate was low and that could affect survey accuracy; and iv) there might be problems with recall bias and response bias. references andren, d. 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(2002). measuring sick leave: a comparison of self-reported data on sick leave and data from company records. occupational medicine, 52(8), 485-490. vingård, e., lindberg, p., josephson, m. et al. (2005). long-term sick-listing among women in the public sector and its associations with age, social situation, lifestyle, and work factors: a three-year follow-up study. scandinavian journal of public health, 33(5), 370–375. westerlund, h., alexanderson, k., akerstedt, t. et al. (2008). work-related sleep disturbances and sickness absence in the swedish working population 19931999. sleep, 31(8), 1169-1177. microsoft word 648, proof2.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 what works? flexibility as a work-participation strategy for people with addiction and mentalhealth problems gunnar vold hansen* faculty of health and social studies østfold university college email: gunnar.v.hansen@hiof.no *corresponding author ragnhild fugletveit faculty of health and social studies østfold university college email: ragnhild.fugletveit@hiof.no petter a. arvesen faculty of health and social studies østfold university college email: petter.a.arvesen@hiof.no abstract for many years the education and training of people with addictions and mental-health problems have been a key strategy to assist people to find ordinary jobs. this strategy is largely concerned with adapting people to the requirements of the workplace. an alternative strategy can also be envisaged, where the workplace adapts to the possibilities and resources of the people (hansen, 2009). in this article, we raise the following question: how is it possible to adapt workplaces for people with addiction and mental-health problems? here we highlight the experiences of a workplace that focuses on adapting to employees’ capabilities and resources. the data collection consists both of 12 interviews with managers and workers and of participant observation of the workplace. our answer to our question is that this is possible because the workplace is flexible in the way that they adapt their demands to the workers’ resources. keywords: work, addictions and mental disorders, flexibility, integration and normalization, user participation and resource orientation njsr – nordic journal of social research vol. 6, 2015 135 background in 2007, the norwegian government presented its ‘national strategic plan for work and mental health 2007-2012’ (nasjonal strategiplan for arbeid og psykisk helse 2007-2012). this was followed in 2013 by the ‘national followup plan for work and mental health 2013-2016’ (oppfølgingsplan for arbeid og psykisk helse 2013-2016). the latter plan has aimed to increase employment of people with mental-health problems, but has also stressed the need for more knowledge about how this goal can be achieved. the plan emphasizes that a number of people mental-health problems also have problems with alcohol or drugs and that the measures outlined in the plan also apply to people with these problems. the definition of mental-health problems used in this article is taken from the norwegian national strategic plan for work and mental health 2007-2012, which states: mental-health problems (troubles or difficulties): severity of symptoms such as various levels of anxiety, depression, and insomnia. the severity of the symptom does need not to be diagnosed (p. 7, our translation). in this article, we present the positive experiences of an initiative primarily aimed at people with alcohol and drug problems but which also included people with mental-health problems, and we identify some of the underlying reasons why the initiative was successful in our case. our intention is to contribute to a better understanding of how the employment for people with addiction and mental-health problems can be achieved by the presentation of a successful example. we shall start our presentation with some arguments for why work is important – especially for people with addiction and mentalhealth problems. later, we question whether it is always the characteristics of the individuals that make their employment difficult. in order to answer this question we present ‘the jobs demand-resources model’, and claim that this model explains that a likely explanation is that it is characteristics of the workplace that makes it hard for this group to get a job. work is important – also for people with addiction and mental-health problems. work is a concept to which many people have an ambivalent relationship. work is often part of the reason why people get ill and drop out of the workforce. stress and burnout can lead to mental-health problems (elstad & vabø, 2008). at the same time, it is generally agreed that adapted work can also be a means of helping people with mental-health problems to improved coping and participation in society (ose et al., 2009). work thus emerges both as a cause of mental-health problems and as a means of reducing mentalhealth problems. most people perceive mental-health problems negatively and absence from work tends to reduce one’s social network and participation and can in turn worsen mental disorders such as depression and burnout (dekkers-sánchez et al., 2008). people outside the workforce report a poorer quality of life than people at work (thorsen & claussen, 2008; hansen & dybvik, 2009). for those who want work, being unemployed is thus a major problem. for employers and society, this means increased costs and reduced production. the organisation for economic co-operation and development (oecd) goes njsr – nordic journal of social research vol. 6, 2015 136 so far as to describe the fact that illness leads to so many cases of reduced work capacity and leaving the workforce that is a ‘social and economic tragedy’ (2010, p. 9). a large proportion of those outside the workforce have a mental-health disorder and mental problems seem to be the fastest growing cause of sick leave and disability benefit. medically certified sickness absence due to mental disorders accounted for just under 20 per cent of the total absence in norway in the fourth quarter 2012 (sundell, 2013) some workers get a sick note with a mental-health diagnosis and only temporarily leave the workforce, at least in the first instance. more worrying is perhaps the trend in disability benefits. musculoskeletal disorders are the diagnostic group with the greatest number of people on disability benefit, while mental-health diagnosis is the secondlargest group. the challenge, however, is that those who are leaving work owing to mental-health diagnosis are becoming younger and there is a deep concern that they will remain on disability benefits for much of their lives. this means that mental-health disorders might eventually be the cause of the greatest number of lost working years (mykletun, 2009). absence from work is therefore a problem for the society in general, but it is also a problem for the individuals, as we shall see next. hammer and øverbye (2006) call work an ‘identity marker’. people are described in terms of the work they do and those who do not have jobs for various reasons have to make quite an effort to justify this situation. to work – to be productive in society – is generally regarded as the most basic requirement for a person to function as a true member of the social community. reneflot and evensen (2011) refer to jahoda (1982), who argues that work upholds a number of important elements in human life. participation in employment involves time structure, social contact, collective purpose and shared experiences, social identity, and regular activity. work also provides adults with an economic basis for an independent life. through work, an individual can demonstrate that he or she can contribute to the community. thus work participation is an important part of most people’s lives. a number of studies (van dongen, 1996; evans & repper, 2000) show that being outside the workforce is perceived by users of the mental-health services as a burden. thorsen and clausen (2008) find a clear correlation between disability, loneliness, and depression. they conclude that increased social participation and integration are more effective than medication in counteracting depressive disorders among disabled people. in this context it is also important to note that people with mental-health problems are less well integrated in the labour market than physically disabled people (schafft, 2008). in contrast, there are several examples that show that participation in the labour market has a positive influence in people's lives. granerud and severinson (2006) have found that having colleagues, everyday routines, and participation in the workforce gave people with mental-health problems the feeling of being valuable as active members of society. borg and kristiansen (2008) have found that having a job was a key element in the recovery process for people with mental-health problems. having an ordinary job in an ordinary setting helped the informants to feel normal. the work situation gave them the opportunity to move out of a troubled life and into a world where they had a different status, greater self-esteem, and became part of a community. there are also a number of studies showing that paid work can be an njsr – nordic journal of social research vol. 6, 2015 137 important factor for maintaining a drug-free life (biernacki, 1986). work fills one’s time constructively and enables financial independence (mcintosh et al., 2008). assumptions about why it is difficult to achieve employment there can therefore be no doubt that a large proportion of people with mentalhealth problems want to be in employment. why, then, do they not get jobs? schafft (2008) provides three explanations for why people with mental-health problems do not find employment. one explanation is that this group has less education and work experience than others. another explanation may be that many are afraid to apply for jobs because they fear that it will increase their stigmatization and have negative consequences for their recovery processes, welfare benefits, and so forth. a third explanation is that employers are reluctant to take on people with mental disorders because they know too little about what this implies. andersen et al. (2012) go a step further and examine in a review article the challenges reported by people with mental disorders after they have started work. they outline several challenges. one is that the employees have difficulties in relating to one’s own expectations about exceeding their working time as fast as possible. social support and the work environment are another challenge. it is difficult to get the workplace to accept and support a gradual return to work. a third area is that the health-care services, nav, and employers lack a common understanding of problems, solutions, and objectives, and a great amount of the employees feel that there is a competition between the different services – a competition they do not know how to handle. fourthly, it is difficult to decide when the right time to return to work is. finally, the employees experience a gap between intentions and implementation; for example, intentions relating to structural adjustments at the workplace take too much time to realize. we believe that these challenges only to a limited extent apply solely to mental-health problems. people with mental-health problems are a heterogeneous group and there is therefore a great need to consider each individual separately (møller, 2005). we also assume a difference between a reduced function and a disability. a reduced function refers both to a characteristic of an individual and the society. according to oliver (1996), the environment, or rather the society, prevents people with impairments from doing what he or she wants to do. the extent to which people with mentalhealth or addiction problems can participate in the labour market is therefore not solely dependent on the disorder, but is the result of the interaction between the individual and how well the workplace is adapted (briand et al., 2007; hansen, 2009). an alternative explanation for why it is difficult to find employment we also find the approach that focuses on the interaction between the individual and the environment applied in the commonly used explanation, where sickness absence may be the result of a kind of imbalance between the work requirements as perceived by workers and the possibilities they have to perform the work in accordance with these requirements. there are various models for describing how employees’ health is affected by the imbalance njsr – nordic journal of social research vol. 6, 2015 138 between the demands and expectations they encounter at work and their possibilities to fulfil them. one of these is the ‘job demands-resources model’ (demerouti et al., 2001). this model can be seen as a further development of the ‘job demand-control model’ (karasek, 1979) and the ‘job demand-controlsupport model’ (karasek & theorell, 1990). this demands-resources model includes an extensive description of both demands and resources. the demands may be factors such as physical and mental strain and the organization and management of the company. resources may be control, autonomy, feedback, social support, and coaching by supervisors (demerouti et al., 2001; bakker & demerouti, 2007). the balance between demands and resources can also be seen as part of the broader theoretical orientation that focuses on the person-environment fit (kristof, 1996; morley, 2007). one aspect of this focus is precisely the fit between individual and organization and between individual and work. a fit between individual and work is generally a question of finding the person with the best qualifications to perform the defined tasks (sekiguchi, 2004). but we can imagine the converse of this perspective, where we can ascertain how the workplace can adapt the tasks to the qualifications of the worker. the basis for these models is thus that problems arise through the imbalance between the job demands and the possibilities to fulfil them. in principle, this imbalance can be offset by two different strategies: the requirements can be reduced or the resources strengthened. if a good balance is achieved between the individual and the work, this will increase job satisfaction and motivation and decrease stress (sekiguchi, 2004). for our particular target group, both of these strategies are likely to be relevant. our basic assumption is that jobs for people with addiction and mental-health problems must be arranged to provide consistency between demands and resources (hansen, 2010). in practice this means that the work must not place greater demands on the target group than one can reasonably expect them to fulfil. it is also important to be aware of the particular resources of each individual and to adapt the workplace to enable each worker to make use of his or her resources (saleebey, 1996; graybeal, 2001). our main question is therefore: how is it possible to adapt workplaces to people with addiction and mental-health problems? the simple answer is thus to achieve a balance between demands and resources. based on our experiences from our study of a project, pedalen, our answer is yes: it is possible to adapt workplaces to people with addiction and mental-health problems, and we shall illustrate this by presenting some approaches that we argue have helped to facilitate participation in the working life for our target group. pedalen: the project in 2007, the norwegian church city mission began a project for people with addiction and mental-health problems. located in fredrikstad railway station the mission set up a parking area for bicycles and a bicycle shop. one of the basic ideas, besides establishing a sheltered workplace, was that the project should have an environmental profile and become a positive and visible offer to train travellers and the general population in fredrikstad. the project was njsr – nordic journal of social research vol. 6, 2015 139 named ‘pedalen’ (the pedal) and has since then become an established feature of the townscape. pedalen today offers sales of bicycles and equipment, repair and maintenance, and secure bicycle parking. pedalen has the capacity for ten participants and the core target group is people in aftercare related to drugassisted treatment (opioid replacement therapy, ort; norwegian: legemiddelassistert rehabilitering, lar) or in drug-free rehabilitation. pedalen is 50 per cent self-financed through the bicycle repair shop and parking. two managers and a volunteer are responsible for the day-to-day running of the enterprise. one of the managers has thorough expertise in bicycle maintenance and design. those who get adapted work in pedalen are described in the data presentation as employees. data collection a qualitative design has been chosen in this study. our choice of method was based on an assessment of what data were available and what data could be collected, the cost of various data-collection methods, and what could be achieved with the various types of data (danermark et al. 2003). the primary goal in this study has been to analyse flexibility as a work-participation strategy for people with addiction and mental-health problems. the starting point for the design of this study was the desire to conduct an intensive study (jacobsen, 2005; danermark et al., 2003) that would focus on gaining the best possible insights into the experience with pedalen as a work strategy. in our data collection, we chose therefore to concentrate on interviews with employees and other key players in the project. in this way, we mainly captured the positive experiences and to a lesser degree examined reasons why some people did not get the help they needed. this was a conscious choice because our limited resources meant that we had to give priority to the most effective activities. in all, 12 interviews were conducted. seven present and former employees of pedalen were interviewed. moreover, they were all at different levels or stages of work experience at pedalen. some informants had just begun, others had worked at pedalen for some time, and others had left the project for ordinary work. we also interviewed the two leaders of the church city mission who initiated pedalen as a strategy for work participation. we also interviewed the two daily leaders at pedalen and the volunteer involved in the project. participant observation was also used to observe how the work took place and how the social environment appeared to function. we made our observations at pedalen during the work hours and also during their daily lunch and their monthly personal meetings. the data from the observations made it possible to analyse interactions among the employees and between the leaders in both social and work contexts and to strengthen the analysis of the interaction and flexibility as a work-participation strategy. the interviews were mainly conducted at the workplace of the various informants. there were two researchers present at all interviews. interviews were carried out in a semi-structured format that allowed the researcher to njsr – nordic journal of social research vol. 6, 2015 140 investigate key topics regarding flexibility as a work-participation strategy for people with addictions and mental-health problems. all participants were informed of the objectives of the research and their right to withdraw at any time. the interviews were all digitally audio-recorded, and were subsequently initially analysed directly from the audio files by one of the researchers. the transcriptions were anonymized. the design and implementation of the project was performed under the approval of the norwegian social science data services (nsd), the data protection official for research for all the norwegian universities and university colleges. the empirical data was transcribed and analysed by all researchers from the printouts. the analysis consisted of processing the material through meaning condensation, coding, and categorization, using a suitably adapted form (miles & huberman 1994). the analysis of the data we have used in this article is based on a simplified model what lemire et al. (2012) call the ‘relevance explanation finder’. this analytical method is based on the identification of mechanisms, alternative explanations, and influencing factors. in this way the researcher discovers whether the findings can be explained by the theories on which the assumption was based, and whether the assumption that the measure led to the specific changes can be justified. in this case it meant that we were particularly interested in identifying statements that showed how the workplace facilitated the balance between demands and resources for its employees. our data analysis revealed two main factors affecting the possibilities of achieving a balance between demands and resources. one was a focus on user-participation and resource-orientation, while the other was a focus on integration and social inclusion. presentation of data user-participation and resource orientation user-participation and resource-orientation seemed to have a strong impact and focus amongst the leaders at pedalen. the first task when a new employee arrived at pedalen was to clarify what he or she can do. one of the leaders described how he proceeded: …i’ve had a little chat with each of them and i’m always trying to get an idea of their knowledge. what they know how to do and so on… yes, i really want the lads to work independently… and the whole time we adapt the system so that they can work independently… the focus of this conversation was what the employees can do, not what the employer wanted them to do. it was also interesting to note that this leader stressed that it was the system that must be adapted for the employees to function as desired. nevertheless, regular supervision by the staff was needed – both to provide advice and guidance and occasionally to set clear limits of acceptable behaviour. the leaders were aware that any matters that needed to be addressed should be discussed in a way that would be as least njsr – nordic journal of social research vol. 6, 2015 141 troublesome for the employee concerned. and this was described by one of the leaders as follows: if there’s a personal matter, we discuss it personally with the individual. we don’t get annoyed with anyone. we give advice and say, ‘maybe we could do things differently’. we don’t tell people off here… it was clear that the employees felt that the focus was on what they are capable of and that the employer appreciates the skills they mastered. this was illustrated by the following description by one of the employees: ...i like it here. i remember i was down here and had a look and i thought i hope i’ll get a job at pedalen soon. and i got the job! it’s great here. xx said, ‘you know about all that technical stuff’. i can fix things inside lamps. it’s called the pole; the shiny metals are called the pole. if they’re not there, you’ll never get power in the bulb. yy and xx tried but they couldn’t do it. i said i’ll try and then i couldn’t do it. then i thought if i put the screwdriver on the pole and bend it out a bit, then i put the wires in place and the soldering on the bulb, then screw in the bulb and roll the wheel, then it’ll light up. i’m really pleased i got this job.... the leaders were well aware that if people are to function properly in a workplace, more is needed than just skills. the employees must also be part of a social environment. one of the leaders emphasized this with the words: ‘the most important thing is the environment’. he clarified this further with the following statement: social coping is important, like feeling one can manage everything from having lunch to being part of a social group, feeling that it’s good to be here. so your self-confidence gets a boost. many of them are afraid to have lunch. so it’s about overcoming minor obstacles like that. in some cases, the workers have told us that they’re here to learn, not to eat. so sometimes they feel the threshold is too low. but it’s all about finding the right balance. and the focus is that we’re here to do a job. and this has been a challenge for providing good training – to make sure we get people in activity. it’s vital to create a good workplace, so they don’t experience new failures… integration and social inclusion pedalen contributed also as a social workplace both for the leaders and the employees. the leaders attached great importance to social activities and organized trips for employees, such as annual visits to bicycle manufacturers and also other companies connected to the bicycle business. these trips were of great importance for conversations over lunch – which was a common meeting point for both employees and leaders – and also an inspiration for enhancing the work with bicycles. these social activities brought everyone in pedalen together in conversations about common experiences and common goals for the future. for most employees, these social activities were an opportunity to socialize with others outside working hours. the social environment was also important to the employees and one of them described how the work has given him a friend whom he also meet in his spare time: njsr – nordic journal of social research vol. 6, 2015 142 …i’ve made a friend here. we live quite near each other. so for some months now we’ve been getting together at his place or mine. we watch films and play playstation – make something to eat and so on. we have a nice time together. that’s good. it’s good to have friends. although pedalen is a sheltered workplace, it is emphasized that certain demands should be placed on the employees. also with regard to the social tone among the employees, it is stressed that it should be like ordinary workplace, and discussions about alcohols, drugs, illness or medication was viewed as private and unsuitable as topics of conversation. one of the leaders explained: …when you’re at work, you’re at work and we try to make things function like any other job. you don’t open up and talk about your big drug problem. it’s not a good idea to start with that if the everyday things are going ok otherwise. other people take medicine for other things without it being some kind of big issue. they get medicines for their problems… although pedalen involves a shielding from certain types of demands the employees may encounter elsewhere in society, it is in many ways one of the least sheltered workplaces in fredrikstad. with its central location at the railway station, pedalen is a distinct element in the urban landscape. it is also obvious that pedalen is dependent on giving customers good service. although it is the only business that offers secure bicycle parking at the railway station, they compete with others in bicycle repairs. this was something the employees realized very clearly, as this statement shows: … it’s worthwhile work. in a way, it’s a normal shop. except the people working here, are unskilled. but we still aim for quality. you can see that in all the bikes we get. and people are satisfied. so that shows people are pleased with the work that’s being done... the employees also found it important that the job made them part of normal working life. one of them put it this way: …yes, you’ve got to feel you’re part of society. you’re doing something useful. and you come home and well, yes, you’ve done something. kind of like, well, now it’s the weekend. you look forward to the weekend… the workers’ descriptions of their everyday work in such statements were quite similar to descriptions of ordinary businesses that are dependent on customers and seasonal fluctuations and have to deal with tasks that pile up. discussion arrangements to help people with addiction and mental-health problems into employment are based on two different strategies. prevocational training creates sheltered work arrangements where employees can receive education and training to enable them eventually to qualify for jobs in the mainstream labour market, while supported employment provides jobs in ordinary workplaces where employees with special needs receive comprehensive support to enable them to fulfil the requirements for the job (crowther et al., njsr – nordic journal of social research vol. 6, 2015 143 2001). both strategies are ways of building the employees’ resources so that they can fulfil the workplace’s ordinary demands. individual resources a basic principle of this project thus seems to be to take the employees seriously and to help each individual to utilize and develop his inherent resources. the focus is not on diagnoses and problems, but rather on the kind of skills and resources each employee represents. the basis here is clearly the principles of social work known as strengths-based social work (saleebey, 1996; graybeal, 2001). we regard pedalen as a workplace where the work adapts to the worker and not the converse. in our understanding of the data, pedalen is flexible in two ways. first, it adapts the work requirements in order to avoid placing excessive demands on the individual employee. the work requirements are not adapted to the employer’s need to boost production or other key expectations found in ordinary working life. secondly, the leaders make an effort to find each employee’s particular resources. they become aware of what each individual can do and try to adapt demands and resources so that each person can utilize his resources and perform the tasks assigned to him. the leaders also emphasize following up the employees with assistance and instructions so that they can broaden their responsibilities, thus strengthening their resources. social inclusion at the same time, the leaders are well aware that this group of employees has certain challenges, such as those related to social participation. these challenges are not ignored, but an attempt is made to help the individual employee to master the situations he encounters. pedalen differs from many sheltered workplaces where the leaders and the employees do not socialize during lunch-breaks. but at pedalen it is important that everybody feel included. therefore the leaders have an open-door policy and try to mingle with the employees as much as possible, also during breaks. like solheim (2007) we see this form of social inclusion as a way of building a network and augmenting social capital. as putnam (1995) points out, social capital is an important part of people's resources. another important aspect of pedalen is the way the work provides the employees with status and self-esteem. on the one hand, pedalen makes an effort to become an ordinary company that conducts normal business activities; on the other hand, it is a sheltered enterprise where all employees have a need for adapted work. in the case of pedalen, it provides adapted and sheltered jobs, but it is also a customer-oriented enterprise. in practice this means that the employees feel that although they have adapted work, they are integrated into ordinary working life. it can easily be imagined that working in a sheltered enterprise could stigmatize the employees. although pedalen involves a shielding from certain types of demands, its employees can meet elsewhere. it is in many ways one of the least sheltered workplaces in the town. centrally located at the railway station, pedalen is a distinct element in the townscape; one could imagine that this might lead to stigmatization of the workers. but they have clearly not experienced this. njsr – nordic journal of social research vol. 6, 2015 144 one challenge in measures such as supported employment is that the organizational culture of the company may not be sufficiently inclusive. kirsh (2000) shows that people with mental-health problems place a great amount of emphasis on the work environment being supportive, fair, tolerant, and socially inclusive. these qualities are encountered at pedalen, which thus represents an organizational culture that makes employees feel included, increasing the chances that they can master the challenges they face. the employees identify with the ideology of the enterprise. one important aspect of pedalen is that it appears to people as a useful initiative that benefits society. several of the informants point out how important it is that the employees receive wages and pay taxes. we also see that encouraging more cycling in society is viewed as a politically correct activity. it is quite evident that the pedalen employees feel that their work is making a positive contribution to society. here the main aspect is that pedalen makes it easier for train travellers to cycle to and from the station, and is therefore an ecofriendly initiative. in addition, several informants emphasized that pedalen’s activities on the premises have made the building itself and its interior more attractive and the building has thus enhanced the general upgrading of the environment outside the railway station. this achieves what is called an ‘ideological congruence ‘(morley, 2007), which helps the employees to feel that their work is meaningful. flexibility what then actually enables pedalen to provide for its employees as described here? we believe that the answer lies in the concept of flexibility. with regard to work in general, flexibility is a term used in different contexts and it is difficult to find a precise definition (skorstad, 2009). but the concept is almost always positive. flexibility is often linked to a strategy to meet the challenges facing an industry in regard to international competition, technological developments, and rapid changes in market conditions (karlsson, 2009). flexibility can be linked to various aspects of work, such as flexible employment, flexible companies, flexible workers, and so on. very often flexibility is mentioned in such contexts in absolute terms: one is either flexible or inflexible. in what respect a person is flexible carries less weight. wilton (2004) shows, for example, that the trends which are usually described as increased flexibility in work generally make it more difficult rather than easier for disabled people to function at work. wilton’s conclusions are admittedly based on a study from canada, but there is no reason to believe that the work context differs greatly between canada and norway in this respect. karlsson (2009) asks the question ‘good and bad flexibility for whom?’ his review of the relevant literature shows, not surprisingly, that the answer to this question depends on how one defines flexibility and on what interests form the basis for one’s assessment of what is good or bad. a clear example of this is the distinction between being flexible – where the worker is required to react appropriately in order to adapt to changing conditions at work – and having flexibility – where the worker has the possibility of exercising some degree of autonomy. when the employee is expected to vary his work by performing different kinds of tasks, one makes use of so-called functional flexibility (atkinson, 1984). such variation in work is normally considered to be positive for the employee, but it is important to bear in mind that it is not the employee’s wish for variety that determines the work he has to perform, but njsr – nordic journal of social research vol. 6, 2015 145 rather the needs of the employer. in practice it therefore makes a considerable difference to a worker whether he or she is flexible or possesses flexibility (bekkengen, 2002). yet both situations are described as examples of flexible working. at pedalen we see an example of a workplace where the workers have flexibility, that is, the latitude to decide for themselves how they work, and our conclusion is that this kind of flexibility is essential if one wishes to create workplaces for people with addiction and mental-health problems. summary the success factor for getting people with addictions and mental-health problems into employment is to find a balance between the demands placed on an employee and 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(2004). from flexibility to accommodation? disabled people and the reinvention of paid work. transactions of the institute of british geographers, 29(4), 420-432. microsoft word 04 care as you like it, final, pages corrected.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2011 – special issue care as you like it: the construction of a consumer approach in home care in denmark tine rostgaard sfi – the danish national centre for social research email: tr@sfi.dk abstract the free choice of a home-care provider was introduced in danish home care in 2001. this article discusses the overall premises for the introduction of free choice in home care and how it constitutes an overarching response to the crisis of the welfare state. the government at that time intended free choice to lead to more user-led services, more cost-efficient services, and the development of a care market, all in line with its ideology. the article argues that to achieve these ambitions, the government introduced many new but implicit assumptions about the role and the responsibilities of the user of care. on the basis of qualitative interviews with elderly users, care workers, and care assessors, the article examines these assumptions and their implications for the user. the findings show that most users desire continuity in care more than the opportunity to ‘exit’ a care relationship. moreover, users do not rate quality any higher in the private for-profit sector than in the public. the article concludes that consumerism is in denmark now part of the logic of governance, thereby changing the conditionality of the welfare state and its subjects, and creating new forms of risks, responsibilities, and dependencies. keywords: choice, home help, denmark, consumerism, elderly introduction in 2003, a liberal-conservative government introduced the free choice of provider in danish home care in order to improve user autonomy and care quality, to cut costs, and more implicitly to encourage the development of a market in care. from this point onwards, local authorities had to ensure that private for-profit providers of home care operate along side municipal njsr – nordic journal of social research 2011 – special issue 55 providers. elderly (and other users of home care) can in most municipalities today choose between the two types of provider once an assessor employed in the municipality has evaluated their needs. the service has continued to be free of charge and the number of care hours remains the same, regardless of which provider is chosen. the minister of social affairs at that time claimed the following: the introduction of free choice has given dignity of the elderly pride of place, simply because from now on they will be able to exercise a choice, rather than merely use the municipal standard service offer. for the government it is simply how we view human nature. (henriette kjær, former minister of social affairs; author’s translation) this statement illustrates that the policy of introducing a consumer choice between public and private for-profit providers of home care in denmark intended to constitute a change of governance, which reflected a perspective of human nature that coupled human dignity with the possibility of exercising choice. however, as this article argues, the introduction of choice is a logic of governance that appears to be multi-functional and goes well beyond concerns about individual human dignity. the introduction of choice acts as an overarching policy strategy in the wake of overall criticisms of the failures of the welfare state and seeks this regime’s modernization. this is not restricted to denmark. ‘choice’ has in many european countries become a major buzzword in political rhetoric, along with others such as ‘user-involvement’, ‘participation’, ‘empowerment’, and ‘active welfare citizenship’ (evers, 2003). along with competition, contracts, and cost control, free choice is an important component of the institutional and organizational reforms inspired by new public management (npm), which have affected the public sector in many countries in recent years (vabø, 2009; pollitt & bouckaert, 2000). the search both for more diversity and pluralism in service orientation and practice and for greater efficiency and effectiveness works surprisingly well with the governmental desire to confer more power on users. thus, at least on the surface, no disparity or conflict between these goals appears to exist. choice has in denmark been an element of reforms of various policy areas since the late 1990s, particularly within care for the elderly. the focus of this article, home help for the elderly, has been the political test case of the introduction of the danish version of choice. the elderly have been provided with what is called a ‘free choice’ between a public and a private for-profit home help provider(s). while other countries have introduced the choice of provider of home help as a voluntary option for the municipalities in recent years (see e.g., blomberg et al., 2000; blomqvist, 2004; edelbalk & svensson, 2004; rønning, 2004; stevens et al., 2011), denmark has gone further and made it obligatory for the municipalities to enter into contracts with for-profit providers, and almost all municipalities today offer this choice. in denmark, the government has framed the choice as being directly related to gains of efficiency and improvement of quality, while toning down its more political and ideological preference for privatization. by focusing on the user of care services, this new policy promised to introduce more empowerment and more individualized services. little, however, was said about whether increased user-involvement would change the care relationship between care recipient and care provider, and if change were to occur, what might be the results. this article aims to investigate both the reasons for the government’s introduction of free choice of home-care provider and its description of the shape it was to take. the aim is first, on a more theoretical level, to njsr – nordic journal of social research 2011 – special issue 56 understand how the introduction of free choice is situated in the overall modernization of the welfare state. secondly, the aim is to investigate after the introduction of free choice the expectations attached to roles and relationships that were communicated to the elderly as recipients of home care. this aspect is illustrated by statements of users of home care, care workers, and care assessors. the article thus examines the implicit assumptions about the elderly as users in the consumerist model in regard to the identification of need, quality, and possibilities for expressing satisfaction through the exit or entry into provider organizations. this article is based on qualitative interviews with users of private for-profit and public home care, care workers working in public or private for-profit home-care sectors, and care assessors employed with the municipality. interviews were conducted in four danish municipalities (bogense, kalundborg, søllerød, and århus) in 2007. in all, 18 individual interviews and 14 focus-group interviews were carried out. observational studies were also applied. this article argues that the initial notions of welfare-state failure have given way to a new regime of consumerism in denmark. free choice was the allembracing answer to many of the paradoxes of the welfare-state crisis: it was supposed to result in better user-led quality of care, and to provide more costefficient services, and it was intended to develop a care market, in line with the ideology of the present government. free choice seems to introduce new rights of equality, making everyone entitled to choice and giving the user a new active role. the argument presented here, however, is that the elderly themselves desire continuity in care, not the possibility of exiting and thus ending care relationships. moreover, free choice in care overlooks the crucial point, that care work involves relationships, trust, and dependency, and thus care cannot be viewed as simply another commodity. the crisis of the professionalized welfare state – where to go from here? the introduction of free choice in danish social policy is part of a strategy to respond to criticisms of the welfarist approach, with its standardized products, top-down decision-making, and the automatic acceptance of the judgment of professionals (evers, 2003). free choice, however, has also been part of a danish political and ideological project to introduce more market mechanisms into the public welfare sector. one important factor contributing to the demands for more free choice has been the underlying assumption that the welfare state in its present form has failed. a look at the internal1 challenges to the welfare state reveals at least three general explanations for this welfarestate failure of legitimacy and governance, all of which are also consistent with the criticisms of the danish welfare approach. first, some scholars invoke the theory of systemic overload, as social problems have become increasingly politicized and made public, and demands are often contradictory and of both economic and political concern (e.g., the lack of producer efficiency, the failure to meet user demands, and the lack of service innovation) (clarke & newman, 1997). the theory of systemic overload has also been a driving factor behind danish modernization 1 for external shocks to the welfare state, see e.g., pierson (2007) beyond the welfare state? polity press: london. njsr – nordic journal of social research 2011 – special issue 57 reforms, which have focused on increased professionalization, accountability, control, equity, cost-efficiency, and more (melander, 2008). secondly, there are researchers who note a conflict between equality that is a political promise of the universal welfare state and the actual welfare outcome (højlund, 2002), especially as decentralization is very pronounced in the scandinavian welfare states. this phenomenon has led kröger (2009), amongst others, to argue that the scandinavian countries have ‘welfare municipalities’ rather than a welfare state, with a single and uniform welfare approach. until 2007, in denmark alone, 275 local municipalities were in charge of social care; after a re-structuring reform they are now down to ‘only’ 98. the local approach is especially pronounced within social-care services, where local politics result in different welfare policies, provisions, and outcomes, which is exemplified, for example, in the variation in public spending for elderly care across municipalities (lolle, 1999). the social-care services are also policy areas in which needs are very individual and therefore difficult to generalize. the same care need may result in different welfare responses across local areas, and the need for social care for two people, despite their having similar social problems, may also be perceived differently. although the danish welfare system is based on this decentralized approach, the welfare state is nevertheless not able to deliver uniform, equal outcomes. thirdly, some scholars see a conflict between ensuring autonomy and legitimizing public intervention in private affairs for a higher social purpose. this is a classic clash between social-liberalist assumptions about the legitimacy of intervention in matters of lifestyles, family formation, choice of education and work, and more, and a more liberal assumption of the sovereignty of the individual (højlund, 2002) – where the latter has been especially successful in advocating for choice, while emerging individualization has been a driving factor favouring the individualist approach. other forces have also fostered this development, through the increasing dominance of bureaucratic logic and consumer-market logic (kremer, 2006). the consumerist approach obviously breaks with previous assumptions that only professionals should define need. the accommodation of participation and empowerment of the user has thus gone hand in hand with increasing criticism of the previously unchallenged dominance of professionalism. not only should users have a stronger voice in the decision-making, but there should be better political control and accountability of the work done by professionals, and it should be paid by the public (foster & wilding, 2000). dybbroe (2008, p. 44) notes that this increasing political and institutional control in the care sector has in fact led to a standardization and manualization of the care work. according to her, this development results in a de-qualification of care workers since work is now ‘less dependent on the learning and development of the care worker and more dependent on political and institutionally directed constructions of caring practices’. the increased participation and empowerment of the user has, however, been of more concern, and the liberal-conservative government that took office in 2003 saw free choice as a way of accommodating such individual preferences. the following statement exemplifies this view: with the free choice, the individual can better influence his/her own life, and at the same time citizens will experience a more attentive public sector, with a focus on individual wishes and needs. (regeringen, 2002, author’s translation) njsr – nordic journal of social research 2011 – special issue 58 welfare reform in a social-democratic welfare regime: entering free choice free choice is an appealing strategy as it appears to offer the possibilities of both introducing more user empowerment and signalling political innovation and responses to criticisms of a lack of equality and individualism. in denmark free choice between a public and private for-profit provider has, therefore, been a central element of many reform strategies since the late 1990s. initially, launched by the conservative government in 1991 in the health-care sector as part of a strategy of marketization and privatization,2 the free choice of public and private for-profit providers was a response to critics who claimed that the health system was both ineffective and too costly, claims that were by then universal in most welfare states. the notion of free choice soon proved persistent in the danish political rhetoric, including with the social-democratic government that came to power in 1992. however, the party backbenchers demanded stronger opposition to privatization and outsourcing, viewing both as antithetical to the very essence of social-democracy. the government decided, therefore, that basic services such as home help were to remain within the public sphere. thus in contrast to the swedish reforms in the early 1990s that allowed the privatization of home help as part of the economic-crisis package, denmark continued its public provision of home care into the new millennium. the form of free choice in home help however, when a liberal-conservative government came into office in 2001, free choice was placed on the agenda as part of its overall npm strategies. since then, the choice option has spread to other policy areas, as a fundamental element in the modernization of the welfare state (greve, 2004). for the elderly who live in their own home, the introduction in 2002 of free choice initially encompassed only practical care assistance, such as help with cleaning, shopping, and doing the laundry. personal care, such as help with bathing and getting dressed, was not included, and continued to be provided by the public home-help providers. this distinction in the free choice clearly reflected the legacy of social-democratic welfare ideas, that the privatization of these kinds of intimate services as personal care was inappropriate. in 2003.3 however, the liberal-conservative government decided to include personal care in the drive for free choice. private for-profit providers thus today offer the same services as public providers and also provide services around-the-clock. in addition to basic personal care and assistance with practical tasks, private for-profit providers can also offer what is called additional services, such as gardening, window polishing, snow clearing, or simply time to sit and chat, as is shown in one of the illustrations from the interviews with private home-help providers below. all of these services are charged. in order to increase the number of private for-profit providers, local councils are now obliged by law to ensure that these providers operate in the municipalities. in turn, municipalities must enter into contracts with private forprofit companies, along with the municipal home-help services, so that the 2 see also rostgaard, 2006 for a more extensive account of the introduction of free choice in home care. 3 lov nr. 399 af 6. juni 2002 frit valg af leverandør af personlig og praktisk hjælp [free choice of provider of personal and practical help]. njsr – nordic journal of social research 2011 – special issue 59 elderly can choose between one or more private and public providers. while the provision of home help remained free of charge, regardless of who provides the care or how many hours were provided, private for-profit companies can charge for extra services such as window cleaning. the process for receiving help has remained the same. the elderly are still assessed by a care assessor who is employed in the municipality according to the same needs-assessment criteria as before. however, with the introduction of a purchaser-provider split these assessors today no longer operate from the same premises as the public home-help provider. by 2010, 611 private for-profit home care companies were operating in denmark, and only four out of 98 municipalities had no private for-profit provision of home help. excluding copenhagen, which has 57 private for-profit companies, on average six companies operated in each municipality offering free choice, with urban areas having the highest concentration of providers (danmarks statistik, n.d). in the spring of 2011, in order to stimulate the privatization of social care, the government debated whether in some municipalities the implementation of free choice should also exclude public providers, so that in those municipalities only private for-profit providers would operate. construction of a consumer approach – what are the assumptions? several political arguments support the decision to introduce more choice for users. first of all, free choice constitutes a timely answer to the requests for more individualized welfare solutions in that it can accommodate what the ministry of finance sees as ‘the citizen who increasingly views her/himself as set free from both the close and the larger communities, and therefore places more individual and critical demands to society, including to the public services’ (finansministeriet, 2002, author’s translation). secondly, free choice breaks with the former public monopoly of service provision, thereby ensuring a more efficient and improved care provision. according to traditional assumptions about the market mechanism, the quality of care should improve as providers compete and as users gain influence through their choices. nonetheless, the question remains of what implicit assumptions there might be in the drive for free choice with regard to the role and responsibilities of the user and the purpose of care provision, as viewed from the perspective of elderly users, care workers, and care assessors. a new focus – the active user at the heart of free choice lies the assumption of the autonomous user. the ageing population is expected to be increasingly more diverse and individualized, and presumably will require more diversified welfare solutions that give the user more say in the organization of care. this assumption underpins the views that proponents of free choice hold, even though users in most danish user surveys pre-dating the introduction of free choice expressed satisfaction with the public provision of welfare. such satisfaction is in contrast to the introduction of choice in other countries, where powerful organizations representing people with disabilities demanded more choice (e.g., stevens et al., 2011). still, the government believed that free choice would make the citizen more satisfied and more autonomous, whether he or she actually exercised this option (kommunernes landsforening, 2004; finansministeriet, 2002). njsr – nordic journal of social research 2011 – special issue 60 thus, care now has a new function: the organization of care must not only ensure that the cared-for receives what they need, but it must also contribute to the users’ autonomy. as care provision becomes user-led, not provider-led, the needs of the user are to lie at the centre, requiring the user to become more active. users need to identify what – for them as individuals – is the best organization of care and they must express this decision through the choice of provider. the new care regime thus assumes that the user is no longer a passive care recipient but an active one. easy exit the user in this way becomes a consumer with the possibility of ‘shopping elsewhere’ if he or she so desires. the choice itself provides him or her with influence and ensures that the care organization listens to him or her. there are in principle no constraints on the individual’s exercise of consumer power, and he or she is obliged to make a choice of provider, but can choose a new provider as often as he or she pleases. as jon, a care assessor, expresses it, the ‘choice technology’ is easy to operate. it only involves contacting the municipality if one wishes to change provider: and now there is a free choice, and many calls us – and they just need to call and say that they would like to change provider, and then we help them. (jon, care assessor, author’s translation) the introduction of choice thus presumes the existence of an easy and real opportunity for exiting, a choice that enables users to express dissatisfaction in a new way. less complex identification of quality in the municipalities, users are then observed how they exercise the choice, as a way of understanding users’ preferences for the organization of care. in this way, municipal home-care organizations, local politicians, and administrators find it less complex to observe how specific users wish to see care provided. the administration statistics on the share of users using forprofit providers and municipal providers, and more importantly, any changes in this distribution, the municipality uses as a guideline of user preferences, pinpointing which provider has provided good-quality care. in this way, the choice option also serves as a complexity reducing technology. from a political and administrative perspective, the identification and determination of how well the home-care organization is performing becomes less complex with respect to the offering of services in accordance with user preferences. previously, such information was difficult to obtain because it required, for example, user-satisfaction surveys. now, the municipality simply interprets users’ patterns of entry into and exiting from public and private services as an important indicator of whether various homecare providers are doing their job properly. consequently, users need to understand that choice is something that is observed and interpreted. the ‘competent’ consumer would, therefore, act differently from michael, who says: ‘i think it is a rather big company, but it was purely accidental that we chose them. or perhaps we asked the care assessor in the municipality, that might be it (michael, user of private for-profit home care, author’s translation). njsr – nordic journal of social research 2011 – special issue 61 common learning the implicit expectation is that choice not only implies a movement between some constant alternatives (the private for-profit or the municipal provider), but choice should also help develop the quality of care, in that the various providers will learn from one another. the user is expected to choose the best alternative, and the provider is expected to consider why it was chosen or not. providers are in this way expected to gain the opportunity to learn from one another by being inspired, thereby contributing to a general upgrading of the quality of care. as anne, who works as a home helper in a private for-profit home care organization, expresses it: i have experienced that those who receive municipal care, they also receive better municipal care after we entered the market. now they [the municipality] suddenly need to deliver better services, and that must in the end benefit the elderly. so, things being equal, i think...that it is a good idea, because we need some competition. (anne, private home helper, author’s translation) choice thus not only ensures that the user has an opportunity help weed out poor quality providers, but also demands that care organizations that are not chosen learn and develop according to user preferences. setting the user free – but obliged to choose although free choice allows the user to choose his or her own provider, the user is also obligated to make a choice. in other words, the user has the right to choose but no right not to choose. all users must make a choice when the care assessor comes to visit: what i do, when i visit an older person, is to bring three booklets explaining the free choice option. i take them out, when i sit with the citizen, and i say ‘you have received these by mail. have you thought about what you want to answer? (kirsten, care assessor, author’s translation) cathrine, a care recipient, says that the municipality involved in communicating free choice to her suggests that it is legitimate to choose a provider other than the public one: you see, i received this form where you could choose. so in a way, it is the municipality that appreciated it that we can choose between a public and a private provider. (cathrine, municipal care recipient, author’s translation) while in principle the care assessor must not make the choice for the user, many users are highly reliant on the care assessor to make the choice, as in michael’s case. npm-remodelling strategies also imply a change in the daily organization of care and a pre-condition for the outsourcing of care is often that the organization of care assessment and care provision is split (trydegård, forthcoming). following the introduction of this purchaser-provider split, care assessors in denmark today also operate from office facilities separate from those of the public home-help providers, and in principle should favour any providers. little, however, is known about whether care assessors assist the elderly in making the choice of provider, and if they do, how. njsr – nordic journal of social research 2011 – special issue 62 moreover, making the choice can be difficult. as anja, a care assessor, noted: i often experience that [older citizens] think that it is difficult to choose. ‘can’t you do it?’, they say. but then…then i leave [the brochures] in their home, and then they can have a look and call me when they have...maybe they call round and see whether they [the providers] can cater to some special needs which they [the older citizens] may have... (anja, care assessor, author’s translation) the elderly in this way are expected to take action and to seek more information, perhaps by contacting other providers and asking about what they offer. essential for the proper functioning of the choice option as a complexreducing technology is that choices are not made randomly, but on the basis of careful considerations of where the best quality lies. as an autonomous user, the elderly individual is, therefore, expected to seek information that allows him or her to differentiate between the different service providers and to make a choice based on an assumption about which provider is best. the new expert of needs and quality users are now the ones who decide what is best for them; if they find that the care is not according to their liking or if they disagree with the care worker’s approach, they can choose another provider organization. this user power makes the user the expert, as with the principles of consumerism, and transfers some of the identification of need and of the right form of care to the user, which is formally the last link in the care chain. in contrast, the professional care worker loses some say and can be challenged about his or her opinions. hanne and sanne, who both work as privately employed home helpers, commented on these changes: it is sort of, when they are with the municipality, they are assigned something, but when they are with us, they are the ones to decide. it’s the mentality. (hanne, author’s translation) they become sort of the employer. yeah, that’s the right word, i will use. masters in their own house. ‘i’m the one living here’, right? ‘i’m the boss’, right? (sanne, author’s translation) nonetheless, even with free choice, the service must be offered according to what is permitted in the care assessment; no one can receive more help than what the care assessor has written in the care plan. as anne, a municipal home helper, comments: i’ve talked with one of those users that i visit regularly and she says ‘i don’t care who does the cleaning, ‘cause in the end i don’t get more time. i get the same service, no matter who i choose’ so she stayed with us. and she is right, you know. (anne-mette, municipal home helper, author’s translation) even so, free choice entails new assumptions about user-influence and responsibility, thereby also stretching the role of the elderly as the one who must identify and assess quality. the expectation that competition between public and private providers will lead to better quality includes the user’s choosing the ‘best’ provider. thus, the user now has part of the responsibility for developing quality. if the user believes that the quality of his or her care is njsr – nordic journal of social research 2011 – special issue 63 insufficient, that user is entitled – but also expected – to change provider. the user must then also answer for the consequences of his or her choices: if the users remain with a provider who continues to provide care, it is partly a consequence of her own actions, because the user could have chosen differently. thus, the discourse of freedom does not acknowledge the new risks which are created, namely, the freedom to make bad or wrong choices. equal choice for all – but not equal outcomes the choice option also includes an assumption that choice is equal for all. in this way choice is in line with the universalist notion of the welfare state whereby everyone, regardless of age, gender or social class, is entitled to exercise choice. in reality, however, how choice is made differs considerably amongst users. it is primarily new users who choose private for-profit providers, presumably because they must exercise choice when entering the system whereas users already in the system may be offered the choice, but do not have to do so – and this difference matters: i would say that most of those who have received services prior [to the free choice], and whom we call, are typically those who decide to stay where they are. there are few who decide to move. the new ones, on the other hand, who might need temporary care following a surgical procedure or something else, very often, once they take a look at it, chooses a private provider just as often as a municipal one. (kirsten, care assessor, author’s translation) new users not only arrive with no prior attachment to a particular provider, but are often also less frail and therefore less risk-adverse. the outcome of choice is in this way not equal; the choice is made on the basis of care needs, where care dependency also influences the choice: there is this tendency of those who are most frail and least self-reliant to choose the municipal provider. while those who do well and manage somewhat on their own primarily choose the private. it’s like: ‘well, i am in safe, municipal hands if something should go wrong’. (josephine, care assessor, author’s translation) in the early days of free choice, then, mainly new users chose a private forprofit provider. often these users received only practical assistance. as expected, however, this practice changed over time: in 2004, two per cent of users receiving personal care and 22 per cent of users receiving practical assistance received help from a private for-profit provider (den sociale ankestyrelse, 2004). in 2009, 31 per cent of recipients of practical assistance used a private for-profit provider, compared to only five per cent of recipients of personal care (danmarks statistik, n.d.). part of the reason for the increase in the use of private for-profit provision of care may be that users today are more acquainted with the free-choice option and the local companies operating in their area. nonetheless, many users remain unaware of the possibility of choosing between providers, and a survey in 2009 has shown that only 65 per cent of users know that they can exercise this right (capacent, 2009). presumably these users are mainly those who have received services for many years and therefore have not had to choose. njsr – nordic journal of social research 2011 – special issue 64 exiting a care relation however, even if users know about the possibility of choosing, exercising choice may not be a straightforward matter. the user can choose as many providers (and as often) as he or she likes, but changing a care provider constitutes stating that the quality of the present provider is insufficient. however, the consequences of using their option to exit may not be clear to the user, as mille, who works as a care assessor, explains: ‘i also experience that they then ask: what if i need personal care? will you be mad at me for choosing [a private for-profit provider]?’ (author’s translation) moreover, for most users of care, their major concern is not whether they are entitled to exit or to end a care relationship, but rather to maintain one, as cathrine, a user of municipal home help, says: ‘i think it would be good if we could have the same home helper more than once’ (author’s translation). often what is at stake is that during the day or week the elderly will be visited by many different care workers. continuity in staff is rare, not only for those elderly who receive services several times a day, for whom care is often provided by more than one care worker. a recent nationally representative survey of home-help users has shown that one in five users of home help (18.2 per cent) is either very dissatisfied or dissatisfied with the number of care workers (capacent, 2009). dissatisfaction is more pronounced amongst users who receive both personal and practical care, and these recipients of care are thus more likely to receive a visit from the home helper several times a day. here 22.4 per cent of users express dissatisfaction, in comparison to users of practical care only, where 17.1 per cent are dissatisfied. as we have seen, most users (95 per cent) of personal care use a public provider and a higher proportion of users of municipal services are dissatisfied with the continuity of staff (21.0 per cent) compared to users of private for-profit providers (10.2 per cent). even if free choice is associated with the possibility of exiting and of maintaining a care relationship, private for-profit providers are nevertheless gaining ground because they are able to deliver continuity in care and to promote their services on the basis of that activity. staff continuity is found in other studies to be the most desired attribute of quality from both older persons and care workers (edebalk et al., 1995; rostgaard & thorgaard 2007). according to monica, a care assessor, users do appreciate the same person coming to visit: ‘this is something the elderly appreciates. that is, that it is the same person’ (author’s translation). monica states that it is not only the same person but also a person with certain characteristics that private forprofit providers can guarantee. ‘some of the private ones also promote themselves by saying that the care workers working with them are mature ladies, instead of the young lasses that the municipality sends. what they mainly emphasize is that it is the same person and that you yourself can decide whether you want a man or a woman’ (author’s translation). but the choice of a certain person or a person with certain characteristics, such as experience with care work, is not part of the assumptions underlying free choice of home-help provider. although some private for-profit providers seem also to guarantee a choice of staff member, this certainly seems not to be practised amongst municipal home-help providers. as gitte and elsebeth, both municipal home helpers, explain: njsr – nordic journal of social research 2011 – special issue 65 well, i have a funny story: when free choice was introduced, one of our users thought you could choose which home help you’d want to come and help you from the municipal provider [everyone laughs]. because it was ‘free choice’, so we let him, but we normally don’t. it depends on who has time and so on.” (gitte, author’s translation) yes, i experienced the same. and then she said: ‘i would like to hire you.’ yes, yes. [they laugh] they misunderstand it, yes, they do. (elisabeth, author’s translation) care in the name of freedom a final implicit assumption when autonomy is communicated as a precondition of quality of care is that care is a commodity like any other, which the user decides to make use of. with several providers offering services, the user must from the beginning act as a critical consumer who is sceptical about the ‘commodity’ which she is offered, that is the kind of care which the provider can offer. this assumption, therefore, rests on the belief that the user must pay attention to whether he or she has received the best quality. rather than a relationship build on trust, the market relationship assumes that the consumer keeps a certain distance and continuously reflects on whether another commodity might be better. however, elderly care entails a very personal and often very intimate relationship between user and care giver. care takes place in the individual’s private home and involves very private and intimate activities. this situation requires that a certain trust be in place between care user and care giver and that the care giver understands and respects the elderly’s dignity, vulnerability, and frailty, and such a relationship often requires time to develop. as rønning (2004) states, however, it seems as if a battle of the very soul of care has been taking place these past years. this battle stands between the view of care as a commodity, where the issues concern cost-efficiency, the standardization of care needs, and the price-setting of care, and the view that considers care as an encounter between care recipient and care provider, which is based in a social relationship between the two. as the assumption behind free choice is that the care relationship can be terminated and replaced, it ignores the process involved in establishing such a relationship. it also overlooks entirely the fact that care needs cannot be postponed until something better is within reach. it is not possible, as with other commodities, for the elderly to ‘shop around’ until something better comes along. nevertheless, the assumption that care can be treated as a commodity is gaining ground, as this conversation between albert, who receives private forprofit home help, and three private home helpers illustrates: albert: ‘when you are at my age, one doesn’t have much family, and then one might need someone to talk to. there isn’t much of that.’ sidsel (private home helper): ‘but have you ever considered that when you receive care from a private provider, you can buy extra time? have you thought about that?’ albert: ‘i know that, but that’s not it. i can’t buy time to have someone sit and chat over a cup of coffee.’ astrid (private home helper): ‘oh yes. you certainly can.’ njsr – nordic journal of social research 2011 – special issue 66 mette-marie (private home helper): ‘you decide yourself what you want us to spend time on. you decide what we should do during the extra time that you purchase. it is not we who decide what to do. it’s your money. so it is only you who has to decide what is done.’ better quality? has the introduction of private for-profit providers of home care led to the expected increase in quality? according to one care assessor, private for-profit providers provide more stable services and a difference in the approach to the user in that private for-profit providers appreciate to a higher degree that they are deliberately chosen: and the municipality is not service minded or provide stability well enough. we are not good enough at this either. and we are not good at getting out there and selling ourselves. well, the private providers in our municipality, they come visiting, every time they have a new user, and say: thank you for choosing us’...well, you know, the municipality would never dream of doing this. (mille, care assessor) users themselves acknowledge the possibility of choosing a provider: 57 per cent thus responded that having a choice of provider is either very important or important to them (capacent, 2009). nevertheless, ratings of quality show little difference between how users rate the care from the two provider types. amongst users receiving practical assistance, 85.8 per cent of users of municipal home care are either satisfied overall or very satisfied with the services overall, whereas the share is only 86.5 per cent for users of private for-profit home care. amongst users of personal care, 92.2 per cent of users of municipal home care are satisfied overall or very satisfied, compared to 85.7 per cent of users of private for-profit home care (capacent, 2009). conclusion the introduction of consumerism in social policy in denmark, exemplified by the introduction of free choice in home care, appears to be part of an overall agenda of re-shifting the problematics of the traditional welfare state and, in particular, of overcoming ideological resistance to privatization. initially, notions of welfare-state failure gave way to the new notion of consumerism in denmark. the criticism aimed at the welfare state has come about because various paradoxes have been created over time and the welfare state has become increasingly complex. paradoxes have arisen 1) because the welfare state at one and the same time has increased the politicization of problems while being accused of public welfare inefficiency and bureaucracy; 2) because both the political goal of unity and the goal of producing differentiated and individualized welfare solutions exist; and 3) because the welfare state has had difficulty finding its footing in the search for legitimacy of public intervention while also trying to secure individual autonomy and involvement. this article has described how the choice was seen to be the ‘overarching‘ answer to these three paradoxes. it was supposed to solve the paradox of how to empower the disempowered user of care (through active involvement); it was supposed to result in better user-led quality of care; it was supposed to provide more cost-efficient services (through the introduction of the market njsr – nordic journal of social research 2011 – special issue 67 principle); and lastly it was to help develop a care market, which would match with the ideology of the present government (privatization). inherent in the principle of the free choice are a number of assumptions about the role of the elderly as users and the responsibilities they are assigned in the consumerist model. this article has described how elderly users, despite their frailty, are expected to become actively involved in the identification of their needs and of the provider that can best meet these needs. the consumerist approach also gives these users room for expression of satisfaction through changing providers. users are now ‘equal’, because the state guarantees that choice will be available for all across gender, ethnicity, income, class, and local authority, and the user is also made the co-producer of what care relationships are worth continuing (and in this way becomes the quality assurer). this article argues that the consequences of introducing free choice are that users are given an opportunity to express themselves through choosing or rejecting a provider. however, the elderly themselves most want to choose the person who provides care and to obtain some continuity in this care relationship. they are much less concerned with their ‘ownership’ of the provider. users also rate quality of care to be more or less the same, regardless of whether the care comes from a private for-profit or public provider. it has also been argued that there is no consideration about the specific nature of care and dependency in the consumerist approach. care is treated just like any other commodity and the elderly just like any other consumer. yet for any market to be efficient it requires that the user exercises critical judgement about the purchased good. mutual distrust is necessary for the market to operate most rationally, and consumers must always be on the outlook for a better or cheaper product if the market terms are to be fulfilled. but care, in contrast, also entails crucial issues of relationships, trust, and dependency. overall, the consumerist way of thinking also changes the conditionality of the welfare state and its subjects because this way of thinking creates new forms of responsibility and dependencies. while the regime of choice was intended to empower the disempowered individual, it also conditions the individual as a self-responsible agent, that is, responsible for his and her own welfare. greater autonomy also implies the risk of choosing poorly or choosing too often, thereby becoming a bad risk that providers seek to avoid. thus the discourse of freedom disregards new risks: the freedom to make bad or wrong choices. references blomberg, s., edebalk, p. g., & petersson, j. 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(1997). the managerial state. london: sage. danmarks statistik. (n.d.). statistik banken, www.dst.dk. dybbroe, b. (2008). crisis of care in a learning perspective. in s. wrede, l. henriksson, h. høst, s. johansson & b. dybbroe (eds). care work in crisis: reclaiming the nordic ethos of care (pp 41-48). lund: studentlitteratur. edebalk, p.g., samuelsson, g., & ingvad, b. (1995). how elderly people rank-order the quality characteristics of home services. ageing and society 15(1), 83-102. edebalk, p. g. & m. svensson (2005). kundval för äldre och funktionshindrade i norden. konsumentperspektivet [consumer choice for the elderly and the physically challenged in the nordic countries: a consumer perspective]. köpenhamn: nordiska ministerrådet, tema nord, 2005: 507. evers, a. (2003). current strands in debating user involvement in social services. giessen: justus-liebig-universität. discussion paper for the group of specialists on user involvement in social services (cs-us) – council of europe. september 2003. finansministeriet. (2001). velfærd og valgfrihed: et reformprogram [welfare and freedom of choice: a reform programme]. københavn: finansministeriet. foster, p. & wilding, p. (2000). whither welfare professionalism? social policy and administration 34(2), 143-59. greve, c. (2004). frit valg-politk i danmark [free-choice policy in denmark]. nordisk administrativt tidskrift 85(2). københavn: djøf. højlund, h. (2002). velfærdsforskydninger: dokumentation, fleksibilitet og delagtiggørelse på ældreområdet [shifts in welfare: documentation, flexibility, and involvement for the elderly]. københavn: handelshøjskolen, institut for ledelse, politik og filosofi, wp 12/2002. kommunernes landsforening. (2004). økonomisk perspektiv om smidigere regler for frit valg på ældreområdet [an economic perspective on more flexible rules for free choice for the elderly]. københavn: kl. kremer, m. (2004). consumers in charge of care: the dutch personal care budget and its impact on the market, professionals and the family. european societies, 8(3), 385 – 401. kröger, t. (1997). local government in scandinavia: autonomous or integrated in the welfare state?. in j. sipilä (ed.), social care services: the key to the scandinavian welfare model (pp. 95-108). aldershot: avebury. lolle, h. (1999). serviceudgifter og brugertilfredhedshed i danske kommuner [service costs and user satisfaction in danish municipalities]. ålborg: ålborg university press. melander, p. (2008). det fortrængte offentlige lederskab – offentlig ledelse efter new public management [the subdued public leadership: public leadership after new public management]. københavn: juristog økonomforbundets forlag. njsr – nordic journal of social research 2011 – special issue 69 pollitt, c. & bouckaert, g. (2000). public management reform: a comparative analysis. oxford: oxford university press. regeringen. (2004). frihed til at vælge [the freedom to choose]. københavn: statsministeriet. rostgaard, t. (2006). constructing the care consumer: free choice of home care for the elderly in denmark. european societies, 8(3), 443-463. rostgaard t. & thorgaard, c. (2007). god kvalitet i ældreplejen: sådan vægter de ældre, plejepersonale og visitatorer [good quality in elderly care: how the elderly, care workers, and care assessors evaluate it]. sfi 07:27.copenhagen: sfi – det nationale forskningscenter for velfærd. rønning, r. (2004) omsorg som vare? kampen om omsorgens sjel i norske kommuner [care as commodity? the battle for the soul of caring in norwegian municipalities]. oslo: gyldendal norsk forlag. stevens, m., glendinning, c., jacobs, s., moran, n., challis, d., manthorpe, j., & wilberforce, m. (2011). assessing the role of increasing choice in english social care services. journal of social policy 40(2), 257-274. trydegård, g. (forthcoming). care work in changing welfare states: nordic care workers' experiences, in the european journal of ageing. vabø, m. (2009). home care in transition: the complex dynamic of competing drivers of change in norway. journal of health organisation and management, 23(3), 346-359. microsoft word hjelte, westerberg the story of a knowledge-based and learning organization.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 5, 2014 the story of a knowledge-based and learning organization jan hjelte umeå socialtjänsten (umeå social services) email: jan.hjelte@umea.se kristina westerberg department of psychology umeå university email: kristina.westerberg@psy.umu.se abstract knowledge is generally viewed as one of the most important organizational resources, and this view is also held in relation to municipal elderly-care organizations. however, the concept of a knowledge-based organization has seldom been addressed in elderly-care research. the aim of the present study was to analyse how political and professional groups involved in elderly care conceive of the idea of a knowledge-based organization, and how these conceptions relate to their expectations in relation to the future of elderly care. this issue is important because these conceptions are intertwined with actions conducted by organizational members. participants were selected for the study on the basis of organizational level and engagement in the development of different kinds of care in an elderly-care organization in a large municipality. a narrative approach was used for data analysis. the study indicates that the interpretations of a knowledge-based organization bring stability and meaning to participants by linking elderly care, as it is in the present, to an image of its future. furthermore, the narratives are adjusted depending on what kind of problems that organization is expected to solve. however, the participants do not view the economic resources of the organization as something they can njsr – nordic journal of social research vol. 5, 2014 2 influence and develop, in either the present or the future. the study also shows that there are multiple perspectives in regard to the meaning of a knowledge-based organization and, accordingly, multiple perspectives on what will need to be done in the future. this is a potential problem for elderly care because it can hinder the coordination of organizational activities and the ability to handle the challenges of the future. therefore the results point to the importance of creating within the organization a shared meaning of its main problems, and to the contribution a knowledge-based organization can make in solving these problems. keywords: knowledge-based organization, elderly care, narrative analysis, multiple perspectives introduction knowledge is generally viewed as one of the most important organizational resources in regard to performance (ma & yu, 2010; wang & noe, 2010). one example is social services, where it has been argued that it is important that the entire organization, including staff and management, base their decisions on scientific knowledge (denvall, 2008) while also systematically valuing the knowledge of users and practitioners (nixon & murr, 2006). in sweden, the political governing boards of municipalities are responsible for social-welfare services. elderly care is an important part of social-welfare services, and has struggled for many years owing to a lack of trained staff. also, the location of elderly care has shifted from hospitals to community-based facilities and private homes (arnetz & hasson, 2007; boström et al., 2007). in addition, municipal elderly-care services face the challenge of managing the growing number of elderly people in need of assistance, and, in turn, the expected increasing need to recruit new employees (salar, 2006). the current state and future challenges have been addressed in general, but the extent to which professionals working in the field perceive elderly care as a knowledge-based organization has received only limited attention. however, it has been shown that there are different views on, and understandings of, the concept of knowledge-based elderly care on different organizational and political levels (westerberg et al., 2011), and that politicians and managers in elderly-care services do not always share an understanding of those services and how they should be delivered and developed (henriksen & rosenqvist, 2003). njsr – nordic journal of social research vol. 5, 2014 3 given the challenges faced by elderly-care services, the divergent conceptions of knowledge and how to develop the organization are of concern. in order to develop a knowledge-based organization, it is important to develop the ability to transfer knowledge and a shared meaning of knowledge within the organization (wang & noe, 2010). problems could arise if staff, management, and politicians differ significantly in their understanding of what constitutes a knowledge-based organization (westerberg et al., 2011). the perceptions and conceptions of the current situation are therefore important when planning for the future organizational structure (henriksen & rosenqvist, 2003). furthermore, the actions taken to develop a knowledge-based organization are intertwined with the idea of such an organization (boreham & morgan, 2004; nixon & murr, 2006). the aim of the present study was to analyse how political and professional groups conceive of the concept of a knowledge-based organization in the elderly-care services and how these conceptions shape their expectations of the future of those services. a narrative approach in order to capture the perceptions and conceptions of a knowledge-based organization, a narrative approach was used. such an approach involves the analysis of stories through which individuals recount events, actions, and objects in their lives (pentland, 1999; sias et al., 2004). people also use narratives to express emotions and beliefs about how things should be (fraser, 2004) and to clarify the legitimacy of different actions (czarniawska, 1997). the literature contains a variety of definitions of narrative. in general, these definitions converge on the notion that narratives elaborate a sequence of events that are linked to a subject (theme) or time. alternatively, they depict a temporal transition from one state to another (chreim, 2007). we used a thematic perspective on narratives, which means that we analysed the use of a label or its synonyms (chreim, 2005). analysing the use of labels is useful in organizational studies because it can create an understanding of the central characteristics and general direction of the organization (chreim, 2005). we chose to use a narrative approach because the real, everyday operation of most organizations is based on narratives in which important experiences are often used as rules of thumb (weick, 1995). hence, a narrative approach allows an understanding of interpretation and sense-making in organizations (chreim, 2007). the narrative approach is especially useful in research on activities where people work together on a social level – which is the case in njsr – nordic journal of social research vol. 5, 2014 4 elderly care – because mutual understanding is a central part of the end result (blom & nygren, 2010; salander, 2002). because narratives can be used to create rules of thumb, they also have a constitutive function through which stories contribute not only to the preservation of, but also to the changes within organizations. in regard to such changes, narratives about what is possible or what other organizations have accomplished provide useful models for what needs to be done (pentland, 1999). when changes arise, it may be necessary to find options for the reinterpretation of an organization’s assignments, and also to link these changes to key symbols from the past (chreim, 2005). therefore narratives are temporal because they can be modified, nuanced, and adjusted to the needs of changes that occur (de fina & georgakopoulou, 2008). the narrative approach is one method used to analyse the structure of both written and verbal communication. traditionally, narratives have been seen as a technique for recounting past experience. as a consequence, narratives about ongoing, future or hypothetical events have been neglected (de fina & georgakopoulou, 2008). to clarify the dual role of the narrative in creating both continuity and change, it is relevant to focus on narratives about both the current course of events and the (organizational) future. as weick (1995) points out, it is necessary to look to the future as well as the past in order to construct an understanding of events. accordingly, the narratives that the analysis in this study focuses on include not only those about events that have already taken place, but also those about actors’ anticipations of the future of elderly care. the interview study this study was conducted within a municipal social-services organization of approximately 2800 employees in a fairly large municipality in sweden. the organization provides family and child services, as well as care for elderly and disabled persons. about 1800 employees work directly in or have supportive functions in elderly care. elderly care is thus the largest department within the social-services organization. elderly care had, for a number of years, been handled specifically with the aim of developing a knowledge-based organization and had received governmental funds to achieve this. these funds were initiated by the swedish government, and municipal elderly-care authorities could apply in order to support activities, such as courses and workplace improvements, for long-term development of quality and skills in that field. the elderly-care organization in the present study participated with the aim of building new infrastructures for learning and improving the quality of care, and stressed the use of evidenced-based practice and knowledge njsr – nordic journal of social research vol. 5, 2014 5 transfer within the organization (svanström, 2008). in addition, in the local operational plan for 2009, the board for social welfare and the social administration stated that during the period 2009–2011 the social services would ‘develop and enter deeply into the knowledge-based organization’ (vp, 2009). participants an organization is characterized by the many voices that contribute to different and sometimes highly divergent versions of that organization (chreim, 2005). therefore, the selection of participants for the interview study was made on the basis of organizational level and engagement in the development of different kinds of elderly care. two of the initially selected managers declined to participate, and consequently two other managers were chosen. twelve individual and four group interviews were conducted. the participants in individual interviews were two local politicians who were members of the local board for social welfare, three senior managers in the organization, four persons belonging to the management staff, two project managers, and one assistant nurse who worked part-time as a pedagogical supervisor. the four groups that participated were: a) the process group (a team of assistant nurses, an occupational therapist, and unit managers who were working together part-time on a project concerning workplace change processes); b) the elderly-care team (a team of specialized nurses, occupational therapists, physiotherapists, and a dietician, working primarily in staff education and supervision, and with the elderly with specific needs); and c) seven assistant nurses from two work groups operating in elderly individuals’ homes.1 the process team, the elderly-care team, the pedagogical supervisor and the project managers may be referred to as ‘change agents’ within the organization, that is, practitioners assigned to a specific responsibility of organizational development (chase, 1997). they worked horizontally across the traditional vertical organizational structure (the line organization) and their work was temporary in the sense that their functions were introduced within a project context with the support of external funds. 1 in sweden, the elderly typically live in their own homes and have access to home-help services. njsr – nordic journal of social research vol. 5, 2014 6 procedure prior to the interview, selected participants were sent a letter with information about the purpose of the study and the selection process. the letter also indicated the anticipated length of the interview, that recording equipment would be used during the interview, and that participation was voluntary. additionally, participants were informed that only the team of researchers would have access to the recorded material. at the time of interview the participants were again provided with this information. they were also told that their statements would be presented at a group level, for instance, as politicians or managers. the individual interviews had a duration of approximately 45 minutes, the group interviews with the change agents lasted about two hours, and the group interviews with the work groups were about one hour long. the interviews were conducted at the participants’ workplace or, for the change agents’ groups, in their meeting room. there were four different interviewers (including the authors). for each individual interview there was one interviewer and for each group interview there were two. an interview manual was used for the interviews. this manual included questions about knowledge and knowledge transfer, as well as questions about resources, shared visions, and communication. the theoretical point of departure was from a socio-cultural perspective (engeström, 2001; boreham & morgan, 2004), but the questions were open-ended and descriptive. the following are examples of questions included in the manual: ‘when i say knowledge-based elderly care – what comes to mind?’ ‘what sources of knowledge should the knowledge base of elderly care be built on?’ ‘what kinds of resources are required to achieve knowledge-based elderly care?’ one question focused on the future of elderly care and was formulated as follows: ‘is there a shared vision of future knowledge-based elderly care in this organization?’ analysis narrative material can be analysed in several dimensions, for example, content, structure or style of speech. as mentioned above, we used a thematic perspective to the narrative analysis, interpreting the content of themes in the context of the whole text (cf. lieblich et al., 1998). the analysis was carried out in four phases. phase 1. coding of individual interviews – content and temporal codings. qualitative methods generally involve some type of coding with the purpose of analysing how respondents impose order on their experiences to make sense njsr – nordic journal of social research vol. 5, 2014 7 of events and actions in their lives (chreim, 2007). in this study we conducted two sorts of coding, content and temporal orientation. the coding of content was initially made with descriptive codes that were relatively close to the empirical material. thereafter the content was coded on a more abstract level where the codes were more inferential (miles & huberman, 1994). the coding of temporal orientation was twofold: the present and the future. the present consisted of themes that described the respondent’s view of the organization at the time of the study, and included past experiences that were related to the formation of their present perceptions. the future related to themes that described the respondent’s view of the organization in the future. in the same way that experiences from the past contributed to the formation of perceptions of the present, experiences in the present were related to ideas about the future. taken together, the contentand temporal-orientation codings yielded a coherent narrative for each respondent. phase 2. aggregation of dominant themes for different professional groups. in this phase, the themes that were dominant for each of the professional groups were analysed (cf. fraser, 2004). phase 3. comparison of dominant themes between professional groups. next, commonalities and differences between the professional groups’ dominant themes were analysed. researchers have recognized that the listing of the material and the naming of the themes make such commonalities and differences visible (cf. fraser, 2004). the themes were classified into three major areas: the problem, the prerequisites, and the communicational processes. phase 4. theoretical interpretation. finally, the material was analysed in relation to theory and previous research. results in the analysis the themes were classified into three overarching areas based on content: a) the problems, b) the prerequisites, and c) the communicational processes. in the following sections the themes are presented by area. the perceptions of functional categories (politicians, managers, administrative staff, change agents, and assistant nurses) are presented separately when there are differences between them. a. the problems this area includes two themes, one that expresses the present problems and another that describes the anticipated problems related to developing a knowledge-based organization (table 1). njsr – nordic journal of social research vol. 5, 2014 8 table1. themes related to the problem areas category the present problem the future problem all categories imbalance in the knowledge base of elderly care increasing demands on and expectations of elderly care the present problem imbalance in the knowledge base of elderly care: respondents across all the categories shared the opinion that the basic problem impeding the development of a knowledge-based organization in elderly care was the emphasis on experience-based knowledge. furthermore, there was a sentiment that the organization needs to draw on varied sources of knowledge in order to provide the highest level of care to the elderly. the problem was not the use of experience-based knowledge per se, but the lack of balance between the different sources of knowledge, especially scientific and experience-based knowledge. the imbalance was described as something that exists within the entire organization, from the care workers to the housing planners. one example of these sentiments is the following (translated) statement made by one of the managers: we have a problem in elderly care because we often base our actions on feelings only. this is very easy in a relation-oriented work. we need to rely on science and what is really tested to a larger extent. (manager 3) even though all categories agreed that the basic problem was imbalance, they had different opinions on the reason for the imbalance. according to the politicians the reason was a lack of available scientific knowledge in many areas. the managers, the staff and change agents described other reasons for the imbalance. one prevalent opinion was that elderly care has a history of not valuing theoretical and scientific knowledge, which implies that there is a degree of resistance to scientific knowledge. the future problem increasing demands and expectations: all the categories acknowledged that, in the future, elderly care would face increasing demands and expectations. the staff and the change agents were of the opinion that the increasing number of elderly people was one of the causes. politicians, change agents, njsr – nordic journal of social research vol. 5, 2014 9 and assistant nurses also opined that the imminent entrance of the large generation born in the 1940s into the sphere of elderly care would increase demands for service and, further, that present conditions in elderly care would fail to meet these individuals’ expectations. key points of present and future problems all categories agreed on the primary problems facing both the present and future of elderly care. however, a variety of problems were mentioned, which implies that a knowledge-based organization is expected to be able to deal with many types of dilemmas, both now and in the future. in the present, the main problem is imbalance in the knowledge base of elderly care. earlier studies have formulated the experience of caring work as a rationality of caring that could not be improved by formal education and scientific knowledge (waerness, 1996). later research has indicated that occupational learning in elderly care is largely based on experience in everyday work (törnquist, 2004; ellström and ekholm, 2001). however, the need for scientific knowledge has been supported by swedish authorities as a means for updated and informed professionalism in elderly care (sou 2007:88), and large competence and education programmes have been launched (ministry of health and social affairs, 2007). furthermore, all of the categories in the present study anticipate that there will be increased demands on and expectations of elderly care. this anticipation has been described in research as well as by authorities (salar, 2006), and is generally considered a challenge. b. the prerequisites there were three themes that emerged related to prerequisites in the organization: limited economic resources, leadership and governance, and learning structures. the themes are presented in table 2, classified within the functional categories. the present prerequisites limited economic resources: all the categories, with the exception of managers, mentioned the financial situation and its impact on the development of a knowledge-based organization. they all referred to the cutbacks that have been made in elderly care over recent years and how these had affected the options for pursuing developmental work within the organization: … sometimes the discussion on economic issues takes over totally and then the developmental perspective disappears until the economic issues have calmed down again. (staff 3) njsr – nordic journal of social research vol. 5, 2014 10 table 2. themes related to prerequisites category present prerequisites future prerequisites politicians limited economic resources deficiencies in leadership and governance deficiencies in learning structures limited economic resources explicit leadership and governance new learning structures managers deficiencies in leadership and governance deficiencies in learning structures explicit leadership and governance new learning structures staff limited economic resources deficiencies in leadership and governance deficiencies in learning structures limited economic resources explicit leadership and governance new learning structures change agents limited economic resources deficiencies in leadership and governance deficiencies in learning structures limited economic resources explicit leadership and governance new learning structures assistant nurses limited economical resources deficiencies in learning structures new learning structures deficiencies in leadership and governance: all categories, with the exception of assistant nurses, stressed leadership and governance as factors that send signals about what is important to the organization. all categories that mentioned leadership and governance implied that there were shortcomings in these areas within the organization. one example is the comment below. one starts to wonder when it [decisions aren’t implemented] goes on year after year whether there is a leader somewhere that can give the direction. (politician 2) njsr – nordic journal of social research vol. 5, 2014 11 deficiencies in learning structures: all categories indicated that in order to achieve balanced, knowledge-based elderly care, there must be wellfunctioning structures for learning. time and space to reflect on one’s work together with colleagues was considered an important part of such structures. according to staff, this was missing in the present organization. another aspect of learning structures that was mentioned was access to change agents. managers, staff, and assistant nurses described change agents as distributors of knowledge and partners for reflection on care work. however, perceptions varied in regard to what extent change agents were available to participate in developmental work in practice. the staff and assistant nurses thought there was a shortage of change agents, while the managers thought there were sufficient numbers available. the future prerequisites limited economic resources: as mentioned earlier, the large, soon-to-beelderly generation born in the 1940s is expected to be more demanding than previous generations, and this implies a future greater need for both focus on the users and quality of care. limited economic resources were expected to be the primary obstacle to such improvements. according to politicians, staff and change agents there will be an imbalance between demand for services and financial resources and, because of that imbalance, the gap between users’ expectations and organizational resources will widen. the anticipated increased number of elderly in need of assistance is expected to further strain limited financial resources. owing to the changing conditions, politicians, managers, staff, and change agents thought that the organization needed to become more effective and that this could be managed by increased knowledge. explicit leadership and governance: in order to become more effective it was thought necessary, according to all categories apart from assistant nurses, to develop a more explicit leadership and governance within the organization. this was considered essential in the transition from words to actions. the managers claimed, for instance, that there must be clear guidelines regarding what is expected of employees in elderly care. in addition, according to managers, staff, and change agents, such guidelines should exist for all employees, and not only the care staff. the politicians also talked about guidelines, but in the context of how feedback to the political board should be developed. one politician described the need for guidelines in the following comment: i have struggled with this since i became a member of the board … that the politicians set the agenda for how things should be executed and then others can do it. the board is responsible for all. you have to have njsr – nordic journal of social research vol. 5, 2014 12 control instruments that enable one to govern and these can give you a reasonable feedback to the board. (politician 2) new learning structures: all categories mentioned that it was essential to create new learning structures in the future. the politicians referred to a more overreaching plan to change the structures, but the staff stressed the time and space necessary for reflection. managers, change agents, and assistant nurses pointed out that there was a need to adapt the forms of workplace learning to the context of practice. this was expressed by one of the managers in the following example: we have, like all in elderly care, worked on the collective solution, in groups as large as was possible and with as many persons as was possible. we have to rethink. to think more on an individual level also when it comes to enhancing staff competence. smaller groups, fewer persons. how else could you learn something new in home care service where you work alone in the users’ homes? (manager 3) key points of present and future prerequisites to a large extent, the prerequisites that were described as problems in the present recurred in relation to the future, as developmental needs. the exception was economic resources, which were portrayed as a restriction in both the present and the future. there were differences between categories with regard to opinions about the prerequisites, and even when they all emphasized the same prerequisite, differences of opinion remained. for example, all categories mentioned the importance of learning structures, but there were differences in their emphases and also in their perceptions of how well such structures functioned. in an extensive study of elderly care in sweden, gustafsson and szebehely (2005) found differences between organizational levels in the perception of working conditions and steering. the perception of the work environment as strained increased with position in the organizational hierarchy. nursing assistants reported having the heaviest workload, the least influence, and the greatest lack of resources. the politicians’ influence over the economy was perceived as high by other categories but not by the politicians themselves. the authors discuss whether this reflects the restrictions outside the control of municipal politicians, and how these restrictions are partly related to the practices of new public management (gustafsson and szebehely, 2005). njsr – nordic journal of social research vol. 5, 2014 13 table 3. themes related to the communicational processes category present communicational processes future communicational processes politicians – – managers deficiencies in knowledge transfer well-functioning workplace learning new methods of knowledge transfer staff deficiencies in knowledge transfer deficiencies in workplace learning development of workplace learning change agents deficiencies in knowledge transfer deficiencies in workplace learning new methods of knowledge transfer development of workplace learning assistant nurses deficiencies in workplace learning – c. the communicational processes the themes related to the communicational processes concerned different qualities in regard to two major topics: knowledge transfer and workplace learning (table 3). the present communicational processes deficiencies in knowledge transfer: in order to achieve a knowledge-based organization with a balance between different sources of knowledge, it seemed important systematically to transfer externally sourced knowledge and to make it available to all workers. however, managers, staff, and change agents indicated that there were deficiencies in the organization that made this transfer problematic. one manager mentioned, as an example, that the organization was stuck in a routine of offering theoretical courses, and there njsr – nordic journal of social research vol. 5, 2014 14 was a need to investigate how the system could be expanded in order for employees to gain access to research-based knowledge. workplace learning: another important aspect of communication was, according to managers, staff, change agents, and assistant nurses, that workplace learning was expected to be realized in developmental work and supported by change agents. however, opinions varied on the success of workplace learning. managers expressed the opinion that there were many opportunities for workplace learning with the help of change agents, but the staff, change agents, and assistant nurses did not agree. the latter categories expressed the view that learning was basically an activity within the limits of a work unit. the change agents thought it was hard to create learning opportunities in home-care services, while the assistant nurses described workplace learning as the oral transfer of experience-based knowledge in specific situations when a problem had occurred and the work group learned from each other and exchanged experiences. the future communicational processes new methods of knowledge transfer: to be able to meet the anticipated demands and expectations it was, according to managers and change agents, necessary to find new ways of improving knowledge transfer. one change agent stated that research and scientific knowledge must become closely grounded and integrated in the work activity. this knowledge would promote independence in acting and thinking, in contrast to reliance on manuals and guidelines. development of workplace learning: in accordance with the statements about the present, staff and change agents also talked about the need to develop workplace learning in the future. one reason given for the importance of future workplace learning development was that it would enable a greater amount of critical reflection among workers, and consequently reduce the amount of wasteful activity based only on routines and guidelines. key points of present and future communicational processes as was the case with the prerequisites, deficiencies in the communicational processes of the present reappear in the future as developmental needs. also, in relation to the communicational processes, there are differences between the functional categories. for example, the change agents saw the future developmental needs of both workplace learning and knowledge transfer, while the staff saw developmental needs in workplace learning only. however, the managers did not see any developmental needs in workplace learning, which is perhaps not surprising because they believed it to be functioning well already. instead they saw developmental needs in knowledge transfer. njsr – nordic journal of social research vol. 5, 2014 15 politicians and assistant nurses did not mention communicational processes at all. the differences in perception between organizational levels have been addressed earlier (gustafsson and szebehely, 2005; davies et al. 2006), and it may not be surprising that it was the change agents that expressed the importance of finding new methods of knowledge transfer and improved workplace development. the change agents comprise the group that moves in the midst of the organization and is capable of taking perspectives from the position of care work as well as from the leadership and administrative levels. but in order to develop the knowledge-based organization, it is of vital importance that all the different organizational levels achieve a shared meaning of the present state and the future needs of the organization (wang and noe, 2010). discussion this study shows that the development of a knowledge-based organization is more complex than simply advancing knowledge transfer and establishing shared meanings in and between organizations. earlier research has shown that it is also dependent on the prerequisites in an organization (westerberg et al., 2011). in addition, the present study shows that the current conceptions about knowledge-based organizations appear to be related to expectations regarding future events. this implies that these conceptions might be important when planning for the future organizational structure (henriksen & rosenqvist, 2003). this relation may be an expression of the need for a coherent narrative about the organization. in order for such a coherent narrative to be constructed, there is a need for continuity from previous experiences to expected directions for the future (cf. weick, 1995). in relation to elderly care, continuity is achieved when present prerequisites and communicational processes become points of departure for conceptions of what elderly care will be like in the future. because of this, themes such as limited resources, research needs, and the use of evidence-based methods recur, regardless of the problem being dealt with. this study also uncovers an exception to the pattern above in the theme of economic resources, which were not considered an area of development despite being seen as a limiting factor in the present. for the change agents and assistant nurses, this may be a consequence of possibility perceived as influencing economic resources in a knowledge-based organization. according to casey (2009), the knowledge-based organization is an expression of a neoliberal perspective on organizations where efficiency and productivity are priorities and employees are considered as organizational resources rather than co-creators in design and management. this approach is in conflict with previous social and cultural values about democratic participation in, for example, the economic regulation of an organization. this may be the reason njsr – nordic journal of social research vol. 5, 2014 16 why the co-workers in the present study talked about efficiency, knowledge transfer, and workplace learning as development areas in line with a knowledge-based organization, but not about the possibility of influencing economic development within the organization. however, the co-workers are not the only group that does not consider the economic situation as a developmental area: politicians and managers also share this belief. this may be a result of the new prerequisites for managerial control in the neo-liberal economy, where many employers’ focus on cutting costs and increasing productivity in response to regulatory changes in the political and economic environment (carter et al., 2011). in relation to municipal elderly care in sweden, regulatory changes have coincided with an increase in the number of elderly people in need of social services and care (salar, 2006). in accordance with the functional groups in this study, salar (swedish association of local authorities and regions) (2010) also argues that there will be a gap between needs and economic resources in future municipal elderly care. based on the gap between needs and economic resources, the politicians’ and managers’ views on efficiency may be a response to the need to handle economic changes in the environment within the context of a neo-liberal perspective on the organization. furthermore, this understanding of the economic situation, as being out of the hands of the organization, is related to consequences of the practices of new public management. these practices affect both elderly care, as described by gustafsson and szebehely (2005), and other public organizations, as outlined by noblet, rodwell, and mcwilliams (2006). for example, different categories emphasized different aspects of the communicational processes and some categories did not mention them at all. one way to interpret this is that all of the groups have recognized the label of knowledge-based organization as legitimate, but have not achieved a collective appropriation of it, a situation which is linked to the collective adaptation and development of a shared meaning by adjusting the label to local needs and constraints (corradi et al., 2010). elderly care is an example of what danemark and kullberg (1999) and hasenfeld (1992) have described as a human-service organization (i.e., a public organization in the welfare sector). as such, its existence depends on external support, and therefore it tries to conform to prevailing local norms and conceptions about knowledge-based organizations. such norms and conceptions may form the basis of a position that the organization should become affiliated with in order to obtain legitimacy (meyer & rowan, 1991). as with the vision of the knowledge-based organization, it is possible to provide stability and meaning in the organization by adopting abstract labels without a collective appropriation. this, however, leads to stability that lies more in the labels used to define the organization than the meaning attached to those labels (cf. chreim, 2005). therefore the ambiguity can create a njsr – nordic journal of social research vol. 5, 2014 17 loosely coupled system of actions, ideas, and people with different agendas (corradi et al., 2010; lindqvist, 2000; weick, 1976). as the results of the present study indicate, such a loosely unified system within the organization might also hinder its future development, as its members’ interpretations will also affect their behaviour during periods of change (chreim, 2007; eden & ackermann, 1998). in order to achieve a knowledge-based organization with coordinated strategies for future challenges, the diverse professional groups within the organization need to create a shared meaning through collective appropriation of the organization’s main goals – what they must do in order to achieve these goals, not only as an overall effort, but also by common and concrete interpretations of the various problems and goals they face. otherwise the delivery of, for example, elderly care as a knowledge-based organization in which communicative processes create, embrace, and spread knowledge and expertise effectively, may be hindered. finally, this study shows that the concept of a knowledge-based organization is not without contradictions. the 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(2011). the meaning of a knowledge-based organization in swedish municipal elderly care. social work education, 31(4), 465–484. microsoft word goth & smaaland_civic engagement and social capital in ship-preservation work in norway.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 4, 2013 civic engagement and social capital in shippreservation work in norway: the scope, impact, and demographics of formal volunteering and publicly funded engagements ursula s. goth (corresponding author) oslo and akershus university college, faculty of education and international studies ursula.smaaland.goth@hioa.no erik småland university of bergen, faculty of humanities, directorate for cultural heritage (riksantikvaren) erik.smaaland@ra.no keywords: volunteer, civic engagement, cultural heritage, elderly, historic ships njsr – nordic journal of social research vol. 4, 2013 140 abstract introduction: the current focus on volunteering related to civic engagement in norway has led to a rise in complementary private initiatives and public funding, specifically with regard to the preservation of historic ships. volunteers for this programme are primarily men aged over 50 years who spend significant amounts of leisure time in municipalities along the coast, fjords, and lakes of norway. despite the historical significance of this kind of volunteering, the social capital that is gained and the substantial funding that the directorate for cultural heritage provides, no study has mapped the impact or outcome of these efforts over the past 20 years. objective: the primary objective has been to study the scope of formal voluntary ship-preservation work in norway. this article aims to map the volunteers in associations in this programme, the breadth of their efforts, and their motivations. design: all ships (n = 90) that were funded by the directorate in 2009 were included in the case study. a qualitative survey of telephone interviews with 82 key informants (100% response rate) was conducted, and questionnaires were mailed to gather descriptive statistics. results: age, gender and a robust relationship with the region and the specific ships appear to be relevant to voluntary ship preservation activities. the reasons for commitment and effort were companionship, unity, and memories of and relationship to the specific ships. the strong socio-political aspect of the volunteers’ efforts was reflected in an aggregate of approximately 5.5 million euros in unpaid work. conclusion: volunteering in this context is an important component of social capital among elderly men in norway. the group dynamics and strong collective aspect of these voluntary associations maintain internal cohesion and the members only leave when forced by increasing age, poor health, or insufficient financial resources. introduction the purpose of this article is to describe the connection between volunteering and historical ships in norway, the volunteers as a group, and the scope of their efforts and motivations. this article seeks to contribute to the understanding of volunteering in norway by the close examination of this area of voluntary activity. this article will highlight njsr – nordic journal of social research vol. 4, 2013 141 and examine two important aspects. first, it will present the impact and scope of volunteer work on historic ships. secondly, it will discuss the motivations of individuals, the collective aspect of volunteering, and the connection between volunteering and historical ships. civic engagement, social capital, and the concept of dugnad civic engagement is defined as ‘individual and collective actions designed to identify and address issues of public concern’ (american psychological association, 2012). types of civic engagement may encompass volunteer activity both individually and in groups. thus, working together in a voluntary association to restore or maintain historic ships is an example of civic engagement, serving to enforce local stability and collective identity. social capital is seen as the expected collective gain derived from cooperation between individuals or groups. social capital is measured by interpersonal trust as well as civic engagement. trust and engagement on all levels might result as the societal value of communal health (putnam, 1995). here putnam pinpoints that excessive personal individualization might lead to the absence of collective orientation. civic engagement refers to a gamut of activities that build social capital and strengthen the local community (adler & goggin, 2005). other empirical studies elaborating on the impact of social capital on health have shown a strong correlation between personal trust and mortality (kawachi et al., 1997) in this article, we examine volunteering on historic ships in norway and focus on social capital, not as an individual asset but, as a significant element in society leading to features and elements of social life that encourage participants to act and attain certain goals. social capital creates bonds among various parts of the community, allowing its members to consort and function together. whereas pierre bourdieu views social capital primarily as an individual resource by virtue of possessing a durable network of more or less institutionalized relationships of mutual acquaintance and recognition (bourdieu, 1986, p. 119), coleman (1990) and putnam (1993) regard social capital bonds as collective resources of which individuals can take advantage (hvinden & gissinger 2005). such bonds and resources are easiest to ‘construct’ in local and informal social networks (campbell, wood & kelly, 1999). social capital might be said to relate to broad societal measures of communal health (putnam, 2000) and to individuals’ health, as shown in epidemiological studies by berkman & glass (2000). njsr – nordic journal of social research vol. 4, 2013 142 volunteering within institutional structures is characterized by reliability, social relationships, and networks characterized by activities for public benefit (atchley, 1989). coleman sees this function comprising a variety of different entities consisting aspects of social structure, facilitating certain actions of individuals within the structure, thus making possible the achievement of certain ends that would not be attainable in its absence (coleman, 1990, 302). furthermore coleman states that social capital gained must be maintained and renewed through use if there is to be no decay (coleman, 1994). social capital in voluntary organizations is thus a special type of community resource that strengthens the connections between individual, community, and national levels (hvinden & gissinger, 2005). in the norwegian context, dugnad is an important tradition of volunteering (lorentzen & dugestad, 2011). the term of dugnad can be roughly translated as ‘do it together’ and originates from a traditional system of mutual help with tasks that a single farming household could not manage alone (frimannslund holmsen, 1965). the call for dugnad requires everyone voluntarily to contribute both time and effort towards a common good. further, it demands everybody’s presence and frowns upon attempts to replace physical presence with the offering of cash or other material goods, thus symbolizing a gesture of equality. like the english term ‘barn-raising’, dugnad in principle strengthens the communal feeling among those who work together. in this regard, dugnad differs from the term ‘volunteering’ as it is more normative and refers to the experience that is evoked. the field of formal volunteering in norway, co-created by the ‘nordic model’, comprises combined public funding and private and individual dugnad volunteering. matthies describes this model as having a particular relationship between the public and society sector that has enabled a certain type of society to develop (2006, p. 13). current changes in nordic welfare politics have effect on the field of welfare services as well as to the civic society sector. with reduced resources for public services this leads to an increasing mixture of private, public and activities within what used to be primarily financed by public means. aiming at an increase in activity, the voluntary sectors activities are organized as projects while the responsibility of the state is becoming more distanced (matthies, 2006, p. 25). njsr – nordic journal of social research vol. 4, 2013 143 in this article, we consider whether certain circumstances render volunteering in non-profit organizations (ngos) more attractive to elderly men, because gender and age are significant parameters of how leisure time is used. women have more social interactions earlier in life, and there is equal involvement in volunteer work between genders in older age (statistics norway 2012). yet a local study has shown that as a group, male volunteers aged over 67 years are the most active with regard to volunteer efforts (wollebæk, selle & lorentzen, 2000). the collective dynamics of volunteering have been debated in various theories that seek to describe and explain the social activities that are associated with people as they age. the continuity theory, states that older adults strive to maintain the same activities in which they engaged earlier in life (atchley, 1989). today the sector of culture and recreation depends heavily on volunteer work, and its economic impact has been highlighted in various public reports (ministry of culture, 2013; senter for forskning på sivilsamfunn og frivillig sector, 2012). our literature search indicates that the field of voluntary ship preservation in norway has not been examined for the past 20 years. more importantly, however, is that our qualitative study of this form of volunteering can enhance the understanding of volunteering in this country, especially among the elderly. in his study on resources, practices and ideologies in ship preservation the anthropologist berkaak investigated the funding situation in 1986 (berkaak, 1992, pp. 28-34). that year there were 48 registered preserved ships in norway and the funding from the directory of cultural heritage (dch) was 685 769 euros (5.1 million nok). in comparison, the figures in this study were 211 preserved ships and seven million euros (52 million nok) in 2009. between 1991 and 2009, the number of registered preserved ships increased steadily by six to ten each year (directorate for cultural heritage 2010, 24). because most organizations own just one ship, the number of registered owners in 2009 was more than four times as many as in 1992. historic ships in norway with the exception of certain public-benefit foundations, large private funding of cultural heritage is uncommon in norway. in 2009, state funding for historic ships by the directorate for cultural heritage (dch) was approximately seven million euros (52 million nok). the njsr – nordic journal of social research vol. 4, 2013 144 chief principle of this funding was that the work carried out by the owners would not be reimbursed. the public funding would only cover the actual cost of necessary equipment, materials, and commissioned work. local contributions mainly consist of donations of services and equipment. most historic ships in norway are owned privately by volunteer-based organizations or by public institutions (e.g., museums). regardless of individual ownership, it is primarily volunteers effort maintaining the ships. the collective dynamics of volunteering and the amount and outcome of the volunteers’ extensive efforts have never been mapped. despite extensive state funding and the general consensus on the importance of volunteering in this programme, the knowledge on the preservation of historic ships by volunteers in norway is limited. volunteering in norway with five million inhabitants, norway has a volunteer sector that comprises more than 90 000 locally based non-governmental and non-profit clubs and organizations with limited financial means (ministry of church and education, 2006). in 2009, up to 48 per cent of the adult population in norway participated in some type of volunteer work (wollebæk & sivesind, 2010), and this can be translated into the work of 115 000 full-time employees (statistics norway, 2009). the slogan of the national association of ngos, “without volunteering norway stops” (association of ngos in norway, 2010), emphasizes the impact of volunteer work, which is estimated to be as large as 4.9 per cent of the gross national product (gnp), exceeding 12.5 billion euros (statistics norway, 2012). nevertheless, the value of unpaid volunteer work is excluded from the gnp. methods definitions the definition of volunteer work that we have used was developed by salamon, wojciech sokolowski, and list and is defined as an activity that is ‘organised, not part of the apparatus of the state, it has not primarily commercial purpose, it is self-governed and the participation is voluntary’ (2004, pp. 9-10). the basis for this definition is the assumption that non-profit organizations promote the common good and that this is the primary reason why volunteers work without expectation of personal profit. njsr – nordic journal of social research vol. 4, 2013 145 survey the survey was a qualitative exploration with a cross-sectional design, involving an observation of all fund receiving voluntary organizations at 2009. by using open-ended questions, we aimed to map the amount and frequency of volunteer work, the demographics of the volunteer work force, and their location in norway in relation to the general funding situation in that particular year. the collection of data all 90 ships that received funding from the dch in 2009 and the volunteer associations restoring those ships were included in the study. a questionnaire with both closedand open-ended questions was sent to the 82 organizations (belonging to 81 owners) of the ships. the initial contact with the organizations was established by mail, requesting that they fill out and return the enclosed questionnaire. owing to the low rate of response of 20 per cent, we issued a reminder by email, asking for consent to contact key informants by telephone over the following weeks. a response rate of 100 per cent was obtained, and all owners were contacted. the survey data from telephone interviews were recorded on paper and systematized by coding, clustering and grouping of the data. the in-depth interviews were recorded and transcribed. on the basis of grounded theory (glaser & strauss, 1967), we began our analysis with open coding in order to capture important concepts and themes and to illustrate central statements. using deductive methods demonstrated the variation of the material. to control for preconceptions and to assess the consistency of the answers, the open-ended questions were validated by the co-authors (usg and es). to check validity, interviews with key informants of two active ngos in this field in california were conducted, and their responses were identical. as part of our verification of data, the results were also validated by a ‘member check’, controlling interpretations and conclusions with each of the interviewees. (patton, 2002, p. 381). this verification by the interviewees was followed by a transcription. thereafter a reflection by authors (patton, 2002, pp. 555-561) was performed. njsr – nordic journal of social research vol. 4, 2013 146 in a follow-up, we conducted, transcribed, and analysed 14 semistructured qualitative interviews with randomly selected volunteers from various projects. these interviews increased our understanding of a volunteer’s personal engagement and relationship and they verified the results of the previous survey. key informants this study held interviews with 82 key informants from volunteer associations identified by the list of fund receiving ships from the directorate of heritage in 2009. all key informants are defined as individuals with knowledge and experience in the field who can articulate their observations. all key informants held managing positions or were in charge of supervising and conducting preservation work in the field. to ensure that key informants understood the nature of the questions, they received information before the interviews (patton, 2002, pp. 321). estimating the value of the commitment we used the un-recommended template for estimating the value of volunteer work to estimate the economic value of the work — a method that has been used by statistics norway to create a satellite gnp including all registered volunteer work in norway in 2007. satellite account is defined here as an account based on national accounts concepts and national accounts figures, while making a special adaptation to emphasize this economic phenomenon (statistics norway, 2010). we employed the average working hours and wages in 2009 as variables. limitations of the study the interviewer (es) has experience as a volunteer and is employed by the dch. being aware of biases that might affect the reliability and validity, the author (usg) analysed all data after transcription. the hermeneutic impact that the interviewer had on interviewees could not be adjusted for. another bias that limited the study is that the study population consisted of key informants in the role as contact persons for the individual project and being themself active volunteers. the provided data were filtered through a key informant (patton, 2002, p. 321) and njsr – nordic journal of social research vol. 4, 2013 147 must be understood to represent an estimate of an estimate. additionally, a recall bias must be accounted for, because informants relied solely on their memory. this study was approved by the regional committee for medical and health research ethics, south-east in norway (reference number 2010/173a). the extent of ship-preservation activities the voluntary sector, also known as the non-profit sector, is an area of social activity dominated by non-governmental organizations. this sector is called the third sector in reference to public and private sector. nordic countries are rich in third sector organizations, but the responsibility for financing, and partially also organizing, still remains in the public sector (grassman, 2006, pp. 325-327). in norway, volunteers carry out the majority of preservation activities on historic ships. their efforts in total, their organization, both formal and informal, including forms of ownership of the ships, and the impact of the active volunteers, is one of the success stories of the welfare states in northern europe (matthies, 2006, pp. 13-14). descriptive statistics table 1 shows the geographic distribution of formal volunteer effort on ships in norway in 2009. most of the volunteers who invested more than ten hours monthly, adjusted for population size, resided in southern and eastern norway, followed by central, western and northern norway. this pattern is consistent with berkaak (1992, p. 21). njsr – nordic journal of social research vol. 4, 2013 148 table 1 – volunteer activity on ships in norway (2009) by region region population jan. 2010 ships adjusted number of volunteers (≥ 10 hours monthly northern norway (nord-norge) 465 000 18 153 middle norway (trøndelag) 423 000 8 63 western norway (vestlandet) 1 263 000 36 256 southern norway (sørlandet) 278 000 3 29 eastern norway (østlandet) 2 428 000 25 295 overall 4 858 000 90 796 njsr – nordic journal of social research vol. 4, 2013 149 figure 1: the regions of norway njsr – nordic journal of social research vol. 4, 2013 150 regarding the ownership of the ships and volunteer activity of the 90 ships that were included, 76 were associated with volunteer activity (figure 2). the remaining 14 ships were owned by museums, corporations or the municipality and one was privately owned. for 2009, we estimated 10.1 per cent (994) from a total of 9887 registered members of various ship-preservation organizations, as active members. figure 2 ownership of the 90 ships in the study only few key informants reported that they only had passive members in their ship-preservation organizations in 2009. this means that the majority of associations maintain at least at some level of activity at the time of the study. over ten per cent of members participated in more than ten hours volunteer activity per month. we used the ‘full data set’ as the inclusion criteria. we ultimately included 796 members for further analysis. the percentage of female volunteers was 19.1 per cent, which is low compared with leisure and culture as a whole, and this number demonstrates that preserving historic ships appeals particularly to men. this is perhaps not surprising; the building and managing of boats and ships have traditionally been male-dominated professions. 26%   24%   15%   6%   11%   7%   9%   2%   founda0on  23   member  organiza0on  22   corpora0on  14   joint  ownership/ coopera0ve  5   individual  10   museum  6   ship  conserva0on  center   8   njsr – nordic journal of social research vol. 4, 2013 151 table 2 shows an overview of the contributing members demonstrating that the active volunteers primarily are men within the 50+ age group with a 60+ age group being heavily represented. large proportions of men in this age group have retired from paid work and have time to spend on volunteer activities. the female volunteers were reported to be less active and mainly took part in more traditional female roles such as preparing food for the other volunteers and visitors. table 2: overview over the field – contribution by hours and demographic data agegroups hours total (hours pr. member) active ≥10hrs (%) {hours} male/female ≥ 10hours ≤39 27 450 (159) 173 (28.9%) 123/50 40-49 14 500 (86) 169 (20.1%) 135/34 50-59 32 860 (186) 177 (13.56%) 153/24 ≥60 54 900 (198) 277 (15.88%) 233/44 total 129 710 (628) 796 644/152 80.9%/19.1% legend: * included all members (full data set) table 2 shows the activity for those aged ≤ 39, 40-49, 50-59, and ≥60 years. the average number of hours of volunteer work per active member (over 10 hours pr. week) was 163. most active members (57.03 per cent) were aged ≥ 50 years. njsr – nordic journal of social research vol. 4, 2013 152 figure 3: active volunteers spending ten or more hours volunteering on an individual ship in 2009, stratified by age and effort based on table 2, figure 3 shows the number of active members who contribute more than ten hours per month. calculating the economic value of volunteer work despite the attention of various policies and public institutions and subsidies from the dch, the value of volunteer work has not been calculated. in the johns hopkins comparative non-profit sector project, heritage and historical organizations are included in the subcategory ‘culture and arts’ under ‘culture and recreation’ (ministry of culture and church affairs, 2006, p. 69). for statistic norway’s estimate of the value of volunteer work in this subsector, the data were supplied by museums, art galleries, and performing arts organizations. volunteer work on historic ships comprises both blue-collar work and tasks that are related to planning, financing, and promoting a project. these tasks resemble the activities of the shipyard industry more than those of the performing arts and museums. to estimate the value of volunteer work in preserving historic ships in 2009, we used the ≤39   40-­‐49   50-­‐59   ≥60   active10   173   169   177   277   0   50   100   150   200   250   300   (n )   njsr – nordic journal of social research vol. 4, 2013 153 average work hours and wages per year in the shipping and oil platforms and modules sectors (statistics norway, 2011). in 2009, the average number of work hours for employees in the shipyard industry was 1666. the 129 775 hours of volunteer work in 2009 equals that of 77.9 full time employees. the average wage in the shipyard industry in 2009 was 70 000 euros (511 000 nok). using the method per statistics norway and these figures, we calculate that the value of volunteer work on the 90 ships that we have included was 5.34 million euros (39.85 million nok) in 2009 (statistics norway, 2009). the funding from the dch is not intended for reimbursement of volunteer work, instead covering expensive equipment, materials, dry docking, and commissioned work by specialists. the volunteer work consists primarily of tasks that are related to maintenance, minor restoration tasks, sailing the ships, planning the work and running the organizations. thus, and due to additional private and local funding, the amount of volunteer work on a ship does not depend solely on funding from the dch. hence, the volunteer work on ships that did not receive funding in 2009, or on ships whose owners did not even apply for dch funding that particular year, may not be less than that on ships that received funding. thus, the value of volunteer work on all 211 historic ships with approval from the dch could have exceeded 12 million euros (nearly 90 million nok) in 2009. in conclusion, funding from the dch is crucial for financing larger or expensive repairs of damage that threatens historic ships, which, for most of them, have surpassed their life expectancy several times over. qualitative results the volunteers were aged between 17 and 85 years, and two-thirds of the group were in their 50s and 60s. many of those who initiated the projects one to two decades ago still remain active. key informants highlighted the volunteers’ distinctive, often personal, relationship to the particular ship or the ship’s original company. a background in maritime-related jobs was also frequently mentioned. all interviewees described volunteering as a function of the social interaction between the individual and his social surroundings. ‘volunteers are people who are enthusiastic about what they are doing’ (key informant 14) and ‘volunteers are active, positive, are in a njsr – nordic journal of social research vol. 4, 2013 154 good mood and are flexible’ (key informant 73). the following statements describe what we found volunteers to be: enthusiastic, active, and positive individuals who are often extroverted. ‘we are optimists and wish to create something’, key informant 51 said, indicating how volunteers as a group have a common set of beliefs and values and a common aim, purpose, task or goal. after coding, clustering, and grouping the data, we identified four major reasons for participation, two or three of which were given by every volunteer. our study shows that the reasons for voluntary participation are compound. the main reasons for volunteering were as follows: • the wish to have a feeling of unity and companionship. • the wish to have a relationship to the individual ships or site. • the volunteer has an interest in the nautical environment and the specific ship. • the wish to see results and to experience empowerment. a close reading of transcripts and interview notes reveals that the patterns of interaction and the decision-making processes were imbued with selfand collective efficacy and a sense of community dynamics. key informant 32 explained this as follows: ‘unity, companionship. getting it right, technically and economically’ (key informant 32). another informant described self-efficiency as follows: ‘we receive and offer both trust and responsibilities very fast’ (interview no. 13); interviewee 12 claimed that ‘…to see a result, this is the important thing. to get it right, no matter what it is’. the strongest motivation was ‘the social aspect and the interest in ships – and having an unbelievably good time’ (key informant 6). expressions of unity, companionship, and specific interest were mentioned in nearly every interview. like within reminiscence, linking memories to objects or giving them a tangible reality through heritage means that they can be collected and preserved. informants expressed this concept as follows: ‘we grew up there so we have been here since childhood, where we used to travel by boat to the town!’ (interviewee 9). the most frequently emphasized factor for volunteer participation was the personal interest in a particular ship or the company that had operated the skip. ‘interest in the history of the company and the ship’ was decisive to key informant 17, because it evoked important memories. njsr – nordic journal of social research vol. 4, 2013 155 reasons for dropping out many key informants could not recall anyone dropping out of their volunteer association or had not experienced it for several years. reasons for discontinuation given were loss of motivation (poor progress or inadequate funding), ‘getting tired’ (old age) or other physical factors, including death. discussion demographic differences and recruiting fifty-one and 64 per cent of all female and male inhabitants of norway, respectively, participated in various forms of volunteer work in 2004. women devoted an average of 24 hours per year versus 44 hours for men (sivesind, 2007, p. 19). owing to the lack of comparable data on heritage volunteering, we must refer to berkaak’s study, which reported ten per cent participation by women (1992, p. 24). in our study, 19.1 per cent of active female members committed over ten hours. this gender imbalance, based on the strong male dominance (80.9 per cent), leads us to conclude that this form of volunteer activity primarily attracts men before and after retirement. in the past two decades, the number of organizations that deal with the preservation of historic ships in norway has grown considerably. because boats and ships have played an important part in norwegian communications and everyday life throughout history, old ships of all kinds are considered an invaluable part of the nation’s cultural heritage (småland, 1995). participation in voluntary organizations differs by social group, age, personal background, and gender (enjolras, steen-johnsen & ødegard, 2012). high income and high education and being a member of the active workforce increase the likelihood of volunteering. in addition, gender has an impact on diverse volunteer activities. the white paper ‘the role of the owner’ expresses tremendous concern over volunteer recruitment (norwegian ship preservation association, 2009, p. 12), as did several of our key informants. our findings indicate that volunteers recruit primarily from their social networks and thus within their own age groups. this pattern might create the impression of stagnation, as the entire group ages. njsr – nordic journal of social research vol. 4, 2013 156 however most associations show a healthy influx of new recruits leading to a stable membership base. because volunteers are aging, work on historic ships becomes increasingly important for the social network and coherence of a growing segment of older men. in berkaak’s study (1992), the average age of volunteers was estimated to be slightly over 38 years, whereas 20 years later in the present study, the average age is 52 years. berkaak’s study included 31 ships and 48 individual responses that were not randomly selected. although only 14 of berkaak’s ships are included in the present study the results still indicate a notable increase in the average age among volunteers. despite the divergent criteria for inclusion, our results indicate a notable rise in the average age of volunteers, consistent with a recent study on volunteerism by christensen, strømsnes & wollebæk (2011, p. 42). furthermore, our results are consistent with the number of protected ships and consequent rising number of organizations over the past 20 years (directorate for cultural heritage, 2010, p. 24). with regard to changes in society and volunteering, christensen et al. (2011, p. 9) have noted rising commitment and growth in nonorganized volunteering, indicating a new tendency of contribution by individuals linked to personal well-being without the requirement of formal membership. characteristics of volunteers the determinants and characteristics of volunteers are seen as contextual, with characteristics in social background, personality and attitude (smith, 2013). additionally volunteering for a non-profit organization is seen as a way to remain active engaged in later life. in this voluntary or third sector, the sphere of social activity is undertaken within organizations that are not for profit and non-governmental. as indicated the informant’s volunteers were mainly men over the age of 50 described as ‘idealistic’, ‘engaged’, ‘enthusiastic’ people using their skills. as a study by mjelde-mossey & chi (2005) indicates, utilizing skills are associated with volunteer experience by men. it is therefore likely that the gender bias registered and their differences in expectation are influencing the choice of activity. as our results show, volunteers frequently show a highly special interest and personal relationship for one particular ship or the ship’s original company. the importance of local history attracts many of the elderly. at the same time volunteers in ship preservation meet others who share their interests. the voluntary ship preservation activities njsr – nordic journal of social research vol. 4, 2013 157 present an arena for social cohesion. these men often regard the wharf or boathouse as a meeting point, a place where they might feel needed in their effort to serve their community along with their peers. within ship preservation the most common reasons for volunteering appeared to be closely related to personal ties and one’s personal sense of history, confirming that memory is an important constitutive element of identity formation—unlike professional historical narratives, it is personal, and thus, collective memory has particular emotive power (smith, 2006, p. 60). also, berkaak (1992, p. 22) has observed that the most frequent motivation factors were closely related to personal experience. wallace notes that volunteer motivation in the heritage sector is based on certain notions of intrinsic value in the labour itself (2006, p. 233), underscoring the preoccupation of skills and the presence of a strong personal factor among initial motivations. although many volunteers have similar or closely related approaches, they are unique and personal, in that they must be experienced personally and included as a part of an individual’s story. our results show that the volunteers desire unity and companionship. beside that, the volunteers’ motivations will both consist of an interest in a specific ship and the wish to give something back to the community. we also detected that the importance of feeling needed, the experience of positive self-worth created by volunteering as well as the opportunity to meet people was under-communicated. this confirms that social capital is strongly linked to subjective experience of well-being through different connections and in different forms. by volunteering, new links are created connecting people outside of their immediate circles and provide ties to friends and neighbours at a point in life when ties to workplace and family are reduced or even disappearing. social capital gained by volunteering is robustly related to happiness and life satisfaction, both directly and through its impact on health (helliwell & putnam, 2004). as seen, over half of the active volunteers in 2009 were 50+ and motivated by wanting to feel useful as members of society. there is also an incentive to fill the void left by retirement. this underlying value is not expressed explicitly but can be interpreted as a deliberate approach to maintain health (frank 1995, sixsmith & boneham, 2003). engagement can take many different forms – actively preserving the ship or more passive by supervising, giving lectures or by participation in annual meetings. in some cases associations almost create a njsr – nordic journal of social research vol. 4, 2013 158 lifestyle for the members – by joining a circle of friends at their local cultural heritage project. because all participants were seen as equal, volunteering was a strong contributor to a feeling of community and establishing a position in the network. this impact also influenced the respondents’ perception of well-being. several international studies (frank, 1995; falck, hanson, isacsson & östergren, 1992; sabo & gordon, 1995; sixsmith & boneham, 2003) on volunteering in the given context have shown that participation in networks is based on a degree of participation in physical activity, tailored to individual requirements. conclusion volunteers in preservation projects spend time, effort and knowledge, and experience a meaningful collective context. participation on ship preservation projects create social communities where experiences are shared and passed on within the community. participation in this kind of social communities provide important relationships, as well as recognition of the individual as a person, and by that create opportunities to form social capital. we found that the main group of volunteers in the field of ship preservation are men over the age of 50 with the desire to help others and to support a cause that they believe to be important. the participation is underpinned by a desire to remain active, to experience empowerment, and to maintain a social life. the comparison with previous studies shows that the average age of volunteers in this field has shifted considerably upwards, but that it still is dominated by male volunteers. making new acquaintances is important for an age group who experience a decrease in social network. this might lead to the assumption that volunteering prevents the loss of informal social capital and social connectedness. thus, the preservation of historic ships is an increasingly important endeavour for this group. they find the maintenance and care of their nation’s maritime and local cultural heritage a meaningful and social activity. volunteering appears to have a positive impact not only on individuals but also on the economic resources dedicated to ship preservation. the value of volunteer work on the funded ships was estimated to be 5.34 million euros (39.85 million nok). this not only equals the annual funding by the dch, but also maintains the value of norway’s marine heritage. njsr – nordic journal of social research vol. 4, 2013 159 we conclude that despite the aging volunteers the volunteer activity itself is increasing. both the number of ships and the number of active members has increased over the last 20 years. on a more general level, this voluntary work on ships is crucial for the implementation, restoration, maintenance, and operation of norway’s historic ships. this activity has tripled over the past 20 years. acknowledgments the authors thank haci akman, university of bergen, for his valuable suggestions on the draft of the article. we also thank steven connolley and the two anonymous reviewers for constructive comments. references adler, r. p., & goggin j. 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[voluntarism: social integration, democracy and economy]. bergen: fagbokforlag. wollebæk, d., & sivesind, k. h. (2010). fra folkebevegelse til filantropi. frivillig innsats i norge 1997-2009 [from popular movement to philanthropy. volunteering in norway 1997-2009]. oslo: senter for forskning på sivilsamfunn og frivillig sektor. microsoft word 598, proof2.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 inequality confirmed: institutional exclusion in the interaction between job-centre advisors and unemployed young people ulla rantakeisu* department of social and psychological studies: social work karlstad university email: ulla.rantakeisu@kau.se *corresponding author kirsti kuusela department of social and psychological studies: social work karlstad university email: kirsti.kuusela@kau.se lis-bodil karlsson department of social and psychological studies: social work karlstad university email: lis-bodil.karlsson@kau.se abstract since the 1990s, the pressures on the unemployed have intensified in sweden owing to increasing demands on individuals to be employable. this article centres on unemployed youths’ experiences of their visits to the public employment services in four swedish municipalities and how these experiences can be understood against the background of the intersection of social class and gender. a total of 18 unemployed youths were interviewed and their reasoning was compared with their respective employment-agency officers. the analysis shows that the employment agency gives priority to young working-class men over young working-class women and to middleclass youths over working-class youths, respectively. young working-class women’s wish to combine employment with caregiving is seen as an encumbrance by the employment agency and these women expressed the harshest criticism against the employment agency. when the advisors meet youths who do not correspond with the current expectations and ideals of the labour market, they risk taking part in an institutional process of exclusion of these youngsters. keywords: unemployment, employment agency, job centre, emotions, gender, social class, exclusion njsr – nordic journal of social research vol. 6, 2015 120 introduction starting work for the first time or re-starting after a period of unemployment can be a complicated process involving more than merely individual aspects. in sweden, the public employment service has a central role in labour-market politics. it is an important actor because of its double role of providing service to job-seekers and employers, on the one hand, and identifying unemployed people who abuse unemployment benefits, on the other (calmfors, forslund, & hemström, 2002). in the 1990s and 2000s, the demands on the unemployed to seek and find work have become stricter, which is similar to the development in other european states (heikkilä, 1999). the public employment service’s efforts have gradually shifted from supporting and controlling to supporting by controlling (walter, 2011). current labour-market policy is implemented through increased monitoring. the officials’ authority to assess and question an unemployed person’s steps and actions in the labour market makes for an asymmetrical power relationship, meaning that the officer has the interpretative prerogative of defining a situation. studies of street-level bureaucrats (lipsky, 1980), that is, officials in direct contact with citizens, show that they have great opportunities to influence the interaction with citizens because of their chance to convey daily messages on how individuals should act as clients, job-seekers, and so on (hydén, 1996; romppainen, jähi, saloniemi, & virtanen, 2010; skogens, 2011). norms and values are established of what is desirable, that is, the experiences and knowledge routinely defined as important and what is less important (hasenfeld, 2000). research with a citizen perspective also points to different experiences of contacts with the welfare institutions’ street-level bureaucrats (mcarthur, thomson, & winkworth, 2013). the present study focuses on a determining aspect of the process of (re-) entering employment, namely, on what takes place when a job-centre advisor meets a young unemployed person in pursuit of a job. the aim of the study is to investigate the interaction between advisors and the young unemployed with an emphasis on the young people’s experiences and how they cope emotionally and to consider whether different patterns of experience can be generated from the unemployed youths’ own living conditions. knowledge of interaction at the employment agency is urgently needed to understand the changes on the labour market in last decades involving a greater emphasis on the individual as a saleable labour-market commodity (garsten, & jacobsson, 2004). people are expected to be mobile, adaptable, and adjustable, where the responsibility for being employable lies with the individual (salomonsson, 2005). employees are trained to act as entrepreneurs, to be flexible, to embrace life-long learning, and to learn different managerial methods for job interviews (fogde, 2010; sharone, 2007). even if the visits to the employment agency take place on the terms of the organization, the basic values that each individual has also colour the visits (tilly, 1998). different life circumstances are important for how the prevailing labour-market norms are accepted, not least for the effects of welfare political reforms. a meta-analysis of evaluation studies shows that participants’ sex, age, and ethnicity are often equally important, and sometimes even more so, than programme design in determining the success of welfare-to-work programmes (ashworth, cebulla, greenberg, & walker, 2004): the fewer the non-whites, the women or the people under 30 there were, the greater the success of the programmes. sharone’s (2007) study of unemployed well njsr – nordic journal of social research vol. 6, 2015 121 educated, white-collar workers indicates that individual competition, an emphasis on entrepreneurship, and marketing themselves were considered obvious aspects of their job-seeking. fogde (2010) shows that academically educated students take an individual attitude to career advice. another researcher has argued that the ideal image of employees in manuals written for the unemployed are masculinely coded, which can have consequences for women’s career opportunities (andersson, 2003). furthermore, according to persson thunkvist (2003), unemployed working-class youths display a resistance to an approach of learning to be competent job applicants that is in line with the ideals of the time and of the middle classes, that is, with an emphasis on individual performance and competition. labour-market norms and inclusion as well as exclusionary mechanisms in respect of sex, class, or age, for example, have been the objects of study. comparative studies of women and men and between social classes with regard to social life conditions are, however, more scarce. this article aims to redress this lack of attention in the literature. exclusion, multiple inequalities, and emotions like other western european welfare states, sweden has developed a tighter control of the unemployed, partly explained by the economic crisis in the 1990s. in contrast to other western european countries, sweden had long enjoyed low unemployment and high employment rates, but in the 1990s the unemployment rates doubled. the concept of social exclusion is used to denote a situation in which people are unable to participate in society, especially the labour market (rodgers, gore, & figueiredo, 1995). people can experience social exclusion particularly in contacts with welfare institutions that deal with unemployment and poverty, according to kronauer (1998). the lower the extent to which employment and social services can help people out of unemployment and poverty, the higher the extent to which these organizations contribute to reproducing what kronauer calls an institutional exclusion. the concept of institutional exclusion enables us to understand the processes of inequality that are reproduced at the studied job centres in a welfare state like sweden. despite efforts made towards inclusion by increased resources intended to improve labour-market links, the consequences might be the opposite. in our article we consider institutional exclusion as a process through which the interaction between the actors concerned reduces individuals’ active possibilities for manoeuvring in the employment market and thus affects young people’s life conditions. our focus is if and how certain groups are dis-benefitted by their interaction with employment agencies. we study a set of unequal social relations – the intersection of the multiple inequalities of class and gender – considered as autonomous social structures (cf. walby, armstrong, & strid, 2012). we analyse this interaction in the interpretative frame of life-mode theory. life-mode theories are connected to the material conditions of class analysis, but they also emphasize the core values of ideologies or cognitive configurations (højrup, 1989; jakobsen & karlsson, 1993; jakobsen, 1999; 2005): people who live different life modes tend to have various everyday norms of what constitutes a good life and of what is possible to do in order to attain the good life aspired for (jakobsen & karlsson, 1993). everyday life consists of work and love. the means of existence are produced through what jakobsen (1999; 2005) calls the forms of njsr – nordic journal of social research vol. 6, 2015 122 work, while the forms of love produce life itself, which in turn is the precondition of human existence in itself and regulated by strong norms (cf. also jónaisdóttir, 1994). the forms of work focused on in our study are the traditional wage-earning jobs and the career-oriented jobs. these forms of work are related to social class structures, such as the working and middle class. referring only to two social classes is admittedly a simplification in this context but it helps analytically to clarify how social class entails differences in power and lead to inequality (skeggs, 1997). two dominant forms of love can be identified, which in turn are related to the gender structure of society: the male empowering love and the female confirming love. these structures can aid our understanding of the norms and values that the young unemployed people express in their contacts with the employment agency. norms and values can be related to emotions. emotions in the form of signals of feelings show how we assess situations (hochschild, 1990). together with rational components emotions play an essential role in every social interaction (dahlgren, & starrin, 2004), not least in the contact with street-level bureaucrats (svensson, karlsson, alexandersson, & nordqvist, 2003). social relations are created in the process of interplay between individuals, but are felt within the individual. experiences are narratives about what the contact feels like, for example, unemployed young people’s experiences of contacts with the employment agency. knowing how the young people emotionally handle their norms and values in their contacts with the employment agency helps us to understand the underlying mechanisms. method we chose a qualitative interview design to collect contextual data. initially, four public employment-agency offices (hereafter referred to as ‘job centres’) were selected in different mid-sweden urban and rural municipalities, with the intention of representing different demographic and socioeconomic character. the manager of these job centres selected the advisors who had at least five years of experience. the nine interviewed advisors were all women. these advisors in their turn asked unemployed young people to participate; this was based on purposive sampling and it was a way of maximizing social differences (silverman, 2006) such as age and sex, how long they had been unemployed, and which upper secondary programmes they had attended. when we considered social class in our study, we used two broad and still common categories in research (skeggs, 1997). the idea was to recruit respondents from academic as well as vocational programmes on the assumption that young people’s choice of upper secondary educational programmes is both classand gender-specific (hagquist, 2000). we employed the categories of working class and middle class in relation to the young respondents’ background in respect of education, work experience, and parents’ occupations, where education was the most influential factor in the categorization. one of the authors (u.r.) interviewed 18 young unemployed persons in the 21-24 age range, whose periods of unemployment varied but were never less than ten weeks. eight respondents were women and ten were men. these interviews were followed by interviews of their advisors. the data were collected with the help of an interview guide consisting of open thematic questions. all interviews were recorded and transcribed verbatim. njsr – nordic journal of social research vol. 6, 2015 123 to determine whether class had an impact on the respondents’ experience of the job centre, unemployed men with different social backgrounds were compared and likewise unemployed women with different backgrounds. when differences between the sexes were found, we compared unemployed men and women with similar social-class backgrounds. the concepts of forms of work and forms of love were the starting-points of the analysis, in line with the orienting concepts as suggested by layder (1998). we analysed the relations between the advisors and youths on the basis of the different perceptions that can be perceived in a contact depending on the various positions that social actors take in a relation. we coded the interviews with the help of a combination of what kvale and brinkmann (2009) denote ‘meaning concentration’ and ‘meaning categorization’, that is, by extrapolating the essential information that can be grouped into common categories. the analysis was mainly analytically inductive (boolsen, 2007), based on an interaction between theoretical concepts and the categorization of the transcript material. results this section presents the experiences of the young respondents and the advisors. we describe the unemployed working-class youths’ experience, which can be understood in the light of the norms of traditional wageemployment. there are also gender-specific experiences which must be included in an analysis of the norms of gender structures. finally, we present the experiences of middle-class youths on the basis of the valuations of career-oriented jobs. high expectations and dependency the working-class youths’ expectations on the job centres are high. the expectations can be interpreted against the background that these young people lack a social network to help them out of unemployment and that their economic situation demands an immediate solution. they expect the advisor to show them a way out of unemployment if they cooperate. their expectations are based on the norms and values informing employees of what is expected of them, namely, that the employer is responsible for how the labour force is used and what the employee is expected to do. working-class youths have the same expectations on the employment authority. they expect the official to tell them how and what to do, and then they will do it and immediately get a job as a result. these expectations combined with the increasing need for help over time pave the way for a growing distance to the job centre. the job-centre advisors on their part report that these young unemployed people have an exaggerated faith in the duty of the employment agency. their demands for a quick solution and requests for hands-on cooperation to secure a job become, despite the generality of the attitude, individualized by the official: ‘i think [the job centre] can be the scapegoat for their own shortcomings also, because there i can hear: “i have not got any help from you”.’ njsr – nordic journal of social research vol. 6, 2015 124 the youths’ expectations are thus interpreted by the professionals as individual expressions of personal failure or a way of escaping personal responsibility. the norms of working-class youths are in fact in opposition to the employment agency’s basic principle that the unemployed are responsible for finding a solution themselves – provided that the job-seeking takes place on the agency’s terms. oppositional defiance and rejection of norms the working-class youths’ expectations of hands-on help tend to be frustrated. misunderstandings, and at worst conflicts, can result and be manifested emotionally in the form of contempt, anger, or sarcasm. some adopt an oppositional, defiant position, even though they do not always express their feelings to the advisor. on the contrary, there is a high degree of self-control – it is important to restrain feelings in the face of the authority’s judgement. on the one hand, they try to present correct behaviours, but, on the other, they describe through language use and expressions of feelings how they reject the officials’ norms when they encounter them. the young people also experience a rejection of their norms. it seems that they swing between keeping within the bounds of agency norms by what we see as flexible compliance and defying and rejecting the advisors. this vacillation relates to their limited possibilities to influence the agency’s norms and rules through negotiation. an expression of the young people’s defiance is to protest against various situations in their visits that are ungraspable, not to mention painful. this kind of rejection is described in detail in the interviews. a young man describes what happened when he failed to tick a box in the form: ‘but then you miss a detail, you see! and the well-educated person working there can’t figure that out. is it possible that he might just imagine that i made a mistake? no way! so i must go back and make a supplementary report.’ the frustration involves being at a social disadvantage and experiencing one’s own shortcomings. they recount situations in which they feel misunderstood and even offended. when one of the men talks about an unemployment scheme where he was supposed to learn how to highlight his unique competence [as a welder] in writing with a great deal of swearing, it is an emotional way of dealing with being categorized as deficient. from a working-class position it is not fair to say that he has a unique competence to offer; rather, it is more accurate to say that he offers his working time. to him these demands are incomprehensible. when one of the young women describes the advisor’s focus on work as an interest, she exclaims sarcastically, ‘interest? my foot! you need money and i would take any job.’ from her working-class perspective the notion of a job as an interest is foreign to her and indeed stressful. interests are pursued in leisure time. the working-class youths want to cooperate with the job-centre advisors by forming an alliance based on understanding and getting assistance with what, how, and when. when this is not achieved, the young people demonstrate an emotional rejection of the advisors, responding to what they regard as incomprehensible demands. the visits to the job centre are crucial to the working-class youths. they rely to a great extent on the employment agency to get a job but at the same time the norms of the system are not adjusted to their culture. njsr – nordic journal of social research vol. 6, 2015 125 he can negotiate while she is expected to take any job compared with young working-class women, their male counterparts have a greater chance of manoeuvring their way out of meeting the job-centre requirement to apply for certain jobs, for instance, by saying, ‘of course, i’ll apply for the jobs i want’. unlike a woman, a man who has to apply for a notified vacancy according to the rules is to a greater extent allowed to influence the decision. the advisors give the young men certain possibilities for negotiation and offer different options; the men themselves can partly decide if they apply and what jobs they apply for. working-class women are not given the same options. the young women’s ifs are decided when they register as job-seekers. the same is true of what jobs they must apply for. the advisors think that the young women have a much too limited job-seeking profile because the women tend to consider their social situation of having a husband or boyfriend and starting a family etc. the young women take their partners’ interests into account, for instance, their wish to stay in a place because they have a job there. this is perceived as an individual choice and from a labour-market perspective it is the wrong priority: ‘and then [the advisor] begins immediately [saying that] there is something all the time that you put a stop to. yes, but then if she had been in my shoes she would have known what i mean. also. yes, here at least i’ve [a boyfriend].’ the interviews with the advisors indicate that women in general are in fact expected to find a job themselves: ‘women, they are more autonomous.’ an advisor puts it like this: ‘in terms of gender, the guys take more of our resources, of my time. the girls have more drive.’ the advisors also link the young women’s own activity to the fact that labour-market training is offered to men to a greater extent (cf. also lodenius, 2005): ‘i can only say generally that there aren’t as many training projects to offer the women. but many of the women do well anyway. i imagine that some perhaps work extra in social and health care.’ the employment agency does not treat the young unemployed working-class men as harshly as they do the working-class women when it comes to if they apply for a job and what jobs they apply for. to understand the differing experiences of the job centres between these men and women, the analytical concept of form of love is essential (jakobsen, 2005). young working-class men’s and women’s conception of work is typically that it is a means of reaching other goals beyond employment. the conception is a consequence of their position as working class. but their respective gender positions also generate different social norms of how men and women should behave. for the young working-class men the future employment must not infringe on their leisure time. when asked what they think about combining employment with family, they jokingly say that they have not given it much thought. to them, there is no conflict between work and family, something that other studies confirm (kennerberg, 2007; kugelberg, 2004). the young men’s job-seeking pattern has no link to possible obligations in a partner relationship or caring for others. when the young women seek jobs, on the other hand, they consider their current and potential future family formation. this means that there is a clash for the women between the demands of the employment agency, which represent labour-market norms, and the demands of the family sphere. the interviews show that when being both working class and a woman, flexibility manifests differently depending on if the woman is single or not, as one njsr – nordic journal of social research vol. 6, 2015 126 woman emphatically remarked: ‘i will stay here now; this is where my boyfriend is.’ if the woman is single, then she is geographically mobile. she can take a job somewhere else if there is no man to consider. however, if there is a boyfriend, his interests are protected and she stays where he wants to be as a result of an unequal distribution of power in love relationships. the advisors commend the former choice while they criticize the latter. however, with the latter women can be required to show job flexibility – meaning that they are expected by the agency to take any job. what she does in the labour market is thus conditioned by the needs of her nearest and dearest irrespective of marital status. in the next section we discuss what the visits to the job centre mean to young working-class men and women and their respective emotional manifestations. attention and pity – invisibility and blame the interviews show that the working-class men are primarily successful in eliciting the help they want, or as one advisor puts it: ‘you look more to who are [full-time] unemployed. even if the women are that when they don’t work full-time or the hours they want to, that’s what it is, sort of. in some way the situation gets solved [for them] temporarily, you know.’ the young working-class men also manage partly to leave the responsibility for the jobseeking to the advisors, which also means that it seems as if it is the duty of the agency to solve the situation, or as one man puts it: ‘often i say to her [the advisor] that she has to fix something so she can have control. and then i sit there talking for five minutes.’ although the young men can do manual work, they are rather ineffectual when it comes to applying for a job. the advisors show interest in them as cases and they get attention. the attention entails a sense of being someone, thus confirming and securing the relationship. the young working-class women, however, are expected to find their jobs on their own. in other words, they have greater challenges when it comes to adapting to the prevailing conditions of the labour market. the obligation to take any unqualified job is a result of women taking responsibility in the labour market as well as in the area of reproduction. this is an underlying issue that creates conflicts both in the young women’s and in the advisors’ accounts of their contact visits. as an advisor says: ‘then i can get a little irritated.’ the working-class women’s goals in relation to their loved ones are not accepted by the employment agency. the advisors also describe conflicts in relation to job-seeking men and women in different ways: if and when conflicts arise in relation to men, it is because a point has been reached where the advisors can no longer negotiate between the interests of the agency, their job satisfaction, and the young men’s requests. this is when advisors express that they themselves become ‘a bit bitchy’ in their interactions with the young men, or ‘but i’m so mean then so i won’t let them go.’ in such situations the advisors attribute negative qualities to themselves and the institution. in similar conflicting situations with young women the advisors tend to blame the young women: ‘so i thought that there was something wrong with her instead.’ if there is a conflict in the interaction with men, however, the advisor can perceive that they are partly to blame. have they as the representatives of a public authority also in fact contributed to a conflict? when it comes to the unemployed and men, this is something njsr – nordic journal of social research vol. 6, 2015 127 employment-agency officials reflect on. he seems to deserve pity, while she can be blamed. the interviewed advisors emphasize that individual evaluation is always done, but in practice, as our analysis shows, young working-class men gain access to the resources of the employment agency and are given more options. as a result, men have a wider scope for action than working-class women for (re-) entering the labour market. the individual evaluation is, we argue, gender stereotypical. the evaluation is to the advantage of the young working-class men. conflicts and sophisticated disciplining conflicts and resistance are more blatant among the young working-class women than among the working-class men. we suggest that there is an informal positional war going on between the young women and the advisors. out of all the interviewed young people the working-class women express more aggression than anyone else: ‘but many times you can feel, what the hell, go there and blow up the shitty place. good riddance. they don’t get that we are ordinary mortals. if you’re unemployed, you aren’t worth a bloody shit.’ there are examples of these women refusing to submit emotionally to the employment agency’s terms, not least in the descriptions of an angry mode of confrontation: ‘it’s up to them how i should behave. if they are cranky i can be cranky too. if they say that it’s so bloody simple – tell you what – let’s switch places!’ the demands for reproduction that pressure young women are not particularly visible at the job centre, and this issue is, in other words, routinely understated. the issue is not discussed openly but is implicitly present in both parties. the intersection, as well as the conflict, between the spheres of production and reproduction, is manifested in the actual encounter but remains complex. this might explain why the situation seems especially emotionally tough to handle for the young women. it involves a shortcoming at a structural level – how production and reproduction should be solved in society – but working-class women are left to handle this problem individually. young working-class women are therefore categorized and disciplined just like ‘the others’ in a supposedly classand gender-neutral labour market. but government officials do not do this through the open exercise of authority. the disciplining of working-class women is subtler; it is done through prevailing norms and good advice given with the best of intentions. in the following section we present the experiences of middle-class youths on the basis of valuations of career-oriented jobs and their emotional manifestations. few expectations and distanced approach unlike working-class youths, middle-class youths have more modest expectations of the employment agency. they voice cautious scepticism and describe their relations with the advisors in formal terms. the importance of being business-like and keeping a distance are emphasized in contrast to the working-class youths’ insistence on personal and equal relations. taking a distanced approach can be seen in the light of the socioeconomic background linked to career-oriented professions that have informed the lives of middle njsr – nordic journal of social research vol. 6, 2015 128 class youths rather than traditional wage-earning jobs (jakobsen, 2005; jakobsen, & karlsson 1993). shared conceptions and norms middle-class youths’ conception of work is in line with the prevailing norms of the employment agency, namely that the future jobs will be based on their unique competence and, unlike working-class youths, they see education as the main instrument of reinforcing their qualifications. the norms are imbued with the importance of obtaining a prominent career position where the young people can decide for themselves how and when the job is to be done. this approach also characterizes their meetings with the job-centre professionals. in comparison with working-class youths, they do not express the same experience of material vulnerability because of being unemployed. therefore, they are not primarily interested in getting professional help in formulating what, how or when. they will be competitive by solving the situation on their own or with the help of their social network. the basic principle of the employment agency that job-seekers should find their own solutions matches the ideals of the middleclass youth category well. this pattern is recurring in the interviews with the job-centre advisors of the middle-class youths. the advisors portray these young people as strong and autonomous individuals. there are no accounts of long dialogues full of misunderstandings, as there are in their accounts of conversations with working-class youths. rather, the interviews with the advisors indicate that unemployed middle-class youths tend to do things in accordance with the advisors’ should, that is, acting by the book. thus, they do not run the risk of being evaluated as ‘deficient’. the middle-class youths’ conception of work interacts well with that of the employment agency and they use other means of emotional expression to describe their visits to the job centre. few or no expectations of the job centre means no disappointment at the outcome: ‘i have no expectations of the job centre, so i was quite surprised when i met [officer], a helpful person.’ the middle-class youths are fully aware of the labour market and its terms, but also pay close attention to the advisors’ signals: ‘i’m eager to keep my unemployment benefit so i can’t do what i want. but then i don’t know if i would have done things differently? probably not.’ even if these middle-class young people are also subjected to the continual monitoring of the employment agency, they do not voice discontent. they have a grasp of the labour-market system and see the officials as parts of the system and also master the appropriate conversational tone for interacting with a representative of a public authority. they are expected to be assertive and active. dialoguing is essential for eliciting information and knowledge, which is also associated with the required intellectual performance of career employment. in comparison with the young working-class people, the middleclass category also takes less time in the form of rumination, or as one of them says: ‘you get answers if you contact them’, and continues: ‘after that i got an appointment with my personal advisor. and i went to talk with her and so she said: “i see, good, keep applying!” and then i got a new appointment.’ it is possible that more help for self-help is welcome when young middle-class people try to maximize their autonomy in accordance with their own view of njsr – nordic journal of social research vol. 6, 2015 129 work, that is, as something to ‘be responsible for, to develop and to be developed by’ (jakobsen, 1999, p. 179). also, unemployment is something they should solve on the basis of their own initiatives and this attitude characterizes the interactions with the job centre. according to one advisor, these young people have a clear ‘understanding of the services they need when they come here’. they take advantage of the system’s potentials and protect their own interests. all is done without any major normative conflicts or emotional tensions. discussion the aim of the study has been to investigate the interaction between jobcentre advisors and the young unemployed with an emphasis on the young people’s experiences and emotional coping, and if the unemployed youths’ own living conditions generate different patterns of experiences. our study shows the interplay between the employment agency as an institutional setting and how gender and class relations interact. in an organizational context the professionals confirm the prevailing labour-market inequality by giving priority to working-class men over working-class women and by confirming the middle-class approach as being consistent with the agency’s policy. when the job-centre advisors meet with young people who do not conform to the current labour-market expectations and ideals, they risk participating in an institutional process of exclusion. unequal social relations are actually confirmed when it is taken for granted that the labour market is class and gender neutral. our analysis shows that middle-class youths are best equipped to deal with the agency’s advisors. other research on career-oriented groups on the employment market (fogde, 2010; sharone, 2007) supports this finding. it is easier for job-seeking clients to be perceived as unique and independent, that is, employable, if they share the norms of the agency’s staff. it is reasonable to assume that working-class youths’ high expectations rest on the norms of work in a worker’s position. these youngsters have difficulties in handling the agency’s conception of work as an interest, a life career. above all, the young working-class women’s wish to combine employment with caregiving is deemed an encumbrance. the working-class young men are allowed to negotiate more freely than young working-class women regarding if, how, and what jobs to apply for. fogde (2010), who has compared well educated young women’s and men’s attitudes to career advice, suggests that the existing gender difference depends on women’s difficulties in marketing themselves, because this violates conceptions of femininity. notions of women as being less confident than men are implicitly reproduced. but what exactly is individualized and downgraded? we argue that the values disparaged are those of caregiving and relationships – being there for others, that is, the necessary reproduction of life, which exist beyond the purview of employment market. working-class youths, and especially the women, display emotions indicating a resistance to and a challenge to the responses they get at the job centre. oppositional emotions are not necessarily indications of resistance in the form of conscious action intended to challenge power hierarchies (cf. ambjörnsson 2004). if thus defined, many actions of resistance would be made invisible. in addition, resistance can be counterproductive, leading to further subordination, while those who comply with the system can escape it (ambjörnsson, 2004). the young working-class women’s emotionally stronger opposition emphasizes the gap between their living conditions and opportunities as well as how a normative institution such as the employment njsr – nordic journal of social research vol. 6, 2015 130 agency widens this gap. when client-advisor meetings are charged with emotions and value-conflicts, this indicates an institutional process of exclusion of a certain category of the unemployed. the employment agency’s shift towards control measures in the processing of people from unemployment to employment de facto involves increasing demands for individual autonomy, which other studies have also shown (allen & hollingsworth 2013; yates, harris, sabates & staff, 2014). in addition, our study reveals that the conceptions of individual autonomy and responsibility in the labour market can be conditional. the advisors act on the basis of stereotypical notions of gender, class, and the young that deviate from an ideal that tends to be challenged. underlying social conditions are seen as individual shortcomings and the job agency’s monitoring further restricts young people with limited options. the advisors impose a change on the workingclass youths that really goes against their material and cultural conditions, namely, their life modes. these young people respond emotionally by defending themselves and reproducing their views from their positions. we can thus regard life modes as strong mechanisms for understanding human everyday life and reality (jakobsen, 1999). in other words, our data reveal the staff members’ process of recreating, confirming, and consolidating inequality, whereby they are participating in a form of institutional exclusion. this process jeopardizes a return to the labour market. our results must, however, be treated with caution, not least with respect to their generality. in addition, we cannot be certain if the results exclusively indicate social change in a (scandinavian) welfare state, namely, sweden. an objection can be made to the fact that all the interviewed advisors were women. are young male job-seekers generally better treated at the job centre? or does this only apply when they meet with women job advisors? when we asked retrospective questions, however, it was apparent that the young women were dissatisfied with female as well as male advisors. further research could clarify this issue. yet another issue that needs clarification is whether middle-class youths’ affinity with the ideals might mean increased pressure on them to succeed in their career projects. the young working-class women and men in our study are not absolutely excluded institutionally. however, when exclusion is viewed as a process, unequal social relations are revealed in the organizational context (here, the job centre), which limit and in turn produce opposition. researchers should study how social processes reproduce and reinforce inequality and over time run the risk of contributing to marginalization and social exclusion. then strategies for challenging the status quo and promoting change must be developed. how social and gender differences matter is an area of definite and urgent concern for future social policy. njsr – nordic journal of social research vol. 6, 2015 131 references allen, k., & hollingsworth, s. 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(2011). early occupational aspirations and fractured transitions: a study of entry into ‘neet’ status in the uk. journal of social policy, 40(03), 513-534. microsoft word 639, proof4.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 exposure to smoking in films and smoking behaviour among norwegian 15to 20-year-olds: a cross-sectional study gunnar sæbø* norwegian institute for alcohol and drug research (sirus) email: gs@sirus.no *corresponding author ingeborg lund norwegian institute for alcohol and drug research (sirus) email: il@sirus.no abstract studies from several countries have revealed significant effects of exposure to smoking in films on smoking behaviour and attitudes among adolescents. this study presents the first findings from the scandinavian cultural region on this topic. with the objective to test for significant adjusted relationships between exposure to smoking in films and established smoking among 15to 20-year-old respondents, and susceptibility to smoking among non-smokers in the same age group, a cross-sectional study was conducted in june 2008. 807 norwegian adolescents and young adults answered a web-based questionnaire. exposure to smoking in films is estimated by asking the respondents if they had seen films from a list of 56 popular film titles of both local and foreign origin from 2007 and 2008. associations of exposure and smoking behaviour are tested in two logistic regression models. respondents with the highest exposure to film smoking are more likely to be established smokers than those with no exposure (adjusted odds ratios=2.22, confidence interval=1.04-4.77). among non-smokers, those with highest exposure to smoking in films are more likely to be susceptible to smoking than those with no exposure (adjusted odds rations=1.55, confidence interval=0.93-2.56). film smoking is significantly associated with smoking susceptibility and established smoking among norwegian adolescents and young adults. keywords: exposure to smoking in films, smoking initiation, media effects, movies, adolescents and young adults, motion pictures content ratings njsr – nordic journal of social research vol. 6, 2015 150 introduction background even though cigarette smoking is decreasing in europe, tobacco remains a considerable risk to public health. to prevent future tobacco-related mortality, it is important to keep encouraging youths to refrain from experimenting with addictive tobacco products. although most european countries now prohibit tobacco advertising, it is still possible to find depictions of tobacco smoking in audio-visual media, that is, movies, television, and the internet. of the various media, however, the medium of movies is unique in its capacity to evoke different sensations in the audience. in recent times, western states have been reluctant to censor artistic expression, and the smoking of tobacco on film has yet to be regulated as tobacco advertising or indeed actual smoking practice is today. movies, in other words, constitute a means of expression in which filmmakers are still at liberty to portray the use of tobacco more or less as they wish. what does this entail with respect to the medium’s potential to depict and promote tobacco use? the film-smoking-exposure effect observational studies have shown that exposure to film smoking exerts an independent statistical dose-response effect on smoking susceptibility, experimentation, and initiation among children and adolescents, after controlling for relevant confounders (sargent et al., 2001, 2002, 2005, 2007; dalton et al., 2003, 2009; song et al., 2007; titus-ernstoff et al., 2008). the more episodes of smoking that youngsters experience, the more likely they are to experiment with tobacco and to become smokers. experimental research has reached similar conclusions (pechmann & shih, 1999; hines et al., 2000). in the following, this effect will be designated as the ‘film-smokingexposure effect’. the suggested underlying mechanism in this process of influence is mediating attitudes (sargent, 2006). supposedly smoking in films communicates positive values of tobacco, and exposure to film smoking will therefore contribute to the development of positive attitudes to smokers and smoking among adolescents. increased smoking susceptibility might follow, which eventually may lead to smoking experimentation (sargent et al., 2002). on the grounds of this research, public-health advocates have taken the initiative to include depiction of smoking as a criterion in film ratings, giving all films with smoking scenes an 18-year age limit. the world health organization (who) has embraced this initiative and has consequently recommended this action as part of the implementation of the who framework convention on tobacco control (who, 2011). parents also tend to support such ratings (mcmillen et al., 2007). differences in the effect of exposure to smoking in movies among national and social groups despite several empirical studies detecting significant effects of exposure to smoking in films, the findings in this field are still subject to some uncertainty. first, there are empirical nuances in relation to national-cultural contexts, which suggest caution in generalizing the effect to any population without reservation. the second uncertainty, related to the first, there are variations among social and ethnic subgroups regarding the magnitude and interaction njsr – nordic journal of social research vol. 6, 2015 151 patterns of the association. the studies referred to in the previous section are all from the united states, with several of them based on the same regional data set from small states in the new england region (vermont and new hampshire). also, the movies were all produced in hollywood and the us. regarding findings from other countries, effects similar to those in the us were found in mexico, albeit somewhat weaker (thrasher et al., 2008, 2009). in egypt significant effects were found only for boys (islam & johnson, 2007), in germany (hanewinkel & sargent, 2007) and the united kingdom (waylen et al., 2011) similar effects as in the us were revealed, while studies from scotland (hunt et al., 2009, 2011) have produced conflicting results. a recent cross-cultural study in six european countries has found significant associations in the netherlands, poland, italy, and iceland, providing a strong case for the generalizability of these results to central europe (morgenstern et al., 2011, 2013). in relation to ethnicity and cross-cultural dynamics, the existing knowledge is ambiguous: regarding differences between black and white adolescents, one us study found significant effects of film exposure among ‘white youth’ but not among ‘blacks’ (jackson et al., 2007), while another study that distinguished between exposure to ‘black-oriented’ movies and ‘mainstream’ movies found an effect among blacks of exposure to black-oriented films, but not of exposure to mainstream films (dal sin et al., 2013). a texan study found a stronger (and more monotonic) effect among mexican-born texans than among us-born youngsters (wilkinson et al., 2009). no studies of the role of film smoking in smoking initiation have yet been undertaken in norway, or indeed in the scandinavia. norway is a small country with a small domestic film output, and movies from the us and the uk dominate the market. these movies are often said to purvey ‘coca-cola-ized’ values and ideas that many young people find attractive. film-smoking exposure in late adolescence the age group observed in the bulk of the previous research in this field comprises 10-14-year-olds. smoking initiation also occurs among older adolescents and young adults. in norway for instance, the mean age for smoking initiation is 17.8 for boys and 18.3 for girls (skretting et al., 2015:138). consequently, the influence of the media may still be in operation among individuals in their late teens. however, only a handful of studies have investigated exposure to smoking in films among older adolescents or young adults, or both. while a cross-sectional study has found a significant adjusted dose-response relationship among 18–25-year-olds, and one longitudinal study has found early exposure to movie smoking to predict later established smoking (dalton et al., 2009), a second longitudinal study has found no significant association between late exposure to movie smoking and established smoking (primack et al., 2012). all these studies were conducted in the us. because previous studies have found that adolescents who are otherwise at low risk for smoking initiation have been particularly susceptible to the influence of smoking in films (dalton et al., 2003; hanewinkel & sargent, 2008), an additional topic of interest is whether such interaction effects are njsr – nordic journal of social research vol. 6, 2015 152 found also among older teens and young adults. no one has investigated this aspect so far. if such interaction effects are at work even among older adolescents, it would provide an even stronger reason to impose age ratings to regulate access and impulses to smoke via movies (millett & glantz, 2010). as european youth largely seem to have access to more smoking scenes than american youth (hanewinkel et al., 2013), it is important to investigate whether smoking scenes occur in movies that are rated as suitable for children and young adolescents, or in movies rated as suitable for adults. research problem this study explores exposure to smoking in films and its association with smoking behaviour in norway. to what extent do smoking incidents occur in popular films, and are there differences between movies in the number of smoking scenes according to age ratings? smoking behaviour is defined as established smoking among all adolescents and young adults (aged 15-20 years) and as susceptibility to smoking among non-smoking adolescents and young adults in the same age group. are any relationships maintained after controlling for other relevant influences, and what are the indications of interaction effects, if any? materials and methods sample respondents were recruited from a web panel of approximately 60 000 individuals of all ages, run by the public opinion institute ipsos mmi. the members of this panel were originally contacted randomly by telephone to participate in unique studies, but then asked if they were willing to become a member of the web base, to be contacted later for other research projects via the internet. this base is thus a random sample of individuals who are willing to participate in online surveys. in norway, internet access is now almost universal (95 per cent), primarily lacking among those over 65 years of age (www.ssb.no/ikthus). from this pool, all available respondents between 15-20 years (n=2227) were contacted for participation in an online survey between june and august 2008. in all, 807 participants agreed to participate, making the response rate 36 per cent. to strengthen representativeness, the sample was weighted by gender, age, and region. the prevalence of current smokers in this online sample was 22 per cent, which is almost identical to the official number of smokers in the same age group (21 per cent), as provided by statistics norway (vedøy & skretting, 2009). exposure to film smoking to arrive at a measure for exposure to smoking in films, respondents were first presented with a list of 56 films, and asked ‘which of the following films have you seen?’ these 56 titles emerged after adding together and subsequently removing duplicates from three lists of popular films: the top 30 box-office njsr – nordic journal of social research vol. 6, 2015 153 successes in norwegian cinemas in 2007, the 25 most frequently bought films on dvd in 2007, and the top 20 box-office successes in norwegian cinemas during the first four months of 2008 (www.kino.no). to help respondents in their recall, they were mounted with a copy of the advertising poster/dvd cover for the film in addition to the film title. all titles were content analysed and smoking scenes were coded by trained coders (the first author and two research assistants). on the basis of a previously validated method (dalton et al., 2002), a smoking scene was demarcated as distinctive in narrative time and space, and defined as any depiction of smoking or smoke, associated with the use of combustible tobacco, by a central or peripheral character, or in the background (for instance in a bar). in addition, we included visual still depictions of smoking packs, ashtrays, advertising boards, and so on, because such representations are known to function as smoking cues (lochbuehler et al., 2010, 2011). verbal exchanges about smoking were not coded, and in line with customary practice in the literature, we did not attempt to distinguish between exposure to ‘positive’ and ‘negative’ depictions or ‘good guys’ or ‘bad guys’ smoking. there were 246 smoking scenes in these 56 films. on the basis of which films the respondents had seen, a sum-score index was computed to measure each individual’s total exposure to smoking scenes (i.e., summarizing the total number of smoking scenes each respondent had seen in the films he or she had ticked for). to enable comparison of the results of this study with previous studies, we recoded the exposure to scenes of smoking in films into quartiles. susceptibility smoking susceptibility can be defined as willingness to experiment with tobacco, and was measured using two standard questions to non-smokers (pierce et al., 1996): ‘do you think you will smoke at least one cigarette in the next six months?’ and ‘if one of your best friends offered you a cigarette at a party, would you smoke it?’ answer categories ranged from ‘definitely not’ to ‘definitely yes’, with the additional option ‘seldom with friends at parties’ for the second question. those who answered ‘probably not’, ‘probably yes’ or ‘definitely yes’ to any of these two questions were defined as ‘susceptible’. established smoking established smoking was measured using the standard formulation of life-time smoking experience: ‘how many cigarettes have you smoked in your life?’ several response alternatives ranged from ‘none’ to ‘100 cigarettes or more’. those who had smoked 100 cigarettes or more were defined as ‘established smokers’. other risk factors social influence was measured using several questions on smoking and drinking habits in the family and among friends, as listed and described in table 1. all social influence variables were recoded into dummy variables with cut-offs at ‘yes’ for maternal, paternal, and sibling smoking, ‘once a week’ for parental drinking frequency, and ‘about half’ for proportion of peers smoking daily or occasionally and peers getting drunk once a week. parental style was njsr – nordic journal of social research vol. 6, 2015 154 measured using the authoritative parenting index (cronbach’s alpha=0.71) (jackson et al., 1998). individual traits were measured using established indices for sensationseeking (five items, cronbach’s alpha=0.56), rebelliousness (6 items, cronbach’s alpha=0.66) and self-esteem (seven items, cronbach’s alpha=0.79). items measuring sensation-seeking and rebelliousness were combined into a sensation-seeking/rebelliousness index, which provided acceptable reliability (cronbach’s alpha=0.75). all items measuring risk factors metrically were recoded before the construction of indices, so that higher scores would signify more of the actual characteristic. the socio-demographic background variables were gender (male/female) and age (15-16/17-18/1920). statistical analysis this study applied binary logistic regression analysis to estimate unadjusted and adjusted associations between exposure to smoking in films and established smoking (among all adolescents) and between exposure to smoking in films and susceptibility to smoking (among non-smokers). to test if new variables contributed significantly to the model, controls were entered sequentially (block-wise), in the following order: socio-demographics, individual traits, and social influence. significant contribution of each block was tested by changes in the log-likelihood levels. to look for interaction effects, three-way analyses of associations between film exposure and prevalence of established smoking/susceptibility in sub-groups were performed. results description of the sample table 1 shows the distributions of responses to smoking behaviour and sociodemographics (as well as the risk factors that were measured categorically). of the respondents 12.9 per cent were established smokers, having smoked more than 100 cigarettes in their lifetime. among non-smokers, 37.5 per cent were susceptible to smoking. exposure to smoking in the films the 246 smoking scenes in the 56 films studied were unevenly distributed among the films. only nine per cent of the films had 20 or more smoking scenes, while 14 per cent had five to 19 scenes (figure 1). the vast majority of smoking scenes (90 per cent) occurred in films rated with the minimum age requirements of 11 and 15 years. njsr – nordic journal of social research vol. 6, 2015 155 table 1. descriptive statistics of the sample, percentages. on average, the respondents had seen 13.1 (sd=10.5 median=14) of the 56 films presented to them. twenty-seven per cent of the adolescents had not been exposed to any smoking scenes at all, making up the first quartile. q1 was thus a truly unexposed group. q2 had seen 1-39 scenes, q3 40-89 scenes, while q4 had been exposed to 90-246 scenes. variables total sample (n=807) nonsmokers (n=631) demography gender -men -women 51.9 48.1 53.0 47.0 age -15/16 -17/18 -19/20 37.6 33.4 29.0 42.4 31.3 26.4 social influence does your father/stepfather smoke? -no/don’t know/don’t have a father or stepfather -yes 78.5 21.5 81.5 18.5 does your mother/stepmother smoke? -no/don’t know/ don’t have a mother or stepmother -yes 76.9 23.1 78.2 21.7 do your siblings smoke? -no/don’t know/ don’t have siblings -yes 80.1 19.9 82.2 17.8 how often do your parents/stepmother or stepfather drink? -never/once a year/once a month -once a week/daily 50.9 49.1 52.6 47.4 think about the youth you usually spend your leisure time with: approximately how many of them do you believe smoke daily or occasionally? -none or almost none/less than half -about half/more than half/all or almost all 78.5 21.5 87.2 12.8 think about the youth you usually spend your leisure time with: approximately how many of them do you believe get drunk about once a week? -none or almost none/less than half/ -about half/more than half/all or almost all 53.6 46.4 60.4 39.6 smoking established smoking -no -yes 87.1 12.9 susceptible to smoking -no -yes 62.5 37.5 njsr – nordic journal of social research vol. 6, 2015 156 figure 1: distribution of smoking scenes. number of smoking scenes (n=56 films) and rating of smoking scenes (n=246 scenes), in percentages. the effect of film-smoking exposure on established smoker status there was a significant positive unadjusted association between exposure to smoking in films and established smoking (table 2). respondents in the fourth quartile, those with the highest exposure to film smoking, were more likely to be established smokers (or=2.52, ci=1.42-4.47, p=.002). the association remained significant after adjusting for socio-demographic background covariates and individual traits and social influence from family and peers (or=2.22, ci=1.04-4.77, p=.040). both demographic and individual factors were significantly associated with smoking status, such that girls, older respondents, and respondents who scored higher on sensation-seeking/rebellion tended more often to be smokers. notably, respondents who said that half or more of their friends were daily or occasional smokers had about ten times higher odds for being established smokers themselves. no. of smoking scenes per film rating of smoking scenes njsr – nordic journal of social research vol. 6, 2015 157 table 2: unadjusted and adjusted relationships between exposure to smoking in films and established smoking, controlling for sociodemographics (2), individual traits (3) and social influence (4) (n=805). logistic regression, odds ratios (95 % ci). * p <0.1, ** p <0,05, *** p < 0.01, ****p<0.001 independent variables model 1: filmsmoking exposure, unadjusted model 2: 1 + adjusted for sociodemographics model 3: 2 + adjusted for individual traits model 4: 3 + adjusted for social influence film-smoking exposure 1st quartile 2nd quartile 3rd quartile 4th quartile 1.00 .99 (.51-1.95) 1.40 (.75-2.61) 2.52 (1.42-4.47)*** 1.00 .86 (.43-1.72) 1.11 (.59-2.1) 2.26 (1.24-4.14)*** 1.00 .89 (.42-1.88) 1.07 (.53-2.13) 2.46 (1.47-4.12)** 1.00 .78 (.32-1.93) .95 (.42-2.16) 2.22 (1.04-4.77)** sociodemographics: gender 1.75 (1.11-2.76)** 2.46 (1.47-4.12)**** 2.14 (1.18-3.90)** age 15-16 17-18 19-20 1.00 4.45 (2.21-8.94)**** 7.24 (3.65-14.37)**** 1.00 6.61 (3.18-13.74)**** 17.46 (8.12-37.52)**** 1.00 6.65 (2.81-15.73)**** 15.73 (6.36-38.91)**** individual traits: sensationseeking/rebellion 1st quartile 2nd quartile 3rd quartile 4th quartile 1.00 2.77 (1.22-6.31)** 5.25 (2.33-11.83)**** 17.09 (7.47-39.09)**** 1.00 2.24 (.88-5.72)* 4.56 (1.81-11.47)**** 10.93 (4.24-28.17)**** self-esteem 1st quartile 2nd quartile 3rd quartile 4th quartile 1.00 .65 (.34-1.22) .61 (.32-1.16) .64 (.33-1.23) 1.00 .70 (.33-1.46) .62 (.29-1.35) .65 (.30-1.39) social influence: father smoking 1.50 (.79-2.85) mother smoking 1.77 (.93-3.36)* siblings smoking 1.09 (.58-2.03) friends smoking 10.37 (5.93-18.13)**** parents drinking .64 (.37-1.10) friends drinking 1.65 (.88-3.08) parental style 1st quartile 2nd quartile 3rd quartile 4th quartile 1.00 1.94 (.95-3.96)* .87 (.39-1.93) 1.51 (.67-3.42) nagelkerke -2ll change in -2ll .03 605,704 *** .14 556,386 **** .29 481,458 **** .50 367,209 **** njsr – nordic journal of social research vol. 6, 2015 158 table 3: unadjusted and adjusted relationships between exposure to smoking in films and susceptibility to smoking among non-smokers, controlling for socio-demographics (2), individual traits (3) and social influence (4) (n=630). logistic regression, odds ratios (95 % ci). * p <0.1, ** p <0,05, *** p < 0.01, ****p<0.001 independent variables model 1: film smoking exposure, unadjusted model 2: 1 + adjusted for sociodemographics model 3: 2 + adjusted for individual traits model 4: 3 + adjusted for social influence film-smoking exposure: 1st quartile 2nd quartile 3rd quartile 4th quartile 1.00 .63 (.39-.1.01)* 1.01 (.64-1.58) 1.84 (1.17-2.89)*** 1.00 .65 (.40-1.06)* 1.12 (.71-1.77) 1.89 (1.18-3.03)*** 1.00 .69 (.42-1.13) 1.08 (.67-1.72) 1.69 (1.04-2.74)** 1.00 .64 (.38-1.08)* 1.08 (.67-1.76) 1.55 (.93-2.56)* sociodemographics: gender .83 (.59-1.18) .93 (.63-1.36) .90 (.60-1.35) age 15-16 17-18 19-20 1.00 .54 (.36-.80*** .73 (.49-1.10) 1.00 .58 (.38-.88)*** .92 (.60-1.42) 1.00 .51 (.33-.78)*** .77 (.48-1.23) individual traits: sensationseeking/rebellion 1st quartile 2nd quartile 3rd quartile 4th quartile 1.00 .84 (.53-1.32) 1.62 (1.00-2.64)* 2.55 (1.49-4.36)**** 1.00 .82 (.51-1.31) 1.69 (1.02-2.83)** 2.45 (1.38-4.35)*** self-esteem 1st quartile 2nd quartile 3rd quartile 4th quartile 1.00 1.29 (.78-2.13) 1.05 (.64-1.71) .83 (.50-1.39) 1.00 1.27 (.76-2.13) 1.10 (.65-1.84) .88 (.52-1.52) social influence: father smoking .63 (.38-1.05)* mother smoking 1.74 (1.10-2.76)** siblings smoking 1.31 (.82-2.11) friends smoking 1.26 (.74-2.16) parents drinking 1.92 (1.34-2.76)**** friends drinking 1.25 (.85-1.83) parental style 1st quartile 2nd quartile 3rd quartile 4th quartile 1.00 1.14 (.68-1.89) .84 (.52-1.37) 1.07 (.62-1.84) nagelkerke -2ll change in -2ll .04 813.649 **** .07 802,697 ** .12 775,821 **** .17 748,618 **** njsr – nordic journal of social research vol. 6, 2015 159 the effect of film-smoking exposure on susceptibility to smoking a significant unadjusted association was found when susceptibility to smoking among non-smokers was regressed on exposure to film smoking (for the fourth quartile: or=1.84, ci=1.17-2.89, p=.009) (table 3). as was the case with established smoking, the association held up after controlling for sociodemographics, individual variables, and social-influence variables, albeit at a low level of significance in the most elaborate model (or=1.55, ci=.93-2.56, p=.090). in addition to exposure to smoking in films, age, sensation-seeking, maternal smoking, and parental drinking patterns were significantly associated with susceptibility to smoking. tracing interaction effects three-way analyses of associations between exposure to smoking in films and susceptibility to smoking, controlling for social influence (one factor at a time), suggested that exposure to smoking in films might be of particular relevance for low-risk groups (figure 2). for five of the six social-influence factors, there were significant positive associations between exposure to smoking in films and susceptibility to smoking in low-risk categories (the exception was ‘less than half of friends drinking’). similar effects were found for low sensationseeking/rebellion, but not for low self-esteem. this pattern was also found in relation to established smoking, social influence, and film-smoking exposure (figure not shown). figure 2: prevalence of susceptible non-smokers (y-axis) by filmsmoking exposure in quartiles (x-axis), in ‘low risk’ social influence groups. three-way analyses. njsr – nordic journal of social research vol. 6, 2015 160 discussion we have presented findings from the first investigation of exposure to smoking in films and smoking susceptibility and initiation among adolescents and young adults based on data from scandinavia. the study, moreover, is both the first from outside the us to look at older adolescents and the first to explore interaction effects among youth over 15 years of age. the findings show that exposure to smoking in films is associated with smoking behaviour even in the specific and relatively homogenous scandinavian culture. thus, this study supports previous major findings reported in the literature. more precisely, this study suggests that exposure to smoking in films may contribute to the development of susceptibility to smoking among non-smoking youth. it is widely accepted that susceptibility theoretically constitutes the initial step in the process of the influence of the media on adolescent smoking behaviour (sargent, 2006), and the findings indicate that this step is empirically supported in norway. furthermore, the analysis of established smoking, which shows that exposure to smoking in films is also associated with this outcome measure after statistical adjustments for all other major risk factors, suggests that the exposure to smoking in films is most likely an independent risk factor for the initiation of smoking. the results of this study imply that similar processes of the influence of smoking in films are in operation in norway, as they are in countries like the us, mexico, the uk, germany, and the netherlands. limitations before discussing our results in more detail, we would like to acknowledge some of the limitations of this study. first, the cross-sectional and observational design of this study makes it difficult to assess the temporal sequence of events, and so these analyses cannot be used to justify the assumption that exposure to film smoking causes smoking susceptibility or smoking initiation. however, it is worth noting that in the international literature these relationships are often considered to be of a causal nature (us national cancer institute, 2008). secondly, the response rate of the study was rather low. even if there were no indications of this factor challenging the representativeness of the data, it did result in a sample size with a limited statistical power to explore interaction terms in the regressions fully. in addition, one effect was significant at a moderate level of significance only (p < 0,1). however, as the overall findings are in accordance with those of similar studies from abroad, it is likely that the results are valid despite these limitations. age regarding the research problem under scrutiny, we may note that the respondents in this study were relatively old (15-20-year-olds). social-learning theory suggests that the influence of film smoking on smoking susceptibility and initiation starts at a much earlier stage in life. empirical studies from the us have uncovered effects of this process among children as young as eight years (titus-ernstoff et al., 2008), and usually on children and young adolescents between ten and 14 years (dalton et al., 2003, sargent el al., njsr – nordic journal of social research vol. 6, 2015 161 2005), indicating that exposure to smoking in films might already have resulted in established smoking for many 15-20-year-olds. still, as ‘older’ adolescents and young adults have not been much studied in the film-smoking literature, it is interesting to observe that associations between exposure to smoking in films and smoking behaviour are statistically significant even for adolescents approaching adulthood (song et al., 2007; dalton et al., 2009). and, of course, there is nothing in the literature on socialization which suggests that 15-20year-olds are not subjected to the effects of the media, even if an emphasis on this age group may involve a smaller and ‘attenuated’ effect of exposure to smoking in films (hunt et al., 2009). it is conceivable, for instance, that the relative importance of exposure to smoking in films (and also parental smoking) is lower towards the end of the teenage years, and may be partly overshadowed by peer smoking (dal cin et al., 2012). interaction effects the findings unambiguously support the argument that a sensation-seeking personality and social factors – particularly peer smoking and parental drinking – are important risk factors for adolescent smoking experimentation and, indeed, initiation too, indicating perhaps that exposure to smoking in films for some adolescents is only one part of a lifestyle charged with risk-seeking behaviour. interestingly, a three-way investigation also revealed that exposure to smoking in films had a strong independent effect even within groups who were otherwise at low risk. more precisely, regardless of having parents who do not smoke or drink excessively, or having many non-smoker friends, a high exposure to smoking scenes in films increases the risk of being susceptible to smoking or being an established smoker. these findings, indicating a moderating effect, are also in accordance with similar findings from the us (dalton et al., 2003) and germany (hanewinkel & sargent, 2008). this effect (which is probably largely cognitive, and according to this study may continue well into the end of the teenage years) is important to restrain, as it affects young people who should have good prospects not to become smokers. it is in this light that policy-makers, who aim to prevent the initiation of smoking among adolescents, must consider regulation of smoking scenes by raising the age limits. linearity in contrast to many (though not all) international studies, our findings were not linear ‘dose-response’ associations. this may be due to some of the following characteristics of the study: the sample of films was smaller than in most other studies, and contained only contemporary films, not recently popular films (for instance including the last five years). consequently, the total number of smoking scenes that a respondent theoretically could be exposed to was small compared with the situation in studies using, for example, the dartmond medical school’s design and data set (sargent et al., 2001; dalton et al., 2003; islam & johnson, 2007; hunt et al., 2011, morgenstern et al., 2011), where 50 titles are randomly selected from a larger sampling pool of 500-600 films. our approach, with a fixed sample of 56 titles, may have underestimated possible underlying variance that might have been more adequately assessed by using njsr – nordic journal of social research vol. 6, 2015 162 a larger number of total smoking scenes. additionally, repeated viewing was not taken into consideration (hunt et al., 2011). having said that, we may note that the fact that the ‘film-smoking-exposure effect’ is supported by means of data sets other than dartmond’s might be construed to demonstrate the robustness of this effect, and is consequently an added support for the underlying hypothesis. however, deviations from stringent dose-response patterns may not necessarily be due to methodological matters. one may also ponder possible substantial explanations, for example, whether the lack of stringent doseresponse patterns may reflect underlying cultural dimensions rather than statistical anomalies. in our norwegian study we found monotonous curvilinear associations, just like those previously found in iceland, which is quite similar to norway in respect of culture and history (morgenstern et al., 2011, 2013). on the other hand, data from italy and poland have displayed nonmonotonous (reversed) curvilinear associations, differing not only from the nordic countries, but also from the us and germany (morgenstern et al., 2011). as far as we know, no one has attempted to test whether such intercountry differences may be due to possible moderating factors like religious affiliation, different smoking cultures in southern and eastern europe (and consequently differences in perceived smoking norms) or even local resistance to hollywood-style cultural imperialism. it is perhaps noteworthy that these kinds of effects occur at all in relatively egalitarian countries such as norway, with smaller differences in relation to economic capital distribution (oecd, 2014; wilkinson & pickett, 2010) and lower smoking prevalence than most other countries (who, 2015). a largely shared common culture in the scandinavian region involves widespread sharing of local practices and understanding, which could potentially act as a kind of cultural resistance towards assimilation. as most of the films in this study are american – and thus different from norwegian movies in language and maybe even values – we could expect that norwegian adolescents would identify less with smoking characters in american movies than american adolescents, and, consequently, be less influenced. what we found however was a tendency of all movies to influence norwegian adolescents and young adults. presumably, the influence of american films works largely via assimilating youth (in norway, like the rest of the west) into the stories and their associated values. accordingly, there are no indications of an overall cultural resistance towards hollywood culture (as is found among blacks in the us). future research future research on this issue in norway should not only consider a prospective or longitudinal design (to meet with the demands of causality), but also a better measure of exposure. future research in this field could investigate the role of cultural dimensions (like religion, smoking culture, local resistance to cultural imperialism) that have yet to be accounted for as possible moderators (or mediators) in the largely socio-psychological model that has dominated previous research. finally, it will also be of interest to look into relationships between adolescents’ cultural backgrounds (including ethnicity, which has not been an issue in this study), film-genre preferences, njsr – nordic journal of social research vol. 6, 2015 163 and identification with various characters on the screen, for example, in relation to exposure to domestic versus foreign films. conclusion the findings in this study suggest that 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(2010). the spirit level. why equality is better for everyone. london: penguin books. njsr – nordic journal of social research vol. 6, 2015 166 world health organization (2011). smoke-free movies: from evidence to action (2nd ed.). geneva, switzerland: world health organization. world health organization (2015). who global report on trends in prevalence of tobacco smoking 2015. geneva, switzerland: world health organization. http://www.who.int/tobacco/publications/surveillance/reportontrendstobaccosmo king/en/ microsoft word ede, starrin unresolved conflicts and shaming processes, proof2.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 5, 2014 unresolved conflicts and shaming processes: risk factors for long-term sick leave for mental-health reasons lena ede department of social and psychological studies karlstad university, sweden eastern norway research institute, östlandsforskning lillehammer, norway lena.ede@kau.se bengt starrin department of social and psychological studies karlstad university, sweden bengt.starrin@kau.se abstract mental illness is the most common diagnosis resulting in long-term sick leave in sweden today, especially stress-related syndromes and mood disorders. the aim of this article is to analyse the relational and emotional processes in the workplace that may contribute to the understanding of long-term sick leave for mental-health reasons. we conducted interviews with twenty-six people who were on sick leave because of diagnoses of mental ill health. the empirical material was analysed using classic grounded theory. we suggest that the risk of being afflicted with mental illness, and forced into long-term sick leave, increases when there are conflicts at work that remain unresolved and which lead to malignant shaming processes that jeopardize personal dignity. in their struggle to maintain self-esteem, the afflicted escalate their work efforts by increasing work intensity, putting in overtime, and working when ill. eventually, this behaviour affects their health and results in sicklisting. the strengths and weaknesses of the study are discussed along with the need for further research. njsr – nordic journal of social research vol., 5, 2014 40 keywords: mental illness, long-term sick leave, shaming processes, unresolved conflicts introduction between 1999 and 2003 there was a dramatic increase in long-term sick leave cases (>60 days) in sweden. in 2010, the numbers began to increase again (swedish social insurance agency, 2010). the latest figures indicate a continued increase (swedish social insurance agency, 2013a). in 2005, diagnoses of mental illness replaced muscular and skeletal disorders as the most common grounds for sick leave (swedish social insurance agency, 2010; 2013b). among diagnoses of mental illness, stress-related syndromes and mood disorders have been increasing (swedish social insurance agency, 2010). internationally, stress-related illness is also on the increase (european agency for safety and health at work, 2013; dollard et al., 2007). throughout this period women have been on sick leave more than men. women are also overrepresented in regard to diagnoses of mental illness. there are several different explanatory models for the emergence of mental illness as the primary reason for long-term sick-listing. the demand control model, which deems imbalances between work demands and individual resources to be risky for people´s health, and also a possible cause of sicklisting, is frequently used. above all, this applies to a combination of high work demands, a lack of both control and opportunities for participation, and a low level of support from supervisors (karasek & theorell, 1990). this model clearly shows that restructuring – involving streamlining, staff reduction, and accelerating the pace of work – is a risk factor not only for those made redundant but also for those kept on (european agency for safety and health at work, 2013; westgaard & winkel, 2010; theorell, 2009; virtanen et al., 2007). in their literature study, michie and williams (2003) found that common causes of mental illness resulting in sick leave included long workdays, high tempo, and high demands in combination with lack of control over the work situation and few opportunities to influence it, especially if compounded with lack of support and unsatisfactory leadership. also, other studies have found that leadership qualities and work group climate correlate with the risk for longterm sick leave (clausen et al., 2012; sandmark & renstig, 2010; nyberg et al., 2008). several studies have observed the role of work-related conflicts as a source of mental illness. romanov et al. (1996), for example, found a correlation between mental illness and conflicts at work. according to hyde et al. (2006), unresolved conflicts or conflicts resolved through the use of authority are particularly risky. njsr – nordic journal of social research vol., 5, 2014 41 another model focuses on the nature of the social relations between people, in accordance with social psychological theory in which stigma (goffman, 1990) and dysfunctional shame (scheff, 2013) are seen to be causes of mental illness. shame signals a state of insecure social bonds, and can give rise to lasting conflicts if nothing is done to remedy the situation (scheff, 1990). studies show that people who have been ostracized, harassed, and humiliated or subjected to other forms of shaming run a greater risk of being afflicted with a mental disorder and sick-listed than people who have not suffered such treatment (e.g. eriksson, starrin, ede & janson, 2011; starrin, 2011; starrin & wettergren, 2009). there are comparatively few qualitative studies that focus on the role of emotional relations in the emergence of long-term sick leave with a diagnosis of mental illness. the purpose here is therefore to analyse the relational and emotional processes in the workplace that may contribute to our understanding of long-term sick leave for reasons of mental health. method this study, which has an explorative approach, was launched in the spring of 2010. the data are derived from qualitative, individual interviews with a strategically selected group of women and men in a mid-swedish region. the respondents were on long-term sick leave (at least 60 days but no more than 365 days) from permanent (at least part-time) positions for reasons of mental health. their ages ranged from 29 to 58, with half of them being under 40. they represent a great variety of professions and educational levels, evenly distributed between the private and public sectors. nearly half of them are in health care and human services jobs. at the time of the interviews, more than half of them had returned to work part-time. some had left their employment, generally voluntarily. the respondents have been allocated pseudonyms. implementation the data collection, in the form of interviews with 26 persons (15 women and 11 men), was carried out in the spring of 2010. two officials at the social insurance agency telephoned persons who were documented to have had been on sick leave for mental-health reasons. they gave information about the study and stressed that participation was voluntary. in all, 40 persons were contacted, of which 13 declined to participate. their names and addresses were handed over to the research group, who in turn sent written information regarding the study, repeating that participation was voluntary. some days later, the interviewers phoned the potential respondents, further informing them about the study, voluntary participation and the possibility to withdraw njsr – nordic journal of social research vol., 5, 2014 42 without stating a reason. on this occasion, one person declined. the time and place of each interview was set at this point. two persons, occasionally three, conducted the individual interviews, mostly in the respondents’ homes, but with some taking place at the workplace (if they had returned to work) and some at the interviewer’s workplace. we asked about the reasons for their sick-listing, their anamnesis, the nature of their relationships at work, and about any critical events in their workplaces. the interviews were conducted with great sensitivity to the respondents’ own narratives. the goal was to capture their personal impressions of the causes of their sick-listings. the interviews were digitally recorded and the interviewers transcribed them immediately after they were done. analysis the classical grounded theory (cgt), which is a pattern-seeking method for analysing data, was used (glaser, 1998). the aim of the cgt is to generate knowledge from data by coding and extracting conceptual labels and categories for patterns of human behaviour or phenomena (glaser, 2011). the analysis started with the open coding of data. the work of coding continued, and evolved into selective coding. the comparison of the codes and how they might be related to each other gave rise to an overarching category – unresolved work-related conflicts. in order to gain an overview of how the proposed categories were related to each other, analysis maps were constructed. the proposed model is presented in figure 1. during the analysis, a number of codes emerged which indicated the importance of shame in the process of being ill, which prompted the use of retzinger’s (1991) shame markers. ethical considerations the possibility of ethical issues was sharply in focus, as the interviews were likely to touch on delicate areas and difficult experiences. nevertheless, we judged the benefits to outweigh the risks. the submission to the regional research ethics board in uppsala was approved on 17 feb. 2010. the respondents were informed by phone, mail, and on the occasion of the interview of the purpose of the study and their right to withdraw at any point, and were also assured of anonymity. before the interview, they signed a consent form and were handed contact information for the research group. njsr – nordic journal of social research vol., 5, 2014 43 results we suggest that the risk of being afflicted with mental-health issues leading to sick-listing increases when there are unresolved conflicts at work that lead to malignant shaming processes that jeopardize personal dignity. in their struggle to maintain self-esteem, the afflicted escalate their work efforts by increasing work intensity, putting in overtime, and working when ill. eventually, such patterns affect health and result in sick-listing. this usually long and drawn-out process should be understood in the context of restructuring in the form of streamlining, reduced staffing, and accelerating pace at work. the general features of the generated model and the focal concepts are presented in figure 1. figure 1 figure 1: model of the process propelled by drawn-out and unresolved relational conflicts at work leading to sick leave for mental-health reasons. restructuring at work the background against which the events reported by the respondents in our study take place is made up of five changes. first, there is the change of business owner, supervisor or work team members. this requires closing old relationships and building new ones. second, there are changes involving various forms of down-sizing, such as reducing staff (although not necessarily the workload). third, there are changes related to the implementation of new technology and it systems, which were supposed to facilitate work, but instead complicated it. fourth, many of the respondents were given many new and/or more advanced tasks, in addition to their old ones, without either more time allocation or professional training. fifth, there were increasing demands from customers or clients for employee availability. some of the respondents experienced all these changes, while others encountered only a few. it was taken for granted in the work place that these changes should take place alongside the regular flow of work, and that any njsr – nordic journal of social research vol., 5, 2014 44 interruption of productivity was unacceptable. all respondents shared the feeling that the changes were undesirable and impossible for them to influence. however, having encountered changes in the workplace, with increasing demands and loss of control, is not sufficient to explain sick leave. the changes are part of the downward spiral leading to illness but they share a further common denominator: the experience of unresolved conflicts at work. unresolved work-related conflicts we suggest that the risk of becoming involved in drawn-out work-related conflicts that remain unresolved increases when work-related changes take place over which employees have no control. we use the term ‘work-related conflicts’ to refer to conflicts between at least two parties in the workplace that are lasting and remain unresolved. these conflicts can be horizontal (between colleagues) or vertical (between supervisor and subordinate). in our respondents’ narratives, the horizontal conflicts were characterized as very bad atmospheres in the work groups or among colleagues. the spirit of the workplace changed from pleasant and unifying to competitive and ‘prickly’, as david puts it. sune, who has experienced a major staff reduction, declares: ‘everyone wants to stay on. there is competition between those of us who have similar duties, work faster and perform the best.’ other respondents gave accounts of disagreements over values-related issues, and differences of opinion on how joint work should be done. further problems included scheming and conflicts, which the respondents were not themselves part of, but which affected them and the overall group spirit in their workplaces. in these cases, the buffer that collegial support can provide against problems at work has not been operative, and therefore feelings of exclusion and rejection have set in instead. vertical conflicts are, however, most prominent in our proposed model because of their inherent imbalance of power. the respondents, all in subordinate positions, tell stories about painful humiliations and maltreatment inflicted by their supervisors. our emphasis will be on vertical conflicts which, we argue, when they remain unresolved, are a major contributor to shaming processes. shaming processes shaming is a relational process which can take place between persons, as an interpersonal process, or within a person, as an intrapersonal process. njsr – nordic journal of social research vol., 5, 2014 45 analytically, we differentiate between these two shaming processes although they are interlinked. the interpersonal dimension of shaming is manifested in external abuse and humiliation and has an identifiable source, reflected in the expression ‘he offended me’. the intrapersonal process, on the other hand, is subtler and occurs when the external abuse is internalized as part of people’s expectations of themselves. they judge themselves, and feel that they are someone they do not want to be, or that they cannot manage their work as they did before. they feel worthless, which is reflected in negative selfesteem. we adopt scheff’s (1990) definition of shame as an umbrella term for a large group of emotions including less intense forms, such as embarrassment and more intense forms, such as humiliation, debasement and disgrace. interpersonal shaming interpersonal shaming involves condescending treatment in two forms of victimization. we define one as confrontational humiliation and the other as evasive humiliation victimization is here used to designate acts producing feelings of degradation, humiliation, and belittlement. confrontational humiliation refers to encounters between a superior and a subordinate in which the superior directly voices dissatisfaction with the subordinate in a public forum or one-on-one situation, and which the subordinate perceives as unpleasant and hostile. gustav has been subjected to this kind of treatment. from the very start of his employment he felt bullied and ostracized by his superiors as well as his co-workers. the antagonism escalated when his supervisor humiliated him in public. he was threatened with dismissal every time he did not do as the supervisor said. another respondent who has had a similar experience of being treated badly by his superiors is manuel, who stands accused of professional misconduct and is being prevented from completing his training without explanation. he feels unjustly treated and is upset at not having the opportunity to defend and explain himself. birgit also feels unjustly treated. she was severely reprimanded when she objected to the, in her opinion, unfair decision to relocate her to a different department. she explains: ‘the boss said that i had a bad attitude, but i’ve never received any complaints. and i work so hard while others are surfing and playing games. i just cried and my whole body ached.’ birger asked his supervisor for assistance to relieve an increasingly stressful work situation, but instead of providing help, the supervisor said: ‘as an employee, you must do your assigned duties in the time allotted.’ at that point, birger’s duties had not only increased in number, but had also changed from product development to sales and accounting without any form of further njsr – nordic journal of social research vol., 5, 2014 46 training. he was forced to work overtime to catch up. when the company was sold to a foreign owner, the demands increased further, and he was no longer paid for his overtime. the second form of victimization – evasive humiliation – occurs when a superior with the authority to facilitate the work of a subordinate neglects to respond responsibly. ‘we were promised help, but the help never materialized,’ says sune. this type of victimization often involves supervisors who listen and show sympathy but, ultimately, ignore problems and avoid conflicts. camilla provides another example of evasive behaviour. she has problems with her co-workers as well as her tasks, and has asked her supervisor repeatedly for help without result. david tried to make his supervisor understand the consequences of a major staff reduction, which entailed more work and new tasks for him: ‘when things were really tough last autumn, i said that i was very tired now, but he said aren’t we all. it didn’t help me.’ generally, respondents set a high threshold before asking for help. there was a prevailing fear of appearing in an unfavourable light. when they finally did draw the attention of their supervisors’ to their problems, they were often treated with hostility or just ignored, treatment which reinforced their feelings of not being good enough. intrapersonal shaming intrapersonal shaming processes have no directly identifiable source, but are incorporated into the self-assessment of being inadequate, often expressed with phrases like ‘i’m not good enough’, or, as helen puts it: ‘i feel as if i’m no longer a person that counts.’ karin does not feel like a competent co-worker either, and asks rhetorically: ‘everyone else can manage, so what’s wrong with me?’ and birger explains: ‘i was mad at myself for not managing what i thought i ought to manage. i worked harder and harder.’ the sense of falling short of expectations results in a mental process of shame leading to a compulsion to work harder. david says: you are your own stick. a great deal of the problem lies with me. i want to deliver a perfect product and work until it’s done, but it’s getting more and more difficult to find the time. i’m ashamed to be doing a bad job. it was important to the respondents to project an image of themselves as competent and capable co-workers, or as helena puts it: ‘i was devastated njsr – nordic journal of social research vol., 5, 2014 47 because i thought that they thought that i couldn’t do my job. i don’t want them to think that i’m less competent.’ making efforts to please feeling of shame continues to grow stronger as the respondents try to hide it from themselves and others. they make great efforts to protect their bruised senses of self-esteem, and to please their employers. these efforts are an attempt by the respondents to present themselves in such a way that the employer will recognize and confirm that they are good enough. we label this activity ‘making efforts to please’. karin pushed herself to the limit to get such recognition: i was constantly in pursuit of meeting the criteria for a raise. from the first day at work i have performed everything required, and yet i never reach the top. no matter how fast i run, i will never catch up. making efforts to please can take three forms: increased work intensity, overtime, and sickness presenteeism. increased work intensity to avoid the shame of not managing tasks in time, work intensity is increased. this is done in two ways. one way is to ‘work through the breaks’, skipping lunch and/or the joint coffee breaks. work allows no rest, and requires full concentration. ‘i don’t have time for a single private thought the whole day because the work demands my full attention,’ doris says. david puts it this way: ‘work spills over into leisure, but leisure is not allowed to trickle into the workplace.’ another way of increasing the intensity of work is to increase the pace of work and race through the tasks. some respondents try to do their extended tasks in a shorter time, so as not to fall behind. others describe the never-ending demands of clients, customers, and other people in need. gunnel, for example, has to receive more and more clients, which means less time for each one. she explains: ‘they were in line outside my office and every interview required extra work.’ maria declares: ‘the pace at work has been stepped up and we are expected to be available at all times.’ the respondents feel trapped in a situation that forces them to do a job at a level far below what they would consider acceptable, in terms of both quality and service. the intense pace at work led to short-term sick-listings among the employees, which in turn meant that the people still at work were forced to do more, since there were no substitutes available and the employer expected njsr – nordic journal of social research vol., 5, 2014 48 the work to be done as if everyone was there. the frustration involved in being swamped with work, with no chance of catching up during the regular work hours, is widespread among the respondents. overtime overtime is another example of an effort to please. when the tasks can no longer be completed during regular work hours, the workdays are extended. in this phase the strain becomes increasingly evident. every task takes longer and people lose focus. there is a greater risk of making mistakes and/or lowering standards. victoria and sara check their work constantly, for fear of forgetting something or making undetected mistakes. they often stay late at work to catch up. others demonstrate their loyalty to employers by assuming responsibility far beyond duty and obligation. doris has had such an experience: when i have worked nearly all day, a customer calls to place a job order and then the supervisor promises that it will be delivered the same day. so even though i have worked all day i still have to stay on late into the evening to finish the job. sickness presenteeism the effort to please often drives the respondents to work even when they should have stayed at home. this is referred to as sickness presenteeism. ailments such as headache, muscle pain, cold, fever and dizziness are not seen as justification for absence from work. most of the respondents have noticed bodily signals of illness over time, like ingrid: ‘i knew why i had a headache but i ignored the signal.’ sometimes sune had to get his wife to help him get out of bed when he was stricken by lumbar-region backache. karin put on sunglasses to protect her eyes and went to work despite having a severe migraine. sara was so dizzy that she had to hold on to the walls when she walked down the corridor. there are three primary types of reasons for going to work regardless of health status. firstly, it is an issue of loyalty to colleagues, since no substitutes would be called in or to customers, clients, or care recipients, since there was a desire to not fail to provide them with service. secondly, it is because the tasks were so specialized that no one else could do them, and they would be collecting dust together with the continuous stream of new cases to handle; ‘there is twice as much on your return to work’, says karin. thirdly, it is because of the shame of being ill, which is seen as showing njsr – nordic journal of social research vol., 5, 2014 49 weakness. this is a phenomenon that birger has experienced: ’i didn’t want to give up. i wanted to admit that i couldn’t take it anymore.’ johan was so afraid of being dismissed that he didn’t dare to stay at home, as this would reveal that he couldn’t make it. he had nightmares about being fired. he says: ‘no matter how i felt, i went to work. i set goals for each day to get the strength to work.’ mental overload living up to expectations takes its toll, and the respondents came to be at a stage when health problems became an issue. the escalating spiral of increased workload and destructive relationships preyed on health and grew harder to cope with. some felt physical symptoms such as palpitations, fatigue, headache, and dizziness, while others had mental symptoms such as apathy and despondency. some experienced both types of symptoms. the disorders mainly appeared in three forms: chronic tiredness and fatigue, social withdrawal, and estrangement from self and others. chronic tiredness and fatigue the respondents describe permanent tiredness, a loss of energy, and an insatiable need for sleep. several testify to experiencing everyday life as ‘embedded in fog’. david grapples with feelings of guilt because of his tiredness: i have to rest when i get home and then i feel guilty because of the children. i’m nice to them but i have no energy to think of stuff to do, take them to the playground and so on. i feel bad about that. ingrid talks about a constant feeling of lack of energy: nothing was fun any more. it was hard to go to work and as hard to go home. i couldn’t readjust. when i was about to leave work, i was so immersed in it that i felt there was no time to go home. usually, i can switch over as i walk to the car but now i couldn’t. once i was just sitting in the car for an hour or so because i couldn’t muster the energy drive out from the parking lot. others talk about intellectual challenges, as victoria does: ‘i lost my memory. i was absent’. doris reread the same text several times without understanding what it said. sara did not recognize her own handwriting, and many recount concentration difficulties and forgetfulness, for example maria: ‘when i got back to work after the weekend, i didn’t remember how to use the phone.’ njsr – nordic journal of social research vol., 5, 2014 50 social withdrawal social withdrawal is a phase of dissociation from others. even socializing with relatives is too stressful. ‘i can barely cope with myself,’ says helena, who is normally a happy and outgoing person. david puts it like this: ‘when i was off work, i wanted to be on my own. i didn’t want to be with people, no parties, no festivities. i entered a bubble. people couldn’t make contact with me.’ maria stopped having coffee and lunch breaks with her colleagues: ‘i closed the door because i couldn’t stand being around people.’ some of the respondents stopped answering the phone when they get home. anna, who normally likes to chat on the phone, asked her children to say that she was in the shower or not home, in order to avoid having a conversation. the respondents also abandoned leisure activities because they needed their spare time to recuperate from work and muster energy for the next day, or as ingrid says: ‘i gave up everything i liked doing. i didn’t have time to exercise; i gave up everything that can generate energy.‘ in gunnel’s case, her whole vacation was spent gathering energy for working in the autumn. she was lying still all the time to save energy: ‘i went into hibernation like a bear to save energy.‘ estrangement from oneself and others mental overload generates a sense of being estranged from oneself and others. this is variously indicated, but most clearly in abrupt mood swings with elements of anger. several of the respondents describe supressed anger, controlled at work but released at home. karin had this experience: ‘i kept up a front so no one noticed how i had changed except my husband and my child. i wasn’t exactly a nice mum.’ david shares this experience: ‘at work i tried to be happy but when i got home my family was confronted with my worst sides. i don’t feel good about that.’ others mention sudden and inexplicable bursts of crying: ‘i never knew when it would happen,’ says helena, ‘it just happened.’ some were not aware of having changed until others told them. ‘my daughters pointed out that i was never happy any more,’ says victoria. birgit was told by her sister that she was ‘absent and sad’, and camilla’s husband said he thought that she had ‘undergone a personality change’, and that she was ‘constantly angry’. sick leave for most of the respondents, being sick-listed was not unexpected. bodily signals had been evident for a long time, in some cases several years. they knew that the situation was untenable and would ultimately result in sick leave. njsr – nordic journal of social research vol., 5, 2014 51 long-term sick leave, however, requires medical assessment. most of the respondents went to see a doctor of their own accord, some on advice from others, and some for a routine check-up. johan contacted a doctor, but has no recollection of what happened just that he was sick-listed: ‘i felt like i had been run over by a train.’ gunnel took a week off to rest, but went to see a doctor when she failed to return to work. at that time she was so dizzy that she could hardly move: ‘i felt intoxicated. my head was spinning and buzzing. all sounds were extremely sharp.’ the doctor sick-listed her immediately. david felt completely drained of energy and went to see a doctor: ‘there was a big black hole in my chest, or so it felt. this is it, i thought.’ the event that prompted ingrid to seek treatment was when a colleague put his hand on her shoulder and asked how she was: ‘i totally broke down and just cried. i couldn’t stop crying.’ he made her go to a doctor and she was sick-listed. birger was driving to work after a week on unspecified sick leave. he was ashamed to share with his colleagues the real reason for his absence, of not being able to cope with the stress of work: ’… because i was extremely stressed but i didn’t say that at work. i gave other reasons.’ on a country road shortly before the workplace, he pulled over and stayed there until his live-in partner came and took him to a doctor. when karin was at the doctor’s for a routine check-up, she brought up her health problems. the doctor said that she was a textbook example of fatigue depression and wanted her to go on sick leave, which she felt she did not have time for: no, no that’s unthinkable – and then she said that she would sick-list me starting from tomorrow, so i could finish things. i worked until six that evening and then i went home. and so it goes. it’s frustrating not to cope. now i have received confirmation that i was not good enough. common to all respondents is that they perceived the sick-listing as a failure, a shame. ‘i lost face. now everyone knows that i’m a fake,’ says gunnel. and helena makes the following comments: ‘being sick-listed equals being weak. by saying that i have been on sick leave is also saying that i’m not resistant to stress. so, i’m not good enough. i’m weaker than others.’ discussion the aim of this article was to draw attention to the relational and emotional processes in the workplace which may contribute to our understanding of njsr – nordic journal of social research vol., 5, 2014 52 mental illness and long-term sick-listing for mental-health reasons. the study uses a classic grounded theory approach. we conclude that the risk of being afflicted with problems of mental health leading to sick-listing increases when there are drawn-out and unresolved conflicts in the workplace which, in turn, give rise to malignant shaming processes that jeopardize personal dignity. in their struggle to maintain selfesteem, the afflicted escalate their work efforts by increasing work intensity, working overtime, and working when ill. eventually, this affects their health and results in sick-listing. the suggested model has a bearing on scheff’s (2013) theory relating to the socio-emotional world. he maintains that recursive shame becomes dysfunctional and might also lead to mental ill health. we see unresolved work-related conflicts as a kind of psychological poison. this particular poison drains people of emotional energy, makes them anxious, afraid, ashamed and anxiety-ridden, which in turn generates further serious problems. finally, the only solution, for many, is sick leave. shame is a central factor for explaining the link between externally stressful events and illness, not least mental ill health. our understanding of the processes leading to mental illness has similarities with the research tradition that identifies high work demands and low participation as a combination causing illness (karasek & theorell, 1990). the significant difference is that our model highlights the impact of conflict-ridden social relations on shaming processes. there are also similarities with studies that explicate the role of conflicts in understanding mental illness (romanov, 1996), especially when the conflicts remain unresolved (hyde et al., 2006). our model also displays many similarities with a study made by eriksson et al. (2008), which emphasizes the role of social relations in understanding mental illness. in this case also, our study further develops the role of shaming processes. further intensive and extensive studies are needed. we have not, for instance, considered demographic factors or that which transpires outside the workplace. future studies should also pay more attention to the relational processes that lead to dysfunctional and recursive shame processes, and how these are linked to mental ill health and sick leave. acknowledgements this study was financed by the nordic research council, via the eastern norway research institute, lillehammer, and karlstad university. njsr – nordic journal of social research vol., 5, 2014 53 references clausen, t., nielsen, k., carneiro, i.g., & borg, v. 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(2011). occupational musculoskeletal and mental health: significance of rationalization and opportunities to create sustainable production systems – a systematic review. applied ergonomics, 42(2), 261-296. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 2, 2011 the understanding of norwegian women’s sickness absence: towards a holistic approach? liv johanne solheim department of education and social welfare lillehammer university college email: liv.solheim@hil.no abstract background: in norway men’s sickness absence from work has been stable or reduced over the last decades while women’s sickness-absence ratio has increased, but the reasons for these developments are complex and unclear. there have been considerable efforts introduced and implemented to reduce sickness absence, but they have not succeeded. one reason for this may be the insufficient knowledge about the reasons for sick leave, and especially for women’s sick leave. the aim: this article aims to examine how social factors influence sickness absence and how long-term absentees interpret and explain their ill health and sickness absence. method: in one norwegian county in 2010 we performed individual in-depth interviews with 20 women and ten men between the ages of 25-60 years who had been or were sick-listed for more than 30 days during the last year with a mental illness or musculoskeletal diagnoses. results: the study illustrates how social factors influence sickness absence in different ways. the women indicated complex causes for their sickness absence, and often described an interaction between work-related and domestic-related aspects. some accounts illustrate that their ill health might have roots in life occurrences from childhood and adolescence that have made them vulnerable to domestic and work-related strains during their adult years. the study also indicates that women, especially single mothers, seem to be especially vulnerable to domestic strains, and that these strains may lead to a paradoxical pattern of women’s sick leave: they take sick leave in order to deal with domestic strains along with the intention of prolonging their presence at the workplace in the longer term. thus, these periods of sickness absence appear to be a necessary accompaniment of a high rate of participation among vulnerable groups in the labour market. conclusion: women’s ill health and sickness absence should be understood as a manifestation of an interplay of the strains found at both the workplace and the home. a successful effort to reduce sickness absence in norway, therefore, requires a holistic perspective that accounts for both the work and the domestic spheres. njsr – nordic journal of social research vol. 2, 2011 2 keywords: sickness absence, gender, work-related strain, domestic strain, holistic approach introduction since 1972 the total sickness absence in norway has steadily increased and shows no signs of abating (dale-olsen & markussen, 2010). since 2001 the reduction of absenteeism has been a central, highly publicized political aim, but these efforts have not been successful (ose et al., 2009). moreover, an overall understanding of why these efforts have not been successful remains elusive and incomplete. there is no indication, for instance, that demographic developments or changes in the health situation in the population can explain the increase in sickness absence (bjørngaard et al., 2009). yet what is perhaps more striking is the difference between men and women, an issue that has only recently come to the fore of the political agenda. the statistics shows that among men sickness absence has been relatively stable (blekesaune & dale-olsen, 2010; dale-olsen & markussen, 2010; nossen & thune, 2009). thus, women’s rate of sick leave is responsible for most of the general increase. a similar gender difference in sickness absence has also been found in sweden (alexanderson & norlund, 2004), and an international comparison of canada and eight european countries has found that in most of these countries, women had higher rate of absence than men (barmby et al., 2002). it appears that men’s rates of sickness absence have been influenced by fluctuations of the labour market (dale-olsen & markussen, 2010), but little is known about the factors that affect women’s rates. a conclusion from a recently published review of quantitative studies on women’s sick leave is that there is a general lack of knowledge about this phenomenon, and that improving our understanding can be the key to achieving reduced sickness absenteeism in norway (kostøl & telle, 2011). one reason for the lack of success in reducing sickness absence may be that the efforts have not been directed towards the main reasons for the sick leave. specifically, the main policies aimed at reducing sickness absence have until now been directed towards the workplace only (ose et al., 2009). this article suggests that this emphasis leads to certain misunderstandings because women’s total work burden is related both to the workplace and the domestic sphere, and that both the remedial efforts and the research are deficient due to this oversight. the efforts to reduce sickness absence have only to a limited degree taken into consideration the more complex work burden that women bear, and the research has contributed little to the understanding of the complexity and women’s work and life situation. if the factors remain largely unknown, then it will be naturally difficult to establish what might be the most effective remedies. this article aims to examine the social factors contributing sick leave and how the absentees explain and interpret their ill health and sickness absence. the focus of this article is mainly on the experiences of the women and on the reasons for their sick leave. we shall refer to the sick-listed men only as a contrast. there are a number of studies that have emphasized the role of social factors in sickness absence. kostøl (2010) has presented some of the popular hypotheses and a review of this literature. one of the hypotheses has been that women with children carry a double burden and are therefore more likely to take sickness absence. quantitative studies have, however, found little or njsr – nordic journal of social research vol. 2, 2011 3 no support for this assumption (mastekaasa & olsen, 1998; mastekaasa, 2000; bratberg et al., 2002). yet bjørngaard et al. (2009), among others, have concluded that women probably to a larger degree experience a role conflict between work and care for children, and that women often have more physically demanding work situations. consequently, they argued that it is urgent to maintain the gender perspective in this area of research, where studies need to look at men’s and women’s situation separately. this article presents a qualitative study as an alternative approach to understanding the causes of sick leave. qualitative studies offer an important complement to other approaches because they allow the sick listed to reflect on their situation and to express their experiences in their own words. individual and personal understandings form the basis for the single person’s actions and decisions. the qualitative data makes it possible to gain an insight into how people cope with their illness and the relation between illness and sick leave. the next section is a short presentation of this study’s theoretical orientation, and a brief review of the recent literature on the social risks for long-term sickness absence follows. the methods and the data material of the study are described before an account of the findings is given. the last section discusses these findings and on this basis reflects upon the consequences on policies and policy-making. theoretical perspectives there is a general furcation in the perspectives for understanding health and illness: the medical and the sociocultural along with the psychosocial (coutu et al., 2007). the medical perspective regards people as natural entities and tries to find exact indicators for diagnoses. this approach seeks to draw objective conclusions. in contrast, the sociocultural perspective sees people as cultural and social beings, and here the relation between the individual and society is important. similarly, the psychosocial perspective provides insight into the individual’s interactions with his or her environment. the last two perspectives focus on how individuals interpret their illness and how they cope with the situation. this study likewise also pays attention to the creation of sick-leave identities as a function of the social interaction between the sick-listed and their social networks. according to this perspective, the state of illness and disease that leads to sickness absence has a relational character, and is seen as an interactive process (verdonk et al., 2008). to understand sickness absence, it is necessary to take the absentees’ psychosocial environments into account, and it is important to clarify how absentees think about themselves and their life situation (nordby et al., 2010). therefore, this study adopts a symbolic interactionist perspective which rests on three premises (blumer, 1969:2): a) human beings act towards things on the basis of the meanings that the things have for them; b) the meanings are derived from the social interaction that one has with one’s fellows; and c) these meanings are handled in and modified through an interpretative process that one uses in dealing with the things that one encounters. included in this perspective is an explorative and holistic approach, a step-wise induction from data, and ideographic knowledge focusing upon an understanding of single cases (alvesson & sköldberg, 2005). for my purpose, this perspective suggests that an individual’s interpretations of the sick role and the reactions from the social surroundings may influence recovery. it is important, therefore, to pay attention to how sick-leave identities are created as a function of the social interaction between those sick-listed and their surroundings, along with njsr – nordic journal of social research vol. 2, 2011 4 general attitudes towards sick-leave in society. to understand how men and women adapt and assert themselves, harding (1986) makes a distinction between three different levels: the individual, structural and symbolic. while the experience of men’s and women’s freedom of action is formed at the individual level, their adaptations are influenced by the gendered structures in society as well as by the imaginations and understandings of gender that are part of our society, that is, the symbolic level. illness is a personal experience of suffering (hoffmann, 2010), and this experience has consequences for how the individual adapts to the situation and what actions are taken. by focusing on gender, this study assumes that factors other than on the structural and symbolic levels also are central in men’s and women’s understanding of their sickness absence, and that workrelated and domestic strains may have varying degrees of significance for developing ill health. social risk factors for long-term sickness absence the connection between work-related health problems and illness along with sick leave is well verified (mehlum et al., 2006; deckers-sanchez et al., 2008; tynes et al., 2008; gravset, 2010). work-related illness is often defined as follows: a) individual factors or injuries, which comprise physical or ergonomic factors due to heavy physical work, awkward work postures and repetitive work, and b) social factors, which cover psychological demands, job control, social support at the workplace, and organizational factors (e.g., shift work). one important aspect of the social factors is the imbalance between the individual’s resources and the demands of the job (westin, 1994). other studies have confirmed the significance of such psychosocial factors as job control, social support from leadership, predictability and role conflicts (lund & labriola, 2009; nielsen et al., 2006). the significance of the different factors varies between men and women, especially the psychosocial factors (lund & labriola, 2009). ockander and timpka (2001) have described the complex influence of work on health. this study shows that work has different meaning for different individuals depending on their life situation and where they are in the life cycle. it is important, therefore, not to place women into one category because there are wide variations in women’s relation to work and how they adapt to the labour market. this is confirmed in a dutch study which shows that work-related fatigue is clearly related to gender, and that this condition was highest among highly educated female employees (verdonk, 2010). irrespective of the amount of paid work, it is common that women bear the main responsibility for domestic work. a norwegian study reveals dramatic gender differences in the distribution of housework and care, even among the households of elite men and women (skjeie & teigen, 2003). most of the elite women had partners who worked full-time or more, while 40 per cent of their male counterparts had partners who worked part-time or were housewives. a high total workload of paid and unpaid work has been found to increase the risk of negative outcomes (krantz et al., 2005; mellner et al., 2006). few studies have examined the separate impact of domestic work on women’s health, but there are some notable exceptions (staland-nyman et al., 2007; chandola, 2004; glass, 1994; griffin et al., 2002; östlund et al., 2004). staland-nyman et al. (2007) have found an association between strains in domestic work measured as ‘domestic job strain’ and ‘domestic work equity and marital satisfaction’, on the one hand, and self-rated health, on the other. the importance of perceived equity in domestic work and a satisfactory njsr – nordic journal of social research vol. 2, 2011 5 relationship for self-rated health was the strongest for the dimensions that measured psychological health. also, findings from other studies (glass, 1994; griffin, 2002) have revealed an association between factors related to domestic work and women’s psychological well-being. these studies have found that the inequity in the division of domestic work to be a greater contributory factor to women’s psychological distress than the amount of domestic work. a considerable proportion of norwegian women are working single mothers. in 2011 22 per cent of the households in norway with children in the ages 0-17 years were single-parent families, and 80 per cent of these were single mothers (statistisk sentralbyrå, 2011). the dual responsibility of caring for and providing for children causes work-family conflicts for many single mothers as well as financial stress (whitehead et al., 2000; ugreninov, 2005). some research has observed single mothers having higher levels of mental problems than non-single mothers (whitehead et al., 2000; fritzell & burstrom, 2006). a study of single and non-single working mothers in denmark, sweden and norway (bull & mittelmark, 2009) shows that financial stress was the most significant predictor of life satisfaction in both groups of working mothers, but also that the level of financial stress is significantly higher for single mothers. single mothers also scored lower on life satisfaction and happiness. quantitative studies often use the number of children as the only variable for measuring domestic strain (mastekaasa, 2000). the literature shows, however, that this method is insufficient and that the relation between work strain and domestic strain versus illness and sickness absence is complex. a crucial question for women’s health, then, is how studies might disentangle the respective burden of illness associated with paid work, domestic work and the combined effect of both. these studies illustrate the significance of making a distinction between different aspects of domestic work, and point to the importance of using measures that include both practical and emotional aspects. this underlines the importance of having a holistic perspective to grasp the different aspects and the complex interplay between the different factors. this present study is also concerned with identifying the variations of experiences and understandings between different groups of women related to their work situation and their situation in the domestic sphere. methodological approach and sampling this is a qualitative and exploratory study. it was critical to the study that the data was collected with an open mind in order to record the informants’ own thoughts and explanations in their own terms. our study adopts the central method of symbolic interactionism of seeking to understand the phenomenon from the informants’ perspectives and to describe their experiences. in addition, our analysis employed a grounded-theory approach (glaser & strauss, 1967; glaser, 2010) because the inductive nature of grounded-theory methods requires openness and flexibility on the part of the researchers. in this way the themes are permitted to emerge from the informant’s account (charmaz, 2003). our study covered four topics in all interviews, but we did not formulate the questions in advance in order to apply the flexible approach to each interview. the interviews were tape-recorded and transcribed. batt-rawden and solheim (2011) have given the first presentation of the data material, which also gives a more extensive presentation of the methods used. the analysis began with open coding in order to capture the concepts, themes, and statements that were central in their descriptions. in the next stage of selective coding, we njsr – nordic journal of social research vol. 2, 2011 6 limited the categories and showed the dimensions representing the variations within the data material. thus we examined the data in order to identify themes, to explore categories, and to develop concepts. the study is based upon a sample of long-term sick-listed persons’ own explanations and understandings of their sickness absence due to mental problems or musculoskeletal problems, the two most frequent groups of diagnoses among people on sick leave in norway. in 2010 among the men, musculoskeletal problems caused 46.9 per cent of the days on sick leave, and mental problems 17.5 per cent (nav, 2011). among the women, 37.4 per cent were sick-listed because of musculoskeletal problems, and 20.3 per cent because of mental problems. with both of these diagnoses it is often difficult to find objective symptoms, and often the background to these problems is complex. in addition there often is an overlap between these two groups of diagnoses. a survey in sweden shows that two-thirds suffer both musculoskeletal pain and mental problems (eriksson et al., 2008). the informants were contacted according to the instructions set by the project sofac in accordance with the regional ethical committee (rek). the department for statistical analysis at the norwegian labour and welfare service (nav) selected a sample of 260 women and 260 men diagnosed with mental illness (icpc-codes: p76, p02, a04) or musculoskeletal illnesses (icpc-codes: l03, l84, l02, l18, a01, l92). the sample included people between 20-60 years old, who were or had been long-term sick-listed for at least 30 days during the previous year. to reduce travelling time, we limited the sample to long-term sick-listed individuals in ten municipalities in one norwegian county. the purpose was to find a broad representation of age span (20-60 years old) and men and women in different life situations. a letter was sent to the sample with information about the study. to comply with the rules concerning anonymity, nav sent the letter and the informants themselves were asked to contact the researchers about participating in the study. in total, there were 30 informants, ten men and 20 women, who made contact and were interviewed. our initial aim was to gather a sample of 20 women and 20 men. however, the lower number of men was not critical due to the exploratory nature of this study. the low response rate might have been connected to the procedure of selection, which relied heavily on the informants’ initiative. owing to ethical guidelines, nav were required to distribute letters that provided the necessary information to potential informants, and then it was up to the informants to initiate the first contact with the researchers. another reason is that the group asked to participate is composed of people who suffer from serious illness, and being sick-listed they might lack the motivation or the strength, or both, to participate. we do not know the reasons why so many declined to participate in this study, but there were certain revealing characteristic of the group that was willing to share their experiences. while most of them have had long-term and repeated experiences of being sick-listed for several years, at the time of the interview they had recovered and they often were willing to participate because they had experiences from their period of sickness absence that they wanted to convey. characteristics of the sick-listed women the interviewed women were between 25-60 years, and two-thirds of the group were in their forties (8) and fifties (7). only three were in their thirties njsr – nordic journal of social research vol. 2, 2011 7 and two in their twenties. for most of the women the sickness had developed over a period of years, and they had been sick-listed two or more times before. they are a group with long and varied experiences with being sicklisted. among the women nine of 20 had diagnoses related to mental problems, and 11 had diagnoses related to musculoskeletal problems. however, some of the women who were diagnosed with mental problems had musculoskeletal problems earlier, and vice versa. this shows that there often is an overlap between the two diagnoses, and therefore we do not make a systematic distinction between the two groups of diagnoses in the presentation of the data. the women were relatively well educated, with 12 of them having attained higher education (at least three years at college or university), four vocational training, and four basic schooling. at the time of the interviews 12 of the women were married or cohabitants. of these, eight had lived in a stable marriage for years, and four were divorced and had established a new relationship. all of the women had children, and ten had been or were in practice single mothers for their children. in this last group the fathers lived far away and did not participate in the daily lives of their children. results: women’s holistic understandings of their sickness absence this study confirms that the reasons for people’s sickness absence are complex. our study shows that individuals often interpret their illness and sick leave as a function of the social interaction between the sick-listed and their social surroundings. among the important elements of this interaction are the gendered structures in norwegian society. the interpretation presented here is how these structures, which enforce the expectations towards men and women in society, influence these individuals’ adaptations. the reasons that the respondents gave for their sickness absence included work strain, domestic strain and the interplay between the two. another important aspect among some of the women was the incidents of strain in their life histories in their childhood or adolescence. in the following i shall first present the dimensions of work strain, and then the interaction between work strain, domestic strain and relational strain in their life histories that seem to have an influence on their ill health and sickness absence. vulnerability to work strain all of the men in our study were full-time workers, and they all described their sickness absence entirely or mainly to be connected to factors at work. the women also had a strong identity of being working women, but some had parttime jobs, and during their life span they had adapted their work to obligations towards their families. accordingly the amount that the women worked varied. the most common work-related dimension mentioned by the women was illhealth and signs of wear after years of pressure. care workers are an especially exposed or vulnerable group in this respect. lise, a woman working in a nursing home, expressed the following: njsr – nordic journal of social research vol. 2, 2011 8 … i think the sickness absence is a result of the expectations placed upon us. it is about being women in typically women’s jobs. the job is demanding both physical and mentally – you are expected to cope with everything, to do it all and to have time for everything. by increasing the number of workers i think the sick leave would have decreased. and then people would have had a much better life. it is only women who would have accepted this situation. … during the day we are not entitled to a break. we have our meals together with the patients and if they need help we are accessible. other dimensions of work-related strain that the women mentioned were workplace conflicts or inefficient leadership and accidents or injuries. another work-related reason for sick leave was the boundlessness of their jobs, which entail expectations of being accessible for extended work time. for some of the women, this condition led to feelings of inadequacy and of having limited control in their work situation. the complexity of strain: the interaction between work-related strain and domestic strain however, these work-related explanations the women give for their sickness absence are often not the only explanation of their sickness absence. their histories of ill health and sick leave often involve descriptions of the struggle to deal with both domestic strains and strains at work, and in some cases also the strain in their life histories. some women attributed the total burden of all these three elements as the explanation of their sick leave. one example is gunn, who had been sicklisted several times in recent years. she is married, has two small children and works in a nursing home. she said that the total work burden represented too much care work. but the background for her sick leave was more complex. in addition she explained that her sickness absence also was related to her deteriorating relationship with her husband, her parents’ recent divorce and her unsupportive mother during her adolescence and childhood. she expressed the expectations that: ... you have to be strong, you will not say anything. if you aren’t managing things well, you have to say that everything is ok. the origin of these attitudes comes from my adolescence. my mother was often negative. i think that many of my problems that have been reinforced over the last years have their origins from my adolescence. signals of negativity and criticism: what i did was never good enough. some of this has been reinforced these past years, and i have to take this seriously and look forward to a better future. when the men in a few cases mentioned aspects of domestic life as influencing their sick leave, they connected it to unexpected events in the families, like a sudden death or family members having had serious accidents or serious financial problems. the dimensions mentioned by the women were very different. one aspect was the workload and challenges related to helping and supporting their children or other family members. other aspects were the feelings of having the overall responsibility along with a lack of practical and social or emotional support. our data indicates that the women still have the role as the head of the domestic life in the families. the burden of this role becomes particularly pronounced in problematic situations. anna, for example, who was divorced and had been a single mother for her two children, was living with a man with two children his own. her son had been addicted to njsr – nordic journal of social research vol. 2, 2011 9 heroin for some years and the daughter of her partner developed serious mental problems, and after some time committed suicide. in these circumstances she described her role in the family as follows: somebody had to keep the family together, so i compromised my own needs … i had to take care of my partner and my son. in my situation it has been impossible to take care of myself, even if somebody had asked me to take a break. i have been doing this continually for a long time … dealing with the strains at work and in the domestic sphere was a challenge for all the women, but it was particularly expressed by women living alone with their children. a ‘single mother’ is normally defined as a woman who lives with children who are neither married nor living with a partner. in our study most of the single mothers are divorced and living alone with their children. the fathers are absent for different reasons, most often because they live too far away and are therefore not able to participate in the daily lives of their children. women married to men who work abroad for long periods may be in a similar situation, since their husbands are absent most of the time. the single mothers related the lack of space for themselves and the sparse opportunities for recreation. their jobs together with the additional demands in the domestic sphere took all their time and strength. the children’s extracurricular activities could be particularly draining. when children participate in sports or other activities, there are strong expectations towards the parents to contribute and show their support the single mothers reported little understanding from the other parents for their situation as an only parent. without support from family and friends this life situation is demanding. dagny described her life situation like this: you want to manage and you have a responsibility for your job. i work with clients and they need help. i was working 80 per cent [of the amount of a full-time job] until the summer and i clenched my teeth. and i worked and cooked for my children – that was the life i lived. a very boring life, but it had to be like this. in the autumn i asked to increase my work to 100 per cent because i needed the money. then i could not be sicklisted immediately after that, so i had to stay in work even if it turned out to be too much for me, but i managed until february. in this statement it is clear that dagny’s economic situation is an additional strain. this was also the case with the other single mothers. their financial situation sometimes forces them back to work too early. women who worked part-time told stories about how they pushed themselves to take on a higher percentage of work than they could manage. the motivations for this were their need of a higher salary, and, if they earned a higher salary, they would be entitled to a higher sickness benefit. for most of them this was only a short-term solution. an additional challenge for some of the women was the strain related to sick children or children in need of extra care. children’s illnesses and social problems are a challenge for parents, and in our study most of the women in this situation were single mothers. the children’s problems included drug abuse, attention-deficit/hyperactivity disorder (adhd), mental problems, sexual abuse, myalgic encephalomyelitis (me), and eating disorders or selfharm. children with drug-abuse or mental problems sometimes exhibit threatening behaviours that make their mothers anxious. the women described the heavy burden of being a single parent to children with health problems. most of them had lived with these problems for years. what is more, the mothers felt that their responsibility for caring for their troubled children extended into their children’s adulthood, when they are normally njsr – nordic journal of social research vol. 2, 2011 10 expected to live their own independent lives. for most of the women dealing with these problems was a lonely task. only a few of the single mothers received support from a social network; the others had a tendency to isolate themselves. the workplace was for many of them a place where they could forget their domestic worries, a place where they could be accepted and gain recognition. but the total burden forced them to take on either part-time jobs or to have periods of sickness absence. the workplace as a recreational arena domestic problems may in some cases legitimize sick leave, but this does not give them a break from their most acute problems. rather, the consequence of being sick-listed may be that they have to stay at home where the roots of their problems are situated, and this gives them no chance to have some relief from the problems. if the roots of the problems leading to ill-health are mainly work-related, the sickness absence period is a chance to have some distance from the place and persons where the problems are situated. for some of the men in our sample this gave them an opportunity to participate more in the daily life in their families. they received the time and opportunity to take their children to kindergarten and to participate in leisure activities, in addition to helping with the daily work in the household. their children and wives very much appreciated these opportunities, and the men regarded them as a positive aspect and an added value of their sickness-absence period. for the women in our study, this was not the case. since most of the women already had most of the responsibility for the everyday life of their families, the out-of-work situation was not a respite from their daily lives. on the contrary, some of the women expressed that they would have preferred to have been sick-listed from their burdens in the domestic sphere. for some of the women in this situation, going to their workplace was actually a time-out from their problems at home. for those who had a job they were coping with their tasks and had good relations with their colleagues and managers. in short, the workplace was an important arena for respect and recognition. one example was anita, who dealt continually with domestic strain because her two children were drug abusers. she isolated herself and was depressed, but she strove to maintain her dignity. in this situation the nursing home where she worked was the best place to go: ‘at my job i am known, respected, accepted and yes – there i feel i am at the top.’ anita is an example of those women who would actually fight to stay at work and to avoid sick leave. staying at home made her depressed, and she looked forward to the day when she could work again. she had even begun planning to look for alternative forms of work if she could not return to the nursing home because of her musculoskeletal problems. the study showed that many women visited their workplace frequently during their sickness-absence period, which indicates that the women had a high degree of job satisfaction and positive interpersonal relations at their workplace. in our study care workers were well represented. in spite of the substantial pressures of the job they enjoyed being together with their patients and colleagues, and they missed this contact when they were sick-listed. njsr – nordic journal of social research vol. 2, 2011 11 discussion this study has shown that to understand sickness absence from the perspectives of sick-listed women, it is necessary to take into consideration their psychosocial surroundings and the complexity of their life situation. from this perspective illness and sickness absence can be understood as manifestations of the strain in people’s lives. the study has pointed out different aspects of women’s work situation and domestic life that may cause illness and sickness absence. certainly, this study is limited; the sample is small and generalizations must be made with caution. we do not claim to have unveiled all aspects that may have an influence, but the data gives some insight into complex developmental processes behind their sickness absence. in particular, the study is a reminder about the different aspects of women’s domestic situation that may have an influence upon sickness leave. the findings of this study are discrepant to those of some earlier quantitative studies (mastekaasa, 2000, mastekaasa & olsen, 1998) that have not found support for an increase in sickness absence among women with high domestic burden. one explanation may be the way that domestic burden is defined, where the number of children is often used as an indicator of domestic burden. the present study finds that number of children as a measure of domestic strain is insufficient. a number of other factors also appear to influence domestic strain, including the presence of children who are sick or have problems that demand a great deal of attention and the adverse effects of having a troubled relationship to their partner. other studies have also confirmed this observation. östlund et al. (2004) have identified three dimensions of domestic strain that influence sickness absence: the division of domestic work, the division of responsibility for domestic life and the amount of social-emotional support at home. staland-nyman et al. (2007) have found correlations between domestic work strain, domestic work equity, marital satisfaction and self-related health. the present study shows that a sufficient understanding of the causes of women’s sickness absence requires a holistic approach. in a few cases the causes of their sickness absence are related solely to either domestic or to work strains, but most often sick leave is an outcome of the interplay between both sources of strain. it is, therefore, insufficient to study work-related or domestic sickness absence in isolation. women’s ill-health and sickness absence must be understood as an interaction between domestic and workrelated strains. the women’s interpretations of their ill health and sickness absence also indicate that the inclusion of their life histories is needed. in addition to life strains in adulthood, life strains experienced during childhood and adolescence also contribute to greater vulnerability to ill health. bjørngaard et al. (2009) have concluded that women probably to a larger degree than men experience a role conflict between being a caregiver of children and a worker. the present study partly confirms this conclusion, but it is necessary to add that work burden and the sense of having total responsibility, as well as the emotional aspects, are important. single mothers and mothers who have partners who are away from home for longer periods are especially vulnerable. our study shows that single mothers and mothers with sick children or with family members in need of care often experienced a heavy burden of responsibility and feelings of underachievement. these factors make them vulnerable groups for ill-health and sick leave. the quality of life of the single mothers can be reduced by both economic strain and the total load of work. njsr – nordic journal of social research vol. 2, 2011 12 the studies of östlund et al. (2004) and staland-nyman et al. (2007) emphasize the importance of using measures that also include emotional content of domestic work. our study illustrates that a sufficient understanding of the factors contributing to sick leave requires the inclusion of emotional dimensions in both the workplace and the domestic sphere. the women in our sample had a strong identity both as mothers and workers. the single mothers experienced the conflicts between these identities especially intensely. according to harding (1986) these identities are formed through interactions between symbolic and structural factors. at the symbolic level the expectation that women are to take care of the children is greater than what is expected of men. at the structural level there are strong expectations for women in our society – including single mothers – to participate in the workforce. this pressure comes to expression through the work fare policy. these factors have consequences on women’s freedom of action and their adaptations in their daily lives. in the last decade, the reduction of the sickness absence has been a main political aim in norway. the efforts to reduce the level of sickness absence have been mainly directed towards the workplace and work-related sick leave. some of the efforts in certain businesses have been reported to have been successful, but the efforts have not resulted in a significant reduction of the national level of sick leave (ose et al., 2009). to find successful actions for reducing sickness absence, it is important to have as precise knowledge as possible of the factors contributing to ill health. our study shows that domestic strain and the interplay between work strain and domestic strain may be important factors that contribute to women’s sickness absence. this study also advises that efforts to reduce sickness absence would do well to take this into consideration. one important question that arises from this consideration is how it might be possible to help relieve women with a high burden of domestic strain. therefore, to reduce sickness absence particularly among women, it may be important for employers, doctors, and social workers to have strategies which meet the absentee’s need for help not only at the workplace but also in the domestic sphere. today some households turn to private firms in order to reduce the burden of domestic work (e.g., house cleaning). however, this solution is beyond the resources of low-income families, who often have problems making ends meet. for some of these families, support from the public services in the form of domestic help could be a solution for keeping women in the work force. however, women may be in need of different kinds of help and support, and it is necessary to take the individual’s specific needs into consideration. conclusion the present study illustrates the importance of both gender-specific approaches and qualitative methods in grasping the scope and complexity of the conditions that contribute to women’s sickness absence. in particular, this study suggests the importance of a holistic approach. the efforts to reduce women’s sickness absence must take into consideration their domestic strain, and especially the situation of single mothers and women who bear the responsibility of caring for grown-up children who are sick or unable to take care of themselves as well as elderly people in the family in need of care. since the factors that contribute most to ill health for some women are situated in the domestic sphere, it is necessary to consider what efforts can be done to mitigate their domestic burdens. njsr – nordic journal of social research vol. 2, 2011 13 both quantitative and qualitative research is needed to explore further the different aspects of domestic strain, the interaction between domestic and work-related strain, and the long-term consequences of the double burden that women carry. only on the basis of this knowledge will it be possible to formulate the appropriate efforts that will effectively contribute to a reduction in women’s sickness absence. references alexanderson, k. & norlund, a. 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(2004). domestic strain: a hindrance to rehabilitation? scandinavian journal of caring science, 18, 49-56. microsoft word bungum, kvande the rise and fall of cash for care in norway.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 4, 2013 the rise and fall of cash for care in norway: changes in the use of child-care policies brita bungum programme for teacher education the norwegian university of science and technology (ntnu) email: brita.bungum@plu.ntnu.no elin kvande department of sociology and political science the norwegian university of science and technology (ntnu) email: elin.kvande@svt.ntnu.no abstract the cash-for-care scheme was introduced in 1998 in norway. during the first period after its introduction, the percentage of users was high at 91 per cent. since 2005, however, the use has decreased substantially year by year. thus, the use of cash for care has changed over the 15 years it has existed. in this article we take these changes as our point of departure and analyse more closely what we might call ‘the rise and fall of the cash-for-care scheme’ in norway. over the last 15 to 20 years, norway has become a multicultural society and we need to include ethnicity when conducting research in the field of family policy. the focus is therefore on the intersection of gender, class, and ethnicity in parents’ use of cash for care over this period. our analysis is based on different sources of data. we have used data from the evaluative programme undertaken by the norwegian research council, including two surveys conducted before and after the reform (gulbrandsen & hellevik, 1998; hellevik, 2000), and a qualitative case study focusing on fathers and mothers working in three different workplaces (bungum et al. 2001). we have also used njsr – nordic journal of social research vol. 4, 2013 32 three other statistical studies which were carried out at two different points in time (pettersen, 2003; hirch, 2010; bakken & myklebø, 2010). our findings indicate that cash for care is a scheme that mainly encourages mothers who have low income and a low educational level and who are to a large degree from immigrant backgrounds to remain outside the labour market. by distinguishing between three phases, we have aimed to illustrate how the intersection of gender, class, and ethnicity enters in different ways into both the discourse and the practices connected to the cash-for-care scheme since it was introduced in 1998. keywords: welfare state, cash for care, family policy, class, gender, ethnicity introduction policies facilitating the reconciliation of work and family in norway, as in many other nordic countries, have been influenced by the idea of gender equality between parents. the focus has therefore been on promoting both mothers’ and fathers’ participation in work and childcare. the parental-leave scheme and high-standard day-care services encourage the model of the dual-earner and the dual-carer family. although this has been the main principle, another principle that supports a traditional family model in the policy measures in this field has been observed. this principle has been labelled the ‘double track’ and has been referred to as a dualism in norwegian family policy (ellingsæter & leira, 2006). during the 1990s two important family policy reforms were introduced in norway. these two reforms illustrate the dualism in the welfare-state provisions for work-family regulation. in 1993 norway extended the parental-leave scheme to one year of paid leave and introduced the father’s quota. these were policy measures which fit the idea of the dual-earner and the dualcarer model. in 1998, however, the cash-for-care scheme was introduced. before its introduction it was the subject of a heated and polarized debate in norway. concerns about the ‘time squeeze’ were an important part of the debate when the new cash-for-care reform was established in norway in 1998. the main goal of this reform was to provide parents with the opportunity to spend more time with their children by giving them njsr – nordic journal of social research vol. 4, 2013 33 money so they could afford to work less and to spend more time at home. another claim was that the scheme would guarantee parents the freedom of choice’ between using publicly funded day care or staying at home and receiving cash for care. the third intention behind the scheme was to create more equality in the use of public support between families with small children not using publicly funded day care and those that did (st.prp. 53, 1997-98:8). the cash-for-care scheme differed from previous parental-leave schemes within norwegian welfare and family policies because it did not depend on parental participation in the labour force. one of the main goals of norwegian welfare policies has been to give women and men the possibility to combine the care of small children with an active working life. improvements and developments of parental leave have been connected to labour-force participation. however, the cash-for-care scheme is not, and it is therefore a separate agreement between the parents and the state. the reform was introduced 15 years ago and thus we now have substantial background experience of how it has worked. in this article we shall take as our point of departure the period from the introduction of cash for care in 1998 through to the present day. our focus is on two research themes: 1) what have been the changes over the 15 years in the extent that norwegian parents have used this care policy? 2) what are the characteristics of the typical users over time? to do this we have divided the timeline of the new scheme into three periods. our analyses are based on different sources of statistical data from the norwegian labour and welfare administration (nav, ny arbeidsog velferdsforvaltning) and from statistics norway (ssb). in addition we use data from the major evaluative study which was carried out by the norwegian research council. njsr – nordic journal of social research vol. 4, 2013 34 the dualism in norwegian family policies – social democratic and christian democratic approaches the dualist aspect in norwegian family policy (ellingsæter & leira, 2006) has encouraged what have been labelled the ‘work-line’ policies, meaning that social-insurance programmes are based on parents’ work participation. accordingly, family policies are closely connected to employment policies and encourage parents to choose employment. a typical example of this principle is the qualifying criteria for being eligible to the parental-leave scheme: participation in the workforce for minimum six of the last ten months prior to the birth of the child. this type of policy encourages both parents to combine work and family obligations, which again leads to a dual-earner model where the ideal is that both mothers and fathers should be employed. this is part of what ellingsæter and leira (2006) have called ‘the politicization of parenthood’, meaning that different governments in the norwegian political system have contributed to redesigning gender relationships in parenting in the nordic countries. approaching welfare policy, we may also understand ‘the politicization of parenthood’ in connection with what gøsta esping-andersen (2006) has called the ‘social democratic’ regime. this welfare regime takes direct responsibility for the care of children, but this policy does not only aim to service family needs; it also allows women to choose work rather than the household. esping-andersen (2006) points out the merging of welfare and work in the social democratic regime. this welfare strategy is committed to a heavy social-service burden and is dependent on full employment (and thus taxation) in the population (esping-andersen, 2006: 169). the other track in norwegian family policies, the christian democratic and liberal track, has advocated policies that are not dependent on the parents’ participation in working life. the family is instead given cash payments in order to value unpaid work and care. the cash-for-care scheme promotes this idea by providing cash benefits irrespective of the parents' earlier workforce activities. this track has come to support a traditional division of work in the family ‘the malebreadwinner family model’. giving more freedom of choice has been a crucial argument for the cash measures in general, and this case refers to cash given particularly to facilitate one of the parents staying at home. taking into consideration the modest amount of money the cash-for-care scheme gives a family, we may regard it as an option njsr – nordic journal of social research vol. 4, 2013 35 mainly for mothers with no or very low income. the fact that it is not connected to the obligation to participate in the labour market makes a clear break with the principles of the social democratic welfare-state regime. drawing upon esping-andersen’s notion of welfare-state regimes (esping-andersen, 2006), we shall argue that the norwegian cash-forcare scheme is closer to a ‘liberal’ or a ‘corporatist’ welfare-state strategy than a ‘social democratic’ one. esping-andersen claims that family policy in a liberal welfare regime is based on the belief in freedom of choice for individuals and the concerns of gender matter less than the sanctity of the market. the norwegian cash-for-care scheme was introduced as a gender-neutral arrangement on the basis of ideas from a liberal ideology and a strong belief in the blessing of the freedom of choice. at the same time, the cash-for-care arrangement could be a part of what esping-andersen (2006) labels as a corporatist welfare strategy ‘typically shaped by the church and strongly committed to the preservation of traditional family practices’ (esping-andersen, 2006 p.168). cash for care has been an important part of the family policy of the christian democratic party in norway, and their goal is to support traditional family values. the christian democratic party also played a central role in the introduction of the arrangement in 1998. according to esping-andersen the most salient characteristic of the social democratic regime is its fusion of welfare and work participation. cash for care represents a welfare arrangement disconnected from working life. it can be seen as an arrangement that supports a private solution to childcare. in this way cash for care fits in with a liberal as well as a corporatist welfare strategy. since gender equality matters less in this welfare arrangement it also supports a preservation of traditional family patterns, typical for a corporatist strategy. we also find expressions of this dualism in the political attitude regarding publicly funded day-care services. norway has had the lowest coverage rate for these services among the scandinavian countries, especially for children under three years of age. the main reason for these differences between norway, on the one hand, and sweden and denmark, on the other, has been the political ambivalence towards mothers’ participation in the workforce and daycare services for children (ellingsæter, 2006). the christian democratic party and the conservative party have supported a more njsr – nordic journal of social research vol. 4, 2013 36 traditional family pattern, with mothers staying at home caring for the children. the social democratic party and the socialist party have supported day-care services for children and mothers’ participation in the workforce. this ambivalence has made it difficult to gain sufficient political support for securing full kindergarten coverage in norway. it was not until 2003 that all political parties joined to sign the so-called the ‘day-care guarantee’, which stipulated that all norwegian children between one and six years of age would be guaranteed a place in a publicly funded day-care centre. thus, the two tracks have influenced the work-family balance in contradictory ways. the question of which family models the welfare state should support reflects different ideas on what a family is or should be in norway today. some family policies aim at conserving a more traditional, male-breadwinner model, whereas others encourage a ‘double-earner/double-carer’ model. it is important to take into consideration the potential tension between these two models in the context of norway as a multicultural society. family policy and the intersection of gender, class, and ethnicity population data from statistics norway show that there has been a considerable increase of immigrants in the norwegian population over the last 30 years. beginning in 1970, immigrants and norwegian born with immigrant parents constituted 1.5 per cent of the population. in 2010 this group had increased to 13.1 per cent of the population1 (statistics norway, 2012 [http://www.ssb.no/innvandring/]). this change represents new challenges for research and policies introduced in the work-family field. the politicization of parenthood (ellingsæter & leira, 2006) in the norwegian context has been 1 in recent years there has been an explosive growth in immigration to norway from new eu countries (eastern europe and especially poland) after the eu enlargement. the number of immigrants from asia, africa, and latin america has doubled since 2000. the proportion coming from these countries has increased from six per cent in 1970 and now constitutes half of all immigrants. (statistics norway, 2010). njsr – nordic journal of social research vol. 4, 2013 37 strongly influenced by universalism and egalitarianism.2 these are what welfare analysts generally consider to be the core values in the constitution of the so-called ‘social democratic nordic model’ (espingandersen, 2006). as the nordic countries have become societies which to a greater extent include people from different ethnic and cultural backgrounds, this type of welfare-state intervention might represent a new challenge both for social-science theory and for policy-makers. in their book on intersectionality, de los reyes and mulinari (2004) criticize what they see as predominant feminist policies for white middle-class well educated women in the nordic countries. they find this feminism to be a type of equality policy that can be measured, assessed, and acted upon. one of the consequences of this approach is that the subsequent focus on women's representation in decisionmaking bodies in politics and business and industry obscures issues relating to inequalities between women. therefore, they argue that it is important to keep women’s different life conditions in mind. thus, instead of a sole focus on gender, the perspective should be on how gender, class, and ethnicity interact. accordingly, an intersectional perspective focuses on relating white women to hegemonic femininity and shows how ignoring other women's life conditions is an important tool in the reproduction of the hegemonic position of white feminism. the nordic countries have maintained a strong focus on affirmative action in order to achieve gender equality, which easily becomes a general narrative of progress that obscures the circumstances of less privileged groups of women in scandinavia and other countries. the focus should instead be on variations between women’s life situations when discussing and suggesting general political measurers. the life situation of women and men is not a sum of disparate segments of race, gender, and class. rather, all these elements are produced and reproduced each day in historically and locally varying contexts. societal patterns of segregation, inequality, exploitation, and oppression are concrete historical processes that are constructed as an integral part of class and gender differences. reducing social 2 universalism refers to a welfare policy that is based on egalitarianism in the sense that a universalistic system promotes equality of status (in addition to a means-tested system). all citizens are endowed with similar rights, irrespective of class or market position (esping-andersen, 2006). njsr – nordic journal of social research vol. 4, 2013 38 positions to simple categories (gender, class, or ethnicity) blinds us to the interplay between different forms of superiority and subordination in societal life (de los reyes & mulinari, 2004). it has nevertheless been difficult for researchers to reach some agreement on how they should understand these types of complex interconnections. this conundrum is expressed in doing gender, doing difference: inequality, power, and institutional change (fenstermaker & west, 2002). in their book, fenstermaker and west state that race, class, and gender are experienced simultaneously, and in order to understand this point, it is important to focus on the actual mechanisms that produce inequality. in this regard, they develop an ethno-methodological perspective through which they see interconnections as ‘situated accomplishments in interactions in which race, class and gender are enacted and reproduced’. de los reyes and mulinari (2004) have a similar understanding as fenstermaker and west (2002), where they look for theories to explain processes that create inequality on different societal levels. central to this endeavour is the approach of ‘doing gender’, an understanding of gender as a practice which is being constructed in everyday activities (west & zimmerman 1987; kvande, 2007). they maintain that power and power relations are things that are done in the interaction between people. it is also impossible to do gender without at the same time doing class, race, and sexual orientations. structural relations come into the picture through their contextualization in space and time with the focus on financial relations, dominant ideologies, and social structure. in addition to analysing the intersection or interaction between gender, class, and race, the idea is to interconnect analyses on different levels. this includes policy levels, which are the focus of this article. even if it is agreed that race, class and gender should be understood and analysed as interlocking elements, the question of how best to understand the intersections between them has been a key issue (collins 1995; glenn 1999, 2002; west & fenstermaker, 1995a, fenstermaker & west, 2002). most scholars are critical of simple additive models of gender, race, and class because such models assume common experiences in each of the categories. an additive model does not capture the fact that gender relations vary within different races and class situations. the dilemma is found in the njsr – nordic journal of social research vol. 4, 2013 39 intersectionality between social structures as opposed to mutually constituting processes. we continue to face the challenge of how to understand what the metaphors of ‘mutually constituting’, ‘intertwining’, and ‘intersecting’ mean in terms of concrete analyses of social practices (acker 2005). mccall (2005) has created a three-part typology for understanding and applying the concept of intersectionality. the first is the anticategorical use of the concept, where the focus is on the deconstruction of social categories to introduce more fluid and open understandings of complex processes. the second is the intracategorical approach that focuses on differences that cut across one particular category of interest and is based on in-depth qualitative analyses on, for example, a special group of immigrant women. with the third type, the inter-categorical approach, the main focus is on differences and similarities within groups and it is based on the use of analytically defined categorical differences such as age, social class, ethnicity, and gender. this approach is more used in large-scale quantitative analyses. if the inter-categorical approach is used, the focus will be more on differences than on similarities between groups. bearing this in mind, in this article we shall use the inter-categorical approach to study how the intersections of gender, class, and ethnicity produce different practices in the use of cash-for-care policies. data and methodology in our analyses of the development in the use of the cash-for-care scheme, we decided to divide the timeline of the new scheme into three strategic periods. we have called this the ‘rise and fall of the cash for care’, indicating the change in the support for this reform. the first period starts in 1998, when cash for care was introduced, and ends in 2005. in 2003, all the political parties joined together and signed ‘the childcare guarantee’, which meant that all children between one and six years of age would be guaranteed a place in public day care. the second period lasts from 2005 to 2009, and the last period is from 2009 up to today. our analysis is based on different data sources. for describing the use of the cash-for-care arrangement and analysing it through the three periods, we use two main sources of statistical data. this is data njsr – nordic journal of social research vol. 4, 2013 40 available from the norwegian labour and welfare administration (nav http://www.nav.no/english) and from statistics norway (ssb http://www.ssb.no/english/). nav carried out a survey on the use of cash for care between april and may in 2010 a representative sample of parents in norway (bakken & myklebø, 2010). data used for this analysis was obtained from government statistics register data; the cash-for-care register, (kontantstøtteregisteret), the employer and employee register (arbeidsgiver-/arbeidstaker registeret), the income register (inntektsregisteret) and more. the data contains all children born from 1998 to 2007 and information about their parents (bakken & myklebø, 2010). we also used similar statistical studies from statistics norway to describe patterns of use for the cash for care through the period of 1999 to 2010 (gulbrandsen & hellevik, 1998; hellevik, 2000, pettersen 2003, rønsen 2004 & hirch 2010) and in addition the latest statistical data on immigration and immigrants to norway (statistics norway, 2012). njsr – nordic journal of social research vol. 4, 2013 41 ta bl e 1. d at a so ur ce s fo r th e th re e st ra te gi c pe ri od s th re e st ra te gi c pe ri od s fo r ca sh fo r ca re in n or w ay 1. th e im pl em en tin g ph as e 19 98 20 05 2. th e ‘f re ed om o f c ho ic e’ p ha se 20 05 20 09 3. th e co ns ol id at in g ph as e 20 09 20 12 s ou rc es of da ta : s ta tis tic s n or w ay : - p et te rs en , 20 03 ; r øn se n 20 04 d at a fro m th e na tio na l e va lu at io n: b ak lie n, g ul br an ds en & e lll in gs æ th er , 20 01 g ul br an ds en & h el le vi k, 19 98 ; h el le vi k, 2 00 0 (s ta tis tic al s ur ve y) b un gu m , b ra nd t & k va nd e, 20 01 (q ua lit at iv e ca se s tu dy ) (n a v ) s ur ve y th e n or w eg ia n la bo ur an d w el fa re a dm in is tra tio n: b ak ke n & m yk le bø , 2 01 0 d at a av ai la bl e fro m : th e n or w eg ia n la bo ur an d w el fa re a dm in is tra tio n (n a v ) h ttp :// w w w .n av .n o/ e ng lis h s ta tis tic s n or w ay (s s b ) ht tp :// w w w .s sb .n o/ en gl is h/ s ta tis tic s n or w ay : p et te rs en , 20 09 ; h irc h, 2 01 0; s æ th er , 2 01 0 fa fo (s ur ve y) : k av li & m ar ja n, 2 00 9 n a v (s ur ve y) : b ak ke n & m yk le bø , 20 10 th e n or w eg ia n la bo ur an d w el fa re a dm in is tra tio n d at a av ai la bl e fro m : th e n or w eg ia n la bo ur a nd w el fa re a dm in is tra tio n (n a v ) ht tp :// w w w .n av .n o/ e ng lis h) s ta tis tic s n or w ay (s s b ) ht tp :// w w w .s sb .n o/ en gl is h/ b ak ke n & m yk le bø , 20 10 (n a v ) s ur ve y th e n or w eg ia n la bo ur an d w el fa re a dm in is tra tio n d at a av ai la bl e fro m : th e n or w eg ia n la bo ur a nd w el fa re a dm in is tra tio n (n a v ) ht tp :// w w w .n av .n o/ e ng lis h) s ta tis tic s n or w ay (s s b ) ht tp :// w w w .s sb .n o/ en gl is h/ njsr – nordic journal of social research vol. 4, 2013 42 four years after the introduction of the cash-for-care scheme the norwegian research council conducted a major evaluation that included several studies. two surveys were conducted before and after the reform (gulbrandsen & hellevik 1998; hellevik, 2000) along with two qualitative case studies. in one of the qualitative case studies (bungum, brandt & kvande, 2001), the main focus was on examining the consequences for equality between women and men in working and family life. in many ways this research question reflected the public debate on the dual-earner model, and this study has found that different work cultures were important when it comes to the possibilities parents have for spending time and providing care for their own children, and also for what sort of care arrangements they choose to use. the data, which illustrates different contexts of norwegian working life today, was based on case studies from three different workplaces with various time-cultures, that is, the norms directed towards working time (epstein et al., 1999; brandth & kvande, 2005). this study focused on fathers and mothers working as skilled workers in the electronics industry, nurses in a hospital, and researchers working in technological research (bungum et al., 2001). one of the members of this research group analysed the family policy debates in parliament prior to the introduction of the reform (håland, 2001). these are the main data sources in our analysis of the first period, which we have labelled it ‘the implementing phase’. in 2002 a new study was conducted on the effects on families with respect to their use of childcare, work participation, and use of cash for care (pettersen, 2003). this material has been used in a number of analyses (rønsen, 2004). we use these results as our point of departure in our analysis of the second phase, ‘the decline-of-usage phase’. in the last phase, which we have labelled the consolidation phase, we use the latest analyses from statistics norway which focus on the decline in the use of cash for care among different parental groups (hirch, 2010) together with the survey from the norwegian labour welfare administration (bakken & myklebø, 2010). the implementing phase – a dramatic rise in usage the cash-for-care scheme was introduced in 1998, and it was greatly used in this initial period. it was at the peak of its popularity and measured in terms how many families received the cash benefit. njsr – nordic journal of social research vol. 4, 2013 43 statistics show that parents of 91 per cent of the children born in 1998 and 1999 received cash for care, and if we look at children born in 2000 and 2001, the numbers are almost identical (bakken & myklebø, ssb, nav, 2010). when the numbers are as high as this, it indicates that families in all social groups received the scheme. however, when we analyse more closely how the cash-for-care scheme was actually used, we find that it was used in quite different ways by different groups of parents. although the main purpose of the scheme was to give parents the opportunity to spend more time with their children, we find that a large number of parents who received cash for care during this period used a private nanny or made other private arrangements, for example using grandparents or other relatives. during this period in norway, few day-care centres had places for oneand two-year-olds. while the intention of the planners of the cash-for-care scheme was to give parents the opportunity to spend less time in the workplace and more time with their children, the opponents of the scheme feared that that a large number of working mothers would leave the workforce. however, the evaluation’s summary report (baklien, gulbrandsen & ellingsæter, 2001) concluded that this major reform had minimal impact on the mother’s practices of workforce participation. the debate about the ‘time bind’ was important in the first phase when the new cash-for-care reform was established in norway in 1998. at this time a growing number of mothers were working on a full-time basis in norway and, therefore, correspondingly more and more children were born into dual-earner families. the concept of the ‘time squeeze’ or ‘time bind’ was often used in the public debate to describe the situation for many of these families. a popular idea in norway was that flexibility was a key solution to the time-bind problem for working parents, not only at the workplace but also in family policy in general. the strong belief in flexibility as a blessing for parents had clear connections to the (liberal) arguments based on parents’ rights to have the freedom of choice in caring for their children (brandth, bungum & kvande, 2005). although cash for care at first glance appears to be a gender-neutral scheme, open to both fathers and mothers, research findings have shown that virtually no fathers reduced their work time owing to the scheme. the main cash for care was for part-time working mothers njsr – nordic journal of social research vol. 4, 2013 44 (hellevik, 2000). part-time work is not common among norwegian fathers. moreover, time cultures in working life seem to influence the way cash for care is used. while norwegian family policies have been presented as attempts to reduce inequality between women and men, cash-for-care policies were not introduced as a scheme for supporting gender equality. the former minister of children and family affairs, valgjerd svarstad haugland, (who is said to be ‘the mother of the cash-for-care scheme’ in norway), had the following comment when asked if it was problematic that the scheme would maintain a traditional genderbased division of labour: i never said that the cash-for-care scheme was going to be a reform promoting equality among men and women, and this i maintain. it is a scheme for parents who wish to spend more time with their children. while one might consider arguing that cash for care is a genderneutral scheme, the statistics indicate that the majority of those who used cash for care to reduce their working hours were women with weak labour-market connections. thus, we see an intersection of gender and class, although some middle-class women also worked on a part-time basis. fathers, on the other hand, did not use the scheme to work less (hellevik, 2000). the cash-for-care scheme, therefore, clearly had some gendered consequences (bungum, brandth & kvande, 2001). our research findings from this introductory phase revealed that gender was important in the choices parents made. norwegian working life is gendered in ways that include different time cultures in different workplaces. we included two male-dominated companies in our study. in both of these companies we found that the labour rights were the crucial concern when it came to the fathers’ possibilities to use more time for the care of their children. our research showed that if fathers are going to work less and are taking on more care duties at home, the welfare schemes have to be connected to labour rights. although cash for care was said to be a gender-neutral scheme with the same impact for mothers and fathers, gendered time cultures in the workplace were adjusted to a gendered use of the scheme. parents’ choices in connection with cash for care appeared to be njsr – nordic journal of social research vol. 4, 2013 45 individual and particular, but together they made a pattern that strengthened the impression that cash for care was a scheme that maintained and reinforced a traditional pattern of gender division. the decline-in-usage phase this phase in a way commences in 2003 with the introduction of ‘the day-care guarantee’ and lasts up to 2009. in the political debate prior to the introduction of the cash-for-care scheme, the christian democratic party and the conservative parties argued that it would guarantee parents ‘the freedom of choice’ between using publicly funded day care or staying at home and receiving cash for care. the norwegian labour party and other parties on the left saw this scheme as a break with the dominant dual-earner and dual-carer model and argued that as long as there were not enough publicly funded daycare places, there would be no real freedom of choice. in other words, this political disagreement mirrors the dualism in the norwegian policies in this area. because of the ambivalence towards mothers active in the labour market and publicly funded day-care services, norway has had the lowest coverage rate for these services among the scandinavian countries, especially for children under three years of age. because of this ambivalence, it has been difficult to gain full support for the political aim of securing full kindergarten coverage in norway. in the political debate that followed the introduction of cash for care, politicians from both leftand right-wing parties pointed out that it was impossible to say that norwegian parents had freedom of choice between these two alternatives as long as day-care services were not fully covered. the important result of this debate was that all the political parties joined together in 2003 and signed what was called the ‘day-care guarantee’, which meant that all norwegian children between one and six years of age would be guaranteed a place in publicly funded day care. thus we can say that it was after 2003 that norwegian parents really had the freedom of choice that they were promised in the 1998 election. however, it took some time before the effect of this reform could be studied because new daycare facilities had to be built. therefore, the second phase in our analysis really starts in 2005 when we can see a dramatic drop in the number of those opting for cash for care. njsr – nordic journal of social research vol. 4, 2013 46 the figures from statistics norway indicate this development (hirch, 2010). in 2009, 32 400 children between one and two years were under the cash-for-care scheme. in 1999, ten years earlier and one year after the introduction of the scheme, the number was 88 700 and the relative figures for all one to two year olds went from 73 per cent in 1999 to 27 per cent in 2009. more one year olds receive cash for care than two year olds. for one year olds, we see a drop from 78 per cent in 1999 to 30 per cent in 2009. for two year olds, we see a drop from 69 per cent to 24 per cent in the same period. there has been a gradual reduction in the use of cash for care during the entire period from 1999 to 2009, but the reduction has been most prominent after 2009.it is therefore reasonable to say that the majority of parents during this second phase have chosen not to use cash for care. when norwegian parents really obtained the freedom of choice, they preferred day-care services to cash for care. however, it is important to look at who used cash for care in 2009. for norwegian parents, we can see the same pattern as in the first phase; mothers with a marginal position in the labour market used the cashfor-care scheme. this trend is even stronger in the second phase. we can see the same pattern for immigrant families. there has been a decrease in the use of cash for care among all groups of immigrants (hirch, 2010). the figures show, however, that children between one and five years of age with parents from africa and asia do not use publicly funded day-care services to the same degree as children with parents from norway (sæther, 2010). the use of the cash-for-care scheme varies according to what country the immigrants come from. parents from pakistan have the highest percentage of cash-for-care usage, which is true for the whole period, from 1999 to 2009. the variation between the different immigrant groups when it comes to using the cash-for-care scheme must be seen in connection with women’s participation in the workforce. women from pakistan, iraq, and somalia have low participation rates in working life and the gender difference between men and women in labour-market participation within the various groups is greatest among those from pakistan (pettersen, 2009). research within this field finds that immigrants from pakistan often are of the opinion (60 per cent) that women should not be in the workforce if they have children between one and three years of age (kavli & marjan 2009). this opinion is held by only one-third of immigrants from iran, one-fourth from iraq, and njsr – nordic journal of social research vol. 4, 2013 47 under one-fifth from vietnam. in comparison, only 11 per cent of parents without an immigrant background have this opinion (kavli & marjan, 2009). the consolidating phase – the decline in usage continues the third phase starts in 2009 and continues up to today. the trend of a decreasing popularity among parents in using the cash-for-care scheme continues in this phase. patterns revealing differences in economic, social, and cultural background among parents’ preferences towards childcare are becoming even more prevalent (bakken & myklebø, 2010). the majority of parents in norway seem to prefer day care for their children. while the recipients of cash for care in the first phase constituted a heterogeneous group of parents, the recipients in the third phase are more and more a homogenous group of parents when it comes to class and ethnicity. the real value of the amount of money parents receive from the cashfor-care scheme has diminished since the introduction of the reform. at the same time, the day-care rates have decreased. relatively speaking, in the period of the third phase it is more expensive to stay at home with small children in norway. the relative value of the money from the scheme is, however, higher for parents with low income than for parents with high income. the latest statistical analyses (nav 2010) show that parents with low income receive cash for care to a larger extent. in regard to opting for cash for care, the income of mothers is the decisive factor. the higher the mother’s income is, the weaker her propensity for opting for cash for care. naturally this is also connected to the mother’s educational level and profession. low workforce participation seems to increase the probability of choosing cash for care (bakken & myklebø. 2010). these findings indicate that mothers’ relations to the labour market continue to be an important key to understanding the function of the cash-for-care scheme in norway today. parents with an immigrant background are over-represented, as are those with low income and low education as well as with a rural address among today’s cash-for-care receivers. the statistics for the njsr – nordic journal of social research vol. 4, 2013 48 receivers of cash for care (nav 2010) also tell us that the differences between immigrant parents and parents born in norway are increasing, and parents born in asia and africa are more likely to receive cash for care than parents born in norway (bakken & myklebø, 2010). these differences have come to influence the political discussion on the integration of immigrants in norway. how can small children learn to speak the norwegian language if they stay at home? how do we encourage immigrants to participate in the workforce while simultaneously offering welfare schemes that encourage them to stay at home? there have been political proposals to abolish the cash-forcare scheme, but a majority still support it. it would appear that the freedom of choice for parents continues to be a popular idea in the public discourse. even though popularity in the cash-for-care scheme has obviously declined, it can still be a political risk to remove a scheme that pays poor parents (mothers) cash for care. the discussion also reflects a problematic issue concerning the idea of gender equality between parents in the norwegian society and immigrants with more traditional ideas about parenthood and gender relations. summary and conclusions – the rise and fall of cash for care in this article we have analysed the development in the use of the cash-for-care scheme in norway. we have shown how the use of cash for care has changed during the 14-year period it has existed. this development we have called ‘the rise and fall of the cash-for-care scheme’. we have applied two theoretical points of departure. first, we have applied the theories on different welfare-state regimes in order to analyse the ‘politicization of parenthood’ in the norwegian context. the norwegian welfare state has followed a double track in family policies, introducing regulations which support the dual-earner model but also introducing regulations supporting the malebreadwinner model. the cash-for-care system which is not based on parent’s workforce participation can be said to support the malebreadwinner model. it is also a break with the social democratic welfare regime which relies on the merging of welfare and njsr – nordic journal of social research vol. 4, 2013 49 participation in the workforce. our second strand of theorizing is based on the perspectives of intersectionality. we have applied the inter-categorical approach where the main focus is on differences and similarities within groups and it is based on the use of analytically defined categorical differences such as age, social class, ethnicity, and gender. by distinguishing between three separate phases our intention has been to illustrate the different ways the intersection of gender, class, and ethnicity has entered into both the discourse and the practices connected to the cash-for-care scheme since it was introduced in 1998. in the beginning, as illustrated by the first phase in our analysis, cash for care was used by a fairly heterogeneous group of parents, whereas usage today is concentrated in a fairly homogeneous group where gender intersects with class in such a way that mothers with low income and low education are encouraged to stay outside the labour market. in the first phase the main issue in the political discussion was about gender and the question of equality in the family. one of the topics in the heated debate on these policy measures was whether the cashfor-care scheme would undermine the dual-earner model by encouraging mothers to ‘return to the kitchen’ and leave paid work. the first evaluative analyses that were carried out in 2001 has shown that cash for care had been ‘a big reform with small consequences’ (baklien, gulbrandsen & ellingsæter, 2001), which meant that the number of mothers in the workforce did not decrease significantly. however, this research was undertaken a short time after the introduction of the reform. later research on this topic indicated that the effects on mothers’ participation in the workforce were not so small after all (rønsen, 2004). this research also showed that there were substantial differences between different groups of women according to their educational background. this concurs with other research that shows how class and educational backgrounds have a significant effect on the care strategies parents choose (stefansen & farstad, 2008) the second phase started in 2005 after the introduction of ‘the daycare guarantee’ in 2003. this was followed by a dramatic fall in use of cash for care. in this phase, the focus in the public debate on cash for care slowly turned from gender towards class and ethnicity. when njsr – nordic journal of social research vol. 4, 2013 50 parents in norway received real ‘freedom of choice’, the majority preferred publicly funded day care for their children. immigrant mothers with a marginal position in the labour market were the majority of the users of the cash-for-care scheme. this is an example of how ethnicity, class and gender intersect. at the same time there has also been a decrease in the use of cash for care among all groups of immigrants. however, the statistics tell us that parents from some countries in africa and asia do not use day-care services to the same degree as parents with a norwegian background. we have pointed out how variations between the different immigrant groups regarding the use of the cash-for-care scheme must be seen in connection with how women’s participation in the workforce is viewed. in the last phase, this tendency becomes even more evident. we find that parents with an immigrant background and parents with low incomes and education are the ones who use the cash-for-care scheme. the most important background factors are the education and income situation of the mothers. the intersection of gender, ethnicity, and class becomes very clear, for it is mothers with low education and income and from immigrant families who are among the main users of cash for care. in this third phase questions concerning ethnicity and the integration of immigrants in the labour market are also highlighted in the public discussion. recently the norwegian government has proposed redesigning the cash-for-care scheme for three-year-olds. it will then be limited to parents with children up to two years of age. the argument for this reduction is that it will be an adjustment that will lead to more women participating in the workforce. it is further argued that more immigrant children would have the opportunity to learn the norwegian language in day-care centres, which will in turn benefit their opportunities in school. the political debate on this issue remains controversial. cash for care has developed into a scheme which is used by mothers in the lowest income groups and with a high percentage of certain groups of immigrants. because of this pattern, it is also a difficult political decision to redesign it, even though it is quite dysfunctional when it comes to the political aims of increasing gender equality and the integration of ethnic minorities. njsr – nordic journal of social research vol. 4, 2013 51 references acker, j. (2005) class questions: feminist answers. lanham, md: rowman and littlefield. bakken, f. & myklebø, s. (2010). kontantstøttens utbredelse og foreldres preferanser for barnetilsyn [the extent of the cash-for-care scheme and parents’ preferences for childcare]. arbeidsog velferdsdirektoratet. baklien, b., ellingsæter, a.l. & gulbrandsen, l. (2001). evaluering av kontantstøttereformen [evaluation of the cash-for-care reform] oslo: the norwegian research council. brandth, b., & kvande, e. (2003). fleksible fedre [flexible fathers] oslo: universitetsforlaget. brandth, b. & kvande, e. (2005). fedres valgfrihet og arbeidslivets tidskulturer [fathers’ freedom of choice and time cultures in working life] oslo tidsskrift for samfunnsforskning, 46(1), pp. 35-54 bungum, b., brandth, b. & kvande, e. (2001). ulik praksis – ulike konsekvenser. en evaluering av kontantstøttens konsekvenser for likestilling i arbeidsliv og familieliv [different practices, different consequences: an evaluation of the consequences of cash benefits for gender equality in working life and family life] rapport stf 38 a01502. trondheim: sintef-ifim and ntnu. børve, h. e. & kvande, e. (2006). kjønnede tidskulturer i en global kunnskapsorganisasjon (gendered time cultures in a globalized knowledge organization) tidsskrift for kjønnsforskning, 3-4: 352–368. collins, p. h. (1995). symposium: on west and fenstermaker’s ‘doing difference’. gender and society, 9(4), pp. 491-494. de los reyes, p. & mulina, d. (2004). intersektionalitet. malmø: liber. ellingsæter, a. l. (2003a). the complexity of family policy reform: the case of norway. european societies, 5(4) pp. 419-443 ellingsæter, a. l. (2003b). når familiepolitikk ikke virker… om kontantstøttereformen and mødres lønnsarbeid [when family policy does not work ... on the cash-for-care reform and mothers’ paid work]. tidsskrift for samfunnsforskning, 44(4), pp. 499-527 njsr – nordic journal of social research vol. 4, 2013 52 ellingsæter, a. l. (2006). the norwegian childcare regime and its paradoxes. in ellingsæter, a. l. & leira a. (eds.) (2006) politicising parenthood in scandinavia. bristol: the policy press. ellingsæter, a. l. & leira. a. (eds.) (2006). politicising parenthood in scandinavia. bristol: the policy press. epstein, c. f., seron, c., oglensky, b., & sauté, r. (1999). the part-time paradox: time norms, professional life, family and gender. london: routledge. esping-andersen, g. (2006). three worlds of welfare capitalism. in pierson, p. & castles, f. (eds.), the welfare state reader (pp. 160-174). cambridge: polity press. fenstermaker, s. & west, c. (eds.) (2002). doing gender doing difference: inequality, power, and institutional change. london: routledge. glenn, e. n. (1999). the social construction and institutionalization of gender and race: an integrative framework. in lorber, j., m. m. feree & b. hess, revisioning gender (pp. 3-43). thousand oaks, california: sage. glenn, e. n. (2002). unequal freedom: how race and gender shaped american citizenship and labor. cambridge, ma: harvard university press. gulbrandsen, l. & hellevik, h. (1998). barnehager og kontantstøtte i et fordelingsperspektiv [day-care centres and cash for care in a distributive perspective] samfunnspeilet nr. 5, 1998. oslo. ssb hellevik, t. (2000). flere småbarnsmødre har blitt deltidsarbeidere [more mothers have become part-time workers] samfunnspeilet nr. 5, 2000. oslo. ssb hirch, a. a. (2010). brukere av kontantstøtte 1999-2009 færre barn med kontantstøtte [users of cash for care 1999-2009: fewer children with cash for care] samfunnsspeilet nr.4, ssb 2010 håland, k. (2001). kontantstøtten: et veiskille i norsk familiepolitikk? [case for care: a crossroad in norwegian family policy?) hovedfagsoppgave i statsvitenskap. trondheim: institutt for sosiologi og statsvitenskap, ntnu. kavli, h. c. & marjan, n. (2009). familiepraksis og likestilling i innvandrede familier [family practice and gender equality in immigrant families] fafo rapport 2009:39. njsr – nordic journal of social research vol. 4, 2013 53 kvande, e. (2007). doing gender in flexible organizations. bergen: fagbokforlaget kvande, e. & rasmussen, b. (eds.) (2007). arbeidslivets klemmer. paradokser i det nye arbeidslivet [the working life squeeze: paradoxes in the new working life]. bergen: fagbokforlaget leira, a. (1998). caring as social right: cash for child care and daddy leave. social politics, 5(3) pp. 362-378 leira, a. (2002). working parents and the welfare state: family change and policy reform in scandinavia. cambridge: cambridge university press mccall, l. (2005). the complexity of intersectionality. signs: journal of women in culture and society, 30(3), pp. 1771-1800 pettersen, s. v. (2003). barnefamiliers tilsynsordninger, yrkesdeltakelse og bruk av kontantstøtte våren 2000 [families with children and care schemes, work participation and use of cash for care spring 2000] rapporter 2003/9 oslo. ssb. rønsen, m. (2004). kontantstøtten og mødres arbeidstilbud. større virkninger på lengre sikt [cash for care and mothers’ work participation in the long term] samfunnspeilet nr. 6, 2004 ssb sigle-rushton, w. (2007). looking for difference? complexity. interdisciplinary communications. 2006/2007, pp. 93-96 sletvold, l. (2000). kontantstøtteordningens konsekvenser for yrkesaktivitet og likestilling [the consequences of cash for care for employment and gender equality]. report 15/00. oslo: nova sletvold, l. (2000). kontantstøtteordningens konsekvenser for yrkesaktivitet og likestilling [the consequences of cash for care for employment and equality]. report 15/00. oslo: nova stefansen, k. & farstad, g.r.(2008).småbarnsforeldres omsorgsprosjekter. betydningen av klasse [care arrangements among parents with small children and the significance of class] in tidsskrift for samfunnsforskning, 3(49), 2008 st. prp 53. (1997-98).kontantstøtte som ledd i en god barneog familiepolitikk [cash for care as a element in positive children and family policy] kap.2, 2.1 regjeringens utgangspunkt og mål [proposal to the norwegian parliament: the government's point of departure and aims]. report to the norwegian parliament no. 4, (1988-89) njsr – nordic journal of social research vol. 4, 2013 54 sæther, j. p. (2010). barn i barnehage – foreldrebakgrunn og utvikling de seneste årene [children in day care: parental background and development in recent years] rapporter 2010/11 oslo ssb west, c. & fernstermaker, s. (1995). doing difference, gender & society, 9(1), pp. 8-38 west, c. & zimmerman, d. (1987). doing gender, gender & society. 1(2), pp. 125-151. microsoft word 06 the adoption of market, final2 pages corrected.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2011 – special issue the adoption of market-based practices within care for older people: is the work satisfaction of nordic care workers at risk? teppo kröger department of social sciences and philosophy university of jyväskylä email: teppo.kroger@jyu.fi abstract market-based practices, including privatization and the increased emphasis on managerialism, have entered nordic socialand health-care systems for older people. this article examines whether the adoption of these practices has affected the work satisfaction of care workers in denmark, finland, norway, and sweden. the data used comes from a postal survey conducted in spring 2005 among nordic care workers, covering 2716 respondents who provided care for older people. the items analysed include background questions, likert-scale questions on working conditions, and questions on the presence of different market-based practices in the workplace. the results indicate that there are many variations between the four nordic countries concerning the adoption of market-inspired practices in the care for older people, with denmark having been the most eager and norway the least to introduce them. employees of for-profit employers report a lower level of work satisfaction than public employees. on the other hand, the adoption of most market-based instruments correlates with higher and not lower levels of work satisfaction among care workers working with older people. the results do not show a simple connection between the adoption of market-based practices and lower levels of work satisfaction, which might have been expected on the basis of earlier research discussions. however, due to some weaknesses of the data and the many variations between individual market-based models as well as between different nordic countries, there is cause for caution in the interpretation of the results. it is particularly necessary for policymakers to remain sensitive to the national context. keywords: care work, older people, work satisfaction, nordic countries, new public management, privatization, market-based practices njsr – nordic journal of social research 2011 – special issue 92 introduction socialand health-care service systems of nordic countries are well known as the most universal and publicly organized of their kind. while in many other countries, for-profit and non-profit organizations play a central role in the provision of socialand health-care services, in the nordic region their role has been limited. it has instead been the public authorities at the central, regional, and particularly at the local levels that have assumed the overwhelming responsibility for providing the services and for employing care workers. the existence of publicly offered care services that are broad in coverage has led some researchers to call these services ‘the key to the nordic welfare model’ or to conceptualize nordic welfare states as ‘social-service states’, in contrast to, for example, central european ‘social-insurance states’ that offer their citizens social-security cash benefits but not public-care services on a grand scale (anttonen, 1990; sipilä, 1997). however, the nordic region is not immune to international trends affecting the organization of public services everywhere. models and doctrines that emphasize managerialism, cost-efficiency, and accountability have also spread to the social-democratic welfare regime, guiding the reforms of public administration since the late 1980s. known as new public management (npm), this trend has brought attributes of a new character, such as totalquality management, balanced scorecards, management by results, and costcontrol mechanisms. these have appeared within nordic public services and also in the care services for older people (doyle & timonen, 2007, 21–38; hasselbladh et al., 2008; højlund, 2001; julkunen, 2004; vabø, 2003). it has been said that nordic care systems have seen ‘a cultural change where the rationality of efficiency has become a salient logic in formerly socially defined care’ (wrede et al., 2008, 28). in addition to the advancement of npm, another influential international market-inspired tendency that has gained increasing strength since the 1980s has been the privatization of the provision of care services, following the example of thatcher’s and blair’s britain (see e.g., means et al., 2002; wistow et al., 1994, 1996). the trend to outsource service provisions to for-profit providers reached the nordic region in the 1990s (behning, 2005; lund pedersen, 1998; vabø, 2003). since then, a growing number of nordic municipalities have created quasi-markets of care and turned the primary role of local authorities from ‘in-house provision’ into purchasing services from a number of different providers. according to means et al. (2002, 135), ‘quasimarkets are based on a belief in the cost effectiveness of getting a number of providers to compete for business from a single purchaser, namely the social services department’. such a belief has become increasingly common within the nordic countries. furthermore, new models that promote ‘consumer choice’ have been spreading in nordic care service systems for older people (edebalk & svensson, 2005; söderström, 2001). as another way to promote privatization, users of publicly organized and funded care services are more and more often given the option to choose between a public provider and one or more private providers. also, the traditional in-house provision is still available if the user prefers it, but by offering for-profit and non-profit alternatives, authorities encourage privatization of at least some parts of public-care service provisions. in finland, this consumer choice is primarily promoted through a new voucher system, formulated in a piece of special legislation in 2004, while in denmark local authorities have in the case of home-based services been njsr – nordic journal of social research 2011 – special issue 93 required from 2003 to offer users a choice between a private and a public service (edebalk & svensson, 2005, 36–41; doyle & timonen, 2007, 23; kröger, 2009, 112–115). all in all, market-based models are no longer foreign to the nordic countries in the field of care services for older people. here, both an increased focus on managerial control and efficiency as well as outright privatization of service provisions are counted as market-based practices. they arrived in the region more than a decade ago and their influence is becoming increasingly tangible. however, the five nations of the region are not identical in this regard, as the national governments in denmark, finland, iceland, norway, and sweden have taken up market-inspired ideas and practices at different paces (wrede et al., 2008, 26-27). furthermore, as nordic municipalities are largely autonomous in their making and implementation of care policies (see kröger, 2011; karlson et al., 2010; lund pedersen, 1998; martimo, 1998), the advancement of market-based principles and practices has been asynchronous and patchy. within-country variations are wide and complex, though often the trend has been fastest in major cities and considerably slower in the rural areas (e.g., vabø, 2003). many nordic care researchers have been very critical of the adoption of market-inspired models (e.g., dahl, 2005; koskiaho, 2008; vabø, 2003). these have been said to challenge the nordic welfare model that is based on universalism and public provision, and it has been argued that npm represents an ideology that is opposite to the rationality of caring. wrede et al. (2008) go so far as to state that the recent focus on efficiency and managerialism has caused a crisis in care work in the nordic countries, bringing recruitment problems as well as medicalization and taylorization of care work. does this mean that the work satisfaction of care workers who provide services to older people is also at risk? does the adoption of market-based practices reduce the satisfaction of nordic care workers with their work and working conditions? from earlier research it is known that work satisfaction is a critical factor for the recruitment and retention of staff, as well as for the quality of care for older people (see trydegård, 2005), but has this satisfaction been affected by the emerging privatization and the advancement of managerialism in the nordic countries? despite the lively debate concerning the adoption of market-based models, empirical studies – in particular comparative nordic ones – on the conditions of care work remain rare. the research question of this paper is to ask whether there are differences in the level of work satisfaction between those nordic care workers caring for older people who have experienced the adoption of market-based models in their workplaces, and those care workers who have not yet had such a personal experience. the question of whether the adoption of market-based practices is connected with the level of work satisfaction will be analysed here through comparisons between four nordic countries, and also through comparisons between different market-inspired models. data and methods the data used comes from a postal survey that was conducted in spring 2005 among care workers in denmark, finland, norway, and sweden (iceland being the only nordic country that was not involved). the 12-page njsr – nordic journal of social research 2011 – special issue 94 questionnaire was designed jointly by a nordic research team that included researchers from all the four countries, and was led by marta szebehely from the university of stockholm (see kröger et al., 2009). it was pilot tested and further developed in each of the four countries. the study (titled nordcare) was directed at basic-level care workers (nurses excluded) who during the previous 12 months had worked with older or disabled people within socialor health-care services, and who were employed by either public, for-profit or non-profit organizations. the questionnaire was posted to 1200 random sampled members of the main labour unions of care workers in each country (in denmark: foa; in finland: jhl, super and they; in norway: fagforbundet; in sweden: kommunal).1 the great majority of care workers in all nordic countries are organized in labour unions – for example more than 80 per cent of home-care workers are unionized in denmark (doyle & timonen, 2007, 33) – so the respondents represented the majority of nordic care workers within social and health-care services. the number of responses was 3208 in total, with national response rates varying from 66.6 per cent in sweden to 79.9 per cent in denmark. for the analysis of this paper, only those respondents who were working with older people were included, which reduced the number of responses to 2716. although care work has been studied eagerly within the nordic countries for decades, this questionnaire study was the first nordic project that gathered original data from different countries, aiming through its design and sampling methods for the best possible comparability. the questionnaire covered a large number of issues because the aim of the project was to gain comparative knowledge on the general state of care work in the nordic region. in addition to background variables such as age, gender, employer, training for care work, and work settings, two specific sets of questions provided the most essential data for this paper. the first of these two sets was focused on work satisfaction. work satisfaction has been the focus of intensive research for decades, which has also generated many theories on its causes and implications (see e.g., locke, 1976; rode, 2004; weiss, 2002). in brief, work satisfaction describes how satisfied a person is with his or her work. there are many ways to measure it, among which likert scales are the most commonly used. research on work satisfaction has also been active concerning care work (see e.g., hannan et al., 2001; häggström et al., 2005; redfern et al., 2002). on the based of instruments used generally in work-satisfaction research, the nordic research team of the nordcare project included ten items of work satisfaction in the questionnaire with which respondents were asked to evaluate different issues of their work and working conditions using a four-point likert scale.2 1 in norway this sample was later supplemented with 150 additional people because in the original sample, care workers working in home-based care were found to be underrepresented. 2 these questions were: ‘a. do you find your tasks interesting and meaningful? b. have you got too much to do in your job? c. does your work present the opportunity to learn new things and to develop professionally? d. can you affect the daily planning of your work? e. does your boss provide you with sufficient information regarding changes in your workplace? f. have you got enough time to discuss difficulties in your work with your colleagues? g. do you get support in your work from your line manager? h. are you provided with the training necessary for your work? i. do you ever feel inadequate because the care recipients are not receiving the help you think is necessary? njsr – nordic journal of social research 2011 – special issue 95 the other section of the questionnaire that is vital for this paper comprised questions concerning the care workers’ experience of the occurrence of different market-based practices. these questions covered the separation of needs-assessments from provision and asked about the existence of qualitycontrol systems, local for-profit providers, customer choice, and competitive tendering.3 the development of quality-assurance systems offers managers a new instrument to document and monitor efficiency continuously and to standardize and formalize service provisions (højlund, 2001; szebehely, 2001) while the existence of for-profit providers is clearly a condition for the privatization of public-care provisions. the separation of needs-assessments from provision makes outsourcing possible. customer choice and competitive tendering, for their part, are instruments of the privatization of care services. the article analyses variations between the four nordic countries as well as between different market-based practices by using cross-tabulations, measuring statistical significance with χ2 and p-values. in addition, pearson’s correlations are used in order to grasp the connections between the adoption of different market-based models and the work satisfaction of care workers. the article describes first the basic characteristics of the respondents, presenting the similarities and dissimilarities between the four nordic countries. after that, the occurrences of different market-based models and care workers’ evaluations on their work conditions are reported, with a focus on whether there are differences in self-reported work satisfaction between employees of public and non-public employers. finally, there is an analysis and presentation of the associations between, on the one hand, privatization and the adoption of market-inspired mechanisms and, on the other hand, the work satisfaction of care workers in the four countries. the article concludes with a discussion on the findings and possible implications for policy. j. do you worry about possible changes in your work situation due to reorganization, completely new work methods or the like?’ for each question, the same four response alternatives were given: ‘most often’, ‘sometimes’, ‘only rarely’, and ‘never’. 3 these questions were preceded by an introduction: ‘recently, quite a few municipalities have reorganized the care for older and disabled persons. some have initiated a purchaser-provider model where a special needsassessment officer decides the amount and form of help provided for a person and orders the assistance from a municipal or private provider unit. some municipalities have initiated customer-choice models, where the care user chooses the provider she/he would like to be assisted by. here are some questions regarding the organization at your workplace.’ the questions were: ‘a. is there a certain needs-assessment officer (situated outside your workplace) who decides the assistance provided for the care recipients? b. are there any private for-profit providers of care and services for older and disabled persons in the municipality where you work? c. has your workplace been exposed to competitive tendering (meaning that different private and public providers have competed for a contract)? d. if they want to, is it possible for care users to switch to another provider unit without extra cost (the so-called customer-choice or voucher system)? e. is your workplace regularly measured by quality standards and/or compared to other workplaces in the local care sector?’ for each question, the same three response alternatives were given: ‘yes’, ‘no’, and ‘i don’t know’. njsr – nordic journal of social research 2011 – special issue 96 results the profile of nordic care workers working with older people to put it briefly, in all four nordic countries care workers who provide care for older people are, in general, middle-aged women who are born in their country of residence, who have training in and extensive experience of care work , who are employed by the public sector, and who work primarily in residential settings (table 1). a more detailed look shows the variations between denmark, finland, norway, and sweden to be statistically significant. for example, according to the data, sweden has clearly the youngest staff (33.7 per cent being under 40) and norway the oldest (44.5 per cent being 50 or over). sweden is also the country that has the largest share of men (4.0 per cent) and migrants (12.9 per cent) working in care for older people. table 1. background data on nordic care workers working with older people by country (%; χ2) variables all participants (n=2716) denmark (n=790) finland (n=654) norway (n=716 ) sweden (n=556) χ 2 age under 40 years 28.3 26.5 29.5 25.1 33.7 16.6* 40-49 years 30.4 33.2 28.6 30.5 28.6 50 years or over 41.3 40.4 41.9 44.5 37.7 gender woman 97.7 98.3 98.8 97.3 96.0 12.2** man 2.3 1.7 1.2 2.7 4.0 birth place country of residence 94.7 95.8 99.1 95.3 87.1 90.0*** abroad 5.3 4.2 0.9 4.7 12.9 care work training under 1 year 20.1 16.4 12.8 25.2 27.6 117.2*** 1-2 years 43.7 53.8 37.9 39.6 41.6 2 years or over 36.1 29.8 49.3 35.2 30.8 care work experience under 10 years 30.8 32.7 33.1 24.1 33.9 22.4** 10-19 years 33.0 30.7 32.2 36.4 33.0 20 years or over 36.2 36.5 34.8 39.6 33.0 work settings home-based settings 22.6 28.0 19.0 16.3 27.3 83.1*** residential settings 60.9 52.7 69.4 63.6 59.3 both settings 12.4 14.2 7.1 16.8 10.6 other settings 4.0 5.1 4.5 3.3 2.8 employer public 94.4 97.0 86.1 98.6 95.2 149.9*** non-profit 2.3 1.6 7.0 0.7 0.0 for-profit 2.5 0.5 5.2 0.6 4.4 other 0.8 0.9 1.7 0.1 0.4 source: nordcare data * p<0.05; **p<0.01; ***p<0.001 njsr – nordic journal of social research 2011 – special issue 97 on the other hand, finnish care workers have backgrounds of longer professional training (49.3 per cent having had training of at least two years) than their nordic colleagues, and working in residential settings (including different forms of sheltered housing, in addition to traditional institutional care) is also most common in finland (69.4 per cent). the largest variations between the four countries concern employers of care workers. whereas, according to the data, non-public employers in care for older people are still very rare in norway and denmark, they are more common in other countries, particularly in finland, which has the highest proportions of both non-profit (7.0 per cent) and for-profit (5.2 per cent) employers. the adoption of market-based practices market-inspired instruments have been applied differently within care for older people in the nordic region. the variation between the four countries is statistically significant for every single instrument (table 2). according to the data, customer choice and competitive tendering are still experienced by the minority of care workers, while quality-control mechanisms, the separation of needs-assessments, and the presence of for-profit providers affect the majority, that is, over 60 per cent of respondents. table 2. the adoption of market-based practices according to nordic care workers by country (%; χ2) variables all participants (n=2716) denmark (n=790) finland (n=654) norway (n=716 ) sweden (n=556) χ2 quality control (n=1499) yes (%) 68.3 82.5 65.7 61.2 59.9 58.3*** for-profit providers in municipality (n=2257) yes (%) 61.7 77.4 86.2 23.3 53.4 594.4*** separate needs assessments (n=2279) yes (%) 60.7 83.5 29.2 42.1 77.7 501.7*** customer choice (n=1619) yes (%) 36.9 69.8 30.6 12.7 13.3 418.9*** competitive tendering (n=1990) yes (%) 22.5 44.4 22.2 4.9 16.6 271.4*** source: nordcare data * p<0.05; **p<0.01; ***p<0.001 overall, market-based practices seem to be most widespread in denmark, as it displays in the data the highest proportions of care workers who have experienced quality control (82.5 per cent), separation of needs-assessments (83.5 per cent), customer choice (69.8 per cent) as well as competitive njsr – nordic journal of social research 2011 – special issue 98 tendering (44.4 per cent) in their workplaces. finland has the highest prevalence of for-profit providers (86.2 per cent), while in sweden the separation of needs-assessments from provision (77.7 per cent) is the most widely applied market-based practice. in norway the frequency of each of these models remains below the all-nordic level within the data. however, the number of missing values is exceptionally high for all of these five items. concerning the existence of quality-control mechanisms and customer choice in the workplace, more than a third of respondents did not answer the question. it seems that for a large proportion of care workers, market-based models and their names were so unfamiliar that many had to leave these questions unanswered. work satisfaction of care workers has the privatization of care services affected work satisfaction of nordic socialand health-care staff working with older people? this can be analysed most directly by comparing the responses of publicly employed care workers with those of other care workers. is there a variation between care staff employed by public, non-profit, for-profit and other employers? table 3. work satisfaction of nordic care workers working with older people by employer (%; mean; χ2) variables all participants (n=2642) public employer (n=2495) non-profit employer (n=61) for-profit employer (n=65) other employer (n=21) χ2 work tasks interesting and meaningful (n=2669) most often (%) 77.5 77.8 83.3 63.1 76.2 10.6 opportunity to develop professionally (n=2675) most often (%) 30.4 29.9 40.7 35.4 52.4 16.6 opportunity to affect the daily planning of work (n=2673) most often (%) 43.8 43.7 45.9 46.2 47.6 15.3 sufficient information on changes at workplace (n=2678) most often (%) 44.2 43.8 53.3 53.8 38.1 19.2* enough time to discuss with colleagues (n=2688) most often (%) 51.7 51.8 55.7 45.3 38.1 26.9** support from closest manager (n=2670) most often (%) 44.4 44.4 45.9 46.9 28.6 9.2 access to in-service training (n=2616) most often (%) 24.1 24.4 23.0 18.3 15.0 7.1 work-satisfaction summary indexa (n=2507) (mean) 22.7 22.7 23.1 21.8 21.6 88.4** source: nordcare data a summary index was calculated by summing up the values of the seven above-mentioned items of work satisfaction where each item received a value from 1 to 4 (1=‘never’; 2=‘only rarely’; 3=‘sometimes’; 4=‘most often’); ranging from 7 = fully unsatisfied to 28 = fully satisfied * p<0.05; **p<0.01; ***p<0.001 njsr – nordic journal of social research 2011 – special issue 99 the short answer to these questions is both yes and no. concerning two items of work satisfaction, whether care workers receive sufficient information on changes in the workplace and whether there is enough time to discuss work problems with colleagues, there is statistically significant variation (table 3). however, the results are contradictory because care workers employed by forprofit organizations are less satisfied with their opportunities for collegial discussion compared with publicly employed staff, whereas they are the most satisfied employee group when it is the availability of information on workplace changes that is in question. concerning the other five items of work satisfaction included in the analysis, there are no statistically significant variations between different kinds of employers. the number of cases in all non-publicly employed care-worker groups remained rather low, which weakens the analysis and its statistical significance. nevertheless, when a summary index of work satisfaction is constructed,4 statistically significant variation reappears. the highest average summary score of work satisfaction (23.1) is found among care workers employed by non-profit organizations, followed by public employees (22.7). correspondingly, care workers employed by for-profit and other employers have on average the lowest total values of the work satisfaction summary index (21.8 and 21.6). connections between the adoption of market-based models and work satisfaction pearson’s correlations are used here to analyse the connections between work satisfaction and the adoption of different market-based practices within care services for older people. if these practices are detrimental to work satisfaction, those care workers who have experienced the adoption of these models in their workplace would be expected to have lower values for the summary index. correlation values are counted for the whole sample but also country by country so that it is possible to compare the results both between the four nordic countries and between different market-based instruments. three of the five instruments studied receive statistically significant correlations with work satisfaction within the whole sample. these are the introduction of quality control mechanisms (.214**), customer choice (.095**), and the presence of for-profit providers (.060**). what is remarkable is that each of these three correlations are positive, which means that the adoption of these marketbased practices is connected with higher and not lower levels of work satisfaction. the only market-inspired model that receives a negative correlation with the work-satisfaction summary index within the all-nordic sample is the separation of needs-assessments from service provision, but this correlation is not statistically significant. 4 the summary index displays a very satisfactory level of reliability (cronbach α = 0.763). out of the original ten work-satisfaction items of the questionnaire, three items (b, i, and j) were left out of the summary index – and out of table 2, as well – as they would have slightly weakened the reliability of the summary index. njsr – nordic journal of social research 2011 – special issue 10 0 table 4. correlationsa between the adoption of market-based practicesb and work satisfactionc of nordic care workers working with older people by country variables denmark (n=741) finland (n=618) norway (n=626) sweden (n=522) all participants (n=2507) quality control (n=1499) r .092 .158 ** .343** .167* .214** for-profit providers in municipality (n=2257) r .003 .073 -.038 -.001 .060** separate needs assessments (n=2279) r -.066 .012 -.030 -.023 -.037 customer choice (n=1619) r .064 .116* .062 -.092 .095** competitive tendering (n=1990) r -.063 .071 -.021 .033 .028 source: nordcare data a pearson correlation value b 0 = no; 1 = yes; ‘does not know’ marked as missing value c summary index ranging from 7 = fully unsatisfied to 28 = fully satisfied * p<0.05 ** p<0.01 (2-tailed significance test) within national samples, there are four statistically significant correlations between work satisfaction of care workers and the presence of market-based practices. each of the four correlations is positive, and three of them concern the adoption of quality-assurance mechanisms: in norway (.343**), finland (.158**), and sweden (.167*) the quality control of care services is correlated with higher levels of work satisfaction. also the presence of customer choice has a positive correlation of statistical significance with the work-satisfaction summary index in the sample from finland (.116*). there are also negative correlations between work satisfaction and the adoption of market-based practices in national samples (for example, concerning customer choice in sweden: -.092), but none of these have statistical significance. discussion the aim of this article has been to address the question of whether the recent adoption of market-based practices within nordic care services for older people constitutes a risk for the work satisfaction of care workers. earlier research discussion on the changing character of nordic care service systems, juxtaposing the rationality of caring with the rationality of efficiency inherent in the npm approach, suggests the existence of such a risk. as a way to find answers to this research question, the article has analysed comparative nordic questionnaire data looking at whether there are njsr – nordic journal of social research 2011 – special issue 10 1 differences in the level of self-reported work satisfaction between those care workers who have experienced the adoption of privatization and npm-inspired managerialism in their workplaces and those care workers who have not yet had such experiences. the question of whether the adoption of market-based practices is connected with the level of work satisfaction has been analysed here through comparisons between four nordic countries as well as between different market-based models. the results show, first of all, that there are significant variations concerning the spread of market-based practices between denmark, finland, norway, and sweden. according to the data, for-profit providers are most usual in finland, but all other studied market-based practices are most widespread in denmark. on an all-nordic level, quality-control systems, the presence of for-profit providers, and the separation of needs assessments are already an experience of the majority, while customer choice and competitive tendering have gained ground at a slower pace. unfortunately, many respondents seem to have been unfamiliar with the terms of market-based practices and did not answer the questions on their existence. the high number of missing values weakens the significance of the findings. concerning the level of work satisfaction, measured with the work-satisfaction summary index that was constructed from seven original items, it was found to be highest among care workers who are employed by public and non-profit organizations, and lowest among the employees of for-profit (and other) organizations. this finding suggests that increasing privatization of nordic care services for older people might be connected to deteriorating levels of work satisfaction of care workers. however, here the low number of respondents employed by non-public organizations made a developed analysis impossible. it is clear that more research is required to gain a firm understanding on this issue. for their part, the results from the correlation analysis do not support the argument that market-based practices jeopardize the work satisfaction of nordic care workers. only the separation of needs-assessments from service provision was correlated with a weaker level of work satisfaction in the whole sample, and this correlation did not have statistical significance. on the other hand, the positive correlations between work satisfaction and quality-control mechanisms, customer choice, and the existence of local for-profit service providers were statistically significant. the strongest connection was found between the introduction of quality-control systems and work satisfaction: quality control was correlated with higher levels of work satisfaction in a statistically significant way, not only on the all-nordic level but also within the national samples from finland, norway, and sweden. the results are partly contradictory. the comparison between different kinds of employers suggests that privatization might bring problems for work satisfaction, but the correlation analysis shows instead that the adoption of most npm-inspired models is connected to higher and not lower levels of work satisfaction. this discrepancy in the findings of the study is a cause for caution when making final conclusions and policy recommendations. caution is warranted for other reasons as well. the analysis showed large variations, on the one hand, between different market-based models and, on the other hand, between the four nordic countries. market-based practices might not in the end form a coherent package that brings only either positive or negative implications. one model may be associated with strong work satisfaction and another model with weak work satisfaction. furthermore, in njsr – nordic journal of social research 2011 – special issue 10 2 the data, individual market-inspired models could be connected with a higher level of work satisfaction in one country and with a lower level in another country. it is thus not only the model in itself but also the national context that is decisive. the four nordic countries are clearly at different stages in adopting the new models, the extremes being denmark, where all the studied marketbased practices are already widely applied, and norway, where most of these models are still experienced only by a minority of care workers working with older people. the national context structures the interaction between marketbased models and work satisfaction, and results from the all-nordic level cannot be used as a simple guideline for policy-making at the national level. finally, caution in making firm conclusions and policy recommendations is also needed because of some weaknesses of the data. the nordic team that gathered the data aimed for the best possible comparability between countries, but having the questionnaire translated into four different languages in itself weakens the comparability. the terms used have different meanings in different languages, which cannot be avoided. the four nordic countries are not identical: their cultures, occupational structures, and care service systems have their national characteristics and all these make full comparability of responses difficult to achieve. furthermore, within the data there were only a few care workers who were employed by non-public employers, and the number of missing values in questions on the workplace presence of the market-based models was high. these weaknesses of the data call for extra caution in the interpretation of the findings. all in all, it is not possible to make general policy recommendations for or against the adoption of market-based instruments on the basis of the results of this study. it is necessary for policymakers to remain sensitive to the national context, as this seems to have vital importance. it also seems that marketbased instruments should not be perceived as one single package since the connections between individual instruments and work satisfaction of care workers are non-identical. finally, it is necessary to remember that the work satisfaction of care workers is only one among numerous different indicators that could be used to evaluate the adoption of market-based models in nordic care policies. work strain, work-family balance, remuneration levels, and many other criteria could be used to analyse whether the adoption of marketbased models represents a change for good or for bad for care workers. moreover, care workers are certainly not the only group that is affected by changing care systems. in order to obtain a full picture, researchers should not forget to examine the implications of policy switches for care users and their family members. references anttonen, a. 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(1996) social care markets: progress and prospects. buckingham: open university press. microsoft word 719, galley.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 from struggling to survive to a life based on values and choices: first-person experiences of participating in a norwegian housing first project ellen andvig* faculty of health sciences buskerud and vestfold university college email: ellen.andvig@hbv.no *corresponding author jan kåre hummelvoll faculty of health sciences buskerud and vestfold university college email: jankhum@online.no abstract introduction: persons with concurrent substance-abuse and mental-health problems often lack permanent housing, and have a poorer quality of life and lower levels of functioning than persons who primarily have mental-health problems. a housing first project (hf) began during the autumn of 2013 in a norwegian city. the target group was persons who were struggling with substance-abuse and mental-health problems and who lacked housing. the hf model has a holistic health and social approach to help this group to establish themselves and to be able to remain in their own homes. aim: little is known about how the hf model works in norway. the aim of this study was to explore, describe, and interpret clients’ experiences of partaking in this hf project. method: the qualitative research interview was used as the method for the generation of data. twelve participants were interviewed, and a phenomenological hermeneutic method was used to analyse the data. results: the structured analysis revealed two themes, and the comprehensive understanding centred around these two interwoven themes: having an available professional companion and taking the lead in your own life. njsr – nordic journal of social research vol. 6, 2015 168 discussion: this study shows that people with a dual diagnosis can begin to recover and obtain a better quality of life if they receive appropriate housing, support, and services of their choice on their own terms. the study confirms the importance of the participants’ active participation, control, and choice in planning and formulating specific services. the results show that if a person wishes and dares to change his or her life, then decisive conditions are having one’s own home, meeting professionals who inspire trust, and having one’s personal preferences and needs recognized. keywords: housing first model, dual diagnosis, recovery, empowerment, person-centredness introduction persons with a dual diagnosis often lack permanent housing, and have poorer quality of life and lower levels of functioning than persons who primarily have mental-health problems (norwegian board of health supervision, 2000). issues associated with dual diagnosis and homelessness are regarded as being difficult to address. these persons have been labelled ‘hard to serve’ by service providers (padgett et al., 2006; pearson et al., 2009), and they often fall through the cracks of services (nooe & patterson, 2010). however, norwegian health and social policy underscores that they have the right to receive the necessary and individually adjusted services in order to be able to live in their own home (official nowegian reports 2011:15; norwegian directorate of health, 2012). the white paper, se meg! (see me!) (20112012), focuses on prevention and prompt measures for people with problems related to substance abuse. it is pointed out that the services must be provided promptly and coordinated better, and should be adapted more closely to the person who needs help. focus should be placed on measures to improve cooperation. in the guidelines of the norwegian directorate of health for services for people with dual diagnosis (recommendation no. 37), it is pointed out that the person’s own resources must be continually utilized in such a way that their quality of life is improved. the housing first project started during the autumn of 2013 in a norwegian city. the target group was persons struggling with concurrent substanceabuse and mental-health problems and who lacked housing. however, 30 per cent of them had some kind of housing arrangement but were in danger of losing it. the project was based on the housing first model (the hf model) and had a proper hf ideology following the hf principles strictly. the housing of the participants was independent, scattered-sited (i.e., housing spread in usual living areas), and permanent. the participants had the same rights and level of security as anyone who rents housing in norway. they were not expected to move out of the programme after a certain time. the project was planned to last for three years and was supposed to be continued as ordinary practice after the end of the project. the municipality, the norwegian housing bank, and the directorate of health financed the project. it was not part of a national programme, but in recent years several municipalities in norway have developed variations of the hf model (cf. snertingdal, 2014). the project had five employees with interdisciplinary health and social professional education (mental-health nursing, psychology, social work, and one person with user njsr – nordic journal of social research vol. 6, 2015 169 experience of mental-health problems, who was fully integrated as a member of the team). the team was anchored in the municipality and offered flexible floating support following an intensive case management model. the team was going to follow up 30 participants. the support was based on the participants’ needs and choices, for example, when a participant uttered some dream or an interest in having a job or education, they began to work towards this goal. the housing first model the hf model has a holistic health and social approach to help the participants of this group to establish themselves and to be able to remain in their own homes (tsemberis, 2010). the hf model was developed in the usa. it is based on the idea that the person is to be allocated permanent housing at once. there should be no conditions attached to the housing regarding level of functioning, being drug-free, or having treatment. instead, follow-up services are connected to the person, not the accommodation. according to the model, it is assumed that it is a fundamental right to have permanent accommodation, and that the person should have the freedom of choice regarding housing and help to get a place to live (tsemberis, 2010). further key principles are that the participants are to be treated with respect, compassion, and warmth. the staff members must have a commitment to work with the participants for as long as it is needed. the housing provided should be scattered-sited and the apartments independent. housing and services are also to be separated. the services are to be provided according to the participants’ perspective, and organized so as to allow them to define their own needs and aims. the services are not to be dependent on available capacity, and administrative procedures are not to take a long time. other important principles are an orientation towards recovery and the reduction of harm (cf. tsemberis, 2010). with regard to the hf principles, most studies have examined experiences from the united states (e.g., the pathways to housing project in new york) rather than in europe. hf is regarded as an evidence-based programme in the us (national registry of evidence-based programs and practices, 2010). the hf model for people with a dual diagnosis has been developed as an alternative to the traditional ‘treatment-first’ approach. according to this approach, participants must first qualify in order to be allocated a place to live. in other words, before they are allocated housing they must undergo treatment to become rehabilitated and drug-free. several studies have been carried out that have compared the advantages of participating in these two types of programme. these studies have shown that participants in hf programmes have a significantly lower rate of substance abuse, have fewer symptoms of mental disorder, and stay longer in hf programmes than participants in treatment-first programmes (padgett et al., 2011; tsemberis et al., 2012). several studies of hf in the us have demonstrated success with persons with severe mental illness (gilmer et al., 2010; gulcur et al., 2003; tsemberis et al., 2004). previous studies of hf programmes have demonstrated that within one or two years after entry into the programme a majority of participants experienced significant improvements in housing stability (tsemberis et al., 2004; stefancic & tsemberis, 2007; gilmer et al., 2010). they also experienced mental-health functioning (mares & rosenheck 2010), consumer njsr – nordic journal of social research vol. 6, 2015 170 choice (tsemberis et al., 2004), quality of life (gilmer et al., 2010; patterson et al., 2013), and reduction in health-service use such as emergency and inpatient services (gilmer et al., 2010). a review of the literature by kertesz et al. (2009) has reported that addiction severity was not always formally measured in hf studies, but was often lower than for homeless persons seeking addiction treatment. the authors criticized the published research on hf for providing less insight into how these programmes work for persons with severe and active substance abuse. atherton and mcnaughton nicholls (2008) have explored the applicability of hf in europe. the authors conclude that the hf approach is not a simple philosophy that can be applied everywhere. they emphasize that adjustments to the programme are needed in order to meet the requirements of local needs. they also point out that it is difficult to draw any general conclusions regarding the results because projects based on the hf concept differ from one another in the range of problems associated with the client base, the ownership of the housing stock, the organization of services, and the number and skills of staff. these findings are also confirmed in a study of the implementation of housing first in 12 municipalities in norway (snertingdal, 2014). in the eu, denmark, finland, france, ireland, and sweden have placed hf at the centre of their national homelessness strategies (pleace, 2011). a european study by busch-geertsema (2014) has reported that evaluations of five hf programmes in five different countries in europe confirm high housingretention rates with this approach in four of the five projects. the study shows that the approach worked in different local contexts and with some variations of the original hf model once the core principles of the hf approach were followed (busch-geertsema, 2014). recovery the hf model is based on a philosophy of recovery (tsemberis, 2010; tsemberis et al., 2012). this philosophy underscores the understanding that people with serious dual diagnosis can recover and that their quality of life can be improved. it is important to consider recovery from mental-health problems and substance abuse as simultaneous processes. two separate treatment systems have existed for a long time. this has led to an incomplete understanding of the problem, and the result has been that persons with a dual diagnosis have fallen between two stools (nooe & patterson, 2010). recovery is a deeply personal, unique process involving changes to one’s values, feelings, aims, skills, and roles. it is about living one’s life with hope, well-being, and the possibility of contributing despite the limitations that substance-abuse and mental-health problems have caused. recovery involves new meaning and new aims in life, and the possibility to grow and develop (cf. anthony, 1993). recovery as a personal process is thus concerned with what is involved in living with and overcoming mental-health and addiction problems. this definition has led to an improved understanding of the importance of everyday life for people with mental-health issues, and the importance of developing strategies for coping with psychological and social problems in daily life njsr – nordic journal of social research vol. 6, 2015 171 (deegan, 1988; davidson, 2003; slade, 2009). ness et al. (2014) have found that creating a meaningful everyday life, focusing on resources, being orientated towards the future, and re-establishing a social life and supportive relationships were important in the recovery process for people with a dual diagnosis. we know little about how the hf model works in norway. additionally it was important to explore how this hf project was experienced and perceived in a first-person perspective. the aim was to explore, describe, and interpret participants’ experiences with partaking in this hf project. the research question was: how do the participants describe their experiences with the hf project? method twelve of 23 clients were included in the study, three women and nine men (between 20 to 65 years of age). most of them were in their twenties or thirties. they were struggling with addiction problems or mental-health problems, or both. some of them had struggled with drug-dependence for many years. when attending the project all of them had problems with buying or renting a property and with keeping a dwelling over time. several had periodically lived on the street. many of them lived in temporary accommodation characterized by drug abuse, noise, and crime. four of them were receiving workassessment allowance, two were receiving disability benefit, and two had temporary jobs. all the informants were participating in the project when the interviews took place; nine had participated for six months and three for four months. the project staff asked the informants if they would participate in the study. the qualitative research interview was the method used to collect data. this method is suitable for detecting human experience related to different research questions (kvale & brinkman, 2011). the aim was to collect descriptions of the clients’ everyday life experiences. the interviews were carried out as open conversations with a theme-based interview guide, related to their experiences of participating in the project. the interviews lasted from 15 minutes (two participants) and from a half to one hour for the rest of them, and they took place in the spring of 2014. ten interviews took place at the city library, and two interviews were carried out in the informants’ homes. the interviews were recorded and transcribed verbatim. after the interviews were carried out, in order to check trustworthiness and communicative validity of the findings, six of the ‘hard-to-reach’ participants were interviewed about their experiences of participating in the project. they were paid 300 nok (approximately 35 euros) as compensation for the inconvenience of coming to an interview. these six persons had participated in the project for one year and a half. analysis of the data a phenomenological hermeneutic method (lindseth & norberg, 2004) was used to analyse the data material – a method inspired by ricoeur’s philosophical ideas on interpretation (ricoeur, 1976) – and it emphasizes the dialectic movement between understanding and explanation, and between the text as a whole and its parts. the task is to get at the meaning of the studied njsr – nordic journal of social research vol. 6, 2015 172 phenomena. the analysis was carried out in three stages: 1) naïve reading, 2) structured analysis, and 3) overall understanding. on the basis of the naïve reading, relevant units of meaning were identified. in the structured analysis, units of meaning were condensed into sub-themes. the amount of text was reduced, but the meaning in the expressions was retained. sub-themes that had the same meaning were collected and abstracted into two themes: having an available professional companion and taking the lead in one’s own life (cf. table 1). ethical considerations the norwegian social science data services approved this study (project nr. 36241). the informants received both verbal and written information about the study from the project leaders. it was emphasized that they could withdraw from the project at any time and without giving a reason. a withdrawal would not have any consequences for them. also, it was stressed that the data would be treated confidentially and the results would be presented anonymously. results through the naive reading, we found that the informants told that they had progressed from a hopeless situation to a new and better situation after they had begun in the project. this involved experiencing that they received support from the staff on their own terms, and that they could decide themselves about the help they received. the informants described the staff as helpers who were available when they needed them, and who gave them help when required. in particular, they valued the practical help and support they received for carrying out everyday tasks. they described the staff as considerate, committed, and easy to talk to. the staff related to the informants in a way that inspired confidence and acknowledgement. the informants compared their experiences of these members of staff who cared with the staff in nav, the norwegian labour and welfare service, who did not care, who gave them the feeling of powerlessness, and who lacked an accommodating attitude and understanding. participation in the project led to a feeling that life had become better, with more peace and security, which increased their motivation to bring about changes in their lives. the results of the interviews are shown in table 1. the themes and sub-themes are first described and then given an overall interpretation. having an available professional companion this theme is about the informants’ descriptions of the availability of the staff in their everyday life and about staff who cared. one of them put it this way: they can follow me and be with me. they are just pleased to be with me; they help me no matter what; they are with me all the time; i get help with exactly what i need. njsr – nordic journal of social research vol. 6, 2015 173 table 1:   overview of the units of meaning, subthemes, themes, and overall understanding. unit of meaning (empirical data) sub-theme (condensation) theme (abstraction) overall understanding (in-depth interpretation) they are concerned about how i am; they help me with practical things. caring professionals having an available professional companion seeking security with a professional person you have confidence in, and getting a grip on your life again it is easy to get hold of them; i just send a text message, and they reply quickly. professionals who are available it is me who decides; i choose what kind of help i get. help on your own terms taking the lead in your life i have the feeling of being independent, of feeling normal, that i have come a long way. empowerment i have got a much better life now. i have a completely different quality of life now that i have my own home. i hope that i can get a job sometime. recovery: improved quality of life and belief in the future being available meant that the informants knew that the staff could be contacted whenever they were needed and that they responded quickly. it was important that the staff were available when the informants were having a particularly tough time, for example, on those days when they felt a strong urge to take drugs or felt very despondent. the informants also emphasized that the staff took the initiative to contact them: she calls me when things are going to happen – yes, she seeks me out. availability also involved the staff providing help and support with everyday tasks, such as assembling furniture from ikea, driving to the shop, helping to remove the number plates from a car, and having a cup of coffee together at a café. it also meant a lot that the staff accompanied them to the doctor or dentist, to look at flats, or to help to sort out old debts: they are available – that is worth its weight in gold. i get help to write applications, help to fill in forms from offices in oslo. mary goes there with me, so i don’t have to go round oslo on my own, and i avoid the temptations there. njsr – nordic journal of social research vol. 6, 2015 174 many of the informants mentioned the importance of the help they got to sort out things with nav, from a member of staff who had worked at nav, instead of having to visit the nav office. this meant that services regarding socialsecurity benefits and housing were available to them and were provided quickly and effectively in a way that they were not used to from nav. several of the informants used the expression ‘closely followed up’. they found that the staff had more time and resources to follow them up than they were used to from before. several of the informants pointed out how positive they were towards the practice that the staff visited them at home, instead of meeting them at the office. this made help more available. one of them explained that being hostess for the member of staff at home made their relationship more equal, and it was less shameful to accept help. also, having a member of staff who visited them at home helped them to establish routines for cleaning the house and keeping it tidy. having an available professional companion also gave them the experience of having a member of staff who cared about them. the staff were described as committed, liking their job, and having a job that suited them. one participant explained: they are very dedicated in their work. i think they enjoy what they are doing. the members of staff are very human, which makes it so good. they care about you personally and are concerned about how you are doing. at the same time, they pointed out that the help and support they received was ‘sufficient’, neither too much so that it was obtrusive, nor too little. staff members who cared were described as easy to talk to, open, attentive, understanding, and as people who one could talk with about anything. one informant told that the first conversation with a member of staff in the project lasted for four hours – which shows how time is a gift. also, meeting a member of staff who had user-experience was described as a positive experience, because he understood what the problems were about: if i tell him about things in my life, he knows what i mean. he doesn’t need to sit there and ask and dig deeper: how does that work, how is this and that, because he knows what i am talking about. the informants emphasized that they felt that the staff acknowledged and valued them: ‘i see that she cares: i feel that i am not a case among other cases; i feel more valued.’ other informants described how they received encouragement and acknowledgement from the staff. one of them put it this way: you feel that they encourage you. i believe that they think it’s good to see that you develop as well. of course it helps; everyone likes to get a bit of praise. njsr – nordic journal of social research vol. 6, 2015 175 taking the lead in your own life this theme is about help on their own terms, empowerment, about improving one’s life, and about belief in the future. the importance of getting help according to one’s own terms was described as: ‘i can give them the sack, but they cannot give me the sack, so i continue to get help, as long as i need it.’ the following expressions were often repeated: ‘it is me who decides’; ‘everything is according to what i order’; ‘it is really your own choice; the staff live up to that’. these expressions can be interpreted to mean that the informants felt that they had control over the help they received, instead of being passive recipients. having control also involves experiencing that the staff supported them, and it challenged them to be active and to take responsibility and initiative: ‘it is a bit up to me, that i ask him if he has an hour to spare’. the expectation of taking responsibility could, for example, mean tidying up their home, or asking the informants what they could do themselves to improve their life situation: they ask: ‘what will you do to make your situation easier?’ so they are clever, they don’t stand behind you with a whip. one informant told about the experience of being trusted, when he had the deposit paid into his bank account so that he himself could transfer the money to the landlord: with that deposit, i felt very independent, and felt as though i was normal, because the money was paid into my bank account. they trusted me, and since i had come so far, they said that they do not do this with everyone, but they chose to trust me. and just this gives me such a lot, to feel that now i really have come a long way. then i could contact the owner alone and agree on a time when we could meet. we could meet at the bank and pay the money from my own bank account. it really was a good feeling that i have never experienced before. this quotation shows and underscores the importance of being trusted and feeling valued after years of drug addiction, while at the same time being challenged. he responded to the trust by showing that he was able to take responsibility for the money. this also shows how strength and motivation can be mobilized when one is treated as an ordinary human being – as an equal. being regarded as worthy seems to strengthen one’s self-confidence and give a feeling of self-empowerment. the transition from experiencing hopelessness to getting a grip on one’s life was about beginning to believe in the future and making changes in one’s life. the informants reported that a lack of accommodation made life difficult and that this led to poor health. they were neither able to think about the future nor do anything about their life situation. they pointed out that they wanted to live in a normal living environment, and not an area with a lot of drug abuse and crime: you cannot manage to get out to work or school, or to finish such things. you have no chance to do this; you can’t manage to get established. because then you are on the slippery slope. and if you start taking drugs again, then it can get worse. njsr – nordic journal of social research vol. 6, 2015 176 when asked what participation in the project meant for the informants’ lives, they used expressions such as: ‘a better life’, ‘improved quality of life’, ‘recovery’, and ‘greater belief in the future’. in particular, they mentioned feeling greater peace and security, being more motivated to get a grip on their lives, and having more social contact. greater peace and security was closely associated with the knowledge that the staff were available. for many of them, they felt secure knowing that the staff had a key, and could get into their home if they had taken an overdose or were having a mental crisis. several informants pointed out that life had become more peaceful with less intoxication after they had begun in the project: when i think about it, i am actually happier now than i was two or three months ago. that is because i now know that i have people around me. for me, this feeling of security is really amazing, that they are there and that they do everything they can to help me. for many of the informants, having got permanent accommodation seemed to increase their motivation to gain control of their lives: having got a flat has led to recovery. because i feel that i have got new initiative and the desire to make an effort again, and to get on with tasks, and to begin to do something with myself again. my situation no longer seems so bleak. several of the informants told about dreams and hopes for a better life after they had come into the project. one of them dreamed about getting his schoolleaving certificate and beginning to study. others dreamed about getting a job or buying their own flat. participation in the project, for many of them, also led to more social contact and activities related to work and school. one of them had begun physical training, others had begun to study subjects at school or to apply for jobs, and others believed that they had become more social. another mentioned being reunited with his family as a very positive change: ‘it has been an improvement in my life, for me, my mother, my family, and everyone.’ from having had almost no contact with his family for several years, he now had regular contact with them. another informant told that his life had changed completely after getting help with dental treatment. new teeth gave him a new quality of life because he could function socially again. he had hidden himself away for many years because he was ashamed about his appearance. now he had the courage to contact people again and to smile and speak to them. overall understanding two quotations from informants express the overall understanding. one informant described his experience of participating in the project in the following way: ‘it is like having a shoulder to lean on. this is necessary in order to come further in life.’ another participant put it this way: ‘earlier, life was just a struggle to survive, but now i have got my life back, i have begun to live.’ the overall understanding is therefore about two interlocking themes: seeking security with a professional person you have confidence in and getting a grip on your life again. njsr – nordic journal of social research vol. 6, 2015 177 methodological considerations the descriptions of the informants’ assessments and experiences of participation in the project indicate very positive results. this study represents a ‘status report’ after half a year’s participation. the results can therefore be a ‘honeymoon effect’ partly because the project is new and different. yet skatvedt and edland gryt (2012) point out that people with addiction problems and mental-health problems have extensive experiences of being rejected by the health and social-care services. therefore, many of them enter new projects with suspicion and scepticism. at the same time, they are very good at detecting whether they can rely on the helpers. therefore, when the informants express such great satisfaction with the programme, there is reason to believe them. a new hope was kindled that improvement is possible, and that they could therefore begin to imagine a better life. it is possible that this new perspective has given them the courage to take the first steps towards managing their daily life independently. a limitation of the study is that it is possible that the informants who took part in the study have a different understanding of the project than those who did not. we do not know how people with the most severe and active substance abuse experienced the project: those who had the greatest difficulties could not manage to be interviewed. therefore there is a danger that the sample was biased. however, owing to this potential bias a sample of six persons of those with great difficulties were later interviewed about their experiences. the results from these interviews confirmed unanimously the findings from this study. a strength of this study is that good contact, trust, and openness between the researcher and the participants were established during the interviews. the participants were strikingly unanimous in their experiences. all of them were encouraged by the staff before the interviews to share both their positive and their negative experiences. this was because this would provide useful information for improving the project. after the interviews, many of them apologized that they did not have anything critical to report. discussion the aim of this study was to explore, describe, and interpret participants’ experiences with participating in an hf project. the discussion is organized under the themes of a home of your own and person-centredness. a home of your own acquiring a home of your own is reported both to be of vital importance for persons with mental-health and addiction problems (andvig et al., 2013; mezzina et al., 2006; padgett, 2007) and to have a positive influence on recovery processes (borg et al. 2005). a randomized controlled trial (patterson et al., 2013) has found that participants in hf programmes reported significantly greater overall quality of life compared with clients in conventional treatment programmes. the differences were most notable concerning security and comfort and satisfaction with their living situation. our findings demonstrate how flexibility and availability of the professionals led the clients to experience a sense of security regarding their housing and their njsr – nordic journal of social research vol. 6, 2015 178 everyday life, which correspond with the hf principles. tsemberis (2010) stresses that the clients should feel secure that the services are available for as long as they wish to receive them. this security establishes a basis for recovery (watson, 2012). the findings show that homeless people are under chronic stress because of their efforts to survive with limited resources. having the security that they will keep their housing and get support as long as they need it is connected with ‘ontological security’ (padgett, 2007). padgett (2007) suggests that ‘housing can provide a fundamental building block for ontological security, thus lending support to a housing first approach’ (p. 1934). ontological security is connected to the sense of continuity regarding life events. life becomes coherent, and this stimulates the person to take responsibility for his or her own life. the importance of receiving support to meet the challenges of everyday life is emphasized in several recovery studies (drake & whitley, 2014; slade, 2012; topor et al., 2011; williams & tufford, 2012). the findings support the importance of having an independent life and a feeling of belonging somewhere. ordinary environments and activities emerge as the most common and recommended areas for mental-health recovery in contrast to mental-health or addiction service settings (ness et al., 2014). maintaining the routines of everyday life contributes to an orientation to the present. being anchored in the present and the day-to-day efforts of being active give support to a greater chance of sobriety (hipolito et al., 2011). person-centredness the findings show that the hf project offered a different service from the one the informants were used to from nav. their experiences with nav are in line with the findings of erikson and hummelvoll (2012) on users’ descriptions of nav as lacking personal and stable contact and of not being met with a helpful attitude from the providers. such experiences of rejection can also be understood as stories about offence. honneth (2008, p. 140) defines the concept of offence as types of ‘contempt or lack of recognition’. the consequences can be loss of self-confidence, self-respect, and intrinsic value. in the hf project, alternative characteristics of the providers as giving help and support with a focus on the individual, his or her preferences and skills, resources, and potential, instead of deficits and symptoms, are described as fundamental values in practising recovery-oriented services (chen et al., 2013). these values can also be understood as person-centredness. personcentredness has to do with establishing a relationship between the person and the professional based on values of mutual respect and understanding and of the individual’s right to self-determination (cf. barker & buchanan-barker, 2009). according to the findings, the descriptions of the availability of the providers may also reflect services that ‘do more than’ or ‘do something different from’ traditional services, something that mezzina et al. (2006) and denhov and topor (2012) have noted as important factors in recovery. staff who are warm and committed are also in line with the hf principles. it is essential that the staff are obliged to follow up the participants and to show in practice that they actually do this (tsemberis, 2010). njsr – nordic journal of social research vol. 6, 2015 179 adjusted and proper support in concrete situations means that the professional neither acts too early in fear of doing something wrong nor too late because of laxity or indifference, but acts when the time is ripe: proper closeness, proper distance, and suitable time spent. thus, ideally the professional does not act ‘en bloc’ and summarily in relation to user groups, but meets the individual as a person and with a willingness to see what he or she basically is longing for and needing (hummelvoll, 2006). findings concerning existential issues such as hope and optimism in this study are also reported in reviews of the recovery literature (bonney & stickle, 2008; leamy et al., 2011; slade et al., 2012). leamy et al. (2011) have identified hope and optimism about the future as a core component in personal recovery. it seems important that the participants experienced professionals who believed in them, shared their dreams and aspirations, and stimulated hope through encouragement, confidence, and positive expectations for the future (cf. williams & tufford, 2012). a psychometric analysis of the core dimensions of recovery of 504 consumers (gordon et al., 2014) has shown that hope and empowerment were connected. hope was seen as a necessary precondition of empowerment and vice versa. our findings also emphasize empowerment. being met with care and trust seems to strengthen personal responsibility and thus self-empowerment. the informants reported that they were encouraged to make their own choices and that they were supported in their decisions in a collaborative manner. this indicates a practice that mobilizes the person to participate and to interact with the environment. according to slade et al. (2012), empowerment relates both to a sense of empowerment within the services, such as having control over the assistance and support that they are given, and having personal responsibility, including becoming an empowered member of society (slade et al., 2012). empowerment is understood as a critical dimension of recovery (leamy et al., 2011; slade et al., 2012). empowerment entails that people gain power and control over their lives through access to meaningful choices and have the capacity to implement those choices. our findings document the important role that making choices plays in the processes of empowerment. participants are empowered when they make choices (and are given trust that they are able to do so) regarding where they live, housing, finances, employment, personal way of living, daily routines, and whom they wish to relate to. it is also important that they have the freedom to take risks and to fail. however, we do not know how they experience being deeply involved in substance-abuse activities while at the same time participating in hf. further research on this topic is important. is having a certain functional capacity a prerequisite for the project to work? implications for practice having secure housing must be seen as part of an integrated support package: housing alone is not enough. the support package must ensure a broad range of community-oriented services that include education, employment, peer support, crisis support, and assistance in daily living. an integrated practice for this group should be centred on the person and focused on supporting the person to live a meaningful life. the professionals must emphasize seeing the person as a whole, believe in his or her potential, and njsr – nordic journal of social research vol. 6, 2015 180 be accessible. the services must be adjusted to the person’s needs and be built on partnership, respect, the promotion of hope, and the facilitation of selfdetermination and choice. it is also important that the person has the right to receive support and adjustments in line with his or her choices, thus ensuring equal participation and citizenship. conclusion this study shows that people with a double diagnosis can start the recovery process and achieve a better quality of life when they receive appropriate housing, support, and services according to their own choices and premises. the study also confirms the importance of the participants’ active participation, management, and choice in planning and developing the support they receive and are offered. this is a prerequisite for receiving active help with rehabilitation. this means that the participants are partners in co-operation, who have a real influence on how the services are to be developed and how the follow-up is to be organized. this approach seems to be the key for establishing contact and developing a trusting relationship between the participants and the staff and the local community. the participants are no longer cases one can do something with, but persons who participate in a collaboration with their own lives as the main project. the results of this study show that if a person wishes and dares to change his or her life, then the decisive conditions are having one’s own home and meeting staff who are trustworthy, who accept them, and who recognize their personal preferences and needs. references andvig, e., lyberg, a. karlsson, b. & borg, m. 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(2012). professional competencies for promoting recovery in mental illness. psychiatry, 75(2), 190201. microsoft word bjerke krange, walk in the wood 0911 pages corrected.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 2, 2011 a walk in the woods: the effects of ethnicity, social class, and gender among urban norwegian adolescents olve krange (corresponding author) norwegian institute for nature research, oslo, norway olve.krange@nina.no tore bjerke lillehammer university college, lillehammer, norway tore.bjerke@hil.no keywords: physical activity, outdoor recreation, hiking, ethnicity, socioeconomic factors, gender abstract objectives: the main objective was to study the influences of gender, ethnicity, and socioeconomic factors on a popular norwegian outdoor activity: walking in the woods. design: data from the large young in oslo 2006 (yio 2006) youth survey is used to investigate the relationship between ethnic and class background and gender in relation to hiking in the woods. in the representative survey sample, 11 529 adolescent respondents aged 16 to 19 were asked how often they participated in hiking in the woods during the season. results: analyses show that more girls than boys are active hikers and that fewer descendents from non-western immigrants and working-class youngsters are active compared to ethnic norwegian and middle-class adolescents, respectively. furthermore, cultural aspects of class seem to be more important than economic ones. a logistic regression analysis shows that the relationship between country of origin and hiking is significantly reduced when class measures are introduced into the model, which implies that the initial difference between ethnic minorities and ethnic norwegians to some extent can be considered to be a class phenomenon. njsr – nordic journal of social research vol. 2, 2011 18 conclusion: norwegian authorities express great concern over health issues among the large group of non-western descendents in norway, pointing to the nordic tradition of outdoor recreation as one means of being physically active. this paper concludes that in the effort to recruit ‘immigrant’ youngsters to outdoor activities, one should keep in mind that a large proportion of the minority population also belongs to the working classes. introduction in its ‘global strategy on diet, physical activity and health, the 57th world health organisation assembly of 2004 urged member states to implement actions to promote increased physical activity (pa). according to world health report of 2002, the proportion of adults who live a sedentary life ranges from 60 per cent to 85 per cent across the populations studied, and it estimated that less than one-third of young people are sufficiently active to benefit their future health. it is well known that a sedentary lifestyle increases the probability of several serious diseases, like allergies and asthma, diabetes, heart diseases, some forms of cancer, anxiety, and depression. the centers for disease control (cdc, 1998) estimated that 23 per cent of all deaths in the united states that were due to chronic illnesses were associated with physical inactivity. focusing on young people, ogden et al. (2002) have shown that the prevalence of overweight children and adolescents in the u.s. increased considerably from 1960 to 1994, and continued to increase by an additional 15 per cent by 2000. the increase was especially rapid among mexicanamerican and non-hispanic black adolescents. felton et al. (2002) have also shown the importance of the role of ethnicity, finding that a higher proportion of overweight and a lower level of pa among black than among white girls. similar findings have been presented in many other countries (e.g., who, 1998). outdoor activities among children seem to be a very important factor influencing the total level of pa. however, studies indicate that time spent in outdoor physical activities has reduced in many populations, and that when children are active outdoors, they tend to stay closer to home compared to earlier records (e.g., valentine & mckendrick, 1997). in a review, dollman et al. (2005) conclude that pa among children in many countries shows a declining trend. odden (2008) has found the same development in norway. from 1970 to 2004 physically exhausting activities like cross-country skiing, long hiking trips, and canoeing had decreased among young norwegians, whilst more sedentary activities like bathing and motorized water sports had increased. ethnicity and socio-economic status as predictors of outdoor leisure activities participation in outdoor physical leisure activities varies across ethnic groups and as a function of social class. attempts to reduce the risks of a sedentary lifestyle could benefit from an understanding of how socio-economic and ethnic factors influence the attractiveness of outdoor pa. two theoretical approaches have predominated in this area of research, originating with the paper by washburn (1978). first, the ‘marginality hypothesis’ has been used to include the various economic and social-class variables that may explain why some groups are underrepresented in various outdoor leisure activities. a njsr – nordic journal of social research vol. 2, 2011 19 multitude of studies have shown that social class affects preferences for sports activities (review: stodolska & alexandris 2004) and for various other forms of leisure pas (e.g., yen & kaplan, 1998; ecob & mcintyre, 2000; gordon-larsen et al., 2000; giles-corti & donovan, 2002; steinback et al., 2011). thus, when ethnic minority groups are found to differ from the mainstream population in outdoor leisure activities, one explanation may be that limited economic resources function as a constraint for various physical activities. one additional mechanism that helps to create ethnic differences in leisure participation or activity preferences is discrimination (philipp, 1999). for example, specific places where minorities are not welcome to recreate exist, and it is well known that participation in some leisure activities is restricted to the ethnic majority group (e.g., gobster, 1998; johnson et al., 1998). stodolska (2005) has developed a comprehensive model of discriminatory behaviour on the individual level applied to leisure settings. secondly, the ‘ethnicity hypothesis’ states that differences between ethnic groups in preferences of leisure activity are due to intergroup differences in values, norms, and attitudes towards various activities and settings. a considerable number of studies on ethnicity and participation in the forms of leisure behaviour have been published during the last 50 years (for review, see allison, 1988; floyd et al., 1994; gómez, 2002; floyd et al., 2008). two special issues of leisure sciences were devoted to multicultural perspectives on recreation and the environment in 2002 (sasidharan, 2002). the large majority of studies have focused on adult leisure preferences, particularly across ethnic groups in the u.s. in the scandinavian context, lindström and sundquist (2001) have found that the status of a sedentary leisure-time physical activity is higher among men born in arabic-speaking countries. this was found also among women; in addition women born in the former yugoslavia and in poland reported a sedentary leisure-time lifestyle. recently, dawson et al. (2005) have shown that men from southern europe, finland, and those born in other countries (e.g., turkey, iran, iraq, african countries), and women from southern and eastern europe and those born ‘in other countries’ practised a low level of physical activity compared with swedish men and women. british researchers have demonstrated that cultural norms among immigrants of bangladeshi, indian, and pakistani origin reduce the likelihood of performing physical activity (johnson, 2000; lawton et al., 2006). oslo is a city surrounded by large and easily accessible forest areas, and everyone in norway enjoys the right to roam or to free access to uncultivated land. outdoor recreation is considered to be of great significance by the national and local governments and by the population itself. in a national representative sample, 95 per cent reported that they went on walks at least once during the last 12 months (odden, 2008). there is a whole culture surrounding norwegian outdoor recreation. the term friluftsliv (translated literally as ‘free air life’), a word found only in norwegian and swedish, signifies that spending time outdoors is important not only as a means to better health, but also as a means of cultural expression. svarstad (2010) shows that hiking as a cultural phenomenon contains various meanings. among 84 norwegian hikers she identified three categories of meaning attached to hiking, ‘as recreation of societal performance abilities, ‘as a way of living out a critique of society’, and as a way ‘to establish a sense of belonging and continuity’. in the contexts of norwegian friluftsliv, an uncomplicated activity like walking in the woods connotes some deep meaning that may appear as something strange and alienating to newly arrived citizens. njsr – nordic journal of social research vol. 2, 2011 20 adolescent outdoor physical activities ethnic differences cross-cultural comparisons of the engagement in pa among university students reveal considerable variation. according to the european health and behaviour survey, carried out between 1989 and 1992, the prevalence of physical exercise in the past two weeks varied from more than 80 per cent to less than 60 per cent across country samples (steptoe et al., 1997). haase et al. (2004) included 21 country samples of students from europe, asia, south america, and south africa. the prevalence of physical inactivity in leisure time varied from 23 per cent in north-western europe and the u.s. to 44 per cent in developing countries. cultural groups within one country have also been compared with respect to engagement in pa. on the basis of national representative data from large health surveys in the u.s., it has been found that minority ethnic groups engage in less physical activity than do non-hispanic white groups (heath et al., 1994; andersen et al., 1998; gordon-larsen et al., 1999; belcher et al., 2010). furthermore, woodfield et al. (2002) have found that among 11to 14year-olds in birmingham, children from asian ethnic backgrounds reported a lower level of pa than did white-caucasian children. in canada, taylor and doherty (2005) have shown that relatively few students who have english as a second language (esl) (immigrants from ten countries) participate in physical recreation, and that they do not participate as often as non-esl students. a study in johannesburg, south africa, had demonstrated that white nineyear-old children expressed a higher level of pa than did black children of the same age. the white children also watched less television and participated more often than black children in physical education at school (mcveigh et al., 2004). previous studies from norway show that young people with nonwestern origins to a much lesser extent than their norwegian peers take part in the iconic norwegian outdoor recreational activity – ‘hiking in the woods’. non-western immigrant adolescents also trained less often and they were less likely to be sports club members (krange & strandbu, 2004; strandbu & bakken, 2007). effects of gender, age and social class studies in several countries, mainly in north america and europe, have shown that among older children and adolescents, girls are generally less physically active than are boys (e.g., hagger et al., 1998; andersen et al., 1998; kristjansdottir & vilhjalmson, 2001; woodfield et al., 2002; klasson-heggebø & anderssen, 2003; cardon et al., 2005; raudsepp, 2006; seabra, 2007; salonna, 2008). this gender difference appears at an early age (six-year-olds: manios et al., 1999; threeto five-year-olds: hussey et al., 2001; pate et al., 2004). it is a common finding that the amount of participation in various forms and degrees of pa decreases as age increases from late childhood into adolescence. this age trend has been demonstrated in both cross-sectional and in longitudinal studies (e.g., culp, 1998; sallis, 2000; sallis et al., 2000; kristjansdottir & vilhjalmsson, 2001; kimm et al., 2002; barnett et al., 2002; klasson-heggebø & anderssen, 2003; norman et al., 2005). since many njsr – nordic journal of social research vol. 2, 2011 21 popular forms of pa take place outdoors, it is interesting to note that adolescent interests in nature-based pa, as well as in studying or observing wildlife, decline with increasing age (and seem to decline steeply at the onset of puberty) (e.g., bjerke et al., 2001; kaplan & kaplan, 2002; bell et al., 2003; brodersen et al., 2005). stamps and stamps (1985) and hutchison (1988) reviewed the first decades of research on the relationships between social class and participation in leisure activities. more recently, kristjansdottir and vilhjalmsson (2001) have found that upper-social-class students in iceland (11to 16-year-olds) were less sedentary and participated in more pa during leisure time, compared with lower-class students. results in the same direction have been obtained in england (woodfield et al., 2002), south africa (mcveigh et al., 2004), estonia (raudsepp, 2006), italy (la torre et al., 2006), and norway (iversen & holsen, 2008). in a recent review of 34 studies, hanson and chen (2007) have concluded that the association between socio-economic status (ses) and pa in adolescents is consistently positive. background and hypotheses of the present study like most european cities, oslo has during the course of 30 to 40 years developed from a rather ethnically homogenous city to a multiethnic society. in 1970 inhabitants with a non-western immigrant background constituted only 0.7 per cent of the total population. today more than 25 per cent of the population has a non-western immigrant background (aalandslid, 2007). the minority population of oslo is a young one, and every third pupil in secondary school has two parents who were born outside of norway. norwegian authorities express great concern for public health among the country’s ethnic minorities, and efforts are being made to recruit ethnic minority youngsters to outdoor activities. however, it is also a fact that ethnic minority parents more often hold working jobs than do ethnic norwegians. this consideration leads one to speculate if it might be the case that minority views on outdoor recreation are also marked by working-class culture. hence we ask: • how does participation in forest hiking vary between minority and majority pupils? • how does it vary between boys and girls and between classes? • what is the relationship between class and minority status concerning hiking? methods data survey design in 2006 norwegian social research (nova) conducted a survey among secondary-school pupils in oslo. the total population of pupils attending grades nine to 11 was targeted. out of 94 schools, 78 agreed to participate. this gave a gross sample of n =12 422. there were 11 519 respondents who completed the survey. there were also 70 questionnaires that were considered to be incomplete and removed from the data file. further, 19 njsr – nordic journal of social research vol. 2, 2011 22 respondents reported to be more than 20 years, and their answers were also removed. hence, the sample used in this paper consisted of 11 430 respondents, which equals 92 per cent of the gross sample. the data set we used covers an age span ranging from 14 to 20 years. the mean age was 15.35, with a standard deviation of 1.05. the majority of students were between 14 and 17 years of age. only very few were between 18 and 20 years, and this group was coded together as ‘18+’. the questionnaire was answered in classrooms during school hours. there were no breaks, and the teachers made sure that there was no interaction between the respondents. the 2006 study was compared with the young in oslo 1996 study, where all secondary schools in oslo participated. no data distortions were identified. measures hiking in the woods the young in oslo 2006 questionnaire contains an eight-item battery measuring different outdoor recreation activities. here we focus on one of the most iconic and most frequent of the nordic outdoor practices, namely hiking in the woods. the respondents were asked how often they participated during the season. responses were given on a five-point scale ranging from ‘never or almost never’ to ‘several times a week’. one important context for this paper is public health, and the norwegian authorities are concerned about young people who are physically inactive. we shall focus on those who reported that they ‘never or almost never’ take a hike in the woods’. in the following analyses we have dichotomized the variable into active and non-active. the non-active group are those who ‘never or almost never’ hike in the woods, and the active group are all the rest. ethnicity respondents were asked to report on their parents’ country of birth. those who reported that one or both their parents were born in norway were classified as ‘majority pupils’. by this definition 28.5 per cent of the respondents were categorized as ‘minority pupils’. within the minority group the vast majority had origins in a non-western or eastern european country. more than every fourth of the minority pupils had parents from pakistan. no other national group amounted to more than six per cent. only very few (less than four per cent) had two parents who were born in north america or a western european country. with regard to the analyses, the group was too small to make any difference. hence, they were included among the minority pupils. social class measures of class background are not easily obtained among teenagers. here we used various instruments to study the effects of parental work status as well as economic and cultural aspects of class. on the basis of self-reported information on parents’ occupation, we used the collapsed version of goldthorp’s comprehensive scheme (erikson & goldthorpe, 1992). a model of five work status categories contains the upper middle class (managing directors, lawyers, physicians, etc.), lower middle class (administrators, teachers, nurses, etc.), self-employed (mostly owners of small business), njsr – nordic journal of social research vol. 2, 2011 23 lower office employees (workers holding low office positions), skilled workers (carpenters and plumbers, etc.), and manual workers (production workers, forklift drivers, etc.). the parent holding the highest position was used to define the informants’ status. the variable of parent’s occupation was constructed on the basis of information on the level of education required for the different jobs and on the average income it provides, and can hence be regarded as an interval variable. a measure of cultural assets within the respondents’ families was based on their assessment of how many books there are in the bookshelves at home. this, of course, was a very rough measure. previous studies have demonstrated that the variable is highly relevant and with good operational validity in the norwegian context. it is, for instance, statistically associated with phenomena like political participation (ødegård, 2008), school achievement (bakken, 2007), smoking (krange & pedersen, 2001), and membership in environmental organisations (skogen, 1996). following the same strategy of rough measures, a crude proxy for family economy was based on a simple question of how many cars the family owns. results figure 1 shows that a majority of 53 per cent among young people in oslo have more or less regular hiking experiences in the woods. there is, however, a clear tendency that very high level of involvement is less common. only 4.2 per cent report that they go for a walk in the woods several times a week, and 7.3 per cent hike about once every week. on the opposite end of the scale, a total of 47 per cent indicate that they never or almost never go for a walk in the woods. 16.1 per cent and 25.5 per cent scored on the in-between activity levels. further, 5.7 per cent did not answer the question. the analyses show that this is a highly selected group. hence, the inactive group is probably even larger relative to the other groups. figure1. participation in hiking during season by minority/majority status. percentages (n=10456) 4.2 7.3 16.1 25.5 47 4.7 8.5 19.3 29.2 38.3 4.1 7.5 16.2 25.9 46.3 2.9 4.5 8.9 17.3 66.5 0 10 20 30 40 50 60 70 several  times  a   week about  once   every  week one  or  two   times  every   month less  than  once   every  month never  or   almost  never total majority the figure also shows a clear association between minority status and hiking in the woods. all activity levels are more common among the majority pupils. those with two parents born outside of norway less often go hiking in the njsr – nordic journal of social research vol. 2, 2011 24 woods, and those with one parent born in norway systematically scores inbetween the two other groups. two out of three minority pupils report that they ‘never or almost never’ go for a walk in the woods, whilst the same applies to only 38 per cent of the majority pupils. hence, there is a clear tendency that minority pupils more often are non-participants when it comes to hiking in the woods. table 1 shows how the hiking activity in addition to minority status is associated with age, gender, and some dimensions of class. table 1: hiking in the woods by minority status, age, gender, and three dimensions of class active non-active chi-square p-value valid n majority pupils 62% 34% minority pupils 34% 67% mixed 54% 46% 617.6 <0.001 10 564 mean age (15-18+) 15.3 15.4 13.6 (f-test) <0.001 10 666 boys 48% 52% girls 57% 43% 89.8 <0.001 10 711 upper middle class 66% 34% middle class 58% 42% self-employed 53% 47% skilled labourer 50% 50% lower office employee 45% 55% manuel labourer 39% 61% 413.5 <0.001 10 786 books: 1000+ 70% 30% books at home:500-1000 66% 34% books at home:100-500 56% 44% books at home: 20-100 41% 59% books at home: < 20 28% 72% 741.9 <0.001 10 597 family car: non 38% 62% family car: one 52% 49% family car: two 58% 42% 150.9 <0.001 10 649 njsr – nordic journal of social research vol. 2, 2011 25 the first finding resembles figure 1. it is almost twice as common among minority pupils to report to be inactive. the non-active group is slightly older than the active one, and boys are more frequently inactive than girls. there is a clear association between hiking in the woods and all three class-related measures. the variable of parent’s occupation reveals an almost linear relationship with the hiking variable. on the extremes we observe that a little more than one-third of the upper-middle-class pupils are non-active whereas almost two-thirds of those who have fathers employed in manual labour report that they ‘never or almost never’ participate in hiking. class is constructed by economic as well as cultural dimensions. the rough proxy of cultural assets in the families, ‘number of books at home’, demonstrates good operational validity. the statistical relationship follows the ordinal scale pattern: the more books there are, the more likely are they to be active. only 30 per cent of those who report to have more than 1000 books at home say that they are non-active, whilst 72 per cent of those who say they have less than 20 report to be non-active. the effect of the variable of number of books seems to be strongest at the bottom end of the scale. the variable is obviously not a good measure for how many books there actually are in the youngsters’ homes. it is probably better to regard it as a measure of how the respondents perceive their families as being book-orientated or not. in earlier studies the measure of number of books has proven to be a strong predictor of class culture-related phenomena (ødegård, 2008; bakken, 2007; krange & pedersen, 2001). hence the interpretation here must be that young peoples’ hiking in the woods is thoroughly woven into the web of class culture, and it seems to be a somewhat ‘high-brow activity’. ‘number of cars’ in the household follows a similar pattern. 62 per cent of the youngsters who do not have a car say they never hike. less than 50 per cent of those who have one or two cars say the same. the important leap is between those who have and those who do not have a car. so, even if hiking is free of charge and requires few economic resources, there is a clear statistical association between the household-economy proxy and hiking in the woods. the relationship is, however, not as strong as in the case of books. this may indicate that hiking, which is after all a low-cost activity, is more influenced by class culture than by family economy. the overall picture is that a simple activity like taking a hike in the woods clearly is marked by class, in the economic and even more so in the cultural aspects of the term. the remaining task is to find out if the initial finding that immigrant pupils less often participate in hiking could be explained by this fact to an extent. below we present a binominal logistic regression with the dichotomized hiking measure as dependent variable. the ‘mixed group’ is left out of the ethnicbackground measure, comparing only minority and majority pupils. the different independent variables are introduced in two blocks. step one has two variables in the equation: ‘hiking in the woods’ and the minority/majority variable. in step two we control for age, gender, and the various class-related measures. on the basis of our hypothesis we expect that the effect of ethnic background should be reduced when the class variables are introduced to the model. the analyses confirm that the outdoor recreational activity of hiking in the woods has a substantial connection to ethnic background, gender, and class. model 1 resembles the bivariate finding already shown in table 1: majority pupils are significantly more active than their minority peers, here expressed by for instance the odds ratio of 3.2. however, the main point is that the effect njsr – nordic journal of social research vol. 2, 2011 26 of ethnic background reduces when the other variables are introduced into the model (odds ratio 2.0). the finding suggests that some of the initial difference between majority and minority pupils in regard to hiking in the woods is mediated through their class belonging, where the class background affects both groups. hence, minority youngsters are not all that different from their majority peers, but they are more often working-class pupils. table 2: estimated effects of ethnic background, gender, age, and class dimensions. blockwise logistic regression in two steps (95% ci). model 1: model 2: b se b or p-value b se b or p-value ethnic (majority =1) 1.2 0.05 3.2 <0.001 0.7 0.07 2.0 <0.001 gender (girls=1) 0.4 0.05 1.5 <0.001 age (15-18) -0.04 0.03 1.0 ns upper middle class1 0.5 0.09 1.6 <0.001 middle class 0.3 0.08 1.3 <0.001 self-employed 0.1 0.11 1.1 ns skilled labourer 0.2 0.11 1.2 <0.05 lower office employee 0.1 0.16 1.1 ns books (scale: 0-4) 0.3 0.03 1.4 <0.001 cars (scale: 0-2) 0.1 0.04 1.1 <0.05 constant -0.7 0.04 0.5 <0.001 -1.1 0.41 0.3 <0.01 o-test2 block chi2 449.1 df 1 < 0.001 chi2 343.8 df 9 < 0.001. o-test2 model chi2 449.1 df 1 < 0.001 chi2 792.9 df 10 < 0.001 hosmer & lemeshow chi2 6.13 df 8 = 0.633 1reference: manual labourer 2omnibus test of model coefficient we may notice that it is the middle classes that stand out as especially active hikers, and that both the class culture and the family economy proxies have strong significant effects. gender also has a clear effect, with girls being more active than boys. however, it is also important to notice that the effect of ethnic background is strong, even after the control for all the class-related measures. this is an expression of the fact that not all the difference between the two groups can be explained by class differences. hence, it might be that some immigrants, regardless of their class belonging, find the nordic tradition of walking in the woods to be alien and strange. njsr – nordic journal of social research vol. 2, 2011 27 in an alternative analyses we introduced age and gender as the single two variables in block two. the block added significantly to the model (omnibus test of model coefficient: chi-square 79.8, df 2, p< 0.368). still, it did not change the effect of the majority/minority variable. the distribution of age and gender are quite equal within the two ethnic groups. it is the class measures, and neither age nor gender, that make the difference. a further expansion of the model contains a control for interactions between the class measures and ethnic background. none of the interaction variables came out with significant effects. neither had the block any impact (omnibus test of model coefficient: chi-square 8.7, df 8, p< 0,001). discussion among adolescents in oslo, norway, 11.5 per cent report that they go for a walk in the woods once or several times a week, whilst 47 per cent answer that they never or almost never do so. adolescents belonging to a minority group are less active in performing this activity, compared with adolescents with at least one parent born in norway. further, more girls than boys take walking trips in the woods. associations between the frequency of hiking in the woods and three class-related parameters appeared: adolescents whose fathers’ occupation is manual labour, who have fewer books in the home, and whose family less often own a family car hiked in the woods less often. the regression analyses show that both ethnicity and the three social-class variables contribute to the differences found in the frequency of walking in the woods. both the ethnicity and the marginality hypotheses receive support from the present study. the present study was not designed to unravel the mechanisms underlying the associations between the activity ‘hiking in the woods’ and belongingness to a class or minority group. previous research has contributed to some insight. for example, the social-ecological model (e.g., stokols, 1996) includes three domains of variables influencing the form and frequency of pa: the intrapersonal (e.g., enjoyment, self-efficacy), the social (e.g., support from others) and the environmental domain (e.g., urban design, access to facilities). ball et al. (2007) have found that factors from all three dimensions explain educational inequalities in leisure-time walking, and carlijn et al. (2007) have shown that the three dimensions are predictive of sports participation. most variables included in the social-ecological model are influenced by more general cultural variables, like tradition and norms, possibly mediated by selfconstrual, that is, how people perceive themselves in relation to others. markus and kitayama (1991) have described this concept in detail, and presented evidence that western europeans and european americans present a self-construal characterized by relative independence and autonomy, whereas a relatively interdependent self-construal is more prevalent in asian and african cultures. it has been hypothesized that different types of selfconstrual may affect the motivation to engage in various types of pas (walker et al., 2005, 2008). traditionally, hiking in the woods has been an independent activity, most often performed alone or with a friend. a person with a selfconstrual characterized by social interdependence may not be easily stimulated to participate in a relatively non-collectivistic activity. previous research has identified many environmental physical factors that may contribute to constraint to some pas (e.g., trost, 2002). some groups of people live in environments where facilities for pa are scarce. for example, gordon-larsen et al. (2006) characterized the residential locations of u.s. njsr – nordic journal of social research vol. 2, 2011 28 adolescents in the national longitudinal study of adolescent health, and found that lower-ses and ethnic minority groups had reduced access to pa facilities, which in turn was associated with decreased pa and an increased overweight population. similar results were reported after analyses of a national sample in the u.s. (powell et al., 2006). in parts of the oslo city centre, where natural areas like woods are very limited, minority groups constitute a considerable proportion of the resident population. however, minority groups to a large extent inhabit suburban areas where access to natural areas is easy. it has been shown that among children and adolescents in such suburban areas, surrounded by forest areas, ethnic norwegians prefer to stay in the woods much more often than do those belonging to minority groups. it was also found that cross-country skiing, tent-camping, and fishing were more frequently performed among subjects who have at least one parent who was born in norway (bjerke et al., 2006). in addition, walking in the forest does not require specific skills, and the activity does not cost money. thus, neither environmental nor economic factors should contribute significantly to the group differences observed. personal and socio-cultural factors seem to be more important. the effects of gender on the frequency of hiking in the woods runs counter to most previous studies on gender differences in pa (see introduction). one explanation to this finding could be that previous studies included more vigorous and sport-related activities, compared with the activity of ‘hiking in the woods’. previous studies in norway have shown that women more than men report positive emotions whilst staying in the family’s mountain cabin (bjerke et al., 2006), and they prefer appreciative experiences like observing and feeding birds and listening to bird song more than men do (bjerke & østdahl, 2004, 2005). these are some of the experiences that characterize some aspects of walking in the woods. an australian study (timperio et al., 2007) has shown that the availability of parks (both density and number included) did not vary across neighbourhoods varying in socio-economic conditions. however, equal access to forests may not be sufficient for the various cultural and ses groups to practise the same frequency of walking trips in the wood. differential requirements across groups for amenities in the recreational areas may exist. for example, crawford et al. (2008) have found that public open space in lower ses areas had fewer amenities (tables, toilets, water features, and paths) compared with space in higher ses areas, even in the outer metropolitan fringes of melbourne, australia. establishing these amenities in suburban oslo could possibly stimulate marginalized groups to increase the frequency of taking walking trips. more research is needed in order to identify these factors in a norwegian context, including the use of qualitative methods to supplement quantitative surveys. intrapersonal and micro-social processes are not easily accessible by use of surveys alone. another issue concerns the measurement of ‘class’. we chose the three variables of occupational status, cultural assets (books at home), and ownership of family car(s) as indicative of social class. a different operation of class could relate differently to the focus activity of the present study. in a marxist perspective class denotes an economic relationship of exploitation of labour. in the context of norwegian society, workers certainly do have the time for outdoor recreation, and walking in the woods is basically free of charge. a focus concentrated on economy would probably reveal a weaker link between class and hiking. and this is exactly what our data shows. however, a class njsr – nordic journal of social research vol. 2, 2011 29 perspective confined to economy does not grasp how structures of power and subordination are mediated through cultural mechanisms. this is one reason for bringing class culture and cultural assets into the analyses. recreational hiking in rough outdoor surroundings was brought to norway by members of english nobility, and up to now several forms of leisure-time nature use are affiliated to middle-class practices. what we observe here might simply be that newly arrived minority people are ‘finding their place’ in the class and cultural structure of norwegian society. oslo is a segregated city. northern and eastern city parts and the satellite towns have a much higher immigrant population. these are working class areas where young people from immigrant families live in the same neighbourhoods as working-class youngsters. peers become increasingly important during youth. we might have observed the effect of some kind of cultural diffusion where non-western immigrant pupils take over the lifestyles that are more common among neighbourhood peers than among peers from more affluent areas. key message minority youngsters have in oslo, as in many other western cities, more often a working-class background than their majority peers. their economic as well as cultural assets are not primarily products of ethnic group membership, but of class background. these are assets that prove important for choosing to participate in outdoor activities. hence in studying minority youngsters’ participation in physical outdoor recreation and in efforts to recruit them to such activities, one should take the mechanisms on the level of class into account. acknowledgements this study was funded by the norwegian research council. references allison, m.t., (1988). breaking boundaries and barriers: future directions in crosscultural research. journal of leisure research, 10, 247-259. andersen, r.e., et al. 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(2007). innvandreres demografi og levekår i 12 kommuner i norge (immigrants’ demography and life circumstances in 12 norwegian municipalities), oslo, ssb (statistics norway) rapport 2007/24. microsoft word johansen sickness presenteeism in norway and sweden.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 3, 2012 sickness presenteeism in norway and sweden vegard johansen eastern norway research institute lillehammer, norway email: vj@ostforsk.no abstract introduction: sickness presenteeism (sp) refers to the practice of going to work despite illness. this article describes the distribution of sp in norway and sweden. it also discusses relations between sp and various work characteristics and personal factors in the two countries. methods: more than 2500 norwegian and swedish workers between 20 and 60 years of age answered a postal questionnaire. the norwegian and swedish samples are weighed and representative with regard to both variables of regional background and demography, but the response rate was low. the distribution of sp is measured by frequency (episodes in the previous year) and by length (total days of sp in the previous year). this study employed binary and multinomial logistic regression to detect which factors influence the frequency of sp. results: fifty-five per cent of the respondents in norway and sweden practised sp in the previous year. the frequency of sp episodes is similar in the two countries. further, respondents with low/medium income, physical work, and managerial responsibilities report sp more often in both countries. non-western immigrants, the less educated, and those employed by others are overrepresented with sp in norway. neither gender nor age had any particular influence. discussion: in accordance with previous studies, this study among norwegian and swedish workers suggests that some sp during a working year may be more common than no sp. our analyses of determinants of sp present some previously undocumented differences. divisions between sedentary versus physical work and management versus non-management were important for sp in norway and sweden. moreover, non-western immigrants are overrepresented with sp in norway, but this pattern does not prevail in sweden. some possible causes for non-western immigrants to report more sp are suggested in the article, but we need more research to follow up on the missing correlation between ethnic background and sp in sweden. keywords: sickness presenteeism, survey, norway, sweden, logistic regression njsr – nordic journal of social research vol. 3, 2012 89 introduction sickness presenteeism (sp) refers to the practice of going to work despite illness. this concept has been a subject of steadily increasing interest since it emerged in the 1990s, though the number of publications on the topic is clearly fewer than those focusing on sickness absence (sa) (vingård et al., 2004; hansen & andersen, 2009; böckerman & laukkanen, 2010). using survey data from a study conducted with more than 2500 workers in norway and sweden, this article describes the distribution of sp and discusses some important determinants for sp. comparative studies are useful both for the similarities and the differences they explore. from an international perspective, one could understand this study on sp in norway and sweden as a comparison of most-similar cases. the chosen countries are neighbours, exchange labour extensively, have healthy populations, and are highly developed welfare systems. at the same time, sickness benefits are much more generous in norway than they are in sweden: a sick-listed person in norway receives full compensation from the first day for a maximum of 364 days, whilst in sweden the employees themselves pay for the starting day and receive 80 per cent compensation for a maximum of 364 days within a frame of 450 days (ministry of labour and social inclusion, 2011; government proposition no.136, 2008). it is argued that generous insurance schemes tend to increase the level of sa (osterkamp & röhn, 2007), and the statistics on sa in norway and sweden echo this position: in the last decade, the mean rate of doctor-certified sickness absence in norway was more than six per cent, but less than four per cent in sweden (statistics norway 2011; statistics sweden 2011). moreover, a survey in the nordic countries five years ago has indicated profound differences in attitudes towards sa: the countries with the most restrictive benefits schemes are those with the most restrictive attitudes towards absenteeism due to sickness (dahl et al., 2007). in brief, norway and sweden share many features, but sickness benefits are less generous in sweden, the level of sa is substantially lower in sweden, and swedes have more restrictive attitudes towards sa. contrasting experiences with sp among norwegian and swedish respondents, this study poses two research questions: 1. what is the distribution of sp in norway and sweden? 2. which factors influence the frequency of sp in norway and sweden? literature review several studies have shown that over a 12-month period numerous employees have gone to work when they ought to have stayed at home for health reasons. a british study with close to 700 respondents indicated that more than 80 per cent of general practitioners, hospital physicians, and senior accountants engaged in sp. the respondents cited both cultural and organizational factors behind their decisions to not take sick leave, and among doctors one of the main barriers to taking sick leave was the difficulty of arranging cover (mckevitt et al., 1997). approximately 80 per cent reported sp in a norwegian study of more than 1000 physicians. factors associated with njsr – nordic journal of social research vol. 3, 2012 90 sp include being of medium age (30-39 years) and having low job satisfaction, and the authors suggest that the latter correlation could be related to problems with taking sick leave (rosvold & bjertness, 2001). in a study of 2400 female workers in lower-level elderly care, more than 70 per cent (finland, norway, and sweden) and 80 per cent (denmark) reported sp in the previous year. the main findings from this nordic study are that more sa and sp accompanies increasing job stress, and that sp rises particularly in cases of high levels of job stress (elstad & vabø, 2008). more than 70 per cent of the danish core workforce reported one or more episodes of sp in a study with 13 000 respondents. time pressure and a close relationship with colleagues increased the likelihood of sp. the analysis also showed that attitudes matter: respondents who found it more taxing to stay at home than to go to the workplace, being over-committed to work, and having a conservative attitude to absence were most likely to report sp (hansen & andersen, 2008). more than 70 per cent had attended work even when they felt sick in a study of 200 respondents in a canadian public-service organization. the top two reasons for sp were that ‘others depend on me’ and respondents had a ‘high workload’ (caverley et al., 2007). in the netherlands, about 60 per cent of a national sample of workers reported sp (vroome, 2006). finally, 50 per cent of the respondents in a swedish labour force survey reported sp in 1997 (aronsson et al., 2000), and in a study from 2000, the proportion was 70 per cent (aronsson & gustafsson, 2005). in the latter study, the analysis of more than 3000 respondents indicated that having a health problem, a poor personal financial situation, difficulties in staff replacement, and time pressure were strong determinants of sp. aronsson (2012) presents the two main approaches to research on sp. first, european research has concentrated on the association between sp and health. secondly, american research has investigated the consequences of sp on the productivity of organizations. with regard to the latter, it is claimed that sp causes much more aggregate productivity loss than sa, and that managing sp effectively could be a competitive advantage (collins et al., 2005; hemp, 2004). although most studies agree that the total costs of sp exceed the total costs of sa, the remarkable variation in studies that report the effects of sp on productivity and the consequent costs is striking (johns, 2010). thus, the effects on the quantity and quality of the work performed by personnel practising sp should be subject to further investigation. with regard to sp and health, there are some studies on the strongly positive association between absenteeism and presenteeism (aronsson et al., 2000; elstad & vabø, 2008; hansen & andersen, 2008; böckerman et al., 2010). kristensen (1991) has argued that studying sp could enhance our understanding of sa because sp and sa are conclusions of the same decision process. moreover, some studies have found that several episodes of sp during the previous year is a risk factor for future sa, and that sp can cause serious health problems at a later stage (kivimäki et al., 2005; bergström et al., 2009). various studies have also investigated what causes sp. they have explored the influence of personal factors and work-related factors on sp (aronsson 2012). personal factors that have been found to have an impact on sp include: state of health, education level, age, economic situation, body-mass index (bmi), social support, state of work-life balance, norms and feelings of njsr – nordic journal of social research vol. 3, 2012 91 moral obligation. the work-related factors that have been found to influence sp include: occupational affiliation, job security or insecurity, workplace culture, possibilities for staff replacement, work burden, working-time arrangements, employment in the public or private sector, job stress, job satisfaction, social support, control over work tasks, and potential for adjusting work demands (mckevitt et al., 1997; rosvold & bjertness, 2001; lovell, 2004; aronsson et al., 2000; aronsson & gustafsson, 2005; elstad & vabø, 2008; hansen & andersen, 2009; agudelo-suárez et al., 2010; böckerman & laukkanen, 2010; hansen 2010). this article expands the body of work on sp. first, this article shows the distribution of sp in norway and sweden. there are two former studies on sp in sweden (aronsson et al., 2000; aronsson & gustafsson, 2005), but sp in norway has not previously been measured in a national sample. secondly, this article uncovers relevant determinants for sp in both norway and sweden. in comparison with the previous literature, the analyses replicate some factors but also discuss the potential impact of ‘new’ factors, such as ethnic background, type of employment, position, and physical working conditions. thirdly, there are few comparative studies that have discussed the determinants for sp in various countries (aronsson, 2012). this article takes a comparative approach, asking whether the same factors influence sp both in norway and in sweden. method the data are from responses to a postal questionnaire in norway and sweden. the questionnaire was sent to random samples of norwegian and swedish workers between 20 and 60 years of age. in both countries, the process of selecting the gross sample was simple random sampling from the population of workers between 20 to 60 years of age. the collection of data was done in 2011 and took two months, from the beginning of march to the beginning of may. it was done in accordance with the rules set by the committees for medical research ethics in both norway and sweden, and was approved by the norwegian social science data services. the research council of norway provided funding for the collection of data, but the council had no role in the study design, in the collection, analysis, and interpretation of the data, or in the writing of the article. the survey was one of three cross-country data collections in a research project called social factors contributing to sickness absence (sofac). the age span of 20 to 60 was used in all data collections for sofac. we decided to exclude the oldest workers in the labour force from the sampling because people above 60 are often entitled to disability pensions and other support. thus, there is a selective process at work, since aged workers with worst health retire early. because health is an important determinant of both sp and sa, it has likely a substantial impact on the distribution and determinants of sp among the oldest workers. the net samples included 1600 norwegians and 1250 swedes. the response rate was only 33 per cent in both countries. response rates tend to be very low for postal questionnaires (edwards et al., 2002), but it was the only financially viable option for this cross-country study. to maximize the response rate, the length of the questionnaire was kept quite short (four pages and 60 njsr – nordic journal of social research vol. 3, 2012 92 questions), a postal follow-up including a questionnaire was sent, the return envelope was pre-paid, and the information letter stressed the benefits of the study to society. in retrospect, there are a number of strategies that could have been considered: the use of monetary or non-monetary incentives, using personalized questionnaires and letters, contacting participants before sending the questionnaires, sending more than one follow-up, and using the official envelopes of stockholm university and lillehammer university college. such strategies could have increased the response rate and improved the quality of our study (heberlein & baumgartner 1978; edwards et al., 2002). to test for non-response bias, known values from the population of potential participants (workers between 20 and 60 years of age) were compared with the values that prevail in the subgroup that answered the questionnaire. it is positive that the norwegian and swedish net samples were representative with regard to ethnic background, as well as representative of regional dimensions like the size of municipality, county, and centrality/peripherality. the norwegian net sample is representative with regard to gender, whilst there is an overrepresentation of women in the swedish sample. in the net samples for norway and sweden, those in the age group 40-60 are overrepresented and those between 20 to 39 years are underrepresented. the data were weighed according to age and gender in order to remedy the underrepresentation of young workers and men. more than 2500 respondents who were working, on parental leave, or absent due to illness (sa) answered the questions about sp. the survey was relevant for those currently on parental leave or sa, because they could have practised sp prior to the time of the survey (e.g., if they were on parental leave for the last two months, they still had 10 months to practise sp). the frequency of sp (the distribution of sp episodes) was measured by the following question: ‘during the last 12 months, did you go to work despite feeling so ill that you should have taken sick leave?’ the respondents were presented with four alternatives: ‘no’; ‘yes, one to two times’; ‘yes, three to four times’; ‘yes, five or more times’. the length of sp (in days) was measured by this question: ‘please estimate how many days you went to work when you were feeling so ill that you should have taken sick leave during the last 12 months.’ the respondents were presented with five alternatives: ‘none’; ‘1-7 days’; ‘8-14 days’; ‘15-30 days’; ‘31 days or more’. it might be objected that it may well measure a low threshold to report ‘should have taken sick leave’, but most of the studies referred to in the literature review use the same (or very similar) questions as this study does. answers to questions about the past can be imperfect and thereby affect the validity of the results of the survey. the responses to questions on sp might have been influenced by recall bias. the accuracy of recall depends on the time interval between the event and the time of its assessment. ninety-eight per cent of the potential respondents answered questions about sp. it is hard to make conclusions about the accuracy of our survey, but the high number of responses is an indication that our respondents found the questions about sp to be relatively uncomplicated. it could be that our choice to give alternatives (i.e., closed questions) made it simpler for respondents to answer these questions about sp than it would have been if they were required to remember the exact number of days/episodes (i.e., open questions). njsr – nordic journal of social research vol. 3, 2012 93 response bias refers to instances when a respondent intentionally responds incorrectly to a question about their personal history. some studies have shown that employees tend to under-report their sa (van poppel et al., 2002). it could be that data on sp suffer from under-reporting or over-reporting, but this study did not control for this possibility. it must be noted, though, that response bias is particularly problematic when you do interviews either faceto-face or over the phone. there was less of an interview effect in this study, since respondents wrote down their answers in an anonymous survey. three types of analysis are performed: cross-tabulations with the mannwhitney u test, and binary and multinomial logistic regression on factors influencing sp. the mann-whitney u test is a non-parametric test for assessing whether one of two samples of independent observations tends to have larger values than the other. binary and multinomial logistic regression is used to detect which factors influence the frequency of sp. the regression models include 11 x-variables and are quite complex. still, the inclusion of other variables could have changed the results. most importantly, the study does not include information about respondents’ health, arguably an important determinant of sp. in addition, former empirical studies have reported substantial variation in the prevalence of sp by industry within the private sector. this article does not analyse the effects on industry with the exception that there is a set of indicators for the public and the private sectors. frequency and length of sickness presenteeism table 1 displays information about the distribution of sp episodes. fifty-five per cent of the norwegian respondents and 56 per cent of the swedish respondents replied that at some point in the previous year they had gone to work despite feeling so ill that they should have taken sick leave. results between the two countries are also similar when we investigate the number of sp episodes: 36 per cent of norwegians and 38 per cent of swedes report one or two episodes; ten per cent in both countries report three and four episodes; and nine per cent of norwegians and eight per cent of swedes report five or more episodes. table 1: distribution of sp episodes in norway and sweden, percentage norway sweden 0 episodes 45 44 1-2 episodes 36 38 3-4 episodes 10 10 5 or more episodes 9 8 sum 100 100 mann whitney: p>0.05 sp has not been measured previously in a national sample in norway, but results for sweden are comparable to studies done a decade ago: 44 per cent report no sp in 2011 compared with 50 per cent in 1997 and 30 per cent in njsr – nordic journal of social research vol. 3, 2012 94 2005; 48 per cent report one to four sp episodes in 2011 compared with 42 per cent in 1997 and 55 per cent in 2000; and eight per cent report five or more sp episodes compared with eight per cent 1997 and 15 per cent in 2000 (aronsson et al., 2000; aronsson & gustafsson, 2005). table 2: distribution of sp days in norway and sweden, percentage norway sweden 0 days 45 44 1-7 days 37 43 8-14 episodes 11 9 15-30 days 4 3 31 days or more 3 1 sum 100 100 mann whitney: p>0.05 table 2 presents the length of sp. in the previous year, 43 per cent of swedes and 37 per cent of norwegians report one to seven days of sp, nine per cent and 11 per cent report eight to 14 days of sp, and four per cent of the swedish and seven per cent of the norwegian respondents report 15 or more days of sp. although norwegian respondents seem to report more days of sp than swedes in the sample, the difference between the two groups is not statistically significant. factors associated with sickness presenteeism this section assesses the impact of 11 variables on the frequency of sp episodes. for the sake of simplicity, the dependent variable has values 0 (no sp) and 1 (one or more sp episodes). gender, age, and ethnic background are important demographic factors. some studies indicate that men more often practise sp (hansen &andersen, 2009; böckerman laukkanen, 2010), whilst other studies reveal small or no gender differences (aronsson et al., 2000; agudelo-suárez et al., 2010). similarly, some studies indicate that the older part of the workforce practises sp less often than younger workers do (hansen & andersen, 2009), whilst other studies find no such correlation (böckerman laukkanen, 2010). earlier studies in norway and sweden have shown that non-western immigrants have poorer health and higher rates of absence than natives and western immigrants (nilsson, 2005; bengtsson, 2006; dahl et al., 2010). ethnic background is seldom considered in discussions about sp, but a spanish study has concluded that immigrant workers report more sp than their spanish counterparts (agudelo-suárez et al., 2010). income and education are important measures of socio-economic position. it is reasonable to assume that personal income has an impact on sp; those with high income report less sp than those with low income (aronsson et al., 2000; hansen & andersen, 2009). the results with regard to education differ: in some studies people with less education report more sp than those who are njsr – nordic journal of social research vol. 3, 2012 95 highly educated (aronsson & gustafsson, 2005; böckerman laukkanen, 2010), and other studies indicate that education has little explanatory power (aronsson et al., 2000). this study also included three work-related factors: employment type, position, and physical work. previous studies have indicated that self-employed people are more likely to report sp than employees (hansen & andersen, 2008; 2009), and that persons employed in public sector are more likely to be present than those employed in private companies (aronsson et al., 2000; bergström et al., 2009). in sweden, a recent report in the series social insurance report (socialförsäkringsrapport) points out that managers have less absence compared with other groups of employees (mulder, 2011). could it be that managers are more likely to ‘choose’ sp over sa than employees without managerial responsibilities? finally, this study investigated the relation between the physical working environment and sp. previous studies of sa have shown that lifting, carrying, pushing or pulling loads, or any of these, comprises the factors increasing the risk of absence (lund et al., 2006), and thus physical work should correlate with sp. the study by hansen and andersen (2009) indicates that work involving heavy lifting increases sp, and in the study by aronsson et al. (2000), excess rates of sp were found among occupational groups characterized by (fairly) heavy physical work. to summarize, this study included the following independent variables: – gender: male (reference category) and female – age in years – ethnic background: natives and western immigrants (comprising western europe, canada, usa, australia, and new zealand) (reference category) and non-western immigrants (other countries) – education: high educational attainment (bachelor degree or higher) (reference category) and low educational attainment (upper secondary school and lower) – income: low income (gross annual income of 299,000 nok/sek or less) medium income (gross annual income between 300,000 and 499,000 sek/nok), and high income (gross annual income of 500,000 nok/sek or more) (reference category) – type of employment: employee in private sector, employee in public sector, and self-employed (reference category) – position: executive, middle management, and non-management (reference category) – physical work: sedentary work (reference category) and physical work table 3 presents unstandardized coefficients (b), odds ratios (or), and pvalues (*) from binary logistic regression analyses of sp episodes in norway and sweden. b refers to the average increase in the dependent variable (y) with one measurement increase in the independent variable (x). p-value refers to the probability that x and y are not related. or is a calculation of the probability of the outcome event occurring divided by the probability of the event not occurring. in both models, there are statistically significant effects (p<0.05) for ‘low income’, ‘medium income’, ‘middle management’, and ‘physical work’. in njsr – nordic journal of social research vol. 3, 2012 96 addition, ‘non-western immigrant’, ‘low education’, ‘employee in public sector’ and ‘employee in private sector’ are significant in the norwegian model, whilst ‘executive’ is significant in the swedish model. the remaining variables are non-significant. table 3: binary logistic regression of the factors influencing sp in norway and sweden. variables norway sweden b or b or constant -1.00* 0.37 -0.31 0.73 female 0.03 1.03 -0.19 0.83 age -0.00 1.00 -0.00 1.00 non-western immigrant 1.68** 5.37 0.03 1.03 low education 0.33* 1.40 0.14 1.15 low income 0.54** 1.72 0.53* 1.70 medium income 0.30* 1.35 0.65* 1.91 employee in public sector 0.44* 1.56 -0.11 0.90 employee in private sector 0.67** 1.95 0.03 1.03 executive 0.35 1.44 0.69* 1.99 middle management 0.43** 1.54 0.40* 1.49 physical work 0.37** 1.44 0.35* 1.41 ** = significant at 0.01, * = significant at 0.05 reference categories: male; native or western immigrant; high education; high income; self-employed; non-management; sedentary work nagelkerke r2: 0.07 (norway) and 0.04 (sweden) ors present an additional way of interpreting results. when the or is close to 1, there is no particular effect; the higher it is over 1, the stronger the positive effect; and the closer it is to 0, the stronger the negative effect. some results correspond: those with low income are 1.7 times more likely to report sp compared with those with high income; middle managers are 1.5 times more likely to report sp compared with those without managerial responsibilities; and persons with physical work are 1.4 times more likely to report sp than persons with sedentary work. the positive impacts on sp of both medium income and executive position are strongest in the swedish model, and executives are 2.0 times more likely to report sp than those with no managerial responsibilities. the impacts of low education, whether one is an employee in the public sector or theprivate sector, and non-western immigrant are strongest in the norwegian model, and non-western immigrants are 5.4 times more likely to report sp than natives and western immigrants. multinomial logistic regression has been used to evaluate the results presented in table 3 further. table 4 discerns between ‘0 sp episodes’, ‘1-2 sp episodes’, and ‘3+ sp episodes’; ‘0 sp episodes’ is the reference category. most of the results in table 4 are similar to those in table 3. starting with the norwegian model, we find statistically significant effects for non-western immigrants, middle management, and physical work (both categories of sp episodes); low education, employee in public sector, employee in private njsr – nordic journal of social research vol. 3, 2012 97 sector (1-2 sp episodes); low income and medium income (3+ sp episodes). in the swedish model, physical work is significant at 1-2 sp episodes, whilst low income, medium income and executive are significant at 3+ episodes. table 4: multinomial logistic regression of the factors influencing sp in norway and sweden. variables norway sweden b or b or 1-2 episodes of sp intercept 1.38** -0.64 female 0.01 1.01 -0.09 0.92 age -0.00 1.00 -0.00 1.00 non-western immigrant 1.63** 5.10 -0.20 0.82 low education 0.33* 1.39 0.23 1.25 low income 0.28 1.32 0.13 1.13 medium income 0.18 1.20 0.48 1.62 employee in public sector 0.60* 1.83 0.09 1.09 employee in private sector 0.82** 2.28 0.16 1.17 executive 0.28 1.32 0.61 1.84 middle management 0.41** 1.50 0.34 1.40 physical work 0.28** 1.32 0.38* 1.47 3+ episodes of sp intercept -2.26** -1.75** female 0.06 1.07 -0.40 0.67 age -0.00 1.00 -0.00 1.00 non-western immigrant 1.77** 5.88 0.37 1.44 low education 0.35* 1.42 -0.03 0.97 low income 1.01** 2.76 1.47** 4.33 medium income 0.56* 1.76 0.86* 2.35 employee in public sector 0.21 1.24 -0.46 0.63 employee in private sector 0.45 1.56 -0.16 0.85 executive 0.50 1.64 0.86* 2.35 middle management 0.47* 1.60 0.54* 1.71 physical work 0.53* 1.70 0.27 1.31 ** = significant at 0.01, * = significant at 0.05 reference category for dependent variable: 0 episodes of sp reference categories for independent variables: male; native or western immigrant; high education; high income; working full time; self-employed; non-management; sedentary work nagelkerke r2: 0.08 (norway) and 0.06 (sweden) discussion this study of norwegian and swedish workers suggests that some sp during a working year might be more common than no sp. this finding is in accordance with prior studies of sp at the national level (aronsson et al., 2000; vroome, 2006; hansen & andersen, 2009). an investigation of swedish studies shows that the proportion of respondents reporting sp in 2011 was somewhat higher than it was in 1997, but lower compared with the remarkable upswing in sp in the study from 2000 (aronsson et al., 2000; aronsson & gustafsson, 2005). the fact that so many people report sp should make us njsr – nordic journal of social research vol. 3, 2012 98 aware of the chance that the current levels of sa in norway and sweden are lower than they would be if workers called in sick every time they felt ill. at this point, the reader would do well to note two main objections against the validity of self-reported sp. one is that there is the potential for respondents to overestimate sp, because it is plausible for people to over-report sp in order to appear more desirable in the eyes of others. the other objection raises questions about the severity of the illness, because it is worthwhile to consider whether people who report sp suffer from genuine illness. this study has replicated many findings from former studies on factors associated with sp. income level is important in both countries: workers with low and medium income more often report sp compared with those with high income. this connection resembles the previous scandinavian studies, and aronsson et al. (2000, 503) propose that the cause could be that low-paid persons have narrower personal financial margins compared with persons with high income: ‘the financial loss of being absent from work has a greater impact on the low paid, and accordingly their disposition to presenteeism might be expected to be higher.’ the strong connection between sa and sp indicates that they are conclusions of the same decision-making process (kristensen, 1991; hansen & andersen, 2008). managers generally have low levels of sa, and this could be interpreted as a reflection of their good health. at the same time, our results indicate that norwegians and swedes with managerial responsibilities report sp more often than employees without such responsibilities. thus, it could be that managers do not have better health, but are more reluctant to partake in sa because they feel obligated to be at work, or for the love of the job or for some other reason. in both countries, persons with physical work report sp more often than persons doing sedentary work. this result matches hansen and andersen’s (2009) finding about the connection between heavy lifting and sp, and the analysis of sp among occupational groups made by aronsson et al. (2000). in the latter study, the risk of sp was very low among ‘deskbound’ occupations (e.g., therapists, computing professionals, secretaries, numerical clerks, bookkeepers, business professionals) and very high among persons in occupations associated with (fairly) heavy physical work (e.g., day-care staff, teachers in primary school, nursing-home aides, nursing and midwifery professionals, different types of welfare workers). occupational groups with high sp are characterized by interrelations with vulnerable groups such as the sick, the old, the young and small children, and ties created between the worker and their care recipients/pupils/clients might reduce the disposition to be absent from work and to increase sp (ibid.). the most notable difference between norway and sweden involves ethnic background and sp. in norway, non-western immigrants report sp more often than norwegians and western immigrants, whilst in sweden there is no significant difference between non-western immigrants and western immigrants and swedes. previous research shows that non-western immigrants have poorer health, precarious employment in semi-skilled and low-paid jobs in the service sector, and higher absence rates than natives and western immigrants (timonen, 2004; nilsson, 2005; bengtsson, 2006; dahl et al., 2010). in the norwegian sample for this study, more sp among non njsr – nordic journal of social research vol. 3, 2012 99 western immigrants is observed, but not more sa. this may reflect that nonwestern immigrants have poorer health, but feel compelled to turn up at work instead of staying at home when ill. other possible causes for more sp among non-western immigrants include lack of knowledge of social benefits, difficulties navigating the health system, and cultural factors (agudelo-suárez, 2010). it could be that different perceptions of illness exist between native and foreign-born workers. or it might be that some non-western immigrants have particular work motivations; for instance, it is likely that workers are more prone to sp if their goal is to earn as much as possible in the shortest possible time. this study lacks the capability to trace causal relationships, and one is simply left to suggest causes for higher presenteeism among non-western immigrants. furthermore, it is difficult to explain the notable difference between results for norway and sweden: more research is needed to follow up on the missing correlation between ethnic background and sp in sweden. the correlations between type of employment and sp raise questions about former studies. in this study, employees in the private sector report sp most often, followed by employees in the public sector, and then the self-employed. this ranking is the opposite of that expected from former research (bergström et al., 2009; hansen & andersen, 2008) finally, gender and age are insignificant in both countries. previous studies have shown tendencies of age and gender differences, but age and gender have relatively little explanatory value with regard to sp (aronsson et al. 2000). education matters in norway, but not in sweden. in the former studies, there is no clear pattern with regard to education. in some studies people with less education report more sp than those who are highly educated (aronsson & gustafsson, 2005; böckerman laukkanen, 2010), whilst education is less relevant in other studies (aronsson et al., 2000; elstad & vabø, 2008). conclusion knowledge of the distribution of and determinants for sp is still relatively sparse, and this article provides some insight into these matters. still, the results presented must be interpreted with caution since the response rate is low and the responses to sp might suffer from recall bias. the article has raised two research questions. the first question raised was that of the distribution of sp in norway and sweden. this study of norwegian and swedish workers suggests that some sp during a working year may be more common than no sp, and this is in accordance with former studies of sp at the national level (aronsson et al., 2000; aronsson & gustafsson, 2005; vroome, 2006; hansen & andersen, 2009). the frequency of sp episodes is similar in the two countries (approximately 45 per cent report no sp, 35 per cent report one or two sp episodes, and 20 per cent report three or more sp episodes). norwegians in the sample report longer sp than swedes in the sample (18 per cent of norwegians report 8 days or more sp compared with 13 per cent of the swedish respondents), but the difference between the two groups is not statistically significant. the second question was about which factors influence the frequency of sp in norway and sweden. comparative studies are useful since they put results for each country in a broader context. in both countries, respondents with low and njsr – nordic journal of social research vol. 3, 2012 100 medium income, employment, managerial responsibilities, and physical work are more likely to report sp. executives are overrepresented with sp in sweden, whilst non-western immigrants and the less educated are overrepresented with sp in norway. the influences of both gender and age are very small in both countries. the use of self-reported and cross-sectional data means that results from this study are tentative. several issues pertaining to sp remain to be studied. more than half of the workers in the study practised sp in the previous year, but we know neither the symptoms that people who practise sp refer to nor whether they suffer from genuine illnesses. further research, especially qualitative research, is needed to understand and explain the differences with regard to the determinants between the two countries, as well as the consequences of sp in both shorter and longer terms. references agudelo-suárez, a.a, benavides, f.g., felt, e, ronda-pérez, e., vives-cases, c., & garcía, a.m. (2010). sickness presenteeism in spanish-born and immigrant workers in spain. bmc public health, 10:791 aronsson, g. 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(2006). prevalence of sickness absence and ‘presenteeism’. retrieved from http://eurofound.europa.eu/ewco/2006/07/nl0607019i.htm microsoft word 527, solheim, relational social capital.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 relational social capital: norwegian women’s experiences of the process of being on sick leave and the path back to work liv johanne solheim faculty of education and social work centre for innovation in services lillehammer university college email: liv.solheim@hil.no abstract background: the reduction of the number of people that drop out of the labour force and temporarily receive public benefits has increasingly been a political priority in norway since the early 1990s. in particular, there has been a focus on reducing sick leave. however, none of the efforts in this direction has had the desired effects. to succeed, more knowledge is needed regarding the factors that create the illnesses influencing the length of the sickness leave. aim: the purpose of this article is to study how relational social capital, both at work and home, has an impact on the experience of being on long-term sick leave and the process of returning to work. methods: individual in-depth interviews have been performed with 20 women between 25 and 60 years old. they were all sick-listed for more than 30 days during 2013 with mental illness or musculoskeletal diagnoses. results: the study illustrates how long-term sickness absence can threaten the identity and self-confidence of the sick-listed persons. the effects of relational social capital are expressed through personal relationships with their family members, friends, colleagues, and managers at their workplace. individuals with high social capital in both the workplace and the domestic sphere have the best prospects for recovering and returning to work. high workplace capital may, to a certain degree, compensate for low domestic social capital. single mothers with low social capital both in their domestic life and in their workplace are the most vulnerable. njsr – nordic journal of social research vol. 6, 2015 93 conclusion: relational social capital influences both the experience of being on sick leave and the process of returning to work. the efforts to reduce sickness leave should therefore focus on not only the sick-listed person, but also their relationships with their family and in their workplace, as well as the interplay between these. keywords: sickness absence, relational social capital, women, mental illness, musculoskeletal diagnoses introduction during the last few decades the relation between social capital and health has been extensively explored (kawachi et al., 2008; berkman & glass, 2000; lomas, 1999), and social capital has become a popular theory through which differences in health and illness between social groups can be explained (turner, 2003). social capital is often viewed as both an individual (bourdieu, 1986; coleman, 1988) and a collective characteristic (putnam, 1993, 2000). a social-capital perspective applied to health presents a view that the quantity and quality of the relationships of a collective or a person play a role in the maintenance of health, and, at the same time, may provide useful resources during the recovery from illness. social capital generally has positive connotations. however, supporting networks may also have negative effects, such as exclusion of outsiders and demands for conformity that may be experienced as restrictions upon individual freedoms (portes, 1998). investigating the experiences of individual social capital may uncover nuances in the experiences of different aspects of social capital. in this article, social capital is viewed as resources accessible to individuals by their involvement in social networks in their private lives and in their workplace. access to individual social capital is expected to influence their experience of being sick-listed and the prospects for returning to work. a systematic literature review of the connection between social capital and health found significant correlations between the two in individual njsr – nordic journal of social research vol. 6, 2015 94 level studies. these studies showed that social capital, when viewed as individual characteristic, could contribute to the field of health promotion (eriksson, 2011). in contrast, studies investigating the link between collective social capital and health show inconclusive results. kim et al. (2008) conclude that the strongest associations are between individual social capital and health, particularly between cognitive components of social capital and self-related health. there are different perspectives from which illness and sickness absence can be understood. the bio-medical model focuses on individual risk factors and tries to find exact indicators for different diagnoses. the socio-cultural model focuses on people as cultural and social beings, and in this model illness has to be understood in relation to the life situation of the individual (gannik, 2005; verdonk et al., 2008; rønning, 2011). consequently, because illness is influenced by the afflicted individual’s surroundings, it can change correspondently with changes in their life situation – health problems might be reduced or cured by changes in their social relationships or environment. this may be particularly important in relation to mental and musculoskeletal problems because the symptoms are often diffuse and difficult to document, and therefore it is also difficult to determine an exact diagnosis and appropriate treatment (steihaug, 2007). in this way, the socio-cultural model may be an important supplement to the dominant bio-medical model. in this article, i have adopted a social constructivist perspective, which is also the basis of the socio-cultural model. employing this perspective, i shall not draw objective conclusions but instead attempt to understand how people interpret themselves and their situations. mental illness and musculoskeletal problems are the most common diagnoses for sick leave among women in norway. the aim of this article is to explore how women diagnosed with mental illness and musculoskeletal problems experience the challenges connected to staying in the work force, and, in particular, how individual social capital influences both the experience of being on long-term sick leave and the prospects of returning to work. in line with the tradition deriving from bourdieu and coleman, several studies about individual social capital and health have focused on social capital and social networks in local communities. some of these studies indicate a significant gender difference. one example of this is a swedish study (eriksson 2011) which shows that women are more likely than men to have access to bridging social networks. another is njsr – nordic journal of social research vol. 6, 2015 95 a study of community network in england that finds that women are more involved in face-to-face local networks, while men are more involved with non-local networks (campbell et al., 1999). other studies have focused on the relationship between employees’ health and factors at the workplace including, specifically, healthpromoting factors. a prospective cohort study of middle-aged french employees (melchior et al., 2003) has concluded that the quality of the work environment and the quality of social relations exerted independent effects on the incidence of sickness absence in the target population over a six-year period. another study performed by oksanen et al. (2008) has found that social capital at work was a predictor of health in a cohort of initially healthy local-government employees. this study supports the hypothesis that exposure to low social capital at work may be detrimental to the health of employees. increasing levels of individual social capital were associated with sustained good health. however, the findings of another prospective cohort study – in this case of public-sector employees in finland – suggest only partial support for the hypothesis of work-related social capital as a health resource (liukkonen et al., 2004). a few studies have focused primarily upon factors in domestic life. mamun et al. (2009) have investigated the bi-directional association between symptoms of depression and quality of marital relationship in a population-based cohort of women. the study suggests that symptoms of depression and quality of marital relationship are strongly associated with each other and that this association is bidirectional. staland-nyman et al. (2007) have found an association between domestic job strain and self-reported health, and the relationship was strongest for the dimensions that measured psychological health. another example is a study by østlund et al. (2004) that shows that the domestic arena is crucial in rehabilitation after sickness absence, and indicates that domestic strain might influence both the length of the sickness period and the decision to return to work. long-term sick-listed women are in a vulnerable situation. they do not know how long they are going to be sick-listed or if they will be able to go back to work. for some this may be a crossroads in their lives. a study by ockander and timpka (2003), focusing on how women handle and explain this interruption of their daily lives, distinguishes between three different groups. the first group is characterized by feelings of hopelessness and of being pushed away. the second njsr – nordic journal of social research vol. 6, 2015 96 group is characterized by the conflict between having the power and initiative to plan their future back to work and a feeling of resignation. the third category was characterized by migration away from the workplace and consisted of women who had no plans for returning to work. another study (eriksson & janson, 2013) has identified four different groups in relation to the work strategies as a norm: the returners, the reoriented, the ambivalent, and those who had given up. these studies show that being long-term sick-listed challenges women’s identities, and illustrate how the construction of identity is influenced by individuals’ social context (goffman, 1961; järvinen & mik-meyer, 2003). since the early 1990s, there has been a growing body of literature focusing on the relation between individual social capital and health. however, within this literature there is a lack of studies that utilize a holistic approach to examine the subjects’ total situation, including all the different roles they have to combine (solheim, 2011). the women in these situations have varying roles in their domestic lives (as mother, wife, daughter, and friend), in their working lives (as employee), and as sick-listed individuals (as patient). social capital potentially has an impact at their workplaces, in their families, and in their neighbourhoods, and in the interplay between work life and domestic life. the ambition of this study is to contribute to addressing some of the gaps in knowledge in this area. the research question is as follows: in what ways do work-related and domestic social capital influence the experience of being on sick leave and the prospects of returning to work for long-term sick-listed women? the study will explore the significance of long-term sick-listed women’s relational social capital, in both domestic and work-related situations, for their health and for their prospects for returning to work. domestic social capital affects relationships with family members and potential relationships with friends and neighbours. work-related social capital involves relationships with colleagues and leaders in the workplace. in the next section, i shall introduce the perspective of relational social capital and present some relevant literature. relational social capital and health social capital is defined in different ways, but there is a distinction of primary importance made between social capital as an individual njsr – nordic journal of social research vol. 6, 2015 97 asset and social capital as a collective attribute (eriksson, 2011). esser (2008) has used the concepts of system capital and relational capital to make a distinction between these two aspects of social capital. system capital is explained as a collective good and an aspect of the organization of a community. a community’s health service and rehabilitation systems may be considered components of system capital. relational social capital is regarded as an individual’s personal social resources. trust and obligation are important aspects of relational social capital. trust capital is the resources and benefits an individual can activate because of his reputation of being trustworthy. obligation capital refers to the agreements between individuals and the resources these can activate. these kinds of agreements can only function if there are mutual interests in the relationship. in this article, the focus is primarily on how relational social capital influences the experiences of the sickness-absence period and the prospects for returning to work for long-term sick-listed women. an individual’s total amount of relational capital represents the sum of all the resources and benefits on which the individual can draw because of direct or indirect relationships with other individuals. the values of these resources are dependent upon earlier investments, and in this way relational capital may be regarded as a form of saving (esser, 2008). the relation between social capital and health has been studied in a public-health perspective (kawachi et al., 2008; lochner et al., 2003, berkman & glass, 2000; campbell et al., 1999, berkman & syme, 1979). there is also an extensive field of studies that have focused on the association between individual social capital and health. finnish studies (hyyppä & mäki, 2001, 2003) show that a great deal of health equality between swedish-speaking and finnish-speaking individuals living in the same finnish regions can be explained by differences in social capital. this is confirmed in a nationwide survey of the two language groups (nyquist et al., 2007). verhaeghe et al. (2012) have examined a representative sample of adults from the belgian population. the aim of their study was to examine whether there was an association between network social capital and self-rated health after controlling for social support. their findings indicate that social networks from the working class could offer people fewer healthbenefiting resources than those from the intermediate or higher service class. this is a reminder that social networks may have different qualities and different contributions to social support, and njsr – nordic journal of social research vol. 6, 2015 98 they may have different effects upon health. a cross-sectional study in northern sweden (eriksson et al., 2010) has aimed to study the links between individual social capital and self-rated health between men and women and between different educational groups. the findings show that access to social capital can partly explain the health inequality between men and women and between different educational groups. the relation between social capital and mental health is complex. studies show that social capital contributes to reducing depression related to life crises (brown & harris, 1978). however, not all close relationships have a positive effect on health. it is therefore not sufficient only to study the amount of social capital; the quality of the relationships must also be considered. portes (1998) makes a distinction between sources and effects of social capital. rose (2000) has found that both human capital (age, social status, gender, and income) and social capital (involvement in or exclusion from formal and informal networks) are major determinants of health. human capital is here defined as characteristics of the individual while social capital is connected to the individuals’ social networks. his study shows that social capital makes an independent contribution to health, and that it increases physical and emotional health more than human capital. the work of eriksson et al. (2011) also shows a positive association between collective social capital and self-rated health for women but not for men. others have studied how people cope with stressful life events and uncovered the need to take into account the social capital available to different groups. one example is the study by garret-peters (2009) that shows that social capital is important for coping with the loss of a job. the following section will introduce the methods of the current study as well as a presentation and discussion of the data. methodological approach this article is based upon data collected as part of the project ‘social factors contributing to sickness absence’ (sofac). this project includes different comparative studies between norway and sweden using both qualitative and quantitative methods. the first part of the project consists of qualitative studies of sick-listed men and women in both countries. this article presents the results from the norwegian study among sick-listed women. njsr – nordic journal of social research vol. 6, 2015 99 this study has an exploratory approach focusing on the kind of knowledge used in everyday life (berger & luckmann, 1967; wagner, 1983). the data were collected with an open mind in order to record the informants’ experiences in their own terms. we covered four topics in all the interviews, but we did not formulate the specific questions in advance in order to apply the flexible approach to each interview. the study adopts the central method of symbolic interactionism, which seeks to understand the phenomenon from the informants’ perspectives and to describe their experiences. in addition, the study has been inspired by grounded-theory approach (glaser & strauss, 1967; glaser 1998) and has sought to come up with more abstract conceptualizations of the role of relational social capital for experiences of being on sickness leave and prospects of returning to work. in the analysis of the data the respondents are classified in four different groups on the basis of their own descriptions and experiences of the amount and quality of their domestic and workplace social capital. the interviews were conducted in the spring of 2010. the respondents were asked where they wanted to meet the interviewer. some of the interviews were conducted in the respondents’ homes, some at the local college, and some in a room rented at the local library. the interviews were tape-recorded and transcribed. batt-rawden and solheim (2011) have given the first presentation of the material and a more extensive presentation of the methods used. the analysis began with open coding in order to capture the concepts, themes, and statements that were central in the subjects’ descriptions. in the next stage of selective coding, we limited the categories and showed the dimensions representing the variations within the data. finally, we examined the data to identify themes, to explore categories, and to develop concepts. the study is based upon a sample of long-term sick-listed persons’ own explanations and understandings of their sickness absences. these absences are all due to mental problems or musculoskeletal problems, the two most frequent groups of diagnoses among people on sick leave in norway. with both of these diagnoses, it is often difficult to find objective symptoms, and the problems presented often have complicated backgrounds. in addition, these groups frequently overlap. njsr – nordic journal of social research vol. 6, 2015 100 the informants were contacted according to the instructions set by the sofac project in accordance with the regional ethical committee (rek). the department for statistical analysis at the norwegian labour and welfare service (nav) selected a sample of 260 women and 260 men diagnosed with mental illness (icpc-codes: p76, p02, a04) or musculoskeletal illnesses (icpc-codes: l03, l84, l02, l18, a01, l92). the sample included people between 20 and 60 years old who were, or had been, long-term sick-listed for at least 30 days during the previous year. to reduce the travel time, the sample was limited to subjects in 10 municipalities in one norwegian county. the purpose was to find a broad representation of men and women of varied ages and in different life situations. a letter was sent to the members of the sample group with information about the study. to comply with rules concerning anonymity, nav sent the letter and asked informants to contact the researchers themselves about participation in the study. in total, 30 informants, ten men and 20 women, made contact and were interviewed. the initial aim was to gather a sample of 20 women and 20 men. in this article, only the women are included because we wanted here to focus on variations among the women. the low response rate might have been connected to the procedure of selection, which relied heavily on the informant’s initiative. owing to ethical guidelines, nav was required to distribute letters that provided the necessary information to potential informants, and then it was up to the informants to initiate the first contact with the researchers. another reason might be that the group asked to participate may contain people who suffer from serious illness, and they might lack the motivation, the strength, or both, to participate. we do not know the reasons why so many declined to participate in this study, but there were certain revealing characteristics of the group that was willing to share their experiences. while most of them have had long-term and repeated experiences of being sick-listed for several years, at the time of the interview they had recovered and they often were willing to participate because they had experiences from their period of sickness absence that they wanted to convey. characteristics of the sick-listed women among the women, nine of the 20 had diagnoses related to mental problems. in addition, four of the women with musculoskeletal issues also had a recent history of mental problems. this is an example of njsr – nordic journal of social research vol. 6, 2015 101 the frequency of the overlap between the two diagnoses. the women in the sample are relatively well educated: 12 have higher education, four have vocational education, and four have basic education. two of the women were in their twenties, three were in their thirties, eight were in their forties, and seven in their fifties. for most of them, their illness had developed over the course of several years, and the majority had been long-term sick-listed two or more times before. results being on long-term sick leave involves a break in daily life routines, and studies shows that the length of the sickness-absence period has an influence on prospects for returning back to work. this may indicate that being sick-listed may have an influence upon identity. the first part of this section will present the experiences of the women in this study. the next part will give a picture of the variations in the women’s experiences with relational social capital in the domestic sphere as well as in the workplace. identity at a crossroads long-term sick-listed women identify themselves in different ways, and they have varied motivations related to returning to work. they face a choice of paths, where one road leads toward the pension system, another back to work, a third to part time work, and a fourth to a new, different career (ockander & timpka, 2003; falkdal et al., 2006). in this study, most of the women in the sample still identified strongly as working people and had an active desire to return to work. consequently, their focus was mainly on how to manage this. the long-term period of sickness absence had not changed their identity as working women, but had challenged it. one expressed her despair in this way: ‘it is a desperate situation in that my body cannot keep up any more and my brain wants to do so much more than my body.’ many women mentioned two experiences: a loss of self-confidence and uncertainty in relation to the prospects for the development of their illnesses and their future health. since they had a strong identity as working women, their feelings of self-worth are eroding, along with their connectedness to their job communities. one woman expressed it in this way: ‘my aim is to return to work. but now i don’t know if it is njsr – nordic journal of social research vol. 6, 2015 102 possible. what pains me most is the uncertainty…. the uncertainty makes me depressed.’ another woman said: ‘without doubt my selfconfidence has been struck. it is like living on another planet – not to be part of the community.’ the women sometimes described the correspondence between their uncertainty and their self-confidence. one of them expressed it this way: my job has been very important for me… you wonder if you will be able to return to your job. you are losing your self-confidence and feel you are less valuable... in addition, it is the uncertainty: that you in your young age will not be able to work – the horror scenario is to be a disability pensioner. during the sickness-leave period, relational social capital may influence recovery and prospects for returning to work in different ways. different aspects at their workplace and in their domestic life have an influence on the ways the individual women cope with the challenges connected to the situation of being sick-listed. the following section will present the ways in which the effects of relational social capital came to be expressed. relational social capital experiences women on sick leave experienced significant changes in their everyday lives. they were no longer employees going to work every day, with routines in their domestic lives adjusted to working hours. they now had other needs for support and community. one woman described the significance of relational social capital in this way: the social relations you have are very important – that you have a social network. many sick people are lonely, and then the problems may increase…. when you are frustrated and have pains, it is your social network that helps you to not give up. there are variations among the women in the amounts of workplace and domestic capital they experience. figure 1 illustrates the connection between these actors and gives a picture of these variations. njsr – nordic journal of social research vol. 6, 2015 103 figure 1: interplay between workplace and domestic social capital workplace social capital (wsc) high low domestic social capital (dsc) high well connected (7) domestic connected (3) low workplace connected (3) unconnected (7) the total amount of social capital is dependent upon both workplace capital and domestic capital. the figure above illustrates that there was an accumulation of cases at both ends of the scale. approximately one-third of the women had high workplace capital and high domestic capital, and about one-third had low workplace capital as well as low domestic capital. the classification is a result of the women’s own descriptions, and is made based on the variations within this sample. classification as high or low is therefore not based upon objective measures of high and low but upon the level or amount of social capital experienced by the women interviewed in this study. there are some smooth transitions between high and low social capital. i thus classified each woman on the basis of the group they best resembled. the women who are classified as having high workplace capital had a positive relation to their workplace at a general level had social relations characterized by trust and social support with at least two or three of their colleagues, and had relatively close contact with the workplace during the sickness-absence period. the quality of the relations was characterized by trust and the relations with the workplace were important as social support. the group with low workplace social capital had a more distant relation to their colleagues and leaders during the sickness-absence period, and they lacked social support from the workplace. the women classified as having high domestic social capital had two or three persons whom they trusted and whom they could talk with confidentially. most important for most of these women was a partner who was supportive and who njsr – nordic journal of social research vol. 6, 2015 104 took responsibility for tasks that the sick-listed women were unable to manage. both social and practical support were necessary to be classified as having high domestic social capital. one important aspect of domestic social capital is having persons in the domestic sphere who can give practical help and emotional support during the process of recovering from sickness and building self-confidence. having high domestic social capital in this case means that there were at least two or three confidant and trusted people among the woman’s family and friends who supported them emotionally, and with whom they could talk confidentially. those who had fewer than two confidant persons around them and expressed dissatisfaction with their lack of a social network were classified as having low domestic capital. according to the sick-listed women’s descriptions, the quality of their social relationships was much more important than the quantity. the attitudes and norms in the local society may also be seen as aspects of domestic social capital. the surrounding neighbourhood could potentially provide support when needed. however, in this study, only a few of the women had close friends in their neighbourhoods and they only rarely experienced the neighbourhood as a supportive arena during the sickness-absence period. being classified as having high workplace social capital means that the woman had a trusting relationship with her leaders and colleagues and that she had regular contact with the workplace during the sickness-absence period. women who had a distant relationship with their workplace and who expressed dissatisfaction with that relationship were classified as having low workplace social capital. domestic and workplace social capital have independent influences on the experience of being long-term sick-listed, but there may also be some interplay between the two. high dsc and high wsc: the well connected the women who had both high workplace social capital and high domestic social capital had the best prospects for support in their rehabilitation. for these women, their relationships with their leaders and particularly their work colleagues played an important role during the sickness-absence period. most of the workplaces had established routines for following up and keeping in contact with sick-listed njsr – nordic journal of social research vol. 6, 2015 105 employees. the women in these situations regularly had meetings with their leaders to discuss their status and what the workplace could do to reduce the sickness-absence period. most of the women appreciated this contact. the sick-listed women’s relationships with their colleagues were also of great importance. some of the women had strong informal relational ties with their co-workers, who became an important source of support during the sickness-absence period. these women often visited the workplace to meet with their colleagues, among whom a few of them had their best friends. one woman said, ‘my colleagues are contacting me all the time, my leader has visited me several times, and they call me, send sms’s and invite me for lunch.’ in this way, contact with colleagues was important as a social arena. the workplace was often an extended space in these women’s lives; here they had not only their work, but also close friends – and for some their closest friends. the women’s relationship with their workplace during the sicknessabsence period was important because it often sent signals – for example, a wish to come back to work, on the women’s part, or, from the workplace, that the women were appreciated and wanted back, and that their presence (or lack thereof) made a difference. it was important that the leaders in the workplace gave such signals, but occasionally they also came from colleagues. such reactions from the women’s colleagues could be just as influential in motivating them to return to work as the signals from the leaders. the experience of being long-term sick-listed sometimes leads to isolation, a feeling of loneliness, and a lower capacity to perform and participate in daily tasks at home. in addition, there may be feelings of uncertainty about the recovery of one’s health, and what to do to stimulate the rehabilitation process. in this situation, it was important for the sick-listed individual to have people in their social network who understood their situation and their worries, and it was of vital significance that these people were available when there was a need to talk about the situation or when help was required. some of the women in the sample needed relief with their daily tasks at home, and it was important for them to have somebody to turn to when they needed help. those who are classified as having high domestic social capital usually had a partner supporting them practically and emotionally. for njsr – nordic journal of social research vol. 6, 2015 106 some, this was an unusual situation because their partners were not used to doing all the housework or to seeing what needed to be done. therefore the women sometimes had to take on the role of the administrator. the women also described how the situation wore them down over time. one of them described the emotional exhaustion between her and her partner: ‘my husband is the person i talk most with about my situation. but you know – he gets tired of talking about it –it’s like that for me, too.’ when their health problems lasted for a long time and there was little progress, a kind of resignation set in for both the women and their partners. a few of the women talked about help and support they received from their extended families. more often, they had a few close friends from whom they received support. they would get together with these friends to talk about their situation, to focus on things other than their problems, or to participate in activities as a way to get away from what was sometimes a boring everyday life. high wsc and low dsc: the work connected for these women, the rehabilitation process was vital. however, this process was often impeded by a lack of practical support for tasks in the home and a lack of emotional support in their struggle for selfesteem. a common characteristic of this group was their satisfaction with the amount of contact and support they received from their workplaces. they had no complaints about their leaders or colleagues, even if some of them had limited contact with the workplace. the main problems for these women were that the burdens of housework and childcare were too much in relation to their health problems and that they suffered from a lack of emotional support. consequently, a low level of domestic social capital was deemed a hindrance to recovery due the lack of necessary emotional and physical support. some of these women were living with a partner, and while they appreciated any emotional and practical support given by a partner, some limitations were described. one of these women said: ‘my njsr – nordic journal of social research vol. 6, 2015 107 partner is not good at conversation – he is a “thinker”. but he does all i ask him to do in the household.’ this woman was living with a partner at the time, but she had been a single mother for many years. in addition, her children had health difficulties, one of them having developed drug problems at an early age. her domestic situation had therefore been a burden, but she had been at work for several years with few sickness-absence periods. however, over the past few years, she had developed complex health problems, and at the time of the study, she had been sick-listed for months. during the years she had spent living as a single mother, she had used all her strength to keep up with her job, and she felt she was successful in her work and that she had good relationships with her colleagues. however, in her domestic life she was isolated. she had little contact with her neighbours and few friends in her surroundings. everyone in the community knew about her son’s drug problems, and her imagination about what people said about her as a mother was one reason that she avoided going to public places. in this case, the high workplace social capital partially compensated for low domestic social capital, and this woman actively connected with the workplace, even while she was sick-listed. this was her successful arena, and therefore it was important for her to continue working. neighbours or friends could potentially supplement low practical and emotional support from families. however, the women in the study showed a tendency to isolate themselves in their homes during the sickness-absence period. for some of the women, taking a walk during the day was important, but the walking route was planned in such a way as to decrease the chance of meeting people they knew. one example of this was a woman who worked in a pre-school. she did what she could to avoid walking in the area where the families who had children in her pre-school lived because she was afraid to meet the parents. going shopping was another challenging situation. she described it in this way: it has happened that i have been in the city and if i saw parents of the children i hid behind a shelf or went into a shop to avoid meeting them – especially if it was from my class – i know they are wondering and want to know. the interviews show that for women with a low amount of domestic social capital it is of great importance to have an inclusive work place that they can visit even during the sickness-absence period. high njsr – nordic journal of social research vol. 6, 2015 108 amounts of workplace social capital may in some cases be the deciding factor in the ability to return to work. however, in most cases, high workplace social capital cannot totally compensate for a lack of social capital in the domestic sphere. high dsc and low wsc: the domestically connected these women usually had a partner who shared the responsibilities for their practical everyday duties. they received emotional support from their partners, and some of them receive high amounts of emotional and practical support from family and friends. low workplace social capital is expressed through a distant connection with the workplace and colleagues during the sickness period. there are different reasons for the limited contact with the workplace. one was a lack of opportunities for the sick-listed women to come and visit their colleagues during working hours. another reason was the sick-listed women’s own hesitation to have contact with their workplaces during the sickness-absence period. the background for this hesitation might be conflicts in the workplace, which was sometimes also an aspect of the background for their sickness absence. a third reason was the lack of a tradition of having contact with colleagues outside working hours. if they did not have a tradition of meeting colleagues outside working hours, it is difficult to arrange when they were sick-listed. some of the women did not want to inform their colleagues about the background of their sickness absence. this may be interpreted as shame, especially among those with mental problems. creating distance between themselves and their workplaces was a reaction in order to protect them from this shame. in their situation as sick-listed, the women are vulnerable and pay extra attention to what people say when they meet with their colleagues. one woman described her experience in this way: ‘there are some colleagues who have commented on my situation in a way that was hurting me.’ in this woman’s case, her colleagues had expressed the opinion that people can go to work even if they had some problems. she felt that they counted her among such people, and this was difficult for her to accept. another woman spoke about similar experiences. her colleagues were friendly and talked to her in a kind and polite way. however, she njsr – nordic journal of social research vol. 6, 2015 109 sensed suspicious attitudes among some of them. this perceived lack of trust contributed to a lack of contact with colleagues and this in turn may have had a negative influence upon her efforts to return to work. to a certain degree, these women compensated for low workplace social capital with partners or close friends, or both, who helped them with daily tasks, gave them energy and comfort, and helped to build up their self-confidence. however, limited contact with the workplace contributed to a less work-oriented attitude, and probably made the road back to work longer. low wsc and low dsc: the unconnected women with both low work social capital and low domestic social capital are the most vulnerable in relation to recovery and return to work. in the sample, these were mainly single mothers. they had little support at home, some of them had a high work burden in a family with small children or children with health problems; in addition, they often had financial troubles. as single mothers, they had been in this situation for years, and there were signs of wear and tear. often their pride prevented them from asking for help when they needed it. isolation and lack of contact with friends, family, and colleagues were often a consequence of their lack of energy. their struggles to cope with their home situations drained a lot of their strength and made it sometimes difficult to cope with their jobs. they felt they were expected to manage a full-time job and bear all the responsibility for their children and sometimes for their extended family. however, for some this was too much. when they were unable to cope with this situation they felt they had not been able to live up to expectations and they feel unsuccessful and lose their self-confidence. sick-listed single mothers were in a particularly difficult situation. they often missed having a person with whom they could share practical tasks as well as their thoughts about their actual situations and their futures. having family members living in the neighbourhood could potentially compensate for of the role of a partner, in part. however, in this study, most of the single mothers had no family members in the neighbourhood, and they often hesitated to ask for help. they were proud and did not want to show other people that they were not coping with the situation: i am not a person who asks for help, but i would be grateful if any one offered themselves to help. for me there is a very high njsr – nordic journal of social research vol. 6, 2015 110 barrier against asking for help. i have a very high threshold to ask for help. some of the women had children who were grown up and had their own problems – drug abuse, eating disorders, disabilities, me, adhd, etc. some of these children still lived with their mothers, and having responsibility for these children was often described as a heavy burden. however, some children could be an emotional support for their mothers in their sick-listed situations. one woman said: i have asked my primary doctor to be sick-listed, not from my job but from my life. i feel my life is very tiresome. if i had some more help at home, i think i would function better in my job. there is a close connection between these two arenas. … i dream of having a wife – having a man is not so necessary – who could make dinner once a week, do the dishwashing, and sometimes clean the house. i think the total life situation has to be taken into consideration. this woman’s account illustrates the interplay between challenges in work and domestic situations. when the total burden is too heavy, the domestic challenges have to be prioritized. this may influence women’s connections to the workplace and their reputations as stable workers. they felt it was illegitimate to use their domestic burden as an explanation for their absence from work; there was an expectation that they should be able to manage both arenas. these women also wanted to manage both their work and their domestic demands and challenges themselves. discussing their heavy burdens and asking for help was, for some of them, regarded as a kind of defeat. nevertheless, this attitude also sometimes led them into isolation. the total workload took all their time. they had little time and energy for social life and therefore they were losing contact with people who could be potential helpers. discussion: challenges in the process of recovery and the path back to work in the introduction of this article, two questions were raised: 1) in what ways do work-related and domestic social capital influence the experience of being on sickness leave? and 2) in what ways do work njsr – nordic journal of social research vol. 6, 2015 111 related and domestic social capital influence the prospects for returning to work? i shall now discuss these two questions. this study shows that the basis of these women’s relational social capital is in their families, in their workplaces and among their close friends, who sometimes are also their colleagues. the quality of these relationships may have an impact upon their experiences of being sick-listed and their prospects of returning to work. (1) experiences of being on long-term sick leave to be long-term sick-listed is to live with uncertainty, and selfconfidence is challenged during such a period. in this situation, relational social capital is an important source of support. it is also invaluable in building self-confidence and working against feelings of shame and stigmatization. relational social capital also contributes to emotional energy and helps to avoid isolation and sometimes depression. having a connection to a workplace where one has positive colleagues and which gives signals that one is expected to return is of great value. the study also shows that diagnoses have an impact on the experience of being on sick leave. mental and musculoskeletal problems are often invisible, and they are frequently described among the diagnoses with low prestige (album & westin, 2006). the invisibility of these illnesses is often a source of suspicion among people surrounding the sick-listed person. in this situation, it is important for the sick-listed individuals to have contact with people who have known them over time and accept them as hard-working persons who do not easily give up and go to their doctor to be sicklisted. the women in this sample are afraid of giving people an impression that it is easy for them to be sick-listed. they therefore need acceptance from key people in their surroundings to confirm that the negative image is not true. the reinforcement of their self-image strengthens them in their struggle to maintain their identity as working women and encourages them to fight for a return to work. being diagnosed as mentally ill is, for some, connected to shame (eriksson, starrin, ede & jansson, 2011). this connection also emerges in this study. the fact that the women avoid going outdoors and meeting people may be interpreted as an aspect of this. however, a few of the women were more explicit in their descriptions of their njsr – nordic journal of social research vol. 6, 2015 112 shame and their fears of being unveiled as a person with mental problems. the use of a great deal of time and energy to hide their problems, both in the workplace and in their general environment, was probably an obstacle to their recovery. the reason given for this was often a desire to be accepted along with their problems, but they were afraid for their reputations and did not always expect people to be understanding. in a swedish study of the same diagnosis groups, eriksson (2013) makes a distinction of four different groups. these are the returners, the ambivalent, the reoriented, and the capitulators. in my study, very few women can be included in the capitulating group. however, in relation to my study, the non-connected group corresponds most closely to the reoriented or the ambivalent. the women in the connected group most closely correspond to the returners or the ambivalent. the reasons for their ambivalence were sometimes connected to bad relations at the workplace, or they could be related to their health situation and their future ability to perform as well as before at work. this indicates that women having high workplace social capital are more inclined to return to work either to their present workplace or, if necessary, orienting towards another workplace; in women with both high domestic and high workplace social capital, the tendency is even stronger. (2) prospects for returning to work some studies have documented the significance of health-promoting factors in the workplace (melchior et al., 2003; oksanen et al., 2008). the connection between work-related health problems and illness, including sick leave, is also well-documented. in addition, social factors such as job control, social support from leadership or at the workplace, role conflicts, and reorganizational processes may contribute to sickness absence (lund & labriola, 2009). however, in most studies, work-related illness is limited to paid work. only in exceptional cases is the association between health, work burden, and social support in domestic life taken into consideration (stalandnyman et al., 2007; østlund et al. 2004; falkdal et al., 2006). this study shows that the prospect of returning to work is influenced by relational social capital both in the workplace and in the private arena. the study indicates that many women have a satisfactory amount of social capital both in the domestic sphere and in the njsr – nordic journal of social research vol. 6, 2015 113 workplace. but for those with insufficient relational social capital in the workplace it is of particular importance to have adequate social capital in their private lives; similarly, those lacking domestic social capital are more dependent upon work-related social capital. in this way, insufficient social capital in the private sphere may, to a certain extent, be compensated for by sufficient social capital in the workplace, and a high amount of domestic social capital may compensate for insufficient work related social capital. the majority of the sample interviewed in this study still identified themselves as working women and strongly desired to return to work. therefore, there is reason to expect that a commitment to building up their social capital would be profitable for both these women and society. a lack of emotional and practical support may decrease their motivation and reduce their ability to return to work. the most vulnerable group is those who have inadequate relational social capital both in their private lives and in their workplaces. the majority of the women in this group are single mothers. they were struggling to cope with financial and practical challenges in everyday life. this caused withdrawal and sometimes a feeling of shame because they were not able to live up to the expectations they had for themselves as mothers and working women. they were in need of and wanted more support, but they got stuck into a vicious circle because their withdrawal decreased the opportunities for potential supporters. also, other studies have shown that single mothers have both financial stress and low scores on life satisfaction and happiness (bull & mittelmark, 2009), and that single women with children have a doubled risk of repeated sick leave than single women without children (voss et al., 2008). for this group, the prospects of returning to work are dependent upon relief and support giving them a possibility to recover and return to work. usually the process of following up on long-term sick-listed employees in norway focuses on facilitation in the workplace and not so much on relational aspects (solheim & berg, 2012). this study shows that to succeed in the recovery process it may be important to take into consideration social relations not only in the workplace but also in the domestic sphere. this study has identified four different groups with different levels of relational social capital. we cannot claim that the sample is representative for women on sickness absence in the two groups of diagnoses. however, the women we were able to interview represent njsr – nordic journal of social research vol. 6, 2015 114 some of the variations in situations for women on sick leave with these diagnoses. these representations give us valuable knowledge about how long-term sick-listed women try to combine challenges in their domestic lives and in their work lives, and the meaning of work-related and domestic social capital during the sickness-absence period. further research is needed to explore how these groups can improve their recovery process to make the road back to work as short as possible, and it is important to illuminate the interplay between workrelated social capital and domestic social capital. therefore, further research is in particular required to find out what kind of help and support is required to avoid long-term sickness absence and to promote a successful rehabilitation process. by using a holistic approach and focusing on relational social capital at work and in domestic life, this study concludes that both are important for the process of returning back to work, and that neglecting the domestic sphere leads to a limited understanding of the challenges sick-listed women are struggling with. references album, d. & westin s. 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(2004). domestic strain: a hindrance to rehabilitation? scandinavian journal of caring science, 18(1), 49-56. microsoft word mwlayout3.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 3, 2012 politicians’ priorities and the determinants of priorities in the swedish social services marie wörlén department of social work mid sweden university email: marie.worlen@miun.se abstract the setting of priorities is an integrated part of social-work politics in sweden as well as internationally. this article explores swedish social services and how politicians on the political boards wish to make priorities and what these priorities involve. the use of regression analyses also reveals which circumstances are of importance for allocative precedence and the impact different distributive principles have. it is hard to detect clear-cut patterns of circumstances that guide the judgements in any one direction. the results show that political affiliation overall is not a determining factor for attitudes towards how priorities are made. another result is a manifest area bias, suggesting that respondents tend to see to the interests of their own professional domain, a result most visible among the politicians involved with care for the elderly and disabled (ced). yet, with regard to allocative principles, political colour seems to matter. conservative politicians, as expected, agree with the principles of economy and of capacity to benefit, while the socialist block, less expectedly, seems to embrace the principle of deservingness. keywords: priorities, decision-making, social services, politicians introduction in the wake of the financial crises of the 1990s and the late 2000s, the financial base for many swedish welfare programmes had become somewhat eroded. within the wide spectrum of services provided, the municipality-based social services represent a major component, including care of the elderly and the disabled, child welfare, social assistance, and treatment of substance abusers. locally elected political bodies decide on the allocation of resources to various sectors and enjoy large discretion in this capacity, since the regulatory social services act essentially provides a framework. njsr – nordic journal of social research vol. 3, 2012 2 a core element in all political activity is making priorities. although individual political practice normally includes neither well articulated ranking lists nor explicit arguments for precedence, the shaping of political policy might concisely be defined, as callahan (1987 p. 141) puts it, ‘as a set of priorities of action and the resources oriented towards achieving a goal’. hence, the necessity of setting priorities is neither a new feature of political life nor a result solely from a consequence of financial constraints. scarce resources do, however, make the setting of priorities more challenging since they often involve cutbacks and less favourable conditions for certain areas or user groups. the overall distribution of resources within the swedish social services normally does not correspond to any single decision or easily identified political actor. in addition to formal political influence, allocative outcomes are also a result of how executives, administrators, and social workers implement political decisions. political decisions regarding the total amount of resources distributed to various programmes or sectors are sometimes referred to as first-order decisions (elster, 1992) or strategic decision-making. second-order decisions refer to the allocation of given resources among potential users. in complex organizations, such as the social services, there are no clear-cut dividing lines between the two levels, which are intimately intertwined, but the range of political decisions and the scope of professional discretion vary from one area to another and between different municipalities (thorslund, bergmark, & parker, 1997). as a result, political accountability may sometimes seem somewhat hard to follow (lewin, 2007; thorslund et al., 1997). the issues of ‘who gets what?’ and ‘on what grounds?’ evoke questions of basic values and how these are manifested in political and economic realities. the fundamental challenge of making choices in the social services lies in the balance between fulfilling public needs within given time limits and the budget provided. this is particularly emphasized in publicly funded organizations, which are expected to be permeated with fairness and equality (martin, giacomini, & singer, 2002; temkin, 2003). this article will, on the basis of a study conducted in 2006-2007, analyse how politicians in a number of swedish municipalities relate to decision-making involving priorities, what groups or activities they give precedence to, and how their orientation in this respect is shaped by values and personal-background factors. the focus here is not, however, actual priorities, but the politician’s attitudes towards priorities. priorities in the political sphere when making priorities in the social services, the decision-maker faces the task of putting one group or person ahead of others, that is setting some interests aside in order to give precedence to others (callahan, 1987; calltorp, 1989). this is a well established ingredient in political life as well as in professional practice. political priorities have a direct bearing on micro-level decisions since they provide the financial and regulatory framework for the individual case (björk & rosén, 1993; lammintakanen & kinnunen, 2004). it is, however, an open question to what extent an allocative profile in a municipality can be regarded as a reflection of political will and of values attached to certain ideological positions (lammintakanen & kinnunen, 2004). the allocation of resources in the social services is a multifaceted policy operation (karski & barth, 2000) that has need as an essential factor, where need is not only the rationale for the sector in itself but also constitutes the cornerstone of the social services act. different actors hold varied and often njsr – nordic journal of social research vol. 3, 2012 3 conflicting views on what constitutes a true or urgent need (lister, 2010). hence, the values and beliefs of political boards, clients, managers, and social workers can have an impact on how politicians make their decisions (reilly, 1994). everyday politics is then not only a trade-off between political parties or the implementation of political programmes, but to a large extent also an internal organizational process where numerous interests are involved (greener & powell, 2003). four material principles of allocation may serve as representations of the different perspectives held by first-order actors: the principle of need, the principle of deservingness, the principle of economy, and the principle of capacity to benefit. as already established above, the principle of need stands out as central in social work, where it is prescribed, in short, that resources should be allocated on the basis of need and that motives for giving higher priority should be constituted on the basis of more severe and extensive needs. the concept of need is disputed, however. on the one hand, ‘need’ can be seen as equal to demand. on the other hand, ‘need’ can be described as a defined level (comparatively low) of welfare. when interpreting need as equal to demand, the social services are allowed to take a more passive stance, and to wait for initiatives or applications from claimants. with need defined as a low level of welfare follows the imperative to search out needy citizens and to establish outreach activities (taylor & devine, 1994). the principle of deservingness originates from the idea that it is morally wrong to recompense people who (knowingly or not) get themselves into trouble. this rests on the notion that negative incentive effects might be generated through generosity to undeserving groups, as it is likely that individuals will be less cautious about involving themselves in troubled situations if they know that compensation or treatment will be available (dworkin, 1981). historically, the principle of deservingness was a central one in swedish poor-relief legislation (wallentin, 1988). the principle of economy (or contribution), on the other hand, with its emphasis on the allocation of resources in accordance with how much the users contribute to their financing, can rather be seen as complementary to the other three. support for a system where fees are paid by the applicants in order to benefit from services is a material expression of this principle, where the utilization of the principle may be regarded as an aspect of redistribution, since fees or co-payments normally only cover a certain amount of actual costs. the use of fees is repeatedly visualized by advocates of this principle as a needs test in itself, since it may serve to keep the less needy out (bergmark, 1996). the capacity to benefit, finally, is the principle whereby the clients who are most likely to improve their situation as a result of a social-services intervention should be given high priority (hasenfeldt & steinmetz, 1981). the goal here is to target interventions in such a way that the highest average increase of welfare is achieved. with this follows the giving of high priority to clients with problems that match obtainable goals; to be exact, precedence is given to clients who have more solvable problems and equivalent lower priority is given to less solvable cases or to long-term cases. from an ideal-type democratic perspective, politicians are expected to base their actions on ideologies and generally held values when fulfilling their promises to their voters. besides following a particular political programme, this political accountability also involves openness to comments concerning how individuals actually are affected by the priorities made. however, strategic considerations are apt to complicate this view of local democracy, since organizational considerations, national politics, and short-term popular opinion njsr – nordic journal of social research vol. 3, 2012 4 may be involved in an unpredictable manner (dierwechter & coffey, 2010; lammintakanen & kinnunen, 2004). it has been argued that pragmatism is a more salient feature of local politics than ideology, and analyses show that political majority is a less significant factor for allocative policy than might be expected (aronsson, 1999; trydegård & thorslund 2001), in which case any underlying assumption that decisions and priorities are made with a rational and objective approach may be somewhat misleading (lewin, 2007). other factors to consider are organizational aspects, individual preferences, regional strategies, and the local parliamentary balance of power (dierwechter & coffey, 2010; lien & arnt pettersen, 2004; trydegård & thorslund, 2001). priorities have further been shown to be affected by area bias, that is, a tendency to advocate or exercise priorities that serve the field one represents or the clients that are the target group for that area (bergmark, 1995; wörlén & bergmark, 2011). these tendencies to choose one’s own area may originate from a self-serving bias, a better acquaintance with conditions within the field or from a fundamental dedication to the area. to sum up, the setting of priorities is a process related to such organizational factors as the given municipality, fellow politicians, routines, and policies, as well as to personal factors. nevertheless, decision-making is also about balancing personal preferences, professional opinions, and the influence of local guidelines and national legislation (elster, 1992; ham, 1997; lewin, 2007). methodology this study is based on a survey addressed to political decision-makers in six swedish municipalities. in order to pick out more homogenous and manageable units to work with, a selection was first made of municipalities with a population ranging from 20 000 to 65 000. this covered 95, or one-third of all municipalities in sweden. out of these 95 municipalities, six were then chosen on the basis of changes in expenditures in the period 2002-2004 for certain services (individual and family services, ifs) or cover ratios (care for the elderly and the disabled, ced). for the ifs, the focus was on child welfare and substance-abuse treatment. two municipalities were chosen for their increase of resources in these areas, and another two for their decrease (picked from the top-two versus bottom-two deciles of municipalities with respect to increased or decreased resources). a similar selection was made in eldercare, on the basis of an increase or reduction in the relative proportion of the elderly who were provided home care or special housing during the same period. a reason for this was to see to what extent allocative trends were reflected in the attitudes and desired priorities of the studied politicians during that period. finally, considerations of convenience were weighed in, on the basis of the distance to each municipality. of the municipalities finally chosen, one (representing increased coverage rate in eldercare) that originally had agreed to participate subsequently withdrew. the municipality originally chosen for the pilot study – östersund – was then added to make up the six. this municipality is situated in the same population range as the others and the only change made in the survey after the pilot was the removal of a number of questions. table 1 presents the general characteristics of the selected municipalities. njsr – nordic journal of social research vol. 3, 2012 5 table 1. participating municipalities. allocative trend, political majority, and population. municipality allocative trenda political majority population östersund no specific* socialist 59 000 avesta child welfare – eldercare +** conservative 22 000 sandviken eldercare – socialist 37 000 söderhamn substance abuse + child welfare +** socialist 26 000 sollefteå child welfare + socialist 21 000 borlänge substance abuse – socialist 47 000 a: = decreased resources; + = increased resources; *selected for pilot; ** not a criteria in the selection procedure at the time of the study, the greater part of swedish municipalities had a socialist majority. this was also the case for my selection, where only one of the six had a conservative majority. in relation to how the individual politicians responded to questions regarding allocative matters in their own municipality, one might expect those representing the minority to be less loyal with recent decisions and less in favour of existing practices of resource distribution. on the other hand, as aronsson (1999) points out, local politics are often characterized by more pragmatism and less confrontation than are national politics and many solutions are reached by consensus. participating politicians who received the questionnaire were selected from a number of defined boards – the municipal, the ced [care of the elderly and disabled], and the ifs [individuals and family services] boards. the invitation to participate was put to 207 politicians, of whom 191 responded to the questionnaire. most of the respondents answered the questionnaire during a regular board meeting, where the present researcher distributed it to them. respondents who did not participate at the board meeting received a questionnaire through the mail. this generated a response rate of 92 per cent. table 2 includes some facts on political affiliation, municipal board, and background. the socialist block comprises the left party, the social democrats, and the green party, and the conservative block the centre party, liberal party, moderate party, and christian democratic party. there were a few smaller, local parties, but these are not included in the political blocks displayed here. the socialist majority in the participating municipalities is well reflected in the distribution of the respondents, with more than 60 per cent belonging to this block. more than one-third were active in the municipal board, meaning that they – at least formally – were involved in more overarching allocative decisions and were supposed to be acquainted with the conditions in most areas. respondents from the more specialized boards can be expected to have a more narrow scope of interest and knowledge and, hypothetically, a stronger area bias. in this respect the ced board group may be depicted as the most specialized, since it only included ‘pure’ ced members, while the ifs board group was here a merger of ‘pure’ ifs boards and other social boards with a somewhat wider scope. njsr – nordic journal of social research vol. 3, 2012 6 table 2. participants (n = 185-191). political block (per cent) socialist 61 conservative 39 political board (per cent) municipal board 37 ifs board 30 ced board 33 gender (per cent) men 52 women 48 no of years in local politics (mean and std) 13 (std =10.4) age (mean and std) 53 (std =10.8) systematic comparisons between respondents from different political boards and different political blocks were carried out. finally, a logistic regression was employed in order to estimate the relationships between desired priorities and certain characteristics, with other factors under control. the dependent variables in the regression models were the politicians’ expressed priorities for groups that in a general manner may be targets for the social services (children, the elderly, the unemployed, and people with other social problems). the variable ‘unemployed’ was constructed out of one answer alternative to the question on what groups should be prioritized for investments for the future, while the other dependent variables were condensed from two answering alternatives. the variable ‘elderly’ was constructed from ‘elderly in general’ and ‘elderly over 80 years of age’, ‘social problems’ from ‘young people with social problems (including their families)’ and ‘grown-up people with other social and psychological problems’, and ‘children’ from ‘children and young people in general’ and ‘day-care children’. throughout the regression models the dependent variables were made dichotomous. the independent variables were the factors that after initial testing on a bivariate level were related to the dependent variables. the choice of independent variables involved tests on a broad range of variables – demographic characteristics; personal factors such as education, age, years in municipal politics, part-time or full-time as politician, usage or experience of childcare or eldercare, or both, financial support, other individual and family services or care of the physically or mentally disabled; to what extent the politicians felt they needed to make priorities; in what areas cutbacks should be made; perceived problems of conflicting demands and insufficient resources; and principles of distribution – all with no significant causalities. all independent variables except the scales covering principles of distribution are, with reference to scale, categorical in the models. tests of multicollinearity were also carried out. for a brief review of the independent variables, see table 3. njsr – nordic journal of social research vol. 3, 2012 7 table 3. independent variables. variable label comment gender woman/man children living in the home yes/no municipality östersund, avesta, sandviken, söderhamn, sollefteå, borlänge political block socialist/ conservative socialist block: left, social democratic and green party; conservative block: liberal, moderate, centre, and christian democratic party. board at municipal level ced (care of the elderly and disabled), ifs (individual and family services), municipal board the board composition differs between the municipalities. in the model i have screened out the ‘pure’ boards in order to be able to make regression models out of the different areas. involvement in increase of resources eldercare, care of the disabled, social assistance, child/youth welfare, measures for substance abusers the questionnaire had more items covering these areas; however, this number was cut down to fit the model. involvement in cutbacks of resources eldercare, care of the disabled, social assistance, child/youth welfare, measures for substance abusers as above, these areas were more numerous in the questionnaire, but were reduced to fit the model. allocative principle deservingness, need, economy, capacity to benefit scales based on three likert-scale items for each principle (added values ranging from 3-12 = no support – total support) results one of the questions raised was how local politicians would like to see future priorities made. in the survey, the respondents were asked to say for what client group they wanted the social services to exert more effort in the future, explicitly, to give top priority in relation to the existing distribution of resources. as mentioned above, we may expect a certain bias in favour of users or problem areas connected with the political board where the respondents operate. the distribution yielded in table 4 essentially confirms the existence of this kind of pattern, which is most visible for decision-makers within the ced board, which to a noticeably higher extent advocated increased priority for the elderly. politicians in the ifs board could be expected to vote for any of the remaining groups, since all fall within the ifs domain. the table shows, however, that their area-specific bias only involves children, a preference they share with ifs professionals (wörlén & bergmark, 2011). children were also the group with the overall highest support. the least priority was given to the category ‘people with social problems’, which is a merger of various client groups and social difficulties where family or youth problems (including youth delinquency, domestic violence, etc.) dominate. the unemployed, a group that also falls within the ifs domain, attracted the least support and no specific priority from the ifs politicians. njsr – nordic journal of social research vol. 3, 2012 8 table 4. group given first priority by political board. per cent. municipal board (n=70) ifs board (n=57) ced board (n=63) p* the elderly 14 10 43 .000 people with social problems 23 25 11 n.s. children 37 49 24 .015 the unemployed 16 14 14 n.s *pearson chi² table 5. group given first priority by political block. per cent socialist (n=114) conservative (n=71) p* the elderly 21 23 n.s. people with social problems 18 21 n.s. children 39 35 n.s. the unemployed 14 16 n.s. *pearson chi² table 5 displays how politicians from the two political blocks wished to prioritize different groups, and the results do not conform to how we may expect political ideology ought to interact with these priorities. thus, a hypothetical stance might be that conservatives may have a tendency to endorse the principle of deservingness – picking groups perceived to have no personal responsibility for their dependence – and thus advocate the needs of the elderly and of children to a higher extent than socialists would. no such pattern is visible, however. there are in fact no significant differences between the two political blocks at all. whether this is a result of negligible ideological differences or a sign that the question does not capture existing dissimilarities in this respect is not possible to say. local politics in sweden is, as already established, frequently depicted as more pragmatic and less ideological than national politics (aronsson, 1999). capturing the differences between the political blocks through their support for different allocative principles does, however, yield visible diversity related to political affiliation. in table 6 we find that the conservatives embraced the principles of economy and of capacity to benefit to a larger extent than the socialists did. if we look at this from a common-sense view of conservative ideology these outcomes may be perceived as expected, especially for the principle of economy, which corresponds with notions of individual responsibility and decreased public financing. we may also, but less evidently, regard the principle of capacity to benefit as congruent with a conservative agenda since an increased focus on measurable outcomes could also be used as an argument for both decreased public involvement and less resources for clients with a long history within the social services. njsr – nordic journal of social research vol. 3, 2012 9 table 6. support for allocative principles by political block. principle socialist (104-108) conservative (67-70) mean std mean std pª deservingness 8.87 1.83 6.66 2.21 .000 economy 5.21 1.77 7.01 1.75 .000 need 7.14 1.73 6.66 1.81 .080 capacity to benefit 5.54 1.56 7.00 1.82 .000 ª t-test a somewhat less anticipated outcome is that the socialists expressed relatively greater support for the principle of deservingness. the notion of negative incentive effects as a result of generous benefits or the idea that it is morally incorrect to support people who are not immaculate victims of external circumstances is definitely more associated with a conservative discourse than a socialist one. the principle that created the least disagreement was the principle of need, which attracted fairly high support from both blocks. besides politicians’ attitudes in relation to principles of distribution and desirable priorities, a majority have been involved in real allocative decisions that entailed cutbacks or added resources. in order to find out how these decisions were distributed over various areas we asked the respondents to report what they had been involved in during the past year. we also asked them to make distinctions between allocative decisions of a more general nature, those addressing an entire area, and those of a more detailed kind where specific activities were the object. table 7 presents how the answers were distributed for the politicians on the different boards. an expected result here was that the domains of the specialized boards would be reflected in these politicians’ allocative decisions and that the members of the municipal board would display the most variety in this respect. in general, it seems that the board-specific pattern is more distinct for added resources than for cutbacks. politicians active within a ced board were the ones most clearly concentrated on their own specific area. they also differed from the other boards by being involved in added resources and cutbacks to the same extent. one reason for this pattern might be that a rapidly ageing population makes this an area where demand has increased more than elsewhere and that this demand has to be met by the reallocation of resources. it is important, however, to be aware that table 7 by no means offers an economic balance sheet of some sort or a manifestation of actual priorities, since we have no information on how big the added or decreased resources were in monetary terms, or how large the user groups were that were involved. the fact that cutbacks on the whole are less common than increases could also be an effect of decision-makers’ reluctance to label their actions as ‘rationing’ or ‘cutbacks’ (bergmark, 1997). alternatively, it could also mean that the data had been collected in a period of improved finances. njsr – nordic journal of social research vol. 3, 2012 10 table 7. added resources and cutbacks by political board. per cent. municipal board (n=70) ifs board (n=56) ced board (n=61) p* added resources to: eldercare in general 33 9 28 .005 eldercare – certain services 24 11 49 .000 care of the disabled in general 17 9 8 n.s care of the disabled – certain services 23 7 21 .047 social assistance in general 19 9 0 .002 social assistance – certain services 7 11 2 n.s. child and youth welfare in general 33 27 8 .003 child and youth welfare – certain services 31 54 8 .000 substance abuse care in general 24 7 2 .000 substance abuse care – certain services 16 36 3 .000 mean 22.7 18.0 12.9 cutbacks of resources in: eldercare in general 26 13 36 .018 eldercare – certain services 30 18 34 n.s. care of the disabled in general 13 2 13 .063 care of the disabled – certain services 6 2 18 .005 social assistance in general 10 11 4 n.s social assistance – certain services 9 9 10 n.s child and youth welfare in general 7 11 2 n.s child and youth welfare – certain services 7 13 5 n.s substance-abuse care in general 9 16 5 n.s substance-abuse care – certain services 16 13 3 .054 mean 13.3 8.8 13.0 *pearson chi² in table 8 we return to desired priorities. this study took the analysis a step further by utilizing logistic regression models. four different models were developed, each one with a group selected for priority as a dichotomous dependent variable, as shown in tables 4 and 5. independent variables were selected in a two-step process, where variables unrelated on a bivariate level were rejected together with variables with a highly uneven distribution. (for further information on the variables included, see the method section above.) factors such as family composition, age, time in local politics or personal experience of using certain social services did not establish any connections with desired priorities. njsr – nordic journal of social research vol. 3, 2012 11 table 8. groups picked to receive first priority. logistic regression (n=180) elderly r2 a = .359 social problems r2=.321 children r2=.282 unemployed r2=.303 or pb or p or p or p gender: male (ref) 1.00 1.00 1.00 1.00 female 0.32 .038 0.71 .479 0.72 .378 4.78 .007 children in family: yes (ref) 1.00 1.00 1.00 1.00 no 2.06 .221 0.43 .109 1.93 .141 0.46 .212 university education: yes (ref) 1.00 1.00 1.00 1.00 1.00 no 0.43 .642 1.25 .655 0.82 .622 2.05 .212 municipality: östersund (ref) 1.00 1.00 1.00 1.00 avesta 2.29 .465 65.41 .018 0.19 .049 0.34 .414 sandviken 2.25 .324 6.02 .251 0.36 .138 0.74 .778 söderhamn 1.05 .959 6.04 .260 0.62 .539 0.39 .418 sollefteå 1.78 .549 19.39 .072 0.59 .500 0.47 .514 borlänge 0.97 .975 19.22 .069 0.23 .047 1.71 .595 political block: socialist (ref) 1.00 1.00 1.00 1.00 conservative 0.52 .297 4.03 .042 1.31 .577 0.78 .722 board at municipal level: ced (ref) 1.00 1.00 1.00 1.00 ifs 0.13 .036 0.89 .895 5.23 .017 0.73 .746 municipal board involved in increasing resources in : (ref=not involved) 0.18 .012 1.01 .986 2.74 .075 1.60 .530 eldercare 2.61 .081 1.20 .738 0.82 .655 1.13 .849 care of the disabled 2.45 .112 0.47 .244 1.21 .675 2.40 .234 social assistance 0.43 .483 10.43 .003 1.16 .807 5.60 .016 child/youth welfare 1.44 .569 1.41 .581 3.54 .008 5.21 .054 measures for substance abusers 0.19 .049 0.28 .078 1.04 .932 0.21 .028 involved in cutbacks in: (ref=not involved) eldercare 0.48 .153 0.44 .147 2.58 .033 1.95 .250 care of the disabled 2.45 .197 1.06 .948 2.26 .161 9.41 .066 social assistance 0.46 .372 2.99 .106 0.50 .210 0.93 .928 child/youth welfare 0.81 .824 0.16 .053 0.78 .688 0.39 .274 measures for substance abusers 1.27 .777 4.37 .029 0.46 .150 0.82 .798 allocative principle: -of deservingness 1.31 .078 1.11 .465 0.71 .048 1.04 .794 -of need 1.09 .513 1.05 .673 0.91 .366 0.99 .923 -of economy 0.98 .939 0.87 .341 1.06 .594 1.12 .514 -of capacity to benefit 1.01 .951 0.73 .076 1.09 .518 1.11 .566 a: nagelkerke; b: p< 0.05 in bold, p<0.10 in italics njsr – nordic journal of social research vol. 3, 2012 12 of the three variables capturing personal background, only gender established significant connections with the prioritized groups. male politicians showed a higher inclination to see to the interests of the elderly, while females tended to support the unemployed to a higher extent. there are no obvious reasons why this pattern emerged. if anything, a more stereotypically gendered pattern would have suggested the opposite, with eldercare as a ‘caring’ and feminine arena and the labour market as a more masculine one; however, such an outcome was not present. somewhat unanticipated also is the fact that politicians from the conservative block showed a tendency to advocate an increased focus on people with social problems. one reason for this may be that many answers within this category involve youth problems with respect to youth delinquency and that ‘law and order’ by tradition is a conservative key issue. a more expected outcome was found for different boards, where the area bias found in table 4, which was most visible for the ced politicians, remains in the multivariate models here. among the municipalities, the politicians from avesta stand out, with significant outcomes for two of the groups. avesta was the only conservativegoverned municipality in the selection, and was selected owing to its having decreased resources in child welfare (see table 1). in table 8 we can see that children were given low support from avesta politicians, which means that there is a certain match between attitudes and allocative trend in this municipality. this is, however, the only case where this kind of match can be identified. the politicians in avesta also gave relatively low priority to social problems. this has no connection to any visible allocative trend, however. as we can see in the table, there were similar tendencies for sollefteå and borlänge. in the models this study also used previous experience of increased and decreased resources as independent variables (as they were presented in table 7, but with ‘in general’ and ‘certain actions’ merged together). a number of the significant relationships that were established here may be depicted as logical with respect to how previous decisions and attitudes go together. one example is that those involved in decisions on increased resources for social assistance also displayed an inclination to advocate priority for the unemployed and for people with social problems. a similar connection was found for child and youth welfare and children. the negative connection between increased resources in the area of substance abuse and priority to the elderly and the unemployed is less explicable, as are the outcomes for cutbacks. considering the allocative principles presented earlier, we can note here that the model displays rather frail relations. however, respondents in support of ‘the principle of deservingness’ are less in favour of prioritizing children and slightly more in favour of the elderly. both of these client groups are by tradition the ones who receive the most support when professionals or political decision-makers are asked to pick a group to give priority to (bergmark, 1995; wörlén, 2010). the only other allocative principle establishing a relation is ‘the principle of capacity to benefit’, showing tendencies of being embraced by politicians who give less priority to people with ‘social problems’. this group consists of clients with possibly less solvable problems and restricted opportunities to benefit from interventions. njsr – nordic journal of social research vol. 3, 2012 13 discussion how predictable, then, is the expressed priority-making of local political decision-makers? to what extent does information on personal background, political affiliation, area of responsibility, and so forth, tell us anything about their preferences and inclinations to support certain groups or activities? the general impression from the results presented here is that it is hard to detect clear-cut patterns of circumstances that guide the judgements in any one direction. the most noticeable exception to this is what is referred to above as area bias, that is, the tendency to prioritize clients and activities within one’s own area of responsibility. this outcome is, of course, anything but unexpected. nor is the fact that ced politicians seem to be the most visible representatives for such a bias, since the users within their domain are less heterogeneous compared to the wider array of client groups sorting under other boards. to sum up, one might have expected more clear-cut divergences between the political blocks, considering the basis of party political ideologies and their positions. the results, however, show that political affiliation overall is not a determining factor. this confirms findings from previous research, where political issues and decisions on a local level have been shown to be more pragmatic and close to everyday life than is decision-making at the national level, or at least this seems to be the general outcome for prioritized groups. yet in relation to allocative principles political colour seems to matter. conservative politicians, as expected, agreed with the principles of economy and of capacity to benefit, while socialists, less expectedly, embrace the principle of deservingness. all these principles seem to be quite loosely connected to desired priorities, however. accordingly, political affiliation seems to have an impact on more general beliefs but less on a micro-level, where different client groups are put up against each other. the selection of municipalities for the study was based on recent allocative trends in different social-services sectors. an underlying assumption was that these trends should somehow correspond to expressed priorities. as actors within a local context, politicians can be expected to be either positive or negative to prevailing changes in resource distribution. the data in this study do not, however, support these kinds of relationships in any direction. in only one of the six municipalities did the allocative trend (decreased resources to child welfare) coincide with expressed priorities (a relatively low priority to children). overall it seems that the decision-makers’ opinions are only very weakly related (if at all) to local standards or local development. is the allocative profile created in a certain municipality, then, independent of basic values and political will? the nature of the data collected here does not allow any definite answer to that question. resource allocation within local politics is a multifaceted activity where numerous interests are involved. in their capacity as those responsible for forming local policy the politicians have to be actively oriented towards professionals within the social-services organizations, local opinion, clients, and other stakeholders. this interaction may be more or less direct but overall it makes political decisions diffuse and rather hard to follow. in practice, local politics surpass the direct implementation of political programmes or compromises between political blocks. the views of the political decision-makers are normally intertwined with a layer of conflicting or alternative perspectives and the outcome of these processes are normally not easy to predict. njsr – nordic journal of social research vol. 3, 2012 14 acknowledgements the author gratefully acknowledges financial support from the swedish council for working life and social research: grant 2004-0401. bibliography aronsson, p. 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(2001). inequality in the welfare state? local variation in care of the elderly the case of sweden. international journal of social welfare, 10(3), 174-184. wallentin, h. (1988). värdiga och ovärdiga i socialpolitiken [the worthy and the unworthy in social policy]. in a. ronnby (ed.), etik och idéhistoria i socialt arbete [ethics and the history of ideas in social work]. stockholm: socionomen förlag. wörlén, m. (2010). att prioritera i socialtjänsten – om kommunalt handlingsutrymme och beslutsfattande [priorities in the social services. autonomy in action and decision making in swedish municipalities]. socialvetenskaplig tidskrift, 17(1) 28-45. wörlén, m., & bergmark, å. (2011). priorities and determinants of priorities of swedish social workers. european journal of social work. published online 26 sept 2011, 0-19. microsoft word 516_thun_proof.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 inclusive and women-friendly in a time of diversity? the scandinavian citizenship regime – the ‘childcare lesson’1 cecilie thun department of early childhood education oslo and akershus university college of applied sciences email: cecilie.thun@hioa.no abstract in this article, i ask: is the scandinavian citizenship regime inclusive and women-friendly in a time of diversity? i approach this question by addressing the intersection of gender and ethnicity in relation to social citizenship with the main concern being childcare. i emphasize norway as a case but also see norway in comparison with sweden and denmark. in comparative studies, the scandinavian citizenship regime is presented as being the most ‘womenfriendly’. however, faced with an increasingly multicultural population, a pertinent question is whether this citizenship model is able to accommodate diversity. i explore two tensions that are basic to the inclusiveness and women-friendliness of the scandinavian citizenship regime in diverse societies: 1) the tension between principles of gender equality and cultural diversity, and 2) the tension between liberating and controlling aspects of the welfare state. this article discusses the norwegian family policy ‘hybrid’, which combines dual-earner support with traditional breadwinner elements. one might say that the norwegian family ‘hybrid’ can be a solution to the tension between, on the one hand, a specific gender-equality family norm, and, on the other hand, the respect for other family norms. however, i argue that there is a double standard with regard to minority women, and it can be understood in light of a discourse about norwegianness. parental choice is considered a good thing – as long as the mother in question is considered ‘fully’ norwegian. however, assumed cultural and ethnic differences – often 1 this article is based on my trial lecture for the degree of phd in political science, which was held on october 24, 2013 at the university of oslo. njsr – nordic journal of social research vol. 6, 2015 2 based on stereotypical collective categories of difference – are used as boundary-markers between the majority and minorities. i conclude that, despite variations, all the scandinavian countries grapple with the same tensions, and that there is a scandinavian double standard regarding minority women. keywords: scandinavian citizenship regime, social citizenship, child care, norwegianness, minority women introduction in comparative studies of citizenship regimes, the scandinavian citizenship regime is presented as the most ‘women-friendly’ (lister et al., 2007; sümer, 2009).2 the contemporary scandinavian citizenship regime is known for women-friendly politics, including affordable day care and paid parental leave. nevertheless, some researchers have argued that immigrants and ethnic minorities pose a challenge to gendered citizenship in norway and other scandinavian countries (lister et al., 2007; lister, 2009). today, the burning question is how to include immigrants in the national community and the welfare state. in this article, i ask: is the scandinavian citizenship regime inclusive and women-friendly in a time of diversity? a central concern is which women benefit from a women-friendly welfare state, and this is of importance regarding the inclusion of minority women. i shall approach this question by addressing the intersection of gender and ethnicity in relation to social citizenship – and my main concern is childcare. research on welfare-state regimes often emphasizes either a gender perspective or a minority perspective. my aim is to combine these two perspectives. norway is the main focus in this article, but i shall also briefly make comparisons with sweden and denmark. 2 citizenship is translated into norwegian and used in in different ways. cathrine holst (2002), with reference to helga hernes (1998), defines the term medborgerskap as ‘the rights and duties that a citizen has, both in relation to the state and between citizens’ (hernes 1998, 85, cited in holst 2002, 62, my translation). njsr – nordic journal of social research vol. 6, 2015 3 first, i shall take a closer look at social citizenship within the scandinavian citizenship regime. the idea of social citizenship is highly valued in the scandinavian tradition, and universalist social policies usually have been regarded as beneficial for working mothers and their children (siim, 2000, p. 122). nevertheless, there have been two different political lines concerning childcare: an expansion of childcare centres (the left) and an increase in support to women caring for children at home (the right) (skjeie, 1992, in siim, 2000, p. 134-135). however, the issue of childcare has reappeared in the debate about the integration of ethnic minority women. in this article, i shall outline two tensions that are basic to the inclusiveness and women-friendliness of an increasingly multicultural norway: 1) the tension between principles of gender equality and cultural diversity, and 2) the tension between liberating and controlling aspects of the welfare state. these tensions will be thoroughly described, and i shall discuss whether the case of childcare – and especially the debate about ‘cash for care’ – sets up a double standard regarding ethnic minority women. social citizenship in scandinavia in his famous book, class, citizenship and social development, t. h. marshall (1965) expanded the liberal concept of citizenship beyond civil and political rights to include social rights. marshall defined modern citizenship in 1950 as ‘full membership of community’ (marshall, 1965, p. 76). in addition to civil (the rights necessary for individual freedom) and political (the right to participate in the exercise of political power) rights, marshall also introduced social citizenship, including economic equality and security (marshall, 1965, p. 78). social citizenship can be defined as ‘the nexus of rights and responsibilities underpinning individuals’ welfare (…)’ (lister et al., 2007, p. 3). in the following, i shall take a closer look at the case of childcare in the scandinavian welfare states. the provision of state childcare is an essential part of social citizenship precisely because it offers parents, especially mothers, the opportunity to combine parenthood, paid work, and political participation. nevertheless, the case of childcare also brings out the two tensions previously mentioned: the tension between njsr – nordic journal of social research vol. 6, 2015 4 principles of gender equality and cultural diversity – as well as the tension between liberating and controlling aspects of the welfare state. the scandinavian citizenship regimes3 are known to have the most generous social citizenship rights. they are universal rights. however, social rights have not been gender neutral. the citizen-worker was framed as a male worker, whereas the citizen-mother was protected and supported by a paternalistic state (hernes, 1987, p. 140). in the 1970s and 1980s, social and cultural changes were taking place in scandinavia. these were partly due to economic development, partly because of the mobilized women’s movement, and partly because of government policies (hernes, 1987, p. 140). helga hernes has called this development ‘the story of “reproduction going public”– the way in which advanced nordic welfare states, through their politics, have “pulled” women into the public sphere, and how women have begun to “push” developments in accordance with their own interests’ (hernes, 1987, p. 9). scandinavian citizenship and women-friendliness in 1982, helga hernes outlined a potential possibility for a womenfriendly polity in the scandinavian countries. according to hernes, ‘a woman-friendly state would enable women to have a natural relationship to their children, their work, and public life’ (hernes 1982, pp. 32-40). hernes coined the term ‘state feminism’ – the interplay between women’s mobilization ‘from below’ and political integration ‘from above’. the mobilization of women from the 1960s and 1970s onwards challenged the public-private divide. the ‘new’ feminist movement at that time claimed that ‘the personal is political’ – and in scandinavia, the private and the public mixed when the welfare state expanded their responsibility for reproductive tasks. they thereby strengthened their women-friendly potential (borchorst, 2006, p. 115, with reference to hernes, 1987; siim, 2000). state feminism resulted in a specific gender regime ‘founded on high levels of education and labour participation, extensive public care, relatively generous maternity/paternity politics, a comparatively strong gender equality 3 the scandinavian countries – norway, sweden and denmark – are usually grouped together, sometimes also with the other nordic countries (iceland and finland) (lister et al., 2007, p. 24). the concept ‘regime’ is used to group countries together based on certain commonalities in ‘institutional patterns and policy logics’ (lister et al., 2007, p. 2). njsr – nordic journal of social research vol. 6, 2015 5 legislation, plus high levels of political participation and inclusion into state political institutions (…)’ (siim & skjeie 2008. p. 323). this link between political and social citizenship together with welfare politics is a central feature of a women-friendly state, and the combination of political and social citizenship – for both men and women – has been a distinguishing aspect of the scandinavian citizenship regime (hernes, 1987). this is partly why the scandinavian states have been perceived as friendlier than states in other citizenship regimes. moreover, there is a positive perception of active citizenship that is founded on social movements. according to helga hernes (1987), scandinavian citizenship was in fact constructed ‘from below’. it was based on an ‘activist, participatory and egalitarian ideal’ (hernes, 1987, p. 139). thus, the scandinavian citizenship regime has emphasized both citizens’ political participation and their social welfare. in other words, there has been a combination of political and social citizenship, which has been an important aspect concerning the tension between liberating and controlling aspects of the welfare state. in norway, the women’s movement fought for state-sponsored childcare in the 1970s, and women’s political inclusion led to an expansion of childcare facilities (skjeie, 1992, in siim, 2000, p. 133). hence, welfare reforms have been initiated from below and have been part of women’s liberation. in anne-lise ellingsæter and arnlaug leira’s words (2006), ‘[t]he scandinavian welfare states pioneered the transformation of parenthood into political issues’ (ellingsæter & leira, 2006, p. 2). since the 1970s, gender equality has been an important part of the scandinavian citizenship regime. the politicization of parenthood and gender equality were closely linked. in particular, the care of young children has been central to the promotion of gender equality in order to improve opportunities for working motherhood and caring fatherhood (ellingsæter & leira, 2006, pp. 6-7). thus, the boundaries between the public sphere and the private sphere have been negotiated and altered several times over the years. the scandinavian welfare states have adjusted politics according to women’s changing needs, and welfare-state intervention in gender and family arrangements has been accepted, or even expected, according to leira (2002). as an example, mothers entered the labour market in the 1960s and 70s before generous state sponsoring of services and benefits for childcare came into being (leira, 2006, p. 33). parental responsibility for children’s care has njsr – nordic journal of social research vol. 6, 2015 6 been translated into social rights of mothers and fathers, and public services for childcare have been made universally available (leira, 2006, pp. 28, 31). gøsta esping-andersen (1999) has called the scandinavian parenthood and childcare politics and policies ‘defamilization’. according to esping-andersen, ‘social democracies differ from liberal and conservative welfare states in providing more services and benefits for families and households, and therefore in lessening the burdens on families’ (esping-andersen cited in leira, 2006, p. 27). however, according to leira (2006), scandinavian parenthood policies since the early 1970s have also been characterized by ‘refamilization’ – not only ‘defamilization’(p. 28). these policies offer parents long periods of parental leave. thus, the welfare state has promoted the caring father as the companion of the working mother. moreover, the dual-earner / dual-carer family model has set new standards for gender relations in families with young children (ellingsæter & leira, 2006, p. 7). leira (2006) describes two different family models: 1) the dual-earner / dual-carer family is characterized by an egalitarian partnership between mothers and fathers. there are public policies for childcare. state-sponsored childcare and paid parental leave advances care-sharing parenthood. this is the family model that came to dominate scandinavian parenthood politics in the latter half of the 20th century. however, there is political disagreement over this model. the social democrats and parties to the left have supported the dual-earner / dual-carer family, whereas the centre and right have been the main supporters of more traditional family forms. 2) the gender-differentiated family model presumes a specialization of parental roles. there is a gendered division of labour. women are responsible for childcare and men provide for the family. this model is also called the male-breadwinner / female-carer family. cash benefits for parental childcare (called kontantstøtte in norwegian) assume a main breadwinner who is not the carer. thus, cash benefits for childcare – also called ‘cash for care’ – are generally interpreted as furthering a traditional genderdifferentiated family model. (p. 29) njsr – nordic journal of social research vol. 6, 2015 7 since the early 1990s, the scandinavian welfare states have pursued wide-ranging parenthood policy reforms. policy innovations like the ‘father quota’ have been introduced, parental leave has been prolonged, and childcare services are approaching universal coverage (ellingsæter & leira, 2006, pp. 265-266). scandinavian work-family policies thus support working motherhood and caring fatherhood. however, the ideal of the combined dual-earner / dual-carer model is only partially realized (ellingsæter & leira, 2006, 267-268). there are still gendered norms concerning childcare and different images of ‘good motherhood’ and ‘good fatherhood’. also, gender-neutral parental leave schemes serve to reproduce gender inequality in the care of young children, confirming mothers as the primary carer, since fathers generally have better-paid jobs (leira, 2006, pp. 45-46). scandinavia is rightly characterized as a situation of ‘gender equality light’ (rønsen & skrede, 2006). also important to notice are the changes in the gender-equality profile in parenthood policies over time, following various political shifts in the scandinavian governments (ellingsæter & leira 2006, p. 266). therefore, the public-private mix is not a given. gender equality does not necessarily mean the same thing for everyone, and it is up for political debate.4 scandinavian welfare states in diverse societies in her seminal book, helga hernes stated that ‘[a women-friendly state] would be, in short, a state where injustice on the basis of gender would largely be eliminated without an increase in other forms of inequality, such as among groups of women’ (hernes, 1987, p. 15, my italics). the scandinavian citizenship regime described by hernes has since been criticized because it is based on the assumption of an ethnic homogenous community (holst, 2002). since the 1980s, the scandinavian countries have become more ethnically diversified. post-colonial feminists have criticized the notion of ‘womenfriendliness’ (mulinari et al., 2009) and claimed that it hides the diversity between women of different races and ethnicities (de los reyes et al., 2003, cited in siim, 2009, p. 151). the post-colonial 4 a recent example is the present government in norway, which has reduced the father’s quota from 14 to 10 weeks. erna solberg’s government was elected in 2013 and represents the conservative party and the progress party. njsr – nordic journal of social research vol. 6, 2015 8 critique, mainly from sweden, has asked whether hernes’ vision of women-friendly societies is based on the living conditions of white middle-class women and excludes minority women. moreover, research from sweden shows that migrant women experience a strong ambivalence in the relationship with the welfare state owing to experiences of gendered racism (mulinari, 2009). as mentioned in the introduction, a central concern is which women benefit from a womenfriendly welfare state, and this is of importance regarding the inclusion of minority women. in their book the limits of welfare. immigration policies and welfare state in scandinavia 1945-2010, brochmann and hagelund (2010) have called the development of a universal norwegian welfare state both an integration project and nation-building project. the notion of ‘integration’ then refers to the inclusion of all social classes in one national community (brochmann & hagelund, 2010, p. 20). economic redistribution and the idea that economic equalizing contributes to integration and solidarity are central elements in this citizenship model. national identity and solidarity have both been conditions for, and consequences of, the development of the welfare state. the notion of ‘integration’, however, was reintroduced in a new version when norway began to face increased immigration from the late 1960s onwards. since then, the problem of adhesion in a multicultural society has been increasingly articulated (brochmann & hagelund, 2010, p. 23). in the 2000s, the ‘glue’ was defined as basic values in society: human rights and gender equality. 5 ethnic minorities are offered rights and cultural tolerance in exchange for accepting these basic values (brochmann & hagelund, 2010). the welfare system has provided an important framework for the incorporation of immigrants and refugees into scandinavia (olwig, 2012, p. 2). however, when facing an increasingly diverse population with regard to ethnicity and religion, the scandinavian citizenship regime grapples with the tensions described at the beginning of this article: the tension between principles of gender equality and cultural diversity – as well as the tension between liberating and controlling aspects of the scandinavian welfare state. olwig (2012) points to efforts to assist immigrants to become equal members of society, which are positive aspects of the universal welfare state (p. 6). 5 from st. meld nr. 49 (2003-2004) mangfold gjennom inkludering og deltagelse. [white paper no. 49 (2003-2004) diversity through inclusion and participation] (brochmann and hagelund 2010:262). njsr – nordic journal of social research vol. 6, 2015 9 however, despite good intentions, the scandinavian welfare societies’ integration projects also have problematic aspects. these aspects include ‘active intervention in the private lives of refugees and immigrants by professionals within scandinavian welfare system seeking to shape these population groups – socially, culturally, physically and psychologically – according to scandinavian norms’ (olwig, 2012, p. 6). moreover, as olwig (2012) notices, the term ‘integration’ does not just denote participation in, for example, employment and education. ‘the term integration has become a powerful notion, designating who belongs – and by implication who does not belong – in society’ (olwig, 2012, p. 2). in the norwegian context, ‘being integrated’ indicates that you have ‘become fully norwegian’, not only legally, but also concerning identity and belonging (informal membership criteria). in multicultural societies, negotiations of informal membership aspects – in addition to formal membership criteria – become important because they include recognition or misrecognition of various identities and belongings within the notion of norwegianness (thun, 2013). being a legal citizen is in norwegian called statsborgerskap, which is a formal membership. however, being a norwegian also includes an informal membership, which is what brochmann (2002) calls the social dimension of citizenship, or medborgerskap in norwegian (p. 59). this social dimension is about ‘being a part of society’, which often means being part of the nation. it is about ‘identity, loyalty, belonging, trust and participation’ (brochmann, 2002, p. 59, my translation). negotiations of informal membership, which take place in the intersection between gender, ethnicity and religion, result in symbolic as well as institutionalized boundaries between the majority and minorities (thun, 2013). a recent thesis on majority and minority women’s political citizenship found that categories of differences – like gender, ethnicity, and religion – intersect and lead to inclusion within or exclusion from norwegianness, or both, have consequences for opportunities for political citizenship. thus, a narrow and exclusive norwegianness makes it harder for those defined as ‘not fully norwegian’ to participate politically (thun, 2013). in the following, i shall discuss whether the case of childcare – and especially the debate about ‘cash for care’ – brings up the issue of norwegianness and a double standard regarding ethnic minority women. njsr – nordic journal of social research vol. 6, 2015 10 the case of care politics / childcare: norwegian ambiguity the norwegian childcare model combines dual-earner support with traditional breadwinner elements. state-sponsored childcare (barnehage) and paid parental leave advances care-sharing parenthood, but cash transfers to families are more in line with a traditional gender-differentiated family model. thus, norway is described as ‘a family policy “hybrid”’ (ellingsæter, 2006, p. 121). seen in light of the hegemony of the dual-earner / dual-carer family model and a strong norm of gender equality in scandinavia, this ‘family model hybrid’ is called the norwegian ‘ambivalence’ or ‘doubletrack’ (leira, 2006). it has also been called the norwegian ‘puzzle’ (sainsbury, 2001). one might say that the norwegian family ‘hybrid’ can be a solution to the tension between, on the one hand, a specific gender-equality family norm, and, on the other hand, the respect for other family norms. the norwegian childcare scheme actually provides two different models of motherhood of young children: first, it provides working motherhood through state-sponsored childcare (barnehage), in combination with parental leave, which supports the dual-earner / dual carer family. secondly, it provides the stay-at-home mom, at least when the children are under the age of two, through cash-for-care benefits (kontantstøtte), which is in line with a gender-differentiated family model. thus, families can choose according to their own family values, and the emphasis on choice or the freedom to choose has been stressed by the non-socialist parties in particular. however, there seems to be a hidden premise behind this ‘parental-choice’ argument. one might ask if the mother making the choice to stay at home with young children better be an ethnic majority woman. one example that illustrates this point is the discussion about cashfor-care benefits in norway. this debate brings out political disagreements regarding childcare – and gender equality. in her analyses of the political debate since 1998 concerning cash-for-care benefits, irene hovde (2010) identifies three main frames: 1) genderequality frame, 2) freedom of the family frame, and lastly 3) public childcare services (barnehage) as necessary care for vulnerable children (utsatte barn). in the political debate, ethnic minorities were njsr – nordic journal of social research vol. 6, 2015 11 only mentioned with regard to the third frame concerning ‘vulnerable children’ (p. 79). the cash-for-care debate indicates a double standard: the same action – receiving cash for care – is interpreted differently depending on whether the person involved is assumed to belong to the ethnic majority or an ethnic minority. cash for care is interpreted as an individual choice – and a symbol of freedom for the family – when it is discussed in relation to the ethnic majority. however, in relation to minority women, cash for care is interpreted as an obstacle for helping vulnerable children. hence, public childcare services are seen as a positive measure to help minority children. an ethnic majority woman who receives cash-for-care benefits and stays as home with her children may be seen as less gender equal than those women who work and choose childcare services. nevertheless, her decision is seen as her autonomous choice, and not determined by her culture. contrary to this, an ethnic minority woman who receives cash for care is likely to be understood as not having freely considered this option. she is rather seen as choosing it owing to different family norms and values in her culture. in addition, her culture is usually seen as less gender equal. the case of childcare – and this example of cash for care – exemplifies a discourse about differences in norwegian society today. the norwegian ambivalence regarding childcare – the dual track with both elements of the dual-earner / dual-carer family model and the gender-differentiated family model – is not new. however, it is not developed and implemented in order to accommodate more traditional gender roles in ethnic minority families. rather, it is a result of different views on motherhood and care within the majority population. according to lister (2009), this is a distinctive equal-opportunity strategy, which grafts the right to make a claim at the basis of difference onto a policy based on equal treatment (p. 249). earlier, the discussion of gender difference versus sameness had brought up differences concerning class. today, the discussion is framed differently when ethnic minorities are also part of the picture. what is new in the present discussion of childcare in regard to ethnic minorities is that the question of cultural and religious differences has become pertinent. and that is an entirely different discourse which concerns whom we consider to be fully members of the norwegian society. njsr – nordic journal of social research vol. 6, 2015 12 this double standard brings up the issue of norwegianness. i would argue that this is a key to understanding this double standard. the concept norwegianness refers to identity and belonging as an informal aspect of citizenship (thun, 2013). identity and belonging are not about formal, legal citizenship status, which of course is important. this informal dimension of citizenship is about ‘being a part of society’, which often means being part of the nation or the ‘imagined community’ in benedict anderson’s (1991) words. the notion of norwegianness is central because it addresses negotiations regarding whom we consider full members of the norwegian society. it refers both to personal feelings of self-identification and to recognition and inclusion in the national norwegian community. in the case of social citizenship and childcare, this discourse about norwegianness is evident. decisions and choices are understood differently depending on whether one is considered to be ‘fully’ norwegian or not. parental choice is considered a good thing – as long as the mother in question is considered ‘fully’ norwegian. however, assumed cultural, ethnic, and religious differences – often based on stereotypical collective categories of difference – are used as boundary-markers between the majority and minorities. this brings me over to the second tension, namely the tension between liberating and controlling aspects of the welfare state. for many mothers, both majority and minority, state-sponsored highquality childcare makes it possible to have a paid job and to be economically self-sufficient. thus, the welfare system is empowering for many women. integrating immigrant and minority women in the labour market has been a long-standing issue on the policy agenda and a political goal in norway (oecd, 2009a). one important determinant of immigrant women’s labour-market participation is the presence of children in the household. a recent oecd report advises that norway abolish the ‘cash-for-care’ subsidy since it hampers the labour-market integration of immigrant women (oecd, 2009a). the amount saved through the abolition of the subsidy should be used to create more places in formal institutions in those parts of the country where there are still shortages. this would be a win-win situation; minority women can enter the labour market and their children would especially benefit from more participation in kindergarten (barnehage) before the age of four. njsr – nordic journal of social research vol. 6, 2015 13 the incentives to send young children to kindergarten are furthermore increased by the fact that there is a maximum fee on day care generally. in addition, the government is funding so-called ‘free core time in day-care centres’ for all fourand five-year-olds in areas with a high proportion of immigrant children (oecd, 2009b). these childcare schemes are based on good intentions – and they facilitate the liberating and inclusive aspect of social citizenship in caring welfare states. however, the welfare state can be also described as janus-faced, which means that welfare politics, including childcare policies, also include elements of control, and even discrimination (melby et al., 2009, p. 15). childcare policies can mean empowerment and inclusion of some women, and marginalization and exclusion of other women (melby et al., 2009). on the basis of the examples previously mentioned, one can argue that the aspects of control are present concerning minority women. the importance of paid work (arbeidslinja) is highly emphasized in norway. this is particularly evident when it comes to minority women. state funding of ‘free core time in day-care centres’ is an illustration of the state’s encouragement of minority mothers’ participation in the labour market. according to the recent white paper on comprehensive integration policy (2012-2013), ‘[e]mployment is the key to participation, financial independence and equality. (…) participation in working life is the key to achieving equality between women and men’ (pp. 4-5). however, the double standard concerning cash for care indicates a paradox where minority women may experience stronger pressure from the majority society when it comes to labour-market participation. they need to prove that they are gender equal – even more gender equal than the majority population. this has a parallel to research on the muslim women in norway, where gender equality is associated with norwegianness, who constantly have to prove that they are not like the stereotypical ‘muslim woman’ (thun, 2012). a quick glance at sweden and denmark as previously described, there are many similarities between the scandinavian countries. they are grouped together in the notion of the scandinavian citizenship regime; however, it is interesting to compare norway, denmark, and sweden. differences between these njsr – nordic journal of social research vol. 6, 2015 14 countries have inspired the paradoxical claim that the scandinavian model is a model with three exceptions (brochmann & hagelund 2010). there are also national differences with regard to childcare policies, which i shall now briefly address (leira, 2006, pp. 43-44). sweden has been at the forefront with respect to parental leave and strong support for fathers as carers, as well as childcare services supporting working motherhood. thus, sweden has been closest to supporting the dual-earner / dual-carer family model. sweden did introduce a cash-for-care benefit in 2008. however, unlike norway, sweden leaves it up to the municipalities whether or not to offer cashfor-care benefits. one in three municipalities offers it (ellingsæter, 2012). another difference is the timing of when this cash benefit was introduced. in 2008, sweden already had good coverage of institutions for child day care. thus, the proportion of parents who receive the benefit is very low. when norway introduced cash for care in 1998, the coverage of childcare services for children under three was very low. despite the national differences, the characteristics of those who do receive cash-for-care benefit are quite similar in the two countries: most of them are mothers, and most of them have low income and low education. women with immigrant backgrounds are overrepresented among the recipients. in sweden, immigrant mothers have a much lower employment rate, and the cash-for-care benefit is considered a ‘trap’ (ellingsæter, 2012). denmark does not have cash-for-care benefits. municipalities may offer it, but it is very marginal and cannot be compared to the norwegian scheme.6 denmark has had a strong support for working motherhood through state-sponsored childcare. however, policy for support of fathers as carers has been the weakest in scandinavia, and parental leave is premised on mothers’ responsibility for small children (borchorst, 2006). the integration of women in the labour force has been central to governmental policies since the 1970s, and public childcare facilities were expanded drastically. the father’s leave was abolished shortly after it was introduced in the early 2000s. this debate addressed the public-private split, and father’s leave was argued to be an invasion of people’s privacy. however, as borchorst (2006) notices, family regulations have been introduced, for instance, 6 thanks to anne-lise ellingsæter for providing updated information about the cash-for-care benefits in the sweden and denmark. njsr – nordic journal of social research vol. 6, 2015 15 by setting an age limit for marriage between danish citizens and noncitizens. according to borchorst (2006), gender equality is strong as an informal norm in denmark, but weak as an explicit policy norm (p. 102). denmark has also experienced a gender-equality paradox where right-wing parties have articulated strong concern for gender equality among ethnic minority groups. the relationship between the public and private arena became re-politicized in the 1990s in denmark, and migrant families became the target of political regulation (siim, 2009, p. 153). in danish official discourse, gender equality has already been achieved and patriarchal oppression is primarily a problem for minority women (siim, 2009, p. 154). this approach to integration denies migrant women autonomy and agency because they are perceived as potential victims of their culture and religion. also in a swedish context, gender equality ‘has developed as the central ethnic signifier of national belonging and the most important boundary between “us” and “them”’ (mulinari, 2009, p. 180). according to mulinari, migrant women are represented as different and in need of institutional support. this continues to guide state intervention in migrants’ family lives through social workers, teachers, and the health profession in sweden. ‘central to these policies is the construction of “other” cultures as patriarchal and in opposition to swedish cultural values on gender’ (mulinari, 2009, p. 172). feminist research has identified similar tensions in different gender models between principles of gender equality and cultural diversity in scandinavia. according to birte siim (2009), ‘gendered conflicts between the cultural values and norms of the majority and ethnic minorities, including family norms, have contributed to constructing a barrier between “them” and “us”’ (p. 151). the official gender-equality discourse has a strong normative power (borchorst & siim, 2002), which tends to exclude, marginalize, and assimilate minority perspectives on the family and gender equality (de los reyes & mulinari, 2005). according to trude langvasbråten (2008), ‘a high-profiled ideal of gender equality has certainly been an important ingredient in the construction of a homogenous “scandinavian-ness”’ (p. 33). there are national differences in approaches to gender equality as well as in gender (equality) discourses. however, gender equality is viewed as a njsr – nordic journal of social research vol. 6, 2015 16 central value in integration efforts in all the scandinavian countries (langvasbråten 2008). the discourse of gender equality is one in which a boundary is drawn between ‘us’ and ‘them’ (lister, 2009; siim, 2007), and this boundary is at the core of the discourse on nationhood in norway and in the nordic countries generally (berg, flemmen, & gullikstad 2010; mulinari et al., 2009, p. 5; skjeie & teigen, 2003; hagelund, 2003; st. meld. nr. 49, 2003-2004). concluding discussion initially in this article, i asked whether the scandinavian citizenship regime is inclusive and women-friendly in a time of diversity. i have approached this question by addressing the intersection of gender and ethnicity in relation to childcare, and by emphasizing norway and norwegianness. the same action – receiving cash for care – is interpreted differently depending on whether the person involved is assumed to belong to the ethnic majority or an ethnic minority. on the basis of these findings, i would argue that minority women might experience a double standard. parental choice is considered a good thing – as long as the mother in question is considered ‘fully’ norwegian. however, choices are understood differently depending on whether one is considered to be ‘fully’ norwegian or not. this double standard concerning cash for care indicates a paradox; namely, that minority women may experience stronger pressure from the majority society when it comes to labour-market participation. they need to prove that they are gender equal – even more gender equal than the majority population. social citizenship rights – which i have exemplified with childcare – can be both liberating and disciplinary. the provision of cash-for-care benefits is a politically disputable issue; however, stereotypical images of ethnic or religious minority women as not being gender equal indicate the existence of stronger pressure for labour-market participation compared with ethnic majority women. thus, one consequence of the double standard concerning childcare may be that minority women experience more control whereas individual choice is a privilege reserved for the majority. i have also briefly looked at norway in comparison with sweden and denmark. i found that the idea of a single scandinavian citizenship njsr – nordic journal of social research vol. 6, 2015 17 regime needs to be more nuanced with regard to childcare. however, despite the differences, all the scandinavian countries grapple with the tension between principles of gender equality and cultural diversity. in norway, denmark, and sweden, gender equality is constructed as a core value and as a value which separates ‘us’ from ‘them’. this could imply that there is a scandinavian double standard regarding minority women. i have addressed the tension between principles of gender equality and cultural diversity – and the normative power of the scandinavian gender-equality discourse. however, by emphasizing such tensions, one may also contribute to a reproduction of the differences between the majority and minorities with regard to gender equality. when gender equality is constructed as a norwegian, swedish, or danish value, it hides the fact that there are differences of opinion within both the majority and minorities regarding gender equality. the gender equality discourse in relation to ethnic and religious minorities in all three scandinavian countries contributes to concealing different views and practices regarding gender equality. these differences exist both among the majority and among minorities. childcare policies in the future need to acknowledge the diversity within the group of ethnic minority women, as well as within the group of ethnic majority women. such policies would benefit from intersectional analyses, including perspectives such as gender, ethnicity, and social class (see nou, 2012, p. 15). helga hernes (1987) addressed the ambiguity and duality of social polity – as both liberating and disciplinary – within the welfare state in the 1980s (p. 27). today, this is still an important concern. the legitimacy of the scandinavian citizenship regime requires that everyone has a say. ethnic and religious minorities must be included on an equal basis in order to avoid welfare paternalism and double standards. thus, it is essential to pay attention to political as well as social citizenship. according to birte siim and hege skjeie (2000), ‘social rights without access to politics is paternalism, and political rights without social rights cannot secure an equal citizenship for women and men alike’ (p. 358). this obviously applies to both ethnic majorities and minorities. social citizenship in combination with political citizenship is not achievable without the recognition of complex identities and belongings. in my opinion, inclusive notions of norwegianness, njsr – nordic journal of social research vol. 6, 2015 18 swedishness, and danishness are important in order to avoid double standards regarding minorities. acknowledgements thanks to beatrice halsaa and hege skjeie for useful and constructive comments to an earlier version of this manuscript. also thanks to the editors and anonymous reviewers for valuable feedback. references andersen, j., christensen, a.-d., langberg, k., siim, b. & torpe, l.. 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(2012). norwegianness as lived citizenship: religious women doing identity work at the intersections of nationality, gender and religion. nordic journal of religion and society, 25(1), 1–25. microsoft word 257 frederiksen galley.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 5, 2014 and mistrust take the hindmost: generalized trust in denmark from 1990-2008 morten frederiksen department of political science aalborg university email: mfr@dps.aau.dk abstract while most countries are experiencing stable or declining rates of generalized trust, this has not been the case in the nordic countries, where levels of generalized trust have continued to increase. in the danish case, trust increased by 50 per cent in the period from 1981 to 2008. this article investigates this puzzling development by testing the dominant socialization, status, and institutional theories on trust development. using the danish 1990, 1999, and 2008 waves of the european values study denmark, the author employs graphical modelling in analysing the drivers of generalized trust increase in denmark. graphical modelling allows hierarchical structures of independent variables and is robust to thin cells, thus giving a more detailed picture than conventional regression techniques. the study shows that socialization has had little impact on the increasing level of generalized trust, whereas both individual achievement and the generally increasing levels of affluence and education are important drivers of the trust increase. however, since large parts of the population reaped the benefits of increasing levels of education and employment in denmark during this period, this is not just a case of increasing trust, but also one of a diminishing low-trust minority excluded from partaking in this development. keywords: generalized trust, denmark, graphical modelling, health, education, income njsr – nordic journal of social research vol. 5, 2014 81 introduction contemporary research indicates that generalized trust is stable at a medium level in most western countries, while in others it is declining due to increasing inequality, individualization, institutional failure, and increasing heterogeneity (delhey & newton, 2003; fukuyama, 1996, 2001; putnam, 2000; robinson & jackson, 2001). meanwhile, generalized trust in denmark has been increasing despite increasing inequality and heterogeneity. comparative research on generalized trust explains why trust is higher in denmark than in many other countries. it does, however, tell us little about why trust is increasing. the purpose of this article is to conduct a single-case investigation of the danish experience, investigating whether the theories and hypotheses predominantly used in explaining trust levels are helpful in understanding the danish increase in trust. analysing the danish data from the three most recent waves of the european values study and employing graphical modelling, this study investigates how the increase in generalized trust has been differentiated between different parts of the population. from this differentiation, hypotheses are outlined on the relationship between the development of danish society and the differentiated increase in generalized trust. in the conclusion these are reconnected to the predominant theories and the consequences for trust research are outlined. table 1: responses to the question: ‘generally speaking, would you say that most people can be trusted or that you can’t be too careful in dealing with people?’ 1981-2008. percentage.* 1981 1990 1999 2008 ‘most people can be trusted’ 51.1 57.7 66.5 76.0 ‘you can’t be too careful’ 48.9 42.3 33.5 24.0 valid n 1061 992 986 1486 * ‘don’t know’ responses comprise less than 4% in 1990, 1999, and 2008. in 1981 they comprise 10.2% of the responses. however, there appears to be no systematic bias in the group choosing this response compared to the survey population on socio-economic variables. the ‘don’t know’ responses are consequently ignored in this analysis. njsr – nordic journal of social research vol. 5, 2014 82 table 1 shows the development in generalized trust in the danish 1981, 1990, 1999, and 2008 waves of the european values study. there has been a significant increase in the part of the danish population who consider other people to be generally trustworthy. this is interesting for two reasons. first, it is interesting in itself that the danes’ trust in other people has increased and that danish society consequently experiences a value transformation on this issue, not least because other countries have experienced a decrease in generalized trust during the same period (putnam, 2000). as can be seen in figure 1, in many other countries levels of generalized trust have either been stable or in decline. additionally, the danish trajectory runs steadily upwards, while many other countries experience shifting increases and decreases. secondly, it is interesting that levels of generalized trust can change so greatly within a relatively short time span. this gives rise to questions concerning what the characteristics of generalized trust are and how trust is established. a third question of interest is why denmark experiences a trust development different from that of many other countries. that, however, is a question which cannot be addressed in a single-case study. rather, this study may contribute to that discussion by questioning our theories about general trust, and thus help to develop a better scientific understanding of the dynamics of trust. njsr – nordic journal of social research vol. 5, 2014 83 figure 1: responses to the question: ‘generally speaking, would you say that most people can be trusted or that you can’t be too careful in dealing with people?’ in seven countries. 1-4th waves of the european values study. mean.* njsr – nordic journal of social research vol. 5, 2014 84 theories on generalized trust to be able to understand changes in the level of generalized trust, it is necessary to understand how it is created, maintained, and possibly lost. there are several different explanations regarding which characteristics, mechanisms and causes are important for generalized trust (anheier & kendall, 2002; bateson, 1988; delhey & newton, 2003, 2005; herreros, 2004; kumlin & rothstein, 2005; newton, 2004; nooteboom, 2007; rothstein, 2000; rothstein & uslaner, 2005; uslaner, 1999, 2000; van oorschot, arts, & gelissen, 2006). table 2: six theories of generalized trust* individual theories societal theories personality theory** success-andwell-being theory** voluntaryorganization theory networks theory community theory societal theory** *adapted from delhey and newton, 2003. **the theories in italics are part of the analysis in this article. jan delhey and kenneth newton (2003, p. 94) classify these different explanations within six general theories (table 2). these theories are subsequently divided into two groups depending on their theoretical point of departure. one group assumes that generalized trust is a characteristic of individuals and the way they relate to their social environs. the other assumes that the generalized trust of individuals is the product of or an aspect of societal structures. this article investigates three of the abovementioned theories on generalized trust: the two individual theories and the structural theory named societal theory. it is the driving hypothesis of this article that such relatively significant changes in the level of generalized trust among the danes have to be analysed and interpreted in connection with general changes in the way the individual dane lives and experiences life, and the general conditions within danish society. the three social-capital theories are excluded from this analysis for several reasons. first, because current research suggests that these theories cannot be substantiated empirically. secondly, there are some njsr – nordic journal of social research vol. 5, 2014 85 theoretical problems in analysing social capital and trust within one model. we know that, empirically, volunteering, organization membership, and community involvement are correlated with generalized trust. indeed, many social-capital theories define trust and civil society as constitutive parts in building social capital. some argue that volunteering leads to increased levels of generalized trust, while others argue that generalized trust is a prerequisite for volunteering in the first place (hooghe, 2008). a third position contends that people volunteer because they trust, but that civil society as a whole impacts society at large in a manner that fosters trust by engendering democratic values, political trust, and confidence in the political institutions in the generations to come (newton, 2008). theoretically, it is at this stage impossible to define a meaningful causal sequence between trust and volunteering, community activity or the general structure and strength of individual social networks. however, as hooghe (2008) points out, the evidence supports the claim that people who trust volunteer, whereas the evidence is at best murky on the reversed causal relation. consequently, i disregard social-capital explanations in this analysis, but this does not mean that social capital cannot, in one form or another, be an intermediary in the connections established in the analysis. however, the general consensus within current trust research is moving towards the position that civil society and social networks have limited impact on generalized trust (rothstein & uslaner, 2005). personality theory assumes that childhood socialization is the main source of generalized trust. according to this type of explanation, it is formative, early-life experiences of the trustworthiness of others, rather than experiences later in life, that influence the level of generalized trust in adulthood. the inspiration for this is erik erikson’s theory about the importance of early childhood experiences to the experience of the world as a fundamentally benign place and the establishment of basic trust (giddens, 1990, 1991; möllering, 2001; uslaner, 2002). success-and-well-being theory focuses on the relationship between generalized trust and the experiences of adult life. this is not a psychological explanation but rather a status-based explanation. the theory makes the claim that successful people with high social status have higher levels of generalized trust, and conversely that unsuccessful people with low social status have lower levels. this claim rests on the assumption that those who have achieved success and high status can better afford the risks associated with trust and, njsr – nordic journal of social research vol. 5, 2014 86 furthermore, that they predominantly have had experiences that reinforce a trusting attitude. conversely, those who are least successful and possess few resources are treated with the suspicion and lack of respect associated with low status. this in turn fosters suspicion within this group (inglehart, 1999; luhmann, 1980, 1988; putnam, 2000; stolle, 1998). societal theory focuses on the characteristics of societies. economic equality, the equity of institutions, and access to democratic participation are central elements of this type of explanation. homogeneity is often emphasized, for example, the influence of ethnic homogeneity on generalized trust compared with ethnic polarization (fukuyama, 1996; inglehart, 1999; knack & keefer, 1997; kumlin & rothstein, 2005; newton, 2001). it is important to note that, in this type of explanation, it is the characteristics of society and of the institutions within it that influence individuals and the way they regard each other. consequently, generalized trust levels are not only explained by either equality or homogeneity; changes in the structure of society may also cause changes in generalized trust at both the general and the individual levels. the institutional element in these changes is of some theoretical significance to generalized trust, but most institutional impact is beyond single-case analysis. however, the individual level impact of large-scale institutional change can in some instances be captured within single-case analysis. the theoretical focus here is, consequently, how structural transformations in society impact individual-level characteristics. the three theories are presented in table 3, which shows three different characteristics of each category of explanation. first, the category source of trust describes the element which is claimed to affect whether or not people have generalized trust. secondly, explained differences refers to the types of differences in generalized trust levels which the theory is primarily focused on. finally, type of reproduction describes the way generalized trust is argued to be created and maintained; this predominantly concerns how the source of trust is reproduced. njsr – nordic journal of social research vol. 5, 2014 87 table 3: generalized trust: comparing the three theories theory source of trust explained differences type of reproduction personality the psychological constitution of the individual between individuals childhood socialization success and wellbeing resources facilitating trust, experiences confirming trust between individuals and status groups successful or adverse experiences associated with socio-economic position societal equity, equality, and absence of conflict between nations and societies, and over time cultural, economic and institutional structures table 3 may also give an indication of some of the problems involved in distinguishing between the causes and the effects of generalized trust. for instance, success and well-being in life are equally as likely to be the consequences of having trust in other people as they are to be the cause thereof. it is therefore important not to conceptualize trust as part of a simple causal chain of events in which it is either a cause or an effect of other social phenomena (lewis & weigart, 2012). rather, generalized trust should be conceived of as part of a process of reproduction in which trust and other elements are mutually reinforcing. in other words, generalized trust is not just an attitude more or less firmly embedded in people’s perceptions, guiding the way they relate to other people and perceive them: it is also a characteristic of the societal process (frederiksen, 2012; uslaner, 2002). when upbringing, life-experience, and social environment are characterized by cooperation and reciprocity, these are related to the level of generalized trust in society in general (hardin, 2002; luhmann, 1979). generalized trust enhances the individual’s ability to cooperate within a variety of social contexts. simultaneously, it is only through experiences with cooperation and reciprocity that trust is possible within these different contexts (hardin, 2002). when the level of generalized trust in different countries can change relatively njsr – nordic journal of social research vol. 5, 2014 88 significantly within a short period, it is because it is not something an individual conclusively possesses. rather, it is reproduced and maintained continually, and social changes may disturb its reproduction (frederiksen, 2012). building from each of these theoretical approaches, i propose three hypotheses concerning the development of generalized trust in denmark: 1. the development of the patterns in the levels of generalized trust is a consequence of changes in the prevalent patterns of socialization within the population. 2. the development of the patterns in the levels of generalized trust is a consequence of changes in both the level and experience of success and well-being within the population. 3. the development of the patterns in the levels of generalized trust is a consequence of structural changes in the demographics and socio-economic conditions of the population. data the study was based on the danish 1990, 1999, and 2008 waves of the european values study. the selection of this particular survey was grounded in the following facts: the survey is longitudinal; it includes a very recent cross-section; it is a well-tested, high-quality survey conducted by skilled interviewers making house-call interviews, and it includes a rather large section on socio-economic background. though not as good as a survey crafted specifically for the purpose at hand, the danish evs survey was by far the best suited compared with other available data (issp, ess). the survey populations of the danish evs waves were random selections of people aged 18 years and above drawn from the danish civil registration system. people in prison, people with no known address, people listed as living abroad, and those with so-called research protection (i.e., people who have informed the authorities that they do not accept contact from researchers) were excluded. the number of completed survey interviews was 1030 in 1990 with a response rate of 75 per cent; 1023 in 1999 with a response rate of 58 per cent; and 1507 in 2008 with a response rate of 51 per cent. response rates are calculated on the basis of all members in the njsr – nordic journal of social research vol. 5, 2014 89 sample (christensen & gundelach, 2011). the 1990-1999 questionnaire deviates from the version used in 2008 by including only one binary item on generalized trust from the rosenberg set of five items, which is consequently the only item available for longitudinal analysis. method graphical modelling is employed in the multivariate analysis of longitudinal data from the four cross-sectional data sets. this is a multivariate statistical model in which causal relations between variables can be symmetrical, traditional (dependent/independent), and block recursive (in which a chain of variables are assumed to be ordered causally). the correlations between variables are controlled for conditional independence (whether correlations with other variables within the model account for the correlation between the two tested variables). the modelling procedure places the variables in a block-recursive structure called the independence graph, from which correlation coefficients of every relationship in the model are calculated. the statistical procedure behind the test for conditional independence is a log-linear analysis. the test statistics used are either a χ²-test if the correlation is non-linear or, predominantly, a γtest in the case of linear correlations. in both cases a monte carlo estimate of the p-value is used to obtain robust estimates (demant & østergaard, 2007; gundelach & kreiner, 2004; kreiner, 1987, 1996). in the process of testing the model, relationships between variables are excluded as they prove conditionally independent. this type of analysis provides a number of advantages compared with traditional regression techniques. first of all, it is suited for analysing both nominaland ordinal-scale variables, which most variables in the evs are. secondly, a large number of independent variables can be included in the analyses and they can be assigned positions in chains as both dependent and independent. thirdly, the analysis is directed at elaboration and explanation rather than causality. fourthly, the method is robust to low-count cells. finally, the graphical model allows the research to handle a more complex modelling process without losing track of theory, hypothesis or assumptions (christensen & gundelach, 2011). njsr – nordic journal of social research vol. 5, 2014 90 model the purpose of this single-country analysis is to identify and differentiate the causes of the increase in the levels of generalized trust in denmark. theoretically, the point of departure is from the different causal drivers of generalized trust proposed by personality theory, success-and-well-being theory, and societal theory, and the three associated hypotheses set out above. the three hypotheses and the associated theories assign quite different roles to generalized trust, and consequently different explanatory relations. significantly, personality theory and successand-well-being theory are incompatible on this point. personality theory claims that generalized trust is established at an early point in life and is therefore less influenced by, for instance, education or marital status. conversely, the theory of success and well-being assumes that it is precisely income, health, and marital status that may influence generalized trust. following societal theory, the sequence of different variables depends on whether one assumes that structures and institutions primarily work through socialization, or that a continued influence and selection process accounts for generalized trust. in other words, is education the cause of generalized trust or is it the effect of it? in modelling the analysis, the answer to this question is pragmatic. it is not a necessary assumption in testing personality theory that generalized trust influences choice of education, income or marital status, whereas it is a necessary condition of testing successand-well-being theory that income, marital status, and education can influence generalized trust. the consequence of this choice is that the model is biased towards the theory of success and well-being. however, bivariate analysis shows significant changes in generalized trust within cohorts, which indicates that generalized trust is not simply set in childhood, but may also change throughout life. this supports the modelling choice of allowing trust to be a dependent rather than independent variable in relation to variables describing experience and life course, such as education. njsr – nordic journal of social research vol. 5, 2014 91 table 4: the three hypotheses and the associated variables. hypothesis independent variables personality hypothesis: gender, birth cohort success-and-well-being hypothesis: number of children, self-reported health, employment, marital status, income. societal hypothesis: urbanization, age, education the operationalization of each hypothesis is limited by the available data. while additional data are available in the 2008 cross-section, the information relevant to the personality hypothesis is limited to gender and birth cohort in the longitudinal data set. these items give good information on differences the dominant patterns of socialization to which people have been subjected. however, important information is lacking, including information about parents’ education or the socioeconomic childhood conditions. consequently, social reproduction of income and educational attainment may conceal socialization effects as either success-and-well-being effects or societal effects. the data relevant to the success-and-well-being hypothesis are more comprehensive. information about children, marital status, health, employment, and income cover the more important areas of attainment within adult life. finally, the amount of data relevant to the societal-impact hypothesis is also somewhat limited. urbanization is a process that changes the dominant structures of settlement, work-life balance, communities, and so on, at a societal level. similarly, age is a proxy for the institutional structures characteristic of specific life stages; while age in itself should not be expected to influence trust levels, the type of experiences and the level of support afforded by society depends very much on age. education is also primarily an indicator of structural change rather than individual attainment. while the specific choice of education may express important individual characteristics, the number of people who get trained as a skilled craftsman compared with the number who get a master’s degree is very much a question of societal structure. the data are here limited to a very specific subset of societal-level characteristics measured at the individual level. while other macro-level characteristics are often included in comparative analyses, these cannot be included in this type of single-case analysis. consequently, the analysis in this article njsr – nordic journal of social research vol. 5, 2014 92 may underestimate the full institutional and structural impact on trust development. analysis the following analysis is based on a statistical modelling of the evs data from 1990, 1999, and 2008, in which relevant variables have been included and excluded as independent variables influencing generalized trust. the three hypotheses are addressed in one model, but in the process of finding the right model, two separate search strands have been followed in order to avoid multicollinearity: one including age and another including birth cohort. the reported correlations are derived from the cohort model – with the exception of age – as this model turned out to be the best fit to data. the three hypotheses are presented with the relevant variables in table 4.the results of the model search are reported in tables 4 and 5. none of the three hypotheses emerges as the better explanation of generalized trust; rather, the analysis supports a combination of the hypotheses. education and survey year turn out to be the dominant variables in the model, but the respondents’ perception of their own health also significantly influences the level of generalized trust. furthermore, income and birth cohort are correlated with generalized trust, but, even though significant, the coefficients are relatively low. the variables of urbanization, marital status, number of children, employment, gender, and age all show low and insignificant correlations with generalized trust. njsr – nordic journal of social research vol. 5, 2014 93 table 5: partial, direct γ-correlations to generalized trust (19902008) variable partial γ-correlation significance (p) urbanization 0.03 0.297 employment 0.00 0.504 marital status 0.04 0.233 self-reported health 0.21 0.000 number of children 0.02 0.362 income 0.13 0.003 education 0.34 0.000 gender 0.02 0.335 birth cohort* 0.02 0.272 age 0.03 0.351 survey year 0.32 0.000 *the correlation between birth cohort and generalized trust is insignificant in the gamma test, but this is caused by a non-linear correlation. a χ2 –test shows a significance of p=0.027. turning to the indirect correlations in figure 2, we see that the temporal changes from 1990 to 2008 are primarily directed at the level of education and the level of employment, apart from the direct correlation with generalized trust. additionally, employment is strongly linked to temporal change, since time and employment are correlated both directly with and mediated through the differential level of employment across birth cohorts. however, employment does not directly drive the trust levels, but has a more moderate, mediated effect through health and income. additionally, a correlation appears between urbanization and education. however, both the healthemployment and the education-urbanization correlations are situated within the same recursive block and, consequently, the causality is njsr – nordic journal of social research vol. 5, 2014 94 unclear. finally, there appears to be an unsurprising causal relation between gender and level of education, showing that there is a gender impact on generalized trust, mediated by the level of education. this suggests that education, rather than gender, accounts for the difference between genders in level of trust. the interpretation of these results is made difficult by the continued significance of survey year, because this correlation expresses the variance, unexplained by the model, in the changing levels of generalized trust from 1990 to 2008. this correlation could arguably be interpreted as a period effect on the increasing level of trust, which is not differentiated between groups but affects the entire society. it is, however, equally plausible that the relevant data needed to account for this increase is unavailable in the dataset. the model search has been much more encompassing than presented here, but with similar results. nonetheless, the analysis indicates some significant correlations. the contributions of education, income, and perceived health are of a magnitude that may help to explain the increase in generalized trust. it is also worth noting that the correlation between generalized trust and birth cohort is significant, if small. this suggests that the personality theory cannot be dismissed completely. in the following sections i shall deal initially with education and income, and secondly with health. njsr – nordic journal of social research vol. 5, 2014 95 fi gu re 2 : p ri m ar y, s ig ni fic an t p ar tia l γ -c or re la tio ns a bo ve 0 .1 0* *c oh or t i s in cl ud ed in p re fe re nc e to a ge in th is fi gu re . m ar ita l s ta tu s an d nu m be r of c hi ld re n ha ve b ee n ex cl ud ed fr om th is f ig ur e as b ot h pr ov ed t o be o f m ar gi na l im po rta nc e. t he f ul l m od el i s in cl ud ed i n ap pe nd ix a . a rr ow s in di ca te co rr el at io ns b et w ee n re cu rs iv e bl oc ks , lin es i nd ic at e sy m m et ric al c or re la tio ns . r ec ur si ve b lo ck s ar e m ar ke d by ve rti ca l, da sh ed li ne s. njsr – nordic journal of social research vol. 5, 2014 96 education the main finding is that education heavily influences the level of generalized trust, confirming the findings of other studies on this issue (delhey & newton, 2005; paxton, 2007; rothstein & uslaner, 2005; yamagishi, 2001). according to both individual-level theories, generalized trust is associated with a perception of the world as fundamentally cooperative and dependable. it is assumed that generalized trust develops from experiencing the social as generally comprehensible and unthreatening. education may greatly influence the perceptions of social relations and activities in that direction. furthermore, increased levels of education may also contribute to the development of skills and reflective competences that allow one to navigate social relations, harvesting experiences that confirm generalized trust outside in-group relations (edwards, ranson, & strain, 2002). the model indicates that it is changes in the level of education, rather than the success-and-well-being effects of increased education (income and employment), that lead to increases in generalized trust. the indirect correlation between survey year and generalized trust, by way of education, supports the idea that the increases in the level of trust are driven by changes in educational level. the multivariate analysis suggests that education with academic content (isced 3 and above) has an influence on the level of generalized trust. the increase in generalized trust from 1990 to 2008 appears to be partially explained by the increase in the part of the population with an academic education, along with a decrease in the part with only primary education or an education as a skilled labourer during this period (table 6). the change in relative size of the populations with the two types of education is quite significant, supporting the hypothesis that the societal changes in the educational system are leading to increasing levels of generalized trust. this is supported by a moderate correlation between survey year and education (γ = 0.14, p=0.000). njsr – nordic journal of social research vol. 5, 2014 97 table 6: population distribution of highest completed education between primary school/vocational training and tertiary education, in percentages. (1990, 1999, and 2008) 1990 1999 2008 primary school/vocational training 69.1 56.9 51.8 tertiary education 30.9 43.1 48.3 valid n 1030 1022 1498 the danish population is increasingly participating in longer, more academically structured types of education, and society and social relations may seem more comprehensible and unthreatening as a consequence (luhmann, 1979). this leads to increased generalized trust in large parts of the population, while the remaining minority of the population has less formal education and lower levels of generalized trust. while accounting for some of the increase in generalized trust, this development cannot explain why there has been an increase in generalized trust within all groups independently of education. a more detailed analysis of conditional independence within thirdvariable strata shows that the correlation between education and generalized trust is intersected by birth cohorts. combining generalized trust, education, and birth cohort reveals a new picture. the cohorts that grew up after the second world war are more trusting than the preceding cohorts, and, from 1990 and onwards, their generalized trust increases. this development can also be traced in the data from 1981, although here information on education is less differentiated. in these post-war cohorts it is particularly those with longer academic educations who are more trusting, while trust in the older cohorts is more evenly distributed between educational categories. the well-educated young and middle-aged people experience an increase in generalized trust to a greater extent than others from the same cohorts, while also being subject to the increase in generalized trust associated with academic education. furthermore, they appear to maintain this trust level even after retirement. this pattern cannot be found among the older cohorts, where trust levels njsr – nordic journal of social research vol. 5, 2014 98 are less dependent on level of education and do not increase at the same rate from 1990 to 2008. consequently, it would seem that the education effect on trust is stronger at the highest level of education and, furthermore, that the effect has changed over time, making tertiary education a stronger driver of trust in younger cohorts than in older ones. in addition, the differences between birth cohorts suggest that the increase in trust from 1990 to 2008 may in part have been caused by mortality in the older cohorts. income the correlation between income and generalized trust is significant, supporting the hypothesis of success and well-being. the influence of income supports the assumption that that the protection against the uncertainties of life that can be provided by money contributes to increases in generalized trust. furthermore, a certain level of income also increases freedom of action and self-efficacy (uslaner, 2002). however, the correlation is weak to moderate, which is somewhat surprising. the multivariate model shows that any impact of employment on trust is partly mediated through income (γ = 0.59, p=0.000). this strong correlation is primarily the difference between employment and unemployment in terms of income. between 1990 and 2008 there was a marked decrease in the level of unemployment, as shown in figure 3. this difference in employment rate has had an impact on trust mediated through income. since the causal direction would primarily be from employment to income, changes in employment status will contribute significantly to the trust-income correlation. there is, in other words, an indirect connection between the trust-income correlation and the changing trust levels from 1990 to 2008 by way of increasing employment rates. njsr – nordic journal of social research vol. 5, 2014 99 figure 3: full-time unemployed, in percentage of workforce (1990 to 2008) source: statistics denmark an examination of the trust-income correlation for conditional independence across third-variable strata leads to some interesting results. it turns out that there are confounding effects involving health, education, and birth cohort, suggesting that the correlation is stratified rather than homogenous. first, the positive correlation between income and generalized trust seems to hold true among those with unskilled, skilled, and shortor medium-length tertiary education. however, among those with a long tertiary education (isced 5) the correlation is reversed: the more money they make, the less they trust. while the overall level of trust among the highly educated is high, those with higher incomes have a relatively lower level of trust than those with lower incomes. secondly, while the positive correlation between income and trust holds true for most birth cohorts, this is not the case among the youngest cohort. here the correlation is reversed, making the youngest with the lowest incomes relatively more trusting than those with higher incomes. finally, the correlation between trust and income is intersected by perceived health. while the correlation remains positive in most of the categories on the health measure, it disappears among those with the poorest quality of health. for this group, income does not matter in regard to trust. the general picture, 0   2   4   6   8   10   12   14   19 90   19 91   19 92   19 93   19 94   19 95   19 96   19 97   19 98   19 99   20 00   20 01   20 02   20 03   20 04   20 05   20 06   20 07   20 08   njsr – nordic journal of social research vol. 5, 2014 100 then, is that while increasing income does have some impact on the trust level, this is not a homogenous correlation. the reversed correlation among the younger cohorts is presumably related to the low income of the students and the relatively higher income of those who enter the labour market earlier in life. this accounts for some of the correlation between income and employment. the reverse correlation between income and trust among the highly educated may be the result of the differences between the different kinds of higher education – either in terms of educational content or in terms of the employment environment. health the self-reported state of health is also correlated with the level of generalized trust, as can be ascertained from table 5. on closer inspection, this correlation is independent of all variables other than birth cohorts. people experiencing a good or very good state of health are predominantly trusting, people experiencing a fair or poor state of health are marginally more mistrustful than trusting, and people experiencing a very poor state of health are predominantly mistrustful. this correlation is similar to the correlation between education and generalized trust, only with the opposite outcome. a very poor state of health may result in the perception of society in general as a less friendly place, providing fewer experiences that support trust and generally making social relations less easy to manage and navigate. furthermore, research indicates that trust is strongly correlated with self-efficacy, which is markedly lowered by poor health (frederiksen 2012). the close connection between socio-economic limitations and a poor state of health conceivably makes this correlation the downside of the positive correlation of trust with income and education (kawachi, kennedy, & glass, 1999; vicky, 2001; whelan & whelan, 2004). it is primarily those with poor health from among the disablement pensioners, those on early-retirement allowance, the retired, and the unemployed who have low levels of trust. the influence of a poor health on generalized trust cannot be explained by education, age, cohort, or employment, even if health is strongly correlated with employment (γ = 0.28, p=0.000). however, the influence of poor health on generalized trust is also present among the employed. full-time employment and higher levels of education seem to be partially negating the influence of experienced health on generalized trust, since those with higher education and full-time employment only express low levels of trust if they experience their njsr – nordic journal of social research vol. 5, 2014 101 health as being very poor. this supports the connection between health, self-efficacy, and generalized trust. however, since there is no direct connection between survey year and health, the impact of the experienced quality of health on generalized trust is quite stable from 1990 to 2008. the indirect influence of survey year on health mediated by employment may indicate that any temporal effect on the trust-health relation is better described in terms of employment. furthermore, the strong correlation between health and employment may be deceptive in this regard since the causality is bi-directional. in summary, self-reported health has a significant influence on generalized trust but cannot help us to understand the increase in generalized trust. it can, however, help us to understand why some groups express a higher level of generalized trust than others. the unequal distribution of health, in which certain disadvantaged groups report a disproportionately high level of health problems, is probably part of the reason why the old, those with little education, the unemployed, the disablement pensioners, those on early-retirement allowance, and the retired do not experience the same increase in generalized trust as all other groups do. generally, the reported correlation between income and generalized trust supports the theory of success and well-being since increased income leads to increased trust in most cases. however, elaborating with the education variable revealed that this general trend does not hold within the highest level of education. for those with the highest level of education, the trend is reversed, suggesting that either the impact of income on trust wears out at a certain income level or that other factors associated with high income and high education are at work. since the correlation is not only reduced, but in fact reversed, the latter explanation seems the more probable. finally, education turns out to be the strongest driver of trust levels in general, as well as the specific increase in generalized trust in denmark from 1990 to 2008. this supports the societal theory, since the structural changes in education in denmark have resulted in a general increase in level of education and, consequently, an increase in generalized trust. njsr – nordic journal of social research vol. 5, 2014 102 the trusting danes the general picture drawn by this analysis is that the danish population has a high level of generalized trust and that the level has been increasing throughout the studied period. among the people with the least education, lowest income, poorest health, and with deceased spouses, generalized trust is much lower than the population average. this is particularly true of those experiencing combinations of these characteristics. consequently, the theory of success and well-being must be revised to fit the danish case. as a consequence of the general positive development within levels of education, income and employment in denmark, the default attitude is one of high levels of generalized trust. thus a more precise theory or hypothesis to describe the danish case would be a theory of misfortune indicating the types of adverse experiences and conditions which seem to lower generalized trust or prevent it from increasing. early retirement, disability, unemployment, old age, or limited education reduces the available courses of action and leads to lower levels of access to economic, cultural, and social resources. rarely (or sometimes never) do they have the possibility of participating in society on equal terms with the population average. this is supported when we look at other parts of the survey showing that those with low generalized trust also express less self-efficacy and less happiness than the population average. the high level of generalized trust in denmark suggests that the success-and-well-being hypothesis is incorrect in this instance. success is a relative phenomenon which loses meaning when most people have achieved it. among those with the fewest resources, generalized trust is at its lowest. generalized trust is contingent upon having access to economic, cultural, and social resources, rather than the level of access. belonging to the richest and best-educated elite or to the large middle class is of far less significance to generalized trust than being employed and having more than a basic level of education. this questions some of the usual assumptions about trust and equality. it is usually argued that generalized trust depends on economic equality because this decrease the relative distances between different social groups (uslaner, 20002). the misfortune theory would indicate that economic equality drives trust because it lifts a larger proportion of the population above the threshold of disempowerment – at least within relatively affluent societies. however, we should expect the threshold of disempowerment to be placed differently in different countries depending on institutional njsr – nordic journal of social research vol. 5, 2014 103 make-up. the danish case places the threshold at the margin of compound exclusion, but this is presumably linked to universal welfare institutions. divorce, lower levels of education or poor health should be expected to lower trust levels even among the employed in countries where institutional backing is less readily available. apart from the importance of success and misfortune, the analysis also supports both societal and personality theory. in itself, birth cohort does not strongly influence generalized trust in the model, but it does intersect with both education and health in influencing generalized trust. with these quite significant changes in the level of generalized trust, personality theory seems an unlikely explanation. generalized trust as a part of personality and socialization would be quite stable from an early point in life, which is not the case according to this analysis. we may, however, imagine another way in which generalized trust and socialization can be linked. since birth cohort is correlated with both education and self-reported health, the influence of socialization and personality is not so much directly on generalized trust, but rather on the way changes within society and individual life come to bear on generalized trust. socialization and the development of personality in early life may greatly influence the ways in which life and society are interpreted, and consequently sustain or suppress the development of generalized trust from experiences of affluence, safety, increased levels of education, and so forth (mannheim, 1952; pilcher, 1994). growing up in a period of economic growth, with employed parents, reasonable housing, and so on leads one to take options and resources for granted, confirming a perception of the world as a friendly and cooperative place. conversely, growing up in want and insecurity will not lead one to take options and resources for granted, nor readily to assume the cooperation and good intentions of others, despite increases in available economic, social, and cultural resources. the general increase in generalized trust from 1990 to 2008 is best accounted for by a period explanation positing the socioeconomic development from 1990 to 2008 as the primary driver of changes – specifically, increasing levels of both employment and education. however, the differences in the increase of generalized trust between birth cohorts indicate that a cohort explanation should also be applied in order better to understand why this socio-economic development may have had different impacts on different birth cohorts, particularly between the preand post-war cohorts (inglehart, 1971, 2003). njsr – nordic journal of social research vol. 5, 2014 104 the analysis gives the strongest support to the societal theory, since education is the most strongly correlated independent variable with respect to generalized trust. changes in educational structure and uptake have taken place since the end of the second world war, and these changes are strongly reflected in the differences between cohorts. consequently, over time the general educational level and composition of the population changes significantly. education helps to build generalized trust since it – and particularly academic education with a focus on analytical and abstract competencies – makes people more skilful in navigating and understanding complex social environments. the significant increase in the average level of education from 1981 to 2008 is in itself an important factor in the increasing level of generalized trust. an increasing number of people command skills that are helpful in developing and sustaining generalized trust. furthermore, the intersection of birth cohorts in the correlation between generalized trust and level of education expresses the changing influence of education on generalized trust between cohorts. this may be assumed to rest on the mutually reinforcing influence of both increased education and positive socioeconomic development on the post-war cohorts. however, it may also be the result of the changes in curriculums, didactics, and institutional structure within the educational system that have taken place since the second world war. the development of the educational system has not just meant that more people have received a higher education, but also that the abstract and analytical competencies formerly associated with higher tertiary education are now also taught at the lower levels of tertiary education (hansen & gleerup, 2004). consequently, the shift towards higher levels of education takes place not only as movement between categories of education, but also as a general development in the educational system. what remains is the somewhat discouraging result that increases in affluence, employment, and education have benefitted only the majority, leaving behind a minority of ‘mistrusters’ who do not share the positive outlook that seems to prevail within the population in general. for this minority, this 18-year period has passed without leaving much of a mark. in the period from 1985 to 2007, economic inequality increased from a gini-coefficient of 0.2209 to 0.2478 (source: oecd). while some of this increase was driven by rising real-estate prices, it was convertible into consumption by way of mortgages. what increases denmark had experienced in affluence, education, and employment from 1990 to 2008, this group received comparably less of than the rest of the population. in the same period, the general shift towards the ‘work-first’ perception of welfare benefits in general – and social njsr – nordic journal of social research vol. 5, 2014 105 assistance in particular – was directed at exactly this residual group, underscoring the fact that they were not only left behind in respect of socio-economic development, but also in regard to inclusion into the moral community. the proposed ‘misfortune’ approach to trust is useful in understanding the gap between the empowered and disempowered which the general theories of generalized trust struggle with. while most theories of generalized-trust development do well in explaining the incremental increases in trust associated with increases in socio-economic position and background, they fail in explaining the shift between the inclusionary and exclusionary aspects of society. however, a misfortune theory of generalized trust would suggest that such a shift is to be expected, since exclusion is compound, making economic, social, and symbolic resources scarce simultaneously. if we consider generalized trust to express a positive outlook on social relations as cooperative and fundamentally unthreatening, those left behind in excluded mistrust 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(2001). trust as a form of social intelligence. in k. s. cook (ed.), trust in society (pp. 121-145). new york: the russell sage foundation. microsoft word thagaard, stefansen expressions of commitment and independence.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 5, 2014 expressions of commitment and independence: exploring men’s emotional responsibility in heterosexual couple relationships tove thagaard department for sociology and human geography university of oslo email: tove.thagaard@sosgeo.uio.no kari stefansen norwegian social research oslo and akershus university college of applied sciences email: kari.stefansen@nova.hioa.no abstract this paper examines men’s contributions to the division of emotional labour in heterosexual couple relationships by exploring the dimensions of commitment and independence, and how couples deal with challenges. the study is based on individual interviews with each of the partners in ten urban middle-class couples in norway. the results indicate diversity in middle-class men’s approaches to emotional responsibility, which is expressed through three models. the model of shared responsibility implies that the man’s contributions in the relationship represent expressions of responsive commitment. the man finds a balance between giving priority to his personal interests and considering shared interests; a pattern we refer to as collaborative independence, and he shares the responsibility for coping with challenges with his partner. the model of gendered responsibility implies that the man’s contributions in the relationship are characterized by nonresponsive commitment. the man gives priority to his personal interests in a way we refer to as conflicting independence, and refrains from sharing the responsibility for coping with challenges with his partner. finally, a third model, termed partial responsibility, is also evident in the data. this model is a combination of collaborative independence and non-responsive commitment, njsr – nordic journal of social research vol. 5, 2014 22 and may represent a phase of transition towards collaboration on an equal basis. a discussion of interpretations of the diversity in men’s approaches to commitment and independence concludes the paper. keywords: heterosexual couple relationships, men, commitment, independence, emotional responsibility, love, gender introduction the aim of this paper is to explore men’s emotional contributions in heterosexual couple relationships. previous research on the emotional dimension of conjugal relationships has focused primarily on women’s emotional investments – and men’s lack thereof: studies have demonstrated that women shoulder the main responsibility for intimacy and commitment in couple relationships (illouz, 1997; duncombe & marsden, 1999; jamieson, 1999; magnusson, 2006). compared with men, women tend to invest more in their relationships and to pay more attention to the well-being of their partners (strazdins & broom, 2004; holmes, 2004; kimmel, 2004; rauer & volling, 2005; thagaard, 2005). this research tradition departs from a feminist perspective in which the traditional relationship structure places the man in a dominant position with the woman relatively subordinate (jónasdottir, 1991; haavind, 2000). jamieson (1999) for instance views the structurally based gender inequality as a bottom layer in modern love relationships. the man’s dominant position implies that he can prioritize his own interests at the expense of the couple’s common sphere, in a way the woman cannot (holmberg, 1995), and the feminist perspective associates the man’s position with autonomy and independence (seidler, 1998; demsey, 2002; kimmel, 2004). while this perspective sheds light on how gender relations are reproduced through women’s emotional work, we believe it is less suitable for the study of men’s emotional contributions in heterosexual couple relationships (see aarseth, 2008). what is needed is an approach that can capture both old and new patterns in the emotional division of labour. our approach is inspired by connell and messerschmidt (2005), who emphasize how changes in conceptions of hegemonic masculinities are related to new gender roles in couple relationships, as seen, for instance, in the companionate marriage. this paper analyses the emotional contributions of men in lasting couple relationships by exploring how they express both commitment and independence. these are key dimensions in couple relationships, and we shall analyse how they combine in distinct models of male emotional njsr – nordic journal of social research vol. 5, 2014 23 responsibility. the concepts of commitment and independence capture, respectively, emotional involvement and differentiation in couple relationships. these concepts have gendered connotations; commitment is associated with the view of women as love experts (kimmel, 2004), while independence is associated with the view that men prioritize their own interests (røthing, 2004). we explore men’s expressions of commitment by focusing on the types of expressions that both partners in each couple see as contributing to their relationship. following this analysis, we explore expressions of independence, defined as the priority of ‘a time of one’s own’. finally, we analyse the interrelationships between men’s expressions of commitment and independence and their responses to challenges and tensions in their couple relationships. the analysis is based on qualitative interviews with both partners from ten norwegian middle-class couples. it should be noted that the nordic countries, including norway, are ‘characterized by an exceptionally strong political emphasis on equality between women and men as national goals, compared to most other countries in the world’ (magnusson, 2008, p. 81). family-policy scholars also commonly point to the nordic countries as having the most pronounced policies for advancing fathers’ share of care work and gender equality (gornick & meyers, 2009; lister, 2009; ellingsæter, 2011). thus, the nordic region makes a particularly interesting case for the study of men’s new roles in couple relationships. theoretical perspectives commitment in the transformation of intimacy, giddens (1992) identifies a particular relational dynamic in couple relationships: the pure relationship. this is a relational dynamic based on reciprocity and a mutual disclosing of the self. intimacy in this sense is incompatible with the traditional gendered pattern of heterosexual love, i.e. relationships in which the woman is responsible for maintaining the emotional bond (jamieson, 1999). the dimension of intimacy that is foregrounded here is a disclosing intimacy, ‘a process of … mutually sustaining deep knowing and understanding, through talk and listening, sharing thoughts, showing feelings’ (jamieson, 1998, p. 158). analytically this dimension of intimacy may be distinguished from what jamieson (1998, p. 8) designates silent intimacy, i.e. an intimacy of doing and being rather than talking. ‘for couples who live together, the time, money and effort each devotes to the household often symbolizes love and care for the njsr – nordic journal of social research vol. 5, 2014 24 other’ (jamieson, 1999, p. 485). cancian (1986) argues that women are considered more loving than men because men’s behaviour is measured with a feminine ruler. she writes: ‘much of this research considers only the kinds of loving behaviour that are associated with the feminine role and rarely compares women and men in terms of qualities associated with the masculine role’ (p. 701). according to kimmel (2004) men’s contributions in close relationships are often instrumental and task-oriented. thus, an exploration of men’s emotional contributions in couple relationships must consider the roles of both direct, verbalized and indirect, task-oriented expressions of commitment. as kimmel has pointed out, one of the consequences of the dominant, feminized notion of love is that expressions of love perceived as feminine, such as talking about feelings, are given priority over practical aspects of the relationship, such as helping one’s partner with different sorts of tasks. following the lead of jamieson, cancian and kimmel, we see intimacy as multi-dimensional. regarding changes in men’s emotional contributions in lasting relationships, we believe that it is important to consider ‘acts of practical love and care’ (jamieson, 1999, p. 477) in addition to practices indicative of disclosing intimacy. our analysis, then, focuses on men’s communicative and task-oriented contributions in couple relationships. we see these contributions as expressions of commitment; such acts communicate the man’s commitment towards maintaining an emotionally close relationship with his partner. our analysis also utilizes asplund’s (1987) notion of social responsivity, which draws attention to the importance of feedback processes in social interactions. social responsivity implies that what one person does, or the words he or she uses, represents a reaction to what the other person has done or said. asplund associates social responsivity with the immediacy and spontaneity of reactions in interactions. a lack of response by one individual to the other is designated asocial responselessness. descriptions of spontaneity in social interactions are represented in our data to only a limited extent. the participants described situations characterized by spontaneous reactions, but they also had more general views on the overall amount of positive feedback from their partner. with asplund’s perspective as a point of departure we apply the concept of responsivity to the exploration of expressions of commitment. in this article, however, responsivity has implications related to spontaneous reactions as well as more general descriptions of the partner’s reactions. njsr – nordic journal of social research vol. 5, 2014 25 independence independence is an important dimension in studies of men’s values and positions. kimmel (2004) emphasizes how men’s independence is encouraged already in early adolescence, and magnusson (2008) refers to couples whose repertoires of individualism imply that they consider it more self-evident for the man to prioritize work and leisure activities than it is for the woman. it is important to consider both the abstract and concrete meanings of independence. in the abstract, independence refers to separateness, a wish to withdraw and distance oneself from other people. the expression ‘a space of one’s own’, which we use in this paper, reflects this connotation. the concrete meaning of independence refers to the prioritization of time for personal interests. in negotiations, arguments for independence tend to be expressed as wishes for pursuing personal interests. in our analysis, the dimension of independence includes both a space of one’s own and the prioritization of time for personal interests. beck and beck-gernsheim (1995) associate separate time with freedom, both to work towards self-realization and simply to be oneself. in their view, freedom for one partner represents the renunciation of freedom for the other. an interpretation of independence which accords with beck and beckgernsheim is that independence is a limited resource, an asset that one partner can use at the expense of the other. this is not necessarily the case: the pursuit of time for separate interests may be practised in ways that do not conflict with possibilities for shared time and that do not entail emotional distancing. our analysis aims to capture this distinction. the study we conducted separate interviews with each of the partners from ten heterosexual, dual-earner couples, all of whom were in their early 30s and living in the oslo area. the participants were in relationships they considered to be permanent. seven couples were married and three were unmarried but cohabiting. the concept partner is used throughout this article to refer to either the male or female partner in both married and non-married couples. at the time of the study, four of the couples had young children. in all the couples, each of the partners worked full-time in demanding jobs. the couples belong to the urban middle class. the selection of couples in this age group from this particular segment of the population was based on the assumption that both partners would be familiar with modern expectations regarding men’s emotional contributions to permanent relationships. the sample represents couples who are sharing costs and benefits equally. this njsr – nordic journal of social research vol. 5, 2014 26 pattern is also documented in a larger study about men’s quality of life (holter, svare, & egeland, 2008). for each couple in our sample, the two partners also have approximately equal amounts of both economic resources and assets. owing to sample size and homogeneity we do not explore variations between the couples in level of education or type of profession. the couples were recruited through personal connections from a variety of professional settings and through snowball sampling. the interviews were semi-structured. all participants were asked questions on the same topics related to both emotional and practical aspects of the couple relationship, but the sequence and the precise wording of the questions were decided during the interview. the interviews provided rich data about both partners’ experiences of emotional and practical aspects of the relationship as well as challenges they faced within the relationship. the interviews were coded and analysed systematically. the analysis of men’s responsibilities in the division of emotional labour is based on a classification of the couples according to variations in the interrelationship between commitment and independence and the men’s contributions in respect of coping with challenges. we have chosen for presentation five cases which best represent the variations in the expressions of commitment and independence. the other five cases show corresponding patterns. to ensure participants’ anonymity, pseudonyms are used and further information about the case couples is not presented. it should be mentioned that there were few differences between couples with and without children. commitment commitment refers to how men communicate emotional involvement in daily interaction. we explore men’s ways of communicating emotional involvement by focusing on the women’s reactions to the men’s contributions. responsive commitment implies that the woman emphasizes that the partner’s contributions communicate emotional involvement. responsive commitment may be both communicative and task-oriented, aspects referred to respectively in the following as communicative commitment and taskoriented commitment. these are not exclusive categories. men can contribute to the relationship in both ways, but generally they are inclined to express emotional involvement through either one or the other. in couples in which the woman did not receive consideration and confirmation, the man’s actions are classified as non-responsive commitment. this classification implies that the man participates in conversations or performs practical tasks, or both, but does not communicate emotional involvement. njsr – nordic journal of social research vol. 5, 2014 27 communicative commitment the case of robert and sara illustrates the pattern of communicative commitment. robert and sara both emphasize that the dialogues between them strengthen the emotional intimacy in the relationship. their descriptions of these dialogues are captured by jamieson’s (1998) concept disclosing intimacy, which suggests that the parties involved are revealing their inner thoughts and feelings to each other. robert points out that he frequently expresses his feelings for sara: ‘i often tell her that i love her. i tell her as often as i can.’ when he tells sara how he feels about her, he is confirming to her that he appreciates her. sara’s reaction indicates what this means to her: ‘he tells me very often that he is proud of me and fond of me. i feel very close to him then.’ the way robert discloses his feelings represents an expression of commitment. robert describes himself as an enthusiastic participant in the conversations he has with his partner: ‘she is very engaged, and i feel very close to her then. she opens herself to me to a great degree.’ robert explains that he responds to sara in ways that not only show his interest in what she is telling him but also reflect his feelings for her. the feedback he provides represents a basis for characterizing his contributions as responsive commitment. sara, in turn, appreciates the sensitivity he displays in their discussions: ‘i think robert is a very considerate listener. he confirms that he appreciates me. he always pays a good deal of attention to what i am saying. this is his way of being very supportive.’ the dialogues between robert and sara are characterized by mutual responsivity because both parties express their reactions to what the other has just said and also convey the feelings they have for one another. both robert and sara describe their partner as a sensitive listener who provides considerate feedback. the communicative commitment robert expresses indicates his emotional involvement. the interaction between robert and sara is characterized by the high priority given to the quality of their communication. over time their understanding of their respective interests and points of view has increased, and they share the opinion that good conversation is necessary for the development of the relationship. the initiative each of them takes to achieve this reflects that they share the responsibility for coping with challenges in the relationship. sara explains how she tries to bring them back on track if the distance between them increases, and robert explains how he has worked to be better at identifying the causes of misunderstandings and irritation. njsr – nordic journal of social research vol. 5, 2014 28 task-oriented commitment the case of john and maria illustrates the pattern of task-oriented commitment. john explains that he has learned from newspaper and magazine articles on relationships that the way to a woman’s heart is doing something for her: ‘i must bear in mind that my partner is actually another person and not a part of myself. it’s important to make an effort to keep the spark alive.’ john’s reflections indicate that he gives priority to doing things for his partner that he knows she appreciates. he explains: ‘she is much more used to tidying up than i am. so when i want to please her i take a good look around and tidy up. she appreciates that.’ the thoughtfulness john expresses through such practical activities forms the basis for characterizing his contributions as responsive commitment. he demonstrates that he cares for his partner, and he communicates his love by doing things for her that he knows she values. maria appreciates what he is trying to express through his efforts: he is good at showing that he cares; i think he is better at it than i am. he tidies up because he knows that when i come home i am going to tidy up. but he has already done it for me. she sees his efforts as an expression of love because she understands that he does this to please her. the type of communication that characterizes interactions such as these is captured by jamieson’s (1998) concept of silent intimacy, which emphasizes how practical sharing and caring can convey love. the meaning communicated, but not explicitly spoken of, contributes to the creation of a common interpretation of these situations. maria’s view of john’s contributions as expressions of love is based on what he does beyond the tasks allotted to him in their equal sharing of household duties. john expresses consideration for her by doing something extra, things that he knows she appreciates. hochschild’s (2003) reflections on what a gift represents capture the process involved here. she writes: ‘in the emotional sense on which i focus here a gift must seem extra – something beyond what we normally expect. the sense of genuine giving and receiving is a part of love’ (p. 104). john and maria have developed an increasing understanding of the practical tasks each of them can do which the partner will see as something extra, and thus especially appreciate. the understanding of each other they have achieved implies that they also share the responsibility for coping with challenges in the relationship. john describes his role in such processes: ‘maria becomes very quiet if there is something wrong. then i must try to find out what has happened during the last hours.’ maria appreciates that john takes the first steps towards coming up with a solution. njsr – nordic journal of social research vol. 5, 2014 29 non-responsive commitment the case of victor and kate illustrates the pattern of non-responsive commitment. non-responsive commitment has both a communicative and a task-oriented dimension, both of which are illustrated below. kate elaborates on the lack of response she receives in conversations with victor: it is difficult to talk with [victor] about things i am interested in. actually, i do not think that he listens very closely. he changes the subject rather quickly. maybe he does not understand what i am trying to say? he is not even close to giving me the confirmation i am longing for. the quotation above mirrors findings from studies that indicate a tendency for women to experience a lack of emotional participation from male partners, with the result that the women are left wanting an emotional response (duncombe & marsden, 1998; dempsey, 2002; holmes, 2004). strazdins and broom’s (2004) perspective captures this tendency: when women do more emotional work than men, it diminishes their sense of being loved. men’s reactions in such situations may be understood as an emotional remoteness, which falls in line with the description seidler (1998) gives of how men learn to keep emotional needs at a distance and to suppress their emotions. men’s task-oriented contributions are characterized as non-responsive when the woman relates that her partner is showing little consideration for her. the implication is not that the man does not do his share of the daily household duties. what the woman feels is missing are the more impulsive contributions that would indicate a deeper level of caring. as kate describes: my husband is good at doing the tasks we have agreed on. but i wish that he would be more attentive and that he would understand how worn out i am at times. if only he could do something to show that he cares for me. i do not think i ask for much – but i wish that he would see and understand. the quotation indicates that what kate wants is for her partner to contribute in ways that demonstrate care and consideration for her, and that he would do this on his own initiative. she is asking for something extra – a gift – beyond the duties he ordinarily performs. the interaction between kate and victor is characterized by disagreements and the shared feeling that they do not communicate very well. kate tries to bring up controversial issues in order to prompt discussions that could improve the situation. the responsibility for coping with challenges rests on her. she thinks that it is important to discuss problems in the relationship before they ‘explode’. victor does not agree with her and describes himself as vague and withdrawn: ‘i try to come up with some white lies in challenging situations in njsr – nordic journal of social research vol. 5, 2014 30 order to make things simple.’ his approach seems to increase rather than to solve the problems, which he also recognizes. independence independence is explored in the context of the partners’ negotiations of the organization of leisure time. in our material two different patterns emerged: conflicting independence and collaborative independence. conflicting independence refers to situations in which the man pursues separate time in ways that entail distancing from joint activities that the woman wants. collaborative independence refers to situations in which the man’s pursuit of separate time is not regarded as a threat to the relationship or to maintaining togetherness, but rather the contrary. the types of activities that partners are engaged in represent different types of challenges. couples face special challenges when one partner has interests that are time-bound and time-consuming. interests offering greater flexibility and demanding less time can more easily be adjusted to the family’s everyday life. in our sample, the typical pattern is that the man has more time-bound and time-consuming interests than his female partner does. the time-bound interests that the men in this sample engage in are, for the most part, activities with typically male connotations: outdoor sports such as hunting and fishing, watching sports on tv, and playing video games. engaging in an activity that has masculine overtones is a way of participating in the world of men. such participation includes both activities that men do together and pursuits that are more individualized, such as attending football matches and watching sports on tv. parker (1996), for one, describes that sports play a role in the maintenance of masculine ideals. conflicting independence the case of peter and jane illustrates the pattern of conflicting independence. having time of his own is especially important to peter. he associates personal time with ‘the freedom to be on your own and do your own things’ and he emphasizes the importance of pursuing his own interests. peter’s interests are activities with typically male connotations, especially sports. he explains that he has lost some of the freedom to pursue these activities as a result of his family life, and this is occasionally a problem for him. his partner holds a different view of the organization of the family's leisure time. jane wants to spend more time as a family unit so that everyone can take part in activities together. she comments on the way peter prioritizes his personal interests: ‘conflicts occur when he is busy a lot with his own things.’ njsr – nordic journal of social research vol. 5, 2014 31 the sporting events peter follows are a particular source of conflict between them. this conflict tends to escalate during the holiday season when he is watching games and jane wants the family to be together. problems that arose during a summer holiday that coincided with the football season are one example of such a conflict. because his interests are bound to outside events, the challenges around the organization of the family’s leisure time increase. the conflicts associated with the way peter gives priority to his interests can be understood by the emphasis he puts on independence as being more important for him than for his partner. he explains: my wife has higher expectations of everyday life than i can fulfil. to be on one’s own is more important for me than it is for her. but i do get permission once in a while. i feel some pressure to participate in family activities and i do my best. the importance he ascribes to independence can be linked to his desire to both engage in his own interests and to withdraw in order to put distance between himself and the perceived expectations of his partner. for peter family time is associated with duty, while being on his own is associated with pleasure. for jane the conflicts related to independence are grounded in her perception that peter prioritizes leisure time on his own terms and shows too little consideration for her and her wish for more time together. she claims that by putting his own recreational interests first, peter avoids participating in family activities. so, it is not time-bound and time-consuming interests, per se, that lead to conflicts for this couple, but the prioritization of one person’s interests with too little consideration for the other’s. his insistence on the need for time of his own also communicates a wish to withdraw and distance himself from her demands. peter and jane have different values concerning the organization of their leisure time. but the conflicts between them are, according to their comments, due to the way they communicate about the issue of separate-versus-shared time. jane especially emphasizes her partner’s lack of consideration for her interests. this pattern is in accordance with studies which emphasize selfrealization as more self-evident for men than for women (magnusson, 2008) and the finding that men more often than women make decisions on their own terms at the expense of maintaining togetherness (røthing, 2004). thus, the different values held by the members of this couple reinforce the conflicts they experience around the organization of leisure time. the disagreements over peter’s leisure time lead to frequent confrontations. in these situations jane tries to keep calm and to find solutions they can both accept. hence, the responsibility for coping with challenges is left to jane. peter comments on her initiative towards solving challenging issues: njsr – nordic journal of social research vol. 5, 2014 32 it is usually jane who talks about our problems and suggests how we can solve them and put them behind us. it is ok, but it can take some time. problems are seldom hidden, she does not allow that. if it had been up to me, i would prefer to hide the problems, i’m good at denial. the pattern of conflicting independence accords with beck and beckgernsheim’s (1995) assertion that freedom for one partner represents renunciation of freedom for the other. when the man insists on being free to decide how to spend his leisure time, his partner’s freedom is restricted; time together is an increasingly elusive option. collaborative independence the case of stephen and ann illustrates the pattern of collaborative independence. stephen, like many of the other men in this study, favours typically male interests such as attending or participating in sporting activities and watching sports on tv. it is also important to him to have the opportunity to meet friends and colleagues after work once in a while. he explains what independence means to him: i believe it is essential to have activities outside of the relationship. and it feels great to be alone once in a while. but i try to prioritize my time so that we all can spend leisure time together. ann appreciates that he is clear about his priorities, which include her and the rest of the family: ‘i enjoy when we take the children with us in the forest on sundays. we have picnics in the summer, and go skiing in the winter’. in this couple, both partners want time for individual interests and both give priority to joint activities. challenges concerning the organization of leisure time are associated with stephen’s interests, as they are more timeconsuming and time-bound than ann’s. this is especially evident when he is watching sporting events. ann, however, expresses an understanding of the situation: ‘my impression is that the closest football match is always the one that is most important. he has to watch the matches when they take place.’ she describes her own interests and discusses how she organizes them: ‘my interests are more flexible than his. i run regularly and i always find some time to meet my friends.’ ann also emphasizes the importance of having some time for herself. ann and stephen had different values concerning the organization of their leisure time at the beginning of their relationship, but they gradually reached a consensus. at the time of the interview, their negotiations were taking into account that they both have separate interests and want time for family activities. neither of them mentions feeling that their partner expects them to contribute more to the njsr – nordic journal of social research vol. 5, 2014 33 family than they already do. rather, both base their decisions about the organization of leisure time on a consideration of each other’s interests. this type of mutual respect is the basis for denoting this process as collaborative independence. the relationship between stephen and ann is characterized by their mutual understanding of the interests and priorities that are important for the partner, an understanding they have reached over the time. this mutual understanding implies an appreciation of the partner. stephen and ann also share the responsibility for dealing with challenges in the relationship. both of them emphasize the importance of bringing up controversial issues at an early stage. stephen describes his role in these situations: ‘i take the initiative to negotiate issues which are necessary in order to achieve a balance in the relationship which both of us can accept.’ negotiations between partners, which represent the essential aspect of collaborative independence, do not support beck and beck-gernsheim’s hypothesis about the paradox of freedom, wherein the freedom for one partner represents the renunciation of freedom for the other. collaborative independence implies that the priorities that one person sets can also take into consideration what the other person wants. to achieve this, neither of the two partners must see the partner’s need for a space of one’s own as entailing a withdrawal or distancing from the other or from the family. independence can, in this context, be interpreted as a way of revitalizing oneself, which, in turn, may contribute to maintaining and even strengthening the couple relationship. three models of commitment the dimensions of commitment and independence and men’s responses to challenges in the relationship combine in patterns which represent the basis for three models. the patterns are indicative of different approaches to the issue of emotional responsibility among men from fairly similar social backgrounds. the model of shared responsibility is characterized by the man’s sharing of the responsibility for maintaining the emotional bond with the partner. the model implies responsive commitment in terms of the man’s contributions. the man’s contributions – whether verbal or task-related – communicate emotional involvement, and the female partner gives corresponding feedback. the interaction between the partners is characterized by the development of a mutual understanding of the other partner’s point of view. the model also implies collaborative independence in terms of the man’s contributions. the implication of collaborative independence is that the priorities set by one person also take into consideration what the other person wants. furthermore, both partners give investments in the relationship high priority and share the njsr – nordic journal of social research vol. 5, 2014 34 responsibility for coping with challenges. four couples represent the basis for this model, two express communicative commitment, and two express taskoriented commitment. the model of gendered responsibility reflects a more traditional division of emotional labour. the basis for this model is that the woman takes the main responsibility for the emotional bond. the interaction is characterized by nonresponsive commitment, which implies that the man contributes to the relationship in ways which leave the partner wanting confirmation and appreciation. the model also implies conflicting independence. the conflicting interaction these couples express is associated with the man’s prioritization of his own time. the man expresses little understanding of his partner’s needs and wishes, and he does not share the responsibility for relationship challenges with his partner. four couples represent the basis for this model. the data also support a third model, the model of partial responsibility. this model represents a position somewhere between the other two. it is characterized by the man’s responsibility for collaborative practices in relation to the organization of the couple’s leisure time, but not concerning expressions of commitment. the man’s prioritization of his own time takes into consideration what his partner wants. however, the man’s communication of emotional involvement offers little consideration for the female partner’s need for confirmation and appreciation. the implication of non-responsive commitment is that the woman has the main responsibility for challenges in the relationship. while the man acknowledges the importance of investing in the relationship, he shows no initiative to act on the challenges the couple is facing. two couples represent the basis for this model. the fourth possible combination of commitment and independence, that of responsive commitment and conflicting independence, has no empirical basis in our data. this combination, which also represents a form of partial responsibility, may apply to couples whose relationships are in earlier phases, where the communication of emotional involvement can be characterized by responsive commitment, but the parties have not yet developed collaborative practices. it may be that the appreciation of the partner associated with responsive commitment represents the basis for developing collaboration in a longer perspective. discussion our analyses suggest a marked diversity in present-day norway in the approaches to emotional responsibility taken by middle-class men, a segment of the population that identifies with dominant gender-equality discourses. in respect of gender equality, the model of shared emotional responsibility represents an egalitarian pattern, while the model of gendered emotional njsr – nordic journal of social research vol. 5, 2014 35 responsibility represents a traditional pattern. the third model of partial emotional responsibility can be interpreted in different ways. our interpretation is that it points towards a more non-traditional pattern of emotional responsibility than the model of gendered responsibility does. the diversity we have described may indicate that heterosexual middle-class couples are in a phase of transition between traditional and egalitarian practices. the link between middle-class culture and the pattern of shared emotional responsibility is supported by research on other aspects of couple relationships and family life among the middle class, as well as research on middle-class working life and lifestyles. for example, research on attitudes towards equality and sharing practices concerning household duties indicates that equality both in attitudes and concerning sharing of household duties is more widespread among men and women with higher education compared with men and women with less education (kjeldstad & lyngstad, 2010). drawing on empirical data on norwegian middle-class couples, aarseth (2009) finds an emerging pattern of degendered division of labour. she attributes this change to a re-articulation, among middle-class men, of the emotional meanings entrenched in the practice of homemaking, transcending the traditional division between ‘duty’ and ‘fun’. qualitative studies on parenthood in norway also find that middle-class couples share the responsibility for child care more equally than working-class couples do (stefansen & farstad, 2010). men’s emotional responsibilities in couple relationships can also be associated with a new cultural emphasis on emotional competence, which applies especially to the middle class. women have traditionally been experts on relational competence (illouz, 1997; kimmel, 2004) and this has lead to separate emotional cultures for men and women (duncombe & marsden, 1999). the cultural emphasis on the importance of relational competence applies to both men and women in the working life associated with the ‘new’ middle-class. the demand for emotional competence in the working culture is evident in the market for courses on leadership training and conflict management, coaching services, and seminars on collaboration. this cultural demand for emotional competence applies to the private sphere as well, and is reflected in the increasing availability of courses, books, and journal articles regarding how to manage the couple relationship. this cultural emphasis on relational competence implies that such competence represents a goal for men as well as for women – at least in the middle class. this change may lead to a transcendence of the traditional pattern of separate emotional cultures, in our study conceptualized as the model of shared responsibility. njsr – nordic journal of social research vol. 5, 2014 36 conclusion in our sample of norwegian middle-class couples, the dimensions of commitment and 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(2009). from modernized masculinity to degendered lifestyle projects: changes in men’s narratives on domestic participation 1990-2005. men and masculinities, 11, 424-440. microsoft word why do administrators employ or not employ support contacts.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 3, 2012 why do administrators employ or not employ support contacts? a norwegian qualitative study aud johannessen* ageing and health norwegian centre for research, education and service development tønsberg, norway nordic school of public health nhv gothenburg, sweden email: aud.johannessen@aldringoghelse.no *corresponding author anders möller nordic school of public health nhv gothenburg, sweden ersta sköndal university college stockholm, sweden email: anders.moller@esh.se abstract this is a qualitative study based on statements by administrators in the dementia sector in norwegian local authorities. the aim of the present study is to investigate the arguments for and barriers to the allocation and organization of support contacts for people with dementia and their families. various services are needed to help these families from being isolated. ‘support contacts’ can be one such service, yet the local authorities rarely use them in the norwegian dementia-care sector and little is known about why that is so. support contacts are ‘paid friends’ and their tasks can be compared to respite carers or volunteers in other western countries. the data was gathered from interviews with 35 informants (34 women and one man, aged 35-66 years) during 2011, from 32 local authorities in norway. the analysis of data involved a qualitative content analysis. three main categories emerged: ‘knowledge’, ‘accessibility’, and ‘management’. ‘knowledge’ describes the range of an administrator's familiarity both with dementia and with the legislation concerning the offering of a support contact to families with dementia, and it has two subcategories: ‘formal knowledge’ and ‘experiential knowledge’. the category of ‘reaching out’ describes the circumstances that lead families with njsr – nordic journal of social research vol. 3, 2012 18 dementia to apply for help and contains the subcategories of ‘supplying information’ about the service and ‘characteristics of target group’ receiving a support contact. the category of ‘management of services’ describes the various ways in which a supporter service may work satisfactorily and contains the subcategories ‘recruitment’ and ‘organization’. in conclusion, the administrators consider support contacts to be a valuable service. the authors conclude that managers of local authorities need to organize their departments in a way that administrators will have sufficient knowledge about making the service available and supporter contacts will receive the necessary guidance and knowledge to maintain the service effectively. keywords: accessibility, dementia, health promotion, public health, services introduction the majority of people suffering from dementia in norway live in their own homes with the assistance of close family members (engedal & haugen, 2009) until the later stages of the disorder. caring for a family member with dementia is associated with a risk of developing health problems oneself because of the burden of caring obligations. in addition, as a consequence of having a member of the family with dementia, the primary familial carer as well as the person with dementia may become socially isolated (ulstein, bruun wyller & engedal, 2007; brodaty & donkin, 2009). the present study focuses on norwegian experiences of dementia care. from a public-health perspective it is important to provide a variety of assistance initiatives to these families during the entire progress of the disease in order to maintain personal activities and to prevent social isolation and thereby to promote their general health (holley, 2007). it is well known that intellectual and social stimulation may both delay the impairment of the disease and enhance the quality of life (engedal & haugen, 2009). the local authorities may choose the best way to help these persons, and a support contact (in norwegian støttekontakt) can be one such service, either by itself or in combination with the other measures listed in the social service act (hod, 2006). this support-contact service is not new, but it has been more frequently allocated to people with a disability in general and to people with psychiatric disorders in particular (norwegian board of health supervision, 2008). until recently, the focus on the services to families with dementia has been on nursing homes, medical treatment, cognitive aspects, and the impact on carers and their experiences. formal help and assistance may help the persons with dementia as well as the carers to take part in everyday life and to maintain a satisfactory level of participation in society. blackman et al. (2003) and brorsson et al. (2012) have also shown that both the availability of access to public spaces and the physical environment affect the dementia patient’s functioning in daily life. according to the recommendations of the norwegian directorate for health and social affairs (2005-2006) and the government’s dementia plan (2008), a strategy is needed to develop different services to make a social life more feasible for families with dementia. this aim is line with the barrier-free principles of universal design, where the overarching objective is promote the health of all persons, regardless of one’s age or abilities (story, mueller & njsr – nordic journal of social research vol. 3, 2012 19 mace, 2001). norwegian legislation as well as the dementia plan proclaims that anyone in need of personal or practical help in their daily life, due to disability, disease, age or some other reason may be deemed eligible to receive support from the local authorities, either to prevent social problems from arising or to alleviate them. this article uses the term ‘supporter’ to identify someone fulfilling the role of support contact (hod, 2006). supporters are supposed to replace neither professionals nor volunteers, but are instead meant to provide a supplementary service (norwegian board of health supervision, 2008). this service can also, if necessary, be offered to carers and people who have been given a day-care placement or a place in an institution, and there is no time limit on the hours that the supporter service may supply. however, the offer is made without any direct relation to the specific needs of the family in question, and it is of a more or less routine character (norwegian board of health supervision, 2008). in norway the supporters are deemed to have the following functions: to help the supported person to participate in social, cultural, and sporting activities, to be a social contact or someone to talk to or to go shopping with, and to provide some respite to the primary carers. supporters neither provide treatment nor require formal education or training, and are often usually hired part-time by the local authorities on a self-employed basis. in norway, supporters are ‘paid friends’ with a low salary, and their tasks can be compared to those of respite carers, befrienders or voluntary workers in norway and other western countries. in the nordic countries, the groups of people deemed eligible to receive a supporter are more or less the same, though in sweden there is an age limit of 65 years for new applicants (svensson, ekvall & storfält, 2007). the supporters can assist the person to maintain earlier activities and can be a link to society and thus help to prevent social isolation. in addition, they can also give the primary carers some time to keep up with their own activities. the service can also be group-based if it is suitable for the people who receive the service. studies confirm that supporters are a valuable and important service and may be a helpful supplement to other services offered to families with dementia (jansson, almberg, grafström & winblad, 1998; bjørge, 2004), such as a day-care centre, or a short-term or full-time institutional placement. however, norwegian dementia care rarely uses supporters: only 34 per cent of the 434 norwegian local authorities offer this service to persons with dementia or their carers and in total 317 persons with dementia received this service in 2007. of these 317 persons, 52 were under 65 years and 75 of the 317 persons also had a placement in an institution (westerberg, 2009). beyond these numbers, little is currently known about why norwegian dementia care uses supporters so rarely or why there are these differences between the local authorities (westerberg, 2009). therefore, in this study the focus is on administrators in the local authorities and how their knowledge and experience inform them on how they can contribute to maintaining a link between families with dementia and society, and consequently decrease the health problems associated with the isolation that these families experience. both research (jansson et al., 1998; bjørge, 2004) and the norwegian government’s care plan 2015 (2005-2006), including its sub-plan (2008), recommend the use of supporters. it is, therefore, important to investigate why local authorities offer supporters so rarely and, if they do, why administrators of different local authorities do so in markedly different ways. this study has applied a qualitative approach to examine these issues. more specifically, certain qualitative methods are advantageous because they describe the subjects’ perceptions of their work in njsr – nordic journal of social research vol. 3, 2012 20 their own words, and these perceptions are at the core of this study’s objectives (karlberg, hallberg & sarvimäki, 2002). the study the aim of the present study is to investigate what administrators take to be the arguments for and barriers to the allocation and organization of support contacts for people with dementia and their families. on the basis of a previous study (westerberg, 2009), we chose to ask 32 norwegian local authorities at the municipal level, representing eight of the 19 counties in norway, with different experiences of using the supporter service in norway to participate in the study. the criteria for participation of the individual administrator in the interview study were as follows: experience of being an administrator in a position of authority to allocate services and of having the responsibility for case management of all kinds of services within health care or home care in general or dementia care in particular; knowledge about dementia; and substantial experience of being an administrator or experiences of working in dementia care for at least two years, of both. we also selected local authorities that represented cities as well as those that represented smaller communities in the countryside, with the result that this study dealt with variations in population size between 1300 and 600 000. these local authorities represented a range of experiences in using supporters, and some of them even had no experience at all with the supporter service in dementia care. administrators from these care services were contacted by telephone and were asked to participate in this study. a total of 35 informants (aged between 35-66 years, all women except one) were interviewed during 2011. all of the informants were administrators and had been involved in managing services in general for persons with dementia. no one declined to participate in the study. following ethical approval by the regional committee for ethics in medical research, southern norway, we collected the data with qualitative interviews using guide that comprised the thematic questions focusing on the informants’ experiences of the kind of services families with dementia need during the entire course of the disorder, on what the local authorities’ duties are towards these families, and on how the local authorities perform these duties. depending on the replies received, the interviewer followed new ideas raised by the informants by asking further questions in order to obtain additional information. one of the authors (aj) carried out the interviews were carried out in a conversation-based form. the interviews lasted for approximately 45–55 minutes and were recorded. (one interview lasted for only ten minutes owing to the informant’s lack of experience.) they were mostly carried out at the informants’ work place at a time and date convenient for them, though eight interviews were carried out on the telephone to save time and expense. within a week after each interview a typist transcribed the complete recorded interviews verbatim. one of the authors (aj) performed a quality-control check of the transcripts by listening to the tapes while reading the interviews. both authors analysed the transcribed interviews. manifest qualitative content analysis (graneheim & lundman, 2003) was applied to the interviews and carried out in the following stages. first, the authors read the text carefully several times to gain an overall impression, identified the words and sentences expressing a central meaning, and systematically condensed the data while being careful not to alter the original meaning. in the next stage, the njsr – nordic journal of social research vol. 3, 2012 21 authors assigned a code to the relevant phrases that identified their content. in the third and final stage, the categories were created. these consisted of groups of codes according to the themes in the interviews. findings the findings in this study describe the variations of possible explanations for and barriers to the allocation and organization of support contacts for people with dementia and their families. there were three categories. the first category, knowledge, describes the variations in administrators’ knowledge of dementia and of the laws regarding the allocation and organization of supporters to families with dementia. this category is divided into two subcategories: formal knowledge and experiential knowledge. the second category, reaching out, describes the variations in the process that leads to families with dementia applying for the service, and it has two subcategories: supplying information about the service and characteristics of target group allocated a supporter. the third category, management of the service, describes the variations of articulated reasons or arguments for and barriers hindering the allocation and organization of supporter services. this third category contains two subcategories: recruitment and organization. each of the categories will be described below with excerpts from the interviews. knowledge the category of knowledge and two sub-categories of formal knowledge and experiential knowledge cover the extent of the informants’ formal knowledge of the legislation that governs the supporter service and their formal and experiential knowledge about families with dementia. these aspects give rise to their offering a variety of different services. formal knowledge the informants’ formal knowledge about dementia and the law granting the supporter service varied. twenty-five informants were registered nurses, two were nursing-assistant graduates, and the other eight had various college degrees within the area of health studies. five informants had formal knowledge about health legislation in general. most of the informants had completed further studies, branching out into geriatrics, psychiatry, and management, and 14 informants had formal knowledge of dementia. those informants saying they had formal qualifications in the care of dementia (and some of those without formal qualifications) stated that it was important to provide families with dementia with services that were individually tailored. according to these informants, they believed that there should be a focus on providing relief and information to these families. moreover, the informants who stated that they knew nothing about the supporter service also had no formal knowledge about health legislation. these informants held a variety of misconceptions. some believed that the service was not allowed to be offered to persons with dementia or their carers, that the service was limited to only a few hours a week, or that it could only be used for recreational activities and not in cases where a person would be unable to participate in group activities. moreover, some thought that it could not be offered to those with access to institutions or placements in day-care centres. for these reasons the families in question were not being given the service. njsr – nordic journal of social research vol. 3, 2012 22 furthermore, the informants without formal knowledge about legislation and dementia stated that this service was not being offered because a lack of resources forced them to give priority to the many younger people who were in need of a supporter. however, administrators with formal knowledge of the legislation maintained that no application would be rejected, even if the budget had been used up. another opinion held by some administrators was that while supporters provide a valuable service to carers, they are nevertheless unskilled workers who cannot provide care to persons with dementia. accordingly, these administrators’ practice was to refer these families to already established services, and to encourage these families to apply to receive an allowance to pay family carers, an institution or a day-care placement. those informants who had no formal education about the relevant legislation and who tried to apply for supporters for families with dementia revealed that they had been rejected by other administrators and did not know how to appeal against the decision through the county council. as one informant expressed: we do not use supporters for care of the elderly. families with dementia may apply, but i do not know if it would be granted. it is outside my remit. furthermore, according to the informants without formal knowledge about legislation, they had received guidance from the county council about how to manage the service, and they described this experience as positive. some informants’ eyes had also been opened to the supporter service by carers whose request for a supporter had been initially rejected but later granted following a successful appeal to the county council. experiential knowledge this subcategory captures the informants’ descriptions of a range of experiences with the supporter services for families with dementia. the findings show that there were some local authorities that offered the service and had a system for organizing the service. other local authorities offered this service to a few families with dementia, but lacked the procedures for organizing the service. still others had no experience of using this service for these families. according to the informants who had experience with the use of supporters in the care of dementia, carers and persons with dementia appreciated the supporters’ help and the informants wanted to increase the use of this service. however, it must be noted that most of them also stated that the service did not work if the person with dementia has reached an advanced stage because the tasks become too burdensome for a supporter with no formal qualifications. for that reason the use of supporters would not be appropriate at the later stages of the disorder. according to the informants with experiential knowledge the use of supporters for these families was aimed at relieving their carers, preventing isolation, maintaining previous activities, and preventing agitation in the person with dementia. they also felt that it could be a complement to other services, such as a placement in an institution or day-care centre. these informants also estimated that this kind of service could be a cheaper alternative to those mentioned above. other informants with experiential knowledge remarked that it was easier for some persons with dementia who were not interested in using a day-care centre to accept supporter services, and that it could delay a placement in an institution. some persons with dementia were in need of a supporter for a few hours a week and others several hours, but the service njsr – nordic journal of social research vol. 3, 2012 23 could be increased when needed if it was working well. in cases of people with dementia with severe behavioural problems, the informants needed to be able to supply skilled supporters with formal qualifications and experience of dementia. one of the informants who had experience with the use of supporters in the care of dementia stated that the service works very well, that it is flexible and easy to adapt to individual needs, and that if the supporter is the same person who comes every time, it creates security both for the person with dementia and for his or her carers. i think this service is very good for carers and persons with dementia, because it is the same person who comes to the family every time. so carers become very confident that the person with dementia is having a good time and as they become more familiar with the supporter the carers will not be so afraid of leaving home and staying away for the whole session. for the persons with dementia who may not benefit from other services, such as day care, or do not fit into groups, this is a very good service. it is also a low-threshold service, which makes it easier to accept it. other experiences with the supporter service that informants shared with us were that supporters should know all they can about the person with dementia, because this would make it easier to understand him or her. the family’s needs must also be identified and the supporter and the person with dementia should preferably be matched according to age and gender. reaching out under this category, reaching out, the informants described how they sought to contact the families in order to provide them with information about the services in general and how the supporter service could be made available to them. the variations in this process are described through the subcategories supplying information to families with dementia and characteristics of target group with dementia who were receiving a supporter service. supplying information this subcategory includes statements by the informants that described how information to families with dementia about supporters and services in general was provided through various channels such as the internet, local newspapers, brochures, courses for carers, information stalls, posters, libraries, local radio channels, senior centres, and through other supporters or carers. they also spoke about using standardized forms where people could apply for all the services as being useful. reaching these families is a challenge, according to the informants, but the families’ receiving information early in the course of the disorder is important in order to prevent carers from burning out, and so that people with dementia will be able to stay at home for as long as possible. they often receive applications from carers when the person with dementia has progressed so far that the need for an institutional placement is unavoidable. according to the informants, the information these families receive depends on the health-care personnel’s knowledge both about the available services and about the disease itself. to improve the distribution of information to these families, local authorities could establish a contact person who is responsible njsr – nordic journal of social research vol. 3, 2012 24 for coordinating services or for mapping out districts with many people over 75 or 80 years in order to identify needs on a general basis and to provide information about services. this effort had resulted in new cases of dementia being detected. but according to the informants the outreach service to the elderly had been discontinued because of financial difficulties with the local authorities, and that dementia teams and dementia coordinator positions had been cut for the same reason, resulting in fewer requests for services. moreover, according to the informants, they had recently received several applications for supporters from elderly people, when normally only younger people apply. other informants reported that they do not provide information about the supporter service to families with dementia because the local authority has a focus on offering day-care centre placement as a priority service for these families. the informants stated that they also believed that persons with dementia do not benefit from support services and for that reason do not inform them about the service. still, one informant commented on how the supporter service is starting to become better known: it has not been widely known that families with dementia can apply for a supporter, but it is now beginning to be known that these families can apply for this service. other groups often do apply for this service. characteristics of target group some characteristics of those families that are more frequently assigned a supporter are that neither the person with dementia nor the carer is more than 65 years old, that the person with dementia has special interests, and that there is no day-care centre in the neighbourhood. another characteristic is that the person with dementia is in need of a high degree of physical activity, particularly when he or she is placed in an institution where the staff are unable to accompany him or her for a sufficient number of walks, or if the person with dementia is troubled upon coming home to a ‘no-care’ situation after a session at a day-care centre. the informants also added that men were sometimes assigned a supporter because the activities at the day-care centre were not orientated towards men. furthermore, the informants remarked that the carers’ need for relief could be a reason for granting a supporter, as could the needs of these families to maintain social activities and interests. the informants also described how cooperating with many of the families could be a challenge for administrators: it is time-consuming, some carers and persons with dementia have difficulty accepting help, and there is often a long process before these families accept it. in many cases people believe that services are not for them and so they do not apply. their belief is linked to their level of knowledge, which varies among families with dementia. the informants were using home visits to enter into a dialogue with these families and they described the supporter service as a low-threshold service, that is, a service that the person with dementia and the carer more easily accept. persons with dementia and their carers seem to be more positive about supporters than about the other kinds of services offered. however, for some families it is still stigmatizing to receive help, even though they greatly need it. one informant remarked on the issue of stigmatization: now we have some younger persons with dementia, and they are not elderly. they should have the same rights as other young disabled persons. but there are still some differences, though i think this has started to change. there is more openness about dementia now and njsr – nordic journal of social research vol. 3, 2012 25 people know a little more about what dementia is, but we are not quite at the place yet where all illnesses can be regarded equally. management of services the category of management of services covers the statements by the informants that point to the variation they had seen in the process of recruiting and organizing the supporter service. this is described in the subcategories recruitment and organization as they relate to the allocation of the service. recruitment with respect to recruitment, some informants described how difficult it was to recruit supporters for the local authorities and how it was particularly difficult to recruit supporters for the elderly and persons with dementia, but they also mentioned that becoming a supporter has been a popular choice. according to the informants, the local authority often recruits supporters through a family network, so that persons with dementia do not have to deal with a stranger. in contrast, other informants said that they recruited supporters neither from within the family nor from its network because this would drain resources away from the network of the family. the informants who had experience of using supporters stated that it was not so difficult to recruit supporters, and the informants had also tried to recruit supporters who could work with several families with dementia. the supporters were recruited by the local authorities from a number of sources, as was described above under the subcategory of supplying information. furthermore, the interviewees with experience of using supporters stated that it was easier to recruit supporters among people over 60 and women, and that they interview prospective supporters and check their references from previous employers before employing them. many of the supporters had experiences of dementia from their own family or friends and some also had some formal knowledge about the disorder. health-care personnel with reduced capability due to illness or who have become unemployed have on occasion contacted administrators and expressed a desire to be a supporter and have subsequently been hired. the informants stated that many supporters continue to be a supporter for years, while others quit after a short time. the informants also stated the difficulty in recruiting supporters because the payment is low, while others said that payment had not been the decisive reason for the supporter’s commitment, but rather it was their need to be an important person for others. according to the informants the payment could vary and if the payment were to be too high it might attract people who would not be suitable supporters. other informants noted that carers often recruited supporters through their own family network. for these carers, it was important that there a payment is involved because it makes it easier to ask others to fulfil the tasks as a supporter. the informants with experience of using supporters expressed how they wanted to organize and give guidance to supporters in a better way. they believed that this would make supporters continue to support families with dementia. they reported that if the supporters received information and guidance, it influenced recruitment in a positive way and the service in general worked better for those who were receiving it. as one informant observed: it has become easier to recruit supporters now because the administrators of the supporter service are very enthusiastic and have njsr – nordic journal of social research vol. 3, 2012 26 created a system of supervision and guidance. it has been difficult to recruit supporters for some groups, but not necessarily for the elderly. organization the subcategory of organization captured how the informants described, with much variation from one local authority to another, how the local authorities manage supporter services and how they guide and introduce the supporters to the tasks. though each of the informants held an administrative position within health care, some of them were not executive administrators for the supporter service. the supporter service was instead managed by people in different departments within the local authorities, some of whom had formal knowledge neither of dementia nor of the laws governing health care. this way of organizing the supporter service within the local authority led to a lack of cooperation and understanding of each other’s fields. the administrators believed that this was one of the reasons why the service was not offered regularly to families with dementia. the informants had found that the healthcare personnel gained more knowledge and information about the supporter service after there had been a successful reorganization where several units had been placed under the same department. according to the informants who were providing this service to families with dementia, they had introduced the supporters to the families and given information and guidance to the supporters prior to the start of the service. they also described their having had regular meetings with the supporters’ once or twice a year, and added that the supporters could contact them if necessary. other informants described that the local authority had organized regular group meetings with the supporters, so that they could receive guidance together, and that all the supporters had someone to contact when they were in need of guidance. these local authorities also give the supporters an opportunity to attend both training with other staff about dementia and training specifically for carers. furthermore, they had set up their own procedures for the payment of salary and other expenses in connection with the supporters’ performance. the informants also expressed that they were not aware of any official procedures relating to this. there were also informants who informed us that they did not know how the supporters were provided with guidance because other units in the local authority were responsible for providing it. however, these units did not necessarily have specific knowledge about dementia, and the informants who had experienced the usefulness of the service and guidance for the supporters found this lack of knowledge to be confusing. another way of supporting the supporters was to put them in touch with staff who have experience of dementia. some supporters also submitted a report every month and the informants described that they had regular contact with the families. other informants also stated that they did not follow up on the service, and lacked information on whether the service was working or not. it depends on the assignment and individual qualifications for what kind of guidance supporters need. some are quick to ask for guidance, while you never hear a word from others, until suddenly they quit and later on njsr – nordic journal of social research vol. 3, 2012 27 it turned out that the challenges were too great for the supporter. so this is a challenge for me as an administrator to which i have to respond. discussion and conclusions the aim of the present study has been to investigate the informants’ statements of arguments for and barriers to the allocation and organization of support contacts for people with dementia and their families. the central issue of the present study is that knowledge about support contact and dementia is crucial for providing this service to families with dementia and that this knowledge can be undeveloped. there is need for improvement in the further education of administrators responsible for the care of dementia at the local level. another issue revealed by the data is that reaching out to these families with dementia was both demanding and time-consuming. lastly, the reason why this supporter service is allocated in so many different ways has to do with the management of the services in the local authorities. local authorities do not make this supporter service sufficiently available for families with dementia, and they have not found an optimal organization for managing it. once again, the degree of availability was connected to the informants’ and other administrators’ level of knowledge of the laws that regulate the health-care services for persons and families with a dementia disorder and to their experience with the supporter service. these findings are in line with a survey in norway by westerberg (2009) that showed that only a minority of communities in norway offer the supporter service. selbæk and høgset (2010) have shown that the kind and quality of service that is offered to the population depend on the individual knowledge of the administrators. an international review of the literature shows that the supporter service is also not much utilized in other countries, and that there is a lack of quality research in this area, according to lee and cameron (2006). axelsson and bihari axelsson (2006) and the norwegian board of health supervision (2008) have also shown that the organizational structure of the local authorities and attitudes among health-care professionals about what makes for a good service in the care of dementia affect the choice of services. furthermore, this study shows that a few of the administrators who were managing this service for families with dementia did not have sufficient knowledge of the law and ordinary case procedure within health care, since, according to these informants, this service was not for families with dementia. this study also shows that the kinds of experiences the informants had of the supporter service had an impact on the allocation and development of the service. furthermore, the informants stated that supporters could be complementary to other services and could be developed further. the service provided continuity and could prevent social isolation, which a number of studies have stressed as important in promoting health (holley, 2007; brodaty & donkin, 2009; hardy & kingston, 2009). a review study by schoenmakers, buntinx, and delepeleir (2010) confirms that continuity in dementia care is important. temporary respite care scheduled only for a short time increases the burden on carers. however, the present study has shown that, according to the informants, supporters may not be a suitable kind of service later in the course of the disease because the tasks at that point are too difficult for an unskilled or uneducated person to handle. silverstein wong and brueck (2010) have also pointed out in their study that persons with dementia require educated health-care personnel in the later stage of the dementia disorder. njsr – nordic journal of social research vol. 3, 2012 28 furthermore, the present study shows, on the one hand, that those informants who had experience of the service and of the guidance that the supporters received stated that it was not difficult to recruit supporters, and that families with dementia often applied when they had received information about the service. on the other hand, informants who had no experience of offering this service declared that supporters were no use for families with dementia and, in any case, supporters were difficult to recruit and it would be a challenge to get the information about the services to these families. however, as it turns out, even when administrators do know about legal and administrative procedures and about dementia, many families with dementia still do not receive this service (norwegian board of health supervision, 2008). only 317 people with dementia received this service in 2007 in norway (westerberg, 2009), and many of them were under 65 years of age. this situation does not seem to have changed, according to a survey by eek and kirkevold (2011). in line with these findings, our study shows that the characteristics of the family, such as age and gender, and other characteristics as described in the findings, affect the allocation and choice of services. this study also illustrates how organizational structures and cooperation within the local authorities affect the quality and availability of services. some informants described how the local authorities divided the administrator’s tasks in such a way that different administrators managed the services that families with dementia received, and this put these families at risk of not being prioritized for economic reasons by administrators who lacked expertise in the law and in dementia. furthermore, local authorities who had organized joint meetings within the various departments had contributed to bettering administrators’ understanding of other users’ needs and consequently also those of the families with dementia. how services are organized and how local authorities cooperate with the users affect the quality of services and their availability, a finding that other studies have also confirmed (ryan, nolan, enderby & reid, 2004; axelsson & bihari axelsson, 2006; öhman, josephsson & nygård, 2008; wihlman, lundborg, axelsson & holmström, 2008; hardy & kingston, 2009). one conclusion that we can draw from the present study is that services are not available to everyone, though norwegian law (hod, 2006) has stipulated that they should be. further, neither the principles of universal design (story, mueller & mace, 2001) nor the norwegian law on the prohibition of discrimination and accessibility based on reduced functional ability (bld, 2009) is being fulfilled. in order to address this shortfall, local authorities must focus on the collaboration between different professions and departments. specialization within welfare services makes it difficult and challenging to provide the comprehensive services needed by families with dementia. bihari axelsson and axelsson (2009) have emphasized this point, and it is the intention of the new public-health law implemented by the norwegian ministry of health and care (2012) to provide these comprehensive services. moreover, this study has also shown that in order to develop the supporter service, organizational structures must have administrators who can follow up on the supporters and provide guidance and education, both of which can affect the quality of services and provide the opportunities for improving the recruitment of supporters and counteracting supporter resignations. other studies have confirmed this finding (severinsson & kamaker, 1999; ryan et al., 2004; testad, mikkelsen, ballard & aasland, 2010). njsr – nordic journal of social research vol. 3, 2012 29 the present study has used qualitative methods (content analysis) to collect and analyse the data (graneheim & lundman, 2004). the choice of method was motivated by the lack of previous studies on the use of supporters in the care of dementia. the qualitative method enables the researcher to focus on the informant’s point of view, and the present study depicts the informants’ own descriptions and stories, which are fundamental for understanding why this service is not offered by all local authorities and where it is offered why it is not provided to more families with dementia. knowledge of why this service is offered so differently from local authority to local authority is difficult to address with quantitative methods, and qualitative methods are helpful for improving our knowledge of phenomena in areas where little is known, as dellve, abrahamsson, trulsson, and hallberg (2002) have argued. even if the findings cannot be generalized in a statistical sense, our findings are transferable to other contexts (malterud, 2001; flyvbjerg, 2004), such as other groups of patients and other local authorities in norway, and perhaps other countries. thus the findings of this study can contribute to the development and organization of services in a more holistic way that would help to promote the health in families coping with dementia. this study chose a strategy that included informants of all kinds, since content analysis aims to describe variation. with 35 informants included from 32 local authorities with different population sizes, representing cities as well as smallcommunity municipalities located in the countryside, coming from eight counties, informants with different levels of formal knowledge and experience (or lack of experiences), working in different organizational structures, and of various ages, we believe that we have made it possible to describe a broad variation of experiences that strengthens the validation of the findings (patton, 2002). in order to contribute to the trustworthiness of the findings, this study has presented quotations in the text and the authors have analysed the data together and discussed critically the categories and level of abstraction (lincoln & guba, 1990). one limitation with the present study is that only one administrator (in one cases two administrators) from each local authority was interviewed. this makes it impossible to interpret the results as the definitive or official views of the local authorities. rather, the ambition with the present study was to find arguments for and against using supporters and these were presented by the individual administrators. acknowledgements this study was supported by the nordic school of public health, gothenburg, sweden, and ageing and health, norwegian centre of research, education and service development, norway. references axelsson, r., & s. bihari axelsson, s. 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(2010). health and well-being in care staff and their relations to organizational and psychosocial factors, care staff and resident factors in nursing homes. international journal of geriatric psychiatry, 25(8), 789-797. njsr – nordic journal of social research vol. 3, 2012 32 ulstein, i., bruun wyller, t., & engedal, k. (2007). the relative stress scale: a useful instrument to identify various aspects of carer burden in dementia? international journal of geriatric psychiatry, 22(1), 61-67. westerberg, t.h. (2009). gode tilbud i demensomsorgen: demensteam, dagsenter, pårørendeskoler. [good services in the dementia-care sector: dementia team, day care, and schools for caregivers]. tønsberg: aldring og helse. wihlman, u., lundborg, c. s., axelsson, r., & holmström, i. (2008). barriers of interorganisational integration in vocational rehabilitation. international journal of integrated care, 8(19 june), 1-12. öhman, a., josephsson, s., & nygård, l. (2008). awareness through interaction in everyday occupations: experiences of people with alzheimer’s disease. scandinavian journal of occupational therapy, 15(1), 43-51. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 7 (2016): special issue intelligence testing, ethnicity, and construction of the deviant child: foucault and special education in sweden thom axelsson faculty of education and society malmö university email: thom.axelsson@mah.se abstract in this article, i discuss how foucault may help us to reach a different understanding of special education. this article primarily draws on two analytical tools from foucault’s ‘toolbox’: genealogy and governmentality. these tools are used to analyse three different cases of intelligence testing from the debate concerning the swedish school organization in the early twentieth century. it is possible to see intelligence-quotient (iq) testing as an overarching tool for controlling social behaviour. intelligence-quotient testing was an important tool of power, with the aim of establishing certain regimes of truth on a societal as well as on an individual level. this article shows through a foucauldian analysis that we should be careful in interpreting this entirely as an expression of state power from above or as different experts’ intentions. rather, by using a genealogical approach, we can attempt to (re)write the history of interpretations, or problematizations, and then we can utilize a perspective of governmentality that focuses on the techniques and their effects. keywords: iq testing, genealogy, governmentality, foucault, special education, sweden introduction throughout the twentieth century, the nature of intelligence has been a ‘hot topic’ and an intensely debated issue, especially in school and in connection with special education. it is the measuring and testing of intelligence in particular that have evoked the strongest reactions from protesters and defenders alike. the discussion of intelligence tests has frequently revolved around questions such as whether these tests will lead to increased social integration and liberation or, on the contrary, to exclusion of and discrimination against certain groups. in this context is it hard to ignore the impact of the work of foucault on special education and on constructions of the deviant child. it is not easy to define exactly what special education is, but it is often associated with school activities and special instruction for students in need of special support. however, this is too narrowly defined, so the special-education mailto:thom.axelsson@mah.se njsr – nordic journal of social research vol. 7 (2016): special issue 23 activities should be seen in a wider perspective that also includes social, organizational, and didactic perspectives. research on special education is often interdisciplinary and includes disciplines such as medicine, sociology, psychology, pedagogy, and, occasionally, history. in recent years, specialeducation research has been exposed to some criticism that it is too selfdirected and focused on deviation. also, it has been argued that specialeducation research is often ideological, normative, and policy-prescriptive, and it lacks a theoretical base (ahlberg, 2007; nilholm & björk-åkesson, 2007). at the same time, the swedish school inspectorate has pointed to several shortcomings both in the identification and the investigation of pupils placed in special classes, which is remarkable in the light that since the early 1990s the placements of students in special classes have increased (skolinspektionen, 2011). the focus of the present article is not intelligence-quotient (iq) testing and the construction of ‘deviance’ as a political and educational concern. rather, it is the tools and techniques of government set up in school and society for ‘the conduct of conduct’ (foucault, 2008). the article primarily draws on two analytical tools from michel foucault’s ‘toolbox’, namely, genealogy and governmentality, and examines how these may help us to raise new questions that are neither normative nor have an ideological perspective. this article primarily focuses on swedish conditions during the early twentieth century, and comprises three main parts. the first gives a background to foucault’s concepts and his views on knowledge and power. the second focuses on intelligence testing and the debate concerning the swedish school organization. i shall use three different ‘cases’ or ‘problem descriptions’ to discuss how foucault’s tools can help us to analyse the differentiation into categories of giftedness in school: the concept of talent; the ‘tattare’: construction of a risky group; and making the right choices. in the concluding third part i shall discuss how foucault’s work can contribute to a reinterpretation of history of both special education and the deviant child and how this may awaken us to a different understanding of the underlying issues. foucault’s concepts of genealogy and governmentality since the concept of genealogy can be used in different ways, it is important, first of all, to make some distinctions. the genealogical method as it was developed by foucault is not about tracing the origin of things, as if thoughts and practices have a definitive and unquestionable beginning which researchers can discover through scientific methods. rather, genealogy, according to foucault, is a historical method that aims not to reconstruct the past as ‘it really happened’, but, … to identify the accidents, the minute deviations––or conversely, the complete reversals––the errors, the false appraisals, and the faulty calculations that gave birth to those things that continue to exist and have value to us; it is to discover that truth or being does not lie at the root of what we know and what we are, but the exteriority of accidents. (foucault, 1984a, p. 81) the genealogical method is more concerned with the often unexpected and strange connections between ideals, intentions, and strategies, on the one hand, and the actual outcome of these, on the other. at a more fundamental level, genealogy is fuelled by a desire to do research without leaning on the well-established enlightenment dream of society as moving towards a njsr – nordic journal of social research vol. 7 (2016): special issue 24 humanistic utopia through reason and science. instead, the genealogical approach presupposes a world where power relations and ongoing conflicts belong to the warp and woof of social life and where human agency, intentions, and aspirations must always be understood in relation to dominant discourses and specific, time-bound ‘regimes of truth’ (foucault, 1980, p. 131). the genealogical approach can never assume, therefore, an underlying essence, a strict cause or an objective truth behind certain phenomena, and consequently do research on this basis. rather, it should examine how, under what conditions, and with what effects a certain phenomenon is viewed as true or false, important or unimportant, relevant or irrelevant, and so on. what is constructed as a problem for school or society during a certain period is, therefore, not viewed as a fact by the researcher but as something contingent, something that could have been ignored or formulated in many different ways, given the different dominant discourses. simply put: genealogy is about destabilizing what has been taken for granted, to defamiliarize that which has come to be viewed as familiar and ordinary (qvarsebo & axelsson, 2015). furthermore, and importantly, a genealogical approach to historical research entails an analysis of power relations and power mechanisms. foucault coined the term governmentality to theorize and analyse power relations in their many historical guises. the concept of governmentality is only briefly discussed by foucault (2008) himself and more fully described in his lectures (foucault, 2010). researchers such as dean (1999) and rose (1999) have developed the concept, and larsson (2005) has discussed governmentality in the swedish context. governmentality can be a specific modern style of governing, such as disciplining power and biopower, but it can also refer to the countless rationalities, logics, truth claims, and techniques that accompany governing in itself. in this article, the analysis of governmentality is understood in this latter sense and is geared towards analysing the different ambitions to form and shape children within the swedish school system. the basic premise of governmentality is that all types of governing rest on certain assumptions about those who are governed. in modern times there is almost always some form of scientific knowledge that is invoked. however, it is not possible to analyse how government works without also studying the practices through which it works as well as the desired personal qualities and behaviours that are expected (foucault, 1988a; dean, 1999; rose, 1999). the assumptions of government, the knowledge it invokes, the techniques it mobilizes, and the kind of subject it seeks to fabricate are, therefore, the central features of this analysis. to make use of genealogy is, finally, to engage in discourse analysis. here this means that the focus is on the more or less systematic ways of talking and thinking about various phenomena and practices, which in different ways serve to structure and organize our lives as individuals and societies (foucault, 1981). based on this constructionist perspective, there is no pure and unmediated knowledge about the world: our knowledge is always mediated through linguistic categories, concepts, and thoughts. the world comes into existence – in the sense of becoming comprehensible, manageable, and possible to act in and on – when it is named and categorized in certain specific ways. to understand foucault, it is important to elaborate his constructionist or, as he himself preferred to call it, nominalistic view on knowledge and his approach to power. njsr – nordic journal of social research vol. 7 (2016): special issue 25 nominalism and power following foucault, beronius (1991) argues that history, sociology, and the social sciences in general should be understood as nominalistic or anti-realistic. from this perspective, language is not perceived as a neutral medium, but as constitutive of the way we understand the world and create meaning. truth is a consequence of the preferential right of interpretation. it is the perspective that gives or ascribes a meaning to the material. the scientist does not expose a hidden meaning, but creates a meaningful context. when working with the theory of science, we should, therefore, according to beronius (1991), avoid concepts like reality and truth. this may sound provocative, but the problem with these concepts is that they are not readily defined. to avoid the muddle that can follow from attempts at defining reality and truth, beronius suggests using the concept of perspective. it is not possible, beronius says, to step outside one’s own social and cultural situation. in other words, it is inescapable that knowledge is tied to a perspective. beronius writes that the idea of a single narrative or a theory must be abandoned in favour of narratives in the plural, a range of diverse perspectives. everything we run into and experience in the world is interpretation. this attitude to the theory of science, therefore, entails an epistemological nominalism, according to which knowledge is created in a social context. all descriptions are necessarily incomplete and fragmentary. in this respect, according to beronius, there is nothing different about scientific attempts to describe or explain situations and events which are not limited in language and concepts. foucault, with his nominalistic view of knowledge, rejects the claims, often absolute, of positivist science (foucault, 2004). in line with this, foucault is also sceptical of the ideological ‘meta-narratives’, which, for example, is found in marxism and liberal humanism. while marxism tends to see different institutions of society, such as school, as repressive and anxious to preserve the prevailing social order, liberal humanism tends to see the same institutions as supportive, as they help individuals to achieve freedom and emancipation. foucault views ideology as a loaded concept, and believes that there is good reason to seek an attitude towards power that is removed from ideological perspectives, as these perspectives are not sufficient for understanding how power works (nilsson, 2008). another problem with the concept of ideology is that it talks about the division between true and false consciousness, which cannot be combined with a nominalist view of knowledge. historically, different processes of power/knowledge, which have contributed to the growth of new knowledge about humans and their behaviour, have acquired scientific status. it is not possible, according to foucault (1993), to separate knowledge from the power that creates it. power and knowledge are what determines at any given time what is to be regarded as a problem in a society. another way to put it is that power produces truths as problems. power and knowledge presuppose each other – there is a mutual dependence between them: power produces knowledge (foucault, 1993; 1988a; 2008; deleuze, 1990; may, 2006). the historian only has access to representations of reality. ‘representations’ should here be understood as a replacement, not a depiction or reflection of reality (nilsson, 2005). foucault believes that power is not something that is owned; it is exercised. furthermore, he views power as a part of all relations, not something separate. however, though foucault believes that power is a part of all relations, this does not mean that all relations are steered by power. the point is that power is negotiable and changeable; it circulates (foucault, 2004). njsr – nordic journal of social research vol. 7 (2016): special issue 26 that power is not owned also implies that there is nothing to disclose. the task is not to see what is behind the veil, but to describe the veil. power in this sense is beyond good and evil. the interesting question to ask is, not what power is, but how it is practised (deleuze, 1990). power is most productive when its effects are not directly apparent as effects of power to those affected by it. yet power should not primarily be regarded as ‘negative’, as a penalty or an obstacle, but as ‘positive’, as something creative, productive and encouraging. all in all, power creates more than it controls (foucault, 1988c; 1980; deleuze, 1990). the productive aspect of power is a frequently misunderstood part of foucault’s view of power (nilsson, 2000; may, 2006) according to foucault (1984a), history is not a decision, a treaty, a reign, or a battle. instead, it is, …the reversal of a relationship of forces, the usurpation of power, the appropriation of a vocabulary turned against those who once used it, a feeble domination that poisons itself as it grows lax, the entry of a masked ‘other’. the forces operating in history are not controlled by destiny or regulative mechanisms, but respond to haphazard conflicts. (p. 88) a foucault-inspired approach, therefore, makes it possible to tackle a research problem with other types of questions, by stressing the association between knowledge formation and power, and the effects this association has on groups and individuals. a fundamental question is what makes a particular phenomenon in a certain historical period gain attention, and this puts the focus on the problematic of power and the link between power, knowledge, and social practices (foucault, 1988d). with this view of knowledge and how it is created, it is possible to question what is taken for granted. to return to iq testing, then, the question is not how many ‘moronic’ or ‘intelligent’ people there ‘really’ are in a country. a ‘stupid’ person, just like an ‘intelligent’ person, does not simply exist, but is constructed with the aid of categories in a cultural context. questions that are central to this perspective are, rather: how do ideas of intelligence arise? in what contexts has it been important to categorize people according to different degrees of intelligence? some examples of this are discussed below. the concept of talent: new technics and technology questions about talent and intelligence became an important part of the changes in the educational system in the western world during the early twentieth century. perceptions of society’s resources of talent and the gifts of individuals shaped the social life in different respects. views on talent led to two central aspects: how good talent should be made use of, and how poor talent should be counteracted. in schools, teachers, school inspectors, psychologists, and so forth were engaged in gathering knowledge on pupils and designing tests to identify special problems and solutions. the study of the social and institutional connections in which intelligence tests came to be seen as useful makes it possible to see the influence that the professionals had, via negotiations, professionalization and scientification, over the shaping of schools and, consequently, over future citizens. education and school were seen as important in the development of conceptual formation around the significance of citizenship and as part of identity-building, but also as a system for differentiation and control (axelsson, 2007). towards the end of the nineteenth century the eugenic movement was growing. it made it important to observe deviations at an early stage, which placed njsr – nordic journal of social research vol. 7 (2016): special issue 27 children and their development and maturity, especially their intellectual ability, in focus. children’s receptivity to education was considered to stand in relation to their intellectual ability. the lesser the talent, the harder it is to influence the environment. when the scientific and political interests started to apply to the inner human being, and their aptitude, abilities and talents, it became more important to gain both knowledge about talent and knowledge of how to measure it (danzinger, 1997; rose, 1995). knowledge was also developed within the international scientific community. the englishman francis galton’s normal curve, that is, his argument that every nation’s intelligence was distributed in accordance with a normal curve, made an incredible breakthrough, as did the frenchman alfred binet’s method for measuring intelligence. binet wanted to use intelligence tests to determine which pupils were behind in their mental development. those who were three years behind their biological age would be separated out and placed in remedial classes. the intelligence test never became popular in france. by contrast, in england, where the intelligence test was mainly used in sorting pupils during the transition from lower to higher forms of education, it had a major impact. so too in the united states, where intelligence testing became even more widespread and strongly influenced social policy through revised education policy, psychological practices, immigrant laws, and the relationship between them. in england, intelligence was often linked to social class; in the united states, it was linked to race (axelsson, 2012a; gould, 1996; zenderland 2001). intelligence testing was introduced in sweden and used for the first time in 1910. a common perception was that 50 per cent of children were normal, 22 per cent were dull, and 22 per cent were bright. of these, three per cent were very bright and three per cent very dull. the comprehensive problems of drawing up boundaries also led to new, stricter categories of talent to describe pupils, such as ‘idiot’, ‘imbecile’, ‘moronic’, ‘slightly backward’, ‘normal’, and ‘above average’. at the same time, at the beginning of the twentieth century, as schools moved towards a more organizationally uniform system, the separation widened regarding talent within elementary schools through new class types being introduced. remedial classes were introduced in 1905 in stockholm and in the following year in gothenburg. during the 1920s many towns introduced different types of ‘b’, ‘extra’, and ‘weak classes’. in sweden, intelligence was frequently linked to social class and intelligence testing was used primarily to determine which class a pupil belonged to. what was central to the sorting of pupils was to homogenize the classes in such a way that all pupils received the type of education that, with reference to talent, they were seen to be able to cope with. the ‘idiots’ and ‘imbeciles’ were completely separated from elementary schools. ‘moronic’ and ‘slightly retarded’ pupils would, however, remain within the framework of elementary school education, but would be separated from normal classes and placed in remedial and ‘weak’ classes (axelsson, 2007). power and knowledge determine, according to foucault (1993), what is considered a problem in society at a given time. historically, new knowledge on the human race and its behaviour has been given scientific status, which has led to various consequences for groups and individuals in society. through different boundaries and exclusions (that is, separating practices) in the educational system, individuals become visible both as individuals and as groups. the processes involved in this sorting work can, in foucault’s terminology, be described as a disciplinary exercise of power where the examination combines hierarchizing and standardizing. what is important in this form of exercise of power is that the social norm, rather than the legal regulations, is central (foucault, 2004). njsr – nordic journal of social research vol. 7 (2016): special issue 28 the examination was shaped in schools where different professionals increasingly began to determine the pupils’ evaluations and the schools’ social organization. different qualities described as desirable or undesirable were linked to the different categories of talent. the examining and separating processes identified students who were understood to be problematic and also revealed a view of what talent is and when it is absent. the techniques that were used were not necessarily connected to a particular profession that exemplifies a system, nor were they linked to a particular person or profession, and in this respect the techniques were impersonal (foucault, 1993). foucault (2004) was interested in different governing techniques that shaped new forms of subjectivities and procedures for the individualization of power. it is possible to see iq testing as an overarching tool for controlling social behaviour. intelligence-quotient testing was an important tool of power aiming at the establishment of certain regimes of truth, both on a societal and on an individual level. it entails techniques and tools that have been instrumental in shaping and moulding collective bodies, regions, and nations in the western world in specific ways, often in relation to social class, gender, and ethnicity. in the next section, i present an example of how this could also be directed against a specific group. the ‘tattare’: how to construct a risky group when the early swedish welfare state was created, the aim was to develop ‘a good society’ through meticulous planning. therefore, it was especially important to be aware of those who could not support themselves. at the time, the so-called ‘tattare’ came increasingly into focus. gradually, the families labelled as ‘tattare’ came to be racialized as they were described as ‘dark’, and ‘black-haired’ and their ways of life were said to be the result of genetics and hereditary biology. the newspapers often wrote about the tattare in a negative way, and as a group they were often portrayed as a heavy burden for society. initially, ‘tattare’ was a name for several transient groups. they were characterized by certain cultural traits, as ‘social outcast[s] formed by continuous exclusion from the majority population’. the tattare can be seen as a minority group created when sweden turned from bring a nation with an agrarian economy into one with an industrialized urban society (broberg & tydén, 1996; ericsson, 2015; axelsson, 2012b). the national board of social welfare were looking to introduce some measures to prevent vagrancy, since vagrancy was viewed as being closely connected to most problems associated with the tattare. furthermore, according to the board, manslaughter, knifing, and violence were common among the tattare. this could, according to the board, be explained by the tattare’s inferior intelligence. in particular, there was an interest in the tattare children of schoolgoing age. the national board of social welfare in 1940 reported that, ‘it is now a well-known fact that childhood can very often lay the basis of criminality and other forms of social maladjustment’ (sociala meddelanden, 1940, p. 805). in 1942 the swedish government commissioned the national board of social welfare to investigate the tattare question. the board of social welfare, in turn, commissioned the race institute to compile a complete register and catalogue all persons considered to be ‘gypsies’ or ‘tattare’. in connection with this, several tattare projects were initiated. one of these was an inquiry into educational ability among this group – a project initiated by a head teacher for the remedial classes (hjälpklasser) in gothenburg, manne ohlander. he thought njsr – nordic journal of social research vol. 7 (2016): special issue 29 that mapping their educational ability might be of practical use in the ‘battle’ against the ‘problem of tattare’. ohlander carried out his inquiry in two different ways. one involved tracing the lineage of three different families. he sent out questionnaires about their marriage, and number of children, as well as work history, criminality, and so on. alternatives to the answers included ‘deceased’ and ‘completed schooling a long time ago’. one of the questions related to signs of intellectual deficiency. ohlander employed different methods to ‘calculate’ and estimate their intelligence. even where no intelligence test had been done, ohlander sometimes estimated an iq of < 80, which meant that they were regarded as ‘backward’ (ohlander, 1943a, pp. 2-4). ohlander’s other method involved sending a questionnaire to approximately 80 school districts. he asked how many tattare children were in each class, and how many attended special-education class. the result was disheartening. no fewer than 30 per cent of the tattare children in this report went to special classes, which meant that they probably had an iq < 80. still, ohlander insisted that this percentage was too low, since not all tattare children could get a place in a special-education class (ohlander, 1943b). in his report ohlander wrote that the tattare were criminals and anti-socials, and that they were unable to look after their homes and children. words like ‘backward’, ‘less able’, and ‘unreliable’ were common in ohlander’s text. referring to the case of the united states, ohlander argued that differences exist between races, especially with regard to ability (ohlander, 1943a). ohlander had a great influence on special education at a local level in gothenburg and, to some extent, at a national level, since in a few official studies he was consulted as an expert. ohlander’s views never became the dominant opinion, but he was a part of the eugenics movement in sweden and represented a commonly held fear that ‘the wrong people’ should be allowed to propagate. social problems were linked to a lack of talent and it was discussed how these problems could be controlled. this does not mean that all ‘less talented’ people were looked upon as asocial or criminal, but there was a ‘high risk’ of this. the problems lay mainly in an imaginary future and had to be prevented through proper education and upbringing. as foucault points out, citizens were directed to recognize themselves as part of society, as a part of a social unit, as a part of the nation or state. the logic and rationality that emerged in connection with the welfare state was that the state referred to its own nature and its own rationality (foucault, 1988e). in order to be a satisfactory citizen, certain rationalities had to be accepted (cruikshank, 1999). intelligence tests can be seen as an alternative to previous categorizations. if someone had a low iq it was not so important which other category they belonged to. though the degree of intelligence replaced earlier divisions, it was nevertheless built on the same pattern. intelligence tests were presumed to make certain invisible differences visible and it did not matter if the person was a tattare, a gypsy, a criminal, an alcoholic or if the person was immoral, unwilling to work, or merely poor. low levels of talent could be reason enough for different authorities such as schools, poor relief or care for the mentally retarded to intervene if they believed it was necessary. in this context, schools had two important tasks to carry out: through intelligence testing the less talented could be discovered in time and by this means the school could educate them correctly (axelsson, 2012b). njsr – nordic journal of social research vol. 7 (2016): special issue 30 making the ‘right choices’: a field of opportunity with the help of intelligence tests, institutional changes were carried out in sweden, which led to a new system and new forms of sorting in schools. sorting according to intellectual ability became the cornerstone in the categorization of pupils in cities during the 1920s and onwards. in a democratic society built on meritocratic ideals it was difficult to justify a school system that was divided according to social class, gender, geography, and, later, ethnicity. the radicals of the time saw this as social injustice. in this context, talent functioned as a bridge. in 1927, a reform was implemented that enabled students to move on after a number of years in the common elementary school to lower secondary school. but education was seen to be expensive and during the 1920s there was also the worry that an overqualified proletariat was being created. for talented individuals, there were no formal obstacles after 1927 to enter further studies, but for the poor, the opportunities were few in reality. that all future citizens required a deeper political education was, therefore, not the same as allowing everyone to have the same education. consequently, a socially stratified school system was by and large preserved (axelsson, 2007; hjörne & säljö, 2008). as a way of bridging the opposition that might arise between the individual’s educational wishes and society’s interests, it was a central task of the school to lead the pupils to come to the decision themselves to want to make the right choices depending on ability and capability. different talent categories were seen to be adapted for different social tasks. symptomatically enough, intelligence was defined as the ability to adapt to surrounding circumstances. the less talented, often hereditarily tainted, were supposed to have difficulties in adapting and were, in some respects, easily influenced by their environment. swedish sociologist and politician alva myrdal calculated that three per cent of the population would never be able to ‘keep house’. these three per cent, ‘the very dull ones’, were a heavy burden on the general welfare system (myrdal, 1946). these divergences from the norm were often found in school among the children in remedial classes (help classes). gunnar dahlberg (1936-1937), director of the swedish race institute, argued that it was important to study the children in the help classes: already at school age, these children showed that their intelligence was too weak for them to follow a ‘normal’ working pace. both myrdal and dahlberg had some degree of influence on the swedish social policy and they shared the fear that the less talented would develop asociality, criminality, and a hostile attitude towards society if they did not receive a suitable education. the special classes would really benefit them and give them the right direction and attitude for society. through training, they could be brought up to become competent citizens who could support themselves (sou 1936:31). but children who went to help class left school, according to paragraph 48, which stated that a pupil who was less talented could be released from school duties before the six compulsory years, but not before the age of 14. paragraph 48 made it difficult for such pupils to enter governmental employment and work for, say, the state railways or the post office; only in 1955 was this paragraph removed (axelsson, 2007). intelligence tests and other techniques can be seen in the light of an early form of social engineering. the logic that characterized social engineering was the acceptance that people needed to be informed or led by different experts. it was science that should organize society in the best conceivable way, and it was able, through its expertise, to find strategic solutions to society’s problems. socalled ‘prophylactic social politics’ were the means for creating good order in society, and they began to make an appearance in the 1930s. njsr – nordic journal of social research vol. 7 (2016): special issue 31 the modernization of society demanded a modernization of the individual and hence new steering techniques were required. i have considered the welfare state as a form of control in the spirit of foucault, in the sense of it structuring a field of opportunities (foucault, 1982). this has been about making the ‘right’ decisions within the frameworks that were formed within schools. these frameworks, which were based increasingly on talent, were decided upon during the construction of the welfare state. talent was seen as crucial in determining which education and which position the individual would later be expected to take. having different sorting systems in elementary schools could be seen as different forms of upbringing and was a way of steering pupils towards the ‘right’ occupation after school. conclusions to use a foucauldian genealogical approach is to write a history of interpretations, or a history of problematizations. this together with a perspective of governmentality – the knowledge it invokes, the techniques it mobilizes, and the kind of subject it seeks to fabricate – can help us to understand our contemporaries and ourselves in different ways. foucault (1988b) argues that we need to recognize the welfare state for what it is: a combination of political power exercised over legal subjects and pastoral power exercised over individual subjects. this complicated relationship between dominant discourses of power brings with it a fundamental contradiction between the welfare and care of individual lives and the upholding and maintenance of the exclusive status of citizenship. who should belong to the flock and receive care and help, and who should be subject to the power of the state? according to foucault, knowledge and political power go hand in hand – they do not go their separate ways. but foucault finds it less interesting to dwell on the state or on different actors’ intentions. he distances himself from the idea that the state can be discussed as if it were a ‘superhuman’ actor with the same will and intentions as individuals. the state, no more probably today than at any other time in history, does not have this unity, this individuality, this rigorous functionality, nor, frankly, this importance. maybe after all the state is no more than a composite reality and a mystical abstraction whose importance is far more limited than many of us might think (foucault, 2008). previous research has pointed to the state’s increasing influence over schools at the beginning of the twentieth century. this was also the case generally, but there was nothing that characterized the schools’ categorization at a local level. the schools’ formation was decided, less as a result of political decision at a national level and more as a result of different local decisions. in this context it is justifiable to speak about social engineering from below. not infrequently decisions were taken in agreement with professionals such as doctors and elementary school inspectors. in schools that were established during the earlier part of the twentieth century new cultural norms became crucial for the separation of certain pupils. many children began to be perceived as problematic in relation to the schools’ institutional and social changes. those pupils who were separated were those who could not live up to the schools’ norms, mainly in respect of intellectual ability, but also regarding physical, moral and disciplinary norms. at the same time one should be careful with individual intentions. the individual can, of course, have intentions, but this is not crucial for foucault. from a njsr – nordic journal of social research vol. 7 (2016): special issue 32 foucauldian perspective, binet’s intentions, for example, are not of primary interest; the central thing is what happens in social practice and what consequences different configurations of power/knowledge have for different individuals and groups in society. generally speaking, foucault finds it difficult to see history as a consequence of people’s deliberate intentions and acts of will. instead, he emphasizes the contingency of history: history is a result of a number of occurrences, uncertainties, and random events (may, 2006). viewing history in a foucauldian manner can help us to see that the present is just as strange as the past, and not to think that a sensible or desirable present has emerged or might emerge (kendall & wickham, 2003). intelligence tests, which in the cases presented became a technique for defining talent as well as quality of citizenship, were used, and are still used today, together with other techniques to identify similarities and differences and to define who the individual is and what can be expected from him or her. thus, for example, mental retardation came to be seen as a boundary between good, responsible citizens and the socially, morally, and intellectually ‘incompetent’. since different tests were seen as scientifically legitimate the drawing of boundaries could be accepted in a democratic society (thomson, 1998). together with democracy, intelligence tests became a way of decoding previous categories, yet were judged essentially to have the same effect on a particular individual and group. or, as cruikshank (1999) puts it, democratic citizenship is less about solutions to political problems than about a strategy of government. the questions that have been discussed here are still of great importance. the educational system builds on the notion that pupils’ abilities to utilize knowledge is to be reflected in the setting of grades and future careers, yet are at the same time a democratic right for everyone, whatever their background and individual conditions. talent is a concept that is still used today – though not so openly, perhaps because it is connected to heredity. the new concepts, or diagnoses, are based, like talent, on biology. within the school’s framework, instruments and tools are being created that describe both the normal and the abnormal. this often takes the shape of different diagnoses, and it is often doctors and psychologists who are responsible for the separating technique in a new type of categorization of behaviour, giving expression to cultural notions and political ambitions. the above shows that the tests tend to take a life of their own, and there is reason to be cautious and to adopt a higher level of humility when dealing with test results. tests in general and iq testing in particular are at imminent risk of stifling and suspending idiosyncrasies. as ydesen (2011) puts it, the reason is that the attraction and allure of quantification is in perpetual danger of overruling human reservation when using test results. the temptation of comparing numbers with no thought as to reservations and sources of bias can be overwhelming. (p. 238) therefore, there is cause to be sceptical of the use of both political arguments and specific techniques, like supposed ‘intelligence tests’, to create categories. testing is a tool of power, although, according to foucault (1984b), it is important to remind ourselves that this faceless power is not necessarily bad, dangerous or oppressive – just that it could be. a foucauldian perspective need not be regarded as either a better or a worse way to relate to our history, but it reminds us that the writing of history also entails choosing events, facts, and perspectives. it is, therefore, a view of history that is not afraid to embrace perspectival knowledge. it is problematic when these categories – often with njsr – nordic journal of social research vol. 7 (2016): special issue 33 biology as the determining argument – are seen as indisputable and impossible to discuss. this entails – as history has proved more than once – that these intelligence tests, whatever the design, will tend to move from descriptive diagnoses to determining forecasts. something that seems to have completely disappeared in today’s debate on placements in special schools is that these categories and boundaries are created in a social context. they should therefore be possible to challenge, negotiate, and change. references ahlberg, a. (2007). specialpedagogik av igår, idag och i morgon special education of yesterday, today, and tomorrow. pedagogisk forskning i sverige 2007, 12(2), 84–95. axelsson, t. (2007). rätt elev i rätt klass: skola, begåvning och styrning 1910-1950. the right pupil in the right class: school, talent and governing 1910-1950. linköping: tema. axelsson, t. (2012a). att konstruera begåvning – debatten om iq the construction of giftedness – the iq debate. educare, 1(4), 7-28. axelsson, t. (2012b). tattare, hjälpklasser och intelligensundersökningar i den svenska folkskolan under tidigt 1900-tal. tattare, help classes and talent measurement in the swedish elementary school in the early 1900s. særklasse. inklusion og eksklusion i grundskolen, 46. årbog selskabet for skoleog uddannelseshistoria, 46, 95-117 beronius, m. (1991). genealogi och sociologi: nietzsche, foucault och den sociala analysen genealogy and sociology: nietzsche, foucault and social analysis. stockholm/stehag: brutus östlings bokförlag ab. broberg, g. & tydén, m. (1996). eugenics in sweden: efficient care. in g. broberg & n. roll-hansen (eds.) eugenics and the welfare state: sterilisation policy in denmark, sweden, norway, and finland (pp. 77-150). east lansing, mi: michigan state university press. cruikshank, b. (1999). the will to empower: democratic citizens and other subjects. ithaca, ny: cornell university press. dahlberg, g. (1936-1937). on the frequency of mental deficiency. uppsala läkareförenings förhandlingar, nf, band 42. danziger, k. (1997). naming the mind: how psychology found its language. london: sage. dean, m. (1999). governmentality: power and rule in the modern society. london: sage. deleuze, g. (1990). foucault (e. van der heeg, s.-o. wallenstein, trans.). stockholm: symposion förlag. ericsson, m. (2015). exkludering, assimilering eller utrotning? ‘tattarfrågan’ i svensk politik 1880–1955, exclusion, assimilation or extinction? the tattare question in swedish politics 1880-1955. lund: lunds universitet. foucault, m. (1980). truth and power. in c. gordon (ed.), power/knowledge: selected interviews & other writings 1972-1977 (pp. 109–133). new york: pantheon books. foucault, m. (1981). the order of discourse. in r. young (ed.), untying the text: a poststructuralist reader (pp. 48-48). boston: routledge. njsr – nordic journal of social research vol. 7 (2016): special issue 34 foucault, m. (1982). the subject and power. in h. l. dreyfus & p. rabinow (eds.), michel foucault: beyond structuralism and hermeneutics (pp. 208-226). chicago: the university of chicago press. foucault, m. (1984a). nietzsche, genealogy, history. in p. rabinow (ed.), the foucault reader (pp. 76-100). new york: pantheon. foucault, m. 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(1988e). the political technology of individuals. in l. h. martin (ed.), technologies of the self. a seminar with michel foucault (pp. 16-49). london: tavistock publications. foucault, m. (1993). övervakning och straff: fängelsets födelse. discipline and punish: the birth of the prison. lund: arkiv. foucault, m. (2004). sexualitetens historia: 1 viljan att veta. the history of sexuality: the will to knowledge . göteborg: daidalos. foucault, m. (2008). regimentalitet. governmentality. in t. götselius & u. olsson (eds.), diskursernas kamp/michel foucault the struggle of discourses/michel foucault (pp. 183-204). stockholm: brutus östlings bokförlag. foucault, m. (2010). säkerhet, territorium, befolkning: collège de france 1977–1978 security, territory, population: lectures at the college de france 1977-1978. hägersten: tankekraft förlag. gould, s. j. (1996). the mismeasure of man (revised and expanded). new york, ny: w. w. norton & company. hjörne, e. & säljö, r. (2008). att platsa i en skola för alla: elevhälsa och förhandling om normalitet i den svenska skolan, to qualify in a school for all: student health negotiation about normality in swedish schools. stockholm, sweden: norstedts. kendall, g. & wickham, g. (2003). using foucault´s methods, london: sage larsson, j. (2005). ordalek och styrningskonst playing with words and governmentality. historisk tidskrift, 125(3), 441-449. may, t (2006). the philosophy of foucault. kingston: mcgill-queen’s myrdal, a. (1946). kontanta barnbidrag kräver skärpt steriliseringslag? cash child support requires stricter sterilization laws. tidskrift för barnavård och ungdomsskyd, 2, 57. njsr – nordic journal of social research vol. 7 (2016): special issue 35 nilholm, c. & björk-åkesson, e. (eds.) (2007). reflektioner kring specialpedagogik – sex professorer om forskningsområdet och forskningsfronterna. reflections on special education – six professors on research and research fronts. (vetenskapsrådets rapporteserie 5/2007). stockholm, sweden: vetenskapsrådet. nilsson, r. (2000). den närvarande frånvaron eller i väntan på foucault: en discussion om foucault och den svenska historiedisciplinen. the present absence or waiting for foucault: a discussion on foucault and the swedish history discipline. historisk tidskrift, 129(2), 183-206. nilsson, r. (2005). postmodernism, källkritik och historieskrivning postmodernism, source criticism, and historiography” historisk tidskrift, 125(2), 233-248., nilsson, r. (2008). foucault – en introduktion. foucault – an introduction. malmö: égalité. qvarsebo, j. & axelsson t. (2015). lutherans, people with values or us citizens? the ever present dream of the good citizen. in a. fejes & k. nicoll (eds.) foucault and a politics of confession in education (pp. 146-152). london: routledge. ohlander, m. (1943a). begåvningsförhållandena hos tattare: en genealogisk och sociologisk studie the talent conditions of tattare: a genealogical and sociological study. tidskrift för psykologi och pedagogik 3. ohlander, m. (1943b). zigenare, tattare och hjälpskolan gypsies, tattare, and remedial school. hjälpskolan: organ för nordiskt hjälpskoleförbund. rose, n. (1995). psykologins blick the gaze of psychology. in k. hultqvist & k. petersson (eds.), foucault: namnet på en modern vetenskaplig och filosofisk problematik: texter om maktens mentaliteter, pedagogik, psykologi, medicinsk sociologi, feminism och bio-politik. foucault: the name of a modern scientific and philosophical problem: texts about power mentalities, education, psychology, medical sociology, feminism and bio-politics (pp. 173-195). stockholm: hls förlag. rose, n. (1999). governing the soul: the shaping of the private self. london: free press. skolinspektionen (2011) särskolan: granskning av handläggning och utredning inför beslut om mottagande special schools: review of processing and investigation prior to decisions on receipt, regeringsuppdrag 31 januari 2011. diarienummer 2010:2593 sociala meddelanden (1940), socialstyrelsen. the national board of social welfare. sou 1936:31 betänkande med utredning och förslag angående åtgärder för särskild undervisning och utbildning av psykiskt efterblivna i barnoch ungdomsåren. report of investigation and proposals regarding measures for specific education and training of the mentally retarded in childhood and adolescence. thomson, m. (1998). the problem of mental deficiency: eugenics, democracy, and social policy in britain c. 1870–1959. oxford: clarendon press ydesen, c. (2011). the rise of high-stakes educational testing in denmark (19201970) frankfurt am main: peter lang. zenderland, l. (2001). measuring minds: henry goddard and the origins of american intelligence testing. cambridge: cambridge university press. microsoft word 03 towards the marketization of early childhood education and care, final pages corrected.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2011 – special issue towards the marketization of early childhood education and care? recent developments in sweden and the united kingdom ingela naumann school of social and political science university of edinburgh email: ingela.naumann@ed.ac.uk abstract extensive public debate is being waged across mature welfare states as to whether social services are best provided by the state or the market. this article examines developments in early childhood education and care (ecec) policy in sweden and the united kingdom, identifying trends towards marketization and universalization of ecec that suggest a complex picture of competing policy logics and goals in the restructuring of welfare states. this article first discusses two models of early-years provision, the market model, and the universal model, outlining underlying assumptions, tensions, and implications of market and state provision of ecec. a comparison of recent reforms in sweden and the uk highlights how similar ideas and trends play out differently in different national contexts. in sweden an integrated public ‘educare’ programme gradually developed over time, and market mechanisms introduced in the 1990s have so far had limited effect on the system overall. in the uk ideas about universal early childhood education became influential as part of a new social-investment agenda in the 1990s but have, owing to their restricted implementation, not fundamentally altered the existing childcare market. historical policy trajectories continue to matter, yet tensions and incoherencies between policies can open spaces for change. keywords: early childhood education and care, marketization, universalism, sweden, united kingdom, social investment introduction the strengthening of economic principles in the organization and delivery of social services has been a recurrent theme in recent public-sector reform throughout mature welfare states (pollitt & bouckaert, 2000). this article examines changes in early childhood education and care (ecec) policy in sweden and the united kingdom since the 1990s, and asks to what extent these developments reflect general trends of marketization. sweden and the uk are commonly characterized as ‘universalist’ and ‘residual’ welfare states, njsr – nordic journal of social research 2011 – special issue 38 respectively, which reflects their markedly different welfare-state designs (see e.g., sainsbury, 1991; wincott, 2006). the generous public ecec system in sweden and the historical marginalization of childcare policy in the uk fit the picture well. comparing developments around ecec in these two contrasting cases helps highlight how similar trends and ideas play out differently in different national contexts. in both countries the marketization of early-years services has taken place with competition and for-profit provision playing a new or enhanced role. however, this is not the only trend in ecec reform: in the same period public responsibility for and universal access to early-years services have been extended. such state-led service expansion may seem surprising in a general climate of financial austerity and retrenchment, and stands in tension with the neo-liberal underpinnings of the ideas of new public management that have influenced both countries (blomqvist, 2004; naumann & crouch, forthcoming). a number of scholars have linked developments around ecec to the broader restructuring of welfare states towards a new ‘paradigm’ of ‘social investment’ (taylor-gooby, 2008; jenson & saint-martin, 2006). in this concept, earlyyears services play a central role in making parents and children productive workers in the present and future, which implies increased state involvement as a means for ultimately economic ends. it is important to note, however, that the various policy initiatives around ecec in recent years cannot all be reduced to economic intentions. the trends of marketization and universalization in ecec services do not add up to a coherent new welfarestate design, but present a contradictory mixture of policy goals and solutions. by disentangling the various developments around ecec, this article suggests that, rather than a move from an ‘old’ towards a ‘new’ welfare state, what we may be witnessing is the maturation of ‘old’ policies alongside the pursuit of new agendas. recent ecec reforms in sweden and the uk indicate some change in policy principles, while remaining enmeshed in the historical policy legacies of each country. the first part of the article provides an analytical discussion of two contrasting approaches to ecec services – the market model and the universal model – as a framework for understanding the tensions and contradictions underlying ecec reform. thereafter, developments in ecec policy in sweden and the uk are examined. first, the two post-war ecec systems are briefly outlined to help identify continuity and change in ecec policy since the 1990s in the analysis that follows. the subsequent comparative discussion highlights tensions inherent in different reforms and the extent to which they have altered the pattern of national ecec provision. the last section draws some lessons from the comparison of ecec reforms with respect to welfare-state change in general. competing models of early-years provision recent academic debate about welfare-state reform in sweden has revolved around the question of whether the introduction of market mechanisms in social services has led to the abandoning of universalism as guiding principle of the swedish welfare regime (blomqvist, 2004; bergh, 2004). in the british case marketization trends are seen to be more in line with the traditionally restrained and targeted nature of state involvement in people’s welfare in this ‘liberal’ or ‘residual’ welfare state (wincott, 2006). here, new commitments to universal provision, such as in preschool education, have been dubbed a ‘quiet revolution’ (smith, 2007). it is noteworthy, however, that the principle of universalism has always been part of the beveridgean post-wwii welfare njsr – nordic journal of social research 2011 – special issue 39 state, for example, in national health insurance or the national pension. such observations invite a focus on the dimensions of ‘selectivity’ and ‘universalism’ when assessing changes in ecec policy in sweden and the uk. the discussion about ‘market’ versus ‘state’ in social-service delivery can be cast within these specific dimensions. however, this debate also has broader scope, because it considers not only the type of policy instruments chosen and level of generosity, but also different perspectives on the types of relations social services do, or should, entail. the market model the ecec market is constituted by the exchange relationship between individual purchasers (parents) and private, commercial providers (firms or corporations). both purchasers and providers are assumed to behave as selfinterested actors: parents by seeking the best ecec solutions and providers by seeking profit-maximization. the ‘pure’ childcare market is also assumed to be self-regulatory: the size of the childcare sector, the available types of services, the prices and the quality will reflect demand; consumer choice and competition produce an incentivizing mechanism in that providers offering unsatisfactory services will be squeezed out of the market. the expected outcome is an ecec sector that both displays a high degree of diversity, which reflects parents’ differing preferences, and delivers high-quality, costeffective ecec services. the appeal of the market model to pressure groups (parents) and policymakers lies in its responsiveness to consumers and its promises of efficiency. it also allows governments to refrain from explicit normative decisions about who should be using ecec services because the market is supposed to be demand-driven.1 a core assumption on which the market is premised is that ‘buyers’ are well-informed about the ‘product’ they purchase and are free to enter or exit a transaction. in practice, however, there are various constraints on parental choice, constraints which are implicated in dysfunctional market developments (see also ball & vincent, 2005). first, since the cost of ecec services is borne by the parent-purchasers, access to services is determined by parents’ resources. some parents will be unable to afford ecec services altogether, and others will have to content themselves with inadequate solutions. secondly, parents tend to be logistically and geographically constrained. since commercial providers are likely to target buyers with the highest purchasing power, geographical service imbalances may be the result, with good and varied availability in affluent urban areas and scarce or unsatisfactory provision in disadvantaged or remote areas. ‘need’ – foremost parents’ need for childcare in order to hold down a job – is the most immediate limitation to ‘free choice’. if the need is strong, providers may become less responsive to demands and expectations, and might, for example, trade quality for efficiency because they will get their customers anyway. lastly, not all parents hold the necessary expert knowledge that enables them to assess the suitability and quality of early-years services. the ecec market can, therefore, be seen as being highly selective, where affordability, availability, and the advertisement power of firms directly influence parental choice, and in practice these factors leave many with little choice at all. 1 while the market model is grounded in normative assumptions about social relations, public debate has tended to focus on its instrumental aspects. this is beneficial for governments since the declining stability in voter-alignments have made value statements politically more risky. njsr – nordic journal of social research 2011 – special issue 40 no such ‘pure’ ecec market seems to exist anywhere. no welfare state dares to leave the provision of early-years services fully to market forces because children are considered a particularly vulnerable group in society in need of special protection. thus, even in countries such as the us or the uk, where ‘childcare markets’ are said to exist, these are in fact strongly state-regulated (penn 2010). secondly, children are not only the ‘private pleasure’ of their parents but carry certain ‘public-good’ characteristics. welfare states have always had an interest in influencing the ‘quantity’ and ‘quality’ of the future generation of citizens, workers, and soldiers via a range of social policies (see e.g., myrdal, 1945; sou, 1972; hmt, 2001). in some countries such as france and sweden, the potential of early-years services to impact on children’s health and socialization, as well as on family and fertility behaviour, has received attention already in the early twentieth century (naumann, 2006); in other countries such as the uk this focus has more recent origins (lloyd, 2008; smith, 2007). broader goals such as poverty alleviation or the reconciliation of family and work cannot easily be achieved through the market owing to its selection effects, and this difficulty has led states to intervene in ecec provision. thirdly, the increasing recognition of young children’s right to educational opportunities, as reflected in article 28 of the un convention of the rights of the child (uncrc), has galvanized governmental action (un, 1989). for these reasons, welfare states are involved in the regulation, funding, and provision of early-years’ services, albeit to varying degrees. in some countries such as sweden, state involvement in ecec has approached a ‘universal model’, as outlined below. the universal model in the universal model, provision and funding of all ecec services are public. ecec in this model is understood as a social right – a right that extends to both parents and children as actual users of ecec services2 – meaning that access is open to all children irrespective of socio-economic background and, in a pure model, free at point of delivery (see also bergh, 2004). the socialrights character implies that social risks associated with the early years – such as parents’ need for extra-familial childcare, children’s special or general needs for good care, and learning environments – are covered collectively via citizens’ tax contributions. the public responsibility for ecec in turn implies a public interest, and public interest thus entails public debate over the content and aims of ecec services, which connects with broader societal goals that are most likely guided by dominant cultural norms. the appeal of this model to pressure groups (children’s advocates, educational specialists, women’s movements) is its emphasis on citizenship, that is, the manner in which ecec extends to wider society and can be claimed as inalienable right. its appeal to governments is state control and its integrative potential. the possibility of pursuing broader goals through ecec services directly influence the behaviour of families and foster social cohesion. but the universal model also has shortcomings because the principle of universalism may produce highly standardized services to ensure equal access and availability across a country. in ‘real-world’ contexts this may imply an unsatisfactory fit between available services and local or individual needs. the focus on children and their rights implies an obligation to certain quality standards of service provision. depending on how ‘quality’ is socially defined 2 in the market model the children’s position is more ambivalent. while they are users of ecec services, they are also the ‘product’ of the transaction between parents and service providers. further, the main focus in the market model rests on parents as service-purchasers. njsr – nordic journal of social research 2011 – special issue 41 this can be very costly for welfare states. under conditions of economic constraint, tensions may arise between ‘universal access’ and ‘quality’ where the latter may be traded for the former. furthermore, by reproducing dominant norms and ideals about children and social relations (e.g., about gender roles) in the types of services offered, certain understandings and forms of ecec will be marginalized or excluded. there is thus an inbuilt tension in the universal model between universalism and citizen’s individual needs and preferences, a tension that has intensified over last decades as advanced societies have become more pluralist and diverse. to sum up, both the ‘market model’ and the ‘universal model’ of ecec provision carry theoretical appeal while also leading to inadequacies in practice. the market is expected to produce responsive, diverse, and efficient ecec services, but is highly selective; the universal system is expected to provide equal access and opportunities for all children, yet may become uniform and unresponsive. ‘quality’ of services can in practice become a problem with both models. when examining recent national ecec reforms we should thus not expect unidirectional developments towards either market or state provision, but policy responses that attempt to cater to an array of goals by combining diverse policy instruments and logics. an increased policy orientation towards the ecec market model, termed ‘marketization’ in the discussion below, could happen along one or more of the following dimensions: a decrease in state regulation, such as the relaxation of inspection regimes or standardized quality requirements (e.g., staff-to-child ratios, health, and safety). a decrease in state funding and subsidies to suppliers or service users. a decline in the proportion of public or publicly funded services in favour of for-profit providers. the introduction of market mechanisms such as choice and competition, and a strengthened focus on efficiency and economic goals. not all developments of privatization necessarily imply marketization: independent charities and other non-profit organizations may also provide private services. privatization is linked to marketization whenever it involves an increase in individual risk and costs to service users (i.e., reduction in state funding) and where non-profit providers are encouraged to act like firms. the ‘universalization’ of ecec means extended access to good-quality services independent of service users’ socio-economic background. it can also include a strengthened framework for public funding and regulation and the recognition of public responsibility for children’s upbringing. yet not every increase in state involvement necessarily equals a development towards the universal model. targeted measures are likely to underscore socioeconomically stratified access to services; differentiated parental fees, on the other hand, may support the principle of universalism. nor does ‘universal access’ of itself imply programme generosity or comprehensiveness, even though these aspects are commonly associated with each other in characterizations of nordic welfare states (bergh, 2004), for it does not define the extent of membership. in practice universal ecec policies may be of quite limited character, guaranteeing access only to certain age groups of children (e.g. threeto five-year-olds) and for certain times (e.g., part-time). njsr – nordic journal of social research 2011 – special issue 42 there is thus no simple trade-off between market provision and universal ecec – more ‘market’ does not necessarily mean less ‘state’ – and no linear relationship exists between the two. rather, both models are outlined here to highlight the shaping of ecec systems by different and competing logics and mechanisms: parental preferences versus citizenship; competition versus public planning; individual interests versus collective interest. the ways in which trends of ‘marketization’ and ‘universalization’ have manifested themselves in swedish and british ecec will be examined next. ecec policy developments in sweden and the uk historical background during the post-wwii decades ecec services were equally scarce in sweden and the uk, the male breadwinner model was dominant in both countries, and small children were seen to be best cared for by their biological mother. in sweden in 1968, two per cent of children aged four, 11 per cent of the fiveyear-olds, and 43 per cent of six-year-olds were in childcare and preschool programs (naumann, 2006). in the uk in 1965, two per cent of three to fouryear-olds had access to state-provided childcare and 11 per cent of children had some kind of out-of-home care (penn, 2009, p.117).3 in the following decades ecec services in sweden expanded dramatically on the basis of strong demand by working parents, radically changing social norms about gender roles and children’s place in society, and a high welfare-state commitment. in the uk, on the other hand, state involvement in ecec service provision remained minimal, where the raising of children was defined as a private family matter and the norm of the male breadwinner remained dominant. sweden in sweden, a unitary public ecec system for children aged one to six was established in the early 1970s. designed as a collective full-day service, modern swedish ecec was intended to fulfil a wide range of functions: to provide good-quality day care while also offering pedagogically sound learning spaces; to enhance gender equality by supporting the reconciliation of work and family life; to mitigate class differences by offering children equal educational opportunities from an early age; and to support economic growth and welfare-state sustainability by bringing as many parents as possible into the labour market. the foundations for this public ecec system were laid in 1972 by an extensive state investigation that detailed major aspects of these services, drawing on psychological child development research, sociological, and economic theory, and by synthesizing political goals with feminist thinking on childcare that had been debated since the 1920s (sou, 1972; naumann, 2006). universal availability of public ecec grew to become a central political promise of the swedish social democratic government (naumann, 2006). 3 children in britain normally enter school at the age of five, while their swedish counterparts do so at the age of seven. njsr – nordic journal of social research 2011 – special issue 43 the universalization of ecec services in sweden was a gradual process that took shape over several decades. in 1973 the state for the first time formalized its responsibility for ecec by obliging municipalities to provide free earlyyears services to preschool children, albeit at that point only for six-year-olds. in 1976 a bill was passed with the ambitious plan to expand ecec with 100 000 new day-care places and 50 000 after-school places (antman, 1996). in 1980 the provision of ecec services was legally placed under municipal responsibility, but with substantial financial contributions by the central state. in 1985 a new expansion programme was passed with the aim to provide by 1991 ecec for all children aged one-and-a-half to six years whose parents were gainfully employed (antman, 1996). the state’s financial commitment to its expansion plans was considerable: social expenditure for ecec rose from 0.15 per cent in 1963-1964 to 2.75 per cent in 1987-1988 (hinfors, 1990, p.49). between 1975 and 1990 ecec services expanded from a coverage of 17 per cent to 52 per cent of children aged one to six (bergqvist & nyberg, 2001, p.243). despite this massive expansion, the demand for places grew faster in line with women’s mass-entry into the labour market; childcare queues were long, and places were generally reserved for children of working parents or for children with special needs (naumann, 2006). united kingdom in the uk ecec services developed slowly in the absence of an explicit childcare policy in a mixed economy with an administrative bifurcation into care and nursery education. the department of health (dhss) was responsible for childcare, mainly developing targeted programmes aimed at children at risk, and the department for education (dfee) was in charge of preschool education. the implementation of programmes and the levels of day-care and nursery-school provision were left to local authorities (las), but limited financial support from central government meant that las’ actions were restricted. during the 1970s the national government started to take greater interest in ecec, especially in preschool education, and a gradual increase in public nursery schools took place. in 1972, the then education minister, margaret thatcher, announced expansion plans for preschools to provide sufficient places for all threeand four-year-olds according to demand by 1982. however, these plans were quickly scrapped when the conservatives returned to power under thatcher in 1979 (randall, 2002). owing to lack of available ecec services and the growing need, parents started to organize play-groups and parent co-operatives, and private day care and childminding, both in registered and unregistered forms, expanded considerably (penn, 2009). contrary to feminist pressure in the 1980s to open the childcare system to all children, the thatcher and major governments focused on preschool education as part of a broader agenda to reform the educational system along the lines of marketization and centralization (ruggie, 1984; naumann/crouch, forthcoming). nursery schools did not have to be organized through the state educational system, but a new voucher scheme led many primary schools to set up ‘reception classes’ for four-year-olds to claim the voucher money (penn, 2009, p.120). the government also initiated a series of ‘under-fives initiatives’ in which it worked directly with voluntary providers, therewith bypassing the las (randall, 2002, p.225). the responsibility for the organization of day care was left to las, mainly as a measure for families in need, and the 1989 childcare act set out an inspection and standards regime under which private childcare providers had to be registered and inspected at local governmental level. as a consequence of these policy developments, public childcare places remained very scarce for children under the age of njsr – nordic journal of social research 2011 – special issue 44 three, with a coverage of two per cent in 1993, while (part-time) nursery schools for threeto four-year-olds expanded considerably to cover 60 per cent of this age group (bahle & pfenning, 2001). private ecec services increased more than threefold, and ecec service provision fragmented, resulting in considerable regional and local variations in the availability and the quality of services (randall, 2002). by the beginning of the 1990s sweden had an extensive public ecec system with a broad remit, while in the uk a mixed economy of ecec services existed with a clear distinction between care and preschool education alongside an increasingly dominant role for private providers. albeit with some delay, both ecec systems had developed in line with the general welfarestate trajectories of the two countries: generous public-service provision in sweden based on the principles of equality and universalism and the dualearner family norm; and limited state involvement in day care in the uk, reflecting a preference for means-testing and low de-commodification, along with an ambivalence towards mothers’ employment characteristic of the british welfare state. part-time preschool education had been recognized as desirable; however, at the same time as preschool services received more attention by the state, they became part of new marketization trends within the educational system. since the 1990s changes have taken place in the swedish and the british ecec system that both strengthen and challenge these earlier developments. ecec reforms in the 1990s and 2000s sweden criticisms concerning the legitimacy and efficiency of large, uniform and centrally led public services had mounted during the 1970s and 1980s. these concerns, together with the spreading of new public management (npm) ideas, led in the 1990s to the decentralization of public-sector governance and the opening up of the welfare system to private providers of every kind (with non-profit and for-profit orientations) (blomqvist, 2004). in 1991 the newly elected centre-right government promised a ‘choice revolution’ that would increase diversity and economic efficiency in public services. the old topdown, regulation-heavy relationship between the central state and municipalities was replaced by a system of governance by objectives for key social services, and detailed earmarked state funding to municipalities was replaced by block grants. deregulation and decentralization gave the municipalities considerable freedom to decide over the organization and delivery of social services, including ecec. until the 1990s, private ecec services hardly existed beyond a few facilities with specific pedagogical traditions (e.g., montessori, rudolf steiner) or facilities set up by parent co-operatives owing to a lack of available public childcare. in 1984 the social democrats passed a law prohibiting commercial childcare services in response to one large corporation’s attempts to develop such nurseries. however, in 1991 the then conservative government removed most of the restrictions on the establishment of non-municipal, private ecec services, and from 1992 onward even for-profit providers were given access to public funding (strandbrink & pestoff, 2006, p.43). following these developments, the number of non-municipal ecec facilities increased from 500 in 1988 to 3113 in 2002, providing ten per cent of places for children aged one to six. the number of for-profit providers on all private facilities was low throughout the 1990s but increased during the 2000s; by 2008 the proportion njsr – nordic journal of social research 2011 – special issue 45 of privately provided places had increased to 14.2 per cent (sos, 2009). today, for-profit ecec makes up a bit less than ten per cent of swedish ecec places overall, but large differences exist between municipalities, with commercial ecec being hardly existent in some whilst being widespread in others (skolverket 2010). in the mid-1990s, sweden was hit by a severe economic crisis. nevertheless, state funding of ecec remained constant in this period: public expenditure for ecec and after-school care was 3.78 billion euros in 1990, 3.67 in 1995, and 3.81 billion euros in 1997. however, the demand for childcare also rose sharply in the 1990s, leading to renewed massive service expansion, from around 330 000 places in 1990 to over 700 000 places in 2000. this expansion that took place without additional funding raised public concern about a potential reduction of quality of early-years services, as indicated in the deteriorating child-staff ratio from 4.4 in 1990 to 5.7 in 1998. however, this trend was reversed through earmarked state grants to increase staff numbers in preschools in the 2000s; in 2006 the staff-child ratio was 5.1 (skolverket, 2008, p.39). it has also been noted that changes in quality are difficult to assess due to other developments (bergqvist & nyberg, 2001). in the same period a professionalization of ecec staff took place, with an increase in the proportion of staff holding university degrees, rising to 54 per cent in 2000 (skolverket, 2000, p.49). furthermore, service integration on the municipal level between school education, ecec, and after-school care intensified in ways that allowed for more efficient use of resources, such as the sharing of facilities and activities (cohen et al., 2004). in 1998 a preschool class for sixyear-olds was introduced as part of the school system, and consequently this age group was removed from the ecec system’s planning and costing. many municipalities also responded to financial constraints by off-loading costs to parents. in 1990 parental fees covered ten per cent of total ecec costs; by 1999 this figure had increased to 18 per cent (bergqvist & nyberg, 2001, p.265). these changes – decentralization, deregulation, and privatization – led to considerable differences between municipalities with respect to variety, availability, parental fees, and quality of ecec services (strandbrink & pestoff, 2006, p.44; cohen et al. 2004). however, policy reforms implemented during the latter part of the 1990s and the early 2000s display attempts to reverse some of these developments, along with a renewed emphasis on universalism and a retrieval of central state control. the pedagogical focus of early-years services was strengthened by transferring the responsibility for these services from the social department to the education department. in 2001 a new system of integrated teacher training for school teachers, preschool, and after-school pedagogues further augmented the educational standing of preschool staff (cohen et al., 2004). in 1998 a national curriculum for children aged one to five was introduced that not only outlined the pedagogical remit of early-years services (which is broader than the understanding of ‘education’ in the uk), but also pointed to their societal mission of transmitting democratic values and practices (lpfö, 1998). following this educational logic, in 1999 a statutory right to early childhood education was extended to all children, including children of unemployed and non-working parents. the 1999 bill obliged municipalities to provide a place for every child from one year of age within three months of application. in addition, preschool for fourto five-year-olds was made free of charge. and in 2000 the national government set upper limits to municipal parental fees, the so-called ‘max tax’, to ensure affordability for all parents: parental fees are differentiated according to income, but do not exceed three per cent of family income for the first child and two per cent for the second child (skolverket, njsr – nordic journal of social research 2011 – special issue 46 2007). by the beginning of 2000, the swedish ecec system had become fully universal. today, almost half of one-year-olds, 91.3 per cent of two-year-olds and 97 per cent of threeto five-year-olds attend ecec services (sos, 2010). united kingdom when the labour party came to power in 1997, it announced radical changes in the direction of childcare policy, committing itself to providing sufficient and affordable ecec services. the then chancellor of the exchequer, gordon brown, declared in his budgetary speech that childcare would be an integral part of new labour’s economic policy, and in 1998 the government produced the first national childcare strategy (dfes, 1998). its aims were to combat child poverty and social exclusion by bringing parents into paid work and supporting children's 'early learning'. linking ecec explicitly to the reconciliation of work and family life also meant a new direction in family policy because it promoted the dual-earner family (lewis, 2003; lloyd, 2008). in addition a ‘sure start’ programme was introduced in 1999 to provide public early-years services in disadvantaged neighbourhoods. declaring the desirability of collective childcare was indeed a radical shift from previous governmental policy. but with the central focus on low-income parents and their children, the new labour government remained committed to their conservative predecessor's focus on reducing welfare dependency, albeit with a more active role for the state. in its 2001 manifesto the labour party promised to create 1.6 million new childcare places and in 2004 the government presented a ten-year strategy (hmt, 2004) that set up an extensive policy framework for the development of ecec services; it became formalized in the 2006 childcare act (applicable to england). with their expansion plans, new labour continued and reinforced the trends of marketization in the ecec sector that had taken place earlier. while the childcare act set out how local las were to assess, coordinate, and inspect public and private ecec services, it also made explicit that las were only to provide services themselves if there were no private alternatives available (hmt, 2004). the government initiated various supply-side measures of ‘pump priming’ and start-up funding, which encouraged private providers to establish ecec services, but it did not increase state funding for las to fulfil their obligations. state expenditure on ecec increased moderately from a low 0.2 per cent of gdp in 1998-1999 to 0.4 per cent in 2003 (oecd, 2005, pp.109f.). a new system of childcare tax credits was introduced to help working parents with childcare costs. these demand-side subsidies covered up to 80 per cent of childcare costs for low-income families, but quickly decreased with growing income to ten per cent or less for middleincome families. with these policies new labour continued the commitment to restrict public-service provision and to strengthen parental choice and service plurality via market mechanisms. however, other aspects of the childcare act and further initiatives in the 2000s did not follow this market logic but instead emphasized the importance of early-years provision for all children’s education and well-being, placing these services in a wider community context. with the 2006 act, the state for the first time announced its legal responsibility to provide ecec. it obliged las to offer a free preschool place to every child aged 3-4 for 2.5 hours a day, as well as sufficient childcare and after-school care for children of all ages whose parents were at work or in training. a preschool curriculum for threeto four-year-olds was introduced, partly to improve educational standards in preschool settings, and in addition to integrate care and education, since the national curriculum njsr – nordic journal of social research 2011 – special issue 47 was also intended for facilities offering day care for this age group. the creation of a new department for children, schools, and families responsible for all childand family-related services further emphasized this more holistic view of the child that linked care, education, and wider aspects. in england the state-run sure start centres were expanded to become children’s centres comprising, besides ecec, a wide range of family and community services such as parenting classes, health care, citizen’s advice, and employment bureaus. the children’s centres were to be located primarily in disadvantaged areas, but were to expand gradually to every ‘local community’ in england (ball & vincent, 2005; lloyd, 2008). following these initiatives, ecec services expanded considerably in the uk. in 2004 35 per cent of children aged zero to two years and 86 per cent three to five-year-olds had an ecec place (plantenga et al., 2008, p.30); among four-year-olds there is today almost full coverage. the expansion of places for three-year-olds took place mainly in the private service sector, and, as a consequence, the proportion of publicly provided places decreased from 85 per cent in 2000 to 47 per cent in 2004 in england and wales. the majority (81 per cent) of four-year-olds attended public settings, mainly through reception classes in primary schools (brewer et al., 2005, p.166). devolution in the uk at the end of the 1990s meant that ecec services became the responsibility of the respective nations, and differences in policy orientation do exist, particularly between england and scotland (wincott, 2006; cohen et al., 2004). from the standpoint of comparisons between countries, however, the similarities in the structure of the ecec sector prevail, not least because important subsidies such as tax credits are operated by the central government. new labour have described their targeted approach as ‘progressive universalism’ (hmt, 2001) –a definition that is notably not based on ideas of public-service provision for all, irrespective of socio-economic background. the labour government’s expansion efforts underscore the aim of a gradual universalization of the ecec system. however, a clear tension exists between these intentions and the chosen policy instruments: sure start and children centres target geographical areas rather than granting a right to every child, and thus actual access to ecec services is not guaranteed. nor do these centres necessarily reach every child at risk or from a low-income background, since locations of disadvantage and individual circumstances of disadvantage do not neatly match.4 the very part-time nature of free preschool for threeto four-year-olds also hampers attempts to support the reconciliation of family and work. most working parents need alternative care arrangements beyond the nursery school, and many are logistically not able to use preschools at all but rely on predominantly private and expensive day care. parents in the uk spend on average a third of their income on childcare costs, the highest among oecd countries (oecd, 2007), and for many families the financial burden is even heavier. in london the average weekly cost for 25 hours of nursery care for a child under two is currently £118.54 (daycare trust, 2011). the affordability of childcare thus remains a significant problem for many families, in practice hindering many mothers of small children from entering the labour market (ball/vincent, 2005, p.561). informal care remains the dominant form of extra-familial childcare; in the early 2000s 70 per cent of employed mothers relied on informal childcare (lewis, 2003, p.232). the quality of ecec services is another problematic area. in nursery schools for threeto four-year-olds there are trained teachers, yet the children 4 tunstall and lupton (2003) have even found that most poor children did not live in disadvantaged areas. njsr – nordic journal of social research 2011 – special issue 48 are subjected to high teacher-to-pupil ratios and have to adapt to school education-oriented classroom settings. for day-care staff, training requirements as well as pay are minimal, and this leads to high rates of turnover in these settings and leaves the question open as to whether there is sufficient competence to implement the national early-years curricula. these tensions are expected to increase as the newly elected coalition government in 2010 has announced their intention to reduce the scope of public sure start centres, providing mainly part-time preschool education, and a refocusing of childcare policy targeting disadvantaged children. discussion: ecec services between marketization and universalization over the last twenty-years the swedish and british ecec systems have undergone fundamental changes with respect to the quantity of available places, underlying rationale, and governance structure. do these changes also reflect general welfare-state trends towards increased marketization? the answer is both yes and no: market mechanisms have been introduced in both ecec systems but only within certain dimensions and to varying degrees. at the same time, early-years provision has been universalized following a very different ‘public-good’ logic, again to varying degrees in the two countries, that has older roots than the recent market-drive in social-services reform. in the uk during the 1980s and in sweden somewhat later in the 1990s a new focus on private-service provision appeared in ecec policy with the aim to increase parental choice, diversity, and efficiency in the system. particularly in sweden, the space for market processes has, however, remained limited. strict fee regulations and public funding of ecec services, whether public or private, make price competition impossible, and high quality standards concerning staff training, ecec activities, and facilities curb profit margins even further. some commentators have even pointed to tendencies towards self-exploitation among small private providers to keep their businesses running (bergqvist & nyberg, 2001). nor did marketization imply decreased state involvement: public funding for ecec has remained high, among the highest in the oecd (2007). furthermore, while the number of commercial providers has increased continuously, the expansion of public places was greater. the changes in swedish early-years provision with respect to marketization were thus incremental and did not lead to the dismantling of the public ecec system. should the number of for-profit providers increase to a more substantial proportion, this could eventually challenge the public organization and underlying social-rights logic of swedish ecec services. in the uk, the trends of marketization in ecec provision were more pronounced. while the development of a childcare market for children of working parents was of a more unplanned nature during the 1970s, npm ideas introduced under the conservative government in the 1980s paved the way for the marketization of ecec governance, which also occurred in other parts of the public sector at that time. it was, however, first under new labour in the 1990s when the rise of social-investment discourse made ecec service expansion part of an economically oriented policy agenda. ecec services in this model play an important role for welfare-state sustainability and economic growth by bringing parents into employment, lifting families out of poverty, and by giving children a good educational foundation so that they become productive workers in an internationally competitive knowledge economy. nevertheless, despite the strong preference for the market model, the uk government did not retreat from the scene. to the contrary, a pronounced njsr – nordic journal of social research 2011 – special issue 49 increase in state involvement can be observed since the 1980s. on the one hand, the childcare market did not grow by itself (lloyd, 2008), but service expansion had to be promoted by the state by means of various measures. secondly, the state had to mitigate negative market effects with respect to availability, affordability, and quality via targeted measures, demand-side subsidies to parents – who nevertheless shouldered the bulk of childcare costs – and standards and inspection regimes. an unexpected side effect of the market approach has been the increase in state regulation and centralization, which is evident in the very detailed and prescriptive english preschool curriculum (dfcsf, 2008). in sweden, we find a contrary development since the 1990s with the decentralization of ecec governance and the relaxing of state regulations. for example, the swedish preschool curriculum is only a few pages long, comprising mainly mission statements and broad objectives (lpfö, 1998). indeed, many municipalities do not even set requirements for ecec providers concerning staff-to-children ratios or the like (skolverket, 2008). yet these reforms cannot be associated with a ‘free-market’ logic because they were attempts to strengthen local self-administration. the state is still the central player, albeit with a much enhanced role for local governments. marketization and decentralization have led to greater variations in the ecec system, and have therewith challenged its universalism. nevertheless, swedish ecec stands out as displaying a high degree of equality from an international perspective (oecd, 2006). this may be a result of the strong and longestablished normative underpinnings of a system that emphasizes ‘public good’ and the social-rights aspects of early-years services. the most dominant trend in sweden dating back to the 1970s has consequently been the universalization of early-years services that followed the concept of integrated ‘educare’ which combines the aims of supporting the reconciliation of family and work with children’s early education. this model has not been abandoned but reinforced in recent years, with massive increases in public ecec services and the extension of a statutory right to a place for all children aged one to six. the underlying logic since the 1970s has been the gradual expansion of citizenship rights, including women’s rights to equal access to employment and children’s rights to a good upbringing and equal educational opportunities (naumann, 2006). developments in this direction have also taken place in the uk, though much more recently and relatively modest in extent, with universal part-time preschool for threeto four-year-olds, and particularly with the broader orientation towards universal ‘educare’ in children’s centres. some scholars have interpreted the limited nature of universal preschool education in the uk as an incoherent implementation of the governments’ social-investment agenda, because it ensures neither education for all children nor adequate support for employed parents (jenson & saint-denis, 2006; lewis, 2003). however, while limited implementation may hamper the yielding of expected returns, the ‘social-investment’ logic in itself does not lead to universal social rights. from an instrumental-investment orientation it might be neither economically nor politically sound to provide universal ecec for all children: post-industrial societies are not only knowledge economies but display large low-skill and low-pay service sectors. providing all children with good ecec would raise expectations, and could potentially create political tensions and demands for social and economic change should the economy prove unable to provide adequate employment for all well-educated children. my point here is that the introduction of universal preschool education and universal children’s centres were driven by a different older, social-rights njsr – nordic journal of social research 2011 – special issue 50 logic. claims around gender equality and children’s well-being and education had been around for a long time in the uk, just as in sweden, but without their transformation into policy. the social-investment discourse then opened the opportunities for feminists and children’s rights advocates to influence ecec policy and to broaden its remit in areas where they had been unsuccessful in the past (wincott, 2006). also, in the swedish case we could argue that ‘social-investment’ ideas created opportunities for ecec services to develop, but long before the 1990s. the link between ecec services and ‘productivist’ welfare-state goals (i.e., raising children to become productive citizen-workers) goes a long way back to conceptions of ‘preventive social policy’ that were constitutive of the swedish welfare state in the 1930s (myrdal, 1945). swedish ecec service expansion in the 1970s and 1990s was also motivated by the government’s interest in increasing employment rates and state revenue (naumann, 2006). the swedish approach to social investment has, however, always been integrated with a redistributive-citizenship conception of service provision (see esping-andersen, 2002). conclusion this examination of recent policy developments in the field of early-years services in sweden and the uk has revealed that marketization is not the only trend common to such provisions in both countries. another important driver for reform has been the extension of children’s rights to early childhood education. further developments include shifts in the relation between central and local governments in ecec governance that cannot easily be attributed to either marketization or universalization trends. thus, a general summation is that service-sector reforms are more complex than the controversy between ‘state’ and ‘market’ in policy debates may suggest. a second, more specific finding stands out: while both economic and rights-based ideas have shaped policy goals in sweden and the uk, it matters which policy reforms came first. in sweden, on the one hand, market mechanisms were introduced into a wellestablished, fairly universal public ecec system, with limited effects on the overall system; in the uk, on the other hand, ideas about universal access to ecec became prominent after a ‘childcare market’ had already been created, and the instruments chosen to support this market (i.e., demand-side subsidies) limited the possibility to expand public-service provision. universal preschool access in the uk is thus of a rather limited nature. the tensions between political promises to ‘invest in children’, all children, and actual policy implementation may, however, produce pressures for further change towards a more universal model. central to this article, therefore, is the observation that policy developments in welfare states continue to be shaped by historical trajectories, but not in a steady and linear fashion; nor do they evolve neatly from one ‘paradigm’ or ‘regime’ to another, but may include the maturation of ‘old’ welfare-state promises alongside the exploration of new paths. an investigation of the interplay between different underlying logics and goals of policy reform and the resultant dynamics of change may be a fruitful focus for future research on the restructuring of welfare states. njsr – nordic journal of social research 2011 – special issue 51 references antman, p. 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(2006). paradoxes of new labour social policy: toward universal child care in europe's ‘most liberal’ welfare regime? social politics, 13(2), 286-312. doi: 10.1093/sp/jxj011\ njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 7 (2016): special issue the subject of exemption: through discourses of normalization and individualization in denmark bjørn hamre* danish school of education aarhus university e-mail: bjha@edu.au.dk *corresponding author tine fristrup danish school of education aarhus university e-mail: tifr@edu.au.dk gerd christensen department of media, cognition and communication copenhagen university e-mail: gerd@hum.ku.dk abstract this article examines the constructions of the deviant subject in danish foucauldian educational research. following the work of foucault, we argue that the deviant subject, on the one hand, could be considered as a subject of exemption. in this case, exemption is deduced from foucault’s understanding of the relation between normality and deviancy. on the other hand, an examination of danish foucauldian disability research shows that this conception of ‘the deviant subject’ has changed over time. hence, the present expectations of ‘the disabled’ are – more or less – influenced by contemporary discourses of general education. thus, this article argues that foucauldian disability studies could benefit from taking into account foucauldian research in the field of general education. until recently, the two research fields have been mutually isolated. keywords: normality, deviancy, normalization, disability studies, the subject of exemption, general education, denmark mailto:bjha@edu.au.dk mailto:tifr@edu.au.dk http://mef.ku.dk/ansatte/beskrivelse/?id=83539 njsr – nordic journal of social research vol. 7 (2016): special issue 7 introduction the distinction between normality and deviancy, and therewith exemption, is one of the recurring themes in the french philosopher michel foucault’s work. according to foucault, madness is a condition that has changed its image from the medieval period to the renaissance and modern times, along with the transformation of society. however, a major shift took place in the middle of the seventeenth century: ‘[…] the world of madness becomes the world of exclusion’ (foucault, 2005, p. 117). this is related to the emergence of institutions solely serving the function of internment. in his archaeological examination, l’histoire de la folie (foucault 1961), foucault explores how the emergence of the asylum tends to position the mad as ‘an exemption’ from reason and normality. the important point here is that normality cannot be understood without abnormality and vice versa. they establish, so to speak, each other’s constitutive ‘outside’ (deleuze, 1986). thus, the two are dependent on one another. the role of the researcher is, then, to examine the relationship between the two. this is also the case when foucault shows how disciplinary power constantly reconstructs the relation between normality and deviancy in schools and institutions (foucault, 1979; 2006). it is meaningless to reduce foucault’s complex thoughts solely to the deviancy-normality issue, since his writings cover many other themes like disciplinary power, the will to knowledge and truth, the subject, and so forth. as we know, foucault develops and refines his understanding of normality and deviance throughout his authorship. in light of this, it is striking that danish foucauldian educational research has followed two separate tracks: one focusing on special (needs) education, and one focusing on general education. when it comes to discussions of pedagogical practice in schools it is, therefore, manifest that the two tracks or traditions have hardly communicated with one another. the two traditions can positively influence each other (hamre, 2012, 2014). thus, in this article, it is argued that an examination of a possible transgression between the two research areas might lead to new valuable insights into ‘the subject of exemption’. this hypothesis entails that studying deviancy and problematic behaviour in schools must include what is regarded as normal behaviour in a given period and institutional setting. this article demonstrates that the very marked delineation between deviancy and normality becomes less clear in present conceptions of ‘the subject of exemption’. thus, the demarcating line between the research field of general education and disability studies cannot be upheld. issues like diagnosing, classification and stigmatization must include analyses of the constructions of normality in schools. the methodological approach in the article takes the form of archaeology of knowledge. hence, this article first presents an introduction to the research field of danish foucauldian disability studies; secondly, it examines how studies in governmentality and subjectification in general education can possibly contribute to a contemporary analysis of this subject. accordingly, this article is positioned within the tradition of critical educational research (see e.g., masschelein, 2004) and critical disability studies (allan, 2005; 2008; tremain, 2005; slee & cook, 1999; slee, 2011; baker, 2002; goodley, 2011; goodley & rapley, 2002/2006). in international foucauldian critical disability studies, the emphasis is foremost on the problem of inclusion of ‘the deviant’; however, this is not explicitly the aim of this article. and though the field has njsr – nordic journal of social research vol. 7 (2016): special issue 8 an international background, it is important to note that the focus of the present article is on the danish conditions for research and current issues related to this context. danish foucauldian disability studies on the efforts towards normalization michel foucault’s analysis of the normality-deviancy issue (foucault, 1962; 2001; 2005; 2006) was introduced in a danish context in the beginning of the 1970s. the first translated book was maladie mentale et psychologie (foucault, 1962), published in denmark in 1971 as sindssygdom og psykologi [mental illness and psychology], and published and revised again in 2005. the french version from 1962 contained a chapter summing up the main points from folie et déraison: histoire de la folie à l'âge classique, which was published and defended by foucault in 1961. this work was not translated into danish until 2003, when it was entitled galskabens historie i den klassiske periode [the history of madness in the classical age], considered to be very close to foucault’s original work. however, the book was also circulated in denmark in a highly abbreviated norwegian translation (foucault, 1973), which did not capture the literary originality in foucault’s language. survieller et punir (1975) was translated into danish as overvågning og straf [survelliance and punish] (foucault, 2002) but a norwegian translation had already been published in 1977. histoire de la sexualité 1. la volonté de savoir (foucault, 1976) was translated to danish in 1978 as seksualitetens historie, 1: viljen til viden [the history of sexuality, 1: the will to knowledge], and revised and published again in 1994. apart from these translations, danish scholars, primarily with a background in literature studies, philosophy or studies within the history of ideas, presented the normality-deviancy issue and the critique of institutions in a number of introductions to foucault’s thought; some of the most important include: esbern krause-jensen, viden og magt. studier i michel foucault’s institutionskritik ([knowledge and power: studies in michel foucault institutional criticism] 1978); dag heede, det tomme menneske ([the empty human] 1992); and jens erik kristensen, knut ove eliassen and niels brügger’s anthology of various works by the philosopher, foucault’s masker ([foucault’s masks] 1995). these introductions all appeared in the danish context before the translations of works such as folie et déraison: histoire de la folie à l'âge classique and survieller et punir (translated into danish in 2003 and 2002). only a few danish researchers within disability studies have carried out research from a foucauldian perspective. these studies lie mostly within the frame of the history of disability, as a way of questioning or problematizing the research undertaken in the field of special-needs education – a field of research which was and remains primarily the domain of psychologists and educational psychologists. the most prominent researcher in the danish history of disability has been the historian birgit kirkebæk, who has conducted several research projects, all within a foucauldian framework (kirkebæk, 1985; 1993; 1997/1998; 2001; 2004; 2007; 2009; 2010). edith mandrup rønn has also conducted research within the field of disability history, but with an ethnological approach to her work on the living conditions of disabled people throughout history (rønn, 1996). another prominent researcher is jesper holst, who has used foucault’s framework in order to question the living conditions of institutionalized disabled people. holst has a background within the research field of social pedagogy and uses the foucauldian approach to njsr – nordic journal of social research vol. 7 (2016): special issue 9 problematize institutionalization as processes of normalization throughout history (holst, 1977; 1993; 1998; holst et al., 2000). finally, frank bylov (2006; 2010) has made a major contribution to understanding the development of empowerment movements among people with intellectual disabilities with inspiration from kirkebæk’s interpretations of the foucauldian framework. bylov’s research focuses on how pedagogical strategies have encouraged disabled people to organize in different movements as counterdiscourses to the dominant medicalization of disabled people. one could say that the contributions from these four danish researchers belongs to the first generation of danish foucauldian research on disability. this research focuses especially on the efforts towards normalization in the 1950s closely related to the pioneering work conducted by the then danish head of welfare, niels erik bank-mikkelsen. his efforts were directed against the eugenic discourse and involved a critique of how danish society treated disabled people; he proclaimed that ‘we’ could and should do better, meaning that ‘we’ as a society could give disabled people a better life than the ideal ‘normal life’ (bank-mikkelsen, 1971). this article interprets the first generation of danish foucauldian disability research as a departure from a normative emancipatory project in the wake of the social political agenda of the 1930s. it installed a process of normalization as a prophylactic approach to the improvement of the danish population, underlining the unavoidable humanism in the wake of the 1948 universal declaration of humans rights (kristensen & schmidt, 1989). bank-mikkelsen introduced the concept of ‘normalization’ as a specific ‘deinstitutionalization’ of disabled people with regard to a ‘visibility’ and ‘equality’ approach to improve the living conditions of disabled people in denmark. this historical concept is significantly different from foucault’s analytical use of normalization in contrast to deviation. it was seen as an effort to install a counter-discourse to the dominant eugenic and medicalized approach to disability. according to a report from the united nations on human rights and disability, there has been a dramatic shift in perspective towards disabled people over the past two decades in favour of a human-rights perspective on disability, which entails moving away from viewing people with disabilities as problems towards viewing them as holders of rights; the debate about the rights of disabled people is, therefore, connected to a wider debate about the place of difference in society (quinn & degener, 2002). the counter-discourse was made possible in relation to the aforementioned 1948 universal declaration of human rights (bank-mikkelsen, 1971). in article one of the declaration, there is a notion of ‘reason and conscience’, which has been used to question the lives of disabled people during the period from the 1880s to the 1950s (un, 1949). earlier, from about 1855 until the 1880s, the view of disabled people was more akin to an optimistic belief in a possible cure for disabilities (bank-mikkelsen, 1971; kirkebæk, 2010). the shift in the 1880s towards a protectionist approach resulted in a classification of disabled people into those who could benefit from treatment or interventions and those who could not (bank-mikkelsen, 1971; kirkebæk, 2010; rønn, 1996). those disabled people who were regarded as being beyond medical and educational reach were excluded, classified as incurable and uneducable, and placed in asylums or prisons, just like criminals (kirkebæk, 2010). this past classification of disabled people as uneducable is reversed in current danish society, because disabled people have become ‘educable subjects’ due to a general shift to a human-rights perspective and a specific approach to the njsr – nordic journal of social research vol. 7 (2016): special issue 10 united nations educational, scientific and cultural organization (unesco) salamanca statement from 1994 and the un convention on the rights of persons with disabilities from 2006. when disabled people become subjects they experience the different subjectifications made available in contemporary society; in this case, the processes of subjectification follow the education or learning agenda from the 1990s, a point to which this article will return. in order to demonstrate how this change is made possible, the article follows the construction of different discourses in danish foucauldian disability studies. danish social political discourse from the 1930s developed during the period from the 1950s to the 1970s into a strong critique of the institutionalization of disabled people, which had been going on since the 1880s (holst, 1993; kirkebæk, 1993). the pioneering work of bank-mikkelsen on trying to broaden the conceptualization of ‘the normal person’ followed the human-rights declaration and the legal changes occurring in 1959. an act known as ‘åndssvageloven’, (i.e., an act directed towards those regarded as feebleminded) made it possible to talk differently about the lives of disabled people according to the discourse of normalization that followed the passing of the law. in general terms, it meant that the efforts of medical categorization were questioned in the normalization efforts emphasizing both deinstitutionalization and decategorization (rydberg, 2006). since the 1970s, denmark has witnessed an approach to the lives of disabled people that is focused on education, training, and treatment, albeit with an understanding of disabled people as objects and not yet as subjects (quinn & degener, 2002). the discourse on education, training, and treatment follows two different tracks, which can be seen as relating to disabled people as objects in contrast to disabled people as subjects (quinn & degener, 2002). the ‘objectifying’ track is constituted in a psycho-medical discourse and aims at training and adaptation (kirkebæk, 2010). the other, ‘subjectifying’ track follows a social discourse focusing on social relations and quality of life (kirkebæk, 2010). it is possible to see the development of these two tracks in disability history as two different approaches to the past efforts towards normalization underlying the shift to a human-rights perspective over the past two decades, best exemplified by the united nations standard rules on the equalization of opportunities for people with disabilities, adopted by the general assembly in resolution 48/96 of 20th december 1993 (quinn & degener, 2002). this shift in perspective from the 1990s has made possible the present efforts towards individualization in the contemporary danish approach to the lives of disabled people as individuals (subjects), and in relation to danish educational research concerning the construction of the individual as ‘the educable subject’ (rydberg, 2006; hamre, 2012; 2014; drejer, 2012). in order to understand how an individual is constructed as a deviant subject, it is necessary to consider and analyse the efforts made in the 1950s to introduce the concept of normalization. according to holst (1993), the efforts towards normalization have made the lives of contemporary disabled people possible as an articulation of social barriers, whether this is related to environmental issues or oriented towards the use of language. the efforts towards normalization were grounded in a discourse on the integration of disabled people into society, departing from the un standard rules on the equalization of opportunities for persons with disabilities from 1993. within a foucauldian framework, it is possible to understand ‘normalization’ relationally, historically, practically, and critically. this can contribute to the njsr – nordic journal of social research vol. 7 (2016): special issue 11 understanding of what constitutes ‘the deviant subject’ as an object, when it is elaborated in a psycho-medical discourse and ordered as a deficit model with a focus on the bodily embedded deficits articulated as ‘impairments’. in the critique of the objectifying and non-social approach to disability as impairments, the individual deficit has been challenged by the social approach to disability. this was done in order to question the ways in which society governs the construction of deviation and ‘deficient’ objects. in order to debunk the dominant medicalization efforts in danish society, the notion of object and subject constellations in a human-rights perspective can be interpreted as a normalizing humanization initiative in regard to the processes of deinstitutionalization and decategorization (rydberg, 2006). this debunking is based on a subject-object dialectic and grounded in an essentialist view, different from foucault’s anti-essentialist approach; further, in this case, the ‘debunking’ is shaped as a normative approach, and the self-evident understanding of the normalization (humanization) efforts as creating better and more humane lives for disabled people than medicalization and diagnostic efforts have done. the pedagogical turn bylov’s (2006; 2010) work elaborated on the development of a pedagogical turn in the approach to the lives of disabled people in regard to the efforts towards normalization, which resulted in the act known as ‘åndssvageloven’ and disabled people’s right to education (rydberg, 2006). the efforts at medicalization were challenged and questioned in the 1970s as the need for deinstitutionalization and decategorization, and a general humanization of disabled people was articulated as an issue of social integration (rydberg, 2006). in the 1990s, the integrative approach to social cohesion was questioned and social inclusion became the new framework of an inclusive approach to advance social cohesion in danish society, which later developed into ‘inclusive education’ and a problematization of the limits in the integrative approach (holst et al. 2000). both of the questions, or problematizations, focused on social cohesion as a necessary approach to maintaining sustainability in danish society, and were elaborated in regard to the generalization of education as a human right that followed the un standard rules from 1993 that included disabled people as ‘educable citizens’ (rydberg, 2006; kristensen, 2012). but while functioning as a social and political drive to empower disabled people to live independent lives, the pedagogical (integrative) discourse became a social barrier to the emancipation of disabled people (bylov, 2010). ‘the disabled’ became, in a foucauldian sense, subject to a new discursive construction of ‘people with special needs’, and the need for pedagogical and therapeutic approaches articulated a ‘lifelong special-education configuration’ of their lives. the issues of integration were problematized in the dualistic objectifying and subjectifying approaches to the construction of ‘the subject of deviation’ as ‘the object of special needs’. the efforts towards normalization replayed the dualism between the individual and the social because the efforts to integrate constituted the processes of normalization in favour of society: the individual had to adapt to society and not vice versa. this can be interpreted as an individual deficit and socialbarrier approach that constitutes ‘the deviation subject’ as a ‘subject of exemption’. ‘the disabled people’ have become normalized; however, in an integrative approach they are constructed as subjects of exemption that can be managed through the pedagogical approach to their special needs njsr – nordic journal of social research vol. 7 (2016): special issue 12 because of the objectifying approach and the tendency to perceive people with special needs as problems (allan, 2008). in danish foucauldian studies of disability, the construction of the deviant subject is constituted as a possible consequence of the project of modernization from the 1800s eugenic discourse and further into the normalization efforts of the early 1930s and late 1950s in the development of a social and political discourse. the humanization efforts in the social and political discourse elaborated a more explicit individualizing approach in the 1980s and 1990s with regard to the shift into a human-rights perspective on the social and political agenda in order to pursue empowerment strategies in the elaborated pedagogical discourses on social inclusion (rydberg, 2006; bylov, 2010; kirkebæk, 2010; hamre, 2012; 2014; drejer, 2012). when looking into the literature that elaborates the pedagogical discourse on ‘inclusive education’ as a problematization of the approach of ‘special-needs education’ to the construction of the subject of exemption, an explicit foucauldian approach to the problematization is missing. the efforts towards normalization in the era of integration have been challenged by changes in an increasingly individualized society. following an (inclusive) agenda on ‘education and learning’ as the ‘best’ way to obtain social cohesion in an individualized society (kristensen, 2012), the efforts for greater normalization and integration have become challenged by the efforts for further individualization and inclusion. in the literature on ‘inclusive education’, researchers point to a necessary shift in the approach to pedagogy and education, which transgress ‘the special education’ into ‘a general education’ (holst et al., 2000). drawing on the analysis outlined above, we argue here that the past normalization (with a focus on integration) efforts (emphasizing training and adaption) have become the present individualization (with a focus on inclusion) efforts (emphasizing social relations and quality of life): both disabled and non-disabled people have become ‘equally’ individualized as educable subjects with individual (special) approaches to learning in current danish ‘learning’ society. individualization in danish foucauldian educational research the view of deviancy has changed over time; in a (post-) modern western society, everybody is considered as an individual, and thus as something ‘special’; further, in a ‘learning society’, everybody is (or must be) potentially educable. concerning research, it therefore seems reasonable that disability studies embraces or at least looks a little further into the research field of the construction of normality in education. here, the inspiration from foucault has had a major impact in denmark in recent decades. danish researchers have conducted foucauldian analyses of gender (søndergaard, 2000); gender, ethnicity, and school life (staunæs, 2002; kofoed, 2003; helms & krøjer, 2011); parental involvement (knudsen, 2010); school architecture (juelskjær, 2007); and student project groups (christensen, 2013). the assumption made by all these studies is that the subject for education is not a static phenomenon, but (to a varying extent) an effect of the present discourse. accordingly, the aim of the foucauldian research is (philosophical) critique: to question ideas that are taken for granted in our culture. questioning the truisms of pedagogics and education inevitably leads to questioning ‘what we (as educators and researchers) are doing while we are doing it’ (allan, 2005, p. 291). this is also the case in the educational njsr – nordic journal of social research vol. 7 (2016): special issue 13 research that focuses on analyses of the discourse of education (e.g., hamre, 2014; krejsler, 2002; krejsler, (ed.) 2004; drejer, 2012; christensen, 2008). from different angles, these studies are all concerned with the construction of ‘the normal child’ as the subject of normalization. thus, they may be considered as resources for further development of the field of disability studies. danish foucauldian educational research can roughly be divided into two traditions: 1) a tradition that primarily focuses on the perspectives of power/knowledge (pastoral, disciplinary, bio-power) and the construction of the human subject; and 2) a tradition that focuses primarily on governmentality. the former focuses on the micro-genetics of the construction of the individual as a subject, whereas the studies of governmentality concern the microand macro-genetics of government in the (post-) modern state (senellart, 2004; hamre, 2012; 2014). while the former can be regarded as belonging to the discipline of social psychology, the latter can be regarded as belonging to the social sciences. thus, governmentality is foucault’s terminology for the internalization of political control mechanisms that make the individual ‘government-able’ (foucault, 1991; senellart, 2004). however, in practice, the studies in both areas are quite diverse and the two traditions are rather intertwined and overlapping. hence, the division outlined below is not fixed and is indeed difficult to uphold. the construction of ‘the educable subject’ foucauldian studies within the field of social psychology are based on the concept of power/knowledge (foucault, 1980; foucault, 1994; foucault, 1998): power as a productive force closely tied to knowledge; a force that has the human subject as its primary product (søndergaard, 2000; staunæs, 2002; kofoed, 2003; christensen, 2013). these studies all focus on subjectification as the production of ‘the appropriate student’ through the micro-genetics of power: these involve mechanisms of inclusion, exclusion, positioning, and possibilities for subjectification in specific settings at school and university. these studies show how teachers and fellow students evaluate specific students and how this process is closely tied to the selection and exclusion of ‘the inappropriate student’. in the school context, students are evaluated according to academic skills and social competencies (kofoed, 2003), how they meet expectations attached to gender and ethnicity (kofoed, 2003; staunæs, 2002; buchardt, 2008; helms & krøjer, 2011), and the extent to which they are able to position themselves as ‘appropriate’ students (christensen, 2013). the studies also show how psychology plays a pivotal role in the evaluation of what can be regarded as ‘the norm’ or ‘being normal’ – that is, in the micro-processes of normalization. consequently, the formation of ‘the normal child’ in pedagogy is achieved through an amalgam of psychology and pedagogy, which forms a power/knowledge complex in contemporary education (rose, 1998; walkerdine, 1998; popkewitz, 2008; fendler, 2001). thus, the thesis in this article is that these analyses not only give an insight into the construction of ‘normality’, but may also serve as means for understanding some of the current and future insights within disability studies. in accordance with pedagogical trends in denmark today, that is, the discourse of ‘inclusion’, no individual must per definition be excluded from the learning environment. the studies of the ongoing subjectification in school contexts are njsr – nordic journal of social research vol. 7 (2016): special issue 14 supplemented by studies of the danish educational discourse that includes analyses of different kinds of texts concerning education and schooling. an example can be found in gerd christensen’s book, individ og disciplinering – det pædagogiske subjekts historie ([the individual and discipline: the history of the pedagogical subject] 2008). through genealogical analyses of contemporary pedagogical ‘trends’ in denmark (multiple intelligences, group and project studies, classroom management, learning plans, and structured education), christensen shows how the power/knowledge complex of pedagogy-psychology works in the formation of ‘the appropriate subject’ for schooling: the rational agent. ‘the appropriate student’ of today knows how to act in a flexible school without timetabled lessons and fixed classrooms, and is even able to identify when flexibility or structure is expected (drejer, 2012; christensen, 2008). many of these ‘traits’ can be traced back to the progressive pedagogy of the early 1900s. thus, the expectations for ‘the normal child’ in current danish education are deeply rooted in the danish culture and concept of the child (nørgaard, 1977; hamre, 2012; øland, 2007). accordingly, they can serve as a means for understanding the discourse of the student as an individual – that is, the discourse of individualization. one of the sources for inspiration in danish research is a paper by valerie walkerdine (1998), in which she shows how psychology infiltrates the practice of school education. influenced by foucault, walkerdine (1998) regards developmental psychology (mental measurement as a science) and education (mental measurement as a practice) as an important power/knowledge complex that ‘[…] produces the object of classification, the scientific techniques for its production and as the pedagogical techniques for its normalization and regulation’ (p. 171). these two concepts define and produce ‘the normal child’, a process of normalization through practices of differentiation. walkerdine’s (1998) conversion of foucault’s concept of governmentality into the concept of ‘developmentality’ emphasizes the individualization processes further. ‘developmentality’ refers to the equivalent internalization of discourse that makes individuals ‘development-able’ according to specific standards that are derived from psychology. this includes an idea of individual freedom and personal rationality that matures within specific developmental stages, and is expressed through the child’s curiosity, creativity, learning ability, and self-initiating activity (walkerdine, 1998, p. 190). lynn fendler also applies the concept of ‘developmentality’ in an analysis of current pedagogical principles which focus on interactionism and at developing ‘flexible’ individuals (fendler, 2001). fendler finds the origin for this concern in the fast-changing (post-) modern labour market, where ‘flexibility’ connotes freedom, liberation, and de-regulation – all components that are regarded as signs of a measure of competence . however, fendler argues that interactionism by no means frees individuals. on the contrary, it constitutes a powerful technology of the self, whose specific form of being flexible refers to being transformable and capable of participation in sociallearning processes such as groups and teams. hence ‘flexibility’ and ‘social skills’ are not in themselves attached to freedom and liberation, but become hallmarks of normalization (fendler, 2001; hamre, 2012; 2014). though these studies are conducted within the field of ‘normality’, they may include insights important to the field of disability studies. hence, ‘flexibility’ and ‘developmentability’ can also be claimed to be in focus in contemporary expectations to ‘the deviant subject’. as indicated, the analyses of fendler (2001) and walkerdine (1998) mark an intersection between the analyses of power/knowledge and njsr – nordic journal of social research vol. 7 (2016): special issue 15 governmentality in general education. the tradition of governmentality studies is taken up by the danish educational researcher john krejsler (2002; 2004). krejsler, informed by thomas popkewitz, analyses the danish state as a contributor to the constitution of the (post-) modern individual through education. danish law establishes different educational apparatuses as essential to current danish education from preschool to university, and krejsler focuses primarily on individualization as the overriding discourse in contemporary danish education (krejsler, 2002; 2004). as krejsler remarks, the discourse of individualization is productive in the sense that it makes individuals believe that institutional intentions are their own goals (krejsler, 2004). likewise, this is an insight that could fruitfully be applied to the field of disability research. the processes of individualization that occur both within the field of ‘normality’ and the field of ‘disability’ are framed by certain institutions that all have interests in upholding certain boundaries. thus, the policies of the subject are an active component in the construction of the individual. to summarize, danish and international educational research has taken up concepts of foucault to identify some traits in the contemporary definition of ‘the normal subject’ in education: ‘the normal subject’ is constructed as autonomous, flexible, creative, socially responsive, suitable within the categories of developmental psychology, and responsible for his or her own individuality and learning as a lifelong process. he or she is capable of coworking in groups and teams and is able to master the complexity of interdisciplinarity and the flexibility of the ‘transformable school’. these desirable ‘traits’ may also have an impact on an analysis of the ideals and standards for ‘the deviant subject’ in postmodernity. as the analyses above show, contemporary expectations for ‘the deviant subject’ seem to meet the expectations of ‘the normal subject’. thus, development-ability, flexibility, and learnability are not only expectations for ‘the normal subject’ but (perhaps to a different extent) things that concern all individuals. on the other hand, the category of ‘normal child’ is dependent on having a constitutive ‘exterior’, which is included through its exclusion (derrida, 1974). thus, the category is both establishing and dependent on the category of ‘the not-normal child’, a category ready to absorb the children who do not fit into the concept of normality. following this analysis, ‘the not-normal child’ lacks all the qualities (demonstrating, acting, and showing) that define ‘the normal child’. conclusion looking at foucault’s contributions to the danish field of disability studies, his early works may seem obvious when it comes to analysing internment and exclusion. however, they are inadequate when it comes to analysing newer phenomena such as individualization, individual rights, education, and inclusion. in the analysis of these issues, an equally strong influence from international foucauldian disability research is not evident in danish disability studies. foucault’s influence on danish disability studies mainly draws on works such as discipline and punish and madness and civilization. according to the analysis presented in this article, one of the reasons for the impact of this influence is the close theoretical connection to the normalization discourse of the 1960s, and the historical incarceration of disabled people, which called for a strong critique of the institutionalization of that time; in line with this analysis, njsr – nordic journal of social research vol. 7 (2016): special issue 16 future analysis calls for a more differentiated critique of discourses such as individual rights, empowerment, and inclusion. in his work, frank bylov has argued for the value of education as a right for people with disabilities (bylov, 2010), which in the current analysis has been labelled ‘the pedagogical turn’. as the analysis shows, disabled people’s conditions are increasingly affected by expectations of individualization, similar to contemporary expectations of people in general. this concerns human rights, ethics, and learning. to some extent, it is even possible to say that the subject of exemption has been ‘normalized’. normalization, in this case, concerns a strong focus on individualization and inclusion. this article claims that this indicates a need for a stronger emphasis on the studies of governmentality within general education in order to analyse the dynamics of individualization as a discourse in education (rose, 1998; fendler, 2001; krejsler, 2004). thus, when it comes to the study of the ‘subject of exemption’ in particular, and issues of inclusion and exclusion in general, this approach calls for a further integration of studies in general education and similar studies in special (-needs) education. in the era of postmodernity, we are all in some way ‘subjects of exemption’, or at least positioned as human beings with unique potentials. within the field of disability in denmark, this change is concerned with a discursive shift from integration to inclusion. the discourse of inclusion cannot be restricted to special-needs education, since everybody in the present school is regarded as ‘special’or ‘unique’, which requires that the teacher and the learning environment must deal with individual learning strategies. this is in juxtaposition to the strategy of integration that regarded the individual as an exemption to the ideal of the normal in schools. in the discourse of inclusion, the problems of learning are caused by the context, rather than regarded as a personal deficit in the individual. the discourse of inclusion currently appears simultaneously with discourses of individualization, empowerment, and lifelong learning. these discourses require new analytical tools, rather than drawing on the madness-reason dichotomy. references allan, j. 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(doctoral dissertation) det humanistiske fakultet, københavns universitet, denmark. microsoft word 711 final.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 psychoeducation: perspectives from individuals on sick leave who are at risk of having a mental disorder line hille højfeldt* psychiatric research unit west, regional psychiatric services west, central denmark region, herning, denmark email: linehille@hotmail.com *corresponding author pernille pedersen psychiatric research unit west, regional psychiatric services west, central denmark region, herning, denmark institute of clinical medicine, university of aarhus, aarhus, denmark public health and quality improvement, central denmark region, aarhus, denmark email: pernille.pedersen@stab.rm.dk kirsten schultz petersen cfk – public health and quality improvement, central denmark region, aarhus, denmark department of social medicine and rehabilitation, faculty of health sciences, university of aarhus, denmark department of health sciences and technology, aalborg university, aalborg, denmark email: ksp@hst.aau.dk lars peter andersen danish ramazzini centre, department of occupational medicine, the regional hospital west jutland – university research clinic, herning, denmark email: lars.peter.soenderbo.andersen@vest.rm.dk njsr – nordic journal of social research vol. 6, 2015 185 abstract the large number of people on sickness and disability benefits due to mental disorders in denmark has increased the need for improved rehabilitative services to facilitate their return to work. the aim of the present study was to explore the use of psychoeducation in relation to the standard services of a danish job centre for individuals on sick leave with regard to relevance, elements contributing to recovery, and improvements of psychoeducation as an intervention. semi-structured interviews were conducted with 16 individuals on sick leave who were at risk of having a mental disorder. the interviews were analysed using systematic text condensation inspired by giorgi’s phenomenological analysis. the resulting core themes describing psychoeducation with respect to the standard services of the job centre included access and relevance of psychoeducation in relation to the job centre’s standard services, social support, self-care, and psychoeducation intervention. this study concludes that the informants consider psychoeducation a relevant offer to individuals on sick leave who are at risk of having a mental disorder. the relevance of the standard services of the job-centre services was considered to be low. furthermore, psychoeducation reinforces peer support and inclusion of relatives as elements to aid recovery to a much larger extent than do the standard services of the job centre. in general, the results support the use of psychoeducation in a municipal job-centre setting as a targeted and beneficial offer to individuals on sick leave who are at risk of having a mental disorder. keywords: qualitative, psychoeducation, job centre, sick leave, mental health, return to work, rehabilitation, social relations, peer support introduction common mental disorders constitute the most prevalent causes of long-term sickness absence (more than eight weeks) and are the reason for 50 per cent of all disability pensions given in 2011 in denmark (danish employers’ confederation, 2014). this has increased the need for improved rehabilitative services to enable individuals on sick leave with mental disorders to return to work. in recent years, the focus has been on developing rehabilitative interventions that facilitate a return to work for these individuals. a broad range of interventions have been quantitatively tested but have not yet been implemented and applied in the practical rehabilitation process aimed at the return to work (arends et al., 2012; nieuwenhuijsen et al., 2008). qualitative studies have described a range of barriers for people with mental-health problems in these rehabilitative processes, such as acceptance from the surroundings, recognition of mental-health problems, individual factors and attitudes, contact, trust and support regarding the workplace and professionals (muijzer, brouwer, geertzen, & groothoff, 2012; noordik, 2011; ståhl & edvardsson stiwne, 2014). rehabilitative processes are, however, complex, involving a range of actors and efforts (rouget & aubry, 2007). in a danish context, we have little knowledge of the practical rehabilitative efforts facilitating the return to work from the perspective of individuals on sick leave who are at risk of having a mental disorder. njsr – nordic journal of social research vol. 6, 2015 186 danish municipal case-management centres (job centres) administrate sickness-benefit cases and are responsible for the process of returning individuals on sick leave back to work. general practitioners and health-care services are responsible for the diagnosis and treatment of the conditions responsible for sickness absence. job centres provide activation programmes to individuals on sick leave, programmes which can be considered the core services of the job centre. a critique of these services emphasizes the lack of evidence-based return-to-work interventions, and that the services are not necessarily targeted at individuals on sick leave who are at risk of having a mental disorder (stafford & colom, 2013). hillborg (2010) has found that individuals on sick leave due to mental disorders may experience despondency and setbacks if they do not perceive the rehabilitation services as being relevant. a recent meta-synthesis of studies on return to work among employees with mental-health problems (andersen, nielsen, & brinkmann, 2012) shows that employees of individuals on sick leave mainly had negative experiences with the social-insurance offices. they felt that the socialinsurance office did not provide the necessary support because there was no focus on their mental-health problem or needs. therefore, this study aims to explore sick-listed individuals’ experiences with psychoeducation in relation to the standard services of a job centre. psychoeducation is an intervention that targets individuals with mental disorders, providing them with tools to support their involvement in recovery and coping (donker, griffiths, cuijpers, & christensen, 2009; stafford & colom, 2013). psychoeducation includes diverse psychotherapeutic techniques, for example, cognitive behavioural and problem-solving therapy (casañas et al., 2012), which promote awareness and forethoughtfulness in relation to the recognition of episodic recurrences, and improve psychosocial and occupational functioning and quality of life (colom, 2011). quantitative studies have examined psychoeducation in diverse groups with mental-health problems (colom et al., 2009; morokuma et al., 2013; rouget & aubry, 2007), but few qualitative studies have explored participants’ perspectives of participating in psychoeducation. psychoeducation has been conducted among patients with schizophrenia and patients suffering from bipolar affective disorder (aho-mustonen, miettinen, & räty, 2010; o'connor, gordon, graham, kelly, & o'grady-walshe, 2008). the experiences of the participants of these studies were positive regarding the information about their illness and the opportunities to discuss illness-related issues. the psychoeducation intervention appears to have positive effects on activation and social interaction. psychoeducation also seemed to have a potential to change participants’ perception and acceptance of their illness, which enabled them to cope better with their illness. to our knowledge, psychoeducation has not previously been used as a rehabilitative return-to-work intervention in a municipal job-centre setting for individuals on sick leave who are at risk of a having a mental disorder. this study provides insight into personal experiences with psychoeducation as a rehabilitative intervention for the return to work as a part of a job centre’s standard services. aim of study the aim of the study has been to explore the experiences of individuals on sick leave who are at risk of having a mental disorder from the perspective of njsr – nordic journal of social research vol. 6, 2015 187 individuals receiving the psychoeducation and individuals receiving standard services from the job centres. this study has focused on three issues: 1) the relevance of psychoeducation in relation to job centres’ standard services; 2) the identification of elements in psychoeducation in relation to job centres’ standard services that might contribute to recovery; and 3) the improvements of psychoeducation as a rehabilitative intervention aimed at a return to work. materials and methods participants the first author conducted 16 qualitative interviews with individuals attending another study involving a randomized control trial (rct) testing the effect of psychoeducation on the return to work among 430 individuals on sick leave as a supplement to standard job-centre services. the rct study was conducted in four danish municipalities from september 2012 to april 2014 (pedersen et al., 2014). the participants included in the research project were of working age, on sick leave from part-time or full-time work or unemployment and scored five or less on symptom checklist-8 anxiety depression (scl-8ad), which is a screening instrument for detecting mental disorders among individuals on sick leave (søgaard & bech, 2009). all participants were obliged to participate in interviews with a job-centre social worker and, based on individual assessments, were entitled to receive individual, standard job-centre services such as mindfulness, physical exercise, a slow return to work, job training or special care, and short lectures. the psychoeducational sessions were not part of the standard services but were carried out at the participating job centres. the informants in the present study (eight women and eight men, median age 47 years (range 29–60) were selected with the aim of assuring a variation in gender, age, work status, and level of education. eight informants had received the standard services of the job centre (control group (c)), and eight informants received the standard services of the job centre plus psychoeducation (intervention group (i)). characteristics of the 16 informants are presented in table 1. eight of the informants were still employed or under education during the interview, two were uncertain about their present work status because they had lost contact with their employer, and six were unemployed. at the time of the interview, six informants had fully returned to work, and ten were on full-time sick leave. depression was the most common self-reported reason for sick leave; the other reasons were stress, anxiety, and physical problems. the informants had been on sick leave between three months and one year. psychoeducation sessions the psychoeducation intervention in this study was designed as group-based sessions, two hours once a week for six weeks. it was a slow-open group, where new participants could join the sessions shortly after they had agreed to participate. a social worker, psychiatric nurses, a physiotherapist, a psychologist, and a person previously on sick leave due to mental-health problems led the sessions. the sessions focused on stress and working life and were a mix of didactic lectures and group discussions. the purpose of the psychoeducation intervention was to provide individuals with the capacity to understand and improve their own situation through knowledge, dialogue, njsr – nordic journal of social research vol. 6, 2015 188 personal experiences, tools, problem-solving techniques, and coping strategies. the six sessions (a-f) dealt with the following themes: (a) information on symptoms; (b) information on options and coping strategies; (c) counselling on the basis of sick-leave legislation; (d) information on mentalhealth psychology; (e) physical exercise; (f) a presentation of a personal story from a woman previously on sick leave due to mental-health problems and a discussion of relational support for the individual on sick leave. the last session (f) included the participants’ relatives, with the purpose of providing them with information and tools to support the individual on sick leave (pedersen et al., 2014). table 1: characteristics of the informants gender age work status educational level intervention /control status of sick leave during interview f 51 unemployed medium i on sick leave f 55 employed skilled/trained i full-time work m 44 don't know skilled/trained i on sick leave f 42 employed none i on sick leave m 48 unemployed none i on sick leave m 38 unemployed skilled/trained i on sick leave m 52 unemployed skilled/trained i on sick leave f 41 employed medium i full-time work f 47 employed medium c full-time work m 54 employed none c on sick leave f 55 employed none c full-time work f 52 employed medium c full-time work m 40 unemployed skilled/trained c on sick leave m 60 don't know skilled/trained c on sick leave f 29 under education skilled/trained c full-time education m 47 unemployed none c on sick leave data collection this study had a descriptive, explorative approach in order to enable each informant to report individual (positive and negative) experiences regarding psychoeducation as an addition to the job centres’ standard services within about a month after having received the psychoeducational sessions. contact with informants was made by telephone. we presented the aim, purpose, expected duration of the interviews, and a choice of conducting the interview in the job-centre offices, in the informants’ own home or at the research office. we developed a semi-structured interview guide with open-ended questions, which were based on the themes of rehabilitation. as the interview guide (see table 2) indicates, the themes of rehabilitation contained principles for an njsr – nordic journal of social research vol. 6, 2015 189 optimal intervention in individuals with limitations, and covered issues such as relevance in relation to a specific health problem, time, involvement of relatives, and quality of services (marselisborgcentret & rehabiliteringsforum danmark, 2004). all interviews were conducted by the first author and began with background and introductory questions about their sick-leave history. all interviews were audio recorded and lasted between 19 minutes and one hour and 23 minutes. the various durations were due to the informants’ individual sick-leave histories, the number of standard services received at different job centres, and whether they had participated in the psychoeducation sessions. data analysis the interviews were transcribed, coded in n-vivo10, and analysed inductively. this analysis used systematic text condensation inspired by giorgi’s phenomenological analysis in four stages: (1) forming an overview of themes by listening to the interviews multiple times; (2) coding and identifying units of meaning, representing subthemes of different aspects of the informants’ experiences; (3) condensing and summarizing the contents of each of the individual meaning units within the subthemes; and (4) summarizing the contents of each meaning unit in order to generalize descriptions and patterns of their experiences (malterud, 2011). the phenomenological analysis identified four themes and six subthemes reflecting the informants’ experience by focusing on the different perspectives on psychoeducation and the job centres’ standard services. table 2: semi-structured interview guide introduction: why are you/have you been on sick leave? 1 can you describe the standard services you received from the job centre during your period on sick leave? 2 did the services offered by the job centre meet your requirements and if so how? 3 in which way could your relatives participate in services offered by the job centre concerning your condition? 4 psychoeducation is a voluntary offer among job-centre standard services, why did you choose to participate? 5 what has been your own initiative to improve recovery and to return to work? 6 can you describe something that you have learned during your sick leave? only for informants offered the psychoeducation intervention 6 how did you experience participation in the psychoeducation? 7 what do you think about the content of the psychoeducation sessions? 8 did any of your relatives participate in the psychoeducation? and what effect did this have? 9 can you describe something that you have learned from the psychoeducation? njsr – nordic journal of social research vol. 6, 2015 190 reflexivity the individuals constituted a vulnerable group, which was taken into consideration during all study phases by the adjustment of activities and questions in accordance with individual vulnerability. to obtain an understanding of the content and context, we participated in the psychoeducation sessions. ethical considerations the informants were given oral and written information on the purpose of the interview. they were informed that their participation was voluntary and that they were free to end their participation at any time during the study. they were assured confidentiality and that the data would be securely stored. each informant gave oral and written informed consent. respect and consideration of the informants’ personal stories were shown at all times. the study as well as the transfer of the informants’ contact information from the research project have been approved by the danish data protection agency. according to the danish ethical committee, neither the rct nor the qualitative study needed to be registered (written communication, 9 july 2012). results four themes and six subthemes emerged from the interviews, reflecting the informants’ experiences of psychoeducation in relation to the job centres’ standard services (table 3). the four themes were ‘access and relevance of psychoeducation in relation to the job centres’ standard services’, ‘social support’, ‘self-care’, and ‘psychoeducation intervention’. table 3: themes and subthemes generated from the interviews access and relevance of psychoeducation and job-centre standard services • job-centre standard services • psychoeducation social support • including relatives in professional settings • seeking connection self-care • own initiative to recover • personal development psychoeducation intervention • content of sessions • time and atmosphere njsr – nordic journal of social research vol. 6, 2015 191 access and relevance of psychoeducation in relation to the job centres’ standard services job-centre standard services all 16 informants described quite different access to the job centres’ standard services. this divided the informants into three rather evenly sized groups: informants who were offered and participated in the job centres’ standard services, informants who were offered but decided not to participate in the job centres’ standard services, and informants who had not received any of the job centres’ standard services. informants who received and participated in the job centres’ standard services described both individual and group-based services. the majority of individual services consisted of a slow return to work and job training. a slow return to work was highly valued by employees on sick leave because having some days off work became an acceptable possibility and this option lowered the pressure to perform. group-based services consisted of physical exercise, mindfulness, special care, and short lectures. several informants took advantage of more than one of these services. the general attitude of this group seemed to be one of having confidence in and appreciative towards participating in the job centres’ standard services, although the overall experience was that job centre’s standard services were not specifically targeted at individuals on sick leave due to mental-health problems. three of the 16 informants had participated in the programme targeting individuals on sick leave due to mental-health problems. sussie, who participated in the physical exercise, said: i feel that this was not the right place for me to be speaking out, because i might come across them (the other participants of the group) at the supermarket the day after. i would have liked a little more intimacy, for instance, a group only for persons suffering from stress. that would have been better because then i could begin opening up. sussie (c) informants who had been offered but decided not to participate in the job centres’ standard services described a somewhat similar range of services as did the informants who had received and participated in them. for some, reaching the locations of the job centres’ standard services by public transport took too much time or was too much of a challenge because of their mentalhealth problem. many described that their current treatment was very time and energy-consuming and consisted of several initiatives. the general opinion in this group was that treatment and self-management were the primary goals before returning to work. one felt that the job centre was not very helpful in her situation. she asked for professionals with particular knowledge of mental-health problems to advise her on what to do and how to reach goals. when thomas was asked why he did not participate in the job centre’s standard services he said: all of it has to be considered in relation to reserves of energy... as well as financial reserves. i might end up using more effort just to get out of my flat than any benefit i got. thomas (i) informants who had not received any standard services expressed that they were not or were poorly informed about the possibilities of participating in the job centres’ standard services. some would have liked to participate in njsr – nordic journal of social research vol. 6, 2015 192 mindfulness or physical exercise; others had given up, assuming a rather negative tone towards the job centres. olivia had been on sick leave for eight months: i didn’t hear one word [from the job centre].... i didn’t get any suggestions or feedback as to what we might do in order to move forward. olivia (i) a few informants in this group were uncertain whether they had been offered any of the job centres’ standard services. throughout the interviews, several informants related experiences with moderate or severe cognitive impairments, such as poor memory. katrin describes how she experienced an interview in combination with her mental-health problem: i would have liked if they [the social workers] had suggested coming to my place for the interview... with such a severe anxiety for leaving home as i had then, i must say that i got nothing, absolutely nothing, out of the first meeting. i didn’t hear anything of what she was saying. in fact, i remember nothing of what i should have remembered. katrin (c) psychoeducation psychoeducation was a volunteer supplementary offer among the job centres’ standard services. therefore, all 16 informants had made a deliberate personal choice about participation. their decisions about participating were based on combinations of five main issues: a wish to receive help to learn about mental health, to receive exercises and tools, to get away from home, to meet like-minded people, and to involve relatives. the informants emphasized that psychoeducation targeted their particular problem and provided a place to meet like-minded people. the general attitude towards psychoeducation was very positive and expectant. hanna said: it sounded relevant to me, and i hadn’t had any offer of services in that respect, and i had no idea that there was that kind of offer so i was actually very happy when i saw it and i thought ‘please help me’. hanna (i) owing to the randomized controlled design, several participants expressed an awareness of the possibility that they might not receive an offer to participate in the psychoeducation sessions. they expressed positive terms like “hope” and “lucky” several times when talking about the possibility of participating in psychoeducation, highlighting the need of being seen and helped by rehabilitation professionals. perhaps i was lucky to be part of this course. i could see that there was potential for self-development. i knew i had to go in this direction. i couldn’t change the world, but i could change who i am. anne (i) in summary, accessibility and relevance of a job centres’ standard services and psychoeducation seemed to have both primary and secondary significance for the informants. the primary significance was to receive services that would support them to become active in their recovery process. the secondary significance was to be seen and respected by the rehabilitation professionals as an individual on sick leave with a mental-health problem. in relation to the job centres’ standard services, psychoeducation seemed to njsr – nordic journal of social research vol. 6, 2015 193 meet both primary and secondary needs better. this indicates a higher relevance of psychoeducation than the job centres’ standard services. social support including relatives in professional settings the social support and involvement of relatives in relation to informants’ sick leave and mental-health problems were mentioned frequently. most informants pointed out both good and problematic experiences with family members as a result of their mental-health problem. the psychoeducation offered an evening session with the possibility to bring relatives along. this was considered a very important opportunity. no informant reported that a job centre offered a standard service that involved obtaining information from relatives on mentalhealth problems in a professional setting. one informant was informed about the possibility to bring her teenage son to a meeting for children with depressed parents. ian did not join the psychoeducation sessions. he said: my father doesn’t understand anything... he really ought to be sitting there, hearing about it from the professionals, because they are the only people that he believes in. they can provide the facts. ian (c) five of the eight interviewed informants included in the psychoeducation intervention each brought one or two relatives. two participants did not have any relatives, and one spouse was unavailable on the particular day of the session. the outcome of the session with relatives was described very individually, depending on the relatives’ previous knowledge. several informants mentioned that the session had increased the relatives’ understanding of their mental problem, including the legitimacy to say ‘no’ and to be in need of time. others mentioned experiences with relatives in supportive episodes during times when they were unable to cope with everyday life. olivia’s husband joined the evening for relatives. she said about him: he was deeply affected by how bad i really was. in fact, he was quite shocked. for the next couple of days he was definitely very different, i must say... i could easily feel that he gave it a lot of thought... actually... not to say that he ignored the problem before, but now he had really got it under his skin. olivia (i) seeking connection one of the core elements was the informants’ need of connection with others in the same situation. social interaction with like-minded people was offered to three individuals through the job centres’ standard services and to all participants joining the psychoeducation sessions. connection with others in the same situation was perceived as a means of obtaining peer understanding, talking about one’s own situation, learning from others, and avoiding isolation. john said: i’ve realized that i’m not alone in this situation. actually lots of people have experienced something like this, and that has given me a boost, socially speaking. john (i) njsr – nordic journal of social research vol. 6, 2015 194 both the job centres’ standard offer of the possibility to meet like-minded people and the psychoeducation were carried out as a group-based, slowopen sessions. this meant no waiting time for eligible individuals on sick leave to begin the offer and psychoeducation sessions, but it also meant that number of participants could vary from session to session. though the offer and psychoeducation sessions were described as providing a comfortable and confident setting during a vulnerable period, the informants generally agreed and wished for one steady group instead of a slow-open group. they believed that at steady group would result in more social interaction, more sharing of experiences with other participants, and a greater feeling of inclusion, reassurance, and confidence. chris said: it would have been nice if it had been a group starting and ending together. then perhaps it could have been possible, if others were interested, to meet afterwards, just for a cup of coffee at someone’s house, having that possibility to be able to support each other because we were stuck in the same situation. chris (i) in summary, involving relatives in professional settings and providing them with information about mental-health problems seemed to increase social support to the individuals on sick leave. activities offered in steady group sessions instead of slow-open groups may increase the experienced connection, social interaction, and feelings of reassurance. these elements may be interpreted as contributive to recovery. in relation to the job centres’ standard services, the psychoeducation sessions seem to improve the possibility of social support. self-care one’s own initiatives to recover the informants participated actively in their own recovery process. most of the informants’ own initiatives to recover involved treatment or preparing a way back to work. the initiatives towards treatment included all kinds of self-paid therapy, alternative treatment, physical exercise, diet, and voluntary counselling. initiatives to prepare a way back to work were concerned with keeping contact with the boss or the colleagues and visiting the workplace. many informants characterized these initiatives as really difficult and frightening tasks. sussie was a registered childminder, working from home but with colleagues in the neighbourhood, and she said: i was almost ready to go back to work, but then i asked if i could take another round with them all [my colleagues] … that would become part of my self-care, because i had been afraid of bumping into them – imagining my seeing them at the supermarket. i had been forced to go shopping somewhere else, because i was so shy or embarrassed about it all.... the fact that i met with them, face to face, and was able to talk to them about things that didn’t concern my disease, that was really a supplement to my working with myself – which is part of it all.... my heart was really beating like crazy every time i went to see them, because i felt so embarrassed. i would rather be reported sick with a broken leg, because this was difficult to put into words. what if i had started crying? but they were so happy to see me.... i felt that they looked at me with different eyes. i had been so disillusioned. sussie (c) njsr – nordic journal of social research vol. 6, 2015 195 like sussie, other informants who had returned to work at the time of the interview emphasized the importance of being encouraged to keep contact with the workplace during the sick-leave period, and they asked for more information about how to cope during their return to work. anne attended the psychoeducation sessions and expressed: i believe that many people expect to be fully recovered when they start working again. they won’t be. i know damned well that i won’t be fit until two or three years after this … it will take an incredibly long time. … for me it is a matter of using tools like meditation, exercising, and the right food in order to manage the problems of everyday life and work. i have to take small breaks every second hour. there are things that i simply must stay away from doing because they are too much for me. anne (i) personal development most informants were able to describe something which had changed or something they had learned about themselves during their sick leave. there were two types of changes. one was practical changes, like beginning to take a driver’s licence, going back to study or changing treatment. the other type was broader personal changes, like the one hanna related: i became much better at accepting that depression was a disease – i have had this bad feeling wondering why i didn’t pull myself together... but then i realized that you just can’t. i would have been in a bad situation without this psychoeducation. hanna (i) informants who participated in the psychoeducation sessions emphasized that they had become more conscious about themselves and their own situations. they frequently mentioned saying ‘no’, knowing themselves and their body better, making new strategies and reassessing their lives. thomas put it this way: i became very much aware that i’m the one responsible for my sick leave, with the choices i make and in terms of making a decision, and i try to handle my sick leave on my own terms. thomas (i) one expressed that the psychoeducation sessions had contributed to recovery and improvement but that the course alone was not enough. in summary, informants’ own initiatives to recover were considered necessary for some of them, since neither the job centres’ standard services nor the psychoeducation sessions seemed to supply adequate information on how to cope with the workplace when on sick leave due to with a mental-health problem, or how to take care of one’s self and to cope after returning to work. these elements might, however, be important for recovery. in relation to the job centres’ standard services, the psychoeducation sessions seemed to present an increased possibility for broader personal development. njsr – nordic journal of social research vol. 6, 2015 196 psychoeducation intervention content of sessions the eight informants receiving the psychoeducation intervention described various perspectives on the session content. five participants expressed that they had received new and important knowledge. three already knew much of the information provided, which led to a disapproving view on the content of the sessions. three wished for more individual counselling devoted to personal issues, but the common approach among the participants was an urge to develop, learn, and improve in order to make a change in their own situation. thomas said: i think it was nice to get a brush up, and i could easily see myself in all the points they mentioned, both in terms of when it went wrong and all those things. i could easily see where i went wrong. thomas (i) all eight informants emphasized the importance of the session in which a woman previously on sick leave presented her personal story in which she related the long process that was involving in overcoming and recovering from the manifold challenges presented by her mental problem. the majority of the informants expressed how they personally could relate to the experiences, reactions, patterns, and feelings in her sick-leave story she, the one who had been sick herself, she gave us a lot, i think. there were so many similarities, and i could understand from what she told us that she had been ever sicker than me. … still, there were many things that i recognized, among others, that she had been angry with her husband, too. olivia (i) the teaching style was described as good, welcoming, and open, but too much information was provided by the structured slides. this form of instruction generated an experience of the sessions being rather inactive. practical tools and exercises were given particularly high priority, either for use at home or together with other psychoeducation participants during the sessions. some suggested more tools concerning the following: exercises making you decide what to do about the situation today and tomorrow, preparing you for what happens when you return to work, and how you could take care of yourself when starting work again or how to make achievable agreements with yourself. tools and exercises already included in the sessions were writing in a diary, using a calendar, exercising, and coping tools. the tools and exercises were considered a manageable and useful way to work with oneself and seemed to create a hope of moving forward within the process of preparing oneself to return to work, to learn new routines or to develop personally. as anne said: when a person is suffering from stress, it is difficult to manage big changes. … but with one little change each week for six weeks – that makes six small changes – that’ll really be a lot. anne (i) time and atmosphere the psychoeducation sessions were offered within the first two months of a sick leave. a large number of the informants expressed difficulties remembering and taking in information during the early stages of sick leave. njsr – nordic journal of social research vol. 6, 2015 197 some felt tired out after taking part in a two-hour session; others suggested half an hour break between the two hours. as thomas said: at the beginning i couldn’t grasp much – two hours were just fine. i was completely filled up, i would say. i can take much more now than i could then. thomas (i) generally, the psychoeducation participants felt that they were positively and openly met by the teachers and given room to ask and speak. if one had a bad day, it was acceptable not to contribute to the session. this created an accommodating atmosphere, which was emphasized as important for the motivation to show up every week. as hanna said: i felt safe, felt that it was ok to turn up. i didn’t feel any anxiety, thinking beforehand: oh no, this doesn’t work... i just felt relaxed and i felt like getting some sort of.... don’t know if i could call it confidence. at any rate i was not afraid to participate or to come forward with something. it was a nice atmosphere where i could easily say what i felt like saying. hanna (i) in summary, the advantages of the psychoeducation sessions are interpreted as a safe and accommodating environment with room for expression of personal stories. the sessions could be improved by introducing more tools and exercises and less information based on slides. to what degree the individual level of previous personal knowledge about mental-health problems affected the participants’ views on the quality of the psychoeducation sessions is difficult to discern. discussion the aim of the present study has been to explore experiences with psychoeducation both in relation to the standard services of a municipal jobcentre service from the perspective of individuals on sick leave and with regard to the relevance of the intervention and the elements that might contribute to recovery and improvement of psychoeducation as an intervention. the results of the study showed that the rehabilitative process of returning to work for sick-listed individuals who are at risk of having a mental disorder was that the informants were to a high extent concerned about attaining the support needed to focus on mental-health problems. this was critical for them to become active in their own recovery process as well as being seen and respected by the rehabilitation professionals. klanghed et al. (2004) have found that respectful and supportive interaction between rehabilitation professionals and sick-listed individuals was a positive encounter with regard to returning to work. the present study shows that psychoeducation offered a support that was considered relevant for individuals on sick leave who are at risk of having a mental disorder. the job centres’ standard services were considered relevant to a lesser extent. this finding supports previously mentioned results from hillborg (2010), which show that activities not relevant for individuals on sick leave with mental-health problems can lead to despondency and possible setbacks in the rehabilitation process. furthermore, the elements that appear to contribute to recovery are social support through involvement of relatives and peers, self-development through njsr – nordic journal of social research vol. 6, 2015 198 information, practical tools and exercises, and an accommodating atmosphere. the positive influence of social support on recovery from mentalhealth problems has been emphasized in other studies (grav, hellzèn, romild, & stordal, 2012; maulik, eaton, & bradshaw, 2010). the psychoeducation intervention also offered information on mental-health issues and seemed to have positive effects on coping, activation, and social interaction. the informants stressed the importance of sharing in groups, which is in line with stjernswärd et al. (2013), who found that group-based interventions with peers are a source of support and inspiration and they increase the motivation to participate. the identified elements that might contribute to recovery were all present in psychoeducation. most of a job centre’s standard services did not include any of these elements. psychoeducation appears to be a valuable initiative in individuals on sick leave due to mental problems, but could be a more effective tool if participating groups did not change during the therapy, there were more exercises, increased possibilities of sharing experiences with people in the same situation, and more information was given about how to cope after returning to work. this qualitative study has contributed to a deeper understanding of the participants’ perspective in relation to the rct study. however, one of the limitations of this study was the small sample size, which was an analysis according to gender and age was not performed. in future studies we would recommend focus group interviews with a larger number of participants in order to be able to discuss relevant topics on the development of psychoeducation as part of return-to-work rehabilitation. conclusion the results give insight into the experiences of individuals on sick leave due to mental problems who participate in return-to-work interventions in municipal job centres in denmark with regard to the relevance of the initiatives, elements that might contribute to recovery, and improvements of psychoeducation as an intervention. four themes emerged from the individual interviews that reflected the informants’ experiences of psychoeducation and the job centres’ standard services: ‘access and relevance of psychoeducation in relation to the job centres’ standard services’, ‘social support’, ‘self-care’, and ‘psychoeducation intervention’. the results highlight the importance of involvement of relatives in psychoeducation. moreover, participating in the groups provided an access to social contact with people in the same situation. the informants participating in psychoeducation also requested tools and exercises to perform, such as homework. all informants emphasized the importance of initiatives on information on how to recover and cope while on sick leave. acknowledgements we would like to thank all the informants and the four job centres for participating in the study. the study was funded by tryg fonden. njsr – nordic journal of social research vol. 6, 2015 199 references aho-mustonen, k., miettinen, r., & räty, h. 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(2013). ‘young women’: the meaning of a collaborative program supporting young women's rehabilitation and reintegration into the labor market. social work in public health, 28(7), 672-84. doi: 10.1080/19371918.2011.593465. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 7 (2016): special issue diagnosing, special education, and ‘learnification’ in danish schools bjørn hamre danish school of education aarhus university email: bjha@edu.au.dk abstract this article focuses on a discussion of diagnosing, special education, and ‘learnification’ in a danish school context in which the increasing use of diagnosis is analysed as resulting from the ideas of normality that are associated with the construction of the pupil as a learner. i argue that diagnosis in schools can be seen as the shadow side of the articulation and management of learning through schools’ requirements for pupils. this article is based on my analysis of files produced by educational psychologists. learning and diagnosis, i argue, constitute two different, but parallel, ways of looking at being a pupil in school, each of which represents conceptions of deviance and normality. the article’s methodological point of departure draws on a foucauldian-influenced analysis of diagnosing and learning in education. keywords: learning, diagnosing, special needs education, learnification, psychopathology, denmark introduction according to søren langager (2014), ‘the number of children and teenagers who are given a clinical diagnosis is increasing so dramatically that the development has been called a tsunami of diagnoses because it has taken place over so few years in denmark’ (p. 284). this article focuses on a discussion of these issues in a danish school context in which the increasing use of diagnoses is analysed as resulting from the ideas of normality that are associated with being a learner in school, similar to what gert biesta (2006) has termed ‘learnification’. i argue that diagnosing in schools can be seen as the shadow side of the way in which learning is articulated and managed through schools’ requirements for pupils, and the ways in which categorizations of problems are constructed in schools today. categorizations of problems take place whenever a particular kind of behaviour, defined as problematic at the school level, leads to different professional actions within schooling and especially within special-needs education. this article is based on my research into files produced by educational psychologists during the period from 2000 to 2010. mailto:bjha@edu.au.dk njsr – nordic journal of social research vol. 7 (2016): special issue 66 langager (2011) touches on the dilemma in danish national school policy: on the one hand, ideals of inclusive schooling have led to a reduction in the number of pupils referred to special support outside the ordinary school environment, and, on the other hand, an increasing number of children are given a clinical diagnosis, most typically attention deficit hyperactivity disorder (adhd). pupils who used to be regarded as having behavioural or psycho-social problems are increasingly categorized with neurological dysfunction in child psychiatry. these issues are not isolated to the danish context, and can be analysed as an international tendency. harwood and allan (2014) refer to the trend towards psychopathology at school, which points to the increasing tendency for children and young people who exhibit risk behaviour in school to be regarded as having psychiatric difficulties that require medication. the ever-increasing use of the diagnosis of adhd is an example of the interpretation of children’s problems in psychiatric terms by school professionals. there is also a trend for increasingly younger children to be diagnosed in terms that were previously reserved for adults. the analysis of this trend also includes valerie harwood’s book: diagnosing ‘disorderly’ children: a critique of behaviour disorder discourses (2006), in which she applies foucault’s concepts to produce a critique of the tendency to diagnose children as ‘disorderly’, specifically with the term ‘conduct disorder’. in her critique she touches on issues like the power of the expert regimes, psychiatry as a powerful discourse, and the increasing medicalization of children and young people. this critical perspective of medicalization in schools and special-needs education is also followed in the medicalization in schools (harwood & mcmahon, 2014). the majority of foucauldian-influenced research in disability studies and special education has followed a tradition of taking a critical approach to diagnosis as an expression of the individualization of human deviation (corker & shakespeare, 2006; tremain, 2005; goodley & rapley, 2002). however, diagnosing may be part of a broader cultural tendency rather than just a categorization of deviancy. in his book the politics of life itself: biomedicine, power and subjectivity in the twenty-first century (2007), nikolas rose, for example, described diagnosis as a cultural tendency to perceive life as biological citizenship, where individuals are subjectivized and expected to take increasing responsibility for their own health and diseases. in the light of biological citizenship, diagnosis can be seen as something that not only restricts, but also provides access to options for treatment and financial privileges (see also rabinow & rose, 2003; hughes, 2009). this article argues that diagnosing may be understood and interpreted in relation to the way learning has been positioned in contemporary schooling today. diagnosing as well as learning thus constitutes two equally important conceptions of how normality and deviancy are constructed. rather than following the insights of the studies mentioned above, i argue that the frequency with which pupils in schools are diagnosed may be related to the way ‘learning’ and ‘the learner’ have been positioned as an ideal in schools. drawing on an empirical study of documents in schools, i show that ‘the diagnosed pupil’ seems to be constructed as someone who has difficulties with everything the ‘learner’ is expected to be able to do (hamre, 2012). files produced by educational psychologists include descriptions of problems showing, for example, that diagnosed pupils have difficulties with being the curious, changeoriented, positive, and social individuals that the standards of education stipulate they ought to be. in this article i argue that learning is primarily relevant for understanding how normality is constructed, and that diagnosing is important in the construction of deviance. through an analysis of my own empirical findings, i shall elaborate on the construction of diagnosis and learning as two njsr – nordic journal of social research vol. 7 (2016): special issue 67 different but entangled phenomena that relate to the way in which pupils are interpreted as successful or not in current schooling. subjectification and problematization the analysis of the empirical findings regarding ‘diagnosing’ and ‘learning’ mainly draw on foucault’s concepts of subjectification and problematization. theoretically, i consider diagnosis to be a technology that situates individuals in a particular form of identity. here i am informed by the three types of subjectivity outlined by foucault (foucault, 1982), namely, scientific classification (such as psychiatry), dividing practices (e.g., exclusion to special education), and subjectification (e.g., the ways in which diagnosed pupils define themselves as different). diagnosis is thus deemed to be a technology that creates the pupil in a specific way in the school. drawing on foucault’s theories on subjectification, i apply the term ‘subject’ as an analytical description of the individual in the article. using technology as a term, i thus drawn on foucault’s theories on how the individual becomes a subject, as sketched out in the three types above. i have chosen to analyse learning by using foucault’s methodological concept of problematization (foucault, 1985, 1997, 1998). this term has gone relatively unnoticed, and, according to paul rabinow (2003), it is only in discipline and punish (foucault, 1979) where it is used in its explicit meaning. in this article, i argue that learning is an expression of such a typical current problematization of phenomena in schooling which simultaneously positions some pupils as non-learners, or perhaps as diagnosed individuals. diagnosing and learning are the key empirical findings in my quantitative approach to the data. i shall now turn to this empirical study. construction of data as mentioned above, the empirical data in the study stems from 44 files of pupils examined by educational psychologists and referred to special-needs education in copenhagen municipality. these files stem from the department responsible for schooling and the referral of pupils to special-needs education in copenhagen in the period from 2000 to 2010. the files include various documents, such as evaluations of pupils, psychological, and psychiatric examinations, and objectives for how the pupil is supposed to develop in special-education contexts. in line with foucault, a file is seen as an expression of a technology and a dividing practice that subjectivizes the pupils. the files are thus applied to demonstrate how modern schooling constructs differences between pupils who are included and those who are excluded. diagnosis – analysis of data drawing on the files, i argue that diagnosing in schooling often appears as something negative with regard to the image of a pupil (hamre, 2012). the person who is diagnosed stands out as an individual who is not able to meet the expectations of being a learning subject. the analysed files make it clear that pupils are expected to fulfil requirements for emotional self-awareness and flexibility if they wish to be regarded as normal in schooling. from this perspective, the diagnosed pupils in the files’ descriptions of problems have failed, since they have not managed to act as successful learners who live up to the expectations of the schools. many of these pupils are referred to specialeducation schools. special-needs education can be regarded in this perspective as a compensatory response whereby the pupils, through different educational manuals, methods, and pupil-plans are positioned as individuals who need njsr – nordic journal of social research vol. 7 (2016): special issue 68 guidance in order to appear as more successful pupils. the diagnosis appears in these documents as self-technologies, with pupils being expected to use their knowledge of their own diagnostic symptoms and behaviour to work with themselves in order to fulfil their potential as subjects of schooling. this can be observed, for example, in the child psychiatric files produced by the educational psychologists. these files describe the pupils not only in biographical terms with reference to their family history, using an examining process that results in a diagnosis, but also in the form of educational guidelines for the pupils diagnosed. as a knowledge regime, psychiatry exerts a hegemony that pervades the special educational approach to problems. in this case the diagnosis appears as a subjectification; it works both as a dividing practice and as a self-technology in the sense that the pupil works with her identity as a diagnosed pupil. drawing on the above-mentioned child psychiatry files, i have found that this subjectification appears in four different ways (hamre, 2012, p. 202). in addition to the information required for medical treatment, recommendations are thus made at four levels: 1) referral of the child to an institution of some kind, 2) the advice of the professionals who work with the child, 3) the guidance of the child’s parents, and 4) the therapy and educational initiatives directed at the child. in the medical records there is a tendency for diagnostic technology to position the pupil as working with their own diagnosis. the diagnosis in the files is associated with a number of technologies that involve a certain subjectification of the pupil. apart from the diagnosis itself and the related medication, these technologies include educational training and guidance plans for the individual pupil, classes involving teaching in disability awareness as a personal issue, and ‘social-classes’ in which the diagnosed pupils are taught about social behaviour. these activities position the pupils as individuals who are expected to reflect on themselves as diagnostic subjects, involving special-education awareness. in an educational context, diagnosing might be a way to categorize pupils who are perceived as troubled or troublesome in modern schooling. informed by rose (2007), the diagnosed pupils in child psychiatric examinations and in special-education schools are manoeuvred into a biological view of themselves and their existence. this biological subjectification appears in the analysed files and documents from the special-education schools as an imperative, ‘know yourself and your diagnosis’, encouraging the pupils to work with themselves as diagnostic subjects. for instance, this happens through the use of educational material such as ‘asperger’s syndrome – what’s in it for me?’, in which the pupil is positioned as someone who needs to reflect upon himself or herself as a diagnostic subject. the medication itself also has a role to play when it appears in the educational settings with regard to producing pupils as biological subjects. for example, one of the child psychiatric files mentions ritalin’s beneficial effect on a pupil’s attendance at school, including its influence on the pupil’s emotional insight and development in relation to concentration, changes in the school environment, the ability to defer needs, and so on. it describes how the medication has had the positive effect that a pupil is now able to speak out – without becoming aggressive and, not least, exhibiting an emerging understanding of disability in relation to his or her own and others’ problems. among other positive effects attributed to the medication is ‘much more calm and coherence’. the medication of pupils together with organized work with their self-awareness and emotional habitus operate as two sides of the same coin, subjectivizing them as less problematic in relation to the school’s expectations of normality. the diagnosed pupils in the educational setting are positioned as emotional and biological individuals who are engaged in an effort to understand themselves with respect to their disability. the pupil-plans in special-needs education reflect ambivalence. on the one hand, they position the pupil as lacking understanding, which highlights pupils’ inability to meet the school’s requirement to practise self-knowledge, and generally manifest themselves as successful school njsr – nordic journal of social research vol. 7 (2016): special issue 69 subjects. on the other hand, the pupil-plans at the same time emphasize the diagnosed pupils’ potentiality, placing them in a learning position in which they are expected to adapt to the ‘know-yourself’ imperative mentioned above. diagnosing – analytical perspectives diagnosing in schooling plays the role of a certain kind of subjectivity, positioning the pupils as unsuccessful learners. according to langager’s (2008; langager & sand jørgensen, 2011) research, a new kind of positivity has arisen through the development of brain science, draped in diagnosis, which results in a waiver of individual responsibility for the diagnosed individuals and their parents. the result is a new landmark in the understanding of issues among children because diagnoses are then surrounded with a form of exclusivity, triggering resources for a child. yet children with social or psycho-social problems, or both, who are ‘non-diagnosed’ but still ‘different’ are subjectivized as clients and are met with requirements for self-normalization. however, it is not easy to define the two different groups. the picture is complicated by the fact that a diagnosis of adhd can occur in combination with several other diagnoses related to anxiety, depression, behavioural disorders, and so forth. the trend is towards children being diagnosed with ‘complex problems’. special-education issues that were formerly described as behavioural problems and learning disabilities are now classified as ‘supplementary diagnoses’, and thus social and emotional problems are covered by a diagnosis (langager & sand jørgensen, 2011, p. 24). according to the danish professor of psychology, svend brinkmann, this has resulted in a social and cultural tendency to treat diagnosis as a way of relating to existential problems (brinkmann, 2010, 2011; rose, 2007, 2010). phenomena that were previously seen as part of human life have become pathologized on the basis of medical and psychiatric terms, with restlessness, for example, becoming adhd (brinkman, 2010). according to rose (2007), the profession’s increased use of diagnoses of mental health has increased in importance as an explanatory model for general human and existential problems. ... we are witnessing a ‘psychiatrization’ of the human condition. in shaping our ethical regimes, our relations to ourselves, our judgements of the kinds of persons we want to be, and the lives we want to lead, psychiatry, like the rest of medicine, is fully engaged in making us the kinds of people who we have become. (p. 481) in recent years, psychology has undergone an increasing psychiatrization that threatens its scientific autonomy, and teachers’ extensive use of adhd as a diagnosis is an example of this (brinkman, 2011). the growing importance of neuropsychology has led to a new form of biological determinism in the observation of people and the ways in which they are positioned in the fields of education, psychology, and psychiatry (rose, 2007). this implies a shift from perceiving the human being as a psychological self to regarding it as a biological psychiatric self. the swedish sociologist thomas brante (2011, p. 73) touches on something very similar when he argues that the increase in the number of diagnoses is due to neuropsychiatry having become a truth regime which has achieved hegemony as a scientific discipline, leading to a biologically deterministic view of human differences. the explanation for this hegemony is found not only in pharmaceutical and professional interests, but also in the fact that neuropsychiatry functions as a socially stabilizing factor: ‘neuropsychiatric diagnosis is a relatively inexpensive method for the identification of problems and the maintenance of social order’ (brante, 2011, p. 62). on the basis of the aforementioned sociological and psychological research, we can argue that njsr – nordic journal of social research vol. 7 (2016): special issue 70 diagnosing is a strong cultural trend that influences the way in which pupils regarded as deviant are subjectivized in modern schooling. this is also the case in danish schooling. in the files produced by the educational psychologists (including the child psychiatric files and pupil-plans from the special-needs schools), it can be observed that several diagnoses often occur simultaneously during the diagnostic process. developmental disturbances, such as those associated with diagnoses, highlight psychological, social, and environmental factors in the child’s upbringing. this trend can be seen not only as an expression of the narrowing of the range of normality that meets the school’s requirements, but also as an expression of the biologization of psychological and social factors in understanding human problems. these two problems, according to rose (2007), show a clear correlation: these disorders on the borders, i think, are experienced and decoded for these purposes by the individuals and their doctors in relation to a cultural norm of the active, responsible, chosen self, which realizes its potential in the world through creating a lifestyle. and they are awarded their kind of available categories, such as depression, panic, social anxiety disorder and adhd. (p. 480) the diagnosis thus reflects a certain concept of normality. first, we shall consider the disorders on the borders. these disorders are, according to rose (2007), positioned in a problem-solution complex according to the dictates of psychiatry and biology. this makes perfect sense, in fact, when we consider how child-psychiatric explanations lead to practical instructions for action in schools on the basis of these statements. it can only be interpreted as a clear narrowing of normality when such phenomena as ‘loss of confidence’ or ‘changed family pattern’ become supplementary diagnoses, so that phenomena which were previously interpreted in sociological and psychological terms now become clothed in a pathologizing diagnosis. the presence of additional diagnoses such as ‘loss of confidence’ and ‘changed family pattern’ in the files might be a manifestation of psychiatry increasingly providing more effective explanations in what has hitherto been regarded as the realm of psychology. this indicates that the school’s understanding of problems is shaped by the phenomenon that has been termed ‘pathologizing disorder’ (nielsen & jørgensen, 2010) and the aforementioned ‘psychiatrization of the human condition’ (rose, 2007). when it comes to the sorting of human differences in school, psychiatric diagnoses seem to offer an efficient technology for separating the able from the less able. at special schools it is part of the curriculum that pupils should evaluate themselves and their diagnosis through learning processes. this illustrates what rose (2007) analyses as the way in which individuals are characterized as biological citizens by having a biological relationship to themselves. in line with the applied data and the subsequent sociological perspectives, diagnosing might be interpreted as a modern way of constructing deviancy, not only in danish schooling, but also as a general cultural tendency. this leads us to the following question: if diagnosing is a modern way of constructing deviancy in schools, how then is normality constructed? the ideal of the learner – analysis of data while diagnosing appears as a self-technology and a current way of constructing deviancy, as seen in the previous section, i argue on the basis of the data that learning and the construction of the ‘learner’ demonstrate an ideal of normality in current schooling (hamre, 2012). learning is, therefore, a njsr – nordic journal of social research vol. 7 (2016): special issue 71 particular way of problematizing education, and involves a certain subjectification of the pupil that includes an ideal normality as opposed to deviancy. what are the implications of regarding learning as a problematization, and how does it work at the subject level? first, learning is seen as a response to scholastic phenomena in the present. the strong focus on learning can be seen, for example, as a response to the fact that danish schoolchildren are very poor at reading (cf. pisa studies). this kind of focus on ‘learning’ is a response to a state that is seen as inadequate. secondly, learning is seen as something that defines what is perceived as normal or aberrant. the defining of a phenomenon as a problem is tantamount to erecting a boundary between what can be observed, both culturally and institutionally, as being either included or excluded (fogh jensen, 2005). in this context, it means that one thing is defined as learning while another thing is defined as non-learning. the problematization of learning subjectivizes some pupils as learners as social or reflective subjects, and this means that a similar distinction is produced in relation to pupils whose behaviour problem is defined as, for example, psychosocial difficulties, lack of impulse control, or simply that the pupil is a ‘problem child’, which is still a current designation in the school debate in the media. in line with the data presented in the previous section, diagnosed pupils are positioned as themselves as successful learners. simply put, it can be said that the ideal of the learner pupil defines the difference between fitness and nonfitness in current schooling. in order to be successful in school, you need to subjectivize yourself as a learning subject. learning as problematization is visible in three different ways: 1) in the ideal pupil whom today’s schools demand, 2) in a special kind of logic that defines how problem understandings are constructed in schools and justifies exclusion, and 3) through a variety of technologies that both reinforce and confirm the construction of the pupil as a learning subject (hamre, 2012). in these cases, learning is constructed as a matter of potentiality; that is, there is an expectation of perpetual readiness for development. you could call this being in a perpetual state of inconclusiveness or ‘maybe-fitness’. secondly, it is clear that learning is always articulated in a positive way as something unequivocally good, which in principle there can never be too much of. thirdly, learning is seen as an overall response to the wide range of issues and situations that occur at school. problems are interpreted as occurring, for example, because the learning method is not taken seriously enough, because the teacher lacks a professional knowledge of learning, or because the professionals have an outdated view of what education is all about (where learning comes in as a solution). the degree of potentiality inherent in learning extends beyond the pedagogical relationship between teacher and pupil, with the responsibility for achieving their potential given to the pupil. similarly, parents are subjectivized as co-responsible for the realization of their children’s potential as learning subjects. the problematization of learning functions very effectively in addition to this because learning can easily be associated with a wide variety of different phenomena: 1) efficiency, pleasure, and curiosity, 2) happiness, health, and well-being, 3) the phenomenon of ‘the learning environment’ as a sacred place where something new is likely to occur, and 4) the methods of different learning styles like cooperative learning, where learning takes on the role of redeemer of the unique and personal. additionally, learning is seen as a response to how the pupil, the teacher, and the organization are expected to orient themselves in a curious and resource-oriented way. at all levels, the message is clear: you have the potential to develop yourself. any limitations are basically just due to your own lack of ability. for the pupils, it is about subjectivizing themselves as willing individuals who, through a labour of self-esteem, open themselves up for leadership through recognition and therapy-like work with their emotional lives. njsr – nordic journal of social research vol. 7 (2016): special issue 72 the development of learning strategies positions pupils in their own professionaland personal-development project, which includes looking at themselves to discover their potential. the problematization of learning thus enables a distinction to be made between what it means to be successful or less successful as a pupil in school. in line with the analytical perspective of this article, the diagnosed pupils have transgressed the standards of what is acceptable to be successful as an individual in current schooling. all pupils are subjected to the standards of being learning subjects, but not everyone manages to be a successful learning subject. technologies like contracts, action plans, and external targets result in an individualization of schooling in which the individual pupil is evaluated and positioned to take responsibility for the learning process. this involves an expectation that the individual has an active relationship with his or her learning process. with the individualization of the learning project, it has become possible to attribute responsibility for the failure to achieve their full potential to the pupil. technologies associated with the ideal of learning have thus introduced new dividing practices involving new types of exclusive mechanisms. as a result, learning and its related technologies constitute the most important subjectification in modern schooling. in the section below i shall discuss how these analytical findings might find support in foucauldian studies on general education. learning as an ideal – analytical perspectives gert biesta’s (2006) concept of ‘learnification’ denotes the increasing tendency for learning to be positioned as the central concept of educational theory in schools and in the training of various professionals. biesta is critical of the concept of learning, and he analyses it as an expression of how neo-liberalism has affected schools and educational science. this ideal of learning also involves a certain idea of the subject. the deconstruction of learning can also be seen in educational studies as being informed by governmentality studies. in his further development of governmentality, rose (1998) has discussed the management of the ‘subject’ in modern society based on the relationship between power and freedom. managing through freedom is based on a number of managerial technologies (rose, 1998, p. 67), and this is, therefore, also applicable in the field of schools and education (fendler, 1998; popkewitz, 2008). according to the american educational researcher lynn fendler (1998), the spread of the concept of learning, as well as allowing pupils to be flexible, is of independent financial value when it comes to generating labour productivity in a globalized economy. the educational system thus reproduces a financial perspective in its requirements for flexibility in training and in the school’s educational approach. for the pupils, this requirement for flexibility is synonymous with the ability to adapt, to react to external demands, and to practise self-discipline (fendler, 1998, p. 20). the education system is expected to produce flexible and adaptable personalities, and the soul is the place where this subjectification of the pupil’s personality is expected to occur. this work on the soul performed by each pupil is designed to teach them the importance of being motivated, which includes having the right, positive attitude and a willingness to accept that all features of the personality may be the subject of learning. the construction of the flexible personality in school is related to the fact that school psychology has become a truth regime that creates pupils as psychological subjects (rose, 1998; fendler, 1998). according to fendler, the school is characterized by a developmentality rationale (walkerdine, 1998); however, this does not mean a development njsr – nordic journal of social research vol. 7 (2016): special issue 73 towards freedom. instead, developmental psychology directs pupils towards self-management in fulfilling the school’s requirements and expectations (fendler, 1998, p. 8). developmental psychology has become a knowledge regime in which power is exercised through normalization technologies in schools, which is consistent with the state’s efforts to format pupils as productive and flexible individuals. following fendler’s argument, the dominance of the concept of learning in school must, therefore, also be seen from this perspective. the importance of learning must be seen in context, with the notion of the future forming an important part of the modern school. as the swedish educational researcher kenneth hultqvist (2008) claims, ‘the concept of learning is both an art and an agenda to the individual to prepare to face a future that is more uncertain than ever’ (p. 163). the idea of the future is an effective managerial technology, both when it comes to the repayment of the logics in a globalized economy and for how individuals manage themselves and their time in school. it is here that the idea of the future enters into an alliance with the concept of learning. the future is not, i would argue, about the time that lies ahead. it is a technology that organises and creates subjects, school children, teachers and parents, and during the course of events links together the two poles of control: control of the individual and control of the population. (hultqvist, 2008, p. 160) as a managerial technology, the notion of the future is inscribed in national programmes and standards for the educational planning of each school’s curriculum and educational methods, as well as the relationship between the teacher and the learner. following hultqvist, i would argue, therefore, that the deployment of the concept of learning in school can be seen as a powerful technology that shapes the pupil as an individual and the population as a whole. we follow the american educational researcher thomas s. popkewitz, who argues that lifelong learning has become a cultural ideal. this ideal, according to popkewitz, should be understood through the concept of cosmopolitanism, a principle that since the enlightenment has constructed the pupil as a rational, thinking individual. cosmopolitanism, therefore, determines how, in different historical periods, perceptions of normality construct the pupil as a school subject (popkewitz, 2008, p. 111). rationality therefore has three different functions: 1) it produces norms and ideals of how one should be a pupil in school, 2) it organizes differences, because it defines what should be included and excluded, and 3) through the organization of these differences, rationality also produces exclusion. as a managerial principle, cosmopolitanism works in two ways, therefore: on the one hand, it acts as an educational ideal, emancipatory and freeing for the individual, but, on the other hand, it also produces at the same time differences and exclusion in relation to pupils who do not comply with the ideal of the rational individual. the ‘learner’ is the current ideal of the subject of cosmopolitanism, defining who is to be included and excluded. to sum up: the above-cited studies positions learning as an important problematization in contemporary schooling. in my empirical studies i have demonstrated how the idea of the learner is positioned as the ideal subject in a danish school context. i argue that the idea of the learner reflects the historical problematization of learning. this can be analysed by taking foucault’s theories of subjectification into account. as we have seen, problematization is a response to a historical phenomenon that is exercising power (foucault, 1985, 1997, 1998), because it governs what is defined as included and excluded (howarth, 2005). as a problematization learning also involves solutions to the problem, and it operates at the subject level as well; that is, individuals are subjectivized and subjectivize themselves as learning subjects (hamre, 2012). learning thus also works as a subjectification on the three different levels as njsr – nordic journal of social research vol. 7 (2016): special issue 74 outlined earlier, positioning the learner as an ideal subject. the two phenomena in modern ‘learning’ and ‘diagnosing’ in modern schooling may thus represent contemporary constructions of normality and deviancy in modern schooling. conclusion in light of the analysis of this article, the diagnosed child appears to be a shadowy entity in relation to the ideal of ‘the learner’, a child who has problems meeting the modern requirements to be curious, motivated, and positive. proficiency in school is synonymous with a pupil’s willingness to work with their potential as an individual learner. the individual in modern schools is thus fixed in a ‘maybe-ability’, since they will always be subject to the ideal of learning: ‘you are always in a process, and it is expected that you will make yourself visible in this process.’ although it sounds ambivalent, this recurring ‘maybeability’ may have exclusionary functions for some pupils, since they may have difficulties in adapting to ideals of knowing themselves, reflecting upon themselves, manoeuvring in groups, and taking responsibility for their own learning. the inability to fulfil such agendas in contemporary schooling might result in a sort of psychopathologization (harwood & allan, 2014), in which psychological or social problems are constructed and interpreted as psychiatric problems that need treatment and intervention. accordingly, diagnosing may represent a shadow side of the tendency towards ‘learnification’ (biesta, 2006). in his description in the history of madness (1973), foucault described how the modern bourgeois sense was constructed as the ideal of normality by banishing the ‘mad’ individuals who deviated from it. the ideal of the learner and the diagnosed is a modern example of how the normal constitutes itself by excluding the deviant. the diagnosed pupil is positioned as a subject who has failed to take responsibility for their own learning, thereby representing the ultimate negation of the learning subject. informed by foucault, we can interpret diagnostic descriptions not as objective scientific descriptions of pupils’ problem, but as constructions that need to be analysed in the current agenda of the school. the school’s many diagnoses and the importance of diagnosis have legitimized deviation, which bernadette baker (2002) has described as a form of ‘newgenics’, seen as quality control and the separation of the non-able. diagnosing represents a new way to separate the competent from the less able in schools, and in this sense is a form of newgenics that deftly ensures the sorting out of those pupils who may not readily be subjectivized as learners, subjects oriented towards a future where knowledge and people need to be transformed in order to fit market conditions. references biesta, g. (2006). beyond learning – education for a human future, london: paradigm publisher. brante, t. (2011). striden om den korrekte diagnose og hegemoniet inden for et professionelt område: videnskabsteoretiske og politiske aspekter. [dispute about the correct diagnosis and hegemony within a professional field: theoretical and political aspects] in i. bryderup (ed.), diagnoser i specialpædagogik og socialpædagogik [diagnoses in special and social education] (pp. 38-77). københavn: hans reitzels forlag. brinkmann, s. (2010). det diagnosticerede liv – sygdom uden grænser [the diagnosed life: disease without borders]. århus: klim. njsr – nordic journal of social research vol. 7 (2016): special issue 75 brinkmann, s. (2011). om psykiatriseringen af hverdagslivet og psykologien [on the psychiatrization of everyday life and psychology]. psykologisk set, 28(82), 5–12. corker, m. & shakespeare, t. (2006). disability/postmodernity: embodying disability theory. london and new york: routledge. fendler, l. (in press). educating flexible souls: the construction of subjectivity through developmentality and interaction. (originally prepared for the symposium: the child in a changing world: refiguring early childhood education. omep conference, copenhagen, denmark, august 13-16, 1998. http://michiganstate.academia.edu/lynnfendler/papers/322728/educating_flex ible_souls) in k. hultqvist & g. dahlberg (eds.), the child in a changing world: refiguring early childhood education. new york: sage press. fogh jensen, a. (2005). mellem ting, foucaults filosofi [between things, foucault’s philosophy]. frederiksberg: det lille forlag. foucault, m. (1979). discipline & punish. the birth of the prison. new york: vintage books, random house. foucault, michel (1973). galskapens historie [a history of madness]. oslo: gyldendal. foucault, m. (1998). history of the present – on problematization – (spring 1998), berkeley 1983. the text is taken from an edited transcription of tapes of the seminar (without a final revision by foucault) by joseph pearson at northwestern university. a copy of the publication is housed in the foucault archive in paris. foucault, m. (1997). politics, polemics, and problematizations. in p. rabinow (ed.) the essential works of michel foucault, 1954-1984, vol. i, ethics: subjectivity and truth, (pp. 111-119). london: allen lane. foucault, m. (1985). the history of sexuality. vol. 2, the use of pleasure (r. hurley, trans.). london: penguin. foucault, m. (1982). the subject and power. in h. l. dreyfuss & p. rabinow (eds.) beyond structuralism and hermeneutics (pp. 208–22 6). chicago: university of chicago press. goodley, d. & rapley, m. (2002). changing the subject: postmodernity and people with ‘learning difficulties’. in m. corker & t. shakespeare (eds.) disability/postmodernity: embodying disability theory (pp. 127-142). london: routledge. hamre, b. (2012): potentialitet og optimering i skolen – problemforståelser og forskelssætninger af elever – en nutidshistorisk analyse [potentiality and optimization in school – problem understandings and unlike sentences of pupils: a present historical analysis]. phd thesis. institut for uddannelse og pædagogik. aarhus: aarhus universitet. howarth, d. (2005). diskurs – en introduktion [discourse: an introduction]. københavn: hans reitzels forlag. harwood, v. (2006). diagnosing ‘disorderly’ children: a critique of behaviour disorder discourses. london: routledge. harwood, v. & allan. j. (2014). psychopathology at school, theorizing mental disorders in education. new york: routledge. harwood, v., & mcmahon, s. (2014). medicalization in schools. in l. florian (ed.) the sage handbook of special education (pp. 913-930). los angeles: sage. hughes, b. (2009). disability activisms: social model stalwarts and biological citizens. disability & society, 24(6), 677-688. http://michiganstate.academia.edu/lynnfendler/papers/322728/educating_flexible_souls http://michiganstate.academia.edu/lynnfendler/papers/322728/educating_flexible_souls njsr – nordic journal of social research vol. 7 (2016): special issue 76 hultqvist, k. (2008). ‘fremtiden’ som styringsteknologi og det pædagogiske subjekt som konstruktion [‘the future’ as control technology and pedagogical subjects as construction]. in krejsler (ed.), pædagogikken og kampen om individet – kritisk pædagogik, ny inderlighed og selvets teknikker [pedagogy and the struggle of the individual: critical pedagogy, new fervour, and techniques of the self] (pp. 159-189). københavn: hans reitzels forlag. langager, s. (2014). children and youth in behavioural and emotional difficulties, skyrocketing diagnosis and inclusion/exclusion processes in school tendencies in denmark, emotional and behavioural difficulties, 19(3), 284-295. langager, s. (2008). inklusionens paradokser – normalitetsopbrud, normaliseringspolitik og diagnosens privilegier. [inclusion paradoxes: normality upheavals, normalization policy and diagnostic privileges]. dansk pædagogisk tidsskrift, 2008(8), 6 – 13. langager, s. & sand jørgensen, a. (2011). diagnoser i udvikling – tendenser og konsekvenser i forhold til socialog specialpædagogik [diagnoses in development: trends and consequences for social and special education]. in i. bryderup (ed.), diagnoser i specialpædagogik og socialpædagogik. [diagnoses in special and social education] (pp. 17-37). københavn: hans reitzels forlag. nielsen, klaus & jørgensen carsten rené (2010). patologisering af uro? [pathologizing of restlessness?]. in brinkman (red.), det diagnosticerede liv – sygdom uden grænser [the diagnosed life: illness without borders] (pp. 179--‐205). århus: klim. popkewitz, t.s. (2008). cosmopolitanism and the age of school reform: science, education, and making society by making the child. ny: routledge. rabinow, paul (2003). anthropos today – reflections on modern equipment. new jersey: princeton university press. rabinow, p. & rose, n. (2003). thoughts on the concept of biopower today. http://www.lse.ac.uk/sociology/pdf/rabinowandrose-biopowertoday03.pdf. rose, n. (1998). inventing our selves: psychology, power and personhood. cambridge: cambridge university press. rose, n. (2007): the politics of life itself: biomedicine, power, and subjectivity in the twenty-first century. oxford: princeton university. rose, n. (2006). disorders without borders? the expanding scope of psychiatric practice, biosocieties, 1(4), 465 – 484. walkerdine, v. (1998). developmental psychology and the child-centred pedagogy: the insertion of piaget into early education. in j. henriques, w. hollway, c. urwin, c. venn, & v. walkerdine (eds.) changing the subject (pp. 153–202). london: routledge. http://www.lse.ac.uk/sociology/pdf/rabinowandrose-biopowertoday03.pdf njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 7 (2016): special issue why michel foucault in norwegian specialeducation research? hege knudsmoen* centre for studies of educational practice hedmark university college, norway email: hege.knudsmoen@hihm.no *corresponding author eva simonsen the national support system for special education (statped) oslo, norway email: eva.simonsen@statped.no abstract this article seeks to identify what impact the works of michel foucault have had on special-education research in norway. we also discuss what his writings may contribute to future research. foucault’s perspectives are far from dominant in special-education research today. we present research within the relevant social sciences which has been influenced by foucault and which has had impact on special-education research. we aim to demonstrate that foucault’s genealogy of ethics may bring new insights and a new critical approach to special-education research. the ethics of inclusion are particularly constructive and productive in both pedagogy and special-education research. in the discussion of foucault’s relevance in special-education research, we focus on his texts on governmentality to conduct and govern a learner and the ethics of inclusion. the mode of subjectivity highlights the productive nature of disciplinary power – how it names and categorizes learners, the conduct of conduct or how learners govern themselves under education. keywords: special education, deviance, conduct, genealogy, ethics, foucault, norway introduction: michel foucault, a critical social philosopher traditionally, special education has centred upon the concept of the deviant, dubious or disabled child. research has been based on traditions of knowledge that are rooted in long-standing labelling, as medical and psychological discourses. therefore, not surprisingly, foucault’s critical writings about those systems of knowledge are far from dominant in special-education research in norway today. in spite of their present modest position, we argue that foucault’s mailto:hege.knudsmoen@hihm.no mailto:eva.simonsen@statped.no njsr – nordic journal of social research vol. 7 (2016): special issue 37 perspectives – in particular, his genealogy of ethics – offer a constructive critical stance for probing special-education research. foucault’s body of works is relevant for the analysis of social and political frameworks – how education could be organized, the ways the system expresses the optimal educational outcome at a particular time, and the ways people frame their views about a learner and what is good for the child. foucault (1997) offers two lines of thinking about human beings, the philosophy of the subject and the genealogy of the subject. in norway, schaanning, a historian of ideas, argues that ‘subjectivity is not only a product of disciplinary practices, but it gives premises and produces conditions, such as the expectation to conduct oneself and to conduct others in institutional practices’ (schaanning, 2000a; own translation). foucault’s perspectives indicate a critical concern about how special-education practices and research divide students by labelling them (thomas, 2014; harwood & mcmahon, 2014). if we take these practices into account, it is reasonable to look at the structures of discipline from the perspective of foucault’s ethical genealogical approach. the genealogy of the subject examines ‘the constitution of the subject across history which has led us up to the modern concept of the self’ (foucault, 1993, p. 202). foucault’s genealogy points to the formative moments in modern history and the scope of discourses about the ‘deviant’ student. in this article we elaborate on how the deviant child is acknowledged as a learner with a subject positioning. according to foucault, subject positioning is to become the subject of a particular discourse. we must locate the position from which the discourse makes sense, and thus become its subjects by subjecting’ ourselves to its meanings, power, and regulation. subject position highlights the productive nature of disciplinary power – how it names and categorizes people into hierarchies of normalcy, morality, and so forth. foucault assumes that genealogical research will result in the disintegration of the epistemic subject, because the continuity of the subject is broken up. the production of knowledge is linked to power, and traces how power is related to ‘true’ knowledge. according to foucault, the construction of truth is not outside power, and systems of knowledge vary between different scientific fields, disciplines, and institutions. the structure of special-education systems facilitates control, observation, and discipline of the deviant, dubious or ambiguous child by expert regimes of knowledge. these expert regimes of knowledge offer measures to govern the politics of welfare and other policies and social formations. for example, one of these formations is the transfer of students from ordinary to special education. the referral process is closely related to students’ academic outcomes, social adaptation, and personal development in ordinary education. foucault changes his perspective through his archaeological, genealogical, and ethical approaches. in this article, we begin by introducing foucault’s genealogy of ethics. our argument is that his genealogy of ethics is particularly relevant and much needed in special-education research in relation to inclusion and the deconstruction of the deviant child. we then trace the impact and influence of foucault’s works on research in special education and the history of disability in norway, focusing on work on the ethics of inclusion, constructions of the deviant child, and the conduct of conduct as a learning positioning. norwegian society has been committed to the ideals of education for all in inclusive settings, and there is a close connection between ordinary and special education and the concept of inclusive special education. however, the volume of special education is growing, and excluding mechanisms in the school njsr – nordic journal of social research vol. 7 (2016): special issue 38 learning community are increasing (bakken & elstad, 2012; nes, 2013, 2014). after the presentation of selected studies within the norwegian context, we discuss what use can be made of foucault’s ethical genealogical writings in future special-education research. we ask how his texts on governmentality, conduct of conduct, and subject positioning may contribute to the ethics of inclusion in future special-education research. foucault on the genealogy of ethics taking care of oneself requires knowing oneself. care of the self, is knowledge of the self, but also knowledge of a number of rules of acceptable conduct or of principles that are both truth and prescriptions. to take care of the self is to equip oneself with these truths: this is where ethics is linked to the game of truth. (foucault, 1997, p. 285) the politics of inclusive education, dating from the salamanca statement (unesco, 1994), have made foucault’s perspectives on the genealogy of ethics highly relevant for special education. inclusion is thus seen as a process of addressing and responding to the diversity of needs of all children, youth, and adults through increasing participation in learning, cultures, and communities, and reducing and eliminating exclusion (unesco, 2009). the educational system in norway has moved from a disciplinary notion of normalizing conduct to one of governing students’ own conduct of conduct (knudsmoen, 2015). student’s subject positioning to become a learner ought to be a main concern in special-education discourses. the enrichment perspective emphasizes how the individual learner in inclusive education can contribute in a fruitful way to the school community (befring, 1997; 2014). children with special needs bring new dimensions to the learning community of the classroom, enhancing diversity and possibilities for learning for all participants. the enrichment perspective means that each subject is being included as an agent in its own learning and development. befring (1997; 2014) highlights how the medical model has led to great attention on diagnosis with the subsequent highlighting of problems and weaknesses in the individual, labelling and its attendant stigmatization, and an overreliance on the identification of problems rather than a focus upon teaching and learning. the ethics to include all students as active participants in educational society presupposes acceptance for various subject positioning. foucault draws ‘three axes of genealogy’ concerning ethics and subject positioning first, there is a historical ontology of ourselves in relation to truth through which we constitute ourselves as subjects of knowledge, for example, a learner or professional as the subject positioning. secondly, there exists a historical ontology of ourselves in relation to a field of power. through which we constitute ourselves as subjects acting on others and ourselves. thirdly, there is a historical ontology in relation to ethics through which we constitute ourselves as moral agents as professionals, students, and learners (foucault, 1982, p. 237). foucault argues that it is not possible to examine a subject’s relation to itself without referring to experience, and he does that by considering the subjective experience from the point of view of practices and selftechnologies. self-technologies, such as self-mastery, is a way of being active – for example, adapting to schooling – in relation to what was passive by nature and ought to remain so (foucault, 1990b). the concept of self-mastery can be the idea of njsr – nordic journal of social research vol. 7 (2016): special issue 39 becoming a learner in school, gaining the agency to become a learner and having a will to conduct oneself (knudsmoen, 2011). foucault’s concept of selfmastery is the degree of control one can exert over oneself, as if at a certain level and in particular, institutions or contexts, certain modes of determinism and free will coexist and circulate. foucault describes a concept of coexistence between necessity (rules, norm, and constraints) and freedom (agency, initiative, choice); that is, in an institutional practice, one is both free and constrained. in an interview about the ethical concern of the self as a practice of freedom, foucault argued that ‘freedom is the ontological condition of ethics, but ethics is the considered form that freedom takes when it is informed by reflection’ (foucault, 1997, p. 284). one result may be that a learner provides a basis for developing self-regulatory skills, with the learner willingly conducting self-discipline as a learner. school is an important arena for building community, from foucault’s perspective; school is a system of power techniques and relationships, involving a range of agency inside and outside schooling. the learning willingness to adapt and normalize oneself is where certain abilities and characteristics will be perceived as good, expected or worth striving for under particular conditions. the will to learn and the willingness to conduct oneself seem to reflect the conduct of conduct in educational practices (knudsmoen, 2011). today we have moved away from disciplinary techniques towards normalizing a learner, creating students who have the agency to utilize self-technologies by being adaptive, autonomous, and engaged in what is going on in school. the concept of genealogy foucault’s notion of genealogy in discipline and punishment from 1975 was concerned with the power of normalization to impose homogeneity (foucault, 1995, p. 184). normalization is understood as a system of graded and measurable categories, indicators, and intervals in which subjects can be distributed across a norm relating to expected conduct of the students. according to foucault’s archaeology, the construction of disability can be to divide the other from the same in the way that foucault describes the discourses on madness in madness and civilization (foucault, 1961). the history of madness could be considered as the history of the other. foucault changed the investigation from ‘the history of the other’ to ‘the history of the same’ in his genealogical writings (o’farrell, 1989) and made the subject position apparent. today, inclusiveness means involving all children in education, rather than developing knowledge about the disability and deviancy of a child within education. in his abnormal lectures at the collège de france 1974–75, foucault (2003) focuses upon the double codification of madness throughout the nineteenth and twentieth centuries. first, disability and deviancy were concerned with the codification of madness as illness, pathologizing disorders, errors, and illusions and undertaking analyses to bring public hygiene, or the social safety it was responsible for, as close as possible to medical knowledge. secondly, madness had to be codified in the same manner as danger. psychiatry produces madness as a danger – a bearer of risk – and as a result, the knowledge of mental illness could be found in public hygiene (foucault et al., 2003). rather than producing discourses about children’s learning and development, the medical system has had a controversial influence on special-education diagnostics labels (befring, 2014). the idea of the norm is not only a discriminating social, economic, and moral constraint; it is also written into the social contract right from language (kristeva, 2013). shifting practices of njsr – nordic journal of social research vol. 7 (2016): special issue 40 labelling ‘the deviant student’ reflect kristeva’s notion of the relation between language and the social contract. it is evident that when the least advantaged individuals are humiliated, cast out, or neglected, there is an abuse of power, a lack of solidarity, insecurity, and a jockeying for the higher, better positions in the social order. in contrast, the enrichment perspective engenders more positive expectations of all students’ potential and gives impetus to creating a more diverse and inclusive learning environment (befring, 1997; 2014). in his genealogical approach, foucault deconstructs knowledge systems such as episteme, which was a concept developed throughout his archaeological approach. the referral process that moves students from ordinary (or no education at all) to special education has changed throughout history, alongside the ideas of upbringing, education, and childhood. the process from ordinary to special education creates a link between particular systems of power in the production of professional knowledge about a student’s learning and development. the limitations of students’ autonomy and freedom as learners are constituted by demands of adaptation to existing norms and expectations of the educational system at a historical time. it is important to develop critical discursive strategies in order to emancipate the student as a learner (knudsmoen, 2011; befring, 1997; 2014). throughout his ethical works, foucault locates two main strategies of power that dominate modernity. the first is the anatomy-politics of humans that are directed towards making the human body docile through normalized conduct, which is an effect of the power that characterizes various disciplines. anatomypolitics focus on the body, biological processes, birth and mortality, the level of health, and life expectancy and longevity, and ‘the question of anomaly permeates the whole of biology’ (foucault, 1998, p. 476). after the anatomypolitics of the human were established in the eighteenth century, the second strategy, ‘bio-politics of the population’, emerged at the end of that same century. bio-politics are no longer the anatomy-politics of the human body, which were effected through a series of interventions and regulatory control, primarily as discipline (foucault, 1990a). bio-politics have become prominent in social and humanistic sciences, and have shaped special-education understandings of deviancy, disability and impairment, with regard to the medicalization and diagnosing of student conduct in special education today (hamre, 2013; harwood & mcmahon, 2014; knudsmoen, 2015). in addition, forms of bio-politics are associated with the construction of a biological citizenship in global governance through the normative regimes of rights and responsibilities (nguyen, 2015). the professional boundary work indicates various systems of judgement of disability and deviancy. the ethical concern of the students’ subject position as a learner can be to adapt – to take care of oneself or the conduct of conduct (foucault, 1997). foucault’s writings in a norwegian context what we call ‘discipline’ is something really important in this kind of institutions; but it is only one aspect of the art of governing people in our society. (foucault, 1997, p. 177) this quotation refers to foucault’s ethics where we find various possibilities for the subject to become a learner within education, rather than to discipline a learner’s conduct. in norway, both sandmo (1999) and schaanning (2000) argue that foucault’s genealogy is concerned with the ethical relationship between knowledge and power. ulleberg (2007), writing in the field of education, njsr – nordic journal of social research vol. 7 (2016): special issue 41 maintains that one of the most important contributions of foucault in this respect has been the discursive analysis of various social interactions and institutions. the two norwegian criminologists ericsson (1974; 1977) and stang dahl (1978) were the first academics to introduce foucault’s perspectives to social-science research in norway. their work has influenced special education, historical research, and disability studies. thuen (2001), a historian in the field of education research, states that the idea of the child as a particularly vulnerable and worthy category among the poor led to the establishment of the first children’s asylums and ‘rescue institutions’ from about the nineteenth century. thuen makes no direct references to foucault. in their works, ericsson, stang dahl, and thuen each demonstrate how the establishment of institutional practices required measurements in order to differentiate between the ‘normal’ and the ‘abnormal’ children. during this process, students were inscribed through a regime of discipline and truth was produced as part of the system of knowledge production. thuen (2001) demonstrates how discourses of discipline influence the whole body, which was inscribed as expectation of the actions or conduct of a learner. the subject itself is a product of the process, as the modern subject is constituted by the internalization of the norm of discipline. discourses ought to be concerned about the students are bearers of diverse subject positions of agency and identity in relation to various forms of knowledge and practice. reindal (2010) argues that today the basic question to be addressed from a foucauldian perspective is an ethical one regarding the meaning of disability and deviancy. the conceptualizing of disability within the context of a socialrelational model opens up for ethical consideration and the possibility of revealing unjust ideologies, practices, and structures. she discusses the interplay between impairment, impairment effects, and disability, stressing the ethical elements of each (reindal, 2010, p. 113). reindal underscores the importance of coming to terms with the purpose of inclusion: to conduct and participate within education. furthermore, hausstätter (2011) refers to foucault’s ethical arguments in his analysis of the professional in special education. the relation between the normality and morality of the professionals’ recognition of a learner is also central to discussions regarding the relationship of a student in between ordinary and special education (hausstätter, 2011). concept of institutional knowledges: disciplinary practices and the deviant child ericsson (1974), in ambiguous care, used foucault’s archaeological approach from madness and civilization for her analysis of how the knowledge of mental illness was integrated with public hygiene. her main thesis is that the history of the system of psychiatric care in norway fits the pattern of ‘the great confinement in europe’: mass poverty resulted in social upheaval, which led to mass institutionalization accompanied by a specific ideology that pointed to the individual as the origin of massive social misery, constructing the deviant and dangerous citizen. ericsson (1997) has updated her analysis to include contemporary political mechanisms of the marginalization and exclusion of disabled people and people with chronic illnesses from the labour market (simonsen, 2015). stang dahl (1978) has made an innovative contribution to the history of child welfare in her analysis of ambiguous motives in the construction and institutionalization of the deviant and dubious child. influenced by ericsson, stang dahl applied the concept of the disciplining asylum as an analytical approach to the double scope of the child welfare system in norway – social control in the name of upbringing and saving the child. other children njsr – nordic journal of social research vol. 7 (2016): special issue 42 were included in special educational institutions or in medical institutions, or they were simply left at home and labelled as not teachable. today these children are included in mainstream schooling in norway. steinsholt (2011), a professor in the field of education, focuses upon the enlightenment with reference to kant’s epistemological project and foucault’s critical perspective on discipline and normalizing. foucault points out that the normative judgement of human nature is engraved with the hallmark of the enlightenment (hacking, 2008; steinsholt, 2011). foucault (1997) identifies the enlightenment as a modern history of thoughts about humanity. in his genealogical approach, he considered power in relation to different domains, such as the structures of knowledge, rationalities, disciplines, and punishment (olssen, 2006). in his ethical writings, foucault does not simply reject the enlightenment’s values, as he does in his archaeological approach. instead, he reworks some of its central categories, such as notions of the self, freedom, and emancipation. in foucault’s version of the enlightenment, the individual subject’s rational autonomy and choice are dependent on how we interact with our circumstances. such critiques cannot be grounded in universal reasoning of satisfactory learning outcomes, because this would ignore individual differences and the elements of rational disintegration within the subject itself and reasoning about a norm such as educational outcomes. the concern about the subject positioning of a learner seems to be an ethical consideration between ordinary and special education to achieve education and upbringing and to become a learner today. steinsholt (2011) emphasizes how the modern subject will invent itself. school is a place where observation, treatment, and training is implemented in order to alter conduct, to train the body or to correct an individual’s mind or conduct (foucault, 1995). within education, discipline can be a normalizing practice, for example, making the body docile and teachable (hoskin, 1990; knudsmoen, 2011). the conduct of conduct and practices of the self were also linked to ‘the way individuals were led to assign meaning and value to their conduct’ (foucault, 1990b, p. 4). concern about a learning subject as a conduct of conduct, with the construction of the deviant, dubious or ambiguous student, seems to be a focal point in special-education research (knudsmoen, 2015). most important is grasping the cultural, social, special pedagogical, and political contexts that produced such discourses about satisfactory learning outcomes from an ethical perspective. collectively, this research identifies the local struggles and points of articulation of specific forms of knowledge, power, and governmentality. they can unmask the contingencies and consequences of systems of power-knowledge and demonstrate the ways that power acts on subjects (yates, 2015). concept of ethics, bio-politics, and professional knowledge bio-politics influenced special education in norway from the first part of the twentieth century (simonsen, 2000). social darwinism and social hygiene interacted, establishing a biologically founded paradigm of normalcy. the disabled or the deviant child was defined as a child with no or very limited chances of intellectual or social development. kirkebæk, a leading scholar in the nordic countries since the mid-1990s, has introduced bio-politics as a topic in nordic special education and has explored foucault in an influential way in nordic disability history research. in her doctoral thesis on the emergence of a medical discourse on intellectual disability in denmark. kirkebæk (1994) has placed this discourse within the eugenic paradigm of western society at the turn of the twentieth century. the influence of foucault, her writings is particularly njsr – nordic journal of social research vol. 7 (2016): special issue 43 prominent in nordic research on the history of disability, which is a joint venture based on networking, conferences, and publications (simonsen, 2005). this influence can be traced to the work of, for instance, simonsen (2005; 2015) and the historical construction of the deviant child as a dimension of bio-politics and eugenics in special education in norway. schaanning (2005), a principal foucault reader in norway, identifies kirkebæk as a researcher who has greatly influenced both disability-history research in norway and nordic special-education research since the 1990s. on the basis of foucault, her discourse analyses of the shifting historical, social, professional, and political processes of constructing intellectual disability include the concept of the deviancy in the shape of the ‘mentally retarded child’, the ‘feeble-minded’, and the ‘morally deficient woman’. introducing the politics of eugenics as part of the history of special education, kirkebæk influenced our research with regard to how medical, psychological, and special-education discourses intertwine and are embedded in professional struggles for jurisdiction (simonsen, 2000). the detrimental discourse on individuals at the very bottom of a hierarchy of disability was introduced, with people identified as being in need of extensive care. from a bio-political point of view, they were creatures with little or no human qualities or value. from foucault’s perspective of power-knowledge, they were of so little value that the professional interest to control them was absent (kirkebæk, 2007). to society, these individuals were literally dispensable. bio-politics advances another understanding of the norm in the face of the development of democracies and the quality of life. the norm is no longer an a priori fixed concept but a dynamic one (kristeva, 2013). sirnes (2005), a political scientist in norway, draws on both foucault (1990a; 1990b) and the adapted concept of bio-politics and agamben’s (1995) concept of ‘bare life’ in order to analyse how human life within a modern biotechnological paradigm is uncategorized, unrecognized, and thus unprotected in times of prenatal diagnostics, research, and therapy. disability differs from nonconformity, which is the matter at hand in the singularity of the disabled subject. the gap between biology and the social norms and expectations may be perceived as a deficiency or disability. as kristeva (2013) writes, ‘the idea of a norm, of a typical form, of a suitable rule is as indispensable in biology as it is for the social bond. politics advances another understanding of the norm’ (p. 226). from an ethical perspective on disability and deviancy, how to govern a learner or to govern oneself during one’s education should be an important concern in specialeducation discourses. in recent decades, neuropsychiatric diagnoses have become more widely used as explanations of school problems. student conduct in education and the conceptualization of challenging conduct in school has been interpreted as individual deficits and categorized within the system of medical diagnostics (potts, 1983; ravneberg, 1999; simonsen, 2000; bakken & elstad, 2012; harwood & mcmahon, 2014). knudsmoen (2015) discusses the importance of viewing the construction of deviant students within education from a learner’s subject positioning, as an interpretation of foucault’s (1997; 2007) ethics. categories of disability and deviancy that have been constructed in medical discourses have greatly influenced special-education research, strategies, and discourses about the inclusion of the ambiguous, deviant or disabled child. norms, problematization, marginalization, and exclusion are the results of diagnostic practices rather than from a desire to govern a learner in inclusive setting (knudsmoen, 2015). njsr – nordic journal of social research vol. 7 (2016): special issue 44 the history of special education has to be understood less as an example of human progress and humanitarian effort than as part of a strategy for social control (tomlinson, 1982; simonsen, 2000) and develop knowledge in the research field. according to schaanning (2005), kirkebæk turns the records from the institutions around: they do not tell the truth about the patient; rather, they tell the truth about their authors. analysing how professionals develop their knowledge, language, and concepts of their students can bring new light to the understanding of their beings as learners, their voice, development, learning, and conduct within education. an ethical genealogy can help us to understand how ‘to govern a learner’, or governmentality as a way to understand a learner or student’s possible subject positioning between ordinary and special education and the ethics of inclusion. this has been taken up in work on disability studies, with, for example, critical commentary on medicalization and a critique of normalizing practices within special-education research (slee, 2001; harwood & mcmahon, 2014). the role of medical discourses, however, is not the main focus of debate within special-education research in norway. why (not) foucault in special-education research? foucault’s genealogies are political, and as a critical social philosopher, he is a contested scholar. the weak position of foucault in special-education research in norway can be interpreted as a consequence of his contentious standing, but there are also other important considerations. steinnes (2007) suggests that special-education research places itself too close to practice and practical aims. because of the focus on empirical research with results that can be directly applied in practice, meta-theoretical thinking and reflection are ignored or regarded as more or less irrelevant. this near-sightedness may be compensated for with more descriptive research, than with theoretical and philosophical analysis. steinnes, however, does not argue for the use of foucault’s perspective in special education in particular, but calls for an epistemological and ontological concept of special-education research. others who have made an effort to apply his perspectives have been criticized for offering superficial interpretations of foucault’s thoughts and writings. according to schaanning (2013), some authors in the field of inclusive education have used foucault’s concepts simply as ornamentation, wrapping their empirical work in impenetrable academic jargon. being met by such denunciations may, of course, discourage some scholars from pursuing and applying foucault’s perspectives. nonetheless, we argue that foucault’s critical and theoretical perspectives, in particular his genealogy of ethics, ought to be accepted as an invitation to special education, not as the name on the door of an exclusive club (simonsen, 2015). there is another interpretation of why foucault’s influence in special-education research has been so restricted, where the dichotomy between the orientation towards practice and theoretical and philosophical reflection may not be the core matter. the image and self-understanding in special-education research constitute a main obstacle for an increased interest in critical social philosophers such as foucault. to start, interest in modern european philosophy in specialeducation research is limited. disability studies has included meta-critical perspectives on the construction of disability, but the interaction between special-education research and disability studies has been almost non-existent. foucault’s critical approach to the constructions of normalcy and deviancy may be perceived as being too critical. njsr – nordic journal of social research vol. 7 (2016): special issue 45 special education represents a brand that is designed as ‘doing good’: historically delivering, meeting, and adapting to shifting political aims (skrtic, 1991; thuen, 2001; arnesen & simonsen, 2011). in foucault’s view, critique begins with questioning the demand for absolute obedience and subjecting every obligation imposed on subjects to rational and reflective judgement. in various educational contexts obedience is required. foucault locates the desire that informs the question, ‘how not to be governed?’ the subject desires to govern oneself and the institutional practices govern the participant, which is the central impetus of critique (butler, 2000). however, educational society expects the subject to govern as a conduct of conduct, and we recommend that special-education research should redirect its orientation on the subject’s conduct of conduct, ability to participation and experiences of wellbeing. disability history demonstrates the shifting historical constructions of the deviant, ambiguous or disabled child in special education (befring & tangen, 2012). with reference to foucault, it seems appropriate to look at the construction of the disabled and deviant child from a new angle. inclusive special education represents the societal and political assignments of our time. inclusive education can also be exclusion if we do not shift the discourses about abnormality, deviances, and disabilities towards a focus upon the resilience of a learner and governing as the conduct of conduct within education. some students have trouble adapting to life in school, and some schools face problems and challenges with other students (nordahl et al., 2012). schools continuously have to handle students’ diversity. inclusive special education and institutional strategies have been the current response for preventing school failure and for handling various concrete dilemmas that will inevitably occur for some students. allan (2005), using foucault’s framework of ethics, phrases the purpose of inclusion as the telos. democracy and inclusion are closely interconnected. educational community, participation, complicity, and outcomes are a central benefit of education as a means of creating democratic participants in inclusive special education (reindal, 2010; haug, 2014; nes, 2014; simonsen, 2015). inclusiveness in ordinary and special education is an approach that allows children with disabilities and deviances to benefit from education. more broadly, education’s purpose is to support diversity among all learners, with the aim of eliminating social exclusion (peters & besley, 2014; allan, 2005; nes, 2013; reindal, 2010). foucault’s ethical perspective on governmentality provides a critical ‘ontology of ourselves’ as professionals in special-education research. a critical ontology means that professionals reflect upon their ethos and attitudes towards the students’ educational outcome in inclusive special education. discursive practices are about the capability to participate, a way of understanding differences and achieving inclusion as an ethical concept of participation during education. the purpose of inclusion is to achieve interrelations and interaction between ordinary and special education for each student. power is not homogeneous, but it constructs and creates regimes of rationality about the disabled or deviant child. by analysing theses regimes as micro-regimes of truth, we may explain and understand rationality ‘as the way a human being turns himor herself into a subject’ (foucault, 2000, p. 327). the agency of a learner or the subject positioning to become a learner in inclusive special education presupposes opportunities to contribute and participate (knudsmoen, 2011; haug, 2014; knudsmoen, 2015). foucault emphasizes how power is not homogeneous but creates regimes of how we can explain and understand knowledge, such as the subject positioning as a learner’s satisfactory learning outcomes in between ordinary and special education. rationality is replaced by njsr – nordic journal of social research vol. 7 (2016): special issue 46 an analysis of micro-regimes of truth as various systems of knowledge and how a learner benefits from schooling during education. the student’s willingness to become a learner and to conduct and participate seems to be the crucial point of being included. concluding remarks foucault’s influence in norway has been quite extensive in social science in general, but his impact is limited within special-education research. in this article we have presented reindal and hausstätter as two exceptions when it comes to his genealogy of ethics. their concern, among others, has been the ethics of inclusion and the conceptualizing of disability. knudsmoen has applied foucault’s thinking in her analyses of learners and conduct of conduct in relation to the construction of the deviant child. in addition, we add the noticeable, but not explicit, influence of foucault’s genealogy of ethics on scholars within special education such as thuen (2001) and simonsen (2000, 2005, 2015). one may speculate about the origins of this lack of attention. we have mentioned a certain element of self-satisfaction within the field of special education, which leads to a lesser demand for new critical perspectives (arnesen & simonsen, 2011). or are we talking about squeamishness or fear of contact? or is there a fear of going wrong in interpreting foucault’s shifting complex and somehow elusive concepts and writings? what we argue is that foucault’s genealogy of ethics may contribute to new understandings of ‘the deviant child’ or satisfactory learning outcomes in inclusive education discourses regard special education. it gives attention to the concept of governance as conduct of conduct, self-mastery, and the subject position as learners within education discourses about satisfactory outcome. participation, inclusion, equity, democracy, equal rights, and bio-politics are complex and pressing issues in special-education research today. consequently, special-education professionals need to reconsider the learner as a subject in context, meaning students within education with respect to governance and subjectivity. as a further exploration of critical ethical reflection and work, we put forward foucault’s reminder that we require parrhesia, professional and personal courage (foucault, 2002; 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[upbringing, education and enlightenment. a retrospective perspective on some key concept of buildung]. in k. steinsholt & s. dobson (eds.) dannelse. introduksjon til et ullent pedagogisk landskap. [formation (bildung). introduction to a hazy education landscape]. trondheim: tapir akademiske forlag. thomas, g. (2014). epistemology and special education. in l. florian (ed.), the sage handbook of special education (2nd ed.) (pp. 267–279). los angeles: sage. thuen, h. (2001). i foreldrenes sted [in place of the parents]. (doctoral dissertation). university of oslo. tomlinson, s. (1982). a sociology of special education. london: routledge. unesco (1994). the salamanca statement: network for action on special needs education. paris: unesco. unesco (2009). policy guidelines on inclusion in education. paris: unesco. yates, s. (2015). neoliberalism and disability: the possibilities and limitations of a foucauldian critique. foucault studies, 19, 84–107. microsoft word jernbro young adults personal views on child abuse copy-edited version3, pages corrected.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 1, 2010 young adults’ personal views on child abuse carolina jernbro public health science karlstad university email: carolina.jernbro@kau.se ulla-britt eriksson public health science karlstad university email: ulla-britt.eriksson@kau.se staffan janson public health science karlstad university email: staffan.janson@kau.se abstract this is a qualitative study based on reports from young adults, both exposed and not exposed to child abuse. the aim of the present study has been to analyse young adults’ thoughts and feelings about child abuse. the data consisted of 358 responses to an open-ended question included in a national postal questionnaire study carried out by the swedish committee against child abuse (kommittén mot barnmisshandel). the analysis of data involved qualitative content analysis. four main categories emerged: children’s rights, consequences of child abuse, the role of the society, and causes of child abuse. the respondents who were abused as children wrote about the experience and the psychological long-term consequences of the abuse. the psychological abuse was particularly detrimental. the sexually abused expressed feelings of shame and guilt, in particular the young men. the nonabused respondents reported primarily on more general issues. they expressed children’s right to a safe childhood and they strongly believed in stricter penalties for child abusers. keywords: child abuse, psychological abuse, physical abuse, sexual abuse, qualitative content analysis, children’s rights njsr – the nordic journal of social research vol. 1, 2010 9 introduction child abuse is a public health problem which exists all over the world regardless of culture, ethnicity, and social class. studies from countries around the world demonstrate that between 80 and 98 per cent of children experience corporal punishment in their homes, with a third or more suffering severe physical punishment (waterston & mok, 2008). in 2002, approximately 150 million girls and 73 million boys under the age of 18 were victims of forced sexual intercourse or other forms of sexual violence (pinheiro, 2006). only 2.4 percent of the world’s children are legally protected from corporal punishment in all settings, home, school, and penal systems (pinheiro, 2006), even though all countries, except the united states and somalia, have ratified the un convention on the rights of the child (crc). the crc contains 54 articles, of which article 19 is of greatest relevance to child abuse because it requires states to take a variety of measures – legislative, administrative, social, and educational – to protect children from all types of abuse (unicef, 2002). sweden was the first country in the world to prohibit all corporal punishment and any other humiliating treatment of children in 1979. since the corporal punishment ban was introduced, there have been further changes in the legislation to protect children from abuse. in 1982, the legislation was amended so that assaults against children occurring in private places, for instance, in the home, could be publicly prosecuted. corporal punishment was no longer a private matter. a number of swedish studies have shown that the use of corporal punishment of children and positive attitudes towards corporal punishment have decreased significantly since the ban on corporal punishment was introduced (janson, svensson, & långberg, 2010). in the year 2000, only eight per cent of the parents reported having punished their children corporally in the past year, compared to 51 per cent in 1980 (sou, 2001a). the definition of child abuse proposed by the swedish committee against child abuse (kommittén mot barnmisshandel) reads as follows: child abuse is when an adult subjects a child to physical or psychological violence, sexual assault, humiliating treatment or fails to meet the child’s basic needs (sou 2001b, p.120). the definition above, which is based on the definition of 1999 from the world health organization (who, 2002), adopts the perspective of the child and does not incorporate cultural standpoints. further, it distinguishes neither between intentional and unintentional acts nor between active and passive neglect (sou 2001b). the definition of the different types of abuse is presented in table 1 below. njsr – the nordic journal of social research vol. 1, 2010 10 type of abuse definition examples physical abuse, including physical neglect physical abuse is when an adult causes the child physical injury, illness, pain, or puts the child in a position of powerlessness or similar state. physical neglect is when an adult hurts or jeopardizes a child’s physical health or development by failing to guarantee the child an acceptable standard of physical care. hitting, kicking, scratching, pinching, biting, poisoning, burning, scalding, trying to drown or suffocate the child. neglect in the form of hygiene, nutrition, clothes, rest, shelter, etc. psychological abuse, including psychological neglect psychological abuse is when an adult systematically or during a longer period of time, exposes a child to discrimination, destructive treatment or intentional emotional suffering. in serious cases, one occasion is enough to be classified as abuse. witnessing violence between parents is also psychological abuse. psychological neglect is when an adult hurts or jeopardizes a child’s physical health or development by failing to meet a child’s basic need for attention, guidance, and so forth. psychological abuse is present in all forms of physical and sexual child abuse. criticizing, ridiculing, dismissing, and isolating the child from social contacts. neglect in form of unavailability, failing to provide the child with experiences and to teach the child right from wrong. sexual abuse sexual child abuse involves all forms of sexual acts that are forced upon a child by an adult. non-contact sexual acts; exhibitionism, voyeurism, sexual indications, comments, and suggestions, as well as exposure to pornographic material. sexual touching and sexual penetration. table 1. definitions of the different types of abuse (sou 2001b) the burden and consequences of child abuse in the western part of the world have recently been analysed in a comprehensive review based on 172 scientific articles, where one of the authors of the current article took part. one of the key findings was that the experience of abuse during one’s childhood increases the risk for long-term health consequences, such as mental health problems, drug and alcohol problems, risky sexual behaviour, obesity, and criminal behaviour (gilbert et al. 2008). abused children are at increased risk for depression during adolescence and adulthood. between 25 and 30 per cent of abused children meet the dsm (diagnostic and statistical manual of mental disorders) criteria for major depression by their late twenties. depression is associated with all types of abuse: psychological, physical, and sexual (gilbert et al., 2008). a study by straus (1998) has shown that the more physical abuse children experienced, the more depressive symptoms they showed in their youth and the more often they had thoughts about committing suicide. further, child abuse has a negative impact on the ability to establish and maintain healthy intimate relationships in adulthood (colman & widom, 2004). few qualitative studies have been conducted examining children’s and adolescents’ self-described feelings and experiences of child abuse. there have been, however, some studies of children and adolescents’ experiences of growing up witnessing violence between their parents (mullender et al., 2002; weinehall, 1997) and of being victimized by sexual abuse (jensen et al., 2005). the qualitative approach is important because it allows the study participants to speak in their own voices. in this way, the realities that often are missed in quantitative methods can be revealed (o’day & killeen, 2002). children’s and young people’s participation in research is also of great importance in order to obtain the child’s perspective. their testimonies and descriptions are needed in order to develop appropriate preventative strategies against child abuse (eriksson et al., 2008). njsr – the nordic journal of social research vol. 1, 2010 11 aim of the study the main aim of the present study was to analyse young adults’ thoughts and feelings about child abuse based on the following three research questions: did the respondents with experience of child abuse express different thoughts and feelings compared to the respondents without experience of child abuse? did the thoughts and experiences differ depending on what type of abuse the persons had been exposed to? were there any gender differences? method sample and data collection in the year 2000, the swedish committee against child abuse carried out a national study containing three parallel surveys to determine the frequency and extent of child abuse at the time. the surveys consisted of one interview study with parents, one classroom questionnaire directed to children ages ten to 12, and a third survey, of which this present study is a component. the third survey was a postal questionnaire study regarding upbringing and was directed to young adults. the questionnaire was constructed from previous studies conducted by the centre for studies of children at risk at mcmaster university in ontario, canada, and included questions about psychological, physical, and sexual abuse (macmillan et al., 1997). the swedish survey was addressed to 2500 randomly chosen twenty-year-olds throughout the country. there were 1576 (63 per cent) of these young adults who completed the questionnaire, a satisfying response rate taking into account that young adults often are on the move. the quantitative results of the survey have been published earlier (sou 2001a). at the end of the questionnaire there was an open-ended, free-text question: feel free to express your thoughts and opinions regarding child abuse in your own words. there were 358 young adults who responded to this item. their texts constitute the material analysed in the present study. analysis qualitative content analysis was used when analysing this free-text data. content analysis is an empirically based method used to draw reliable and valid conclusions from a text (krippendorff, 2004). qualitative content analysis offers great opportunities for interpretation. it can focus on the manifest content, that is, describing the visible and obvious elements of the text. the method can also focus on the latent content, which is the underlying, deeper meaning of the text. both manifest and latent content involve interpretation, but vary in depth and level of abstraction (graneheim & lundman, 2004). the analytical process started with an overview of the textual material, followed by several thorough readings. next, the meaning units, that is, the phrases relevant to the aim of the study, were chosen from the texts. these units were condensed in order to shorten the text without changing the original meaning. thereafter, all condensed meaning units were coded and grouped into subcategories. following this step, we then merged the subcategories into four main categories. this process is presented under each category in the results section (figures 1 – 4). the interpretation has focused mainly on the manifest content, but with elements of the latent content of the texts. to ensure credibility, three researchers have been involved in the analytical process. quotations have also been included in the results to illustrate and njsr – the nordic journal of social research vol. 1, 2010 12 verify the interpretation. in addition, a quantitative analysis was done in order to see how representative the subsample was in relation to the main sample. ethical considerations child abuse is a sensitive issue, and there is a risk that a study designed to examine the matter can arouse unpleasant memories and feelings in the respondents. on the other hand, a positive aspect of this study is that the participants have the opportunity to express their views and experiences of the matter confidentially. the survey including the open-ended question was approved by the statistics sweden’s ethics committee in the year 2000. participants were given the opportunity to refrain from answering the questionnaire, or any item in it, including the open question. the material did not contain any information that can identify the participants in the study. quantitative results there were 1576 twenty-year-olds who participated in this national study of child abuse (the main survey). of the participants, 576 young persons (36.5 per cent) reported that they had been physically punished or sexually abused during childhood. the most common forms of punishment were slapping and the pulling of the child’s hair. the questionnaire also included six questions related to psychological abuse: if they had been insulted by an adult, locked out of home, threatened with physical punishment, or if an adult had acted neglectfully. twenty-two per cent responded that they had been threatened with physical punishment and nearly 15 per cent answered that adults had acted neglectfully. the results also showed a relationship between poor family economy and reported abuse (sou 2001a). there were 358 of the 1576 participants who answered the open-ended question at the end of the questionnaire. of those who answered the last item, 66 (50 women and 16 men) had been victims of child abuse of some kind. the distribution of the young adults in the subsample who experienced different types of child abuse is presented in table 2. the classification of the types of abuse is based on the definitions in table 1. type of abuse men women total psychological 1 3 4 physical & psychological 8 21 29 sexual & psychological 2 9 11 sexual, psychological & physical 5 17 22 total 16 50 66 table 2. the distribution of the young adults who have been victims of child abuse according to type of abuse and gender.note that those who had been physically and sexually abused also were subjected to psychological abuse. njsr – the nordic journal of social research vol. 1, 2010 13 of those who had answered the open-ended question, 61 per cent were females, while in the main sample the gender distribution of respondents was 54 per cent females and 46 per cent men. compared to the main sample, there were fewer abused men who answered the open-ended question. of the 268 young men who reported being abused in the main sample, only 16 answered the open-ended question (six per cent of male respondents reporting abuse). of the 308 women who reported experience of child abuse in main survey, 50 shared their views and experiences by answering the open question (16.2 per cent of female respondents reporting abuse). it was nonabused participants who most frequently gave their views, feelings, and attitudes towards child abuse. of the 453 young men who in the questionnaire reported having no experience of abuse, 122 shared their views in the openended question (26.9 per cent of male respondents who did not report abuse). of the 545 young women who in the main survey reported not having been victims of any child abuse, 170 answered the open-ended question (31.2 per cent of female respondents who did not report abuse). qualitative results the analysis of free-text answers resulted in four main categories: children's rights, consequences of child abuse, the important role of society, and causes of child abuse. the process of the analysis is presented under each main category. children’s rights the emergence of the category ‘children’s rights’ is described in figure 1. code subcategory main category child abuse is never justifiable child abuse is children should never be abused wrong in any way children’s rights children need a safe upbringing children’s children need love and care needs figure 1. the emergence of the main category “children’s rights” the majority of the respondents expressed that all child abuse is wrong. they argued that children have a right to a childhood without abuse. this was expressed very strongly, regardless if they were victims of child abuse or not. they also described what children need in order to develop and thrive, such as love and safety. a woman who was not abused as a child stated: all types of abuse are disgusting! using violence in any way (physically, psychologically) against children can never be justified. we need to look at children as individuals with their own feelings and their own rights. children are human beings and adults must help them to become ‘good’ adults. that will be difficult if corporal punishment is used in the upbringing. protect the child instead and we will get a safer society. all children have a right to be loved and cared for. no one has the right to violate someone else! njsr – the nordic journal of social research vol. 1, 2010 14 some respondents who grew up in non-abusive families reflected on their childhoods. they expressed gratitude for ‘being lucky’ to have had a good upbringing, while they argued that good rearing should be a matter of course for all children. consequences of child abuse the emergence of the category ‘consequences of child abuse’ is described in figure 2 below. code subcategory main category never forget the abuse painful repression of hurtful memories memories feeling blue and depressed feelings of despair depression feeling insecure insecurity, abuse creates hate low self-esteem abuse lowers self-esteem hatred abuse transfers from one generation to the next the cycle abused children will think of violence it is acceptable to insult and beat others consequences of child abuse harder to prove mental abuse mental abuse leaves deeper consequences wounds than physical abuse of psychological witnessing family abuse is more abuse devastating than self being abused blame themselves for the sexual abuse difficult to disclose sexual abuse not taken seriously by authorities consequences difficult to have normal sexual of sexual abuse relations because of memories visions of children in sexual context figure 2. the emergence of the main category ‘consequences of child abuse’ many of those who had been victims of child abuse wrote about their own experiences of abuse and its consequences, with the emphasis on psychological consequences. it appears clear that many respondents were experience lasting hurt, no matter what type of abuse they had been exposed to. many respondents expressed painful memories about the abuse. usually, njsr – the nordic journal of social research vol. 1, 2010 15 they reported that they had tried to repress the memories, but they often recurred in adolescence and adulthood and haunted them throughout their lives. the memories were so deep that it was difficult to process them, even with help from professionals. a woman who had been a victim of psychological and physical abuse as a child expressed this experience as follows: to abuse a child is the most vicious thing an adult can do. it leaves a wounded soul that takes many years to heal. sometimes it does not heal, which will give you psychological damage that you have to live with for the rest of your life! sure, you can try to process the memories of abuse with therapy and anti-depressants, but if you have been abused both psychologically and physically, you do not forget the words or blows no matter how much therapy you get. some of the respondents who had been victims of child abuse wrote that they suffered from depression. a man who was physically and psychologically abused wrote the following: my dad was brought up in an east european way, which means beatings and punishments. this made him hit me as well. i feel awful about this, and i think about it quite often. i am suffering from depression. do not know what to do with myself. some of the respondents who were abused when growing up expressed insecurity and low self-esteem, which they attributed to abuse. they wrote that children easily adapt to situations and therefore accept the abuse. most often they also believed that they deserved to be maltreated. however, a couple of respondents wrote that they had feelings of hatred towards the perpetrators as a result of abuse. the cycle of violence is a consequence of child abuse that was particularly noted by non-abused respondents. these respondents expressed that parents shape their children’s characters and argued that children who are exposed to humiliation and corporal punishment when growing up will think that it is acceptable to insult and beat others. they also expressed the view that violence will be transmitted from one generation to the next. consequences suffered by respondents who experienced abuse differed depending on what type of abuse the respondents had been exposed to during childhood. many of the respondents argued strongly that psychological abuse is as detrimental as physical abuse. some of the respondents claimed that the psychological abuse was worse since it was easier to overcome physical blows than humiliation. the consequences of psychological abuse were not visible in the same way as physical abuse and was therefore harder to prove (to one’s self or concerned others, or both). a young man described the psychological abuse by his stepfather as follows: what happened during those years is so damned hard to describe, and that in itself has been a major problem. never been able to prove what happened. i wished many times that he could beat me instead so that i would be able to demonstrate to my mother how he really was. what happened (in broad terms) was that it started gradually and then it intensified. exclusion, insults, mental humiliation, threats, staring, blaming, oppression, ridicule. everything happened behind the back of others. i was the only one who knew. being witness to violence within the family was often described as devastating as being a victim oneself. one woman stated that witnessing violence against her brother had more damaging impact than the abuse directed at her. njsr – the nordic journal of social research vol. 1, 2010 16 another woman wrote that she struggled with depression because of the abuse she witnessed between her parents. those who had been sexually abused wrote about painful memories and feelings of shame and guilt. some blamed themselves for the abuse, which made it difficult to disclose this abuse to others. this was especially true for the male respondents. a man who had been sexually abused as a child wrote about the shame: the reason i never told anyone about the sexual abuse is because i was ashamed. i was convinced that i did something wrong. it took me many years to realize that this was not the case. now it’s too late. my secret. the sexually abused respondents who had the courage to report incidents to the authorities said they had felt violated during the interrogations. i was abused as a child by a paedophile in the neighbourhood. the police said it was not worthwhile to report. so we never did. when i was fifteen, i was sexually abused by an older guy and i decided to report it. in a way, i regret that now. the interrogations of prosecutors and police were extremely insulting. they humiliated me and were very insensitive. have met others in my situation, and heard the same thing from them. the chance of getting the offender convicted is extremely small. some respondents who had been sexually abused as children described the difficulties in having normal sexual relations with partners because of the recurring painful memories. a couple of respondents also wrote that they had thoughts of children in a sexual context and were afraid of becoming perpetrators themselves. the important role of society the emergence of the category ‘the important role of society’ is described in figure 3 on the following page. many respondents, both in the abused and non-abused groups, thought that the social environment is of great importance for giving children support when needed. respondents felt that schools and authorities play a critical role in addressing abuse, but that legal systems are also important so that justice is done for victims of child abuse. the combined group also expressed the need for an increased openness about child abuse in society. many of those who had been victims of some form of abuse reported that they had no adult to talk to about their experiences during their childhoods. the need to talk about the abuse was obvious in many responses. one woman wrote, ‘i want to discuss further’, another person wanted to be phoned and left a phone number. some respondents thought that the survey instrument did not include enough space for their free-text answers. njsr – the nordic journal of social research vol. 1, 2010 17 code subcategory main category penalties for perpetrators of child abuse are not strict enough psychological abuse should be as need for stricter punishable as physical abuse penalties child molesters deserve the death penalty or castration society should be more open it is important to take abused children seriously need for greater it is important for everyone to be aware awareness in the and to notify the social authorities if community necessary it is hard to know what to do if a child is abused the important role of society school staff can detect abuse the importance can get information about of the school children’s rights in school setting social authorities need to adopt the approach of a children’s perspective the authorities the health-care system lacks resources it should be easier for victims and need for strengthened perpetrators to receive the help resources in health they need care figure 3. the emergence of the main category ‘the important role of society’ the need for stricter penalties for offenders was expressed very strongly by the combined groups of respondents, but to a greater extent and in a more intense way among those who had not been subjected to child abuse. a woman who had not been exposed to abuse when growing up stated: i believe that those who assault children do not get the penalty they deserve. children cannot for the most part protect themselves and if there is hardly any punishment of the offenders, the world becomes an insecure place for them to live in. a couple of months in prison for a destroyed life and a ruined future. the perpetrators are pampered. i think a proper strengthening of the penalties and a legal review would be appropriate. i have no confidence in the legal system. the respondents who had been psychologically abused thought that this type of abuse needs to be considered as serious as physical abuse and should be as punishable. when the respondents wrote about the penalties for those who have abused children sexually, very strong feelings were expressed. many suggested the death penalty or castration. many of the respondents thought there is a need for greater awareness regarding the problem of child abuse in the general population. the respondents expressed that there should be an openness in society that could njsr – the nordic journal of social research vol. 1, 2010 18 facilitate the disclosure of abuse without children feeling stigmatized. it is also important for adults to pay attention to abused children and to take disclosures seriously so that the children can get the appropriate help in time. some respondents wrote about the importance of notifying the social authorities when child abuse is suspected. they argued that everyone who suspects child abuse is obligated to intervene. on the other hand, some respondents who were not exposed to child abuse wrote about the difficulty to detect child abuse and about not knowing what to do when they suspect that a child is abused. a couple of respondents also mentioned the importance of organizations such as children’s rights in society (barnens rätt i samhället, bris), where children can anonymously talk on the telephone to adults about issues affecting them. several respondents argued that the school setting is central in addressing child abuse. the respondents wrote that the school can give children information about their rights. the school is also a setting where child abuse can be detected and therefore it is crucial that teachers and other staff are responsive to the children. the respondents also stressed the importance of school resources, such as counsellors and school nurses. a woman who was psychologically and physically abused as a child wrote: i turned ‘into myself’ when i was bullied / beaten at home. this led to depression which the school nurse and school counsellor discovered by chance and resulted in therapy. guess if i get upset when i see how these services (school nurse, school counsellor) are removed from schools. i would probably not be alive today if they would not have been there for me! some respondents wrote about the importance of appropriate responses from authorities. respondents stated that the social authorities need to take the children’s perspective into account when they approach an abused child. when a child discloses and asks for help from the authorities concerned, the child should be listened to and taken seriously. some respondents who had been abused wrote about their unpleasant experiences with the social authorities. one woman who was abused as a child wrote: incest and corporal punishment are absolutely illegal and adults need to be aware of this. a social worker was sent home to my stepmother when i was five-six years old and my stepmother admitted that she hit me. the social worker made her promise never to do it again and that was it. obviously everything got worse after that, because i was accused of bringing the social worker home. this is unacceptable! nobody should have to be afraid of being beaten in their own home. a number of respondents expressed the need for strengthened resources in health care. they believed that medical and psychiatric services should be improved so that both victims and perpetrators can get the help they need within a reasonable time. causes of child abuse the emergence of the category ‘causes of child abuse’ is described in figure 4 on the next page. njsr – the nordic journal of social research vol. 1, 2010 19 code subcategory main category a lack of parenting skills can be a contributing factor to child abuse abusers have psychological causes attributable problems to caretaker abusers have been abused themselves during childhood corporal punishment is needed occasionally to teach right from causes of wrong child abuse corporal punishment is not the same thing as abuse causes attributable immigration; many cultures and to society religions allow corporal punishment; they do not know better the gender inequality is a contributing factor to child abuse figure 4. the emergence of the main category ‘causes of child abuse’ respondents frequently stated that there are no excuses for child abuse. however, many respondents attributed causes of child abuse. some respondents argued that causes of abuse are attributable to the caretaker, such as a lack of parenting skills. a number of respondents wrote that those who abuse children have psychological problems – a common explanation was that abusers are ‘sick’. they also wrote that the perpetrators are likely to have had an insecure childhood and that they probably had been exposed to abuse themselves. a couple of respondents wrote that some parents abuse their children because they like to exercise power over another human being. some respondents wrote that the causes of child abuse are attributable to social factors. some brought up the rise of immigration to sweden, which has led to a multicultural society, as an explanation for some child-abuse cases, because many cultures and religions allow corporal punishment in the upbringing of children. a couple of respondents had a greater understanding that parents of foreign origin and culture spank their children. on the other hand, some respondents thought that religions that advocate corporal punishment should be prohibited in sweden. one respondent felt that gender inequality is a contributing factor to child abuse. she wrote that women are less likely to use physical force against their children, compared to men. she argued that if women were to become more influential in the society, their more gentle ways would reflect upon society. no respondent felt that children benefited from regular physical punishment, but a few respondents, even those who had not themselves been abused, wrote that they think that corporal punishment is necessary at certain times when the child has misbehaved. corporal punishment should only be used occasionally to teach the child right from wrong, they wrote. the respondents who were positive to corporal punishment distinguished between corporal punishment and abuse. njsr – the nordic journal of social research vol. 1, 2010 20 discussion this study is based on a nationally representative sample of young people with or without experience of abuse expressing their views regarding child abuse. to our knowledge, no such study has been reported before. previous studies are entirely based on reports from victims. the major difference between the responses from the non-abused and the abused respondent groups was that the victims of child abuse often wrote about their own personal experiences of the abuse and its consequences, while the non-abused group merely offered their opinions on public institutions and children’s rights. since the non-abused have no personal experience to refer to, they reported primarily on more general issues, or on the basis of reports from abused peers. the non-abused answered the open-ended question to a higher degree, while abused men shared their thoughts and experiences the least. one finding of the present study is that many of the victims of child abuse, regardless of the type of abuse, expressed that they had been harmed psychologically from the abuse. the psychological consequences differed to some extent depending on the type of abuse the person had experienced. those who were victims of sexual abuse often described feelings of shame and guilt, especially the young men. this is in line with other findings (dorais, 2002; feiring, taska & lewis, 1996; finkelhor & brown, 1985). a few respondents also expressed the fear of becoming perpetrators themselves. there are studies that suggest that there is an increased risk that victims of child sexual abuse may become perpetrators later in life. although far from all the perpetrators have been victims of sexual abuse, this relationship between childhood victim and adult perpetrator is still two to three times higher in perpetrator groups than in the general population (svedin & banck, 2002). there also seems to be a greater need for respondents who were sexually abused to share their experiences since the victims of sexual abuse in our study represented half of the abused respondents in the subsample. it is possible that it was the first time for many of the sexually abused respondents to share their experiences of the abuse. this supposition can be supported by the fact that about half of the sexually abused respondents reported in the main survey that they had no adult they could trust enough to disclose their experiences of abuse during childhood and adolescence (sou, 2001a). our study has found that psychological abuse can be just as destructive as physical abuse. some of the respondents who reported having experienced physical and psychological abuse claimed that the psychological abuse was worse and that more attention needs to be paid to this type of abuse. psychological abuse, including neglect, is a subject that has not received much scientific and public attention in comparison to other types of abuse (gilbert et al., 2008). research shows that psychological maltreatment in childhood is related to a number of emotional problems later in life, such as anxiety, depression, and somatic complaints (allen, 2008; higgins & mccabe 2000; spertus et al., 2003). all children who are victims of physical and sexual abuse are also psychologically abused because abuse always violates the child’s integrity. physical and sexual abuse is also often coupled with psychological threats and insults (sou 2001b). such violation can hurt as much as the physical pain. this is in line with eisenberger, lieberman, and williams’ (2003) finding that social pain (e.g., exclusion, rejection) shows the same pattern in the brain as physical pain. opinions expressed by non-abused respondents highlighted the great importance of institutions such as schools, social services, legislation, child rights organizations, and health care to prevent child abuse and to pursue measures for reducing the consequences of the abuse. these respondents njsr – the nordic journal of social research vol. 1, 2010 21 strongly and frequently criticized the penal system, which they expressed as too weak to result in stopping abuse. by comparison, opinions on the broader subject of children’s rights and penalties were not expressed in such a strong fashion by respondents who had been victims of child abuse. however, some of them wrote about their own experience of public institutions. a couple of respondents who had been in contact with the social services and police department wrote about their unsatisfactory experiences. they expressed that they have not received the support they needed. a study by lindell and svedin (2004) has shown that social services in sweden has experienced difficulties in enacting and enforcing adequate measures to end child abuse and to prevent the continuance of the abuse in many cases they pursued. many abused children did not receive the health care and treatment they needed in order to recover, according to this study. one limitation of the present study relates to problems concerning adult recall. when adults are trying to remember and describe negative experiences during their childhood, it is common to forget or distort the memories. forgetfulness and dissociation are especially common among those who have experienced serious abuse (femina, yeager & lewis, 1990). consequently, there is a possibility that the most serious cases of child abuse are not represented in this present study. another limitation is that the material currently analysed was obtained in the year 2000. it is possible that the results could be different if the same study were done with the twenty-year-olds of today, in 2010. child abuse is an issue which has been discussed more frequently the past ten years, and it is possible that young people have been informed about children’s rights in school and other public institutions to a greater extent over the past ten years. it is possible that, fewer people today believe that spanking is acceptable. the increasing number of police reports of child abuse indicates a reduced tolerance for abuse (national council for crime prevention, 2000). however, the experiences and consequences that the abused have described would probably be the same today. this present study has indicated that many respondents felt a need to express their thoughts and feelings about child abuse. many of them wrote long and detailed texts and some commented on the great importance of studies concerning the matter. it may be easier for respondents to express feelings, thoughts, and experiences in writing because of the feeling of anonymity provided by confidential surveys. however, using the answers from an openended question is a somewhat limited way to collect data. it is difficult to derive the deeper meaning merely from written text, since there is no opportunity to ask follow-up questions and to interact with participants. indepth interviews with victims of all types of child abuse would therefore complement this study. we note that the issues relating to the psychological abuse of children need to be explored further, both quantitatively and qualitatively, in order to develop more fully our knowledge on the long-term impact of this type of abuse. references allen, b. (2008). an analysis of the impact of diverse forms of childhood psychological maltreatment on emotional adjustment in early adulthood. child maltreatment, 13(3), 307-312. njsr – the nordic journal of social research vol. 1, 2010 22 colman, r. a., & widom, c. s. (2004). childhood abuse and neglect and adult intimate relationships: a prospective study. child abuse & neglect, 28(11), 1133-1151. dorais, m. (2002). don't tell: the sexual abuse of boys. montreal: mcgill-queens university press. eisenberger, n. i., lieberman, m. d. & williams, k. d. (2003). does rejection hurt? an fmri study of social exclusion. science, 302(5643), 290-292. eriksson, m., cater, å.k., dahlkild-öhman, g., & näsman e. (2008). barns röster om våld: att tolka och förstå [children's voices about violence: to interpret and understand] (1st edition.). malmö: gleerups. femina, d. d., yeager, c. a., & lewis, d. o. (1990). child abuse: adolescent records vs. adult recall. child abuse & neglect, 14(2), 227-231. feiring, c., taska, l., & lewis, m. (1996). a process model for understanding adaptation to sexual abuse: the role of shame in defining stigmatization. child abuse & neglect, 20(8), 767-782. finkelhor, d., & browne, a. (1985). the traumatic impact of child sexual abuse: a conceptualization. american journal of orthopsychiatry, 55(4), 530-541. gilbert, r., widom, c. s., browne, k., fergusson, d., webb, e., & janson, s. (2009). burden and consequences of child maltreatment in high-income countries. the lancet, 373(9657), 68-81. graneheim, u. h. & lundman, b. (2004). qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. nurse education today, 24(2), 105-112. higgins, d. j., & mccabe, m. p. (2000). relationships between different types of maltreatment during childhood and adjustment in adulthood. child maltreatment, 5(3), 261-272. janson s., svensson b., & långberg b. (2010). sweden: a 30-year ban on physical punishment of children. in durrant j & smith a. (eds), global pathways to abolishing physical punishment: realizing children’s rights. london: routledge publications (in press). jensen, t. k., gulbrandsen, w., mossige, s., reichelt, s., & tjersland, o. a. (2005). reporting possible sexual abuse: a qualitative study on children's perspectives and the context for disclosure. child abuse & neglect, 29(12), 1395-1413. krippendorff, k. (2004). content analysis: an introduction to its methodology. thousand oaks, ca: sage. lindell, c. & svedin, cg. (2004). social services provided for physically abused children in sweden: background factors and interventions. international journal of social welfare, 13(4), 340-349. macmillan, h. l., fleming, j. e., trocmé, n., boyle, m. h., wong, m., racine, y. a., beardslee, w. r., & offord, d. r. (1997). prevalence of child physical and sexual abuse in the community: results from the ontario health supplement. jama, 278(2), 131-135. mullender, a., hague, g., imam, u., kelly, l., malos, e. & regan, l. (2002). children’s perspectives on domestic violence. london: sage publications. national council for crime prevention. (2000). barnmisshandel. en kartläggning av polisanmäld misshandel av små barn [child abuse: a study of reported child abuse]. brårapport 2000:15. o'day, b., & killeen, m. 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(2003). childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice. child abuse & neglect, 27(11), 1247-1258. straus, m. a. (1998). corporal punishment of children and adult depression and suicidal ideation. new york: cambridge university press. svedin, c.g. & banck, l. (2002). sexuella övergrepp mot flickor och pojkar [sexual abuse of girls and boys]. lund: studentlitteratur. unicef (2002). implementation handbook for the convention on the rights of the child. geneva: united nations publications. waterston, t., & mok, j. y. q. (2008). violence against children: the un report. archives of disease in childhood, 93, 85-88. doi:10.1136/adc.2006.113340 weinehall, k. (1997). att växa upp i våldets närhet [growing up in the proximity of violence]. dissertation, umeå universitet, pedagogiska institutionen. who (2002). world report on violence and health. geneva: world health organization. microsoft word 417 proof3.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 5, 2014 stereotypes and welfare attitudes: a panel survey of how ‘poor carina’ and ‘lazy robert’ affected attitudes towards social assistance in denmark troels fage hedegaard department for political science centre for comparative welfare studies aalborg university email: troelsfh@id.aau.dk abstract what is the impact of a predominantly negative debate about social assistance on public and individual support for the social benefit? over the course of a year the public debate about social assistance flared up twice in denmark. the debates drew on classic stereotypes of the social assistance recipients lacking both the financial incentives and the will to work. according to theories of the impact of media on welfare attitudes, this had the potential to undermine public support. a two-wave panel survey, however, showed only a small drop in public support for spending on social assistance, in a comparison of attitudes before and after the debates. the small overall impact on public opinion, however, hid a polarization of attitudes on the individual level. this shows that there was not a uniform reaction to welfare debates, but that people tend to seek out a version of reality that is consistent with their values and self-interest. the article thus shows that people when faced with public debates on welfare policies will seek to confirm their personal biases and this limits the possibility for overall changes in public support. keywords: welfare attitudes, stereotypes, attitude formation, panel study, social assistance, welfare njsr – nordic journal of social research vol. 5, 2014 140 breaking the ‘welfare consensus’? across europe politicians and policy organizations argue that social assistance and other social benefits should be made less generous. the arguments for making the social benefits less generous range from the need to create better incentives, in order to ‘make work pay’, to the social and moral benefits of working. the proposals to cut the social benefit levels do not, however, go unopposed. some oppose them out of self-interest, as they directly or indirectly gain from the benefit, or because they think they might need this benefit in the future owing to a feeling of exposure of unemployment (iversen & soskice, 2001; pierson, 1996). others are against the cuts since they believe that it is important to maintain and extend social protection for ideological reasons (feldman, 2003; lipset, 1963). therefore political scholars have argued that politicians who seek to retrench social benefits without facing negative electoral consequences need to gather public support for the cuts (pierson, 1996). one way to create public support is to draw on negative stereotypes about the recipients and thus undermine support for the benefit. stereotypes can play on ethnic prejudices (gilens, 1996; 2000), present the recipients as lacking incentive to work, or simply as lazy and unwilling to work (baumberg et al., 2012; golding & middleton, 1982; larsen & dejgaard, 2012). golding and middleton (1982) argue that by drawing these stereotypes politicians can invoke ‘(…) a series of images and beliefs that have historical continuity and lie very shallowly below a veneer of apparent “welfare consensus”’. (59). many studies of media depictions and stereotypes are built on the premise that media and elite discourses are able to affect attitudes which then make social reforms more or less politically viable. this article challenges that perception by tracking the impact of a dramatic example of a predominantly negative media debate on social assistance in denmark. in spite of harsh rhetoric and much media attention, this debate did not seem to break the ‘welfare consensus’. this article therefore creates and tests what i believe is a more realistic model of how and why attitudes change from a negative debate. in the next section the cases around which the debate centred will be introduced in detail. then theoretical perspectives on the impact of media on attitudes are presented, followed by a survey on attitudes before and after the debate. following this, theses are outlined to explain the attitude pattern. in the section following that the data and variables are introduced, and finally the results of the analysis are presented and discussed. njsr – nordic journal of social research vol. 5, 2014 141 introducing ‘poor carina’ and ‘lazy robert’ in the spring of 2013 the new york times reported that the danes had begun debating: ‘(…) whether their beloved welfare state, perhaps europe’s most generous, had become too rich, undermining the country’s work ethic’ (daley, 2013). the newspaper reported that according to experts and politicians the danes now wanted a tougher line on social assistance recipients. the source of these new attitudes was a debate about social assistance. that debate had started in the fall of 2011, as a political debate about the existence of poverty in denmark. this led to a discussion of whether the recipients of social assistance can be considered poor. the neo-liberal party liberal alliance supported an absolute definition of poverty, and therefore argued that social assistance is too generous, as it provides far more than the social minimum. the leftwing parties argued for a relative definition of poverty and thus concluded that many recipients are poor, as they cannot participate in society on an equal basis. as a part of this debate özlem cekic, a mp for the socialist people’s party, invited joachim b. olsen, mp for liberal alliance, to take part in a series of formal debates on this issue. one of these debates involved visiting carina, a single mother and recipient of social assistance, whom özlem cekic had chosen as her case of a poor dane on social assistance. there were no members of the media present during the visit and the first name carina was a pseudonym given to her in order to protect her privacy, but afterwards carina’s household budget was made public and the two politicians discussed the visit on a popular evening entertainment program. carina’s budget showed that she could not be considered poor by the oecd-definition, or in comparison to low-wage job holders, because she received additional benefits supplementing her income as a single mother (goul andersen, 2012; vangkilde, 2011). though carina’s situation is not representative of most social assistance recipients, her budget became a symbol of some social assistance recipients’ luxury expenses (e.g. cigarettes, a flat screen tv, and a dog), and provided a way of discussing the fairness of that. this resulted in the mocking nickname ‘poor carina’ in the press and sparked a moral outcry in the public about the disincentives to work created by social assistance. this also prompted strong reactions in the newspapers, with readers comparing the income from low-wage work and social assistance, for example, ‘no! she is not poor. this is an insult to all working people’ (eskesen, 2011), and ‘how sad it is that an idiot like me has not realized there is more money to be made njsr – nordic journal of social research vol. 5, 2014 142 on social assistance!’ (jespersen, 2011). the media attention surrounding social assistance slowly faded throughout the spring of 2012, but the debate revived when the state television programme on the other side aired a documentary on prime time featuring another recipient of social benefits, robert nielsen, who stated that he was a ‘lazy bastard’ and would rather receive social assistance than take a ‘crappy job’ like janitorial work at mcdonalds. the press quickly nicknamed him ‘lazy robert’ and the debate about social assistance peeked through again, though this time the debate focused more on the work ethics of recipients. this again prompted strong reactions in the media and even the social democratic prime minister helle thorning smith commented that: ‘(…) if there are people like ‘lazy robert’ out there, then there will be stricter requirements for such “lazy roberts”’ (søndberg, 2012, 7). overall, the cases focused much media attention on the social assistance scheme, as shown on figure 1 below. figure 1. articles mentioning social assistance in five major newspapers source: the newspaper database infomedia. newspapers: bt, ekstra bladet, berlingske, politiken, jyllands-posten. 0   50   100   150   200   250   300   20 11  ja nu ar y   fe br ua ry   m ar ch   a pr il   m ay   ju ne   ju ly   a ug us t   se pt em be r   o ct ob er   n ov em be r   d ec em be r   20 12  ja nu ar y   fe br ua ry   m ar ch   a pr il   m ay   ju ne   ju ly   a ug us t   se pt em be r   o ct ob er   n ov em be r   carina case! robert case! njsr – nordic journal of social research vol. 5, 2014 143 figure 1 shows the number of articles in five major newspapers using the word ‘social assistance’ in a period before, during, and a short while after the media events took place. the figure shows how salient the debate was in the period covered. there are normally some mentions of social assistance as a part of general public debate, which is reflected in the period from january 2011 to october 2011, when between 47 and 122 articles made references to social assistance. the figure also has two peaks where the number of references to social assistance more than tripled, compared to the average for the period leading up to the debate. the peaks were around december 2011 and august 2012, coinciding with the publicity surrounding the two cases described above. the impact of media on attitudes scholars have argued that we view the world as a series of mental images called stereotypes (lippmann, 1922; zaller, 1992). the stereotypes help us make sense of a complicated world, and are especially impactful in dealing with areas where we have little or no personal experience. therefore the media can have a large impact on attitudes, helping form the mental images of the unknown. though the cases of ‘poor carina’ and ‘lazy robert’ do not portray typical recipients of social assistance (larsen & dejgaard, 2012), they quickly came to identify recipients in the public debate. they thereby transformed themselves from single cases into stereotypes of how social assistance undermines economic incentives and makes the recipients lazy and unwilling to work. somers and block (2005) argue that debates about helping the poor, going back to malthus’ essays on poverty (1798), have always rested on these two categories of critique. it is, however, important to notice that opposing arguments also were put forward in the debate, which could act as positive ‘counterstereotypes’. the positive stereotypes focused on examples of more deserving recipients of social assistance who had lower disposable incomes and a history of previous work (flensburg, 2012; nørgaard, 2011). the positive counter-stereotypes were, however, less dominant than the negative. a study of 60 articles on social assistance, sampling from three major newspapers in the period from november njsr – nordic journal of social research vol. 5, 2014 144 2011 to november 2012, showed that about half had a negative slant, about one-fourth had positive representations of social assistance, and one-fourth did not lean one way or the other. the study also showed a sharp rise in the use of negative terms in articles about social assistance in 2011–12 compared to the period from 1998 to 2010 (jensen & mose, 2012). this marked a break from the previous coverage of social assistance recipients which had been predominantly positive (jensen & mose, 2012; larsen & dejgaard, 2012). the debate thus seemed to have the potential to challenge the welfare consensus, as a result of the increased salience of the issue and the changed makeup of the debate (soss & schram, 2007; zaller, 1992). explanations of attitude change a number of theoretical arguments have been put forward as to why negative debates might affect public opinion. from an institutionalist perspective rothstein (1998) argues that selective policies such as social assistance tend to create a public discussion about ‘(…) where the line between the needy and the non-needy should be drawn and (…) whether the needy themselves are not to blame for their predicament (…)’ (rothstein, 1998, 158-159). thus in this situation of increased media attention surrounding social assistance, the general population is more likely to question whether the benefit is too generous. other scholars argue that attitudes on whether recipients deserve benefits are informed by deservingness heuristics (m. b. petersen, 2009; van oorschot, 2000; 2006). heuristics are ‘(…) decision rules that produce quick judgements based on limited information and, hence, allow for opinion formation even when substantive information is absent’. (m. b. petersen, slothuus, stubager, & togeby, 2011, 26). quick judgements seem likely to create attitude change in this situation of increased salience but limited information about social assistance. studies applying these deservingness heuristics show that recipients of benefits who are of working age and perceived as unwilling to contribute to society foster the most negative reactions (m. b. petersen, 2012; van oorschot, 2000; 2006). the cases of ‘poor carina’ and ‘lazy robert’ clash with these criteria, as both of these persons had been out of work for a number of years despite being of working age. soss and schram (2007) argue that social assistance constitutes a ‘(…) potent but distant symbol for the mass public (…)’ (122), since attitudes towards njsr – nordic journal of social research vol. 5, 2014 145 social assistance, for most people, are not grounded in everyday experience, but in media representations and stereotypes (baumberg et al., 2012; golding & middleton, 1982). a change towards less support for social assistance based on the description of the debate and theory outlined above should be expected. in table 1 a crosssectional view of attitudes towards spending on social assistance before and after the publicized cases is presented. the surveys are part of a two-wave panel study in which the first wave was collected about two months before the carina case and the second, about two months after the robert case. this provides a baseline of attitudes before the debate and a measurement a short while thereafter. table 1. attitudes towards spending on social assistance before and after the robert and carina cases in percentages too much suitably too little don’t know n before the robert and carina cases 23 46 20 11 1997 after the robert and carina cases 29 37 19 15 1707 question: ‘do you think that the government spends too much, suitably, or too little on social assistance?’ from table 1 we can observe a rise in the number of respondents who think that too much is being spent on social assistance and a small drop in the percentage who think that the amount is suitable. this is a movement towards less willingness to spend compared to the time before and after. however, the movement in attitudes is relatively small. overall, this shows a relative stability throughout the period, which fits poorly with the expectations outlined above. this leads to the question of why attitudes towards social assistance do not seem to be more affected by the criticism and the media spotlight. njsr – nordic journal of social research vol. 5, 2014 146 explaining stability in attitudes one possible explanation may be that overall stability hides opposing attitude changes. a panel study by togeby (2004) finds few variations in the overall public attitudes on a number of issues, but large variations on a few issues. on the individual level togeby (2004) finds that the issues that display the smallest overall variation have the biggest individual variation. this pattern is created by uniform media messages on some issues which change the attitudes of few respondents but in the same direction. on other issues there is a small overall variation but a large individual variation in both directions created by a mixed media influence. the mixed media message fits with the description above and might help explain the small change in attitudes. studies from political psychology have also found this polarization effect in survey experiments where both pro-and-con arguments are presented. the studies explain the polarization of attitudes as confirmatory or biased reading of information (lord, ross, & lepper, 1979; taber & lodge, 2006). other studies have also found this to be true for stereotypes: people are more likely to believe information that supports their preconceived stereotypes and they ignore or discredit information that does not (allport, 1954; munro & ditto, 1997). to investigate the possible explanation of a polarization in attitudes, i outline four individual-level theses below. the theses cover both why some respondents could become more positive towards spending and why other respondents more negative. theses the literature on individual attitude change takes its starting point in converse’s (1964) seminal essay ‘the nature of belief systems in mass publics’. in a panel study converse (1964) found that most citizens answered inconsistently both across the waves of the panel and between related issues. this result led converse (1964) to question whether most citizens have something resembling real political attitudes, and therefore whether attitudes recorded through surveys are the expression of something more than random answers. the conclusions drawn by converse (1964) have since been criticized (achen, 1975; page & shapiro, 1992) and the subsequent literature on attitude formation has since modified that position. in much of the research following converse (1964) the prevailing position has been that attitude instability is not due to people’s lack of political attitudes, but to an ambivalence stemming from their having several and often njsr – nordic journal of social research vol. 5, 2014 147 opposing attitudes regarding most issues (chong & druckman, 2007; saris & sniderman, 2004; togeby, 2004; zaller, 1992). in this interpretation of attitudes the media play a big role since they transmit elite messages which are crucial to attitude formation and attitude change. when people are exposed to new or changing media messages on an issue, it can lead to changes in attitudes (togeby, 2004; zaller, 1992). the theses outlined in this study are based in the understanding of attitudes and the role of the media, as presented in zaller’s book the nature and origin of mass opinion (1992). in addition, theories of welfare-state attitudes are used to form my theses. i hope this provides a more realistic model of how attitudes are affected by the stereotypes put forward in the debate. instead of expecting a uniform effect, this model seeks to incorporate personal experiences and political values to explain polarization in the public’s attitudes. zaller (1992) argues that attitudes, recorded though surveys, are formed ‘on the fly’, on the basis of available information and predispositions. it is this process of attitude formation that is described in zaller’s (1992) receive-accept-sample (ras) model. this model describes whether the message is received or not, whether the message is accepted or rejected, and finally how the sum of available information is translated into an opinion. an important precondition for zaller’s (1992) model is the fact that people do not have personal firsthand information about most issues they are surveyed about. therefore they have to rely on information obtained through the media. on this basis i can outline my first thesis: for the cases to have an impact on attitudes, the respondents need to have received them, that is, they need to still remember the cases. thesis 1: respondents who remember the cases will develop more negative attitudes, while the attitudes of respondents who do not remember the cases will be unchanged. the debate over social assistance constitutes what zaller calls a twosided discourse, since both positive and negative stereotypes were available and could have affected attitudes positively or negatively depending on what stereotypes individuals were most exposed to. in the situation of the two-sided discourse, zaller (1992) argues that individuals tend to follow arguments that are in agreement with their predispositions or values. one way to schematize the values or predispositions involved is in the opposition of egalitarian versus antiegalitarian values (feldman, 2003; lipset, 1963). other researchers njsr – nordic journal of social research vol. 5, 2014 148 have argued that individuals take the position of their political parties (slothuus, petersen, & rathlev, 2012). however, since left-wing arguments fall in line with egalitarian values, and right-wing arguments fall in line with anti-egalitarian values, this leads to a similar prediction. this opposition of values fits the competing stereotypes seen above: one side of the debate stresses inequality and the other side disincentives and laziness. on this basis i formulate my second thesis about accepting or rejecting the message: thesis 2: respondents with anti-egalitarian values will develop more negative attitudes, while respondents with egalitarian values will develop more positive attitudes. together thesis 1 and 2 outline a simplistic understanding of zaller’s (1992) ras-model. to achieve greater nuance i further connect zaller’s (1992) general model of attitude formation to the research tradition on welfare attitudes. here a number of studies have emphasized how attitudes are formed by a combination of political values (thesis 2) and self-interest, in what is called the dual utility function (rothstein, 1998). self-interest can be measured in a number of ways, the most straightforward of which is personal gain. however, the indirect gains such as benefits to close family or the protection offered by the benefits also need to be taken into account (iversen & soskice, 2001; kumlin, 2007). this forms the basis of my third thesis: thesis 3: respondents who have no direct or indirect self-interest in the social assistance scheme will develop more negative attitudes, while respondents who have a direct or indirect self-interest in the scheme will develop more positive attitudes. the final thesis is based on the policy-feedback literature, which argues that in addition to self-interest and political values, attitudes are also shaped by feedback from the welfare institutions (campbell, 2012; pierson, 1993). this policy feedback can be in the form of personal experiences or proximity to welfare institutions, which has been shown to affect attitudes towards a number of issues and areas (hedegaard, 2014). zaller (1992) also acknowledges that some information is created or transmitted though experiences and personal contacts, leading him to describe this as a shortcoming in this theory: ‘it would obviously be desirable to be able to measure exposure to interpersonal influence independently of exposure to elite discourse in the mass media.’ (44). the impact of interpersonal influences fits with the policy feedback literature with both emphasizing how proximity to njsr – nordic journal of social research vol. 5, 2014 149 social assistance creates more positive attitudes by creating personal experiences to compete with the negative stereotypes. thesis 4: respondents with no proximity to social assistance will develop more negative attitudes, while respondents who are proximate to the social assistance scheme will develop more positive attitudes. i believe that this outlines a more realistic model of attitude change resulting from the debate. instead of expecting that attitudes will be uniformly changed, we instead test whether there is a confirmation bias, because people seek out information and stereotypes that fit their predispositions and experiences and therefore attitudes diverge (lord et al., 1979; taber & lodge, 2006). data and variables the data used in this paper were collected as a two-wave web-panel study in which 2000 respondents were surveyed in both waves. the 2000 respondents were chosen from a larger pool in the first wave, which insured minimal dropout between the two waves of the panel. the first wave was collected prior to the carina and robert cases in september and october 2011 (t1), and the second wave was collected after the cases in november 2012 (t2). the target group of respondents was age 18–65 years and weights were applied to match national averages on age, gender, regions of the country, and education level. the dependent variable throughout was based on the question which also was used in table 1 above: ‘do you think that the government spends too much, suitably, or too little on social assistance?’ since the prediction was that the small change in attitudes hid larger variations, a variable was calculated to show developments in attitudes between t1 and t2. the changes in attitudes were measured as attitudes in t2 after subtracting attitudes in t1 (menard, 2002). this is presented in table 2. table 2 shows that attitudes can develop in a very negative direction (-), a negative direction (-), remain unchanged (0), a positive direction (+), or in a very positive direction (+ +). for example, a njsr – nordic journal of social research vol. 5, 2014 150 respondent who in t1 answered that a suitable amount is being spent and that too much is being spent in t2 constitutes an attitude change in a negative direction (-). in reality, very few respondents moved from one extreme to another (less than two per cent in all), which is why the positive and negative categories were combined in the study. table 2. the method for calculating development in attitudes between t1 and t2 attitude towards spending on social assistance in november 2012 (t2) a ttitude tow ards spending on social assistance in s eptem ber/o ctober 2011 (t1) too little suitable too much too little 0 suitable + 0 too much + + + 0 independent variables to test the outlined theses a number of independent variables were also outlined. in longitudinal studies the relationship between the dependent and independent variables can be measured in four different ways (menard, 2002). this study investigated how independent variables explained changes in attitudes in both negative (x→∆y↓) and positive directions (x→∆y↑). to investigate thesis 1 about receiving the message, this question was used: ‘do you remember the so-called ‘carina case’ which was discussed in the media about a year ago?’ a similar one was asked about the robert case and the response categories were simply ‘yes’, ‘no’, or ‘uncertain’. no further help was provided for the respondents and the nicknames provided by the press were not used, as they could have biased the responses. njsr – nordic journal of social research vol. 5, 2014 151 thesis 2, concerning accepting or rejecting stereotypes on the basis of egalitarian values, was investigated by the proposition: ‘in politics one should strive after securing for everyone the same economic conditions regardless of education and occupation’. the response categories are on a five-point scale: fully agree, somewhat agree, neither agree nor disagree, somewhat disagree, and fully disagree. this was only collected in t1, but as values are believed to be relatively stable, they should not have changed significantly during the one year between the surveys (halman, 2007). thesis 4 was studied by means of self-reported proximity to recipients of social assistance. these questions were collected in the second wave of the panel (t2). the proximity to recipients of social assistance is called the ‘order of proximity’ throughout the analysis, as it measures how proximate or distant the respondent is to recipients of the benefit. the 1st order of proximity is the group that, at the time or up to 12 months previously, were recipients of the social assistance benefit. the 2nd order of proximity contains respondents who were related to recipients of social assistance, that is, spouses, cohabitants, parents, children, or siblings. the 3rd order of proximity contains respondents who had recipients of social assistance within their closest circle of friends. the variables also contained a reference category of respondents who had no close relation to recipients of social assistance. this is listed as the 4th order. the proximity variables were structured such that respondents who answered that they had 1st-order proximity did not count in the other categories, and similarly for the 2nd and 3rd order. thesis 3, about direct and indirect self-interest, was based partly on the measure above, as 1st-order and 2nd-order proximity outlined above fits the measures of, respectively, direct and indirect selfinterest. furthermore, a question regarding the self-reported risk of becoming unemployed was also used to capture another form of indirect self-interest: ‘to what degree do you feel that you and/or your partner are at risk of becoming unemployed within the next year?’ here respondents could answer: to a high degree, to some degree, to a lesser degree, or not at all. this form of indirect self-interest differed from having family members who received benefits (2nd order proximity), as it measured the protection provided by social assistance. njsr – nordic journal of social research vol. 5, 2014 152 results using the dependent variable outlined above i could track the individual development in attitudes. i found that 24 per cent of the respondents became more negative towards spending on social assistance, 15 per cent positive or more positive, and 61 per cent did not change their opinion between the surveys (n=1585). this suggests the explanation of overall relative stability hiding larger variations fitting the case, as 39 per cent changed their attitudes over the period. however, in order to further explore the divergence of attitudes and the theses of why the divergence happened, the relationship between the independent variables and the dependent variable was tested in two binary logistic regressions. to test the theses outlined above i constructed two separate binary logistic regressions. the models tested how well the theses explained why respondents became more negative (model 1) or positive (model 2) towards spending on social assistance, compared to respondents who did not change their attitudes. the models were created as separate binary logistic regressions instead of a multinomial logistic regression, as this allowed me to set the reference point for categorical variables, but otherwise the combination of the two models had the same effect as a multinomial logistic regression. the models tested for the outlined independent variables as well as for age and education (not shown). in addition to that, i controlled for the attitudes in t1. since the dependent variable measured changes in attitudes from a starting point, it might have prevented some groups from becoming significantly more positive or negative compared to their starting attitude. for example, if respondents had a very positive position as a group in t1, it is very unlikely they would become significantly more positive towards greater spending in t2. the models therefore expressed the relative changes in attitudes. the regressions from this control are not shown, as they do not add to the interpretation the models. njsr – nordic journal of social research vol. 5, 2014 153 table 3. logistic regression models of changes in attitudes towards spending on social assistance, odds ratios and significance levels model 1 negative direction odds ratio p model 2 positive direction odds ratio p remembers the case – carina remembers the case – carina yes 1.1 0.569 yes 1.0 0.877 no reference no reference remembers the case – robert remembers the case – robert yes 1.5 0.128 yes 0.8 0.282 no reference no reference in politics one should strive to ensure equality in politics one should strive to ensure equality (scale 1–5) 1.2 0.030 (scale 1–5) 0.8 0.000 proximity to social assistance proximity to social assistance self (1st order) 0.2 0.022 self (1st order) 2.3 0.136 close family (2nd order) 0.9 0.636 close family (2nd order) 0.8 0.491 close friends (3rd order) 1.1 0.639 close friends (3rd order) 1.1 0.795 no proximity (4th order) reference no proximity (4th order) reference perceived risk of unemployment perceived risk of unemployment (scale 1–4) 1.2 0.055 (scale 1–4) 0.7 0.002 note: no change n=739. positive direction n=164. negative direction n=284. see methods section for scales of the continuous variables. model 1 – negative direction (0=no change, 1=negative direction). model 2 – positive direction (0=no change, 1=positive direction). the models are also controlled for age and education with so significant effects (not shown). overall the model presented in table 3 helped to explain the polarization of attitudes in a negative direction (model 1) and a positive direction (model 2). model 1 showed some interesting and njsr – nordic journal of social research vol. 5, 2014 154 quite surprising patterns. first, it showed that remembering the cases did not have a significant impact on attitudes. thus i initially had to reject the first part of thesis 1 – that remembering the cases had a negative impact on attitudes. this initially seemed like a strange result, as it suggested that remembering the cases was entirely separate from a negative reaction. one explanation for this pattern might be that there was an overlap of thesis 1 about receiving the message and thesis 2 on rejecting or accepting the message on the basis of egalitarian/anti-egalitarian values. here model 1 showed a significant effect (odds ratio 1.2, p=0.03) indicating that people with more anti-egalitarian values were more likely to move in a negative direction. this suggested that people made a self-selection in their sources of news based on predispositions in order to confirm their preconceived stereotypes (lord et al., 1979; taber & lodge, 2006). this could happen through people choosing to ignore or discredit news that did not fit their predispositions. this would also explain why the effect of remembering the cases disappeared with control for egalitarian values, compared to the bi-variate relationship between remembering the cases and a movement in a negative direction (not shown). being a recipient of social assistance now or within the last 12 months (1st-order proximity) also had a significant effect as it made respondents much less likely to move in a negative direction compared to respondents with no proximity. the other proximity variables did not, however, have a significant impact on the chance they would move in a negative direction. the other type of self-interest investigated was the protection offered by social assistance and how it affected respondents who felt more or less at risk of losing their jobs. here, the more respondents felt secure in their jobs, the more they were likely to move in a negative direction (odds ratio 1.2, p=0.055). this, combined with the proximity variable, indicated the importance of self-interest. this confirmed thesis 3 on the effect of self-interest, but not thesis 4 on the effect of proximity, as the effects were insignificant. model 2, which explained movements in a positive direction, displayed the same overall patterns as model 1. similarly to model 1 there was no effect from remembering the cases, but that was in agreement with thesis 1, as it states that respondents who do not remember the cases do not change attitudes in any direction. this again might be due to the effect of egalitarian values, which display a strong and significant effect (odds ratio 0.8, p<0.000). the proximity variable did not create significant differences, not even for 1st-order proximate respondents receiving social assistance at the time or within the last 12 months (odds ratio 2.3, p=0.136), though this maybe was due to njsr – nordic journal of social research vol. 5, 2014 155 the low number of respondents (n=31). finally, the perceived risk of unemployment also showed a significant effect of dependence on the social safety net that benefits represent. overall, the results indicate that danes became more polarized on attitudes towards social assistance. the models outlined above found this polarization to happen along two dimensions: egalitarian values and self-interest. this shows that the chance of picking negative or positive stereotypes of people on social assistance is not uniform in the population. the polarization effect further explains why so little overall effect from the debates was found: it conceals a lot of the movement when looking in the aggregate attitude changes compared to the individual attitude changes. discussion can negative stereotypes undermine the public’s support for welfarestate policies? much of the literature on welfare attitudes and the impact of media coverage implicitly assume that there is a strong and uniform effect on the public. however, studies from other fields suggest that the effect is more complex. instead of an overall movement of public opinion we might see a polarization of the public, as individuals seek out information that aligns with their predispositions and thus their confirmation biases. to investigate the impact of a salient and overall negative debate, the cases of ‘poor carina’ and ‘lazy robert’ were described. these singlecase stories of recipients of social assistance received much attention and presented strong stereotypical images of the recipients. the cases touched on the classic critiques and stereotypes of social assistance which – other studies argue – create negative attitudes in the population. in addition, the case was set in the wake of the financial crisis, when a public discussion of budget cuts was taking place. there were, however, also positive stereotypes of deserving recipients put forward during the debates. this allowed individuals to pick the version of the story that best fit their worldview and selfinterest. by using panel data to track individual attitudes before and after the two cases, the article shows that there was only a small drop in public support for social assistance. the small overall change in attitudes, however, hid a larger polarization, as 39 per cent changed their attitudes. inspired by zaller’s (1992) ras model and theories of welfare attitudes, i outlined four theses to capture the polarization in njsr – nordic journal of social research vol. 5, 2014 156 attitudes. this, i believe, is a more realistic model of attitude change during increased media attention, as it includes political values, selfinterest, and personal experiences. using the theses to explore the variations in attitudes, i show how part of the population became more polarized along the two dimensions of egalitarian values and selfinterest. this article thus shows that people tend to seek out information that aligns with their predispositions and thus confirm their biases. therefore we should not expect a single debate to create large changes in public support and thereby undermine the existing support for social spending and the welfare state. the bulk of this article concerns the 39 per cent who changed opinion, but maybe just as importantly, the 61 per cent who did not change their opinion. this shows that it takes more than one debate to alter public opinion. the question is then whether, or for how long, the stereotypes stick in the public’s consciousness. if the stereotypes do stick longer in public consciousness this might lead to a harsher debate the next time, with stronger negative reactions among the 61 per cent, and thus a downward cycle of debates and more sceptical attitudes among the majority. alternately, if the stereotypes are quickly forgotten or only available to those with anti-egalitarian values, there might be little or no long-term impact from the debate. another stabilizing factor might be that the universalistic nordic welfare states tend to create a feedback effect whereby the overall values of the welfare state affect attitudes in other areas (esping-andersen, 1990; larsen & dejgaard, 2012; svallfors, 2007). finally, it is worth noticing that though the debate had little impact on public opinion, it potentially had an impact on policy developments. in may 2012 the social democratic government introduced a tax reform that tripled the income-tax deductions for working single mothers. this aimed at fixing the incentive problems presented by the carina case, in which she faced a gap between social assistance and low-wage work, i.e. to make low-wage work financially more attractive than social assistance. this was followed by a large-scale reform of social assistance in january 2014. this reform emphasized moving all ‘jobready’ recipients into the workforce, and deepened cuts in benefits to recipients of age 25 to 30 without an education. these were significant policy changes, and i would argue that my findings show that they were not made because of changes in public opinion. instead we have to look to other possible explanations such as political opportunities and paradigm changes in the perception of the unemployed (torfing, 2004). njsr – nordic journal of social research vol. 5, 2014 157 references achen, c. h. 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(1992). the nature and origins of mass opinion. cambridge, uk: cambridge university press. microsoft word 02 experiences with the privatization of home care, final2, pages corrected.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2011 – special issue experiences with the privatization of home care: evidence from denmark barbara fersch department of economics, politics and public administration aalborg university email: fersch@epa.aau.dk per h. jensen centre for comparative welfare studies aalborg university email: perh@epa.aau.dk abstract processes of privatization in home care for the elderly in denmark have primarily taken the form of outsourcing public-care provisions. the content and quality of services have in principle remained the same, but the providers of services have changed. the welfare state has continued to bear the major responsibility for the provision of elderly care, while outsourcing has allowed clients to choose between public and private providers of care. the major aim of outsourcing has been to empower the frail elderly by providing them with exit-opportunities through a construction of this group as consumers of welfare-state provisions. the central government in denmark has produced the public-service reform, but the municipalities bear the administrative and financial responsibility for care for the elderly. further, national policymakers have decided that local authorities (municipalities) must provide to individuals requiring care the opportunities to choose. with this background in mind, this article analyses how national, top-down ideas and the ‘politics of choice’ have created tensions locally in the form of municipal resistance and blockages. the article draws on case studies in two danish municipalities, whereby central politicians and administrative leaders have been interviewed. we have identified four areas of tensions: 1) those between liberal and libertarian ideas and values versus local political orientations and practices; 2) new tensions and lines of demarcation among political actors, where old political conflicts no longer holds; 3) tensions between promises and actual delivery, due to insufficient control of private contractors; and 4) those between market principles and the professional ethics of care providers. keywords: elderly care, home care, free choice, marketization, privatization, political conflicts, denmark njsr – nordic journal of social research 2011 – special issue 24 introduction the organization of elderly care has changed dramatically in most western countries in recent decades. where care was previously provided within households and kin networks, it is now a public activity subsidized by the welfare state. this development has led to the marketization of intimacy and the commodification of care (ungerson, 2000, p. 69). the trend towards the marketization of intimacy has assumed different forms in different countries or contexts. a distinction can be drawn between paid informal (black market work), semi-formal (cash for care) and formal (care provided by paid employees in the social services or a voluntary agency) forms of care (ungerson, 1997; geissler & pfau-effinger, 2005; jensen & møberg, 2011). in the danish social democratic welfare state, formal forms of care have become predominant (andersen & jensen, 2011, pp. 280ff). care has become a universal citizen’s right, with the municipalities being responsible for operating the elderly-care sector, and services offered include housing and care facilities for the elderly, as well as personal and practical assistance in the form of home care. as formal forms of care are predominant in denmark, care givers provide care to persons outside of their family, and care giving has become a profession-like occupation. care givers are unionized, public salaried employees, and their wages and work conditions are regulated by the social partners, that is, unions and employers’ associations. in effect, care givers are paid wages equivalent to those that are paid to persons with similar qualifications, hours of work are regulated, and social rights, such as sick leave, are derived from employment in care. in 2005, roughly 100 000 persons – about 3.7 per cent of the total labour force (calculated as full-time employees) – were employed in the public elderly-care sector (cf. jensen & rathlev, 2009). with home care, municipalities could freely choose until the early 2000s whether they wanted to make use of private (for-profit) contractors or whether all staff in the home-care sector should be municipally employed. however, municipalities were reluctant to make use of their outsourcing opportunities. by march 2002, only about 2.5 per cent of home care for those over 67 years was provided by private contractors (strukturkommissionen, 2004). by january 1, 2003, however, a liberal-led, right-of-centre government introduced public care service reform according to which the recipients of home care would be free to choose from different providers (public or private for-profit) of home care, meaning that municipalities became obliged to contract out the provision of home care if individual citizens so desired. as in other european countries (e.g., knijn, 2000; pavolini & ranci, 2004; whitfield, 2006), the elderly-care reform in denmark was inspired by liberal and libertarian values, epitomized as the ‘freedom to choose’, which was believed to empower seniors by providing them with opportunities to choose. this constructed them as the consumers of welfare services (cf. morris, 1997) while at the same time reinforcing the superiority of the market as a decisionmaking mechanism. clarke (2004) and clarke et al. (2007) have strongly argued that ‘free choice’ is a proxy for deeper processes of privatization and that the introduction of ‘free choice’ is a vanguard of ‘direct’ forms of privatization, that is, the transfer of services, organizations, and resources to the private (for-profit) sector. however, the organizational design of the ‘free choice’ of elderly care in denmark has thus far (only) taken the form of outsourcing as well as the creation of a new provider market by supporting the formation of for-profit service providers. njsr – nordic journal of social research 2011 – special issue 25 free choice as a key organizing principle in elderly care was legislated at the national level. neither the users nor the providers of care from below demanded the new policies. rather, national politicians with neo-liberal convictions defined a new orientation with regard to the future of public services in the face of relatively autonomous municipalities, which are responsible for defining and financing policy outputs.1 increased choice, or exit-opportunities, in the area of elderly care was thus imposed on autonomous local politicians and administration from above. such top-down imposed policies might have contributed to new tensions and contradictions, not least because the local level is able to resist or block ‘politics of choice’. as will be shown, municipalities are in practice able to facilitate or hinder the entrance of private for-profit providers into the care market. with this background in mind, this study has sought to shed light on the following questions. how do local municipal actors in politics and administration deal with the introduction of choice and market mechanisms in elderly care? how do they react to national politics of choice, and how do they obstruct or ease the process for private providers of entering the care market? how do they see and perceive the consequences of the introduction of choice for the quality of care work, on the one hand, and the working conditions among care givers (i.e., the staff), on the other? to do so, this article draws upon qualitative interviews held with local actors in the administration of two different municipalities, and aims to reach a conclusion on how privatization creates tensions between pervasive ideas and local orientation and practices. the two municipalities represent two different approaches and orientations regarding the ‘politics of choice’. whereas one municipality was ‘enthusiastic’ about outsourcing and competition, the other was ‘sceptical’. in the conclusion, we reflect upon the tensions, contradictions, and local reactions that have emerged from the top-down reform of public home-care services for seniors. the local system of elderly care in denmark it is important to understand the context in which the ’politics of choice’ were introduced in denmark. there are 98 municipalities in denmark, and these municipalities play a central role in the provision of care to senior citizens. the relevant legislation, the social services act, stipulates that the municipalities bear the responsibility for the care for senior citizens. elderly care is a citizen’s right, and the municipalities must offer personal assistance and care together with help or support relating to necessary practical work in the home. like other scandinavian countries, the municipalities thus bear the main responsibility for running residential homes and nursing homes, and for providing staff and practical care in the form of home help (szebehely, 2005; trydegård & thorslund, 2010). still, contrasts in elderly care exist between the scandinavian countries. while denmark’s provision of elderly care complies with the image of the scandinavian social-service model, sweden’s deviates significantly from this image (rauch, 2007). the municipalities have considerable autonomy and room to manoeuvre when it comes to the actual extent and substance of the care, however, as well as the situations in which one is entitled to receive care (cf. jensen et al., 2004). 1 factors such as ageing populations (e.g., ungerson, 2005), the overload of the welfare-state apparatus (e.g., offe, 1982), and differentiation or individualization (e.g. rostgaard, 2006) played a role to advancing the care reform, but these factors do not necessarily call for a liberal-inspired reforms. njsr – nordic journal of social research 2011 – special issue 26 this means that the municipal council has extensive authority to define the level of municipal services (quality, coverage, etc.) for seniors. still, the municipalities are obliged to make their political priorities and level of services visible to the municipal residents. the municipalities have been required to establish quality standards for municipal services since 1999. these standards must indicate the level of service that the municipal council has set for the municipality, just as the municipalities are required to install particular control mechanisms aimed at ensuring the fulfilment of the quality standards. the connection between policy and financial responsibilities is very close in the area of elderly care. the municipality defines the content of elderly-care services, and the municipalities finance elderly care entirely (municipal spending in denmark accounts for approximately 55 per cent of the total public expenditures). danish municipalities have the authority to tax income, which, in combination with user fees, is the most significant source of municipal revenue. taxes and user fees accounted for 56 per cent of the combined revenues for municipalities in 2002. other sources of revenue include operating and installation revenues, refunds, borrowing, and compensatory payments (from the state). compensatory payments aim to level out the conditions between rich and poor municipalities with respect to spending needs, tax bases, and other factors (strukturkommissionen, 2004). overall, there has been a strong tendency in denmark towards the formalization of care for seniors and such care becoming a public responsibility. by the end of the 1980s, however, the public sector and formal care for seniors had been restructured. denmark has been marked by a trend towards ‘de-institutionalization’. home care and residential homes replaced senior housing, which led to an increase in home care (i.e., personal assistance, care, and assistance with practical tasks in the home). the most common type of home care is cleaning. home care aims to keep seniors with reduced functional capacity (physical or mental) in their own home as long as possible. this shift towards de-institutionalization has been accompanied by a trend towards flexible and private (free choice) care for seniors (rostgaard, 2006). with regard to home care, municipalities could freely choose until january 1, 2003 whether they wanted to opt for a private contractor or whether all of the staff in the ‘home-care sector’ should be municipally employed. since january 1, 2003, however, the care receiver has been free to choose from among different home care providers, that is, public or for-profit private providers. not just anyone can establish a private company and provide home care. the municipality must first recognize these companies, and this recognition is based on the quality and price requirements outlined by the municipality. the municipality must also control the compliance of private contractors with quality standards. the municipality – not the care receiver – must pay directly to the private contractor for services delivered, and the municipality is responsible for all of the paperwork associated with the delivery of for-profit private home care. in other words, the scheme is not based on cash-for-care principles. private contractors cannot, therefore, compete on the price for care, but private contractors have some advantages in attracting costumer’s vis-à-vis the public care provision. private contractors are allowed to offer additional services such as gardening or dog-walking to the care receiver, and the care receivers themselves must pay for these additional services. public providers of care are only allowed to offer personal assistance and help for domestic tasks. all the same, the overall responsibility of providing care remains with the municipality. if a private contractor were to choose to stop njsr – nordic journal of social research 2011 – special issue 27 delivering care to a specific individual, the municipality is obliged to assume the provision of care.2 cases and methods the data used in this article originates from case studies of danish municipal governance structure in the area of elderly care, and two cases have been selected and compared. the two cases have been selected on the basis of ‘most similar’ design criteria (e.g., lijphart, 1975). the two municipalities resemble each other with regard to numerous structural characteristics, including the tax base, debt, degree of urbanization, and the percentage of elderly, frail individuals who have chosen a private home care provider (cf. indenrigsog sundhedsministeriet, 2011). the two municipalities differ from each other, however, regarding population size and how much money the municipalities spend per senior per year on elderly care. furthermore, the two municipalities differ markedly when it comes to local policies, organizational structures, and practices concerning the introduction of privatization and choice. these marked differences are mirrored in different cultural orientations towards the ‘politics of choice’. in municipality a, the central actors appeared to be quite ‘enthusiastic’ about the introduction of economic principles, whereas in municipality b they seemed quite ‘sceptical’. both municipalities have a lengthy historical tradition of electing a social democratic (local) government. it is peculiar, then, that in the last election in 2010, the sceptical municipality, b, produced a liberal majority, whereas the enthusiastic municipality, a, continued under a social democratic banner. municipality a is not only characterized by political stability, but it is also marked by administrative stability and continuity. the seniority among the interviewed administrative staff is much greater in municipality a (7-11 years) as compared with the seniority in municipality b (1-4 years). the same pattern of continuity and discontinuity can even be found with regard to the person chairing the municipal seniors committee, which is responsible for all questions relating to the elderly before the municipal council. in municipality a, the chair celebrated his 40-year anniversary in this position, while the chair in municipality b was a newly elected municipal council member. the different orientations in the two municipalities have had an impact on the magnitude of private providers. the number of private providers is much larger in municipality a, where individuals requiring care can choose between 18 providers (13 private and five public providers), whereas only five providers (four private and one public) can be found in municipality b (servicestyrelsen, 2011). the ‘core’ of the empirical material consists of qualitative interviews with the central actors involved in the formulation and implementation of local care policies. in 2010 we interviewed the most important political and administrative actors in relation to local elderly care. in each municipality, we have interviewed one elected politician, that is, the chair of the municipal senior committee. moreover, we have interviewed persons in key positions within the local administrations, including: (1) the chief executive in the social administration (including elderly care) and overall head of all of the administrative staff interviewed; (2) the head of the care-assessment unit. the care-assessment unit serves a dual role of assessing care needs and grants 2 according to the legislation, private contractors can not refuse their services to citizens, and they cannot terminate a contract (§ 15). in practice, however, they can. njsr – nordic journal of social research 2011 – special issue 28 care while and at the same time of controlling the quality of services delivered by private and public home-care providers; (3) the head of the municipal elderly-care unit, who is the overall head of all municipal providers of elderly care; and (4) the municipal elderly-care unit is subdivided into sections (district organizations) and we have interviewed the head of a district organization. additional information has been taken from official municipal documents, such as the official quality standard in the municipality. not all interviewees spoke unequivocally. the interviewed actors expressed quite different (or even opposing) approaches regarding the introduction of economic and market principles into the organization of elderly care. our criterion for distinguishing between ‘enthusiastic’ and ‘sceptical’ municipalities is, however, that most interviewed actors in municipality a were in favour of the introduction of market mechanisms, whereas the vast majority of those interviewed in municipality b appeared to be rather sceptical towards the phenomenon. local policies, municipal service organizations, and forms of competition all danish municipalities have an elderly care unit responsible for the overall provision of elderly care within the municipality. the care unit is sub-divided into districts covering different geographical areas within the municipality. the districts are responsible for the delivery of public home care to the client or user. at the time of the interviews, there were five districts and 13 private providers of care in municipality a, and four districts and four private providers in municipality b. in the latter, the older person could choose between the municipal provider (home help will be delivered from the district in which the senior lives) or from one of four private providers. quite unusually, it is not only possible in municipality a to choose between public or private provisions, but also between the five municipal service units. we have chosen an organizational structure in which the municipal providers compete with each other, because the user can also choose between the municipal providers. this is a little bit atypical, i think. normally, one can choose between the municipal provider and private providers. but here we’ve chosen to go one step further… (the chief executive in the social administration in municipality a)3 the reason for this ‘dual’ competition, that is, internal as well as external, is that the chief executive in the social administration in municipality a is able to influence the competition. the chief executive believed that competition would improve the quality of municipal services: well, i am committed to competition. and i am committed to the idea that we in the public sector should be exposed to competition all of the time in order to be forced to be cutting-edge. without any question. (the chief executive in social administration, municipality a) another interviewee from the administration, however, the head of the care assessment unit in municipality a, was more critical about the chosen ‘onestep-further’ competitive structure. she states: instead of installing free choice between private and public, we’ve installed free choice between five municipal providers. and then you don’t have the time for the private providers... well, we absolutely don’t 3 all interview quotations have been translated from danish to english by the authors. njsr – nordic journal of social research 2011 – special issue 29 have the time to have meetings with them, to inform them, to check on them, and to keep them at bay and to say to them, ‘now you have to document things’, and things like that... (head of care assessment unit, municipality a) this interviewee indicated that ‘dual’ competition may become an obstacle for efficiency and cause negligence in the control of private providers. this was not a critique of private provisions; rather, it referred mainly to the enhanced competitive structures in municipality a. her experience and interpretation of the situation are based on her position as the head of the care-assessment unit in charge of controlling both the private and public providers of care. conversely, municipality b has employed a less competitive organizational structure, and clients or users have fewer opportunities to choose compared to municipality a. they can choose between three private providers and the public offerings. if the client or user chooses the public option, services will be delivered from the district unit covering the receiver’s place of residence. in municipality b, the atmosphere that stifles competition is even supported by practices of blockage: we don’t have any private providers for meals on wheels. the political system is against that... i almost said... they are of course not against it, but they make demands that don’t make it easy for the private providers to access the market. ... the word is – at least in our department – that it’s because they demand skilled kitchen staff – even for the delivery of food. everywhere else, it’s just a driver who can read an address and run the meal upstairs. (head of care assessment unit, municipality b) as can be seen, the special demands set by municipality b restrict the access to the care market for private contractors. these restrictions are not informal practices, since they are clearly spelled out in the quality standards for municipal services. under the item ‘delivery’ in the quality standards regarding ‘meals on wheels’ in municipality b, it is stated: the meal ought to be delivered by skilled staff so that the citizen receives adequate instructions concerning the meal and answers to any questions. (quality standards municipality b;4 cf. national board of social services, 2011) the quality standards for the delivery of ‘meals on wheels’ in municipality a are quite different. here, the following requirements must be fulfilled: the drivers must understand and speak danish. the drivers must be familiar with the pensioners’ possible special problems, and they must meet them with understanding and flexibility. (quality standards municipality a, source: national board of social services 2011) the drivers in municipality b must clearly be skilled staff, whereas this is not the case in municipality a. this possibly helps to explain why there is no private provider of meals on wheels in municipality b, whereas there is one in municipality a. the interviewed head of a district organization in municipality b seems to describe these tendencies in more general terms: but i think it [the choice between private and public providers] did not receive as much importance as it possibly could have gotten. and i’m not 4 the authors have translated the quotes from the quality standards of municipalities a and b from danish to english. njsr – nordic journal of social research 2011 – special issue 30 surprised, because there are no equal market conditions. ... this might be a little hypocritical. but it probably depends on what kinds of politicians you have in the municipality. there are some other municipalities ... which have privatized their senior centres and that kind of thing... so it’s possible one way or another (head of district organization, municipality b). this quotation demonstrates how municipalities within the same legislative framework can create different environmental conditions from which private providers can emerge. municipalities may support the formation of private providers by creating ‘equal market conditions’ for public and private providers, or they might resist or block the formation of private providers in the face of the ideas and intentions of national policymakers. the comparison between municipalities a and b outlines two distinct patterns in the organizational structure and practices. in municipality a, most of the interviewed actors were positive or enthusiastic about competition and ‘politics of choice’. municipality a had even taken competition a step further than was envisaged, by introducing competition between the municipal district units in addition to the competition between public and private providers. this structure, however, has been criticized from within for being inefficient and undermining the control mechanisms. in municipality b, on the other hand, the introduction of economic principles appears to have been delayed and impeded by various forms of resistance. local policymakers can restrict the market for private providers, as seen in the case of the obstructive quality standards set on the meals-on-wheels service. patterns of interpretation it is often argued that competition enhances the quality of services, and the chief executives in the social administration in both municipalities appear to support such basic ideas. even the chief executive in the social administration in sceptical municipality b made the following statement: i think it’s really fine that the user can choose between public and private home care services. ... and our quality awareness and costconsciousness and so on clearly got sharpened by the fact that we have competition. so it’s really fine. i would be sad if they were not there anymore. (the chief executive in the social administration, municipality b) however, competition can also have a negative effect on the quality of care. as described above, the head of the care assessment unit in municipality a believed that complex and competitive structures drain the resources for controlling private providers, which in turn threaten the quality of care: they [the private providers] do allow themselves … not to document anything about the individual citizen, even though they have to. well, because they just have to work profitably and to earn money with that, they don’t get it done, even though it’s actually a requirement for them… and until now, there was no case in which they have been reprimanded for not doing so. (head of care assessment unit, municipality a) the interviewee’s colleague in municipality b, a clear ‘sceptic’, thinks that the private competitors actually do provide a lower quality of care: the private firm is usually able to have more unskilled staff than the municipal home care. what they have to provide is the same – the same services. and well, to be completely honest … i think it’s a somewhat njsr – nordic journal of social research 2011 – special issue 31 poor alternative to municipal home care. and so the question is where to give the money that one uses for these services; if one thinks that it is really fantastic to give it to private providers or if one rather lets it circulate in the public system… (head of care assessment unit, municipality b) this interviewee drew a connection between the educational backgrounds of the care givers and the quality of the care: a lower proportion of skilled staff is expected to mean lower quality care. some anticipated that the introduction of market mechanisms would have an effect on the staff’s and care givers’ professional self-understanding and work ethics. one head of district in municipality a emphasized the positive consequences of market mechanisms and cost-benefit thinking: well, in any case, the fact that the private providers came in did mean that we had to look at our own tasks with different eyes. and that we also had to look at what we’re doing today. and all of a sudden, we had to put time and a price on everything we do. that was a good experience for a lot of the employees – that they all of a sudden found out, well it isn’t something we just do... … so for many of our employees, it meant that they felt that they were growing a little professionally by focusing on what they’re doing. and all of a sudden what they were doing became very visible. and suddenly, what they did had a value (head of district organization, municipality a) in line with this argument is the notion that the introduction of economic thinking casts light on the economic value of caring and fosters the recognition of care work and care workers. standardization in the sense of ‘putting’ a time and price on every task may actually support the processes of professionalization. hanne marlene dahl (2009), who has analysed how care workers handle the implementation of new public management (npm) within home care in two danish municipalities, has argued that npm reforms may lead to increased recognition of care work. npm can also lead to increased misrecognition, however, depending on how npm reforms are translated into work practices. ‘the different translations of npm … matter a great deal for their impact on recognition and misrecognition’ (dahl, 2009, p. 649). similarly, we find different interpretations in municipalities a and b regarding how the fortification of economic principles affects the ethics and quality of care work: for me, welfare services depend on relations. in reality, i don’t like the word ‘services’ – for me it’s not the right word when it comes to relations. because services are something more tangible, concrete that you give to a customer. the term ‘service’ also comes from a different world. so all of this terminology we have about it … also ‘level of service’, for example. service is something we provide to a citizen. one tends to forget that, in reality, one is cooperating and establishing a relationship [with the senior]. and here, i do see a risk when it comes to the perspective that the citizen is a customer … it becomes a business transaction instead of saying that it is actually the establishment of a relationship. and it is really very much about finding out what kind of needs the individual actually has. (head of elderly care unit, municipality b) here, the interviewee points to care as a reciprocal relationship based on responsibility and relatedness, a topic which has also a focus in the academic discussion of care (see also daly & lewis, 2000). later on, when asked about her individual definition of good elderly care, the same interviewee again emphasizes ‘basic values’ such as ‘responsibility’ and ‘respect’. in her view, njsr – nordic journal of social research 2011 – special issue 32 the specific character of care work makes any ‘privatization’ efforts difficult. this leads her to being one of the ‘sceptics’ in municipality b: one must be very aware that it [elderly care] is not just some… some… some thing, or something you can just do to someone … and here i do see some risks. but it’s not like i’m completely against it – you can’t say that. i just think that you shouldn’t go into it in a starry-eyed manner. i think you should be very aware about who does what in such situations. (head of elderly care unit, municipality b) another aspect that is criticized by nearly all of the interviewed actors – although, as we shall see later on, with different motives and diverse conclusions – is the fact that no real privatization took place, in other words, that the privatization in the context of danish elderly care was actually outsourcing. home care was not understood as a ‘real’ market. the socialadministration chief executive in municipality a (a competition enthusiast) was really annoyed about the fact that there were no genuine market conditions in the field of home care: i disagree strongly with how it is today – that there’s no competition over price. i just don’t get it … because without competition over price, what’s left from the private sector? at the end of the day, isn’t it what the private sector is grounded in? that there should be competition over price? but i would also like to have marketization in the sense … that the users should pay much more themselves. so that seniors could buy from the private providers what they miss from the level of service that we provide – as some kind of base … i think that would be really fine. but here again, i think something is wrong today. (head of social administration, municipality a) earlier on, the same interviewee made it clear that she saw competition as a means of enhancing quality and of enforcing development in municipal elderly care. in this context, we can see how she criticizes the danish ‘imperfect’ form of marketization as a hindrance to the unfolding of what would have otherwise been proclaimed to be the great effects of market competition. she criticized two main aspects. first, that there was no competition over price, and secondly, that seniors did not pay at least part of the services themselves, because that is how a market usually works. earlier in the interview, she already made it clear that she only sees the provision of personal care as a public responsibility and that she would embrace making practical help like cleaning as services which seniors must pay out of their own pockets. a common point made by many of the interviewees was the claim that private and municipal providers do not compete on an equal footing: the municipalities are challenged by the fact that we must always be ready to overtake the citizen again and that we have to provide 24-hour coverage. and that’s costly. so as a firm you can opt out of these tasks but you can’t do it as a municipality. that challenges the municipalities in this competitive world through unequal conditions. (head of elderly care unit, municipality a) this interviewee emphasizes that the private providers have some advantages within the market, since the municipality must act as a ‘last resort’ and is responsible for assuming the costly and non-profitable tasks. one of the district heads in municipality b underlined an additional aspect of the unequal market participation: what i think isn’t okay is that one ... isn’t equal. for example, the private providers can provide extra cleaning for extra payment. we can’t. ... we njsr – nordic journal of social research 2011 – special issue 33 don’t have equal conditions ... there are things we are not allowed to do. and we have to take over. if a citizen is tired of the private firm, we have to take over. whereas the private providers can ... say ‘no thanks’, and they can pick and choose. and then it’s the municipality that takes over. (head of district organization, municipality b) hence, the last two actors criticized the policy of privatization in denmark for favouring private providers and leaving the more costly, less attractive tasks to the municipalities. whereas the ‘enthusiastic’ head of social administration in municipality a criticized the ‘imperfect’ privatization for hindering the ‘blessings’ of market principles and competition, the other two interviewees criticized how the home care market is constructed, which benefits private providers vis-à-vis municipalities. as can be seen, different interviewees and actors assigned privatization to different meanings and consequences. some of the interviewees saw a positive impact on the quality of care from competition and the market mechanism, while others saw the introduction of a market and private competitors as a threat. when it comes to the impact on care work and care workers (the staff), we again see opposed interpretations of the consequences of privatization. one interviewee believed that market mechanisms strengthen the recognition of care work; another saw it as a threat to care-work ethics. there were also different interpretations regarding the actual functioning of the market mechanisms. some argued that the ‘market’ is constructed in such a manner (i.e., outsourcing) that the rewards from privatization are suppressed; others believed that private providers are privileged. conclusion since the early 2000s, the danish right-of-centre government has supported the establishment of private home-care providers in order to help to shift the provision of care and resources from the public to the private sector. this endeavour has been imposed on autonomous local municipalities from above, even though municipalities already had the opportunity to contract out service provisions prior to the service reform in 2003 if they wanted to do so. as of 2003, however, the free choice of local political communities has only been tolerated as long as it is exercised in the right direction. nevertheless, the abstract values of free choice have never become a reality. the municipalities still define which services clients are entitled to receive. it is not like a supermarket, where clients can choose between different products. rather, clients will be offered a product or service defined by the public authorities. accordingly, the ‘politics of choice’ only allow clients to choose whether the municipality or a for-profit private contractor delivers a pre-defined commodity (or service). a genuine ‘politics of choice’ in denmark is also undermined because of the neutralization of market or price mechanisms. because there is no real competition over price, the only incentives for care receivers to choose a private instead of a public provider are, first, that clients feel more comfortable with a private rather than a public provider of care, and, secondly, that private providers, contrary to public providers, are allowed to offer additional services. even though a relatively small proportion of total care is provided by private contractors, privatization policies in elderly home care in denmark have created several layers of tensions. njsr – nordic journal of social research 2011 – special issue 34 in denmark, municipalities bear the responsibility for providing care for senior citizens, and municipalities control how quality standards in public and private (for-profit) care are defined locally. these standards can be defined in ways that tend to exclude private contractors. in one of the municipalities examined in this article, we have found that this municipality demands that the provision of meals on wheels can only be delivered by skilled kitchen staff, which makes it difficult (i.e., expensive) for private contractors to access the care market. this creates tension between the overall idea of choice as a political value versus local political orientations and practices. different municipalities and different actors within municipalities are oriented differently towards the ‘politics of choice’. on the basis of our case study, we draw a distinction between ‘enthusiastic’ and ‘sceptical’ municipalities and actors, which indicates that the same phenomenon is interpreted quite differently by different actors. this causes local political struggles and conflicts. however, the demarcation between the ‘enthusiastic’ and the ‘sceptical’ does not follow conventional political thinking. it was a liberal-led government that introduced ‘politics of choice’, but our case studies show how the social democratic municipality is ‘enthusiastic’, whereas the liberal municipality is ‘sceptical’. the ‘politics of choice’ thus gives rise to new kinds of tensions and lines of division among political actors. in addition, we have found a tension between what is promised and what is actually delivered. the municipality defines the quality standards, and these quality standards may deviate from what is actually delivered by private contractors, who tend to deprive older people of what they are actually entitled to get. such tensions may occur owing to the insufficient control of private contractors. the municipalities are responsible for controlling the quality of services delivered by private providers, but the control can be inadequate. in our case study, we have found examples showing a lack of resources to control private providers. a similar tension between promises and delivery arises because private contractors are inclined to use unskilled staff to maximize profits. finally, tensions between professional ethics and market principles may arise, since cost-benefit thinking tends to pose a threat to the ethics of the profession-like occupation of care. this tension, however, is not clear-cut. at least administrative leaders in the two municipalities report that outsourcing and the introduction of market mechanisms have also led to the increased recognition of care workers 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(2006). a typology of privatisation and marketisation. european services strategy unit, essu research report, no. 1. microsoft word eriksson, janson an explorative interview study of men and women on sick leave with a musculoskeletal diagnosis seeking an acceptable life role .docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 4, 2013 an explorative interview study of men and women on sick leave with a musculoskeletal diagnosis seeking an acceptable life role ulla-britt eriksson eastern norway research institute email: ulla-britt.eriksson@kau.se staffan janson eastern norway research institute email: staffan.janson@kau.se abstract introduction: a dramatic increase in sicknesses absence in sweden has led to a shift in the public debate. departing from the view of sickness absence as a result of a poor work environment and stress, the debate in the early 2000s became more concerned with the breakdown of norms and the abuse of sickness insurance. sickness absence became the responsibility of the individual rather than of society. aim: this study has sought to explore the consequences of being on sick leave with a musculoskeletal diagnosis, the experiences of encounters with rehabilitation professionals, and the attitudes towards sick-listing from the perspective of the sick-listed persons. methods: individual in-depth interviews were conducted in 2010 with eight women and nine men aged 33-60 who were on long-term sick leave (at least 60 days) with a musculoskeletal diagnosis. we analysed the data using a grounded-theory approach. results: there was an obvious tension between work strategy as a societal norm and finding an acceptable life role when sick-listed. four groups with partially differing experiences and perceptions crystallized out of the total population. these experiences and perceptions formed their choice of different acceptable life roles and strategies for gaining self-respect and the respect of others. discussion: the fact that the four groups that emerged from our study experienced their sickness absence in different ways and their pathways back to work were different demonstrates the value of not considering those on sick leave with a musculoskeletal diagnosis as a homogeneous group. the results imply that rehabilitators should adopt a sensitive approach based on the sickness absentees’ wishes and views since the latter spend much of their time and thought during their period of sickness on counteracting distrust in search of an acceptable life role to regain respect. njsr – nordic journal of social research vol. 4, 2013 56 keywords: sickness absence, musculoskeletal diagnosis, societal norm, acceptable life role, respect introduction sickness absence in sweden has been marked by considerable fluctuations (lidwall, 2011). there was a dramatic change between the end of the 1990s and 2003 when the number on sick leave more than doubled in just a few years. attitudes in the public debate on sickness absence also changed during the same period. from having seen sickness absence as the result of a poor working environment and stress in working life and the absentee as a victim of circumstances, the debate in the early 2000s, when sickness absence peaked, concentrated more on a breakdown in values, a misuse of the health insurance system, and even cheating (johnson, 2004). sickness absence became a political problem in the swedish debate on welfare and came to be seen as the responsibility of the individual rather than of society (junestav, 2010). the focus was on the state costs and the situation was seen as a threat to the stability of the health-insurance system (frykman & hansen, 2009). there was also considerable emphasis on what is referred to as ‘work strategy’, which implies investing in active measures to enable people to earn their own living (the social insurance agency, 2008). hofman has described work strategy as ‘work as a social duty’ (hofman, 2011:53). significant changes were successively introduced in the health-insurance system such as time limits, standardized national guidelines for length of sickness spells for most diagnoses, and legislation was made more restrictive (the social insurance agency, 2008). since 2003, the level of sickness absence has continued to decline and during the most recent years has been close to the average level for western europe (the social insurance agency, 2009). another discussion that arose in the wake of the increase in sickness absence focused on the increase in diagnoses that some maintained did not represent real medical conditions and were not in accordance with objective conditions. this description resulted in a discrediting of these diagnoses (michailakis, 2008). the ‘new’ diagnoses were termed ‘symptom diagnoses’ (symptomdiagnoser) because they were medically accessible through the patient's own experiences and conveyed to the doctor by means of the patient's description. this meant that it was also more difficult for the doctor to verify the symptoms through medical tests (olin, 1999). symptom-based diagnoses include psychiatric diagnoses but also many complex musculoskeletal diagnoses (olin, 1999). these diagnoses account for a large number of the long-term (i.e., more than 60 days) sickness absences, representing together more than half of the total number (27 and 26 per cent, respectively). psychiatric diagnoses are the most common among swedish women on long-term sick leave whilst among men musculoskeletal diagnoses predominate (the social insurance agency, 2010). common psychiatric diagnoses are depression, anxiety, and stress reaction. frequent musculoskeletal illnesses that cause long-term sickness absence are pain in the lumbar region and problems emanating from the neck and shoulder region (brage, ihlebaeck, natvig & bruusgaard, 2010). njsr – nordic journal of social research vol. 4, 2013 57 there are several studies indicating that patients have negative experiences from their health-care encounters. werner and malterud (2003) have found that women with chronic pain were met with scepticism and a lack of understanding, although they made great efforts to be believed in. further, they worked hard to maintain their self-esteem and dignity as patients and women. in a recent swedish study it was found that approximately one-third of the studied population of long-term sickness absentees had experienced negative health-care encounters described as negligent behaviour, disrespectful treatment, and distrust (wessel et al., 2012). in eriksson, starrin, and janson's (2008) study of individuals on long-term sick leave with a psychiatric diagnosis, several of those interviewed experienced that sickness absence resulted in a reduction in status, which in its turn led them to withdraw from social contacts with friends and workmates. withdrawal is one means of protecting one's social self and a signal of shame (scheff, 2001). schei (2006) suggests that being a patient in itself contains a threat to dignity when transformed into an object of study, a phenomenon caught by the doctor’s eye. the potential shame of the patient is a barrier that has to be overcome by all in health-care encounters. persons with musculoskeletal illnesses associated with pain often report feelings of shame when physicians doubt their wish to recover (gustafsson et al., 2004). on the basis of interviews with persons on long-term sick leave vidman (2009) has found that her respondents, in addition to the limitations resulting from their symptoms, had to deal with distrust due to the invisibility of their impairments, which made it hard for others to understand. these difficulties lowered their self-esteem. most studies on sickness absence have focused on the causes underlying sickness absence and not on its consequences (bryngelson, 2009). knowledge about sickness absence as a social phenomenon is limited and the number of studies which systematically investigate how individuals perceive and experience their sickness absence are few. according to anthony (1993), an individual's own perceptions of the factors that are of importance for a return to work are of considerable prognostic value. recovery also includes more subjective outcomes such as self-esteem, empowerment, and self-determination (anthony, 1993). the present study forms part of a more extensive swedish-norwegian research project on the social factors of significance for sickness absence. sick-listing due to psychiatric and musculoskeletal diagnoses was selected as the main focus of the studies since they are the two most common diagnostic groups behind sickness absence. a number of studies have been conducted on the causes of sickness absence and on the perceptions and experiences of those on sick leave (solheim, 2011; batt-rawden & tellnes, 2012a; 2012b). the aim was to study the consequences of being on sick leave with a musculoskeletal diagnosis, the experiences of encounters with health-care and rehabilitation professionals, and the attitudes towards sickness absence from the perspective of the sick-listed persons. methods design and procedure we collected the data, in the form of individual interviews, during 2010 and analysed it qualitatively. a qualitative research design was selected as it is njsr – nordic journal of social research vol. 4, 2013 58 suitable for the study of a phenomenon that has previously not been sufficiently well understood (starrin et al., 1997). in designing the study, we paid particular attention to ethical issues and we obtained written consent before the interviews commenced (the swedish research council for humanities and social sciences, 1999). the research team was aware that the interview might deal with sensitive matters because the respondents might have suffered some traumatic experiences. there might be a risk that the interview would reopen ‘old wounds’. however, our previous experience of interviewing people in difficult situations is that respondents can react positively when somebody listens to their story and they have an opportunity to verbalize their feelings. the interview might also increase their understanding of themselves in that they have an opportunity to talk about and reflect on these issues, and thus it might even contribute to the healing process. still, if difficulties were to have arisen from the interview, arrangements were made to refer the interviewee to professional staff. however, the situation did not arise. there were no previous relations between interviewer and interviewee. the respondents were recruited with the aid of staff at the regional branch of the national social insurance agency, which registers and administrates sickness allowances for all inhabitants in sweden. two officials contacted by telephone individuals on sick leave who fulfilled the criteria for inclusion. all those contacted agreed to participate. the criteria for inclusion were as follows. the interviewees were to be long-term sick-listed (at least 60 days but no more than one year) or recently returned to work (after long-term sickness absence); swedish-speaking man or woman aged between 20 and 60, with at least halftime employment prior to sickness absence; living in the province of värmland, and diagnosed with some form of musculoskeletal illness of the following types according to icd-10 (the national board of health and welfare, 1999): m54.5 (acute lumbago), m53.9 (unspecified back illness), m54.9 (unspecified back pain), m79, r52 (established long-term non-malignant musculoskeletal pain), m62.6 (muscle strain), m62.9 (unspecified muscle disease), m75 (shoulder and shoulder-blade problems). the diagnoses were selected in consultation with medical staff. a strategic selection (i.e., purposive sample) was made to provide a spread in age, gender, and place of residence in order to achieve as rich and varied a picture as possible. we conducted the interviews as semi-structured individual interviews. we asked open questions in order to capture the respondents' stories expressed in their own words. the interviews lasted between one and two hours, were recorded, and then transcribed. apart from background questions the interview guide covered issues regarding sickness history, the respondent's own work and work environment, the balance between work and private life, and critical incidents in private and everyday life, the diagnosis, the rehabilitation, and finally the hopes and fears for the future. description of the study population the study is based on interviews with 17 individuals (eight women and nine men) who were on long-term sickness absence with some form of musculoskeletal diagnosis. almost all of them had pains in their shoulders and back and reduced mobility in their shoulders, arms or legs. in most cases, it was a question of gradually worsening repetitive strain injuries but there were njsr – nordic journal of social research vol. 4, 2013 59 a number of cases where the injuries were acute or sub-acute, having occurred as the result of a heavy lift or an accident. two of the respondents (a woman and a man) also had a psychiatric diagnosis. the respondents were between the ages of 33 and 60. ten respondents (five women and five men) were under 50, two men and one woman under 40. seven women were married or cohabiting. five of these families had one or two children at home. five men had partners, two of them with schoolchildren. of the four single men, two were divorced fathers with joint child custody. the level of education was relatively low. six men had completed the nine-year compulsory schooling and the other three had completed upper secondary school or vocational training. five women had completed upper secondary school or vocational training. all nine men were employed in the private sector and worked in the building, forestry, manufacturing or service and transport industries. three women worked in the municipal home-help service or school. four were privately employed in the service sector. one woman was selfemployed. analysis the interview data has been analysed using the grounded-theory approach proposed by glaser (2011). this analysis method involves a process of continual coding, categorization, and constant comparison of conceptual indicators in the data. the two researchers read each interview transcript repeatedly and made memos describing the relations between concepts and categories. the codes emerged from the data and the coding proceeded from the descriptive to the conceptual level in order to allow a core category to emerge. theoretical coding enables the conceptual integration of the core and related categories to produce hypotheses about the relationships, thereby making it possible to explain the latent pattern of the social behaviour of the sick-listed individuals that forms the basis of the emergent theory. the data coded under each category was re-examined to ensure that it was represented in the transcripts, thereby minimizing the risk of bias. excerpts from the interview transcripts are presented below to support and illustrate our categorization. false names are used in the quotations to prevent identification. we have also changed the place names and the names of workplaces, relatives or other identifiable attributes but without affecting the content. the regional ethical review board, uppsala, has approved this study (dnr 2010/014). results finding an acceptable life role the respondents experienced the social and health consequences of longterm sickness absence with a musculoskeletal diagnosis differently depending on illness, previous experiences, treatment, and total life situation. a pattern emerged from the interviews, which has been summarized in figure 1. njsr – nordic journal of social research vol. 4, 2013 60 figure 1. the sickness absentees’ relation to the work strategy as the norm and their main concern during the absence of finding alternative life roles to regain respect and acceptance acceptable life role the main concern given up reorientated returners disability pension another job old job work strategy/wage labour the norm ambivalent job or disability pension the figure shows the field of tension between work strategy/wage labour, which is the social norm, and the ability to find an acceptable life role as a sick person. since they were sick-listed, that is, not able to work and live up to the work strategy, they needed to find another life role to feel respected and accepted. even if all expressed a wish to work and irrespective of prospects of a return, the search for an acceptable life role became their main concern. four subgroups crystallized out with different acceptable life roles and with specific strategies for gaining respect in their own eyes and in those others. the following is an account of the significance of this thematic model. four different groups of sickness absentees we categorized the groups in accordance with how the respondents experienced and coped with their situation during their sickness absence in the search for an acceptable life role. those who had given up sought disability pension disability pension was the acceptable life role that this group strove for during their sickness absence. they did not see any pathway back to work. at the same time as disability pension could entail a sense of defeat, of no longer being capable of working, the idea produced a feeling of relief. there would no njsr – nordic journal of social research vol. 4, 2013 61 longer be any need to get a doctor's certificate for continued sickness absence and absence from work would gain a legitimacy, which meant that they would no longer need to be on their guard against those around them. two individuals (a man aged 58 and a woman aged 60) were included in this group. those who were ambivalent vacillated between a return to work and disability pension characteristic of this group was that they vacillated emotionally between returning to work and trying to obtain a sickness pension. they felt a pressure to return to work too early despite the fact that they were unsure of a permanent return because they still suffered from obvious health problems. the group consisted of two women and two men between the ages of 34 and 48. the individuals in this group had as yet not found a final acceptable life role. those who had reorientated turned their sights on a new job three women and three men between the ages of 32 and 58 had injured themselves in their previous work and had been advised to look for a job that was better adapted to their disability. sickness absence was for them a signal to change jobs. at the time of the interviews, they were in the process of finding new solutions and accepting some retraining. an alternative job was their acceptable life role. the returners went back to their old job this fourth group consisted of three men and two women aged 46-59 without previous experience of long-term sickness absence. they experienced their sickness absence as emotionally unproblematic and more as a stage in their rehabilitation, pending a possible operation. they really saw themselves as ‘healthy’ and reckoned that they would eventually be completely fit for work and could return to their old job. their acceptable life role was thus a return to their previous job. even though there were certain experiences common to all the sickness absentees, their experiences and the way they coped with their life situation was clearly marked by the category to which they belonged. in the following presentation, therefore, the emphasis is on the features that distinguish the groups from each other as regards sick role, attitudes to work, and social relations, including relations with the rehabilitation institutions (i.e., health care and the social insurance office). experiences and perceptions during sickness absence varying attitudes to the sickness role for the group who had given up, their illness formed and controlled their daily lives. their illness placed a limitation on their everyday existence and, because of severe pain, they suffered sleep problems. viktor, 58, who had injured his back in connection with loading, was up walking all night and could only sleep or rest in short periods. rita, 60, who was physically worn down after two decades as a cleaner, could not manage cooking, cleaning or dressing without help. an adult daughter often helped her with everyday matters. rita described a typical day in the following terms: njsr – nordic journal of social research vol. 4, 2013 62 it's very tedious. i just lie on the sofa watching television all the time, sit at home, don't go out, can't cope, don't see anybody, but workmates phone sometimes. viktor and rita had extensive health problems and did not believe their health would improve sufficiently for them to start working again. ‘i reckon i'm through with work’, was viktor's comment. as concerns rehabilitation, viktor felt that it was pointless for him and not at all adapted to his individual situation, and though rita had been on sick leave for almost a year, she had not been offered any form of rehabilitation during this period. those who were ambivalent had also previously suffered from extensive health problems. they expressed feelings of being under pressure to return to work before their injuries had healed or their pain abated. ingvar, 48, who had been in the same workshop all his working life and on sick leave for six months when interviewed, was very concerned that returning to work too early would aggravate his problems, which would result in an even longer sickness absence. those who had reorientated gradually came to realize that their sick leave was clearly related to their work and that it would be impossible to return to the same workplace. after some time they began to look for alternative solutions. despite his injury, patrik, a 39-year-old carpenter, attempted to return to his work after six months on sick leave but was in such pain that he had to give up. as he expressed it: it was a big defeat ... and then i realized it was over. ... [i] have never had any other job. [i] hope to retrain. i'm waiting to start. it's tough, but that's how it is. i'm not so old, have 26 years left to work, so i'll have to do something else. the returners did not see themselves as sick but maintained that their body had been damaged as a result of an accident or hard work. it was not so bad that they could not live with it. none of those in this group had suffered from long-term sickness absence earlier and they described themselves as ‘alert’, ‘active’, and ‘healthy’. prospects of returning to work influenced attitudes to work all the respondents stated that they really wanted to work. they had internalized the social norm of the work strategy but their attitudes both to work and to the role of work were influenced by the prospects of returning to work. those who had given up had had a long and hard working life. both individuals had left school early and worked from that point on. work was important to them but they were unable to work because of their extensive health problems. they also did not see any other jobs compatible with their current capacity. njsr – nordic journal of social research vol. 4, 2013 63 those who were ambivalent described work as important for social contact but, above all, they expressed a strong work ethic. ulrika, 46, who had worked in the home-help service and suffered repeated injury from heavy lifts, maintained that she had a sense of value when she worked; she also said that it was her duty to work. those who were ambivalent all voiced a tension between two worries. on the one hand, they expressed the fear that their being on sick leave would cause them to be labelled as work-shy; on the other, they were concerned at the same time about being forced to return to work before they had completed rehabilitation. those who had reorientated had heavy jobs but the fact that they liked their work meant that they had remained at their workplace even though, long before the last sickness absence, they had understood that it was the job that was causing their problems. during their sickness absence, they gradually began to have second thoughts and to look forward to a new job. eva, 43, who worked in a shop, had previously undergone an arthrodesis operation for a back injury and then suffered an increasing lack of feeling in one hand and arm. just prior to the interview, she had begun training to run a home for taking care of other children, ‘since i think that my body could cope with that – receiving children and young people at home’. common to the returners was their professional pride, job satisfaction, and fellowship. they had status in their workplaces in that they were knowledgeable, experienced, and well liked. during her sickness absence, colleagues had sent flowers and letters to nina, a 46-year-old animal keeper, who was waiting for an operation on an injured shoulder. she had also visited her workplace several times and felt that she was still a member of the team. secure or insecure social relations social relations contributed to no little extent to shaping the sickness and work roles. those who had given up had tense relations with their families, friends, fellow workers, superiors, and health-care staff. they felt they had no real support from anybody apart from the odd relative or acquaintance. both had been involved in conflicts at the workplace before their sickness absence. viktor became depressed when he reflected on the mistrust directed towards him from both senior management and fellow workers who ‘whispered’ behind his back. even his neighbours treated him with mistrust. he came here, half drunk, started on me saying i wasn't that sick. .... then i went and fetched the medical certificate and showed him. ‘ok, but i'm sure there's something you could do without living off the taxpayer.’ … then i got angry. after that, i haven't had much to do with him. rita did not feel she had been offered any form of rehabilitation. she was shunted between different doctors and did not get answers to her questions such as: ‘what's the matter with me?’ ‘what's going to happen now?’ she also found it very trying to have to describe her symptoms to new people repeatedly. respondents in the other groups did not describe any open mistrust. however, those who were ambivalent experienced general mistrust towards people who were on sick leave. therefore, they only told a few people who they felt they could trust about their sickness absence. ingvar's strategy was to lie njsr – nordic journal of social research vol. 4, 2013 64 sometimes and to say he had time off to avoid having to answer the same questions all the time. he considered it was ‘difficult to make people understand how i felt’. those who had reorientated generally indicated that they had secure social relations with their families and their social networks. sometimes it was the case that the relations had improved during the period of sickness absence as they had more time to spend with their children and friends. for instance, erik's children appreciated the fact that father was home in the mornings and made breakfast for them. their secure network was also seen as providing an environment where they did not need to pretend but were accepted for what they were. even relations with their case officer at the insurance office were described as good and supportive. however, relations with the health-care service were seen from the start as problematic and a major source of irritation, perhaps because they were not given a thorough examination, had a feeling that the doctor thought they were simulating their sickness, or felt that waiting times were long. nina put this in the following terms: all that waiting. it's a scandal that swedish health care should take such an awfully long time. it causes a lot more suffering and costs a lot more. several in this group had changed doctors or had to wait a long time for an appointment with a specialist. some telephoned and persisted until they received quicker treatment. getting a new doctor raised their spirits and they were generally satisfied with the measures taken but not with all the waiting they had experienced. moreover, several in this group claimed that it was a doctor, physiotherapist or welfare officer who opened their eyes to the possibility of doing something different. the basic reason seems to be that they listened to and treated their patients seriously, which restored their hope for a better future. it had taken several years for pia, a 41-year-old assistant nurse with repeated sickness absences, to obtain a medical analysis of the causes of her problems. she felt that the doctors on previous visits had adopted a nonchalant and uninterested attitude, and they found it much easier to prescribe more analgesics rather than to listen to her questions about the underlying causes of her problems. her questions were not taken seriously and she often felt ‘diminished in the encounter’ the returners provided innumerable descriptions of the support they had received from their families, neighbours, and fellow workers during their sickness absence. anders, for instance, a 57-year-old worker in the timber industry who was in a great deal of pain, reported that his neighbours went shopping for food for him, and nina, the 46-year-old animal-keeper, expressed it in the following terms: if i hadn't had the social safety net but had sat in an apartment and had a job where i wasn't welcome back, then i would've given up a long time ago. during their rehabilitation, some of the returners had also formed new social relations and networks with others in the same situation during the time they participated in various group activities for those on sick leave. this made it easier for them to gain access to a social environment that treated them with respect and openness. conversations with others in different groups also led to a certain understanding for and solidarity with others on sick leave – ‘there njsr – nordic journal of social research vol. 4, 2013 65 are those worse off than me’. the returners also believed that the good contacts they had with their case officers at the insurance office were in part due to the fact that they agreed to the proposed rehabilitation and that they also showed initiative in making efforts to be able to return to work more quickly. they were ‘good patients’. experiences of being on sickness absence affected status and self-image it is clear that an individual's self-image is formed by their perception of how others see them. being treated with open mistrust and burdened with guilt could create a powerful sense of shame and result in withdrawal from social relations to avoid the risk of further shaming. those who had given up believed that their only means of improving their selfimage was to obtain a disability pension: ‘then i'd get a dignified end to my working life’, said viktor. in the ambivalent group anna, a 36-year-old children's nurse, felt she had changed during her time on sick leave so that she no longer recognized herself but thought of herself as being surly and dull. she asked her son to answer the telephone, to lie, and to say she was taking a shower in order to avoid talking. several of those on sick leave thought it problematic that they were expected to behave in a certain way and that their illness should be visible. ‘pain is not visible’, was a comment from a number of them. in most cases, they felt that a clear and distinct diagnosis or a visible disability was necessary if they were to justify their sickness absence. among those who had reorientated, there were several examples where the expectations of their environment were seen as problematic and in contradiction to how they wished to present themselves. pia did not want to show her crooked back and christer did not want to appear as a cripple. however, a safe environment meant that it was possible to let go of these expectations. ‘now everybody knows i'm in pain’, said tomas, 33, who had gone on working with severe pain until it became impossible – ‘it's obvious i'm in pain’. the financial situation for all of them had deteriorated but not all of them experienced financial stress. one used their savings; another borrowed from a close relative. in one case, the partner resolved the situation by working longer hours. several had reduced their outlay, switched to a cheaper car and so on. however, rita, whom we have met earlier, was worried that they would have to sell their house and nina did not like being financially dependent on her partner. financial stress could create a sense of shame. this is partly a question of being perceived as poor or, as in viktor's case, the negative feeling of being dependent on his wife for the family's income. the returners felt so secure in their sickness role that they remained unaffected by their environment. furthermore, they perceived themselves as healthy and as legitimately sick-listed and did not see these issues as a problem. on the other hand, those who had reorientated experienced certain mistrust at the beginning of their period of sickness absence. when they had njsr – nordic journal of social research vol. 4, 2013 66 successfully managed to get better care and to orientate themselves towards a new job, their self-image strengthened. the pride of returning to work was the predominant feeling in both of these groups and they were treated with respect. discussion the main result of this hypothesis-generating study is the exemplification of the tension between the work strategy as the social norm and finding an acceptable life role from the perspective of both the individual and the people around. the respondents' life situation during the sickness-absence period largely concerned the issue of convincing those around that their pain was real and that their sickness absence was justified despite the mistrust and disrespect. however, those sick-listed with a musculoskeletal diagnosis proved not to be a homogeneous group. we identified at least four groups who coped with their sickness absence in substantially different ways. the respondents in the different groups experienced markedly different treatment from both the health-care system and other actors concerned with their rehabilitation. their differing experiences had an effect on which strategy they used to find an acceptable life role and to gain respect. the value of being treated with respect for facilitating the process of rehabilitation emerges in other studies as well (kugelmann, 1999; werner & malterud, 2003, wessel et al., 2012). treating people with respect may also affect the experience of health and pain. in the current study, the four groups on sick leave needed to apply different strategies. the group with dimmer prospects of returning to work was also the group that had most experience of being mistrusted and treated with disrespect. the disrespect described was both direct and indirect. this was the group that apart from struggling to gain respect and credibility also spent much time, energy, and effort in preserving their self-esteem and dignity, both as patients and as clients. semmer and his colleagues (2007) have shown that being treated in a disrespectful and disparaging manner represents a threat to an individual's self-esteem. it arouses negative feelings of failure and shame and has consequences for well-being. as illness is related to an individual's personal identity, general societal campaigns against sickness absence may have a counterproductive effect in that exposed groups feel even more exposed (hofmann, 2011). this also concerns the status of different diagnoses. at the bottom of the status ladder are musculoskeletal and psychiatric diagnoses (album & westin, 2008). the respondents in at least three of the four groups in the present study had difficulty in coping with the fact that their illness was not visible and thus they risked being treated as malingerers by both the health-care system and those around them. to a large extent, they also took the blame for their illness upon themselves and this demonstrated that they had accepted the view of sickness absence as an individual problem. at the same time, they had also shown responsibility and willingness to work by carrying on and fulfilling the moral decree that one should work. they were aware of the distrust that existed towards those on sick leave and, on occasion, even shared this doubt themselves. when they did fall ill, they strove therefore by means of various strategies to regain respect in order to avoid feeling disparaged, failed, and ashamed. nevertheless, several of the njsr – nordic journal of social research vol. 4, 2013 67 respondents pointed out that a psychiatric diagnosis had an even lower status both for them and for the people around them. vidman (2009) also shows that the experience of being ill differs between those with mental ill health and those with musculoskeletal disorders. no clear gender differences emerged in the present study. the group to which the individual belonged seemed to be of greater importance for their perception of the situation. this may possibly be explained in part by the fact that several of the informants were older, did not have children at home, and were single or separated and thus had shared responsibility for the children. the four groups of sickness absentees that emerged in the study experienced their sickness absence in different ways. their pathways back to work also differed. it was evident that the period of sickness absence was lengthened for many of them through the long waiting times in the health-care system, which resulted in frustration and further suffering for the individual. waiting may also aggravate the illness (charmaz, 1983). the results demonstrate the value of not treating those on sick leave with a musculoskeletal diagnosis as a uniform group and indicate how important it is that those providing rehabilitation adopt a sensitive attitude and listen to the wishes and views of the individual in question. the need, for instance, for the alleviation of pain, an operation, a medical analysis or psychosocial support may differ from patient to patient. the group which in larsson lund's study (2001) had the shortest period of rehabilitation included those who felt they had actively participated in their own recovery. it is also evident that efforts and support on the part of close relatives was also of great importance for how they experienced their sickness absence. furthermore, on many occasions the respondents themselves took the initiative in their process of recovery by, for instance, training, walking, and reorganizing work at home. the results show that even though they have worked hard some persons were experiencing disrespect and the treatment they received unnecessarily increased their suffering and hindered their recovery. the focus of the current study has been on the life situation for the men and women on sick leave with musculoskeletal diagnoses. these, together with the psychiatric diagnoses, constitute the two major diagnostic groups for longterm sickness absence in sweden. despite this, these diagnostic groups receive less research funding, which has consequences for the level of knowledge. there is an urgent need for more research on these diagnostic groups; we also believe that continued research should, to a great extent, take the total life situation of the sickness absentee into account and place it in the social context. an approach of this nature would also be in agreement with a transition to a biopsychosocial concept of illness. this concept enables the medical system to reflect on the relationship between the organization of society and ill health and involves the experiences of the individual, as this study has done, adding biological signs and statistical links (michailakis, 2008). although the current study is based on the experiences and perceptions of a limited number of individuals in a special context, the idea is that, in accordance with grounded-theory analysis, what has emerged from this study can be transferred to sickness absentees in other contexts. however, the results cannot be generalized directly to all long-term sickness absentees with musculoskeletal diagnoses. several studies are needed to test the hypothesis njsr – nordic journal of social research vol. 4, 2013 68 that sickness absence concerns striving for an acceptable life role in order to regain respect in one’s own and other’s eyes. acknowledgements there is no conflict of interest to be declared in this study. the study was funded by the norwegian research council (nfr). references album, d. & westin, s. 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(2009). långtidssjukskrivning som en fråga om att bete sig rätt [long-term sick-listing as a question of behaving properly]. in j. sandvin (ed.), arbete, sjukdom och moral [work, sickness, and ethics] (pp. 75-98), lund: studentlitteratur. microsoft word blom & morén the evaluation of quality in social-work practice.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 3, 2012 the evaluation of quality in social-work practice björn blom dept. of social work umeå university email: bjorn.blom@socw.umu.se stefan morén dept. of social work umeå university email: stefan.moren@socw.umu.se abstract this theoretical article describes and discusses the concept of quality in relation to the evaluation of social-work practice. of particular interest are the difference between quality of services and quality of life and the importance of balancing the stakeholders’ different interests in order to make a sound judgement of quality in social work possible. this article begins with presenting some basic perspectives on quality as well as the transference of the concept of quality from manufacturing industry to social-work practice. thereafter the two main issues are discussed: the concepts of quality of service and of quality of life and the importance of balancing different stakeholders’ perspectives in the evaluation of quality in social-work practice. this article concludes that: 1) it is crucial to be aware of and to consider the distinction between quality of service and quality of life; 2) clients’ perspective on quality of life is an aspect of outcome that currently receives insufficient attention; 3) clients’ subjective experiences of welfare or well-being deserve greater attention for ethical as well as methodological reasons; and 4) judgement of quality in social work are inevitably dependent on different stakeholders’ perspectives. keywords: evaluation, quality of life, quality of service, welfare, well-being, social work njsr – nordic journal of social research vol. 3, 2012 72 why focus on quality of life in social-work practice? it is probably not controversial to claim that it is important to evaluate socialwork practice. it is also reasonable to assert, as stake and schwandt (2006) do, that evaluation to a great degree is concerned with discerning and substantiating quality. at a general level we can presume that most people would agree on this point, whether they are a politician, civil servant, researcher, social worker, client, taxpayer and so on. however, at a more concrete level – when it comes to the evaluation of specific activities – it can be far more difficult to reach a consensus about what should be evaluated and how an evaluation should be carried out. the authors of this article believe that one reason that makes it difficult to obtain unity about the evaluation of social-work practice is that there are a number of possible answers to a basic question: why does social work exist? there are several ways to respond to this question and the conceptions can differ between individuals, organizations, countries, cultures, and more. let us present a few examples. one answer might be that social work exists because people have material needs that must be met. another answer might be that social work exists in order to get the ‘societal machinery’ to run smoothly by fixing the problems that ‘disturbing’ citizens create. in other words individuals with problems are to be (re)adapted to society. a third way of viewing this is that social work aims at developing and changing societies. yet another answer is that the purpose of social work is to emancipate people from constraining forces and structures in society. in this article we argue that social work primarily exists in order to maintain a good quality of life or to improve the insufficient quality of life that socially vulnerable people might often face. this is a normative standpoint, which we believe has concrete consequences for evaluation of social-work practice. it directs a focus on quality of life as an important aspect of an outcome and it reminds us that the stakeholders’ perspective is constantly present. the aim of the article this article discusses quality in relation to the evaluation of social-work practice. the aim is to highlight and to investigate two important aspects of this issue: 1) the difference between quality of services and quality of life: we especially point to the relevance of the latter in the context of social work. 2) the importance of balancing the stakeholders’ different interests in order to make a sound judgement of quality in social work possible: in this act of balancing, we especially stress the relevance of the clients’ perspective. as the evaluator often has the most far-reaching possibility and responsibility of considering different aspects of quality within an evaluation, the issue of quality is primarily discussed from the evaluator’s perspective. first we present, as a background to the discussion of the two main issues, some basic perspectives on quality as well as the transference of the concept of quality from manufacturing industry to social-work practice. one important aspect of this transference is the differences between quality of goods and njsr – nordic journal of social research vol. 3, 2012 73 quality of services. we shall thereafter address the first main issue and discuss the concepts of quality of service and quality of life in relation to social work. two central aspects of quality of life are stressed, welfare and wellbeing. the discussion of the second main issue involves the delicate matter of balancing different stakeholders’ perspectives in the evaluation of quality in social-work practice. we emphasize especially the importance of acknowledging the client as a stakeholder. finally, the article ends with a brief concluding discussion. to a large extent, this article draws from our own experiences of evaluating different social-work agencies (mostly municipal social services) in different parts of sweden (e.g. blom, 1996, 1998; blom & morén, 2007; morén, 1992, 1996; morén & blom, 2003; nordlander & blom, 2000). we have also developed a theory for evaluation of social-work practice, concentrating on the way social work is organized in the nordic countries (blom & morén, 2010, 2011, morén & blom, 2003). perspectives on quality the concept of quality stems from the latin word qualitas, which means ‘property’ or ‘characteristics’. the concept also implies an order of precedence, that is, the discerning of something that is considered to be good or desirable (dahler-larsen, 2008). in everyday life it is fairly self-evident and unproblematic to talk about different qualities of cars, clothes, furniture, and so on. these items are considered to have different characteristics that can be graded as better or worse. in contrast, when it comes to social work we have to consider immaterial and abstract entities like structure, process, and goalfulfilment. in the course of carrying out evaluations, we face the task of discerning, describing, and measuring qualities of these immaterial and abstract entities. discerning quality in social-work practice necessarily includes expectations and comparisons (stake & schwandt, 2006). there is always someone (an individual, group or stakeholder) who has certain expectations concerning the quality that is to be judged. one cannot talk about quality (in a positive meaning) without involving comparisons, and sometimes even words that denote the lack of quality, like ‘inferiority’, ‘meaninglessness’, or ‘worthlessness’. this means that quality is rarely unambiguous and is often disputable. as stake and schwandt note, ‘quality is multifaceted, contested, and never fully representable’ (2006, p. 405). consequently, perspectives, concepts, and theories are needed to help us to capture this elusive property. dahler-larsen (2008) defines quality from five perspectives: 1) reducing variations around a defined standard, 2) obtaining certain effects, 3) reaching declared political goals, 4) meeting the preferences of the users, and 5) securing quality by the organizational system. these perspectives build on different problem areas as well as different criteria of quality. 1) reducing variations around a defined standard. this perspective presumes that there is a certain quantitative or qualitative standard regarding what is considered to be an acceptable level of quality. for example, it can be about certain types of work tasks that are expected to be carried out within a stated time limit (quantitative), or about attaining in recurring surveys a certain level of reported client or customer satisfaction (qualitative). thus, the criterion of njsr – nordic journal of social research vol. 3, 2012 74 quality in this perspective is about the work being as close as possible to a stated standard. however, there can be different sources that influence the formulation of these standards, like political agreements, managerial considerations or different stakeholders’ preferences. standardization sometimes serves as an effective guiding principle, but in a complex enterprise like social work there are many elements that are not possible to standardize. for example, the relationships and therapeutic alliances between social workers and their clients cannot be standardized. however there are a number of fundamental aspects of the relationships between social workers and clients that have shown to be relatively general and thus important to pay attention to when evaluating social-work practice. these are, for example, empathy, commitment, trust, caring, genuineness, and acceptance (frank and frank, 1991; howe 1987, knei-paz, 2009; miller & rollnick, 1991). 2) obtaining certain effects. public organizations are often described and valued on the basis of the resources they possess and the welfare services they deliver (i.e., outputs). a typical measure for these outputs would be, for instance, the number of treatment sessions or a certain number of residents in a home for geriatric care. it is equally important, however, to obtain knowledge on the effects of these interventions in people’s lives (i.e., outcomes).1 accordingly, the criterion of quality concentrates on the improvements that are achieved in people’s lives and in society at large. this knowledge might be difficult to obtain, especially if one wants to know if the effects stem solely from interventions. in spite of the difficulties it is not impossible to obtain this kind of knowledge from an evaluation. in the field of human services, efforts are made to handle this problem from different methodological and metatheoretical perspectives, for example, by using experimental or quasiexperimental designs (roberts & yeager, 2004) or a critical realist approach (blom & morén, 2010; kazi, 2003, pawson & tilley, 1997). 3) reaching declared political goals. political decisions form the source of the overarching goals of public organizations. for social-services agencies and other similar agencies, a common point of departure for the evaluation of quality is the political goals on different levels in the so-called parliamentary chain of governance (see vedung, 2009). accordingly, the criterion of quality is about the extent to which political goals are obtained. a common problem with this perspective is that political goals are often stated in a generalized way, which makes them rather tricky to measure empirically. further, especially in complex enterprises like social work, interventions may also cause side effects, both positive and negative, that are not present in the general political goals. an evaluator’s concentrated focus on an organization’s achievement of political goals (e.g., the implementation of a purchaserprovider split) could mean that unintended consequences (e.g., diminished cooperation between professional) go unnoticed. 4) meeting the preferences of the users. in the same way that customer investigations are carried out in profit-based private enterprises, it is now almost standard procedure to ask for clients’ or users’ opinions on the interventions in public organizations. the users’ opinions provide a criterion of quality and contribute to continuously developing the activity and in this way help to even out differences in power relations in society. however, in social 1 the meaning of the concepts ‘outputs’ and ‘outcomes’ will be described below. njsr – nordic journal of social research vol. 3, 2012 75 work it is not always obvious who the users are. a certain type of intervention might focus on, say, vulnerable children or adolescents, but these may not be the only users; their parents, siblings, and grandparents may also be users. sometimes information can be gathered indirectly by turning to different user organizations. to secure quality by means of the organizational system. this perspective involves the idea that quality is a matter of controls that should be built into the organizational structure. this kind of ‘quality assurance’ often involves different documentation systems that ensure the continuous gathering of adequate data. sometimes this kind of system is criticized for being too generalized and abstract and therefore unable to focus at the quality of client work itself. these five perspectives provide a basis that takes us part of the way to understanding the meaning of quality. in the rest of the article, we shall discuss the concept of quality and the evaluation of quality, especially in relation to the area of social work. the issue of quality – from the manufacturing industry to social-work practice somewhat surprisingly, many of the issues concerning quality in social-work practice come from the manufacturing industry. the focus on quality in the manufacture of goods was a way of reducing the amount of products that needed to be thrown away. in a free market it is important for the survival of a company that the quality of its products corresponds to the customers’ expectations and willingness to pay. this means that the quality of a product is defined not only in relation to the product itself, but also to the customer’s expectations concerning, for instance, the cost, appearance, reliability, performance, safety, and environmental influence. this way of reasoning about quality, which concerns material goods, spans from the purchase of a cup of coffee to the purchase of a car or an apartment, is for most people a natural part of everyday life. this mindset was gradually transferred from the manufacturing industry and used as well in the service sector. the concept of quality came to include the production of physical goods and of services because of the need to compete in a market. table 1 below shows a comparison between goods and services. even though social workers are not salesmen and clients are not customers, it is obvious that social work involves the production (or rather provision) of services. let us imagine, for example, a woman who has contacted a social worker at a hospital in order to share her feelings after a miscarriage. this type of counselling means, by necessity, that the service is provided and consumed simultaneously in the encounter between these two persons. the service itself cannot be stored, but the experience of the service can linger on in the consciousness of these persons. though services are delivered and consumed almost simultaneously, it is important to consider that necessary conditions for services already exist before the services are provided (e.g., social workers’ education, organizations, resources, laws). this point implies that we must account for contextual factors if the ambition is to reach a more comprehensive understanding of how quality in social-work practice emerges. njsr – nordic journal of social research vol. 3, 2012 76 table 1. examples of differences between goods and services. source: sundström (2009:25, our adaptation). physical goods services production à consumption production and consumption are often simultaneous a physical product an activity or a process the basic value is produced in a factory or similar place of production the basic value is produced through the interaction between customer and provider the customers usually do not participate in the process of production the customers participate in the process of production can be stored (with the provider as well as the customer) cannot be stored indirect contacts (e.g., through a retailer) often possible direct contact often necessary so far we have discussed the fundamental differences between goods and services and that quality not only relates to the inherent properties of the product or the service, but also to the experiences of the customer or client. the phrase ‘the customer is always right’ captures this idea in the business sector. the customers’ attitudes and preferences serve as guidelines for the kinds of products or services that will be delivered – even if the customer’s apprehensions do not correspond to the general (or societal) ideas concerning what is appropriate to demand. in social-work practice, depending on the character of the task, this matter is somewhat more complex. one major reason for this complexity is that the client does not have the sole prerogative to claim what good quality is. this is an issue about stakeholders’ perspectives, which will be discussed in a later section, but first we shall focus on the difference between quality of service and quality of life. quality of service and quality of life different types of public organizations, such as the social services, the healthcare system, and schools, often carry out social work. obviously, it is important that these organizations function as well as possible, that is, that they provide a good quality of service. this kind of quality refers to the resources and professional competences in the organization and the service that is provided. what is equally important is that these resources and services lead to the intended results, that is, improvements in the clients’ life-situation, or, more succinctly, a good quality of life (or at least better than before). this kind of quality refers to life circumstances in general, as well as well-being. osborne (1992) shows how the evaluation of social work not only demands a working knowledge of quality of service and quality of life, but also knowledge about the influences of context. figure 1 below illustrates osborne’s view on quality in relation to the evaluation of human services. njsr – nordic journal of social research vol. 3, 2012 77 figure 1. production of human services and their links to quality of service and quality of life. (osborne, 1992:447). human services influence of social environment consumers inputs serviceproduction process outputs (services) intermediate outcomes (effects) final outcomes (impacts) quality of service quality of life figure 1 shows that a comprehensive judgement of quality in social-work practice must consider both what is going on inside the agency or organization (i.e., quality of service) and the effects of the services on a client’s life-situation (i.e., quality of life). moreover, the figure demonstrates that the social environment always affects an agency’s interventions. for example, this latter aspect could refer to the client’s life-situation in general or to circumstances in the local community. in the figure there is also a distinction between ‘outputs’ and ‘outcomes’, where the former is connected to quality of services and the latter to quality of life. the concept of ‘outputs’ refers to an agency’s or organization’s performances, in the form of, for example, the number of decisions made in relation to a certain type of errand, the number of performed therapeutic sessions or the number of hot meals that were distributed to elderly people. the concept of outcomes denotes the effects of such interventions in the clients’ lives, that is, improvements in the life-situation of clients. the results in respect of quality of life can also be measured at certain points in time, partly as intermediate outcomes (in the short run), and partly as final outcomes (in the long run). figure 1 also indicates a qualitative distinction involving outcomes. a certain intervention can lead to a person to refrain from drugs (‘effect’), which can, in turn, lead to other improvements in that person’s quality of life (‘impact’). besides the temporal dimension, the results also have dimensions of surface and depth, which osborne’s model does not account for. we have previously pointed out that the question of results in social work is extraordinarily complicated to conceptualize and study (cf. blom & morén, 2007, 2010). we argue that the results of social work are partly characterized by surface aspects (e.g., the freedom from drugs and an adaptation to demands of the surrounding environment), and partly by depth aspects (e.g., a reappraisal of one’s previous way of living and relation to other people). there is also a temporal dimension, which means that we can talk about results as a process. this highlights, as an aspect of the complexity of the task, the fact that change in social-work practice cannot be unambiguously established at a certain point in time; it is dynamic and changeable. njsr – nordic journal of social research vol. 3, 2012 78 osborne (1992) also argues that quality of life can be divided into welfare and well-being.2 in general terms welfare means ‘individual satisfaction of needs’ (which roughly corresponds to abraham maslow’s hierarchy of needs), and well-being means ‘individual experiences of life’ (osborne, 1992, p. 444). these types of quality of life can, according to osborne, be valued from objective as well as subjective criteria. consequently, there are four different aspects of life quality, as table 2 demonstrates. table 2. four different aspects of quality of life. (adapted from osborne, 1992:444). type of life quality criteria objective subjective welfare (individual satisfaction of needs) e.g., socio-economic status, health condition e.g., oral or written accounts (e.g., ‘i get the help i need’ or ‘i never have money for a vacation’) well-being (individual experience of life) e.g., psychological tests or instruments e.g., oral or written accounts (e.g., ‘i felt like a king’ or ‘the future looks dark because…’) in short, this model illustrates that quality of life relates to two basic dimensions: welfare and well-being. these dimensions can be measured with objective as well as subjective criteria. a cross-tabulation of dimensions and criteria yields four different aspects of quality that can be used as a guide when conducting empirical studies. the importance of distinguishing quality of service from quality of life distinguishing quality of service from quality of life is important in several respects. for example, it illustrates the general difficulty in equating good quality of service (e.g., interventions in social-work practice) with good quality of life because appropriate interventions do not necessarily result in a good or better quality of life for the client. an almost ‘classical’ example would be the swedish ‘uppsala model’, which was developed during the 1990s; this was an programme of activation for persons applying for financial subsidies from the social services. in brief, this programme established a higher quality of service in some respects; all clients were treated quickly, equally, and to the same 2 the concepts of welfare and well-being are somewhat difficult to define because the literature varies a good deal in this regard (see, for example, baldwin, godfrey & propper, 1992; dickinson, 2008; jordan 2008). in this article we have chosen to use osborne’s definition since it explicitly relates these terms to the evaluation of quality in human services. moreover, many other definitions of welfare and well-being are quite similar to osborne’s. njsr – nordic journal of social research vol. 3, 2012 79 standard. it was assumed that the quality of life (in respect of welfare) improved for those clients who received monetary benefits. however, evaluative studies of the programme showed that several clients were not helped, and that quality of life (as subjectively experienced well-being) for many clients deteriorated as a consequence of the programme (karlsson, 1995; milton, 2006). many clients felt offended, sad, and despondent. on the other hand, there are other examples where the interventions in some respects were inferior, but the results for the clients were positive. for instance, in one of our studies (blom & morén, 2007), we noted that personnel at a treatment clinic treated a young woman with drug problems in a deeply offending manner. however, thanks to persons in the young woman’s social network (e.g., other professionals), she was able to transform her negative experiences into something positive. she turned the feelings of being offended into anger and that made her more motivated to quit using drugs. this effect can be a consequence of the fact that social work always takes place in a context where social workers’ interventions interact with other and often unpredictable factors in the clients’ surroundings (blom & morén, 2010). the conclusion is that it is not sufficient to focus merely on the quality of service, even if it is a highly important aspect of quality in social work. the problem with regarding all sorts of quality of results as quality of life for clients another problem that arises when evaluating social-work practice is that it is uncertain how clients’ quality of life relates to other types of quality of results. this problem can take one of two different expressions: 1) all types of quality of results are considered to be important for the clients, and 2) a certain type of quality of results is regarded as more important than others. let us start with the first expression of this problem, that all types of quality of results are considered to be important for the clients. as we see it, not all indicators of quality of results are adequate for evaluating clients’ quality of life. changes which are positive for politicians, managers, social workers, other professionals, taxpayers and others do not always have a positive influence on clients’ quality of life. sometimes several assumptions about the quality of results obviously coincide, so that most stakeholders can agree that a certain measure mirrors a positive change. an example would be the survival of a drug abuser as a result of the social services’ interventions. but unanimous opinions about results are not always the case in social-work practice. imagine, by way of example, evaluations that concentrate on compulsory care of people with psychiatric problems, drug addicts or youth with detrimental behaviour. these are examples of rather drastic interventions that from the society’s perspective can be highly desirable. these types of interventions can be carried out with a high quality of service, can be costeffective, and can lead to reduced levels of burglaries, gang violence, persons with mental problems in the streets and so on. in this respect the quality of results would be high – but mainly for others than the clients directly affected. for the clients such interventions can mean that their quality of life declines, and some of them will probably receive rather unwanted interventions. this, in turn, could make them feel worse – at least in the short term. our point is that njsr – nordic journal of social research vol. 3, 2012 80 all sorts of quality of results are not important from a client’s perspective and cannot routinely be ranked as being equal to quality of life. the other expression of the above-mentioned problem is the claim that a certain type of quality of results in social work is more important than other types. for example, in the present discussion on social work and evaluation there are many who argue in favour of evidence-based practice (ebp). it is said to be the most ethical to use interventions or methods that have been proven in previous studies to produce positive client effects, that is, results in the client’s life-situation (above all, as changed behaviour). by way of ethical arguments advocates of ebp have thus asserted that client effect is a superior dimension of the quality of results. obviously, it is hard to argue against the claim that results in the form of client effects are important in social-work practice. nevertheless, it can be questioned if client effects are always the most relevant dimension of quality of results. we can also ask the extent to which client effects are comparable to changes in quality of life. in our opinion it is problematic to adopt an a priori view of client effects as being equal to clients’ quality of life. from time to time – as in the example above – clients do not want help and therefore experience a reduced quality of life as a result of the interventions. moreover, measures that are used for evaluating client effects sometimes do not reflect clients’ quality of life accurately. currently it is quite usual that client effects are measured through standardized instruments that concentrate on behavioural change (e.g., changes in use of alcohol and narcotics). often these instruments are very useful for social workers and researchers, but the diminished use of drugs, for instance, does not necessarily mean an increased quality of life for the client. the addictive behaviour can persist but in other forms, like a gambling addiction or eating disorders, which make the client feel terrible. in sum, we argue that clients can still have problems and feel bad after (or as a consequence of) a programme, in spite of the fact that quality in relation to client effects are good. it is consequently problematic to claim that a certain type of quality of results is more important than other types.3 we do not claim that social workers always must pay most of their attention to their clients’ conceptions of the results. sometimes, for example, other persons’ need of protection and stability are more important than a client’s desire to live his life as he or she wants. what we emphasize is that all sorts of results in social-work practice do not necessarily mean an increased quality of life for the clients. evaluators and commissioners should therefore reflect on this distinction before conducting an evaluation in social work. now, let us turn to the stakeholders’ perspective and the importance of balancing different interests when evaluating quality in social-work practice. quality from the stakeholders’ perspectives in public organizations, that is, the kind of arena where much social work is carried out, the issue of quality can be viewed from different perspectives. if we take the personal social services (pss) as a typical example, there are at 3 it is not only client effects (e.g., less drinking, less criminality, more days in work) that are sometimes regarded as the foremost quality of results; efficiency (‘value for money’) is also often viewed as a superior type of quality of results. njsr – nordic journal of social research vol. 3, 2012 81 least four different stakeholders that an evaluator has to consider and relate to: politicians, administrative management, social workers, and clients. as mentioned earlier, our point of departure is that the evaluator is often able to influence how the evaluation is ultimately designed and carried out. in contrast to the business sector, it is not an easy matter to decide who the ‘customer’ is in social work. if there are several stakeholders, the evaluator has to decide whether all of them are equally important or whether one or more of them are more important than the others. this decision is necessary due to limitations of time and money. the involvement of many categories of stakeholders often means that the evaluation takes more time and costs more. a number of researchers have argued for the merits of including several stakeholders in the evaluation (e.g., greene, 1988; weiss, 1983), and in principle we can sympathize with this idea. however, our experiences as evaluators of smalland middle-sized agencies and organizations strongly suggest that there are seldom enough resources to include more than two or three categories of stakeholders. consequently the evaluator is often forced to make a choice. for example, is the perspective of the politician most important because social work is part of a representative democracy where the people elect the politicians? or is the clients’ perspective most important because they are directly affected by the interventions? it is also possible that the social workers’ perspectives are most important because they deal with many clients and possess knowledge and a more holistic view of the organization and the helping processes. the issue of balancing the different interests of the stakeholders in order to make a judgement on quality is truly a delicate matter in social work. on the basis of our experiences, we believe that this act of balancing between different stakeholders can be handled in different ways when evaluating social-work practice. for analytical reasons we here present them as three distinct strategies: 1) the inclusion of representatives of all categories of stakeholders: when this is accomplished, the evaluator could a) use the dominant opinion among them as the basis for conclusions, or b) only describe different stakeholders’ opinions without making concluding judgements. it is up to the reader of the evaluative report to decide how different perspectives should be balanced; 2) the use of theory or a normative basis: here the evaluator turns to some text that in principle states how something should be or should work in order to decide which category of stakeholders are most relevant to include in a specific evaluation. texts on political theory, theory of professions, ethical principles, or a law could provide this basis; 3) the involvement of only intended users: this strategy looks only to persons who want and can make a difference by using the results of the evaluation, like strategically positioned bureaucrats within an organization. this strategy risks excluding clients’ participation, since they normally have limited possibilities to change a programme or an organization directly. njsr – nordic journal of social research vol. 3, 2012 82 in practice it is sometimes possible (or necessary) to combine these strategies. by way of example, one of us conducted an evaluation where almost all possible stakeholders were included (blom, 1996). the commissioner wanted to know how the presence of a social worker at a local health-care unit was experienced by the management, physicians, nurses, physiotherapists, clients, and other organizations that cooperated with the social worker. the intended user of the results (the head of the unit) participated in the evaluation, and theory about inter-organizational cooperation was used to decide which external stakeholders were most relevant in this case. the commissioner regarded the client’s perspective as being tremendously important and nearly self-evident. thus several clients – both women and men, with different problems – were interviewed about their experiences. even if the client often is considered to be the most important stakeholder, it is still not self-evident to assume that the client’s perspective is always the most important when evaluating social work. many clients do not (at least initially) want interventions from the services or any contact with social workers. one example of this reluctance would be parents whose children are taken into custody against their will or persons who are involuntarily treated for drug abuse. as the concept of customer presumes that there is a market in which there is information about different alternatives and choices of products and services (le grand & bartlett, 1993), it appears inappropriate to view clients as customers at all. however, many consumer investigations in social work do base evaluations on this market-orientated view. the groups of stakeholders mentioned above are not the only stakeholders that need to be taken into consideration, and there can be other aspects of quality as well. in the next section we shall discuss this point in relation to basic elements of quality of services. judging quality of services with regard to different stakeholders’ interests the quality of services can be divided into three basic elements: structure quality, process quality and results quality. in this article, these concepts are defined in accordance with a swedish government report (swedish ministry of finance, sou 2005:110, p. 61): structural quality concerns resources, staffing and levels of competence, localities, group sizes, and so on. processual quality covers the implementation of the services, for instance, work modes, attitudes towards the clients, content, and working climate. quality of results denotes the goals and results of an organization, both what is actually obtained and whether this is in accordance with official goals. an example would be whether a social-services agency obtains the goal of offering refugees a certain level of living standard (e.g., a place to live, food, clothes etc.) and a certain level of quality of life (e.g., reduction of anxiety and meaningful daily activities). njsr – nordic journal of social research vol. 3, 2012 83 as mentioned in the foregoing section, quality in social work can be viewed from several perspectives. the complexity of the concept of quality becomes even more apparent when the three elements of quality are placed in a table with eight possible categories of stakeholders that have different demands concerning quality. the result is table 3 below, with 24 different fields concerning different aspects of quality, all in varying degrees relevant to evaluations of social-work practice. owing to a lack of space, each cell in the table contains only one of the areas that each category of stakeholders can lay claim to. it should also be noted that several of the categories of stakeholders could lay claim to the same areas. by way of example, it is not only the clients who are interested in results concerning quality of life, but several categories of stakeholders (e.g., relatives). table 3. examples of aspects of quality from different stakeholders’ perspectives. structural quality processual quality quality of results clients rooms treatment quality of results staff number of colleagues influence quality of service managers group sizes working climate output politicians economy methods efficiency relatives competence security independency other caregivers organization carrying through productivity other organizations competition interventions effects the public supply justice ethics it is seldom possible to include all the dimensions of quality in evaluations because the evaluator has to concentrate on a smaller number of stakeholders and fewer aspects of quality. as mentioned above, it is often a question about the evaluator’s resources. table 4 presents an example of elements of quality that are defined in relation to two groups of stakeholders at a care-giving institution within the elderly care: the clients and the staff. table 4. different aspects of quality at a care-giving institution within elderly care. structural quality processual quality of njsr – nordic journal of social research vol. 3, 2012 84 quality results clients rooms fees staff’s competence care/living conditions etc. continuity trust treatment security time to use etc. the elderly’s satisfaction with the results (quality of life) staff equipment and aesthetics working hours and status colleagues management/support working conditions etc. stress responsibility and influence work content physical strain contacts with the elderly and the relatives etc. the staff’s experiences of the care work (quality of service) the example in table 4 illuminates a number of central aspects that can be important for the evaluator to consider when evaluating quality at an institution within elderly care. it is apparent that even if the example is less complex in comparison to table 3, it can still be difficult to include every aspect in an evaluation. in reality an evaluator (via a dialogue with the those who commissioned the evaluation) must often narrow an evaluation down by choosing one category of stakeholders (e.g., the elderly) or only one element of quality (e.g., processual quality). another alternative is only to evaluate one aspect of the processual quality (e.g., old people’s experiences of the treatment). more generally, this discussion has aimed to illustrate that the concept of quality consists of several aspects, and that it is seldom possible to include all of them in an evaluation. consequently, it is important to clarify the aspects that are most relevant, and as a result one focuses on certain aspects and disregards others. one way of doing this is, as discussed above, to use theories about quality in the kind of agency or organization one plans to evaluate. concluding discussion this article has discussed quality in relation to the evaluation of social-work practice. as it has been shown, quality in social-work practice is a very multifaceted phenomenon and the concept can be approached from different perspectives and with different foci. owing to the complex character of the practice, interventions cannot be fully standardized and the effects of the interventions in peoples’ lives are not always evident. regarding the evaluation of social-work practice, one conclusion is that it is crucial to be aware of and to consider the distinction between quality of service and quality of life. referring back to dahler-larsen (2008), the reader will recall that this distinction will make it easier to define desirable standards of different aspects of the services: structural quality, processual quality, and quality of results. it will also help the evaluator to make better and more njsr – nordic journal of social research vol. 3, 2012 85 nuanced descriptions of the effects in clients’ lives and, not least, to infer the way these effects stem from the content of the interventions. with respect to effects, another conclusion is that increased or at least maintained quality of life on behalf of the clients is an important but often disregarded aspect of outcome. currently there is a focus on measuring client effects in terms of drug use, criminality, school attendance, bullying, days at work, aggressiveness, and more. we have already mentioned the predominant ebp movement as a promoter of standardized instruments that concentrate on behavioural change. though these changes are obviously important, we cannot routinely and a priori regard positive behavioural changes as an indication of increased quality of life for a client. a third conclusion concerning judgement of quality of social work is that such judgements are inevitably and internally linked to and dependent on different stakeholders’ perspectives. this not only goes for the judgement of quality of life, but for all kinds of outcomes in social work. consequently, it is important in any evaluation to be clear about and to describe in the report explicitly from whose perspective observed outcomes are viewed and assessed. in this article we have discussed the issue of judging quality in social-work practice mainly with regard to the public sector. however, the same general aspects of human-services quality will probably be valid for the private and voluntary sectors (e.g., with the social work carried out by the salvation army). our general conclusion is that in every evaluation of social-work practice, regardless of branch or direction, it is important to be explicitly aware of which aspects of quality are being considered and investigated and which are not. we hope that this article can be useful for those who initiate, conduct, and utilize evaluations of social work. furthermore, we hope that it can contribute to an increased consciousness about the importance of studying quality of life when evaluating social-work practice. in particular, clients’ subjective experiences of welfare and well-being deserve greater attention. this is important partly due to ethical reasons (since social work primarily exists for clients), and partly due to methodological reasons (since the clients’ subjective experiences form a source of fundamental knowledge for those who carry out and are responsible for social work). disregarding this perspective will incur a risk that the overall aim of social work – which focuses on either the maintenance of a good quality of life or the improvement of an insufficient quality of life for socially vulnerable people – will be obscured. acknowledgements we would like to acknowledge the work done by the copy editor and the two anonymous referees. references baldwin, s., godfrey, c., & propper, c. 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(2009). tjänster och relaterade begrepp – innebörd och implikationer för policy [services and related concepts: meanings and implications for policy]. vinnova rapport vr 2009:08. vedung, e. (2009). utvärdering i politik och förvaltning [evaluation in politics and administration]. lund: studentlitteratur. weiss, c. (1983). the stakeholder approach to evaluation: origins and promise. new directions for evaluation. vol. 1983, (17), 3-14. microsoft word 01 tensions between, final2 pages corrected.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2011 – special issue tensions between ‘consumerism’ in elderly care and the social rights of family carers: a germandanish comparison birgit pfau-effinger institut für soziologie university of hamburg email: pfau-effinger@wiso.uni-hamburg.de per h. jensen centre for comparative welfare studies aalborg university email: perh@epa.aau.dk ralf och institut für soziologie university of hamburg email: ralf.och@uni-hamburg.de abstract the focus of this article is on the effects of the strengthening of economic principles in the field of care that have taken place in many european welfare states since the 1990s, which are connected with new emphases on ‘choice’, on the role of the market in the provision of elderly care, and on efficiency as a new main welfare value. as a central part of this development, the figure of the elderly person in need of care, who was interpreted before these changes as the client or patient, has been replaced by the figure of a ‘consumer’ who makes ‘free choices’. in most countries the frail elderly can choose between offers by different providers of home care who compete on the care market and care performed by family members. the focus of this article is on the legal construction of the working conditions of the family care giver. it aims to give an answer to two different research questions: how do different welfare states legally construct the working conditions of caring family members and their relationship with the elderly ‘care consumers’? and to what degree does this cause tensions between the desire to care or not to care and actual care conditions and opportunities? in order to answer these questions, we compared the njsr – nordic journal of social research 2011 – special issue 8 legal construction of the work situation of family care givers in germany and denmark, as well as the resulting effects on their relationship with the older relatives who receive care. the findings show that the degree to which ‘consumerism’ in long-term care causes tensions in the situation of the caring family member and in the care relationship depends on the ways in which it is embedded in a family-care regime. in this regard, the tensions are clearly greater in the semi-formal familycare regime of germany compared to the formal family-care regime in denmark. keywords: consumerism, elderly care, social rights, family, germany, denmark introduction the way social care is organized is crucial for the structuring of work in european welfare states. as a reaction to such changes as the ageing of society and the increase in women’s labour-force participation rates, many welfare states in europe have extended financial support and public provision in the field of childcare and elderly care since the 1990s, and have introduced new social rights both for care recipients and for those who provide care in the family (anttonen & sipilä, 2005; kröger & sipilä, 2005). at the same time, a restructuring of policies towards elderly care has taken place. these were based on a fundamental shift towards the strengthening of economic principles and on new emphases on ‘choice’ and the role of the market in the provision of care for older people and on efficiency as a new main welfare value. accordingly, the introduction of new welfare markets in which non-profit and market-based providers compete together with new elements of public management and new fordist principles in professional care work have been the main elements of the restructuring process (bode, 2007; daly, 2002; knijn & verhagen, 2007; rostgaard, 2006; vabø, 2006; pavolini & ranci, 2008). as a central part of this development, the figure of the old person in need of care, construed before these changes as a client or patient, has been replaced by the ‘consumer’ who makes ‘free choices’ (rostgaard, 2006; ungerson, 2004; vabø, 2006). older people who need care should now be able to choose between different offers. in most countries these include offers of different types of providers of home care who compete on the care market – public, for-profit, and non-profit providers. family members are also included in part in the market competition, since the elderly person in need of care can also chose paid family care instead of home care in many programmes for long-term care in european welfare states (ungerson, 2004). the introduction of these new policies towards care has in part created substantial new tensions and contradictions in the care arrangements in european welfare states, because the new principles of care provision contradict in part other principles like the need for a high quality of care. germany provides a good example. care work done by agencies on the basis of competition, as is allowed by the ‘long-term care insurance act’, is strongly standardized and restricted to physical care activities, with the consequence that it often does not match the socially constructed expectations of care recipients and their relatives (eichler & pfau-effinger, 2009). njsr – nordic journal of social research 2011 – special issue 9 this article aims to answer two different research questions. first, how do different welfare states legally frame the work conditions of caring family members and their relationship with the elderly ‘care consumers’? secondly, to what degree does this cause tensions between a desire to care or not to care and actual care conditions and opportunities? in order to answer these questions, we compared the legal framing of the work situation of family care givers in germany and denmark, as well as the resulting effects on their relationships with the older relatives who receive care. we used for this objective the approach of different ‘family-care regimes’, by which we mean the ways the institutions of the welfare state legally construct the work situation of the person who provides care for an older relative and the care relationship between care giver and care receiver. we assumed that the differences in the legal construction of the work situation of the family carer, the care relationship, and the social rights connected with family care all differ in different types of welfare states. we present a comparative analysis of the legal framework regulating the family-based care of senior citizens in the welfare states of germany and denmark. both welfare states have distinctly different cultural and institutional traditions in relation to care for old people. in germany, for a long time and up to the mid-1990s, the family mainly provided elderly care, which was unpaid and not defined as ‘work’ (pfau-effinger, jensen & flaquer, 2009). the danish welfare state, in contrast, has had a longer tradition of state responsibility for the care of old people. since the 1990s, these two different types of welfare states have further developed in regard to the ways in which they organize long-term care for older people. on the one hand, the sector of social services engaged in the care of old people has been extended in both societies. on the other hand, in both societies the field of care for old people has seen a strengthening of economic principles (pfau-effinger et al., 2009). our analysis is an outcome of two research projects, one on germany and the other on denmark, led by the authors and funded by the german research council (dfg) and the danish research council for the social sciences. discussion of the state of the art most scholars would probably agree that care needs are increasing with the ageing of populations, and that change in the roles of care and care relationships is associated with changing institutions, cultures, policies, and processes. however, while some scholars employ a biographical approach for analysing the conditions of the ‘biographical continuity’ of care givers in the face of life-changing challenges (e.g., chamberlayne & king, 2000), this study employs a state-centred or citizenship perspective; that is, we are interested in how welfare policies (and citizens’ rights) rather than biographical resources structure the organization of care. this article has as its starting point in the fact that many welfare states have introduced long-term care programmes based on allowances which give older people in need of care the choice of either hiring a paid care giver from the marketplace or paying caring family members. the idea is that older people in need of care can act as autonomous, self-reliant social citizens who have the ‘freedom of choice’ between different offers, which is epitomized as a right to receive care. furthermore, these programmes also include new social rights from the point of view of the family care giver (see knijn & kremer, 1997). these include their right to receive some kind of pay for the care they provide, a social right to time off for care tasks (i.e., an exemption from the obligation to work), and in part elements of social security for the duration they provide long-term care (pfau-effinger, 2005). njsr – nordic journal of social research 2011 – special issue 10 these new policies of ‘freedom of choice’ represent ideas of consumerism, especially on the part on the person in need of care, as consumerism is based on ‘access, choice, information, redress and representation’ (vabø, 2006:405). whereas other concepts like empowerment, user-orientation or userinvolvement treat the relationship between the person in need of care and the care provider as a trust relationship, this relationship of consumerism is one based on material interest and is mediated via the market. this means that the care receiver is viewed as an autonomous market participant who acts ‘with scepticism and distrust towards the provider, [is] always ready to take action if services fail, [is] always looking for the best buy (“value for money”)’ (vabø, 2006:405, 413). consumerism in elderly care has been a common trend in european countries since the 1990s. various factors have been identified in the literature to explain this common trend, such as the incapacity of the traditional welfare state to meet individuals’ needs and the trend towards marketization. in part, governments have justified the introduction of cash-for-care programmes with the need to empower those in need of care. another reason is the trend towards the recognition of (formerly unpaid or cheaper) informal care work (ungerson, 2005). thus far, little research exists about the consequences of consumerism on the ways in which the work relationship of the caring family member with the old person in need of care is legally constructed in different types of welfare states in a comparative perspective. da roit and le bihan (2011) have investigated the situation of women in cash-for-care arrangements of longterm elderly care in france and italy. they were particularly interested in the ways these programmes shape informal care and family relations in these countries. they have analysed the situation of family care givers, mainly women, who combined employment and long-term care of an elderly family member, and have found that cash-for-care systems, differently from what is sometimes expected, do not in principle support a reintroduction of the family into care in these countries. instead, people use them for outsourcing longterm care. however, unlike this present article, the main perspective of their study was on the work-family balance of caring women and less on the legal framework of family care. claire ungerson (2004) has also conducted international comparative research into the ways that wages for the care work of caring family members are constructed. she has analysed how the ‘commodification of care’ has developed in five european countries: france, great britain, italy, the netherlands, and austria. her main focus is on the pay that caring family members receive and on how it is paid. she found that in several welfare states these payments have the character of what she calls ‘routed wages’, that is, ‘the method whereby people in need of care are given cash rather than (or in addition to) formal care services, and then encouraged to employ their own care labour directly with this cash’ (ungerson, 2005:49). ungerson, moreover, shows that the labour-market impact of the welfare-state policies towards work in long-term care is to some extent dependent on the funding regime of the specific welfare state. these regimes represent different combinations of the degree of regulation, on the one hand, and the degree of commodfication of care work, on the other. according to ungerson, funding regimes cover a spectrum between fully commodified informal care and care paid only by additional inflows into the household. the results of the above-mentioned studies also show that long-term care provided by family members no longer fits the description of informal work. njsr – nordic journal of social research 2011 – special issue 11 often it is paid in the context of welfare-state programs, and includes elements of social security. for this reason, pfau-effinger (2005) has introduced the term ‘semi-formal care’ for these kinds of family care. comparative policy analyses of the legal framework of paid family care, how it constructs the work situation of those who provide care for elderly relatives, and their relationship with the elderly ‘care consumer’ have hitherto been relatively rare. the conceptual approach of this article we assumed that the family-care regimes in the welfare states of germany and denmark differ substantially, and therefore that the degree and nature of tensions which are connected with the care provided by family members for their frail elderly relatives also differ. by ‘family members’ we mean persons who belong by definition broadly to the same family as the persons in need of care, such as daughters and sons, spouses or partners. the indicators that we used to compare different family-care regimes in the field of long-term care include: § the quality and degree of the elderly’s social right to receive care provided or organized and co-financed by the welfare state and how these relate to their ‘consumer’ role; • the quality and degree of the family members’ legal rights connected with their care work in comparison with standard employment, such as: § the duration and amount of pay, as well as conditions of eligibility for pay; § the level of social-security rights to benefits for unemployment, pensions, sickness of caring persons; § the right to leave regular employment or to reduce the working time in employment, and the degree to which the job is protected in this situation; § the legal rights within the care relationship (e.g., protection against dismissal, etc.). we shall analyse tensions that may be associated with the situation of the options that frail senior citizens have as ‘consumers’ of long-term care to ‘choose’, on the one hand, and the working conditions of caring relatives in the same legal context, on the other. main features of welfare-state policies towards long-term care in the context of the german care insurance act (sgb xi) until the early 1990s, the care of elderly people in the former west german state had essentially been organized as unpaid family care, and for this reason the classification of the german welfare state in this respect as a ‘conservative welfare regime’ in esping-andersen (1999) and its description as a ‘political regime strongly oriented towards the male breadwinner’ in lewis and ostner (1994) were fully accurate. care in residential homes played a secondary role by comparison (alber & schölkopf, 1999). in the former east german state, elderly care was also mainly based on unpaid family care njsr – nordic journal of social research 2011 – special issue 12 despite the orientation towards a dual-earner family model (heusinger & klünder 2005: 69; naegele & dallinger 1993: 308). with the ‘long-term care insurance act’ implemented in 1995 and 1996, the german welfare state for the first time defined care for senior citizens as a task for the central state, and established a new social insurance that finances a universal basic provision for those in need of care on the basis of contributions from everyone in gainful employment. an important goal of this act was to make it possible for elderly people in need of care to live a selfdetermined life in a private household. the long-term care insurance act (sgb xi) also introduced such elements as the market and ‘consumer choice’ into the organization of care. further, on the basis of the financing of ambulant professional care by the long-term care insurance fund, the act encouraged the emergence of a broad sector of publicly financed providers in the field of ambulant care (schulz-nieswandt, mann & sauer, 2010). on the basis of these changes in the institutional framework of care, the autonomy of those in need of care has tended to be strengthened, since elderly people can release themselves from relationships of dependence on family care through opting for ambulant professional care. nevertheless, in the largest proportion of cases family members exclusively still carry out the care of frail elderly people who live in private households. among those people in old age who receive care allowance in the context of the long-term care insurance, 69.3 per cent live in their own household. in this group, the percentage of those who were cared for exclusively by a family member was 67 per cent in 2009 (eichler & pfau-effinger, 2009; motel-klingebiel, 2002; mischke & meyer, 2008; statistisches bundesamt, 2009).1 the role of the consumer principle and ‘free choice’ for old people in the german policies towards long-term care old people only have the right to receive paid care if they can prove that they have a physical need for it through illness or disability (§ 14 abs. 1 sgb xi). those who meet the rather tight selection criteria receive a care allowance that mainly covers only actual physical health care, and as long as they are not very seriously ill. they must themselves organize other items such as housework. most recipients are thus still dependent on the additional support of family members if they want to live in their own households. old people who need care can choose between various providers of care: service agencies run by local authorities or non-profit organizations, as well as commercial providers. they also can claim care from family members such as spouses, partners, daughters and sons, and social networks. all these types of care are publicly paid to a certain degree. the care insurance makes the payment of the care allowance to the service agency if the care receiver has opted for care by an agency. the amount that the care insurance pays differs according to which of the three ‘care levels’ the person in need of care has been assigned to, that is, according to the extent of that person’s requirements. if a person in need of care opts for an ambulant care service, the long-term care insurance fund pays a lump sum to the care service. this sum should cover a particular period of time for care per day. a lump sum of 1 elderly people who need care can also receive it from people outside the family, like neighbours or members of social networks, if these persons are willing to accept the conditions of care work done by family members. currently, the share of persons belonging to such groups who provide care in this legal framework is relatively small (statistisches bundesamt 2009). njsr – nordic journal of social research 2011 – special issue 13 € 420 (care level 1), € 980 (care level 2) or € 1,470 (care level 3) is guaranteed per month (deutscher bundestag, 2008 sgb xi). however, if a family member provides the care, the care allowance is considerably lower, and it is not paid directly to the family care giver but to the person in need of care. this constitutes a system of ‘routed wages’ (ungerson, 2005 ). payments to family members involved in care are from € 225 per month (care level 1) to € 430 per month (care level 2) and € 685 per month (care level 3) (§ 37 abs.1 sgb xi).2 also, the elderly person who receives care has the freedom to decide to forward parts or all of these funds to the caring relative, or not at all. the decision on agency care or family care – but not the choice of a specific family member – is binding for the person in need of care for a period of six months. this means that the person who receives care can dissolve at any time the care relationship with the relative. if a family member is providing care, an official inspection of the care situation and the person providing the care takes place once the care period starts. this is the only time an inspection of the specific care situation in the family takes place. the construction of the role of the caring family member in the german policies towards long-term care as we have mentioned above, caring family members can receive payment for their care work. this pay is defined as some ‘financial ‘compensation for effort’ paid for certain categories of otherwise unpaid voluntary work (cf. pfaueffinger et al. 2009). this corresponds to a payment of between four and five euros per hour for the average amount of time a caring family member spends on care. however, the caring relative does not have a legal right to payment for her or his care work. instead, the care receiver is free to decide whether to keep the money or to forward it to the caring relative; there is no obligation to pay, and the way he or she uses is not monitored. family members who provide care at least 14 hours per week in the framework of the care insurance law have the option to be included in the pension system for the periods in which they provide long-term care (§ 19 sgb xi). they are also covered by insurance against accidents at the workplace (§ 44 abs. 1 satz 4 sgb xi, hervh). on the other hand, they have neither the right to be covered by public health insurance nor by unemployment insurance, even though the care relationship can end anytime when the care recipient moves into any kind of home, dies, or just decides on a different care giver. even though the person in need of care is bound to the decision for family care or agency care for six months (§ 38 sgb xi), this does not mean that she or he is obliged to maintain the relationship with a specific person during this time. further, even though a family member who cares for an older relative who receives the care allowance enters into a legal relationship with the care recipient, the law explicitly mentions that caring family members do not have a position as ‘employees’, that their pay does not have the character of wages, and that their relationship with the care receiver who pays them does not have 2 it is also possible for the person in need of care to transfer the benefits from the care insurance to a ‘personal budget’ account, from which he or she ‘buys’ care work (§ 35 a sgb xi). in practice, this solution is rather similar to the direct payments made by the care insurance. njsr – nordic journal of social research 2011 – special issue 14 the character of an employment relationship (§ 3 s 2 sgb vi; krauskopf soziale krankenversicherung, pflegeversicherung, 71 ergänzungslieferung 2010 randnummer 4 zu § 19 sgb xi). the care relationship is also not based on any written contract. this means that family members who care for a frail older relative do not have any of the rights usually connected with an employment contract, like protection against unfair dismissal. they do have a right to four weeks’ leave from the care situation in case they are sick or for holidays, but they do not receive pay for time off. during these four weeks, the care insurance pays for substitute care from another family member or a care agency (§ 39 sgb xi). the unpaid time for holidays of four weeks is reduced for each day the care giver is sick and cannot work. this means that only healthy family carers have the full right to four weeks’ unpaid holidays. independent of sgb xi, there is a state programme for elderly-care leave from regular jobs in firms. people who temporarily care for an older family member can take unpaid care leave from the firm where they are normally employed. during this leave the worker’s job is protected; dismissal is not possible. there are two different leave plans for persons who provide care for relatives: the ‘care holiday’ (pflegeurlaub) and the ‘caring time’ (pflegezeit). the ‘care holiday’ comprises a maximum of ten working days and can be paid time if this is permitted by collective bargaining agreements. the ‘caring time’ is unpaid and can last a maximum of six months. the option is limited to employees of firms with a size of more than 15 employees. during the leave the job is likewise protected (§ 5 and § 7 pflegezeitgesetz). it is also possible for employed people to reduce their usual working hours over a longer period, maybe even over several years, if they have been employed at least six months in the firm, if the employer does not object for economic reasons, and if the firm has more than 15 employees (§ 11 teilzeitund befristungsgesetz).3 main features of welfare-state policies towards long-term care in denmark contrary to the case in germany, where public long-term care was institutionalized as cash-for-care as soon as the welfare state started to take over the main responsibility for long-term care, public long-term care in denmark has historically been delivered as a public in-kind service, in part as home care and in part as residential homes for older people in need of more extensive care. the coverage of in-kind care has grown constantly and rapidly (finansministeriet, 1995:9) – already by 1996 about 30 per cent of the total population aged 65 and over was receiving some kind of long-term care (regeringen, 1999) – and so have public expenditures (strukturkommissionen, 2004). in effect, almost all older people in need of care are offered publicly financed and organized in-kind care provision. public in-kind care has become a citizen’s right. the provision of in-kind services is regulated by the social service law which stipulates that necessary services must be given in accordance with every individual recipient’s need (cf. jensen, larsen & stoltenborg, 2004; jensen & lolle, 2010; rostgaard in this issue). to relieve the pressure on the public-care sector, from 1996 public authorities have offered prophylactic visits to people over 80 years, and from 1998 to those over 75. the aim of these advice and support measures is to enable older people to look after themselves better. 3 teilzeitund befristungsgesetz vom 21. dezember 2000 (bgbl. i s. 1966), last change by artikel 1, 19. april 2007 (bgbl. i s. 538). njsr – nordic journal of social research 2011 – special issue 15 in denmark, family care by spouses and inter-generational family care and family carers has practically disappeared, which is in accordance with majority cultural orientations in denmark. the vast majority of danes have the opinion that frail elderly people should be taken care of by public in-kind care. the family has thus been emptied of elderly care functions (christoffersen, 1997). this development does not mean, however, that children do not at all care for their frail elderly relatives. a time-use study conducted in 2001 shows that 40 per cent of all danes had helped or eased the situation of their parents or parents-in-law within the last four weeks. still, this sort of help remains optional. the welfare state first and foremost delivers personal help to frail elderly people. the strengthening of economic principles in elderly care in the danish welfare state has primarily taken the form of outsourcing public-care provision and of allowing clients to choose freely between different public and private providers of elderly care. home care, and not residential care, has been subject to outsourcing, and outsourcing has not changed the content or quality of in-kind home care. public authorities finance and define the quality of care provision, and the welfare state has remained the primary party responsible for ensuring the adequate offer of care. it is only the care providers who have changed with outsourcing. thus the major aim of outsourcing has been to empower frail elderly people by giving them choices or exit-opportunities as ‘consumers’ of welfare-state provision. only a relatively small proportion of old frail elderly, however, have actually chosen a private provider over a public provider of home care. the role of the consumer principle and ‘free choice’ for old people in need of care in the danish policies towards longterm care since january 1, 2003, recipients of home help have been free to choose from different providers of home care, both public and private. the advantages of choosing a private provider are that private providers are allowed to offer additional, non-care services such as gardening, walking the dog, and so forth. becoming a for-profit private contractor, however, requires the certification of the company by the municipality, and to attain this certification the private contractor must provide the quality of services required by the municipality. there is, however, no real price competition in the care market. private contractors receive the same amount from the municipalities as the municipality itself spends on home care. if a consumer of home care chooses a private contractor, then the municipality pays for the private services directly to the private contractor. this means that the users are not involved in any kind of economic transaction, except in cases where users have ordered additional services (such as dog-walking) from the private contractor. such services are settled between the consumer and private contractor. a ‘softer’ free-choice approach has been introduced in relation to residential care. since july 1, 2002, elderly people who have been assigned a residence in a residential home can in principle choose from institutions within and across municipal borderlines. with this change, it is possible for older people to take up a residence that is more in accordance with their wishes. previously, municipalities only assigned residences to ‘their own’ population. the idea underlying this change was that older people in need of care should be able to settle closer to the homes of their children or other relatives. njsr – nordic journal of social research 2011 – special issue 16 the construction of the role of the caring family member in the danish policies towards long-term care home care is delivered as personal assistance or care or as practical work in the home, in the form of cleaning, and so on, or both. these services, however, are to some extent dependent on the household situation of the elderly person in need of care. if the elderly person in need of care shares his or her household with a physically capable person, that person is expected to do all the practical work in the home; in other words, payment for home care in the form of housework is not granted. with respect to personal assistance and care, relatives may themselves substitute for the public or private care provider. in such cases people who care for their frail elderly relatives do not enter into any legal relationship with the person in need of care, which would make them dependent on this person. instead, they can choose public employment as carers with a ‘normal’ employment contract. the ‘law on social service’ allows the person who is entitled to help and support to appoint a person to do the task (e.g. a spouse or a relative) (§74). the municipality must, however, recognize the person appointed, and a contract that specifies the extent and content of services, security of delivery, costs, and so on, between the municipality and the appointed person must be made. in effect, the family care giver becomes a public employee. if the care receiver is granted, for example, seven hours home care per week, the municipality will employ the appointed person for seven hours per week at a wage rate of about 19 euros per hour. since those people who provide long-term care for their relatives in principle act as public employees, they are entitled to all types of social security and other legal rights of a standard employment relationship. this regulation is very rarely used, however. different from germany, in denmark there is no general state programme which gives family members who care for their frail older relatives the right to ‘care leave’ from their jobs. in denmark, employees only have a right to unpaid care leave if they have to take care of a closely related dying, handicapped or seriously ill person. as far as people must take leave to care for a dying close relative, they are entitled to compensation amounting to 1.5 times sickness pay but not exceeding the wage that they have earned so far. in contrast, there are no legally based rights to absenteeism for ‘ordinary’ long-term care on a nearly daily basis. the legal framework of family care and its contradictions in the german and danish care policies it has turned out that the legal framework of family care differs considerably between the german and the danish welfare states (see also table 1). these differences of legal framework regard the social rights of senior citizens as well as their role as ‘consumers’. njsr – nordic journal of social research 2011 – special issue 17 table 1: differences in the family-care regimes of the german and the danish welfare state german welfare state danish welfare state quality and degree of the elderly’s social right to receive care medium high quality and degree of the family members’ legal rights connected with their work situation, in comparison with standard employment low to medium high • duration and amount of pay to family carer, and conditions of eligibility for pay; low to medium, clearly below level of standard employment high – at level of standard employment relationship • level of social-security rights of the family carer low to medium, clearly below level of standard employment high – at level of standard employment relationship • family carer’s right to leave regular employment or to reduce the working time, and job protection medium low • legal rights of family carer within the care relationship (e.g., protection against dismissal, etc.). very low high – at level of standard employment relationship the magnitude of personal care performed by family members high very low in germany, the frail older person in need of care is considered a ‘consumer’ with ‘free choice’. therefore, senior citizens who need care have various rights and options. they can decide between different types of care, which includes the option to choose the care of a relative. if she or he decides that care should be given by a relative, the person receives funds to pay the care work of the relative, but does not have any obligation to forward the whole amount, or any part of it, to the caring family member. this means that in principle the person in need of care also has the option to use the funds as desired, say, to improve his or her own lifestyle. however, the financing of agency care carried out in private households mainly only covers physical health care. this limits considerably the social rights that senior citizens have in relation to long-term care. if they are not very seriously ill, they do not have the right to get payment for household help or overnight care. care policies, therefore, rely considerably on family support of the old persons who want to live in their own households. this is different in denmark, where the conceptualization of old people who need care as ‘consumers’ is embedded in a different type of family-care regime. old people in need of care usually get comprehensive care by public agencies. different from germany, public care for the individual person in need of care is also comprehensive. it includes 24-hour care if needed, and support in housework like cleaning and shopping. the consequence is that people in need of care are much less dependent on a caring relative’s staying with them overnight and providing household work. the differences in the legal framework of the caring family member are even greater. the other side of the relatively privileged situation of the care receiver njsr – nordic journal of social research 2011 – special issue 18 in the german welfare state reveals that the situation of the care giver is relatively precarious. care in the context of the sgb xi does not constitute an employment relationship, and does not even require any contract. it constitutes a relatively precarious, semi-formal form of care work paid in hourly wages clearly that is below market levels. the care giver does not even have a legal right to receive this pay. the social rights connected with the care situation of the family carer do include insurance against accidents and in part also pension insurance, but two fundamental social rights are absent, namely rights to health insurance and unemployment insurance. free time off for sickness or holidays is guaranteed for up to four weeks but is unpaid, and it is possible for the care receiver to dissolve the care relationship at any time. that the person in need of care can terminate the care relationship at any time means high income-loss risks particularly for those caring family members who may have given up or interrupted their regular jobs in the employment system in order to provide the family care. the care provider is, therefore, largely dependent on the good will of the person in need of care to maintain the care relationship and to receive the payments. even if they do receive the full pay that the care insurance pays to the person in need of care, they may still be dependent on additional income sources, since the pay is below the poverty-line level. given that family care, in 75 per cent of the cases, is provided by women, the law also contributes to maintaining gender inequality. the fact that family members who provide long-term care for a relative can take leave from their regular job which is then formally protected for the period, balances these risks to some degree. however, the leave is limited to six months. the care policies of the german welfare state – the ways in which they construct the care situation of family care givers and their relationship to the person in need of care – therefore create particular tensions. the way the care relationship is legally framed causes distinctly contradictory interests within the family, that is, between the ‘consumer’ and the ‘worker’. the care receiver, on the one hand, has the option of a free choice between different types of care and care providers, and can decide how she or he uses the ‘care money’ in the cases where the care is provided by a family member. the care giver who provides care for a family member, on the other hand, is legally in a relatively weak and precarious position. the affective nature of the relationship can reinforce this vulnerability. a main motive for why people care for older family members is love or the feeling of moral obligation (eichler & pfau-effinger, 2009). the options of living autonomously in one’s own household and of choosing between different types of care provision, including family care, are not at the expense of the family-care provider in the danish welfare state. family members can take over the daily care of a relative under an employment contract with the municipality and thereby act as a public employee, albeit on a (short) part-time basis. this means that they receive wages at levels commonly paid in the care sector, and have all the social rights and job protection of standard employment relationships. differently from germany, they do not have any legally constructed, direct financial relationship with the care receiver, and thus there is no personal or financial dependence of one or both partners on the care relationship. on the other hand, again differently from germany, an option for leave during which the job of the person who temporarily provides family care is guaranteed, does not exist. this may mean a substantial risk of job loss or difficulties returning to regular employment for an employee who decides to njsr – nordic journal of social research 2011 – special issue 19 stay away for a longer time in order to care for an old relative in need of care. in this regard, the law creates a tension between the wish to take care of a family member temporarily, and the risk of losing one’s regular job in doing so. as shown in table 1, denmark and germany differ in all dimensions of the two family-care regimes. other things being equal, the danish situation is more favourable for the care recipient as well as for the family care giver as compared to the german situation. paradoxically, however, the amount of family care giving is much greater in germany than in denmark. conclusion it has turned out that the family-care regimes of germany and denmark differ considerably. on the one hand, a common trait of the welfare states of germany and denmark is that they construe old people in need of care as ‘consumers’ who have free choice in the care market. frail elderly people have the option to decide between different types of care provided by agencies and between the care of agencies and family care, and they can get the funds to pay for the type of care they choose. this also means that people in need of care have the option to be ‘freed’ from personal dependence on the family. however, this option is more consistently supported in the danish welfare state, since care provision is comprehensive and covers different types of needs of the person. in germany, by contrast, care policies still rely on the care given by family members. on the other hand, the family-care regimes of the german and the danish welfare states are clearly different in the ways in which the situation of the person who provides family care is legally construed in her or his relationship to the relative receiving care. the care work of the person who provides family care in germany is constructed as semi-formal care. it is based on poor pay, only some rights to social security, and little protection for the care giver in the care relationship. in this context, some main tensions are substantive to the care work and the care relationship between the relatives. tensions exist between their wish to give the care and the financial and social insecurity and risks connected with the care situation. moreover, the legal framework constructs tensions between the interests of the person who receives care and the person who provides care, and between the affective and the financial dimensions of the relationship between the care giver and care receiver. in denmark, the degree of tensions connected with the care situation of somebody giving temporary care to an older relative is clearly lower. since family care is formalized, care during the daytime instead of working at their normal workplace is an option. in that case, the caring family member has an employment contract and receives wages that usually are paid for long-term care. also, she or he has rights to social security and job protection as in any standard employment relationship. caring, however, is associated with a loss of income, in as much as care is given only part-time, and the carer is forced to give up his or her ordinary full-time job. it follows from this disadvantage that there is tension caused for people who decide to take over the daily care of a family member, since they risk a loss of income as well as of their job itself because only a very restricted leave-taking scheme exists. our findings show that the degree to which ‘consumerism’ in long-term care is associated with tensions in relation to the care situation of the caring family member and the care relationship depends on the ways in which it is embedded into a family-care regime. in this regard, the tensions are clearly njsr – nordic journal of social research 2011 – special issue 20 higher in the semi-formal family-care regime of germany – compared to the formal family-care regime in denmark. acknowledgements we would like to thank tine rostgaard and the anonymous reviewer for their very helpful comments on an earlier version of this article. references alber, j. & schölkopf, m. 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(2006). caring for people or caring for proxy consumers? european societies, 8(3), 403-422. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 7, 2016 neo-liberalism and the nordic welfare model: a study of the liberal alliance and ideological adaptation in denmark troels fage hedegaard department of political science centre for comparative welfare studies aalborg university troelsfh@dps.aau.dk abstract this article explores whether and how the neo-liberal ideology has adapted to the nordic welfare model by studying the attitudes of voters and grass-roots members of the danish party liberal alliance towards the welfare state. this inquiry into one of the key issues for the neo-liberal ideology is inspired by theory on how an ideology will adapt to its context. the expectation outlined in the article is for the neo-liberals of this party to favour features that make the nordic welfare model distinctive – extensive governmental responsibility, especially for children and the elderly, and a universalistic approach to providing welfare. i have explored this question using a mixed-methods approach, where i analyse a survey of voters and interviews with grass-roots members of the party. combined this shows that the neo-liberals in liberal alliance do support a role for the welfare state that extends beyond a minimum welfare state, especially for the care of children, but they view old age and retirement mostly as a problem each individual must deal with. regarding the universalistic approach to providing welfare, the neo-liberals seem torn between two different tendencies, one being a perception of a fair way to provide welfare and the other the idea of a selective welfare state as a neo-liberal core idea, which leads to ambivalent attitudes. i argue that this results in a form of the neoliberal ideology that has adapted to the nordic welfare model. keywords: neo-liberalism, liberalism, welfare, tax, nordic, ideological morphology introduction over the last 30 years the neo-liberal ideology has gained considerable political influence across the world, including the nordic countries (saad filho & johnston, 2004; turner, 2008). the latest, and perhaps clearest, example of the neo-liberal ideology gaining a foothold in a nordic country is the danish party liberal alliance, which from 2008 onwards has successfully established itself on the political scene. in this article, i have sought to describe neo-liberalism in a nordic country by studying the attitudes among the voters and members of this neo-liberal party. mailto:troelsfh@dps.aau.dk njsr – nordic journal of social research vol. 7, 2016 17 there is no single definition of what the term neo-liberalism covers, and there is great variation in how the term is used throughout the academic literature. according to nielsen (2009), these definitions can be sorted into two fundamentally different camps, as some scholars use the term narrowly to describe an ideology, while others apply it in a broader and substantially different way to describe a situation of ideational hegemony (peck, 2011) or a mode of governance, often inspired by foucault (1988). in this article, i have used the term in its narrow definition to describe the ideology in its current form in a nordic country. this inquiry into the attitudes of nordic neo-liberals was inspired by literature on how an ideology adapts to its context (freeden, 1998; 2013; turner, 2008). i have studied the adaptive capabilities of the neo-liberal ideology by focusing on the neo-liberals’ attitudes towards the welfare state. though the neo-liberal ideology informs attitudes towards a wide range of issues, the question of what the role of the state should be is, arguably, the key issue for the ideology (gamble, 2013; hartman, 2005). macgregor (2005) argues that this focus on the state has developed because the neo-liberal ideology primarily arose in reaction to and in the context of the developing western welfare states. similarly, the neo-liberal philosopher hayek (1979) has described how the term liberal has shifted from describing a general attitude of mind to covering specific views about the proper function of government in its new form (turner, 2008). the aim of this article has been to examine whether the neo-liberal ideology has adapted to the nordic welfare model. the choice of focusing on this central aspect of the ideology has also resulted in this article drawing together two relatively different fields of study, as i have combined studies of attitudes towards the welfare state with theory of ideological adaptation. though the two fields of study are normally separate from each other, this combination has been fruitful in the effort to describe neo-liberalism and its possible adaptation to the nordic welfare model. the rest of this section provides a description of the liberal alliance and neoliberalism in denmark. the second section outlines the theoretical expectations of how neo-liberalism might adapt to the nordic welfare model. the third section outlines the design of the study and the methods that have been applied. the fourth section presents the findings and the implications, and the fifth section discusses their limitations. neo-liberalism in denmark as a proportional-representation system, with a low barrier of two per cent of the votes, the danish multiparty system is well suited to allow for the rise of protest movements and niche parties within the established political system. this has created a political system with high levels of change and volatility, as it was famously displayed in the ‘landslide election’ of 1973, where three new parties were elected to the parliament for the first time. the largest among these parties was mogens glistrup’s progress party, which captured 16 per cent of the votes, partly on the back of neo-liberal anti-tax and anti-welfare rhetoric (glans, 1984; wilensky, 1975). this was the first instance of a party with a neoliberal streak gaining considerable public support in denmark. the progress party later collapsed onto itself in the mid-1990s and transformed into the new right party, the danish people’s party (andersen & bjørklund, 1990). an important part of the danish people’s party that rose from the ashes of the progress party was the transformation of the welfare policy from highly critical position to holding a more positive, though welfare-chauvinistic, perception of njsr – nordic journal of social research vol. 7, 2016 18 the welfare state (rydgren, 2004). this left most of the neo-liberal voters to the more centrist liberal party, which throughout the period also housed a strong neo-liberal wing. this was the state of neo-liberal ideology in denmark until liberal alliance was founded in 2008 on the basis of a failed centre-right party, called new alliance. today the party has positioned itself as the strongest critic of the welfare state in the eyes of the voters (stubager, holm, & smidstrup, 2013), and though liberal alliance cannot be characterized as a single-issue party, it mainly drew attention from its messages critical of the welfare state. the party was first elected to parliament in 2011, with five per cent of the vote, though it already had members in parliament who jumped ship from other parties. they strengthened this position at the next parliament election in 2015, where they got seven per cent of the vote. this shows that, although liberal alliance is a niche party, it has gathered consistent support among the population. adaptive neo-liberalism the theoretical argument i present in this section is that the neo-liberal ideology that liberal alliance represents has adapted to the nordic welfare model. in order to do so, i shall draw on theories and studies of how ideologies adapt to a given context. here the work of freeden (1998; 2013) is central, as it outlines how ideological adaptation, or ideological morphology, as freeden (1998; 2013) terms it, can be studied. this will be linked to literature on the nordic welfare model in order to describe the context for neo-liberalism in a nordic country. according to freeden (2013), the morphological approach stands in opposition to the idea that ideologies can be described solely as normative systems of ideas or through studies of significant of political thinkers throughout history. instead, the approach argues for a different method where ideologies are studied through ‘a ubiquitous practice, under-researched by political theorists, namely, that people in all walks of society think about politics in discernible patterns (…)’ (freeden, 2013, p. 115). these patterns of political thought, and how they might have adapted to the context of the nordic welfare states, are central to the approaches applied in this article. the first part of describing ideological adaptation is to define what an ideology is. here a wide range of definitions can be outlined but, since i shall draw on the work of freeden (1998), i shall also employ his definition of ideologies, which are the ‘distinctive configurations of political concepts […] that […] create specific conceptual patterns from a pool of indeterminate and unlimited combinations’ (p. 4). ideologies are thus defined by the concepts that are at their ‘core’. the core concepts make up the central ideas of the ideology, and thus cannot be abandoned without the existence of the ideology being threatened. the core concepts of an ideology are, however, translated into a given context through the ‘adjacent’ and ‘peripheral concepts’ (freeden, 1998; 2013). the differences between the concepts can in some regard be likened to hall’s (1993) three orders of change, where the third-order or peripheral changes are common, while the first-order changes fundamentally alter the world view. by studying how the concepts are translated in a given context, freeden (1998; 2013) argues it is possible to study how an ideology adapts to a context. njsr – nordic journal of social research vol. 7, 2016 19 studies of neo-liberalism and ideological adaptation on the basis of freeden’s (1998) theoretical framework, turner (2008) has tracked the formulations of neo-liberal thinking in germany, the uk, and the us in the book neo-liberal ideology. turner (2008) argues that the neo-liberal core concepts are a belief in the market, a general scepticism towards the welfare state, and an emphasis on the legal rights of the individual. the core concept of scepticism towards the welfare state, which is the main interest of this article, is then translated into adjacent concepts like support for a minimal state, equality of opportunity, negative rights, and personal responsibility. the adjacent concepts then give support for peripheral concepts like support for reduced social spending, workfare, and voucher systems. the peripheral concept is thus where the ideology meets policy and is adapted to the context. in accordance with the theoretical framework, turner (2008) finds major differences in how the core concepts are translated into adjacent and peripheral concepts when comparing between countries and over time. here turner (2008) argues for large differences in perceptions of the welfare state between germany and the us, because the german neo-liberalism has its roots in the tradition of ordoliberalism, which argues that a strong state is not contradictory to personal freedom, but often a precondition to it (bonefeld, 2012). overall, this seems to support the idea that the neo-liberal understanding of the welfare state will develop differently, depending on its context (turner, 2008, pp. 140-166). on the basis of the systematic finding of differences, turner (2008) calls for ‘varieties of neo-liberalism’, where the neo-liberal perception of the welfare state varies with the institutional setup and size of the welfare state. adaptation to the nordic welfare model the countries in turner’s (2008) study, however, have welfare states that are qualitatively different from the danish case, and, therefore, neo-liberalism in the nordic countries may have adapted to a different context. to use espingandersen’s welfare-regime typology, the countries are typical representatives of the liberal regime (the us and the uk) and the conservative regime (germany). denmark is, however, closer to esping-andersen’s (1990) description of the social democratic regime. since esping-andersen’s typology of regimes refers to the historical actors mainly responsible for the welfare regime, i shall instead use the term ‘nordic welfare model’ because it refers to the current institutional setup and further avoids the contradiction with respect to a ‘social democratic neo-liberalism’. the aim of this study has thus been to determine whether the nordic welfare model has indeed had an impact on the attitudes of the neo-liberals in the liberal alliance. so how can the welfare regime affect neo-liberal ideology? according to institutional theory, this adaptation could happen through the welfare regime affecting what is perceived as the ‘normal state of affairs, and what it deviant and even impossible’ (svallfors, 2003, p. 172) with regard to the role of the government in the provision of welfare. a similar conclusion could be reached on the basis of the directional theory of issue-voting. this theory argues that the best strategy for a niche party is to place itself at an extreme point on the political scale in order to attract unhappy right-wing voters who seek the greatest impact of their vote (kedar, 2005). the directional-voting theory, however, also contends that this extreme position should not be outside the ‘region of acceptability’, which is the socially accepted political space on the issue, because being perceived as ‘extreme’ or ‘radical’ will carry a harsh penalty from the voters (rabinowitz & macdonald, 1989). the welfare regime should presumably affect what is perceived as normal and ‘the region of njsr – nordic journal of social research vol. 7, 2016 20 acceptability’, and thus neo-liberalism should be different in a nordic country. in order to determine if this is the case, i needed a set of theoretical expectations. this is rather uncharted territory, but in trying to do this i have emphasized the three features that are common in the descriptions of the nordic welfare model. the first defining feature in the descriptions of the welfare states in the nordic countries is the fact that the state has the key responsibility for the provision of welfare to the citizens. this has been described by scholars as ‘nordic stateness’, as the state becomes the central authority in organizing how welfare goods are produced and according to which principles they are distributed (kautto, 2010). though most descriptions of neo-liberalism do reserve some role for the government in providing welfare for the very poorest, this goes far beyond the idea of a ‘minimal state’ (hayek, 2014). therefore, if there is an impact of the nordic welfare model on their attitudes, there should be indications that the respondents support the idea that it is the government’s responsibility to provide welfare. secondly, compared with other welfare state models, the greater responsibility of the state is especially prevalent within welfare service and care tasks (espingandersen, 1990; kautto, 2010). a detailed breakdown of social-spending data from the oecd by adema, fron and ladaique (2011) shows the areas where the nordic countries especially differentiate themselves are on non-health welfare services, which cover care for children and the elderly. these two policy areas are thus especially interesting to examine, as they are areas where the state can take over tasks which otherwise could be argued to be a personal or family responsibility. if the neo-liberals argue that it is the government’s responsibility to take care of these groups, it would thus support the idea of adaptation of the ideology. the final feature of the nordic welfare model that is common in the descriptions points to the fact that the nordic welfare states distinguish themselves from other welfare states by awarding a comparatively larger degree of the welfare by the universal criteria (castles, 2008; esping-andersen, 1990; greve, 2007). a number of studies have shown that universal policies tend to generate larger public support (jordan, 2013), in part because the recipients tend to be viewed more positively (campbell, 2011). thus, there should be indications of the universal policies being perceived as normal and part of what should be the government’s responsibility (svallfors, 2003). on the other hand, selective policies, targeted at the poorest, are normally considered to be a concept closely connected to neo-liberalism (plant, 2010; turner, 2008). therefore, empirical support for universal over non-universal welfare programmes, and also for designing policies in a universal manner over a selective or targeted manner, would be a sign of adaptation of the ideology. i have used the three criteria both to structure the analysis and to evaluate the results. though these are not strict hypotheses, they have provided a sense of whether it is reasonable to argue for the existence of a neo-liberal ideology that has adapted to the nordic welfare model. research design and methods in order to study the proposed adaptation of the ideology, i used a mixedmethods design. this design combined a survey of attitudes towards the welfare state with five interviews with party ‘grass-roots’ members. this approach to studying the ideology was inspired by skocpol and williamson’s (2012) njsr – nordic journal of social research vol. 7, 2016 21 investigation of the american tea party branch of the republican party. the authors argue that in order to provide a fuller description of attitudes and ideology of the members of the tea party, it is necessary to rely on a combination of methods in what adds up to a mixed-methods design: ‘interviews and ethnographic observations are also crucial for understanding what people’s survey responses really mean, moving beyond crude characterizations…’ (williamson, skocpol, & coggin, 2011, p. 27). this article has aimed for the same combination of an overview of their attitudes with an in-depth understanding of their reasoning. methods the first part of the analysis was based on an election survey collected in the fall of 2011. the survey is the most comprehensive one covering attitudes towards the welfare state, and liberal alliance is also listed among the political parties. the survey was collected by yougov among their online panel members after the election in november 2011. the survey included 6028 respondents, of which 333 voted for liberal alliance, which fits their overall support in the elections and polls of about five per cent at the time. there were enough respondents to run a meaningful analysis for comparing its voters with voters of other parties. the voters of other right-wing parties are especially interesting because this shows the degree to which voters of liberal alliance differ from the existing parties. it has been argued that there is a bias in respect of who participates in online surveys and panels, as the respondents tend to be younger, better educated, and interested in politics than the general population (dennis, 2001; sax, gilmartin, & bryant, 2003). it is possible that this panel had higher rates of participation from more politically active and partly younger voters, though the biases are unknown. it was necessary, therefore, to be careful to read too much into the results. the results of the survey were supplemented by five semi-structured interviews with members of local party committees in four cities. these local members of the parties are whom i call the ‘grass roots’ throughout the article. they performed a number of key tasks within their party, such as selecting the candidates for elections among their own ranks, organizing election campaigns, holding regular meetings, and much more. they thus constituted much of the life within the party. a total of five interviews is quite a small number to conduct, but the purpose of the interviews was not to describe the interviewees’ attitudes towards the welfare state fully. instead, the purpose of the interviews was to look into the reasoning behind the attitudes found in the survey, and possibly to explore the differences and ambivalences, and thus to help substantiate the survey results. i conducted the interviews where it was most convenient and suitable for the respondents, and therefore these took place at a residence, a library, a university campus, and in the local parties’ offices, among the election posters. the timing of the interviews coincided with a local election for the municipal government, and this meant that the grass roots were active but also somewhat difficult to get a hold of. whether this affected who was available for the interview is difficult to determine, but it might have given me less access to the higherranking members. the interviews varied in length from 35 minutes to 1.5 hours, depending on how talkative the respondents were and how frequently the follow-up questions strayed from the interview guide. i found the respondents (referenced by their initials) by contacting all local committees via e-mail. i also collected simple descriptive statistics after the interviews in order to determine how representative the respondents were. however, since liberal alliance does njsr – nordic journal of social research vol. 7, 2016 22 not have any public record of their members, it is hard to judge this. on the basis of the election survey and their profiles, they compared reasonably well to the average voters. the largest divergence from the party was the fact that all respondents were men. i analysed the interviews ‘cutting’ interviews into smaller parts and adding a coding structure to them, using the program nvivo 10. this program enabled me to add one or more codes to each question and response and to search between the codes. for example, one question on whether the state should provide childcare was coded with the question, the respondent, and all the theoretically relevant concepts that came up in the answer. using this structure of codes i could search between the answers and concepts in order to provide a better overview. there are, however, also downsides to choosing this mixed-methods approach of combining surveys and interviews with different groups. first, it might be problematic to assume that the attitudes of the voters expressed in a survey show the attitudes and ideology of the party. the directional-voting theories argue that the strategy of niche parties is to take very extreme positions in order to attract attention (meguid, 2005), which could lead to the voters being more centrist than the party. secondly, by interviewing party grassroots members, instead of analysing party programmes and texts from political thinkers, i might have found formulations of the ideology that are less crystallized. in spite of these problems, i argue that this kind of study can give us insights that party programmes and texts from political thinkers cannot. it is more likely that not that texts and statements from professional politicians would be ‘polished’ to remove anything that might offend some voters. therefore, the survey and interviews could provide insights that are closer to the attitudes to the real voters and the real debates within the party. survey results for the survey-based part of the results, i shall present items on whether the government spends too much money, a suitable amount, or too little on several welfare policies. this measure can be interpreted as the overall support for or opposition to each welfare policy. to illustrate the support for each welfare policy further, i calculated the overall opinion balance by subtracting the percentage that answered ‘too much’ from the percentage that answered ‘too little’ was spent on the welfare policy. this produces a number ranging from +100 (all respondents found the spending level too low) to -100 (all respondents found the spending level too high). respondents who answered that the spending is ‘suitable’ or who answered ‘don’t know’ were included, but did not count as either for or against spending on the opinion balance. the results of this are presented in table 1 below, with full details for liberal alliance. in order to contrast these results, i divided the other danish parties into three groups: the traditional centre-right parties, consisting of the liberal party and the conservative people’s party, the populist new right danish people’s party, and the left-of-centre parties. the last category could be subdivided further, but as the focus mainly is on liberal alliance, in comparison with the other right-wing parties, i have not done this. njsr – nordic journal of social research vol. 7, 2016 23 table 1: attitudes towards government spending on welfare policies, presented as opinion balances for groups of parties, with full details for liberal alliance. liberal alliance liber al allian ce traditio nal rightwing parties popul ist new right left of centr e too muc h suita ble to o littl e do n’t kno w opini on balan ce opinion balance opini on balan ce opini on balan ce education 5 44 45 6 41 34 35 66 homecare for elderly 9 47 34 10 25 35 63 57 healthcare 13 44 38 5 25 35 64 67 childcare 11 50 30 9 19 35 34 53 state pension 19 51 17 10 -2 18 49 35 unemploy ment insurance 35 46 9 10 -26 -16 -1 27 social assistance 52 33 7 8 -45 -36 -20 20 notes: from a 2011 election survey. the traditional right-wing parties consist of the liberal party and the conservative party, the populist new right party is danish peoples party, and left-of-centre parties consist of the social-liberal party, the social democrats, the socialist people’s party, and the red-green alliance. n (total) = liberal alliance (333), traditional right wing parties (1446), populist new right (624), left-wing parties (2966). the results in table 1 can be broken down in a number of ways. first, the results demonstrate the overall support for most of the welfare policies covered in the survey, as indicated by the positive opinion balances for most of the welfare policies. this overall support is much in line with pierson’s (1996) predictions of the welfare-state policies creating vested interests that sustain public support. there is also the expected difference between the left-wing parties and the parties on the right, where the opinion balance is positive for all policy areas for the left-wing parties, while the right-wing parties score negatively on unemployment insurance and social assistance. the results also show that there are major differences between the policy areas in respect of public support. these differences seem to fit the general finding that universal policies are more popular than selective ones, because public support is significantly greater for the universal welfare services in the form of education, homecare for the elderly, healthcare, and childcare (jordan, 2013). another possible interpretation of ranking between the policy areas is that while the more popular policies are targeted at groups that are universally found to be ‘deserving’ (the elderly and children), the less popular policies are targeted at the unemployed who generally are perceived as undeserving (van oorschot, 2006). this concordance between the explanations might be due to the policy design fostering the perception that the recipient groups are deserving or undeserving (campbell, 2011). if we turn to the liberal alliance voters, there is a largely similar attitudinal pattern, with overall support for four of the seven policy areas. this is lower than the other party groups, but it still shows a degree of support for welfare spending. this indicates an acceptance of governmental responsibility, as the njsr – nordic journal of social research vol. 7, 2016 24 first criterion states, which goes far beyond a ‘minimal state’. the results for liberal alliance voters also show that they are much more polarized between universal and non-universal policies than other groups. the policies awarded by the universal criteria are in the positive range (education, homecare for elderly, healthcare, and childcare), while the non-universal policies are in the negative range of the opinion balances. one deviation from this pattern of support among them for universal policies is the state pension. here, they are split down the middle (opinion balance -2); most find the spending suitable, but 19 per cent of them find the spending too generous. this deviation from the pattern might be explained by reforms that have made the state pension more selective and less available to younger, high-income groups (goul andersen, 2011). a similar age effect on the attitudes towards state pensions is also present in other parties. therefore, part of the negative attitudes towards this policy can be attributed to a disproportionate amount of younger voters (not shown). regarding the two non-universal policies aimed at the unemployed, liberal alliance voters were by far the least supportive of spending, and in fact they supported retrenching both policies. this thus fits the third criterion of support for universal policies over selective policies. this does not necessarily mean that these voters rejected the idea of selective policies, but perhaps they felt that these were too generous. finally, regarding attitudes towards the government’s responsibility for the elderly and children, there is overall support for the government taking responsibility for care tasks (childcare and homecare for the elderly). this support, however, seems to co-exist with the lower support for the state pensions, the reason for which can be explored in the next section. interview results what the survey cannot tell is why the neo-liberals expressed support for some welfare policies but not for others, and more generally, how they perceived the welfare state. this was the aim of the second part of the analysis, which was partially guided by the results above. i shall present the results of the interviews in three parts, following the criteria outlined in the theoretical section. ‘what we can rightfully call common goods’ as the first criterion focuses on what the government should have in providing welfare, this part of the interviews focuses on what should be the responsibility of government and what should be left to the individuals to handle. though the respondents tackled this question differently, they, in one form or another, answered this by making distinctions between legitimate and illegitimate governmental tasks. the most descriptive version of this was made by kl, who argued that the state should take responsibility for, what we can rightfully call common goods. this is that which helps the country and society function and from which we all gain. this we get through the common purse, and the common purse is justifiably filled through taxes and fees. further defining the ‘common goods’, kl mentioned healthcare and education as examples of things that benefit all citizens and have a positive effect on society, and thus are justified. on the other hand, kl argued that areas in which welfare policies only benefit certain groups, or where the welfare state is in direct competition with private companies, should not be the government’s njsr – nordic journal of social research vol. 7, 2016 25 responsibility. other respondents made distinctions that were either wider or narrower with respect to what was included, but with a similar emphasis on universal welfare policies as legitimate. the exception in this regard was fb, who argued that the government should take care of the ‘core welfare areas’ such as education, help for the sick, the disabled, and the involuntarily unemployed. though this covers some of the same areas as outlined by kl above, this differs in the sense that instead of an opposition between universal and non-universal policy areas, he drew on the heuristics of deserving and undeserving groups (van oorschot, 2000). however, no matter how the distinction of what should and should not be a governmental responsibility is drawn, this seems to extend far beyond a minimal state. ‘you have to presume that this is a personal responsibility, but…’ the interviews also touched on more specific welfare tasks and whether these should be a responsibility of government. following the second criterion outlined above, i was especially interested in attitudes regarding the government’s role in taking care of the elderly and children. as shown above in table 1, there were somewhat mixed attitudes towards the government taking responsibility for the state pension. this attitude was also echoed in the interviews, as all respondents supported the idea that it should be the personal responsibility of the elderly to ensure their own living standards. as one of the respondents, tf, put it: ‘you have to presume that this is a personal responsibility, since you can save for it over your lifetime’. some of the respondents pointed to policy developments in the state pension, which have transformed into a multi-pillar pensions system (goul andersen, 2011) as the basis of this reasoning. this can be exemplified with kl, who argued: ‘i think we are making it a personal responsibility and that fits well with my way of thinking that you have to save for your own old age’. however, kl did not support full privatization of responsibility, for in the next sentence he added that: ‘but again, those who do not save for their own retirement or for other reasons don’t have anything; there i would like to see that they have a sort of minimum income’. ka argued similarly, but as in the discussion above with how to determine what should be a governmental responsibility, he kept underscoring how the recipients should be ‘deserving’, and if the recipients have not contributed to society in their lifetime, then they should not be helped. on attitudes towards the responsibility of government for children, the attitudes were more mixed among respondents. one line of argument, provided by some of the respondents, mirrored the one for the elderly outlined above. for instance, fb argued: ‘why should i pay such high taxes, just so the state can give me money to have children. you can have all the kids you want, but you have to pay for them yourself’. on the other hand, fb also argued that the one area where he would support increasing government spending was for at-risk children. this follows the same logic of personal responsibility, but with a government-provided ‘social minimum’. other respondents did not seem to favour any changes, and thus perceived this as the normality: ‘[state-financed] kindergartens are fine; someone has to look after the children while you are at work, so that has to be a responsibility of the government’. here the primary criticism focused on the lack of choice among private providers, but not with governmental responsibility itself. regarding the second criterion, the attitudes of the neo-liberals seem to support the idea that this should be a personal responsibility, but also that the state njsr – nordic journal of social research vol. 7, 2016 26 should step in when individuals fail. this was the most prominent attitude towards pensions for the elderly – a process possibly pushed along by policy reforms. ‘people want something back; it is only natural.’ as outlined by the third criterion, the final part of the interviews focused on the question of whether welfare policies should be universal or targeted at specific groups (i.e., selective). as table 1 displays, there is little overall support for the non-universal benefits among liberal alliances voters. however, what the survey cannot reveal is the reasoning behind this and what it is about the selective benefits they object to. in the discussion of the welfare state generally, and the selective benefits in particular, the respondents kept returning to one core critique, namely, the distortion of incentives. the respondents argued that many people are unemployed not because they are unwilling to work, but because they do not have the incentive to work. the respondents thus did not blame people for not having the will to work, but instead pointed to the structures of incentives created by the welfare state. as fb, very directly, put it: ‘people are not stupid. they will not work for less than what social assistance pays’. kl, who is an employer himself, also argued that there are many of the unemployed whom he cannot hire: ‘many of these people just aren’t valuable enough’, with reference to paying them more than social assistance. the unemployed are, in the respondents’ perception, not lazy, but instead rational actors who chose not to work. this also leads them to a clear solution to the problem: social benefits have to be retrenched in order to give the low-skill unemployed enough incentive to work. at the heart of their world view seems to be an ‘economicman’ logic, which came through in the interviews (plant, 2010). this logic of ‘economic man’ seems to clash with the structures of incentives created by selective benefits, what have also been called ‘poverty traps’. this logic thus seemed to help explain both the apparent support for universal benefits and the rejection of non-universal benefits displayed in table 1. this was also what i found when i asked whether the welfare-state benefits should increasingly be targeted. here the respondents displayed general support for the idea, coupled with scepticism about whether it was possible and in some cases desirable. an example of this was nn, who argued: ‘this is what the welfare state should do—help the poor’. he added: ‘it is okay to help the rich and the middle classes, and that has to remain’. similarly, kl argued: if you exclusively make a community that most people pay into and which more or less ensures that people are not dying in the streets or helps the sick and handicapped, then people would not support it. people want something back; it is only natural. the respondent fb outright rejected the idea of a more targeted welfare state: ‘(…) it is not an either-or proposition. in an area like healthcare it is fine to finance it commonly, since it can affect anyone. [this is] similar to unemployment. here it makes no sense [to target the welfare].’ altogether, i would argue that this adds up to a set of attitudes that can best be described as ambivalent. on the one hand, the respondent seemed to support the principle of targeting; on the other hand, the respondent also underlined the positives of universalism within a range of welfare tasks. njsr – nordic journal of social research vol. 7, 2016 27 limitations and implications in this article, i have put forward the claim that the neo-liberal ideology in the nordic countries has adapted to the nordic welfare model. this claim is inspired by freeden’s (1998) morphological theory on how ideologies adapt to a given context and create a distinct form of the ideology. in order to study this, i have focused on the neo-liberal perception of what the role of government should be, and whether this has adapted to the context, which in this case is the nordic welfare model. i studied these questions by focusing on the danish political party liberal alliance, which is the newest iteration of a neo-liberal party in a nordic country. following the morphological approach, i tracked the attitudes of voters of the party and ‘grass-roots’ members towards the role of government and the welfare state. this mixed-methods approach, drawing on both a survey and interviews, provides a different approach to studying ideological change, and it has yielded some valuable insights. nevertheless, there are some shortcomings, and thus it might be problematic to assume that the voters or the ‘grass roots’ can fully capture the ideological position of the party on the issue of the welfare state. in spite of these clear limitations in what the methods can capture i argue that i find some impact on the neo-liberal understanding of the role of government. in this regard, the concept of universalism was especially interesting because it seemed to create a strong ambivalence between the neo-liberal idea of targeting and the support that universalism tends to create. this result is very close to what williamson and skocpol (2012) have found in their study: ‘tea partiers favour generous social benefits for americans who “earn” them; yet in era of rising federal deficits, they are very concerned about being stuck with the tax tab for “unearned” entitlements handed out to unworthy people’ (p. 56). this ambivalent relationship to the welfare state, and the constant search for deserving and undeserving groups, is perhaps the product of an ideology that is critical to the welfare state which has been fostered in the age of big governments. i believe that this is not a result unique to the nordic counties and the nordic welfare model, and, in fact, following the idea of morphology, we can expect distinct versions of the ideology in all welfare regimes (as also shown by turner, 2008). this also helps to provide a clue about how the regimes remain distinct in the face of the increasing pressures resulting from neo-liberalism, which some researchers (hall & lamont, 2013; saad filho & johnston, 2004) predict will spark a ‘race to the bottom’, where the welfare states will increasingly retrench and become more alike. the literature on the impact of welfare models often argues that the stability of the regimes is caused by ‘lock-in effects’, where the current institutional set-up over time reinforces decisions to remain within this path, since welfare reforms seem politically impossible because of the high economic costs that changing paths would involve (pierson, 2001). béland (2010), however, argues that the lock-in effect can also be of an immaterial nature, and that the studies of welfare states have focused too much on the material lock-in effects. the finding of an adapted neo-liberalism could be one such immaterial lock-in effect. njsr – nordic journal of social research vol. 7, 2016 28 references adema, w., fron, p., & ladaique, m. 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(2011). the tea party and the remaking of republican conservatism. perspectives on politics, 9(1), p. 25-43 microsoft word 458, örestig, proof2.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 5, 2014 ageing towards meaningful work? age, labour-market change, and attitudes to work in the swedish workforce, 1979–2003 johan örestig department of education umeå university, sweden email: johan.orestig@umu.se abstract a central finding in earlier research on work orientation is that there are substantial age-differences regarding attitudes to work. generally, more older workers describe their jobs as intrinsically meaningful than younger workers. this result has been interpreted in three different ways, the psychological, the cultural, and the structural hypotheses, where the first emphasizes cognitive age-differences, the second sees age-differences as outcomes of generational differences, and the third regards them as expressions of labour-market inequalities. these different approaches lead to quite different hypotheses regarding recent developments, but the relevant research is limited. drawing on data from the swedish survey of living conditions (ulf), this study has examined attitudinal change within the swedish workforce during 1979–2003. three sub-periods, 1986-1987, 1994-1996, and 20012003 were compared with 1979, the year of reference. the results showed that a consistently smaller share of the workforce held extrinsic work values in the subsequent periods, and that this applied to all age-groups. further, the results did not support the assumption of broader cultural differences between generations. rather, the results provide support for the structural hypothesis. older workers held extrinsic work values to a lesser degree than younger workers regardless of period. most strikingly, the gap between the youngest group on the labour market (ages 16–29) and the older groups widened during the period. furthermore, class differences in njsr – nordic journal of social research vol. 5, 2014 162 the distribution of the extrinsic attitude were intact throughout the study period; manual employees were consistently more likely to hold an extrinsic attitude than were service-class employees. this implies that differences in the probability of extrinsic work attitudes have been identifiable regardless of period, but that their prevalence has decreased as jobs involving features related to extrinsic work values have decreased since 1979. keywords: age, work attitudes, labour-market change introduction a growing branch of research revolves around individuals’ subjective evaluations of work, for example, orientation to work (esser, 2005; svallfors et al., 2001), commitment to employment (hult, 2004) or motivation for working (twenge et al., 2010). there are a variety of reasons behind the growth in this area of research. first, there is an empirical argument based on the assumption that attitudes are important determinants behind productivity, work motivation, and retirement patterns. since the 1980s, the organisation for economic co-operation and development (oecd) has argued for the need both to increase the level of participation in the labour market among older workers and to postpone retirement (oecd, 2006, 1988). having meaningful work is expected to increase the likelihood for a longer work life (gould et al., 2008). secondly, there is what can be called an argument of ‘governmentality', a term borrowed from foucault (2007). from this perspective, knowledge about the social determinants of attitudes can be used in policies to adjust attitudes towards policy goals (in favour of postponing retirement) (nordenmark & stattin, 2009). thirdly, there is an emancipatory argument. the point of departure here is that inequalities in the social division of labour deprive disadvantaged people of their right to a dignifying, selfimproving, and stimulating job. from this perspective, attitudinal measures serve as indicators of progress in a long-term attempt to balance inequalities that stem from the social division of labour (bolton, 2007; sayers, 2002; alvesson & willmott, 1992; braverman, 1974). njsr – nordic journal of social research vol. 5, 2014 163 a central finding in earlier research on subjective evaluations of work is that attitudes are strongly related to age: the older the individual, the more intrinsic the attitude. in other words, older workers have a greater tendency to emphasize work as rewarding in itself, in the sense that it offers meaningful, enriching, and stimulating work tasks and social contacts. by contrast, younger people are more likely to hold extrinsic attitudes, emphasizing external outcomes resulting from having a job, such as the pay or other opportunities associated with working (e.g., hult & svallfors, 2002; svallfors et al., 2001; mathieu & zajac, 1990). three different explanations for the differences in attitudes have been put forward, which i refer to as the psychological, the cultural, and the structural hypotheses. the psychological hypothesis rests on socioemotional selectivity theory, a life-span approach in which it is argued that individual’s subjective evaluations change when they reach an advanced age. advanced age is associated with a re-evaluation of time followed by motivational changes (e.g., carstensen & mikels, 2007). the cultural hypothesis is a line of theory and research which emphasizes the importance of generation. from this point of view, age-differences reflect that different age-groups belong to different cohorts. the fact that different cohorts established themselves on the labour market in different historical periods, each of which was dominated by a particular set of norms and values about work, should be reflected in age-differences regarding attitudes (twenge et al., 2010; stamov-roßnagel & hertel, 2010; lubinski, schmidt, & benbow, 1996; meglino & ravlin, 1998). the structural hypothesis explains age-differences as reflections of structural conditions in the labour market. from this perspective, agedifferences in work attitudes mirror an unequal distribution of healthpromoting, stimulating, and enriching jobs between different agegroups rather than psychological or cultural (i.e., generational) differences (bolton, 2007; ebbinghaus, 2006; sayers, 2005). the literature in this field is theoretically rich but empirically poor. a central reason for this is the lack of data required for repeated crosssectional or longitudinal analyses. consequently, earlier research has predominantly been based on cross-sectional data from a single timepoint. such research has enhanced our understanding of how working conditions, institutional configurations of the welfare state, and the structure of the labour market influence attitudes towards work (edlund & hult, 2008; esser, 2005; hult, 2004). however, since these studies lack a temporal dimension they do not inform us about attitudinal change in relation to age. therefore, such research fails to explain whether attitudes within a given context (for example a country njsr – nordic journal of social research vol. 5, 2014 164 or region) have changed across time and, if so, in which direction and for what reasons? this gap between theory and research is particularly problematic considering the substantial changes that the labour market in general, and the composition of the workforce in particular, have undergone during recent decades, that is, the relative growth of the service sector and the increasingly heterogeneous character of the labour force (mulinari & neergaard, 2004; åberg, 2004). this is a case study of developments in attitudes to work for different age-groups during the period 1979–2003 in sweden. the main idea behind the study design has been to examine the validity of the psychological, cultural, and structural hypotheses by following developments for different cohorts across this period. more specifically, the aim has been to analyse (i) changes in the prevalence of extrinsic and intrinsic attitudes towards work for different agegroups and (ii) to what extent such changes follow patterns that can be expected from the different hypotheses, as well as (iii) to what extent these developments can be understood using the structural hypothesis, that is, as a reflection of labour-market change. the analysis is based on comparisons between four distinct sub-periods: 1979, 1986–87, 1994–96, and 2002–03. an analysis of how attitudes towards work are distributed within different age-groups in the different sub-periods makes it possible to examine and compare general developments for different cohorts. the main contribution of the present study is that it covers a longer time span than previous research (twenge et al., 2010; berglund, 2001). the design also enables examination of continuities and disruptions in attitudinal change, while relating these developments to parallel changes in the structural conditions of the labour market. thus, the aim is not just to examine if attitudes to work are differentiated between different age-groups, but also to discern how these differences have evolved across time and to identify important driving forces behind such developments. theoretical framework and earlier research in considering work centrality (i.e., the generalized importance of wage labour in people’s lives) in advanced capitalist welfare states, theorists and researchers have paid particular attention to values njsr – nordic journal of social research vol. 5, 2014 165 related to work (noon & blyton, 2007). work values have been defined as ‘the outcomes people desire and feel they should attain through work’ (twenge et al., 2010, p. 1122). however, the latent nature of values makes them difficult to measure. one common way to get around this is to use attitudes as proxies for underlying values (thompson & mchugh, 1990, p. 273ff.). attitudes have been defined as individuals’ motivational orientations, consisting of three components: ‘(1) cognitive, our thoughts about an issue; (2) affective, the emotions associated with the issue; and (3) behavioural, how we behave with respect to the issue’ (goldstein, 1994, p. 733). social psychological theory and research suggest that attitudes emerge from a complex and dynamic interplay between the individual’s experiences, memories, and underlying values and the social context in which they are expressed. hence, research on attitudes by definition calls for a inter-disciplinary approach, including psychology, sociology, and economics (thompson & mchugh, 1990, p. 262ff.). earlier cross-sectional research and cross-country comparisons show that attitudes to work are indeed strongly related to social-background factors (e.g., stamov-roßnagel & hertel 2010; hult & svallfors, 2002; svallfors et al., 2001; mathieu & zajac, 1990). as stated above, one central finding is the significance of age: older age-groups are more likely to emphasize intrinsic rewards than younger age-groups are. this is not the same thing as saying that workers hold either intrinsic or extrinsic attitudes. on the contrary, work situations are made composed of various conditions, work tasks, and relationships, where an individual might express both intrinsic and extrinsic rewards depending on which dimensions are taken into consideration. furthermore, the research cited above suggests that when people are asked about how they view work in general, older workers tend to emphasize intrinsic rewards from their job to a greater extent than younger workers do. why, then, should we expect age-based differences in attitudes to work? as discussed in the introductory section, the psychological, the cultural, and the structural hypotheses suggest explanations from rather different perspectives. the most general answer is provided by recent psychological research which has demonstrated a general socalled positivity effect in older people’s reconstructions of past events and attitudes (carstensen, isaacowitz, & charles, 1999). drawing on the theory of socioemotional selectivity, a life-span theory that focuses njsr – nordic journal of social research vol. 5, 2014 166 on how temporal horizons shape human motivation, carstensen et al (1999) argue that individual goals are developed in relation to temporal contexts. this means that one’s perception of time will affect one’s cognitive appraisals of one’s life situation, focus, priorities, and goals. on the one hand, younger people tend to perceive time as expansive since they have many life choices ahead of them, thus having mindsets that are focused on preparing for the future. on the other hand, older people tend to perceive time as limited, a perception strongly related to a reorientation towards emotionally grounded goals. advocates of the positivity effect add that such goals follow a particular pattern; they are biased towards positive and meaningful goals that offer emotional equilibrium, and based on the desire to lead a meaningful life, to seek out and to invest in emotionally intimate social relationships and to achieve and maintain social connectedness. older people adapt cognitive appraisals to the aim of regulating emotional experiences (mather & carstensen, 2007; carstensen & mikels, 2005; carstensen et al., 1999). consequently, the psychological hypothesis should expect persistent agedifferences, regardless of time period. despite having different roots and standpoints, the cultural and structural hypotheses share the assertion that attitudes must be situated with regard to the immediate social context surrounding the individual. in other words, attitudes are reflections of the norms, values, and conditions that structure our lives. how is this possible? the influential theory of cognitive consistency argues that human beings have an inherent desire to be consistent in attitudes and behaviour. if there is some inconsistency between what we think is good, morally right or legitimate and what we actually do, we tend to adapt our attitudes so that they are in line with our life situation. alternatively, we act to change our surrounding environments and conditions so that they allow us to act in accordance with our underlying values. in the field of work attitudes, we are dealing with a process of cognitive (in)consistency if the everyday reality of work in which we are situated acts as ‘an irritant of a stimulus that motivates us to modify or change them [attitudes] until they form a coherent if not logical package’ (atkinson et al., 1990, p. 703). from this perspective, the close relationship between attitudes to work and factors of the surrounding social context is understood as one in which attitudes reflect or tend to be adjusted toward the structural and cultural conditions in which they are expressed. njsr – nordic journal of social research vol. 5, 2014 167 the cultural hypothesis is a line of theory and research which (i) assumes that work attitudes are socially informed and (ii) underlines the importance of generations as historically distinct results of sociocultural influence. a generation can be defined as a cohort that includes individuals who were born in the same period and have distinctive social or historical life events in common (e.g., schaie, 1965). the common features of each generation are influenced by a number of forces (i.e., parents, peers, media, critical economic and social events, and popular culture). these forces create common values among the cohort, distinguishing them from younger and older generations. a general understanding of values is that these include learned, general, impervious, ends-oriented tendencies to choose some alternatives of action rather than others. understood in this way, they represent standards of behaviour towards which the individual has a strong positive attitude (liu & lay, 2012). different generations face different experiences and events during their lives, and this might, in turn, generate different experiences, expectations and values about work that are then expressed as generational differences of attitude (cennamo & gardner, 2008; lubinski, schmidt, & benbow, 1996; meglino & ravlin, 1998). in a recent study from the united states, twenge et al. (2010) compared work values of three different generations born after world war ii and found that leisure values (i.e., extrinsic values) increased steadily over the generations, while work centrality and emphasis on intrinsic work values declined. there are several different strands of theories that fit the cultural hypothesis. most importantly, labour-market researchers have argued that, in the decades following the economic crisis in the 1970s, postwar european welfare states established ‘early exit cultures’, in which work values were undermined and early retirement was established as a social right (guillemard et al., 2004; de vroom et al., 2002). in addition, laslett (1989) introduced the concept of the ‘third age’ to distinguish a new generation of healthy and relatively wealthy pensioners that laid the basis for a normative shift through which retirement is increasingly associated with self-realization. the cultural hypothesis is sometimes combined with moral-hazard theory, which assumes that attitudinal change should develop in a particular direction since generous social security is expected to undermine work values and because people, to a growing extent, seek selfrealization outside work (e.g., sou, 2011:48; noon & blyton, 2007; sou, 2004; kreuger & meyer, 2002; lindbeck, 1995). this view, at least in part, explains attitudinal change as an expression of generational differences. if self-realization takes place more and more njsr – nordic journal of social research vol. 5, 2014 168 often outside work, there is room for an increase in extrinsic work attitudes; that is, work is to a greater extent viewed as a means for individuals to obtain resources to fulfil needs and desires during leisure time. this implies persistent differences between generations regarding their views on work. from a rather different angle, the structural hypothesis underlines how attitudes towards work are related to conditions of the labour market. working conditions and work content are central social determinants for how we view our work. earlier research shows that work attitudes in general, and intrinsic and extrinsic work attitudes specifically, relate to class position, educational level, working conditions, gender, and type of work. in general, with higher social position, better working conditions and greater control over one’s work, more positive attitudes towards work should follow (e.g., gould et al., 2008; edlund & hult, 2008; vogel & stattin, 2006; svallfors et al., 2001; johansson, 1997; herzberg et al., 1993). the different structural conditions that different age-groups are exposed to explain age-differences in attitudes to work. working conditions are unequally distributed across age-groups. younger people tend to hold jobs with poorer working conditions and lower employment security, but, since most working people advance throughout their working life, they are likely to express rather different attitudes in later years. other explanations suggest that many older people find that they are less competitive on the labour market than their younger colleagues, and therefore place a higher value the job that they have (ebbinghaus, 2006). furthermore, age differences can reflect selection effects. for example, older people of working age, who have poor health and are in professions with difficult working conditions, are more likely to be excluded from the workforce than they would have been at younger ages. therefore, a comparison between the oldest age-group with younger ones (where those worst off are still included) might indicate that the oldest age-group is a particularly satisfied group (e.g., mathieu & zajac, 1990; hult & svallfors, 2002). moreover, general changes in the distribution of attitudes across time are understood as a reflection of structural changes on the labour market. for example, different cohorts enter the labour market under different conditions, which can affect their experiences of and views on work. if labour-market conditions affect the distribution of work attitudes, changes in the labour market should be followed by njsr – nordic journal of social research vol. 5, 2014 169 attitudinal change. from this perspective, age-differences in work attitudes reflect an unequal distribution of stimulating and enriching jobs between different age-groups rather than cultural or generational differences (noon & blyton, 2007; berglund, 2001). thus, there are competing hypotheses and explanations for why attitudes towards work are unequally distributed between different age-groups. cross-sectional studies which are limited to a single measurement point of time consistently show that structural conditions are influential but fail to rule out the possibility that age-differences stem from psychological differences between age-groups or cultural differences between generations. longitudinal studies which follow developments for a single cohort over time fail to show whether the observed pattern only applies to the cohort in focus or if it can be generalized (schaie, 1965, p. 95). the best way to research this further is to follow developments over time while distinguishing psychological, cultural, and structural control factors. focus is placed on ageing-effects as well as cohort-effects. ageing-effects refer to the age-differences within a cohort, for example, how attitudinal patterns for those aged 16-29 differ from those of other age-groups at a single period. are ageing-effects distributed similarly at different periods or did they change across time? cohort-effects refer to differences in attitudinal patterns between the same age-groups measured at different periods, for example, how those aged 16-29 at a particular period differ from those aged 16-29 at other periods. if psychological factors are central, we should expect stable agepatterns, regardless of period. if cultural factors are central, we should expect that people hold stable attitudes while they age, and that the distribution of attitudes will be different for a cohort of older workers at one point of measurement than for another cohort of older workers at a subsequent point. last, but not least, if structural factors are central, attitudes for different cohorts should change with improved or worsened structural conditions. before the study design is presented more closely, a general background on the swedish case is presented, with a focus on labour-market change during the study period. njsr – nordic journal of social research vol. 5, 2014 170 background: labour-market change in sweden, 19792003 and study design sweden is a suitable choice for a case study on attitudinal change in relation to structural factors as the country has undergone substantial changes in its labour market from the 1970s onward. before discussing these changes in detail, a general illustration of developments regarding labour-market participation is relevant as a background. figure 1 shows how the labour-market participation of the oldest age-groups has changed throughout the study period. figure 1. labour-market participation rates for men and women, 1979-2003. source: based on the author’s own calculations of the oecd’s (2010) labourforce statistics. this period is characterized by changes in respect of both the job structure and the composition of the workforce. first of all, åberg (2004) finds substantial changes in the swedish job structure between the middle of the 1970s and the early 2000s. he shows that the number of jobs with high rates of pay, that require higher levels of 0 10 20 30 40 50 60 70 80 90 100 19 79 19 82 19 85 19 88 19 91 19 94 19 97 20 00 20 03 year p er ce nt men 50-54 men 55-59 men 60-64 women 50-54 women 55-59 women 60-64 njsr – nordic journal of social research vol. 5, 2014 171 education, has increased, while the number of jobs with lower rates of pay, that require lower levels of education, has decreased.this process was accentuated during the economic recession that took place in the 1990s. in this sense, sweden diverged from the trend in other countries, such as the united states, where the job structure changed more unevenly (benner, m. & bundgaard vad, 2000). this can be explained by a number of characteristics that obstructed the emergence of low-paid jobs in sweden during this period, that is, the influence of trade unions on income policies, tax levels, social protection, and outsourcing of low-paid or unskilled jobs to other countries (le grand et al., 2002). moreover, the work environment changed during the study period but not unambiguously. vogel (2006) shows that, in general, the self-reported physical work environment improved during the period 1980–2003. these improvements were more profound among men than among women. the self-reported psychosocial work environment developed more unevenly. the psychosocial demands of work increased dramatically during the late 1990s, which resulted in rising long-term sickness absence. this was mainly a consequence of rationalizations in the public sector as a response to the economic recession (lidwall, 2011). also, the gender and age composition on the labour market changed dramatically. in general, women’s and older workers’ labour-market participation increased. women primarily entered into the labour market within the expanding public sector (education, child care, elderly care, etc.), which also meant that the labour market was increasingly gendersegregated (daly, 2000). thus, the swedish case is suitable for the study of changes in age patterns of work attitudes. by examining attitudinal change we can analyse if actual developments coincide with those that can be expected from the different hypotheses. also, by introducing a set of control variables related to structural conditions, we can examine the extent to which observed changes are related to labour-market change. data, included variables, and method the dataset used here comes from the survey of living conditions in sweden (ulf), conducted by statistics sweden (vogel & häll, 2006). the ulf has been conducted annually since 1975 and includes a large set of variables on work environment, housing, economy, health, njsr – nordic journal of social research vol. 5, 2014 172 leisure, material assets, civic activities, social relations, employment and work time, education, security, transportation, and communication. the dataset is based on a random sample of approximately 7500 respondents per year, comprising adults aged 16 and older. cross-sectional data are used in the analysis. as stated above, the years included are clustered into four sub-periods: 1979 (i), 1987 (ii), 1994–1996 (iii), and 2001–2003 (iv). the fact that the ulf comprises a rich set of information and covers a relatively long time span offers unique possibilities for analysing long-term trends, in this case changes in the distribution of attitudes to work. the sample consists of employed individuals, as the focus is on how working people valued the work they held at the time when the survey was performed. table 1 displays the frequencies for age-groups distributed according to the analysed sub-periods. table 1. included cases (n) distributed by age-group and period. age-group 1979 1987 1994–1996 2001–2003 16–29 1746 1118 2235 2044 30–39 1346 1192 2898 2617 40–49 2006 1187 2595 2475 50–54 636 409 1322 1305 55–59 563 371 979 1286 60–65 419 323 621 794 total 6716 4600 10650 10521 table 1 shows that developments for six different age-groups: 16–29, 30–39, 40–49, 50–54, 55–59, and 60–65 are examined. table 2 shows which birth cohorts the different age-groups represent for the different periods. njsr – nordic journal of social research vol. 5, 2014 173 table 2. age-groups, birth-year, and sub-periods age-groups 1979 1986-87 1994-96 2001-2003 16-29 1950-1963 1957-1971 1965-1980 1972-1987 30-39 1941-1949 1947-1957 1955-1966 1962-1973 40-49 1930-1939 1937-1947 1945-1956 1952-1963 50-54 1925-1929 1932-1937 1940-1946 1947-1953 55-59 1920-1924 1927-1932 1935-1941 1942-1948 60-64 1915-1919 1922-1927 1930-1936 1938-1943 the oldest individuals within the sample were born in 1938 and reached the former statutory, and still most common, age of retirement, 65, in 2003, the last year in the fourth sub-period. the youngest individuals within the sample were born in 1987 and turned 16 in 2003. thereby, the data cover an age-span of 49 years, from the oldest to the youngest individuals, and people born during the period 1938-1963 are represented in all sub-periods included in the study. the dependent variable, ‘attitude to work’, is based on the following survey question: which one of the following sentences best describes your experience of your current work situation? (i) this job is like any other job. you do what is expected of you, but the only thing that matters is the earnings. (ii) there is something special about this job. apart from the earnings, it gives me a feeling of personal satisfaction. those who identified themselves with the first description were placed in the extrinsic attitude category. those who chose the second description were placed in the intrinsic attitude category. thus, the extrinsic and intrinsic dimensions of work are treated as dichotomous. however, it should be pointed out that this is a simplification in relation to the empirical world. for real working people of flesh and blood, such a distinction is not as clear-cut. in fact, people can be motivated by both extrinsic and intrinsic rewards in their work. a continuous measure that allows individuals to appreciate the degree to which they hold extrinsic and intrinsic attitudes might be preferable, but that is not njsr – nordic journal of social research vol. 5, 2014 174 an option given the arrangement of available data. additionally, a dichotomous measure has the advantage of identifying and illustrating how the centre of gravity in attitudinal formation within the workforce is distributed. regarding the specific variable used in the present study, it should be pointed out that ‘attitude towards work’ refers to an individual’s attitude towards his or her actual work situation at the time the survey data were collected. other measures often refer to extrinsic orientation towards paid labour in general (e.g., hakanen et al., 2006; esser, 2005; hult, 2004; berglund, 2001). the included independent variables are as follows: (a) period; (b) gender: male or female; (c) class: unskilled workers, skilled workers, service class iii, ii, and i; (d) sector: privately employed, stateemployed, county-council or municipality-employed; (e) physical work environment: high exposure, medium exposure, low exposure; and (f) psychosocial work demands: high exposure, medium exposure, low exposure. the main variable is ‘period’ since we are interested in developments over time. the circumstances associated with some of the independent variables call for some comments. the choice of included periods is partly pragmatic due to restrictions in the data, that is, the fact that the dependent variable of ‘attitude towards work’ is not accessible every year between 1979 and 2003. ideally, the periods included in the analysis should include more recent years and sub-periods. indeed, ulf-data is available for 2010-11 but, unfortunately, the dependent variable used has not been included in the survey since 2006, and that year does not include a sufficient number of cases to meet the necessary conditions for an additional sub-period. these limitations aside, the aim was (i) to cover a longer time than previous research, (ii) to distinguish a maximum number of cohorts for comparison, and (iii) to choose measuring points which capture important events related to changes of structural conditions in the swedish labour market. the reference year of 1979 represents a time when the swedish social-security system was established, and the subsequent periods capture fluctuations in sweden, such as the high labourmarket participation in the 1980s, the economic crisis and the mass unemployment of the early 1990s, and the economic recovery in the late 1990s (holmlund, 2006). the remaining independent variables are indicators of structural position and conditions and were selected as control variables on the basis of previous research (e.g., twenge et al., 2010; esser, 2005; njsr – nordic journal of social research vol. 5, 2014 175 hult, 2004). the class variable is based on the swedish socio– economic code (sei), a classificatory system developed from data on occupation, working conditions, and education (bihagen, 2000). service classes are organized in three categories. service class i includes professionals and other higher non-manual employees, service class ii includes intermediate non-manual employees, and service class iii includes assistant non-manual employees. the variable physical work environment is an index (cronbach’s alpha of .63) composed of five measures. respondents were asked both whether they were exposed to heavy lifting, dirt, vibrations, and bentover working postures and to what extent their work tasks call for exertion to the point of sweating. the respondents were grouped into the three subgroups – high, medium, and low exposure – on basis of the number of ‘yes’ answers given. finally, the variable ‘psychosocial demands’ is an index (cronbach’s alpha of .94) based on individual exposure to psychological strain, time-pressure, and monotonous work tasks; the classification of individuals is based on the same principle used for physical work environment. to observe associations between the independent variables and attitude to work, we shall estimate logistic regression models in which the different periods are included as independent variables. in this study, odds ratios are presented. this means that we can determine whether the analysed category’s distribution over the dependent variable corresponds to or diverges from the distribution of the reference category (hosmer & lemeshow, 2000). through the multivariate analysis, the relative importance of the remaining independent variables is controlled for. the inter-period comparison is done using cross-sectional analysis, in which periodic change for the three latter periods is expressed as the change in the probability to hold extrinsic work values in relation to the reference year 1979. periodic change will be presented separately for the six age-groups, namely, 16–29, 30–39, 40–49, 50–54, 55–59, and 60–65. results this section examines the periodic development of attitudes towards work among older workers. by way of introduction, descriptive statistics for various key groups in the swedish workforce are presented and discussed. there is a focus on ageing-effects as well as cohort-effects. thereafter, multivariate models are employed to njsr – nordic journal of social research vol. 5, 2014 176 determine whether periodic change can be identified when factors related to workforce changes are controlled for. table 3 displays the distribution of the extrinsic attitude in workforce subgroups, that is, men, women, and various age-groups in four different periods. table 3. workforce subgroups: percentages with extrinsic work values in sweden in 1979, 1987, 1994–1996, and 2001–2003, and distributed by workforce, gender, and age-group. 1979 1986–1987 1994–1996 2001–2003 workforce 25.3 21.5 19.5 19.2 women 21.8 18.9 16.2 16.2 men 28.8 24.0 23.0 22.2 age-group, years 16–29 33.7 30.7 31.2 32.8 30–39 21.6 17.4 15.6 16.0 40–49 23.9 19.8 18.7 18.7 50–54 18.9 17.6 14.5 12.7 55–59 24.4 21.3 14.5 15.6 60–65 19.7 13.5 14.8 10.4 the results in table 3 indicate that, for the working population as a whole, there is a downward trend for the extrinsic attitude, from 1979 to 2003. in other words, more people reported that they found their work intrinsically meaningful rather than economically rewarding. the proportion of individuals with an extrinsic attitude decreased from 25.3 per cent in 1979 to 21.5 per cent in 1987, stabilizing at approximately 19 per cent in the last two periods. throughout the time period of the study, a substantially larger proportion of men than women held an extrinsic attitude.table 3 also shows developments for different agegroups. figure 2 shows how attitude to work was distributed across different age-groups for each included sub-period. njsr – nordic journal of social research vol. 5, 2014 177 figure 2. developments for the prevalence of the extrinsic attitude between age-groups in four different sub-periods, 1979–2003. regarding the three different hypotheses, we may recall that they imply different expected patterns. first, the psychological hypothesis implies stable differences between younger and older workers. secondly, the cultural hypothesis suggests that we should expect differences in how the same age categories within different cohorts report attitudes, considering that they belong to different generations. thirdly, the structural hypothesis suggests that attitudinal developments should follow labour-market developments. the results presented in figure 2 indicate no qualitative differences in how work attitudes are distributed in different age-groups, that is, a clear majority express intrinsic attitude for all groups at all subperiods. rather, there is a distinctive general tendency for the proportion of the workforce possessing an extrinsic attitude to be lower, moving from the youngest to the older age-groups. but these age-effects are not linear; the proportion of people emphasizing extrinsic rewards is not consistently lower as the age of the age-group increases. for example, among working people aged 55-59 extrinsic attitudes are consistently more widespread than among working people aged 50-54. also, the relationship between working people aged 30-39 and 40-49 is different for the different sub-periods. this implies that the consistent age-effect appears between the older agegroups and the youngest age-group. the centrality of this relationship 0   10   20   30   40   50   60   70   80   90   100   16–29     30–39   40–49   50–54   55–59   60–65   1979   1986-­‐1987   1994-­‐1996   2001-­‐2003   njsr – nordic journal of social research vol. 5, 2014 178 is further demonstrated by the fact that differences between the older age-groups are smaller than they are in relation to the youngest category. with regard to cohort-effects, the age categories older than 29 show a clear increase in individuals judging their work as intrinsically meaningful rather than as economically rewarding. for most groups, this trend applies to the three earlier sub-periods and seems stable between the third and the fourth sub-periods. the attitudinal change is substantial. in fact, in the oldest age-group, the proportion of working people with the extrinsic attitude was approximately ten per cent lower in 2001–2003 than in 1979. again, the youngest age-group (16–29 years) stands out as the category in which the cohort-effects are most modest between different periods. in sum, the descriptive analysis shows that a declining proportion of the swedish working population holds the extrinsic attitude. more working people emphasize non-financial rewards when describing their work. since this pattern is general, except for the youngest agegroup, the results deviate from the differences between cohort that would be expected from the cultural hypothesis, but are in line with what should be expected from the psychological and the structural hypotheses. to deepen our understanding of this problem and to take structural factors into account, multivariate logistic-regression models have been estimated in which each of the four periods are included as an independent variable. in doing this, i have been able to isolate the periodic change in order to examine whether we can identify statistically significant changes in probability for extrinsic attitudes between time-points while controlling for factors related to the structural hypothesis, namely, gender, sector, social class, and work environment. table 4 shows how these variables are related to the probability of an extrinsic attitude. in this article, the importance of the variable of period is of particular interest since it demonstrates whether a cohort-effect remains statistically significant when structural factors are held constant. the year 1979 constitutes the reference category, and the coefficients for the other periods express the change of the odds ratio when the rest of the independent variables are controlled for. njsr – nordic journal of social research vol. 5, 2014 179 table 4. the probability of holding an extrinsic attitude depending on gender, period, physical work environment, psychosocial work environment, sector, and social class (1979–2003). logistic regression (odds ratio). expb coefficients and r2 values in percentages. reference group in parentheses. 16-29 30-39 40-49 50-54 55-59 60-64 period (1979) 1 1 1 1 1 1 1986/87 .803* .892 .803* 1.012 .877 .69 1994-1996 .718*** .789* .724*** .945 .603** .899 2002/03 .83* .813* .756** .836 .725* .661 gender (women) 1 1 1 1 1 1 men 1.09 1.454*** 1.116 1.507** 1.346* 1.201 class (sce i & ii) 1 1 1 1 1 1 sc iii 2.647*** 2.549*** 2.516*** 2.929*** 2.277*** 3.636*** skilled 2.55*** 4.177*** 4.027*** 4.702*** 3.076*** 4.401*** unskilled 4.815*** 6.848*** 6.028*** 7.747*** 4.351*** 7.882*** sector (com./county) 1 1 1 1 1 1 state 2.746*** 1.848*** 1.743*** 1.474 3.01*** 2.33* private 3.447*** 2.296*** 2.78*** 2.014*** 2.725*** 2.549*** physical (good) 1 1 1 1 1 1 medium 1.21*** 1.185 1.408*** 1.108 1.554** 1.415 bad 1.81*** 1.521*** 1.506*** 1.688** 1.44 1.386 psychosocial (good) 1 1 1 1 1 1 medium 1.608*** 1.126 1.295*** 1.095 1.213 1.518 bad 4.114*** 3.779 4.185*** 2.267*** 2.224** 7.35*** n 5949 6693 7016 3025 2566 1600 nagelk. r2 21.3 21.6 22 19.8 16.7 21.1 *** p < 0.001, ** p < 0.01, * p < 0.05 the results show that attitudes to work have indeed changed for several age-groups; that is, a cohort-effect can be observed. in all age-groups where the coefficients for period are statistically njsr – nordic journal of social research vol. 5, 2014 180 significant, however, the odds-ratio probability for extrinsic work attitude decreased. the results also show that the changes in attitudes are influenced by structural factors. regarding cohort-effects, the oldest age-group, together with the age-group 50–54, displays no statistically significant periodic change when other independent variables are controlled for. in other words, the odds ratio of working people in these age-groups holding extrinsic work attitudes is neither greater nor less than it was in 1979. the four remaining age-groups, in some sub-periods, display statistically significant changes in relation to 1979. however, when this is the case, the odds ratio is consistently lower in the two last periods than it was in 1979. most importantly, the youngest age-group shows a statistically significant decrease when structural factors are held constant. this implies that the indicated polarization between the youngest and the oldest agegroups is mainly explained by differences in class composition, work environment, and more. furthermore, the results presented in table 4 underscore the general importance of structural conditions for understanding work values. there are strong and stable differences in the odds ratios for extrinsic work values between social groups, especially regarding social class and psychosocial work environment. these characteristics were important for every single age-group regardless of period. another noteworthy result is that the higher odds ratio for an extrinsic attitude among men than women is no longer statistically significant within the youngest and the oldest age-groups and quite weak within the remaining age-groups. some remarks on the study design are warranted. in line with earlier research, the present study reveals significant differences between sub-categories, that is, the included control variables. there is a risk that there may be underlying tendencies that contradict the general results. for example, the odds ratio of extrinsic work values among worker subgroups may have changed significantly while the general trend has remained stable. therefore, the various sub-categories have been separately analysed. these sub-categories include dichotomized versions of the control variables, that is, workers versus service-class employees, public-sector versus private-sector employees, men versus women, high versus low exposure to psychosocial demands, and highversus mediumand low-strain physical work environment. the results of the separate analyses – which are not shown here – display a striking stability. no single age-group in the various subcategories displays an increased odds ratio for extrinsic work njsr – nordic journal of social research vol. 5, 2014 181 attitudes. in other words, the analyses generated no support for the assumption that the odds ratio for extrinsic work attitudes has increased among workers in relation to service class employees, men in relation to women, and so on. the results confirm the findings of the general analysis of work values among the various age-groups. despite all the changes in the swedish labour market over the period 1979–2003, the attitudes of working individuals have been stable or strengthened in relation to the reference year and differences between groups have persisted. concluding discussion this study analysed changes in attitudes to work for different agegroups in the swedish workforce during the period 1979–2003. earlier research shows that older working people generally express intrinsic rather than extrinsic work attitudes, while a substantially greater share of younger workers emphasize extrinsic rewards (e.g., edlund & hult, 2008; hult & svallfors, 2002; mathieu & zajac, 1990), but there is limited research on how age-differences have evolved over time (twenge et al., 2010; berglund, 2001). there are competing theories about why attitudes to work are distributed in such a way and how they have changed during recent decades. the psychological hypothesis states that differences between younger and older people reflect age-differences in cognitive and motivational orientations. younger people are generally oriented towards planning for the future, while older people emphasize emotional equilibrium. the cultural hypothesis emphasizes generational factors and norms concerning work. different cohorts share different life events and conditions and this tends to generate generational differences in how work is valued. the structural hypothesis assumes that attitudinal change is driven by structural changes in the labour market. from this perspective, agedifferences in work attitudes reflect age-differences in working conditions. these different hypotheses imply different expectations on how work attitudes should have developed across time, but earlier research on how age-patterns in work attitudes develop over time is limited. to contribute to this discussion, developments for different age-groups were examined while factors related to structural change were taken into account. thereby, the argument that we should expect changed age-patterns besides those that are explained by structural factors could be empirically tested. njsr – nordic journal of social research vol. 5, 2014 182 results showed no signs of the attitudinal developments that would be expected from the cultural hypothesis. first, results indicated that the younger age-groups at all periods had a substantially higher proportion with an extrinsic attitude than older age-groups. thus, the age-effects found in earlier research, that is, older workers to a lesser degree emphasize extrinsic rewards than do younger workers, remains valid for all periods included in this study. secondly, results indicated that cohorts have different proportions of people with extrinsic attitudes at different periods. thus, cohort-effects provided no empirical support for the stability of work attitudes within cohorts that is suggested by the cultural hypothesis. the multivariate analyses that included structural factors as control variables indicate that the general pattern of decreased prevalence of extrinsic work values reflects general changes in job structure and the composition of the workforce. in comparison with the year of reference the subsequent periods are characterized by more high-skilled and well-paid jobs and an increase in emotional work at the expense of traditional industrial work, and such jobs are related to intrinsic rather than extrinsic work values. for several older age-groups, periodic change between one sub-period and the year of reference no longer are statistically significant when structural factors such as class, work environment, gender, and sector were controlled for. thus, these results provided support for the structural hypothesis. furthermore, such an argument is strengthened by the fact that there were strong and stable differences in the odds ratios for extrinsic work attitudes between social groups, especially regarding social class and psychosocial work environment. this implies that differences in the odds-ratio for an extrinsic attitude have been strong regardless of period. in other words, there have been no qualitative changes in the distribution of attitudes between age-groups. the changes should rather be understood as quantitative changes; the prevalence of the extrinsic attitude has decreased and the gap between the youngest group and the older groups, which was already there in 1979, has widened over time. one important finding was the substantial difference between the youngest age-group, aged 16–29, and the older age-groups. approximately one-third of the youngest group reported an extrinsic attitude, irrespective of sub-period. given that the remaining agegroups show decreased levels of extrinsic attitude, the gap between the youngest and the older age-groups has widened over time. this result indicates that developments on the swedish labour market have njsr – nordic journal of social research vol. 5, 2014 183 been towards a polarization between the relatively well-off middle aged and the youngest age-group who suffer from the poorest working conditions and hold the most extrinsic attitudes towards work. however, if we consider the psychological hypothesis, we may interpret this result as at least partly a reflection of different cognitive and motivational orientations between the youngest and the older agegroups. the design of this study does not allow for conclusions about the relative importance of psychological and structural factors, and these factors should be addressed in future research. of course, it should be pointed out that there are other limits to this approach. first, since this is a case study the results cannot necessarily be generalized to other contexts. patterns are likely to vary between different countries depending on how labour markets have evolved. in countries where low-paid jobs with low skill levels and low educational demands have grown more widespread, extrinsic work attitudes are likely to have become more prevalent. this might explain why the results in this study deviate from earlier case studies from the united states (e.g., twenge et al., 2010). one question for future research is how different developments of the job structure are related to cross-country differences in work attitudes. secondly, the included sub-periods do not cover every year within the study period. thus, there is a risk that the results cannot be generalized to years or periods not included in this study. indeed, the aim of the study was to cover a period that captured the important structural changes to the swedish labour market, the most important being the changes in the job structure following the financial crisis of the early 1990s. the design of the study covers the period 1994-1996, which was a critical period with high unemployment resulting from layoffs in swedish industry, but not the last years of the same decade. during the final years of the 1990s, patterns changed. the rates of employment among men increased while the effects of the financial crisis hit the public sector. austerity programmes led to downsizing and layoffs in branches where most employees were women. since we know that (i) during the early phase of the crisis it was predominately men who lost their jobs (and therefore were not included in the measurement of attitudes to work) and (ii) that men are more likely than women to express extrinsic attitudes, this might mean that results for the third sub-period, 1994-1996, cannot be generalizable to the years between the third and the fourth sub-period. however, this limit is not likely to affect the general conclusions of this study, that is, that extrinsic attitudes decreased across time, but that age-effects were stable and njsr – nordic journal of social research vol. 5, 2014 184 cohort-effects confirmed that the distribution of attitudes changes as working people grow older. policy implications while the majority of swedish workers hold attitudes that are less extrinsic, the youngest age-group do not follow this pattern. around one-third of the 16–29 year-old swedish workers identify with the description that ‘[t]his job is like any other job. you do what is expected of you, but the only thing that matters is the earnings’. this attitudinal lag is related to the generally weaker position of younger people on the labour market. earlier research shows that, particularly since the swedish financial crisis of the 1990s, it is the youngest workers who have the weakest employment security, the poorest working conditions, the lowest wages, and the highest prevalence of mental-health problems (strandh et al., 2012). furthermore, for these young workers, labour-market entry and establishment have been delayed owing to longer educational periods, protracted unemployment, and weaker employment security. if policy-makers aim to change younger peoples’ work attitudes, and thereby decrease age-differences regarding work attitudes, the results of this study imply that researchers and policy-makers should engage more thoroughly in demand-side factors, that is to say, how conditions on the labour market and in the workplace affect work attitudes. the significance of class and work environment – the psychosocial dimension in particular – suggests that such measures should include an examination of how increases in levels of skill and improvements in work environments directed to improve the balance between demand, control, and social support in work 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[what kinds of jobs have been created in the swedish labour market in recent decades?], ekonomisk debatt 7/2004 (32), 37–46. microsoft word inge, proof, sept2.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 3, 2012 the transfer of knowledge and the problems of identity in a managed and online context inge hermanrud hedmark university college, rena nordland university, bodø email: inge.hermanrud@hihm.no abstract the purpose of this article is to look into the social aspect of learning, and in particular how the construction of identity influences the transfer of knowledge in a managed and online context. the relationship between the ‘old-timer’ and the ‘newcomer’ is given special consideration through a qualitative study of the norwegian labour inspection authority. the study shows that inspectors construct their identity and categorize others in a way that creates barriers to the transfer of knowledge, constructions that are influenced by managerial participation. this article contributes to our understanding of how social aspects influence the transfer of knowledge between old-timers and newcomers in a managed and online context. keywords: managed networks, communities of practice, knowledge transfer, identity construction, public inspectorate, online context introduction this article illustrates how the construction of conflicting identities creates problems for the transfer of knowledge between dispersed old-timers and newcomers in a managed and online context. two central concepts that this njsr – nordic journal of social research vol. 3, 2012 53 issue relates to are ‘managed networks’ and ‘communities of practice’. managed networks are formally initiated arrangements that organizations use to try to exploit the advantages of communities of practice (lave & wenger, 1991; wenger, 1998) in order to enhance organizational learning. communities of practice are groups of people who regard themselves as practitioners in the same area of work and therefore share an interest in the same knowledge, since they conduct the same tasks (wenger, 1998). this article seeks to increase the understanding of managed networks for the sharing of knowledge. specifically, i contribute to the management of communities of practice by describing the managerial dilemma in relation to the construction of identity. this study focuses on experiences of the implementation of networks of competence in the norwegian labour inspection authority (nlia). historically nlia recruited its employees on the basis of their years of experience from branches like building and construction. newcomers were assigned to an experienced employee and therefore the process of becoming an experienced inspector was the mode of learning. in their respective districts the employees had to conduct inspections regarding different areas of health and safety, ranging from the prevention of accidents to psychological well-being. during the last years this has changed: nlia now expects the employees to be more specialized professionals who to be assigned both to projects (where the production takes place) and to managed networks of competence (where organizational learning is supposed to take place). in general, managed networks sometimes overlap with existing communities of practice and serve to enhance current identities and learning practices. some managed networks are attempts by the organizations themselves as a means of developing new communities of practice (newell, robertson, scarborough & swan, 2009). while social identity is a core concept in the literature on communities of practice (brown & duguid, 1991; lave & wenger, 1991; wenger, 1998), problems of identity have often been underestimated (hong & fiona, 2009). the research concerning managerial efforts to oversee the communities in and between organizations is also in its early stages (newell et al., 2009). one issue that requires further study is the problem of the use of communities of practice as a proxy for situated learning for presentday heterogeneous workspaces (macpherson & clarke, 2009). because situated learning takes place in the same context in which is it is applied, heterogeneous workspaces might limit the value of sharing knowledge, since the experiences are generated and interpreted in different contexts. in this article, i address this gap in the literature by examining networks of competence established by management, and how the members of these managed networks struggle to transfer knowledge among themselves. in particular the relationship between ‘newcomers’ and ‘old-timers’ is investigated. the central problem i consider is the constructions of identity that create barriers to the transfer of knowledge in designed organizational learning processes. in particular i discuss how a managed and online context contributes to identity-construction problems. this is an interesting issue because research on networks of practice (brown & duguid, 1991; brown & duguid, 2000) and communities of practice (lave & wenger, 1991; wenger, 1998) suggests that different forms of constructions of identity might be related to the cultivation of and access to resources of knowledge. a relatively new aspect of this phenomenon is the managerial ambition to integrate njsr – nordic journal of social research vol. 3, 2012 54 geographically spread units into one integrated unit by using information and communication technology (ict) and networks aiming to develop communication, collaboration, and learning horizontally in the organization (newell et al., 2009). this study has examined an instance of this development. this article is structured as follows. first, the concept of the transfer of knowledge and the trade-off between old-timers and newcomers is elaborated. secondly, the role of identity-construction in the transfer of knowledge is defined and the role of managed and online context is discussed. thirdly, the research setting and research method and analysis of the study are explained, the multidisciplinary context is emphasized here, which only a few studies on learning across communities of practice has addressed (oborn & dawson, 2010), followed by the empirical section of this article. finally, findings are discussed and concluding remarks articulated. theoretical framework the transfer of knowledge and the trade-off between old-timers and newcomers carlile (2004) has developed a useful framework for reflecting upon the management of the transfer of knowledge when the participants have not yet formed a homogenous community. this framework identifies three types of circumstances. the first type describes a continuum with, on one end, a situation where differences and dependencies are known and, on the other, unfamiliarity generates a less clear situation. the second covers those circumstances when there are different interpretations of the same experience (or other types of knowledge). the third occurs when different interests regarding what knowledge is are generated. in the first circumstance a common lexicon is needed for the transfer of knowledge; in the second, a common meaning has to be developed; and in the third, a common interest must be developed – all to ensure the sharing and assessing of knowledge. østerlund and carlile (2005) suggest that newcomers and old-timers have different interests at stake in the sharing of knowledge. there are power issues related to the identification and ownership of meaning, and tensions between canonical and non-canonical practices. viewed from a practice-based perspective, the transfer of knowledge is simultaneously the transformation of work practice (gherardi & nicolini, 2000), since the transfer of knowledge implies that it transforms what you do, your interpretations and interests, and at the same time how you view yourself and others. march (1991) suggests that the turnover of personnel between old-timers and newcomers in organizations produces a trade-off in the distribution of knowledge. experienced members on average know more, but what they know is made redundant by the knowledge already reflected in the organizational code, and they are less likely to contribute new knowledge. on the other hand, new recruits are less knowledgeable (i.e., less experienced in this organizational context) than the individuals they replace, but what they know is less redundant in respect of the organizational code, and they are njsr – nordic journal of social research vol. 3, 2012 55 more likely to deviate from it. according to march, old-timers induce exploitation, that is, production, efficiency, and implementation. newcomers, on the other hand, increase exploration, namely, search, discovery, and innovation. exploitation and exploration are about negotiating the experiencebased ‘best practices’ and developing new practices. hence, the trade-off between old-timers and newcomers is enabled by constructions of social identity that empower the participants to identify themselves with these negotiated work practices. the role of the construction of identity in the transfer of knowledge researchers currently make use of the term ‘communities of practice’ to analyse and facilitate the transfer of knowledge in a wide range of organizational environments (roberts, 2006). the literature on communities of practice offers a mutually constitutive account of social identity and the transfer of knowledge. learning is seen as the process of negotiating identity (jørgensen & keller, 2008). lave and wenger’s (1991) early account of communities of practice is based on apprentice styles of learning, a theory of newcomer learning whereby novices or newcomers acquire knowledge and skills through interaction with experienced members. thus the process of gaining competence and membership in a community is linked to changing identities, involving newcomers gradually taking on more expert roles or ‘identities of mastery’, as lave and wenger denote it. in communities of practice a shared sense of identity is seen as an enabler for the transformation of identity and an outcome of the transfer of knowledge (wenger, 1998). wenger (p. 149) argues that identity is characterized as: being a negotiated experience; established through membership of the community; connected to our learning trajectory; and reconciling our memberships in different communities negotiating experience contributes to the broadening of meaning and the development of identity. lave and wenger (1991) view learning as the process of becoming a member of a specific community through participation, and wenger (1998) refers to the unique history of the individual who has multiple memberships and identifies with different communities of practice, and takes part in different learning trajectories. as wenger explains: … we all belong to many communities of practice: some past, some current; some as full members, some in more peripheral ways. some may be central to our identities while others are more incidental. whatever their nature, all these various forms of participation contribute in some way to the production of our identities. (1998, p. 158) hence, the construction of identity with respect to the transfer of knowledge has been described in two ways. one view is that it is a one-way, linear process, the movement from apprentice to master, like becoming a tailor or butcher (lave & wenger, 1991). the other view is that the construction of identity is a dual process, involving the belonging and positioning in a discourse in negotiations, where the development of a new identity helps in accountability to others in the same activity (wenger, 1998). njsr – nordic journal of social research vol. 3, 2012 56 in the organizational context, social categorizations regarding being a member of the organization or sub-groups, or both, produce prototype-based depersonalizations of self and others responsible for the social identities in organizations (hogg & terry, 2000). social-identity theories focus on how social categorizations and participation in groups form who you are. newcomers enter the organization with one social identity which will influence their learning and their construction of other social identities. social identities can, therefore, both enable and constrain the transfer of knowledge between newcomers and old-timers. in the literature on identity in organizations there are two competing views regarding the role of social identity. the integrationist view emphasizes the coherent characteristics of organizations, stressing that the transfer of knowledge can be supported by the development of organizational identity, through trust, loyalty, and shared values and implicit norms, for example (willem, scarborough & bulens, 2008). this integrationist view proposes a positive relationship between organizational identity and the transfer of knowledge (haslam, postmes & ellemers, 2003; kane, argot & levine, 2005). in this view, through the de-personalization in social identity, spontaneous and unconditional willingness to transfer knowledge and transformation of practice can occur. the fragmentationalist view, in contrast, regards social identities as being multiple and fragmented, and are thus more unpredictable (albert, ashforth & dutton, 2000; alvesson, 2000; willem et al., 2008). willem et al. (2008, p. 374) identify three scenarios for forms of social-identity construction in organizations: 1) there is a dominant company-wide social identity, without or with a weak sub-group social identity; 2) there are multiple social identities, different social identities in each unit or community of practice, and possibly coexisting with a non-dominant company-wide identity. 3) organizational members do not primarily identify with the organization or sub-groups, but with external groups, such as professional associations. it is interesting to note that the employees, both newcomers and old-timers in scenarios 2 and 3, do not need to identify with the organization at all. this gives us a complex, less straightforward, and less optimistic answer to the positive role of ‘managed’ identity-construction in the transfer of knowledge between old-timers and newcomers in managed networks. the role of managed and online contexts for the construction of identity and the transfer of knowledge the establishment of managed networks supported with ict is an intervention by the organization to constitute the necessary conditions for their employees to connect and transfer knowledge. regarding the content, some researchers advise that management should support peer-to-peer-based learning methods instead of classrooms, and avoid privileged and formally objectified knowledge, because it neglects the tacit practice-based knowledge and allows the participants to decide and control which components of knowledge are important to them (hislop, 2009). njsr – nordic journal of social research vol. 3, 2012 57 managed networks for the transfer of knowledge imply two contradictory managerial roles. managerial interventions are sometimes required because organizations primarily use these networks to integrate dispersed knowledge, which reflects organizational value. distributed networks require also some form of managerial control because the members are dispersed, which makes social learning less likely to take place than in a community of practice, whose members are typically co-located. then again, the literature describes networks and communities of practice as being strongly emergent in nature, self-organizing, informal, and free from influence from management, or even negatively influenced by interventions by management. managerial control will, therefore, likely frustrate members’ desire to share their geographically dispersed practice-related knowledge (agterberg, hoof, huysman & soekijad, 2010; alvesson, kärreman, & swan, 2002; thompson, 2005;). it is widely accepted in the literature on virtual communities of practice that ict is not a perfect substitute for face-to-face encounters or meetings and most virtual communities of practice need some face-to-face time to be most effective (dubé, bourhis & jacob, 2006). deprived of an abundance of face-toface contacts, especially at the beginning, virtual communities of practice may have problems or take longer to establish a sense of identity, or both (cramton, 2001; dubé et al., 2006). there can be several explanations for these challenges. on the personal level, identification with others can be related to those who are helpful and those who are not. in face-to-face settings, reciprocity appears to be critical for sustaining supportive relationships and collective action (putnam, 1995). on the other hand, in electronic networks of practice – web-based forums in which anyone can access and participate (wasko & faraj, 2005) – findings have shown that the norm of reciprocity is not a significant predictor for helpfulness of knowledge contribution. wasko and faraj’s explanation is that online-based interactions may be generalized rather than dyadic, and direct reciprocity is not necessary for sustaining collective action. at the level of community amin and roberts (2008) point out that benefits of online communication in knowledge-transfer processes are higher for professional communities (whereby you become a clinician through individual academic study, teamwork, and virtual interaction) than communities of task or craft (whereby you become a midwife, tailor or flute maker through apprenticeship in a close-knit, face-to-face community), since once individuals have mastered a body of professional knowledge, they appear to benefit from exchanges of knowledge facilitated by online communications with dispersed members of their profession. their explanation is that the presence of professional standards and identity ensures the circulation of knowledge. methodology research setting the nlia has undergone a process of organizational change, from a hierarchical rule-based bureaucracy towards a more professional, knowledgebased bureaucracy (mintzberg, 1983). the organization has also moved towards a heterarchy, relying increasingly on collaboration and cooperation and making it a more decentralized network-based organization. one can njsr – nordic journal of social research vol. 3, 2012 58 argue that the nlia is a hybrid organization, consisting of the following coexisting elements: user-oriented logic (we inspectors know how to help the business), control-oriented logic (we inspectors know the legislation), and emerging professional logic (we inspectors know when stress is unacceptable). the nlia is a geographically distributed public organization, with employees dispersed around the country. the inspectors conduct inspections of the use and storage of chemicals, installed ventilation facilities, measures taken to prevent accidents at work or psycho-social well-being at work, or some or all of these. some work within one area (like occupational hygiene or the psychosocial well-being at work). others (in particular, inspectors in remote areas) have to conduct many different kinds of inspections. the inspectors in this organization have a range of backgrounds. historically speaking, people with years of experience have been recruited from industries in the building and construction sectors. others moved up from working as clerks to becoming inspectors, often after gaining college qualifications. more recently, people have entered the organization with a fuller and more extensive professional college degree or a university degree (bachelor’s or master’s). while the nlia used to keep its experts at its central core, it now has to develop their expertise in different regions, among the geographically dispersed inspectors. these people are now expected to be collective experts, experts for their region, but not national experts. attempts have been made to achieve this aim by setting up the networks of competence among inspectors. the networks of competence are managed networks, aimed to promote the sharing and learning of knowledge in the organization. the name of these networks has been debated. some argue that these networks are not ‘networks of competence’, as management labels them, but ‘professional networks’, stressing the development of academic knowledge within the networks. others use the broader concept of a ‘network of competence’, emphasizing the mix of professional and experience-based knowledge which needs to be developed. the inspectors within each region are assigned to one of four different networks, usually on the basis of their professional orientation or area of interest. the geographical distance between the different members can be as much as 1300 km, and, owing to their limited budget, they may only see each other face-to-face twice a year for two days at a time. the sharing and learning of knowledge are therefore supposed to take place via the use of ict. the networks meet up around once a month for one to two hours. the tool used in the network setting is gotomeeting™, a highly rated web-based tool that allows everyone in a group meeting to share whatever is on their computers (lipschutz, 2007). this tool contains features that enable screen, keyboard, and mouse sharing, as well as web chat and telephone conversations. it is also integrated with email and an outlook™ calendar to allow meetings to be booked effectively (see http://www.gotomeeting.com). while they are able to share everything they have on their computers and engage in meetings over the telephone, the participants do not actually see each other. at face-to-face meetings, which take place once or twice a year, they visit a business as a group and discuss what they have experienced there. or they invite an external expert lecturer or practitioner to give a talk on a particular topic. njsr – nordic journal of social research vol. 3, 2012 59 sampling procedure this study involves data from five networks of competence: two networks set up for the prevention of accidents, one for occupational hygiene and two within the area of psychological well-being. all of the networks were staffed with around eight to 14 people. the networks were selected on the basis of the following criteria: they all offered a distributed context (as they were networks from the two largest regions), and they represented different areas of knowledge, thereby adding variation to the study. in the two networks of psychological and social well-being there were no psychologists, but instead people with degrees in human geography and sociology, priests, former police constables, social workers, and others. the two networks for the prevention of accidents were staffed with both engineers and social scientists. the most homogeneous network was the network for occupational hygiene, in which at the time of the study nearly all of the participants had some type of degree in engineering. all of the networks, as well as the inspectors, included one or two lawyers. this study therefore represents a context including multiple preexisting identities. since the networks of competence had not been functioning very well, one manager had taken part in the discussions to ensure that everybody was polite and respectful, and to encourage further participation through acknowledging the importance of their attendance. the collection and analysis of data the collection of data took place over a three-year period. this involved interviewing network members and managers in the organization, as well as observing physical and online meetings and documents (see table 1 for an overview). i sought the data from multiple members, newcomers and oldtimers, inspectors and managers, from different networks, figuring that they could provide different insights into my topic. i was logged in to the same meetings as the participants, with access to what was happening via the telephone and the computer. sometimes, at the end of the meetings, when the participants were making evaluations, i asked questions regarding what had taken place. table 1. the methods of collecting data in this study. interviews 18 individual interviews one group interview of five managers questions asked during observations observations 2.5 years of observation of face-to-face and online meetings in two networks archival material agendas of meetings minutes of meetings official evaluation this study defined newcomers as participants in the networks of competence with work experience of less than seven years in the organization. among the 18 interviewed i had four informants with less than three years of experience, four with four to seven years’ experience and ten with seven up to 30 years of experience in the authority. njsr – nordic journal of social research vol. 3, 2012 60 the individual interviews lasted between 45 minutes and two hours. the group interview lasted for two hours. owing to the long distances i had to travel, nine of the 18 individual interviews were conducted via telephone. although telephone interviews are thought to be the second-best option for obtaining data in situations where social cues are important (opdenakker, 2006), the telephone interviews proved to be just as elaborative as the ones conducted face-to-face. one reason for this may have been the informants’ familiarity with presenting and elaborating on complex matters via the telephone. all of the interviews were recorded, transcribed and analysed by the use of the nvivo 8.0 tool. the interviews were coded around sensitizing concepts (blumer, 1954; hoonaard, 1997), such as ‘newcomer perception’, ‘old-timer perception’, ‘negotiations’, and ‘identity’. in the axial coding i devised the categories of ‘givers’ and ‘receivers’ and ‘negotiating identity’ and ‘role of manager’ and ‘online environment’. in this final stage, notes from observations and archival data were used to develop the categories further. findings the overall findings indicate that there are problems in the relationship between newcomers and old-timers situated in the managed-network context. i shall report and discuss my detailed findings in the following sections. how newcomers and old-timers perceive each other in the context of networks of competence judging from the viewpoints of the newcomers and the old-timers (table 2), we can see that it is evident that both parties were constructing sub-identities. the findings also suggest that the nlia was lacking a strong organizationalwide identity which could provide the spontaneity and willingness to transfer knowledge from old-timers to newcomers. there are also differences in inward and outward orientations between newcomers and old-timers, respectively. this i have already reviewed in my second interview in this study. one oldtimer put it in this way: ‘many of the inspectors are not interested in what’s going on in the organization at all; they spend their time out in the field inspecting’. newcomers, on the one hand, are eager to learn about their organization, but the old-timers spend more time interacting with others in the field than they do with their colleagues in the organization. while the newcomers regarded the networks as an opportunity to learn about their organization and to nurture their professionalism, many old-timers regarded the networks as a scheme which does not work for them. these contrasting images have created tensions and a lack of engagement (e.g., no-shows at meetings). njsr – nordic journal of social research vol. 3, 2012 61 table 2. conflicts of identity between newcomers and old-timers in networks of competence in the nlia newcomers’ perceptions old-timers’ perceptions we are becoming specialized experts. ‘for the nlia, it is very important that we have people with in-depth expertise and professional expertise in different fields, nurtured by activities in the networks.’ (male inspector, three years of experience at the nlia) we think that the network is a good idea. ‘i think the intention behind it is very good, as we need a place where we can get professional input.’ (female lawyer, one year of experience at the nlia) we relate to other newcomers. ‘i relate, when i have questions, to other young people; i think it is the age dimension’ (female inspector, one year of experience at the nlia.) i am often alone with my questions in my office. ‘i miss having somebody to talk to, as there are only two of us at my office, and the other one is a lawyer.’ (female inspector, one year of experience at the nlia) the old-timers are a problem. ‘they are not willing to share their experience.’ (female inspector, one year of experience at the nlia) we are inspectors, and inspecting is a separate professional field. ‘this … inspection … is about communication skills … communication with the managers of the inspected business to ensure that change happens there. but sadly our management doesn’t understand that inspection is a separate professional field.’ (male inspector, seven years of experience at the nlia) we miss the national experts. ‘now there are a lot more employees in the labour inspectorate, and we are divided into networks, and it is not so easy. previously we had contact with those who were specialists in the directorate. i would call the expert at the directorate on the phone, and talk to him directly. we don’t have this anymore, and i miss it.’ (male inspector, more than 30 years of experience at the nlia) we use our informal network. ‘i know from experience who is a specialist regarding certain types of accidents.’ (male inspector, more than 30 years of experience at the nlia). we learn while doing inspections. ‘all of the learning takes place when conducting inspections together, in twos.’ (male inspector, more than 20 years of experience at the nlia) newcomers are a problem. ‘when “newcomers” enter the network, the discussions are brought back to level one.’ (norwegian labour inspection authority, 2008 official evaluation, p. 10) the construction of the ‘givers’ and the ‘receivers’ the inspectors view the exploitation of experience-based knowledge as problematic, as there are members who become ‘givers’ who always share with others but rarely receive anything in return. the newcomers are the ‘receivers’, who then benefit from the network. one senior inspector expressed his views in this way: njsr – nordic journal of social research vol. 3, 2012 62 [the networks of competence] are most useful for the less experienced members, and less so for the more knowledgeable and experienced. your role as a giver is larger than that of a receiver. these networks are supposed to play the role of a collective, to whom individual inspectors can ask questions. it seems to be less useful for those with the highest competences, as reflected upon by this manager, with more than 30 years of experience in the organization: many feel that they do not receive as much in the networks ... it seems to me that those with the highest competence get little out of it ... and this is just because they are supposed to give to the others this unbalance has made it difficult to motivate the more competent employees to contribute to the network. for an outsider to this organization it might be obvious that the participants should have expected that the contributions from the older ones would be larger than those of the newcomers. in this organization however, the old-timers compare what they had before the networks of competence, when they had a national expert and an informal network of peers with special expertise to whom they could turn. negotiating identity and the role of the manager what is an inspector in the labour inspectorate? as presented in table 2, the old-timers refer to what they do in the field. they often describe how they work with their clients to instigate real changes in the inspected businesses as communicative or pedagogic skills. at the network meetings information from management is given, inspectors or invited external lecturers conduct academic lectures, and experiences are shared in form of stories and powerpoint™ presentations. for example, in the network for occupational hygiene, academic lectures are held on the hazards involved when different chemical substances are stored together, and what might happen and what they should look for when inspecting. another example is what takes place in meetings in the area of psychological well-being. here by reviewing research they try to determine what causes stress by and how this can affect individuals in a negative way, and how they can become aware of unhealthy stress when carrying out inspections and writing orders on it. these activities are good examples of how an exploration of implications of academic knowledge and new research can be integrated with existing experiences and inspecting practices. on the other hand, several of my respondents reported problems. first, the inspectors emphasized differences in professional orientation as a major problem that made it difficult to integrate different areas or perspectives of knowledge. like when they stressed that the language of some of the other participants in the network was too full of unknown terms. several of my respondents emphasized that some of these problems were related to the differences between newcomers and old-timers. at a regional meeting, a former district manager, who is now an adviser, voiced an emerging problem: i think we have encouraged new employees to believe that they should be able to immerse themselves in their field. companies have now begun to complain that the inspectors are academically strong but that they are difficult to communicate with (notes from a regional meeting). njsr – nordic journal of social research vol. 3, 2012 63 this quotation reveals a conflict which exists within the organization regarding knowledge and which path should be followed, for both the individual and the organization. for many of the experienced old-timers, inspections are about engaging in a dialogue with clients and making real changes in the workplace under inspection. some newcomers, in contrast, have formed another picture, as noted by one inspector: ‘the business has hired the best experts; we need to develop the same [expertise] to be able to carry out inspections there’ (notes from a regional meeting). to me this reveals two different and conflicting orientations of knowledge: one towards the inspected business from the perspective of finding practical solutions (through communication), and the other towards mobilizing expertise to match the highly competent organizations that offer company health and safety services, which are hired by the inspected business. the latter orientation indicates a movement towards a greater degree of specialization in the nlia. the networks of competence seem to have participants who advocate competing orientations of knowledge with different learning trajectories and practices. secondly, newcomers expressed their frustration about how they sometimes do not know where to go with their questions regarding policy. they asked their managers and colleagues, addressed the problem in the network of competence meetings, and sent letters to the head office of the directorate, and they did not get any answers. some old-timers, on the other hand, said that they are unwilling to share their experiences or to reveal their practices in the setting of the network of competence because this might result in new formal directives regarding how they should do their work in accordance with policy. old-timers were also more accustomed to stronger dyadic relationships: i think the old boys probably do not think that the network is the right venue for learning ... they come from another time ... before the organization was reorganized … [they] miss [having] one key expert to deal with. they are used to a much stronger personal relationship with the expert. i can understand that they do not have the same trust in a network (newcomer). the expert in this quotation pointed to the time some years back when the inspectors could call an expert at the directorate in oslo and get answers there. old-timers, when describing their early days in the inspectorate, also referred to the importance of learning from one experienced inspector and from the national expert. two old–timer inspectors talked positively about the networks of competence. both of them had developed ict skills over the year and seemed to be very out-spoken. thirdly, the role of the participating manager is of interest here. many of my informants said that to have a manager present was very helpful since he or she contributed useful information about the organization and was often very experienced. on the other hand, this study has also revealed another role. one female inspector reflected upon this situation in one meeting when the manager was not present: ever since you asked us, i have started to reflect upon it, and i think the manager, through engagement, controls us. the manager reduces the number of perspectives in the discussions, and the discussions end njsr – nordic journal of social research vol. 3, 2012 64 earlier compared to when the manager does not participate (notes taken from conversations after a gotomeeting™ meeting). examples of different perspectives are current policies and rules and the needs of the client or findings in recent research. in one meeting a manager expressed this when discussing whether or not this group should learn about the solutions-oriented approach, and use it as a tool to reflect on their work practices: ‘we must not create new uncertainty around the policy… in a way the learning must not give mixed signals regarding our role…’. learning this framework would promote the role of problem-solver that the inspectors have often taken. in my interview data some old-timers stressed that this was their role. this manager was not sure, however, that they should adopt this role of helping inspected businesses to solve their problems, and thought that their role should be limited to control. to summarize, i would say that the newcomers relate the transfer of knowledge to a professional field and policy, while the old-timers are more likely to relate it to activities in the field that make a positive impact there by finding workable solutions and by problem-solving in the field. discussion the newcomers and the old-timers situated in the managed and online network seem to have experienced problems in establishing a common identity, as envisioned in the theory of communities of practice (wenger, 1998). i can point to several reasons for this situation. there have been a number of organizational changes and there are many new employees in the organization with different backgrounds. they rarely meet face-to-face, they work in different localities and with different clients, and it seems that there are very few strong interpersonal ties between the self-managed, independent, and dispersed inspectors. both the social categorization and the construction of identity have taken other paths than ones that could have enhanced a mutual construction of identity and the transfer of knowledge. as a result, these developments have created unclear learning trajectories for the newcomers and problems regarding the negotiation of experience and meaning across old-timers and newcomers. first, the categorization of each other as ‘givers’ and ‘receivers’ is counterproductive in making the old-timers and newcomers accountable to each other in a way that promotes a good balance between exploitation of existing knowledge and exploration of new knowledge (march, 1991). the narratives behind these two social categories communicate an uneven contribution from individuals, reducing the willingness of those who see themselves as ‘givers’ to contribute. this categorization of self and others reduces the generalized reciprocity and also hampers the development of the sub-group identity and reciprocity which could have been useful for the transfer of knowledge in this context. since the members do not know when or if they can benefit from the networks of competence, nearly only general norms for reciprocity and loyalty to the organization move them to contribute. in the long run this is not enough to develop the supportive relationships needed for transfers of knowledge. the distinction between the ‘givers’ and the ‘receivers’ resembles the distinction between the ‘worthy’ and the ‘unworthy’ in other contexts, giving in this context the ‘givers’ (often experienced old-timers) a legitimate reason to stop contributing, since they get so little out of it. this is an example of a creation of njsr – nordic journal of social research vol. 3, 2012 65 a self-identity where non-participation becomes socially acceptable among a group, in this case, the old-timers. this construction resolves tensions among the old-timers regarding what they should do (i.e., organizational norms) and what they are willing to do. it is counter-productive for the transfer of knowledge between newcomers and old-timers, however. table 3. negotiating identities in a context of managed networks negotiating identities problem what causes the problem? consequences problems when negotiating experience it is difficult to integrate different perspectives. there are conflicts in the orientation of knowledge. there are also a lack of a common lexicon, different interpretations of the same issue, and interest invested in practices. experiences are viewed from very different perspectives. the old-timers leave questions unanswered. the old-timers are not able (ict environment) or willing (managed environment), or both, to give an answer to the newcomers’ questions it is unclear who the experts are, who can give an answer regarding what to do. it is unclear how to become an expert. discussions end early. managers actively put an end to discussion since it might threaten a unified interpretation of the policy. it hampers the negotiation of experience from different perspectives, i.e., hinders the mutual construction of identity. secondly, due to different knowledge orientations and interests, and sometimes due to the role of the manager (table 3), it is difficult to negotiate experiences towards a mutual understanding, which is, according to wenger (1998), important in the identity-construction process. the lack of joint tasks and shared responsibilities contributes also to too few opportunities for developing mutual interests of knowledge. the role of management and online context will be discussed more in depth in the following sections. the role of the managed context for the mutual construction of identity and the transfer of knowledge old-timers and newcomers might have different interests at stake regarding access and control over resources of knowledge (østerlund & carlile, 2005). the old-timers in my study have an interest in conducting their work in a way that is consistent with their own preferences, or, put differently, in the practices of inspection they have invested in. in this context of managed networks of competence, old-timers seek to guard this interest by not disclosing njsr – nordic journal of social research vol. 3, 2012 66 everything, since disclosure might turn into new formal rules which could reduce flexibility in the field. the old-timers prefer learning in twos, face-toface, during inspections or on the phone with people they know and trust. their key asset of knowledge is the experiences and communicative skills they have developed through their relations to their clients, an area of knowledge that they feel is not acknowledged by management (table 2). others, often newcomers, put their professional identity in the foreground and are eager to discuss their professional field online as well as face-to-face. nurturing the professional identity can also be seen as a strategy to avoid managerial control and to increase the inspectors’ individual freedom to handle tasks. but it is also an orientation of knowledge that creates many barriers related to language, interpretation, and interest (carlile, 2004), which influence negatively the negotiation of experience and the mutual construction of identity among the participants. the old-timers and newcomers are not the only ones with interests at stake in the context of managed networks: the participating manager also has interests. agterberg et al. (2010) state that online intra-organizational networks of practice require some form of managerial control and support to develop their social learning. my findings similarly suggest that managers contribute positively through their engagement, their experiences or just by their presence. but managers also contribute negatively when their direct involvement cuts short the sharing of experiences and the exploration of new ideas (table 3). when the manager states that the inspector role is ‘only’ control, the manager also denies the participants the discretion to decide what aspect of knowledge is important in their practice. this relives the dilemma: on the one hand, managers are supposed to focus their employees towards organizational goals and to end debates, one the other hand, much of the tacit knowledge here is embedded in a user-oriented role. management hesitates to acknowledge this user-orientated role, but it is a core component of the oldtimers’ practice, identity, and knowledge. the exploitation of existing practice threatens the fragile ‘impression’ of consensus around the interpretation of the existing policy, and this threatens managers’ ability to control their employees and to implement policy effectively. when all three groups – newcomers, old-timers and managers – have these different interests at stake, it is hard to negotiate freely and to develop the mutual identity needed to enhance the transfer of knowledge among the participants. these findings support the idea that learning processes can be assisted, but also that interventions by management negatively influence them (agterberg et al., 2010; alvesson et al., 2002; thompson, 2005). when writing about managing communities, newell et al. (2009) emphasize that they only can be successful if managers limit their tendency to control and find new ways of managing, like supporting new expert roles, creating events, and documenting work practices. the management should, therefore, be more thoroughly informed about how the inspectors actually work if a managed transfer of knowledge is to succeed. one way forward could be for managers to support and acknowledge the user-oriented practices and knowledge, and to promote the roles of the old-timers as experts in order to motivate the transfer of knowledge from old-timers to the newcomers. njsr – nordic journal of social research vol. 3, 2012 67 the role of online relations for the construction of identity and the transfer of knowledge the online encounters in these managed networks of competence do not seem to be supported by the same generalized reciprocity, which, according to wasko and faraj (2005), facilitates collective action in the case of electronic networks of practice (web forums). instead it seems that the transfer of knowledge across the inspectors is more dependent on direct reciprocity, which is difficult to develop in this group-oriented online environment. in my findings i can see several reasons for this situation: 1) there are too many participants in the gotomeeting™ meetings, as many as 15, and many are silent. 2) the participants do not see each other (gotomeeting™), and it is difficult to get to know each other. 3) the old-timers were used to a dyadic relationship with a ‘master’ (when they were newcomers) and a national expert (later on) when learning. the third reason implies an interesting finding in relation to the role of reciprocity in these managed networks. maybe the reason why the experienced old-timer creates problems is due to his or her familiarity with dyadic relations rather than the generalized types of reciprocity a managed network can provide. when the old-timer reminisces, he or she looks back on a master-apprentice relationship and a strong association with an expert at the directorate. offering and receiving generalized reciprocity by a larger managed network seems to be an unfamiliar source for the transfer of knowledge for these dispersed inspectors. this offers a complementary explanation besides the role of professional standards (amin & roberts, 2008) regarding why online communication in knowledge-transfer processes is easier for professional communities than this task or craft community that these veteran inspectors seem to belong to. the old-timers appear to represent a task community where dyadic relationships are important – in contrast to the more academically oriented newcomers who rely on other newcomers or groups of the same profession. conclusion for more than two decades, learning theorists have studied the social aspects of the transfer of knowledge. the literature on communities of practice regard the forms of constructions of identity as being related to the cultivation of, and access to, resources of knowledge. novices learn from masters and are becoming central members in the community (lave & wenger, 1991; wenger, 1998). however, i have found that the newcomers and old-timers in this managed and online network context often do not regard each other as peers who possess useful knowledge and practices. the role of managed and online context contributes to complementary explanations for why they struggle to construct a mutual identity that facilitates the transfer of knowledge. while managerial intervention is needed to integrate dispersed knowledge (newell et al., 2009), and more is required in online contexts (agterberg et al., 2010), it also creates problems of identity. my study reveals that the njsr – nordic journal of social research vol. 3, 2012 68 negotiations of experience and the broadening of meaning, that is, the mutual construction of identity and the transfer of knowledge between newcomers and old-timers, is hampered by a lack of willingness or ability to share and by managers who control what knowledge is. on the other hand, there is need for some managerial effort to formulate goals for the networks of competence and to negotiate and communicate with and to motivate the members. i also suggest that online communication is easier for professional communities than it is for this task or craft community that the old-timers appear to belong to, not only due to a lack of shared professional standards (amin & roberts, 2008), but also due to a lack of familiarity with generalized reciprocity among the old-timers. further studies should look into whether veterans and more academically oriented newcomers in present organizations rely on different forms of reciprocity. if old-timers in craftor task-based communities in general mostly rely on dyadic relationships, and the aim is to transfer knowledge to more academically oriented newcomers and vice versa, managers should promote dyadic relationships in addition to networks in order to promote the mutual construction of identity for the transfer of knowledge. acknowledgements an earlier version of this paper was presented at the 2011 international conference for organizational learning, knowledge and capabilities (olkc), at hull university business school. the author would like to thank editor steven connolley and the two anonymous referees of the nordic journal social research for their helpful comments and suggestions on further drafts of this manuscript. references agterberg, m., van den hooff, b., huysman, m. & soekijad, m. 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(2008). impact of coherent versus multiple identities on knowledge integration. journal of information science, 34(3) 370386. østerlund, c & paul, c (2005). relations in practice: sorting through practice theories on knowledge sharing in complex organizations. the information society, 21(2), 91–107. microsoft word jakobsson, kotsadam, szebehely informal eldercare and care for disabled children in the nordic countries.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 4, 2013 informal eldercare and care for disabled children in the nordic countries: prevalence and relation to employment niklas jakobsson norwegian social research (nova) email: nja@nova.no andreas kotsadam norwegian social research (nova) email: ako@nova.no marta szebehely department of social work stockholm university email: marta.szebehely@socarb.su.se abstract in an international comparison, the nordic countries are generous care spenders and a relatively large proportion of the populations receive formal care services. however, in respect of service provision, the nordic countries are less similar today than they were some decades ago. using survey data from three nordic countries, denmark, norway, and sweden, we first document the differences in informal care between the countries, and then we assess its impact on the relationship between informal caregiving and formal employment. njsr – nordic journal of social research vol. 4, 2013 2 we find that informal care is most common in denmark and least common in sweden. however, those who provide care in sweden provide care more often than people in both norway and denmark. there is a negative correlation between being a caregiver and the probability of being employed in norway and denmark, but not in sweden. with specific regard to parental care, there is no general relation between the provision of parental care and employment, but those providing substantial care are clearly less likely to work than others. caring for a disabled child is less common than caring for a parent, but the negative effects on employment are even stronger. keywords: care, eldercare, informal care, disabled children, employment 1. introduction informal care is widely acknowledged to affect paid employment, but the main focus in the work-life balance discourse is on childcare (ackers, 2003; crompton & lyonette, 2006; leira, 2006). this aspect is well exemplified in the policy debate in europe (see ackers, 2003 for an overview), where there are concerns about the effects of an aging population on the tax burden of the working-age population (rubery et al., 2001). if the time devoted to informal eldercare is negatively associated with female employment, it is a fact that merits consideration in discussions on eldercare and especially on the reliance on informal care. furthermore, if different institutions and policies change the impact of informal care on female employment, then the results can serve as a basis for further policy discussions. the literature on nordic childcare and employment focuses on healthy children (e.g., leira, 2006), and care of disabled children may be an important complement as it is likely to be more time-demanding even if it is less common. hence, this article is situated in the debates on work-life balance and makes two central contributions regarding the scope of the type of care studied. first, it considers informal eldercare, which is very common among working-age people. secondly, it njsr – nordic journal of social research vol. 4, 2013 3 considers the care of disabled children, which is potentially more timedemanding than is the care of healthy children. in the literature on the welfare state, the nordic countries are wellknown for their de-familializing and universal approach to welfare, where services are paid by all and are available for all based on individual need and are to the same standards (esping-andersen & korpi 1987; kautto et al., 1999). some of the central principles of universalism in care services include the objectives of offering services according to need and not purchasing power and making the same services affordable for the poor but still attractive for the better off (szebehely, 2005). it seems to be the case that caregiving to older people has less of an effect on employment in the nordic welfare states than in the rest of europe, but the data used is becoming outdated (bolin et al., 2008; kotsadam, 2011; 2012). moreover, it is questionable whether these countries can really still be grouped together. rauch (2007) compares childcare and eldercare services in six european countries and questions the assumption that the scandinavian countries constitute a coherent model. he makes two distinct and important points: welfare states differ internally across different types of care provision, and even within, for example, eldercare the scandinavian countries differ between each other a lot. in the present article we investigate how different patterns of caregiving are related to employment in three nordic countries, denmark, norway, and sweden. we focus on differences in caregiving and on the links between informal caregiving and formal employment. our aims are to describe the differences in informal caregiving between the countries and to see if there is a relationship between being an informal caregiver and formal employment. we contribute to the literature by investigating both the relationships between informal eldercare and employment in the nordic countries, and the relationships between care of disabled children and employment. the first aspect is important because most studies have only investigated the relationship in anglo-saxon countries. the second is important due to the lack of focus on disability care in the employment literature and the lack of comparative studies across the nordic countries in this respect. comparing informal care for older and disabled people is potentially important because care services for njsr – nordic journal of social research vol. 4, 2013 4 these two groups tend to differ even in the same country. a swedish study that has compared informal caregiving for disabled adults and frail older people suggests that those helping a disabled person under the age of 65 provide more hours of care and receive less support from the formal care services than do those caring for a parent or another relative 65 years or older (jeppsson grassman et al., 2009). we find that provision of informal care (including all types of care) is most common in denmark and least common in sweden. however, those who provide care in sweden provide care more often than people in both norway and denmark. there is a negative correlation between being a caregiver and the probability of being employed in norway and denmark, but not in sweden. in regard to parental care (i.e., eldercare), there is no general relationship between providing parental care and employment, but those providing substantial care for a parent or for a disabled child are clearly less likely to work than others. this article proceeds as follows. in section 2 we review the previous literature on the relationship between informal caregiving and employment. in section 3 we describe the differences and similarities in care systems in the three countries, with respect to both formal and informal caregiving, and present our hypotheses. in section 4 we describe the data used and present descriptive differences between the countries. section 5 presents the results regarding the differences in informal caregiving and the relationship between informal caregiving and employment. section 6 concludes the article with a general discussion about the implications of the results and the limitations of the data. 2. previous studies on the link between informal caregiving and employment the previous evidence on the effects of informal care on employment outcomes is mixed, and the institutional context seems to be important. most of the existing studies on the relationship between informal care and employment-related outcomes do not differentiate njsr – nordic journal of social research vol. 4, 2013 5 between care for older people and for disabled children or adults. the majority of these studies have been carried out in the united states (e.g., ettner, 1996; johnson & lo sasso 2000; lilly et al., 2007; pavalko & artis, 1997; wolf & soldo, 1994; ) and the united kingdom (carmichael & charles, 1998; 2003a; 2003b; carmichael et al., 2004; 2008; 2010; heitmueller, 2007; heitmueller & inglis, 2004; 2007; michaud et al., 2010). in the uk, there are large cross-sectional differences between caregivers and non-caregivers in employment (e.g., carmichael & charles 1998; 2003a) and wages (heitmueller & inglis, 2007). these differences persist for co-residential and highintensity caregivers in dynamic longitudinal fixed-effects analyses as well (carmichael et al., 2010; heitmueller, 2007; michaud et al., 2010). in the us, ettner (1996) similarly finds negative effects on the number of hours worked for co-residential caregivers, and johnson and lo sasso (2000) find, investigating men and women aged 53–65, that informal eldercare reduces the number of hours worked, whereas wolf and soldo (1994) find no effects of parental caregiving among married women on the reduction in number of hours worked or the probability of being employed. leigh (2010) uses australian panel data from 2001 to 2007 and finds an effect of caregiving on labour force participation but not on wages. thus, there are negative effects of informal caregiving on labour outcomes in the anglo-saxon liberal welfare states, especially for high-intensity caregivers. outside the anglo-saxon countries there exists much less evidence on the relationship between informal care and work. to gain knowledge on the role of institutional factors in mediating the relationship between work and care, studies from other contexts are crucial. three previous studies compare groups of european countries (bolin et al., 2008; kotsadam, 2011; spiess & schneider 2003;). spiess and schneider (2003) use a difference in differences approach on two waves of data from the european community household panel (echp) to see how changes in caregiving hours (for an older, disabled or chronically ill adult) affect changes in number of weekly work hours for women aged 45–59. they find that starting a caregiving spell reduces the number of hours worked for women in countries with well-developed formal care. however, they find no significant association between changes in care intensity and changes in the number of hours worked in this group. for women in countries njsr – nordic journal of social research vol. 4, 2013 6 with less formal care, starting a caregiving spell is negatively correlated with changes in working hours, and there is a strong association between increased caregiving hours and a reduced number of work hours. the divergent results across the two groups are interpreted as indicating more formal care leading to more possibilities of choice and thereby smaller adverse effects. bolin et al. (2008) focus specifically on care for an older parent and use the first wave of data from the survey of health, ageing and retirement in europe (share) from 1994. these authors divide the total sample into three groups: nordic, central european, and south european. the main hypothesis is that the adverse effects of parental caregiving on labour supply are stronger in the nordic group since family care is less accepted in these states, leading to fewer acceptances among, say, employers. considering the employment probability and number of hours worked for persons aged 55 and over, they find that care has a larger negative effect in central european countries, but that wages are less affected in this group. contrary to bolin et al., (2008), kotsadam (2011) argues that the effects should be lowest in the nordic group and highest in the south european group due to the greater availability of formal care and less coercive gendered care norms in the former group. he finds, using the echp, that while being a female caregiver in the nordic countries is not related to employment, it greatly reduces the number of hours worked and the probability of being employed in the south european group. these results are somewhat reinforced in kotsadam (2012), where he finds in norway no effects of being an informal caregiver in general, as opposed to providing substantial care. similar findings are reported from sweden (szebehely, 2006). hence, while there is a clear negative effect of providing substantial care on employment in anglo-saxon welfare states, much less is known about the relationship in other contexts. it seems to be the case that caregiving to frail older people or other adults has less of an effect in the nordic welfare states, yet the data used is becoming out of date, and another important issue concerns whether these countries can really still be grouped together. furthermore, it has not been analysed whether informal care for disabled children and for older people have similar consequences for women’s and men’s employment. in the present article we investigate how different njsr – nordic journal of social research vol. 4, 2013 7 patterns of caregiving are related to employment in three nordic countries, denmark, norway, and sweden. we focus on describing differences in informal caregiving and in the links between employment and informal caregiving for older parents and for disabled children in the three countries. 3. care in the nordic countries and hypotheses in a much cited article, anttonen and sipilä (1996) compare the proportions of elderly over 65 who receive institutional care or home help across 14 european countries, and conclude that there is a scandinavian model of public services in which eldercare services are widely available. universalism is the guiding principle, which means that women benefit and members of the middle class use the services, which in turn facilitates public funding. there is also a familycare model (consisting of portugal, spain, greece, and italy) characterized by a limited supply of social-care services. a third, central european model is also identified (germany, the netherlands and, to a lesser degree, france and belgium) where the responsibility for eldercare formally falls on the family. in these countries, religious and other organizations provide a large range of services and the state has the main responsibility for funding. the volume of eldercare services is at an intermediate level, except in the netherlands where it is high. the differences in quality of formal eldercare services are great across countries and also follow the north-south dimension. the level of education and skills required are lowest in the south european countries, highest in the nordic countries, while the central european countries are placed in between (anxo & fagan, 2005; simonazzi 2008). although there are similarities between the nordic countries, there are also crucial differences between them. in an international comparison, all three countries are generous spenders and a relatively large proportion of the populations receive care services (huber et al. 2009: p. 74, 99). however, in terms of service provision, the nordic countries are less similar today than they were some decades ago. of the three countries, denmark stands out as reaching the largest proportion of the older population with home care services (twice the proportion njsr – nordic journal of social research vol. 4, 2013 8 compared with sweden), while norway has far more places in residential care than the other two countries. taking the two forms of care services together, the danish eldercare services cover the largest and the swedish eldercare services the smallest proportion of older people (see table 1). table 1. eldercare provision in denmark, norway, and sweden denmark norway sweden eldercare expenditure as % of gdp (1) 1.7 1.6 2.4 share of population aged 80 years+ (2) 4.1 4.5 5.4 in residential care (65 years+) (3) 4.9 9.7 6.4 home-care recipients (65 years+) (3) 17.6 10.8 9.2 eldercare total (65 years+) 22.5 20.5 15.6 sources: 1. huber et al. 2009: p. 99; 2. nososco 2009: p. 24; 3. nososco 2009: pp. 160–161. on the other hand, those who receive home care in sweden receive more help than recipients in the other countries: on average, an older danish home-care recipient receives 3.7 hours of help per week compared to seven hours per week in sweden (nbhw, 2009; statistics denmark, 2011;). in norway, on average an older person receives 4.4 hours of home care and home nursing combined per week (statistics norway, 2010). there are some studies on the prevalence of care, and especially parental care in the nordic countries. these studies are usually not straightforwardly comparable since the kinds of care or help they include differ, and of course also due to differences in samples. in norwegian data from the early 1990s, lingsom (1994) finds that about 16 per cent of children over 40 years of age provided care for their parents regularly. in norwegian data from 2007-2008 (herlofson, 2012), 18 per cent of children provide care for their parents at least once a month. on the basis of the 1992-1993 eurobarometer survey, alber and köhler (2004, p. 60, 63) find that 25 per cent of danish adults provided care for a family member or friend who was ill, disabled or old (17 per cent cared for an older person and four per njsr – nordic journal of social research vol. 4, 2013 9 cent for a disabled child); in sweden the corresponding figures were 27, 19, and seven per cent, respectively. using data from the share survey, ogg and renaut (2006) find that about 40 per cent of the sample in denmark and sweden (all above 50 years of age) provide some eldercare (norway is not included in this dataset). in all, there seems to be a lot of variation in the findings regarding the prevalence of informal care. as fewer older persons receive formal care services in sweden than in denmark, we would expect the families of frail older people to provide more care in sweden. a recent analysis of sources of care among older people in denmark and sweden points in the same direction: significantly more older people in need of care in sweden report that they receive help from children and other family members or friends (help from spouses not included) (rostgaard & szebehely, 2012). however, as the danish services are less intensive, it may be the case that informal care is more intensive in denmark. our research questions are: • how common is it that men and women in the three nordic countries provide regular care to parents, disabled children, and other dependents? • does the link between informal caregiving and formal employment differ between the three countries? 4. data and descriptive statistics in august 2010, tns gallup was hired to send out an internet-based survey to a random sample of 4500 danes, 4500 norwegians, and 3252 swedes aged 18–65. in total, 6164 out of the 12 252 responded (50.3 per cent).1 the respondents had three weeks to answer the survey and received three reminders. the multi-purpose survey included questions about informal care, employment, and demographics such as gender, age, and education. 1 the total comprised 2088 (46.4 per cent) danes, 1705 (52.4 per cent) swedes, and 2371 (52.7 per cent) norwegians. njsr – nordic journal of social research vol. 4, 2013 10 ta bl e 2. c ar e, d es cr ip tiv e st at is tic s to ta l c ar e p ar en ta l c ar e d is ab ili ty c hi ld ca re p ar tn er c ar e o th er c ar e s ha re of sa m pl e n um be r of ho ur s /m on th s ha re of sa m pl e n um be r of ho ur s /m on th s ha re of sa m pl e n um be r of ho ur s /m on th s ha re of sa m pl e n um be r of ho ur s /m on th s ha re of sa m pl e n um be r of ho ur s /m on th to ta l 0. 44 1 (0 .4 97 ) 12 .8 74 (1 8. 37 6) 0. 23 9 (0 .4 27 ) 13 .4 29 (1 7. 85 3) 0. 03 9 (0 .1 93 ) 21 .7 45 (2 5. 66 5) 0. 04 0 (0 .1 97 ) 24 .9 75 (2 6. 40 4) 0. 22 3 (0 .4 17 ) 10 .7 92 (1 5. 89 0) s w ed en 0. 37 7 (0 .4 85 ) 16 .2 74 (2 5. 05 3) 0. 21 2 (0 .4 09 ) 15 .6 94 (2 3. 57 7) 0. 02 8 (0 .1 64 ) 34 .7 61 (3 8. 89 1) 0. 02 1 (0 .1 42 ) 44 .7 14 (3 8. 59 2) 0. 18 1 (0 .3 85 ) 14 .4 35 (2 2. 36 9) n or w ay 0. 44 7 (0 .4 97 ) 12 .3 96 (1 6. 32 2) 0. 22 8 (0 .4 20 ) 13 .8 15 (1 6. 31 6) 0. 04 1 (0 .1 99 ) 19 .5 05 (2 0. 11 5) 0. 04 4 (0 .2 06 ) 23 .1 3 (2 2. 99 7) 0. 23 7 (0 .4 25 ) 10 .3 42 (1 4. 91 3) d en m ar k 0. 48 8 (0 .5 00 ) 11 .1 78 (1 4. 68 1) 0. 27 5 (0 .4 47 ) 11 .5 91 (1 4. 47 6) 0. 04 5 (0 .2 08 ) 17 .5 98 (2 0. 26 4) 0. 05 2 (0 .2 22 ) 20 .1 06 (2 1. 24 5) 0. 24 2 (0 .4 29 ) 9. 03 9 (1 1. 05 6) st an da rd d ev ia tio ns in p ar en th es es . njsr – nordic journal of social research vol. 4, 2013 11 table 2 presents descriptive statistics of the data on caregiving. we present data on the shares of the sample providing different types of care, as well as the mean number of care hours for those providing care. even though there are clear differences in demographic factors between the countries (table a1 in appendix 1), we start by describing the differences regarding the care variables before we turn to a more formal analysis in section 5. the central survey question on informal care provision posed to the respondents was: ‘have you helped a family member, relative, friend, or neighbour who needs help in everyday life owing to long-term illness, disability, or old age at least once a month during the past year (e.g., with cleaning, paper work, personal care, or going outside)?’ a respondent is considered to provide care (the column marked total care in table 2) if he or she provides care within at least one of the following categories: parental care, child care, partner care, or other care. first, considering caregiving in general (total care), the results indicate that a large share of the sample provides some kind of informal care on a regular basis: 49 per cent in denmark, 45 per cent in norway, and 38 per cent in sweden. these numbers seem very high, but many of the respondents only provide care for a very limited number of hours. fifty-eight per cent of those who provide care provide less than ten hours of care a month. the share providing monthly parental care (24 per cent) is somewhat higher than the numbers presented in other studies (e.g., alber & köhler 2004; herlofson, 2012; ), but lower than the numbers reported in the share survey (see, e.g., ogg & renaut, 2006). care for a disabled child is much less frequent (four per cent), slightly lower than indicated in previous studies such as alber and köhler (2004) and jeppsson grassman et al., (2009). finally, the share of respondents who provide care to others (a relative, friend, or neighbour) at least once a month is as high as the share providing parental care (22 per cent), which seems very high, but is in line with the findings from a swedish survey (jegermalm & jeppsson grassman, 2009). one possible reason for comparatively high proportions of caregivers in this study could be that the question asked includes a wide range of tasks (e.g., cleaning, paperwork, personal care, or going outside), not only the more demanding aspects of family caregiving, such as personal care. njsr – nordic journal of social research vol. 4, 2013 12 turning to the average number of hours of care provided per month, swedes provide 16 hours, norwegians 12 hours, and danes 11 hours. in all the three countries, those providing care for a disabled child provide more hours of care than those who care for a parent or another relative or friend. table a2 in appendix 1 gives variable descriptions for all the variables used in this article; the questions on care posed to the respondents are presented in appendix 2. table 3. descriptive statistics, by the extent of care input variable non-care care substantial care age 41.853 (13.512) 47.126 (13.069) 48.200 (12.415) married 0.687 (0.464) 0.716 (0.451) 0.740 (0.440) employed 0.743 (0.437) 0.723 (0.447) 0.694 (0.462) male 0.507 (0.500) 0. 4805 (0.500) 0.434 (0.500) capital 0.200 (0.400) 0.162 (0.368) 0.187 (0.391) high income 0.092 (0.289) 0.100 (0.300) 0.119 (0.324) low income 0.158 (0.364) 0.135 (0.341) 0.145 (0.353) high education 0.495 (0.500) 0.467 (0.500) 0.506 (0.501) low education 0.097 (0.297) 0.093 (0.291) 0.094 (0.292) standard deviations in parentheses. njsr – nordic journal of social research vol. 4, 2013 13 table 3 presents descriptive statistics for the categories non-care, care, and substantial care, where ‘substantial carer’ refers to those providing at least 30 hours of care per month (4.4 per cent of the population). these carers are particularly interesting to investigate since they spend a substantial amount of time caring for others. noncarers are younger, less likely to be married, more likely to be employed, and more likely to be men. the table clearly shows that especially those providing substantial amounts of care are less likely to be employed than both non-caregivers and caregivers in general. since the characteristics of these three groups differ in so many other ways (e.g., age, civil status, and gender), these findings should be interpreted with caution. in section 5 we turn to a more formal analysis of caregivers and non-caregivers, but first a few words on the representativeness of our data. our sample is fairly representative with regard to both gender and age, whereas with education it is biased towards highly educated people. moreover, there are serious concerns regarding the nonrandom rate of response. although this aspect should be considered when comparing raw correlations and mean values, we can somewhat alleviate the problem in the regression analyses by explicitly controlling for education and other confounding factors. for a more detailed description of the representativeness of the data, see jakobsson and kotsadam (2010; 2011) and kotsadam and jakobsson (2011). 5. results as seen in the descriptive statistics above, there are some clear differences across these countries. we also know our country samples differ in composition. we therefore move on to analyse the relationships explored in the previous section, controlling for potential confounding differences between the countries. njsr – nordic journal of social research vol. 4, 2013 14 table 4. parental care and substantial care (1) (2) (3) (4) variables care care substantial care substantial care sweden -0.061*** -0.050*** -0.015** -0.013** (0.013) (0.013) (0.006) (0.006) norway -0.045*** -0.008 0.006 0.010 (0.012) (0.013) (0.006) (0.006) male -0.050*** -0.010** (0.011) (0.005) capital -0.036*** -0.006 (0.014) (0.006) high income 0.018 0.010 (0.019) (0.010) low income 0.006 0.014 (0.018) (0.009) high education -0.032*** 0.004 (0.012) (0.005) low education -0.007 0.008 (0.020) (0.010) married 0.040*** 0.004 (0.012) (0.006) age 0.018*** 0.000 (0.003) (0.001) age2 -0.000*** 0.000 (0.000) (0.000) observations 6164 6164 6164 6164 standard errors in parentheses. *** p<0.01, ** p<0.05, * p<0.1. marginal effects after probit regressions. differences in informal eldercare we start by considering the differences between individuals in the three countries with regard to parental caregiver status. table 4 presents marginal effects after probit regressions. in columns 1 and 2, the dependent variable is whether the respondent provides parental care or not. when controlling for confounding factors, we see that being a caregiver is least common in sweden, and the difference between norway and denmark is not statistically significant. these njsr – nordic journal of social research vol. 4, 2013 15 results are also very similar for the other types of caregivers (results available upon request). in columns 3 and 4, substantial care (i.e., providing at least 30 hours of care per month) is the dependent variable; the results here also indicate that this practice is least common in sweden. these findings are contrary to our hypotheses, to wit, that informal eldercare provision should be more common in sweden than in norway and denmark. we now turn to investigating how much eldercare (in terms of how many hours of care to an elderly parent or parent-in-law per month) is provided and whether this is something that differs across the countries. the first column of table 5 shows the raw difference across countries. denmark is the excluded country, so the number of care hours in denmark is given by the constant term. we see that danes give an average of 11.59 hours of parental care per month, whereas swedes give about four hours more and the norwegians place in between, giving two more hours per month than the danes. these relations hold fairly well when we control for confounding factors in column 2, which is important as we do not want the country differences simply to reflect compositional factors. in columns 3 to 5 we split the sample by country in order to examine possible country differences in the determinants of care hours. the highly educated and those with a low income in denmark provide more care than others; this is not the case in norway and sweden. danish men do not provide less eldercare than danish women, contrary to the case in norway and sweden. living in the danish capital (copenhagen) is associated with providing less care, while living in the other capitals (oslo and stockholm) is associated with providing more care. the effect of age is insignificant in denmark, as opposed to in norway and sweden. being married is associated with providing less care, but the coefficient is only statistically significant in sweden. the findings for parental care are very similar to the results for care in general (not shown here). njsr – nordic journal of social research vol. 4, 2013 16 table 5. parental-care hours (1) (2) (3) (4) (5) variables no controls controls sweden norway denmark sweden 4.103*** 3.861*** (1.204) (1.204) norway 2.224** 2.631** (1.080) (1.098) male -3.311*** -4.501* -4.071*** -1.542 (0.957) (2.502) (1.467) (1.306) capital 3.365** 8.156** 6.298** -1.565 (1.363) (3.183) (2.488) (1.716) high income -0.299 -0.585 -0.444 -0.521 (1.556) (4.511) (2.280) (2.053) low income 4.075** 5.703 0.606 6.363*** (1.617) (4.316) (2.511) (2.081) high education 0.123 -0.900 -1.742 2.482* (1.000) (2.683) (1.503) (1.331) low education 0.128 -0.797 0.379 0.770 (1.792) (4.263) (3.421) (2.236) married -1.820 -2.675 -2.698 -0.728 (1.121) (2.877) (1.665) (1.572) age -0.358 -1.470 -0.699* 0.266 (0.280) (0.904) (0.403) (0.362) age2 0.005* 0.016 0.010** -0.002 (0.003) (0.010) (0.005) (0.005) constant 11.59*** 17.86*** 50.98** 26.56*** 4.710 (0.755) (6.256) (20.90) (8.716) (8.070) observations 1446 1446 360 531 555 r2 0.008 0.033 0.047 0.056 0.027 standard errors in parentheses. *** p<0.01, ** p<0.05, * p<0.1 njsr – nordic journal of social research vol. 4, 2013 17 in this section we have described the differences in parental caregiving in norway, sweden, and denmark. we have shown that giving such informal eldercare is most common in denmark and least common in sweden. however, those who provide care in sweden provide more care than do people in both norway and denmark. country differences in the relationship between informal care and employment we have seen that there are differences in parental caregiving between the countries and that these differences persist even when we control for factors at the individual level. but do these differences also imply that there are differences in the relationship between caregiving and work? in table 6 we investigate the relationship between being a caregiver (i.e., all types of caregivers) and being employed. in column 1, no controls are added and we see that the caregivers are about two percentage points less likely than noncaregivers to be employed. in column 2, we see that the relationship is actually stronger once we control for confounding variables. looking at the three countries separately, as is done in columns 3 to 5, we see that the effect is only statistically significant in norway and denmark. the difference between sweden and the other countries is also statistically significant (results not presented). looking at those who provide substantial care (more than 30 hours per month), we also find a negative effect of care provision (column 6) (no statistically significant country differences, results available upon request). hence, the conclusion is that there is a quite strong negative correlation between being a caregiver and the probability of being employed in norway (4.5 percentage points) and denmark (5.0 percentage points) but not in sweden, even when we control for individual-level variables. njsr – nordic journal of social research vol. 4, 2013 18 table 6. care and employment (1) (2) (3) (4) (5) (6) variables basic with controls sweden norway denmark substantial care care -0.019* -0.033*** -0.002 -0.045** -0.050** -0.075** (0.011) (0.013) (0.021) (0.022) (0.023) (0.032) male -0.003 -0.011 -0.023 0.023 -0.003 (0.013) (0.020) (0.022) (0.024) (0.013) capital 0.023 0.005 0.000 0.033 0.023 (0.016) (0.026) (0.030) (0.027) (0.016) high income 0.008 -0.184*** 0.026 0.181*** 0.009 (0.022) (0.050) (0.036) (0.030) (0.022) low income -0.588*** -0.554*** -0.608*** -0.598*** -0.586*** (0.019) (0.037) (0.030) (0.032) (0.019) high education 0.042*** -0.014 0.071*** 0.035 0.043*** (0.013) (0.022) (0.023) (0.024) (0.013) low education -0.094*** -0.094** -0.105* -0.110** -0.093*** (0.026) (0.039) (0.057) (0.043) (0.026) married 0.038*** -0.006 0.090*** 0.034 0.038*** (0.014) (0.021) (0.025) (0.026) (0.014) age 0.076*** 0.055*** 0.073*** 0.093*** 0.076*** (0.003) (0.006) (0.006) (0.006) (0.003) age2 -0.001*** -0.001*** -0.001*** -0.001*** -0.001*** (0.000) (0.000) (0.000) (0.000) (0.000) sweden 0.130*** 0.132*** (0.014) (0.014) norway 0.008 0.010 (0.015) (0.015) observations 6105 6105 1704 2325 2076 6112 standard errors in parentheses. *** p<0.01, ** p<0.05, * p<0.1. dependent variable: employed. marginal effects after probit regressions.. njsr – nordic journal of social research vol. 4, 2013 19 we now move on to investigate the relationship between parental care and employment in the same fashion as above. the results are presented in table 7. in column 1, we actually note a positive correlation between being a caregiver and being employed. once we control for confounding variables, however, the relationship is not statistically significant (column 2). these results are in accord with the results in kotsadam (2011) which demonstrate that there are no effects of providing informal eldercare on the probability of being employed in the nordic welfare states, and with kotsadam (2012) that shows the provision of eldercare in general (as opposed to providing substantial amounts of care) in norway is not related to employment. there are no statistically significant differences between the countries in the relationship between being an informal eldercare giver in general and employment (results are available upon request), and we note that the correlation is not statistically different from zero in any of the countries (columns 3 to 5). however, looking at those who provide substantial eldercare (more than 30 hours per month), we find a negative effect of providing care (column 6). this is in line with the results from previous research on norway (kotsadam, 2012). again, there are no country differences with respect to this correlation (results are available upon request). turning to the relations between care for disabled children and employment, we can see the results in table 8. in contrast to parental care, we note a negative relationship between employment and childcare in the total sample (column 2). we find an even larger effect of substantial childcare but no statistically significant differences between the countries (column 6). njsr – nordic journal of social research vol. 4, 2013 20 table 7. parental care and employment (1) (2) (3) (4) (5) (6) variables basic with controls sweden norway denmark substantial care parental care 0.049*** -0.002 0.027 -0.026 0.010 -0.090** (0.013) (0.015) (0.024) (0.026) (0.026) (0.042) male -0.002 -0.010 -0.023 0.027 -0.003 (0.013) (0.020) (0.022) (0.024) (0.012) capital 0.024 0.004 0.000 0.037 0.023 (0.016) (0.026) (0.030) (0.027) (0.016) high income 0.007 -0.186*** 0.025 0.181*** 0.007 (0.022) (0.050) (0.036) (0.030) (0.022) low income -0.588*** -0.554*** -0.603*** -0.599*** -0.587*** (0.019) (0.037) (0.031) (0.032) (0.019) high education 0.043*** -0.013 0.070*** 0.038 0.043*** (0.013) (0.022) (0.023) (0.024) (0.013) low education -0.094*** -0.093** -0.107* -0.109** -0.093*** (0.026) (0.039) (0.057) (0.043) (0.026) married 0.038*** -0.007 0.089*** 0.032 0.038*** (0.014) (0.021) (0.025) (0.027) (0.014) age 0.076*** 0.055*** 0.073*** 0.092*** 0.077*** (0.003) (0.006) (0.006) (0.006) (0.003) age2 -0.001*** -0.001*** -0.001*** -0.001*** -0.001*** (0.000) (0.000) (0.000) (0.000) (0.000) sweden 0.132*** 0.132*** (0.014) (0.014) norway 0.009 0.010 (0.015) (0.015) observations 6112 6112 1705 2329 2078 6112 standard errors in parentheses. *** p<0.01, ** p<0.05, * p<0.1. dependent variable: employed. marginal effects after probit regressions. njsr – nordic journal of social research vol. 4, 2013 21 table 8. care for disabled children and employment (1) (2) (3) (4) (5) (6) variables basic with controls sweden norway denmark substantial care childcare -0.049 -0.072** -0.097 -0.067 -0.056 -0.153* (0.031) (0.034) (0.072) (0.055) (0.055) (0.081) male -0.002 -0.011 -0.022 0.026 -0.00 (0.013) (0.020) (0.022) (0.023) (0.013) capital 0.023 0.004 0.001 0.035 0.023 (0.016) (0.026) (0.030) (0.027) (0.016) high income 0.008 -0.181*** 0.024 0.182*** 0.009 (0.022) (0.050) (0.036) (0.029) (0.022) low income -0.587*** -0.551*** -0.603*** -0.598*** -0.586*** (0.019) (0.037) (0.031) (0.032) (0.019) high education 0.044*** -0.013 0.071*** 0.039 0.043*** (0.013) (0.022) (0.023) (0.024) (0.013) low education -0.093*** -0.093** -0.109* -0.108** -0.094*** (0.026) (0.039) (0.057) (0.043) (0.026) married 0.038*** -0.006 0.089*** 0.034 0.038*** (0.014) (0.021) (0.025) (0.026) (0.014) age 0.076*** 0.055*** 0.073*** 0.092*** 0.077*** (0.003) (0.006) (0.006) (0.006) (0.003) age2 -0.001*** -0.001*** -0.001*** -0.001*** -0.001*** (0.000) (0.000) (0.000) (0.000) (0.000) sweden 0.131*** 0.132*** (0.014) (0.014) norway 0.009 0.010 (0.015) (0.015) observations 6112 6112 1705 2329 2078 6112 standard errors in parentheses. *** p<0.01, ** p<0.05, * p<0.1. dependent variable: employed. marginal effects after probit regressions. njsr – nordic journal of social research vol. 4, 2013 22 6. conclusion it seems to be the case that informal eldercare has less of an effect on employment in the nordic welfare states than in other western countries, yet the data on which this notion is based is becoming timeworn (kotsadam, 2011; 2012). furthermore, it is questionable whether these countries can really still be grouped together. there is also a relationship between formal and informal care in the sense that more informal care is provided in areas with less formal care, also within welfare states (jakobsson et al., 2012). yet even at a more basic level the relation is intertwined as the very fact that makes care ‘informal’ is the existence of formal care institutions. in periods and places without formal care, there is just care. our analysis addresses this issue by providing results from a context with extensive formal care services. it is also important because it does not lump the nordic countries together into a single model and it differentiates between different types of care provisions. this is the first study investigating the relationship between informal care for disabled children and employment across countries. in this article we have shown that informal care is most common in denmark and least common in sweden. however, those who provide care in sweden provide more care than do people in both norway and denmark. there is also a large negative correlation between being a caregiver and the probability of being employed in norway (4.5 percentage points) and denmark (5.0 percentage points) even when we control for individual-level variables, but not in sweden. with regard to parental care, there is no general relationship between the provision of parental care and employment, yet those providing substantial amounts of care are clearly less likely to work than others. the situation is similar but stronger for care of disabled children. so, why do we find a non-negligible relationship between the provision of informal care and not being employed in denmark and norway but not in sweden? since the relationship is present also when controlling for confounding factors, the difference is not due to differences in observed characteristics between the samples. however, we cannot njsr – nordic journal of social research vol. 4, 2013 23 say that the relationship is causal in the sense that starting to provide care in denmark and norway causally reduces the likelihood of formal employment. it may very well be the case that people with a weaker relationship to the labour market are more likely to be informal caregivers in denmark and norway than in sweden. the findings of the present article contribute to several ongoing academic and policy debates. in contrast to studies from anglo-saxon countries, informal eldercare in general is not found to be negatively correlated with employment. this highlights the importance of context in analysing the effects of informal care and hints at the importance of formal care for the effects of informal care. for people who provide a lot of informal care either to parents or disabled children, however, there is a negative relation to employment, and this fact is important to consider when making policy choices. we also show that it is important to analyse the different nordic countries separately and that discussing ‘the nordic model’ may mask important heterogeneity. future studies should investigate both whether the relationship we find is causal and why there are differences between the different countries regarding different types of care. as welfare policies are a result of political struggles, it would be interesting to investigate the political organization of eldercare and disability-care advocates in the different countries. acknowledgements the research reported in this article was supported by a grant from the research council of norway (project equalcare 196425/v50), which is gratefully acknowledged. we would also like to thank thomas hansen, kristin koløen, and seminar participants at norwegian social research for useful comments and suggestions. references ackers, p. 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(2006). informella hjälpgivare. in j. vogel, & l. häll (eds.), äldres levnadsförhållanden. stockholm: statistics sweden. wolf, d., & soldo, b., (1994). married women’s allocation of time to employment and care of elderly parents. journal of human resources, 29(4), 1259–1276. njsr – nordic journal of social research vol. 4, 2013 28 appendix 1. tables table a1. variable description variable explanation age respondent age married =1 if respondent is married or cohabiting employed =1 if employed fullor part-time male =1 if male capital =1 if living in the capital (oslo, stockholm or copenhagen) high income =1 if respondent earns >600 000 nok/sek/dkk per year low income =1 if respondent earns <200 000 nok/sek/dkk per year high education =1 if at least some university education low education =1 if respondent only has elementary education or less care =1 if respondent provides informal care to someone substantial care =1 if respondent provides care 30h or more per month carehours number of hours in informal care, truncated at 99 hours per month parental care =1 if respondent provides informal eldercare parental care hours number of hours in informal eldercare, truncated at 99 hours per month childcarehours number of hours in informal childcare, truncated at 99 hours per month childcare =1 if respondent provides informal care to a child njsr – nordic journal of social research vol. 4, 2013 29 table a2. descriptive statistics variable norway sweden denmark pooled age 41.809 (13.839) 45.049 (13.275) 46.183 (13.100) 44.187 (13.572) married 0.673 (0.469) 0.693 (0.462) 0.737 (0.441) 0.611 (0.488) employed 0.712 (0.453) 0.797 (0.402) 0.708 (0.455) 0.734 (0.442) male 0.494 (0.500) 0.521 (0.500) 0.476 (0.500) 0.495 (0.500) capital 0.158 (0.365) 0.178 (0.383) 0.216 (0.412) 0.183 (0.388) high income 0.104 (0.306) 0.079 (0.269) 0.101 (0.301) 0.096 (0.294) low income 0.148 (0.356) 0.158 (0.365) 0.138 (0.345) 0.147 (0.355) high education 0.579 (0.494) 0.460 (0.499) 0.390 (0.488) 0.482 (0.500) low education 0.061 (0.239) 0.124 (0.330) 0.112 (0.315) 0.096 (0.294) care 0.447 (0.497) 0.377 (0.485) 0.488 (0.500) 0.441 (0.497) substantial care 0.051 (0.221) 0.031 (0.174) 0.045 (0.207) 0.044 (0.204) carehours 12.396 (16.322) 16.274 (25.053) 11.178 (14.681) 12.874 (18.376) parentalcare 0.228 (0.420) 0.212 (0.409) 0.275 (0.447) 0.239 (0.427) parentalcarehours 13.815 (16.316) 15.694 (23.577) 11.591 (14.476) 13.429 (17.853) childcare 0.041 (0.199) 0.028 (0.164) 0.045 (0.208) 0.039 (0.193) childcarehours 19.505 (20.115) 34.761 (38.891) 17.598 (20.264) 21.745 (25.665) njsr – nordic journal of social research vol. 4, 2013 30 appendix 2. question on care posed to the respondents have you helped a family member, relative, friend, or neighbour who needs help in everyday life owing to long-term illness, disability, or old age at least once a month during the past year (e.g., with cleaning, paperwork, personal care, or going outside)? □ yes, husband/wife/cohabitant/partner □ yes, children □ yes, parents/parents-in-law □ yes, other relative, friend or neighbour □ no □ if yes, how many hours a month? microsoft word browning, brentlinger, soernes, stephens the rhetoric of organizational stability and creativity.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 4, 2013 the rhetoric of organizational stability and creativity: an analysis of the term ‘platform’ larry d. browning department of communication studies the university of texas at austin bodø graduate school of business the university of nordland email: lbrowning@mail.utexas.edu joseph brentlinger department of communication studies, university of texas at austin email: jbrentlinger@gmail.com jan-oddvar sørnes bodø graduate school of business the university of nordland email: jan.oddvar.soernes@hibo.no keri k. stephens department of communication studies university of texas at austin email: kstephens@austin.utexas.edu abstract this article analyses the term platform as it surfaced in interview data from norway and the united states that was collected in a field research project on organizational technology use. through an inductive analysis of the term’s use in six interviews, a conceptualization of the term reveals it to be rhetorical in nature, expressing the interplay between stability and creativity. in order to explain the rhetorical aspects we describe, the authors turn to the rhetorical critic kenneth burke’s work to aid in conceptualizing the term, specifically his understanding of scene and agency. the authors present the conceptualization to help researchers on two levels. on the micro-level, we offer an analysis of the term platform. on the macro-level, we illustrate how grounded theory can help locate other terms that have unacknowledged salience to researchers, consultants, and interviewees. njsr – nordic journal of social research vol. 4, 2013 101 keywords: platform, inductive, stability, creativity, scene, agency, communication, organizations, burke introduction this article analyses the usage of a single word—platform—to illustrate that communication relies upon what we call the two tenets of creativity and stability. more specifically, we analyse the usage of the term in six specific instances of contemporary organizational communication to illustrate that technology’s relationship with communication is not merely a means to acting in the world, but can also constitute the scene upon which communication is played out. because communication relies upon creativity and stability, our inductive method of analysis leads us to the rhetorical critic kenneth burke’s understanding of agency and scene. nearly a decade ago, waters (2005) noted that the term platform deserved attention, and, rather than podcast, should have been the new oxford american dictionary’s word of the year for 2005 due to its ubiquity. the term continues to grow in popularity, and as ashforth and humphrey (1997) say about a label that has such prominent usage, it influences how individuals understand—and therefore communicate—a particular social object. orlikowski (2009) argues that platform is not merely a label for an organizational structure, ‘but is integrally and materially part of constituting that phenomenon’ (p. 14). the most prominent use of the term platform at present is for source code for computer software (von hippel & von krogh, 2003), but that basic meaning was derived from a more historical usage of the term which has been expanded to include all kinds of concepts and structures. the expanded meaning allows one to use the term with relative ease and flexibility (browning & morris, 2012). for instance, martin sköld and christer karlsson (2007) have dealt with the managerial aspects of ‘multibranded platforms’ (p. 554), and consoli and patrucco (2008) have analysed technology platforms as they pertain to innovation. ciborra (1996) analyses the olivetti company of italy as a platform organization, conceiving the term broadly when he observes that the company has the ability to adapt quickly ‘to sport whatever organizational form is required under the circumstances’ (p. 103). olivetti has a concern for efficiency and reliability in its structures. because olivetti has standards for products, they can be recombined from disparate elements ‘at the last minute’ into a bundle to meet the ‘specific products required by the market’ (p. 112). ravasi and schultz (2006) conceive the term more finitely, using the term platform as an interface between weickian sense-giving and sense-making (pp. 452-3). in these examples, meaning is added (and some meanings are eschewed) when the term is used in novel ways for particular situations. but whereas others have analysed corporations as platforms, we turn to the term platform itself to illustrate that the word simultaneously communicates a powerful symbolic meaning and provides practical solutions for organizations. our purpose in this paper is to examine the term platform in detail by our analysing a collection of examples that illustrate how the term is used to communicate a combination of stability, order, and reliability as a shifting companion to creativity, movement, and speed. concerning the term platform, njsr – nordic journal of social research vol. 4, 2013 102 gawer states that ‘the research on industry platforms builds on several distinct literatures, which hitherto had rarely been brought together’, citing ‘engineering (ulrich, 1995; baldwin & clark, 200); organizational literature on modularity (sanchez & mahoney, 1996; schilling, 2000), with economics literature on standards and network externalities (kaz & shapiro, 1985; shapiro & varian, 1999)’; as well as ‘strategy research on new forms of industry dynamics mixing competition and co-operation (coined as ‘co-opetition’, see brandenburger & nalebuff, 1996)’ (gawer, 2010, p. 288). we add to this list communication studies, since kenneth burke’s work offers us insight into the term platform because it sits astride two grand dimensions of his theoretical work: agency and scene. if an organization is too fixed and unresponsive, it will wither and be replaced by a new and more flexible one (hirschman, 1970). yet if an organization is only focused on creativity and flexibility without commercializing and routinizing its practices, all the novelty in the world simply goes to waste, failing in its endeavour (jolly, 1997; porter, 1995). we believe our scholarly intervention works on two strata: the micro-level and the macro-level. on the micro-level we offer this article as an analysis of the term platform, and how that analysis may help researchers and consultants. for example, if a person is relying excessively on the stability he or she is being offered, then the researcher or consultant might suggest relying more upon creativity. but we also believe that this article works on the macro-level. researchers and consultants might—through the inductive process that grounded theory allows—find other words that reveal rich sources of theoretical and practical knowledge. these researchers could then use the inductive method on different words that surface in interviews, and follow where those words take them to make novel, meaningful interventions themselves. the remainder of this essay attempts to show how the term platform connotes the interplay between scene and agency, what we are calling stability and creativity. the first section will detail our research protocol and reasoning. the next six sections are case studies that detail the term platform in its everyday use. the last sections will discuss the cases and explain the complex interplay between agency and scene, what we call the negotiation between creativity and stability. research protocol and data analysis after analysing 66 interviews (half from norway, half from the united states) to identify 20 to rewrite as narratives on the practice of using informationcommunication-technologies (icts) in the workplace (2008), we completed an additional qsr nud*ist software search for additional themes, noticing that the term platform reoccurred in the data set in six quite different places in a manner that no other distinctive term did. we conclude that the most appropriate way to represent these six cases is to bundle them and treat them as a sensitizing concept, or, something in the data that sparks a thought by the researchers (van den hoonaard, 1997) and allows them to expand on that idea. in qualitative research a sensitizing concept is an idea that appears in the natural language of the field being studied and as a result invites the researcher to explore its theoretical depth. we do so here when we take an njsr – nordic journal of social research vol. 4, 2013 103 idea surfaced by the interviewees themselves, then inspect and dimensionalize the concept inferred and make linkages to other contexts (van den hoonaard, 1997). we follow this guidance and link the term platform to an analysis of stability and creativity in organizations by showing how the term represents a communicative force that affects order and variety in organizations. ultimately we take a grounded approach in this essay (glaser & strauss, 2011), deriving our conceptualization of the term platform from an inductive analysis of the term in its use. by analysing similarities and differences between the cases, we find that each instance of the use of platform in our examples leads us to conclude that when the word is invoked, it connotes a strange interplay between stability and creativity. this peculiar interplay indicates that people require the means not only of enacting meaningful communication, but also of grounding through communicatory practices that can provide a stable means of fact-checking, that is, of being able to make assertions and then to point to their validity. because of the dual dimensions of creativity and stability inherent in the term’s usage, we turn to burke’s rhetorical approach. his body of work is immense (works of his were published from 1931 until after his death in 1992) but here we describe only two small aspects of his broad range of thought—scene and agency—because his theorizing on these two terms correspond with our own ideas concerning the dual aspects of the platform: stability and creativity. burke’s most explicit contemplation on the concepts scene and agency are found described in his work, a grammar of motives. the idea of scene itself is rather simple, being either the ‘environment’ where action takes place, or the background that helps to explain actions in a meaningful way (burke, 1969). in his analysis of the concept, burke places all materialist philosophies (marx, darwin, et al.) under the heading of scene (p. 128). agency, however, serves to answer how people act in an environment, or the means by which they do so (burke, 1969). agency in its usual scholarly usage is meant as the ability to act as one means to do in the world. in burke’s sense, however, agency is to be understood as a technology for action, as the thing that allows one to act. under his analysis, burke would place philosophies such as pragmatism (dewey’s, james’, etc.) under the rubric of agency (p. 128). the case studies below detail different examples of the term platform in its average, everyday usage. they are rarely spectacular, but we believe that studying the usual often yields unusual observations. the examples showcase the term differently, and we track how the different uses indicate the complexity involved in maintaining a balance between creativity and stability. for example, sometimes the internet or other communication technologies is the scene upon which communication is enacted; other times, it is merely the means of communication, and an office or hospital constitutes the scene; but at each turn a need for the negotiation between creativity and stability is implicated in the invocations of the term platform. we are loyal to the platform chosen in this first case of the term’s use, the platform frank (all the names and organizations used here are pseudonyms) refers to a gives kind of consistency in the protocols for communication that requires a great amount of loyalty from njsr – nordic journal of social research vol. 4, 2013 104 its users. adherence to protocol is so important because of the effort required to make a sale for frank’s company. employees promote the company’s distinctive offerings by using ‘relations marketing’, or more simply what frank calls ‘good, honest sales work’. the firm has approximately 650 clients that use products either bought online or billed by the hour as consulting services. the platform therefore works as a repository. it acts as a collection and storage device, one the one hand; but, on the other hand, it acts as a bulwark against data misuse or loss. he says of his communications, ‘everything i do is documented digitally—ranging from appointments, logging customer information, offers to customers, and other types of information used in the sales process. we store everything digitally, and throw away the hard copy.’ in response to a question about the most important communication principle in his organization, frank says that primary importance is placed on ‘loyalty to the communication medium, or mediums, chosen for the sales process. by that i mean, we have to be loyal to the platform chosen. that is, if we have agreed on a certain way to store information, or the entire communications process for that matter, it is important that everybody is loyal to that.’ sales persons both store information about the sales process and conduct further matters on the sale in a uniform fashion. frank insists on exactly following this communication protocol because ‘the system breaks down’ the moment a colleague breaks the rules, and this infraction results in some sort of mistake. for frank’s firm, fidelity to procedure is needed to allay any ambiguity. something as rudimentary as taking minutes at a meeting and posting them online necessitates strict adherence to procedures previously agreed upon. not having the stability of the protocol means that a colleague might, during a subsequent meeting, be expected to contribute some expert piece of information to which she or he has no access. but information retained in a procedural way safeguards against ambiguous situations: recording dealings with a difficult or volatile customer allows colleagues to build on what others have done, and then to make plans of action. at every turn, frank’s response to ambiguity is standardization: ‘it is necessary to have a policy on this, not just a wish or statement from somebody.’ lrn-tech offers a learning platform the term platform is placed at the core of amanda’s u.s. firm when she explains what they do. in response to a question about their product she says, ‘lrn-tech offers a learning platform’, meaning they offer web-based training for their client’s employees. lrn-tech partners with the client, who provides proprietary subject matter and content, to set up training modules tailored for the clients’ employees. lrn-tech’s product is offered on a platform in the sense that her company hosts ‘the entire application’ for the client firm, including the means to enter and experience the training and to monitor program use. the monitoring is used both to allow the client company to track compliance and for lrn-tech to charge user fees. amanda is a salesperson and spends approximately three hours a day searching the internet for qualified prospective clients. the searches are extensive, as she must make her judgements regarding client selection on the basis of criteria such as company size (lrn-tech’s services are best suited for companies of 1000 or more employees), maturity (start-ups have different needs than established businesses), and key players (who makes the decision njsr – nordic journal of social research vol. 4, 2013 105 to pay for lrn-tech’s services?). her online computer time using a commercial search program allows amanda to locate most of this information, but she also improvises and utilizes online boards of other resources (such as the american society for training and development) to uncover useful information. in a recent search she discovered that a potential client had listed on the astd board the exact names of the other firms vying for offering their training services. as she stated, ‘they would never have told me this information if i had asked for it directly’. in another instance, she was able to identify on a client’s webpage for jobs their new openings so that she might have an idea of the training modules the potential client would require. the time invested in qualifying clients is important because her firm’s protocol is to move towards face-to-face meetings, but her firm only does so when it believes direct contact will result in an immediate sale. as she says, one of the easiest errors to make before the face-to-face encounter is to get ‘happy ears’ by misinterpreting what the potential client is communicating, and declaring them ready to close on a sale when the client is not ready to commit. such an error not only wastes resources by travelling to attend the face-to-face meeting, but it can also backfire, causing a potential client to recoil, misdirecting the entire sales process. while the research process and client preparation are both nuanced, the platform itself is not. the learning platform is a stable, yet adaptable system that allows for the easy transfer of distinctive content that can then be accessed for particular clients. we are over on a new platform ivar is an assistant professor at a regional hospital in norway, and he also works for norway’s national centre for telemedicine. although he uses one computer to examine patients’ electronic pathology charts, all other computer work (emailing and other routine work) is done on a completely separate pc. the security precautions necessary to protect the patient’s electronic records and anonymity are too important. much of ivar’s medical diagnostic work is completed in the traditional manner, with his making his judgements on the basis of the patient’s medical record, or occasionally consulting a colleague when difficult diagnoses arise and he would like a confirmation. in addition to these usual protocols he also uses pubmed, which is an international periodical database for medicine maintained and updated by the national library of medicine in washington, d.c. there is a concerted effort in norway to expand the breadth of experience in diagnosis, and the country has an intranet connection that allows all norwegian doctors in ivar’s specialty to share information and even to complete remote analyses by controlling microscopes via computer controls. research is integral to ivar’s profession, and he uses the word platform simply to indicate a recent change in technology that alters the rules for ‘read only’ and open access to files: ‘now we are over on a new platform because we have changed software to an upgraded version.’ he describes the access rights since the new platform was established: ‘guest members have read— but not write—privileges, while regular members have write privileges, and they can publish onto the intranet.’ ivar complains that of the 100 000 articles in medical journals, half of them should never have been published because their contribution is minimal. also, njsr – nordic journal of social research vol. 4, 2013 106 he finds that there are too few review articles that give direction to finding reliable research because such reviews are ‘hellish’ work for doctors. he too bemoans the lack of adaptability some of his older colleagues display, especially their slowness to adopt newer communications technologies. for instance, ivar describes the hospital’s decision to invite doctors to board meetings only by email invitations to force them to utilize the tool. ‘those who missed the meetings’, he says, ‘because they didn’t read their email, have no good reason’. ivar also comments that doctors are slow to use technology, because they are accustomed to the tradition of talking directly together, and are reluctant to make judgements on distant records. searching for a platform vegar is an administrator at a regional university in norway who handles communication tasks associated with the web, including both sending and receiving messages about the tasks to disparate members of university management. he talks about platforms when he assesses communications products that offer something innovative while meeting university standards. vegar must also act as the contracting agent for university publications on such items as handbooks, brochures, class schedules, and other documents that are printed in large numbers. he publicizes the specifications for bids and then follows up to assure that contractors in fact have the capability to deliver what is needed before he signs the agreement. vegar’s responsibilities means that he acts as evaluator and protector of his institution’s image by making sure that the paper type and colour, as well as the logo, of the university’s official printings is properly represented on documents. he compares the various printing offers when there are competitive bids. he reviews printing work from individual academic departments who provide their own information for publications such as schedules, class offerings, and so forth. he assures that the publications submitted by the individual departments for printing conform to a single quality standard. his project-funding list is drawn from a university document that lays out its priorities in a strategic plan that the university board approves each fall. in addition to reviews of his work as a communications manager on these projects, he also has to prepare for and to pass state audits that prove his documenting competence. this standard by conformity means that his search for various solutions is tied to particular platforms. but since he is not a programmer, his attention is directed towards the ‘structure and presentation of information that goes on the web’, including its interactive services. to complete the contracting for services, his pattern of communication is well established. he meets with people he is working with for the first time or on big projects in face-to-face meetings to get a feel for what they are about. he then turns to managing that relationship through email because it saves time, offers detail, provides a record of interchanges, and allows for follow-up editing and other kinds of changes. when vegar says he is searching for a platform, he is looking for programs that allow him to meet each of these demanding needs. njsr – nordic journal of social research vol. 4, 2013 107 i want a stable platform john’s work requires him to search the internet and then translate what he finds into useful information for his employer. when he says he wants ‘a stable platform’ he is merely commenting on the qualities a mac versus a pc platform as his preferred tool for producing graphics for presentations. prior to his current career, he was in the u. s. air force (usaf), and he speaks with pride as he says, ‘i spent 20 years in the military, and at sac (strategic air command) headquarters i was a staff officer. that’s the kind of job i really like. you need something, you go get it done.’ john now spends from five to ten hours a day on the internet and he is comfortable ‘going in and saying, okay, this is a good company; this doesn't seem right; this does.’ as well as ‘a lot of it is dated, old. you know, it may be good data, but it’s no longer credible.’ john sees himself as a functionalist with a tool for every task. for example he offers—without solicitation—great detail about his goal-oriented approach, one that allows him to assemble 30-second ‘elevator pitches’, to design trainings, to create logos for new companies, and to craft just the right message to communicate to potential customers and his superior. in his interview, john is direct and specific about every step that he takes as a technical communicator, and he often summarizes a plan as having the potential to ‘blow apart’ a market they are entering. he represents his ability to complete this work by describing the tools he chooses for a particular job. john’s preferences are somewhat typical in that he uses a mac at work and a pc at home to take advantage of the best of each system. the mac graphics platform is crucial to his primary task of communicating his findings to the ceo of his company, who prefers a powerpoint presentation with all the key information represented in graphics. he says of his boss, ‘he’s a tinkerer, and it’s best to present him graphics. he works best with that, and let him play with it, look at it for a while.’ john says his boss has a noticeable pattern and that an hour or two after receiving the information, ‘he’ll start bringing ideas back and we’ll change things—over a day or two’. john has learned not to send his boss typed messages because ‘textual [matter] with him takes a little longer—he just doesn’t have time to read it all’. john simply sends him information ‘in quick little bursts via email, and then wait[s] a day or two’ for a response. when john comments that he wants a stable platform, he is saying that he is so adaptable and has so much task variety that he wants to give dependable order to his dynamic job. mapping competencies onto a platform the term platform is used at norwegian hr-360 to represent a person’s career path ‘mapped’ onto a document. hr-360 sells a human resource (hr) model that captures the employee’s abilities through testing, then documents the employee’s varied resources and skills. key to the product’s success is the individual employee’s accepting this summary document as the official record of her or his ability. the document is viewed in totality from a ‘life-long learning perspective’ that encourages people to own and ‘actively develop their own career’ the hr-360 model assumes that there is an incentive ‘for the employee to update the information’, ensuring that the individual’s and hr360’s interests are commonly allied because it lists an individual’s ‘competency iq’ in modules that are valuable for the company. njsr – nordic journal of social research vol. 4, 2013 108 hr-360 serves three different client segments: oil and gas, the public sector, and banking and finance. like other consulting firms, hr-360’s success depends on selling its service. they pursue this goal by having sales representatives in two different cities in norway, and by allocating much of their top company leaders’ time towards closing deals. while the platform is intended to provide stability for the employee, the client company, and hr-360 itself, the sales process that leads up to ‘closing a client’ is anything but stable. the sales process is constantly changing, which then necessitates adapting quickly to expectations and stylistic changes. hr-360 uses the internet to establish its corporate presence and to communicate a particular competence by identifying key words from other websites and showcasing these words as their own. the purpose is to demonstrate that they know and can accurately articulate the jargon of the human-resource industry. the platform emphasizes stability, but the sale of that platform is mercurial. discussion of cases1 thus far our claims have been: 1) communication is based upon the ability to manage or balance creativity and stability in order to make meaningful contributions in the world; 2) that creativity is a kind of agency, while stability is a kind of scene in the burkean sense, and; 3) that by analysing the term platform in its everyday use, we can see how the two tenets of creativity and stability work themselves out in organizations to create meaningful solutions to challenging problems. we find more evidence for our understanding of the term platform as a combination of scene and agency, stability and creativity, in the etymology of the word itself. platform is a composite of two shorter words, and the first, plat, stems from the old french word ‘plot’, meaning a piece of ground. ‘plot’ is associated with the ancient greek word ‘platys’ (πλατύς), meaning ‘flat, wide, broad’. plat is a root word for a variety of current words associated with stasis: place, plaza, piazza, plate, platter, plaque, plot, plan, placenta, placid, plateau, placard. the latin and ancient greek root plac(πλακ-) simply means flat. the many meanings encompassed by these words create a large background in the burkean sense for the concept of a platform. similarly, the english word form stems from the latin word forma, meaning to ‘form, shape, mold, case; the first instance of form occurred in 1225’.2 to form is analogous to agency, and in burkean readings, this is important. a form, from a narrative standpoint, works to intrigue and satisfy—and often conveys experiential kinds of knowledge. it can be repetitive or brand new, but it is inevitably designed to bring about predictable results and reactions: ‘basic forms may, for all that concerns us, be wholly conventional. the subject-predicate form of sentence, 1 an easy reference table (1) summarizing this section follows the conclusion of the article. 2 entry downloaded july 1, 2012. ‘1550, “plan of action, scheme, design,” from m.fr. plate-forme, lit. “flat form,” from o.fr. plate “flat” (see plat) + forme “form” (see form). the literal sense of “raised, level surface” is first recorded 1560. political meaning, “statement of party policies,” is from 1803, probably originally an image of a lit. platform on which politicians gather, stand, and make their appeals, perhaps influenced by earlier sense of “set of rules governing church doctrine” (first attested 1573). railroad station sense is from 1838.’ (http://www.etymonline.com/index.php?term=platform) njsr – nordic journal of social research vol. 4, 2013 109 for instance, has sanction enough if we have learned to expect it. it may be “natural” only as a path worn across a field is natural. but if experience has worn a path, a path is there—and in using the path we are obeying the authority of a prior form’ (burke, 1931, p. 142). these six cases indicate that the term platform contains a plurality of connotations. in them, platforms are described as the means through which learning, searching, mapping, stabilizing, adapting, and standardizing occurs within organizations. however, all six of the term’s description can be understood as disparate ways organizational members manage and balance the two aforementioned dimensions of stability and creativity. we present our first two cases—that of frank’s consultancy firm and amanda’s online training firm—next to one another because each exemplifies one of our terms over-determining the other. in frank’s case, it is agency that helps to dictate the scene, whereas with amanda’s case, it is the scene that helps to dictate the means of agency. in frank’s case, the means of communication helps constitute the consultancy firm’s understanding of the scene. we take seriously the idea that, to those in the firm, loyalty to the communication medium becomes synonymous with being loyal to the platform chosen. also, we find a link between these statements and the fact that everything is stored digitally, while the hard copies are thrown away. communication becomes the means of stability, and therefore creativity is restricted, after the agreement has been made on how things ought to be done with regard to communicating with a particular client. we find three reasons for this restriction. the first is the nature of the business: as a consultancy firm, what is being sold is largely communicative in nature, in the form of agencies designed to help clients and organizations. that the firm’s business is selling something seemingly ephemeral is not to be ignored. second, the restriction of agency compelling conformity upon the scene acts in political ways, not only allowing one colleague, at a glance, to be up to speed on a client’s situation, but the conformity also acts as a form of consistency—practising what one preaches—whereupon a client can see how success is achieved when all employees fall in line. the third is economic in nature. the nature of the product requires specialized sales techniques, and these techniques are put into action in a formulaic manner because statistics bears out the pattern’s effects: if we do these steps, in this order, then we get what we want x% of the time, and this is the most effective technique we have come up with to date. we therefore see an analogue between the consultancy firm’s constitution of a platform in political advocacy, meaning that the consultancy firm looks at the world, finds ways to communicate its core message to the world, and then sticks to that message and promulgates it in uniform ways to garner favour with as many clients as possible. in the case of amanda’s firm, things look different. whereas frank’s firm offers what we call a political advocate’s understanding of a platform, amanda’s firm understands platform as analogous to product of the environment. we shall explain what we mean by this claim. amanda’s firm offers online training services, and so the scene becomes what dictates the means of agency. the world now is online; the world wide web has taken over. where the web was once merely a means of agency, it has become so ubiquitous as to become a scene unto itself, and, in this sense, the njsr – nordic journal of social research vol. 4, 2013 110 web-as-agency has achieved what frank’s firm would like to see for its own form of agency, political advocacy. the advantages we see in the constitutive effects of this sort of platform are found in its stability. if one is a product of one’s environment—or produces products of the environment—then one knows many of the nuances of being in the scene, both of placement and of background. we see this sort of behaviour in amanda’s ability to find information through alternative search practices, and also in her confidence to be able to utilize them properly, as they are merely an extension of the larger scene of the world wide web. also, because of the stability of relying on the scene itself to carry the means of agency, time is not wasted on what might become a fruitless exercise: the product amanda sells is already tailored to certain potential clients, and not others, and she can sift through the proper ones without wading through companies who would never be worth her while. the four remaining cases seem to make a balance between creativity and stability, and where we find this balance is in the area of communication. instead of having an agenda and firmly proclaiming it to the world, or looking at the world and claiming that this is what can be done in the world as it is, the last four examples—those of ivar, vegar, john, and hr-360—show us an interplay between scene and agency. further, they show us how multiple scenes temper agency. ivar and john both rely on their former training as a scene: like the world wide web, ivar’s medical training and john’s military training, though once agencies, have now been constituted as scenic, as an integral part of their background. ivar combines his medical training with that of the new scene of the internet to utilize the tools available, and laments that some of his colleagues can’t do the same. john does something similar, utilizing his former military training in relation to information gathering so that he can communicate with his boss in a way that makes information accessible. but, though dealing with it differently, ivar, and john are saying the same thing when constituting their respective platforms: you can’t teach an old dog new tricks. ivar cannot make the newer platform more accessible to those who do not understand the world of the internet and john cannot give his boss his old intelligence training. vegar, instead of translating for other people (an activity ivar shrugs off, and john welcomes), interprets everything others give him into one standard. all his university departments as well as the individuals who work for them must meet the dictates of the university concerning publication. so where john might take disparate forms of information and translate it to one person, vegar takes information from many people and departments and funnels it into one pre-approved publication format. this changes the nature of the scene for vegar. ivar’s or john’s multifaceted scene is partially constituted in their backgrounds (medical training and military service, respectively); vegar’s scene is partially constituted through the standards by which he must make everything adhere, and partially by the people and departments for whom he must interpret. the advantage to vegar’s platform is that there is a stable standard by which to judge materials. the disadvantage comes from a seemingly small ability to make political change. njsr – nordic journal of social research vol. 4, 2013 111 this is the main similarity between vegar and hr-360. hr-360 interprets a corporate employee’s strengths in relation to corporate needs, and relays the message that who they are is valuable to the company, so long as those strengths match up with the tasks they are given. like vegar on a personal level, hr-360 on the corporate level has the ability to make judgements on the basis of the needs of others, but sacrifices the ability to advocate for an alternative means of evaluation. none of the six examples is necessarily better than the other. each, to varying degrees, functions in its context. what we are noting here is not a situation of ‘better or worse’ nearly so much as we are directing attention to the shifting interplay between agency and scene—creativity and stability—that becomes apparent by analysing the term platform when people invoke it in order to explain what they do and how. conclusion in conclusion, the six cases still have many similarities unifying them. for each, the platform is a discursive structure: it can be captured as a set of rules or as rules of access to a structure. as such it is a force for large-scale coordination and control (mcphee & poole, 2001). these cases reaffirm the platform as a structure because it is a ‘social object’ that is open to interpretation, as are people, events, decisions (ashforth & humphrey, 1997). structures fabricate a reality that is constituted in real-time interaction (mcphee & poole, 2001). the structure standardizes practices on a platform because the rules constituted by the platform protect resources and personal and corporate identities, and provide a means of adhering to legal requirements, all of which make the manipulation of practices easy to train, to bill for, and to control (mcphee, & poole, 2001). yet they also reveal quite diverse balances between creativity and stability when individuals mention a platform as a social object or a concept. in some instances the term platform means nothing more specific than the difference between the platforms of a mac and a pc. in other cases the term ties electronics to additional features of control and allows for experts to monitor relative correctness of use. lastly, in most of our six cases, rather than relying on technology to complete the task, the platform consistently leads to face-to-face communication. for all their ability to control, liberate, comfort, and educate, platforms appear both to result from and to lead to direct interpersonal communication. john, the usaf retiree, completes charts for his boss, then goes to see him in person. amanda uses the platform to search for people in a process she hopes will culminate in an important and pivotal face-to-face meeting. ivar, the norwegian doctor, pits his knowledge of the platform against the resistance his peers. he casts their view as a preference for face-to-face communication in meetings and diagnostic decisions, while also noting that it is meant to foster face-to-face communication between colleagues. vegar, the norwegian administrator, maintains the platform for his university, but he also meets people face-to-face to make sure the work is done correctly. these examples of alternation in sequence between technical platform and direct face-to-face communication extend the communication process and add still another component to the structure: the alternation in effect creates structuration (giddens, 1984). most importantly, the platform is a structure that adds the physical component of technology to the act of communication, making the message eventful in a way that it could not be if it were merely words on paper njsr – nordic journal of social research vol. 4, 2013 112 or something said by a person. this alternation in sequence between platform and face-to-face communication extends the communication process further by providing ‘material embodiment’ (mcphee and poole, p. 519) to a communication process that otherwise can be transitory and uncertain. platforms, in all their instantiations, simultaneously give us the means by which to move, and the grounding in experience to do so. the two culminate in organizational communication to produce an interplay between creativity and stability. table 1 scene (stability) agency (creativity) interplay positives negatives frank database for communicatio ns storage database for communicatio ns storage agency is dictated by scene. reliable. innovation stagnates amanda the internet the internet scene is dictated by agency reliable. innovation offline goes unnoticed ivar previous medical training technological communicatio ns: internet and intranets 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(2005, december 30). word of the year? application development trends. retrieved august 23, 2006 from http://www.adtmag.com/article.aspx?id=17744 njsr – nordic journal of social research vol. 4, 2013 114 von hippel, e., & von krogh, g. (2003). open source software and the ‘private collective’ innovation model. organization science, 14(2), 209-223. microsoft word snellman, nygård, jungerstam conceptions and tendencies of age discrimination and attitudes.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 4, 2013 conceptions and tendencies of age discrimination and attitudes towards older people in selected regions in finland and sweden fredrik snellman faculty of social sciences, department of social work, umeå university, sweden swedish school of social science, university of helsinki, finland email: fredrik.snellman@socw.umu.se mikael nygård faculty of social sciences, department of social policy åbo akademi university, finland email: mikael.nygard@abo.fi susanne jungerstam degree programme social services, novia university of applied sciences, finland email: susanne.jungerstam@novia.fi njsr – nordic journal of social research vol. 4, 2013 116 abstract this study aims to access and explore tendencies in the conceptualization of age discrimination and the perceived attitudes towards older people in regions of finland and sweden. the analysis draws on gerda survey data (gerontological regional database), a repeated cross-sectional study in which data was collected in 2005 and 2010. the results indicate that the conceptions of age discrimination are changing in a positive direction, which is contrary to results shown in the eurobarometer. on the basis of balance coefficients we show that conceived attitudes towards older people are changing as well, except for individuals in some sub-groups. we discuss the role of political rhetoric in relation to ageing awareness, the (non)individualization of society and the negotiation of age relations as tentative interpretations that strongly challenge the observed empirical tendencies. keywords: age discrimination, attitudes, ageism, tendencies, conceptions, older people, finland, sweden njsr – nordic journal of social research vol. 4, 2013 117 introduction few things permeate social life in the same way as the category of age. evidence, sometimes dismissed as ‘anecdotal’, shows that age matters in many diverse ways (bytheway 2011). however, we might not always acknowledge that it does, and we might not even possess the words that allow us to articulate these everyday experiences. much less do we have ‘real’ insight into how these experiences evolve over time. however, a study by tornstam (2007) has demonstrated evidence of slightly improved levels of knowledge about the ageing process among swedes between the years 1982 and 2005. some of the ways in which we identify age as a constituent of experiences in everyday life are through concepts like ageism (cherry & palmore 2000; coupland & coupland 1993) and age discrimination. in this article we focus on manifestations of age discrimination and attitudes towards older people. age discrimination is something with which many individuals are familiar (eurobarometer, ebs 2009), but individuals rarely use the label ageism when describing or talking about such experiences. in finland and sweden, and the regional contexts in which we empirically examine these age-related issues, the phenomena are well known in everyday life but not by the term ageism (cf. snellman, manuscript). however, in the article we orientate the analysis in relation to the ideological field of ageism by scrutinizing two of its central aspects, attitudes and self-reported discrimination. for the present article we define discrimination as ‘behaviour that creates, maintains, or reinforces advantage for some groups and their members over other groups and their members’ (dovidio, hewstone, glick & esses 2010, 10). we understand attitude (prejudice) as a thought on the individual level ‘(whether subjectively positive or negative) towards groups and their members that creates or maintains hierarchical status relations between groups’ (dovidio, hewstone, glick & esses 2010, 7). the concepts of attitude (prejudice) and discrimination (alongside stereotypes) are often used as components in definitions of ageism. our study is delimited to the emotional dimension of attitudes (i.e., neither behavioural nor cognitive dimensions) (kite & smith wagner 2002), which we refer to as ‘conceptualizations’. we have aimed in this study to access and explore tendencies in the conceptualization of age discrimination and the perceived attitudes towards older people in selected regions of finland and sweden by seeking to answer four main research questions. first, how have individual conceptions of being discriminated against on the grounds of age changed between 2005 and 2010 in a cross-country regional context? second, how have the conceptions of attitudes towards older njsr – nordic journal of social research vol. 4, 2013 118 people changed between 2005 and 2010 in different domains of society? third, how common are these tendencies across different subgroups? and, finally, given the condition that tendencies are identifiable, how can these be tentatively understood? existing empirical evidence reveals a degree of stability in the prevalence of self-reported age discrimination, as well as a dramatic increase in terms of how widespread people consider age discrimination to be (ebs 2009). different currents of modernization theory (e.g., bauman 2000; beck, giddens & lash 1994; featherstone & hepworth 1991; beck 1992; cowgill 1972) suggest that the social construction of (old) age may indeed become more negative over time as a result of individualization and an increasing idealization of youth. we arrived at our hypothesis on the basis of these theoretical assumptions and tested whether conceptions of age discrimination and negative attitudes towards older people occur more frequently as time goes by. in the analysis we have drawn on data from the gerda (gerontological regional database) multidisciplinary research project. ways of conceptualizing age researchers have attempted to conceptualize age in different ways. in this section we outline previous research that has influenced our interpretations of our empirical results. we begin by outlining the discussion about ageism, which serves as an ideological background (cf. krieger 1999) to the more specific studies of age discrimination. other contributions function more explicitly as analytical tools, such as those of age relations (calasanti 2003), age-coding (krekula 2009), age positions (lundgren 2010, lundgren & ljuslinder 2011), and the analyses of age-talk in everyday and institutional settings (nikander 2009). ageism is a complex phenomenon (kite & smith wagner 2002; tornstam 2006) and has been defined in a large number of ways (iversen, larsen & solem 2009; snellman, manuscript). the meanings attributed to ageism ranges from narrow concepts of prejudice, stereotypes, and discrimination (butler 1969; 1975) to very broad concepts of everyday ageism (bytheway, ward, holland & peace 2007; ward & bytheway 2008; bytheway 2011; snellman 2009; 2011; snellman, johansson & kalman 2012). within this everyday discourse individuals articulate their experiences with the help of certain signifiers, for instance, old(er) or young(er) (snellman, johansson & kalman 2012). ageism is sometimes discussed in parallel with power relations based on age. calasanti (2003) argues that there is a need njsr – nordic journal of social research vol. 4, 2013 119 to theorize age relations and old age systematically as a political location in its own right, predominantly on the basis of the experiences of older people. according to calasanti (2003, 215), ‘examining age relations … will allow us to explicate the structures that deny power to so many of the old for reasons having less to do with the aging of bodies and more to do with our construction of old age as sickness, dependence, lack of productivity, unattractiveness, and decline’. one such theoretical concept that elucidates age relations is that of age-coding (krekula 2009, 7), which means ‘practices of distinction that are based on and preserve representations of actions, phenomena, and characteristics as associated with and applicable to demarcated ages’. krekula illustrates how age codes can be used as i) age norms to negotiate identities ii) a means of legitimizing, negotiating, and regulating resources, iii) a resource in interaction, and iv) for the creation of age-based norms and deviation (i.e., situations where people are assigned a position of ‘the other’). this reasoning clarifies that codings of age are crucial in order to understand how age relations, for instance, age discrimination, are created and effectively enforced. krekula (2009, 15) argues that the concept ‘can be understood as a logic of distinction that can be used in negotiating resources and the contingent actions that different categories allow for’. both lundgren (2010) and lundgren and ljuslinder (2011) discuss the practice of age positioning, that is, one of the ways of negotiating and making sense of social worlds. lundgren and ljuslinder (2011) suggest that individuals in different contexts use age in ways that reproduce hegemonic images of older people simultaneously as they attempt to show other, more nuanced and norm-breaking images of the target group. age positions, for instance, those connected to decline versus activity, are among other ways created by means of referring to ‘population ageing’. another way of conceptualizing age is to draw on nikander (2009, 864), who argues that ‘chronological age and lifespan categories and other interactional formulations of age surface and are made relevant for and by us, implicitly and explicitly, and we position each other or describe and account for our own and others’ actions in various everyday settings’. some of these ‘interactional formulations of age’ are explored in this article, since they help us understand the interactional processes that stem from using ‘age’-related survey questions, that is, how respondents position themselves (lundgren 2012; lundgren & ljuslinder 2011) when confronted with questions of age-related discrimination and attitudes. njsr – nordic journal of social research vol. 4, 2013 120 empirical evidence of age discrimination within the eu in western societies, the awareness of discriminatory or exclusionary behaviour has increased dramatically in recent decades. in the minds of citizens of the european union, there is a widespread perception that discrimination based on age occurs frequently: according to the ebs (2009), 58 per cent of the european respondents – as compared with 55 per cent of the swedish and 63 per cent of the finnish respondents – considered discrimination based on age to be widespread. in some countries the perception of extensive discrimination seemed related to peoples’ evaluation of how much effort was being made to combat discrimination in general (ebs 2009, 31). curiously, the highest proportion among europeans who felt that enough effort in counteracting discrimination was being made was found in finland – 68 per cent – whereas only 31 per cent of the swedish respondents felt the same (ebs 2009, 31). within the european union, the perception of the existence of discrimination based on age had undergone an increase between 2008 and 2009. when asked to make a comparison with the situation five years ago, 58 per cent of the ebs respondents believed in 2009 that discrimination based on age was widespread, as compared with 42 per cent in the previous year. this was the largest increase in the perception of the prevalence of any form of discrimination included in the study (ebs 2009, 11, 73). simultaneously, the perception of age as a basis for discrimination against oneself, that is, self-reported discrimination, had not changed. in part, the shift in opinion concerning age-based discrimination was attributed to changes in the economic climate in recent years, as older employees and job seekers may feel that employment opportunities are less secure today than they were prior to the economic recession. this assumption may be supported by the fact that older people were more likely than young people to report that discrimination based on age was widespread: 60 per cent of all respondents aged 40-55 and 55+ as compared with 49 per cent of respondents aged 15-24 (ebs 2009, 73, 118). ways of understanding social change there is today little consensus regarding the ways in which social constructions of age come to life or how they prevail, and how and why conceptions of age generally – and age discrimination specifically – change over time. njsr – nordic journal of social research vol. 4, 2013 121 one early attempt to understand the changing social status of older people was presented by sociologists (e.g., parsons 1951; 1964; cowgill 1972), suggesting that older people became less appreciated in the industrial epoch due to rising standards of rationalization and effectiveness. whereas previously older people were respected, admired, and believed to possess wisdom, their social status has declined over time as societies have become modernized, and preindustrial modes of production were replaced by highly industrial and technological structures. cowgill (1972) has identified four central mechanisms in this process: advances in health, technological developments, urbanization, and education. as medical practices advanced and public health was improved during the twentieth century, longevity increased, which in turn increased the level of competition between age groups within labour markets. allegedly this competition has led to a crowding out of older workers by younger ones. similarly, advances in economic and industrial technology brought along new qualifications that favour younger workers while demoting older workers into less prestigious jobs or into retirement. as older people become excluded from the labour market, they not only lose social status and income, but they also become dependent on the younger generations. although some scholars (e.g., palmore & manton, 1974) have downplayed the relevance of this theory, it has received some support from postmodern and post-materialist sociology (e.g., sennett 2006; bauman 2000; beck, giddens & lash 1994; beck & beck-gernsheim 2002; beck 1992; giddens 1991; inglehart 1990; 1977). one common denominator of these contributions seems to be that cultural changes bring about different, and most likely more negative, social and political constructions of old age in a world that is becoming less socially embedded, more individualized, and more insecure. for instance, featherstone and hepworth (1991) have pointed out that post-modernity with its accentuation of individualization and reflexivity poses possible threats to the social image of older people because society as a whole is tending to become increasingly characterized by an admiration of youth (cf. morganroth gulette 2011). similarly, gerontologists such as estes (1979), townsend (1981) or walker (1981) have argued that older people have become structurally more dependent and thus less respected. another source for ageism may arise from the process of globalization. although the empirical evidence for a connection between age discrimination and globalization remains scant, it is likely that it has affected the images of older people negatively since they are increasingly depicted as a threat to the welfare state (cf. lynch 2010). whether or not these predictions actually hold true, they serve as a fruitful theoretical point njsr – nordic journal of social research vol. 4, 2013 122 of departure for this article. not only can strengthened ageist structures lead to a cultural devaluation of old age and weaken public support for, among other things, public care services for older people, but they are also likely to have an influence on older people’s selfimages and their feelings of inclusiveness. for example, in a world of growing competitiveness, economic inequality, and individualization, we may reasonably expect older people to adopt more negative selfimages and stronger sentiments of exclusion (cf. kite & smith wagner 2002). data collection, preparation, and methods regional data and participants this article used survey data from the gerda (gerontological regional database) population study, a cross-sectional data collection carried out in two waves. the first wave of data collection was carried out in 2005 among 65and 75-year-old people in the ostrobothnia region in finland and the västerbotten region in sweden (n=3370). the second wave of data collection was carried out in 2010, and it involved identical sampling procedures. in 2010 the age cohorts of 65-, 70-, 75-, and 80-year-old people were surveyed (n=6838). the response rates were 69 per cent in 2005 and 64 per cent in 2010 (herberts n.d.; 2011). in this article we delimit the analyses to individuals who were 65 and 75 years of age in 2005 and 65 and 75 years of age in 2010. the participants were asked to answer identical survey questions on self-reported age discrimination and attitudes in the year 2005 as well as in 2010, alongside a wide range of other questions regarding, for instance, activities, values, and health. the general objective of the two waves of gerda data collection was to attain knowledge about older people’s life situation, health, and wellbeing. the sample included all individuals living in rural municipalities, while every second individual living in the town of vasa (finland), and every third individual living in skellefteå and umeå (sweden), were randomly sampled. in order to avoid an overrepresentation of the rural population, design weights were used (herberts 2011). skellefteå and umeå were assigned a weight factor of three and vasa a weight factor of two. njsr – nordic journal of social research vol. 4, 2013 123 the gerda questionnaire was externally validated among older people (n=24) in both finland and sweden by means of qualitative pilot-testing (fagerström et al. 2011). analysed items and methods of analyses the first question in this study was as follows: ‘during the last year, have you sometimes been badly treated or discriminated against merely on the grounds of your age?’ the response alternatives to this question were ‘yes’, ‘no’, and ‘don’t know’. this self-reported measure of age discrimination is identical to the spirit of the one used in the ebs and it has been suggested that self-reported age discrimination is a valid indicator of unfair treatment (gee, pavalko & long 2007). the internal response rate on this question was high, with only 1.9 per cent (139 individuals) not responding to this question. the other main question was: ‘what point of view (swedish ‘inställning’, finnish ‘asenne’) do you think generally exists towards older people in our society?’ the four response alternatives were ‘positive’, ‘neutral’, ‘negative’, and ‘don’t know’, and this question related to eight specific domains in society: in newspapers, on tv, in advertising, in politics, in the labour market, in health/medical care, in shops/banks, and at cultural events. owing to a relatively high nonresponse rate on this question an inclusion limit of 50 per cent was set for these eight items, which resulted in the exclusion of 149 cases from the data set. in the analysis we examined whether reports of age discrimination and attitudes towards older people varied across the subgroups. the variables of year of data collection (2005 or 2010), age (65 or 75), gender (female or male), employment status (working or no longer working), resident country (finland or sweden), health (good or poor), and marital status were included in the analysis. the analysis focused on describing the extent to which participants had experienced age-discrimination and whether participants perceived positive, neutral, and negative attitudes towards older people as a group. we carried out chi-square tests in order to analyse the magnitude of change in self-reported age discrimination and to see whether such tendencies were present across different subgroups. balance coefficients for the whole data-set and for subgroups were calculated in order to show tendencies in the attitudinal measures. other methods of analysing data (e.g., a multivariate analysis) would have required a deletion of many cases (owing to the response alternative ‘don´t know’) from the data-set in order to njsr – nordic journal of social research vol. 4, 2013 124 construct ordinal-scale data, thus reducing the descriptive value of the analysis. in short, the use of balance coefficients was seen as a more appropriate way of analysing the data. the balance coefficient is calculated as the difference between those who report a positive selfexperienced attitude and those who report negative attitudes in different domains. the coefficient varies between +100 and –100 (imaginary extremes that represent a totally positive or negative society) and represents the intensity and direction (positivity or negativity) of self-experienced attitudes towards older people. the greater the share of neutral or indecisive respondents, the closer to zero the coefficient will be. empirical findings tendencies in age discrimination as stated earlier, we anticipated that the extent to which individuals report age discrimination would be stable over time. however, as shown in figure 1, the analysis illustrates that 4.2 per cent of the respondents in 2005 and 2.6 per cent in 2010 reported age discrimination. consequently, between the two points in time, and in contrast to what was expected, a minor but statistically significant decline in self-reported age discrimination had occurred (chi-square test p≤0.001). a higher share of respondents in 2010 reported that they did not have any experiences of being discriminated against (92.4 per cent), compared with the individual reports in 2005 (90.4 per cent). the share of respondents who didn’t know whether they had been discriminated against or not were approximately the same in 2010 (five per cent) as in 2005 (5.5 per cent). njsr – nordic journal of social research vol. 4, 2013 125 figure 1. percentage of self-reported age discrimination in 2005 and 2010. an examination across sub-groups exposed the following results. the declining tendency in age discrimination was confirmed among the swedish (p=0.007) as well as the finnish (p=0.001) respondents, and the tendency was also present when we examined the subgroups 75 (p=0.012) and 65 years of age (p=0.002). the tendency was statistically significant for both women (p=0.002) and men (p=0.006). however, when we examined the tendency among those still working in comparison to those retired, we found that the tendency was not significant for the former group (p=0.368), but significant for the latter (p≤0.001). somewhat surprisingly, the tendency was significant for respondents reporting poor health (p≤0.05), but not for those reporting good health (p=0.109). regarding martial status, the tendency was significant for those who were married (p≤0.001) and for widows/widowers (p≤0.05), but not for those living with a partner (p=0.496), were divorced (p=0.587) or unmarried (p=0.285). thus, the declining tendency of conceived age discrimination was observed in some of the examined subgroups, but not among those who were still working, were in good health, were living with a partner, were divorced or were unmarried. when we compared these regional results with previous findings at a european level (e.g., the ebs), we found a certain discrepancy that might suggest that conceptions of age discrimination are highly context-sensitive. when specific regions and specific subgroups of individuals are studied we can observe subtle patterns. compared with the eurobarometer, which was based on a random sample from the whole eu population and on all age cohorts, the gerda-data used in our study was only based on the age cohorts 65 and 75 and njsr – nordic journal of social research vol. 4, 2013 126 targeted almost all of these respondents in the studied regions. in light of this, it is perhaps not such a big surprise that the results came out differently. these incongruent empirical results are noteworthy because they illustrate different sides of a context-sensitive phenomenon. it is not necessarily the case that conceived age discrimination is stable in all contexts. the extent to which older individuals conceive age discrimination might therefore be changing in the regions studied in finland and sweden. in the discussion we shall turn to tentative interpretations of what might be the reasons for the observed declining tendency. tendencies in perceived attitudes towards older people when we examined how older adults in 2005 and 2010 conceived attitudes towards older people within different domains of society, we noticed changes. we observed a tendency that was similar to one found with self-reported age discrimination. each of the eight examined domains (tv, advertising, politics, labour market, health and public medical services, shops/banks, and cultural events) exhibited a similar response pattern (appendix 1). the observed tendency demonstrates a change towards the more frequent assignment of a positive response alternative, a neutral response alternative, and, less frequently, the ascription of the negative response alternative. additionally, the share of uncertain respondents, those who responded ‘don’t know’ decreased between 2005 and 2010. on the basis of these frequencies, we calculated balance coefficients in order to assess the overall attitudinal tendencies. table 1 shows the balance coefficients for the different societal domains. the aggregated data shows an average decline in negative attitudes from -14.2 in 2005 to -10.8 in 2010. the largest difference between the two years occurred within the labour-market domain, in which the coefficient rose from -59.4 in 2005 to -51-1 in 2010. njsr – nordic journal of social research vol. 4, 2013 127 table 1. self-experienced attitudes towards older people in different societal domains in 2005 and 2010, balance coefficients year of data collection: 2005 2010 coefficient difference in newspapers + 0.8 + 2.2 1.4 on tv – 7.6 – 5.8 1.8 in advertising – 30.1 – 26.3 3.8 in politics – 39.0 – 35.9 3.1 on the labour market – 59.4 – 51.1 8.3 in healthand public medical services – 7.7 – 1.5 6.2 in shops, banks +19.6 +19.5 -0.1 at cultural events +9.7 +12.2 2.5 average – 14.2 – 10.8 3.4 note: the balance coefficient is calculated as the difference between those who report a positive self-experienced attitude and those who report negative attitudes. the coefficient varies between +100 and –100 and represents the intensity and direction (positivity or negativity) of self-experienced attitudes towards older people. the greater the share of neutral or indecisive respondents, the closer to 0 the coefficient will be. a closer examination revealed that the aforementioned tendency remained quite robust across the sub-groups. the only exceptions were the finnish and divorced respondents, which did not exhibit this tendency. the average balance coefficient for respondents in finland was -8.8 in 2005 and -9.5 in 2010. similarly, the average balance coefficient for divorced respondents was -15.7 in 2005 and -16.4 in 2010. the analysis revealed that the changing tendency was present among women (-15.4 in 2005, -11.5 in 2010) as well as men (-13.0 in 2005, -10.2 in 2010). the average balance coefficient indicates changing tendencies among people who were 65 as well as 75 years of age. for individuals who were 65 years of age the shift was from -17,1 to -13,7, and for the 75-year-old age group from -10.0 to -4.85. the change for swedish respondents was from -17.3 to -11.6. among respondents who reported that they still worked the balance coefficient changed from -11.7 in 2005 to -10.0 in 2010. among those who no longer worked the shift was also in the same direction, from -13.7 to -8.1. for respondents who reported that they have a good health the coefficient changed from -13.4 to -10.2, and among those with poor health from -14.5 to -11.5. njsr – nordic journal of social research vol. 4, 2013 128 table 2. self-experienced attitudes towards older people in 2005 and 2010, average balance coefficients within subgroups year of data collection: 2005 2010 coefficient difference women -15.4 -11.5 3.9 men -13.0 -10.2 2.8 age 65 -17.1 -13.7 3.4 age 75 -10.0 -4.85 5.15 swedish respondents -17.3 -11.6 5.7 finnish respondents -8.8 -9.5 -0.7 respondents who report that they still work -11.7 -10.0 1.7 respondents who reported that they no longer worked -13.7 -8.1 5.6 good health -13.4 -10.2 3.2 poor health -14.5 -11.5 3 married respondents -14.2 -10.1 4.1 living together with partner -15.4 -15.2 0.2 divorced -15.7 -16.4 -0.7 unmarried -11.8 -9 2.8 widow/widower -8.3 -4.9 3.4 discussion the observed tendencies can be understood in different ways, and our continued analysis yields alternative interpretations. our analysis evolves around four broad tentative interpretations: (i) political rhetoric and ageing awareness, (ii) the individualization of society, (iii) the negotiation of age positions, and (iv) design effects. owing to the complexity of the age discrimination and ageist processes under investigation, we do not think that it is possible to pin down any single explanation for the observed tendencies. our interpretations derive from the dialectical relationship between the individual and the societal structure, in which individual acts are influenced – but not necessarily determined – by structural conditions (cf. hendricks 2003). our discussion is occupied with the conceivable chains of events that influence the respondents’ conceptions. first, one tentative interpretation is that the observed tendency is a reflection of the political articulation of improvements for older people njsr – nordic journal of social research vol. 4, 2013 129 in the local societies that have been examined. it is reasonable that self-reported age discrimination and negative attitudes towards older people actually are declining as a consequence of shifts in the ways politicians, researchers, and other stakeholders talk about older people as a group (lundgren & ljuslinder 2011). judging from the average balance coefficient, we may regard the situation for older people on the labour market, for instance, still to be troublesome. but the potential contribution that older people offer to society as a whole, say, by the postponement of the retirement age and the prolongation of working lives, is today encouraged to a considerably higher extent than just some decade ago. currently, it is even expected that we shall participate in working life for a longer period so that society can manage the financial effects of an ageing population. moreover, mass media often construct older people as an under-exploited labour supply. two specific examples that are intertwined can be useful here: political rhetoric in election campaigns and the increased awareness of the ageing process. policy-makers on a european, national, and local level often make political statements that might have affected how individuals conceive and report age discrimination and attitudes in different domains. for instance, in both countries in our study there were electoral campaigns taking place when the second wave of the gerda study was launched. the political parties in sweden, for instance, were vying against each other to convince the public that their own political programme would benefit retired people the most. the observed tendencies can perhaps be seen as reflection of this. by turning their attention to older people, politicians may have created a more positive atmosphere that made older people feel more appreciated than before. startlingly, in 2011 – approximately one year after the elections – the swedish government cancelled the tax reductions that had been promised to retired people during the election campaigns. it is not hard to imagine that the data on age discrimination and on attitudes towards older people as a group might have been very different if the respondents had known that the promises of improved economic conditions would not be carried through. to what extent can the observed tendencies be related to changes in the meaning of ageing itself? where does it lead us if we argue that ‘all [tendencies] reflect conceptual changes in what “to age” means’ (bytheway 2011, 77)? the awareness of what it means to age is also shaped by political rhetoric, that is, by facts and new information that are made evident in public debates by politicians based on scientific research (cf. tornstam 2007). palmore states that ‘those with more knowledge [about aging] tend to have less negative and more neutral njsr – nordic journal of social research vol. 4, 2013 130 attitudes’ (1988, 43). this interpretation seems intriguing, since this is exactly what the empirical data reveals (cf. appendix 1). according to palmore’s line of reasoning it makes sense to ask whether the respondents had a deeper awareness (or even perhaps more knowledge) about the ageing process in general in 2010 than they had in 2005. this would seem plausible considering the fact that a current trend in society is increased knowledge about ageing (palmore 1999; cf. tornstam 2007). increased research, more debates in the media, informational campaigns, attentiveness to the population ageing, and the political capital inherent in age-related issues (cf. tornstam 2007) might have increased the knowledge about the everyday issues, difficulties, and opportunities that the ageing process actually encompasses. an improved level of knowledge about ageing might in turn have affected the respondents’ answers to the questions of age discrimination and attitude. on the other hand, tornstam (2007) points out that changes in levels of knowledge in relation to flows of information in society are not simple. for instance, he shows that levels of knowledge about the lives of older people (e.g., housing, hearing, living in institutions) do not change over time even though debates in society might be expected to influence the levels of knowledge. this observation does, however, not mean that improved levels of knowledge, generally speaking, cannot have a moderating effect on perceived age discrimination and attitudes towards older people. secondly, another interpretation is that the observed tendencies are related to the individualization of society (e.g., sennett 2006), and that the respondents were less influenced by collective values in 2010 compared with the year 2005. the respondents might have taken on board more individualistic values during this short period. previously, the respondents were perhaps more inclined to report negative conceptions of age discrimination as a way of expressing their commonality with a group that they believed to be oppressed, even though they had not been discriminated against themselves. that is, in 2010 (or perhaps as time passes) fewer people identified themselves with older people as a group or with a group being discriminated against. individuals are well aware of the severity of age discrimination in society, as suggested in the ebs, but between the two points in time people might have come to view themselves as being more independent of that large-scale societal issue. with regard to the contexts between the two countries, it is also plausible that the tendencies are related to cultural and historical differences. for instance, the fact that we detected a shift towards more negative age attitudes among the finnish respondents (mirrored also in the eurobarometer) can perhaps be a reflection of cultural njsr – nordic journal of social research vol. 4, 2013 131 differences and historical events, such as the fact that the finnish respondents experienced the second world war while most swedish in the same cohorts did not experience the war in a similar kind of way. individualistic values might therefore not be rooted, or at least not influence conceptions of age-related issues, in the same way in finnish society. if it is true that processes of individualization, which is one of the consequences of modernization, has influenced the inclination to opt for negative self-reported age discrimination and negative attitudes towards older people, then this would mean that despite the desirable tendencies shown in the empirical data, we might still be heading towards stable, stronger, and possibly more negative ageist structures (e.g., sennett 2006). this opposing tendency would simply not be exposed in individual conceptualizations. unfortunately, it cannot be ruled out that we are dealing with illusionary tendencies. tornstam (2007) argues that observed changes of this kind might reflect persistent attitudes that merely have changed shape and taken on new forms. tornstam has phrased this point nicely: ‘the persistent pattern of stereotyping old people, in its old or new forms – “positive” or “negative” – is in reality the ageist society’s way of controlling and exercising power over old people’ (2007, 56). accordingly, precautions have to be taken so that the results of our study are not used to nurture new undesirable attitudes. we cannot, for instance, conclude that the exposed tendencies are signs of improvement. thirdly, the exposed tendencies may be connected to how people make sense of their social worlds by means of taking age-related standpoints. as we showed earlier, previous research has argued that age can be conceptualized in many different ways, and one of these ways is the negotiation of age and the attempts to make sense of our social world by means of these negotiations (krekula 2009). age, in any of its everyday forms (snellman, johansson & kalman 2012), is an articulatory device (cf. nikander 2009) that individuals use as a resource to position themselves within the social world (lundgren 2010) by coding experience (krekula 2009). the responses to the discriminatory and attitudinal questions can be understood as a part of a broader societal negotiation of age relations that serves to pinpoint one’s political location (calasanti 2003). only fragments of this totality of negotiations, or individual attempts to position oneself and thereby choose a political location with the help of ‘age’, might actually reflect, or qualify as, shifts in age discrimination or changing attitudes towards older people. in consequence, this means that age-positioning, which in this context is the negotiation and sense-making of social worlds by means of general responses to questions concerning age discrimination or attitudes towards older people, is not used in the njsr – nordic journal of social research vol. 4, 2013 132 same way or to the same extent as previously. that is, the tendencies can be understood as a shift in how age relations are negotiated (calasanti 2003). the respondents may not have felt the same need in 2010 to use the resource of negotiating age discrimination in order to position themselves or to choose a political location. consequently, we are perhaps observing latent changes in ‘conceptions about ages’ (krekula 2009, 15), and changes in how the respondents make sense of their age-related life-worlds when they are given a chance in a delimited context. finally, design effects could also have influenced the tendencies in self-reported age discrimination and attitudes. even though the analysed questions used in 2005 and 2010 were identical, other questions differed as a result of the introduction of additional questions in 2010. one question allowed respondents to state whether they had had experiences of being treated as old, while there were also some new attitudinal measures included in the 2010 survey. the tentative interpretations discussed above might singly explain the observed tendencies. importantly, it is also possible to understand the findings in light of a mixture of all the particular interpretations (cf. tornstam 2007). conclusions in this article we have exposed the tendencies of decreasing selfreported age discrimination and negative attitudes towards older people as a group. these tendencies did not corroborate our expectations and hypothesis, which were derived from earlier european empirical survey data as well as from theoretical contributions. the results are worthy of note insofar as they indicate a declining tendency in self-reported age discrimination and unexpected shifts in attitudes towards older people as well. we have suggested that the tendencies can be understood as time-, place-, and contextsensitive phenomena. our discussion has revolved around the role of political rhetoric connected to an enhanced awareness of ageing, the individualization of society, individuals’ negotiation, positioning, and choice of political location based on age, the potential consequences of design effects, and the possibility of a complex mixture of the aforementioned as a way of explaining the results. these theoretically guided interpretations strongly challenge our empirical results, just as the empirical results challenge previously exposed results in the eurobarometer. an important limitation to this study is that we do not know what kind of situation the respondents had in mind when they answered the njsr – nordic journal of social research vol. 4, 2013 133 questions. for instance, we do not know how they understood the concept of discrimination. bytheway et al. (2007) have shown that people might relate their experiences of discrimination to many different situations. thus, the magnitude of age discrimination or attitudes cannot be understood in an absolute sense. however, it makes sense to carry out relative comparisons between different points in time and across sub-groups since we are dealing with identical survey items (cf. tornstam 2007). on the basis of these tentative interpretations, future research should try to uncover the rationale that makes people identify the presence of age discrimination or certain kinds of attitudes towards older people. what are the contextual and structural factors that are involved in – or maybe even determine – people’s conceptualizations of age discrimination and attitudes? by continuously monitoring the tendencies in conceptions of self-reported age discrimination and discriminatory attitudes towards older people, we can learn more about the ageist power-relations that influence individual lives. an implication relating to policy and practice arising from this study is that we have to exercise caution in how exposed age-related patterns (e.g., stability or shifts in self-reported age discrimination) might be used: how do we allow these to have an impact on the decisions that we make? there is a serious risk that anticipatory anti-ageist discriminatory work could decrease in political decision-making and in practices that care for people if the results of our study are interpreted as improvements. this would lead to an unwarranted view that what has been accomplished is satisfactory. we need continuously to ask ourselves what these tendencies really mean and in what ways they are related to and influenced by other phenomena in society. acknowledgements the authors wish to express their gratitude to the anonymous reviewers for their comments on earlier drafts of this article. previous versions of this article were presented at 10th conference of the european sociological association in genève, switzerland (sept. 2011), and, at the 21st nordic congress of gerontology in copenhagen, denmark (june 2012). the gerda data collections were funded by the kvarken-mittskandia and the bothnia-atlantica cross-border co-operation programmes funded by the european union; the regional council of ostrobothnia; the municipality of umeå; the county administrative board in njsr – nordic journal of social research vol. 4, 2013 134 västerbotten; the university of vaasa; the åbo akademi university; the umeå univerity and the novia university of applied sciences. references bauman, z. 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(2008). researching age and multiple discrimination. london: centre for policy on ageing. njsr – nordic journal of social research vol. 4, 2013 138 a pp en di x 1. p os iti ve n eu tr al n eg at iv e d on ’t kn ow y ea r of d at a co lle ct io n: 20 05 20 10 20 05 20 10 20 05 20 10 20 05 20 10 in n ew sp ap er s 14 .1 14 .9 56 .9 60 .7 13 .3 12 .7 15 .7 11 .7 o n tv 11 .7 12 .3 52 .2 56 .9 19 .3 18 .1 16 .8 12 .8 in a dv er tis in g 6. 1 6. 4 32 .5 40 .8 36 .2 32 .7 25 .3 20 .2 in p ol iti cs 5. 8 7. 2 33 .3 36 .6 44 .8 43 .1 16 .1 13 .2 o n th e la bo ur m ar ke t 3 4. 4 16 .4 25 .2 62 .4 55 .5 18 .2 14 .9 in h ea lth an d pu bl ic m ed ic al se rv ic es 20 .7 22 .9 39 .7 44 .1 28 .4 24 .4 11 .2 8. 6 in s ho ps , b an ks 28 .7 27 .9 (* ) 49 .2 54 .3 9. 1 8. 4 12 .9 9. 4 a t c ul tu ra l e ve nt s 17 .1 18 .3 43 51 .6 7. 4 6. 1 32 .5 24 a pp en di x 1. t he r ep or te d at tit ud es ( in % ) to w ar ds o ld er p eo pl e in 2 00 5 an d 20 10 ( n 61 25 -6 30 2. c hi -s qu ar e te st . al l ite m s p≤ 0. 00 1) . microsoft word 605, nygren, fahlgren, johansson.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 (re)assembling the ‘normal’ in neoliberal policy discourses: tracing gender relations in the age of risk katarina giritli nygren mid sweden university email: katarina.giritli-nygren@miun.se siv fahlgren mid sweden university email: siv.fahlgren@miun.se anders johansson mid sweden university email: anders.johansson@miun.se njsr – nordic journal of social research vol. 6, 2015 24 abstract the purpose of this article is to explore through a reading of an official swedish policy document what questions and challenges such a document poses for feminist theory by the way the ‘normal’ is (re)assembled in accordance with what others have called the risk politics of advanced liberalism. the intensified focus on risk in neoliberalism has seen responsibility move from the state to individuals, and old divisions between society and market as well as between civil society and state are being refigured. the argument put forward here is that current modes of governance tend to neglect the complexities of present-day life courses when using a gender-‘neutral’ approach to social policy that is in fact the work of a gender regime. keywords: normalization, gender, risk, policy, sweden an actor grows with the number of relations he or she can put, as we say, in black boxes. a black box contains that which no longer needs to be considered, those things whose contents have become a matter of indifference. the more elements one can place in black boxes – modes of thoughts, habits, forces and objects – the broader the construction one can raise. (callon & latour, 1981, p. 285) introduction the purpose of this article is to explore, through a reading of an official swedish policy document, what questions and challenges such a document poses for feminist theory by the way the ‘normal’ is (re)assembled in accordance with what rose (1996, 2000) and others have called the risk politics of advanced liberalism. one of its theses is that the ‘normal’ – for example, in regard to gender – in part could be understood as a black box like the one that callon and latour describe in the quote above, since what is considered ‘normal’ is something that no one needs to think about at any length, as long as one does not touch its boundaries, but which, on reflection, turns out to be composed of numerous ideas, thoughts, and relationships, also njsr – nordic journal of social research vol. 6, 2015 25 materialized in performative practices. we have chosen to analyse swedish national reform programme 2011. europe 2020—the eu’s strategy for smart, sustainable and inclusive growth (swedish prime minister’s office 2011, hereafter swe. 2011),1 since it, as a document reflecting some kind of an eu consensus, can be seen as demonstrating some essential traits of present day policies in european liberal democracies. the aim of the reform programme is to show how the eu strategy ‘is being implemented in the national policy’ (swe. 2011: 5). it is, thus, a document that postulates that economic growth is integral to, and a prerequisite for, the government’s policy as a whole. and as the formulation of the eu strategy shows, strategies for economic growth should incorporate areas such as knowledge (‘smart’), environement (‘sustainable’), and welfare (‘inclusive’). such ‘economization’ or ‘marketization’ is a well known fact of neoliberal governing, described by foucault in his lectures of 1978-79 as a ‘complete superimposition of market mechanisms […] and governmental policy’ (foucault, 2008, p. 121). given that the programme is an important policy document, that it mirrors a central eu strategy, and that it expresses a fundamental neoliberal view on economic growth as vital and integral to all areas of governmental policies, it is worth reading as presumably also exposing important aspects of how gender and normalization are being treated and made in contemporary political discourse. another aspect of this discourse, which a number of researchers have noted, is that ‘risk’ has become a central framework for describing and managing the welfare policy of today. in this perspective ‘old’ welfare states like sweden have dealt with a limited amount of risk resulting from the industrial production process while in post-industrial societies, new risks fundamentally challenge old welfare states and welfare policy (taylor-gooby, 2006; bonoli, 2005) which have responded with shifting some risks from the state to the individual (hacker 2006; marston et al. 2010). activation policies and the changing ethical foundations of welfare have also created competing discourses of responsibility in different ‘welfare-settings’ in the transfer from welfare to workfare, as well as in individual responses (dean, 2006). the penetration of market relations and of abstract systems into every aspect of the life-world compels the individual to choose. at the same time, these processes promote forms of market and 1 the reform programmes of 2012 and 2013 largely consist of updates of the initial 2011 document. njsr – nordic journal of social research vol. 6, 2015 26 institutional dependency. each individual is to be her own political economy, an informed, self-sufficient consumer of labour markets, personal security markets, and other consuming interests. within a regime of responsible risk-taking, all differences, and the inequalities that result from them, are seen as a matter of choice (shamir, 2008). hence, governmental risk-management (intended to reduce uncertainty about future national welfare obligations) has offloaded responsibility for welfare procurement and use to the private consumer. neoliberalism can, according to larner (2000), be discussed in three different dimensions, as policy, as ideology, and as governmentality. we are, in this article, most interested in how a neoliberal rationality of governance permeates policy discourses and how this effect gender relations. today, the intensified focus on risk in neoliberalism has seen responsibility move from the state to individuals, and old divisions between society and market as well as between civil society and state are being refigured. however, the argument put forward here is that current modes of governance tend to neglect the complexities of present day life courses when using a gender-‘neutral’ approach to social policy (daly, 2011; lewis, 2005). a task for feminist theory can then be to analyse the ways liberal governmentality is productive/destructive in relation not only to freedom but also to (gender) equality. in the present article we therefore want to explore how normalization processes within current swedish government policies can be of a challenge for feminist theoretical interest. according to dahl (2012), there is surprisingly little written from a feminist perspective on neoliberalism in nordic countries, although the changes brought about by this policy have had immense impact on welfare issues that have traditionally been of great importance for feminist research (p. 284). nor has much been published on how this policy works with nordic welfare regimes. many researchers, both inside and outside sweden, are unaccustomed to relating aspects of neoliberalism to the swedish case and still see sweden as an example of the so called ‘third way’ (rönnblom & keisu, 2013, p. 345). still, according to rönnblom and keisu (2013), sweden is one of the most privatized countries in the world, and all governmental authorities are audited in neoliberal ways (p. 345). as we shall show in our analysis, it is very obvious that while the document addresses all kinds of reforms, the dominating discourse is an economic-market discourse. we seek to open this normalized and normalizing black box in order to analyse how this discourse has been njsr – nordic journal of social research vol. 6, 2015 27 created by reassemblages, closures, and shifts in meaning, and the effect it has on understandings of ‘normality’ regarding gender, but also how gender here comes to intersect with ethnicity, and class. the questions that speak to the discourse analysis to be addressed in this article are as follows: 1. if the economic-market discourse is the one that produces most of the meaning of swedish politics today, as well as the meaning of this political programme, what does this discourse predispose one to see? in other words, what is normalized by the discourse, and thus closed in the black box? 2. how are the discursive normalization processes inherent in this discourse performed, or what are the conditions for this, and what makes the discourse possible with respect to reassemblages, stabilizations, and closures, that is, how relations and connections become contained in the form of a structured whole, easily seen as a self-evident black box? 3. and finally, how could we discuss the possible outcomes of these normalization processes, or what do the discourses do, particularly in relation to gender (fahlgren, 1999, 2009; rhätzel, 2007)? we are interested in whether—and if so, how—gendered relations are (re)produced or transformed in regard to new openings or closures, particulary in a country such as sweden, which during the previous decade was regarded as a front-runner for gender equality in the eu (dahl, 2013). analytical framework in our analysis we shall discuss if the meaning of gender is (re)assembled in new ways and thus normalized and placed in black boxes by the neoliberal marketization found in this swedish policy document. in that case, what are the discursive conditions for this, and what are the possible outcomes of these normalization processes? such an analysis of discourses in policy documents at the time of policy reforms is a useful method for understanding the rationale that is offered to legitimize policy changes. by connecting the concept of normalization, as used by foucault, with that of the black box of callon and latour, we want to emphasize how njsr – nordic journal of social research vol. 6, 2015 28 they both aim at problematizing the relation between individual and society as well as the very fact that such relations are often taken for granted. foucault’s concept actually divides into two: disciplining normalization, which is about the imposing of norms, and autogenetic normalization, which belongs to biopolitics’ ways of fostering processes of a population, mainly through security and risk (foucault, 2007). what we get from foucault is, thus, descriptions of two ways in which societal belonging has been created since the late eighteenth century, ways that can be analysed and problematized in their concretizations as ideas, practices, technologies, and so forth. in addition to these concepts, callon and latour’s black box adds a metaphor for how processes such as these becomes naturalized or made invisible by the very idea of how a society functions today, when ‘actors macro-structure reality and […] sociologists help them to do so’, to use a phrase from the title of their article. our point of departure is that such normalizing processes tend to render unequal power relations, for example, those of gender, invisible. notions of normalcy of this type, but also notions of normalization, creates an integrating ‘us’ at the same time as it tend to exclude certain groups of people and (re)produce inequality (fahlgren et al., 2011). in order to problematize this kind of belonging from the perspectives of feminist theory it is necessary to continue the kind of genealogical questioning of the very relations between selves and society that are found in foucault, cannon, and latour, making the contingency of these relations visible, or, according to the metaphor above, picking them out of their black boxes. it is the notion that individual actors and society (or structure) fit together that has to be problematized, and this is not done by emphasizing either the freedom of individual actors or structural determination. liberal individualism relies on normalization as the unquestioned glue of society, and therefore upon a strong notion of societal structure. this is what foucault means by stressing that liberal freedom depends on restrictions: liberalism as i understand it, the liberalism we can describe as the art of government formed in the eighteenth century, entails at its heart a productive/destructive relationship [with] freedom […]. liberalism must produce freedom, but this very act entails the establishment of limitations, controls, forms of coercion, and obligations relying on threats, etcetera. (foucault, 2008, p. 64) njsr – nordic journal of social research vol. 6, 2015 29 our analysis requires us to trace what is reassembled under the umbrella of normalcy today in respect of gender intersecting with race/ethnicity, age, and class – and to that end, we have looked for new links, or what latour (2005) calls movements of reassociation, that redefine the notion of normal. actor-network theory (ant) offers examples of how assemblages and movements of reassociation can be operationalized using the concepts closure and stabilization (latour, 2005). closure means that social perceptions become more similar and that other alternatives are excluded from consideration, and stabilization that a specific phenomenon in a specific social context over time becomes a matter of fact (a black box). reading the swedish reform programme – a discourse analysis since june 2010, the europe 2020 strategy has been the eu’s common strategy for growth and employment. accordingly, since 2011, member countries have been expected to submit a national reform programme to the eu every april in which they explain their efforts to realize the european strategy at the national level. we have concentrated on the programme from 2011 because it was the first document to frame the agenda for how sweden wanted to implement the strategy for europe 2020 and its political consequences. its own introductory summary demonstrates the main points of the swedish national reform programme 2011 – ‘europe 2020 – the eu’s strategy for smart, sustainable and inclusive growth’: the main task of economic policy in sweden is to create the highest possible sustainable welfare by means of high sustainable growth, high sustainable employment, welfare that benefits everyone and economic stability. economic growth must also be compatible with a good environment and health. (swe. 2011, p. 5) against the background of the current economic situation – the european crisis, from which sweden is said to be ‘making a strong and rapid recovery’ – the government’s main aim for policy is described as ‘to guide sweden to full employment and thus reduce exclusion’. this is because the ‘primary reason for social disparities is that people do not have jobs’ (swe. 2011, p. 5). the regulation of labour is thus held to be the primary aim of policy, as a result of which the government has ‘given priority to jobs with further structural njsr – nordic journal of social research vol. 6, 2015 30 measures such as a strengthened work-first principle and improvements in the functioning of the labour market’ (swe. 2011, p. 5). the ‘structural’ measures should therefore aim to facilitate the functioning of the labour market – the so-called ‘free market’. in the process, the concepts of ‘exclusion’ and ‘outsiderhood’ (‘utanförskap’, a politically constructed concept used in the swedish version) and ‘work, not welfare’ become bywords in neoliberal swedish politics. the discursive starting-point here is that economic markets form the backbone of the governmental reform programme. their meaning and importance cannot be questioned. nor can it be denied that, equally, they are the basis for any consideration of what policy is or should be. an economic-market discourse is, thus, not very surprisingly (we are not trying to expose any hidden agenda), the governing discourse for the entire governmental reform programme. this new way of thinking about what reform is – no longer a direct intervention in, for example, social politics, but in its marketized surroundings – has been most deeply investigated by research following foucault that focuses on neoliberal governmentality. mitchell dean (2010) calls it ‘a form of government through the economy’ (p. 145), and nikolas rose (1999) states that all ‘aspects of social behaviour are now reconceptualized along economic lines’ (p. 141). central to this discourse, as the cited summary shows, is the idea of the market as having the ability of creating nothing less than a society in the form of a harmonic totality. this idea is taken for granted, without any discussion of problems or conflicts at any point in the programme, and therefore becomes a kind of black box that never has to be opened. it thus appears that there is only one way to go, along a pathway that appears to be inevitable (cf. davies et al., 2005). in congruence with this, the document’s use of the concept of ‘normal’ tends to slide from the valued ideal to the ordinary (or statistically normal), which is constituted as the opposite of deficiency, a deviation or a social problem (cf. hacking, 1990). the ‘normal’ comes to stand for an ideal of equilibrium, or, rather, the balance of an organic whole: ‘[i]n the emerging economies, resource utilisation is near normal’ (reg, 2011, p. 9); ‘interest rate differentials […] continue to be somewhat higher than normal. this indicates that financial market conditions have not yet fully normalised’ (reg, 2011, p. 9); ‘potential gdp are expected to grow at a more normal pace’ (reg, 2011, p. 13); ‘normal adjustment for inflation’(reg, 2011, p. 43). political regulations aim at obtaining the normal, with a strong analogy to the medical concept of normal health: ‘requirements for admission to a national njsr – nordic journal of social research vol. 6, 2015 31 programme will be tightened so that students are better prepared for their studies and thus have better chances of completing their education in normal time’ (swe. 2011, p. 31f.). the notion of the normal is thus tightly connected to the way the market underpins all policies, the main objective being, according to the reform programme, ‘full employment and thus [reduced] exclusion’ (swe., 2011, p. 28). thus, the greatest threat or risk is defined as ‘exclusion’, here taken to mean lacking paid work in a given labour market. who then is identified as being ‘at risk’ of this outsiderhood, and thus of not being part of the normal? the answer is those who have been signed on with the employment service for long periods, especially ‘some groups, such as young people, older people, the foreign-born, people with disabilities that impair their capacity to work, and people with no more than a pre-upper secondary school education, have a relatively weak foothold in the labour market (swe., 2011, p. 20). the groups mentioned, along with everyone who ‘is at risk of becoming sick or unemployed for shorter or longer periods’ and ‘[y]oung adults and the foreign-born, who have not yet got a firm foothold in the labour market’ (swe., 2011, p. 21), are thus all categories described as being ‘at risk’ in the labour market. what we see here is that the programme designates the outsiderhood-position as a risk category that is understood in relation to the market, and relational concepts such as gender, class, race/etnicity, and age become recoded as risk factors to be administered by politics in order to avoid exclusion, or outsiderhood. the identification of people with a weak foothold in the labour market is not related to any form of structural inequality; instead, the processes and dynamics of risk and causation are reduced to the individual level, and as such they become translated into direct personal lifestyles and behaviours attributable to the individual ‘at risk’. the very concept of exclusion is here reduced to economic terms: not at work, not profitable, and therefore something that can be administered through means of making the market function. the way to reduce outsiderhood is duly thought to be to strengthen the socalled work, not welfare approach, for example by using earned income tax credits (giving more money to those already in work), and by reforming social security (which basically in this case means cutting the welfare system and forcing individuals reliant upon it into work). framed by the market discourse, the welfare state’s watchwords – welfare, equity, gender equality, justice – implicitly acquire new meanings. meanings are shifting towards a neoliberal njsr – nordic journal of social research vol. 6, 2015 32 interpretation, far from the welfare-policy interpretations of the twentieth century, and are possibly renormalized by the market discourse. in one passage of the governmental text, for example, swedes are depicted as almost already being (gender) equal, a position that will be safeguarded by ensuring that a fair distribution of welfare is adjusted to the market (implicit in words such as ‘choice’ and ‘access’) so that it can offer better and more quality: a fair distribution of the welfare is a key starting point. sweden will safeguard its position as one of the world’s most equitable and gender-equal countries. the government has carried out a number of reforms to improve quality, provide more freedom of choice and increase the accessibility of welfare. (swe., 2011, p. 17) the concept of exclusion, or outsiderhood, while retaining connotations of the ideas of the welfare state and its ideals of inclusion, makes it possible to shift away from the political meanings of the concepts used in the welfare state – away from, for exemple, ‘social problems’, ‘vulnerable groups’, ‘non-privileged groups’, ‘social exclusion’, and others that denote so much more than just ‘no job’ (meeuwisse & swärd, 2002). it was such groups that set power relations and political struggle in motion in specific ways. identity politics, of course, has had its problems, but the way in which different identity groups could raise questions about power has more or less disappeared in the new political discourse. for example, questions of (gender) equality are no longer being depicted as questions of power or political dispute, or indeed disagreement between the sexes or between different economic or ethnic groups (cf. carbin & rönnblom, 2012), but as nothing more than a matter of having the same job openings. providing more women and men with the opportunity to get a job is a matter of fundamental fairness. there is no divide as great as that between those who have work and those excluded from the labour market. so that everyone has the same chance to shape their own lives, it must be possible for women and men, like all groups, to enter the labour market. this is not only crucial from a fairness perspective, but also for effective use of society’s resources (swe., 2011, p. 19). the question of justice becomes a matter of how one is positioned in the labour market and the efficient use of market resources. in this way, gender (in)equality becomes an issue that can be administered njsr – nordic journal of social research vol. 6, 2015 33 within the realms of the market. this, again, is an example of how a new closure of gender, politics, and ethics is taking place within the economic-market discourse. the rationale of the welfare state was that the social technologies it used were intended to civilize or normalize individuals or groups (not always in ways appreaciated by them (see for example, fahlgren, 2009), turning them into citizens with duties to fulfil in exchange for certain guarantees against uncertainty. but the market discourse means that the political climate no longer requires one to carry out (welfare) interventions. rather, it is deemed necessary to put ‘structural’ measures in place to encourage the market to function better; hence, the government will, as we have already seen, give ‘priority to jobs with further structural measures such as a strengthened work-first principle and improvements in the functioning of the labour market’ (swe., 2011, p. 5). courtesy of the market discourse, the exercise of politics becomes the administration of the market in order to improve and facilitate the market’s functioning: ‘to reduce exclusion, increase sustainable employment and make it more attractive to start and run a business, the government wants to reinforce the in-work tax credit’ (swe., 2011, p. 28). with political issues now left to the autogenetic operations of the market, the power hierarchies that were previously the subject of political conflict (cf. carbin & rönnblom, 2012), for example, with regard to gender relations, have been depoliticized and reformulated in market terms. what we see is a new form of governmentality, one where politics is re-made as administration, and, because of the individualization this allows, conflicting social groups seem to disappear. the structural and growth-promoting measures advocated are therefore not reforms of welfare, or even politics, but rather aim to facilitate entrepreneurship and to enable individuals to take care of themselves in the market. the basic problem – so-called outsiderhood – is individualized and privatized and unemployment has been turned into a question of individual motivation. hence, coaching is one way to motivate people to find employment: to encourage people to look for work more actively, coaching initiatives at the public employment service have been expanded […] coaching for the unemployed is individualised help aimed at supporting a high level of job search activity. (swe. 2011, 23). njsr – nordic journal of social research vol. 6, 2015 34 the government’s policy has thus been to take ‘measures to ensure that the unemployed remained motivated and employable’ (swe., 2011, p. 22), which has led to an increase in activity and fewer sick reports: the extensive reform of sickness insurance carried out in the government’s previous term of office has had good results. the sick leave process has become more active. fewer individuals are on sick leave and periods of illness are of shorter duration there has been a 20 per cent decline in the number of people with sickness compensation. all in all, the decline in ill-health has led to a sharp drop in exclusion. (swe. 2011, p 28) individual responsibility thus legitimizes the administration of outsiderhood. even ill health can be administered into non-existence by market forces, and it becomes a moral code for the individual to stay or become healthy. this is justified by the way the market discourse replaces identities that connotate political strife with an allembracing concept denoting those that happen to be outside. the normal, ‘not at risk’ but rather ‘insider-position’, is, however, if one looks a little closer at the cited parts above, gendered (not a woman), ethnified (not foreign born), and aged (neither too young nor too old), sound in mind and body, and with a strong position in the labour market. so, although the risk categories created are so numerous that it becomes difficult to see how one might possibly avoid falling into one of them at some point in one’s life – making fear of falling by the wayside rife and all-embracing – the unmarked, normal, position of belonging is structured through implicit power relations. by reading the reform programme we can see how neoliberalism and gender equality are articulated together. (gender) equality is not depicted as a question of power or political dispute, or indeed disagreement between the sexes or between different economic or ethnic groups. instead it becomes rewritten as the policy of fair distribution and redefined here entirely in administrative terms as something that can be administered within the realms of the market. in the next section, we shall discuss what makes this neoliberal gender politics possible in relation to reassemblages, stabilizations, and closures and we shall argue that it works through a reassembling of welfare concepts, which stabilizes depolitization and conflates individualization and privatization. njsr – nordic journal of social research vol. 6, 2015 35 reassembling welfare concepts, depoliticization, individualization, and privatization as we have seen in the previous section, a construct such as ‘outsiderhood’ cannot alone support the market discourse’s legitimization; for such a pronounced market discourse to have any sort of legitimacy in a welfare society such as sweden’s, the meaning of the old, politically privileged terms such as ‘welfare reform’, ‘justice’, ‘equality’, and ‘gender equality’ (jämställdhet) must be written into the market discourse, acquiring new meanings in the process. reforms of the type supported by the market discourse are, however, entirely different in nature from those advocated within the welfare discourse. any ‘scope for reform’ should, according to the governmental programme, ‘be used for structurally warranted reforms which strengthen employment and improve the functioning of the economy. the government will thus give priority to measures that ensure sound growth by pursuing a tax and business policy promoting growth’ (swe., 2011, p.16). the concept of reform, which in welfarism meant (welfare) interventions with normalizing and perhaps also equalizing ambitions on behalf of vulnerable groups (fahlgren et al., 2011), now comes to mean structural measures to enable the market to operate according to the notion of a free market. faced with the primacy of the economy, the term ‘reform’ has shifted meaning and reassembled, reduced to a desire to manage the market and facilitate its proper functioning. a new closure could also be said to have arisen from the concept of reform, for reform here (unlike welfare reforms) should promote growth in the market: income taxes for low and middle income earners have been reduced in four stages via the in-work tax credit, the social security systems have been reformed to support a return to work and reduce the risk of exclusion and important initiatives have been taken to improve various parts of the education system. (swe., 2011, p. 22) the policy of fair distribution is redefined here entirely in administrative terms as something that can be administered, and, at the same time, the question of equality seems to become nothing but a question of distribution, individual choice, and availability. according to the logic of the market discourse, the challenge of politics has become the challenge of working with at-risk groups njsr – nordic journal of social research vol. 6, 2015 36 all the talk of the risk of outsiderhood thus becomes the node at which marketization and subsequent depoliticization and privatization take place – the node that separates inside from outside, and legitimizes individualization, individual responsibility, and ‘individualized assistance’. under these circumstances, the normalization sought by the welfare state with its cure or reform of clients, patients, or individuals (see for example rose, 1996, p. 349) – of which vulnerable groups could sometimes demand a share (fahlgren et al., 2011) – has been decoupled from its previous meanings caused by a shift in vocabulary where ousiderhood replaces other concepts and distinctions. the possible outcomes of shifting governmentalities in our analysis we have shown how exclusion and outsiderhood function as routine description of certain kinds of subject positions. the managerial focus on risk works to individuate differences and conceal the continuation of systematic inequalities. unemployment is reproblematized as a lack of individual, marketable skills on the part of the unemployed (individualized), to be counteracted by a multitude of private coaching organizations that compete in the market for public contracts. the social logic of the swedish welfare bureaucracy has been replaced by the new logic of individual competition, market segmentation, and service management – a market for exclusion, not inclusion. in the reshaping of the swedish welfare model, a new type of public governance has emerged (see also larsson et al., 2012 for a similar way of reasoning), with risk, primarily in relation to the economy, the labour market, and safety, used to drive the system shift. normalization, as it was produced under welfarism, has been decoupled from its old meanings and the language of social reform has shifted. the swedish government’s official policy can thus be seen as an example of how, as rose (1996) writes, ‘government of a whole range of previously social apparatuses is restructured according to a particular image of the economic – the market’ (p. 340). with the concept of risk, processes of normalization become coupled with the market and somehow decoupled from society. the seperation of market from society that was present in swedish welfare politics is here refigured, or maybe dissolved. the meaning of normalization has njsr – nordic journal of social research vol. 6, 2015 37 changed from being a question of including people in society to a question of making individuals choose the ‘right’ way on the market. through individualism and risk management, the general (statistical) level becomes intertwined with individual risk behaviour. the market, ethics, risk, and normality blend into one another another and become mutually constitutive. according to foucault (2008) the neoliberal change consists of the market becoming a model for societal organization at large, not only in the form of exchange but even more as competition (p. 121). in accordance with this change, political interventions are limited to what ensures that the market works and becomes nothing but administration or, as foucault phrases it, ‘active policy without state control’ (p. 133). the state is not less active, but its involvement is restricted to creating the framework and the conditions for the market to function freely. when policy documents are formulating dangers and risks in a community, ‘the normal’ is, in a silent way, reassembled as not being ‘at risk’, an assemblage that constantly becomes even narrower and more difficult, if not impossible, to uphold in one’s desperation not to be positioned within ‘the outsiderhood’. for when does one know that one is not ‘at risk’? how should one define inclusion? the word insiderhood is not even used. on these points, the market discourse has nothing to say – or rather, it is silent. to be ‘normal’, or an insider, only seems to be defined as not being at risk – as if those people could form a neutral, unified group of ‘us’ with no internal conflicts or power structures or relations. in this way, the normal position is not depicted as a gender, or a class, or a race-defined position – as if the market does not create privileged locations from which some individuals actually never need to seek a job; as if, for example, a black, working-class man with a foreign name might enjoy the same opportunities and choices that a white, middleclass man has when it comes to inclusion in a european work context. to be administered and forced into the labour market so as not to be considered at risk is the implicit future prospect of those who cannot secure their livelihoods and their purchasing power in the market – as if these power hierarchies no longer existed; as if they did not still prop up the structures of power, inequality, and injustice; as if women’s and men’s positions in the labour market did not differ in sweden; as if most women did not have jobs in the ailing public sector or men in the so-called market that is the private sector; as if women’s pay were not 80 per cent of men’s; as if the swedish labour market were not racialized, and so on. structural inequalities not only in respect of njsr – nordic journal of social research vol. 6, 2015 38 gender, but also race/ethnicity and class have existed and do continue to exist, but they are made invisible in this document. the market discourse legitimates practices of acting ‘as if’ a certain relationship of equality already pertains, even when it patently does not. acting ‘as if’ is, according to asplund (1987), tantamount to playing games. in this case, it is a serious game played with people’s lives, because the identification of certain individuals as members of ‘at-risk’ groups without exploring or naming any of the structural forces that creates certain groups, often in direct comparison with others, is connected to both implicit and explicit gender, racial, and class implications (aradau, 2004; fahlgren, 2011; rose, 2008; lupton, 2012). it may look like a game but is the work of a gender regime. in the policy document in question, gender equality has been translated and re-articulated in relation to discourses of neoliberalism, and therefore also subjected to the possibilities and the restrictions inherent in the kind of freedom these policy discourses produce. by making individual freedom of choice the very ground of politics and gender equality something ‘we’ have already accomplished, neoliberal discourses tend to mystify and obscure the need for and impact of feminist theory and political practice. normalization, risk, and the (im)possibility of feminist critique: some conclusions the strategy document mirrors the fact that market and consumption have become the new mechanisms for shaping conduct (rose, 1996, p. 343). the result of shifting the responsibility for citizens’ welfare from the state to the individual is greater individual competition that actively increases individual vulnerability (davies, 2011, p. x). being ‘at risk’ thus tends to be described as personal failures, an individual who lacks the cognitive, emotional, practical, or ethical skills to take personal responsibility for rational self-management. the risk of what here has been called outsiderhood has become the driving force behind normalization. the threat of outsiderhood, regarded as the most serious predicament in contemporary swedish society, sustains people’s willingness to pursue normalization, spurred on by strong feelings of fear of outsiderhood, but also by individual guilt, and shame (davies, 2011; fahlgren et al., 2014). individualization conceals processes of normalization beneath the cloak of individual choice; in doing so, it makes them even more powerful and almost impossible to criticize, since freedom and individual choice are seen as something njsr – nordic journal of social research vol. 6, 2015 39 everyone desires. thus, the operations of normalization processes work to obscure their functioning, making any critique of both the underlying assumptions and their operationalization almost impossible (fahlgren et al., 2011). in this way, structural inequalities such as gender, but also class and race/ethnicity, are mystified, made invisible and depoliticized. the character of normalcy has always been dependent on its context, to the extent that it has never been possible to rest secure in the knowledge that one is ‘normal’ (hacking, 1995; sandell, 2001). yet now there is virtually no obvious or unified normalcy to seek or adhere to; it is something one must continuously ‘make’ or perform as an individual. but this does not make the normalization processes less important. rather it could be said that we are witnessing an intensification of normalization at the moment – one which involves a focus on the body and its perfectibility. it is through the framework of risk that power reaches all aspects of life through subjective internalization and normalization, but also draws the boundaries between those who need to be safeguarded against risk and those whose lives are expendable. the use of risk, risk calculations, and risk prevention becomes a kind of normalizing politics that connects human bodies with policy issues and constitutive power. but in the very act of defining what should be considered a risk, other risks are hidden and silenced. from which position, then, under the sway of this governmentality can feminist questions be asked? from which position can one conduct a political struggle for equality? if we are all said to make free, individual choices about everything in life, choices which each and everyone of us has to stand for, a critical position becomes difficult to see. the notion of a common, political struggle in the spirit of solidarity recedes. in this present study, we have taken the current dominating neoliberal market discourse to be not ‘normal’ and most of all not inevitable. we have tried to prise open the normalized black box of this discourse to show how it has been made and what it may do, looking at how the politics of normalization processes have reassembled the meaning of normality, especially in regard to gender, race/etnicity, and class, in a swedish neoliberal context. such a critique may enable us to break loose from the habitual practices by which an often unequal, unfair, globalized world is produced. njsr – nordic journal of social research vol. 6, 2015 40 references asplund, j. 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(1999). the exclusive society. london: sage. microsoft word glasdam, praestegaard, henriksen placed in homecare.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 4, 2013 placed in homecare: living an everyday life restricted by dependence and monitoring stinne glasdam* division of nursing, health sciences centre lund university email: stinne.glasdam@med.lu.se * corresponding author jeanette praestegaard division of physiotherapy, health sciences centre lund university email: jeanette.praestegaard@med.lu.se nina henriksen health, man and society, institute of public health university of southern denmark email: nihenriksen@health.sdu.dk abstract through a sociological case study this article analyses how, seen from a relational perspective, everyday life for elderly people receiving care in their own homes is lived with dependence on health-care professionals. the healthcare professionals’ time and tasks are assigned and allocated in advance so that the elderly people are neither allowed nor able to vary their response in relation to the situation they encounter. the life of the client is also treated as though it were a solid, structured everyday life with minimal private time. work in the home, for example, household chores and personal care, resembles a disciplining strategy. the client lives under conditions of monitoring and control comparable to conditions of imprisonment. the client is subject to the will of and social intercourse with other people in his own home; he both knows it is necessary and offers resistance to the conditions. in short, the authors argue that the homecare service acts as a disciplining practice in modern society. keywords: field study, case study, elderly, homecare, dependence, prison, denmark, foucault njsr – nordic journal of social research vol. 4, 2013 84 background today, western homecare is managed in accordance with a neo-liberal ideology based on new public management, which creates challenges for both the professionals and the clients (dahl, 2005; vabø, 2009; dahl & rasmussen, 2012; hamran & moe, 2012). in denmark, elderly people have been able to apply for and to receive free and practical permanent homecare since 1958, a policy that seems quite unique to denmark (rostgaard & pfaueffinger, 2011; rostgaard et al., 2011). the municipal authorities assign and allocate assistance according to existing laws, local standards, and a personal estimate by the assessor. the assessor is forced to abide by the neo-liberal ideological values of efficiency, calculability, predictability, and control over people when it comes to allocating services (dahl, 2005; duncan & reutter, 2006; rostgaard & thorgaard, 2007; bjornsdottir, 2009; ryberg & kamp, 2010; glasdam, henriksen, kjaer & praestegaard, 2012; hamran & moe, 2012; rostgaard 2012). clearly, the health-care professionals are subject to the structural framework and have limited autonomy for performing their professional duties. the standardization of homecare seems to challenge the professions’ autonomy; however, health-care professionals are creative and adapt a multitude of strategies to mitigate the rigidity of the rules by focusing on the client and his situation (dahl, 2009; dahl & rasmussen, 2012; glasdam et al., 2012; rasmussen, 2012). studies show that the elderly are to some extent violated and pre-institutionalized in their homes when they receive homecare because their everyday life often has to be arranged according to the professionals' schedules and frameworks. furthermore, both illness and the homecare service disrupt the relationship between the client’s sense of self and his home (angus et al., 2005; cook, 2007; engström, 2012; glasdam et al. 2012; gullestad, 1989; kofod, 2008; lillestø, 1998; lindahl, lindén & lindblad, 2009). it is evident that the everyday life of elderly people who receive homecare changes, partly because of disease or fragility, or both, and partly because of dependence on strangers in their homes (angus et al., 2005; dyck, kontos, angus & mckeever, 2005; lindahl et al., 2009; oudshoorn, ward-griffin & mcwillia, 2007; mcgarry, 2008). professionals often become friends whilst they work in clients’ homes, but friendships in a context of professional care are affected by the condition that those involved have not chosen each other voluntarily. they have been appointed to be with one another and their encounter is determined by the clients’ disease or fragility and concomitant need for support (lindahl et al., 2009; mcgarry, 2008; oudshoorn et al., 2007). the meeting between the elderly and the health-care professional can be seen as a negotiation of meanings of bodies and homes (dyck et al., 2005). this article challenges prevalent understandings of these meetings and explores how elderly people who live in dependence on health-care professionals in their own homes are able to handle, decide, and act in their everyday life in relation to themselves, their relatives, and the health-care professionals. method this is a single-case study designed as a field study in the home of a client receiving homecare. the case study consists of one elderly person who njsr – nordic journal of social research vol. 4, 2013 85 depends on health-care professionals in his everyday life, his cohabiting wife, and the health-care professionals around him. based on observations and interviews, this study is an analysis of an individual unit comprised of persons, relationships, events, and decisions in a politically ruled health-care system. the single-case study is shown to be a valuable method when used to analyse how people frame and solve their challenges in life. the case study can also illuminate and explain the single unit so that we may be better able to understand a larger class of (similar) units (armato & caren, 2002; flyvbjerg, 2006; gerring, 2004; thomas, 2011). theoretical framework this case study operates within a sociological theoretical framework in which discipline, power, and resistance are central, inspired by the concepts of michael foucault. foucault shows how the individual is formed through the discipline applied by a series of institutions of modern society, such as the educational, military, factory, prison or hospital systems (foucault, 1995). discipline is identified neither with an institution nor with an apparatus. rather, it is a type of power, a modality for its exercise, comprising a whole set of instruments, techniques, procedures, levels of application, and targets. likewise, bureaucracies contribute to the process of ‘dis-individuation’ in that they promote the facelessness of the bureaucrat (foucault, 1995). whenever people meet, power is a condition for every relation. power is understood as the ability to bring things into action; it has productive forces. it is important to grasp the context within which people speak and act, that is the position they speak from, in order to understand how they speak and act. power will always generate some kind of resistance. the more visible an exercise of power is, the easier it is to oppose or react to it (foucault, 1995). the theoretical framework of foucault is often applied to research in the medical field (e.g., daneski, higgs & myfanwy, 2011; nielsen & glasdam, 2011), and it is fitting to apply his thinking to homecare as well (ceci, 2008; funk, stajduhar & purkis, 2011; purkis, 2001). recruitment this study took place in a danish municipality of about 50 000 inhabitants. the leaders of what we here call the homecare department pragmatically selected the client with whom the field study could take place. the inclusion criteria were as follows: age 65+; dependency on health-care professionals at home; fluent understanding and speaking of danish; and acceptance that the healthcare professionals involved in the person’s everyday life could be asked for their participation in the study. the client was also not to suffer from dementia or aphasia. the chosen client lived with his wife during the field study; therefore, the spouse was also included. a discussion with the client about the formal professionals with which he had contact determined the selection of the health-care professionals. this study included two social and health-care assistants, one physiotherapist, and one homecare allocator with a background as an occupational therapist (table 1). njsr – nordic journal of social research vol. 4, 2013 86 table 1: short presentation of the persons in the case study the client, ian: the client is 75 years old and has lived with his wife for 35 years. they live in their own house. he has two grown children (and three grandchildren) from a former marriage. he is an educated lithographer and worked as a manager for many years. the family is financially prosperous. his main interests have always been painting, art, and travelling abroad. they have a dog. for eight years he has been a dialysis patient, and he has managed his treatment himself until two years ago when he suffered cerebral thrombosis. now he has difficulty walking and is using a wheelchair and (seldom) a walker. he receives assistance from health-care professionals for his personal care and dialysis four times daily and training by a private practising physiotherapist twice a week. the client’s wife, sue: the wife is 63 years old and has retired from a job as an accountant three years ago. she has no children and has been married twice. her main interests have always been socializing with friends and family, decorating her home, and travelling abroad. she is physically healthy but has suffered with depression after her husband’s illness and all the changes it brought about in the couple’s everyday life. the daytime social and health-care assistant: the assistant is 52 years old, has three grown children, and is twice married; she has been married to her present husband, a former refugee, for 23 years. they live in a large house. they often travel to visit her husband’s family in his homeland. she has been working as an uneducated post-office worker for 13 years. after two years of unemployment she began training as a social and health assistant and has been working as such for ten years now. her husband is currently an unemployed crane operator; one of the children is studying construction, another nursing care, and the third law. the evening social and health-care assistant: the assistant is 53 years old and has a daughter from a former marriage who is studying to become a teacher. she has been married to her husband for 13 years; he is a cook. she studied briefly at a business school but, for many years, she has worked as an unskilled helper at a residential home. over the last few years she has trained as a social and health-care assistant, and has worked in this position for one year. the allocator: the allocator is 59 years old and has three grown children (carpenter, nurse, and engineer) and a grandchild. she has married and divorced twice. she finished training as an occupational therapist in 1975 and has worked as a therapist and later a manager. since 2003, she has worked as allocator, whose responsibility is to distribute home-care services and has the economic responsibility and authority in the municipality. the physiotherapist: the physiotherapist is 34 years old and married. he qualified as a physiotherapist in 2000 and has since then worked at a hospital and in private clinics. now he is working as a private practitioner at a large training centre. njsr – nordic journal of social research vol. 4, 2013 87 procedures of field study a three-week field study was carried out by a research assistant in the autumn of 2010 in the home of the elderly person. appointments on days suitable for observations were made and, when needed, changed according to the family’s preferences. the observations were conducted over eight days between 8 am to 10 pm. the research assistant took field notes on a laptop, constructed by a scheme containing the categories: time, place, action – what happens, actors, conversation – both verbal and non-verbal, and the researcher’s immediate reflections. the research assistant carried out the interviews with the client, spouse, and health-care professionals. the interviews took place during the field study, both when situations offered the occasion spontaneously and in more formal settings. for the spontaneous interviews the research assistant either made notes on a laptop or recorded them, depending on the situation. the formal interviews lasted about one to two hours and were conducted with a semistructured interview guide containing three categories: personal background, description of a typical day, and description of the relationships between the client, the relatives, and the professional(s). the interviews took place according to the participant’s preference. the interviews were recorded and transcribed in full length. ethical considerations the study followed the helsinki declaration (the world medical association, 2008). approval by the national committee on health research ethics (2012) is not legally required for this kind of study. the study has been reported to the danish data protection agency (j. no. 2010-41-5125). first, the leader from the homecare department orally informed the client and his family about the study, and then she informed the health-care professionals in the home. after they had all expressed interest in participating, the researcher informed all of them, both orally and in writing, about the study. informed consents were obtained. all data have been anonymized and kept inaccessible to everyone but the research team. in the quotations, we have removed names, person-specific job names, and toponyms to maximize anonymity in the illustrations of the empirical material. method of analysis first, we carried out a naive reading of the transcribed field notes to grasp the general meaning of the texts. then, in order to grasp the different perspectives and speech positions of the participants, we read the texts through the research questions: who is speaking, and who is meeting whom, where, and how, with a particular focus on contexts and the relations. on the basis of this reading, we constructed analytical categories, as shown in the results section, across the empirical material, guided by the theoretical framework and the theoretical concepts of power, discipline, and resistance (foucault, 1995). finally, we analysed the texts within those categories, still guided by the theoretical concepts in relation to receiving and providing homecare seen from the different perspectives and positions of the participants. njsr – nordic journal of social research vol. 4, 2013 88 results we present the results of the analysis below as seen through the lens of the sociological understanding and the foucauldian framework and therefore they incorporate and set into play the different positions of the actors. the actors met in different places in different ways and with different agendas. in general, the meetings with the assistants appear to be an important and temporally crucial part of the everyday life of the client and his wife: they were at the house of the client every day from about 8-10 am, 1-2 pm, 5-6 pm, and 8-9 pm, helping the client with personal hygiene and handling his medical treatment. likewise, the two weekly sessions from 11:30-12:00 am with the physiotherapist and half an hour in transport time seem to constitute a solidly integrated practice in the everyday life of the household. the homecare allocator had limited contact with the client because the homecare service was already activated. a structured everyday life with minimal private time – for everyone in the household it became clear that the client’s – and his wife – everyday life is maintained and renewed, restored, and recreated to fit the new structural frame and becomes organized around the schedule of the homecare service. when the professionals arrive the client has to be present and ready to receive the service to which he is assigned. the client and his family have a feeling of being under pressure, and they experience limited possibilities for living compared with their previous daily life. they are dependent upon and invaded by others in their private home, and as a result of this and the disease itself, they have lost their former lifestyle. it can be seen as a loss of one’s self through structural discipline and a tacit adaptation of the framework for the premises and schedule of the homecare system: ian explains that he cannot do the things he used to do; he needs help to get dressed, to cut the food; to go to the toilet; to do everything. stairs have become a forbidden area, and he can no longer visit friends or family. it makes him bitter and irritable, and it is hard for his wife. they can’t do what they used to: for example travel, go out. (field notes) the wife, moreover, is left feeling isolated in her own home: normally, they would visit friends or receive visitors. now, there are many persons they can’t visit any longer because of stairs; or some friends live too far away. today she says she lives within the four walls of the house; all activity depends on time; she expresses it as ‘hanging in a bell’: she must do everything before or after the visit of the homecare service. (field notes) the client is allocated permanent staff, and he and his spouse try to incorporate the professionals as friends in their home during their working time: sue says that they are privileged compared with others. because of ian’s need for dialysis they have been allocated mainly permanent staff. it means that they become friends and the professionals know where njsr – nordic journal of social research vol. 4, 2013 89 things are placed. sue and ian talk and have tea with the professionals in the evenings. (field notes) the family is aware that they need help from the professionals, that the professionals have to stay in their house for a shorter or longer time several times every day, and that they have to accept the rules of the game to receive assistance. this mode of discipline would, however, be easier for the client and his spouse to bear if they were also able to define their relationship with and socialize on an equal basis with the professionals, that is, as friends. but all in all, the client likens the experience of being dependent and disciplined into a medical client to being in hell: ian says that being dependent on others can be described in few words: ”it is hell! […] i don’t have the possibility of visiting my youngest son; he lives in an old flat in xcity […] i can’t get up there at all. i would have to call (a service company) so they could carry me up [...] (and) there are only four hours between my dialyses. (field notes) the professionals know it is difficult for the family to be dependent on them, but they just do their jobs: imagine being dependent on other people in that way. in the beginning he did the dialysis himself. but suddenly, to be dependent on somebody being there four times a day for 1 ½ to two hours; i think it must feel like being in hell. (evening assistant) the professionals cannot give the client his independence back owing to the fact that the client needs their help in his everyday life. the professionals personify and represent his dependence and remind him of it by their presence. throughout the observational period the client often closed his eyes in the forced but necessary togetherness, which could be regarded as a silent resistance against his life conditions and the health-care system to which he has to be subject, as a silent whisper, ‘do what you have to do; i am not present’. self-care and self-help as a disciplining strategy regardless of how dependent the client is on professionals, there seems to be an underlying idea that he can always do a little himself – and perhaps more – in order that the utopian project of ‘being independent of health-care professionals’ could ultimately succeed; this is underpinned by the notion of activation of the elderly: they [the client and his spouse] must not do what they can do themselves. it’s important to keep them going. it’s important with help to self-help […]. it’s not because i don’t want to do it, but it is for your own sake that you have to do it yourself. (evening assistant) this could be seen as a strategy of normalization. the client is regarded as abnormal but with an immanent opportunity to become partly ‘normal’ again, n spite of the dependence on professionals. the client seems to be met by an upbringing and educational project of the professionals in their aim of achieving self-care. the professional task ‘to care for’ seems to convert into a njsr – nordic journal of social research vol. 4, 2013 90 pedagogic project where the development of the client’s self-care competences is in focus: i don’t want to be a maid for him. there are advantages to doing something yourself instead. he sleeps all day long. (evening assistant) and it is a disciplining project aimed at both the client and his spouse: earlier, ian was doing all the practical chores. and suddenly she is the one who has to do it all. i think it’s too much for her. she cannot pull herself together […]. i get annoyed by lazy people. [...] i want them to listen to me. they ask for advice but at the same time they are unable to act. (evening assistant) it seems as if the professionals regard psychological and physiological reactions to changes in everyday lives as ‘a matter of pulling yourself together’. the client and his wife do and say what they have to do and say when the professionals are in their home. they know the rules of the professionals for correct action and behaviour. but when they are on their own, they do exactly what they are used to do: in short, ian sleeps, eats, and watches television; sue sleeps, does some housework, watches television, and assists and serves ian. in the physical absence of the professionals, there seems to be space for elements of the usual everyday life and at the same time their behaviour is functioning as a silent resistance against the professionals’ self-care and normalization strategies. incarceration and monitoring as disciplining strategies the physical space of the client is very limited. at daytime, he more or less lives his life indoors in his wheelchair and at night-time he lays in bed for ten hours. it is a rare event for him to get outside the home, and that usually only happens when he visits the physiotherapy clinic twice a week. staying outdoors seems to be beyond the daily routines of domestic life and of the professional services. it is something you must ask and obtain permission for: ian says he wants to go out for a stroll after dialysis. but sue turns down his request. he sleeps again. later sue asks if he is hungry. ian drives to the table where sue has placed his lunch. he eats in silence, sitting next to sue. when ian is finished eating, sue pushes him out on the terrace where the sun shines. (field notes). ian would like a ride on his scooter, but sue slows him down because she wants to control him. but he’s still an adult and he is still okay in the brain. so i say, of course, as long as he has his cell phone, he can just call if anything happens. (evening assistant) a person who stays at home is quite easy to monitor. he is never left on his own. even during the interview with ian, which took place outdoors on the terrace, he was monitored. his wife came out a couple of times with blankets and the window nearby was opened so that the interview conversation could potentially be overheard. njsr – nordic journal of social research vol. 4, 2013 91 he was really unhappy. and he also said: ‘in the past i was a director and was respected, and now i'm just here and i’m nothing. sue never listens to me and she uses her power on me.’ (evening assistant) obviously, the wife’s monitoring of her husband is based on good intentions. she wants the best for him and at the same time it is a big sacrifice for her, which is difficult to manage. there seems to be a delicate balance between care and violation. she cannot relinquish control over him; and in a way he has no choice because he is dependent on her in his everyday life. the only sanctuary for the client is the toilet, where the door can be locked; he can silently resist by being absent and out of reach. being a health-care client and at the same time a spouse in one’s own home seems to be a position of ongoing monitoring and observation, where the wife also consolidates the professionals’ institutionalization of the home through her extended exercise of power and discipline. regulations of behaviour as a disciplining strategy the professionals visit the client, and in principle the client has no impact on who is allocated and therefore who enters his home. the allocator in the local authority allocates the staff, without involving the client. the professionals have a working plan with a schedule and pre-defined tasks: the citizen asks for house cleaning and talks about the situation. i ask for certain information in order to estimate whether the citizen is entitled to the service. [...] we have to comply with a level of service, standards of quality and legislation. (allocator) both the client and the professionals have the opportunity to complain about each other to the leader of the homecare service if the interaction between them does not work out. from the perspective of the professionals a complaint carries the connotation that they may lose a task with one client and will instead be assigned tasks with another client. from the perspective of the client, a complaint implies a risk of interrupted continuity with professionals he or she knows well, which may not be wanted. in this case the client may seem to be overruled: observed, controlled, and administrated by the extended arm of the welfare systems, namely, the health-care professionals, in order to be ‘normal’ and to behave ‘normally’ in their understanding of these terms. there is a potential managerial construction of good relationships between professionals and clients, but there is also a threat that misbehaviour on the part of the client may result in punishment. there is a latent threat that the professionals to whom he had grown accustomed may disappear: (i) told (them) that i take a break now and also why. [...] i have to take care of myself. […] the way you have behaved towards me means that i need a break. [she does not visit the client for a week afterwards]. (daytime assistant). in this way, the health-care system gives more weight to the interests of the professionals than the interests of the client. immediately this seems to lead to self-disciplining by the client. the client has to behave in an acceptable way and if not, he will be corrected or punished. he knows and resigns, a matter he returned to several times during the period of the field study. being abnormal njsr – nordic journal of social research vol. 4, 2013 92 means being subject to strategies of discipline and normalization from the health-care professionals. threat of suicide as an ultimate treat – an ultimate resistance the client is aware of his dependence on other people and that he is subject both to them and to their perception of his situation as abnormal. the aspiration of being re-normalized is significant. he hopes that he will be able to walk again. but behind this there is a realism and cynicism about the impossibility of this hope. in this way, the hope of being able to walk again reflects the hope of becoming normal again and the ability to escape from the situation of dependence. the ultimate reaction to the strategies of disciplining, monitoring and normalization is the threat of suicide, threat of one’s finality: if it turns out that i can’t walk again, i’ll commit suicide. i don’t want to live this way of life. it is undignified. (client) the resistance produces the power relations and also their opposite: the more the client is observed and subject to the professionals and the family, the more he threatens suicide and the more the professionals and the family must observe him and vice versa. it seems to be a self-perpetuating, vicious circle. discussion we have chosen a foucault-inspired theoretical framework as the perspective for the study, knowing that many other perspectives could have been chosen. the analysis consists of detecting relationships and patterns and their various ways of being understood; it is neither an attempt to present statistical evidence that can be applied to different circumstances nor an attempt to judge if it is good or bad. all in all, the results point to likening of a home with a prison: the structuring of time for the client; the exit permit; the discipline through self-care (work); the monitoring; and sharing of one’s life with people not of one’s choosing. foucault (1995) has showed that discipline is a technology of power, used in prisons, schools, hospitals, and so on. this study indicates that the homecare service has become a disciplinary institution in modern society, one that shapes tractable clients. other studies also show how dependence on others for assistance in everyday life makes the clients feel imprisoned within their own body and within their own home (goffmann, 1961; lillestø, 1998; moore, 2000; price, 2002; casey, murphy, cooney & o’shea, 2008). there is a time to sleep, a time to wake up, a time to dress, a time to eat. every day has the same rhythm and schedule. but in contrast to incarcerated prisoners, the elderly living in their own home who are dependent on health-care professionals in their everyday life have no rights in relation to going outdoors. prisoners in denmark have the right to go outdoors for a minimum of one hour every day; this complies with the united nations’ standard minimum rules for the treatment of prisoners (bekendtgørelse af lov om fuldbyrdelse af straf m.v, [consolidation act on the criminal code] 2010, §43,3; united nations, 1977). angus et al. (2005) describe the client’s dependence on family and health-care professionals in his everyday life as being ‘a “prisoner” on an island’. the elderly who are dependent on health-care professionals at home are subject to the laws of health and social services (bekendtgørelse af sundhedsloven njsr – nordic journal of social research vol. 4, 2013 93 [consolidation act on health care], 2010; bekendtgørelse af lov om social service [consolidation act on social services], 2010). these laws include the right to get treatment, to be fed, have a bath, to get dressed, and to have the house cleaned, but none of them include the right for elderly people to spend some time outdoors if they are not able to do this themselves, even though the unions of health-care professionals have advocated for this right as a human right (danish nurses’ organization & the association of public employees, 2002). accordingly, elderly people have to negotiate their needs for fresh air and for staying outdoors with the health-care professionals, and the healthcare professionals have to be obliging and creative in making informal space for this need in their scheduling, which seems difficult in a neo-liberal-ruled practice (ceci, 2008; glasdam et al., 2012; oudshoorn et al., 2007). furthermore, in this case study, the client is subject to the family and the family’s willingness or lack of willingness or ability to help the client outdoors. accordingly, this form of discipline works through self-discipline, and the client more or less becomes resigned to it. on the other hand, both the family and the health-care professionals seem to be both powerful in relation to the client and powerless in relation to the conditions of their relationships with the client. the wife is in a situation where her condition of living has totally changed, her husband is changed by his worsening disease, and the professionals’ time and tasks are assigned and allocated beforehand. the treatment and its management by the health-care professionals isolate the client in his home. he is trapped by his own disease and treatment, without even a little flexibility and with few possibilities for an exit permit. in modern society, work has become the statutory goal of life itself, on top of being an economically determined vocation, as weber (1972) has shown many years ago. behind it all lurks the idea that laziness is the root of all evil – otium est pulvinar diaboli (i.e., idle hands are the devil’s workshop) – or more precisely: the way the idleness is handled. resting in order to recover from disease has disappeared from the modern medical understanding in a time where rehabilitation has replaced recreation. people must be active and work in order to get well. work is understood both as self-therapy in relation to one’s own mental health and as physical work at the labour market (glasdam, 2011). the self-care movement seems to be an offshoot of this thinking, in the form of a pedagogical upbringing project: you can teach people to behave in the right way. it is quite similar to that of a prisoner who has the right and the duty to participate in work, education or other approved activities and must attend to practical tasks concerning personal matters, including cooking and cleaning (bekendtgørelse af lov om fuldbyrdelse af straf m.v.[consolidation act on the criminal code], 2010). indeed, dahl (2005) has dealt with the reconstruction of the needs of the elderly, and shows how the emergent ideal of the active elderly by engineering development is constructed as a relatively new discourse in the homecare system. the client in homecare service has to work regardless of his evident health limitations. the disciplining of the client is increasingly functioning as a technique for making individuals useful, as foucault (1995) has shown. a consequence is the demotion and violation of the individual in the name of discipline and self-discipline, as lillestø (1998) also describes it, where the client loses influence over his own life. in addition, more often than not, the health-care professionals and family members’ conflicting demands and expectations of him place strain on him. the client is fixed in a place, his own home, where he is spun into a web of formal and informal execution of power. the ultimate resistance from the client is his njsr – nordic journal of social research vol. 4, 2013 94 threat of suicide. suicide means that all discipline strategies have failed. in many ways, the wife of the client lives under the same conditions as the client, but she still has the possibility physically to leave the home whenever she wants. she can be substituted in the life of the client. he is captured in his own body from which he cannot escape; he is chained to his own fate. the client is not able to take care of himself; if he wants to live at home he is dependent on health-care professionals in his home. the sole realistic alternative is living in a nursing home, but several studies show that there are nearly the same conditions for living in a nursing home as at home subject to health-care professionals (harnatt 2010; hauge, 2004; hauge & heggen 2008; kofod, 2008; thomasen, 2009). in comparison, prisoners cohabitate with many strangers, fellow inmates, and prison guards, but prisoners have the possibility of being alone once they have completed their duties. they can withdraw to their cells or, in specific situations, ask for voluntary isolation (elmquist, 2009). in the present case study, the elderly person did not have the opportunity to be alone, except in the toilet and when sleeping; people – family and health-care professionals – surrounded him from when he opened his eyes in the morning until bedtime. lillestø (1998) has shown that the toilet and the bedroom are the most private and intimate rooms in a home; this invisible border for privacy and intimacy seems to be accepted for a health-care-dependent man, even though professionals unconsciously violate a client's home through their institutionalization (angus et al., 2005; cook, 2007; engström, 2012; glasdam et al., 2012; gullestad, 1989; kofod, 2008; lindahl et al., 2009). this violation of the private sphere could also be seen as a breach of the intimacy of the married couple. in other words, it is not only the private home that is invaded by the homecare system; it is also the relationship of the couple. bachelard (1994) shows how the self is mirrored in the home, its architecture, and decor. once the sense of home is degraded, the self is degraded. the importance of the homecare system’s transformation of a client’s home radically affects the client’s self-perception and opportunities for self-realization and relationship; the system produces vulnerable homes and vulnerable bodies (dyck et al., 2005). finally, the method of this case study has to be discussed. the construction of the single case is based on the client’s perspective of his relations with his family and the formal health-care professionals, and therefore the general practitioner is not included in the case study. clearly, this is a weakness in the study. the analyses indicate that the logic of medicine socializes and rules the homecare services as an underlining structure. therefore the analyses probably could have been improved by including this position. it is a well-known and well-tested anthropological method to move into the environment and context of the persons being studied, in this context a private home (angus et al., 2005; kofod, 2008; terp & glasdam, 2009; thomasen, 2009). with such a method, ethical dilemmas appear regarding how researchers can intrude into a private sphere, how the client and his family can accept the intrusion, and how the participants might handle the situations that arise, either individually or collectively. the researcher in this case was very aware of the participants’ well-being and needs, and adjusted her observations in response to the actual circumstances. both the interviews and the observations were carried out with an awareness of the language she used, her presence, and her genuine interest. njsr – nordic journal of social research vol. 4, 2013 95 conclusion the results show how the health-care professionals’ working day and the everyday life of the client (and family) in dependence are solidly structured and disciplined by a neo-liberal logic of time allocation and scheduling that rules the homecare system. all in all, everyday life in dependence on health-care professionals (and family) in one’s home resembles a life in imprisonment, but with fewer human rights than prisoners. the clients assigned to homecare services have neither the human right to get out every day nor the right to visit friends and relatives. furthermore, the clients have no influence on the staff composition in their home and are thus forced to incorporate strangers into their life. homecare services could be viewed as a disciplining institution of society to normalize and discipline the clients through work, routines, and rules. self-care can be seen as an underlying strategy to become re-normalized, in which the ultimate and illusory goal of the professionals is an independent client. one result is that the toilet and the bed are the only private places in the home. in all other places, the client seems to be incarcerated and monitored by the health-care professionals or the family. the family of the client magnifies those disciplinary strategies. punishment is a part of the disciplining system: the utmost consequence is the withdrawal of the health-care professionals. on the other hand, the health-care professionals’ time and tasks are assigned and allocated beforehand, and so they are neither allowed nor able to respond to the situation in the home. the client rebels and resists in small ways through signalizing his ‘non-existence’ in the situation and not doing what he is asked to do, but the ultimate resistance to the power is the threat of suicide. it becomes a vicious circle where everybody reinforces and amplifies the power relations and the power strategies. the client and the family are not only stuck at home, they are stuck in a home that is ‘broken’. these results are only based on one case. although the case study with its theoretical analyses has implications on a general level, the results may be regarded as limited and must be qualified in a larger study with more client cases. acknowledgements the authors thank the municipality where the case study took place and all participants. we also thank lone kjaer for her assistance with the project. we are also grateful to our colleagues kristin bjørnsdottir (iceland), frode fadnes jacobsen (norway), inge storgaard bonfils, claus fenger, and marianne munksgaard (denmark) for their critical comments on the draft of this article. we also thank penny bayer (uk) for proof reading the manuscript. njsr – nordic journal of social research vol. 4, 2013 96 references angus, j., kontos, p., dyck, i., mckeever, p, & poland, b. 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[the protestant ethic and the spirit of capitalism] copenhagen: fremad. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 7 (2016): special issue democratic and inclusive education in iceland: transgression and the medical gaze ólafur páll jónsson school of education university of iceland, email: opj@hi.is abstract ‘inclusive education’ and ‘democracy’ are more than buzzwords in education. they refer to official educational policy in much of the western world. democracy as a school policy seems to be widely accepted while inclusive education is more controversial, sometimes fuelling lively public debates where parents and politicians are vocal. however, there seems to be little agreement on what ‘inclusive education’ means, although one can discern a certain core to the understanding of ‘inclusive education’ among many of those who participate in the public debate. central to the above understanding of inclusive education and democracy are certain features that i want to draw attention to. first, what falls under the headings ‘democracy in schools’, ‘democratic education’ or ‘student democracy’, on the one hand, and ‘inclusive education’, on the other, have little to do with one another. i discuss how the medical gaze in the context of education belongs to the dominant ideology of the time and is thus prevailing without ever having to be argued for or defended. the consequence of this is, as i see it, that education (which sometimes is more training than growth) is being cast in pathological terms. i connect the idea of transgression to that of democratic school and character. transgression is relevant in two ways here. the school has to be a place where transgression is encouraged and, secondly, it is a place where transgression is valued as a democratic virtue. virtue here could, i think, be understood in aristotelian terms – or even given a socratic interpretation. keywords: inclusion, medical gaze, transgression, democratic education, dewey, foucault, iceland introduction in this article, i look at democratic and inclusive education in iceland since the mid-1970s when important educational reforms took place. these changes marked the beginning of democratic and inclusive education as official educational policy (section 1). however, in the 1990s there was a backlash in this development as many of the democratic principles from the 1970s were abandoned for a more managerial system of education (section 2). the changes during the 1990s were not simply changes of policy but reflected underlying mailto:opj@hi.is njsr – nordic journal of social research vol. 7 (2016): special issue 78 ideological differences concerning schools and education in general (section 3). i use foucault’s notion of the ‘medical gaze’ to reflect on these ideological differences (section 4). i then turn to inclusion and democracy as a task for schools and go into some details about democratic education, drawing on foucault’s notion of transgression and john dewey’s conception of democracy (sections 5 and 6). finally, i conclude by arguing that inclusive, democratic education has to be a branch of character education backed by institutional commitment to students as moral subjects and not only as objects for formation. 1. inclusion and democracy in icelandic schools – the beginning ‘inclusive education’ and ‘democratic education’ refer to official educational policy in iceland that can be traced back to the school act of 1974, when the primary objective of compulsory education became the preparation of students for life and work in an ever changing democratic society. although the word ‘inclusion’ did not appear until 20 years later, the 1974 school act had clear implications in the direction of inclusion. whilst the 1946 education act shifted the main focus from school subjects to the students’ needs, it was the 1974 education act that recognized in law for the first time that all children of a given age had an equal right to education in the state school system and that the school had a role in meeting the full diversity of student needs ... the view that this should be done in the child’s neighbourhood school rather than as a segregated provision has been stated since then in an increasingly unequivocal fashion by those who formulate official education policy. (bjarnason & marinósson, 2015, p. 281) the school act of 1974, and the subsequent national curriculum for elementary schools (ages 7 to 16), was in many ways revolutionary, not only for the explicit statement of democracy and demand for more inclusive schools, but also for the extensive work on curricular design, teacher training, writing of new educational material, and so forth (edelstein, 2013; jónsson, 2014). ingólfur ásgeir jóhannesson (2006) describes the changes in the following way: if we look at late twentieth-century educational history in iceland from this perspective, we see that the reform efforts of the 1970s and 1980s were aimed at modernizing the icelandic education system, with an emphasis on primary education (6 to 16 years). the reform was based on childcentred, humanistic, and egalitarian views which i will call the democratic principle. these views are apparent in cooperative learning methods, integration of subject matter, evaluation as process rather than product, and many other ‘progressive’ views in education. (p. 105) following the school act of 1974 much work was devoted to putting these progressive views into practice under the leadership of wolfgang edelstein, though with more emphasis on democracy than inclusion. however, during the dark months of the icelandic winter in 1983 to 1984 a new minister of education brought that work to a halt after fierce debate about the fate of history teaching in elementary schools. despite the great controversies surrounding this progressive work, democracy as a school policy was widely accepted, and although changes in the 1990s were in important ways antagonistic to the democratic principles from the 1970s, njsr – nordic journal of social research vol. 7 (2016): special issue 79 those principles have hardly ever been explicitly challenged in public discourse. the same cannot be said about inclusive education which has been more controversial, sometimes fuelling lively public debates among parents and politicians as well as scholars and teachers. 2. discursive patterns the term ‘inclusive education’ – or the clumsy icelandic correlate ‘school without differentiation’ – came to iceland with a translation of the salamanca statement in 1995, which the ministry of education sent to every school (bjarnason & marinósson, 2015). however, the messages from the ministry and municipalities were far from unequivocal, as bjarnason and marinósson have observed: as a whole the act from 2008 emphasizes equity, equal opportunities and an appropriate education for all children, irrespective of their physical, mental or sensory capacities, their socio-economic situation, national/ethnic origin or linguistic competences. but [in] the article on specialized services and support system for schools the emphasis is on increase in diagnostic psychological services in place of pedagogic or therapeutic work. students should be evaluated from the first year of schooling to secure them appropriate teaching and support. further, students who may have psychological or social problems, affecting their learning are entitled to diagnostic services, if the parents agree. (bjarnason & marinósson, 2015, p. 140) in the public debate on inclusive education, beginning in the 1990s when it became official educational policy, one can discern certain understandings or discursive patterns of both the role of schools in general and their ‘proper role’ for inclusion in particular. although these patterns are reflected in some of the policy documents that came from the ministry of education in the 1990s (jóhannesson, 2006; bjarnason & marinósson, 2015), they do not form an explicitly stated and defended view of inclusive education, but figure rather as an ideological background to many of the claims about schools, teachers, students, and educational practices in general that are made in the public debate, as well as in various official policy documents. i shall label four distinct but interwoven themes. (1) individualistic understanding: difficulties that students face are usually viewed as their difficulties, although those difficulties often result in problems for teachers and schools as well as the families of the students. the source of the difficulty is located in the individual students and the remedies proposed focus primarily on the individuals. likewise, much of the demand for support is premised on individualized learning and the rights of the students which are, as discourses on rights usually are, very much individualistic (jóhannesson, 2006). (2) medical model: much of the discussion of inclusive education operates not only with a vocabulary of various individualistic learning difficulties (as in (1) above), but also from such a vocabulary, emphasizing mental and physical defects along with emotional disturbances. the difficulties are the starting points, often in the form a diagnosis, and the means taken are seen as remedies for whatever defect has been detected. in 2012, 16 per cent of the total elementary student population in iceland had some formal diagnoses and in the east, where the number was highest, it was 24 per cent (menntavísindastofnun háskóla íslands, 2014, p. 20). accordingly, educational practices take the form njsr – nordic journal of social research vol. 7 (2016): special issue 80 of special education rather than inclusive education, revolving around diagnosis and fixing whatever is found to be out of order. (3) technical approach: to address the problems which are the concern of special education – rather than inclusive education – appropriate methods or techniques are called for. jóhannesson puts it very succinctly when writing, ‘diagnosis rather than pedagogy appears as the method (technology) for inclusion’ (jóhannesson, 2006, p. 111). this is only to be expected, given the medical view of learning difficulties, but it has at the same time resulted in an increased drive towards diagnosis which has generated an overload of demands at the state diagnostic and counselling centre. a technological view of education is also manifest in higher education, although not rooted in diagnostic practices as in primary and secondary education. reflecting on the bologna process for higher education in europe, ronald barnett (2003) remarks that ‘... in this discursive shift, in this reduction of curriculum or specifications largely of skills, we see a framing of the curriculum in instrumental terms. a curriculum is nothing but the production of a set of skills, and is only to be valued providing it delivers skills’ (p. 564). (4) market-commodity view of education: all this is then set against a background condition of schools where students compete with each other for rank and opportunity – and where the schools themselves (from primary schools to universities) compete with each other for rank and funding – in an environment where education is by and large seen as any other market commodity. education, especially at the upper secondary and university levels but also to some extent at the lower levels, is talked about as an investment and the students are said to increase their own market value by obtaining education. although the market-commodity view of education may not be as entrenched in iceland as in the us (molnar, 2005), it has become a dominant view in much of the educational discourse (jóhannesson, 2006), not least since 2013 when the independence party took over the ministry of education from the left-green movement. one can discern somewhat similar discursive patterns or underlying ideas relating to democracy in education. individual preferences are taken to be the ultimate unit of analysis, democracy is thought of as a means for advancing such preferences (thus ‘technical’), and its basic function is to regulate a free competition of individual opinions and preferences (thus the ‘market-commodity view’). public understanding of democracy as an educational ideal may, however, show itself more in what is omitted than what is explicitly stated. this is in part due to the fact that democracy, unlike inclusive education, has never been the explicit topic of public controversy. thus, when the democratic principles of the 1970s were abandoned during the 1990s, democracy as an educational objective remained intact, though only as a dead letter. official educational policy was silent about things that one should expect to be central to democratic educational policy such as equality, gender, and class. this has been pointed out by jóhannesson (2006): the conjuncture of the vision of inclusion, the technological approach to defining differences, and the market-oriented approach in financing education (e.g., management by results) creates a silence about equality in other terms, such as gender, residence, class, and culture. (p. 114) the final thing i want to point out concerning background ideas or discursive patterns relating to democratic and inclusive education is that the two are by njsr – nordic journal of social research vol. 7 (2016): special issue 81 and large considered to be distinct fields. although inclusive education and democracy as educational policy can both be traced back to the school act of 1974 the two have not been thought of as part and parcel of the same ideal. this may perhaps be explained by such down-to-earth factors as school financing (jóhannesson, 2006). debates about inclusive education – or tensions between inclusive education and special education – tend to revolve around (a) systems of aid for specific groups of students (diagnosed with specific conditions) rather than general pedagogical practices; (b) the distribution of limited resources such as welfare provisions rather than things that are owed the individuals as matters of basic rights; and (c) the role of schools as preparation for what awaits the students once they move on to the next school level and, finally, to the job market. 3. different ideologies of schools and education the above view of democratic and inclusive education runs contrary to strong currents in scholarship and advocacy on inclusion and disability exemplified by, for instance, the salamanca declaration from 1994 and the world report on disability from 2011(who, 2011). it also runs contrary to recent academic work in the field of inclusive education (allan, 2003, 2008; jóhannesson, 2006; jónsson, 2011; slee, 2011). considering inclusive education as an essentially democratic requirement that ought to permeate school practices means that inclusion must be taken as a fundamental value, both political and educational. and here one encounters differences among teachers, parents, and scholars alike which are both deeply rooted and have widespread implications. the differences are not simply about the effectiveness of certain methods or some practical matters but are best described as ideological differences about education and schooling in general. a dominant ideology is a collection of ideas, prejudices, and conceptions of the world in virtue of which people look at and think about society, social institutions, their surroundings, other people, and themselves. ideology in this sense is not explicitly expressed, neither by certain individuals nor by any group of people, but is exemplified by what people say and do, and what they don’t say or do. it may be difficult to articulate or even recognize because the dominant ideology constitutes, at any time, the obvious – it is ‘common sense’ – though in retrospect it is often all but that (zizek, 1997). foucault (1984) puts the point well when discussing the sources of his work on psychiatry and medicine: there were no ready-made concepts, no approved terms of vocabulary available for questions like the power effects of psychiatry or the political function of medicine … the price marxists paid for their fidelity to the old positivism was a radical deafness to a whole series of questions posed by science. (pp. 52–53) ideology is also implicit in the institutional structures that are found in society, not least in schools where it is shown by what is counted as normal functioning of those institutions. ideological differences, although general in character, generate conflicts in the everyday work of teachers who feel pulled in different directions (bjarnason & gunnþórsdóttir, 2014). many teachers experience frustration and when things are at their worst, school may turn into a territory of failure (allan, 2008) – for students and teachers alike. njsr – nordic journal of social research vol. 7 (2016): special issue 82 conceiving of the frustrations in the field of inclusive education as a conflict of ideologies echoes some recent trends in the related field of disability studies. in an editorial to a special issue of the international journal of inclusive education, recent trends in the field of disability studies are described in the following way: gabel & peters (2004) acknowledged that the social model is explanatory, but insufficient for creating change. to move forward, they suggested the use of resistance theory to comprehend the intricate and multifaceted relationships, interactions, and negotiations among divergent ideas, while simultaneously bringing together the global community in pursuit of praxis. (connor et al., 2008, p. 443) though gabel and peters (2004) do not describe their approach in terms of conflicting ideologies – and may narrow the focus too much by using the word ‘paradigm’ – they come close to this when writing: thinking of resistance in this way, as operating in all directions of the social sphere and across paradigmatic boundaries, helps one to understand the push and pull of the conversation of resistance. resistance functions as a way for disabled people to push against dominance while also attempting to pull society into disabled people’s way of seeing. (p. 594–595) the resistance described here does not stem from nuances between competing views of specific professionals, but from a conflict of ideas about what is a normal function of a social system. in the field of inclusive education similar conflicts concern ideas about what are the normal workings of schools, what institutional structures are legitimate, and to what kind of authority students can be subjected. recent trends in inclusive education have emphasized human diversity and the demands of justice and democracy in general, not only for disabled students, but also for the very bright, the non-native speaking, the poor, and the very shy (guðjónsdóttir & karlsdóttir, 2010). 4. ideology and the medical gaze foucault’s concept of the medical gaze can be illuminating when discussing ideological presuppositions for inclusion and democracy. in the introduction to reassessing foucault: power, medicine and the body, jones and porter (1994) write: [foucault] was fascinated by the conventions of the medical ‘gaze’ for eliciting truth; the production of symptoms and signs within determinate frameworks of signification: the vital role of technologies of power and specific institutional settings (diagnostic tests, hospitals, asylums); and not least the capacity of medical power to be – or appear to be – positive and benign rather than oppressive, and to create ‘subjects’ in both senses of the term: clients subjected to protocols of power, but also specific individuals (everyone has, for example, his or her own unique medical history or fingerprint). (p. 11) as noted above, discourse about inclusive education has been individualistic, medical, and technical and premised on education as a market commodity. students with special educational needs are accordingly identified as having ‘symptoms and signs within determinate frameworks of signification’ and although the treatment these students receive is portrayed as benign – and certainly may have various good consequences – it subjects them to power njsr – nordic journal of social research vol. 7 (2016): special issue 83 which has little or no commitment to democratic principles nor need it be sensitive to the socio-economic conditions of the students. the latter is observed by jóhannesson (2006) while examining policy documents from the late 1990s. … because clinical methods have become the way to deal with special educational needs, they must be treated as individual differences; clinical psychology or medicine cannot properly deal with cultural differences or gender differences. this means that only individual differences are acknowledged, thus side-lining differences that may arise in terms of culture or the socio-economic circumstances of the children. (p. 115) the medical gaze is not only relevant when considering treatment of ‘diagnosed’ special educational needs but extends to the conception of the child itself, as noted by bjarnason (2008): medical staff, trained to alleviate suffering and prevent harm, tend to favour screening and the termination of pregnancy when the fetus is found to be impaired. prospective parents are more than likely to share this view owing to the widespread acceptance of the medical perspective. such prospective parents are likely to take upon themselves the suffering of abortion to save their future child and the family from suffering, stress, and harm, and to prevent the unborn fetus the loss of future opportunities. (p. 266) bjarnason (2008) then refers to foucault’s notion of medical gaze to contextualize the above observation: [the medical gaze] implies the power the medical professionals gain over their patients when they denote the often-dehumanizing method of separating the patients’ body from the person in diagnosis and treatment. this term [medical gaze] captures some of the greater social issues involved that reify the impaired fetuses as ‘a social artifact’ and how that is communicated to parents-to-be who themselves are placed under the gaze as patients. (p. 269) the medical gaze constitutes an element of the dominant educational ideology. however, it is not something people deliberately accept or defend, but figures as a legitimizing principle and structuring force in both institutional design and personal interaction. the medical gaze is also evident in much research on deviant children or deviant child behaviour, where the children themselves, as persons with complex lives in a socio-economic setting, fade out of sight – or become ‘a social artifact’ – with the researchers gaining power by defining what is legitimate or deviant behaviour and what constitutes a deviant child as opposed to a normal one. the focus becomes predefined deviation and the means of either managing it directly or modifying antecedent behaviour that has been found to correlate with future behaviour defined as deviant (kazdin, 1980; ialongo et al., 1999). 5. inclusion and democracy as tasks for schools different conceptions of democracy not only entail different roles for schools as institutions in a democratic society, but they also entail different conceptions of what makes school practices democratic. an underlying idea in the conception of democracy that i described above is that social affairs should be organized njsr – nordic journal of social research vol. 7 (2016): special issue 84 as a free and open competition among people for preferences, positions, and various other social as well as personal goods. it is granted that people have different views, needs, and preferences, and democratic institutions are then designed to ensure a free market of ideas and opinions and competition free of coercion and monopoly to accommodate this diversity. this conception of democracy has been labelled ‘aggregative democracy’ (young, 2002, pp. 18– 22). the democratic role of the school, in this view, is mainly twofold. first, it is to make people fit to participate in the market of ideas and, secondly, to ensure knowledge of fundamental rights and basic principles that are needed for society to function efficiently. in this view, the role of the school is to prepare students for a society to which they do not yet belong, in much the same way as the school serves to prepare students for the workplace. here we see the technical, individualistic, and neo-liberal aspects of the dominant ideology of education. democracy becomes a task for the schools or even a problem; it is something that schools face and must solve however successfully, just as they must produce knowledgeable and skilled workers for the workplace (biesta, 2006). but democracy as a problem for schools may be impossible to solve as keith ballard (2003) observes, drawing on work by paul james: james … says that in the fragmented, individualized and globalized world of new right liberal economics, the ‘sociality of identity’ is being lost…. in part, this is because the concept of a society is challenged, and replaced with the idea that only the ‘personal and familial’ … has meaning. in this context, rather than recognizing and valuing our dependencies and interdependencies, which would seem to be central to the notion of an inclusive society, the term dependent is constructed as involving a ‘lesser person,’ one who cannot, or will not, fend for themselves ... (p. 11) 6. democratic character and transgression the aggregative view of democracy is often contrasted with a deliberative conception (bohman & rehg, 1997). most theories of deliberative democracy focus primarily on structure and policy and on the making of collective decisions, premised on the mutual benefit of people who live together as equals and who have joined forces in a free association (cohen, 1997; gutmann & thompson, 2004). proceeding from these premises, one faces difficult problems when applying a theory of deliberative democracy to schools where (a) the individuals involved do not come together as equals but as unequal in important respects (teacher/student, headmaster/teacher), (b) are not there for mutual benefit, and (c) part of the population, namely, the students, has no choice but to participate irrespective of experience or preferences. considering the diversity of the students, both psychological and socioeconomic, the deliberative model lacks an account of the role of attitudes and practices that are essential for sustaining and cultivating just and democratic functions, while at the same time being central for transforming the school into a truly educational setting; a learning community in the sense of bell hooks (1994). however, such a concept of democracy and education was argued for by john dewey (1916) 100 years ago. despite important similarities between dewey’s conception and the deliberative tradition there are also important differences between the two, the most important of which have to do with dewey’s starting point. in a speech from 1939, ‘creative democracy – the task before us’, he states: njsr – nordic journal of social research vol. 7 (2016): special issue 85 instead of thinking of our own [democratic] dispositions and habits as accommodated to certain institutions we have to learn to think of the latter as expressions, projections and extensions of habitually dominant personal attitudes. (dewey, 1998 [1939], p. 341) the common way of applying a theory of democracy to school practices is by beginning with a notion of democracy as a system of government or means of making collective, binding decisions and then adapting it to the circumstances in the school. dewey, on the other hand, insists that the starting point should not be a theory of institutional structure or procedural design but ‘habitually dominant personal attitudes’ (p. 341). it is here where foucault’s idea of transgression becomes helpful. in ‘a preface to transgression’ (1977), foucault says: transgression is an action which involves the limit, that narrow zone of a line where it displays the flash of its passage, but perhaps also its entire trajectory, even its origin; it is likely that transgression has its entire space in the line it crosses. (pp. 33-34) a little later, foucault (1977) reflects on the interdependence of the limit and transgression: the limit and transgression depend on each other for whatever density of being they possess: a limit could not exist if it were absolutely uncrossable and, reciprocally, transgression would be pointless if it merely crossed a limit composed of illusions and shadows. (p. 34) it is important to note here that when talking about transgression, foucault is not envisaging a world without distinctions – without class, gender, roles such as student/teacher, and so on – but is opening up a way of seeing the distinctions as dynamic and not defining of their constituent elements. transgression means that the relevant distinctions are as much a potential for a new being as they are definitive of being itself. thus, he writes: transgression, then, is not related to the limit as black to white, the prohibited to the lawful, the outside to the inside, or as the open area of a building to its enclosed spaces. rather, their relationship takes the form of a spiral which no simple infraction can exhaust. (foucault, 1977, p. 35) julie allan (2011) has applied the notion of transgression to disability research where she has observed students with disability. she writes: transgression, the practical and playful resistance to limits … is an important way for people with disabilities to challenge the disabling barriers they encounter. transgression is not antagonistic or aggressive, nor does it involve a contest in which there is a victor; rather, it allows individuals with disabilities to shape their own identities by subverting the norms that compel them to repeatedly perform as marginal. (p. 154) this idea of challenging barriers and subverting norms that compel students to perform as marginal can be applied more widely to a theory of democratic education and, i shall argue, one can see this as a central feature of a deweyan conception of democracy. dewey’s way of framing his ideas is different from that of foucault, and i do not want to hint at any general agreement between the two. my point here is simply that foucault’s conception of transgression can be used to shed light on dewey’s idea of democracy and, likewise, dewey’s njsr – nordic journal of social research vol. 7 (2016): special issue 86 ideas of democracy can help us see the relevance of the concept of transgression for democratic education quite generally. to move forward in this direction it is important to situate foucault in the kantian tradition – as he himself readily did. as mark olssen (2006) writes: foucault ... situates his own work within the critical tradition of kant. this tradition, says foucault, entails ‘an analysis of the conditions under which certain relations of subject and object are formed or modified’ and a demonstration of how such conditions ‘are constitutive of a possible knowledge’. (pp. 246–247) the process of education and its ‘possible knowledge’ is a constant play on the relations between subject and object. but possible knowledge for foucault is not simply possible propositional content (as it may have been for kant) but also possible ways of knowing where the body is as relevant as the cognitive powers, and where feelings and emotions are as relevant as propositional knowledge. foucault would also include considerations about who is recognized as a knower and the various power relations that come with such recognition. we only know the limits of possible knowledge by reflecting on actual knowledge. here, transgression is relevant as a means of challenging and expanding these limits. however, for an educational setting to be genuinely free and democratic, no individual nor any specific group of individuals (be it adults, teachers, ‘the experts’, et al.) may have an authority on where these limits lie. thus, in democratic education, the very process of education must be open to creative challenges, not only the ordinary challenges to claims of knowledge one might see in a scientific debate, but also to challenges that constitute transgression of categories which define who someone is, what is appropriate for such a person, and where such a person belongs. an illuminating description of a transgression in this sense is ‘on being a cripple’ by nancy mairs (1986). in this essay mairs deliberately chooses the label ‘cripple’ for herself, for she finds that it describes her condition better than labels such as ‘disabled’ or ‘handicapped’. mairs embraces the label while, at the same time, she rejects the ideological baggage that comes with it by being in charge of her own life as a cripple. people – crippled or not – wince at the word ‘cripple,’ as they do not at ‘handicapped’ or ‘disabled.’ perhaps i want them to wince. i want them to see me as a tough customer, one to whom the fates /gods /viruses have not been kind, but who can face the brutal truth of her existence squarely. (mairs, 1986, p. 9) in an educational setting the most basic defining categories are that of subject and object, categories which ought not to be fixed although much of the institutional educational structure is precisely designed for fixing them. disabled students, as well as students of colour in many parts of the us (see e.g., bell hooks, 1994), and poor students or shy students, students portrayed as having special educational needs, or students showing deviant behaviour are commonly denied the possibility to be subjects in their own lives (jørgensen, 2004). such students are constantly the object of this or that programme, steered into this or that direction, being modified for this or that end, none of which are of their own choice. not only are they compelled ‘to repeatedly perform as marginal’, as allan notes (allan, 2011, p. 154), but they are also denied the ability, within the educational process, to pass judgement on what they find interesting and what counts as relevant, fair, or worthy of knowing. in njsr – nordic journal of social research vol. 7 (2016): special issue 87 short, intellectual authority is handed to them from the teachers (with the medical gaze) or from textbooks. none of this is confined to disabled students or students who are marginal or deviant for some reason or another but applies to the whole category of the student. in the introduction to her book teaching to transgress (1994), bell hooks writes: school was the place of ecstasy – pleasure and danger. to be changed by ideas was pure pleasure. but to learn ideas that ran counter to values and beliefs learned at home was to place oneself at risk, to enter the danger zone. home was the place where i was forced to conform to someone else’s image of who and what i would be. school was the place where i would forget that self and, through ideas, reinvent myself. (p. 3) school is a place for transgression for hooks – a learning community which urges students ‘to open [their] minds and hearts so that [they] can know beyond the boundaries of what is acceptable, so that [they] can think and rethink, so that [they] can create new vision’ (hooks, 1994, p. 12). this kind of learning community is one which, according to hooks, makes education the practice of freedom. it is this connection between learning, transgressing boundaries, and freedom that must be at the centre of any theory of democratic education, that is, education opposed to coercion into predetermined forms of knowing and being. going back to dewey (1998 [1939]), we can see how he identifies learning as a central element in the democratic process, emphasizing both its cognitive and emotional aspects: [...] democracy as a way of life is controlled by personal faith in personal day-by-day working together with others. democracy is the belief that even when needs and ends or consequences are different for each individual, the habit of amicable cooperation – which may include, as in sport, rivalry and competition – is itself a priceless addition to life. to take as far as possible every conflict which arises – and they are bound to arise – out of the atmosphere and medium of force, of violence as a means of settlement into that of discussion and of intelligence is to treat those who disagree – even profoundly – with us as those from whom we may learn, and in so far, as friends. (p. 342) dewey does not describe democracy as a way of managing differences – or providing means for making decisions in the face of differences – but as a way of living with other people with whom one may disagree. fundamental to the democratic way of living is the ability to approach other people not only rationally but also emotionally – as friends, as he says, and as people from whom one may learn. dewey thought of democracy as rooted in personal attitudes and habits – democratic character or moral virtue, one could say – arguing that institutions are democratic only in so far as they can be seen, in their day-today functioning, as being projections of democratic character. dewey may overstate the point when using the word ‘friend’, since from the perspective of society, friendship as a basis for democracy is too strong a demand. however, we can maintain his insight, for what is needed may not be friendship but respect. the point is not simply that respect will make society better, but that without respect for each other the social relations among the citizens will be cast into a competitive mould and living in a society will be a struggle – a fight for one’s own interests – and not a life of mutual learning among people. njsr – nordic journal of social research vol. 7 (2016): special issue 88 central to most contemporary thinking about democracy and justice is an acceptance of pluralism and a rejection of independent authority on moral and political issues. rawls (2001) takes ‘reasonable pluralism’ as his starting point, and sen (1992) and nussbaum (2006) go even further in their insistence on the acceptance of profound diversity, not only in opinions and philosophies of life but also in capabilities. the french philosopher chantal mouffe (2000) goes further still, insisting that theorizing about democracy and justice must not only accept pluralism and diversity but has to recognize actual disagreements and conflicts as a basic social condition. a theory of democracy, according to her, is a theory about how to live justly in a society that is marked by such social realities. i think she is right, and i also think that any such theory must include within its scope an account of personal, democratic attitudes in much the same way as dewey (1916; 1998 [1939]) argued for. moreover, democratic education in this sense will be an education for transgression along the lines of foucault and bell hooks, helping people to face the truth of their existence squarely, to use the mairs’s words, whether it is brutal or not. this requires that students be subjects in their own lives and not mere objects of formation. it also requires that students be given both the opportunity and ability to define and redefine who they are and how they are. the deviant child must be on board from the beginning, not as an afterthought or a case for concern, but as an individual facing his or her own reality. 7. transgression and icelandic educational reality reflecting on icelandic educational reality from the point of view of transgression and democratic education, one can observe both positive and negative aspects. on the positive side, there is high enrolment of students in general compulsory schools; less than one per cent attend special schools (sigurðardóttir et al., 2014, p. 103). moreover, data from 2012 shows that around a quarter of all students in the compulsory school receive special support (menntavísindastofnun, 2014, p. 16); this support is often provided in the classroom, although there is no clear data on this. but on the negative side, the system relies heavily on a medical model view of learning difficulties, with formal diagnosis (usually carried out by the state diagnostic and counselling centre) being a precondition for extra funding and, consequently, increasing the ‘need’ for diagnoses instead of turning to pedagogical responses. accordingly, sigurðardóttir, et al. observe that disabled students are often not included except in a superficial way: however, the location of students with disabilities within the mainstream schools does not mean that they are included or acknowledged as participants in the school life. participation has not been measured generally in iceland, but authors of a recent study of the education of mentally disabled students [marinósson, 2007] concluded that the ground rules were that the school is still considered a ‘normal’ place where all major deviations were considered problems in need of ‘fixing’. (sigurðardóttir et al., 2014, p. 103) shortcomings do not only affect disadvantaged students but also extend to educational practices quite generally. the dominant way of teaching is direct lecturing by teachers followed by students working with textbooks and predefined assignments (óskarsdóttir, 2014). and even though changes towards more open spaces, wider cooperation among teachers, more thematic work, and a move towards a professional learning community (sigurðardóttir, 2010) have had positive influence on educational practices, teacher-centred njsr – nordic journal of social research vol. 7 (2016): special issue 89 educational authority is rarely challenged (jónsson, 2015). students are given little opportunity to influence the work, to contribute to the formation or transformation of values and goals, and to exercise their own critical and creative abilities. their inclusion in the process of education is shallow and there is little sign of students transgressing the line between being objects of formation and subjects in their own lives. this is not without exceptions, as, for instance, hanna ragnarsdóttir and börkur hansen have observed, documenting the development of a collaborative school culture in an inner city school in reykjavík (ragnarsdóttir & hansen, 2014). the progressive changes in the 1970s and early 1980s in iceland opened up spaces for students to be more involved in the process of education, relating it closer to their own reality by curriculum amendments and the writing of new teaching material (edelstein, 2013). this movement never got to the point of what one might call transgressional education, and it is difficult to say how things would have evolved if the whole project had not been cut short in the mid-1980s. during the 1990s and the first decade of the twenty-first century, the whole educational system moved away from democratic education, with increased emphasis on standardized tests and a technical view of education. a new national curriculum in 2011 aimed at a return to democratic principles in education. how it will fare in the long run is still unclear but, as things are today, it seems that schools are preparing students for a predefined future rather than setting them on a journey of transgression and discovery. references allan, j. 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(1997). the plague of fantasies. london: verso. microsoft word hjort, panican navigating the market of welfare services, proof2.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 5, 2014 navigating the market of welfare services: the choice of upper secondary school in sweden torbjörn hjort school of social work lund university email: torbjorn.hjort@soch.lu.se alexandru panican school of social work lund university email: alexandru.panican@soch.lu.se abstract due to increased market orientation and deregulation, welfare services in sweden have taken on the form of market-based services. the body of research on deregulation and privatization is quite substantial regarding the implications of this kind of development. however, studies of the actual process of how choices are made are less common. this article discusses the implications of greater freedom of choice for swedish citizens in diverse socioeconomic situations, focusing on factors that limit opportunities for choice. deregulation and the increasing number of alternatives affect the relationship between the citizen and the welfare state in several ways. the swedish school system is used here as an example of an empirical field. the analytical focus of the article consists of two different kinds of restrictions on choice: structure-based and agencybased. one conclusion is that both affluent and underprivileged citizens have limited choices. another conclusion is that social njsr – nordic journal of social research vol. 5, 2014 56 citizenship, when freedom of choice is stimulated, can reproduce and even increase social and ethnic segregation. an additional potential consequence is that, when we consider social rights in their tangible form, the development of greater freedom of choice is focused increasingly on the consumer’s range of choices and less on the quality of the service offered. keywords: citizenship, deregulation, freedom of choice, education, welfare services introduction the aim of this article is to discuss the conditions and prerequisites for citizens’ choices of welfare services within the context of the swedish welfare state. the deregulation of public sector-based welfare services towards an increased number of private and non-profit alternatives should be understood from the perspective of the previous situation, where the state was the dominant provider. this means that greater freedom of choice in selecting welfare services is a relatively new phenomenon for swedish citizens. we want to discuss what freedom of choice regarding welfare services implies for citizens in diverse socioeconomic situations, not just for groups who are considered as disadvantaged, which is the usual focus of welfare deregulation studies. we analyse the actual opportunities for choice, which means that we focus on substantial, rather than formal, freedom of choice. we employ the swedish school system as an example, focusing on the upper secondary school system, an area where marketization has increased and where the pupils and parents are offered a range of alternatives concerning school and education. education is one of the most significant factors regarding the development of an individual’s well-being (vinnerljung et al., 2010) since it strongly influences future opportunities in the labour market (olofsson & panican, 2008). in recent decades, education has increasingly become a matter of personal choice for citizens of sweden, and this is also the case for navigating the market for other welfare services. the greater number of options for welfare services creates new opportunities, but also places new demands upon citizens. the body of research on deregulation and privatization is quite substantial concerning the njsr – nordic journal of social research vol. 5, 2014 57 implications of this development. however, studies of the actual process of selection – for instance, choosing a healthcare or education provider – are less common. increased freedom to choose also changes the relationship between the citizen and the welfare state, moving it towards what can be considered a consumer relation. the responsibility for obtaining a product of good quality that is also individually adapted is increasingly being placed upon citizens. this transformation has been framed in neoliberal terms, promoting concepts like freedom and individuality in contrast with a welfare state burdened by bureaucracy (eriksen & weigård, 1999; harvey, 2005). one argument behind increased deregulation has been that welfare services should be better tailored to individual needs and preferences. a wider range of alternatives is thought to increase the competition between providers and, consequently, the efficiency and quality of welfare services (eriksen & weigård, 1999; norén, 2010). this belief, inspired by the neoliberal agenda, challenges the idea of citizenship as it is understood in the context of the type of welfare state that has prevailed in sweden. citizenship within this kind of welfare state is based on two main principles: (i) citizens have equal opportunities to participate in welfare services, and (ii) government, at both the national and local levels, is considered the guarantor of equality regarding welfare services. among citizens in sweden there is a high degree of trust in the capacity and ambition of the welfare state to deliver premium services to all citizens, irrespective of income or ability to pay (e.g. svallfors, 2004). this ideological welfare context implies that an increased freedom of choice also places greater demands upon citizens. having the knowledge and competence to be able to compare different alternatives is an example of one such demand. greater freedom of choice does not represent, by definition, any ‘paradise of personal discretion’ (offer, 2006:357). our main interest in this article is to analyse how the citizen relates to and manages the process of choosing. how does the citizen approach the role of consumer in considering welfare services, in this case with a special focus on the upper secondary school system? choosing an education, considering both content and provider, is a complex task that includes consequences and dimensions that are difficult to foresee. the literature on deregulation of welfare services gives us some ideas of the complexity, including opportunities as well as restrictions regarding the process of choosing. in this article we discuss the process of choosing in the context of this literature. njsr – nordic journal of social research vol. 5, 2014 58 method and material this article is based on a level of abstraction driven by theoretical reasoning about the importance, for citizens in diverse socioeconomic situations, of increasing the freedom to choose from among welfare services. when speaking of socioeconomic situation, we are referring to factors such as one’s status in the housing and labour markets, education and income. this article is also a review of existing research and attempts to organize the various critiques of freedom of choice. we synthesize previous research by constructing two forms of restrictions concerning freedom of choice. the literature review is primarily based on literature of deregulation in the educational sector in a nordic context and in an international context mainly focused on uk. we also use government publications reflecting government bills and swedish government official reports to provide background information on the changes that the educational system has undergone through the introduction of increased opportunities of choice regarding both school and educational programme. review of previous research on freedom of choice research on how individuals and groups make selections based upon different preferences is well represented in the body of research on consumer behaviour and on marketing (bettman et al., 1998; alba & hutchinson, 2000; trentman, 2007). the majority of research on freedom of choice has been in commodity markets and services, whereas we focus on welfare services. regarding an increased freedom of choice of school education, the research has focused primarily on the effects of the deregulation of the school system for school representatives and, in particular, for citizens from disadvantaged social backgrounds (ball, 2003, 2006, 2007; bunar, 2010a). in contrast, we aim to discuss the process of how choices are made by children and parents in diverse socioeconomic situations. research on freedom of choice in relation to welfare services such as health care (blomqvist, 2005), school systems (ball, 2003; bunar, 2009, 2010a, 2010b, 2010c; norén, 2010) and social care (norén, 2003; szebehely & trygdegård, 2007) is comprehensive, nationally and internationally (blomqvist, 2004). both international research (ball, 1994, 2006, 2007; ball et al., 2007; gewirtz et al., 1995; ambler, 1998; hatcher, 1998; reay & ball, 1997) and national research (kjellman, 2001; damgren, 2002; skawonius, 2005; johnsson, 2004) show that the opportunities to choose are not equally distributed; some groups have more of the resources, knowledge and skills required to navigate among different alternatives. the research also njsr – nordic journal of social research vol. 5, 2014 59 indicates that an increase in opportunities to select a school and educational programmes augments segregation (richardsson, 2004; bunar, 2005; lund, 2006; kallstenius, 2009; olofsson, 2010). where the state and the municipality once stood as guarantors for equal access to welfare services, these services have now become more customized. the educational system in sweden is characterized by privatization, deregulation and liberalization; pupils and parents choose from diverse public and private educational options. schools have become providers of education in a competitive market. reforms towards greater choice in secondary education in sweden show that a broader range of options consolidates existing differences that follow patterns of class, parents’ education, income and position in the labour market (bunar, 2009; englund, 1993; arnman et al., 2004; broady, 2001; lund, 2007). at the same time, the research concludes that greater freedom of choice also leads to a less segregated and stigmatized school (gorard & fitz, 2000; gorard et al., 2001). those who advocate an expanded freedom of choice argue that welfare services can be customized to better accommodate individual needs and preferences. but these arguments for individualized citizenship tend to disregard the structural aspects that are likely to reinforce existing social norms. the consumer is also governed by collective and structural factors. in his research, bourdieu (1984) demonstrates how taste, style and consumption are closely connected to social class, concluding that class-based social distinctions are recreated through consumption. factors such as class, gender, education level, ethnicity, age and income define the “right” choice when selecting a product or service. a citizen faces collective expectations for the choices he or she makes. there seems to be an equality principle within one’s own social group, in the sense that groups select the options that are consistent with their own group’s preferences (johnsson, 2004). it should be stressed that even if we, to some extent, can be influenced in our selection of, for example, pasta or shoes, these choices are to be regarded as freer than the regulated choices we make concerning welfare services. when freedom of choice is regulated, the actual selection is more limited, because politicians and government agencies strive to offer choices within a range of what is considered reasonable in relation to the public interest and policy objectives (norén, 2003, 2010). market mechanisms also impose limitations on freedom of choice, since the fundamental objective of market-based activities is profit. welfare service providers select customers based on a specific profile, making it more difficult for other customers to obtain equivalent services, which is a process known as ‘skimming the cream’ (bunar, 2009). njsr – nordic journal of social research vol. 5, 2014 60 choosing a school and an education requires resources and capital (bourdieu, 1986) such as knowledge, access to information, contacts and understanding of the educational system. the resource-poor or ‘capital-poor’ (bunar, 2001) do not have the same opportunities to manage a greater range of options as those who are well established or well-off. it turns out that freedom of choice has more to do with competition based on segregation, symbolism, beliefs and traditions than with competition based on the quality of education provided by a school (bunar, 2008). equality, as the central value of citizenship, tends to be replaced by the ambition of equivalence that provides greater freedoms but less regard for pupils’ and parents’ ability to achieve those freedoms (dovemark, 2007). as earlier noted, however, the focus of research thus far has mainly been on resource-poor, or underprivileged, groups. theoretical starting points we use citizenship as an analytical framework to increase knowledge of how citizens, in this case children and parents choosing between upper secondary schools, are affected by a neoliberal concept of citizenship that is dominant in the political and administrative systems in sweden. citizenship can generally be understood as a theoretical-analytical term, as a political conceptual tool to explain individual membership in a political community or as lived experience capturing a range of issues articulated in a citizen’s daily practices (lister et al., 2007). in our study, it is relevant to discuss citizenship as lived experience since we emphasize citizens’ opportunities regarding how choices are made. this analytical starting point also necessitates an inclusion of the relationship between the citizen and the welfare state in the analytical model. this kind of relationship is regulated by citizenship rights (marshall, 1992). furthermore, we focus on social rights as these rights determine the redistributive process, public interventions and institutional arrangements to provide welfare services in the nordic countries (esping-andersen, 1990, 1999; kvist et al., 2012; kautto et al., 2001; kildal & kuhnle, 2005). we refer, thusly, to citizenship rights of a legal nature. marshall (1992) makes a distinction between civil, political and social rights. these rights are the basis for the concept of modern citizenship and have gradually evolved over the last three centuries: civil rights in the 18th century, political rights in the 19th century and social rights in the 20th century. equality is a fundamental principle of citizenship rights: all njsr – nordic journal of social research vol. 5, 2014 61 citizens must be able to enjoy the same rights. social rights should not only ensure a minimum of social security, but also the right ‘to live the life of a civilized being according to the standards prevailing in the society’ (marshall, 1992:8). examples of social rights are benefits related to health care, social welfare, economic security for diverse groups and education. the right to education constitutes ‘a genuine social right of citizenship’ (marshall, 1992:16). the most imprecisely formulated are social rights, causing them to be the most debated and contested citizenship rights (bottomore, 1992). social rights are relative while political and civil rights are absolute. political and civil rights are used as a protection against the state, while social rights delineate the responsibilities of the welfare state to protect the individual against social risks. this means that citizenship rights affect the nature of the relationship between the citizen and the welfare state in different ways (eriksen & weigård, 1999; westerhäll, 2002). social rights, which build the core of the welfare state, are based on the principles of solidarity and universality (eriksen & weigård, 1999). citizens can benefit from social rights through various human service organizations. professionals from health care, social services and education are primarily responsible for the implementation of social rights, in accordance with the welfare state’s social assignments. in this process of attaining social rights, the individual risks becoming a passive client, deprived of decision-making power and put in a position of accepting ‘one-size-fits-all’ services. the client is exposed to a process of de-individualization, relying on the competence and good will of professionals and, thereby, compelled into the role of passive receiver of social benefits. in order to preclude a paternalistic social system and to improve client status by emphasizing the importance of respect for the client's autonomy and their right to selfgovernance, the role of client has gradually been changed to the role of customer by involving individual service recipients in the decisionmaking process. but this role change has also been brought about in order to create social services of high quality based on effective use of resources. the relationship between citizens and social service institutions is increasingly influenced by the neoliberal values that dominate the organization of, and current thinking about, welfare policy. in the last few decades, there has been a sharp increase in the privatization and deregulation of welfare services, which have subsequently taken the form of market-based services. the citizen, taking on the role of customer, has been empowered through a greater freedom of choice of social services. reflecting the active, obligatory participation of individual service recipients in shaping social benefits and choosing social service providers, agencies have njsr – nordic journal of social research vol. 5, 2014 62 adapted themselves to their demands. social service agencies must embrace market mechanisms, following a customer-oriented approach in which individualizing models of services increases the power of attraction when competing for customers on the market of welfare services (eriksen & weigård, 1999). citizenship as lived experience requires an additional clarification. citizenship regulates the legal, formal relationship between the individual and the state through citizenship rights. this relationship is the basis for formal citizenship (thin citizenship). each right, however, is largely a result of ideological notions. the content of citizenship rights is negotiated within the political arena. an example is the political right to vote, which arises from negotiations as to who should have this right and when this right can be exercised. in different contextual circumstances, implementation of rights requires negotiation. the same right may manifest itself in different ways, depending on the citizen’s ability to invoke his or her rights and the official interpretation of the same. preceding the interpretation of citizenship rights according to law and their implementation is a process involving negotiation based on prevailing sociocultural norms. the standards and attitudes of public, legal, political and private life are socialized and reproduced through these negotiations. thus, negotiation shapes sociocultural citizenship (thick citizenship) (panican, 2007). in our study we assume formal citizenship when we describe the changes in the swedish school system. the formal relationship between citizens and the welfare state has moved towards a more customer-oriented relationship between the individual and the welfare services. this part of the study comprises the descriptive part of our work. in the analytical portion, we will discuss the existing conditions and prerequisites for freedom of choice in the context of the swedish welfare state, from a sociocultural citizenship perspective. this means that we will analyse the substantial, rather than the formal, freedom to choose. this perspective is important in studies that have citizenship as the theoretical starting point because ‘[…] citizenship must be understood as a contextualized concept and lived experience’ (lister et al., 2007:6). the period after the second world war has been characterized as a time of sociocultural citizenship based on an egalitarian social spirit. the core of this spirit is equal citizenship anchored in solidarity for underprivileged groups (voet, 1998). since the early 1980s, the egalitarian spirit has been gradually replaced in favour of a neoliberal ideology with freedom of choice, competition, accountability and flexibility as basic principles. the reagan and thatcher politics, in the njsr – nordic journal of social research vol. 5, 2014 63 us and the uk (new right) respectively, are often mentioned as significant factors in this development (wagner, 2004; harvey, 2005). universal equality is exchanged for equivalence privileges in the sense that all citizens have the same freedom of choice when it comes to welfare services: everyone has the right to choose an education, pension fund and from among various forms of care. according to the concept of neoliberal rights, the idea of equal conditions and the equality of reciprocity between citizens moves towards freedom of choice in order to carry out one’s own life project. at the same time, governance is delegated to the local level. power has been increasingly decentralized, leading to a market adjustment and the liberalization of welfare services (lister et al., 2007; florin et al., 2007). according to neoliberal ideology, the success of this system is dependent on the development of the active and autonomous ‘citizen-consumer’ who is socially, economically, politically and culturally competent (trentmann, 2007; aberbach & christensen, 2005; clarke, 2007; mitchell, 2003; hvinden & johansson, 2007; roberts, 2008). in an education context, such an ideal necessitates that pupils receive an adequate school education that conforms to the current spirit of citizenship in society (ravitch, 2010). pupils should acquire proficiency in what neoliberal ideology considers ‘real knowledge’. this is defined as information that prepares pupils for a knowledgeintensive working life characterized by rapid changes in skill requirements in the wake of new technologies and the need for language skills due to greater internationalization (gandin & apple, 2003). according to this logic, the ‘education industry’ has to ’get smart and get real’ (kenway et al., 2007:2). the makeup of social rights is collectively negotiated within the political arena, while market adjustment has, as shown, led to depoliticization of social citizenship. this means that a citizen’s willingness, ability and position in society are crucial for the implementation of social rights. we wish to emphasize that the opportunity to claim and exercise social rights, not citizen rights as a concept in itself, is changing. elementary and secondary school in sweden the educational system in sweden underwent major changes in the 1990s. these changes were implemented with the explicit purpose of increasing the efficiency and quality of school education. school reforms have promoted free market principles and decentralized njsr – nordic journal of social research vol. 5, 2014 64 decision-making, giving municipalities and individual schools the right to determine the local curriculum (government bill 1990/91:85, swedish government official report 1997:121). this decentralization was followed by an additional school reform granting greater freedom for the establishment of private schools with municipal funding (government bill 1991/92:95). before the deregulation of schools, private alternatives were few and directed towards certain groups of pupils, mostly from the economic elite. it was more or less taken for granted that children and young adults in sweden received their educations from public schools. deregulation in the 1990s, has, among other things, resulted in the replacement of a more detailed set of rules and regulations by performance-based and goal-driven outcomes. the curricula for compulsory schooling and upper secondary schools follow neoliberal ideas: the management of performance and personalization of education via variable content as opposed to regulatory control of school education and uniformity in content. substantial aspects of school activities are determined locally. the freedom to shape education at the local level is combined with freedom of choice in education. one of the aims of the independent school reform of 1992 was to redistribute resources. independent schools would receive municipal grants up to 85 per cent of the individual pupil allowance (government bill 1991/92:95). in the 2009/10 school year, the number of pupils who chose an independent school was 12 per cent of the total pupil volume in primary schools. during the same school year, there were 741 independent schools, as compared to just over 100 in the 1992/93school year. at the secondary level, the proportion of pupils studying in independent schools was 22 per cent in the 2009/10 school year (the swedish national agency for education, 2011). the development of an increased range of choices is not solely a case of providing a greater number of options when choosing between public or independent schools. in sweden, an additional market of education has emerged within the public sector. public schools can hence face the same challenges as independent schools, exposed to competition on a market where those who fail to recruit pupils will meet difficulties in receiving public funding (richardsson, 2004). thus a neoliberal market discourse emerges: humanistic values are viewed as a key principle of education, and the equivalence of knowledge and access to education are being challenged by market motives, through which profit margins and competition between schools are becoming important factors for the educational system. njsr – nordic journal of social research vol. 5, 2014 65 this, however, is not the main focus of our discussion; our main focus is instead the pupils’ and parents’ freedom of choice of schools and education. possible restrictions on choice the process of choosing from among different alternatives opens up opportunities to choose an alternative that can increase the probability that the specific service is tailored to the individual’s own preferences and needs (norén, 2010). however, as the literature has shown, this process of choosing also includes dimensions that restrict the opportunities to make a fairly independent choice. in this section we problematize the process of choosing and discuss some restrictions that affect the choice of an education program and provider. there are several ways to approach the question of restrictions on choosing. we suggest two types of constraints that, in different ways, hamper or thwart the selection process. the first one – structural restrictions – focuses on causes that can be defined or understood as restrictions arising from societal structures and can be considered as external in relation to the individual. examples of this type of hindrance are a lack of information and/or knowledge of alternatives, geographical barriers, ethnicity and class. such restrictions reflect the way opportunities and possibilities are distributed and can partly be seen as a consequence of how market dynamics contribute to an already unequal distribution of opportunities regarding choice among diverse groups. these hindrances are sometimes more explicit, and appear as ‘closed doors’, and at other times are more discreet. agency-based restriction – the second type of restriction – builds upon the analytical framework of bourdieu, or more precisely, his concept of habitus (bourdieu, 1984). habitus is basically defined as the way people behave in different settings and contexts. bourdieu considers habitus class-based and as being reproduced in an unconscious way. this perspective can be viewed as more agency-based, focusing on dimensions that explain why some prefer a certain school or programme. that is, agency-based restriction is founded on ideas of how a citizen, dependent upon aspects like sociocultural acceptance, is expected to act. even if the concept of habitus has structural connotations, we suggest that individuals, in this context, can be considered as agents who make their own choices. this analytical tool implies that the citizen, in different ways, is directed in the process of choosing when several options are considered inappropriate, even if these options are seen as attractive to the individual. this type of restriction is often expressed and interpreted as if the choice is a real and rational one. njsr – nordic journal of social research vol. 5, 2014 66 structure-based restrictions personal desire to choose from among alternative schools and programmes may indeed exist. however, due to various restrictions, actual opportunities to choose may be lacking. one structural barrier could be geography. for example, schools with highly qualified staffs and good performance records are often located in affluent areas far away from socially marginalized neighbourhoods (arnman & jönsson, 1986; bunar, 2010b). attractive schools are thus out of reach for disadvantaged groups, as the range of alternatives is limited due to time constraints or travel expenses. in this way, freedom of choice can reinforce geographical segregation concerning education alternatives. however, overcoming this obstacle is not necessarily a response to greater freedom of choice; a citizen may simply have ‘geographical luck’ and live in an area that has developed into a wealthy district. however, the rhetoric promoting the growing range of alternatives points to opportunities, made available through an increased freedom of choice, to counteract geographical barriers. another type of barrier is the pedagogical/didactical methodology used in schools. the form and content of education are sometimes directed only to pupils with specific cultural and social capital. the actual opportunities for choice are limited to one single school, or to one type of school that coincides with the pupil’s sociocultural capital (for empirical examples see dovemark, 2007; bunar, 2009). freedom of choice is also blind to the citizen’s own actions. freedom of choice follows the logic that all citizens are equal regardless of class, ethnicity, gender, sexuality, ability, competence and cultural and social capital. yet choice does not take place ‘… in a social vacuum. choosing a school other than the nearest one requires knowledge of educational alternatives and how other schools work, knowledge that is often unevenly distributed socially. the real opportunities are often very different among diverse groups of parents in a socially stratified society’ (arnman et al., 2004:31, our translation). the lack of knowledge needed to exercise freedom of choice can be a barrier to the disadvantaged, who do not always have the necessary tools regarding knowledge, time, status and resources (broady, 2001; swedish government official report, 2000:39). disadvantaged groups are not necessarily poor or socially marginalized. through a variety of social constraints, financially well-off groups can also be included in the category of disadvantaged in this context. self-image and family values and networks, as well as social conditions, can make it more difficult to manage information about different options; the options available can be unfamiliar. the njsr – nordic journal of social research vol. 5, 2014 67 disadvantaged have to choose between different schools and educational alternatives in competition with the highly educated. yet the structural conditions are different: in these cases freedom of choice may be described as a selective mechanism that strengthens social and ethnic segregation (bunar, 2009, 2010a). these barriers have also been explored in an international context where similar freedom of choice exists; see peters (2001) on choice in the rapidly changing educational system in new zealand, as well as studies of problematic choice reforms within the us-american educational system (young & clinchys, 1992; ravitch, 2010) and ball’s (2003) studies on the same conditions in the uk. difficulties associated with freedom of choice could result in abandoning the process of choosing altogether. ball (2003) distinguishes between ‘cold knowledge’ – more formal information provided by schools – and ‘hot knowledge’. ball suggests that the middle class prefer ‘hot knowledge’, such as information gleaned from informal conversations about evaluations of schools, or gossip and rumours discussed within their network. this type of information is often dominated by symbolism that can only be interpreted by those within the same class (johnsson, 2004). the shared social capital within this social category allows one to communicate and absorb information in a way that perpetuates class positions. like-minded middle-class people, for example, can conclude that the range of schools does not include suitable alternatives that meet their educational needs (lund, 2006). in this case, one is forced into a passive role. in the absence of suitable alternatives, there is a risk that no choice is made – something that could be considered a form of not being able to choose. another obstacle that is relevant is the fact that the opportunity to choose from among alternatives may be largely unknown, especially among immigrants (dahlstedt, 2007; bunar, 2008). this lack of awareness can be attributed to language barriers or lack of cultural competence, which make it difficult to absorb information about school choice. also, school administrators might withhold information about options in order to keep potential pupils or keep out those that the school does not deem desirable (bunar, 2009). it is not only market-based mechanisms that can create hindrances and barriers related to the process of choosing. such obstacles can also arise as a result of governmental policy. upper secondary education is voluntary; individuals may choose not to study at this level. however, in reality, opting out is discouraged. there are individuals who prioritize work and choose not to study at all, but there are few employers who want to hire young adults without upper njsr – nordic journal of social research vol. 5, 2014 68 secondary level qualifications. such ‘unskilled’ jobs are often advertised at employment offices. in interviews with representatives of municipal and governmental authorities in a small municipality, characterized by a high density of self-employed persons, the findings suggest that there is a demand for unskilled labour. nonetheless, those interviewed argued that discouraging upper secondary level education is unthinkable. several interviewees refused to recommend unskilled labour jobs to young unemployed persons despite a right to opt out of upper secondary level education. the same normative attitude, that considers a capable workforce as one with skills obtained from upper secondary education, prevails in several municipalities (panican, 2013). in addition, not only do government agencies more or less coerce youngsters to study at upper secondary level, they also promote choices of education within a range of what is considered as reasonable in relation to public interest and policy objectives (norén, 2003; 2010). another aspect that affects the freedom of choice is that alternatives are directed, in more or less sophisticated ways, towards increasing or reducing a citizen’s ability to select a particular option (peters, 2001; lund, 2007). representatives from schools can make it difficult to choose, or persuade potential pupils and parents to not choose a particular school or educational programme. it is not just the parents and pupils who choose the school, but also the school that chooses its’ pupils. according to a study conducted by skawonius (2005), ‘…the headmasters made [...] informal agreements with each other to keep the children of foreign origin in “immigrant schools” [...] with the argument that these schools have the competence to work with them. the headmasters also decided where pupils were placed among their respective institutions’ (2005:327, our translation). the same study provided empirical examples of how headmasters neglected to inform some parents of alternatives, or how they attempted to make decisions without including parents. in this context, it is also important to mention the principle of proximity (the importance of pupils attending schools in their own neighbourhoods) as a means to reduce the demand on attractive schools. occasionally, under this principle, pupils from areas outside of the local school’s catchment area – sometimes from ‘problem’ areas – are excluded from the selection process (damgren, 2002; hohnen & hjort, 2009). these different aspects of hindrance and barriers are important to take into consideration when the transition from citizen to consumer is discussed. principles such as equality and solidarity are challenged by market-based mechanisms such as segmentation, competition, and flexibility. even if there are positive aspects of increased freedom of choice, this must be problematized with regard to the principal njsr – nordic journal of social research vol. 5, 2014 69 differences in the relations between, on the one hand, customer and provider and, on the other hand, the citizen and the welfare state. agency-based restrictions there seems to be an idea of a rational citizen who can make sagacious choices based on quality. the ‘right’ choice is not merely an instrumental and strategic choice focusing on matching the pupil’s ability and interests to educational content and future labour market opportunities. it can also include various external factors such as ‘… pupil status (how many pupils from the domestic swedish population there are at a school) and neighbourhood status, “the reputation of the neighbourhood”’ (bunar, 2005:77, our translation). as previous research suggests, making the ‘right’ choice also means adapting to, and relating with, the sociocultural norms that shape the acceptable alternatives for various socioeconomic groups. in the literature on freedom of choice and education, bourdieu’s concept of habitus – the socialized and reproduced subjectivity of the individual – is often emphasized (johnsson, 2004; dovemark, 2007). different social groups distinguish themselves by the choices they make and thus reproduce the social order. conformity with prevailing expectations governs the choices made: ‘the educational background of the parents is thus the most critical factor in school choice’ (skawonius, 2005:17, our translation). pupils with well-educated parents are expected to choose theoretical programmes that prepare them for university studies, while children of less-educated parents are expected to choose vocational programmes (arnman et al., 2004). johnsson (2004) suggests that individual preferences combined with external expectations create the perception of a rational choice among diverse groups. strategically and socioculturally correct choices may at times coincide, but, in failing to do so, may also emphasize the gap between the alternatives. the usual focus of works related to this theme is on how disadvantaged groups are affected by the increasing freedom to choose. one of our main findings in this paper can broaden the understanding of the transformation from client to consumer, which is an important issue for all citizens regardless of their socioeconomic position. also, the alternatives for well-educated and resource-rich groups tend to be restricted. the same is true about less-educated groups with limited resources. a pupil can break out of this generated conformity, but does so at the risk of being labelled as deviant, regardless of socioeconomic group. a doctor’s child who chooses an automotive vocational programme tends to violate established social njsr – nordic journal of social research vol. 5, 2014 70 norms. making the ‘right’ choice means choosing from the options associated with social norms, which are based on similarities within a social group. it can be assumed that citizens with higher socioeconomic status may to be more likely to make independent choices and go against the tide, while the socioeconomically underprivileged citizens are more apt to make choices that are in line with expectations. the former group may well be in a position that makes it easier to justify choices that defy social norms. pupils that are performing at a high level may also have some difficulties in choosing educational programmes. they may be able to choose whatever they want, but perhaps others intend for them to be doctors or lawyers, while they may be most interested in an artistic education; for example dance. in a recently completed study, results indicated that there were two categories of pupils that seemed to experience the most difficulties regarding choice. on one hand were pupils with weak academic results from relatively disadvantaged families and, on the other hand, pupils with good academic qualifications from well-educated families. the first group’s problems seemed to be caused by difficulties decoding information. for the other group, managing a substantial range of alternatives that included not only the educational programme they wanted to choose, but also that which they were expected to choose, was problematic. the second group seemed to be worried about closing doors in relation to future career possibilities (hjort, hjärpe & panican, 2013). the tendency to choose in accordance with, and not against, expectations reveals a limitation in what is intended to represent freedom of choice for all citizens. despite the fact that the institutional and policy-based arrangements of comprehensive schooling have increasingly been replaced by new alternatives, the reproduction of sociocultural norms remains (dovemark, 2007; olofsson, 2010; dahlstedt, 2007). in the rhetoric promoting freedom of choice, differences and inequalities are attributed to citizens’ choices and not to societal structures. whether or not the freedom to choose changes the problems accorded to the citizen by inequality in the previous educational system is a subject for debate. freedom of choice involves the risk of perpetuating inequality among all social strata. from this perspective, making the ‘right’ choice restricts the freedom of choice, since ‘right’ bears different meanings for different social groups. equality prevails within a group, implying the assumption, and continuation, of inequality between groups. additionally, examples of agency-based restrictions can include individuals who abstain from exercising freedom of choice; those who oppose the increasing marketization of welfare services and on njsr – nordic journal of social research vol. 5, 2014 71 principle refuse to choose a school, for example. the reason behind this point of view could be the idea that public schooling is an expression of solidarity and social justice as well as a tool to reduce class divisions. perhaps there is no interest on the part of the individual in educational alternatives or alternative schools. the choice of school is passively delegated to municipal officials. this could be the case even if the assigned school does not meet the child’s skill and personal developmental needs (damgren, 2002). a combination of structural and individual obstacles exists, in the sense that options can be presented or described in an incomprehensible way for those less familiar with the school system. the selection process is conducted in a way that is difficult for individuals to understand, using complex information to describe the alternatives. agency-based restrictions emphasize important issues in a process of choosing. the idea of the independent individual with competence to choose in accordance with personal preferences is challenged by previous research results indicating that the individual is interwoven in a web of values and perceptions constituting the ‘right' choice. a choice deemed as individual-based can thus be questioned. conclusion and discussion the transformation of the relationship between the citizen and the welfare state, with the aim of improving the position of the individual in attaining social rights, is a complex process. the goal is that the individual will be empowered to participate to an increasing extent in shaping social benefits. however, these good intentions can be problematized, as there seem to be different types of constraints, such as market logic and socioeconomic structures, which influence the process of choosing. the citizen is forced to assume greater responsibility in choosing welfare services. instead of playing the role of recipient, the citizen is viewed as a consumer of services. when schooling for a child fails to meet expectations, it is no longer primarily the problem of the welfare state that provided a defective service. rather, this becomes the responsibility of the parents, who made an inadequate choice. the question is how citizens, who to varying degrees have power over the limitations discussed above, can be regarded as responsible and selfregulating members of society. one conclusion that can be drawn from this article is that when we consider social rights in their explicit njsr – nordic journal of social research vol. 5, 2014 72 form, we are increasingly assessing the consumer’s ability to choose while focusing less on the quality of the services rendered. a greater range of alternatives is meant to enhance both competition between and the quality of services, and also to better address citizens’ specific needs. critics have previously argued against a government monopoly stating, for example, that monopoly circumstances attempt to create services that suit all (‘one-size-fitsall’), while implying that such services will actually suit none. these arguments often promote the idea that a greater share of welfare services should be market-driven. despite this rationale, there remains a strong support for public welfare services (svallfors, 2004). educational reform has mainly taken place in recent decades, and we have a fairly limited knowledge of attitudes towards it. an important aspect of this reform is the fact that the welfare state relinquishes responsibility for guaranteeing citizens equal access to qualitatively acceptable welfare services. as discussed in this article, there are various reasons why citizens find themselves in problematic situations in which they are forced to choose and must invest more time and energy to gain access to welfare services. this applies to many different types of citizens, including those who are highly skilled, unskilled, and disadvantaged. the research reviewed in this article suggests that sociocultural citizenship is increasingly anchored in neoliberal rhetoric, indicating a shift in responsibility from the state to the civil and private spheres. in recent decades, there has also been a shift in favour of the market and towards increasingly placing on the individual the responsibility to ensure that citizenship rights provided by the (welfare) state are materialized. the citizen is expected to act on, choose, apply for or otherwise exercise his or her right to the freedoms the state provides. through the manifestation of social rights based on freedom of choice, equality within one’s own social group is reproduced, while inequality between such groups persists. it appears that social citizenship reinforces social and ethnic segregation via the freedom of choice that is deeply rooted in the concept of social rights. the concept of modern citizenship strives to abolish inequality between groups. modern citizenship is complemented by the principle of universal equality: all citizens are equal in status. the swedish welfare state, which includes extensive social citizenship, is traditionally based on the belief that citizens should have the same opportunities to receive welfare services and that the state and local governments should guarantee equal welfare services. there appears to be a risk that greater freedom in choosing welfare services produces inequality between groups in different socioeconomic njsr – nordic journal of social research vol. 5, 2014 73 positions with social and ethnic segregation as tangible consequences. in the neoliberal market-based discourse that dominates sociocultural citizenship, the principle of universal equality is actually transformed into equal freedom of choice. regarding the actual opportunity to choose, citizenship rights are based on the idea that there should be universal equality of access to and opportunity for utilization of welfare services. since the individual, in the role of customer, has an increased responsibility for monitoring and exercising his or her rights, we believe that the principle of universal equality is being challenged. all citizens have a formal right to a range of welfare services. that means that the state has guaranteed equality from a quantitative perspective: everyone has the same formal rights to the same welfare services. however, the opportunities to utilize these services are not equally distributed, because of the knowledge and ability required. in addition, socioeconomic structures can hamper or thwart the process of choosing; what can be understood as a free choice can also be seen as predestined by dimensions such as class and ethnicity. as we have shown, not all citizens have the same conditions and opportunities for making choices. in addition to these factors, we also want to emphasize how institutional arrangements can govern the distribution of alternatives. this occurs when welfare-service administrators prioritize their own interests instead of the principle of universal equality. in the context of this study, this means that not everyone receives the same offer of alternative schools and educational programmes. this article emphasizes two issues for further study: the first concerns the development of the relationship between citizens and welfare services towards one in which the citizen takes on the role of customer. the second issue introduces sociocultural citizenship as an expression of public opinion. the extent to which the marketization of welfare services reflects a general change in attitudes can be debated (svallfors, 2004; calzada & del pino, 2008). does the marketization of education reflect prevalent sociocultural norms? this development raises questions about 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(1992). choice in public education. new york: teachers college. njsr nordic journal of social research www.nordicjsr.net getting it right: estimating the share of volunteers in denmark jonathan hermansen department of research and development university college ucc, denmark email: johe@ucc.dk abstract abraham, helms and presser (2009) demonstrated that people who volunteer are more likely to participate in surveys. the apparent consequence of such a pattern among respondents is that estimates of volunteering could be biased. surveys with voluntary work as the main topic could be further biased due to the volunteers’ interest on this issue compared with non-volunteers. the article uses panel data from denmark in order to examine the bias due to panel attrition as a special kind of nonresponse bias and its consequences for estimates of volunteering. the results show that panel attrition leads to an overestimation of the share of people who volunteer. keywords: volunteering, panel attrition, participation, social desirability introduction panel attrition in longitudinal studies can give biased estimates (callegaro & disogra, 2008), which is why many researchers are exploring a wide variety of incentives and attributes to encourage more people to participate in surveys (keeter, miller, kohut, groves, & presser, 2000; ryu, couper, & marans, 2006; van ingen, stoop, & breedveld, 2009). panel attrition may introduce bias if it is not random, and it is particularly troubling if the nonresponse pattern is somehow related to the outcome of one or more of the key variables of interest (see also hauser, 2005). this article investigates how volunteering affects the potential respondents’ willingness to participate in surveys on volunteering in the case of denmark, but the results are likely to reflect the same obstacles in many other european countries that depend on survey estimates, particularly those that rely on longitudinal studies. abraham, helms and presser's (2009) study demonstrated that nonresponse did inflict bias on estimates of volunteer work in the united states since the probability of participation in a survey is associated with doing volunteer work. the reason that survey participation and volunteering might coincide could be that they express a similar set of personal traits. both activities are characterized by a willingness to devote time to something that may not offer immediate benefits to the participant. it has been argued that survey njsr – nordic journal of social research vol. 9, 2018 2 participation is closely linked with the notion of civic duty (groves, singer, & corning, 2000). a panel attrition bias on estimates of volunteering would imply that other measures of prosocial activities could be overestimated due to a social desirability bias (cnaan, jones, dickin, & salomon, 2011). that is, people would be more interested in participating in surveys that would allow them to tell about their social engagements if they are engaged in such activities. the outcome would be that nonresponse would lead to overestimations of prosocial activities in general. the article is organized in the following way. first, a review of the literature on survey participation and potential barriers that lead to nonresponse or panel attrition is discussed. survey participation is associated with a demonstration of civic duty, which is a reason to test whether panel attrition affects estimates of volunteering and the degree to which survey participation and volunteering are associated. second, the research question, which concerns how volunteering may affect survey participation in a panel on volunteering and how panel attrition in return could distort the estimates of volunteering in denmark, is discussed. third, the design and the results of the analysis are shown; employing data from a two-wave panel survey allowed an analysis of the extent to which the attrition can be ascribed to whether or not the respondents volunteer. finally, the effect of panel attrition on estimates of volunteering is summarized, and the consequences for measures of volunteering and prosocial activities are elaborated. previous research the key dependent variable of this study concerns the decision of whether or not to participate in the second wave of the survey. in other words, the primary aim is to identify the factors that cause panel attrition. panel attrition may be treated as a type of nonresponse since the effect of panel attrition is a lower overall response rate. in a longitudinal survey, as used in this study, attrition is defined as the percentage of members in the panel who drop out from one wave to the next. the decision not to take part in a survey may be determined by the characteristics of the individual respondent (e.g., the gender of the respondent) or the design of the questionnaire (e.g., the number of questions or the personalization of the cover letter). respondent factors have been shown to be more influential than survey design factors in determining what causes panel attrition and nonresponse in general (helgeson, voss, & terpening, 2002). in this article, attention is directed towards three categories of respondent factors that may contribute to panel attrition. first is a lack of interest in the topic of the survey (groves et al., 2000). second is the absence of a prosocial attitude and the sense that it is important to participate in non-commercial population surveys (sharp & frankel, 1983). third is a general lack of knowledge or aptitude to answer and understand the questions of the interview (tourangeau, 2003). the following section describes how these three factors may affect the decision to participate in a survey. in survey research, it has been well-established that a respondent’s interest in the topic is a crucial factor impacting the decision to participate in surveys (heberlein & baumgartner, 1978; sheehan & mcmillan, 1999). the importance of the survey topic is referred to as ‘topic saliency’ within the survey research literature (e.g., zillmann, schmitz, skopek, and blossfeld, 2014). however, njsr – nordic journal of social research vol. 9, 2018 3 respondents may also be motivated by the interviewer and a number of other contextual factors (campanelli & o’muircheartaigh, 1999). hence, it has been proposed that the decision to participate in surveys could be perceived as a form of community involvement (couper, singer, & kulka, 1998). this would help to explain why certain subpopulations are typically more inclined to participate in surveys when being invited. evidence suggests that the sense of civic duty in filling out a questionnaire is a better indicator of survey participation than the amount of time that people have on their hands (pääkkönen, 1998). voogt and saris (2003) demonstrate that the sense of civic duty, along with an attachment to the local community, is likely to increase the probability of participating in surveys. thus, people who volunteer are more likely to express a higher degree of civic duty, as they would have an inherent interest in the topic of volunteering. this argument would support the notion that volunteer work and survey participation are associated. if prosocial attitudes are crucial for survey participation, it could imply profound bias on estimates of civic engagement, such as volunteering, without a compensatory research design. moreover, social desirability could explain the coinciding of volunteering, survey participation and the awareness of civic duties. it could lead to overestimation of civic engagement, and the overestimation would increase as response rates decrease (wilson, 2012). abraham, maitland and bianchi (2006) demonstrate that the use of weights will improve measures of volunteering along with measures of daily activities, such as household chores, albeit with a modest effect. such weights could take into account the demographic characteristics of the respondents when compared with non-respondents or with the entire population of interest. it should be noted that gender has been identified as a relevant factor in studies of panel attrition, as men tend to attrite more frequently than women do (uhrig, 2008). this finding is congruent with previous studies of nonresponse differences between men and women (e.g., sax, gilmartin, & bryant, 2003). another reason for panel attrition could be the inability to comprehend and answer questions in the survey. a bias could arise if incomprehension is related to the propensity to answer the questions of the survey. in this context, incomprehension as a barrier does not refer to intelligence but only to the capability and self-confidence necessary to accept the request and complete a survey interview. thus, one reason an individual would not participate in a survey is communication difficulties (johnson, o’rourke, burris, & owens, 2002). this could partly explain why people with more resources, such as educational achievements and sufficient comprehension, are more likely both to volunteer and to participate in surveys (e.g., abraham, helms, and presser, 2009; freese, 2006; wilson, 2000). the research question abraham et al. (2009) note that low response rates may have contributed to higher estimates of the volunteering rate. in other words, the nonresponse bias may skew the estimates of volunteering positively. volunteer work is associated with possession of resources and social networks (see wilson, 2012; wilson & musick, 1997), which would make the implication of the bias even stronger. it could also imply that other activities reflecting a prosocial attitude and possession of personal resources would be overestimated as well. therefore, it seems plausible to assume that volunteer work and survey participation are associated. volunteering is also associated with a possession njsr – nordic journal of social research vol. 9, 2018 4 of personal resources and skills. thus, panel attrition due to communication difficulties could lead to an overestimation of the share of people who do voluntary work. panel attrition could also lead to an underestimation of the importance of the association between incomprehension and volunteering, due to the self-selection in the panel, which may affect the representativeness of those with a lower aptitude. based on previous studies of survey participation and volunteering, the research question of this article is formulated as follows: how does volunteering affect panel attrition in surveys concerned with voluntary work? the question derives from the study of abraham et al. (2009). this article attempts to test the association between volunteering and panel attrition within a european country, namely denmark. if there were an association to be found, it would imply that estimates of volunteering would be skewed. thus, this article aims at identifying the importance of such a distortion on estimates of volunteering. data and variables zillmann et al. (2014) identified two common approaches to examining how respondents’ interest in the topic affects the survey estimates. one approach is to conduct a classical experimental study with a treatment group and a control group in randomized trials. the stimuli could be different presentations or content of survey items in a controlled environment. these experiments have the obvious advantage of avoiding selection bias. however, one should be cautious when drawing conclusions because of the varying external validity of such experiments (barabas & jerit, 2010). a different approach is to use panel data. panel data enable researchers to determine issues of order since all the data is collected at different times. hence, it is possible to track changes in the same respondents over time. the drawback of this approach is that it is difficult to determine the causal impact of each stimulus that might affect the decision to participate. this study uses panel data to investigate the potential bias. it is based on data from a danish two-wave population survey. the surveys were carried out in 2004 and 2012 with an identical focus on volunteering, charitable giving and informal helping in denmark. the principal aim of the surveys was to map the extent of these activities in denmark and to track potential changes over the years. the surveys functioned as the empirical foundation of a large-scale research collaboration concerning the composition of civil society in denmark. the danish national centre for social research collected the responses. the questionnaires were developed in cooperation with researchers from aalborg university, roskilde university and the university of southern denmark. the 2004 survey was designed to be representative of the adult danish population with a simple random sampling of respondents. the survey in 2012 was designed as a panel study, which included all the respondents from the previous survey who were younger than 86 years of age. in addition, a supplementary sample was conducted to ensure a sufficient number of respondents. the sampling frames were created using administrative records, which provide an exhaustive coverage of the danish population. the response rates in each of the two surveys were 75% (first wave) and 71% (second wave). hence, the overall response rate of the panel study, from the initial survey through the second survey, was 53%. the response rate of the supplementary sample collected in 2012 was 59% (fridberg, 2014c). in both surveys, most of the njsr – nordic journal of social research vol. 9, 2018 5 interviews were conducted over the telephone. in the case of non-contact, interviewers were sent out in person. the analysis is based on the answers of 2,511 respondents from the 2004 survey. the empirical model contains respondent factors, two demographic control variables and a dependent variable. table 1 descriptive statistics of the dependent and independent variables variable n mean std. dev. min max attrition 2511 0.331 0.471 0 1 volunteer 2511 0.368 0.483 0 1 incomprehension 2511 0.096 0.295 0 1 years of school 2511 10.435 2.116 6 15 trust in associations 2511 0.831 0.375 0 1 obligation 2511 1.330 0.897 0 2 pol. interest 2511 1.714 0.842 0 3 male 2511 0.483 0.500 0 1 age 2511 45.023 14.816 16 76 the dependent variable of this study is panel attrition. it is a simple dichotomous variable that represents whether the respondent who participated in the 2004 survey took part in the subsequent wave in 2012. unfortunately, even if contact was established, any reasons that the respondents may have given for refusing to participate in 2012 are not matched with the individual respondent. therefore, the analysis consists of respondent factors from the 2004 survey. first, the primary independent variable is whether the respondents were volunteering in 2004. the respondents were asked if they had volunteered within the last 12 months. in total, 36.8% of the respondents reported they had been actively engaged in voluntary work within the last 12 months. above, table 1 states that the attrition rate is 33%, so approximately 67% of the 2004 respondents also participated in 2012. the attrition rate is 4 percentage points higher than would be expected if the focus was on the overall response rate of the second wave in the panel study. this is due to the listwise deletion of respondents who did not answer all of the interview questions. that is, the 67% completion rate contains only those respondents who completed the entire interview. the a priori selection—in the sense that only people who participated in 2004 were eligible for the panel—has to be considered in order to determine whether the completion rate is satisfying (see also schoeni, stafford, mcgonagle, & andreski, 2013). in total, 19.6% refused to take part in the second wave, whereas the remaining non-respondents were either ill, could not be found or had moved to an unknown address (fridberg, 2014a). it is not possible, due to data limitations, to distinguish between different sources of attrition in the analysis. second, a set of variables measured the prosocial attitude of the respondents. one question asked the respondents if they felt morally obligated to donate money to charity. the answers were coded into three categories: ‘agree’, njsr – nordic journal of social research vol. 9, 2018 6 ‘neither agree nor disagree’ and ‘disagree’. since the three categories were given the values of zero, one, and two, respectively, the mean value of 1.3 shows that more people disagreed than agreed with the statement regarding moral obligations (see table 1). another item asked if the respondent had trust in voluntary associations. the variable was a dummy variable indicating whether the respondent trusted voluntary associations or had little/no trust in voluntary associations. table 1 shows that 83% of the respondents trusted voluntary associations. the final variable concerning the prosocial attitude of the respondents asked how interested the respondent was in politics. the question consisted of a four-point rating scale, from ‘no interest’ (assigned the value zero) to ‘very interested’ (assigned the value three). as shown in table 1, the average score of political interest was 1.7. third, two variables measured the respondents’ comprehension and personal resources. one dummy variable measured whether the respondent had difficulties understanding the questions during the interview. unlike the other variables, this question is the judgment of the interviewer immediately after the interview. in total, 9.6% of the respondents were reported to have had difficulties answering the question. the other variable measured the years of school completed by the respondent. on average, the respondents had completed 10.4 years of school. the variable did not distinguish between any educational achievements of upper-secondary level. however, in terms of understanding the questions during the interview, there is little reason to believe that there would be significant differences among people who had finished 15 years of school. the demographic control variables were gender and age. table 1 shows that 48.3% of the sample were men, the average age was 45 years and the respondents’ ages ranged from 16 to 76 years (in 2004). analysis fridberg (2014b) mapped the field of volunteers in denmark. he concluded that the share of men who volunteer is slightly higher than for women and that people aged 36 to 45 are the most likely to volunteer across all age groups. in addition, a larger share of people with higher education do volunteer work as compared to people with little or no education (fridberg, 2014b, p. 52). furthermore, qvist (2014, p. 181) argued that language barriers are one of the key reasons immigrants are less engaged in voluntary work as compared to the rest of the population. overall, the level of volunteering in denmark has been relatively stable in recent years (fridberg, 2014c). a logistic regression model is used to determine how the respondent factors contribute to panel attrition. the results of the logistic regression models are presented in table 2. the table contains the regression coefficients (log odds) represented, as well as the robust standard errors. in the model, the value of the squared age variable is included to allow for a nonlinear association. furthermore, table 2 contains a column of the percentage change in the odds of panel attrition for a unit increase in each of the independent variables. the interpretations of the coefficients and the percentage change should take into consideration the statistical significance denoted by asterisks. in order to investigate whether the model is specified correctly, a formal test was conducted that entailed testing whether a squared term of the predictors was significant. the test yielded a p-value of .41. hence, this test did not show any problems or misspecifications with the model. njsr – nordic journal of social research vol. 9, 2018 7 table 2 logistic regression of panel attrition attrition log odds (robust standard errors) percentage change in odds for unit increase in x volunteer (ref. non-volunteer) -0.268** -23.5% (0.094) trust in voluntary association (ref. no trust) -0.054 -5.2% (0.116) moral obligation: neither agree/disagree (ref. agree) -0.210 -19.0% (0.170) disagree (ref. agree) 0.129 13.8% (0.102) political interest: little interest (ref. no interest) -0.065 -6.3% (0.164) somewhat interested (ref. no interest) -0.509** -39.9% (0.163) very interested (ref. no interest) -0.400* 33.0% (0.187) incomprehension (ref. comprehension) 0.142 15.3% (0.145) years of school -0.074** -7.1% (0.025) male 0.334*** 39.6% (0.091) age -0.087*** -8.3% (0.018) age squared 0.001*** 0.1% (0.000) constant 1.897*** (0.519) observations 2,511 *** p < 0.001, ** p < 0.01, * p < 0.05 log-likelihood: -1594.096. mcfadden pseudo r2: 0.04. overall model fit: p < 0.001, n = 2,511. table 2 shows the results of the logistic regression model. most importantly, the results confirm that volunteering is negatively associated with panel attrition. the association is statistically significant (p < 0.01). volunteering in 2004 decreased the odds of opting out of the survey in 2012 by 23.5%. this finding suggests that there is reason to believe that estimates of volunteering could also be skewed in denmark due to attrition rates. in other words, people who volunteer are more likely to take part in surveys on voluntary work. concerning the prosocial attitude of the respondents, the results indicate that these measures may have less impact on panel attrition. neither the trust expressed in voluntary associations nor the question of donations to charity as a moral obligation is statistically significant. a higher interest in politics decreases the likelihood of dropping out of the panel. respondents who said that they were ‘somewhat’ or ‘very’ interested in politics had a 39.9% and 33.0% chance of lower odds of attrition, respective to the years of the study, as compared with those who had ‘no’ interest in politics. the results of the variables that measure the comprehension and personal resources for survey participation show that years of school is a significant predictor of the attrition rate (p < 0.01). each additional year of education reduces the odds of attrition by 7.1%. on the other hand, difficulties understanding the questions (e.g., due to language problems) is not a significant predictor. this finding could in part be explained by the fact that the model controls for years of school, and that a relatively small group of respondents njsr – nordic journal of social research vol. 9, 2018 8 were reported as having problems understanding the interview questions. furthermore, it is possible that some people who would find it difficult to complete an interview had opted not to participate in the first survey of 2004. hence, they would not have been invited for the second survey in 2012. both of the demographic control variables are significant. in accordance with the results of lugtig's (2014) study, men are less likely to remain a part of the survey. furthermore, middle-aged people, who are also more likely to carry out voluntary work in denmark (fridberg, 2014b), have a higher propensity to participate in the survey. the attrition rate is significantly higher among men as compared with women (p < 0.001). men have 39.6% higher odds of dropping out of the panel. the age variable is included in simple form and as a squared term. the negative coefficient of age and the positive coefficient of age squared show that the attrition rate is highest among the youngest and the oldest. thus, panel attrition in relation to age has a u-shape, and the association between attrition and age is significant (p < 0.001). figure 1 illustrates how volunteering affects the probability of panel attrition. as the regression analysis shows, other factors contribute to panel attrition as well. hence, the figure shows how the attrition rate differs between men and women depending on years of education (95% confidence intervals have been added to display the statistical uncertainty). the estimates of figure 1 contain the same independent variables as the regression analysis. figure 1 predicted probabilities of panel attrition for women and men on a scale of years of school figure 1 predicted probabilities of panel attrition for women and men on a scale of years of school figure 1 shows the discrepancy between volunteers and non-volunteers in terms of panel attrition. volunteers are more likely to participate in the second wave as compared with non-volunteers. moreover, figure 1 illustrates that the differences can be substantial. women and people with more years of education have lower attrition rates. in order to assess the question of how panel attrition then affects estimates of volunteering, it is useful to look at the overall probability of panel attrition for the volunteers and non-volunteers, respectively. the overall probability of panel attrition is 29.5% for a volunteer and 35.1% for a non njsr – nordic journal of social research vol. 9, 2018 9 volunteer when controlling for the other independent variables, resulting in a 5.6 percentage points difference that is statistically significant (p = 0.004). the nonresponse bias due to panel attrition could increase in every subsequent wave, thus leading to a much greater bias. the topic saliency could amplify panel attrition, as the respondents would be familiar with the questions from the previous wave. thus, the experiences from the first survey could affect the decision to participate in subsequent surveys, although there are many other possible influences on whether one participates. it is not possible to determine to what extent this effect is at play in this study. however, the eight-year gap between the two waves is likely to reduce the individual respondent’s recollection of the previous interview. it would be necessary to continue the panel design in future waves of the population survey on volunteering in order to examine whether panel attrition amplifies the non-response bias due to non-volunteers opting out. however, a simple way to estimate the potential bias due to panel attrition is to compare the rate of volunteers in the 2012 panel to that of the supplementary sample collected in the same year. in the panel, 39% reported volunteering within the last year, whereas the corresponding statistic is 29% in the supplementary sample. this suggests that panel attrition is likely to bias the overall estimate. if one relies on the panel data without considering panel attrition, the share of volunteers appears to be overestimated. as the results of this study indicate, if one estimates the overall rate of volunteers, controlling for demographic characteristics, the bias could be reduced. it is unlikely that it could remove the bias entirely, as the attrition is contingent on factors that are difficult to measure. for instance, whether or not the respondent was volunteering in the previous wave is not an exhaustive indicator of topic saliency. the nonresponse bias from panel attrition may very well differ from other sources of nonresponse (e.g., the nonresponse obtained during the first wave). it seems plausible to assume the share of volunteers among those refusing in the first wave would be lower when compared with the respondents of the survey, as was the case when comparing the 2012 panel study and the supplementary sample. therefore, the nonresponse bias discussed in this analysis is only a partial investigation of the overall nonresponse bias. both the bias related to the topic saliency and the decision to respond prior to the first survey in 2004 are worth considering, especially since many researchers in recent decades have faced problems with decreasing response rates (peytchev, 2013). the lower response rate in the supplementary survey from 2012 as compared with the 2004 survey serves as an example of this trend. thus, an exclusive focus on panel attrition as a source of bias is likely to overlook many aspects that could affect the aggregated estimates of volunteering rates. summary and implications panel attrition is a specific kind of nonresponse in the sense that people have already participated in a previous survey on the same topic. therefore, the most reluctant people may have declined an invitation during the first wave of the survey. the problems related to panel attrition are nevertheless analogous to challenges of other sources of nonresponse. it creates a bias if the nonresponse is in some way related to the key variables of the study. the research question of this article concerns how volunteering affects panel attrition. the results show that people who volunteer are more likely than nonvolunteers to remain in the panel. the difference is statistically significant, and this finding is in accordance with the study by abraham et al. (2009). njsr – nordic journal of social research vol. 9, 2018 10 furthermore, the propensity to participate in the survey is affected by political interest, which indicates the need to account for more than demographic variables when identifying nonresponse bias. the findings of the analysis reveal that the estimates of volunteering in denmark are likely to be biased. it appears that panel attrition leads to an overestimation of the volunteering rate. the bias due to panel attrition may only in part be accounted for by controlling for demographic characteristics (e.g., education and gender). the findings of this article are consistent with similar empirical studies, which gives reason to believe that the nonresponse bias on estimates of volunteering could be found in other european countries as well. furthermore, the measure of volunteering is closely linked with measures of other prosocial activities and civic engagement in general. a study conducted by groves, presser and dipko (2004) demonstrates how topic interest affects survey participation in studies that cover diverse areas, such as education, childcare and voting. their study showed that the odds of cooperating are approximately 40% higher for topics of likely interest than for other topics (groves et al., 2004, p. 25). these results indicate that any survey with a topic that is more salient for a specific subpopulation (e.g., volunteers) is likely to suffer from similar problems concerning nonresponse bias, which would then have an impact on estimates of prosocial activities or attitudes. the bias would, in most cases, lead to an overestimation of the share of people who are engaged in prosocial activities, as they would have greater interest in the topic and, hence, be more likely to participate in surveys regarding such matters. therefore, nonresponse bias due to panel attrition is likely to affect estimates of related prosocial activities, in addition to voluntary work. this article demonstrates that the tendency among non-volunteers to opt-out could be amplified in subsequent waves of a panel study, which would worsen the initial nonresponse bias in surveys concerning volunteering. references abraham, k. g., helms, s., & presser, s. 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(2003). to participate or not to participate: the link between survey participation, electoral participation, and political interest. political analysis, 11(2), 164-179. https://doi.org/10.1093/pan/mpg003 https://doi.org/10.1093/ijpor/edh089 https://doi.org/10.1023/a:1024232915870 https://doi.org/10.1177/0002716212456363 https://doi.org/10.1086/268765 https://doi.org/10.1093/ijpor/15.1.3 https://doi.org/10.1177/1525822x08323099 https://doi.org/10.1093/pan/mpg003 microsoft word blom codetotalityprobv4 copy-edited version(lnbb)2 pages corrected.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 1, 2010 analysing written narratives: considerations on the ‘code-totality problems’ björn blom department of social work umeå university email: bjorn.blom@socw.umu.se lennart nygren department of social work umeå university email: lennart.nygren@socw.umu.se abstract this article describes and discusses a number of fundamental aspects of analysing short written narratives. of particular interest are the code-totality problems that arise during the transformation of several individual stories into a collective narrative. this article starts with a brief introduction to our previous narrative research on swedish social-work students, which is followed by a description of textual interpretation according to paul ricœur’s theory of interpretation, and a discussion and elaboration on the different concepts of meaning within his theory. the core of this article is an account of four models for analysing narrative data from several informants. this is followed by a concrete example of the implications that follow from the implementation of these models. we conclude that the degree of heterogeneity in the narrative material affects the choice of the mode of textual analysis and the code compilation. keywords: narrative analysis, text interpretation, coding, meaning, knowledge, social work, ricœur introduction the qualitative analysis of texts often implies some form of coding of text units, with the purposes to reduce, categorize or find the meaning in the material (miles & huberman, 1994; robson, 2001). for example, in grounded theory, coding in several steps (open, axial, and selective) is necessary in order to build theory about the phenomenon under study (strauss & corbin, 1998). in narrative analyses, which this article employs, coding is a necessary step in order to uncover the meaning in a text (riessman, 1993, 2004, 2008). njsr – the nordic journal of social research vol. 1, 2010 25 the literature on qualitative analysis often discusses different aspects of the coding procedure in rather great detail, and is frequently based on the principles in grounded theory (strauss and corbin, 1998). two common topics are how coding can reduce empirical material, and how codes can be created, sorted, and theoretically amalgamated (bryman, 2001; miles & huberman, 1994; robson, 2001). it is our experience that the literature less commonly addresses closely what we regard as the ‘code-totality problems’, and especially in relation to narrative analysis. we argue that these problems arise when the researcher ‘transforms’ several individual stories into a collective narrative during the coding process. we can identify these problems by posing the following questions: 1) when during the process of analysis should a material be coded? 2) should codes be treated as unique singularities or as aggregations into more generic codepackages, and if so, how? 3) how can codes (single or aggregated) be connected to overall interpretations? 4) what kinds of analytical totalities emerge in the final stage in narrative analysis? 5) in what way are the answers of these questions dependent on how heterogeneous the empirical material is? different answers to these questions will generate different qualities, and if a researcher is not aware of the choices that are made in the coding process he or she will not be able to contrast interpretations against alternatives. these are the queries that we have dealt with in previous studies where we have investigated swedish social-work students at umeå university, and in this article we want to share some of our experiences. we do not present the final answers to these questions, but we present a number of principles and examples that we hope can be helpful to others who might be confronted by code-totality problems. with the aim of contextualizing our discussion, this article starts with a short introduction to our previous narrative research, followed by a description of textual interpretation according to the french philosopher paul ricœur. we also discuss the different concepts of meaning which form a fundamental but sometimes ignored part of his theory. the major part of this article consists of an account of the four principal ways of analysing narrative data that we have constructed by utilizing ricœur’s methodological principles. this description is followed by a section in which we present a concrete example of the implications that may result from the usage of these models. finally, we summarize some of the main points that we wish to pass on to the reader. analysis of short written narratives – a brief background one point of departure for narrative analysis is that when we narrate, we put forward a message about the understanding or meaning we receive from (or attribute to) our experiences. an essential assumption within narrative analysis is that storytelling serves the purpose of creating meaning from one’s lived experiences (atkinson 1997; czarniawska 2004, riessman, 2008). the narrative method is particularly advantageous for research of activities where humans work with humans on a social, and thus abstract, level because mutual understanding becomes a central part of the result (e.g., riessman & quinney, 2005; salander, 2002). therefore, we assumed that an analysis of social-work students’ stories about such situations provided a relevant point of departure. the students’ stories have been used in studies on narrative analysis where we have focused on the meaning of critical situations during field studies as well as on the use of knowledge in social-work practice (e.g., in blom, 2009; blom, nygren, nyman & scheid, 2007; nygren & blom, 2001). the authors of this article were previously involved in the follow-up of field studies at the social-work programme at umeå university in northern sweden. njsr – the nordic journal of social research vol. 1, 2010 26 social-work students in their seventh and last semester of their education (which then was preceded by 20 weeks of field studies that included training for working directly with clients) were requested to write a story. we asked the students to write down a ‘narrative’, a compressed story, where they described a critical situation from their practical training. we also asked them to reflect on the use of knowledge in relation to these situations. a shortened version of sven’s (false name) narrative offers an example of these short narratives. one of the patients i regularly have contact with comes to a dayactivity centre where we have decided to meet. he is in a miserable shape: hollow-eyed, in a cold sweat, and filled with anguish. … he tells me of, for him very important, the beginning of school the night before, that according to him ended up in a catastrophe. the man is heartbroken; words and tears are flowing out of him, and for a few moments he loses his connection to reality. during the first part of the conversation i am almost completely quiet, only asking some brief questions. after he has ended his story, i take a more active role, where the purpose is, to some extent to try to tone down the un-controlled negative thoughts that govern him. maybe his failure could be relativized. … … when it comes to the types of knowledge that i used, it is difficult to exclude any of the forms that the teacher of this course talked about. to say that facts to a great extent governed my acting feels, in a way, rather futile. nevertheless, there is always a ‘bank of knowledge’, containing facts, which you … often have to start from. in this case, information from countless, more or less obscure, books on psychology and psychiatry concerning symptoms and other things surely was part of the picture. moving towards a micro level, one might say that my knowledge of where the ‘conversation rooms’ are situated at the clinic partly forms the situation. my understanding is, to some extent, formed by my facts. the situation with a human in a state of breakdown, i would probably regard as frightening, if i were not to have any idea about why the person would be in that state. here i believe that understanding (identification) and my ambition to understand are present in, for example, my questions, during the conversation. skill can in this case be about the choices i make during the situation, as well as the forms and the techniques around and in the conversation – for example, to choose a secluded place, not to govern the conversation, not to finish after an hour, and not to moralize and simplify. at the same time i do not recall anything that might be conceived as craftsmanship. familiarity might be a part of the picture. – maybe earlier experiences from meetings with a number of persons in crisis are such a source of knowledge. the social-work education, especially the relational approach it conveyed, in combination with christian values, could be another source. the psychodynamic frame of interpretation that i’ve been dragging around with me during my practice term, and that probably influenced my way of apprehending, is naturally from the literature (education, other courses, own reading), but also from influences from the supervisors and colleagues i’ve been in contact with. the majority of the social-work students wrote narratives that were one-and-ahalf pages long, but the length of the material ranged between one and two njsr – the nordic journal of social research vol. 1, 2010 27 pages. the resultant 144 stories were used as a pedagogical instrument, as a foundation for verbal presentation and discussion in the class, and as material for research purposes. they were analysed with a method of analysis that we have previously developed (nygren & blom, 2001). the method is based on paul ricœur’s theory of interpretation (ricœur 1976; 1981), but also inspired by a method for research on lived experiences that was developed within nursing research (lindseth & norberg, 2004). examples of analysis and presentation of results chart 1 below illustrates how we coded the empirical material and presented the output of the coding. the example is built upon our experiences from working according to model 3, which is described later on in the article.1 chart 1. examples of units of meaning and codes from sven’s narrative. preliminary units of meaning what-codes howand whocodes reflective codes 1. one of the patients i regularly have contact with comes to a day-activity centre where we have decided to meet. patient, setting we met 2. he is in a miserable shape: hollow-eyed, in a cold sweat, and filled with anguish. condition patient is suffering interpretation of appearance 3. he tells me of, for him very important, the beginning of school the night before, that according to him ended up in a catastrophe. storytelling patient describes a negative situation regards the negative story as the patients experience – – – 25. the psychodynamic frame of interpretation that i’ve been dragging around with me during my practice term, and that probably influenced my way of apprehending, is naturally from the literature (education, other courses, own reading). psychodynamic theory frame of interpretation practice term literature formal and informal studies the student’s knowledge has various origins book-knowledge important foundation for action 26. … but also from influences from the supervisors and colleagues i’ve been in contact with influences experiences by contact with supervisors and colleagues informal knowledge also important – – – among the 144 narratives that were analysed in the main study (blom, nygren, nyman & scheid, 2007; nyman & scheid, 2004), we could identify a number of different strategies concerning the students’ use of knowledge in 1 this is described more thoroughly in nygren and blom (2001). njsr – the nordic journal of social research vol. 1, 2010 28 critical situations. these were merged and restructured in two new – more concentrated and chronological – narratives that according to ricœur is the final step of the narrative analysis.2 these new narratives helped us to reach a more general and deepened understanding (comprehension). we have chosen to call one of these the opening of a locked situation, and we present a shortened version as an illustration. the student (who is called doris) in this story is preparing herself meticulously before meeting the client. she reads case records and statements about the client (here called tom), whom she is about to meet. doris therefore has a rather fixed opinion about tom’s life-situation beforehand. on the basis of all the information that she gathered before the meeting, she also has a clear idea of the appropriate intervention in this case. nevertheless, doris is quite nervous before the meeting, and she repeats to herself what she wants to achieve during the meeting. nevertheless, she feels rather awkward and appears as though she is groping when she arrives to meet tom. doris enters the meeting with intention to solve tom’s problem quickly by suggesting the intervention she considers appropriate. however, the knowledge she brings with her leads to a cognitive and emotional blockage. she is stuck in her predefined conception about tom. in fact, she does not bother to listen to his opinion of the situation. but suddenly, when doris’ previous knowledge does not seem to help during the meeting, she becomes very frustrated! and this frustration forces here to reconsider the situation, and new ideas arise. during the meeting she is confronted with the idea that she might be on the wrong track, because she has not been listening to tom. doris realizes that, her preparations and fixed conceptions are hindrances in this particular situation. at this point doris feels that she has partly loosened her grip of the situation. after a moment of confusion she has chosen to change her strategy: she now tries to disregard her own previous knowledge and her prejudices. afterwards, when doris is reflecting upon this meeting, she feels a sense of satisfaction over her newly won insights. she has managed to get around the barrier created by her prejudices, and doris thinks that from now on she will try to be more open-minded meetings with clients. we believe that this new narrative is a representative example of the comprehension of the material as a whole, which was obtained after combining the previous naïve understanding and the structural analysis (according to model 3). in other words, we had reached a better understanding of our own social-work students’ use of knowledge. in one of our studies of the research method (nygren & blom, 2001), we concluded that there are several reasons for refining and developing further all the steps in the analytical procedure. this concerns, among other things, more consciously made processes in the steps from naïve reading to depth interpretation. and this is essentially what we shall deal with in this article. 2 concepts and analytical principles are discussed further on in the article. njsr – the nordic journal of social research vol. 1, 2010 29 textual interpretation according to paul ricœur the following sections present a detailed discussion about textual interpretation based on ricœur’s theory of interpretation. a rather extensive explanation of the basic concepts and ideas is necessary, so that our later discussion about models and coding is comprehensible. ricœur (1976, 1981) argues that we can adopt two possible attitudes before reading a text: understanding or explaining. understanding is about grasping or getting a feel for the whole chain of seemingly fragmented meanings in a merged manner; in other words, this attitude involves finding the meaning of the text. explaining a narrative is the sorting out of the fugue-like organization of interlaced actions, its skein of movements. in other words, explaining is about uncovering the internal relations of the text through structural analysis. ricœur considered explanation as well as understanding to be encompassed in the superior concept of interpretation. put differently, interpretation is the dialectic between understanding and explanation. in this manner, understanding precedes, accompanies, and encloses the explanation. conversely, the explanation develops the understanding analytically. according to ricœur, the dialectic between explanation and understanding is an initial movement from understanding to explanation, followed by a movement from explanation to comprehension, which is a more sophisticated mode of understanding. initially, understanding is a naïve (i.e., open, without prejudice) grasping of the meaning of the text as a whole. it is virtually a guess at the meaning in the text. later on in the analysis the understanding (as comprehension) is more advanced. in between the two modes of understanding is the indispensable explanatory stage of structural analysis. finally, the interpretation might reach what ricœur denominates as appropriation (ricœur, 1976; 1981). these concepts are discussed more thoroughly later in the article. we believe that ricœur presents convincing arguments for the importance of the dialectic between explanation and understanding with respect to ontology, epistemology, as well as methodology. on the basis of his theory we have developed a way of analysing narrative data where the different moments of the interpretative process are under control. hence, both the analyst and the readers of an analysis can observe, quite explicitly, how the analysis relates to the original text. four different concepts of meaning in ricœur’s theory one question that it is necessary to ask when doing narrative analysis is what meaning is. ogden and richards (1989/1923) have written a book with the accurate title, the meaning of meaning, that presents more than 20 different definitions of the concept. meaning can, by way of example, mean an intrinsic property, an essence, an event intended, the connotation of a word, and that to which a symbol refers. these examples demonstrate that it is all but selfevident how the concept of meaning should be defined, and lead us to understand that there is an obvious risk of misunderstanding when the goal is to uncover the meaning in texts. analysts will quickly find themselves confronted with two basic queries: what is meaning? and, for whom is a meaning a meaning? according to ricœur (1976), the meaning of a text can be divided into four different concepts: one that he calls the utterer’s meaning (utterer = the one that writes or says something), and three different types of utterance meaning njsr – the nordic journal of social research vol. 1, 2010 30 (utterance = that what is written or said). we want to emphasize that these different types of meaning are not explicitly stated in ricœur’s works exactly as we present them. consequently, what we write are our interpretations of his somewhat muddled discussions on the subject. our main sources are his books interpretation theory (1976) and hermeneutics and the human sciences (1981). below, we provide a short definition and a number of illustrative examples of each concept. utterer’s meaning this concept of meaning refers to the author’s own explicit intention, purpose, motive, et cetera. ricœur writes that this is the subjective side of meaning. for example, with his book, das kapital (capital, 1867), karl marx wanted to criticize the political economy of the nineteenth century, and sigmund freud’s intention with the book die traumdeutung (the interpretation of dreams, 1900) was to show that it was possible to interpret and understand dreams. this way of defining meaning, which draws upon the author’s conscious and often explicit intention, is what we usually connect with written texts. utterance meaning 1 (semantic meaning). here, the autonomous meaning of the text, that what is said, is in focus. it is not a question of the author’s intended meaning. the semantic meaning concerns the comprehensive and communicative aspects of language. an example of this type of meaning is to understand that the utterance ‘wright’ – write, right, rite to the right! is not a consequence of stuttering, but a concentrated request to a skilled worker to write down the correct ceremonial practices on a specific part of a paper. in other words, the semantic meaning is about the relation between the language symbols and what they denote. utterance meaning 2 (reference backwards or behind). this type of meaning refers to what the text talks about: what exists, irrespective of the author’s intention with the text. for example, one can read the books about pippi longstocking as entertaining stories about a very strong little girl with strange clothes, who lives without parents but instead with a monkey and a horse and so on. however, her books also have a historical reference, which, among other things, would include the cultural values that prevailed in sweden, and many other countries, around 1946 when astrid lindgren wrote the first book about pippi. the comical (and even shocking for some adults at that time) about a nine-year-old girl living on her own in a big house, being self-assertive and not afraid of adults and so on, should be understood against the background that children in the 1940s usually did not behave that way. children were expected to be like pippi’s friends tommy and annika: obedient, disciplined, clean and well dressed. the point is that all texts are created at a certain time and under certain circumstances, thus one can say that, for example, hamlet, don quixote, and frankenstein, besides conveying their respective authors’ intended message, also (unintentionally) refer backwards and tell us something about the conditions, norms, values, fears and joys, and so on, at the time and place that the text was written. utterance meaning 3 (reference forward or ahead). the meaning in this sense refers to the future possibilities that dwell in the text, that is, to that which can become: propositions or possibilities. the text is regarded as a medium for the reader to understand himself or herself and to develop, and, as with utterance meaning 2, it is a question of the meaning that exists in the text irrespective of what the author intended. for example, the books about pippi longstocking can be read as amusing stories for children. furthermore, it is reasonable to believe that this was astrid lindgren’s conscious purpose. however, it is quite possible that an adult person could also read the books and extract some guidance for his or her life. for instance, a person with a great deal of money and power could begin to consider that he or she – just like pippi declares – njsr – the nordic journal of social research vol. 1, 2010 31 should be generous and kind because of the possession of great resources. therefore, what a text means for somebody’s future, depends on the reader’s individual characteristics and traits. key concepts reconsidered according to our understanding, there are four basic alternatives (models) that can be used to analyse the kind of story we discuss. these models are described in the subsequent section. however, before describing the models, it is important to explain that we do use some of the key concepts in a manner that diverges from ricœur’s definitions. our reconsideration of some of ricœur’s theoretical concepts is partly an effect of our research itself, which is based on other types of empirical material (several short texts, instead of ricœur’s singular long texts), and partly because we have developed ricœur’s approach somewhat. for example, we think that it is important to make a distinction between the processes and the products of the analysis, and to distinguish between different kinds of analytical results, namely, material and cognitive products. these differences necessitate a demonstration of how we intend to use the concepts in connection with the models. naïve reading is an almost entirely cognitive process, which ends up in a naïve understanding of the text as a whole, and can be described as a changed cognitive state (i.e., one conceives something in a new way). ricœur describes it as ‘a naive grasping of the meaning of the text as a whole’ (1976, p. 74). the naïve understanding of the text as a whole can also be documented and thereby handled as a material product (usually as a text). metaphorically, naïve reading is like trying to grasp a superficial idea of the different motifs in a children’s cube-puzzle (usually a puzzle with twelve cubes, and six motifs) without having seen the motifs on the front of the puzzle box. in such a case, one does not know what is ‘hidden in’ the cubes, only that there are six different possibilities. we assert that, from an ontological perspective, it is a realistic assumption that a text can have one or several meanings that are possible to unveil. structural analysis is something of an analytical artefact. texts are deconstructed, restructured, and analysed, which results in explanations in terms of conceptual codes that, for example, answer questions about what, how, and who, and hence, mainly a material product (usually a text). however, this explanation also has a cognitive element because both the analyst and the person who reads the explanation must understand it. therefore, the semantic meaning of the text (utterance meaning 1) is in focus. a structural analysis can resemble an extensive mathematical calculation. for example, it is made and ‘stored’ on a paper or a white board, but human reason is needed to carry out or evaluate the calculation. the point is that the structural analysis is a concrete artefact as well as an abstract cognitive procedure. comprehension. ricœur writes that the final stage of the analysis is a new story, and he describes the dialectical process of interpretation: ‘first as a move from understanding to explaining and then as a move from explanation to comprehension. … comprehension will be a sophisticated mode of understanding… at the end… [understanding] satisfies the concept of appropriation.. (ricœur, 1976, p. 74). it is possible to read this as if comprehension and appropriation were almost identical, but we claim that there are methodological and epistemological reasons to differentiate between comprehension and appropriation. they are, in fact, two dissimilar results of the analysis, and it is important to pay attention to this point in the course of planning and conducting analyses as well as when reading the results. njsr – the nordic journal of social research vol. 1, 2010 32 comprehension is a way to grasp the meaning in the empirical material in the form of a new text (both a material and a cognitive product). appropriation, on the other hand, is only a cognitive product. furthermore, we cannot assume that these two forms of understanding automatically coincide because a reader will not always appropriate a text (i.e., make it one’s own, become changed, and discover new possibilities) even though he or she comprehends (i.e., understands, mentally grasps) it. in the kind of analysis we propose, comprehension is a reference backwards, that is, it shows what exists, how something is (utterance meaning 2). moreover, it is a material product (usually a written document) that has two main components: one or several naïve understandings of the text or texts as a whole, and a number of conceptual codes from one or more structural analyses. the integration of these components implies an intellectual process as well as an artefactual one. in practice, it usually means that texts from different documents (1. notes on naïve understanding of the texts, and 2. ‘lists’ with conceptual codes) are reflected on and put together to form a new, more qualified and logical narrative. appropriation is something that we regard as the solely cognitive (but sometimes also emotional) end product of the analysis. as mentioned above, we distinguish between appropriation and comprehension, because they do not obviously coincide. appropriation means a developed understanding (discovered future possibilities) from the empirical material, namely, the original stories. this kind of understanding can emerge when somebody reads the comprehension (the material product) of the analysis, that is, one or several new stories. the reader can also be someone other than the person who conducted the analysis.3 consequently, a human subject is necessary – a reader – if appropriation is to emerge. a new story in itself (comprehension) does not automatically imply increased understanding. in other words, there is a difference between information and knowledge, which means that a text is only information until the reader puts it in his or her own context and makes something of it (cf. liedman, 2002). subsequently, it is possible to assume that appropriation does not always occur. another metaphor might also clarify the differences between comprehension and appropriation: it is possible to fit the parts of a puzzle correctly (which is analogue to comprehension) without understanding what the motif of the puzzle means in a deeper sense (analogue to appropriation). our point is that an analysis can be done quite instrumentally without bringing a deeper insight of the results to the researcher or another reader. as a consequence, a text’s reference forward or ahead – ideas of what can come to pass (utterance meaning 3) – is not ready-made and available to be picked up from the comprehension, like taking a pearl out of a mussel. in the way we understand this process, future possibilities only emerge when someone has absorbed the comprehension and has become affected by it cognitively and often emotionally. the degree of appropriation will consequently vary between different readers. the researcher who conducted an analysis might receive a deeper understanding than a reader who ‘only’ reads the analysis and the results (the comprehension) as a new story. 3 here we probably diverge from ricœur (1976), who seems to indicate that it is only the analyst who can obtain appropriation. our conclusion draws upon ricœur’s theory of interpretation that clearly expresses that comprehension and appropriation are based upon the two previous steps of naïve reading and structural analysis. normally it is only the analysing researcher who, in a more qualified sense, deals with the parts and meanings of an interpreted text, while any reader can, at least to some degree, appropriate a comprehension. njsr – the nordic journal of social research vol. 1, 2010 33 however, as already mentioned, it could be different because it all depends on how the reader interprets the comprehension. four principal ways of analysing short narratives in the following section we describe the four basic ways of analysing short narratives that follow from our way of using ricœur’s theory of interpretation. we shall also discuss what kinds of empirical material that each model is suited to analyse. our survey shows the importance of bearing in mind that the choice of analytical model is very much a question of matching specific empirical material, and that different models lead to different results. model 1 each story is naïvely read, which leads to as many naïve understandings (in the form of memoranda) of the text as a whole, as there are stories. thereafter, every story is structure-analysed which generates x number of codes from each story. in the subsequent step, the naïve understandings (memoranda) and the codes from each story are merged into a comprehensive understanding of each story. next, the comprehensive understandings of all the stories are merged together to an aggregated comprehension of the material as a whole, and this could, in turn, form the basis for an eventual appropriation. narrative 1 naïve reading: naïve understanding structural analysis: x number of codes comprehension aggregated comprehension appropriation narrative 2 naïve reading: naïve understanding structural analysis: x number of codes comprehension narrative 3 naïve reading: etc. figure 1. the first model for analysing narrative material. this way of analysing narratives can be adequate if the material is very heterogeneous, that is, if the stories differ from each other despite a common main theme. by way of example it is possible to imagine that within the theme, my greatest moment in life, it would be possible to write narratives about giving birth to a child, winning a billion dollars, or catching the largest salmon. contextual contingencies and the events are in such cases so dissimilar that the narratives are only logically consistent within themselves. a reasonable connection between them is only possible to make at the end of the analysis, when comprehensions from each different narrative are merged into an aggregated comprehension. njsr – the nordic journal of social research vol. 1, 2010 34 model 2 every story is naïvely read and the results of all naïve readings (memoranda) are put together as a naïve understanding of the material as a whole. then a structural analysis is conducted which generates x number of codes from each story. next, the codes from each story are merged with the preceding naïve understanding of the material as a whole into a comprehension of each story (this is symbolized by a grey frame in the figure below). all the comprehensions are then amalgamated to an aggregated comprehension of the material as a whole, which makes a foundation for appropriation. narrative 1 naïve reading structural analysis: x number of codes comprehension aggregated comprehension appropriation naïve understanding of the material as a whole narrative 2 naïve reading structural analysis: x number of codes comprehension narrative 3 naïve reading structural analysis: x number of codes comprehension narrative 4 etc. figure 2. the second model for analysing narrative material. this mode of analysing can be relevant if the narratives are somewhat more similar than in the previous example. in order to obtain a useful naïve understanding of the material as a whole, it is reasonable that the stories are fairly congruent in some structural sense, for instance, that they are about roughly the same things (e.g., a certain type of activity), or that the events occur within similar contextual conditions (e.g., in a certain environment). this model is, like the previous one, mainly suitable for analysing one story at a time, and thus aggregating at the end of the process. narratives can be highly diverse even if there is an overarching main theme (e.g., social work in the 21st century). it is easy to imagine that stories within such a theme, despite common points of contact (e.g., social work with adults), are so dissimilar that it is most reasonable to conduct a separate structural analysis and comprehensive interpretation for each story at a time. this would, for instance, be true for stories about handling financial benefits to young adults, psychotherapy to older drug addicts, and counselling to abused women. njsr – the nordic journal of social research vol. 1, 2010 35 model 3 with this model, each story is naïvely read, and memoranda from all of these naïve readings are compiled to a naïve understanding of the material as a whole. in the subsequent step, each story is structurally analysed. the codes from the structural analysis of all the stories are then put together into a totality. next, the totality of codes and the naïve understanding of the whole are merged into a comprehension of all the stories, which in turn lay the ground for appropriation. narrative 1 naïve reading structural analysis comprehension of the material as a whole appropriation naïve understanding of the material as a whole totality of codes narrative 2 naïve reading structural analysis narrative 3 naïve reading structural analysis narrative 4 etc. figure 3. the third model for analysing narrative material. this mode of analysis is adequate if one has relatively homogeneous empirical material. in our research based on social-work students’ narratives about critical events during field studies, that was the case. even though all the narratives were in some respect unique, there were many common denominators (types of clients, types of interventions, types of knowledge, etc.) that made it possible to compile a naïve understanding of the material as a whole, relatively trouble-free. however, the narratives also contained numerous unique components (descriptions of places, individuals, feelings etc.) that only made it possible to analyse structurally the stories one by one. in other words, each narrative’s building blocks – words, concepts, sentences – were only possible to explain in relation to each story as a whole. nonetheless, thanks to fundamental similarities in the stories (e.g., concerning strategies, use of knowledge, reflections), it was possible to put together the codes from the structural analysis into a rather consistent ‘totality’. model 4 with model 4, each story is naïvely read, and memoranda from all the naïve readings are compiled to a naïve understanding of the texts as a whole. then all the stories are put together to form a ‘grand’ story that is structurally analysed. in the next step, the codes from the structural analysis and memoranda from the overall naïve understanding are merged into a comprehensive understanding of the texts as a whole. this provides a foundation for somebody’s eventual appropriation of the material. njsr – the nordic journal of social research vol. 1, 2010 36 narrative 1 naïve reading structural analysis (of all narratives) comprehension appropriation naïve understanding of the material as a whole narrative 2 naïve reading narrative 3 naïve reading narrative 4 etc. figure 4. the fourth model for analysing narrative material the fourth model can be relevant if someone wants to analyse material where all the respondents or informants have experienced exactly the same event, for instance, an accident in which many persons were involved. as the respondents or informants share the context and course of events (though individual experiences obviously vary), each person’s story can be regarded as a part of a bigger narrative about the event. example of an analysis based on model 1 as a means of illustrating the analytical problem that this article focuses on – the code-totality problems – this section presents a short example of an analysis based on model 1 above. the analysis comprises three stories within the theme of what characterizes a survivor. the stories have this question in common, which makes it reasonable to include them in the same analysis. at the same time they are so heterogeneous that they can only be analysed according to the first of the four models. as an empirical starting point we have chosen three stories (odysseus, cinderella, and robinson crusoe) that we can assume are relatively well known, which makes it unnecessary to present the whole stories in the article. moreover, these stories are easily found in books and on the internet. it is important to clarify that the stories are chosen for quite pragmatic reasons, that is, as a means of exemplifying the code-totality problems in a fairly condensed way. we are aware of that there are numerous versions of these stories, and that it is possible to interpret them in several ways. by way of example, it is not self-evident that cinderella is a story about a survivor, but it is possible to regard it as a story about someone being rescued. however, it is not necessary that the reader agrees with our coding and interpretations – the point is not to understand these particular stories better. they are only here to serve as concentrated illustrations of our discussion. njsr – the nordic journal of social research vol. 1, 2010 37 we start the illustrative analysis with a naïve reading, followed by a structural analysis and a comprehension of each single story. next, we present an aggregated comprehension and finally our appropriation. the stories do have a common theme, but they are too dissimilar to each other to aggregate parts of the stories (e.g., codes or understandings) in a meaningful way before the last stage of the analysis. the first three analytical steps table 1. the first steps in the analysis of the story about odysseus. odysseus naïve reading structural analysis comprehension whatcodes who where& why-codes reflective codes a greek king returns to ithaca after the battle of troy. on the journey back he is delayed by several monsters and gods, hence the journey takes ten years. during his absence there are a number of men who want odysseus’ wife and property. eventually, he returns and takes back what is his. sailing drifting off course facing different monsters back home, he kills the men who wanted to steal his wife and home. odysseus troy arrogant poseidon enraged cyclopes scylla & charybdis sirens et al. odysseus telemachus ithaca with arrow and spear odysseus’ emotions got the upper hand; he felt divine odysseus uses his cunning to survive odysseus controls his and his son’s anger, and takes revenge in a ‘rational’ way odysseus’ arrogance after the victory at troy enraged poseidon. poseidon puts odysseus through many trials for a long period. these taught odysseus to control his emotions and to become an even more rational human. the complete story about odysseus can be read in homer, knox, and fagles (2006). njsr – the nordic journal of social research vol. 1, 2010 38 story 2 table 2. the first steps in the analysis of the story about cinderella. cinderella naïve reading structural analysis comprehension whatcodes who where& why-codes reflective codes a widower with a daughter marries a haughty woman with two vain daughters. the stepmother and her daughters force cinderella to do all the housework. one day the prince invites all the young ladies to a ball. -- cinderella must return before midnight before the spell is broken. … entering stepfamily forced to do all the housework a ball gets dress, carriage, coachman, and lackeys dance until midnight, admired by the prince. loses shoe search for the girl tries shoe, which fits gets married cinderella stepmother sisters wickedness, envies her beauty at the castle fairy godmother pumpkin rats the prince falls in love wants to marry her a search for evidence her life is sad and miserable her work never ends temporary escape from the treadmill magic makes a dream come true but magic is volatile, reality bites back back in the treadmill, lady luck seems gone but not for long a combination of magic and persistence makes luck return cinderella’s beauty got her in trouble, due to the stepfamily’s envy. she had to work like a dog, but she persisted in being amiable to everyone. thanks to her persistence and neverending amiableness, she received help in the form of magic. beauty, magic and wealth can facilitate, but the main cause of the happy ending was the persistence and the attitude not to give up. the complete story about cinderella can be read in perrault (2002). njsr – the nordic journal of social research vol. 1, 2010 39 story 3 table 3. the first steps in the analysis of the story about robinson crusoe. robinson crusoe naïve reading structural analysis comprehension what-codes who where& why-codes reflective codes robinson crusoe is an english castaway who spends 28 years on a remote tropical island. together with friday, he encounters natives, captives, and mutineers before being rescued. slave ship shipwrecked builds cave helps escape cannibals retakes ship from mutineers r. crusoe english island near venezuela storm tries to survive cannibals friday needs a servant r. crusoe friday and his father disrupted slave-trade voyage manly independence faces the problem of cultural relativism helped by natives, formerly viewed as savages robinson crusoe was an unscrupulous slave trader, who became more humble during his stay on the island because he had to live in accordance with nature and friday helped him. he struggled with moral questions when witnessing cannibalism. the complete story about robinson crusoe can be read in defoe (2001). the final two analytical steps after the naïve reading and the structural analysis of each individual story, it is logically possible at this point to start merging the comprehensions into an aggregate in the search for those specific elements that ‘characterize a survivor’. in a ricœurian analysis this step leads to a new and more understood story. the reader should note that the following example is only a miniature illustration of how a new story could look like. aggregated comprehension male and female survivors struggle against different types of forces. it can be superhuman (e.g., gods, monsters), social (e.g., tyrants, criminals), psychological (e.g., fear, hate) or natural (e.g., winds, rain). fundamentally, it is a battle between good and evil. weapons as well as intellect are used in this battle, but moral decisions and virtues can also play a role… the next and final step is appropriation, a kind of deeper insight, which is a cognitive end product of the analysis. this is a potentiality for the analyst as njsr – the nordic journal of social research vol. 1, 2010 40 well as for the reader. the reader should bear in mind that this short example is meant to illustrate the developed understanding that the authors of this article obtained from the analysis. in reality, appropriation is not a text, but a process in somebody’s mind. appropriation everyone fights a lifelong battle against outer and inner forces. one possible lesson from narratives about survivors is that it can be worth fighting on, even when it seems hopeless. often it is possible to turn a setback into a success. and even if it does not turn out that way, the struggle in itself can be meaningful… someone who reads our analysis might arrive at a similar insight, but this person might also get a partly or totally different insight. a further possibility is that the analysis does not offer a new insight at all. to a large extent it depends on who the reader is (previous experiences, expectations, motives, etc.) and in what context the analysis is read (during education, for research purposes or by chance, etc.). examples of an illogical analysis following the demonstration above of how an analysis might look when the empirical material and mode of analysis fit together squarely, we shall now illustrate how it may turn out with an analysis of a heterogeneous material that utilizes an inappropriate model of analysis. this is made by taking a look at the three stories during the second step of analysis (naïve understanding of the material as a whole), as in model 2 to 4. the example below shows that it is indeed possible to create a story – a rather twisted one – without the kind of logic that is necessary in a scientific context. naïve understanding of the material as a whole odysseus, cinderella, and robinson crusoe were sailing home when they were hit by a storm created by the enraged poseidon. they ended up on an island, whose habitants consisted solely of cinderella’s stepfamily. they began to fight over cooking and cleaning, a struggle that lasted for ten years. robinson and odysseus fell in love with cinderella’s stepsisters, which at a closer look turned out to be the monster scylla. the stepmother was a cannibal who was eventually killed by odysseus before he went to the ball at the castle … from a scientific point of view, the analysis is going down the drain. the stories are too dissimilar to create a reasonable naïve understanding of the material as a whole. although the example might seem ridiculous, it is nevertheless a possible result if one were to try to merge the naïve readings from the stories in question. another purpose with this example is to demonstrate that it is inappropriate to use model 3 or 4 for analyses of such heterogeneous material. if anyone, contrary to our expectations, should succeed in making a naïve understanding of such a heterogeneous material (as above), we assume that the analysis will fail at a later phase. by way of example, the totality of codes that is the fourth step in model 3 could look something like this: njsr – the nordic journal of social research vol. 1, 2010 41 totality of codes her life is sad and miserable, disrupted slave-trade voyage, odysseus’ emotions got the upper hand, lady luck seems gone, he felt divine, helped by natives, her work never ends, manly independence, odysseus uses his cunning to manage, a combination of magic and persistence makes luck return, faces the problem of cultural relativism, back in the treadmill … as this example shows, this is just a mixed list of codes that can hardly be related to each other in a reasonable way. therefore, the codes become a bunch of words without logical relations. it is possible to continue exemplifying this way, but we assume that we have made our point by now. summing-up in this article we have discussed important aspects of meanings, models, and coding that we believe are important to consider when analysing written narratives. the starting point was our earlier studies of swedish social-work students’ use of knowledge in critical situations. in relation to four different models for analysing short written narratives, we have discussed the codetotality problems that arise when transforming several individual stories into a collective narrative. as a means of reaching a qualified understanding of the entire empirical material, the focus of discussion was on questions concerning the compilation of codes and aggregate comprehended wholes. we are aware that the principles that we have discussed do not present a simple or final solution to the problem concerning how narrative data can best be organized in order to uncover different meanings, but we hope that this article can help researchers who plan to perform a narrative analysis to make more informed choices concerning the analytical process in relation to the empirical material. a conclusion that we want to convey to the reader is that the degree of heterogeneity in a narrative material affects the mode of analysing texts and compiling codes. in other words, the extent to which the stories are similar or dissimilar determines to a large degree the type of analysis that it is reasonable to carry out. moreover, we believe that there is a certain similarity with a statistical principle used when analysing quantitative data. many readers may be familiar with the principle that it is not possible to perform all forms of statistical analyses with all types of quantitative material. to a large degree, the forms of analysis that can be carried out depend on the level of measurement to which the material belongs. in other words, the higher level of measurement (nominal, ordinal, interval or ratio scale) the material is on, the more possible it is to perform more sophisticated analyses. similarly, a researcher has to consider which mode of analysis can be employed logically in relation to the degree of heterogeneity of the qualitative material. narrative material that can be analysed with model 4 can also be analysed with models 1 to 3. further, material that can be analysed with model 3 can be analysed with models 1 and 2 as well, but not with model 4. in other words, it is logically possible to analyse material with a model ‘lower’ than its goodness of fit, but not with a model ‘higher’ than its goodness of fit.4 in spite of the fact that our discussion has been based on a certain type of qualitative material (short narratives) and a certain theory of interpretation 4 goodness of fit is a statistical term that describes how well a statistical model fits a set of observations. here it is used as a way of discussing how well qualitative empirical material fits our four narrative models of analysis. njsr – the nordic journal of social research vol. 1, 2010 42 (ricœur’s), we believe that it encompasses a certain amount of generality. many researchers work with qualitative materials that have basic similarities with our narratives, for example, transcripts based on interviews, observations, diaries, and so on. furthermore, in the majority of cases the sorting and coding of the materials are necessary, and this would be done in the case of ricœur’s theory as well as, for example, grounded theory. as we understand it, there are parallels between analytical steps in ricœur’s theory (e.g., naïve reading and structural analysis) and steps in grounded theory (e.g., open and selective coding). consequently, it is reasonable to assume that it is important to pay attention to the code-totality problems when performing other forms of qualitative analyses such as grounded theory. we do not claim that our discussion has solved the code-totality problems once and for all, but we hope that this article will contribute to an increase in methodological 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(1998). basics of qualitative research: techniques and procedures for developing grounded theory (2nd ed.). thousand oaks, calif.: sage. microsoft word 05 care, final2 pages corrected.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2011 – special issue care ‘going market’: finnish elderly-care policies in transition anneli anttonen institute for advanced social research university of tampere email: anneli.anttonen@uta.fi liisa haïkïö department of social policy and social work university of tampere email: liisa.haikio@uta.fi abstract the article evaluates marketization and its effects on elderly-care policies in finland, where the welfare state has been the most important mechanism in mitigating failures caused by the functioning of market. in addition, since the 1960s the public sector has been regarded as the guarantee for citizens’ social rights and the common good. therefore, marketization, denoting to market logics intervened with social-care practices that construct care as a commodity and the individual in need of care as a consumer, is a critical juncture for an evaluation of the underlying pattern change. to evaluate the change this article employs a framework of institutional policy analysis. by focusing on institutional framing of care policies, institutionalized responsibilities, policy discourses, and policy outcomes and by using textual and statistical data, this article aims to reach a detailed but comprehensive picture on marketization and its influence in the finnish social-care regime. all institutional aspects analysed in the study show a clear transition from universal social policies based on public responsibility to market-friendly policies and the marketization of social care. however, they also imply that marketization is regulated by public authorities. on the basis of these results, we argue that finnish elderly-care policies is going through a profound change, in magnitude similar to what occurred 30-40 years ago when the politics of universalism was breaking through. the new direction points to the market and a deep-going reform of social-care service provision is taking place, and the earlier state-centred welfare production mode is at least partly withering away. in this respect the pattern of social-care service provision is turning into something else. in all, finland seems to be approaching the form of a liberal welfare state. keywords: marketization, elderly care, institutional policy analysis, finland njsr – nordic journal of social research 2011 – special issue 71 introduction the feminization of labour-market participation, the attempts to raise the retirement age, and the overall individualization of lifestyles have reduced the informal care that even today is the main source of adult social care. informal, unpaid care done mainly by women has to be complemented and substituted by formal arrangements more extensively than ever before owing to the ageing of societies. researchers and politicians in various countries are searching for socially and economically sustainable solutions to meet the increasing care needs of aged persons. as daly and lewis (2000) wrote about ten years ago, social care is today one of the most important social-policy issues in europe. this is also the case in finland (anttonen, valokivi & zechner, 2009). this article scrutinizes social care by analysing the marketization in the social-policy field of elderly care in finland. we use the concept of mixed-care production to refer to the multiple ways of providing care in post-industrial societies (sipilä, anttonen, & kröger, 2009). the concept of mixed-care production comprises care provision both in the private sphere of households and the public spheres of the state, market, and civil society. marketization, in turn, is a context-bound concept used in a number of different ways. in this study marketization refers to market logics intervening in social-care practices that construct both care as a commodity and the individual in need of care as a consumer. marketization refers first to the increased presence of for-profit providers in providing social care, and, secondly, to the institutionalization of market-like mechanisms in providing care services within the public and third sectors (or civil society). promotion and implementation of market and quasi-market mechanisms have created space for new operational practices such as ‘vouchers’, ‘personal or independent budgets’, and ‘payments for informal care’, often together with the introduction of purchaser-provider models (anttonen & sointu, 2006; clarke, 2006; newman, glendinning & hughes, 2008; stevens et al., 2011). reforms have aimed at targeting society’s resources in a more effective way, building up social-care markets, promoting choice, and giving citizens a voice. since the early 1990s, researchers have emphasized that innovations within social care often represent mixed-care production or new welfare mixes, where the clear demarcation between public and private provision is withering away (evers & sevetlik, 1991). this is true even in finland with its fairly strong tradition of tax-funded service provision and fairly universal social-care policies. marketization is related to the promotion of new welfare mix (or mixed welfare governance as we later show) in producing welfare and social care for citizens but also the overall regime or pattern change taking place in western welfare states. to understand better the meaning and processes of marketization for social policy and social-care practices, this article employs a framework of institutional policy analysis. this approach analyses marketization as a critical juncture in which to evaluate the underlying pattern change by focusing on the institutional framing of social care, institutionalized responsibilities, elderly-care policy discourses, and some policy outcomes in the field of social-care provision. according to historical institutionalists, it is important to pay attention to incremental changes that may in the longer run lead to pattern or regime change in western democracies that rely more heavily on market-based solutions in their public policies (streeck and thelen, 2005). there has been a move from ‘against market’ or anti-market welfare positions to ‘pro-market’ views that emphasize the public sector’s inability to njsr – nordic journal of social research 2011 – special issue 72 mobilize a significant amount of new resources for any welfare purposes (sipilä & anttonen, 2008). market-friendly welfare production the timing of adopting market-based or market-like mechanisms and practices varies across countries as does the extent of realized reforms. while there are profound changes now taking place, we speak here about the ‘new politics of social care’ (cf. pierson, 2001; julkunen, 2006) leading to a new type of regime or national pattern in the production of social care. in europe, the united kingdom was among the first countries to reform its public-service model thoroughly (clarke, 2006). since the 1990s, a number of countries, including finland, have followed the british route, at least to some extent. international organizations such as the organization for economic cooperation and development (oecd) and the european union have paved the way for the ‘new politics of social care’ by recommendations and rules structured with market logics (jenson, 2009). the governance of social welfare is changing owing to the stronger emphasis on issues such as consumer choice, user-friendliness, social-care markets, commissioning, externalization, commercialization, and contracting-out of care services (clarke, 2006; newman & tonkens, 2011; vabø, 2006). countries in the first wave of marketization that adopted new mechanisms to reform public-sector service production represent the liberal welfare regime (newman, 2001; stevens et al., 2011; streek & thelen, 2005). however, in the second wave the market-related reform movement also reached the nordic countries, where the state traditionally assumed a wide responsibility for producing and financing social care for its residents. there are reasons to look more closely at one nordic country, finland, and its market-related reforms in social care. for two or more decades the phrase of ‘care going public’1 has captured, first, the politicization and increased societal recognition of unpaid care work; and, secondly, it has referred to the processes through which an increasing proportion of care has moved from being solely in the private domestic sphere of the household and now falls in the spheres of the state, the formal economy of the market, and the voluntary and third sectors (anttonen, baldock & sipilä, 2003). because of the importance of the process of ‘care going public’ and the metaphoric strength of the phrase, we instead use here the expression ‘care going private’. since the 1950s, in the nordic countries care has increasingly ‘gone public’ in the sense that the public sector has assumed much of responsibility for producing care services for both children and adults. by using the expression of ‘care going private’, we do not claim that a considerable part of ‘public care’ has now gone back to the private domestic sphere of the household; rather, it refers to a number of developments taking place within social-care policies and practices. many nordic scholars – without using the phrase – have made reference to the informalization of care (rostgaard, 2004; szebehely, 2005), the privatization of the management and provision of public-care services (szebehely, 2004; vabø, 2006), and the marketization of service provision (trydegård, 2000). care is ‘going private’ in the sense that one part of social care is now removed from the public sphere of welfare states and now to a 1 the expression of ‘reproduction going public’ was coined by helga maria hernes in the mid-1980s. with this slogan she implied that the division of reproductive work between the family and the rest of society radically changed in the course of the twentieth century (hernes, 1987). njsr – nordic journal of social research 2011 – special issue 73 great extent overlaps with the formal economy of market, third sector, and the private domestic sphere of households. yet it is equally important to recognize that market-like mechanisms have gained more importance within the public sector. marketization is one important developmental path framing and shaping finnish elder-care policies. in this article, we start from the general assumption that care is now rather going private than public, and that the marketization of care and the strengthening of market or economic principles in social-care production is part of this process. the marketization of care includes, as already mentioned, different but intersecting processes (e.g., contracting out, the use of vouchers, tax credits) through which social care as a public good becomes a ‘commodity’ purchased in (social-care) markets. overall marketization and the adoption of market-like mechanisms shape social-care institutions, care-related responsibilities, and the production of care both in the public sphere of the state and local administrations and in households (szebehely, 2005). in addition, the sphere of thirdand voluntarysector service provision is similarly affected by the logic of market. anttonen and häikiö (2011) have recently shown that marketization is present both in policy discourses and in the actual policies of social care for the elderly. thus there is good reason to take a closer look to different sides of the phenomenon of ‘care going market’. our aim is to ascertain whether there is a major market-related change taking place in finland. secondly, we ask how intensively and extensively ‘care is going market’. thirdly, it is important to ask if the whole pattern of producing care and care services is changing in finland into something different than that based on the nordic social-care regime, with its foundational principle of universalism (anttonen and sipilä, 2010) these questions are studied, as we call it, in the framework of institutional policy analysis. with a focus on institutional framing, institutionalized responsibilities, policy discourses, and policy outcomes we aim at to achieve a detailed but comprehensive picture of marketization and its influence in the finnish social-care regime. first, we are concerned about how legal reforms frame and shape social-care production and particularly social-care markets. we follow changes from the major social welfare legislative reform of 1984 to the most recent reforms by paying attention to the ways that national legislation opens (or speeds) up and structures processes of marketization. secondly, a more detailed analysis concentrates on diverse institutional aspects of marketization in the field of social care. we use the available statistical data mainly concerning coverage of social-care services to analyse shifts in public and private responsibilities in meeting care needs. thirdly, national and local policy documents that determine elderly-care policies provide material for interpreting policy discourses and the ways these discourses are structured with market logic. policy outcomes are measured using statistical data on the share of public and for-profit social-care service providers in social services. the nordic social-care regime and market failures in contextualizing current processes of marketization of the finnish social-care regime, it is worth noting that social policies and the universalist welfare state have been the most important mechanisms in mitigating failures caused by the functioning of the market in the nordic countries. citizens and decisionmakers have viewed the state and the public sector as the guarantors of citizens’ social rights and the common good. this is why the welfare state has njsr – nordic journal of social research 2011 – special issue 74 been considered as a mechanism functioning against rather than for the market (esping-andersen, 1985). in every society rich people can purchase the assistance and care they need from the market by employing nurses and care workers. however, the great majority of people do not have this option. this has been one of the main reasons for extending social rights to cover such needs as social care – to simplify the complex reasons behind universal social-care policies. care practices are always and everywhere an integral part of the wider order and structure of a society. the norms and assumptions that govern care policies are products of gendered, political, cultural and religious norms, values, and habits (pfau-effinger, 1998; pfau-effinger & rostgaard, 2011). international comparisons (anttonen, baldock & sipilä, 2003; bettio and plantenga, 2004; rostgaard and fridberg, 1998) show that there are surprisingly large national differences in the scale, scope, and targeting of formal care services as well as in the operational practices used and justifications adopted. one and the same function may be arranged through services provided by central or local government, by private businesses, by welfare organizations or through various combinations of public and private sources. for example, carers and care recipients in some welfare systems may be offered cash benefits or tax concessions instead of services. alternatively, a whole system may rely largely on social care being provided by relatives, friends, and partners or on care provided by immigrant care workers working in private households (williams, 1995 and 2009). in the comparative welfare-state literature the nordic countries constitute one of the most distinctive welfare and social-care models. it is legitimate to speak about a nordic social-care regime (anttonen & sipilä, 1996; bettio & plantenga, 2004) and universalism as a guiding principle behind its care policies and service provision. in the field of care policies there are (or at least have been) many important similarities between finland, sweden, norway, and denmark (sipilä et al., 1997, 39-40). first of all, services are available to all citizens, irrespective of their economic status; secondly, the system offers fairly uniform services all over the country. thirdly, a majority of citizens actually use these services when in need. fourthly, universalism may also include the idea that citizens have rights to services. fifthly, municipalities or regional administrative bodies are responsible for service provision. the grand idea of universal social services was brought into public political discourse by the swedish social democrats as early as in the 1920s (‘society as people's home’). it was closely connected to the promotion of gender equality and a work society for all. since the 1950s, universalist solutions often enjoyed strong support in social policy reforms. this was also the case with social-care services. in aged care two main instruments were used. in finland until the 1960s institutional care was the main mechanism for meeting the care needs of elderly people and the rate of institutionalization among the elderly remained high until 1980s (noro, 1998). the municipal home-help service was greatly expanded in the 1960s and 1970s. developments in municipal home-help serve as a very good example of universalist social policies. in 1966 the home-help service was made available to all those who needed them, irrespective of age and financial position, and the municipalities were required by law to provide these services (rauhala, 1996). municipal home help was the first truly universal social service in finland. in 1970, around seven per cent of the population (65+) received home help, and in 1990 finland was in the top position internationally with a coverage of 24 per cent (oecd 1996: table 3.6; according to the national njsr – nordic journal of social research 2011 – special issue 75 statistics the corresponding figure is slightly lower, 19 per cent). in the 1980s and early 1990s finland as one of the nordic countries had the most advanced systems for safeguarding citizens’ and also aged citizens’ rights to social care. in this sense, it is possible to argue that the universalist social policies peaked in the early 1990s. legal reforms paving the way for marketization in finland, universal principles in the field of social-care policies were challenged during the economic recession of the early 1990s. the recession of 1990-94 was unparalleled in western economic history, with unemployment rising up to the level of 20 per cent. this particularly unbalanced the central government budget, which again resulted in drastic cuts. one of the main objects of cost containment was state subsidies to local governments, which hit municipal social-service provision severely. being less protected by social rights, services for the elderly were among the main victims of the cuts. the economic recession together with the growth of a liberalist market ideology have led to a profound restructuration of social-service policy. it is interesting to note that even before the collapse politicians had opened up some important doors for promoting diversity in service provision. the major reform of the social-welfare legislation in 1984 permitted the use of state subsidies for purchasing social services produced not only by the municipal authorities but also by voluntary and private organizations, as well as payments for informal caring. the social welfare act of 1984 obliged municipalities to provide services according to need, but it also gave them freedom to decide how these needs would be met. this was the beginning for the new politics of social care based on marketization and thus increasingly on mixed-care production. since the 1984 reform, the system of home-care allowances (hca) has constituted the third instrument in providing care for the aged along with institutional and home-care services. the system of hca brought into being new mechanisms and operational practices in making social-care policies. instead of providing services for aged and disabled persons, relatives and other laypersons are paid to take care of those who need regular help and attendance. in finland, cash benefits like hca are primarily seen as an alternative to social-care services (anttonen & sointu, 2006). payments for care schemes are a crucial part in the process where the government tries to reduce the costs of social-care services financed by tax revenues and provided with high professional standards that have also characterized publiccare service provision in the nordic countries. another major legal change that opened up space for marketization took place in 1993, when the system of earmarked state subsidies for social welfare was dismantled. this legal reform strengthened the idea that municipalities are in charge of arranging services, but they have the freedom to decide how these services are arranged and produced (following the danish model of that time). these two legislative reforms paved the way not only for marketization but also for the informalization of social care by making it possible for local governments to purchase services from private (forand non-profit) providers and to substitute some part of care service provision by supporting informal care given at home. all this has led to increased diversity in the social-care production for the elderly and mixed practices of governance in managing social-care systems at the local level of municipalities. njsr – nordic journal of social research 2011 – special issue 76 further steps towards mixed governance that involved the market logic were taken when the tax credit for domestic help was introduced in 2001. this credit can be used for employing assisting personnel, including domestic and care workers, for instance, at an aged person’s home. the tax credit for domestic help clearly represents a market-friendly policy alternative to publicly funded service provision. in principle, this reform allows people to purchase care services (with the exception of childcare) directly from private providers or to employ care workers, but in practice the use of this credit for purchasing care has been very limited (finnish tax administration, 2011). the introduction of the voucher system has strengthened market-like mechanisms in social-care production. since 2004 municipalities have been able to provide some care services by means of service vouchers. the services provided for aged people most often include home help and cleaning services as well as services to support informal carers’ legally defined right to some time off. in 2009, the law on health and social service vouchers was passed to regulate better the diversity in local practices adopted in the finnish municipalities. thus it is only very recently that the system of service vouchers has started to gather more momentum within health and social-care policies in finland. diminishing public responsibility on social care social care for the elderly is going through major changes with respect to the principles behind the legal reforms and mechanisms used in care policies. a working group set up by the ministry of social affairs and health suggested in february 2011 that long-term care given in old age homes and long-term health-care wards in hospitals should be reorganized so that all aged people needing 24-hour care should be living in sheltered housing (service housing) instead of institutions by 2020 (working group ikähoiva, 2011). one motivation behind this reform is to speed up marketization by building up sheltered and extra-care housing for the elderly. through the latter mechanism service users have to pay more for ‘residential’ care because services, medication, and housing are separate packages. this is also an avenue to move one part of the financial responsibility from the municipalities to the state. finally, for private companies sheltered housing is a much more attractive care commodity than the traditional institutional care given in old-age homes and other similar institutions. this major reform was to be accompanied by increases in home help, home nursing, and other home-based services, but in fact the trend has been quite the opposite since the early 1990s. for instance, the home-help service provision has been declining since the heyday of universalism. in 1999, homehelp services covered only 11 per cent of the 65+ population compared to 19 per cent in 1990 (table 1). njsr – nordic journal of social research 2011 – special issue 77 table 1: coverage of municipal home-help services, 1990-2009, finland * number of households receiving home-help services. ** individuals receiving support services (meals-on-wheels etc.) source: sotkanet 2011. table 1 reveals a major change in care service provision. in addition, the decrease in home-help service provision has not been accompanied by an increase in support services such as meals-on-wheels and bathing services. on the contrary, the coverage of these services has also in fact decreased. the system of hca has been designed to compensate some of the losses in municipal home help provision as seen in table 2. table 2: recipients of home-care allowance (hca) 1990-2009, finland year recipients 65+ 65+ 75+ 85+ 1990 13 196 2,0 3,3 6,6 1995 11 294 1,5 2,7 5,0 2000 14 355 1,8 3,0 5,3 2005 19 796 2,4 3,7 6,0 2009 23 548 2,6 4,1 5,9 source: sotkanet 2011. declining figures in home-help coverage and the increasing significance of hca suggest that ‘care is going private’ at least in the sense that aged persons receive fewer home-help services. this loss has been compensated only partly by paying hcas for relatives and spouses of aged persons needing care. compared to other nordic countries, the development of home-help service provision in finland resembles most closely the situation in sweden (figure 1). home-help services* support services** year recipients 65+ % 75+ % 85+ % 65+ 65+ % 1990 125 571 18,7 31,5 42,4 103 096 15,3 1995 86 748 11,8 22,1 35,7 97 967 13,4 2005 85 604 10,2 18,3 34,4 108 249 12,9 2009 103 863 11,4 20,4 37,3 116 347 12,8 njsr – nordic journal of social research 2011 – special issue 78 figure 1: people living at institutions or in service housing and people receiving home help in the nordic countries, as percentages of the age group 65 years or more, 1995-2008 source: nososco, social protection in the nordic countries 2007/2008, figure 6.2.3. figure 1 shows that in finland and sweden the governments have carried out reforms that have shrunk the scope of public-service provision and have limited aged citizens’ access to core social-care services by tightening the eligibility rules (anttonen et al., 2009; palme et al., 2002). in finland, this has been done without any major changes in the social-welfare legislation. the law makes it possible to meet the needs of aged persons in very different ways. even if there are national laws on social-care services, the social-care rights of aged persons are rather weak compared, for instance, to childcare rights (kröger, anttonen & sipilä, 2003). this is also largely the case with home help that has turned into a municipal service. today central-government grants cover only a minor part of local-government expenses in social and health care. the financing of public-care services is based primarily on taxation: the share of national tax-based financing is less than 20 per cent of total costs. the reminder is covered by local taxes and user fees. customer fees vary to some extent, being in 2007 on average 16 per cent of nursing home-service expenses and 14 per cent of home-care expenses (sjöholm, 2009). in this section we have shown that public responsibility for social-care service provision is diminishing. as there are fewer services available than before and new mechanisms have not compensated these losses, new solutions are badly needed. the only elderly-care service that has increased since early 1990s is sheltered housing and extra-care housing. these services, however, compensate shortages in institutional rather than in home-help services. all these changes have paved the way for marketization as well as for the informalization of care. marketization in public policy discourse even today municipalities carry the main responsibility for financing and providing of social services. the introduction of legislative reforms coupled with limited financial resources since the early 1990s have contributed to the old age, disability and surviving relatives 151 when needed. in all the countries, home help is provided to the elderly. the extent of the assistance is determined on the basis of individual needs and may vary from a few hours per month to several hours per day. with the exception of the faroe islands, the assistance is a municipal matter and is provided by municipally or privately employed staff. the statistics concerning home help in the nordic countries are not easily compared. while the figures for denmark, the faroe islands, norway, finland and sweden are situation-statements, the icelandic data contain information on how many people received help during the year. figure 6.2.3 people living at institutions or in service housing and people receiving home help, as percentages of the age group 65 years or more, 1995-2008 95 96 97 98 99 00 01 02 03 04 05 06 07 08 0 5 10 15 20 25 people living in institutions or service housing percent 95 96 97 98 99 00 01 02 03 04 05 06 07 08 0 5 10 15 20 25 elderly people receiving home help denmark finland iceland norway sweden percent faroe islands denmark finland iceland norway sweden faroe islands njsr – nordic journal of social research 2011 – special issue 79 development of new forms of governance in finnish municipalities (häikiö, 2010; haveri, 2006). the municipalities have created structures based on the separation of purchasers and providers and have enabled for-profit or nonprofit services, or both, to replace public services. the language of social-care policies is changing to include words such as choice, customer orientation, partnership, contracts, and the market. finland is, however, a ‘latecomer’ in the league of countries favouring marketfriendly social policies. some municipalities, like the city of tampere, have adopted an extensive purchaser-provider model (häikiö, 2010), with a steadily increasing presence of market mechanisms and market providers. in this section we trace market-related change from policy documents. the data used comprises 14 documents published between 2001 and 2008. half of these documents were national ones, including those produced by the government and the ministry of social affairs and health. the other half comprised local policy documents produced by the city of tampere. we do not present a detailed analysis of the policy documents here, since this has been done elsewhere (anttonen & häikiö, 2011). we briefly illustrate the role of elderlycare policy discourse in introducing markets as a policy alternative in providing elderly care. the documents analysed confirm that the language of social-care policy is increasingly giving way to an elderly-care discourse that emphasizes personal responsibility, choice, and social-care markets (anttonen & häikiö, 2011; häikiö & anttonen, 2011). the documents of 2001-2004 referred clearly to the constitution as the foundation of social citizenship and social security and public responsibility for social care. one cornerstone of the finnish social policies is that the social rights of residents are guaranteed by the constitution. social protection is intended to support equal opportunities for all citizens. section 19 of the new constitution of finland, which came into effect on march 1, 2000, guarantees the right to indispensable subsistence and care for those who cannot themselves obtain the means necessary for a life of dignity. the section develops this theme by guaranteeing the right to basic subsistence in the event of unemployment, illness, disability, old age, at the birth of a child or in the event of the loss of a provider. this is a general right to be provided in detail under separate legislation. the public authorities are also obliged to guarantee adequate social, health care and medical services for all and to promote the health of the population. (strategies for social protection 2010, 2001.) the discourse constructed with reference to the constitution underlines that public authorities have the main responsibility for meeting citizens’ basic needs and that citizens are entitled to social and health care as well to education and income protection. however, since 2004, policy documents make fewer and fewer references to the constitution, citizens’ rights, and public responsibilities. instead, these documents emphasize the active position of older people themselves to take responsibility for their personal well-being. in addition, there are increasingly references to the issue of choice. it is particularly the ‘freedom of choice’ through which care is framed by market logic. in the documents elderly-care services were increasingly seen as commodities produced in the emerging social-care markets: securing the provision of services calls for a sound financial basis and new ways of organizing and producing services. the government promotes partnerships between the public, private and third sector in the provision of services. the adoption of the purchaser provider model will njsr – nordic journal of social research 2011 – special issue 80 be encouraged. the applicability of social service vouchers and the domestic help credit will be expanded which will contribute to the emergence of working service markets. (the government programme. prime minister matti vanhanen's second cabinet, 2007) the purchaser-provider model, social-service vouchers, and domestic-help credit are all public-policy measures designed to promote social-care markets. care markets are constructed as means for securing universal access to services. the discourse underlines the public responsibility for creating functioning care markets and the individual’s responsibility for meeting care needs (häikiö & anttonen, 2011). the municipality retains the legal responsibility for meeting the care needs of aged citizens and carries the responsibility for quality control of private services, but in practice most of these new market mechanisms shift these responsibilities to individuals. for example, by using tax-funded service vouchers citizens become consumers with consumer rights, and they use care services according to consumer rules and legislation (huhtanen, 2011). public authorities are in most cases not responsible for consumer failures or choices (vabø, 2006). in the social-care markets individuals also act as true consumers because they bear the financial responsibility for the care and cannot make demands with reference to universal social rights. consumerist positions were most visible in the local policy documents where inhabitants of the municipality are framed as clients and customers with individual needs and expectations (häikiö, 2010). whether the aim is to create new markets for social services or to create market-like mechanisms within public-service provision, individuals were positioned as choice-makers. the kotitori (“homemarket”) programme also makes it possible for old people to be both clients and patrons. as clients they use the services arranged by the city administration and as patrons they use services paid for with their own money. (homemarket planning and decision documents 2.6.2008) this extract demonstrates that the city of tampere was planning to start in 2009 the so-called homemarket project, which is based on the idea of the citizen as a conscious consumer, whose care needs are negotiated together with care integrators (or care managers). the project started in 2009, and interestingly homemarket is run by a private company. from this it follows that these managers first assess the social-care needs for aged persons is first assessed and then make decisions concerning the help and services needed, including publicly produced services. the project does not yet cover the whole city, but the firm aims is to extend its authority in the coming years. thus, care managers are responsible for setting up a service package for each consumer according to their needs and personal financial resources. they will also provide access to information covering all service provision within the municipality and beyond. an analysis of the most recent policy discourse on social care for the elderly reveals that there is a major change in the vocabulary used by politicians and administrators. market-related change is fairly obvious when reading official policy documents produced between 2001 and 2008. a longer period would have given much more information of the change from universal social protection to mixed welfare governance. both a change in fundamental views and a change in political vocabulary are necessary preconditions for the new politics of social care to be implemented at the local level of municipalities. njsr – nordic journal of social research 2011 – special issue 81 the analysis (see also anttonen & häikiö, 2011; häikiö & anttonen, 2011) supports the argument that ‘old’ universalist politics founded on strong centralized institutions (hierarchies), universal treatment of ‘clients’ or ‘patients’, and the professional interpretation of needs is changing towards a politics of mixed governance, including in finland. the state-centred service production relied heavily on steering mechanisms embedded in bureaucracy, paternalism, and professionalism (langan, 1998). the concept of mixed (welfare) governance emphasizes that local authorities are to mix different organizing principles, governing methods, and coordination mechanisms to promote diversity instead of universalism. according to jessop (1999) the new governance of welfare is characterized by changes in the definition of welfare, changes in the institutions responsible for delivering services, and changes in the practices of service delivery. social care has always been produced by individuals, families, third-sector organizations, and private companies, besides public authorities, but within the mixed-governance structure, the relations and power positions of these providers are altered (burau, theobald & blank 2007). table 3. forms of mixed welfare governance. source: häikiö & anttonen 2011. according to table 3 market-based service provision is based primarily on competition and choice. competition is a new steering mechanism used by public authorities, and choice is attached to the behaviour and rights of service users. a number of european scholars have argued that at the centre of the new politics of social care lies the figure of the ‘consumer’ making ‘free choices’ on the socialand health-service market (clarke, 2006; kremer, 2006; vabø, 2006). anttonen and häikiö (2011) have argued that the transition from government to mixed welfare governance shapes and frames both policy discourses and operational practices taken into use in finnish social-care policies. it is too early to speak about a major shift in fundamental views from state-friendly to market-friendly social policies. yet the public political debate encourages municipalities to adjust their welfare systems to the new mental, economic, and social situations. in finland, citizens or residents even today give strong support to universalism and tax-funded social and health-care service provision (kallio, 2010). this means that the new politics of social care is favoured and promoted primarily by elites. surprisingly, the new marketfriendly social-care politics has been implemented without any extensive public debate or opposition. marketization of social-care service provision although we have paid much attention to mixed welfare governance, it is worth noting that in finland there has always existed some kind of welfare mix in social-care service provision for aged persons (kröger et al., 2003). most organizing principle governing method coordination mechanisms position of service user hierarchies administrative and political power command and control client, patient networks norms trust and support service user, coproducer markets money competition and choice consumer njsr – nordic journal of social research 2011 – special issue 82 particularly sheltered housing has for decades been in the hands of welfare organizations extensively supported by public financing. figure 2 presents the situation in 2008. however, in the field of sheltered housing, non-profit providers have had much influence for decades. figure 2: public, non-profit and for profit service provision: old-age homes, service housing and intensive service housing, 2008, finland. however, for first time in the history of finnish social policies, public goods such as home help services have been transformed extensively into products that one can purchase in the emerging socialand health-service market with public money involved. at the same time it is estimated that elderly populations can afford to use more care services purchased from market with their own money. first, we shall look at the market orientation of aged persons as purchasers of purely private-care services, and, secondly, we shall consider some outcomes of the process of marketization within local governance structures. the introduction of tax credit for domestic help in itself reflects a marketrelated change in social policies. according to the tax-credit system all finnish residents with taxable income can deduct a certain amount of wage (30 per cent) and work compensation (60 per cent) when purchasing home services including, for instance, household repairs, gardening, and cleaning services. the maximum amount of deduction was €3000 in 2011. while the deduction is granted on an individual basis it favours households with two adults. the system has existed since 1997 and has expanded rapidly, particularly since 2001, when the corresponding law came into force. yet even today the system is very little used to purchase care services for aged persons, although adult children have a right to deduct expenses of care and cleaning services purchased for their parents. in 1998, roughly 20 000 users availed themselves of the tax credit for domestic help, in 2004 the corresponding figure was nearly 180 000 users that is 6.6 per cent of all households in finland, and in 2009 360 000 users availed njsr – nordic journal of social research 2011 – special issue 83 themselves of the tax credit, which is almost ten per cent of all household.2 in 2009, roughly one-fourth of the total amount was used for domestic (17 per cent) and care (three per cent) services and the rest to repairs to the home (81 per cent).3 from these figures we see that the system of tax credit for domestic help has become very popular, but it is used mostly for repair work at home and not very much for the purposes of social care. a survey conducted in tampere and jyväskylä regions in 2010 supports these findings (figure 3). nearly 15 per cent of population of 75+ used the system of tax credit to purchase domestic services, mostly cleaning services. in addition, about 20 per cent of all respondents had purchased some private socialor health-care services with their own money. this means that every fifth person over 75 uses some private care-related services. we can expect that more aged persons will turn to private services in the future. figure 3: use of private-care services among population 75+ in tampere and jyväskylä region, 2010 people 75+ funding private services 0,00 % 5,00 % 10,00 % 15,00 % 20,00 % 25,00 % used tax credit for domestic help funded service with own money close relatives funded the service used service voucher and own funds people 75+ funding private services as already shown, marketization is a strong trend in the public political discourse. in this section we look at some outcomes of marketization at the level of policy practices. within municipalities the market logic has become an important rationale. municipalities have since the 1980s had the freedom to purchase services from nonand for-profit service providers. in some areas there is already a fairly long tradition of relying on non-profit service provision. this is most particularly the case in sheltered housing for aged and disabled persons. in some other service areas, such as home-help services, municipalities have dominated service provision up to the present time. generally speaking, we can discern a clear increase in both nonand for-profit service provision as measured by the share of personnel working in social services according to the status of the provider (see table 4). the distinction between forand non-profit providers is tricky, however, because most of the non-profit providers have been forced to transform themselves into business 2 source: eurofound: www.eurofound.europa.eu/areas/labourmarket/tackling/cases/fi004.htm. 3 source: tax administration: http://vero.fi/?article=7558&domain=vero_main&path=5,422,412&language=fin.85. njsr – nordic journal of social research 2011 – special issue 84 like providers in order to be able to take part in competitive tendering arranged by the municipalities. in addition, there are no reliable figures from social-care services separately for all social services. in fact, this is not a big problem, because care of aged persons is one of the areas in which marketization process has been an exceptionally strong trend. table 4: the share of personnel working in public, non-profit and for-profit social services in finland, 1990-2007 provider % of total number of personnell 1990 1995 2000 2002 2004 2006 2007 public providers 87.6 86.6 79.3 76.0 73.3 71.4 69.6 non-profit providers 11.6 11.9 16.2 18.1 19.0 17.8 17.9 for-profit providers 0.5 1.6 4.5 5.9 7.7 10.8 12.5 nonand for-profit (total) 12.1 13.4 20.7 24.0 26.7 28.6 30.4 source: www.thl.fi/yksityinenpalvelutuotanto [11.3.2011]. the non-profit or third sector has historically been an important actor in socialservice provision, particularly in old-age welfare, while the importance of private market-based social-service provision is a fairly recent phenomenon. this explains why in 1990 only one per cent of the total personnel working in social services were employed by private providers and 11 per cent by nonprofit providers. in the ten years between 1990 and 2000 there was a clear increase in the share of private sector personnel. the early 2000s witnessed a rapid growth of both nonand for-profit sectors so that in 2007 the share of nonand for-profit of total personnel in social services had arisen to 30 per cent. to sum up, in the 17 years between 1990 and 2007 the role of publicsector service provision has clearly diminished. private-service provision has been steadily increasing but has not exceeded the volume of the non-profit sector. against this background we can speak of only a moderate marketization in the fields of social care and social services. yet it is worth noting that the growth of private-sector enterprises in social services has been very rapid since 1990. in 2008, there were 4100 private enterprises in the field of social services in finland, while the corresponding figure in 2000 was 2664 and in 1990 only 741 (yksityinen palvelutuotanto, 2011). as already mentioned, there is considerable variation between different services. housing (sheltered and extra-care housing) is one of the social carerelated services where the role of non-profit and for-profit service provision is most extensive. in 2008 (see figure 2) more than one half of all sheltered housing for the elderly was provided by nonand for-profit providers and 65 per cent of this was provided by welfare organizations. the situation is slightly different regarding the care given in old-age homes. of all old-age homes the share of non-public provision was only 12 per cent in 2008. besides housing services, home-help service is of great importance for aged persons living at home. home help also represents social-care service par excellence. it is estimated that one-third of home-help services was produced by nonand for njsr – nordic journal of social research 2011 – special issue 85 profit providers in 2008. roughly 56 per cent of non-public home-help service provision was for-profit and the rest non-profit provision (yksityinen palvelutuotanto, 2011). one of the most recent legal reforms, the law that allows the use of vouchers for buying both healthand social-care services, is of great importance from the marketization point of view. this reform certainly accelerates the process in which care becomes marketized. before the 2009 law, service vouchers were used in home help. in 2006, the municipal authorities granted service vouchers to roughly 3000 service users and in 2009 the number had risen to nearly 7000 users. while the system of service vouchers is now extended to cover nearly all socialand health-care services, the real voucher boom is yet to come. conclusions in this study we have established a framework for institutional policy analysis to evaluate if marketization has become a vocal element in finnish elderlycare policies and practices. drawing evidence from institutional legal changes framing mixed-care production, institutionalized responsibilities in care, elderly-care policy discourses, and policy outcomes in the field of social-care provision, we have arrived at the conclusion that market logic is intensively structuring finnish social-care policies. all institutional aspects analysed in our study show a clear transition from universal social policies based on extensive public responsibility to market-friendly policies and the marketization of social care. however, the process of marketization is fairly strongly regulated by public authorities. in finland, public-sector service provision has now been redefined and reorganized so that the state and municipalities take less responsibility for producing care services-in-kind. this means that forerunners and late-comers in relation to market-related reforms are facing the same problem: how to produce care in a situation where neither family-based nor public-service provision can be the only or even major solution to meeting the increasing care needs of older people. for historical reasons and the finnish social-policy tradition, marketization represents a critical juncture in which to evaluate the overall pattern change. it really is time to ask if the pattern of social-care service provision is turning into something other than that of nordic care regime. so far the nordic social-care regime has rested firmly on the principle of universalism, meaning that services are designed for all citizens irrespective of their class, gender or ethnicity (kröger et al., 2003). universalism, however, is challenged by globalization, new liberalism, market-friendly social-policy doctrines, and demands to develop user-friendly service systems that make choice possible. the transformation of public administration into public management and the influence of managerialism and new public management (npm) on the recent public-sector reforms in many european countries have accelerated welfare state change. the new market-friendly language of social-care policies is closely linked to an overall change in the welfare state. a very extensive and profound reform of social-care service provision is taking place in finland. however, the change has been most dramatic since 2007. there are so far no reliable statistics on the recent developments. these changes mean that the mixed governance njsr – nordic journal of social research 2011 – special issue 86 mode will be strengthened and the earlier state-centred welfare production mode is at least partly withering away. in this respect finland is approaching the liberal welfare states. it is possible to argue that finnish elderly-care policies are going through a change of a magnitude similar to the change of 30–40 years ago, when the politics of universalism was breaking through. the new direction points towards the market, although the role of welfare organization and similar associations remains important. as already stated non-profit third-sector providers have also been forced to transform their service ideology and practices into a market-rational form. the demarcation between non-profit and for-profit provision is becoming blurred because non-profit providers have to compete with for-profit providers under the same rules and same expectations of effectiveness and efficiency (karsio, 2011). this way the market-like mechanisms are becoming extremely powerful in social-care policies for the elderly. in 2011, a governmental proposal for a new law on social care for the elderly was made. this law if passed would strengthen elderly persons’ rights to social care. it would also make it easier to control service providers and their possible failures (luonnos laiksi..., 2011). this is important, because in finland most political parties seem to celebrate the power of competition and markets. there is so far very little criticism of the new market-like mechanisms and operational practices adopted during the wave of liberalization and marketization. however, at the time of writing the true finns political party achieved 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(2010-2011)). in addition, a major national policy has been to provide short-term economic incentives to municipalities that want to establish local lmcs through intermunicipal cooperation. the lmc is a case of innovative activity unfolding across organizational boundaries where neither the roles nor the characteristics of those who participate are made clear. moreover, because innovation means doing something new and different, it will always challenge prevailing and well perceived political and organizational conditions (windrum & koch, 2008). hence, innovation requires energy from the multiple actors involved (hartley, 2014). furthermore, we should not overlook that nationally promoted innovations provide opportunities for people who have the will, interest, and energy required to innovate. the last consideration begs the question: who are those individuals or groups of individuals who have contributed to converting the lmc idea into local praxis? this case study provides insight into how one nurse without much formal power or authority could stand out as a strong driving force in the conversion of the lmc idea into praxis. in this context, it is interesting to examine how the subject of power relates to the role and behaviour of individual actors in collaborative innovational processes. combining theoretical perspectives of power and the role of individual actors, this article provides a new theoretical framework for the understanding of power in collaborative innovation. overall, the article offers a perspective on the power of enthusiasm as a crucial driving force in collaborative innovational processes. collaborative innovation in the public sector while the literature on new public management (npm) has emphasized the role of the entrepreneur as a central source of innovation (sørensen & torfing, 2011b), scholars inspired by ideas of new public governance have promoted collaboration and multi-actor engagement as a better innovational strategy in public-service organizations (bommert, 2010). at the core of the concept of collaborative innovation is the idea that governments should adopt a form of innovation where a diverse base of organizations and individuals discover, develop, and implement ideas within and outside organizational boundaries (bommert, 2010; borins, 2001; eggers & singh, 2009). this concept further holds that complex problems in the public sector cannot be solved without engagement and involvement from multiple individuals in different roles and positions (sørensen & torfing, 2011b). thus, collaborative innovation is a process where stakeholders share power in the decision-making in order to make shared and new solutions to complex problems that cannot be solved without multi-actor engagement (roberts, 2000). in line with current literature njsr – nordic journal of social research vol. 7, 2016 33 on public-service innovation (hartley, 2005; sørensen & torfing, 2011b), innovation in this article includes the ‘reinvention or adoption of ideas to a new context, location or time period’ (hartley, 2005, p. 27). this study regards the case investigated as a case of collaborative innovation because different persons on different organizational levels have cooperated to create innovation. although collaboration is based on a model of shared power, collaborative innovational processes do not automatically translate into power equality (gray, 1989). sources of power and arenas for use of power will always shape the direction and outcomes of innovational processes (bommert, 2010; purdy, 2012). moreover, some individuals or groups of individuals may be more dominant and powerful than others (gray, 1989; roberts, 2000; rønning & knutagård, 2015; young, 2002). to engage in ‘real’ collaborative strategies, power has to be dispersed, but not contested (roberts, 2000). collaborative skills are still limited, and although multi-actor engagement may in many instances be characterized as a smooth interaction, it is often a conflict-based game (sundbo & fuglsang, 2002). hence, we should not ignore that innovations appear more often as a result of contested power relations and constellations than as a result of collaborations (roberts, 2000; rønning & knutagård, 2015). power one of the most widely used definitions of the concept of power is as follows: a has power over b to the extent that a can get b to do something that b would not otherwise do (lukes, 2005). this definition is relevant for the current research because it underlines that power is not necessarily connected to formal positions and authority. it also takes individual differences related to one’s expertise, information, charisma, and goodwill into consideration (treadway, breland, williams et al., 2013). nevertheless, it is important to note that the subject of power comprises both policy structures and contextual conditions (rønning & knutagård, 2015). different political structures, processes and contextual conditions raise different power games. thus, power is always embedded in socially constructed structures and has to be seen as multi-layered (arts &tatenhove, 2004). asymmetries of power in collaborative arenas may prevent certain groups of actors from voicing their opinion and bringing new ideas to the table (torfing, sørensen & fotel, 2009). asymmetries of power due to authority may cause such biases. conversely, authority may also be used to empower actors or groups of actors to participate more effectively in collaboration than others (purdy, 2012). thus, a lack of authority does not necessarily mean a lack of power. for example, this is the case if a participant is perceived to advocate a socially important idea (purdy, 2012). the most effective way for individuals without formal authority to achieve power is to make others involved dependent on them (mechanic, 1962). employees without formal sources of power may achieve considerable informal power owing to their expertise, information, friendly disposition, and as a result of their position within the organization (mechanic, 1962; treadway, breland, williams et al., 2013). the extent to which lower-ranking participants exercise power depends in part on their willingness to exert effort in areas where higher-ranking participants are often reluctant to participate, and the effort exerted relates directly to the degree of interest one has in an area (mechanic, 1962, p. 359). njsr – nordic journal of social research vol. 7, 2016 34 some individuals may be more enthusiastic than others. overall, some people can build a larger power base than others and increase their chances to win and define the problem and solutions in a way they see fit (roberts, 2000). in this article i define ‘power base’ as the available resources individuals possess. the role and power of individual actors while studies of collaborative innovation (hartley, sørensen & torfing, 2013; sørensen & torfing, 2011a) have played down the role of individual actors in favour of multiple action, public-entrepreneurship studies have focused on creative individuals, often termed ‘public entrepreneurs’, as the primary source of innovation (osborne & brown, 2005; windrum, 2008). the literature on public entrepreneurs regards the link between personality traits and the entrepreneurial role as essential to innovation (roberts & king, 1996; windrum, 2008). public entrepreneurs’ success at translating ideas into practice is closely linked to their highly creative, self-confident, hard-working, charismatic, decisive, energetic, and dedicated behaviours (roberts & king, 1996, p. 11). through an extensive field study, roberts and king have developed a model of the public entrepreneur as tenacious and persistent, willing to work long hours and to take risks to reach his goals, and confident and skilled at using political connections (roberts & king, 1996, pp. 10-11). with this set of core personality traits, public entrepreneurs are quite often seen as heroes who support and promote innovation against entrenched interests and the status quo in organizations (osborne & brown, 2005). they appear to be change agents who constantly search for ways to convert their visions into reality (roberts & king, 1996, p. 145). røvik (2007) claims that actors’ ability to convert ideas into reality is an area that generally is overlooked and neglected. on the basis of this lacuna, he presents a model of the ‘capable translator’ as an actor who has detailed knowledge about the idea which should be translated, the context the idea is taken from, and the context into which the idea is going to be translated. the ‘capable translator’ has to be strong and determined because the translation of ideas often takes place in a context of interest-based power games, negotiations, and conflicts, and where the translator’s new local models mobilize resistance as well as support. this requires translators to be able to handle resistance and to understand dimensions of conflict and interests (røvik, 2007). network connections are essential for creative individuals’ ability to succeed (røvik, 2007; windrum, 2008), and, according to meijer (2013), ‘instead of one hero’, distributed heroism is needed for successful innovation (meijer, 2013, p. 6). one hero may be crucial in one part of the process, but may run into problems in another part, for instance, because his role as an ‘idea fighter’ may be too prominent (meijer, 2013). this, however, does not mean that individual personality traits and skills are not important drivers in innovational processes (meijer, 2013; osborne, 2005). we should keep in mind that such individuals or groups of individuals may increase their chances of obtaining a power base needed to realize their interventions. a combination of the literature on characteristics of public entrepreneurs and theories of power single out the role of individual actors in collaborative innovational processes. with the empirical data, i shall investigate to what extent personality traits can lead to a power base with implications for using collaborative strategies in public innovation. njsr – nordic journal of social research vol. 7, 2016 35 introduction to the case the case in this study involves a region located in a rural part of norway that comprises six small municipalities. these municipalities, like many others in norway, struggle to meet the legal requirements and to produce services efficiently. they also have concerns related to depopulation, long geographic distances to the hospital, and a lack of competences and resources to be able to handle future health challenges. given these circumstances, and because of organizational and economic incentives established by the coordination reform, inter-municipal collaboration is seen as an appropriate solution to their challenges. simultaneously, and consistent with the long-standing tradition of local autonomy in norway (andersen & pierre, 2010), each of these municipalities wants to retain as many healthcare services as possible in their own municipality. hence, reaching agreements about new collocated municipal health services has been difficult, and scepticism, resistance and conflict has marked the lmc process. since 2002, the region has operated a district medical centre (dmc) providing specialist health services in partnership with the local hospital. the dmc was located in the region’s biggest municipality. thus, in contrast to many other lmc cases, this region already had an integrated health centre with similarities to the lmc idea that was presented in national reform documents. notwithstanding, the provision of healthcare services in the sense of small medical institutions on a level between primary care and general hospitals is in itself not a new idea. in norway (pedersen, 2013) as well as abroad (tucker, 2006), it has been a widely used concept since the early 1900s. in norway, such centres have been quite common in rural areas because of long distances to the local hospital. most of them were called ‘cottage hospitals’ (ch) or district medical centres (dmc). after 1970, the norwegian government prioritized the development of general hospitals, and the number of chs or dmcs declined (aaraas, 1998). in the wake of the coordination reform (green paper no. 47 (2008-2009)), national authorities have brushed the dust off this idea and changed the term ch or dmc to lmc. such centres are said to be desirable, both in rural areas and in cities, to handle new municipal responsibilities in the wake of the reform. we may regard december 2008 as the starting point for the new plans for the region’s already established dmc that at that time lacked physical space. simultaneously, the nursing home in the biggest municipality was ‘out of date’. furthermore, the newly launched coordination reform stressed innovation through inter-municipal cooperation. to address these issues, some of the leaders in the region’s largest municipality and the nurse who is the focus of the study suggested establishing a new lmc comprising a new nursing-home unit, an intermediate unit, and the already existing dmc. a few months later, the nurse and these leaders applied for and obtained short-term economic incentives from the state, a move that had political backing in all six municipalities. the aim was to identify interest in the establishment of new collaborative healthcare services in the region, and whether the new lmc was needed and possible to establish. the nurse who at that time worked as a health advisor in the biggest municipality was very enthusiastic about the establishment of a new lmc. because of her strong engagement, she was appointed as project coordinator for the lmc project. this position did not entail authority to make any decisions, but through the role as project coordinator, she got the opportunity to be a driver in the njsr – nordic journal of social research vol. 7, 2016 36 innovational process. today, the region’s new lmc has been established in accordance with how it was presented for the first time in 2008. research design and method we can view the presented case as informative. i have selected it partly because it has many similarities to other lmc processes in the wake of the norwegian coordination reform, and partly because it is different, as it already had a dmc (magnussen & tingvold, 2015).the benefits of a single-case study lies both in its capacity to investigate a phenomenon in depth in its real-life context and in the investigator’s opportunity to use a variety of data-collection methods (flyvbjerg, 2006; gerring, 2004, 2007). the strength of this case study is that it enabled me to follow the process from the birth of the idea to the establishment of the new lmc. the data material included interviews and participant observation, which have strengthened the internal validity of the case. the interviews the selection of informants resembles snowball sampling (atkinson & flint, 2001), starting with an inquiry to the nurse and one of her managers. i then undertook semi-structured interviews with 12 key actors involved in the establishment of the new lmc. common for all the informants was their participation in this innovational process. table 1 specifies the informants’ roles and relation to the lmc project. the duration of the interviews was from one hour to one hour and a half. all except one of the informants had lived and worked in the region for many years. they were interviewed about their experience of how the development of the lmc took place in their region. i interviewed the project coordinator twice with approximately a two-year interval between interviews (2010, 2011). the other interviews were conducted in autumn 2011and in spring 2012. table 1: list of informants informant profession/role relation to the lmc 1 nurse in leadership position member of the project group 2 municipal administrator member of the project group 3 municipal administrator familiar with the lmc plan 4 nurse in leadership position member of the project group 5 physician initiator and member of the project group 6 project adviser member of the project group 7 nurse, health adviser in the biggest municipality initiator and project coordinator of the project group 8 politician strongly involved in the process 9 politician strongly involved in the process 10 nurse in leadership position member of the project group 11 nurse in leadership position member of the project group 12 physician familiar with the lmc plan njsr – nordic journal of social research vol. 7, 2016 37 the observational period the participant observation took place between 2009 and 2014 and consisted of participation in a broad variety of meetings, seminars, and workshops connected to the planning process of the lmc. during the period of observation, i had regular contact with the project coordinator by telephone, e-mail, and in person before and after the meetings. i also participated in a study tour arranged by the lmc project group. i had access to the case region’s project reports, powerpoint presentations, and minutes from their meetings. participant observation and access to all of the project’s written documentation provided an opportunity to get first-hand insights into how the actors involved discussed and planned their lmc, including insights into various issues affecting the individual municipalities’ lmc processes. data collection and analysis the data from observations were collected through hand-written field notes. i developed and adapted the initial semi-structured interview guide as new questions emerged. the main focus was nonetheless the collaborative process of the establishment of the lmc. all the interviews were recorded on tape and then transcribed. i read and analysed the field notes from the observations and written documents, listened to and transcribed all the recorded interviews. all the interview data and parts of the observation notes and written documents were coded and categorized with the qualitative analysis programme nvivo. i began with ‘open’ coding (glaser & strauss, 1967). the purpose of the open-coding process was to generate codes directly from the data (strauss & corbin, 2014). most of the data-generated codes were labelled from words found in the data itself. subsequently, i categorized the codes in terms related to the research question: ‘who contributes to converting the lmc idea into local praxis?’ in this part of the analysis i found an interesting link between power and individual actors’ enthusiastic engagement in the innovational process. accordingly, i focused on the development of theory and how present theory could contribute to the understanding of my empirical data. through this interactive inductivedeductive approach the aim was to get a sharp and in-depth understanding of the innovational process in establishing the new lmc. case analysis the case analysis includes the two phases where the establishment of the lmc project was assessed and decided politically. in the first phase the project group’s mission was to investigate the need for a new regional lmc. in the second phase they planned the content, localization and organization of a new lmc. by following these two phases closely, i received insight into the scepticism, conflicts, and resistance regarding the lmc. furthermore, i became aware that the project coordinator, owing to her enthusiasm for the lmc project, played a central role in putting it on the local political agenda and in steering the content and structure of meetings and other activities related to the lmc. the further analysis will elaborate on these aspects, including the nurse’s strategies to succeed in establishing the lmc. scepticism, conflicts, and resistance especially in the first phase of the project, the nurse hired as a project coordinator felt that leaders, politicians, and physicians in some of the njsr – nordic journal of social research vol. 7, 2016 38 participating municipalities frequently opposed her. she also stated that she had been disappointed by the lack of involvement and support from people she had expected would understand the importance of a new lmc. despite these negative experiences, she said, ‘i am an optimist; with more constructive information, i think we will succeed’. other informants also described the first phase of the lmc process as marked by scepticism, resistance, and conflict. one of the physicians actively involved in the process said: we have a ‘physicians’ club’, a forum where all the physicians in the region meet several times a year. the atmosphere usually tends to be very good and we agree on most things. i would say that this [the lmc idea] is the case where we have had the most disputes and conflicts in the almost 30 years i’ve been here. (5) some claimed that the lmc could result in health services with lower quality and safety. another contested subject was the location of the lmc. all of the municipalities involved had long and strong traditions of local political autonomy, and many stakeholders (politicians, leaders, physicians, and other health professionals) still wanted to keep most of their healthcare facilities in their own municipality. thus, a concern that was often voiced was a lack of jobs and competences in each of the municipalities when the focus was on the regional level. the most prominent concern was related to the lack of financial resources. some assumed that the establishment of the lmc would be at the expense of the ordinary primary healthcare services in each of the municipalities. because of the location, some also asserted that they were not interested in paying for the biggest municipality’s new nursing-home unit. instead of attempting to resolve scepticism and conflicts through collaborative effort and through learning from one another, the strongest opponents remained on the sidelines and discussed the idea in negative terms. regarding some of the physicians’ attitude, an informant said: some physicians have renounced intermediated care services. they call it not very nice things! they say they are never going to refer patients there. they do not attend venues where the lmc idea is presented and discussed, except perhaps occasionally in the physicians’ club, to announce their opposition. (2) the physicians’ resistance was not just observed in this study, but has been debated since the idea of intermediated healthcare and emergency health services was launched by the coordination reform (skinner, 2015). however, other opponents, particularly politicians and people in leadership positions in the surrounding municipalities, showed resistance with their absence from collaborative meeting places. one informant explained the use of such soft resistance as follows: in the beginning, the lmc idea was more like a castle in the air. i think many of the opponents thought this idea would just blow away or die if they didn’t engage in it. (10) however, despite widespread scepticism, conflicts, and resistance expressed through absence, negative talk, and threats about not referring patients to the suggested intermediated unit, the lmc idea did not die out. njsr – nordic journal of social research vol. 7, 2016 39 the nurse’s enthusiasm for the lmc idea the nurse was quite convinced that a new lmc was the best way to address new responsibilities referred to in the coordination reform (green paper no. 47 (2008-2009)). thus, through her role as project coordinator and by virtue of her professional knowledge and experience from primary healthcare, she talked about the lmc idea with exceptional energy. as one administrative leader said: there is no doubt where the professional enthusiasm and zeal is located (...). it is pretty clear that this enthusiasm has been a major driving force in the project. (3) the nurse’s strongest argument for a new lmc was that shorter travelling distances to specialist services and access to treatment in a safe and familiar environment would provide better and more cost-effective healthcare services. because of her professional eagerness to establish the new lmc, she also stood out as an energetic and dedicated project coordinator, with a deep commitment and drive to convince people in her environment that the establishment of the lmc was the only right thing to do. her personality traits had many similarities with roberts and king’s (1996) characteristics of the public entrepreneur. she had the self-confidence needed to handle resistance. from her point of view, resistance was a natural part of the process, caused by a lack of information and knowledge about the upcoming tasks described in the coordination reform. as she put it: i think it [resistance] is because of some strong actors who don’t understand the consequences of ‘not being in’, and because of some politicians who don’t have enough competence to see the consequences, and thus do not appear to be sufficiently convincing. hence, i think more information is the key to handle this. (7) furthermore, as the next quotation illustrates, she was tenacious and not afraid of taking risks: i think a new lmc will provide economic challenges for the involved municipalities, but it might also lead to something positive, for instance, because it leads us to think and handle primary health services in a different and new way. (7) from the observational data, it was clear that the nurse was confident and skilled in using political connections too. she invited politicians and professional experts to speak about the benefits of the lmc concept at regional venues. if something was unclear or problematic, she did not hesitate to make a phone call to national political authorities. she was not afraid of working long hours either. she searched continually for information and knowledge that could strengthen the reasons why the region should implement the innovation. in the second phase of the project, her job was estimated to be full-time employment for four months. in the written report from this period, her real workload ended up being full-time work for six months. overall, she worked significantly more than her position warranted. the power of individual action in collaborative innovation the empirical analysis indicates that the nurse, with the entrepreneurial skills described above, developed four key strategies, which were either intentional njsr – nordic journal of social research vol. 7, 2016 40 or unintentional: 1) a monopoly of expertise knowledge; 2) strength and determination; 3) enthusiasm, bravery, and an orientation to the future; and 4) connections and alliances. in sum, her use of these strategies provided her with an opportunity to bring the lmc idea forward. first, through political connections and hard work, she became an expert on the lmc idea, the context the idea was taken from, and the regional context. she actively used her expert knowledge and information in her presentations, and she stressed that the lmc idea aligned fully with national political guidelines. owing to this expert knowledge monopoly, she received the responsibility to obtain, maintain, and control the conversion of the lmc idea. the nurse’s second strategy relates to the virtues of strength and determination. from the very beginning, the nurse appeared as a strong, positive, and resultoriented front figure. owing to her perception of other stakeholders’ resistance as the result of a lack of information and knowledge, she maintained her belief in the lmc idea. furthermore, with considerable determination, she consistently strengthened the process of conversion of the lmc idea. for instance, one informant said that people in the regional nurse’s organization had in the beginning expressed scepticism to the idea, but to quote this nurse: in a meeting, the project leader preached about the lmc project for two hours. you know how she is! afterwards we had a discussion and the scepticism disappeared. (4) not only does this quotation show the nurse’s determination, it also illustrates how her energetic and charismatic traits, and not least, her professional selfconfidence, diminished scepticism and resistance. the nurse expressed her own reflections about her role as follows: politicians have requested my expert knowledge on many occasions. they have experienced that i have been able to answer their questions. i’ve been working on this for many years so i think i know a lot about the coordination reform – and that, i think, politicians have confidence in. when i come to inform them about things, i talk about things i know! it is not something i believe, but something i’ve learned. i think i have provided security for politicians (...) but so, i may [also] become a threat because i’m so convinced this is something we must do in the region. (7) in the beginning of the lmc project, the nurse also hired an ‘inspirational agent’ to speak about how to succeed with innovations, using enthusiasm as a prime strategy. the agent made a strong impression. during the first phase, the official vision of the lmc project became ‘bravery, enthusiasm, and future orientation’. this vision also turned out to be important in the second phase and may be seen as the third strategy, used to combat resistance. as one of her supporters in the host municipality put it: the surrounding municipalities are not very easy to handle. on the one hand, it is expected that we pull the load, and so we largely do. on the other hand, we are criticized because we decide too much and are locating everything in our municipality. (…) we have used the vision and value foundation for all its worth to remind us that we have agreed that generosity, bravery, and enthusiasm are important factors in our lmc project. (2) njsr – nordic journal of social research vol. 7, 2016 41 this quotation shows that the vision of enthusiasm and braveness was used as a strategy. it also shows that the nurse was not the only one fighting for a new lmc. from the very beginning, she had close connections to leaders with more authority than herself. in her own description of the process, she emphasized that the medical leader for the already established dmc and some of the leaders in the host municipality were valuable allies: the head of the dmc and the leaders in the host municipality have been adept at providing information in their forums – if something was unclear, they stepped in very quickly and took of it by themselves, or they dragged me into it right away. (7) the quotation shows the nurse’s ability to mobilize support and trust, which enabled her to participate more effectively than others. as a further illustration of how powerful actors trusted and supported the nurse’s suggested lmc plan, the following statement from one informant in a leadership position may serve as an example: this research work is on a very high level, and i know what good research work should consist of. (3) this quotation can be seen as an example of how a leader used his authority to strengthen the lmc plan. simultaneously it also illustrates how powerful actors can use their authority to empower individuals or groups of individuals to speak in favour of an important issue (purdy, 2012). hence, because of the nurse’s interaction with these leaders, her fourth strategy can be described as her willingness and capacity to make connections and alliances with people with more authority than herself. overall this analysis shows how the nurse stood out as an energetic and enthusiastic person with a deep commitment and drive who won over scepticism, conflicts, and resistance. in other words, her development of the four strategies described above seemed to produce a power base strong enough to overcome the resistance expressed by the opponents. closing discussion this in-depth case study illustrates how a very enthusiastic and dedicated nurse played an important role in the conversion of the national lmc idea to local praxis. physicians, leaders, and politicians with differing views on what was the ‘right’ thing to do had the power to contest the lmc process. however, they contested the suggested lmc only to a very limited degree. one explanation may be that the national political support for the lmc innovation made it difficult for local authorities to express their resistance loudly. it is possible that physicians and politicians, owing to their formal positions, thought that the whole idea would disappear if they did not engage in the process. if one thinks of power in the form of a bureaucratic silo structure and hierarchical, top-down processes (bommert, 2010), this might have happened, but it did not. instead, these powerful opponents’ absence and soft resistance seem to have enhanced the nurse and her supporters’ ability to succeed with their lmc plan. hence, while other studies (windrum & koch, 2008) have revealed the public sector’s need for champions to succeed with innovations, a key finding in this study is how collaborative innovation creates space for single individuals who have the will and energy required to innovate. njsr – nordic journal of social research vol. 7, 2016 42 the findings regarding the relationship between power and personality traits show how the nurse, either intentionally or unintentionally, developed four strategies that seemed to make it difficult for both opponents and more neutral stakeholders to contradict the realization of the lmc idea during the process. the nurse’s strategies of expertise knowledge monopoly and strength and determination overlap with røvik’s (2007) description of the ‘capable translator’. in line with røvik’s proposals, the analysis shows how the nurse’s strong and determined attitude, combined with a will, interest, and energy to acquire as much knowledge as possible, were crucial for her capacity to handle resistance and to make others feel confident about the lmc. when the local political authorities made their overall decision regarding the lmc idea, they trusted the nurse’s suggestions. the nurse’s third strategy is closely connected to her energetic and optimistic personality, as well as her willingness to take risks. from the very beginning, she was quite convinced that a new lmc, despite its huge economic costs, was the best way to handle the new and expanded health responsibilities signalized in the coordination reform. enthusiasm, bravery, and future orientation also became the official vision of the lmc plan, and was used as trump card in disagreements during the process. nevertheless, in line with other public entrepreneurial studies (meijer, 2013; windrum, 2008), this case study highlights that no single individual can carry out innovations by themselves but needs to build meaningful connections with others. therefore, the nurse’s fourth strategy related to her skills to maintain and develop new connections and alliances with people who had more authority than herself. one example of these connections was the medical leader at the already established dmc; another was her alliances with some of the leaders in the host municipality. although none of these stood out as strong advocates for the new lmc, it was no secret that they supported the professional justifications of the lmc idea. thus, like meijer’s (2013, p. 14) concept of heroes as idea fighters, this nurse’s behaviour and skills may be seen as a valuable innovational force for positive leaders more bound by organizational routines and lacking the time to fight for innovation (e.g., the medical leader at the dmc). this article does not claim that complex problems in the health sector can be solved by enthusiasm or by single individuals. however, it underscores that individual actors without much authority can obtain a power base strong enough to steer the direction and outcomes in collaborative innovational processes through enthusiasm and entrepreneurial traits how individuals acquire power has been less prevalent in the literature (treadway, breland, williams et al., 2013), and so a key finding of this study is the effect of nurse’s self-confident and persuasive attitude (roberts & king, 1996; windrum, 2008). owing to her enthusiastic and determined attitude, the data indicates that she behaved if she had the power to realize her own and her supporters’ innovational efforts. as she often said, ‘i talk about things i know! it is not something i believe, but something i’ve learned’. although such an attitude does not harmonize with a collaborative-innovation ideology (sørensen & torfing, 2011a), it is appropriate to quote meijer, who says, ‘that a process of innovation seems to require a rebel in the early phase of the innovation process to challenge organizational routines’ (meijer, 2013, p. 14). hence, it should not be overlooked that the power of enthusiastic and convincing heroes, in this case a heroine, is necessary to achieve innovations. njsr – nordic journal of social research vol. 7, 2016 43 this study illustrates how people who have the energy required to innovate can take the opportunity that ideas of collaborative innovation provide to take a driving seat in the process. the unclear outcomes resulted from the development of the lmc unfolding across organizational boundaries, where neither the roles nor the characteristics of those who participated were made clear. it contributes to the understanding of how unresolved collaborative relationships encompass an opportunity for enthusiastic individuals to produce a power base strong enough to overcome resistance and to steer the direction in innovational processes. this, however, does not mean that such energetic behaviour is enough to realize successful collaborative innovations, as the power of individual action in one part of the process may be a problem in another (meijer, 2013). in the phases of innovation conducted in this study, the nurse’s conviction about her own perspectives as the right ones can be seen as necessary, and a reason for success. simultaneously, in the next steps it may entail challenges because such an attitude can make it more difficult to be open to other perspectives and to accept necessary compromises. thus, in order to bring an innovation to success, there is a need for different types of heroes in the different phases of the process (meijer, 2013). because innovational processes have their own dynamics and are influenced by the specific organizational and institutional settings (meijer, 2013), this case study cannot be generalized to other processes of innovation. nevertheless, this specific case has revealed that more attention has to be paid to the power of enthusiastic individuals in collaborative-innovation studies. acknowledgements my thanks to professor rolf rønning, professor albert meijer, and associate professor laila tingvold for constructive comments in the writing process. i would also like to thank editor and reviewers in njsr for your very carefully review of my paper. references aaraas, i. 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(2002). inclusion and democracy. new york: oxford university press njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 7, 2016 depicted welfare-recipient stereotypes in norway and denmark: a photo-elicitation study sofie dencker-larsen* sfi – the danish national centre for social research university of copenhagen, copenhagen, denmark email: sdl@sfi.dk *corresponding author kjetil g. lundberg the uni research rokkan centre bergen, norway email: kjetil.lundberg@uni.no abstract welfare recipients are continuously subjected to media debates and governmental campaigns drawing on images and symbols encouraging improved work ethic and individual responsibility. only few studies, however, have analysed how welfare recipients as ‘othered’ citizens react to these often stereotypical symbols and images targeting them. in this study we have investigated how welfare recipients in norway and denmark, and caseworkers in denmark, understand and account for images which, through the use of stereotypes, directly or indirectly may question welfare recipients’ work ethic and deservedness. analysing photo-elicitation interview data, we have uncovered a variety of reactions characterized by ‘problematization’. the interviewees problematize the image and depicted stereotypes, which they link both with motif and symbols and with surrounding public debates on the work ethic and deservedness of welfare recipients. furthermore, as photo-elicitation is a rarely used tool in welfare research, we address methodological aspects of using photo-elicitation in a study of ‘othered’ welfare recipients. keywords: welfare recipients, stereotypes, work ethic, photo-elicitation, visual culture, visual methods mailto:sdl@sfi.dk mailto:kjetil.lundberg@uni.no njsr – nordic journal of social research vol. 7, 2016 2 introduction welfare, work ethic, and individual responsibility are hot topics of public debate in nordic welfare states (hedegaard, 2014; larsen & dejgaard, 2012; lundberg, 2012). experts, policy-makers, and other media actors continuously present images that, on the one hand, encourage citizens to be healthy, active, and responsible for their own well-being, and, on the other hand, discourage stereotypical ‘otherness’, which is linked with amoral attitudes and behaviour. stereotyping others is a social process that can be understood as a ‘form of labelling, which attains a taken-for-granted quality and serves to portray particular social groups as homogenous. it is a discursive strategy that magnifies and distorts difference’ (lister, 2004, p. 101). like lister, we view stereotypes mediated through language and images as closely related to ‘othering’ practices that instil boundaries between ‘us’ and ‘them’. for social scientists, the emerging field of visual studies offers tools for exploiting the visual medium by integrating it in research (e.g., bagnoli, 2009; margolis & pauwels, 2011; rose, 2012; spencer, 2011). few studies, however, have used visual methods to explore how citizens on the ‘ground level’ of welfare services, ‘welfare subjects’ and employees in welfare agencies, experience and react to depictions of ‘others’. in this study we aim to do exactly that. using images in qualitative interviews, we investigate how welfare recipients and caseworkers understand and account for stereotypical depictions of welfare recipients’ work ethic and deservedness. our analysis is based on merged interview data from one norwegian and one danish research project. in both research projects we conducted lifeworld-focused, narratively informed qualitative interviews with welfare recipients (and in the danish study also with caseworkers). during the interviews we presented the interviewees with images containing potential stereotypes of welfare recipients and individual-responsibility discourse, and asked them to comment on them. this is a technique called photo-elicitation (pe) (see harper, 1988, 2002; rose, 2012). pe is a visual method ‘based on the simple idea of inserting a photograph into a research interview’ (harper, 2002, p. 13). despite not being widely used in studies of ‘othered’ welfare recipients, pe is used in interview studies on related topics, including research on poor and vulnerable groups (e.g., martin, 2012; ornelas et al., 2009; ortegaalcàzar & dyck, 2012; radley & taylor, 2003), often in search of reflexivity and participation of research subjects (e.g. ortega-alcàzar & dyck, 2012; rose, 2012). the images we chose for pe are a photograph of robert nielsen, also known as ‘lazy robert’ (‘dovne robert’) from denmark and a print advertisement from the ‘faster back’ (‘raskere tilbake’) campaign from norway. the images themselves are dissimilar, and they work in two different national settings, but both images channel stereotypical depictions of welfare recipients’ work ethic and deservedness. we have analysed data from pe interviews with individuals situated at the ground level of welfare services. in the following section we present and contextualize the two images. we then present our analytical strategy, including methods and data. we divide our analysis into three parts: i) problematizations related to the danish image; ii) problematizations related to the norwegian image; and iii) examples of non-problematization. finally, we discuss how meaning is constructed in and from the two images in complex and often overlapping ways connected to issues of self-presentation and stereotypical portrayals of welfare recipients’ work ethic and deservedness, and to methodological points concerning the use of pe in a study of ‘othered’ citizens. njsr – nordic journal of social research vol. 7, 2016 3 nordic depictions of welfare recipients’ work ethic and deservedness the analysis is situated in two specific national settings belonging to the same family of welfare-state systems. both denmark and norway have welfare-state models which combine comparatively generous welfare-state benefit levels with active labour market policies. policy reforms and organizational reforms have been implemented in both countries since the millennium shift and activation policies have been expanded. welfare benefits and welfare recipients remain intense topics of debate in both countries. in our research projects we included pe interviews and chose images which we interpreted as connected to broader social policy issues concerning welfare recipients. beginning with the photograph of danish citizen robert nielsen, we present and contextualize the two images used in this article. figure 1: photograph of robert nielsen copyright: henrik moberg jessen photography a long-term unemployed person, robert nielsen (rn), became famous and a catalyst of intense public and political debate in denmark during the autumn of 2012 after being interviewed on the debate television programme on the other side (‘på den 2. side’). rn publicly described himself as lazy, saying that he preferred receiving welfare benefits rather than working at mcdonald’s or accepting other low-skilled jobs that he felt, from experience, insulted him as both a citizen and a human being (dr, september 21, 2012; dr, september 8, 2012). the press swiftly named him ‘lazy robert’, and his television appearance sparked extensive political debate concerning the legitimacy of welfare recipients (see hedegaard, 2014). this debate occurred in the aftermath of the 2008 financial crisis when denmark experienced an increase in unemployment rates. according to the new york times, who introduced an american audience to rn, the debate concerned ‘whether their (the danes’) beloved welfare state, perhaps europe’s most generous, had become too rich, undermining the country’s work ethic’ (daley, 2013, april 20; see also hedegaard, 2014). the debate was extensive, and readers of the dr’s online news site voted the term ‘lazy robert’ the 2012 ‘news expression of the year’ (pinholt, 2014, march 27). njsr – nordic journal of social research vol. 7, 2016 4 despite the image not containing any direct symbols of work ethic and deservedness, it portrays rn who, as we show above, is frequently linked with the label ‘lazy robert’. the label thus originated from a person, but is often used as a symbol on its own. ‘lazy robert’ has become an influential symbol in denmark. in public and media debates, top-level politicians use the symbol as a depiction of welfare recipients when discussing unemployment issues (hedegaard, 2014). although the photograph does not directly contain symbols, the extensive media debate has caused the motif of rn, and the link to the ‘lazy robert’ label, to become a symbol on its own. figure 2: nav advertisement the second image in the pe study is part of an autumn 2008 advertisement campaign conducted by the norwegian employment and welfare administration (nav) in newspapers, cinemas, and online. the campaign, named ‘faster back’, targets employees receiving sick-leave benefits and their employers. the advertisement is illustrated by a human-shaped figure consisting of hands and arms. the advertisement’s headline tells the reader that ‘it is dumb to put the whole body on sick leave, if it is only the arm that hurts.’ in november 2008, this advertisement won a prize for being particularly effective in its communication to its target audience (see lundberg, 2012). the advertisement encourages employers and employees to shift their focus from health-related issues and barriers to coping strategies that can assist the individual’s return to employment. it combines and depicts symbols of the individual and his or her problems and options and encourages the employee to revisit his or her ability to work fullor part-time. we view the campaign and the advertisement as soft measures for preventing or reducing sick leave and as a governmental empowerment strategy (cruikshank, 1999; mik-meyer & villadsen, 2012), subjecting citizens to specific ideas and practices of handling and solving their individual problems and taking responsibility for their return to work. thus, the advertisement encourages increased inclusion in the labour market, on the one hand, and targets the individual and his or her work ethic, on the other hand. analytical strategy depictions and media images are omnipresent in contemporary societies. advertisements and images directly and indirectly channel discourses on how the viewer should behave, look, and lead his or her life. we chose the two images as potentially powerful images at the centre of on-going welfare debates. the norwegian advertisement was featured in various media sources njsr – nordic journal of social research vol. 7, 2016 5 when the norwegian interviews were conducted in 2009 and 2010. the sender of the image was the norwegian welfare-state institution nav. nav is a ‘onestop shop’ agency that handles most benefits and contact with benefit recipients in the norwegian welfare system. the image addressed welfare recipients directly and encouraged a revision of their status as recipients of sick leave. the motif of rn was frequently featured in danish media concerning debates on unemployment and welfare recipients and used as a symbol of welfare recipients especially from 2012 to 2013. the image of rn did not have a clear sender. high-profile politicians, media commentators, and rn himself took part in various ways in distributing the image and symbol of ‘lazy robert’. the two images are visually dissimilar and stem from different sources, but both are embedded in a discourse of individual responsibility in which there are expectations of individual responsibility in the work ethic of welfare recipients. photographs and images are polycentric (barthes, 1981); they are un-coded messages that have multiple potential meanings and may be interpreted in many ways. the purpose of using pe is to analyse the interviewee’s response to the image and his or her opinions and values related to the image topic(s). harper (2002, p. 13), a key contributor to the development of pe, explains the difference between traditional interviews and those using images and text as related to how people respond to these different forms of communication. the strengths of pe include the possibility of enabling of tacit and native knowledge (harper, 2002, 1988) and of enabling further investigation into the visual and sensory dimensions of experience (bagnoli, 2009). according to advocates of pe, it offers an alternative or complementary ‘medium of communication that can open up issues that might escape the spoken word’ (ortega-alcàzar & dyck, 2012, p. 109). meaning-making is context-dependent and audience-driven; images can therefore be understood in various ways (grosvenor & hall, 2012). fink and lomax (2012) emphasize how pe enables dialogue among context, text, and image. they also highlight ‘the importance of understanding inequality through the essentializing and stereotyping discourses by which welfare subjects are constituted’ (fink and lomax 2012, p. 3). these discourses, they argue, can be identified, problematized and negotiated through the visual. fink and lomax find that pe and related methodological techniques invite collaborative dialogue between researchers and interviewees in which knowledge is created through a relational process of interpretation and negotiation. thus, a dialogue of the visual through pe, for example, can function as ‘a strategy for acknowledging the hierarchical power relations in the research process while embedding reflexivity at the core of their (the researchers’) research practices in order that knowledge is produced with rather than about their participants’ (fink & lomax, 2012, p. 6). similarly, ortega-alcàzar and dyck (2012, p. 108) view pe as a medium for creating subject-centred accounts that ‘can be invaluable in breaking down dominant discursive constructions of ‘othered’ groups’. the specific images that we selected are loaded with symbols that may implicitly question the legitimacy of the interviewees’ position and deservedness as recipients of welfare benefits. as is thoroughly established in the qualitative research literature, the interview situation can be an arena of impression management and the ‘presentation of self’ (goffman, 1969; silverman, 2001). a key tradition that has dealt with understanding people’s responses to explicit or potential accusations is the sociology of accounts (järvinen, 2001; orbuch, 1997; scott & lyman, 1968). scott and lyman (1968, p. 46) describe accounts as ‘a linguistic device employed whenever an action is subjected to valuative inquiry’. regarding rituals of speech they theorize that people use accounts when feeling pressured, accused, questioned or blamed. building on insights njsr – nordic journal of social research vol. 7, 2016 6 from austin (1957), they emphasize that accounts can take the form of ‘excuses and justifications’, two forms of linguistic strategies of defending one’s position or action. being accused or potentially accused of something means facing ‘valuative inquiry’, which is a common occurrence in most people’s lives. however, knowing precisely when someone feels accused is not necessarily straightforward. because these issues may be relevant to the welfare recipients’ (and caseworkers’) responses, we address them in the discussion. our study represents a merged norwegian and danish research project with concurrent focus and analytical objectives combined after the collection of the norwegian data and during the collection of the danish data. the norwegian research project explored experiences of welfare recipients receiving unemployment and health benefits during a significant organizational reform of welfare services in norway (see lundberg, 2012). the norwegian project comprises of interviews with a total of 29 welfare recipients (2009-2010). the danish research project (2013-2014) is part of a mixed-methods investigation into unemployment, re-employment, and well-being of unemployed persons. the research project comprises ten interviews: five interviews with current or previous recipients of unemployment benefits and five interviews with caseworkers working in danish job centres. danish job centres handle the casework related to unemployed persons and other welfare recipients, and are equivalent to nav. in both research projects we conducted lifeworld-focused, narratively informed qualitative interviews. in the danish study pe was introduced from the third interview and consistently used in each of the following interviews (five of the welfare-recipient interviews, and three of the caseworker interviews). we used pe in the five first interviews of the norwegian study until one interviewee reacted emotionally stressed and began to cry after seeing the image. this caused a discontinuation of using pe for the following interviews. we recognize that the two images may activate sensitive issues for interviewees. this consideration affected the development of both studies’ datacollection strategy. it did not, however, cause interviewees with certain characteristics to be presented with the images. the research projects have been reported to and approved by the norwegian social data services (nsd) and national institution of research ethics and the danish data protection agency, respectively. the pe components of the interviews were shorter parts of lengthy conversations regarding experiences with health, unemployment, welfare encounters, and the future. we introduced the interviewees to the images during the middle or last part of the interview when the flow of the interview had been established, and the interviewer had obtained an overview of the interviewee’s experiences. when presenting the image to the interviewee, we simply asked them to comment on and to give us their thoughts of the image. we wanted the interviewee to comment on the image as freely as possible. in some cases, we named the campaign or motif, or briefly presented the image. in both of our research projects, we remained open to interviewee interpretations and categories by exploratively including pe, allowing the interviewees to form the discussion on the basis of their perception of the images. furthermore, the stereotypes associated with both images are consistent with the overall themes of the interviews. in the merged study, we read the parts of the interview in which the pe technique was used, and repeatedly discussed the merged pe data, seeking meaning-bearing commonality and discord. in the danish case, the accounts by the caseworkers and the welfare recipients were strikingly, and surprisingly, similar. overall, the interviewee accounts from both countries were varied, but showed strong commonalities between accounts activated in the pe interviews njsr – nordic journal of social research vol. 7, 2016 7 that could be grasped through the term ‘problematization’. hence, secondly, we used ‘problematization’ as a sensitizing concept (blumer, 1969, p. 148) through which to give direction to the analysis, guiding the following rounds of our reading and discussions of the pe interview data and analytical findings. problematizing ‘lazy robert’ in the danish study, all interviewees expressed that they had encountered rn and the closely linked symbol ‘lazy robert’ through the media. when the author presented each interviewee with the photograph, the image evoked various reactions and comments, including frustration, joking and laughter. the most common reaction to the image was to question rn and ‘lazy robert’ as representative of danish welfare recipients. as line (a caseworker, in her twenties) and anne (a welfare recipient in her forties) say: well, he (rn) has become an illustration of the (unemployed) citizens in some way, and he has become an illustration of the majority of the people who are in the (unemployment) system, and i think that this is tremendously wrong. (line) he (rn) is being used in all sorts of ways, right, well (sighs) (…) then, all cash-benefit recipients are perceived as lazy robert. (anne) the interviewees directly or indirectly questioned rn’s generalizability. the accounts reveal widespread frustration with the media’s and politicians’ use of rn as a symbol of all welfare recipients. even before being presented with the image of rn, several interviewees discussed public opinion which they perceived as viewing welfare recipients as lazy. in the media, rn was presented as a person whose problems were laziness and a lack of a good work ethic. several interviewees, however, questioned rn’s health. well… i think he must have asperger’s syndrome or some kind of mental disorder (laughs). (…) he is good at getting people’s attention, but he isn’t… i don’t know… what i primarily think is that both him and the carina case and the whole poverty debate and the lazy people… it simply isn’t right. it isn’t representative for the people in job centres (…) and i think that robert is not mentally right. (…) i think it is awful that the people that are so exposed and ashamed and have had so few chances in life of making a good life, that they are being misused and thought of as being lazy. as far as i know, there are no people who wish for a bad life, but you don’t have a good life being on cash benefits. (thea) here, thea (a caseworker in her fifties), problematized a premise implicit in perceptions of the symbol of ‘lazy robert’, namely, that through receiving welfare benefits a person can live on other people’s efforts and not encounter problems. when describing rns appearance in the media, interviewees used words such as ‘sad’, ‘tragic’, and ‘tragicomic’, indicating that they did not support his view of his ‘right to be lazy’ to cite the title of lafargue’s (1907) famous contribution to the discussion on the role of work in society (1907). the interviewees questioned the media’s and politicians’ use of ‘lazy robert’ as a representative symbol of all welfare recipients, because the interviewees considered rn’s unwillingness to work as atypical and extreme. njsr – nordic journal of social research vol. 7, 2016 8 one interviewee, however, stated that the media had misunderstood rn. joergen (a welfare recipient in his fifties) questioned rn’s health, as did most interviewees, but he also presented rn as a system critic pointing out flaws about labour market policies whose points were obscured in the public debate. well, there may be a tad of laziness in him, but what he tried to say, which still hasn’t been in focus (in public debate), was very important. because he was saying that he did not want to be sent out to create unemployment (…) it was exactly this peculiar job scheme (workplace activation) where one can get tossed into unpaid labour, and he (rn) would not do that, and i thought that he was absolutely right. but, as a person, well, i have heard him talk many times. he is probably not a sound person. he is not exactly my cup of tea. i like people better who want to do something. he does not want to do anything (joergen). joergen problematized the media’s and politicians’ conduct in the debate involving rn. on the one hand, he drew boundaries between himself and rn. on the other hand, joergen’s comments were directed at labour-market policies, criticizing parts of the activation system which he believed works against structural job creation. similarly, louise (a former welfare recipient in her twenties) criticized the debate concerning rn on a structural level. she also criticized a discourse of individual responsibility while defending rn’s choices. there has been much of the: ‘well one should simply not take advantage of the system’, ‘welfare scrounger’, ‘lazy bastard’, ‘blah blah blah’. where i’m thinking that: ‘nobody is perfect, right?’ (laughs) and if he gets more out of staying at home, there is no problem for me. there aren’t enough jobs for everyone anyway. and i also sometimes believe that a society does not just consist of economy. a welfare society means that there is room for people, in my world. (…) we don’t know if lazy robert will be the next to write a grand literary work because he was allowed to stay at home. or, he won’t, but maybe he has ignited thoughts in someone else who does (louise). louise did not link rn to her own situation as a former welfare recipient. instead, she criticized the policy of activation. her account advocated for a generous attitude towards social diversity. for others, the photograph of rn mobilized discussions of perceived consequences of the media debate. anne viewed the media debate regarding rn as causing the stigmatization of welfare recipients. well, it isn’t him (rn) that is the cause of all this (the debate) … liberal alliance (a danish political party) has had a bullying campaign in the media, i suppose we could call it that, on how cash benefit recipients are, how useless we are and that we need help with everything. their rhetoric and their view on humanity and on people (receiving welfare benefits) simply are so degrading (…) i am of course not untouched by it. it is a poor society, i think, when one bullies groups of people, no matter who they are, immigrants or cash-benefit recipients or the handicapped or jews or whomever (…). it hurts to be looked down upon (anne). following this statement, anne discussed the consequences of the debates involving rn and feeling belittled for being a welfare recipient by a stranger whom she encountered leaving a job centre. we found that anne and other interviewees problematized not only the discourse of individual responsibility njsr – nordic journal of social research vol. 7, 2016 9 but also the potential and experienced stigmatizing effects of the symbol of ‘lazy robert’ being used in this discourse. we address this further in the discussion. problematizing ‘faster back’ the accounts following the presentation of rn’s photograph in the danish study evoked the interviewees’ emotions, thoughts, and opinions related to the specific public debate ignited by rn’s statements. in contrast, most of the norwegian interviewees’ had not seen the ‘faster back’ advertisement prior to the interview. additionally, unlike the photograph of rn, the advertisement was not associated with a specific debate or viewpoint and was therefore open to various interpretations. erna (a welfare recipient in her forties) and aslaug (a welfare recipient in her fifties) questioned the most basic message of the nav advertisement. oh, wow! well it’s not just the arm that hurts in my case! (laughs heavily). oh my god, this was some…(illustration). (…) no i feel… oh my good… it’s not just the arm for me, that’s for sure. is it possible to distinguish between the arm and (the rest of the body)…? (erna) the first reaction is that it’s seldom only the arm that hurts if it hurts badly. then, it spreads to the cerebellum and other places too. (…) if you’re in pain then it’s impossible to limit it to the arm (aslaug) neither erna nor aslaug had seen the advertisement prior to the interview. both women commented on and questioned the illustration, its title, and its written message. neither interviewee elaborated on their thoughts regarding the media side of the campaign; elsewhere in the interviews, however, they both commented on the stereotyping effects of media presentations of welfare clients’ problems. a strikingly different response was activated in the interview with bjarne (a welfare recipient in his sixties). before his encounter with nav, he had worked in a company in which he was a partner. when shown the advertisement, his thoughts went to his own experiences regarding sick leave. (laughs) i have been on sick leave one time (prior) in my life. when i broke my foot, as i told you. that’s many years ago now; it’s nearly forty years ago. then, i cycled to work with one foot. with cast on it. and then i got yelled at for going to work when i was on sick leave. (…) but… in the firm i worked in recently… there, we had those kinds of people that were on sick leave and stuff…. all the time (…) and that is bothersome. it is people who exploit it. it’s horrible. and it’s almost impossible to sack them. yeah. so there’s of course a whole range of freeloaders in our society. i will call many of those that continuously are on sick leave on mondays and stuff, freeloaders. i don’t tolerate that. but if they are away one day when the flu ravages, that’s fair enough. but when they’re on sick leave because their hair hurts, or their stomach hurts, or… that’s totally reprehensible. but that’s how it has become: it is easy to get sick leave (bjarne). bjarne did not comment on the campaign. instead, he discussed his own experiences related to sick leave and the legitimacy of people on sick leave. anchored in his own experiences as an employer, he questioned other people’s work ethic. the account represents accusations of people claiming sick leave njsr – nordic journal of social research vol. 7, 2016 10 benefits as being freeloaders and slackers. furthermore, bjarne did not seem to relate potential questioning of others’ practices to his own legitimacy of receiving welfare benefits. on a related, yet distinctly different note, mona (a part-time welfare recipient in her forties), interpreted the advertisement as questioning welfare recipients’ work ethic. mona’s response should be seen in light of her suffering from diabetes and facing a lack of sleep caused by hypoglycaemia. she found it difficult to continue full-time employment. mona was the only interviewee who had seen the faster back advertisement prior to the interview. being shown the image triggered a strong emotional response as well as a rich and complex account of her ambivalent feelings towards receiving benefits. you know, for me, it’s the whole body that hurts, if you know what i mean. because it has something to do with … when you’re, let’s say that i on average have hypoglycaemia one night… every damn week… (starts to cry). (…) i think it’s complicated being on sick leave. because first, i used a long time to adapt that you’re on sick leave and not be ashamed. because in my family, it’s like that you work till you kick the bucket. interviewer: strong work ethic? yes! extremely hard work ethic. i actually told my parents for several months that i was employed in 80 per cent, because i didn’t manage to tell them that i was on sick leave for 20 per cent. because it felt so shameful (mona). the interviewer presenting the advertisement to mona evoked a strong emotional response from her (crying) and an account relating to her family values, as well as her coping strategies at work. she discussed the work ethic in her family and how her parents expected her to help them paint their house when they were told she was on sick leave, which they apparently viewed as spare time. she then mentioned an episode where her father proudly told a story about mona finishing primary school without taking a single sick day. mona commented that she remembered throwing up on the way to school after throwing up all night, and then her father said: ‘but you made it, mona!’ you see? it wasn’t an option to lie down and feel sick unless you were almost dying. so it’s… of course, you don’t want a society where people are shirkers. but the campaign that nav runs in the media makes you feel even more miserable (mona). similarly to bjarne, mona discussed her own experiences and memories when confronted with the advertisement. another similarity between the two interviewees is that they are both influenced by strong work ethic, although these ethics were arguably formed by strikingly different experiences. for mona, the image presented in the interview obviously evoked strong emotions concerning her own experiences. this recall led her to problematize the nav campaign. there is a link in her account between the campaign’s message of individual responsibility and her father’s apparent attitudes relating to a strong work ethic. however, we interpret the faster back image as ambivalent; it has both an inclusionary and a moralizing message. this ambivalence is activated in the interview with mona. her account provides insight into the award-winning ‘faster back’ campaign as also potentially stigmatizing its audience. njsr – nordic journal of social research vol. 7, 2016 11 non-problematizing although the analysis uncovered different types of problematizing in the two sets of data, there were also two interviews in which the concept of problematizing does not easily fit as a sensitizing tool. we consider it an important analytical point to examine variations found in our data; therefore, we also include the accounts of the two interviewees who did not ‘take the bait’. first, jonas (a welfare recipient in his thirties) gave the following response when shown the ‘faster back’ advertisement: well… actually i think it’s quite okay. yes. i kind of come from the advertisement industry myself. i think it’s a decent presentation. you get an eye-catcher with all these arms. hm, the text is tiny, but the headline is visible though. i don’t think it is too bad (jonas). here, norwegian interviewee jonas discusses his own professional background of working in the advertisement industry as he evaluates the image. he judges the image from a technical-professional rather than a normative standpoint. the last of the two interviewees reacting differently to the image than the other interviewees is christian (a welfare recipient in his forties). christian was the only participant in the danish study who did not immediately recognize and react to the photograph of rn. the interviewer followed up by asking him whether he was familiar with the media debates on ‘lazy robert’. he recognized the label but placed rn in the context of his later participation in a reality-television programme. i haven’t really heard that much about him. (…) wasn’t he a participant in robinson or something like that? (…) that was where it popped up that he was so lazy or something. i did not watch it, but i believe it was robinson he participated in (christian). in the aftermath of the media and public debate, rn became somewhat of a national celebrity. he participated in several television programmes, including the reality programme the robinson expedition, which was adapted from the american television concept ‘survivor’. however, christian was the only interviewee to link rn primarily to his subsequent television appearances. neither jonas nor christian connected the image they were shown with the moral dimensions implicit in it, unlike the other interviewees who indirectly or directly made the connection. we interpret this difference as related to the activation of a professional perspective (jonas) and not having encountered the specific media portrayal of rn (christian). discussion and conclusion in our merged study, we asked welfare recipients to react to images which relate to discourses of individual responsibility and which potentially contribute to ‘othering’ of welfare recipients through stereotypes (lister, 2004). the discussion that follows is to be viewed in light of that our data material is limited in scope. still, we emphasize that the commonalities found in the analysis, despite the use of dissimilar images and seeing ample variation in responses, are interesting to discuss further in light of reactions to stereotypical portrayals of welfare recipients’ work ethic and deservedness, and integrating pe and other visual methods into empirical investigations of ‘othered’ citizens. our analysis shows that most interviewees in both national contexts in a nuanced manner problematize the stereotypes targeting and affecting them. njsr – nordic journal of social research vol. 7, 2016 12 despite taking place in two national contexts, and being presented with dissimilar images, our interviewees discussed much the same themes. the respondents discussed the images’ motif surrounding welfare debates, and what they interpreted as the expectations the images conveyed of welfare recipients’ responsibility and work ethic. repeatedly, and related to both images, most of the interviewees either discussed directly the symbols of work ethic and deservedness and its consequences for themselves and others or they discussed these themes indirectly through associations, personal narratives, experiences, and values. even zooming in on a relatively narrow data material we discovered, in both research contexts, interviewees directly or indirectly discussed the image, stereotypes, stigma, and the role of portrayals of how welfare recipients should and should not act. this finding supports our assumption that the discourse and stereotypes work through the nav advertisement and the photograph of rn. one question which arises with the analysis of the pe data concerns the possible effect of pe as a particular methodological strategy for generating responses. according to harper (2002, p. 3), the contribution of pe to the interview can be substantial because ‘the parts of the brain that process visual information are evolutionarily older than the parts that process verbal information’. however, although we do not question the insights related to this, we view it as likely that similar findings from our study could have emerged using other methodological approaches that may create similar methodological ‘spaces’, such as focus-group interviews. it is important to note, however, that the two images create different processes of response. in the danish case, in which the context of the media debate surrounding the image is treated as more important than the image itself by the interviewees, the interviewees discussed and problematized the symbol of ‘lazy robert’, not the photograph of rn itself. they problematized the stereotypical portrayal of welfare recipients having a poor work ethic as they experienced it in the debate surrounding the symbol of ‘lazy robert’ being used as a representative of all welfare recipients. in the norwegian study, the image opened for more variation in responses. this could be related to the norwegian image being ambiguous and open to various interpretations and associations, though the norwegian interviewees often discussed the same themes of the stereotypical portrayals of welfare recipients as the danish interviewees. reviewing the pe literature, harper (2002) describes different versions of pe. he sees the selection of photographs and images as following a continuum ranging from (1) ‘visual inventories of objects, people and artifacts’ that can be used in interviews as direct representations, via (2) images that can be used to elicit memories of collective or institutional experiences, to (3) images related to intimate or emotional dimensions of the self and the social (harper, 2002, pp. 13-14). we see our images as related to all three points, but perhaps more importantly, we see our study as a highly specific pe approach among many possible ones. using other types of visual methodological approaches could likely generate both similar and differing findings. as with all social research, findings also depend on the choice of analytical perspective. related to the potentially sensitive nature of the themes associated with the images for our interviewees, we examined whether the responses to the images are likely to be influenced by self-presentation. indeed, some of the replies can be seen as elements of ‘self-defence’, as described by the literature on ‘accounts’ (scott & lyman, 1968). introducing the images gave rise to the problematization of not only the discourse of individual responsibility, but also of others’ work ethic. these accounts may be understood as containing elements of lingual self-defence practices by interviewees who justify their own status as unemployed or ill and by distancing themselves from ‘others’ whom njsr – nordic journal of social research vol. 7, 2016 13 they perceive have a deviant work ethic. we conclude, however, that to interpret these responses purely as lingual self-defence strategies would imply too narrow a perspective. not only do the interviewees defend their own (or, concerning the caseworkers, their welfare recipients’) status as welfare recipients, they also engage in nuanced discussions of broader welfare discourses and their consequences for citizens and society, including points of view formed by personal experiences and broader normative orientations of justice. these findings from our study are in line with fink and lomax (2012) and ortega-alcàzar & dyck (2012), who view using pe interviews as a means of obtaining new insights by exposing individuals to images that target them. in most of the reactions to the images, we identify logics of justice. on the one hand, these logics are linked with normative perceptions of obligations of the welfare state and welfare recipients. on the other hand, they are connected with insights into human beings’ situations as being more complex than what is portrayed by potentially stereotypical images channelling work ethic and deservedness of welfare recipients. debates on welfare benefits, sick leave, poverty, and so on, are often dominated by experts, media commentators and policy-makers, while the voices of those at the frontlines of welfare institutions are often marginalized (e.g., beresford & croft, 1995; devereux, 1998). discussing images with interviewees can contribute to challenging traditional hierarchical structures (fink & lomax, 2012) between, for example, the sender of the image and the recipient. consistent with this we found that the images gave rise to the problematization of stereotypical perceptions and depictions of welfare recipients. through pe interviews we enabled accounts of micro-narratives challenging the visual narratives in which specific groups are depicted and targeted by government organizations, policy-makers, and media institutions. in conclusion, we found pe to be a useful methodological tool that enabled interviewees to reply to images targeting them, and giving voice to problematizations of stereotypical portrayals of welfare recipients. we hope to see more studies introducing these non-linguistic dimensions into research interviews with ‘othered’ citizens. acknowledgements the authors wish to thank robert nielsen for volunteering for the photograph and henrik moberg jessen photography for taking the photograph and granting us permission to use it in print. furthermore, we wish to thank the two anonymous referees, anna s. bach; morten hammerborg; hans-inge hansen; margaretha järvinen; jorunn mjøs; hogne sataøen;and the participants at article discussion sessions at sfi – the danish national centre for social research; department of sociology, university of copenhagen; and the research group ‘health, welfare, and citizenship’, uni research rokkan centre for providing valuable comments on the 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(2011). visual research methods in the social sciences: awakening visions. london: routledge. http://www.dr.dk/nyheder/indland/2012/12/23/142426.htm microsoft word 599, kongshøj, moderate universalism.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 ‘moderate universalism’ in china and the nordic countries: reviewing the major challenges in unemployment protection kristian kongshøj centre for comparative welfare studies (ccws), aalborg university sino-danish centre for education and research (sdc), beijing email: kongshoj@dps.aau.dk abstract rapid welfare expansion is taking place in china across a range of policy fields. in the nordic countries, intra-nordic diversity and significant policy changes are not difficult to identify despite the notion of universal nordic welfare regimes. this article will bridge these very different worlds of welfare in an effort to classify the chinese unemployment-protection system with a comparative framework aimed at furthering the emerging sino-nordic research dialogue. this research dialogue has gained relevance in recent years with the new official chinese goal of building a more universal welfare system. welfare research that includes china from a comparative perspective is still extremely rare. despite the lofty chinese goals, many chinese policy challenges still loom large. these are the rural-urban divide exacerbated by the chinese household registration system, coverage of unemployment insurance and social assistance, inadequate and declining benefit levels, and, finally, funding issues. as this article will also substantiate, denmark and finland are something approaching best cases for illustrating intra-nordic diversity. as regards the chinese challenges, it is explained how they can to some extent be understood as the teething troubles of a developmental welfare state, since the nordic counterparts have faced similar issues during their eras of welfare expansion. keywords: china, nordic countries, unemployment, income protection, welfare regimes, denmark, finland, social policy njsr – nordic journal of social research vol. 6, 2015 69 introduction market-oriented reforms of the labour market and the emergence of unemployment as a social problem are more than anything else the epicentre of dramatic social change in china in recent decades (xu, 2012; lee & warner, 2007). the social-policy response to this has been the introduction of both unemployment insurance and social assistance, and there is by now a relatively rich english literature on the development and challenges of these new schemes (for example liu & kongshøj, 2014; ngok, 2013; gao, 2013; lei, 2012; chan, 2010; duckett & carillo, 2008). this literature will also be drawn on later in this article. however, very little has been done in terms of classifying the chinese income-protection schemes towards unemployment from a comparative perspective. the first and most basic aim of this article is to engage in this. dimensions of income protection benefits such as benefit levels, coverage, eligibility, and financing are classic in comparative welfare research (danforth & stephens, 2013), and will also be used to track developments and challenges here in social rights for the unemployed from a comparative perspective. for such comparative enquiries to include china is still a rarity. even within the broader welfare regime approach, china is curiously enough not always included in the literature on east asia, although this might in part be a reflection of the fact that there is great deal of social policy devolution in china, which makes it difficult to talk of a nationally coherent welfare state as such. to the extent that china is included, china is mostly seen in light of the predominant east asian regime traits (lei choi, 2013; lei, 2012; leung, 2005), which we will return to below. the chinese welfare state might still be described as existing in a state of institutional ambiguity, in which several paths of welfare development are still open. hugh heclo (1974) was among the first to point to the role of ideas and information in the way policy-makers try to solve problems, which is of course also crucial to understanding the development in china. interestingly, chinese policy makers are actively learning from other countries and often engage experts from international organizations such as ilo, un, and the world bank (leung, 2005). as unemployment policy is the focus of this article, it is interesting to note that the chinese ministry of labour reviewed the experiences of more than 40 countries before setting up a system of unemployment insurance. amidst all these ambiguities and possibilities, this article will track current chinese policy developments njsr – nordic journal of social research vol. 6, 2015 70 and point to some issues faced by income-protection schemes for the unemployed. a second aim of this article is basically to contrast china, popularly perceived as bogged down by rising inequalities and freshly unleashed market forces, with two other cases popularly perceived as relatively equal societies with all-encompassing welfare states deeply enmeshed in market forces, namely denmark and finland. limited as the comparative literature on china is, analyses of china and nonasian cases are much rarer. sino-nordic comparative research is still almost non-existent. kettunen et al. (2014) have edited the first sinonordic welfare anthology, but of the individual contributions, only hua and rønning (2014) include a sino-nordic comparison of elderly care. there is nothing to be found on unemployment policy. consequently, our basic comparative aim is narrowed down to a sino-nordic framework. this framework is rooted in the welfare-regime literature on nordic and east asian welfare regimes. the particular choice of the two cases of denmark and finland as the nordic cases is not only based on welfare regimes but also on a closer scrutiny of the actual labour-market schemes, which we shall expand upon below. this scrutiny reveals how these two cases serve well to capture intranordic diversity despite the more general notion of nordic welfare regimes. the third and final aim of this article is simply to contribute to and to further the emerging sino-nordic scholarly dialogue. china is of course an interesting case for nordic researchers because the global impact of its rise and the rapid development of chinese social policy, which can serve as a playground for old theories on welfare-state development. however, chinese interest in nordic social policy has also been growing, both among scholars and policymakers. chinese researchers began writing on nordic welfare states as early as the 1980s, but the chinese literature grew in earnest in the late 1990s (zhang, 2013; lin, 2001). sweden has dominated that literature as the most well-known example of the universal welfare state. at the same time, in the new millennium, chinese policymakers have increasingly emphasized the need for more comprehensive welfare, for example, under the slogan of creating the ‘harmonious society’ under hu jintao and wen jiabao (ngok, 2013). in spelling out this vision, the term ‘social policy’ was used for the first time in official documents in 2006. an idea of building a ‘moderate’ or ‘appropriate’ universal welfare system has also been voiced frequently by policymakers and was first promoted by the chinese ministry of civil affairs (lei & walker, 2014; njsr – nordic journal of social research vol. 6, 2015 71 china.org.cn, 2012). as an example of the potential for sino-nordic social-policy dialogue, the report ‘constructing a social welfare system for all in china’ by the development research centre of the chinese state council, an official think tank reporting directly to the chinese state council, deserves to be mentioned. the report showcases specific nordic policies several times as it lays out a vision for a more inclusive welfare system. the foundations for the report were laid when the research group behind the report made a trip to copenhagen and gained input from danish researchers on ‘…the experience of european countries and america in building and reforming social welfare systems’ (cdrf, 2012, xxviii). it should be noted that the enquiry in this article will focus on social rights for urban citizens in china. this is because of the household registration system, hukou, that in essence enforces a divided citizenship in china by dividing people into rural and urban citizens with very different sets of social rights, often leaving rural citizens to fend for themselves (xu, 2012). in rural china, the policy responses towards unemployment are still very fragmented and limited, especially because unemployment there is still regarded as ‘hidden’ or ‘surplus labour’, and still not subject to national policy objectives (murphy & tao, 2007). consequently, there is no official registration of unemployment in rural china. however, as will be explained later, rural citizens have the right to enjoy social assistance. the hukou system is also essential for understanding the biggest challenge for chinese social policymaking, namely the 250 million rural-urban migrant workers living in urban areas with rural hukou. they are excluded from urban welfare schemes, despite attempts from the national government in recent years to make urban welfare schemes more inclusive. in this context, it is important to note that rural-urban migrants are still excluded from the new social assistance, the minimum living standard scheme (mlss)., which will be explained further below, and that surveys in 2005 and 2010 placed coverage of unemployment insurance among migrant workers at a very low nine to ten per cent (wong, 2013). establishing the comparative framework while the exact clustering or grouping of countries, as well as the number of regime ideal-types, is a subject for endless discussion in njsr – nordic journal of social research vol. 6, 2015 72 the welfare-regime approach, the notion of a nordic ‘universal’ continues to find support (arts & gelissen, 2010). there is a good deal of literature on east asian welfare regimes, complete with a host of different labels to name them, with those of ‘productivist’ and ‘developmental’ being the most popular (abrahamson, 2011). another popular label has been that of ‘confucian’ welfare regimes, which, as the name suggests, have a strong tacit notion of culture as a driver of welfare-state development, but mostly emphasizes the same characteristics as those we list below in table 1. ‘universalism’ as a concept is quite contested and multi-dimensional (anttonen et al., 2012), but the same can be said of the labels of ‘productivism’ or ‘developmentalism’. however, the core of both labels is that social policy in these regimes is subordinate to economic policy (choi, 2013; holliday, 2005). yet productivism in social policy is certainly not isolated to one specific welfare regime. it has often been noted that productivism has been a very strong characteristic of the nordic welfare states (andersson, 2009). esping-andersen (1999), for example, wrote that ‘scandinavian welfare and employment policy has always been couched in terms of “productivism”, that is maximizing the productive potential of the citizenry’ (p. 80). trying to achieve policy for markets rather than against markets is not specific to any welfare regime. however, the degree to which the welfare state shapes market forces varies across regimes. a universal welfare regime alters the workings of market forces more than any other to promote social citizenship, at least in the ideal-typical world. here we find a core motivation for contrasting china with nordic countries. we can continue to spell out this difference between these two welfare regimes even further. even if the labels traditionally used to describe both nordic and east asian welfare states are complex and contested, particularly as principles for social policy, a set of welfare-regime characteristics spanning both outputs and outcomes have become connected to these labels in the welfare-regime approach. first, esping-andersen’s (1990) regime typology was based on decommodification and welfare stratification. secondly, there is, as mentioned, the question of the different policy principles that govern social rights. this is where labels such as ‘universal’ or ‘residual’ more correctly come into play. thirdly, as the research tradition increasingly emphasizes the diversity within welfare provision, the welfare mix becomes important. finally, one can also consider the degree to which social policy is subordinate to market forces and economic njsr – nordic journal of social research vol. 6, 2015 73 goals, a question raised by the literature on east asian welfare regimes. taking the dimensions of welfare regimes mentioned here into consideration, we can summarize the differences between universal and productivist welfare regimes in table 1: table 1: dimensions of universal and productivist welfare regimes social policy in relation to market forces social rights degree of decommodification degree of welfare stratification welfare mix: individual vs. family & market vs. state universal least subordinate extensive, linked to citizenship highest lowest individual-state productivist most subordinate minimal, linked to productive activity lowest highest family-market assessment based on anttonen et al. (2012), aspalter (2011), lee & ku (2007), holliday (2000). the purpose of table 1 is mainly to illustrate how these two idealtypical welfare regimes are very nearly polar opposites on all dimensions, though it would be wrong to conclude that the three classic regimes are opposites in any way. all of these five dimensions are, of course, very closely linked. extensive, citizenship-based rights spill over into high decommodification, low stratification, and a more prominent role of the state in the overall welfare mix. with this framework in mind, we can leave the ideal-typical world behind. while it is of course trivial to say that there is no truly universal welfare regime in this world, in the nordic family it seems to be particularly true of finland. here we find our motivation for including denmark and finland as representatives of the diversity one can actually find within the nordic cluster of welfare regimes. while the many studies within the welfare regime industry consistently group denmark, norway, and sweden together, finland does not always seem to fit too well. for example, in the 11 studies reviewed by arts and gelissen (2010), finland is covered by ten, only five of which njsr – nordic journal of social research vol. 6, 2015 74 actually classify finland as a ‘universal’ welfare regime. indeed, even in esping-andersen’s (1990) original study on the three worlds of welfare, finland’s decommodification score 1 for unemployment insurance lagged somewhat behind the three other countries. in scruggs and allan’s (2006) replication of the decommodification index for the year 2000, only belgium, denmark, the netherlands, norway, and sweden score above ten, while finland scores 8.1 for unemployment insurance. replacement rates are a case in point of these differences; danish unemployment insurance is the least earnings-related of the four nordic schemes (constituting instead something approaching a relatively generous flat-rate universalism) while the finnish scheme is the most earnings-related2 (oecd, 2010). it should be noted that the question of flat-rate versus earnings-related benefits is a long-standing discussion in the literature on universalism (see for example anttonen et al., 2012). the argument for earningsrelated benefits as being more universal is that these more adequately guarantee income protection for a larger share of the population and prevent the crowding-in of private insurance. regardless of this discussion, denmark and finland are nordic opposites in this respect. in unemployment protection, denmark, finland, and sweden have all retained their state-subsidized, voluntary unemployment-insurance funds administered by trade unions (also known as the ‘ghent model’, named after the belgian city in which the system originated). norway was actually the first nordic country to adopt this system in 1906, but switched to compulsory insurance in 1938 (edling, 2006). this also means that unemployment policies and labour markets in general are very different in finland and denmark. for example, while the concept of flexicurity has been seen as a strong danish trait, the data of berglund and madsen (2009) from the beginning of the millennium suggests that finland has the weakest flexicurity profile within the nordic family. in this case, this is measured by the following indicators: 1) benefit spending per unemployed, 2) active labourmarket policy spending as percentage of gdp, 3) employmentprotection legislation (index defined by oecd), and 4) the share of the workforce engaged in life-long learning measures. 1 the decommodification score is measured by replacement rates, duration, eligibility, coverage rate, and waiting days. 2 measured simply as the difference between net replacement rates for 150per cent of average wage and 67per cent of average wage (all household types included). njsr – nordic journal of social research vol. 6, 2015 75 unemployment insurance is also a good example of how real-world policies may often be far removed from ideal-typical universalism since it requires insurance participation; however, the nordic experience is also a good illustration of how policy institutions can incrementally be reformed towards a relatively high degree of universalism (compared with other countries) by increasing coverage, minimum benefit levels or state-financing (goul andersen, 2012; edling, 2006), which we shall also discuss later. from this perspective, universalism is seen as a continuum of degrees rather than either/or. in this article we shall also consider social-assistance-like schemes, and here gough’s (2001) oft-cited study of social-assistance typologies places denmark, finland, and sweden together in the cluster characterized by ‘average extent, average inclusion/exclusion and generous benefits’ (p. 169). the more recent data of kuivalainen and nelson (2012) suggests that although the nordic countries are still relatively similar in respect of replacement rates, they are no longer particularly generous in this respect. pfeifer (2012) tries to include both the insured and non-insured in her study which includes four main indicators. 3 of the four resulting clusters, denmark and the netherlands end up together in ‘extensive protection-functioning labor market’, while finland, sweden, and four other countries are labelled as ‘targeted protection–insider/outsider labor market’ (p. 20). the discussion above pinpoints some arguments why denmark and finland are something approaching best cases when one wishes to capture intra-nordic diversity (both from the approaches of general welfare typologies and typologies of unemployment protection). now we are faced with the question of how china fares in relation to these typologies. unemployment policies in a sino-nordic perspective a thorough historical account of the post-maoist labour market reforms and the incremental commodification of chinese labour will not be engaged here (see for example xu, 2012; warner & lee, 2007). a clear trend in unemployment policy is the emergence of a two-tier 3 the four indicators being generosity, spending (per recipient and per cent of gdp), recipiency rates, and unemployment rates njsr – nordic journal of social research vol. 6, 2015 76 system, one being unemployment insurance, and the other the minimum living standard scheme (mlss). the chinese unemployment-insurance scheme was formally acknowledged in 1999, but it has precursors dating back to a very important 1986 labour-market reform, in which employer discretion to lay off workers was recognized and a so-called job-waiting insurance was set up for a limited group of state-sector employees (vodopivec & hahn, 2008; webber & ying, 2007). the mlss developed in successive phases from the early 1990s and onward. social researchers initially promoted the idea of a universal, social-assistance-like scheme following the collapse of the old ‘iron rice bowl’ (guan & xu, 2011). an urban mlss was pioneered in shanghai, while a county in shaanxi province pioneered a rural counterpart, but the development and expansion of the rural mlss remained sluggish, not least because the central government did not prioritize it. the mlss was made a national policy in 2007. this also means that the mlss is the most important example of a social right being expanded to both rural and urban china. however, since it is not available for people without local hukou, many chinese citizens, particularly the rural-urban migrants, are still excluded from the scheme. it should be noted that residual social relief in china goes further back than the new mlss. importantly, the so-called five guarantees (originally food, fuel, clothing, education, and burial, but also later expanded to include housing assistance and medical care) have been in place in rural china since the days of the planned economy. in urban china, residual relief was mainly directed at people afflicted by the so-called three no’s (no work, no family, and no independent means of living) (leung, 2005). turning to comparative policy variations between the countries in question here, table 2 reveals the main differences regarding generosity, eligibility, and duration of unemployment insurance (ui). one important distinction is that the chinese ui scheme is not earnings-related, but flat-rate and defined by local governments, with the requirement that it must be above the minimum level of living, but below minimum wage. these two boundaries are also locally defined, however, so this is another example of the high level of policy discretion of local government. njsr – nordic journal of social research vol. 6, 2015 77 table 2: unemployment insurance in china, denmark and finland china denmark finland generosity not earningsrelated: locally defined, but must be above locally defined minimum level of living and below local minimum wage. 2011 average net replacement rate: 23% 90% of previous wage, but with a low ceiling at 2300 eur/month (2012). de facto a flat-rate benefit for most workers. basic allowance at 675 eur/month (2012) + 45% of previous wage above basic allowance up to 3290 eur (2012). for any remaining wage level above this, the rate is reduced to 20%. these replacement rates can be raised to 57.5% / 35 % (initial 100-200 days) or 65% / 37.5% if special requirements are met. duration 1-2 years dependent on contribution period: less than 5 years = 1 year duration, more than 10 years = 2 year duration. 2 years (within the last 3 years) 2 years (500 benefit days, 5 days per week) eligibility contribution requirement of 1 year. work requirement: 52 weeks of full time work (37 hours) within 3 years. membership: 1 year. work requirement: 34 weeks of parttime work (18 hours) within 28 months. membership: 34 weeks. sources: national bureau of statistics of china (2013); the federation of unemployment funds in finland (2012); the national labour market authority (2012); vodopivec & hahn (2008) njsr – nordic journal of social research vol. 6, 2015 78 however, formally earnings-related benefits can also be made de facto flat-rate if coupled with low benefit ceilings. this is the case in denmark, where the benefit ceiling has become quite low relative to most working wages (goul andersen, 2011a). the difference is, of course, the level of the benefits. while the danish benefit still constitutes a somewhat generous flat-rate universalism, the average net replacement rate in urban china has dropped from 33 per cent to 23 per cent of the average urban working wage in 2001-2011. benefit levels have increased significantly in absolute terms, but have simply not been kept level with the rapidly rising wages. figure 1: gross replacement rates of unemployment insurance in denmark and finland (2012) note: average wages are based on the assumption that the difference in average wage between denmark and finland in 2012 was the same as in 2011 (38% higher in denmark according to unece) * increased unemployment insurance in finland: available during the first 20100 workdays of unemployment, depending on work and membership history (20 days = 3 years of work; 100 days = 20 years of work, membership for five years) ** unemployment insurance with transition assistance: available during participation in certain active measures (maximum is 200 work days) sources: the federation of unemployment funds in finland (2012); the national labour market authority (2012); unece statistical database (2013); statistics denmark (2013) as mentioned earlier, the danish scheme might be understood as somewhat generous flat-rate universalism while the finnish counterpart is much more earnings-related, which is exactly what 0   20   40   60   80   100   0.5   1   1.5   2   2.5  g ro ss  r ep la ce m en t  r at e   times  average  wage   ui,  denmark   ui,  finland   ui  -­‐  increased,   finland*   njsr – nordic journal of social research vol. 6, 2015 79 figure 1 illustrates (albeit as gross replacement rates). this is a reflection of the fact that the danish benefit ceiling is quite low (and affects almost all incomes), while the finnish scheme has no ceiling, which is quite unusual. because of the high replacement rate of 90 per cent below the ceiling, the danish scheme is relatively generous for low incomes (nososco, 2012), which is also shown in figure 1.this is an example of an area where the finnish welfare regime can be understood as a hybrid between universalism and labour-market status-maintenance (clasen et al., 2001). however, if an unemployed is eligible for ‘increased’ ui in finland (available the first 150 days of unemployment for unemployed with long employment histories) or ui with ‘transition assistance’ (where specific plans for re-employment are drawn up with the aid of almp measures), the finnish scheme becomes more generous for middle and lower incomes compared with its danish counterpart. if we turn to eligibility, the danish scheme appears to be the least ‘generous’. both membership and work requirements are stricter than in china and finland. in denmark, the work requirement entails 1924 hours of work (within the last three years) while it in finland is 612 hours of work (within the last 28 months). instead of a fund membership requirement, china has a contribution requirement. duration periods are somewhat similar, with a notable difference in the way that duration in china is graded according to contribution time, ensuring that only a 10-year contribution period gives access to the full two-year duration period. in all three countries, it is of course also required that one is actually available for vacant positions and actively looking for a job, but the specific job-availability requirements may vary. looking at venn’s (2012) indexes of job search and availability requirements, as well as the sanctions linked to these, it appears that overall job-availability requirements are far stronger in denmark (only germany and norway are stricter among the 36 countries examined), while finland is among the most lenient countries. sanctions for breaching the job-availability requirements are somewhat stronger in finland. if the insured unemployed face much lower benefit levels in china, the differences are even more pronounced for the uninsured. in 2010, the average recipient of the urban mlss was granted 162 rmb/month, or a mere 5.3 per cent of the average wage (gross replacement rate) in njsr – nordic journal of social research vol. 6, 2015 80 urban china4 (national bureau of statistics of china, 2013; ministry of civil affairs, 2013). in 2008 in denmark and finland, uninsured unemployed would get 41 per cent and 38 per cent, respectively, of the disposable income of the average worker (net compensation rate) (nososco, 2012). the mlss is income-tested, and a recipient is formally entitled to get the difference between his current income and the local mlss threshold (also the so-called minimum level of living, which defines the lower threshold of ui benefits). this mlss threshold has been lagging somewhat behind disposable incomes (gao, 2013). from 1999 to 2009, the average urban threshold dropped from 31 per cent to 16 per cent of average per capita disposable income (lei, 2012). the finnish and danish counterparts for the uninsured are also means-tested like most social-assistance schemes. while nordic social-assistance schemes have often been classified as having relatively generous benefit levels, the means tests are quite strict. in denmark, about 75 per cent of the uninsured employed will not be able to receive social assistance if they lose their job because of strict negative selectivity regarding personal assets and spousal income (the economic council of the labour movement, 2012). in finland, it should be noted that two types of flat-rate unemployment assistance exist. the basic unemployment allowance is available for those who meet the formal work requirements (these are the same as for the earnings-related ui component, see table 2), while the labour market support is paid to those who have exhausted their ui benefit duration or do not meet the employment criteria (kela, 2012; ervasti, 2002). the labour market support is means-tested and graded according to personal and spousal income, while the basic unemployment allowance is only graded to incidental or part-time income while unemployed. however, the means testing of the nordic schemes pales in comparison with their chinese counterpart. often, eligibility becomes 4 it should be noted that the mlss is granted on household basis and that the income test is also based on average income in the household (ngok et al., 2011). for example, in a one-income household with a wage of 500 rmb/month, the average income is 250 rmb if there are two household members. if the mlss-line is at 300 rmb, that means that each household member is granted 300-250 = 50 rmb/month (or 2x50=100 rmb for the household). on average there are two household members in households enjoying the mlss (and each member on average gets the 5per cent replacement rate mentioned above) njsr – nordic journal of social research vol. 6, 2015 81 extremely strict in implementation, even if the scheme formally covers everyone below local poverty thresholds. in practice, able-bodied poor with the ability to work are often excluded, and possession of material housing goods (electric appliances such as a refrigerator or motorized vehicles, for example) or even pets can be included in local practices of determining eligibility (gao, 2013; lei, 2012; solinger, 2011). local administrations often turn down applications on the basis of a general perception of welfare dependency or ‘raising lazy people’. consequently, coverage is still much lower than should formally be the case. that the mlss scheme might be able to create poverty traps or perverse incentives is certainly possible, even if the cash-benefit level itself is quite meagre and declining in relation to replacement levels. this is due to the fact that a range of extra entitlements often accompanies the status of being a beneficiary, such as health, housing or education. for example, recipients in guangzhou in 2010 could get significant benefit increases if they were eligible for an extra educational subsidy, elderly-couple subsidy, ‘three-no’ subsidy, or health subsidy. other entitlements included additional housing subsidies, complete exemption for educational costs, free access to medical insurance, vouchers for daily necessities, and more (lei, 2012). that the baseline for the cash benefit is only part of the story regarding social assistance is very common, but it is particularly true in the chinese case. still, the stigmatizing effect of the local means test is also part of the story, just as the status of being a recipient itself can be stigmatizing and shameful. this is exacerbated by policies such as the ‘public review’, formally defined as a tool to avoid fraud, where information on applicants is publicly available on local noticeboards. interviews with the poor have also revealed that many simply refrain from applying for these reasons, or that recipients avoid socializing with others owing to feelings of shame (liu, 2011; solinger, 2011). resolving some of the teething troubles of a developmental welfare state? this account of chinese unemployment policy has touched upon some of the developmental obstacles. one major challenge is the low coverage of the various schemes. it is difficult to assess the number of potential beneficiaries of the mlss, though, as mentioned, large njsr – nordic journal of social research vol. 6, 2015 82 numbers of chinese seem to refrain from applying for the mlss. on the other hand, the number of urban beneficiaries rose sharply from 3.2 million in 2000 to 22.5 million in 2003, and has since been stable. owing to the recent expansion of the rural mlss, the number of recipients in china jumped from 16 million in 2006 to nearly 50 million in 2009 (zhang, 2012). the coverage of ui, however, varied between a mere 32-57 per cent of the registered unemployed in the years 2000-2006 (cdrf, 2012), and then one has to take into account that real unemployment is several times higher. outside of unemployment policies, policy efforts have expanded health care coverage dramatically and to a lesser extent also pension coverage (national bureau of statistics of china, 2012; cdrf, 2012; manning, 2011). this is mainly a result of new schemes such as the rural cooperative medical system, the new rural pension insurance and pension insurance for hitherto uninsured and unemployed urban workers. of course, it cannot be taken for granted that a similar expansion of coverage will take place within unemployment. recent developments such as gradually channelling the previously separately registered ‘laid-off’ ( xiagang) workers into registered unemployment, and also allowing rural migrants to register as unemployed have great potential to increase the match between real unemployment and registered unemployment. these problems are not entirely unlike the situation in previously developing welfare states, which would be the case if, for example, we take a historical look at the nordic countries. in 1913, only about a fifth of norwegian industrial workers were covered by unemployment fund membership (edling, 2006). the absolute number of fund members was even lower in finland, but much higher in denmark. coverage of unemployment insurance in china, which has fluctuated around 40-45 per cent of the urban employed in the new millennium, is very like the situation in denmark and sweden in 1960 (cdrf, 2012; edling, 2006). the same goes for the low replacement rates of unemployment insurance and the mlss. in denmark, for example, the replacement rate for an average worker was close to 35 per cent before a 1967 reform which doubled the benefit ceiling and the replacement rate jumped to 70 per cent (jørgensen, 2007). unemployment insurance and pensions are also bogged down by a large number of local funds and consequently low-risk pooling, a problem also faced by the pension system (cdrf, 2012). the unemployment funds also operate at city or county level, or even at city district level in some cases (duckett & hussain, 2008). however, njsr – nordic journal of social research vol. 6, 2015 83 fragmented systems of numerous funds, leading to big variations regarding fund surplus or deficit (and therefore also variations in fund contributions and benefits) were also common problems in the infancy of unemployment insurance in the nordic countries before the state assumed marginal responsibility (jørgensen, 2007; edling, 2006). a possible solution to the issue of fragmented chinese unemployment funds and declining benefit replacement rates is tied to the financing of the unemployment funds. in denmark, a reform in 1958 replaced a system where contributions varied according to unemployment levels across a range of small funds with one where state reimbursements were tied to unemployment levels (jørgensen, 2007). in 1967, the state assumed full financial responsibility, and all unemployed began paying fixed contributions. in the nordic countries, increased state funding made member financing minimal in the 1970s and 1980s at around five to ten per cent in all the nordic countries when it was at the lowest (torp, 1999). subtle contribution reforms (in combination with non-decisions to lower contributions in accordance with falling unemployment) have led to increased member financing in denmark in recent decades, however (goul andersen, 2011b). by 2008, the danish government even made small profits from the ui scheme. in general, strongly fragmented welfare systems were also a nordic experience, despite the fact that these countries were much smaller. before the first national social-insurance laws in the late nineteenth century, large local disparities could be observed. in pensions, for example, municipalities set up their own insurance schemes, and benefit levels varied widely between rural and urban areas even as national pension schemes had been adopted (petersen & åmark, 2006). such disparities were most pronounced in finland, the nordic latecomer of welfare-state development, which continues to exhibit the strongest regional differences with respect to socio-economic conditions (pelkonen, 2008). numerous other problems facing current chinese social policymaking could be mentioned, but coverage, benefit levels, and funding constitute the major issues. the aforementioned china development research foundation (2012) dedicates half of its major report constructing a welfare system for all to all these issues. similarly, china’s 12th five-year plan (2011-2015) lays out, among other things, a clear vision for increasing coverage of the existing schemes and remedying the rural-urban divide (lei & walker, 2014; cdrf, 2012). njsr – nordic journal of social research vol. 6, 2015 84 the awareness of these problems is clearly there, but it remains to be seen how they will be handled. conclusion while some policy fields such as health and pension insurance in china have seen some significant improvements in coverage and financing (ngok, 2013), this article has focused on the still significant challenges of income protection for the urban unemployed. here, the notion of ‘moderate universalism’ is still detached from reality, and little improvement has been made. in addition, national-level policy towards rural citizens still needs to be developed. problems with fragmented funding and low-risk pooling persist in china. as regards the nordic country cases, it has been emphasized that the ‘nordic model’ includes a great deal of intra-nordic diversity at the policy level. among the nordic countries, the danish unemployment-protection scheme is arguably the most universal, and the finnish scheme is the least so. however, the common nordic experience has been that it certainly is possible to universalize unemployment insurance by letting the state assume the marginal risk of unemployment and increasing tax financing, even if such a benefit is formally far from being universal (goul andersen, 2012). fragmented funds with low-risk pooling, low benefits, and financing problems were also pronounced in the nordic countries (edling, 2006). at the same time, however, the nordic ghent model of unemployment insurance (which does not apply to norway) has also in recent decades seen some trends of retrenchment or deuniversalization with declining benefit levels, increasing member financing, and declining coverage (goul andersen, 2012; sjöberg, 2011; ervasti, 2002; torp, 1999). chinese benefit levels, as they have been examined here within unemployment insurance and minimum living standard scheme (mlss), have been lagging behind the general income development and are very far from being able to secure adequate livelihoods for citizens facing social risks. yet some improvements on these issues should not be neglected. in 2007, the mlss was expanded to rural china. urban-rural chinese migrants are now formally being recognized as part of the urban work force, and can for example register as unemployed, even if problems in enforcing their rights still njsr – nordic journal of social research vol. 6, 2015 85 exist. the problem of decreasing replacement levels within unemployment and the mlss remains to be dealt with, however, and so do the risk-pooling and financing issues within the unemploymentinsurance scheme. as we have also seen, however, the various problems can be understood to constitute some of the expected teething troubles of a developmental welfare state. our in-depth analysis of unemployment policies revealed how the chinese problems in some respects are somewhat similar to historical problems in the nordic universal welfare states in the 1950s and 1960s. yet the chinese future is not shaped by irreversible and steadily progressing welfare development locked in on any particular path of convergence with the nordic countries. china is concerned first and foremost with putting out the immediate fires of its emerging social-insurance model (liu & kongshøj, 2014; 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(2013). origins, developments and transformations of the idea of the nordic model – a social policy perspective. chinese journal of european studies, 31(2), 105-119 (in chinese). microsoft word 272 høyer, proofc.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 5, 2014 implementing regional innovation policies: doctrines and factors of influence hans christian høyer hedmark university college email: hans.hoyer@hihm.no abstract this article examines the implementation of regional innovation policies by focusing on a selected group of bureaucrats and evaluating the characteristics of the doctrines of action they utilize when creating innovation. the data used in the article were collected through in-depth interviews conducted with 21 employees in the trade and industry departments in two county administrations, the offices of innovation norway in two counties and the agricultural departments of two county governors’ offices. the primary task for all the interviewed employees is to facilitate innovation within their respective counties. the analysis shows that the employees’ doctrines are characterized by being interpretations of what, according to different theories of innovation, is necessary to create innovation. the strategies used by the employees in both the trade and industry departments and the innovation norway offices are very similar to what is prescribed by the theories of innovation, while the doctrines of the officials in the agricultural departments deviate from these theories. keywords: public regional policy, innovation policy, doctrines of action njsr – nordic journal of social research vol. 5., 2014 111 topic and research question implementation of regional innovation policies is the topic of this article. the focus, more specifically, is on the question of what characterizes the doctrines of action of a selected group of regional bureaucrats. the implementation of public policies has been a matter of significant scientific interest for the last 30 years. among other things, results have revealed that features of the executive apparatus itself often have an independent influence on how the policies are put into practice (hill, 2011; kjelberg & reitan, 1995). in the field of implementation research, the need for more studies with a ‘bottomup’ approach is frequently pointed out. such research focuses on specific factors and properties of the agents who actually implement policy (winter, 2003, 2006). the present study focuses specifically on how the organizational and demographic characteristics of the executive apparatus may affect the implementation of innovation policies. historically, in norway the implementation of public policy at the regional level has attracted less attention than at the national and local levels (tranøy & østerud, 2001). kasa and undertun (2010) point to the need for additional studies of innovation policies, and for studies focusing on how implementation policy and administrative policy are connected and how they influence each other (olsen, 2006). this has led me to concentrate on implementation policy at the regional level. there are different perceptions concerning which factors are pivotal in order to understand the relation between public policy and policy outcomes (hill, 2011; winter, 2003). the ‘top-down’ approach views implementation as a step-by-step process beginning with policy formulation, continuing to design, and then to implementation and, finally, results. critical factors in this process include the capacity and competence of the implementing authorities, as well as the balance of strength between the two. according to this model, the degree of vagueness and conflict are also critical factors in the stages of policy formulation and policy design a (van meter & van horn, 1975; pressman & wildavsky, 1973). the ‘bottom-up’ approach puts more weight on the processual aspects of the implementation of public policies. in particular, this approach focuses on the importance of local problem solving and the tension, among “street-level bureaucrats” (who ultimately carry out policies), between central and local logics of action. in this portion of implementation studies, the focus is on implementation as adaptation through negotiations and compromise (hill, 2011) the third approach is a synthesis of the two former njsr – nordic journal of social research vol. 5., 2014 112 approaches, based on a pragmatic selection of the most promising variables from the central and most referred to implementation studies. winter (2006; 2003), who is a recognized contributor to this approach, argues that we should be more concerned with what explains output, understood as performances of the specific implementation, than with a general theory of the implementation of public policies. there is a need, therefore, to look for specific theories which will shed light on aspects of the policy formulation, policy design, inter-organizational conditions and the behaviour of ‘streetlevel bureaucrats’ (hill, 2011). the focus on the implementation of public innovation policies has been chosen because the need for improved knowledge about what characterizes the participants in the design and implementation of innovation policies has been pointed out in several contexts (olsen, 2006; edquist, 2001). studies of innovation policies have demonstrated that the goals and measures of the policies are perceived to be somewhat diffuse and unclear (høyer, 2009; edquist, 2001). sabatier (1986) indicates that “bottom-up” approaches, focusing on determining the characteristics of the behaviour of the officials carrying out the policies are particularly suitable when it comes to understanding the implementation of publicpolicy areas which can be characterized as having goals and measures which are somewhat diffuse and unclear. studies of modern management systems show that such systems are characterized by different forms of regulations and administrative doctrines. it is, among other things, pointed out that important doctrines in contemporary management systems are doctrines for empowering citizens and for how public authorities are to be perceived as good and efficient resource managers (jordana & levi-faur, 2004; veggeland, 2010). within norwegian economic policy, the rule that limits use of oil revenues to four per cent of the size of the oil fund (‘handlingsregelen’) is an example of a specific doctrine. according to hood and jackson (1991), an administrative doctrine represents a construct of ideas regarding what, how, and by whom something should be done, within, for example, an administrative functional area.1 the doctrines can vary in character, they can be rather general, but also concrete and action-oriented and influence the specific and daily behaviour of individual officials in the public administration (hood & jackson, 1991). on the basis of the last of the above approaches to studies of implementation of public policy, i shall utilize what peters (1999) refers to as new institutional theory in political science and organization theory. in addition, i shall use innovation theory, which is specifically concerned with understanding science and technology and 1 dusire (1973, p. 39) defines doctrine as ‘…a set of ideas that lies halfway between “theory” and “policy” – where “theory” means an attempt to explain some part of the environment’. njsr – nordic journal of social research vol. 5., 2014 113 their relation to economy and society (edquist, 2005). these theoretical contributions will be used to analyse the doctrines expressed through the interviews conducted with a selected group of bureaucrats whose main job it is to carry out national innovation policies on a regional level. on this foundation, the superordinate research question in this study is: what characterizes the doctrines of a selected group of innovation bureaucrats, and how are these doctrines created? the term ‘characterizes’ here refers to that which is typical of the content of the doctrines of the selected officials. furthermore, the term ‘created’ refers to determining the things that influence the content of these doctrines.2 studies of what is characteristic of the behaviour and mindset of employees in public organizations have generally shown that they to a large extent seem to be characterized by three kinds of factors of influence (olsen, 2010; march, 2008). first of all, there are factors that stem from the formal tasks the organizations are obligated to carry out, and formal knowledge of the relationship between ends and means related to these tasks. these are factors that were born out of a classical instrumental understanding of organizations, where organizations are seen as formal instruments designed to reach goals that have already been defined. the actions and perceptions of the members of the organization will, with the limitations inherent in the norm of limited instrumental rationality, be characterized by being goal-oriented and coordinated, and in agreement with what is specified by the organization’s formal structures. this behavioural logic can be described as an instrumental cost/benefit analysis (scott, 2003). the second category of influential factors stems from cultural and historical trademarks of the organizations, in addition to demographic characteristics of the officials, in this case educational background and gender (egeberg, 2003). these factors are rooted in an organizational understanding that is often referred to as culturalinstitutional. according to this understanding, organizations are seen as organisms that develop their distinctiveness as a consequence of people spending time together over longer periods of time. in addition to the formal characteristics, the organizations have distinctive features, with their own collections of more informal norms and values establishing themselves in the organization’s culture, where the superordinate value is survival (scott, 2003). this culture has a strict framework for the behavioural logic of the organization’s members, which is characterized by being adapted to these informal values and 2 the reasoning behind this is that an analysis of the specific content of the doctrines is necessary to be able to say something about what seems to have influenced them. collectively this entails that the study both has an exploratory and an explanatory design. njsr – nordic journal of social research vol. 5., 2014 114 norms, and can be described as ‘the appropriate logic’ (march & olsen, 1995; lægreid et al., 2009). the third category of influential factors consists of the myths and fashions, existing in the organizations’ surroundings, concerning what should characterize organizational behaviour. these factors are rooted in an understanding of organizations based on the belief that organizational behaviour is chiefly characterized by a desire, on the part of organizations, to achieve legitimacy and status in their surroundings, and that they therefore will do anything to please these surroundings (meyer & rowan, 1977). the actions and perceptions of the members of the organizations will thereby be characterized by being based on interpretations of reality and a behavioural logic that is characterized by what appears to be fashionable and modern in the environment outside the organization, in addition to more random and temporary points of reference in the organization’s surroundings (dimaggio & powell, 1991; røvik, 1998). against this background the general thesis statement is specified in three more theoretically founded sub-questions: against this background, the general thesis statement is specified through the following theoretically founded sub-question: which of the following statements characterizes the doctrines of the organizations most strongly? 1) they are a pure reflex of the organizations’ formal tasks and the dominant knowledge status in the area of innovation. 2) they are characterized most strongly by the public officials’ demographic characteristics and experience, in addition to the history and culture of the organization. 3) they are characterized most strongly by modern and more fashionable perceptions of the factors that condition innovation. focusing on these questions will also indicate whether or not there is a relationship between administrative policies, specifically the manner in which the public administration is organized and staffed and the execution of the innovation policies. delimitation of the research object norway’s innovation policies have been viewed as an important part of regional politics by the norwegian authorities (higdem et al., 2011). there are a number of political actors involved in innovation at the regional level (amdam & bukve, 2004). i have chosen to delimit the selection of informants to employees in the county governors’ agricultural departments, the county administrations’ trade and industry departments and innovation norway’s regional offices. the organizations have clear, formally defined tasks related to contributing to innovation within their own geographical areas. in general, njsr – nordic journal of social research vol. 5., 2014 115 innovation and innovation politics have often been considered areas where the discussions can be characterized as strictly academic and objective (hernes & koefoed, 2007). at the same time, questions have been raised as to whether the subject area of innovation will come under pressure if it challenges other subject areas (fagerberg, 2009). the selection of organizations is therefore related to the fact that the agricultural departments are very closely connected with the agricultural segment, traditionally seen as being one of the strongest and most dense, in its community of interest, of the industrial segments in norway, while innovation norway and the trade and industry departments are not connected in the same way with a specific segment with such a dense community of interest (olsen, 1978). an underlying concern in this study will therefore be to examine whether this difference in connectivity to ‘the segmented state’ also influences the doctrines of the employees in the various types of enterprises (cf. also the research model below). the study’s research model and method the model below, figure 1, illustrates the research model of the study with dependent, intermediate and independent factors. figure 1. the research model. njsr – nordic journal of social research vol. 5., 2014 116 the set of instrumental independent factors are operationalized into the following questions: to what degree do innovation bureaucrats see innovation as a separate field and themselves as professionals in such a field? to what degree are the bureaucrats’ perceptions of what inhibits or promotes innovation a pure manifestation of accepted thought in the field and the guidelines that spring from the tasks they have been assigned? can any possible dissimilarities in perception be caused by differences in the organizations’ formal and instrumental characteristics? the following operational questions are related to the cultural independent factors: to what degree are the perceptions of the innovation bureaucrats characterized by the organizations’ histories and traditions, in addition to the demographic characteristics of the bureaucrats, and has this caused them to have different interpretations of the knowledge status? can any possible dissimilarities in perceptions be related to the bureaucrats’ demographic characteristics, or differences in the cultures and histories of the organizations to which they belong? the fashionable independent factors are operationalized into the following questions: to what degree are the perceptions of what inhibits and what promotes innovation influenced by which recipe for innovation is ‘in’ at the moment, without this being linked to any particular academic standpoint? further, can this result in doctrines that are primarily characterized by the bureaucrats’ personal interests and practices and by not varying systematically based on instrumental or cultural factors? in the research model it is presupposed that there is a relationship between doctrines of action and actual behaviour. this presupposition is supported by previous research showing that the significance of doctrines, in relation to actual behaviour, increases in accordance with increasing subject matter complexity (hood & jackson, 1991), and also by research showing that the area of innovation is characterized by this kind of complexity (fagerberg, 2009). the comparative logic that is applied in this model comes closest to ‘the methods of differences’, which assume that dissimilarities in the dependent variable are explained by dissimilarities in the independent variable (denk, 2002). the study has a case design in which the previously mentioned institutions make up the case categories, each consisting of two cases. qualitative in-depth interviews have been utilized because the purpose of the study is to illuminate the bureaucrats’ more fundamental thoughts about and perceptions of certain phenomena. the empirical analyses are also primarily of a qualitative character and are principally combinations of what are njsr – nordic journal of social research vol. 5., 2014 117 often referred to as narrative analysis and analysis of meaning (thagaard, 1998). the interviews were carried out based on an interview guide that had been sent to the informants beforehand. the data have been collected through qualitative in-depth interviews with some strategically chosen employees in the organizations in question. the interviewees are all responsible for supporting various kinds of initiatives intended to create innovation within a county. the strategy for selection consisted of choosing informants whose conceptions could be presumed to be typical of their unit. studies show that the general influences on public servants’ opinions are education, experience and gender (christensen & lægreid, 2009). on this basis i chose to interview the leader of each unit, as well as employees who had both a certain length of service in the organization and demographic characteristics typical of their fellow employees. table 1 below presents the demographic characteristics of each organization, in the categories of gender, education and previous work experience of the employees. table 1 shows that the employees have previous experience mainly from other public organizations, but also, to a lesser extent, from private enterprises. this makes it clear that innovation, and the regional innovation policies, are managed by bureaucrats with experience within management in general and must therefore be assumed to be well socialized into the administrative culture they are currently a part of. close to 60 per cent of them have a long formal education of an economic, agricultural or social scientific character. the agricultural departments’ innovation bureaucrats have a much more uniform agricultural educational background than the employees in the trade and industry departments and the employees in the offices of innovation norway. out of a concern for capacity, i chose to limit the analysis to a total of 21 employees, representing 32 per cent of those whose main task it is to work with innovation. table 2 below presents the demographic characteristics of the selected informants. njsr – nordic journal of social research vol. 5., 2014 118 ta bl e 1: g en de r, e du ca tio n, a nd w or k ex pe ri en ce o f th e em pl oy ee s of t he s ix o rg an iz at io ns i n nu m be rs a nd p er ce nt ag es th e c ou nt y a dm in is tr at io n in no va tio n n or w ay th e c ou nt y g ov er no r’ s of fic e c ou nt y a n = 8 c ou nt y b n = 7 c ou nt y a n = 11 c ou nt y b n = 14 c ou nt y a n = 9 c ou nt y b n =1 0 in to ta l n = 59 n um be r o f w om en 5 2 5 8 5 4 29 49 % n um be r o f m en 3 5 6 6 4 6 30 51 % n um be r w ith ec on om ic e du ca tio n, in to ta l 1 4 7 8 1 0 21 36 % n um be r w ith s oc ia l sc ie nt ifi c ed uc at io n, in to ta l ( a) 6 2 3 2 0 1 14 24 % n um be r w ith ag ric ul tu ra l ed uc at io n, in to ta l (b ) 1 1 1 4 (c ) 8 9 24 41 % n um be r w ith ex pe rie nc e fro m pu bl ic s ec to r 7 5 11 11 7 8 49 83 % n um be r w ith ex pe rie nc e fro m pr iv at e se ct or 2 6 8 3 2 4 25 42 % a ve ra ge n um be r o f ye ar s in c ur re nt or ga ni za tio n 12 ( d) 7 11 ( e) 15 ( f) 10 10 11 n ot es fo r ta bl e 1. a ) in cl ud es e du ca tio n w ith in to ur is m , p ed ag og y, p la nn in g, m an ag em en t a nd la w ; b ) se ve ra l o f t he em pl oy ee s w ith a n ag ric ul tu ra l e du ca tio n ha ve a ls o st ud ie d ec on om y; c ) in cl ud es o ne c iv il en gi ne er ; d) n um be r of ye ar s in t he c ou nt y ad m in is tra tio n va rie s be tw ee n 3 an d 47 ; e) t hi s nu m be r al so in cl ud es t he o ld s n d ; f ) un ce rta in nu m be rs h er e, a ls o in cl ud es e m pl oy m en t i n th e ol d s n d . njsr – nordic journal of social research vol. 5., 2014 119 ta bl e 2: g en de r, e du ca tio n an d w or k ex pe ri en ce o f t he in fo rm an ts th e c ou nt y a dm in is tr at io n in no va tio n n or w ay th e c ou nt y g ov er no r’ s of fic e fy lk e a n = 8 fy lk e b n = 7 fy lk e a n = 11 fy lk e b n = 14 fy lk e a n = 9 fy lk e b n =1 0 i a lt n = 59 to ta l n um be r o f in te rv ie w ee s 4 4 3 3 4 4 21 n um be r o f w om en 2 0 1 1 2 2 n um be r o f m en 2 4 2 2 2 2 n um be r w ith ec on om ic ed uc at io n, in to ta l 1 2 2 2 0 0 n um be r w ith s oc ia l sc ie nt ifi c ed uc at io n, in to ta l ( a) 3 2 0 1 0 1 n um be r w ith ag ric ul tu ra l ed uc at io n, in to ta l ( b) 0 0 1 0 4 3 n um be r w ith ex pe rie nc e fro m an ot he r p ub lic or ga ni za tio n 4 3 2 3 4 3 n um be r w ith ex pe rie nc e fro m pr iv at e en te rp ris e 1 2 2 3 2 3 n ot es fo r t ab le 2 . a ) i nc lu de s ed uc at io n w ith in to ur is m , p ed ag og y, p la nn in g, m an ag em en t a nd la w ; b ) s ev er al o f t he em pl oy ee s w ith a n ag ric ul tu ra l e du ca tio n ha ve a ls o st ud ie d ec on om y njsr – nordic journal of social research vol. 5., 2014 120 challenges regarding collection and analysis of data from the interviews the reason for choosing a qualitative method of data collection and analysis is that it provides opportunities when it comes to bringing forth more fundamental and complete reasoning from the informants. however, this method also has several weaknesses. one weakness is that it will not be possible to make statistical generalizations of what the 59 employees of the institutions perceive to be conditions of innovation (spector, 1981). on the other hand, i believe that there are ample opportunities to make what esaiasson (2003) refers to as an analytic or logical generalization when it comes to characteristics of the doctrines in the selected units. on the condition that my chosen units are not fundamentally different from corresponding units in the other counties in norway with respect to tasks and demographics, the study should also be able to indicate what is characteristic of the doctrines of action of innovation bureaucrats in these units a different challenge when using this method of data collection is the possibility that the answers given by the informants in their interviews are influenced by different forms of a posteriori rationalizations (repstad, 1993). although this cannot be completely ruled out, it is difficult for me to see how the answers could be influenced by any form of bias weakening the validity in any decisive way. the organizations’ formal tasks in the formal description of the tasks of the county governor’s office it says, among other things, that: ‘the office of the county governor will contribute to new business development in agriculture, based on farming, forestry, and related businesses. the county governor administers rural development funds for exploratory and facilitative measures. the funds are to be used to promote profitable business development in the countryside and in relation to agriculture (from the website of the county governor).’3 in the formal description of the function of the trade and industry department in one of the counties it says: ‘the unit will appear with a leading competence milieu within regional business development, 3 the tasks and functions of the county governor and the county administration within development in innovation and industrial development have been changed somewhat after jan. 1, 2010. the descriptions given here are those that were in effect at the time of the qualitative interviews. njsr – nordic journal of social research vol. 5., 2014 121 value creation, the environment and social planning. the unit will facilitate for those wanting to create and establish, to achieve increased value creation and adaptation’(from the website of the county). in the formal description of the tasks of innovation norway and their offices it says: ‘innovation norway will promote business and social economically profitable business development in the entire country and realize different districts’ and regions’ industrial opportunities through contributing to innovation, internationalization and visibility’ (from the website of innovation norway). how to create innovation – dominant knowledge status today innovation is seen as an independent field with its own definitions of innovation and theoretical models of inhibiting and promoting factors. the dominant perception of innovation is to regard it as a novelty with commercial benefit (grodal et al., 2005; rønning & teigen, 2007). the dominant knowledge status, with regard to which factors inhibit and promote innovation, is characterized by two different innovation models. the oldest of these are the linear models. in these, innovation and innovation processes are perceived as rational, in the sense that they are characterized by being planned and carried out by actors with relatively clear perceptions of the relationship between ends and means. the model builds on an assumption that innovation processes also pass through different stages, from research, to development and, finally, production (fagerberg, 2005; spilling, 2007). the model will also put more emphasis on the ‘hard’ factors of influence, like competence and financial resources, in addition to formal organization, as critical factors in the process of creating innovation. the newest and most modern models are the interactive innovation models. these models see the innovation process as both a technical and a social process that is non-linear and created through interaction between organizations and their environments, where the environments are often referred to as national or regional innovation systems (smith, 1994). innovation is created in a collective process, and these innovation processes are promoted, for example, by organizations working together and organizing themselves in geographical clusters or larger units advanced through centralized organizing (porter, 2000). in this model of innovation we find that attitudes, traditions, culture and the more ‘soft’ and informal organizational conditions are important influential factors for creating innovation. this opens up possibilities for the idea that innovation processes may be influenced by historical ties through path dependency (fagerberg, 2009). the interactive models also njsr – nordic journal of social research vol. 5., 2014 122 presuppose that innovation can happen both as leaps and through obvious breaks with former development processes. these are the innovation models that have been popular and that have been referred to the most in recent years when it comes to examining correct and efficient ways of creating innovation (rønning & teigen, 2007; fagerberg et al., 2009). analysis research question 1 the analysis will be based on the theoretically deduced research questions. in the first one, related to the independent instrumental factors, the focus was on to what extent the bureaucrats viewed innovation as a separate field and themselves as professionals in this field. there were also questions regarding whether or not the content of the doctrines, concerning what inhibits or promotes innovation, was a reflection of the knowledge status in the field of innovation and of the formal tasks the organizations have been entrusted with. and finally, there were questions regarding whether or not any differences in the bureaucrats’ perceptions can be traced back to dissimilarities in the formal functions and tasks the organizations are required to perform. the evidence shows that all the innovation bureaucrats’ doctrines of action contain various inhibiting and promoting factors that to some extent can be placed on a macro-, mesoor individual level. in general, three groups of influential factors are highlighted: 1) resources (finances and competence), 2) structural and organizational factors, and 3) cultural factors and values. table 3 below presents an overview of what a majority of the informants think inhibits and promotes innovation. njsr – nordic journal of social research vol. 5., 2014 123 table 3: the innovation bureaucrats’ understanding of inhibiting and promoting factors factor level inhibit promote resources in the form of finances, knowledge, competence society a generally low level of education and knowledge. limited knowledge about what creates innovation. limited access to capital in environment that can contribute with capital. high level of education and sufficient knowledge about what creates innovation. easy access to capital. organization weak innovative milieus in the organizations. organizations with poor finances and limited financial security. strong competence in the businesses and organizations. solid finances with room for leeway. individual weak competence among the individual employees. good competence among the individual employees. structural factors society weak market organization, far from market. weak infrastructure. limited competition. good market organization, close to market, globalization. strong infrastructure. strong competition. organization poorly organized support functions for innovation. bureaucratic hierarchical organization, npm-based management systems. power struggles about localizations, decision-making influenced by politics. times with solid profits and financial leeway. large units, separate research units. well-organized support functions for innovation. cluster network organization, partnerships and flat structures. crisis with focus on the need for action. leeway in the organization. small units. individual limited authority and autonomy for the individual employee. greater degree of authority and autonomy for the individual employee. attitudinal and cultural factors society ‘inland culture’ characterized by cautiousness and inertia. politicized culture, egalitarian culture. ‘west coast culture’ characterized by willingness for risk-taking and a rapid life cycle. organization bureaucratic culture, culture based on mistrust. non-bureaucratic culture with a large degree of trust and acceptance of mistakes. individual fear of risk, innovation seen as something unattainable and big. closed attitude toward environments and novelties. willingness to work hard and take risks for one’s own ideas. openness toward environments and novelties. njsr – nordic journal of social research vol. 5., 2014 124 all the informants point to commercial market competition as the primary driving force for creating innovation in the world. almost all of the innovation bureaucrats point explicitly to network building, partnerships, clusters and cooperation between different actors and environments as important to the creation of innovation. a majority of the innovation bureaucrats emphasize organizational culture and societal culture, in addition to attitudes and values of individuals, more than finances, formal organizational conditions and competence. the innovation bureaucrats view the question of which factors influence innovation as both complex and complicated. to some extent the complexity revolves around the fact that there are many different factors that are relevant to the ability to innovate, and partly around the fact that some of the factors, in different given situations, can work either for or against innovation. easy access to financial capital, for example, is in general seen as a factor that will influence innovation in a positive way, while limited access will have the opposite effect. a male informant with an education within social sciences says it like this: ‘especially here in the interior, capital is probably a limitation. it is important that we manage to find venture capital that can follow the good projects.’ at the same time, times of crisis with weak access to capital in the market are described as conditions that can force innovation forward, while times of good capital flow may actually result in a standstill. a male informant from one of the offices of innovation norway, with an education in economics, says it in this way: ‘good times do not promote innovation – no one is under pressure or feels forced to do it.’ the complexity and ambiguity in the ways different factors influence innovation are also expressed when it comes to the importance of the market for innovation. here, some of the informants point to the tension between the market’s focus on resource utilization and the need for exploration.4 table 4 below summarizes the complexity of the factors that influence innovation and how their content can be related to the dominant knowledge status. 4 this is in line with march's classical statement of the difference between exploitation and exploration (march 2008). njsr – nordic journal of social research vol. 5., 2014 125 table 4: the content of the doctrines conditions based on newer models of innovation conditions based on classical linear models of innovation inner organizational outer environmental inner organizational outer environmental unambiguously good conditions open and trusting organizational culture. tradition for innovation. ‘west coast culture’ with high acceptance of risk taking. good competence. flat and informal organizational structure. closeness to market. ambiguous conditions historical ties. poor economy. crisis. organizational size. strong economy. strong competition. localized in the in rural areas. ‘good times’ unambiguously poor conditions bureaucratic organizational culture. culture characterized by mistrust. inland culture focusing on egalitarianism – politicized culture. strongly formalized and hierarchical organizational structure. weak competence. not close to the market. the bureaucrats have different perceptions of themselves as professionals when it comes to innovation and whether or not innovation is an independent field. those who are employed in the trade and industry departments and the offices of innovation norway are all concerned with this, and several of them refer directly to schumpeter or other theorists when reflecting on the concept. a male informant from one of the trade and industry departments, with an education within economics, says it this way: ‘i have drawn quite a lot upon ola spilling who has worked with classical theories concerning innovation, which again are based on other theorists.’ these employees see innovation as an independent field, and themselves as professionals in that field. among the informants in the agricultural departments, on the other hand, these perceptions are significantly weaker and nobody sees him or herself as a professional in the field njsr – nordic journal of social research vol. 5., 2014 126 of innovation. one of the male informants, with an agricultural education, says it like this: ‘the concept is somewhat academic and theoretical, far removed from my everyday life – and because of this i have never been concerned with the definition of innovation.’ in general, for the agricultural bureaucrats it is far more important that it is their own experiences over time with working to achieve innovation that constitute the foundation of what they actually do. there are also systematic differences regarding whether or not individual factors inhibit or promote the possibilities for innovation. the informants in innovation norway and the county administrations believe that a peripheral location, in terms of few people and few businesses – far away from the larger markets, will lessen the opportunities for innovation, while centrality and increased organizational size and strength will enhance such opportunities. a male informant from one of the innovation norway offices, with an education within economics, says the following: ‘it is when many people are gathered that you frequently see new groupings of people with certain hobbies and interests that may turn out as purchasing power and a market for this and that. and that means that most of the innovation necessarily has to occur in large cities with several different kinds of people.’ in the agricultural departments, on the other hand, peripheral location is pointed out as something that can have a positive effect on the opportunities for innovation, and the idea that such opportunities are limited in the periphery is seen as a myth. in general, the perception of inhibiting and promoting factors is more uniform among the agricultural bureaucrats, and examples of what inhibits and promotes innovation are more specifically related to a sector (agriculture), than among the other informants. collectively, two general sets of doctrines take shape: one that applies to employees in the agricultural departments and one applying to employees in the innovation norway offices and the trade and industry departments. njsr – nordic journal of social research vol. 5., 2014 127 table 5: typical doctrine of action in the trade and industry departments and the innovation norway offices characteristics of those meant to contribute to/create innovation innovation is an independent field with a specific knowledge base, and we innovation bureaucrats are professionals in this field because we have acquired this knowledge. what it takes to create innovation many factors influence innovation; individual, organizational and community-based. their influence is complex. in general, factors like traditions, culture and historical experiences are more important than formal organization, finances and competition. where innovation is created innovation is more easily created in large environments and geographical centres very close to the market. small and scattered units in the periphery inhibit the opportunities for innovation. table 6: typical doctrine of action in the agricultural departments characteristics of those meant to contribute to/create innovation innovation is not an independent field and we innovation bureaucrats are not professionals when it comes to innovation. our competence lies in using our experience as professionals in agriculture to think about innovation within our specific field. what it takes to create innovation many factors influence innovation; individual, organizational and community-based. their influence is complex. in general, factors like traditions, culture and historical experiences are more important than finances and competition. where innovation is created innovation can be created just as well in small environments localized in the periphery as in large environments localized centrally in the interior. njsr – nordic journal of social research vol. 5., 2014 128 the evidence shows that the innovation bureaucrats clearly relate the question of what it takes to create innovation to finances, and that they all emphasize that the image of what inhibits and promotes innovation is complex. this complies well with the formal tasks of the organizations and the knowledge status in the field of innovation, cf. point 3.1. this indicates that the instrumental factors in general have had a clear influence on the content of the doctrines. the instrumental factors can also contribute to the explanation of the differences in the perceptions. the agricultural departments’ formal tasks are much more sector-specific than those of the other departments, and this may explain the uniformity of the perceptions in the agricultural departments. the fact that the agricultural bureaucrats do not see themselves as professionals in the field of innovation or innovation as an independent field, and have opinions about inhibiting and promoting factors that intersect the knowledge status, may be explained by the fact that the function of the agricultural departments’ instrumental set of tasks is to promote the interests of the periphery. it was mentioned in the introduction that the agricultural segment is one of the densest in its community of interest among the industrial segments in norway. from this perspective, it will be difficult to unite these segmented interests with the dominant knowledge status, where it is pointed out that large units and different forms of centralized organization promote innovation while the opposite hinders it. it is difficult to evaluate whether this ‘deacademization’ has contributed to the fact that the perceptions are partly in conflict with the dominant knowledge status, or whether it is the conflict with the knowledge status that has led to the ‘deacademization’ with the agricultural bureaucrats. i shall return to this in the analysis of the importance of cultural factors for the doctrines of action. analysis relating to research question 2 in the second research question i focused on whether or not the perceptions were characterized by being interpretations of the knowledge status anchored in and adapted to more informal features of the organizations, like their culture and history and the individual bureaucrats’ demographic characteristics. in this question there is an implicit expectation that any differences in perceptions may be traced back to differences in the organizations’ histories and cultures, or to variations in the bureaucrats’ demographic characteristics. so far the analysis has shown that the content of the doctrines is well embedded in the knowledge status. the content is not, however, a pure reflection of the knowledge status. few bureaucrats refer directly to the various models of innovation. the relationship is more indirectly expressed by referring to what innovation means to them, by using certain concepts and expressions, and by pointing out certain factors njsr – nordic journal of social research vol. 5., 2014 129 and ways of reasoning which are in line with the various innovation models. their understanding is therefore characterized more by being an interpretation of the knowledge status than a reflection of it. the gender of the innovation bureaucrats seems to be relevant when it comes to which factors are emphasized. seven out of the eight female interviewees emphasize ‘soft’ factors like culture, historical experiences and traditions the most. consequently, the women constitute a majority in this group who emphasize `soft` factors, in spite of the fact that they are a clear minority in the total population of interviewees. gender seems to have contributed to differentiating the content of the doctrines regarding which innovation factors appear to be the most important. the women’s emphasis on cultural and more informal conditional factors is in accordance with other studies of administration policy, showing that hierarchical and formal organizational factors are better suited to a male form of logic, while flexible and informal factors are better suited to a female logic (rothstein, 2001). the systematic difference between the agricultural bureaucrats’ doctrines and those of the other bureaucrats can, as mentioned above, be explained by this department’s close relationship with the agricultural segment of the population and the strong interests this segment represents. an industrial segment does not only represent a set of interests, but also a historical lineage with a culture and a set of values (olsen, 1978). the agricultural segment has, through its history, its culture and values probably been characterized by having a positive view of opportunities in the periphery. the knowledge status, with its emphasis on a certain organizational size and centralization as a promoting factor seems, then, to have been rejected because it is too far removed from what the agricultural departments represent historically and culturally. the consistent deviation in the agricultural bureaucrats’ perceptions can in this way be explained by the fact that the offices of innovation norway and the county administrations’ trade and industry departments on one hand, and the agricultural departments on the other hand, place themselves differently in the centre – periphery dimension, which is one of the classical divides in norwegian politics (narud & valen, 2007). as mentioned in the introduction, our selected agricultural departments also have employees with a much more uniform educational background than the employees in our trade and industry departments and innovation norway offices. in my opinion, these observations support the image of the strong community of interest in the agricultural segment. it is therefore probable that the agricultural segment meets expectations that are both more unambiguous and somewhat different, in terms of values and attitudes, than the expectations other segments of business, for example industry or njsr – nordic journal of social research vol. 5., 2014 130 service, meet. in my opinion this may have contributed to making the perceptions of the agricultural bureaucrats somewhat different, and more unequivocal, than those of the bureaucrats from innovation norway and the trade and industry departments. collectively, it appears as if there is an interaction between cultural and instrumental factors that have led to the fact that the doctrines of the agricultural bureaucrats clearly distinguish themselves from the doctrines of the employees in the trade and industry departments and the offices of innovation norway. it is somewhat surprising to see that the educational background of the individual employees does not seem have an important impact on the content of the doctrines. several other studies of public bureaucrats’ behaviour have shown this kind of importance (tranøy & østerud, 2001). based on this research it would be possible to expect that those with an education in the field of economics would view various significant conditional factors for innovation differently than those with, for example, an education in the social sciences. this is not the case. to the contrary, the evidence here shows that the only informant in the agricultural departments with an education in the social sciences has a doctrine typical of the agricultural informants, and different from the doctrines of action of the remaining informants educated in the social sciences. likewise, the evidence shows that the only informant with an agricultural education in the offices of innovation norway has a doctrine in line with the doctrines of the other informants from innovation norway, and which therefore differs from the other informants with an agricultural education who are employed in the agricultural departments. several studies have shown (see for example tranøy & østerud, 2001) that instrumental factors like formal belonging and instrumental interests have a very strong influence on public officials’ behaviour and can override a potential influence through educational background. likewise, my findings indicate the possibility that education first becomes strongly influential when it becomes collective in character. this is in line with later studies of how bureaucrats’ education influences behaviour (christensen & lægreid, 2009).5 in this case, this has contributed to strengthening the uniformity of the perceptions when they are typical of a strong segment like agriculture. analysis relating to research question 3 in the third question i focused on whether the content of the doctrines is primarily characterized by fashionable perceptions and myths regarding what inhibits and promotes innovation. implicit in this question is an expectation that differences in perceptions will be more 5 the findings may also indicate that the three types of education do not have a differentiating effect on perceptions having to do with the field of innovation. njsr – nordic journal of social research vol. 5., 2014 131 random, and not vary with either formal or informal features of the bureaucrats’ organizations or demographic characteristics such as education and gender. in the rhetoric used by the innovation bureaucrats themselves when they reflect on what creates innovation, concepts and expressions like ‘knowledge clusters’, ‘clusters’ and ‘networking’ appear more often than concepts and expressions like ‘economic restrictions’ and ‘formal organization’. this leads us to the understanding that the innovation bureaucrats’ perceptions of what inhibits and promotes innovation are more in line with the newest and most modern innovation models than with the classical models. it therefore appears that the innovation bureaucrats’ own opinions about innovation are influenced by what is fashionable. the empirical findings also indicate that innovation bureaucrats perceive innovation as a fashionable trend that everybody must speak of in positive terms. one informant with a background from social science who works in one of the trade and industry and trade departments states that: ‘it (innovation) is a modern concept – it is in. it’s not legitimate to be non-innovative’. if we look more collectively at the individual bureaucrats’ reflections when it comes to what they see as conditions for innovation, we can also see that the perceptions seem to have a ‘personal touch’, only partly determined by formal structure, culture and demography. the individual informants’ doctrines of action therefore have an individual touch causing them to vary independently both of the education and gender of the individual bureaucrat and independently of formal and informal features of the specific organization the bureaucrats belong to. this is precisely what the third research question expected to find. summarizing analysis the content of the doctrines appears to be characterized by having three different foundations related to the study’s three sets of independent factors. figure 2 below illustrates this. njsr – nordic journal of social research vol. 5., 2014 132 figure 2: the three foundations of a doctrine. 1. instrumental factors formal tasks and interests formal knowledge in the field of innovation 2. cultural factors cultural and historical trademarks demographic characteristics 3. fashionable factors -myths about, and fashionable perceptions of, innovation the first foundation is the most obvious and the most consistent with the instrumental tasks assigned to the organization and the general knowledge status within the field of innovation. the knowledge status seems to contribute to the facts that the doctrines contain different kinds of factors that inhibit or promote innovation, and that the answer to the question of what it takes to create innovation is complex and complicated. the organizations’ instrumental tasks, and the interests related to them, have contributed, among the agricultural bureaucrats, to doctrines that are more sector-specific, and also to the way that their doctrines, in some areas, contrast with the knowledge status. the factors in foundation 2 have contributed to the fact that the doctrines are not characterized by being pure reflections of the knowledge status, but are instead results of interpretations of the knowledge status along with the formal tasks assigned to the organizations. the breadth of the knowledge status and of the formal tasks, when it comes to innovation, have created a good scope of action for different interpretations, and have therefore offered good doctrine njsr – nordic journal of social research vol. 5., 2014 133 conditions for the ability of foundations 2 and 3 to influence the content of the doctrines. the genders and individual experiences of the bureaucrats, in addition to the culture and history that they represent, constitute the most important bases for the interpretations. in the agricultural departments, culture and history have caused the knowledge status to be partially omitted from the interpretations, and that the doctrines are only partially related to the subject matter of innovation. interaction between factors from foundations 1 and 2 has caused two sets of doctrines to develop, one for those working in the trade and industry departments and innovation norway offices and one for those in the agricultural departments. generally, education seems only to influence the doctrines when it is a part of a mutual cultural factor. foundation 3 has contributed to both sets of doctrines having a ‘personal touch’, and also to the presence of more of the newest and most modern innovation models in the doctrines than of the older models. the doctrines prescribe relatively different ‘cures’ to create innovation, and it is therefore highly likely that the variance between the doctrines will be significant for the implementation of innovation policies. in general, the study also shows that there is a systematic difference between female and male innovation bureaucrats in the emphasis put on conditional factors for innovation, which indicates that gender is a relevant variable for studies of innovation – at least when assuming an administrative political perspective. the fact that the institutional influence is particularly clear when the bureaucrats belong to the county governors’ agricultural departments, can be interpreted as being an indication that the importance of institutional belonging increases when it represents strong, segmented interests. other studies have shown that the municipalities have just as much trust in the county governors agricultural departments as they have in the counties’ trade and industry departments when it comes to questions concerning support for innovation (teigen et al., 2010). this can indicate that the less subject matter-oriented doctrines of the agricultural departments, regarding innovation, resonate well in the municipal innovation milieus, and that they are just as competent in inspiring confidence in the municipalities as the trade and industry departments’ more subject matter-oriented doctrines are. conclusion on the basis of the research literature regarding what characterizes administrative behaviour, this study has assumed that administrative doctrines are characterized by instrumental, cultural and fashionable factors of influence. the study shows that the doctrines of the innovation bureaucrats are influenced by all three factors, but that particularly the instrumental and cultural factors have been important for the content of the doctrines. interaction between the cultural and njsr – nordic journal of social research vol. 5., 2014 134 institutional factors of influence has caused two sets of doctrines to develop, one in the agricultural departments and another in the trade and industry departments and innovation norway offices. the two doctrines represent perceptions of innovation that fit both linear and interactive models of innovation, but, taken together, the doctrines more closely approximate the understanding of innovation put forth in the interactive models. the differences between the two sets of doctrines are significant. in marsh and olsen’s (1995) terminology, the two doctrines represent two types of ‘appropriate logic’ regarding what it takes to create innovation. assuming that there is a correspondence between doctrines and actual behaviour, this implies considerable differences in the implementation of innovation policies. the reason for studying the doctrines in the chosen organizations was to examine whether the organizations’ dissimilarities in interests and traditions they represent, would impact the doctrines. the study shows that dissimilarities in the relationship with industrial segments have significance for the doctrines. the importance of institutional belonging increases if it represents strong segmented interests. the doctrines are practically disconnected from the field of innovation when the doctrines comes into conflict with other policy areas that have been entrusted to those who carry out innovation. in all, the study shows that exercising the public regional innovation policies, at a public official’s level, is primarily characterized by a mix of more or less subject matteroriented perceptions, from the perspective of the individual official, about what creates innovation, and the specific interests to which the institutions set to implement the policies are historically attached. concerning the implementation of the innovation policies, the following paraphrase of rokkan’s classical formulation may be suitable: academic knowledge matters, but interests and history decide. the study therefore supports olsen (2006), who calls for a greater focus on power and interests in studies of innovation. the findings imply that the way in which the public apparatus is functionally and demographically organized impacts the implementation of innovation policies on the regional level. in other words, it seems as if there is a relationship between administrative policies and innovation policies on the regional level. in this way the study indicates that the newly executed reform of government administration, where some of the functions within the regional innovation management have been moved from the county governors to the counties, may have a greater significance than is claimed by some in the general debate about this administrative reform. the perspective of this study has been bottom-up. independent variables selected from organization research and theory give robust and relevant knowledge of what actually characterizes and influences njsr – nordic journal of social research vol. 5., 2014 135 implementation of innovation policy at the regional level in norway. the findings indicate that the lasting and stable action doctrines of the officials in charge of implementing the policies influence, and to some extent even transform, signals of general policy. the relationships of power and influence, that historically have characterized the policy areas that the implementing body is connected to in a more general way, influence these action doctrines in their turn. the study thus supports other implementation studies that show the difficulty of distinguishing policy-making from policy implementation, as two separate phases (lane, 2000). in addition, the findings support the implementation perspective that emphasizes relationships of power and influence in the study of how public policy is put into practice (barrett & fudge, 1981; olsen, 2006) for policy-makers, the study suggests that they should be concerned with what constitutes the doctrines of the officials charged with implementation of specific policies. the study also suggests that it is useful to have a pragmatic attitude to the kinds of variables defined as independent, when the goal is to investigate how public policy is actually implemented. last but not least, the study indicates that the concept of doctrine of action may be relevant in this context acknowledgements i want to thank professors tom christensen and sjur kasa 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(2006). implementation. in b. g. peters & j. pierre, (eds.), handbook of public administration (pp. 151-166). london: sage. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 7 (2016): special issue foucault and deaf education in finland lauri siisiäinen department of social sciences and philosophy university of jyväskylä email: lauri.m.siisiainen@jyu.fi abstract the influence of michel foucault’s thinking in critical disability studies, and to social studies of deafness, can hardly be doubted. foucault has offered valuable tools for the critical rethinking of deaf education and pedagogy with respect to normalization and disciplinary power, which are integrally related to the historical construction of deafness as deficiency and pathology by modern, medical, and psychological knowledge. this article explores the applicability and critical potential of the foucauldian concepts of disciplinary power, surveillance, and normalization within the specific context of the history of deaf education in finland. the article focuses on the modernization of the education of deaf children that began during the latter half of the nineteenth century in finland, with the influence of oralism – a pedagogical discourse and deaf-education methods of german origin. deafness was characterized as a pathology or abnormality of the most severe kind. when taken at the general level, foucault’s well-known concepts are easily applicable to the analysis of deaf education, also in the finnish context. however, it is argued that things become much more complex if we first examine more closely the roles played by the eye and the ear, by optic and aural experience, in these foucauldian notions, and if we then relate this enquiry to our analysis of oralist pedagogy and deaf education. keywords: deaf education, deafness, oralist pedagogy, oralism, normalization, disciplinary power, finland introduction the significant influence of michel foucault’s thinking in critical disability studies can hardly be doubted (allan et al., 1998; allan, 2007; tremain, 2005). this is also the case when it comes to social studies of deafness. foucault’s work – especially the seminal concepts he coined in the 1970s – has offered valuable tools for the critical, problematizing, and de-naturalizing rethinking of deaf education and pedagogy with respect to normalization and disciplinary power, which are integrally related to the historical construction of deafness as deficiency and pathology by modern, medical, and psychological knowledge (bauman, 2004; branson and miller, 2002; lane, 2002). the article contributes to this topical discussion and further probes the applicability and critical potential of the foucauldian concepts of disciplinary power, surveillance, and mailto:lauri.m.siisiainen@jyu.fi njsr – nordic journal of social research vol. 7 (2016): special issue 52 normalization, within the specific context provided by the history of deaf education in finland.1 first, i focus on the modernization of the education of deaf children that began during the latter half of the nineteenth century. in this reform, the import of oralism, a pedagogical discourse and deaf-education methods of german origin, played a prominent role. i shall show that oralist pedagogy is underpinned by a binary opposition of the ear and the eye, or sense of hearing and sight. in this setting, the sense of hearing and aural experience are determined as the origin and necessary condition of ‘normal subjectivity’, the ability to think rationally and to use abstract concepts. according to the oralist doctrine, it is only through the speaking voice and aural experience that a thinking subject can be born, one who has a permanent and coherent identity. it follows that deafness – the lack of hearing and ability to speak – is characterized as a deficiency and pathology or abnormality of the most severe kind. allegedly, it hampers the entire development of human being and the separation of the human from animal life. as purely visual and silent, the sign or gesture language used by the deaf is judged as inherently non-conceptual. the only way to make the deaf ‘truly human’, the central objective of deaf education, is to give them voice, speech, and aural experience. we shall discover how these oralist notions were elaborated, put into practice, and institutionalized in finland over time. despite opposition and despite the weakening of the german influence, they have remained influential even up until today in modified forms. at a general level, foucault’s well-known concepts of modern disciplinary, surveying, and normalizing power are easily applicable to the analysis of deaf education, including in the finnish context. however, the article contends that things become much more complex if we first examine more closely the roles played by the eye and the ear, by optic and aural experience, in these foucauldian notions, and if we then relate this enquiry to our analysis of oralist pedagogy and deaf education. this is something which, to my knowledge, has hitherto been missing in critical deafness studies that draw upon foucault. the article seeks to substantiate that in foucault’s analyses of disciplinary, surveying and normalizing power – in fact, these three belong integrally together – there are no parallels to what has taken place with the oralist pedagogy and education of deaf children in finland, as well as elsewhere: the production of normality through voice-ear-aural experience, and the pathologization of visuality and silence. more serious, from this angle, is foucault’s strong insistence on the purely optic-visual modus operandi of modern discipline and normalization, together with the characterization of the ear and aural experience as the adversary of normalization and discipline. this does not leave much room for the recognition and critical analyses of such cases as the history of oralism and deaf education. if critical thinking and theory are to keep a critical impetus and even strengthen and expand it and to avoid the exclusion of particular phenomena as being beyond critique, they need to engage in this kind of selfcritical reflection on the taken-for-granted presumptions lurking in their own language. 1 primary sources or even studies on the early history of finnish deaf education are somewhat difficult to find. below, i mainly draw upon the study by salmi & laakso (2005). although published by finnish society of the deaf, which is not an academic publisher, it is credible in its use of historical material. primary sources or even studies on the early history of finnish deaf education are somewhat difficult to find. below, i mainly draw upon the study by salmi & laakso (2005). although published by finnish society of the deaf, which is not an academic publisher, it is credible in its use of historical material. njsr – nordic journal of social research vol. 7 (2016): special issue 53 oralism in deaf education (i): johann conrad amman the german school of deaf education, developed in the eighteenth century, had a great impact on the nordic countries, including finland. therefore, we need to begin with a concise discussion of this school: the pedagogical discourse of oralism (a set of central notions and arguments) as well as the related oralistvocal-aural methods of teaching deaf children. generally, it is thought that the birth of german school dates back to the late seventeenth century to johann conrad amman (1669-1724), who was a swiss medical doctor. amman’s views on deaf education are based on the belief on the unique, privileged status of voice and vocal speech as media of expression and communication. voice is the most immediate, the most faithful, the most truthful, and the most certain sign expressing and conveying the interior life of the mind, both emotions and ideas or conceptions: there is still a very different reason, why men should desire to open the secrets of their hearts and the conception of their minds to others in speech rather than by pictures, gestures, or characters, and other things of this kind (…) for nothing emanates from us which bears a more vivid character of life than our voice; neither have i gone beyond the truth in affirming that the breath of life resides in the voice, transmitting its light through it; for the voice is the interpreter of our hearts and signifies its affections and desires. (amman, 1873, pp. 7-8, emphasis added) as we find out, any visual medium and genre of signs, pictures or gestures is condemned as being essentially defective in comparison with voice. they are mediated, partial, incomplete, and deceptive in their signifying power (amman, 1873, pp. 7-8). in this respect, amman’s argument is reminiscent of what derrida (1967) has called phono/logocentrism (see bauman, 2004; 2008). voice is also the most natural and primary vehicle for the deaf to express their feelings, affects, and sensations: ‘deaf men laugh, cry out, hollow, weep, sigh, and waile, and express the chief motions of the mind, by the voice’ (amman, 1694, ch. i). however, what they remain incapable of, most essentially, is articulate vocal speech and understanding of speech. through their non-speaking voice, they may give a subjective expression to their own affects and sensations. still, without speech, they are unable to form, convey, understand, and learn concepts and ideas. what results from this is the necessary predicament in the development of the higher, conceptual mental faculties, that is, of intellect together with moral sense of duty. the ‘enlightenment’ of these faculties can only occur through the circulation of speech. consequently, the deaf remain attached to the life of sensations and affects (amman, 1873, pp. 2-3). most importantly, amman asserts, the silent language of gestures used by the deaf can never compensate for the deprivation of speech in education, through which the higher, properly ‘human’ spiritual capacities could be realized. hence, the deaf are stuck somewhere between human being and animal: how dull are they in general! how little do they differ from animals (…) and even if their parents are most attentive to them, how inadequate and defective is the language of gestures and signs which they must use! (...) how little do they comprehend, even superficially, those things which concern the health of the body, the improvement of the mind, or their moral duties! who does not pity their wretched condition? who will refuse to relieve it by all the contrivances which can be devised? (amman, 1873, pp. 2-3, emphasis added) njsr – nordic journal of social research vol. 7 (2016): special issue 54 in this manner, giving deaf people the ability to speak and to understand the speech of others and replacing the ‘primitive’ and defective sign language with speech becomes the primary objective of deaf education. otherwise, all attempts to educate and teach deaf children – to develop their intellectual and moral powers, to emancipate them from their ‘dullness’ – are doomed to failure. only by making them speak and understand speech, instead of using silent gestures, can the deaf become detached from their animal existence and be elevated to the rank of true humanity. in amman, the strong influence of christian ideas is explicit when he attempts to legitimate the urgency of the task of making the deaf speak: voice is a living emanation of that spirit which god breathed into man when he created him a living soul (amman, 1873, p. 10) (…) i will state some preliminary axioms of indisputable truth, by which it will be shown from the nature of god, that creatures formed in his image ought, of necessity, to be able to speak and in this respect resemble their creator (…). (amman, 1873, pp. 12-13, emphasis added) god is endowed with the capacity to speak, that is, to convey ideas or concepts in an articulate voice that preserves their meaning without any distortion. thus, the human being, the ‘image of god’, must have this capacity also (albeit less perfect than god’s, of course), and the lack of it equals nothing less than falling short of humanity. although not totally lacking, the capacity to speak remains dormant in the deaf-mutes. relatedly, what also remains dormant is the human power to govern both oneself as well as others, to govern the whole of nature, again in the model of god. it is only with speech that the active human subject, the ruler of the earth, is created: at last, the eternal word (…) creates adam, that is man, in his own image, and commanded him to subject the land and sea and all the host of them to himself; but to the end that he might properly exercise this empire over them, it was necessary that adam himself should have effectually the power of commanding, the force of which consists in an emanating word. (amman, 1873, pp. 14-15, emphasis added) this religious justification is hardly surprising or original. rather, amman is reiterating the doctrinal belief – dominant in the christian church already in the middle ages – that the deaf are separated from the word of god, from the christian community, and from education. it had become a commonplace to authorize the exclusion of the deaf by reference to paul’s letter to the romans: ‘faith cometh by hearing, and hearing by the word of god’ (10:17). the established opinion of the church was that the use of gestures, such as silent sign language, could never match hearing and vocal speech as the medium of religion (knowlson, 1965). yet amman thought that the deaf could be released from their state of incapacity. they could be ‘humanized’ with apt methods of education. through these methods, it would be possible to activate the capacities to produce and understand speech that were latent in the deaf: after close investigation, i found that most of the mutes have their organs of speech perfect, and that they are speechless because they are deaf (amman, 1873, p. 3, emphasis added) (…) for human speech, as will appear to every one who considers it with a little attention, is a certain njsr – nordic journal of social research vol. 7 (2016): special issue 55 combination of many different kinds of sound, the variety of which arises, in my opinion, from the various motions of certain organs, which if they were sufficiently visible, i should think, would suffice for the deaf to discern them with their eyes, just as others receive sounds through their ears; and thus, in time, they may learn to speak. (amman, 1873, pp. 3-4, emphasis added) oralism in deaf education (ii): samuel heinicke amman’s ideas, in turn, were a major influence on samuel heinicke (1727– 1790), a prussian teacher. it was largely through heinicke that the oralist discourse and methods of teaching were institutionalized into what came to be known as the german school of deaf education (lane, 1984, pp. 100-103). moreover, it was to a great extent via heinicke that oralist pedagogy became established in the nordic countries, when deaf education was reformed there in the course of the nineteenth and twentieth centuries. hence, heinicke’s thought needs to be discussed in some detail. the backbone of heinicke’s pedagogical thinking is provided by his empiricist philosophical position, inspired to some extent by john locke. in summary, heinicke jettisons the notion of ideas and principles that would be innate in the mind. the mind is initially empty, while all knowledge originates in sensual perception. as amman did before, heinicke submits that thinking has its origin and its necessary prerequisite in spoken language. thinking is a process that takes place in the mind only by means of the sounds uttered in talking, that is, through words as phonetic and auditory units. thinking cannot occur independently of and detached from this perceptual, aural-vocal basis. heinicke infers that those who cannot speak or hear, or both – in other words, deaf people – cannot think either, or at least, they cannot think abstractly or conceptually. at best, without speaking voice and aural experience of words, the deaf can think in merely concrete terms. the higher stages of abstract and conceptual thinking can only be reached through the regular use of vocal speech and the aural experience of words (arnold, 1984; markowicz, 1972). in heinicke’s thinking, as it was with amman, the privilege of voice and aural experience has its reverse in the inferiority of sight and visual experience: ‘it is a mistake to believe that the sense of sight, through written speech, can replace the sense of hearing for deaf mutes. abstract concepts cannot be developed through the aid of writing’ (cited from markowicz, 1972, p. 21, emphasis added). writing and reading, just like manual communication with gestures, cannot by themselves evoke the sounds of words in the mind. hence, they cannot offer the solid medium needed for the communication and understanding of abstract concepts: (w)e must not believe that because words permit themselves to be represented on paper that they therefore can be similarly presented inside ourselves. no, this in no way follows. written or printed words are like heaps of flies’ feet or spiders’ legs; they are not forms or figures that can be presented as fixed or abstracted in our imagination; and we are hardly able to represent individual letters to ourselves subjectively with any continuity. (cited from markowicz, 1972, p. 21, emphasis added) as we can observe in the quotation, heinicke sets forth his variation of the binary setting of the ear and the eye. also in heinicke’s version, the voice, the ear, sense of hearing, and aural experience are determined as the necessary origin njsr – nordic journal of social research vol. 7 (2016): special issue 56 and condition of normal adult subjectivity, and, even more fundamentally, of the formation of human beings as separate from animals. with heinicke, this setting becomes perhaps still more explicit and meticulous than with amman. heinicke argues that only voice and aural experience can give the firm medium, through which can develop the higher faculties and activities of the mind, ones that operate with abstract concepts, ideas or notions. only voice and aural experience can offer the medium that supports and safeguards the permanence, unity, coherence, and clarity of concepts and abstract thinking, and of the thinking subject itself, over and against the flux of sensations and affects. only voice and aural experience enable our memory to grasp and keep words and concepts so that they remain the same in their meaning. in opposition to this, heinicke proposes, our eyes, visual experience and visual signs are bound to the concrete, which is to say, to the flow of shifting and vanishing impressions and affects. in a rather mysterious fashion, voice and aural perception – although originally sensual – are supposed to provide the highway of abstraction, leading to the permanence and fixity of intellectual ideas above the instability and confusion of the sensual, concrete world. visual experience and optic signs – forever incapable of rising to the abstract level – may even ‘contaminate’ concepts or ideas, the thinking mind, and the subject with their sensual concreteness, thus making the latter fluid and unstable. if hearing and speech are the ground of continuous and unfailing memory, then sight, writing, and gestures are the allies of forgetfulness (arnold, 1984; markowicz, 1972). again, we can note the considerable influence of logo/phonocentrism (derrida, 1967) in the history of modern deaf pedagogy. it is no wonder that from these premises heinicke came to oppose vehemently the use of sign language in deaf education. the only way for deaf people to gain the ability to think abstractly and conceptually would be, as with amman, through becoming cured from their sordid state. thus, the primary goal of deaf education is to teach deaf children to speak and to speech-read from the lips. heinicke’s methods included the use of a model leather tongue to illustrate the correct position of the tongue in the generation of speech sounds (arnold, 1984). heinicke admits that even if deaf persons learn to emit words and to speechread, they do not actually hear the sounds of words. still, he believed that even this obstacle could be overcome. his solution was somewhat strange. heinicke contends that the sense of taste could function as something like the substitute for the sense for hearing, and that through this curious detour of taste, the adequate aural experiences of words could still be evoked in the mind of the deaf. as the result, the basis for the evolution of rational, conceptual thinking could finally be constructed (markowicz, 1972; lane, 1984, pp. 102-103). regardless of the obscure nature of his ideas, heinicke’s oralist pedagogy became popular and institutionalized in deaf education in germany during the late eighteenth and early nineteenth centuries. oralism elaborated by amman and heinicke was not the only significant strand of deaf pedagogy in eighteenth-century europe. in france, most notably, it was abbé charles michel de l’épée (1712-1789) who developed a very different kind of pedagogical thinking and methods for educating deaf children. de l’épée claimed, first, that gestures are the real natural as well as universal language of humanity. secondly, he thought that the language of gestures could be ‘refined’ through methodization, yet without losing its natural origins. in this manner, a silent language of manual gestures could be built, one that was capable of representing even abstract ideas in terms of physical movements. due to its natural and universal basis, this manual language would be even superior to njsr – nordic journal of social research vol. 7 (2016): special issue 57 speech. de l’épée’s idea was to divide complex and abstract concepts into elementary, concrete parts, which might be expressed through gestures. the first school for deaf, using de l’épée’s methods, was established in paris in 1760, but his insights began to gain support more broadly in europe (knowlson, 1965; seigel, 1969). as we have found, de l’épée’s pedagogy and method, also known as manualism, are almost the complete opposite of oralism. indeed, he debated on the issues of deaf pedagogy with heinicke. oralism and manualism, the german and french schools, respectively, were the two major, competing veins of deaf education in europe during the eighteenth and nineteenth centuries. gradually, their rivalry also reached scandinavia and finland. the arrival and victory of oralism in finland by the mid-nineteenth century, the use of sign language had become fairly common in the education of deaf children in scandinavian countries. however, it was in this period that a process of profound transformation began to take place. from the mid-nineteenth century on, the oralist discourse and methods, discussed above, began to gain a more secure foothold in norway and sweden. this was supported by teachers’ increasing fieldtrips to germany, where heinickean methods were acquired. the development in finland followed a similar course. the 1860s were a period during which the entire finnish system of elementary education underwent a profound transformation. in 1869, elementary schools were detached from the lutheran church. uno cygnaeus (1810-1888) – a clergyman, educator, and the chief inspector of the finnish school system – is often named as the ‘father’ of the finnish public-school institution. in his study trips around europe, cygnaeus became acquainted also with schools specialized in the education of deaf children. he was particularly impressed by the weissenfels school in germany, which was a pioneer in the application of oral notions and methods. cygnaeus had a significant role in the initial rooting of oralism in finnish schools, and in launching the parallel process of the marginalization of sign language during the second half of the nineteenth century (salmi & laakso, 2005). besides cygnaeus, the finnish teacher g.k. hendell (1843-1878) was one of the key figures in the importation and consolidation of german oralist pedagogy in finland. hendell made a visit to swedish and norwegian deaf schools, and also worked at manilla school in stockholm, where the oral method of teaching was already firmly established. there, he adopted the tenets of german pedagogy and brought them to finland. hendell was given the opportunity to put them into practice when he became the director of the school for deaf-mutes in kuopio in 1874 (salmi & laakso, 2005, p. 151). in the course of the late 1800s, the hegemonization of oralist pedagogy progressed in finnish deaf education. to encapsulate, this was a period in which the aims and methods of special education were taken into more strict state control. the objective of making the deaf speak and the oral method became ossified as primary, far more crucial than any other subject matter taught and their contents (salmi & laakso, 2005, pp. 155-159, 170). meanwhile, various new schools for deaf children were opened in different parts of finland. an official committee memo from 1907 asserted that through compulsory education and schooling, organized to meet their special needs, the deaf population could be integrated as members of finnish society, able to make their own living by normal, productive work (salmi & laakso, 2005, pp. 159, 162). finally, in 1921 (after the civil war) finnish parliament passed the law on njsr – nordic journal of social research vol. 7 (2016): special issue 58 generalized compulsory education, making no exception for deaf children (salmi & laakso, 2005, p. 162). the institutionalization of oralist pedagogy – together with the marginalization of sign language and manualism – continued in finland during the twentieth century. many teachers themselves acknowledged that sign language was felt by deaf pupils themselves to be their own, ‘natural language’ that they used with ease. however, this ‘naturalism’ and spontaneous facility of silent, visual signs and the parallel difficulty and anguish in oral teaching were often regarded as yet another piece of evidence on the primitive, animalistic and deficient nature of sign language, and on the superiority of vocal speech. the finnish discourse of special education leaned particularly on heinicke, and considered sign language, at best, only suitable for the expressions of the ‘will of the deaf’, but not a medium of conceptual thinking and abstract reasoning. it was condemned as inherently and irreparably confused, ambiguous, and insufficiently articulate. the effort, pain, and even the use of physical violence in oralist education were regarded as both justified and necessary in the task of turning the deaf into speaking beings, which also meant releasing them from their animalistic, concrete, sensual, and affective mode of life. in line with the ideas of amman and heinicke (see above), the task of deaf education was to make the deaf speak and understand speech, and as a result, to transform them into reasoning, concept-using, and self-governing human beings. in the early decades of the twentieth century, one of the notable and very articulate advocates of these views was the teacher veikko lehvä (salmi & laakso, 2005, pp. 172-175). finnish oralism after world war ii these oralist notions kept their dominant status in finnish deaf education through the first few decades of the twentieth century, in spite of opposition from both deaf people and some teachers (salmi & laakso, 2005, pp. 172-177). after world war ii, germany lost its position in finland as the major source of pedagogical ideas and methods. yet this did not mean that the basic tenets of oralism, as scrutinized above, lost their impact. in the 1950s, american pedagogical ideas began to play a more central role in finnish special education. still, the elementary oralist notions remained central. for instance, finnish educators became inspired by the john tracy clinics, which proposed that it is the task of each mother to start teaching her deaf child to speak as early as possible, already before school (salmi & laakso, 2005, pp. 181-183). there is one seminal finnish contribution following world war ii to the psychological study of deafness that needs to be discussed from the perspective of oralism. jyrki juurmaa (1929-2010) was a finnish psychologist who conducted research on ‘sensory deficiencies’, both blindness and deafness, and their effects on the development of mental ‘ability structures’. juurmaa was in his time a somewhat influential figure in finnish academic culture. moreover, he forged relations of close collaboration with american researchers and has attracted international attention. juurmaa implemented various tests on the mental performances of deaf and hearing persons and then compared the results. interestingly, his studies do not refute the core notions of oralism, already familiar to us from the seventeenth and eighteenth-century discourse of amman and heinicke. rather, these notions are translated into the language of psychology after world war ii. on the basis of the tests, juurmaa’s study proposes that for the minds of deaf persons, it is the concrete, perceived details that are predominant. in those njsr – nordic journal of social research vol. 7 (2016): special issue 59 mental tasks in which concrete empirical material is presented and operations of reasoning remain attached to immediate perception, the performance of the deaf matches those of the hearing (juurmaa, 1963). contrariwise, the deaf are considerably weaker than the hearing in those tasks that require abstract reasoning, non-concrete ideation, and application of general principles to concrete instances (juurmaa, 1963). ‘on verbal ability, numerical ability and reasoning the hearing were definitely superior to the deaf’ (juurmaa, 1967, p. 118). juurmaa (1967) proposes that blind are superior to the ‘normal’ precisely in the abstract numerical abilities or arithmetic. furthermore, juurmaa submits that when it comes to the linguistic abilities of acquiring and mastering verbal symbols, the deaf cannot surpass the ‘ostensive’ level, that is, the stage where concepts are understood and acquired with the help of empirical demonstration. therefore, abstract concepts that are difficult or impossible to teach through ostentation can only stay incomprehensible and alien to them (juurmaa, 1963). indeed, as a result of the psychological tests and comparisons, what reemerges is the binary setting that is already quite familiar to us from the earlier oralist discourses. once again, the ear and sense of hearing are posed as the origin and condition of the higher conceptual-abstract activities of the mind, while the lack of hearing and the silent visuality of the deaf mind are defined as a decisive deficiency, a pathology/abnormality that inflicts the whole mind and subjectivity. the lack of audition deprives the subject of the capacity of conceptual, abstract and theoretical thinking, and as a result, of the mastery of the world and her/himself. the deaf remain passively captivated by the flux of immediate sensations and affects, akin to animals: correspondingly, the crucial and most interesting problem in the study of the deaf is: how is it possible to learn language and to acquire a body of concepts without the sense of hearing? (…) the crux of the problem (…) relates (…) in the case of the deaf to theoretical mastery of the world. (juurmaa, 1963, introduction, emphasis added) as it turns out, the seventeenthand eighteenth-century oralist notions of deafness proved to be insidious in twentieth-century psychology, including in finland. this being the case, it is not surprising that the oralist methods persisted in the education of deaf children in the 1970s in finland, despite the rise of the deaf pride and deaf awareness movements, which began to demand guaranteed education and teaching in sign language (salmi & laakso, 2005). it was not until 1995 that the finnish parliament, as a part of the finnish reform of basic rights, legally recognized the status of sign language. still today, much remains to be done when it comes to the practical realization of the equal status of sign language in education, especially in finnish universities (salmi & laakso, 2005). foucault and the silence of discipline the applicability of foucault’s seminal analyses of modern disciplinary, surveying, and normalizing power (foucault 1979; 2003; 2004) of the 1970s is fairly obvious when it comes to the history of deaf education in general, including the case of finland. the oralist pedagogic doctrine and methods, as well as their institutionalization in deaf schools, can be seen as an exemplar of a more pervasive transformation in the eighteenth century. in this historical shift, the school becomes a disciplinary institution (along with the mental asylum, prison, and so on) that seeks to produce normal, docile, productive, and beneficial njsr – nordic journal of social research vol. 7 (2016): special issue 60 individual subjects that survey and control themselves (bauman, 2004; branson & miller, 2002; lane, 2002). if we examine foucault’s insights more closely, things become much more complex. foucault himself does not consecrate any explicit treatment to the medicalization and normalization of deafness, unlike for instance, of homosexuality or children’s masturbation. still, i suggest there is an essential link between foucault’s genealogy of modern discipline and normalization and the history of deaf education, one that has hardly been noted before. this link is unveiled if we scrutinize the roles played by different modalities of sensual perception and experience, by the eye and the ear, by optic and aural experience, respectively, in foucault’s integrally interrelated notions of surveillance, discipline, and normalization (foucault 1979; 2003; 2004). in other words, we need to explore what the role of visual and aural perception and experience is in the operation of disciplinary and normalizing power, but also in their product, which is the normal subject. this means asking which account of normalizing and normal perception and sensuality is to be discovered in foucault’s take on discipline and normalization. concomitantly, it means inquiring, what the reverse of this is, that is, the view of abnormal or pathological sensuality and perception. the next step is to query how this foucauldian account of disciplinary and normal sensuality relates to and compares with that major construction of the normal perceiving subject, which we have already exposed in the history of modern oralist pedagogy and deaf education, and in the finnish case in particular. as discussed earlier, at the very nucleus of oralist discourse – ranging from its seventeenthand eighteenth-century origins in amman and heinicke up until the work of juurmaa in the 1960s in finland – there is the normative idea of a determinate kind of sensual and perceiving subject: the speaking and hearing subject, the subject of auditory experience (or its simulation), whose normality, whose rationality, whose self-government, and whose productivity are underpinned by speech and aural experience. we also saw that in the oralist discourse, visuality and optic experience without voice, the silent language of manual gestures, were attached to abnormality and pathology, to irrationality and lack of self-government. in oralist special education, normalization was inseparably associated with curing deafness, with making the deaf speak and hear. undoubtedly, the most widely known idea in foucault’s work of the 1970s (and possibly in his thinking taken as a whole) is the panopticon (foucault, 1979). for foucault, it is the general, modern scheme of surveillance, disciplinary power, and normalization. foucault developed the analysis already in his lectures during the early 1970s at the collège de france, but it became generally known through discipline and punish (originally published in 1975). as is generally known, generalized and continuous surveillance – or the illusion of being continuously surveyed – is the modus operandi of the panopticon. it is pivotal to remember that the panoptic scheme of surveillance, its modus operandi, its logic of functioning, and its effects are not just one particular technique of power among others. panoptic surveillance is operative, in one way or another, in all modern disciplinary and normalizing power, in all of its various institutionalized forms. to put it briefly: there is no modern discipline or normalization that would operate without panoptic surveillance (foucault, 2001). consequently, what foucault has to say of panoptic surveillance has implications for his entire account of discipline and normalization. what he states on the role of senses and sensual perception in panoptic surveillance has njsr – nordic journal of social research vol. 7 (2016): special issue 61 implications to his entire notion of modern discipline and normalization. from this perspective, it is of utmost importance for us to note how strongly foucault emphasizes the key role of optic-visual perception in the operation of panoptic surveillance. foucault not only highlights the central function of invisible visibility, that is, the experience of being seen all the time by the gaze that stays hidden. he presents the much more forceful claim that it is a mode of power which is purely and exclusively based on optics and visibility: the panopticon means two things: it means that all is seen all the time, but it means also that all the power that is exercised is never anything but an effect of optics (...) this power is rather of the order of the sun, of the perpetual light, it is the immaterial illumination, which is shed indifferently on all the people on whom it is exercised. (foucault, 2003, p. 79, emphasis added) the panopticon works solely through optics and visibility, in other words, through illumination and providing visibility. we can infer that the gaze and the seeing are also what make things visible and throw light so that things show themselves. by these purely visual-optic, immaterial means the panoptic dispositive produces its most profound effect, which is not the detection of transgressive behaviour, but the production and maintenance of individuality – individual, self-governing, and docile, normal subjectivity. whether we are dealing with modern prisons, mental institutions, schools or factories, the same optic-visual techniques are at play (foucault, 1979; 1997; 2001; 2003). one can read foucault’s account of the all-intrusive panopticism of modern society as a critical response to guy debord’s diagnosis of the 1960s, according to which modern society is essentially a society of the spectacle. nonetheless, similar to debord’s (1999) ‘spectacle’, the panopticon is also an apparatus of power that is essentially visual-optic in its performance. in both cases, it is sight, gaze, and seeing that spawn the effects of objectification, individualization, division, separation, and isolation (foucault, 1979; 2001). in the working of the panoptic apparatus, as foucault understands it – and consequently in all the numerous institutions of discipline and normalization, which cannot operate without panoptic surveillance – there is neither use nor need for other sensory modalities except vision. nevertheless, in jeremy bentham’s original, late-eighteenth-century depiction of the panoptic scheme, we discover that this is not the case. there, the ear and aural perception are indeed given a function in the deployment of surveillance: complaints from the sick might be received the instant the cause of the complaint, real or imaginary, occurred (...) here the use of the tin speaking-tubes would be seen again, in the means they would afford to the patient, though he were equal to no more than a whisper, of conveying to the lodge the most immediate notice of his wants (...). (bentham, 1995, letter xx) foucault recognizes that the tin tubes, hearing, and aural experience figure in bentham’s scheme, but is nevertheless unwilling to ponder their significance any further. when michelle perrot draws attention to this issue in a discussion, foucault does not take this initiative (foucault, 2001).2 in discipline and punish, all we find is a footnote, which briefly points out that bentham later expressed some hesitations about the usefulness of the tin tubes (foucault, 1979, p. 317, 2 to compare, we meet reflections on hearing, listening, and surveillance along these lines in roland barthes (1982, pp. 217-220). njsr – nordic journal of social research vol. 7 (2016): special issue 62 no. 3). in my opinion, all this shows foucault’s reluctance to question his own belief in the purely and exclusively visual-optic modus operandi of modern surveillance, discipline, and normalization, pertaining to all their various institutional arrangements and the concomitant absence of the ear and aural experience. for foucault, modern discipline, surveillance and normalization operate in and through silent visuality. it is through silent visuality, in the absence of hearing and aural experience, that these modern forms of power produce their most profound effect: the normal, self-observing, and self-governing individual subject. when surveillance and discipline become internalized into the selfrelation of the subject, the silent, optic-visual experience continues to be the key vehicle of power. in foucault’s genealogy of discipline and normalization, the normal subject is the seeing subject. it is not the hearing or vocal subject. in even more radical terms, the normalized and docile subject of foucauldian modernity is akin to the image of the deaf subject, constituted in and through silent visuality, in the absence and deprivation of other sensual modalities, such as aurality. in foucauldian discipline and normalization, there is hardly any room for something like aural-oral normalization and aural-oral normality, aural-oral subject of self-government, and aural-oral docility. however, as demonstrated above, it is precisely the fabrication of aural-oral normal subjectivity which is at the core of the modern oralist discourse and practices of deaf education, in finland as elsewhere. inversely, the ear, voice, sound and aural experience are very much present when it comes to foucault’s depiction of the adversaries of the modern discipline and normalization. in 1970s foucault, masses, crowds, and multitudes all refer to resistance that confronts disciplinary and normalizing power. in various instances, when foucault characterizes these masses, crowds, and multitudes, he states that they are emitting sounds. the masses are howling, or they generate chatter and chanson. foucault associates these sounds with some of the central qualities of the masses: centrifugal mobility, movement in which bodies and forces spread, generating multiple horizontal contacts with one another. the horizontal conjunctions forge a merging, mingling or confusion between individualities (foucault, 1979). it appears that sound and aural perception belong to these ‘massy’, dynamic, and horizontal relations. what transpires in such relations – including noise, chatter, and chanson – is transition or contagion. this can occur between states of mind, between affects or between tasks and their performances (as collective distractions). through sounds and hearing, the subjects share with each other what ought – according to the logic of disciplinary individualization – to remain separate. crowds, masses, and multitudes collide with disciplinary power, which strives to individualize, and through individualization, to take care of the usefulness and productivity of bodies and forces. it seems that from the perspective of discipline and normalization, just like other horizontal relations and dynamics of bodies, sound and aural experience find themselves under suspicion. in foucault, we end up with a setting, in which silent, visual-optic normalization clashes with the aural, noisy dissolution of the individual subject. in the strand of oralist pedagogy that we have followed, from amman and heinicke to 1960s finland, it is rather the opposite: it is the silent visuality and manualism of the deaf culture that are defined as the dangerous origin of de-subjectivation, the loss of self-government, and the affective ‘animalization’ of human beings. njsr – nordic journal of social research vol. 7 (2016): special issue 63 conclusions in foucault’s genealogy of modern discipline and normalization, what is absent is any insight on the auditory-phonetic-oral determination and spawning of the normal subject and normalization in modern institutions. foucault is somewhat reluctant even to ponder the potential role of such a form of auditory power. yet, as exposed in this article, it is precisely the ear, hearing, and aural experience, through which the normal, rational, and self-governing individual subject was fabricated in modern oralist pedagogy. this whole history of pedagogic as well as psychiatric-medical power, as it took place in finland among other countries, seems to contradict foucault’s notion of the regime of perception and sensual experience, so central in his view of modern discipline, surveillance, and normalization. in foucault’s account, the latter revolves strictly around the eye, gaze, and visibility, deployed in silence, in the absence of voice and aural experience. furthermore, if we follow foucault, there is a conflictual relationship between disciplinary-normalizing power, on one hand, and sound and aural experience, on the other. this conflict ensues from the very logic of the disciplinary dispositif itself. sound and aural experience belong together with the enemies of discipline and normalization, that is, with crowds and masses and the affective loss of conceptual thinking and self-government. to recapitulate, what we have witnessed in the history of deaf education, stressing the finnish case – the auditory-oral-vocal construction of the normal, rational, concept-using, and self-governing subject, and the pathologization/abnormalization of silent visuality – appears as something like an anomaly in relation to foucault’s genealogy. in this way, we are invited to question the deep-seated binary setting of the eye and the ear, which relates the first with calmness, order, harmony, and stability of soul and community alike, and the second with madness, rapture, and subversion. in a way, we may conclude that this binary setting inverses the one that was active in the oralist discourse of deaf education, in which the ear is the source of stability and reason, whereas the eye is the origin of animalistic instability. the pertinence of this problematic is certainly not limited to reading foucault. western critical theory and critical thinking need self-critical reflection on their own sensoryperceptual presuppositions. otherwise, they risk becoming uncritical to the variety of powers operating through various different sensory modalities. this is something that social and political theory could learn from studying the history of the deaf. references allan, j., brown, s. & riddell, s (1998). permission to speak? theorising special education inside the classroom. in c. clark et al. (eds.) theorising special education (pp. 21-32). abingdon and new york: routledge. allan, j. (2007). rethinking inclusive education: the philosophers of difference in practice. dordrecht: springer. amman, j.c. (1873). a dissertation on speech. london: sampson low, marston, low, and searle. amman, j.c. (1694). the talking deaf man. london: tho. hawkins. arnold, p. (1984). the education of the deaf child: for integration or autonomy? american annals of the deaf, 129(1), 29-37. njsr – nordic journal of social research vol. 7 (2016): special issue 64 barthes, r. (1982). l’obvie et l’obtus: essais critiques iii. manchecourt: éditions du seuil. bauman h.-d. (2004). audism: understanding the metaphysics of oppression. journal of deaf studies and deaf education, 9(2), 239-246. bauman, h.-d. (2008). listening to phonocentrism with deaf eyes: derrida’s mute philosophy of (sign) language. essays in philosophy, 9(1), article 2. bentham, j. (1995). the panopticon writings. london: verso. branson, j. & miller, d. (2002). damned for their difference: the cultural construction of deaf people as disabled. washington dc: gallaudet university press. debord, g. (1999). the society of the spectacle. new york: zone books. derrida, j. (1967). of grammatology. baltimore: the johns hopkins press. foucault, m. (1979). discipline and punish: the birth of the prison. new york: vintage books. foucault, m. (1997). ‘il faut défendre la société’. cours au collège de france [‘the society must be defended’. course at the collège de france]. 1976. paris: gallimard/seuil. foucault, m. (2001). l’oeil du pouvoir [the eye of power]. in d. defert & f. ewald (eds.) michel foucault: dits et écrits ii. 1976-1988 (pp.190-207). paris: gallimard. foucault, m. (2003). le pouvoir psychiatrique. cours au collège de france [psychiatric power. course at collège de france]. 1973-1974. paris: gallimard/seuil. foucault, m. (2004). securité, territoire, population. cours au collège de france [security, territory, population. course at collège de france]. 1977-1978. paris: gallimard/seuil. juurmaa, j. (1963). on the ability structure of the deaf. jyväskylä: oy keskisuomalainen kirjapaino. juurmaa, j. (1967). the ability structure of the blind and the deaf: final report. in clark, l.l. (ed.) research bulletin no (pp. 109-123). new york: american foundation for the blind. knowlson, j.r. (1965). the idea of gesture as a universal language in the 17th and 18th centuries. journal of the history of ideas, 26(4), 495-508. lane, h.l. (1984). when the mind hears: a history of the deaf. new york: random house. lane, h.l. (2002). do deaf people have a disability? sign language studies, 2(4), 356379. markowicz, h. (1972). some sociolinguistic considerations of american sign language. sign language studies, 1, 15-41. salmi, e. & laakso, m. (2005). maahan lämpimään: suomen viittomakielisten historia [into the warm ground: the history of finnish people using sign language]. helsinki: kuurojen liitto ry [finnish society of the deaf]. seigel, j.p. (1969). the enlightenment and the evolution of a language of signs in france and england. journal of the history of ideas, 30(1), 96-115. tremain, s. (ed.). (2005). foucault and the government of disability. michigan: the university of michigan press. microsoft word 601, proof3.docx njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 6, 2015 retaining older workers: the effect of phased retirement on delaying early retirement åsmund hermansen fafo institute for labour and social research email: ahe@fafo.no abstract introduction: phased retirement involves reducing working time in the final years before retirement. the aim of phased retirement is to extend working careers and retain older workers who would otherwise opt for full early retirement. this article investigates the effect of offering phased retirement on early-retirement behaviour in norway. method: the data used in the analysis covers the period between 2000 and 2010 and comprises all employees between 61 and 62 years of age (n= 18 174) who were employed in any of the 442 companies that participated in a 2010 survey carried out by the fafo institute for labour and social research and respons analyse as, a norwegian research firm. i use a difference-indifferences approach and logistic regression, which enables the measurement of changes in the individual relative risk of retiring full-time on the contractual pension (afp, avtalefestet pensjon, contractual early-retirement pension,) before and after the introduction of phased retirement as a retention measure. results: the results show that working in a company that offers reduced working hours for older workers does not have an effect on the relative risk of a 61or 62-year-old withdrawing a full contractual pension in the next two years of their employment. this result is evident both before and after controlling for a range of known individual risk factors, as well as after controlling for company characteristics. discussion: in the search for suitable measures for retaining older workers, offering phased retirement may still be part of the answer. though my analysis does not support the idea that more flexible working hours is a decisive factor for those who choose to opt for full early retirement, a possible next step could be to investigate the impact of offering flexible working hours on the employment duration of those who do remain in employment. keywords: difference-in-differences, early retirement, older workers, retention measures, phased retirement njsr – nordic journal of social research vol. 6, 2015 45 introduction and research question reducing early retirement and prolonging employees’ working careers are important to the future of the welfare state. a large number of persons outside the labour market give rise to great political concern because it erodes the funding basis of the welfare-state system. succeeding in reducing the number of early retirees as the population ages calls for polices and measures that prolong employees’ working careers (midtsundstad, hermansen, & nielsen, 2012; taylor, 2011). in the european union, the so-called lisbon strategy led to the ‘barcelona target’ in 2002, which demanded that every eu member state seek an increase in average retirement age of about five years by 2010 (hofäcker, 2010). the increased attention to the ageing part of the workforce in norway is manifested through the inclusive working life agreement (the iwla) which set out to increase the average age of retirement (2001-2010) and from 2010 to increase the total years in employment. with the signing of the iwla in 2001, the norwegian government called for employers to take greater social responsibility for keeping people in employment until they reach pensionable age. they thus acknowledged, as many other european countries have done, that it is changes to employers’ policies that can drive a significant change in retirement behaviour (vickerstaff, cox, & keen, 2003). the increased attention on the employer’s role in reducing early retirement has fostered a growing interest in measures for retaining older workers both in the eu and norway (taylor, 2006). since the signing of the iwla in 2001, offering older workers the possibility of reducing their working hours in the final years before retirement has increased in popularity in norway. almost 20 per cent of norwegian companies with ten or more employees offered their older workers such an arrangement in 2010 (midtsundstad & bogen, 2011). several studies have suggested that flexible working hours can have a positive effect on the labour supply of older workers, providing a more phased transition into retirement and thereby extending the working career of older employees (bredgaard & tros, 2006; delsen, 1996; gielen, 2009; johnson, 2011; taylor, 2006; wadensjö, 2006). despite the recognition of phased retirement as an effective means of increasing the labour supply of older workers, research into the efficacy of reducing working hours as a retention measure is limited in norway. the aim of my study is to examine whether offering phased retirement has an effect on the relative risk of retiring full-time on the contractual pension. njsr – nordic journal of social research vol. 6, 2015 46 the few norwegian studies investigating the impact of retention measures on early-retirement behaviour show that the existing measures in 2005 did not always help to delay retirement (midtsundstad, hermansen, & nielsen, 2012; midtsundstad, nielsen, & hermansen, 2012). however, the aim of these studies was not to evaluate the impact of individual retaining measure, such as phased retirement, but to evaluate the overall effect of being offered retention measures. furthermore, very few companies had initiated such measures by 2005 compared with the 2010 situation (midtsundstad, hermansen, & nielsen, 2012; midtsundstad, nielsen, & hermansen, 2012). hence, further analysis of the effects of the measures used by companies to retain older workers is needed. previous research reducing early retirement and increasing employees’ working careers has been on the policy agenda for many years (disney, 1996; espingandersen, 2000; meier & werding, 2010). in contrast to the many alleged advantages brought about by phased retirement, measures promoting a smooth transition between full employment and full retirement are rare in most countries. thus, research on the laboursupply effects of these measures in respect of retaining older workers is limited (graf, hofer, & winter-ebmer, 2011; hutchens & gracemartin, 2006; taylor, 2006). studying phased-retirement policies in denmark, finland and sweden, delsen (1996) argues that only the swedish programme, which was abolished in 2001, can be considered successful with regard to reducing the number of early retirees. according to delsen, part-time employment helped to reverse a negative trend in the labour-market participation rate of older workers. compared to denmark and finland, the crucial conditions making phased retirement a success in sweden were an adequate supply of part-time jobs and financial incentives for continuing working. the danish programme was inspired by the swedish, but unfavourable labour market conditions, in the form of a recession, and a generous earlyretirement scheme meant the programme was less successful (delsen, 1996). the same factors limited the success of the finnish phased-retirement scheme, in addition to the fact that pensioners had difficulties finding part-time work. according to these experiences, njsr – nordic journal of social research vol. 6, 2015 47 labour-market conditions, the supply of part-time jobs, the impact of part-time employment on pension entitlements and the existence of generous retirement schemes all seem to be important factors determining the success or failure of phased-retirement schemes (delsen, 1996; latulippe & turner, 2000; redaymulvey, 2000). evaluating the subsidized austrian old-age part-time scheme introduced in 2000, graf et al. (2011) find the scheme to have a negative impact on labour supply among older workers. their analysis indicates that workers who would normally work full-time change to part-time, resulting in an overall decrease in the labour supply among older workers. these findings are supported by a norwegian study by becken (2011), which reveals subsidizing reduced working hours to older employees in four norwegian public agencies to have a negative effect on labour supply. other studies reach the same conclusion: subsidizing reduced working hours induces a larger number of those who would have otherwise continued working full-time to reduce their working hours (hilsen & salomon, 2010; midtsundstad & bogen, 2011). several studies have shown that a considerable proportion of older workers emphasize reduced working hours as a decisive factor in the decision to prolong their working career (midtsundstad, 2006, 2009; midtsundstad & nielsen, 2013; reichborn-kjennerud, gamperiene, & hilsen, 2011). similarly, charles and decicca (2007) reveal that older american workers who are not free to lower their usual working hours, that is, workers who are hours-constrained or over-employed, are much more likely to retire than workers who are free to adjust their hours of work. using the three first waves of the health and retirement study (1992 to 1996), charles and decicca show that these findings hold true for both sexes, but the lack of flexibility had the greatest effect on men. studying the presence of constraints of hours in the labour market in the united kingdom, gielen (2009) finds that some over-employed women in the uk, especially those working full-time, leave the labour market early owing to a lack of gradual retirement opportunities with their current employer. however, the study was unable to investigate whether more flexibility would actually increase the labour supply of older workers. according to gielen, increasing flexibility may increase total hours worked as a result of increased participation, but this might be offset by shorter hours among previously hours-constrained workers. njsr – nordic journal of social research vol. 6, 2015 48 using data from the health and retirement study, gustman and steinmeier (2004) have used simulations to yield insight into the effect of abolishing minimum-hours constraints. abolishing minimum-hours constraints significantly increases the number of partially retired workers, reducing full-time employment among older workers and resulting in a small net increase in labour supply. wadensjö (2006) reaches the same conclusion in his study of the abolished swedish phased-retirement scheme. the scheme had a positive effect on the labour supply of older workers (number of hours worked), especially among women. the positive effect of people working part-time instead of retiring early outweighed the negative effect of reduced working hours among those who would have otherwise continued working fulltime until normal retirement age. boockmann et al. (2012) have analysed longitudinal employeremployee data for german1 companies in order to investigate the effect of age-specific part-time work among older workers. up until 2009 the german federal employment agency paid subsidies to employers offering age-specific part-time work to employees aged 55 and over. the results of this study indicate that offering part-time work to older workers tended to reduce the duration of employment among workers between age 58 and 63. the existing studies on phased retirement exhibit mixed results and do not allow us to draw universally applicable conclusions. the effect of offering phased retirement on labour supply seems to vary with labour-market conditions, the supply of part-time jobs, the impact of part-time employment on pension entitlements, and the existence of generous retirement schemes (delsen, 1996; latulippe & turner, 2000; redaymulvey, 2000). boockmann et al. (2012) conclude that the search for suitable retention measures which utilize the potential of older workers must continue. more research is needed before we can draw any conclusions as to ‘what works in age management’ (p. 21). 1 the analysis is based on survey information for 1063 west german establishments between 2000 and 2002. the establishment data is linked with retrospective register data on all employees between ages 40 and 65, providing information on employment durations observed back to 1975. east german establishments are excluded from their analysis, owing to missing data before the 1990s. njsr – nordic journal of social research vol. 6, 2015 49 method the data used in this analysis covers the period between 2000 and 2010 and comprises all employees between 61 and 62 years of age (n= 18 174) who were employed in any of the 442 companies that participated in a 2010 survey. the survey was conducted by the fafo institute for labour and social research and respons analyse as, a norwegian research firm, in the period august to september 2010. the sample was representative for all norwegian companies with ten or more employees in 2010, and one or more employees between 61 and 62 years of age. the survey provides information on company characteristics and whether reduced working hours is used as a retention measure and, if so, in which year the measure was introduced (midtsundstad & bogen, 2011). all information on individual employees has been provided by statistics norway (ssb) and is drawn from administrative registers. in my analysis, i investigate whether, in the period 2000 to 2008, the introduction of phased retirement affected the relative risk of workers aged 61 and 62 fully retiring on the contractual pension in the next two years of their employment. the contractual pension (contractual early retirement pension afp) offered older workers the possibility of opting for early retirement between the ages of 62 and 66 in the timespan investigated in this article.2 early retirement was available to all publicsector workers and about 40 per cent of private-sector workers (the scheme was optional for private-sector companies) (nergaard, 2009). of the 442 companies included in the analysis, 135 companies are in the public sector and 307 are in the private sector. all of the private sector companies i include in the analysis offer the contractual pension (contractual early retirement pension afp) to their employees. difference-in-differences in my analysis, i use a difference-in-differences approach which enables the measurement of changes in the individual relative risk of fully retiring on the contractual pension before and after the 2 from the 1st of january 2011 the contractual early-retirement scheme was changed to a flexible lifelong annuity for private-sector workers, making the scheme distinctly different from the scheme in the public sector, which is still designed as an early-retirement scheme. nevertheless, this regulatory change was implemented after the timespan investigated in this article. njsr – nordic journal of social research vol. 6, 2015 50 introduction of reduced working hours. this is a standard method for measuring the effects of interventions and regulatory changes. the method consists of comparing two groups, where one group experiences a policy change or intervention during the period under consideration. in my analysis, the introduction of reduced working hours as a retention measure represents the policy change or intervention (angrist & pischke, 2008; wooldridge, 2005, 2009). i investigated whether offering phased retirement impacts the individual relative risk of withdrawing a full contractual pension. these differences in average change are also referred to as a difference-indifferences estimator (angrist & pischke, 2008; wooldridge, 2009). given that the dependent variable is binary categorical, i use logistic regression in the analysis and i report odds ratios. i have also estimated the two models as linear probability models, obtaining substantially similar results (not shown). all my analyses were performed using stata, version 12. in model 1, i investigate the total effect of offering phased retirement. to be able to investigate the total effect i have included the retention measure as a dummy variable, a dummy for separating the pre-treatment period (0) and post-treatment period (1), measuring the overall change and the interaction between the change and the retention measure (differencein-differences estimator). thus, in model 1, i estimate the gross effect of offering phased retirement. however, it is very unlikely that companies offering phased retirement are identical to those without such a measure in all other respects, and that the employees working in companies offering phased retirement are identical to those in companies without the measure. thus, in model 2, i control for various individual and company characteristics which may vary between the intervention and control group. the measurement of phased retirement which i apply in this article is based upon the hr manager/executive director in the surveyed sample of companies reporting to have made it possible for workers to opt for reduced working hours from the age of 62, thereby facilitating phased retirement (midtsundstad & bogen, 2011). hence, the measurement of phased retirement i use in this article is based on a reduction in weekly or annual working hours for older workers aged 62 and above, continuing with their current employer. the measurement i use includes arrangements where the reduction is subsidized as well as those where it is not, the former comprising 65 per cent of the treatment group and the latter 35 per cent. njsr – nordic journal of social research vol. 6, 2015 51 the number of companies offering phased retirement was quite low prior to 2005, with less than two per cent of the companies surveyed offering reduced working hours. the measure increased in popularity from 2005, with more than six per cent of the companies offering reduced working hours by 2006, increasing further still to 18.6 per cent in 2010. to make a clear delimitation between the preand posttreatment period i have chosen to include only those companies which initiated reduced working hours as a retention measure from 2005. thus, i investigate the relative risk of 61and 62yearolds retiring in the next two years of their employment during a period when none of the companies in my data had initiated this retention measure, compared with the relative risk of retiring during a period when a known selection of the companies had introduced such a measure. i refer to the first period, 2001/2002 to 2004/2005 as the pre-treatment period, and to the second period, 2005/2006 to 2009/2010, as the post-treatment period. offering phased retirement is a choice made by each individual company and thus the group of norwegian companies offering this retention measure is self-selected. however, i find it reasonable to assume that the distribution of older employees between the intervention and the control group is random. i base this assumption on the fact that very few change jobs after the age of 60, enabling them actively to seek out companies with such retention measures for older workers (lien, 2013; oecd, 2013). however, in order to be able to measure the true effect of providing phased retirement, i must assume that the two groups are comparable over time. such comparability is not very likely, thus i control for a range of individual and company characteristics. including these individual and company characteristics allows me not only to control for differences between the two groups, but also to control for known factors associated with early retirement. factors associated with early retirement understanding the transition from work to retirement and the role played by phased retirement as a retention measure rests on our ability to recognize the variety of factors influencing early-retirement practices. whether an early exit from working life is voluntary or involuntary and whether it is mainly affected by labour supply or labour njsr – nordic journal of social research vol. 6, 2015 52 demand are two related and central questions within the debate on early retirement (jensen & øverbye, 2013; midtsundstad, 2013). working on the assumptions that individuals desire to maximize their lifetime earnings and that the exit of older workers from the labour market is voluntary and mainly affected by labour supply, economic studies primarily place the emphasis on financial incentives ‘pulling’ employees out of working life early (engelhardt, 2012; gambetta, 1987; gruber & wise, 2007, 2010; hernæs, røed, & strøm, 2002). to account for the effect of financial incentives presumably ‘pulling’ older workers into early retirement, i included ‘income percentile’ (net income after tax divided into percentiles); ‘spouse income percentile’ (spouse income after tax divided into percentiles) and ‘household debts percentile’ (household debts divided into percentiles) in the analysis. contradicting the emphasis on free individual choice and ‘pull-factors’, a growing research literature is focusing on involuntary retirement as a result of ‘push-factors’ and labour demand. this includes ‘labour market and company-level push factors’ such as structural adjustments, rationalization, increased eligibility requirements, and other factors that ‘push’ elderly, less productive or less skilled workers out of the labour market (halvorsen 1977; gambetta 1987; dorn and sousa-poza 2010). referred to as ‘individual push factors’, health problems as well as physical and mental strains related to the job have proven to increase the relative risk of older workers opting for early retirement (buchholz, hofäcker & blossfeld 2006; midtsundstad 2006; börsch-supan, brugiavini, & croda 2009; engelhardt 2012; gørtz 2012; calvo, sarkisian & tamborini 2013). one of the limitations of the data i apply in the analysis is the lack of variables controlling for differences in health, working environment, and conditions between the intervention and control group. however, controlling for ‘sick absence’, ‘level of education’, ‘occupation’, and ‘industry’ does presumably capture important aspects of differences in health, working environment, and conditions between the intervention and control group. thus, i included ‘sick absence’ (‘sickness absence’ certified by a physician and lasting for more than 16 days, ‘no sick absences’ (ref.)) and ‘level of education’ divided into ‘elementary school’ (ref.), ‘secondary school’, ‘undergraduate from university/college’ and ‘postgraduate from university/college’ in the analysis. the classification of the different occupations i use is based on the erikson-goldthorpe social class schema, using the njsr – nordic journal of social research vol. 6, 2015 53 international standard classification of occupations (isco88) which distinguishes between ‘workers’, ‘routine non-manual employees’ and ‘professionals, administrators, and officials’ (ref.) (leiulfsrud, bison, & jensberg, 2005). to control for type of ‘industry’ in the analysis, i included the following: ‘public administration’ (ref.), ‘other industries’, ‘teaching’, ‘health and social services’, ‘manufacturing’, ‘construction’, ‘hotels and restaurants’, and ‘wholesale and retail trade’. as i have illustrated in table 1 (below), the intervention group has a higher proportion of employees with ‘elementary school’ as their highest ‘level of education’ and a lower proportion with ‘undergraduate from university/college’ than the control group. the intervention group also has a higher proportion working in ‘public administration’ and ‘other industries’. hence, i also included ‘level of education’ and ‘industry’ to control for the differences between the intervention and control group. older employees working full-time may feel a greater need to reduce working hours in the final years of their career than those working part-time and thus have a higher relative risk of opting for phased retirement than employees already working part-time. to account for the effect of working hours, i included contractual working hours, that is, ‘full-time’ (ref.), ‘long part-time’ (from 50 to 80% full-time equivalent), and ‘short part-time’ (less than 50% full-time equivalent) in the analysis. table 1. distribution by independent variables 2001/2002 – 2004/2005 2005/2006 – 2009/2010 intervention group control group intervention group control group woman 65.6 62.3 60.1 62.1 living in a one-person household 18.8 20 19.4 21.4 sick absence 20.2 16.5 13.8 12.2 elementary school 25.8 21.5 22.1 14.2 secondary school 43.2 44.3 49.6 39.1 undergraduate from university/college 24.7 25.6 19.9 34.9 postgraduate from university/college 6.3 8.6 8.4 11.8 njsr – nordic journal of social research vol. 6, 2015 54 income percentile, mean (s.d.) 46.2 (29.1) 51.9 (28.5) 46.6 (29.4) 53.1 (28.4) spouse income percentile, mean (s.d.) 42.7 (30.5) 43.2 (31.3) 43.5 (30.1) 46.2 (33.1) household debts percentile, mean (s.d.) 36 (29.6) 39.9 (29.5) 44.7 (29.5) 40.2 (28.3) spouse retired on afp retirement scheme 7.5 7.3 6.8 5.8 spouse retired on disability pension 16.9 15.9 16.5 13.6 full-time 30 hours or more 64.4 69.7 70.8 72.7 part-time 20-29 hours 16.3 14.4 13.2 13.5 part-time <20 hours 19.2 15.9 16 13.8 worker 64.2 42.6 50 34.7 routine non-manual employee 14 39.9 20 40 professional, administrator or official 21.8 17.6 30.1 25.3 100 or more employees 83.9 82.8 88.8 84.7 human resources manager 97.9 91.1 97 92.3 public administration 16.2 10.3 18.8 7.7 other industries 16.1 8.2 27.1 8.6 teaching 38.6 28.1 15.9 33.9 health and social services 22 27.7 20.9 27.8 manufacturing 4.7 12.6 6.2 10.7 construction 2.2 4.3 1.7 2.9 hotels and restaurants 1.1 2.6 1.3 2.1 wholesale and retail trade 1.7 7.2 4.2 2 not iwla-company 28.4 41.3 33.5 57.6 iwla-company 2001 4.9 11.2 7.3 8.7 iwla-company 2002-2010 66.7 47.5 59.2 33.7 n 3 986 3 870 3 624 6 694 in the analysis i also included confounders controlling for whether the employees work in a company with ‘100 or more employees’ (‘less than 100 employees’, ref.) and whether the company has a ‘human resources manager’ (‘no human resources manager’, ref.). larger njsr – nordic journal of social research vol. 6, 2015 55 companies are presumably more flexible since they have a large workforce, which provides greater leeway for offering flexible working hours. the human-resources manager holds an important role in facilitating working conditions which safeguard the needs of employees and advocates adaptions to account for these needs. as i have shown in table 1, the intervention group has a slightly larger proportion employed in companies with a human-resources manager, thus i also included the confounder to control for this difference. studies show that retirement practices vary according to individual circumstances, such as gender, and experiences outside the workplace, such as family situation and spouse retirement behaviour, referred to as ‘jump-factors’ (hallberg, 2007; hank, 2004; hauge & årethun, 2008; midtsundstad, 2002, 2005a; oude hengel, blatter, geuskens, koppes, & bongers, 2012). to account for gender and possible jump-factors i included ‘woman’ (‘male’, ref.), ‘living in a oneperson household’ (‘not living in a one-person household’, ref.), ‘spouse retired on the contractual pension’ (‘no spouse or spouse not retired on the contractual pension’, ref.) and ‘spouse retired on disability pension’ (‘no spouse or spouse not retired on disability pension’, ref.) in the analysis. companies that have signed the inclusive working life agreement presumably have a greater focus on supporting and motivating older workers to continue working. from 2006, all iwla-companies were also obligated to formulate an active ageing policy (midtsundstad & bogen, 2011). to account for working in an iwla-company and when the company signed the inclusive working life agreement, i include ‘iwla-company 2001’ and ‘iwla-company 2002-2010’ (‘not iwlacompany’, ref.) in the analysis. results i have illustrated the early-retirement behaviour for the period and companies under consideration in figure 1 below. employing a difference-in-differences approach rests on an assumption that the underlying trends in the outcome variable would be the same in the absence of treatment (angrist & pischke, 2008). as i illustrate in figure 1, the number of employees withdrawing a full contractual pension is quite similar for both groups in the pre-treatment period from 2001/2002 to 2004/2005. thus, i argue that figure 1 provides njsr – nordic journal of social research vol. 6, 2015 56 visual evidence of an equal underlying trend in the pre-treatment period. figure 1. percentage of 61and 62-year-olds withdrawing a full contractual pension in the next two years of their employment working in companies offering phased retirement as a retention measure compared with the percentage working in companies without such an arrangement for older workers. in the post-treatment period from 2005/2006 to 2009/2010, the earlyretirement figures are also quite similar. however, the early-retirement figures in the treatment group do not seem to be significantly different from the figures in the control group. one would expect the figures to be significantly different if reduced working hours have an impact on the relative risk of withdrawal of a full contractual pension. nevertheless, in the analysis i have investigated the changes in the individual relative risk of withdrawing a full contractual pension and not the changes in the companies’ numbers of early retirees, as i have illustrated in figure 1. in addition, i have performed a ‘placebo difference-in-differences’ test (not shown) as a check for robustness to investigate the trends in figure 1. in the placebo test i simulated that reduced working hours were initiated among the intervention companies from 2003 and not from 2005 onwards. i used 2001/2002 to 2002/2003 as the pretreatment period and 2003/2004 to 2004/2005 as the post-treatment period. the placebo difference-in-differences did not yield significant njsr – nordic journal of social research vol. 6, 2015 57 results, thus strengthening my assumption that the trends were quite similar in the pre-treatment period and that there were no unobserved trends affecting one of the groups but not the other. as i have illustrated in table 1, the proportion of workers with ‘elementary school’ as their highest level of education, the proportion of ‘workers’, and the proportion working in a ‘non iwla-company’ change significantly in the control group from the pre-treatment to the post-treatment period. also, in the treatment group, the proportion working in ‘other industries’ changes significantly from the pretreatment to the post-treatment period. to control for these changes i have re-estimated the analysis and included interactions between the respective confounders and the dummy for change from the pretreatment to the post-treatment period (not shown). to control for clustered data on company level, i have also performed a regression using clustered standard errors (not shown). the regression results using clustered standard errors and including these interactions did not differ from the results which i have presented in table 2 (below) using normal standard errors and not including the respective interactions. table 2. individual relative risk of withdrawing a full contractual pension among 61and 62-year-olds in the next two years of employment, having been exposed to reduced working hours as a retention measure, before and after controlling for a range of individual and company characteristics. or = odds ratio. model 1 or model 2 or woman .787*** living in a one-person household .804*** sickness absence 1.608*** elementary school (ref.) 1.000 secondary school .868*** undergraduate from university/college .674*** postgraduate from university/college .406*** income percentile .994*** spouse income percentile 1.006*** household debts percentile .993*** spouse retired on contractual pension 1.495*** spouse retired on disability pension 1.092 part-time <20 hours (ref.) 1.000 njsr – nordic journal of social research vol. 6, 2015 58 part-time 20-29 hours 2.039*** full-time 30 hours or more 1.780*** professional, administrator or official (ref.) 1.000 routine non-manual employee 1.120 worker .940 less than 100 employees (ref.) 1.000 100 or more employees 1.190*** no human resources manager (ref.) 1.000 human resources manager 1.056 public administration (ref.) 1.000 other industries 2.984*** teaching 2.194*** health and social services 1.282*** construction 2.745*** manufacturing 4.933*** hotels and restaurants 3.755*** wholesale and retail trade 2.562*** not iwla-company (ref.) 1.000 iwla 2001 1.184** iwla 2002-2010 1.156*** retention measure – reduced working hours 1.012 1.037 change from pre-treatment period to post-treatment period .814 .913 retention measure* change (difference-in-differences estimator) 1.137 .964 pseudo r² .001 .077 n 18 174 18 174 **: p ≤ 0.05, ***: p ≤ 0.01 the analysis shows that offering 61and 62-year-olds reduced working hours has no significant effect on the relative risk of withdrawing a full contractual pension in the next two years of employment. the lack of an effect is evident both before (model 1) and after controlling for the selected individual and company characteristics (model 2). i find almost no change in the difference-indifferences estimator when controlling for the different confounders. i have done a re-estimation, delimiting the treatment group to only those with a subsidized reduction in working hours, excluding those with an unsubsidized reduction (not shown). the re-estimated results are the same, offering reduced working hours does not affect the njsr – nordic journal of social research vol. 6, 2015 59 relative risk of withdrawing a full contractual pension among 61and 62-year-olds in the next two years of their employment. thus, the results provide evidence for phased retirement having no impact on the individual relative risk of withdrawing a full contractual pension. discussion the results i have presented in this article show that working in a company that offers reduced working hours for older workers does not have an effect on the relative risk of a 61or 62-year-old withdrawing a full contractual pension in the next two years of their employment. this result is evident both before and after controlling for a range of known individual risks, as well as after controlling for company characteristics. thus, the lack of an effect of reduced working hours cannot be ascribed to differences in these respects between individuals working in intervention companies and those working in the companies that constitute the control group. i must emphasize that the analysis is based on information about whether the companies have introduced the reduced working hours as a measure for retaining older workers, and not information about whether older employees actually opt to reduce their working hours. thus, my analysis is based on the initial treatment assigned and not on the treatment actually received, known as intention to treat analysis. nevertheless, the possibility of reduced working hours is available to all employees from the age of 62 years. thus, i find it quite unlikely that a large proportion of the employees in the treatment group have not been faced with the possibility of opting for phased retirement when deciding whether or not to make an early exit. the existing research on phased retirement does not allow universally applicable conclusions to be drawn. the results differ according to labour-market conditions, the supply of part-time jobs, the impact of part-time employment on pension entitlements and the existence of generous retirement schemes (delsen, 1996; latulippe & turner, 2000; redaymulvey, 2000). using phased retirement as a retaining measure implies by definition that companies offer older workers the possibility of entering part-time work. furthermore, opting for phased retirement – combining part-time work and partial retirement – will provide higher financial rewards than withdrawing a full contractual pension. thus, i find it reasonable to assume that such an arrangement reduces the attractiveness of withdrawing a full njsr – nordic journal of social research vol. 6, 2015 60 contractual pension. thus, the lack of an effect of offering phased retirement on the withdrawal of a full contractual pension does not necessarily stem from constraints in the supply of part-time possibilities or generous retirement schemes. it needs to be emphasized that the norwegian labour market was characterized by low levels of unemployment during the vast part of the period which i have investigated. when the financial crisis hit in 2009, the number of unemployed increased somewhat, yet marginally compared with the rest of europe (nav, 2014; eurostat, 2014). delsen (1996) concludes, as previously mentioned, that the danish and finnish phased-retirement programmes failed, among other reasons, because of unfavourable labour-market conditions, in the form of a recession. thus, on the basis of the experiences from denmark and finland, i find it reasonable to assume that the worsening labour-market conditions following the financial crisis would not have changed the results presented in this article. even though i studied a period with quite favourable labour-market conditions, my results demonstrate that phased retirement does not have an impact on early-retirement behaviour. i find it reasonable to assume that reduced working hours reduce psychical and mental strains in the final phase of working life, providing older workers with the possibility to reconcile a wish for more leisure time and to continue working. surveys show that two out of ten early retirees in norway justify an exit to full retirement on the basis of a lack of working time flexibility (midtsundstad, 2002, 2005b; midtsundstad & nielsen, 2013). two out of ten norwegian employees also express that combining part-time work and part-time retirement is difficult at their workplace (dalen, 2012). thus, providing older overemployed workers with the possibility of a smooth transition between full-time work and full-time retirement may have a significant impact as a retention measure. nevertheless, the results in this article do not support the notion that offering phased retirement may reduce overemployment among older workers or have a positive effect on the labour supply. however, these surveys also show that the need for more leisure time, physical and mental strains related to the job, health problems, and loss of interest and motivation are emphasized as reasons to retire by early retirees to a greater extent than a lack of working time flexibility (midtsundstad, 2005a; midtsundstad & nielsen, 2013). thus, the possibility of opting for phased retirement may simply not be enough to discourage early retirees from withdrawing a full contractual pension if they also experience physical and mental njsr – nordic journal of social research vol. 6, 2015 61 strains at work, health problems, or a loss of interest and motivation. justifying an exit to full-time retirement on the basis of a lack of working time flexibility may be just one of many reasons and not the reason for leaving the labour market altogether (midtsundstad, 2002, 2005b; midtsundstad & nielsen, 2013). the data i have used in this article consists exclusively of older workers above the age of 60 years. these workers are a select group compared with the population of older workers as a whole, since a large proportion of employees retire on the disability pension before they turn 60 (midtsundstad, hermansen, & nielsen, 2012). i cannot rule out the possibility that other facilitation measures involving some sort of work time reduction would be different for other age groups. thus, the results from this analysis cannot be generalized outside the age group investigated in this article. midtsundstad, hermansen, & nielsen (2012) emphasize that the age requirement for eligibility to retaining measures, such as phased retirement, appears to be excessive in some industries (62 years). workers who become disabled before reaching the age requirement and who may have been the most in need of facilitation will not benefit from these measures. the results must be interpreted with caution, given the fact that the data i have used in my analysis lack of possibility of controlling for factors related to health status, working environment, and working conditions. thus, i cannot rule out the possibility that the health status of older workers, the working conditions, and the working environment in companies that offer reduced working hours are on the whole less favourable than in companies that do not provide reduced working hours. thus, in not controlling for health status, working environment and conditions it might be that i have underestimated the effect of reduced working hours. even though controlling for ‘sick leave’, ‘level of education’, ‘occupation’ and ‘industry’ may capture important aspects of possible differences in health, working environment, and conditions between the two groups, i find it most likely that they fail to capture all the differences in health, working environment, and conditions. however, despite the fact that offering reduced working hours as a retention measure is a choice made by the individual company, i find it reasonable to assume that older workers are most likely randomly distributed between the intervention and the control companies. thus, i argue that the health status of the workers, in turn, is most likely randomly distributed and should therefore not influence the results. njsr – nordic journal of social research vol. 6, 2015 62 in the search for suitable measures for retaining older workers and to utilize their potential better, the offer of phased retirement may still be part of the answer. in this article i have only investigated whether offering reduced working hours affects the relative risk of withdrawing a full contractual pension. though my analysis does not support the notion that reduced working hours is a decisive factor for those who choose to opt for full early retirement, my analysis does not shed light on the duration of employment of those who keep on working. a possible next step could be to investigate the impact of offering flexible working hours on the duration of employment of those who do remain in employment. in any event, there is little doubt that working time flexibility will be on the norwegian policy agenda in the years to come. flexibility is a cornerstone of the norwegian pension reform implemented in 2011, which has made the withdrawal of the old-age pension from national insurance flexible from the age of 62 for both publicand privatesector workers. previously, the old age pension was first paid from the age of 67. for private-sector workers, the contractual pension was also changed to a flexible lifelong annuity and is no longer purely an early-retirement scheme. pension benefits are also adjusted according to life expectancy. by making these changes to the pension system, policy makers hope to increase the labour supply of older workers in the years to come. acknowledgments i would like to express my deep gratitude to professor espen dahl and senior researcher tove midtsundstad, my research supervisors, for their guidance, enthusiastic encouragement, and very useful critiques of this research work. this article has been financed by the research council of norway as part of the project ‘senior policy for whom? the distributional consequences and effects of initiatives to promote active ageing 218364’. njsr – nordic journal of social research vol. 6, 2015 63 references angrist, j. d., & 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(2009). introductory econometrics: a modern approach. mason, oh: thomson/south-western. microsoft word occupational health services and the socialization of the post-fordist employee.doc njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 3, 2012 occupational health services and the socialization of the post-fordist employee christian maravelias school of business stockholm university email: chm@fek.su.se abstract there is a heightened interest in the health of employees among scholars, employers, legislators, and employees themselves. the concern for employees’ health is not a new phenomenon. it has held a central position in political and economic discourses throughout most of the twentieth century. the central argument of this article, however, is that the economic and political changes of the last three decades – the neo-liberal turn – have played a part in altering the very notion of health so that the healthy individual is now a person who not merely passes bio-medical tests, but a person who also leads a particular life and possesses particular skills, namely, those of the active, positive, and self-governing individual. by means of a qualitative study of the sector for occupational health services (ohss) in sweden, this article will show how an active lifestyle has become a defining criterion of health. furthermore, it will describe how health thereby becomes a question of choice and responsibility and how the healthy employee comes across as morally superior to the unhealthy employee. in this connection, this article shows how health experts such as therapists, health coaches, physicians, and so on become important points of authority in the fashioning of the new healthy, active employee. keywords: self-governing, health promotion, medicalization, post-fordism introduction this article examines the role that occupational health services play in ensuring that employees willingly and capably adapt to the requirements of current capitalist labour processes. it is widely accepted in social as well as in economic theory that a capitalist system relies on its abilities to subordinate and control living labour according to the principles of capitalist production and njsr – nordic journal of social research vol. 3, 2012 34 consumption (agglietta, 1979; harvey, 2006). this obviously involves a multitude of different activities – education, the mobilization of social sentiments such as loyalty and professional pride, emotional identifications created via the media and more – and out of these the measures directly and indirectly taken in the names of individuals’ health constitute but a small part. nevertheless, health measures are important to study because they tend to concern much broader issues than those of maintaining a working population fit for work in a strict, clinical sense. more specifically, over and above that of securing individuals’ physical and psychological fitness for work, measures taken in the name of the health of employees tend to play a part in the socialization of employees who lead lives which correspond to moral criteria of what is considered ‘a good life’ and ‘a good employable man’ (crawford, 2006). it is the function of health measures and health expertise in relation to the management of employees who willingly subordinate their lives and themselves to the principles of the current regime of capitalist accumulation that is the focus of this article. this article contains three parts. below i present the well-known distinction between fordism and post-fordism with a specific interest in how health issues and health expertise have played a part in fashioning the ideals, norms, and practices that make up the employable individual. this section is then followed by a case study that illuminates current developments in the sector for occupational health services (ohss) in sweden. this article ends with a discussion and conclusions. fordism – the factory regime in the early twentieth century persons as different from each other as the swedish social-democratic intellectuals alva myrdal and gunnar myrdal (1997), the imprisoned italian marxist intellectual antonio gramsci (1996), and the american industrialist henry ford all identified the quality of the working population as a core problem for western industrializing societies. by ‘quality of the working population’, they meant not just individuals’ strict professional competencies, but also their general cultural capacity to live and function in accordance with the principles of mass production and mass consumption implied by the developing factory regime. ford realized already in the 1910s that his employees were ill-adapted to a life as a worker in his factories. as his workers did not eat properly, drank too much alcohol, consumed irrationally, and did not put aside enough savings, he sent doctors out as social workers to the homes of his workers for the sake of teaching them the ‘proper ways of life’ (harvey, 1991). foreseeing that this problem would require far more than the individual efforts of industrialists like ford, gramsci (1996) claimed in the 1930s in his prison notebooks that industrialization would result in ‘the biggest collective effort to date to create, with unprecedented speed, and with consciousness of purpose unmatched in history, a new type of worker and a new type of man’. this was, of course, a highly intricate and politically sensitive affair. how would this creation ‘of a new worker and a new man’ be achieved? furthermore, how would it be achieved so that both the capitalist class and the working class would accept it? it was precisely as an answer to both these questions, that is, to both the economic and the political dimensions of the issue about the quality of the working population, that myrdal and myrdal (1997) developed their notion of a welfare state. to the extent the factories were to become efficient and accepted engines of the newly industrialized societies, welfare systems, predominately public health njsr – nordic journal of social research vol. 3, 2012 35 along with childcare and public schools, were required to socialize and maintain a population that were both willing and able to the adhere to the norms underlying the fordist society: discipline with regard to daily routines at work and in private life, obedience with regard to those with authority in the factories and in society at large, and loyalty with regard to the collective task of building the welfare state. foucault’s works on discipline and power perhaps best describe the principles of how the socialization of individuals’ was achieved (e.g., 2007). in his view, this socialization was done through a welfare state that used neither force nor domination, but instead set up specialized institutions governed by experts (in medicine, psychology, economy, etc.) who made sure that their ‘scientific’ observations and judgements gradually became part of individuals’ own understandings of who they were and how they ought to behave (dean, 1999; rose, 2007). within this system of ‘knowledge/power’, myrdal and myrdal have emphasized the importance of health expertise, noting that: ‘already during their university studies medical doctors must be equipped with the social-hygienic insights for sanitary inspections and control … especially housing inspections’ (1997, 248, my translation). in factories, schools, and families ‘medical doctors and nurses are required as authorities who lead and supervise’, but, above all, who ‘enlighten and discipline’ (1997, 248, my translation) for the sake of maintaining a sufficiently large population of individuals who are not merely clinically healthy and hygienic, but also appropriately socialized for the new fordist society. the good and employable man is a healthy man; and a healthy man is a man who maintains strict daily discipline in alignment with the norms endorsed by those in authority. post-fordism the flexibility regime the alliance between the factory regime and ‘welfarism’ – that is, fordism – achieved almost three decades of steady growth.1 yet around 1970 increasing intercontinental competition pushed the us and the world into an economic crisis. two general reactions to the crisis among capitalist firms would prove to undermine gradually the fordist political economy. on the one hand, firms reduced the quantitative need for workers, and, on the other hand, they altered the type or qualities of workers required. more specifically, shrinking demands and profit margins led capitalist corporations to try to cut down labour costs either by extensive technological automation or by relocating factory production to low-wage countries in south-east asia, south america, and later china (arrighi, 1994). this development permanently raised the level of 1 in part this growth was due to how fordism managed immediately to curb social and political unrest by providing social security to the lower and middle working classes (unemployment support, public schools and health care, etc.), and, in that very process, was able to socialize a working population appropriately configured for mass production and mass consumption. yet this growth was also in part due to the fact that the second world war had torn most of europe’s and japan’s production facilities apart while leaving the us intact. the war thus temporarily ‘solved’ the capitalist economy’s inescapable need for growth; not only could the us profitably invest its excess capital in europe and japan, it could also through these investments establish for itself a market where it could profitably sell the commodities it could not sell in its home market. eventually, however, european (especially german) and japanese production facilities were rebuilt, and these countries began to look to the us to find markets where it could both invest its excess capital and export its excess commodities. njsr – nordic journal of social research vol. 3, 2012 36 unemployment, and in turn made it increasingly difficult to find support for costly, taxed-based welfare systems both from big capital and from the middle and upper classes. as bourdieu (1999) and bauman (1998) have noted, the welfare state was strongly supported by these groups and classes as long as the growth of the economy was based on the welfare state’s securing a corresponding growth of an appropriately configured army of submissive workers; when profits no longer came from getting workers into the factories and began instead to be derived from getting them out (so called ‘down seizing’), the welfare state began to be seen as a system where those who are valuable support an underclass of people who are not. yet the persistence of higher levels of unemployment was not the only problem that undermined the legitimacy of the welfare state. the welfare state also began to be seen as a problem in itself; by taking over the responsibility for the populations’ health, education, employability, and so on, it was seen to create a passive and dependent working population that was unfit to handle the requirements of reformed and more competitive labour markets. this critique was related to another reaction to the economic crisis among capitalist corporations, that is, to attempts to establish new more flexible and innovative organizational arrangements that would make them better able to exploit emerging markets. as smith (1997) points out, this ‘flexibilization’ involved two dimensions, which were both based on the distinction between core and noncore activities: on the one hand, a ‘numerical flexibility’ was achieved by giving non-core workers temporary employment contracts so that they could quickly be laid off.2 on the other hand, a ‘functional flexibility’ was achieved via modes of organization such as team work, project work, through an emphasis of corporate culture instead of rules and so on, all of which attempted to tie and commit the core employees closer to their organizations (e.g., smith, 1997; vallas, 1999). while core employees would work harder, longer, more creatively, and more enthusiastically because they were committed to their work and their organization, peripheral employees would do so because they were afraid of losing their jobs. it is important to note that regardless if workers were part of the core or the periphery, the new regime of flexibility required a new type of individual who was active and self-governing rather than passive and submissive. in this way this regime reopened the issue about the ‘quality of the working population’. the welfare state had been effective in socializing individuals who accepted a limited freedom of choice in work as well as in consumption and life, who skilfully followed routines, and who developed a specific work-based identity through a stable and unbroken career. in a situation where stable jobs and uninterrupted careers became increasingly rare and sometimes were replaced by temporary jobs, blurred boundaries between previously distinct occupations, patch-work careers, and the like, it was no longer the ‘organization man’ (whyte, 2002) who the welfare state so effectively had been part of ‘prefiguring’ but the innovative entrepreneur, namely, the person capable of seizing on fleeting opportunities, who was now idealized. 2 the pursuit of numerical flexibility has involved a move away from regular employment towards temporary employment. furthermore, it has concerned tasks and activities which have been defined as peripheral in relation to a corporation’s core activities and tasks. as a result, the number of flexible employees who can be taken onboard quickly and who can be let go with little economic and political cost when there is less need for them has increased steadily in both europe and the us since the 1970s (evans et al., 2004; smith, 1997; vallas, 1999). njsr – nordic journal of social research vol. 3, 2012 37 it is in relation to this reopened issue about the quality of the working population that programmes in worksite health promotion (whp) emerge as new ways of socializing employees who are capable and willing to manage themselves in accordance with contemporary ideals and practices of flexibility, self-discipline, and self-improvement at work as well as in private life. as will be shown below, while whp is still an example of the knowledge-based forms power that reached their apogee during the fordist era, it also differs in some significant ways that makes it illustrative of a typical post-fordist form of power (cf. rose, 2007; dean, 1999). as we shall see, the form of power exercised through whp operates not primarily through health experts employed by the state, but through health experts selling their services via the market. this characteristic, furthermore, plays an important role in transforming the health expert from that of a ‘detached’ observer who disciplines employees’ conduct to that of an involved coach or mentor who listens to the employee and morally guides him or her towards self-discipline and self-improvement (rose, 2007). yet, as will be indicated, whp also plays a role in handling the other central issue in post-fordist societies mentioned above, namely, what society should do with the increasing amount of people who are excluded from the labour market. here whp appears to provide ways of sorting out those who are unfit for work either on moral grounds (your ill health is a result of the lifestyle you yourself have chosen) or on medical grounds (your unemployment is a result of your illness or disability). empirical material the basic aim of the study of the sector for occupational health services (ohss) in sweden was to understand better how these services relate to human-resource management (hrm) programmes and activities within its client companies. more specifically, to the extent that contemporary hrm practices increasingly seek to make use of ‘the whole’ individual by attempting to foster particular individuals that freely subordinate themselves to corporate values (barrat, 2002, covaleski et al., 1998), the ambition was to study which role occupational health services and health experts play in this pursuit. the material presented below comes from a study of the swedish sector for ohss that was conducted in two stages, first between 2004 and 2006 and secondly between 2007 and 2009. forty-five in-depth interviews were conducted with three separate groups of interviewees: (1) professional and administrative staff from seven different organizations within the sector for ohss; (2) humanresource (hr) managers and line-managers working for firms which are customers to the ohss companies; (3) employees who had taken part in some kind of health-promotion programme or service. twenty-five of the interviews were held with people from the first group, nine with people from the second, and nine with people from the third group. human-resource managers, line managers, as well as employees who had taken part in some health-promotion programme were contacted in client companies to the selected ohss companies. the selection of companies in the ohss sector as well as client companies was based mainly on access. interviews were semistructured; participants were asked to describe their professional role, how they found their professional role to have changed, which main problems and issues they dealt with, and which concrete methods they used. all interviews were held in swedish. the quotations below are translations from swedish. njsr – nordic journal of social research vol. 3, 2012 38 ohss – general background most countries in the developed world have laws stipulating that employers should employ ohss when required. these laws are mostly based on the international labour organization’s (ilo) occupational health service convention in 1985. this convention defines ohss as … services entrusted with essentially preventive functions and responsible for advising the employer, the worker and their representatives in the undertaking on: … the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work … (ilo, 1985). the convention, furthermore, specifies the overarching functions of ohss as the identification and assessment of health risks, the provision of advice on how to organize work in order to minimize health risks, and the surveillance of workers’ health in relation to work (see also sou, 2004: 113). the convention does not give directives as to how ohss should be financed or organized. yet most countries have adopted one of the following three models: ohss which are state-funded or subsidized via taxation; ohss which are sold on a market by ohss companies in competition with other ohss companies; and ohss which are set up, used, and financed by a group of companies as a joint venture. the models are not mutually exclusive. ohss can be subsidized by the state, but they can still be organized via the market, or can basically be market-financed, but organized as a joint venture, and so on. apart from the us, which never really adopted the european notion of the welfare state and where ohss accordingly have mainly been market-financed all along, countries in europe and australia have mainly gone from a system where ohss were part of the state-funded or subsidized welfare arrangements to a neo-liberalized system where ohss are largely market-financed. finland is a somewhat rare example of a country that has held on to a state-funded ohss system, whereas the netherlands and sweden are more typical examples of countries that have adopted a largely market-financed ohss system (sou, 2011: 79). worksite health promotion in the swedish sector for occupational health services in sweden cooperative agreements between unions and employer organizations have traditionally regulated ohss and the swedish state subsidized 50 per cent of the costs. in the mid-1990s state funding was terminated and the ohss sector became market-financed. this had a number of significant ‘contractual implications’ (donzelot, 1991) with regard to effects on organizational, individual, and professional identities, and on professional relations. in particular, the new contractual mechanisms resulted in suppliercustomer relations replacing the cooperative agreements, whereby ohss companies were driven to establish relations with and to win the loyalty of employer representatives – which now became their customers. in that process the type of clients and customers as well as the type of health services offered shifted. previously, ohss had primarily been directed towards the quantitatively largest groups of employees in the working population and the services mainly concerned the prevention and rehabilitation of work njsr – nordic journal of social research vol. 3, 2012 39 related injuries or illnesses. as a head of customer relations in an ohss company explained, the situation is now different: [t]he leading ohss companies seek to get away from working with the prevention of illness and injuries. i mean, heavy-labour, intense industries, where a significant part of the preventive health measures used to be directed, either have been automated throughout or have moved to low-wage countries. and there is no money in working with the lower end of the service sector. it is among the high-end companies that the profitable customers are to be found. normally such companies do not have problems with directly work-related ill health; they have problems with stress and other socio-psychological issues, which concern their employees’ private lives as much as their working lives. hence, being successful in the profitable segment of the market is no longer about preventing ill health; it is about providing services that help employees to stay healthy and fit for work. it is typically said that high-end companies employ people who have to deal with a rapid tempo, high but imprecise expectations, an abundance of choices and opportunities, and potentially conflicting interests especially relating to the balance between private and professional life. as one psychologist explained: … such employees confront various health risks that concern the difficulties of managing all parts of their lives. at times they suffer from stress: they are depressed because they do not spend enough time with their kids, sometimes they do not sleep well, and so on. but that is not the whole story: they are also part of a culture where the norm is that you should constantly try to improve, become healthier, and so on the ohss companies have responded to the needs of these customers by providing services that concern both dimensions touched upon in the last quotation: helping employees to steer free from health risks and to help them improve their health and well-being. the general term for such services is worksite health promotion (whp). one health coach defined whp in the following way: if our objective is to prevent ill-health, [then] we search for concrete health hazards in employees’ immediate work-environment and give directives on how these can be handled. when, however, our objective is to promote employees’ health and well-being, our perspective is much broader and we do not give directives, but try to help or coach employees to choose freely a healthier way of working and living. hence, rather than saying that an employee should work and live in this or that particular way, we map the employee’s work routines and lifestyle, trying to distinguish what is already good from what is not so good, and then we try to promote the former by providing the necessarily skills. this view corresponds with what other studies have reported, where whp is distinguished from traditional medical treatments by its ambition of being patient-centred in its approach and holistic in its mode of analysis. in the ohss sector this has entailed a change in focus in the ohss companies away from the work-environment to the private sphere of their clients’ lives. a psychologist in one of the ohss companies explained that this change of focus is somewhat problematic because, njsr – nordic journal of social research vol. 3, 2012 40 … the very definition of ohss is to deal with work-related health issues. in reality, however, it is no longer what we do. i am not saying that our services do not concern work-related health issues. but mostly the distinction between work-related health and non-work-related health is very difficult to make. if, for example, one of my clients is stressed out and depressed, is this because he has a hectic job with a lot of responsibilities or is it because he has three children and his wife wants a divorce? in such a situation i obviously cannot leave the family situation aside, but nor can i truthfully say that the roots of the problem are work-related. but mostly this does not matter, because if the employee is important to his employer, the employer wants him back regardless if his basic problems are private or professional. as the quotations above more or less explicitly state, the turn towards whp implies a fundamental change of the ohss sector. whereas ohss was defined by its concern with health issues that were work-related, in that the causes of ill health or some health risk were to be found at work, ohss now increasingly concern health issues, which affect or may affect employees’ work performance, but where the causes of potential or actual ill health are to be found in the private sphere or in the integration of the private and professional sphere of employees’ lives. hence, with the turn towards whp the main task of the health professionals in the ohss sector is to help companies make sure that their employees’ whole life-situation is such that they are likely to remain not only healthy in a restricted bio-medical sense, but also healthy in the sense of being capable and efficient at work. the fact that the ohss sector has begun examining clients by using a much wider lens is also reflected in how the very notion of health is understood. as one health coach said: ‘to us, health is no longer merely a question of whether or not our clients are defined as such in medical tests, it also relates to clients’ lifestyles, if they are motivated, active, self-aware, and able to take care of their health.’ hence, health is increasingly seen to signify certain behavioural and personal characteristics. the active and motivated employee who seeks to improve himself or herself in all areas in life and who maintains a vigilant attitude towards his or her health and well-being is typically seen as healthy, whereas the employee who lacks drive, is negative, and seems unwilling or unable to care for his or her health is typically seen as representing the risky group of ‘the potentially ill’. a physician pointed out that this new and more encompassing notion of health relates directly to a new culture and managerial philosophy in their customers’ organizations: i think the new type of health services that we provide relate to how health has become an integrated part of most of our customers’ culture and philosophy. it is often assumed nowadays that a healthy company is an efficient company. healthy individuals are seen to be more change prone, self-managing, and so on; so nowadays all companies want to take the ‘health-turn’. hence, the turn towards whp conveys a partly new notion of health that implies a particular lifestyle that is active, motivated, and self-aware. furthermore, this new notion of health is not merely seen as a value in its own right, but it is also seen as a vital resource that makes employees more productive, flexible, and generally more appropriate for the type of work and careers that current working life can offer. njsr – nordic journal of social research vol. 3, 2012 41 the ohss companies offer a range of services that may generally be given the label whp – programmes for stress-management, for work-family life, for the improvement of one’s body-mass index (bmi), and so on. two examples illustrate the more concrete meaning and effects of such programmes. one is a programme for so-called lifestyle, health, and career coaching that many ohss companies offer. generally, employees attend this type of programme as a fringe benefit, a sign of that one is considered valuable by one’s employer. an hr manager explained that, … these programmes are not for all employees. they are intended for those employees who are in the middle of their careers, who want to perform better at work, who want to be more challenged, more enthusiastic about work, and so on, but who find it difficult to combine those ambitions with the rest of their lives where they might have a family, a house with a garden, and all of those things. typically a lifestyle and career-coaching programme involves a series of three to five steps. the first step, as a health therapist described, … is to help the employee describe for him or herself how he or she lives on a day-to-day basis; what kind of work he or she is doing; whether or not he or she is happy with life in general; whether or not he or she is satisfied with his or her work and career; whether or not he or she is able to uphold a sound balance between work, family, and private life, and so on. by asking and answering these questions the employee is meant to become aware of his or her life and career and can begin to think about whether or not he or she is on the right track. the second step is to establish a comprehensive ‘self analysis’, where the employee is asked first to describe his or her personal characteristics, then to describe what he or she believes what other people would say are his or her main personal characteristics, and finally to point out which of these characteristics are his or her strong qualities and which that are his or her weak qualities. on the basis of the two first steps, the employee is then, as a third step, given the task of working out his or her visions and goals, on the one hand, concerning his or her work, and, on the other hand, concerning the rest of his or her life. once these steps are completed the health coach helps the employee to work out a concrete plan for how the career and life goals can be achieved. but this is not something that the health therapist does for his or her client: … my role is that of a coach. i ask the questions and thereby direct the employees’ attention in some directions instead of others. but it is the individual who comes up with the answers. it is so much more powerful to hear yourself say what you feel about yourself, your job, and so on, than to hear it from someone else. in these mapping, analysing, and goal-setting activities, work and private life are treated as two separate spheres that should be managed using the same basic principles. a health therapist said that, … while it is important to keep these spheres apart, it is also important to see how they interrelate. you cannot excel in your career if you do not consider how it affects your private life and vice versa. so in both spheres strategic problems need to be pinpointed and related to one another and goals have to be set which consider how the other sphere is affected. njsr – nordic journal of social research vol. 3, 2012 42 one health therapist who had recently coached a promising, up-and-coming manager in his mid-30s gave a concrete example of these activities. the manager had begun showing signs of stress, which, among other things, surfaced in the forms of a sleeping disorder and of irritated and aggressive behaviour that significantly affected the working climate among his subordinates. the therapist explained how the problem was clarified: in this case i helped him see how his professional life and his private life were two equally important domains, because until then everything had been about work. at first he did not admit that, but when we mapped out his daily routines, his interests, what he thought about, dreamt about, and so on, it became obvious that most of his days and nights were occupied with work. the ‘solution’ that the health therapist worked out with this client was to treat his work and his family life as two separate enterprises. the health therapist went on: … by treating his family as an enterprise of equal importance as the professional enterprise he was managing, he began to find it easier to balance work and private life. his wife, who is a housewife, was titled president of the family enterprise while he was president of the professional enterprise. so, now there were two managers and two enterprises. in general the lifestyle, health, and career programme can be seen as expressions of how ohss companies seek to exploit the growing concern among hr managers that employees who may have the proper formal competencies lack the necessary and required social and lifestyle skills (e.g., the capacity to adjust flexibly to changes in the work situation, to cope with stressful situations, to stay fit and healthy, etc.). as expressed by an hr manager in a large swedish insurance company: [c]ompanies have always searched for excellence when they hire and promote people. but today, the meaning of the word ‘excellence’ has much wider connotations. it is no longer just a statement about the particular set of occupational skills that a person may hold. now, excellence is also used to characterize a person who leads a particular type of life, who is physically active, who eats proper food, who avoids unnecessary risks, who is moderate with drugs and alcohol, and so on. in this context the lifestyle, health and career programme is supposed at once to help companies monitor the potential of their human resources and to help employees help themselves to become healthier, happier, and in that process to be better able to match the expectations of their employers. the other example is about another type of whp programme that many ohss companies offer, the stress-management programme. with respect to the issues the stress programme seeks to cover, its focus is narrower than the lifestyle, health, and career programme. furthermore, in contrast to the former programme it is intended for employees who have shown early signs of ill health caused by stress. yet these programmes are still basically similar in that they examine and correct not primarily the organization of work but the lifestyle and the individual self. in the case of the stress programme the objective is to teach individuals how to handle stress, or rather the early signs njsr – nordic journal of social research vol. 3, 2012 43 of stress, by giving them better ‘self-knowledge’ and abilities to maintain ‘a dialogue with themselves’. yet, as a therapist explained, ‘it all has to start with the clients’ accepting that they are responsible for their lives, that they are not victims, and that they always have a choice’. the therapist related how many clients, … initially tend to place their stress-problems outside themselves. it is their job that is too demanding, or their boss who expects too much or is unable to set realistic and clear goals and performance standards. we try to turn that around. we want them to see that the problem and the solution lie within themselves. thus, the stress-management programme emphasizes the idea of individual responsibility. one therapist explained that the focus on individual responsibility does not imply that the ohss companies would consider the employees’ work conditions as unproblematic with regard to stress. quite the contrary, but … the possibilities of changing work conditions are generally very limited. we can help by temporarily limiting the responsibilities and the performance criteria of those employees who come to us with stress problems. yet in the long run the employees either learn to cope with their work or try to find other less demanding work. in this respect, the ohss basically treat the clients’ professional environment as something that is accepted. although it profoundly affects the clients’ health and well-being, the clients cannot do much about it other than learning to cope with. a therapist discussed this point: [u]ltimately we do try to teach them how to cope with their work and life,. we teach them to listen to themselves, to choose, and to accept the fact that in the final instance it is they themselves who are responsible for their health and well-being. if the result of the stress programme is that a client decides to leave [his or her] work for some other career, so be it. therefore, in the stress-management programme the focus of the therapeutic sessions is the individual and the aim is to teach the individual how to adapt to work rather than the other way round. differently put, the problem, or at least the part of the problem, that the therapist seeks to do something about is on the individual level, not on the organizational level; it is the individuals’ lack of ability to cope with stress, to set limits, and to prioritize that is at the centre of the therapists’ attention. in this pursuit the first step in the therapy is to establish a trustful climate that helps the employee to accept and commit to ‘the fact’ that is he or she himself or herself who has a problem with stress. a therapist said that, … daring to be open and honest about the fact that you do have a problem is very important, because stress has a lot to do with an experience of not being able to meet expectations, not the least those expectations that you have on yourself. declaring openly that you have a problem relieves you of some of that burden, at least momentarily, and gives you the opportunity to be honest to yourself and to accept that you have a problem. in the long run, however, the therapist emphasized that it is obviously not enough for the employee just to be open and honest about his or her problems njsr – nordic journal of social research vol. 3, 2012 44 to the therapist and to himself or herself. the employee also needs to be open to his or her colleagues and supervisors. ‘we try’, the therapist continued, ‘to involve employees’ superiors in the therapy after some sessions, because if there is no understanding and acceptance for an individual employees’ problems, the risk is that things will be just like they were before the problems surfaced’. the second step in the therapy revolves around the mapping out of the employee’s daily routines. these mapping procedures concern not only how the employee handles his or her work, but also the rest of the employees’ daily routines. as one psychologist mentioned: many companies talk about ‘the 24-hour employee’ these days. it means that they take an interest in and care for their employees not only at work, but also in their lives outside work. this is not merely a question of being nice and caring. managers know that the ways in which employees live outside work significantly affect their abilities and their efficiency at work. clients are taught to deal with stress not only by being more aware and reflective about their own behaviour and attitudes, but also by beginning to think strategically about all areas of their lives. more specifically, clients are taught to make distinctions between work, private life, and self, and to set goals in all three areas. one therapist said that, … it is a mindset that we want our clients to adopt. they should be aware of what they are doing and they should think in relation to how the different areas of life, work, private life, and self relate to another. some interviewees considered the stress-management programme to be somewhat problematic since it could jeopardize the career prospects of the employee. for instance, a therapist said that, … the problem when trying to deal with stress is that the capability to work under pressure and to cope with stress and uncertainty are core features in contemporary descriptions of successful career persons. to declare openly, perhaps even in front of your boss, that you cannot cope with the stress will be seen by many as a way of saying that you are no longer in the race. an employee who had undergone therapy for a couple of months because of problems with stress commented on this issue: at some point i had to admit, not the least to myself that i had a problem. i received therapy and i was helped by the therapist to discuss with my boss how my work could be changed so that it would be less stressful. for me, this was necessary, but the price i had to pay was relatively high, because now no one sees me as a person with much chance of advancing career-wise. another employee who had also gone to therapy for her stress problems likewise elaborated on this point: about a year ago i was on the verge of crossing a line where things would have begun to fall apart. it was actually my boss who acknowledged the state i was in and suggested that i should seek help. to step aside for a while and to receive therapy proved to be both njsr – nordic journal of social research vol. 3, 2012 45 necessary and helpful. it helped me to look at myself, my work, and my life with some perspective. before i was completely occupied by my work, now i am able to keep some distance. yet at times i still feel a little bit bitter because throughout the whole process we never discussed how the organization in which i work could or should be changed. it was i who had a problem, it was within me and in the ways i related to and handled my work that the problems were to be found. with regard to the whp programmes accounted for above as well as to others offered, the interviewees generally emphasized that participation is voluntary and that active and motivated participation is required for any of the whp programmes to have any positive and lasting effect. one hr manager pointed out that ‘whereas the employees have a direct right to demand that their employers see to it that the work environment is safe, the employers cannot command their employees to eat properly, to exercise, and so on’. in that connection a health-promotion specialist said that ‘we can provide our clients with the necessary knowledge and skills, and inform them about the responsibility they have to keep themselves in shape, but we cannot obviously demand that they actually do what we advise them and want them to do’. yet some of the ohss professionals underlined that there are delicate issues involved here: ‘even though it may not be spelled out, nowadays companies tend to employ people not only because they have certain formal competencies, but also because they are fit, healthy, and perhaps even because they look good.’ in that connection, some ohss professionals stressed that ‘if you never read anything, just sit around watching tv, eating fast-food and never exercising, you might end up as a very unattractive employee’. these quotations indicate that although the employers have no right to command employees to live in a certain way so that they remain not only healthy but also attractive and capable employees, this was still expected, especially from employees with career ambitions. an hr manager believed that this expectation is further reinforced by the fact that ‘many companies have begun to focus on health issues in the recruitment processes and in the yearly development talk that all employees have with their superiors’. in addition to this normative pressure there is also a potential coercive pressure on employees to take part in and to follow the whp programmes provided by the ohss companies when an employee is unable to cope with work because of his or her health. as one nurse noted: ‘if someone cannot cope for instance with stress and is relieved from work because of illness, this person is obliged to follow the therapeutic procedures and the directives outlined by the responsible medical professional’. in general, this relates to what parsons (1951) has referred to as ‘the sick role’, in which a person who is diagnosed as sick or injured has a right to care and is relieved of his or her ordinary responsibilities – say, those concerning work – provided that the person subordinates himself or herself to the authority of medical expertise. what this means is that when an employee has been diagnosed as ill because of his or her incapability to work, the ohss professionals have considerable power to influence all spheres and parts of the employees’ life. furthermore, the employee has considerable incentive to follow the directives of the occupational health-care specialists since limited health improvements or limited motivation and activity in trying to become better can be interpreted as a sign that the employee is inappropriate for his or her job and should seek other assignments. njsr – nordic journal of social research vol. 3, 2012 46 it is important to note here is that those employees who fail to adjust their lifestyles and their selves to the combined conditions of work and life tend to be diagnosed as suffering from ill health, for example, in the form of stress and sleeping disorders. a former key account manager in a bank related a personal story on this matter, when i began working here i was very ambitious and my bosses gave me loads of work. i never said no, and i could not, really, because, i mean, you are not supposed to say no; it is sort of expected that new employees who are relatively fresh from university should be prepared to work hard and long hours. yet after two years or so i started getting stress problems – at times i could not sleep and i became emotionally unstable. i did receive help from a therapist, but i still remained unable and unwilling to put in those long and demanding hours. my therapist eventually advised me to seek another job because of health reasons, and i did. but i think it is sick that i should be considered ill because i cannot cope with a job where it is expected that you work enthusiastically up to 12 hours a day. discussion and conclusions before we discuss the more specific implications of the turn to health promotion in ohss, let us briefly return to the role of these services within the context of the broader transformation from fordism to post-fordism. i have outlined how fordism was based on a subtle alliance between a massproducing-factory regime and a welfare regime and how experts in medicine, psychiatry, economy, pedagogy, and so on, were central in in maintaining this alliance. on the basis of the authority of these professions, a combination of regulatory arrangements, such as collective social insurance and unemployment support, and disciplinary arrangements, such as public schools, health and child care, was set up, which managed to reconcile the interests of big capital with those of big labour by providing appropriately configured workers and consumers to the former and social and economic security to the latter. yet i have also outlined how the new form of capitalism that was shaped in the aftermath of the economic crises of the 1970s needed both fewer and a different breed of workers, thus undermining the legitimacy of the welfare state and opened for neo-liberal reform programmes. it is in the context of the neo-liberalization of the welfare state that a discussion about the transformation of swedish ohss must begin. as stated in the introduction of the case study, countries differ with regard to the more specific ways they organize and finance ohss. yet, as part of a general neoliberalization, there is a trend in all former welfare states either to privatize or to set up pseudo-markets for ohss (e.g., sou, 2011: 79). according to advocates of neo-liberalism, this kind of privatization of social welfare simultaneously reduces taxes while creating new markets for capitalist expansion. in addition it is claimed that these changes make society more liberal because privatization means that the state’s monopoly of power over the usage of expertise is broken when it is offered through the ‘free’ market. yet neo-liberalism has never been intended to be a return to classical liberalism’s emphasis on laissez-fair, but rather as a new form of state governance, which operates indirectly through expertise mediated via the play of market forces and individual choice (foucault, 2007; dean, 1999). in this njsr – nordic journal of social research vol. 3, 2012 47 regard, the case study presented in this article provides an example, giving us some clues of how health expertise is central in fostering a new working population that is not merely clinically healthy and physically fit, but also equipped with the right ‘mindset’ that makes it willing and able to handle the ‘individualized risk management’ associated with post-fordism (rose, 1993; du gay, 1996; hancock & tyler, 2004). more specifically, the case illustrates how the privatization of ohss sets in motion a transformation of the role of ohss experts. the purpose of ohss is no longer merely to prevent work-related accidents and illness among all employees, but to coach and empower in particular core employees of business firms in how to make sensible choices with regard to their health, careers, families, and so on (du gay, 1996). accordingly, this transformation is illustrative of a general trend among experts in mental and physical health of turning away from a traditional hierarchic practice, where the client or patient is subordinated to the experts’ authority and given instructions that he or she is expected to obey, to a collaborative practice where the client is instead offered expertise as a form of service and support that the client then either chooses to follow or not (lupton, 1995). as rose (2007) has noted, rather than regulating individuals by implanting norms of good conduct, these ways of using expertise appeal to individuals’ will to improve themselves and to use the expertise offered as a means of doing so. using foucault’s terminology (foucault, 2007), we can say that the turn to market-distributed expertise in ohss has led to a disciplinary logic of power that has been replaced, or at least complemented, by a ‘pastoral logic of power’. whereas ‘disciplinary power’ is based on the knowledge that comes from the examinations of an individual by an authority, pastoral power is based on the knowledge that comes from the individual, because he or she avows or confesses to an authority what she or he feels is good, bad, problematic, and so on. under the guidance of a moral authority, be it a therapist, a pastor, a coach, a mentor, and more, pastoral power binds the individual to the objectified image of the self that the individual himself or herself has avowed (barrat, 2002; covaleski et al., 1998). as we saw in the accounts above, it is through pastoral forms of power and expertise that active individuals are now to be socialized; individuals who are not subjugated to the rules of experts, but who make active use of expertise to learn to define and govern themselves and to receive moral guidance on how they should improve themselves in response to the opportunities and risks they face. central in this pursuit is a partly new or expanded notion of health. for as we saw, health was seen to include not only individuals’ bio-medical condition, but also their attitude, motivation, level of activity, and so on, or more generally, their personality and lifestyle. this is in no way specific to the ohss, but it is illustrative of a general trend expressed, for instance, by the definition of health set by the world health organization (who): ‘health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (1948). to be considered healthy, then, you need to be positive, if not happy, and have an active lifestyle (lupton, 1995). accordingly, we have seen how the whp programmes offered to employees made health, well-being, and prosperous careers products of individuals’ lifestyles and personalities. through the health experts’ advice and support individuals are provided with knowledge of how they can sleep better, balance njsr – nordic journal of social research vol. 3, 2012 48 private and professional life better, eat better, and so on. yet we have also seen that more important than providing individuals with ‘proper’ knowledge was making them accept that they themselves are responsible for their health and making sure that they have enough ‘self-discipline’, ‘motivation’, and ‘selfcontrol’ to shoulder this responsibility. two general consequences seem to follow from these observations. first, whp programmes contribute to nurturing ascetic personal qualities and an ethic which makes all spheres of life subject to managerial practices. on several occasions we have seen how health expertise attempted to teach their clients to attend to their lives and selves strategically (i.e., through the controlled use of specific means to achieve specific ends). to achieve health and even happiness, it seems, individuals ‘ought’ to set goals and standards and ‘ought’ to strive to improve. secondly, whp programmes present themselves as opportunities for those who have the healthy character traits to mark their distance from and moral superiority over those who lack them. this elitist tendency is in fact implied by the very name of ‘worksite health promotion’. this title suggests that the purpose of whp programmes is not to create self-discipline, motivation, self-control, and so on, that is, the moral faculties that are seen by ohss specialists as the foundation of health, but rather to promote these traits and to guard against the threats that may result in individuals losing them. in this respect the whp programmes do not seem to be conduits to better health, well-being and success that are equally available to everyone. on the contrary, for those who lack the ‘moral faculties’ required for a healthy life and a prosperous career, whp programmes instead come across as tests that aim to reveal precisely those deficiencies. therefore, whereas whp programmes provide employees with opportunities to assert their moral superiority over those who are incapable of taking advantage of these opportunities, they provide employers with the possibilities to ‘blame the victim’ legitimately because they can say ‘you have yourself to blame; you have been given all these opportunities (i.e., whp programmes) but you have not had the character to get anything out of them’. these findings can be related to studies of ‘the active’ or ‘neo-liberal’ society that have shown that large parts of the populations have been unable to embrace an active subjectivity fully (e.g., dean, 1995; o’malley, 1992). these studies argue that a growing number of people are systematically dislocated and dispossessed by the impact of advancing market relations and dismantled social-security nets. in this respect there are signs that neo-liberalization in post-fordist societies produces paradoxical results: while it promises freedom of choice, activity, and inclusion for everyone, it tends to create a large number of individuals who are excluded from society’s front stages. the whp programmes offered to employees appear to play an interesting role in this regard, for they tend to operate as catalysts in processes where social class is turned into a question of health. when, as we have seen above, health is treated as a product of individuals’ choice of lifestyle, the healthy individual is also the ‘good’, ‘responsible’, and, in general terms, the ‘morally superior’ individual. furthermore, health appears to become part of a more encompassing new version of the protestant work ethic, which declared that the ‘good and moral man’ to be hard-working and disciplined, and the immoral man idle, undisciplined, and non-working. as baumann (1998) points out, this work ethic and the way it was preached in schools, families, churches, and so on, played njsr – nordic journal of social research vol. 3, 2012 49 an important role in industrial societies of the late nineteenth and early twentieth centuries, for it helped to push people into the factories and once they were there it made them accept their low wages and poor working conditions with little complaint. in current post-fordist working life, where the ‘good employee’ is no longer the obedient, disciplined servant, but the active and entrepreneurial employee who is capable of disciplining himself or herself, the experts of health have become the new pastors, preaching the secular ideology of self-improvement as a means to well-being and professional success. as boltanski and chiapello (2005) has shown, the ethic that these new pastors preach is not simply the protestant ethic of toil and of rationalinstrumental conduct that weber so famously described as the spirit of nineteenthand twentieth-century industrial capitalism . rather, it is an ethic which puts a premium on activity ‘without any clear distinction between personal or even leisure activity and professional activity. the doing something, to move, to change – this is what enjoys prestige, as against stability, which is often regarded as synonymous with inaction’ (boltanski & chiapello, 2005: 155). should we then conclude that this new work ethic, backed as it is by the scientific discourse of health, gives rise to an increasingly harsh distinction between the morally superior and the morally inferior? the studies of bourdieu (1999), baumann (1998), and waquant (2003) have proposed that this is the case; they argue that western post-fordist societies have given rise to an ‘underclass’ of individuals who are not merely useless, unhealthy, and morally inferior with regard to the standards of the labour market, but who are also potentially dangerous with regard to the norms of citizenship. according to these authors, the role of the neo-liberal state is less and less about trying to help these individuals, and more and more about protecting the rest of the population from them by means of a stronger penal system. this study also points to a related potential development, where medical language and expertise mask moral judgements. as we have noted in the account above, those individuals who fail to live according to the norms and ideals of being active do not seem to be deemed to be morally inferior, but are instead considered to be ‘ill’ or ‘potentially ill’. somewhat paradoxically, the tendency of regarding health not merely as a clinical condition but also as a matter of choice and behaviour seems to open the possibility of seeing the failure or lack of motivation to take care of oneself as a sign of a defect or illness. this study thus suggests that individuals who fail to meet the performance standards of contemporary working life are ‘medicalized’ (zola, 1972). ‘medicalization’ then refers to the tendency that more and more of everyday life and behaviours fall under the dominion of medical expertise and medical diagnosis. examples abound: compulsive gambling, substance abuse, eating disorders, stress disorders, sexual addiction, learning disabilities, procrastination disorders, and more. this labelling of groups of individuals as sick or disabled because they have failed to take care of themselves in accordance with norms and ideals of health, well-being, employability, and so on is a way of leading them into the classical parsonian sick role (1951), where they are relieved of their moral responsibility and thus from their failure provided that they subordinate both to the authority of medical expertise and to the public authorities that make administrative decisions on the basis of medical diagnoses (holmqvist & maravelias, 2011). therefore, ‘medicalization’ (zola, 1972) emerges simultaneously as a way of removing if the not the shame, then at least the blame of those who fail to be active, to take njsr – nordic journal of social research vol. 3, 2012 50 responsibility for their health and employability, and as a way of opening possibilities to rule these individuals through the authority of medical expertise. acknowledgements i would like to thank the two reviewers and the editors of the njsr, in particular steven connolley, for their thoughtful and constructive critique of the first version of this article. references aglietta, m. 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(1993). self, identity and the naming question: reflections on the language of disability. social science and medicine. 36(2), 167-173. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 9, 2018 not just “sweet old ladies” – challenges in voluntary work in the municipal long-term care services laila tingvold* center for care research norwegian university of science and technology, norway email: laila.tingvold@ntnu.no *corresponding author nina olsvold center for care research norwegian university of science and technology, norway email: nina.olsvold@ntnu.no abstract introduction: the norwegian government is addressing the need for increased voluntary work in the municipal care sector. several reforms over the last decades have transferred important care tasks to the municipalities, as it is a political aim for people to live longer in their own homes. despite important structural changes in the provision of public care services, less attention has been devoted to the investigation of how voluntary work interacts with the overall development of care tasks within municipal care services. this paper aims to discover how the contribution of volunteers matches the current needs of service recipients and the daily work of professional staff and, additionally, to discover what level of volunteer competence and qualifications are considered necessary when cooperating with staff. method: eight case studies addressing opportunities and barriers to voluntary work in long-term care were carried out. our study included participants from both voluntary organisations and long-term care. results: volunteers were considered to fill important functions and gaps by providing social support, offering activities and by communicating with the service recipients. however, the poor health of service recipients risked putting undue strain on volunteers. volunteers need to have personal qualifications, such as good observation and communication skills, in order to function well and be useful in their role as volunteers. discussion: care is seen as a complex task requiring time, effort, and technical and social skills. relational care is not easily distinguished from the overall care needs of service recipients. service recipients in the municipalities are seen as increasingly frail and have complex health needs. with the expected increase in the number of elderly mailto:laila.tingvold@ntnu.no mailto:nina.olsvold@ntnu.no njsr – nordic journal of social research vol. 9, 2018 32 with dementia in the future, we may need to question whether volunteers are equipped to take on such advanced health problems. keywords: long-term care, volunteers, welfare state, professionals, dementia, service recipients, advanced practice nursing, future care planning introduction the need for voluntary work since welfare states in the western world are under increasing fiscal pressure to provide safe, effective and sustainable health and social care, new models of service provision are being sought within civil society (frederiksen, 2015; trägårdh, selle, henriksen, & hallin, 2013). norway is no exception, as the costs of maintaining the current level of welfare are expected to increase in the near future. the demographic composition of the population is changing, and people are living longer. it is estimated that by 2030, a third of the citizens of norway will be over 60 years old. moreover, it is estimated that there will be a considerable deficit of nurses and care workers by that time (helseog omsorgsdepartementet, 2013). there seems to be a general agreement amongst western governments that local communities and voluntary organisations are key elements in planning the future of the welfare state. in norway, the government has repeatedly emphasised the need for third sector involvement in providing and co-producing welfare services at the municipal level. white paper no. 25 addresses how care services must prepare for the growth in the elderly population (helseog omsorgsdepartementet, 2006), and white paper no. 29, which followed, argues for the importance of stimulating the support of relatives and volunteers in tackling future welfare challenges (helseog omsorgsdepartementet, 2013). along similar lines, primary stakeholders in the norwegian association of local and regional authorities (ks) call for more volunteers and point out that: “each and every one of us has the potential to become a volunteer”(fagforbundet, 2016). long-term care services in the municipalities share the belief that volunteers will be increasingly important and necessary in future service development. municipalities are encouraged to develop their own volunteering plans, and promoting voluntarism and participation in social and cultural activities organised by volunteers is presented as being beneficial both for the service user and the volunteer (hunter & linn, 1981; post, 2005; van campen, de boer, & iedema, 2013). although norway has an extensive public sector, the voluntary sector is generally seen as strong (selle, 1993). for example, it is estimated that the adult population performed nearly 200 million hours of voluntary work in 2009 (wollebæk & sivesind, 2010). most of these hours are related to sports, leisure or cultural activities (folkestad, christensen, strømsnes, & selle, 2015). however, a recent study concluded that only 1.1 percent is related to voluntary work in formal institutions of “old age care”(andfossen, 2016:9). over the last decade, researchers have stated repeatedly that we have limited knowledge of voluntary work in long-term care (grassman, 2006; rønning, schanke, & johansen, 2009). a few qualitative studies have emphasized variations in how municipalities proceed to recruit, train and organize the efforts from volunteers njsr – nordic journal of social research vol. 9, 2018 33 in long-term care (fensli, skaar, & söderhamn, 2012; hansen, 2005; johansen & lofthus, 2011; nødland, bergsgard, bjelland, & leknes, 2007; rønning et al., 2009), while a few other studies have looked at factors that promote or hinder voluntary work in the care services (rønning, 2011; solbjør, ljunggren, & kleiven, 2014). the field of knowledge is, however, largely inconclusive and leaves important questions about who the volunteers are, what tasks they undertake and what are the practical experiences of volunteers contributing to long-term care. since the organisation of the municipal health service in norway has undergone rapid changes in recent years, the constellation of service users has also changed, as have the severity of their problems and consequent needs. however, there is limited knowledge about what role and functions volunteers can and should play, and how their current efforts harmonise with that of the professional staff in the practice field. there seems to be a consensus that volunteers should provide social support and engage care receivers in social contact and in activities. nevertheless, little is known about what this entails and whether any challenges are emerging between professional staff and volunteers in relation to each other and the needs of service users. drawing on a study of voluntary work in long-term care, the aim of this article is to explore the experiences of leaders in care services and voluntary organisations. the focus of the exploration will be the experiences in respect to voluntary workers in the context of long-term care services, including both nursing homes and home care facilities. one of the questions to be discussed is: how is the contribution of volunteers seen to fit the current needs of service recipients and the daily work of professional staff? a related question concerns whether the transfer of aspects of care provision to volunteers underestimates the skills involved in caring for the elderly population in today’s nursing homes. based on an analysis of the findings, we suggest that the present enthusiasm for contributions from volunteers in long-term care rests on an assumption that care work can be separated into discrete tasks that can be divided between professional and non-professional workers, regardless of context and complexity of needs. we start by introducing a theoretical perspective on care work in bureaucratic institutions before we go on to present an outline of the changing role of the municipal health service and how it affects formal care in nursing homes. we then move on to present the study methodology before we elaborate on the findings and discuss their implication for the use of volunteers in long-term care. care in health service institutions care work is a complex activity that requires time, effort, and technical and social skills. in the literature on care, it is common to highlight time and discretion as key components in care work because it takes time to build a trusting relationship and to organise the work around the needs of the recipients of care (abel & nelson, 1990). there has long been an agreement in the research that paid care work in bureaucratically organised institutions leads to tension for caregivers since the organisation, rigid scheduling and managerial control of work contradicts the flexibility and affective involvement required to give individually tailored care (abel & nelson, 1990; glasdam, praestegaard, & henriksen, 2013; wærness, 2004). wærness (2004), one of the staunchest critics of the socio-political planning of public care, claims that the modernisation processes of recent years run counter to what is distinctive about the rationality of care work. wærness emphasises that in proposals for changes and reforms in the sector, plans and policies that aim to improve the quality and efficiency of public care work tend to neglect central components of caregiving. those who njsr – nordic journal of social research vol. 9, 2018 34 perform the specific everyday care of the sick, disabled and elderly in institutions and in the home need to have some personal knowledge of the person cared for and some control over time in order to care well. thus, specifying and dividing care into discrete tasks to be performed within a set time and in a standardised manner may undermine caring as a skilled, emotionally-involved practice. nurses, for example, see it as their responsibility to care for the patient holistically, and also hold that certain aspects of their work are best carried out in relation to a broader scope of caring activities (mellow, 2007). doing a physical assessment of a patient whilst giving a bed bath, observing how a patient manages specific activities of daily living by being present at mealtimes or sharing a cup of coffee are examples of how nurses can gather important patient knowledge (mellow, 2007). at the present, however, there is a tendency for care work to be rigidly specified and scheduled on the basis of patient classification systems and divided between different types of care workers, paid and unpaid, as well as skilled ad unskilled, with qualified nurses increasingly being driven to perform both medical and administrative work (kristiansen, obstfelder, & lotherington, 2015; kristiansen, westeren, obstfelder, & lotherington, 2016), as we shall outline below. a changing municipal healthcare sector in recent years, the municipalities’ responsibility for healthcare has greatly increased due to organisational reforms and legal regulations imposed by central government. the latest and most important of these was the coordination reform that was introduced by the health authorities in 2012. the reform extended the municipalities’ responsibility for service provision by changing the functional division between hospital or specialised care and primary health care (gautun & grødem, 2015). key features of the reform, such as financial incentives promoting shorter hospital stays and the implementation of low-threshold acute care wards in the municipalities, call for new institutional arrangements and higher staff competence. whereas elderly persons with complex care needs used to receive medical care in hospitals, they are now to a large extent treated in nursing homes, municipal acute wards or in their homes. recent studies show that service recipients in nursing homes and home care are increasingly frail older people characterised by multi-morbidities, cognitive failure and polypharmacy (helvik, engedal, & selbæk, 2010; selbæk, kirkevold, & engedal, 2008). this development leads to increased job demands and a need for more advanced nursing competence in nursing homes and home care (bing-jonsson, hofoss, kirkevold, bjørk, & foss, 2016; bing‐jonsson, bjørk, hofoss, kirkevold, & foss, 2015; tyrholm, kvangarsnes, & bergem, 2016). seen against a service context that is becoming more task-driven and where nurses are expected to play an extended role in the medical management of residents, including the acute and critically ill, the capacity to meet the social needs of service users has become limited. furthermore, health professionals must carry out more tasks related to documentation and reporting, reinforcing the trend that care professionals have less time to spend in direct social contact with residents (vabø, 2012). there is a legal requirement to meet social needs, such as enabling service users to interact with and form relationships with other residents and staff, as well as for service users to experience a sense of community and engage in meaningful activities (helse og omsorgsdepartementet, 2003), and this is now considered to be an arena for volunteers to enter. in accordance with these rights, nursing homes are responsible for meeting the social needs of residents. however, few studies have scrutinised how volunteers contribute to this aspect of care and how it finds its shape in the practice field. njsr – nordic journal of social research vol. 9, 2018 35 material and method the case studies in 2016, eight case studies were completed in various nursing home and home care locations. activities that required communication and coordination between volunteers and professionals in the municipal care services were selected, while the activities of volunteers who operated autonomously with various tasks not requiring involvement from staff in the caring facility were left out. we also prioritised the inclusion of activities that had been in operation for more than a year in order to gain the insights of experience. lastly, we picked activities from different regions in norway that represented both small rural communities and urban areas. the activities included in the case studies were visiting schemes, physical activities and exercise, and cultural arrangements. visiting schemes and participation in physical activities, in particular, fostered interaction and communication between volunteers and service recipients, while participation in cultural activities was organised more as entertainment that required little involvement from the attending residents. in this paper, our findings stem from the data related to the visiting schemes and physical activities that required considerable interaction and communication between volunteers, service recipients and professional staff. the purpose of visiting schemes is to link lonely residents with volunteers, thus providing increased social contact. volunteers who wish to participate in a visiting scheme receive some training in the voluntary organisation before they start. the visiting schemes are organised both for home residents and residents in nursing homes. the volunteers visit the service recipients (visiting host) on the basis of their common interests and what activities are practical and feasible. the aim of the scheme is to develop a social relationship over time. physical activities include various activities related to indoor and outdoor exercise where volunteers accompany residents. definitions a commonly used definition of “voluntary work” is the work a person does within voluntary organisations for individuals other than family and close friends without receiving regular payment for it (wollebæk & sivesind, 2010). unpaid work, informal care or help given to members of one’s family, friends or neighbours is not defined as voluntary work in our study. “service recipients” is applied to persons receiving care either in nursing homes or from home care services. the interviews the first author carried out qualitative interviews with one activity leader from each of the voluntary organisations and one manager in each municipal care service who was responsible for voluntary work. by interviewing the leaders in the voluntary organisations and the care services, we were able to compare their experiences and opinions of the voluntary activities that took place. the leaders brought forward their own thoughts and ideas in response to the questions, but also the voices and opinions of their staff and volunteers that had been shared with them in both formal and informal meetings. njsr – nordic journal of social research vol. 9, 2018 36 the interviews took place on the premises of voluntary organisations or in the workplace of the care staff and lasted from 45-80 minutes. the interviews followed a structured interview guide consisting of five main topics (the volunteers, the service recipients, organisational procedures, mobilisation and coordination). adhering to a qualitative methodology, the interviewer was keenly aware of the participant’s voice and reasoning (malterud, 2012). all respondents allowed the interview to be recorded provided that they remained anonymous in any written reports. analysis all interviews were transcribed by the first author, with the material consisting of approximately 200 pages. firstly, and in line with thematic analysis (braun & clarke, 2006), the texts were read several times in order to gain a thorough overview of the data, looking for patterns and emerging themes both related to the five main topics and in relation to other topics that were raised during the interviews. data-driven coding was then carried out on the entire data set to condense and organise the data into meaningful and analytically interesting groups. interviews with leaders of the municipal care services were compared systematically to the interviews with the activity leaders, with a focus on similarities and differences in their statements on all five main topics. interviews were analysed together (seen in connection with each other) for the same activity and separately with regard to how the activities were viewed and experienced independently of each other. the analysis as a whole proceeded in an iterative and interpretive manner, moving back and forth between the empirical codes, the research questions and the theoretical perspectives on caregiving (tjora, 2017). this process led to the identification of two thematic groups: a) the needs and situation of care receivers and b) the views on volunteers and what is required of them. finally, thick descriptions were written to detail as much as possible of the leaders’ experiences with tasks related to (a) and (b) above. the various steps of the analysis were discussed continuously with a research group of participants who all worked with the development of services in long-term care and with voluntary work, in particular. a few of the respondents were re-contacted to double-check the meaning of some aspects of the content to ensure our understanding was correct. ethics the project was registered and approved by the norwegian centre for research data. all informants who participated in the study consented to the recording of the interviews. we have omitted the names of municipalities and nursing homes or any information that can be traced back to the participants in order to safeguard their anonymity. findings the findings are presented in two thematic groups. first, we present findings pertaining to the views on the needs and situation of care receivers by leaders in care services and voluntary organisations, and second, we present findings on their views of volunteers and what is required of them. njsr – nordic journal of social research vol. 9, 2018 37 multifaceted needs and demanding service users in line with recent studies, our findings confirm the impression that service recipients are generally considered more frail than a decade ago (pedersen & tingvoll, 2014). the everyday work of staff in municipal care services was hectic and involved a number of professional nursing tasks that required technical expertise. social contact with residents often had to give way to more acute and urgent needs. one leader in a nursing home thought that the volunteers could help out in this area: “the users are frailer now than before. they have poor health before they are admitted to the nursing home. now they tend to stay at home as long as possible. they have home care up to six times a day. so, when they are finally admitted to the nursing home, they are in quite poor health. this means that much more is required of our nurses! and now that there is – on top of a lot more wound treatment and care – much more documentation... yes, and then there is the social aspect and having good conversations that they [the staff] don’t have time for at work. and i think that volunteers can contribute here.” in addition to the frail elderly, leaders in home care also experienced a greater complexity of needs among users of all ages. many needed help with ordinary care tasks, but there was also an increase in the number of recipients with mental illnesses, substance abuse and terminal illness. one leader in home care pointed out that she generally believed that volunteers could contribute a lot, but she was often unsure whether she could send them to some of the more challenging service recipients: “i think volunteers, in general, have a lot to contribute. particularly [when it comes to] shopping and small practical things, but... the persons who need the most care are often those who have psychological challenges or alcohol or drug problems. these people are very demanding. i have many times wondered whether it is justifiable to send out volunteers to visit a service recipient…” managers in both voluntary organisations and care services thought that volunteers could play an important role for care service recipients, but were concerned that the physical and mental health problems of care receivers might prove to be too complex and challenging. in particular, they were concerned about those volunteers who visited care receivers in their homes. in the event of something happening, the volunteers would have less opportunity to seek guidance and support as compared to volunteers in a nursing home with staff members present at all times. although the leaders thought that volunteers could help with practical assistance and social contact, they argued that not everyone could work as a volunteer in the municipal care services. in particular, leaders considered service recipients with more severe problems to represent a challenge and one leader pointed out that she made assessments with regard to safety before she involved a volunteer: “in many cases, i have chosen not to do that [send out volunteers] because i consider the user[s] to be in too poor health. they will eat these volunteers alive! they [the volunteers] don’t have any competence in setting limits! as a professional, you learn to set limits for yourself, so you are not overwhelmed”. njsr – nordic journal of social research vol. 9, 2018 38 leaders in voluntary organisations sometimes experienced volunteers asking to visit the healthiest elderly. some volunteers explicitly stated that they wanted a visiting host with few complaints, while others were willing to take a challenge and attach themselves to a person with fairly large or complex care needs. a leader in a voluntary organisation pointed to the importance of clarifying expectations with volunteers in advance: “there are a few young people who come and say that they miss their grandparents and that it would be nice with a sweet old lady who lives right by [their] flat... then we have to go in and ... we have to bring home the reality, which is that there are no sweet old ladies out there… the few sweet old ladies are taken straight away – they get taken by others – or – they aren’t difficult to connect, to put it like that. not that we want to scare anyone, but there is a reason why people contact the visitor service... they [the volunteers] are often altruistic when they come, and value-wise concerned about being ‘good people’, but they have to be able to handle difficult things – and that is the challenge!” leaders in the care services mentioned repeatedly that the volunteers had to understand that service recipients could often be unstable. in their experience, it was fairly common for service recipients to break or forget a scheduled appointment or to change plans. when having experienced this, many volunteers felt their personal motivation for volunteering decreased. one leader in the care services noted that being an unpredictable host was fairly common in younger hosts with mental challenges and in hosts with dementia. a need for experience and commitment communication skills were considered very important for volunteers. people with dementia were mentioned specifically, and training and instruction regarding dementia was given regularly. a leader in a voluntary organisation explained: “it is most demanding [for the volunteers] to visit persons with severe dementia. then you have to know quite a bit about dementia... we try to provide some subject-related top-ups through ‘theme nights’ (1-2 times a year), and these have been about dementia because that is the most relevant [topic]. there is a particular way to handle them, a technique, a conversational technique, which you should know about and practice a little... i have experienced volunteers who want to give up if they haven’t handled residents like that, so keeping the volunteer... then you have to do it in a way that they find interesting”. several of the informants pointed out that today’s volunteer cannot be just "anyone". specifically, individuals with cognitive impairment are known to be a very demanding group to visit. to ease the burden, one nursing home paired new volunteers with more experienced volunteers in order to teach the new volunteers practical techniques for dealing with situations involving people with dementia. this was arranged after the volunteer coordinator had to terminate agreements with some of the volunteers because of communication difficulties. the coordinator did not want to lose more volunteers: “some of our users have additional psychiatric symptoms as well as their dementia diagnosis, and then it can go completely pear-shaped if the volunteer doesn’t speak clearly and concisely”. njsr – nordic journal of social research vol. 9, 2018 39 another challenge concerning people with dementia was their need for frequent contact. leaders in care services pointed out that the volunteers had to visit people with dementia regularly for them to be able to remember their visitor. one informant emphasised that some volunteers felt the need for frequent visits was too demanding, and so they chose to give up: “the volunteer’s commitment to four hours a month is too little for the recipient! the volunteers are new to the people with dementia every time they come... they [the residents] forget everything after just a few hours! there is a difference between the person with dementia’s needs for contact and the activity companion’s capacity. i don’t think that the volunteers would want to come more than four hours a month”. in activities where people with dementia were involved, the staff often had to be present. they had to check that the communication between users and residents was satisfactory. another aspect involving additional work for the staff was that they had to have consent from the families of residents: “but it is clear that [the residents] who used [the volunteer service] were those who were healthier. but there were also people with cognitive decline and that was why we had to do so much and involve relatives to get their consent. persons with cognitive decline are a major challenge, also when it comes to cooperation with volunteers...” informants pointed out that it is important to think about when it is most suitable to introduce a volunteer. for people with dementia, it was important that support from volunteers did not come too late in the course of the illness: “the question is how far the dementia has progressed for the person to have use of and enjoy the presence of a volunteer visitor?” this meant that employees had to carry out an ongoing assessment of the health of the service recipients and evaluate the individual benefit of their having contact with volunteers. in some cases, the care facilities preferred to use retirees from their own care facility rather than relying on individual volunteers or volunteers from organisations. at some care facilities, agreements were signed with the employees shortly after they retired. retired employees had the necessary knowledge and experience to work with service recipients. they were also familiar with the routines and procedures of the care services and knew how it all worked: “it’s much easier for us who work in the [municipal care] service to use people who are former employees. then we almost don’t have to get involved at all. that’s much easier for everyone! they know our routines, can order taxis themselves and organise everything. so, a volunteer who doesn’t have care training or any kind of knowledge of the ideas behind our work... it is harder to make it work. and then there is the issue of confidentiality, competence and many things”. the benefit of understanding routines and procedures in the caring facility seemed especially important seen against the background of the rapid pace and busy workdays of the staff. njsr – nordic journal of social research vol. 9, 2018 40 training and clarifying expectations several informants stressed the importance of training the volunteers. training was seen as important, but the scope of the training and courses varied. generally, leaders in the caring facilities were concerned about establishing contracts with volunteers regulating which activities they should take part in and how often. volunteers were offered training as a benefit whereby they would increase their competence and strengthen their relationship with service recipients. a leader in a nursing home explained: “i have different topics: setting limits, special diagnoses, dementia, how to relate to residents ... i don’t have a set program, but i plan it depending on which activities the volunteers have and which residents they go to see”. in addition, mutual contracts with the volunteers were seen as important: “it is very important to be clear … especially the first time i deal with volunteers. we have confidentiality statements, registration forms, and [we] write a contract that can be revised. i go carefully through the tasks [and] all the points thoroughly, and this is very useful”. a leader of the voluntary activity at a care facility had deliberately terminated the contract with some volunteers because they had motives that were not considered compatible with being a volunteer: “i have tried to get rid of a few [volunteers] who were there before i started. i got rid of them because it was their needs that came first … they just wanted work experience ... and this didn’t fit very well with being a volunteer here. it is about spending time with vulnerable people. psychosocial insight, ability to empathise, and being able to take control if a situation arises and patients get unsettled. there is a reason why they need help, and not everyone is suitable to do this, to be frank”. there are several requirements that volunteers must meet, including understanding the needs of the vulnerable service recipient and gaining knowledge of various health conditions and how to manage them. in addition, staff and leaders assess the volunteers’ motives. many stressed that it is more important than ever to formalise contracts with volunteers in order to specify what their responsibility will be. concerning this point, it might be worth noting that too much administration of volunteers is controversial, as it may reduce the volunteers’ interest to remain active (nødland et al., 2007; studer & von schnurbein, 2013). the leaders in this study also carried out frequent appraisals of volunteers to ensure that their contribution was in line with the wishes of the care sector. discussion since professional staff in long-term care are increasingly pressured by the complex needs of residents and by administrative demands, less time is available for social activities and personalised care. to compensate, the health authorities wish to bring in an increasing number of volunteer care workers to meet the social needs of residents, for example, by involving them in conversation, taking them for a walk or arranging social events. however, our findings show that relational care is not easily split off from the overall care needs of residents. in particular, caring for residents with serious mental and/or physical health problems requires competence, experience and commitment, njsr – nordic journal of social research vol. 9, 2018 41 characteristics that were not always forthcoming in volunteers. furthermore, our findings show that the expectations of staff and volunteers were not always in tune. whereas volunteers wanted to visit “sweet old ladies”, staff needed volunteers that were willing and able to visit residents with dementia and other demanding conditions. thus, while it may seem sensible to let volunteers take over the emotional and social care needs of residents, it is important to recognise that this rests in part on a reductionist understanding of care. in the introduction, we suggested that bureaucratic or public caring tends to undermine central aspects of care, such as time, personal commitment and knowledge of the person being cared for (wærness, 2004). in addition, the competence and skills required to care well are generally underestimated, as the feminist literature on care has argued for decades (davies, 1995). dividing care into discrete tasks to be provided by different types of carers not only poses the risk of deskilling care work but also risks reducing the overall quality of care. several studies question whether the process of splitting up care work affects its quality. while it can be argued that care and care work is subject to differing social, political, ethical and cultural interpretations, milligan and power (2010) state that good care involves a typical holistic approach to the provision of “appropriate physical, social, and emotional supports to meet the [self-defined] needs of the person requiring help in order to maintain as much independence as possible in their own lives” (milligan & power, 2010, p. 569). the holistic approach states that biological, psychological and social needs are interconnected and need to be understood simultaneously in caring for a person (povlsen & borup, 2011). furthermore, fjær & vabø (2013) point out that caring in nursing homes is not only directed at individuals but also at the residents’ social environment as a whole. an ethnographic study of two nursing homes in norway found that care workers actively shape social situations by manipulating the physical environment and the composition of groups and that this was considered an integral aspect of good care by the care workers themselves (fjær & vabø, 2013). it is crucial to understand and allow for all aspects of care to be met in order to care well. it is repeatedly documented that ignorance of the psychosocial dimension of health is likely to result in failure to provide effective, efficient and equitable healthcare (tones & tilford, 2001). service recipients in the municipalities are increasingly frail and have complex health needs. with the expected increase of elderly with dementia in the near future, we might question whether informal carers are equipped to take on such advanced health problems. studies have shown that care work with people with cognitive and mental impairments, such as dementia, can be challenging, and informal carers for this group are more likely to experience a decline in their own mental and/or physical health status than those caring for individuals with physical impairments (schofield, murphy, herrman, bloch, & singh, 1998). the professionals in our study were aware of the challenges involved in using volunteers and tried to resolve the problem by strategically recruiting retired staff that were familiar with both the content and context of care. the tendency to prefer retired staff when engaging volunteers is also found in other studies. as baines (2004) explains, ex-staff are skilled and require no training or orientation, and no more supervision than paid workers. they also understand “the details of the service environment, thus avoiding expensive gaffes or insensitivity” (baines, 2004), p. 289). if such persons were not available, however, care professionals provided support and arranged courses for volunteer workers. in our study, care professionals also shielded volunteers from the most demanding residents, clarified expectations, set up contracts and screened volunteers for suitability. in other words, they carried out a substantial amount of largely invisible work to facilitate the work of the volunteers. apart from the extra strain this unacknowledged work puts on professional staff, it also calls into question njsr – nordic journal of social research vol. 9, 2018 42 whether all citizens can take on a role as a volunteer in the long-term care services, as is assumed in the political rhetoric about voluntary work. our findings show that professionals in the care services claim that caring for persons whose physical and mental health is poor requires volunteers to have a range of personal qualifications, for example, communication skills, empathy, reliability, psychosocial insight and an ability to observe and handle symptoms of declining health in service recipients. even when providing a small fraction of care, such as being a volunteer in a visiting scheme, there is a need for skills like commitment and timeliness. the voluntary organisations and care services in this study offered courses, training and transfer of know-how to a varying degree to their volunteers. formal contracts were used to make sure that the volunteers understood what their role entailed, especially regarding frequency of visits. this study raises a number of questions concerning the role of the voluntary sector in long-term care and the expediency of dividing care into professional tasks and tasks that supposedly can be done by unpaid and unskilled voluntary workers. firstly, our study has shown that the complex nature of care recipients’ needs requires care workers to have expertise in all aspects of care. secondly, the division of care gives rise to delineation and coordination issues between formal providers and informal caregivers (weinberg, lusenhop, gittell, & kautz, 2007). consequently, it’s important to attend to questions concerning the communication and information needs of different care providers, as well as to attend to how tasks should be distributed in terms of content and scope, and how they should be coordinated between formal and informal caregivers. the definition of a volunteer is not fixed and includes notions that a volunteer is a helper at the side of the trained professional (hussein & manthorpe, 2014) and is a person that “fills gaps” within the services (butler & eckart, 2007). several researchers have, however, addressed how the boundaries between services have a tendency to become blurred (anttonen & häikiö, 2011; pfau-effinger & rostgaard, 2011) and that there is ambiguity concerning which roles volunteers should take on as opposed to paid care (hoad, 2002). the consequences of a new welfare mix have so far been sparsely studied. limitations this study represents a relatively small qualitative study. the design has been exploratory and more targeted research is needed to understand this complexity. we have deliberately chosen to include activities run by volunteers that required communication with the care facilities and, hence, we have not addressed the effort provided by volunteers operating autonomously. conclusion the growing demand for health and care services and the concern that fewer personnel will be available in the future to meet these demands are active factors triggering redefinitions of care tasks and who should perform them. questions that ought to be asked in this regard are: what shall the content of care be? how should it be delivered? who shall carry out the tasks involved? what should be the responsibility of public welfare services, of the voluntary sector, the family and the local community, in the future? a growing proportion of service recipients in long-term care are people with dementia, frail elderly people with multiple chronic diseases, and those with complex health needs in all age groups. their needs sit uneasily with the current njsr – nordic journal of social research vol. 9, 2018 43 enthusiasm for advancing unpaid voluntary care work as one solution to the potential future “crisis in care”. in examining the ability of advanced capitalist states to meet the welfare needs of their populations, fyfe and milligan (2003) claim that “voluntarism raises a range of fundamental questions about the extent to which it is capable of addressing welfare needs”. our study supports that concern, and we argue that the fragmentation of care in long-term care institutions needs to be subject to critical scrutiny. more research is needed to address the potential match or mismatch between the political view of voluntary work as a way to “help out” professional staff and the actual role and contribution that volunteers have and may have in the future long-term care services. acknowledgements this work was funded by the research council of norway through the helsevel programme (health, care and welfare services research) as part of the research project ’voluntary work in norwegian long-term care prevalence, forms, interaction with professionals and potentials for the future’. references abel, e. k., & nelson, m. k. 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(2004). omsorgsetikk, omsorgsrasjonalitet og forskningens ansvar [care ethics, care rationality and the responsibility of the research]. oslo: gyldendal akademisk https://brage.bibsys.no/xmlui/bitstream/handle/11250/177668/vr_2010_3_web.pdf?sequence=3&isallowed=y https://brage.bibsys.no/xmlui/bitstream/handle/11250/177668/vr_2010_3_web.pdf?sequence=3&isallowed=y njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 8, 2017 care work an diffusion of innovation in danish elder care luise li langergaard* department of people and technology roskilde university, roskilde, denmark email: luiseli@ruc.dk *corresponding author abstract this article explores the interplay between different types of knowledge and rationality in care work through a case study of a nursing home innovation project in a danish municipality. the aim is to understand the implications for innovation processes and dissemination within the context of elder care. care work, in some sense, relies on relational and contextual knowledge which may lead to challenges when innovation and best practices are to be diffused across organizations. this is especially true since diffusion often relies on codification of practices and knowledge. caring rationality is essential to how technologies and methods are practiced in the care situation, and thus also essential for best practices and how they are disseminated. however, other types of codified and explicit rationality are equally important. the article concludes that there are several types of knowledge in play in care work practices and innovation, and it indicates that communities of practice could be key to understanding how to share and learn from best practices across organizations. keywords: public sector innovation, elder care, knowledge sharing, care work, denmark introduction in scandinavian welfare states, elder care is a core welfare domain which, to a large extent, is provided by the public sector (daly & lewis, 2000). the right of elderly citizens to have care provided in order to have a decent life and wellbeing in later age is not contested as an overall welfare state responsibility (knijn & kremer, 1997). however, ageing populations and increased lifespan, combined with financial pressure on the public sector, make the question of how to ensure efficient elder care a major policy concern. another central issue is how quality of life and ethical standards are upheld in elder care institutions and organizations in general and under these particular circumstances. one widespread answer to these challenges is to initiate innovative efforts in the public sector in order to meet the desired level of welfare today and in the future under conditions of changing demographics and increasing demands on the quality and flexibility of public services (bason, 2007; fuglsang & rønning, mailto:luiseli@ruc.dk njsr – nordic journal of social research vol. 8, 2017 19 2014; moltesen & dahlerup, 2007; rådet for teknologi og innovation, 2008; tanggaard & wegener, 2015). this has led to political strategies and initiatives to enhance innovative efforts and find new solutions to increase the effectiveness and quality of elder care. in danish elder care, for example, this manifests itself as a political interest in diffusion of innovation and learning from best practice across the sector. this article studies an innovation project in the municipality of copenhagen, which involves developing and sharing of innovation across five nursing homes. an aim of the project is to develop a ‘catalogue of methods’, which will function as a tool for sharing best practices and for harvesting ideas from successful local practices. under the project, the nursing homes have received funds to systematically experiment with activities aimed at increasing citizens’ quality of life. each nursing home has the autonomy to choose activities with which they wish to work. some nursing homes have experimented with ‘interview techniques’ as a method by which to gain a better understanding of the citizens’ lives. others have experimented with tablets as a tool to create ‘special moments’ for the citizens, and also with a ‘buddy arrangement’, where new residents are greeted by one of the other residents when they move in. these innovations all emerge from everyday work practice in the specific local contexts of the respective nursing homes. the endeavour to diffuse and spread innovation in the public sector to a wider population of organizations is linked to the pursuit of allowing society to benefit from innovation in the broadest possible sense. this can be seen in contrast to protecting innovations in order to maintain a competitive advantage, as is the case in the private sector (hartley, 2005, 2016). there seems to be a growing recognition that diffusion of innovation and spreading of best practice often rely on cultural and tacit dimensions of knowledge (hartley & benington, 2006). despite these insights, many innovation projects in the public sector still seem to rely on a concept of knowledge as codified and explicit, and innovation as something which can be replicated from one organization to another. it is often assumed that public service organizations will share their knowledge through benchmarking, integrated databases, websites and collaboration, even when there is no clear strategy for knowledge transfer and no articulated theory of what knowledge is and how it can be shared (hartley & benington, 2006). a similar tendency is seen with the case study of this article, where there is an aim to develop a ‘catalogue of methods’ and to spread innovations across organizations. there are few explicit reflections about how to understand knowledge and learning in the context of elder care work, or what this means for processes and diffusion of innovation. theoretically, care work is often conceptualized as highly relational and contextual, as characterized by a socalled ‘care rationality’ (dybbroe, 2012; wærness, 1984). from a perspective of dissemination of practices across organizations or local contexts, not understanding the specifics of care work could create tensions between the contextuality of innovation practices and the requirement for codification and explication of these. this schism is explored in the article through a study and discussion of how different types of knowledge and rationality play out in care work practice and what it means for innovation processes. subsequently, the article discusses the implications of different types of knowledge and learning for dissemination of innovation in elder care within a public sector context. the focus is on everyday work practices and the implications of these for innovation processes; not least because they are seen to have implications for the dissemination and adoption of practices in other contexts. the contribution of this article is a contextualization of public service innovation in the domain of elder care, which njsr – nordic journal of social research vol. 8, 2017 20 elucidates the interrelationship between the contextual and relational character of formal paid care work and more systematic, formal and codified types of knowledge. the insights are particularly relevant to professional care in the public service domains of care work, such as nursing, elder care and child care. diffusion of innovation: between replication and learning there is currently a great political interest in the role of diffusion or dissemination of innovation in the public sector. in rogers’ contribution to understanding diffusion of innovation, he argues that an important factor for the adoption rate of innovation is its compatibility with the values, beliefs and experiences of the individuals in the social system (1995). recently, the recognition of the role of context and culture for diffusion of innovation has led researchers to reconsider ideas about dissemination and adoption of innovation and to dismiss concepts like replication (hartley & benington, 2006). hartley and benington (2006, p. 104), for example, argue that there may not be a best way to share knowledge and that perhaps there has been an overemphasis on explicit knowledge in the public sector. challenging what they call the ‘drag and drop’ metaphor of knowledge transfer, (which implies the movement of explicit – abstracted – knowledge from one context to another), they suggest instead that knowledge be seen as ‘continuously reviewed, recreated and re-appreciated as it is taken into different settings’. thus, they suggest the metaphor of ‘grafting and transplanting’, which is an active process rather than a passive copying of best practice. they also suggest that adaption rather than adoption is central to knowledge transfer (hartley & benington, 2006, p. 104), meaning that innovations are often adjusted when implemented in a new organizational context. hartley (2016) further emphasizes that service innovations, which often require greater tacit knowledge than technological innovations, do not spread linearly and are often adapted to the local context and conditions (hartley, 2016). these ideas lie well in line with practice based understandings of innovation as well as theories of organizational learning. practice based understandings of innovation appear in parts of organizational learning literature, as well as in service innovation literature. they emphasize the role of everyday practice for innovation and break with the assumption that innovation is always intentional and disruptive (fuglsang & sørensen, 2011). practice based understandings of innovation recognize incremental and less tangible improvements as significant for innovation and as something that may gradually lead to more radical changes (sundbo & toivonen, 2011). from these perspectives, innovation does not rely mainly on explicit and codified knowledge and is not always easily replicable. concepts like ‘ad hoc innovation’ (jong & vermeulen, 2003; toivonen, 2010) and ‘bricolage’, as well as ‘problem-solving with resources at hand’ (brown & duguid, 1991; fuglsang & sørensen, 2011), signify that innovation activities are closely integrated into daily practices (fuglsang, 2008). in other words, they can take place partly as a hidden activity and contain tacit dimensions that are not always acknowledged (fuglsang & sørensen, 2011). a challenge with this kind of innovation is how to systematize it in a way that makes it possible to transfer or disseminate information to other localities or organizations. these concepts of innovation may help us understand innovation processes in this case study. njsr – nordic journal of social research vol. 8, 2017 21 the break with abstracted and codified knowledge: organizational learning, situated knowledge and rationality of caring a break with the strong reliance on abstracted and codified knowledge, and claims of the importance of tacit and practice based types of knowledge, is seen in theories on organizational learning. organizational learning literature emphasizes the role of situated knowledge, experience and practice for knowledge sharing. distinctions between explicit and tacit knowledge (nonaka, 1994), and between abstracted and situated knowledge and learning (brown, collins, & duguid, 1989), have been unfolded in this literature. common to these distinctions is an interest in breaking with the prevailing valorization of abstracted and codified knowledge (brown & duguid, 1991). instead, more practice based understandings of innovation are stressed and communities of practice are seen as important sites for learning, knowledge sharing and innovation in organizational settings (brown & duguid, 1991). according to wenger (2000), it is by participating in such communities that professionals define with each other what constitutes competence in a given context, such as determining what defines a reliable doctor or what defines a gifted photographer. another group of theories that break with abstracted knowledge are theories on care rationality. here the distinction is presented as one between scientific, instrumental rationality versus expressive, emotional rationality (wærness, 1984). organizational theory has paid little attention to the type of knowledge that rationality of caring represents. however, it has been widely debated in feminist theories of care and theory on care work (davies, 1995; dybbroe, 2012; parton, 2003; wærness, 1984), and also concerning the relationship between justice and care (friedman, 1995; habermas, 1990; okin, 1989). theories about knowledge in care work with dichotomies between caring and science and between abstract versus situated knowledge. wærness also distinguishes between the cognitive versus sentient actor (1984) and valorizes the sentient actor over the cognitive when it comes to care work. the characteristics of care work are central to understanding the everyday practices in nursing homes. care rationality is represented as a relational and contextual rationality combined with a high level of empathy. it implies that the assessment of what should be done in a certain situation is based on knowledge of the citizen and understanding of his or her situation. this rationality is central to the meaning of care work and, thus, to the practices in everyday care situations in nursing homes. dybbroe (2012) describes that meaning and identity in care work are given in situations when care workers interpret and understand the situation of the other and are able to organize tasks and do them in a particular way. the specific experiences and interactions with the other are key to this meaning. in human work, the citizens, patients or clients involved are a significant dimension of interactions in work, and professional identity is saturated with understanding, reflection and experiences of interacting with human beings (dybbroe, 2012). this elucidates the ethical dimensions in care work, which have been conceptualized in care ethics (gilligan, 2009) and in literature on ethical literacy in care work (krøjer & dupret, 2015). care ethics focus on caring ability as a fundamental competence we acquire through our history as caregivers (kamp & hvid, 2012). it is contextual and relational ethics that link to experience and practical reason developed from particular situations, rather than universal principles of ethics (gilligan, 2009). the concepts of care ethics and care rationality have normative underpinnings; these concepts aim at valorizing ways of reasoning that have been devalorized in hierarchical dichotomies between body and rationality, female and male, private and public, and between particular and universal in relation to knowledge njsr – nordic journal of social research vol. 8, 2017 22 or ethical judgement (bacchi & beasley, 2002; dahl, 2012; parton, 2003; young, 1989). however, this concept of care has been challenged and nuanced in theoretical debates, such as debates about justice and care, and in debates about care and rights in a disability context. in disability studies, the discussion and critique of the concept of care, especially regarding its implications for dependency and asymmetry in power relations (kröger, 2009), argue that this makes empowerment and care incompatible (kröger, 2009; morris, 1997, 2001). further, it is argued that the language of and policy-focus upon ‘care’ tends to be oppressive and objectifying (fine & glendinning, 2005). in feminist debates about justice and care, it is sometimes argued that we need to rethink the relationship between justice and care in ways that integrate or reconcile the two (friedman, 1995; held, 1995). formal paid care as professional practice relevant to this article is the view on care in the field of formal paid care work, such as that in a welfare state setting. here, the concept of care is developed within a framework of competencies and professional practice, sometimes in ways that break with a dichotomized view on care as something opposed to or separate from scientific knowledge. davies (1995) argues that care work is characterized by flexibility of response to what is required in the situation, where nothing is predictable in advance and care is ‘committed attending’ which cannot easily be translated into a set of specific and identifiable tasks. however, her view also represents an understanding of care that challenges dichotomous thinking, counterposing the head with the heart and rationality with emotion. it imparts a rather purposeful, active and ‘rational’ love as the essence of caring. it is not about contrasting competence and caring, instead but rather to see viewing it as competence in caring (davies, 1995, p. 19). furthermore, she stresses that formal knowledge, such as scientific knowledge, stands alongside other types of knowledge and leaves considerable space for adjustment and negotiation in the caring situation in light of acquired and detailed understanding of people and situations (davies, 1995). this suggests that we can see caring as produced by and supported through a variety of knowledge forms. when dealing with formal paid care work in a welfare state setting, care recipients are also characterized as being citizens with rights. from a normative perspective, the public sector is structured by a particular principle of justice and relates to citizens as rights bearing persons (eriksen, 1999; langergaard, 2011; rothstein, 1998). but even beyond this particular normative definition of the public sector, one can argue that due process and individual rights are important formal principles that, in some instances, cannot be bypassed by relational and sentient concerns. some argue that values of equal treatment, impartiality, predictability and fairness in the handling of cases, alongside a concern for due process, are important in the public sector (du gay, 2008), thus putting a limit on the scope of the ethics of care and opening an additional dimension to be balanced in the daily practice of care work. methodology and the case study this article builds on a qualitative case study of an innovation project called ‘quality of life at nursing homes’ in the municipality of copenhagen. the data were collected between spring 2015 and autumn 2016. this particular project encompasses local sub-projects at five nursing homes; they receive funds from the municipality to carry out innovative activities with the aim of improving njsr – nordic journal of social research vol. 8, 2017 23 citizens’ quality of life. the resources are used to give employees extra time to work on the activities, on consultancy aid and to buy technology. each nursing home has a local project group and has the autonomy to define the focus and aims of their activities. this opens up a complementarity between top-down structure and bottom-up practice in the project as a whole, and makes the case relevant for studying the conditions around disseminating and spreading innovation across local organizations in the sector. all nursing homes couple the project with currently existing focus areas of their activities and allow these to determine the foci of their local sub-projects. the innovation activities that they experiment with are mostly non-technological and directed at improving the self-determination of the citizens or the relational aspects of the citizens’ lives. the activities range from new human practices to the use of information and digital technology. these include activities such as a ‘buddy arrangement’, where new residents are greeted by a neighbour responsible for welcoming them and establishing initial contact, the systematic use of interview techniques, or the deployment of tablets to support the relationships between staff and residents by creating ‘special moments’. the latter method is used in particular with cognitively impaired citizens who have difficulties with articulating how their quality of life can be improved. the project is about both creating innovation in the sense of new practices and making already existing best practices visible in order to let other nursing homes learn from them. table 1: overview of innovation activities nursing home 1 neighbourliness (internally between residents and with external local community). role models in relation to meals (such as the role of hostess). collaboration between different professional groups. nursing home 2 ‘special moments’ of spontaneous presence, sometimes supported by tablets or musical instruments. focus on citizens with dementia. life stories, sometimes supported by technology such as tablets. nursing home 3 debate groups in combination with dinner. nursing home 4 ‘the good life’: action plans developed by use of certain interview techniques. focus on homeliness and the citizen’s understanding of the good everyday life. nursing home 5 ‘your choice, your life’: an interview technique focusing on the citizen’s notions of the good life. ‘moving in’ well: a buddy arrangement for new residents who are greeted by a neighbour. this article builds on group interviews carried out with care assistants, nurses and managers at the five nursing homes. the interviews were conducted in two rounds: the first round was in spring 2015 in the early days of the project, where a combined total of six interviews from all five nursing homes were conducted. a total of 13 employees and leaders participated in the interviews, which lasted between one and one-and-a-half hours each. the interviews were exploratory with the aim of gaining insight into innovation processes in the particular setting and context of the nursing homes, and gaining insight into the role of everyday practice and top-down project structures for innovation processes. the interview guide was centred around themes such as: details about the local sub-projects and the backgrounds for and decisions made in relation to these, how changes are initiated at the nursing homes, challenges and resources in relation to the njsr – nordic journal of social research vol. 8, 2017 24 innovation projects and the relationship between the overall municipal project and the everyday practices and activities. the second round of interviews, conducted in autumn 2016, consisted of six follow-up interviews aimed at covering how the project had developed and the results the nursing homes experienced in relation to it. these interviews also lasted between one and one-and-a-half hours each. the interview guide had themes like: the innovation process so far, the results of the initiatives, the relationship between the sub-project and the overall project, the role and relationship with the citizens and their ideas about future retention of the efforts and potential adoption of methods from other nursing homes. interviews were conducted with a total of 18 employees and leaders, some of whom had also participated in the first round. all interviews were qualitative and semi-structured (kvale, 2007), and were conducted in groups of care assistants, nurses and leaders. this approach allowed the interviewees to express their own perspectives and let the conversation develop in ways where the interviewees could introduce themes they perceived as important to the project and their everyday work practices. in looking at the differences between the nursing homes and the local subprojects, one recurring theme in the stories about everyday work life and practices was the meaning of care and the relational dimension of care work. even though the interviewees were not asked directly about care, their answers consistently reflected that care and their relationships with citizens were perceived to be central to their everyday work. thus, the meaning of care is pivotal to the success of the project and its goal of working systematically to increase citizens’ quality of life. it is this particular dimension of everyday practices that will be discussed in relation to its implications for innovation processes and organizational learning within the context of public sector nursing homes. the nursing home managers selected particular employees for interview because they considered them most able to provide insight into the project. this potentially led to issues due to the managers’ positions as gatekeepers. however, as the aim was not an evaluation of the project, something which could have led to self-censorship of the employees, but rather to understand how they make sense of the project in relation to their everyday work life, this issue did not come across as relevant. in the analysis, emphasis was placed on statements by care assistants and nurses, as they are closest to the everyday practices and methods used to work with citizens. no particular differences between these two groups of care workers were revealed in the interviews regarding the way they portray care work or the competencies and skills necessary for carrying out care work; both groups are similar in the sense that they explicitly emphasize the importance of relations and empathy while at the same time stressing professionalism and knowledge about dementia. the analysis displays how the nursing homes work to systematize and codify certain dimensions of care in order to better share knowledge and understanding about the citizens. a thematic analysis was used with a focus on the theme of care and the types of knowledge at play in the practices that are developed through the project. quotations have been selected that demonstrate these issues as expressed by the employees. njsr – nordic journal of social research vol. 8, 2017 25 findings and analysis: the ‘quality of life at nursing homes’ project in a review of the interviewees’ responses, the dimensions of care work in relation to the identity and meaning of this work is expressed as being of central importance. to the employees, an essential part of care work has to do with building a relationship with the elderly citizens. in both the first and second rounds of interviews, employees expressed that in order for innovations to be successful, citizens must be approached with care, empathy and understanding. across almost all interviews, the relationships with citizens are stated as a primary motivating factor in choosing the care worker profession. one care worker says: ‘most people who apply for this job are not too concerned with leaving at precisely one o’clock […] that is how it is when you deal with people. [it’s about] empathy, caring and an interest in how other people live their lives and how they feel. you get very affected by how the residents feel’ (care assistant in nursing home, first round of interviews). a number of the innovations that are developed in the project seem to focus on supporting this dimension of care work. contrary to what is often stressed in literature on care, namely that the competencies and rationality connected to care work are often difficult to articulate (davies, 1995) and thus easier to overlook, the nurses and care assistants in the interviews are very explicit about that particular dimension of their work. the relational and empathic aspects of work were the foremost thoughts in their minds when asked about their activities in the innovation project. upon closer inspection, however, it appears that while the formal dimensions, in terms of the frame of the project and professional care competencies, are clearly important, they are not the only factors in play here; other types of professional knowledge are equally significant to the care workers and their work within the project. the following section will demonstrate this point by indicating how the care workers portray their understanding of the situational and relational dimensions of their work, how they attempt to systematize these dimensions through the project methods, and how other professional competencies and skills come into play alongside caring rationality. attempts to systematize and support care relations the innovation project constitutes a frame where relational dimensions are codified and systematized in a way that makes it possible to deal with them in more explicit ways. in this section, two examples of methods from the project shall be presented. they both illustrate the importance of care rationality in practices aimed at supporting the good life for citizens, but also demonstrate how the work with the innovation project leads to attempts to systematize and formalize certain dimensions of care work. in this sense, it is the interplay between systematic approaches to the innovations, as well as the competency of reading situations and people, that makes the innovation successful and possible to share within the organization. working with life stories and action plans through the use of interview guides represents ways of sharing (through documentation), codifying and systematizing the relationship with citizens. providing good care is easier when the care workers know the citizens and their life stories well. getting the citizen to tell their life stories, however, requires time and trust. a care worker notes that it is often through one-to-one conversations njsr – nordic journal of social research vol. 8, 2017 26 with citizens that silent needs are uncovered. it is important to take the time to talk to the citizen and to understand the expression of a need when something turns up in conversation. she explains that very often the things that are most important to the resident are not articulated during encounters with practical purposes and small talk. working with people implies that you cannot always follow a script or plan all details in advance, however the systematic approach to talking with citizens about their wants and needs works as a way to get closer to the citizens and strengthen the relationship. care workers also reported that the systematic approach has helped open up new perspectives of the citizens which were not seen before. on the other hand, care workers also stress that it is important to seize the moment with the citizens and be able to understand their needs in that particular moment. often, major insights occur unexpectedly because the care workers are good at reading the situation and understanding what the citizen wants in that particular moment. in this sense, the use of the interview guide for citizens is supported by the situational competence of the care worker. another example is the use of tablets to support the active work with citizens’ life stories and to create what they call ‘special moments’ of spontaneous presence. tablets are used as a form of technology to support this relationship and aid the establishment of trust and intimacy. for example, the tablets can be used to listen to music that the citizens used to like when they were younger, or to look at locations on google street view to stimulate the citizens’ memories of places where they used to live. a care worker from one of the nursing homes presents a story where she used the tablet with a citizen with dementia who had been very confused one evening. the citizen immediately calmed down when the care worker found a picture of his daughter on the tablet. this good feeling lasted all evening and the citizen remained calm and happy. this, of course, could also be done with a photograph alone, but the tablet has a number of options. the tablet represents a way to systematize and make some of the relational aspects of care concrete and to create certain practices which all care workers can take part in and which can be transferred to other organizations. the use of the tablet, however, relies on situated knowledge and such incidents cannot be fully planned. especially with citizens with dementia, one cannot know in advance how the citizen will feel on a certain day, so it is about seizing the moment when the citizen is feeling well and is willing to engage. as another care worker says about the citizens who cannot participate in the ordinary activities of the nursing home: ‘this is for example residents with cognitive impairments, dementia etc. where they can manage something for fifteen minutes and that has to be done here and now, that is not planned, because then they will not be able to do it anyway, because they are not feeling well enough. but here you can see that the resident is feeling well so that you can have a special moment’ (care assistant, first round of interviews). even with the strong dimensions of tacit, situated knowledge in these interactions, there are ways of systematizing and codifying practices to support these dimensions. the rationality of care is constituted through the way care workers conceive of the here and now situation and the needs of the other (dybbroe, 2012). there is also an ethical dimension to this, where the care workers make an effort to understand the resident as a concrete other for whom they have a responsibility. the tablet is a new technology put into use in the nursing homes as part of the project, which in itself is a tool or support but cannot be the njsr – nordic journal of social research vol. 8, 2017 27 innovation itself. only through correct use, which requires certain skills that are not part of the script or the manual, can the tablet be successfully used to support the intimacy and good moments with the citizens. this requires care rationality or, in other words, a sensitivity to the resident in order to understand when and how to use the tablet in concrete situations. as brown and duguid (1991) point out about manuals, they specify what to do but not why. similarly, a ‘catalogue of methods’ may give some suggestions on the technical use of the tablet or the purpose of using it in a care relationship. however, when and how to use it with a particular citizen requires situated knowledge and skills, which also entails ethical, practical reasoning. this might be understood through krøjer and dupret’s (2015) concept of moral literacy in technological care. krøjer and dupret (2015) present examples of nurses using new technologies that affect their relationships with patients by creating a feeling of distance between the nurse and the patient. in order to keep the relationship with the patient as the concrete other and maintain professional standards, nurses develop a moral literacy which helps them navigate and deal with morals and ethics in complex care situations (krøjer & dupret, 2015). the relationship between the care worker and caregiver raises both technical and ethical claims as to the use of technologies, such as the use of a tablet in care work. the competencies to deal with this can be learned and also partly articulated, but it requires experience. if the tablet as a method of best practice is to be transferred or diffused between organizations in the sector, this aspect is essential to understand. this aspect is what determines the adaption and concrete use of it in a new organization, and determines whether the technology will actually support the quality of life of the citizens in nursing homes. before ending the analysis, a few remarks shall be made about the types of knowledge and rationality not previously emphasized, but which are also important to the practices of care workers as expressed in the interviews. this analysis indicates that the innovation project supports attempts to codify and systematize care work and its relational dimensions. the importance of empathy and the relational dimensions of care work were prevalent in both rounds of interviews, but other rationalities and types of knowledge became especially clear in the second round of interviews; they will be briefly touched upon here. the aim is to contrast and clarify the different rationalities in formal paid care and to avoid an overemphasis on the local, tacit and contextual dimensions. an example from the second round of interviews indicates how one of the nursing homes assesses the impact of the innovative activities on citizens. this nursing home focuses specifically on citizens with dementia who have difficulties in articulating their wants and needs. the methods they use are life stories, or ‘special moments’ of spontaneous presence (sometimes with the help of music), and they use these systematically to share knowledge and experiences about what works well with particular citizens. to make this work, care competencies about reading the citizen in a particular moment, as well as scientific and medical knowledge about dementia, is central. this is central both in regard to the actual activities and in the way that they attempt to document the effect of the innovation methods. they use a set of well-known parameters from science about dementia to assess the effect on citizens’ moods, levels of activity and waking states, and keep records about the reactions and development of citizens. in order for care workers to work effectively with residents with dementia, they must possess a great deal of specialized knowledge about dementia, about rights to due process (e.g., rules for use of force, duty of care, confidentiality and consent, all of which were parameters especially prevalent in the second njsr – nordic journal of social research vol. 8, 2017 28 round of interviews), as well as about empathy and caring rationality. as davies (1995) argues, the formal knowledge works alongside caring competency, and this is revealed through the interviews. the interplay between situational and formal competencies is central to the innovations themselves and the processes through which they are developed. adaption and diffusion of innovation in care work the study shows that care rationality stands central in care workers’ portrayals of their care practices, but it also shows attempts to systematize practices in ways that can be shared. the analysis highlighted the fact that other, more explicit and formal forms of rationality and knowledge, such as scientific rationality and understanding of formal rights to due process, were seen as central to the care workers. practice based innovations, such as the ones in this case, are key to understanding innovation processes and the conditions for adaption and, consequently, diffusion of innovation between organizations. the interviews indicate that the local practice contexts determine which and how innovations developed in other organizations will be adapted by other organizations. the understanding of both rationality and values are central, as will be argued in this section. the study indicates that rather than focusing on one type of knowledge in relation to care work practice for processes and diffusion of innovation, it must be understood how various types of knowledge unfold in different situations. there may be value in emphasizing the knowledge dimensions of care as a professional practice, even if it is highly relational. some theories of care work and care ethics tend to be one-sided, working with a dichotomous representation of care in contrast to other types of knowledge. in the setting of formal, public sector care work, such dichotomous approaches seem to miss the interrelationship between different types of knowledge and underplay the importance of scientific, medical knowledge. this is apparent in the example of working with citizens with dementia and the professional distance required: not only must the care worker ensure equal treatment without favouritism/preferential treatment, but the care worker must also meet the citizen openly in order to read their needs and wishes in regard to their everyday lives. in the second round of interviews, one of the care assistants states how the practices related to the project, specifically the action plan for citizens, have given a more systematic approach to citizens; this has opened new perspectives on how to reach an understanding of what the citizens want. working with an action plan for each citizen, where notes about the citizen’s habits, history and wishes are written down, has revealed new vistas about how the citizens want their everyday activities organized. one important competency of care workers is to assess the situation and understand what type of knowledge and skills are required, something davies also indicates with her representation of competency in care (1995). as a contribution to care work research, it can be seen how different rationalities and types of knowledge are in play. as in the examples illustrated, the rationality of caring and the moral literacy in the relationship with citizens is crucial to care work and to judging what type of knowledge is required in each situation. thus, this study is relevant to innovation processes in that domain, as well as to diffusion of innovation across organizations. the interviews reveal that for care workers there are important values and identities connected to caring and, as the context of caring is one of ethics and values, they also determine the conditions for learning by the care workers and the organizations. njsr – nordic journal of social research vol. 8, 2017 29 the second round of interviews touched more directly upon the connection between the different local sub-projects and the possibility of adopting innovations from other nursing homes. the employees expressed that the local anchoring of the sub-projects and the autonomy to define the methods by which to work have been important to them in making sense of the project. this autonomy has allowed new practices to evolve from existing practice and, according to the employees, is important to the potential adoption or adaption of methods developed at other nursing homes. when asked whether they would consider implementing methods presented from the other nursing homes, they agree that they would only consider taking on innovations that fit their local practices, routines and the needs their citizens experience. it seems also that there is an emphasis on adapting and remodelling methods to fit local contexts: ‘it is more about the small things rather than large systems. it can be ideas about everything from how to greet a new citizen or how citizens with mutual interests find each other. you can take what you like and adapt it a little and make something new’ (care assistant, second round of interviews). in order to understand diffusion or adoption of innovation in this setting, which is characterized by both scientific, formal knowledge and concern for rights, and by relational and contextual rationality and competence related to care, communities of practice may be a key concept. this is supported by the interviews where it is made clear that sharing of knowledge and experience between the care workers is a central part of implementing and sustaining a focus on the activities. if we acknowledge the role that communities of practice play in knowledge sharing and adaption of innovations and methods, we can avoid the juxtaposition of abstracted knowledge with learning. we can look at ‘communities of practice’ as central sites for learning and knowledge sharing (brown & duguid, 1991; wenger, 2000). communities of practice refer to the specific work practices, which are central for negotiating meaning between participants (dybbroe, 2012). they are also the communities with certain professional values and norms, which are essential to how care workers make sense of innovations in a ‘catalogue of methods’. in relation to care work, communities of practice play a central role in communication about care practices. in the interviews, several care workers refer to internal and external networks for learning and knowledge sharing, which can also be seen as communities of practice. organizationally, this means that it is through the communities and groups of care workers that new methods will be negotiated and ascribed meaning before they are adapted into practice. overlooking this may lead to resistance or to a use of technology that does not support the purpose of improving citizens’ quality of life. dahl (2009) and dahl and rasmussen (2012) have described how the implementation of standards and procedures, and part of new public management, have led to different kinds of resistance at the care worker level. thus, a lack of understanding of the value context means that there are no guarantees that the technology will even be adopted or adapted; if it does not make sense or seems to collide with the ethical demands and experiences, care workers may choose not to implement new methods into their daily practice. this has, however, not been the direct object of study in the research of this article, which has focused more on processes of innovation in a care work setting and less on communities of practice. thus, these results can merely be indicated based on insights into innovation processes and knowledge shared as reported in the case. this could potentially be a subject for future research. njsr – nordic journal of social research vol. 8, 2017 30 conclusion this article has discussed the conditions for dissemination of innovation across organizations in elder care in the municipality of copenhagen. this has been discussed by investigating the knowledge and rationality at play in daily practice and innovation processes in care work in nursing homes. the article argues that understanding the knowledge and rationality at play in innovation processes is key to understanding conditions for the dissemination of innovation in care work, as the local context and identity is important for participants’ willingness to adopt innovations. it elucidates the interrelationship between the contextual and relational character of formal paid care work and more systematic, formal and codified types of knowledge, while the analysis illustrates how various types of knowledge and reasoning are relevant to care practice. the work with innovations in the case study involves an interplay between formal, explicit types of knowledge and situated, contextual knowledge of care. in this sense, the analysis of the article represents a break from an overly dichotomous view on care and competence, and it stresses that care rationality stands alongside other, more formal types of knowledge and rationality. the caring competence of reading the citizen and his or her needs in a particular moment, formal scientific knowledge about dementia, as well as an understanding of formal rights to due process are all central for the situations of care that employees portray as successful. the innovation project represents ways to systematize and formalize dimensions of care in ways that make it possible to talk, explicate and share experiences about care situations with particular citizens. the deep anchoring in local practice is emphasized as an important factor for the innovation project and its activities to be experienced as meaningful to the employees. they also express that adoption of innovations from other nursing homes would only be interesting if they fit into the local practices and experienced needs of citizens and, furthermore, that it would involve a great deal of adaption. in that sense, the article contributes to existing research on diffusion of innovation in the public sector by providing a concrete example of practices related to innovation and adaption in the domain of elder care. based on the statements of care workers concerning how knowledge is developed 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(1989). polity and group difference: a critique of the ideal of universal citizenship. ethics, 99(2), 250–74. https://doi.org/10.1086/293065 https://doi.org/10.1086/293064 https://doi.org/10.1093/bjsw/33.1.1 http://ufm.dk/publikationer/2008/filer-2008/strategi-for-styrket-innovation-i-den-offentlige-sektor.pdf http://ufm.dk/publikationer/2008/filer-2008/strategi-for-styrket-innovation-i-den-offentlige-sektor.pdf https://doi.org/10.1017/cbo9780511598449 https://doi.org/10.4337/9781849803304.00021 https://doi.org/10.1177/0143831x8452003 https://doi.org/10.1177/135050840072002 https://doi.org/10.1086/293065 microsoft word how does urban neighbourhoods matter njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol 11, 2020 how do urban neighbourhoods impact parents’ subjective well-being? jaana poikolainen* youth research and development centre juvenia south-eastern finland university of applied sciences email: jaana.poikolainen@xamk.fi *corresponding author kati honkanen the school of applied educational science and teacher education university of eastern finland, email: k.honkanen@dnainternet.net abstract introduction: in this paper, parents’ well-being is examined from their subjective point of view of their living experiences in a certain residential area. the subjective viewpoint is relevant as the focus of the research is interlinked with residential areas. aims: the research aims to determine what meaning parents ascribe to their residential area (suburb or city centre) as a space for physical, social and psychological well-being. it also aims to discover whether there are qualitative differences between the given meanings of parents living in different areas. methods: the data were acquired through semi-structured interviews with parents who live in a suburb or the city centre of lahti, finland. data analysis was conducted using abductive thematic analysis. results: the results revealed that physical, social and psychological spaces were experienced differently depending on the residential area in question. in parents’ narration about the physical space, in both areas the basic services were defined as valuable for well-being. parents living in the suburb experienced the natural environment as an important source of well-being. when talking about the social space, the parents living in the suburb emphasised social networks and the importance of building well-being bridges in their neighbourhood, unlike the city dwellers. the psychological space was connected to the reputation and security of the residential area. an important well-being factor for all parents was the wellbeing of their children, with an emphasis on the safety of the residential area. discussion: subjective assessments of neighbourhood attributes are more important in explaining neighbourhood satisfaction than any perceived reputation. parents’ ways of thinking and acting in certain residential areas appear to tie in with the social capital that forms social resources. almost all parents who participated in this research estimated their well-being as rather high, irrespective 20 njsr – nordic journal of social research vol 11, 2020 of their socioeconomic status, but the city centre residents rated their well-being even higher. keywords: parents, neighbourhood, subjective well-being, place, space in this paper, well-being is examined from a subjective point of view based on parents’ living experiences in a certain residential area. parents often think about their neighbourhood context through parenthood (cuellar, jones, & sterrett, 2015). using a subjective viewpoint has proved to be relevant when the focus of research is interlinked with residential areas and their meaning to residents (clark, 2009; clark & lisowski, 2018; honkanen & poikolainen, 2014; koistinen, peura-kapanen, honkanen, & poikolainen, 2017; permentier, bolt, & van ham, 2011). well-being is often approached through risks, insecurities, shortcomings and social problems, but a positive, empowering approach is also needed. a positive notion of well-being is based on the strengths and capabilities needed for human growth, especially when facing unpleasant episodes (e.g., clark & lisowski, 2018; luhmann, hawkley, & cacioppo, 2014; luhmann, hofman, eid, & lucas, 2012). well-being is based on individual experiences (kroll, 2011) and therefore subjective well-being (swb) indicators have been used in research in many countries for decades (e.g., pontin, schwannauer, tai, & kinderman, 2013). in these studies, the core idea is to study the respondents’ views on, for example, life satisfaction and happiness. variance can be explained by personal traits and specific life circumstances such as employment, income and meaningful social relationships, which are the factors that have been reported as scoring highly when people feel positive about their well-being (luhmann, hawkley, & cacioppo, 2014). background variables are supposed to correlate with subjective well-being, and the statistical conclusions are drawn from these correlations (diener, inglehart, & tay, 2013; pontin et al., 2013). however, there is variance in such influences depending on individual differences and coping strategies (hofman, eid & lucas, 2012). well-being is experienced in certain neighbourhoods (mellander, florida, & stolaric, 2011) and where possible, parents decide where they live with their children. a neighbourhood is a place where everyday life is lived with children and therefore it is an important research context (cuellar, jones, & sterrett, 2015). a deprived neighbourhood is supposed to lead to negative well-being outcomes (garvin et al., 2012). parents experience their well-being uniquely and also assign their own meanings to their residential area as a well-being 21 njsr – nordic journal of social research vol 11, 2020 environment (koistinen et al., 2017). for example, parents attribute different meanings to social resources in their neighbourhood context, and therefore it is reasonable to examine such nuances (coleman, 1988; cuellar, jones, & sterrett, 2015; kleinhans, priemus, & engbersen, 2007). more research is needed on the meaning of a residential area as a well-being environment. therefore, the research questions are the following: what kind of meanings do parents ascribe to their residential area (suburb or city centre) as a physical, social and psychological well-being space? are there qualitative differences between the given meanings of parents living in different areas? significance of the residential area as a source of wellbeing during recent years, research has pointed to the effects of the residential area on well-being. it has been stated that geographical or political dimensions and political decisions affect well-being (bernini, guizzardi, & angelini, 2013). for example, housing policy directs housing choices—where and how citizens live (rasinkangas, 2013). of course, during the course of life different issues are important such as income, health and family (e.g., koistinen, et al., 2017; margolis & myrskyla, 2013). suburbs and the lives of their inhabitants have been studied for a few decades in finland, but so far the research is scant. often the focus has been on housing preferences in the helsinki metropolitan area (kemppainen, lönnqvist, & tuominen, 2014; vilkama & vaattovaara, 2015), place attachment (koistinen et al., 2017; seppänen, 2012), social segregation (rasinkangas, 2013) and the spatial nature of urban well-being (ala-mantila, heinonen, junnila, & saarsalmi, 2018). lately, the experiences of the middle class living in socioeconomically disadvantaged areas have been in focus in the helsinki metropolitan area (vilkama & vaattovaara, 2015). our focus is also on disadvantaged areas, but we concentrate more on the working class or parents who are not working at the moment, and examine how they define the issues that are important to their well-being. parents live in different physical, social and psychological spaces, and define the contents and meanings of those according to their own preferences. parental well-being is shaped by a combination of spaces constructed in different dimensions. the first dimension, physical space, consists of the physical residential area and its services, the transportation network (cuellar, 22 njsr – nordic journal of social research vol 11, 2020 jones, & sterrett, 2015) and the natural environment (carter & horwitz, 2014), for example. the importance of green space usability to the well-being of individuals and communities has been proved (carter & horwitz, 2014; völker & kistemann, 2015), as have the health effects of water, or blue space (völker & kistemann, 2015). nearby nature appears to “buffer” the effect of a lack of social connectedness on well-being (cartwright, white, & clitherow, 2018) and the presence of nature in cities can support recovery from stress (taylor, hahs, & hochuli, 2017). the experiences of the physical environment affect wellbeing; for example, unbuilt vacant land is seen as frightening and unattractive (garvin et al., 2012). bell, phoenix, lovell, and wheeler (2014) and ala-mantila, heinonen, junnila, and saarsalmi (2018) have stated that we still know relatively little about the meaning of the local environment for well-being as defined by the inhabitants. the key idea in this article is that parents define for themselves which issues in their residential area are meaningful for their wellbeing. the second dimension, the social space, refers to how inhabitants value their social relationships in the residential area (runge, 2018). a neighbourhood is a potential space for creating social relationships, if these are seen as valuable (benson, 2014; coleman, 1988). the place of residence and family stage play a role in the style of community involvement (hofmaister & edgell, 2015; strange, fisher, howat, & wood, 2014). social resources are linked to the social climate of the neighbourhood, as people generally place importance on the feeling of belonging to a group and place (strange et al., 2014). when studying the connection between social relationships and well-being (honkanen & poikolainen, 2014), we adopt the classical division of social capital defined by coleman (1988; kleinhans et al., 2007), who divides social capital into different dimensions according to the form and solidity of the social relations. these relations in certain social spaces in certain neighbourhoods are an important interest of this study. the first dimension is bonding social capital, which refers to a rather tight-knit group consisting of, for example, family members, relatives and close friends. this capital produces the feeling of solidarity, as the members involved in the relationships share similar norms. the second dimension is bridging social capital, which is built between different groups, for example, friends and neighbours. the members of these groups often have a similar background in terms of social status, beliefs and appreciation. the third dimension is linking social capital, which operates vertically, combining bonding and bridging capital. the divisions are used here 23 njsr – nordic journal of social research vol 11, 2020 to describe the importance of parents’ social networks to their well-being in certain residential areas. for example, clark and lisowski (2018) showed in their study that social capital has strong associations with subjective well-being when the individuals evaluated their community and neighbourhood relationships. also, local social capital is strongly associated with place satisfaction and modestly associated with life satisfaction. the third dimension, the psychological space, relates to how inhabitants feel about living in the neighbourhood, and the issues that are important for wellbeing in that neighbourhood (cuellar, jones, & sterrett, 2015), such as whether they define the area as a safe place to live (kemppainen et al., 2014). unbuilt vacant land is a problem for the economy of many cities, and can be a frightening place according to inhabitants’ opinions, as garvin et al. (2012) have shown. research context, data and analysis suburb and city centre the research contexts of this study are the liipola suburb and the city centre of lahti, which is situated in southern finland, 100 km from the capital, helsinki. the suburb is located around 3 km from the city centre. finland’s urbanisation took place between the 1960s and 1970s. the suburbs were created as a solution to the needs of industrialised society, with apartments built in areas near factories with good public transport connections (kortteinen, 1982). the number of industrial jobs has decreased, and the majority of the inhabitants of liipola are now older people, while the number of families with children has decreased (seppänen, haapola, puolakka, & tiilikainen, 2012). in 2014, when the data were gathered, the population exceeded 4,400 (tilda, 2014), and most people were living in houses built during the 1970s (seppänen et al., 2012). services in the area have gradually reduced, but at that time there was still a grocery store, a library and a church hall. furthermore, there was a daycare centre and grades one to four at the comprehensive school. the education level of the inhabitants was significantly lower than the average level of the city residents; the employment rate was also much lower than the average in lahti (tilda, 2014). the reputation of the suburb has been poor (seppänen et al., 2012). 24 njsr – nordic journal of social research vol 11, 2020 around 15,500 people live in the city centre, but mobility is constant. the densely populated area consists mainly of new and older blocks of flats, but there are also a few parks. all services are easily reachable by foot, such as schools, shops, malls and healthcare (honkanen & poikolainen, 2014; koistinen et al., 2017). most of the interviewed parents had lived in lahti before moving to their current neighbourhood. all of the families had lived in the residential area for at least two months, with some having lived there for 20 years. most had lived in the area for several years, and some had even been born there. eight interviewees lived in the suburb and seven in the city centre. the aim was to reach parents with different socioeconomic positions. we recruited the interviewed parents, 13 mothers and two fathers, from schools’ parental evenings, a settlement house and using the snowball method. we tried to reach more fathers, but we did not succeed. earlier studies have also shown that fathers are not so interested in participating in this kind of research (e.g., gabb, 2010). three parents were immigrants from russia, egypt and thailand, while the rest were native finnish. the language spoken at home was finnish for 11 parents; the other languages were russian, arabic and thai. most interviewees (10/15) were homeowners. most parents (10/15) had vocational or basic education as the highest education level: university (1), polytechnic education (4), vocational (8) and basic education (2). their labour market positions were: working (6), (unemployed) housewife (4), part-time work (2), entrepreneur (1), student (1) and disability pension (1). four of the highly educated parents were either retired or housewives. the basic statistics of the residential areas and their inhabitants are presented in table 1. the parents were 29 to 60 years old and the children who still lived at home varied in age from 1 to 14. the interviewed parents had altogether 32 children living at home. the number of children per household were: parents 3, 4, 5, 10 and 12 (1), parents 8, 13, 15 and 18 (2), parents 6, 7, 9, 11 and 17 (3) and parent 2 (4) (parents 1 and 14 no longer had children living at home). the aim was to capture the thoughts of those parents whose children lived at home. eleven of the parents were in a relationship, while four lived alone with their children. suburb year of statistics city centre year of statistics inhabitants n 4,419 2014 15,482 2014 25 njsr – nordic journal of social research vol 11, 2020 families n families with children % 1,099 49 2014 2014 3,441 30 2014 2014 education (only basic) % 43.3 2013 31 2013 native language finnish % 86 2014 97 2014 unemployed % 30 2012 7.8 2013 block of flats n % 2,764 97.3 2014 12,293 94 2014 homeowner % 31.8 2013 34 2013 rental apartment % 62.5 2013 49 2013 table 1: statistics of the suburb and city centre. (source: tilda, 2015; statistics finland, 2015a) data and analysis the research interviews were conducted using a thematic interview form. the basic themes were well-being in the physical, social and psychological spaces (carter & horwitz, 2014; cuellar, jones, & sterrett, 2015; völker & kistemann, 2015), which framed the conversation but did not direct it. the form of the interview was constructed based on earlier research; therefore, familiarity with it was a precondition for the interviewer to be able to lead the themed interview according to the interviewee’s answers (madill, 2011; roulston, 2011). the parents used their own concepts, and also brought their own significant experience to the discussion. in addition to background questions, an interview form usually involves basic themes and, if necessary, supplementary questions can be used to assist in the completion of the interview (roulston, 2011). the interview extracts were translated from finnish into english for this article. the semi-structured interview data consist of knowledge about the factors significant to the parents from the point of view of their own well-being and in relation to where they live. the aim was to be sensitive to parents’ stories. open questions were used such as, ‘if you think about your neighbourhood, which issues are important to you?’ and ‘what kind of meaning does the residential area have for your well-being?’ the thematic interview form also involved a figurative (ladder) well-being scale (1–10), which was used as a tool to stimulate discussion and get general information about the subjective well-being of parents. the more familiar the interview environment is to the interviewee, the more natural the interview situation becomes (madill, 2011). therefore, the interviews were performed in places that were most suitable for the parents, such as 26 njsr – nordic journal of social research vol 11, 2020 workplaces, cafés and researchers’ offices. the interviews took an hour each on average, and the transcribed data corpus takes up 219 pages (calibri, 12 pt font, single line spacing). the recorded interviews were analysed using thematic analysis, a method that provides useful tools for organising interview data without losing the core meaning (vaismoradi et al., 2013). the analysis followed an abductive form. according to gläser and laudel (2013), the basic idea of coding interview data is that the transcribed text material is marked according to codes, which can be, for example, keywords or sentences that indicate the occurrence of the information in separate segments of the text. first, the data of the interview were classified according to the well-being dimensions: physical, social and psychological spaces. the second step was to analyse the contents and themes of the dimensions, and the third step was to find out the meanings the parents attributed to the themes when talking with the researchers. during the third phase, a thematic map was generated and the designation of the themes and interpretation were re-evaluated (vaismoradi et al., 2013). the examination focused first on the parents living in the suburb, and after that, the researchers analysed whether there were differences between this group and the parents living in the city centre. research ethics were addressed during the entire process according to scientific guidelines. the anonymity of the respondents was guaranteed following the general rules and best practices of research ethics, as well as national laws and policies (see carusi & jirotka, 2009). we committed to complying with responsible research conduct and adhering to the guidelines of the finnish advisory board on research integrity (2016). all the participants were informed about the research and its purpose. because of the sample size of this research, instead of the generalisation of the research results, the portability of experiences can be used, meaning that there is possible compatibility with previous studies in different contexts (metteri, 2012). by comparing results, the interpretations of the data can be confirmed, or it can be stated that something new has been found. in qualitative research, generalisability is not concerned with the collection of representative data; instead, the focus is on the researcher’s analysis and interpretation of contexts (delmar, 2010). 27 njsr – nordic journal of social research vol 11, 2020 findings the factors supporting the well-being of parents in the residential area were divided into three dimensions according to the themes (table 2). the first theme was physical space, which the parents defined as the availability of basic services and the importance of the natural environment. the second theme was social space, which indicated parents’ valuation of the balance between privacy and communality. the third theme was psychological space, which to the parents meant a safe environment for children, an area with a good reputation and the possibility of choosing a residential area. the residential area as a well-being space was defined differently depending on where the interviewed parents live. inhabitants of the suburb valued sufficient services and the natural environment that surrounds their neighbourhood. the natural environment was an important well-being factor for many parents; they appreciated good outdoor recreation possibilities in the immediate natural environment. the parents living in the city centre appreciated the ease of mobility, nearby services and available hobbies. while the parents living in the suburb appreciated communality, it was avoided in the city centre. those living in the suburb mainly estimated their well-being as lower than those living in the city centre. residential area physical space social space psychological space subjective well-being suburb sufficient basic services, area surrounded by natural environment and easy habitation large bonding resources are strong, more bridging communality is hoped for better reputation and security are hoped for 10 [2], 5 [3], 8-9 [7], 8 [8], 7 [9], [12], [17], 7 [18] city centre good services, enjoyable natural environment sites within the city restricted bonding resources are strong, communality is avoided urban environment with adequate security and reputation 9 [4], 9-10 [5], 9 [6], 9 [10], 9 [11], 9 [13], [15] table 2: physical, social and psychological spaces and well-being 28 njsr – nordic journal of social research vol 11, 2020 physical space: services, the natural environment and housing sufficient services are available for parents living in the suburb, such as a grocery shop, and many social services, such as a child welfare clinic, are located nearby. as previously mentioned, services are part of physical space (cuellar, jones, & sterrett, 2015). the parents were satisfied with the services, which were, in their opinion, reachable by walking or using public transportation. koistinen et al. (2017) found that family-centred residents appreciate services above all, such as social and health services, their availability and quality. the parents discussed many issues regarding the well-being of their children. the area was criticised as being depressing due to its external reputation, suggesting an idea of a reputation without an individual experience. in general, the parents were satisfied with the suburb and had no plans to move out. the natural environment and good facilities for outdoor recreation, both for adults and children, were seen as attractive. according to previous research, an urban, green, natural environment is an important factor of well-being (see carter & horwitz, 2014; cartwright, white, & clitherow, 2018; honkanen & poikolainen, 2014; völker & kistemann, 2015). we had a dream that we would buy a bigger flat than those in our previous apartment building. we wanted to live in this house because we like it that much. i like to exercise, and here we have good roads and trails, and there are good places for children to play. it is very easy to be outdoors with them. we do not have to go near the road if we do not want to. we can walk through the forest. so i like this very much. (mother 2, four children— 8, 6, 3 and 1 year old, polytechnic bachelor’s degree, housewife, suburb, swb 10) parents living in the city centre valued easily accessible services and versatile possibilities for hobbies. the inhabitants living in a block of flats in the city centre particularly appreciated the handiness of living near services. in addition, the natural environment located nearby was appreciated, although the parents emphasised its significance for well-being less than the parents living in the suburb. everything is near in lahti—forests and outdoor recreation areas. we have to go only 500 metres and we can ski and skate. there is a lot of everything for younger children, such as playgrounds. and there is a library, which has been very much in use, and a theatre; these are the most important ones. (mother 4, one child—13 year old, polytechnic education, secretary, city centre, swb 9) many parents living in the suburb stated that they were thus far satisfied with the range of services, but if the school—which had already been downsized— 29 njsr – nordic journal of social research vol 11, 2020 and the shop closed, this would cause difficulties in everyday life. greater significance was placed on staying in the residential area because of the quality of the area than, for example, because of economic factors. the most important factors were the beauty of the area and the physical environment (see also mellander et al., 2011). nature has the potential to support well-being, especially in urban environments (taylor et al., 2018). in the city centre there are several schools and all the necessary services, and the parents were satisfied with those. social space: resources and communality communality and social resources were appreciated by parents living in the suburb. the parents participated in events that support communality, and they found it important to have manifold friend and kin networks. communality was mostly supported by people who shared similar life situations—parents who had either created bonding or bridging capital or were working towards doing so. the uniting factor was children; parents found it easier to interact with people who shared the same norms (see also hofmeister & edgell, 2015; kleinhans et al., 2007). well, we have regular friends who visit the place [playground]. i think it was me who suggested, ‘what if we do some voluntary work and take rakes and gather the garbage and afterwards have juice?’ it is so fun, even in the children’s opinion. (mother 3, one child—4 year old, comprehensive school, cleaner, suburb, swb 5) a vital entrenching factor was that the inhabitants could build and maintain friendships in the area (mellander et al., 2011). active inhabitants wanted to invest time and effort for the sake of the neighbourhood. some parents said they wanted to keep their distance from neighbours, and instead continue with active, pre-established friendships. as kleinhans et al. (2007) have noted, newcomers in a neighbourhood can be more active in searching for social networks than long-term residents. some parents mentioned that forming and sustaining social networks had proved difficult, even though they wished to participate in the social networks of the neighbourhood. however, the concrete methods and actions required to strengthen communality were often missing. the parents also discussed cultural differences; for example, native finnish people are used to exercising outdoors, but parents from many other cultures are used to staying indoors. there are no tempting communal meeting points, 30 njsr – nordic journal of social research vol 11, 2020 with the exception of playgrounds. however, inhabitants born outside finland liked their finnish neighbours, and said that they received help when needed. a multicultural neighbourhood was seen as a positive. well, finnish people are very friendly. my neighbour has many children and they talk with us; our children exercise outdoors and walk to school together. (mother 9, three children—13, and two 9 year olds, polytechnic bachelor’s degree, unemployed, suburb, swb 7) despite the poor reputation of the residential area, it was described as a good neighbourhood—one that is approving and tolerant. the social environment was seen as responsive, with children who could be defined as “different” easily able to make friends. where we lived previously, aku was in kindergarten half the day, and he never got any birthday invitations. we tried every children’s club, but because he could not speak, no one invited us. it was terrible; we were very lonely. and when we moved here, aku fitted in at the kindergarten just like that. he made friends immediately; they did not mind his disabilities and they asked him to their homes to play. (mother 7, five children—10, 8 and 6 year old, and two children aged 19 and 21 who do not live at home, vocational education, housewife, suburb, swb 8-9) the social environment has become individualised in the city centre, and there are no collective obligations. the parents living in the apartment block purposefully kept their distance from their neighbours. they did not feel the need for communality, as those living in the suburb did, but they were committed to keeping in touch with relatives living near or far. bonding capital was linked only to relatives; there was no room for others. unfortunately, there are people who live here who make a lot of trouble. as my uncle used to say, the neighbours are only for greeting. but oh well, we get along and we used to participate in voluntary work, but nowadays the maintenance man takes care of that too. (mother 4, one child—13 year old, polytechnic education, secretary, city centre, swb 9) those parents living in terraced or detached houses took care of their own regional communality, although there were also territorial battles related to privacy. we have had some disagreements with the neighbour; he has been against everything. we have even been to court. (father 15, two children—14 and 12 year old, vocational education, entrepreneur, city centre, no swb) social space was regarded as positive for the children living in the suburb. they have friends who live in the same area and meet them, among other places, at 31 njsr – nordic journal of social research vol 11, 2020 an adventure playground. the children’s social environment was experienced as pluralistic and tolerant of differences. most of the parents have connections to other parents in the residential area and the community was appreciated. in terms of developing the area, there was a feeling that there is a need to increase communality. psychological space: reputation and security the poor reputation of the suburb appears to matter little to almost all parents (see also garvin et al., 2012; permentier et al., 2011). however, a clear division between better and poorer areas, based on street addresses, was expressed. the geographically defined lower part of the suburb was characterised as peaceful, while the upper area was defined as a place where parents do not willingly walk around with their children. this division is maintained by the parents using the playground of the area with the better reputation. feelings of insecurity with regard to surroundings impacted the parents’ feelings of wellbeing, while the behaviour of some intoxicated people had driven away potential customers from the local shopping centre. parents found the environment to be unsuitable for children, as these drinkers are negative role models for children. this [part of the suburb] is a very good district. my experiences are limited to down here and halfway to the hill, but overall i would say this is a very good place for families with children. i do not want to go up the hill when it is dark, and i do not find the surroundings of the shopping centre safe. the customers of the bar make me shudder. it does not feel safe with the children. so we do not visit the area around the shopping centre much. (mother 3, one child—4 year old, comprehensive school, cleaner, suburb, swb 5) most of the parents had not experienced criminal activity that had targeted their homes or belongings in the neighbourhood. the few who had did not view it as a serious problem. in the city centre, the psychological environment was described as quite secure, but the parents set strict limits on their children’s walks in the evenings. during the daytime, i feel that walking is totally safe, as there are so many people walking. when it is darker, we do not let the children walk home from friends’ houses. we do not trust that it would be safe. we strive to pick them up or meet them. (mother 6, three children—13, 8 and 4 year old, polytechnic bachelor’s degree, salesperson, city centre, swb 9) the parents also tried to protect their children from negative temptations. the mall, which is located in the city centre, was defined as a negative environment for children and young people. because of the high crime rate, the city has been 32 njsr – nordic journal of social research vol 11, 2020 called the ‘chicago of finland’. however, the parents living in the city centre did not find that the city’s reputation matches its reality. when we moved here in 1994, people asked why we were moving to the criminal city, and i wondered what they meant. in the 1980s, the city had a reputation of being like chicago, but the crimes were solved very well. really, if we consider the statistics, there is crime in other places too. for some reason, the city got that reputation. (mother 4, one child—13 year old, polytechnic education, secretary, city centre, swb 9) the reputation of the area was significant for living satisfaction, and thus also for well-being (see permentier et al., 2011). kullberg et al. (2010) found that residents’ perception of area reputation was strongly associated with environmental well-being; however, residents expressed their happiness about living in their dwelling, irrespective of area. an area’s reputation is based on historical events and it changes slowly even if, for example, the physical conditions are altered through renovation work or other innovations. with regard to psychological space, the reputation of the suburb was significant, especially from the point of view of feeling safe when walking in the area. the women discussed feelings of insecurity (see kemppainen et al., 2014). the parents who live in the suburb were generally attached to the area despite its reputation. according to them, the reputation was created years or decades ago, and is not valid anymore. the willingness to move was not strong, except if the current apartment became too small for the needs of the family. discussion and conclusion welfare-state regimes differ between countries and regions in terms of how they take care of social inequality (samuel & hadjar, 2015). in europe, there has been increasing debate about the rising differences between inhabitants’ subjective well-being and living environments. neighbourhood has an important meaning in life satisfaction (clark & lisowski, 2018). in finland, similar results have recently been reported. the well-being of the finnish population is examined by the national institute for health and welfare in annual reviews. the latest review shows that there are clear differences between the various population groups in terms of well-being and neighbourhood (see ilmarinen, kauppinen, & karvonen, 2019). in finland, over the last 20 years, the disadvantage has begun to accumulate in some areas, and there are several areas of the metropolis where the number of unemployed and low income households has grown (vaattovaara & kortteinen, 2012, 2015). almost all the 33 njsr – nordic journal of social research vol 11, 2020 parents who participated in this research estimated their well-being as rather high, irrespective of their socioeconomic status, but the city centre residents rated their well-being even higher. however, we are aware that recruiting and interviewing more fathers could present a different set of experiences and challenges compared to those of the mothers. for parents’ residential well-being, there were three important themes or topics: services, natural environment and housing, social resources and communality, and neighbourhood reputation and security. in both the suburb and the city centre, the parents often rated their residential area and its significance for well-being from the point of view of their children’s growth environment. the family was considered a protective factor if the neighbourhood was seen as unsheltered. the interviewees who live in the suburb had clearly mentally bound themselves to their residential area despite the criticism that it receives. the safety and peacefulness of the residential area were considered important for well-being, irrespective of the dwelling place. no one was considering moving from their residential area, as they were satisfied. permentier et al. (2011) found that subjective assessments of neighbourhood attributes are more important in explaining neighbourhood satisfaction than any perceived reputation. parents use places for different reasons and purposes. urban places are set aside for certain activities and furnished with spatial borders, which are implicit structures of power (dean, 1999). in the suburb there are no places for, for example, the disadvantaged population, so they linger in public places that families with children now avoid as far as possible, as a few of the interviewed parents mentioned. there is a need for spaces for all citizens without segregation (see honkanen & poikolainen, 2014), especially in the suburb. even though the suburb largely became their place of residence for economic reasons, the parents adapted to the residential environment and, despite criticising it, emphasised the strengths of the area more strongly than its weaknesses. all of the interviewed parents stated that they had freely chosen where they live and their type of housing. they did not point out any particular reason to move out, such as to gain supplementary social capital for their children. the reasons for living in a certain area were often practical, but it was possible to identify a relationship between well-being and the residential area. people’s valuations depended on individual differences, such as their personality, cultural values and other factors (see also diener et al., 2013). 34 njsr – nordic journal of social research vol 11, 2020 the parents living in the suburb were satisfied with the services on offer, which they felt were accessible by walking or using public transport. parents mentioned the importance of green space for their well-being, as has been noted in earlier studies (carter & horwitz, 2014; völker & kistemann, 2015). parents’ ways of thinking and acting in certain residential areas appear to tie in with the social capital that forms social resources. social capital is also associated with both place satisfaction and life satisfaction (see clark & lisowski, 2018). the parents living in the suburb enthusiastically talked about the importance of the social network and the need for communality, but the activities, especially those designed to strengthen communality, varied. bridging capital was more important for parents living in the suburb. there is a need for opportunities to interact (see strange et al., 2014). some of those living in the suburb were in need of tighter communality. the concrete methods and means of adding to the communality and building social bridges between inhabitants are missing, despite continued attempts to develop them by the communal developers of the city. as hofmaister and edgell (2015) found, the place of residence and family stage play a role in the style of involvement in the community. parents living in the suburb with small children created social networks, for example, by using the local settlement house. parents of older children did not have the same aspiration for communality, and this could be because of the older children’s ability to network more independently. social status and its creation did not seem to be important, contrary to, for example, benson’s (2014) results. of course, people tend to understate this kind of factor when talking about preferences. some parents living in the suburb defined the strict borders of their neighbourhood; they outlined some parts of the area that they believed were home to people with social problems. they did not construct a class division, as the middle-class participants in benson’s (2014) research did, but there was a clearly defined attitude: some people are like us and others are not like us. the residents of the suburb, unlike the city dwellers, did not construct distinctions according to the social statuses of ‘us’ and ‘them’. there have been several attempts to develop residential areas to be more inhabitant-friendly, and such development projects have also been a focus in other european countries, as wouter et al. (2009) report. therefore, the local decision makers and designers of residential areas need information about the factors that increase feelings of well-being in different areas. how do the 35 njsr – nordic journal of social research vol 11, 2020 satisfaction and dissatisfaction of inhabitants construct well-being? by studying subjective factors and gaining knowledge about the issues that stimulate inhabitants’ well-being and satisfaction, it is possible to develop better residential areas (bernini et al., 2013). subjective indicators that describe satisfaction offer a view of people’s experiences, both positive and negative, which matters in society (diener et al., 2013). the results of our research highlight that the meanings parents attribute to their residential area as a physical, social and psychological well-being space reveal valuable knowledge that cannot be obtained through merely examining residential areas according to socioeconomic indicators. it is important to be aware of parents’ ways of thinking; for example, how mental bonds to residential areas are constructed and how residential areas affect subjective well-being in many positive ways. author note this research was supported by the housing finance and development centre of finland [grant 8987/828/13] and university of helsinki centre for continuing education hy+ references adler, n., & steward, j. 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(2009). disentangling neighbourhood problems: area-based interventions in western european cities. urban research & practice, 2(1), 53–67. https://doi.org/10.1080/17535060902727066 microsoft word pdf developing an app could be the wrong place to start njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 11, 2020 ‘developing an app could be the wrong place to start’: user reflections and ideas about innovation in municipal substance abuse services vidar bakkeli* work research institute, oslo metropolitan university fafo institute for labour and social research email: vidar.bakkeli@oslomet.no *corresponding author arne backer grønningsæter fafo institute for labour and social research email: arne.groenningsaeter@fafo.no abstract introduction: there has been an increased focus on the search for innovative ways to use technology to improve public welfare services. however, this focus has been less apparent among municipal substance abuse follow-up and aftercare services. historically, this is a field that has had weak user involvement. therefore, we have explored user ideas and reflections on whether and how technological innovation can improve these services. method: we conducted four group sessions with a total of 14 users of substance abuse follow-up services (five women and nine men) in the southern part of norway in june of 2014 and february of 2016. results: the users who participated in the study pointed out that face-to-face interaction with service practitioners is an important dimension of these services. some expressed fear that more technology might lead to services that are less relational or more standardized and that such developments might lead to reduced availability. they pointed out that enhancing individualization, continuity and service collaboration might be more important than prioritizing technology-oriented innovation. nevertheless, the users viewed technology as positive and useful when it improves service accessibility and communication between service providers and users. more generally, the data also 87 njsr – nordic journal of social research vol. 11, 2020 shed light on users’ service experiences. the analysis of these data shows that access to support from peers who have had user experiences was found to be particularly valuable. discussion: we contribute to the literature on co-production and user involvement by highlighting user perspectives on the risks, uncertainties and possibilities for the use of new technologies in service delivery. based on these findings, we develop the ‘coproduction triangle’. in this model, the relationship between the service provider and the user is expanded to include skilled peers as a third actor. keywords: user involvement, co-production, technology, follow-up care, addiction, peer support introduction in this study, we explore whether and how technology in a broad sense can improve local-level services, specifically substance abuse follow-up and aftercare. technology is rapidly changing society and social relations, and in norway, as in many other countries, there is an ongoing shift in public services towards digitalization and the increased use of new technologies for service delivery and development. such changes are taking place across all sectors, including social benefits and activation services, health care, elderly care, the disability field and education (lindgren, madsen, hofmann, & melin, 2019; pollitt, 2010). however, in the area of municipal follow-up and aftercare for drug use, alcohol and addiction, less attention has been paid to service innovation and the potential implementation of new technological solutions to existing problems. this type of care and follow-up work must address many unique challenges and is particularly difficult to manage and provide (norwegian ministry of health and care services, 2015). mortality rates due to overdose in norway are among the highest in europe (emcdda, 2017, p. 78), and recovery from drug and alcohol dependence is a long, difficult and complex process. for these reasons, there is a need for more research on user perspectives and the potential for service improvement. in recent years, user involvement in service design, development and delivery has moved, in general, ‘from margin to mainstream’ in both research and policy fields (barnes & cotterell, 2013). since users have direct experience with the services they receive, they have important insights into how these services work, how to improve them and what new services could be introduced 88 njsr – nordic journal of social research vol. 11, 2020 (magnusson, 2003). their involvement can also empower them and lead to positive effects on their recovery efforts (crawford et al., 2002). therefore, in order to advance research developments in the field of substance abuse care, we set out to examine: (1) users’ views of and experiences with their local follow-up services and (2) users’ views and ideas concerning some of the new ways in which technology can be implemented to improve local services. in the analysis of our findings, we drew on concepts from the coproduction literature (osborne, radnor, & strokosch, 2016). we organized four group sessions of 14 participants, all users of municipal follow-up and aftercare services. we conceptualized these sessions as ‘pockets of co-production’ (wilkinson & wilkinson, 2018, p. 6) in which knowledge production can take place through interactions between service users and us as researchers. the central aim of these sessions was to create an arena where users could generate, discuss and reflect on new ideas for service development. while we came to these sessions with a sense of optimism with respect to the use of technology, we found that the service users had a more critical approach to service development and technological innovation. co-production and innovation in recent years, co-production has become increasingly popular in the contexts of policymaking, research and governance in many countries (needham, 2008; osborne et al., 2016; voorberg, bekkers, & tummers, 2015). co-production has been conceptualized in many ways, but it can generally be defined as ‘the voluntary or involuntary involvement of public service users in any of the design, management, delivery and/or evaluation of public services’ (osborne et al., 2016, p. 639). osborne et al. (2016, p. 641) emphasize that services are ‘intangible processes, not concrete products’ and that value for the user is created through interactions with service practitioners. municipal services providing follow-up and aftercare are based on a form of social work characterized by co-production; positive social results cannot be achieved without the direct involvement of service users (parpan-blaser & hüttemann, 2010). in the literature on co-production, technology and public services, there is a focus on the positive impact of digital technologies. for instance, it is maintained that technology can enhance co-production by creating new forms of social interaction through which users can contribute to service delivery (e.g. through social media). the belief is that this leads to higher participation and 89 njsr – nordic journal of social research vol. 11, 2020 engagement (meijer, 2012) and the creation of new opportunities for participation (lember, 2018; lember, brandsen, & tõnurist, 2019; noveck, 2015). however, as lember et al. (2019, p. 1666) note, there is considerable ‘techno-optimism’ in the field, with most research highlighting the benefits and ignoring the potential risks, uncertainties and unintended consequences of new technologies. little research has focused on these aspects, so there is a need for more knowledge about both the potential advantages and risks of pursuing technology as a means to improving public services for vulnerable groups. the co-production literature generally focuses on interactions between service providers and service users (verschuere, brandsen, & pestoff, 2012; voorberg et al., 2015). we build on this understanding of co-production in our analysis on user experiences with services. we also explore another dimension of coproduction, namely the interactions between users and researchers – in other words, users involved in research (beresford, 2013; cairns & nicholls, 2018; trivedi & wykes, 2002). according to beresford (2013), a main argument supporting user involvement in research is that users have important experiential knowledge derived from direct experiences that are relevant to the research subject; consequently, their involvement will improve the quality of the research. this involvement can also be beneficial insofar as it empowers users and positively affects their beliefs about recovery. the degree of user involvement in research can vary widely, and user involvement can mean a lot of different things (beresford, 2013, p. 142). for example, users can be involved in only a few stages of the research process or throughout all phases, from the first step of defining the research question to the final step of publishing the findings. in our study, we aimed to create what wilkinson and wilkinson (2018, p. 6) call ‘pockets of co-production’ by establishing sessions in which users could generate, discuss and reflect on ideas in conversation and through interactions with us as researchers. in contrast, a more ‘full-fledged’ co-production approach would have involved the users in several or all phases of the research, such as in developing research aims and objectives, gathering data, conducting the analysis, writing articles and other activities. an innovation process can typically be divided into four phases: (1) exploration, (2) creation, (3) reflection and (4) implementation. exploration involves understanding the situations of the service users and stakeholders within a particular context. creation entails developing new solutions, visions and ideas while imagining alternative futures grounded in the knowledge and insight 90 njsr – nordic journal of social research vol. 11, 2020 obtained from the first phase. reflection consists of getting feedback, testing out ideas and discussing design changes. finally, implementation involves introducing the innovation (a product, service or technology) in a given context (forshaug, 2015; stickdorn & schneider, 2012). in this study, we have focused on the first two phases of exploration and creation. the study employed a broad understanding of technology, although we focused primarily on digital technologies or information and communication technologies (ict). we wanted to avoid narrow definitions in order to promote the creativity and imagination of the workshop participants. since digital technologies are developing at such a rapid pace, it is generally difficult to define and categorize them in great detail (lember et al., 2019, p. 1669). following insights from science and technology studies and innovation studies, we understand technology as tethered ‘not just to a device in isolation, but also to forms of knowledge, skill, diagrams, charts, calculations and energy which make its use possible’ (barry, 2001, p. 9; pollitt, 2010, p. 33). technologies have social and human elements and are part of wider networks. this broad understanding highlights the integration among technology, social practices and political, organizational and economic factors (sismondo, 2010). user involvement and new technologies in substance abuse services the international literature indicates that there is significant ambiguity regarding systemic user involvement in the field of substance abuse treatment (barnes & cotterell, 2013; crawford et al., 2003; crawford et al., 2002; king, 2011; patterson et al., 2009; patterson, weaver, & crawford, 2010; schulte, moring, meier, & barrowclough, 2007). thus, there is a need for more clearly defined roles for both service users and professionals as well as increased competency in strengthening user involvement. in the norwegian context, askheim (2009) and others have pointed to the considerable distance between (1) policy ideals and the rhetoric of user involvement and (2) the realities of actual user involvement in the substance abuse field. the government has also acknowledged that there has been a lack of systematic user involvement at both the individual and system levels (norwegian ministry of health and care services, 2015, pp. 16-17). several studies have found that user involvement can be difficult in practice. in one study, aasmundsen and sagvaag (2011) interviewed 15 service users about their experiences with service development, and they generally reported 91 njsr – nordic journal of social research vol. 11, 2020 negative experiences. they felt that they had been stigmatized and negatively labelled and that their views had not been taken seriously. user involvement has also been an important focus of several projects related to the development of municipal social service offices (johannessen & eide, 2015; slettebø, brodtkorb, & dalen, 2012). slettebø et al. (2012) found that when establishing collaborative projects and arenas for dialogue, important factors for user involvement include recognition of user competency, involving users from the start of projects, service practitioners’ relational skills and training and competency-building. there is also a growing international body of literature concerning user involvement in and innovative uses of technologies for local-level substance abuse services. in one qualitative study from west ireland, van hout and mcelrath (2012) highlight that the involvement of service users in the development of treatment and rehabilitation pathways can improve the awareness of service provision in local areas, increase empowerment among service users and strengthen local partnerships. they recommend the implementation of internet user forums and support networks as concrete ways of improving treatment services and strengthening service user involvement. in another study, owens et al. (2011) focus on the involvement of service users in the development of a text messaging intervention service aimed at reducing self-harm in the united kingdom. in this case, the researchers held a series of participatory workshops with service users and clinicians. the study found that working with service users is important for uncovering unmet needs and preferences and that such collaborations increase the chances of developing solutions that are ‘safe, usable, clinically effective and appropriate to cultural context’ (owens et al., 2011, p. 292). however, they also found that involving service users in development processes requires flexibility and openness to uncertainty. until recently, little work had been done concerning the use of technology in norwegian local-level follow-up services in the substance abuse field. however, the norwegian journal rus og samfunn published an issue in 2016, which focused on welfare technology in substance abuse services (renland, 2016). one of the articles describes a project in the kristiansand municipality in which ict tools were used in municipal services (haugjord & wivestad, 2016). the project included tools for collecting feedback from service users for service providers and rapid mental health diagnosis. haugjord and wivestad then stress the need to involve both service users and providers in the development process from the onset. in another article, bjelland, solheim, and rørendal 92 njsr – nordic journal of social research vol. 11, 2020 (2016) present a programme for cannabis withdrawal, and a third article covers challenges linked to health applications (apps), such as privacy and security (meisingset, 2016). the norwegian service context in norway, four regional health authorities are responsible for specialist treatment of drug and alcohol addiction, while municipalities are responsible for providing outreach services, community teams and follow-up services from specialist health services or in prison. the primary tasks of municipal services include helping out with issues such as work, housing, finances and leisure activities, and individual follow-up services and counselling are key elements of providing such assistance. there is significant heterogeneity in terms of how municipal welfare services, including substance use treatment services, are organized, with the most common set up being a specific unit that provides both substance abuse follow-up services and mental health services (dyrstad & ose, 2014). however, providing substance abuse follow-up care is not necessarily easy or straightforward. as a group, service users with drug and alcohol addiction issues have a diverse set of problems related not just to addiction but also to physical or mental health issues, social issues and finances. they face considerable stigmatization and marginalization in many social contexts, and many have been met with a lack of respect by those working in the welfare system (antonsen, 2008). user involvement is a central policy goal in the norwegian policy context. more specifically, the norwegian national action plan on alcohol and drugs states that user involvement is the first of five goals to ‘ensure genuine user influence through free treatment choice, more user-driven solutions and greater participation in the design of services’ (norwegian ministry of health and care services, 2015, p. 6). a central part of this plan is to increase funding to municipalities in order to improve services. 93 njsr – nordic journal of social research vol. 11, 2020 method research design our study was based on a series of focus group sessions with current and former substance users in four municipalities in the southern part of norway. we wanted to casually open these sessions to user reflections and the sharing of views concerning municipal follow-up services. we also wanted to create constructive discussion and idea generation regarding new solutions and improved services, with an emphasis on the innovative use of technology. to achieve these aims, we combined a relatively traditional focus group interview approach with ‘brainstorming’ and idea generation. each session lasted between 2.5 and 3 hours. the first part of each session was structured in a focus group format, during which we asked questions and then encouraged reflection and discussion with the participants. the themes of concern were the participants’ experiences with local municipal services, challenges in using these services, experiences with user involvement and ideas on how technology can be used to create improved services. in the second part of each session, we handed out post-it notes and a4 size paper so that the participants could write down the ideas emerging from the sessions, along with other ideas they might have had. in the last part of each session, we reviewed and discussed these ideas. two researchers were present for each session, one of whom had the main responsibility of taking notes. we tried to create a relaxed and open atmosphere so that the participants could feel at ease. we had pizza delivered, served snacks and drinks and made sure to take frequent breaks. our impression was that most participants appreciated the opportunity to share their thoughts and perspectives. the atmosphere was a bit tense at the beginning of some of the sessions, and the group dynamics varied between the meetings, but our overall impression was that we managed to create a relaxed setting in which most participants felt free to share their ideas and reflections. as researchers, we tried to find a balance between playing an active role in the conversations (e.g. by directly asking questions or trying out reflections) and serving as facilitators of user reflection and idea development. approval for the project was granted by the norwegian ombudsman for research at the norwegian centre for research data in april of 2014. the project was part of a wider project consortium, with the university of agder 94 njsr – nordic journal of social research vol. 11, 2020 serving as project leader. between 2014 and 2017, several workshops and seminars were held to discuss project progress and paper drafts. academics, researchers and user representatives participated in these discussions. recruiting participants the participants in the first three sessions were recruited through local service providers in three different municipalities. those in the fourth session were recruited with the help of a user organization. in the early phase of the project, we met with municipal social workers to gain access to participants and better understand the local contexts. our selection criteria for the municipalities were related to the overall framing and localization of the research project. the main project leader, the university of agder, is located in the southern region of norway, so it made sense for us to choose municipalities in the same region. the main criteria were that the municipalities should have a focus on service development and user involvement and that they would agree to help us recruit session participants. three of the sessions were conducted in midsized municipalities, while the fourth took place in a larger city municipality in the southern region. a total of 14 service users (five women and nine men) participated in four group sessions. three sessions took place in june of 2014, while the fourth was arranged in february of 2016. table 1. group sessions and participants session date number of participants women men 10.6.2014 3 1 2 11.6.2014 3 1 2 17.6.2014 3 1 2 2.2.2016 5 2 3 initially, our aim was to recruit only younger people (aged 18 to 25). the main argument for this was that younger people are more familiar with social media and new technologies. following dialogue with the municipalities, however, we chose to include some older participants, as there was a risk of non-attendance or withdrawal on the day of the sessions. altogether, 11 out of 14 participants were between 18 and 25 years of age, and 3 participants were between 30 and 95 njsr – nordic journal of social research vol. 11, 2020 50 years of age. overall, we found that this wide age gap was a strength, as it resulted in a broad spread of data. prior to participation, potential participants received a document with information about the project. it contained information about the research aims and objectives as well as informed consent. it also stated that participation was voluntary and that participants could withdraw at any time. it further stipulated that all participants were assured of confidentiality and that they would not be identifiable in project publications. we reiterated this information at the beginning of each session. data analysis our main data material consists of extensive notes, which we took during each session, as well as the users’ ideas, which were written down. the data also included some of our field notes containing our own reflections about the sessions. the sessions were not audio recorded. while in hindsight we think that recordings would have been advantageous, we also think that the choice not to do so contributed to the relaxed atmosphere we wanted in the sessions, since some participants might have reacted negatively to recording their conversations. we conducted a thematic analysis of the data material, in line with the approach outlined by braun and clarke (2006). this involved first becoming familiar with the data, labelling the data with initial codes, searching for broader themes to organize the codes and then reviewing and developing the themes further. in our analysis, the codes included ‘life situation’, ‘challenges with services’, ‘peer work’, ‘experiences with user involvement’, ‘technology-oriented ideas’ and ‘general ideas’. we also divided technology-related ideas into three categories: ‘information’, ‘communication’ and ‘organizing daily life’. these codes were sorted into broader themes. four themes emerged as most important: (1) user experiences and challenges with current services; (2) views on service development and technology; (3) the importance of peer support and (4) specific technology-oriented ideas for improving services. findings based on our analysis of the four sessions, we will now review the user reflections on technology and service development. the presentation of the 96 njsr – nordic journal of social research vol. 11, 2020 findings is structured according to the four themes developed in the data analysis. user experiences with services the participants emphasized the importance of individualization, availability and continuity while also identifying issues with coordination. we present these views briefly to give a sense of how the users conceptualized these services in a more holistic way. individualized services, with the user being the central focus, embody important values in local follow-up services, but these ideals can be difficult to implement in daily service delivery (dyrstad & ose, 2014). an important aspect of individualization is treating users with respect while demonstrating some curiosity about their individual situations. the users had many stories that contradicted this ethos, as illustrated by the following quotes: in all meetings, the person should be taken seriously. i have had many bad experiences with a system running over me. they do not listen properly to what i say are my needs, desires and views on situations. it doesn’t really take a lot, but show respect. professionalism and humanity [are important]. these statements point to the need for social workers to listen attentively to service users. the study participants, such as those quoted above, generally expressed that they had experienced a lack of user involvement and felt that they were not being heard. this was the case for both their individual situations and in relation to their involvement on a more systemic level. these are important conditions for establishing active co-production in daily service interaction. however, there were some differences in opinion; for example, one participant with a background in user representation had more experience in representing the user’s voice in different arenas. participants were also concerned about lack of access to services. in their experience, social workers were often hard to reach: it is very demotivating when you want to stop using drugs and those who should support you are not available. you end up in a queue on a call centre [line] when you need contact with a social worker. it does not help to have an appointment with the social worker three weeks ahead if you are desperate for drugs. you need help at that very moment. the users expressed the need for greater flexibility and increased capacity in the services they received. another concern was related to the fact that the 97 njsr – nordic journal of social research vol. 11, 2020 relationships between the users and service providers were characterized by high personnel turnover rates and instability. the following transcript of an exchange between two users sums up this view: user a: it’s important [to have] continuity and stability in relation to the services. we have many experiences of feeling insecure in meetings with the system. so it’s important with stability, that people are not frequently replaced. user b: now they have a new guy in. it is working out well, but he will quit in june. this makes me panic. they are the ones i go to when i need help. user a: it’s very tiring to explain the same things to new people all the time. user b: yeah, i had to explain again and again about things that were already agreed upon. consequently, due to staff turnover, these users had many experiences of repeatedly telling their life stories to new people or having to start all over in building relationships with new supervisors. while turnover in these services is unavoidable, it is important to be aware of the costs on the user side. the participants were also concerned about coordination and cooperation between services. many had had good experiences with one form of collaboration, namely responsibility group meetings (ansvarsgruppemøter). such meetings function as an important tool for the coordination of services around each user. in these meetings, professionals from different relevant services meet with the user in the same room to discuss goals, progress and how to resolve issues together. a coordinator has a central role in organizing this type of meeting. this arrangement can be conceptualized as an ongoing and institutionalized form of co-production, emphasizing user voice, participation and integration of services in the local welfare system (osborne et al., 2016, p. 647). overall, our study participants were quite positive about this process and underlined the importance of mutual trust in making it work. as one participant said, when you ask for help, you must get a responsibility group (ansvarsgruppemøter), which follows you throughout, and trust is crucial here. there should not be any time limit to receive follow-up. however, several of our participants alluded to the need for better coordination. research has shown that coordinated aftercare and follow-up treatment are a critical element in the long-term recovery of substance users (dahle & iversen, 2011; nordfjaern, rundmo, & hole, 2010). in fact, there has been considerable 98 njsr – nordic journal of social research vol. 11, 2020 critique in the norwegian context of the lack of coordination between actors receiving substance abuse treatment and the municipalities responsible for follow-up and aftercare (norwegian ministry of health and care services, 2015, p. 25). our study participants also highlighted these issues as crucial. users are in a vulnerable situation when they leave treatment, often left with a weak network and high levels of insecurity. as another participant said, [there] should be close follow-up from the nav [norwegian labour and welfare administration] office and other service providers. we need support when we leave treatment and enter follow-up services. this could be either from a social worker or from a peer/coordinator. while certainly essential, this process is challenging, as it requires coordination between municipalities and specialist treatment services. there is also a need for some level of coordination among different municipal actors, such as substance abuse follow-up services and the local labour and welfare administration office (nav). views on technology and service development having established this range of challenges as a background to our discussion, we move on to explore how technology can contribute to resolving the issues identified with the services. looking back, it is quite clear to us that, initially, we had some preconceived and over-optimistic notions about the potential application of technology in the field of substance abuse treatment. however, several of the study participants had doubts about this focus and challenged us in the sessions. according to one participant who was especially clear on this, ‘to develop an app can be the wrong place to start’. this participant was sceptical about adopting such a narrow focus on technology, pointing out that there were other more pressing issues. in contrast, the participants introduced what can be referred to as a more holistic approach, where human relationships are the primary focus. they were concerned about the importance of face-toface meetings with real people in the services and developing meaningful relationships. drawing this distinction between the ‘unreal’, artificial online world and the real offline world is common and has been discussed in earlier studies (angouri, 2015, p. 324; bell, 2001). this statement from one participant in the fourth session is particularly illustrative of this point: i think all the apps are very scary. you need people. there are enough apps. i meet people through my contacts. i miss people. if you need a person to talk to, it can be a bureaucrat. there is too much focus on other things than the individual. 99 njsr – nordic journal of social research vol. 11, 2020 many users stated that they struggled with loneliness and limited social networks; some had a history of losing touch with their families and noted that they missed meaningful daily activities. their relationships with their social workers and their participation in social services were, therefore, very important to them. one participant wrote on a post-it note, ‘technology must not replace the relationships between social workers and the [service] users’. some of the service users’ stories were characterized by experiences of inflexible services, which were only available during office hours; distant, overworked social workers and rigid bureaucracies with excessive paperwork and other demands. these participants also viewed ict as part of the problem and associated it with rigid inflexibility, limited availability, cost cutting and standardization. another underlying reason for the scepticism regarding technology among some of the study participants was based on their telephone interactions and issues regarding website accessibility. as one participant said, ‘thinking about accessing a web page to get help makes me so stressed. i prefer to use the phone and call. the simpler, the better’. several participants also had what they called ‘phone fear’, especially when they have to make a call to a public service agency. they had negative experiences relating to not getting needed help, being put on hold in endless telephone queues and not getting through to the right person in the municipality. others pointed out that basing services entirely on mobile phones can be problematic. many users’ lifestyles are characterized by a high risk of frequently losing or selling their phone and being without a phone for long periods. in short, we found considerable variation between the participants concerning their views on technology and how they relate to technology in their lives, with these views ranging from positive to highly negative. consistent with the previous literature, these findings highlight the importance of grounding new solutions on specific knowledge about user preferences, needs and the different contexts in which users live their lives (see owens et al., 2011; van hout & mcelrath, 2012). the findings also underline the significance of the initial exploration phase in innovation processes (forshaug, 2015). this phase is structured around facilitating an understanding of the situation and context of service users and other actors involved. as such, this phase is especially crucial given that the other phases (creation, reflection and implementation) build on this knowledge. strong user involvement is important in all stages, perhaps especially so in the exploration phase. 100 njsr – nordic journal of social research vol. 11, 2020 the importance of peers several of the participants highlighted the benefits of developing relationships with peers and other helpers who have personal experiences with receiving services: [there] should be more use of consultants with user experience. [it is] important to see people, not just their diagnosis. [there should be] better use of peers. [there should be] cooperation between the municipalities and organizations so that the best interests of the users are taken care of. discussing and sharing information with peers who understood them was described as an important experience. our respondents saw this as both valuable in itself and as a necessary prerequisite for their empowerment. a general observation from across the sessions was that the participants were especially concerned with creating opportunities for connecting with peers. one set of ideas emerged regarding the use of social media or online discussion forums, where support groups could be formed, along with participation from user organizations. these ideas point towards the need to develop collaborative online platforms or a form of sharing economy, with peer-based activities through which participants could share experiences, information and services (hamari, sjöklint, & ukkonen, 2016). many of the participants seemed to think in terms of a three-way cooperative structure, where users, skilled peers and professional social workers were equal partners. this framework exhibited clear aspects of co-production, with the aim of developing stronger interactive relationships by connecting service practitioners, skilled peers and service users in new ways. this line of thinking can be illustrated as a ‘co-production triangle’, as shown in the figure below. 101 njsr – nordic journal of social research vol. 11, 2020 figure 1. co-production triangle between users, service provider and skilled peers specific user ideas most of the session participants had several ideas on the ways in which ict and other forms of technology could work to improve services or help with the management of their particular situations. in this section, we present the ideas discussed in the sessions. chatting with social workers or having a ‘chat mentor’ one of the ideas mentioned involved communicating with social workers through text-based chatting, which can have some advantages over talking on the phone, such as an increased sense of anonymity. as one participant said, a channel for chatting would be experienced as safer. sometimes, it is easier to write than to talk. writing can lower some barriers. many people could be helped if the barriers were lower. some people are afraid of telephones. the participants also pointed out that such a service should have extended opening hours, preferably 24/7, as the main point would be to lower barriers for connecting with this service. one participant also mentioned the possibility of having a ‘chat mentor’, i.e. someone who follows you over time and provides motivation: one could have a button to press so that it is possible to engage a supporter or a mentor. sometimes, one only needs a person to drink coffee with. they can be linked up through an app. 102 njsr – nordic journal of social research vol. 11, 2020 the participants also noted that a chat service connected to persons with their own user experiences (peers) would also be beneficial. online discussion forums with these kinds of mentors could also be helpful. a map in the ‘service jungle’ one problem pointed out by several participants was that while there was a considerable amount of help and many services available, information about these services remained scarce. they explained that there are many relevant services and organizations that can help, including public, non-profit, civil society and user organizations and private initiatives; however, trying to access them can be like walking through ‘a jungle’. regarding this matter, one participant said the following: there are a lot of offers out there. what you need is a portal. it feels like there are 40 posts hanging around in nature but no map showing how to find them. nobody has a map. an online portal could include information about the various organizations and services and about issues pertaining to users’ rights. it could provide clear, concise information and would be useful for both users and their families. either a web-based portal or one available through a mobile app could work here. booking appointments and everyday structure many participants had problems organizing their everyday lives. several wanted an easier way to book appointments with municipal agencies. an appointment tool with a calendar connected to the social worker’s schedule would make services more transparent and accessible. such a tool would allow participants to book appointments online when needed. other key issues and challenges emerging from the sessions were related to keeping track of appointments; creating a structure and sticking to it; budgeting and financial planning and following medication guidelines. one participant noted that it could be useful to have an app which integrated the different needs in terms of structure, finances and medication. discussion overall, the study participants viewed service development and technology issues in a nuanced and holistic way. during the sessions, they drew a larger picture of their service experiences and the challenges they faced in terms of 103 njsr – nordic journal of social research vol. 11, 2020 the lack of individualization, continuity, availability and flexibility in services as well as issues with coordination and collaboration. it is clear to us that remaining cognizant of these factors is crucial when developing services in general and especially with regard to technological innovation. issues of organization, user accessibility, technology and service content cannot be clearly viewed or effectively addressed in isolation. we contribute to the literature on co-production and the impact of technology by pointing to the risks and uncertainties associated with technology in service delivery, as seen from the user’s perspective. the participants were concerned that technology could have negative consequences on service quality; decrease the availability of social workers and supervisors; replace human relationships; be part of cost-effectiveness and budget cut strategies and lead to a more standardized bureaucracy. these views have some parallels with discussions about technology and services in the social care sector, where ‘cold technology’ is typically portrayed as a threat to ‘warm hands’ (pols & moser, 2009). through an analysis of the empirical material, we conceptualized three different forms of co-production, namely co-production understood as regular service interaction between users and frontline employees; the ‘co-production triangle’ as a conceptual model for service development and sessions as ‘pockets of coproduction’ involving users and researchers. regarding co-production as daily service interaction (e.g. ansvarsgruppemøter), we found that user participants were well aware that interactions between service providers and themselves form the heart of the services they rely on. they experienced challenges relating to the lack of individualization, user involvement, participation, continuity and coordination. as they reflected on the challenges faced and the potential for new technological solutions, they emphasized the importance of strengthening human relations. technology can play a positive role if it supports existing relationships between people, such as by strengthening and facilitating access to social workers, social services and peer support. we also present the idea of the co-production triangle as a conceptual model. co-production models usually focus on two actors: service providers and users (bovaird, 2007; nabatchi, sancino, & sicilia, 2017; osborne et al., 2016). we argue that the co-production triangle represents an expansion to this idea by introducing peers as a third actor, with a mediating role between the other actors. many participants highlighted the benefits of receiving support from peers based on their own user experiences. in this triangle, technology can be used to facilitate and strengthen relations between these three actors. 104 njsr – nordic journal of social research vol. 11, 2020 this study was an attempt at creating ‘pockets of co-production’ involving service users and researchers, which take place outside regular service interaction. we believe that this approach of exploring user experiences through ‘pockets of co-production’ has contributed some important insights, particularly concerning user ideas for integrating digital technologies in service delivery. all the actors involved have experiences, interests and agency that need to be acknowledged, especially in the design and development of new services. the study participants stressed the importance of setting up inclusive processes when developing services. nevertheless, we also acknowledge the limitations of our research. first, the sessions involved a limited number of users. a research design involving a greater number of users and sessions might have provided richer empirical material. furthermore, repeatedly engaging with users and practitioners over a longer period of time could have enabled us to achieve a better understanding of the lived experiences and local service context as well as strengthened the potential for co-production in the project. involving service practitioners in integrated or separate sessions would also have opened up the potential for more ideas to be developed and would have strengthened the co-productive dialogue between users, service providers and researchers. conclusion in this article, we presented service user perspectives and reflections on the potential of using new forms of technology to improve municipal substance abuse services, such as follow-up and aftercare. the study participants were all users of these services, and they expressed both scepticism and optimism towards new forms of technology. some warned that technology could replace human interaction and lead to services of poorer quality. the participants were also concerned about individualization, service availability, continuity and coordination, but there was a general consensus that new uses of technology could improve services if, for example, they lead to increased availability and easier interactions with social workers or supervisors. lastly, the participants highlighted the importance of receiving support from peers with user experiences as well as the benefits of what we call a ‘co-production triangle’, which includes social workers, skilled peers and users themselves. our findings indicate that better cooperation between users, peers with user experiences, service providers and researchers could contribute to innovation in the provision of substance abuse services. we need to expand our 105 njsr – nordic journal of social research vol. 11, 2020 understanding of how individuals and technology can interact. the coproduction triangle could be a good starting point for further research and the exploration of new forms of co-production in this field. references angouri, j. 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(2018). researching drinking 'with' young people: a palette of methods. drugs and alcohol today, 18(1), 6-16. https://doi.org/10.1108/dat08-2017-0036 microsoft word pdf lundberg and stranz a matter of choice njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 10, 2019 a matter of choice—professionals’ views on the incorporation of practical work with intimate partner violence into swedish personal social services lisa lundberg* department of social work stockholm university email: lisa.lundberg@socarb.su.se hugo stranz department of social work stockholm university email: hugo.stranz@socarb.su.se *corresponding author abstract during the last decades, efforts have been made to increase local support provided to victims of intimate partner violence (ipv) in sweden. as with other social problems, responsibility to address ipv falls on the municipal personal social services. the present article draws upon data obtained via structured telephone interviews with designated personal social services staff members from a sample of 99 municipalities, focusing on aspects of potential progress in social work with ipv. the results show that successful incorporation of ipv into personal social services largely seems to depend upon the commitment and dedication of individual actors within the organisations. furthermore, the data indicate that competence in this field depends on personal inclination, with attention to ipv appearing as ‘a matter of choice’. the results are analysed using neo-institutional theory as well as concepts related to social movement studies, with focus on individual agency in organisational change and the potential relevance of ipv as an issue related to gender inequality to gender inequality. the analysis suggests that while ipv social work may challenge institutionalised practises within social services, change may go both ways with ipv being reframed to fit within the established framework of social services. njsr – nordic journal of social research vol. 10, 2019 49 keywords: intimate partner violence, domestic violence, social services, organisational change introduction as in many other affluent nations, the swedish women’s shelter movement emerged from the greater radical feminist social movement during the late 1970s. a basic principle of this movement was the idea of women helping other women, not only by providing individual support but also by instigating political change. the movement has been largely successful; men’s violence against women has been placed on the agenda of the un, the eu and national governments (e.g., european union agency for fundamental rights, 2014; cf. garcia & merlo, 2016). likewise, in compliance with the nordic council of ministers’ (2005, 2017) goal to increase gender equality, the swedish government has made eliminating men’s violence against women a central goal. over time, by gradually raising awareness of men’s violence against women, this social problem has been recognised by swedish social services. in contrast to the non-government sector, social services are not only bound by a large number of rules and regulations but also demand professionalism and handling of social problems on an individual level (lehrner & allen, 2009; mehrotra, kimball, & wahab, 2016; stranz, wiklund, & karlsson, 2016). this implies that, as men’s violence against women has been incorporated into social services, the more political aspects of the issue as it was expressed by the feminist social movement have somewhat diminished (see barrett, almanssori, kwan, & waddick, 2016; lehrner & allen, 2009). the social services act (sfs 2001:453), which regulates all municipality-based social work in sweden, is a framework law that gives municipalities extensive autonomy to organise and carry out services. while such discretion renders it possible to adapt both services and organisations to meet the specific and local needs of individuals, it also leads to variation in how services are carried out (stranz et al., 2016). consequently, official reports identify general difficulties and local variations in the incorporation of intimate partner violence (ipv) into social service organisations (national board of health and welfare, 2014; sou 2004:121; sou 2015:55). while some organisations have provided specialised support for decades, others have not yet started to develop services focusing on victims of ipv (national board of health and welfare, 2014; sou 2014:71). also, one concern is that ipv services, when developed, may fail to become well-established and integrated parts of regular organisations (sou 2015:55; cf. the nordic council of ministers, 2017). lack of resources, weak local njsr – nordic journal of social research vol. 10, 2019 50 political initiatives or determination and conflicting understandings of the nature of the problem are some of the suggested barriers to the development of effective social work responses to ipv (e.g., barrett et al., 2016; ekström, 2018; häggblom & möller, 2009; sou 2004:121, sou 2015:55). given the responsibility of municipalities to provide support and services to victims of ipv, factors that may impede or increase the opportunities for successful integration of this group into local social work practice ought to be examined. the present study builds on interviews with ipv coordinators and other members of staff with a more or less formal responsibility of introducing, developing and/or handling ipv in swedish social services. the development of ipv coordinators, who are usually responsible for exploring, initiating and developing services related to ipv, has been a widespread approach for implementing ipv services in swedish municipalities. this position is usually mandated to instigate organisational change, such as through the introduction of new administrative routines related to the identification or investigation of ipv cases or increases in staff members’ competence through training initiatives. in this article, we aim to analyse these professionals’ views on organisational conditions that promote or hinder incorporation of ipv into municipal social services. the following research questions are addressed: which conditions or features are stressed as important for facilitating the incorporation of ipv into social services? which aspects or circumstances are considered barriers to the incorporation of ipv into social services? drawing upon a theoretical framework comprised of neo-institutional theory and social movement studies and given the specific circumstances of swedish social services and ipv, how can the processes of organisational change and resistance be understood? background during the last decades, ipv has been recognised as a gender-based problem affecting women’s access to equal rights, physical safety and integrity (e.g., garcia & merlo, 2016; jonassen, 2013; sou 2004:121; steen, 2003). for a long time, the women’s shelter movement has been the main actor offering support to ipv victims and working to raise awareness of ipv, with engagement of voluntary staff as one of its core principles (eduards, 2002). from a feminist standpoint, violence against women is partly a cause and partly a consequence of structural inequality, which implies that the risk of violence njsr – nordic journal of social research vol. 10, 2019 51 affects women beyond those who are actually victimised (hearn, 2013; lehrner & allen, 2009; wendt höjer, 2002). by the early 2000s, it was acknowledged in both academic research and national government investigations that ipv was a prevalent experience among women in general (lundgren, heimer, westerstrand, & kalliokoski, 2002; sou 2004:121; wendt höjer, 2002). today, however, with the expansion of both research and practice, there are multiple perspectives on ipv not only in academia but also in politics and practical social work (mattsson, 2013; nilsson, 2009; steen, 2003). further, as a central provider of ipv services, the women’s shelter movement has increasingly moved towards collaboration and professional legitimacy (e.g., wies, 2008; barrett et al., 2016; mehrotra, et al., 2016). in general, swedish municipal social service organisations consist of two main branches, one of which provides care to the elderly and disabled and one of which—so-called personal social services— provides services to (non-disabled) children and adults. by tradition, the main focuses of personal social services are provision of child welfare services, (non-medical) treatment of substance/alcohol abuse in adults and administration of social assistance benefits. personal social service organisations also tend to be specialised in accordance with these core domains, for example, child welfare services may be performed in units that are organisationally separated from those that administer social assistance benefits (e.g., stranz et al., 2016). hence, there is an obvious risk that social problems such as ipv, which are not directly related to any of these core domains, fall into an organisational vacuum (cf. ekström, 2018; lundberg, 2018). national regulations and recommendations regarding municipal social work practice in sweden are issued by the national board of health and welfare. the regulations regarding social work with ipv (sosfs 2014:4) stipulate that local social services should assess the needs of ipv victims seeking assistance and offer services based on their individual needs for shelter and support. nongovernment actors may act on assignment of the social services to carry out services to victims of ipv. although the national board of health and welfare states that all social service caseworkers should have the knowledge and skills needed to handle cases that involve ipv (sosfs 2014:4), ‘competence’ and ‘skills’ are not clearly defined. in fact, empirical data indicate that swedish social workers consider themselves rather ill-equipped to handle ipv cases (lundberg & bergmark, 2018). since the late 1990s, government funding has been continuously allocated to municipalities intending to develop ipv routines or services. the first official government report on how ipv is handled in public agencies (sou 2004:121) njsr – nordic journal of social research vol. 10, 2019 52 indicated that implementation of ipv support had been unsuccessful not only within the social services but also in a number of other agencies. lack of prioritization and resource allocation as well as insufficient co-operation between agencies were some of the problems specified (sou 2004:121). later reports show that the professional field of ipv is generally expanding in sweden, but considerable investments have been linked to short-term projects and, hence, have not left a lasting impression on current practical social work (sou 2015:55). in the broader nordic context, aspects such as a top-down implementation approach, reluctance to allocate resources and lack of commitment to ipv have been identified as factors resulting in a rather limited effect (e.g., jonassen, 2005; häggblom & möller, 2009; the nordic council of ministers, 2017). there are also studies that point out the significance of political and leadership priorities at the local level, including allocation of resources, organisational support and appointment of responsibility to specific staff members (e.g., ekström, 2018; hjalmarson, 2015; münger, 2015, swedish association of local authorities and regions, 2016). theoretical considerations neo-institutional theory has shown how organisations establish frameworks of rules and taken-for-granted practices in the form of norms, routines and beliefs through processes of institutionalisation (powell & dimaggio, 1991; scott, 2005). within the field of locally governed social work, institutionalisation may influence, for instance, organisational structures, the distribution of resources and day-to-day routines. incorporation of a social problem such as ipv into the practices of long-standing personal social service organisations demands some degree of change in institutionalised routines and arrangements (cf. campbell, baker, & mazurek, 1998). however, neo-institutional theory points out that established structures are difficult to change: as institutionalisation provides stability it also embeds individual actors in the ideals and norms of their surroundings (powell & dimaggio, 1991; scott, 2005). still, change is an important part of the institutional theory of organisations, with one approach focusing on how conflicting institutional logics can enable institutional entrepreneurs or other agents of change to reform practices within a field (scott, 2005). while neo-institutional theories have evolved around the dilemma of structure and agency when approaching institutional change, social movement studies have drawn attention to the extra-organisational identities and values of organisational actors, focusing on aspects of power and social beliefs (mcadam & scott, 2005; scully & segal, 2002). scholars combining social movement njsr – nordic journal of social research vol. 10, 2019 53 studies with organisational theories have described activists’ attempts to change organisations from the inside, either single-handedly as tempered radicals instigating organisational change while balancing between their conflicting loyalties to their professional identity and personal values (meyerson & scully, 1995) or collectively organised as workplace grassroots activists (scully & segal, 2002). the individual tempered radicals described by meyerson and scully (1995) come across as more reluctant and ambivalent change agents who draw motivation from their personal identity or political beliefs while remaining committed to their professions and organisations. workplace grassroots activists, on the other hand, tend to collectively mobilise in opposition to injustice or oppression, drawing support from a broader social movement (scully & segal, 2002). despite their differences, both the radicals and activists are united by the fact that they bring outside interests and strategies into their workplaces, challenging their fields’ institutional power structures. when analysing the prerequisites for ipv social work, an approach that combines social movement perspectives with neo-institutional theories is particularly relevant. men’s violence against women have been brought into the public eye and national politics by a successful social movement, but general societal changes towards neoliberalism, increased individualism and professionalisation have changed the conditions in which the problem may be tackled (e.g., barrett et al., 2016; mehrotra et al., 2016). in a time of increased formal municipal responsibility with regard to ipvservices, changes in the swedish welfare state has made non-government organisations more and more taking on a role of social services providers acting on assignment of municipalities (johansson, arvidson, & johansson, 2015; cf. lehrner & allen, 2009). women’s shelters still play an important part in the provision of support to victims of men’s violence, but their services are increasingly regulated as ipv social work becomes a municipal obligation. this may indicate that women’s shelters are shifting away from their role in a vocal social movement and towards their role as service-providing actors with professional staff. even though this process not in any way is delimited to this issue, but rather part of a larger change (cf. lundström & wijkström, 2012), professionalisation in the field of ipv demands for less identification with victims of violence than what has been distinguishing for the radical feminist movement (wies, 2008). njsr – nordic journal of social research vol. 10, 2019 54 methods the article is based on data obtained via structured telephone interviews with staff members who formally (e.g., ipv coordinators or frontline managers; n=54) or informally (e.g., social workers who investigate ipv cases on a regular basis or are assigned to initiate organisational change regarding ipv through the development of administrative routines, although they are not given the formal title of ipv coordinators (n=45). the staff members were recruited from 99 swedish municipalities, with one interview in each municipality. the interviews were carried out in 2014, and the municipalities were randomly drawn from three strata based on size: (1) ≤ 15.999 inhabitants (n=25), (2) 16.000–59.999 inhabitants (n=50) and (3) ≥ 60.000 inhabitants (n=25). as only one municipality in strata 2 was unable to find the time for an interview, the external response rate was 99 per cent. the sampling frame consisted of all swedish municipalities (n=290), except the three largest cities (stockholm, gothenburg and malmo), which are divided into city districts. as the present data is part of a larger research project that consists of both qualitative and quantitative data sets (for further studies conducted as part of this project, see lundberg, 2017; lundberg & bergmark, 2018), such divisions into cities districts renders it impossible to gather information that is valid for the municipality as a whole. nearly all the respondents (97 of 99) were women, and the interviews were conducted with the support of an interview guide consisting of questions with set responses as well as open-ended questions. the guide covered a wide range of aspects related to the organisational prerequisites for municipal work with ipv (e.g., formal/informal routines for intake and processing ipv cases; collaboration with actors within/outside of the personal social service organisation; provision of services to ipv victims, perpetrators and children that have experienced violence). in this article, we examine responses to three questions: (1) what circumstances do you consider to facilitate or to obstruct the development of ipv work in your organisation? (open-ended responses) (2) if you were asked to reorganise your workplace in order to enhance its ability to handle ipv cases, what type of organisation would you visualise? (open-ended responses) (3) what is your opinion about the current level of knowledge concerning ipv within your organisation? (set responses—a=high, b=fairly high, c=uneven, d=fairly low, e=low—followed by open-ended questions intended to clarify and deepen the responses) njsr – nordic journal of social research vol. 10, 2019 55 we also included remarks or arguments related to the aim of this article that arose in other parts of the interviews. the interviews were not recorded, but careful notes were taken and longer responses were read back for verification. each interview lasted for approximately 45–60 minutes. the data were analysed by a combination of directed and conventional qualitative content analyses (cf. hsieh & shannon, 2005). on the one hand, the analysis was guided by the issue focused upon in this article: the incorporation of a ‘new’ professional field into a pre-existing organisation. this, in turn, was based on a theoretical framework that combines perspectives from social movement studies with institutional theory. on the other hand, as the body of knowledge on the organisational prerequisites for municipality-based work with ipv is considered meagre, parts of the analysis were guided by the data rather than the theoretical framework used for the article. initially, all open-ended responses and clarifying remarks were read and assigned to one of eight more or less pre-defined categories or to a general, non-defined category that emerged while examining the data. in the next step, points in common between (shared by) categories were identified and the data were reorganised into three final themes: (1) a matter of personal commitment, (2) developing expertise and (3) too personal and too political. under the first of these themes we address the facts that practical work with ipv seems to largely depend on individuals’ commitment to the task and attention to ipv and skills related to this area appear to be a matter of choice. under the second theme we present results that are centred on possibilities or hopes of increasing professionalism in the field of municipal work with ipv. tension concerning the issue of ipv itself is related to the third theme, where aspects of commitment as well as resistance are brought forward. to increase transparency and give a more vivid presentation of data, we provide excerpts from the interviews in this article. however, as the interviews were not recorded, all quotes are derived from the notes taken during interviews. this implies that there may be some limitations with regard to details in phrasing. other methodological limitations of the study should be stressed. first, as pointed out, the interviews were carried out in a randomly selected sample of swedish municipalities (n=99). the municipalities varied with regard to factors such as population size, sociodemographic conditions and geographical location, enabling us to cover a greater part of the country and thereby a large variety of the organisational prerequisites for practical work with ipv, but excluded the three largest cities in sweden. it is possible that interviews with relevant staff in these cities would have added perspectives on factors that might promote or hinder the incorporation of ipv into pre-established personal njsr – nordic journal of social research vol. 10, 2019 56 social service organisations. second, since we focus on personal social services, significant parts of swedish social services are excluded. hence, even though our results may be partially applicable to other aspects of social service organisations, there is an obvious need for further research on how the establishment of ipv support and services can include the diverse needs of victims of ipv in the social services context as a whole. findings a matter of personal commitment a personal interest in and commitment to ipv was a recurrent theme in the interviews that was related to successful organisational adjustments, development of expertise and varying levels of ipv proficiency among frontline social workers. regarding factors that promote work with ipv, respondents spoke of devoted individuals who pushed work forward. in fact, commitment and devotion were pointed out at various levels of the municipal hierarchy. in some cases, the respondents highlighted specific staff members (or themselves), and in other cases, they referred to managers or politicians. regardless of the level at which these actors were positioned, they seemed to play a significant role in raising awareness or upholding ipv work in the municipalities. it is hard to make the politicians understand that ipv is something that has to be prioritised. but i have a manager with a passionate interest; it is necessary with someone who pushes the work forward, who carries the torch. (front line manager, municipality 64) the importance of politically prioritising ipv was often mentioned by the respondents. those striving to achieve greater prioritisation were frequently referred to using terms that indicate devotion and dedication. it was implied that people working to promote and develop the field of ipv are spurred by an interest beyond what is expected of them. the work has been pushed forward partly through pressure from the national board of health and welfare and partly by the two of us, who are dedicated to this. we have been given carte blanche by the manager and, thanks to our colleagues, we have been able to continue our education and draw up routines, etc. (social worker, municipality 97) in some cases, devotion to ipv was referred to as a secondary activity or a line of work performed outside of regular duties that, as in the quote above, was only made possible by support from colleagues. at times, it appeared to be carried out almost as an individual mission, independent of organisational support. njsr – nordic journal of social research vol. 10, 2019 57 in addition to being referred to as a condition that promotes incorporation of services and routines into organisations, commitment was described as a grounds for ipv skill and competence among caseworkers in general. acquiring knowledge about how to handle cases involving violence was often related to the level of social workers’ individual commitment. the level of skills is rather low […] i think it has to do with personal commitment. those who take an interest [in ipv] have acquired skills. we have relatively few [ipv] cases since people don’t ask about violence. (front line manager, municipality 9) describing ipv skills as dependent on individual commitment implies that such skills are not expected of social workers. an individual commitment to the issue of ipv was associated rather to personal preferences than to professional responsibilities, making ipv seemingly an issue possible not to attend to. as a condition promoting incorporation of practical work with ipv, dependence on individual commitment seems like a source of variation between both units and municipalities. the level of knowledge is uneven between different units [… and is] tied to individual staff members. some examples are scary; psychological violence is considered as nothing, but physical violence, that is real violence. (ipv coordinator, municipality 41) developing expertise a great majority of the respondents emphasised the need to develop or expand ipv expertise within personal social services. in most municipalities, some specialisation had already been developed, and it was apparent that the respondents based their desire for further development on what already existed. the respondents in smaller municipalities mainly hoped for time explicitly allocated to ipv, as opposed to trying to fit work with cases of violence in between other tasks. in the larger municipalities, many respondents expressed a wish to establish separate ipv units or teams. a lack of ipv-specific resources was frequently mentioned in relation to the significance of political and managerial prioritisation of ipv as well as the context of legitimacy. work done with violence is much about how high priority the issue is given in the council and with the managers. some slow it down, others are committed. i would wish the municipality to raise the issue in all sectors. it does not have real legitimacy yet, far from it, but it is getting better. it is obvious that violence is not yet an area in its own right. (ipv coordinator, municipality 31) respondents argued for the development of specific ipv expertise, mainly by pointing to a likely increase in the quality of case work and support. they related their thoughts to what they perceived to be randomness in the quality of ipv njsr – nordic journal of social research vol. 10, 2019 58 investigation due to varying skills and routines between organisational units and individual social workers. ipv being handled by units mainly focusing on other social problems was frequently stated as a significant problem. in order to increase the quality of practical work with ipv, respondents called for ipv to be viewed a specific social problem that requires specific competence. but the demand for specialised competence implies not only proficiency in casework but also a certain amount of pressure on organisations to maintain focus on ipv. specialisation is needed to keep focus on the violence; in order to perform risk assessments and investigations of high quality, one has to work a lot with violence. it is easy to lose focus otherwise. (front line manager, municipality 43) the matter of ipv being left out from both organisational agendas and practical casework was frequently underlined. with ipv not being a professional field of its own, respondents spoke of continuous efforts to keep the issue from getting neglected. you can never relax; you always have to be there and point out violence— it keeps disappearing, as in new treatment methods. every other case includes violence, especially in child and family cases. all the time, one needs to uphold the issue of violence. (ipv coordinator, municipality 22) one suggested solution to resource-related problems was development of ipv specialisation within other areas, particularly child welfare services, or relocation of staff from other units to teams or groups working with ipv. the respondents argued that with ipv specialised case workers within child welfare services, aspects of violence would not risk getting lost when parents and children are investigated. this approach, however, does not necessarily imply a desire to transfer resources; it may be understood as a request to include ipv in the work performed within other areas of competence. this line of reasoning suggests that many of the concerned clients are already present within the organisation, but their experiences of violence are not properly or sufficiently addressed. many respondents referred to general financial hardship within personal social services and pointed out that practical work with ipv is characterised by loss of expertise due to cutbacks and staff turnover. dependence on temporary project funding was a recurrent problem and there are indications that the process of incorporating practical work with ipv into pss may in some municipalities be moving in reverse. in a few interviews there were reports of organisational measures being taken to circumscribe demands, for example by not advertising ipv services when there is a waiting list. other respondents worried about the financial consequences of increased competence and routines. the social services are always under financial pressure. if everyone is to be screened for violence, the number of ipv cases will increase. will njsr – nordic journal of social research vol. 10, 2019 59 resources be enough then? i have heard of other municipalities that quit asking since there were too many cases. (ipv coordinator, municipality 32) too political and too personal while there were reports of organisational progression on the one hand and slow-changing organisations on the other, some of the respondents had faced more open resistance to incorporating ipv into personal social services. mainly, they related this opposition to the issue itself; they described the gendered aspect of ipv as challenging to underline, as it touches upon a general and societal lack of gender equality. as pointed out by one respondent, equality as an ideal might become a barrier when that ideal grows into a normative standard and even a general view on the state of affairs. the issue of men’s violence against women is not taken seriously; it is controversial to point out the gendered aspect, since we are supposed to have gender equality in sweden. (ipv coordinator, municipality 41) when ipv is related to inequality and patriarchal structures, the problem takes on a more political dimension, as does the (lack of) resources and prioritisation of incorporating social work with ipv. we still live in a patriarchal society. this is still a women´s issue. […] we have faced a lot of resistance. violence is so tricky. it is hard to investigate, time-consuming and people get annoyed with the women for them not being able to protect their children and all that. (social worker, municipality 21) when ipv was put into the context of gender inequality, the similarities between professional work with ipv and the women’s shelters movement, which may be viewed as a feminist activist movement, were described as a possible source of ideological tension. there are those who think people should not listen too much to [ipv specialists]; they say they are like those women’s shelter activists. (ipv coordinator, municipality 80) one basic principle of the women’s shelter movement is drawing attention to the high prevalence of ipv as well as the diverse group of women experiencing violence. as ipv is considered part of the female experience of oppression, it has been stressed that victims of ipv do not differ from women in general. this view was observed in some parts of the interviews, when respondents related the difficulty of working with ipv to personal experiences among staff members and personal attitudes towards gender and equality. i have never experienced such resistance against any other issue. […] it might be about personal experiences, about women and gender, about njsr – nordic journal of social research vol. 10, 2019 60 their own lives. there needs to be more done for staff members who have been abused. (social worker, municipality 21) the suggestion that staff members have personal experiences with ipv is supported by the prevalence of the problem, and it may be related to the framing of men’s violence against women as a problem that affects women in general, disregarding social class, age and ethnicity. apart from the matter of personal experience, ipv was depicted as an intimate and generally upsetting problem, raising fear and apprehension among staff members and setting it apart from other social problems. violence is difficult, scary and personal. there is a difference between education and skill that involves personal ability. (ipv coordinator, municipality 85) the efforts of the feminist movement to raise public awareness of violence against women may be considered a success given the national political attention this issue has received. however, this notion may be disputed due to respondents’ emphasis on the significance of personal commitment in the process of incorporating ipv into social work. social workers handle a large range of social problems, yet ipv was described as an issue relying upon personal commitment and devotion and evoking personal concern, fear and resistance. discussion and conclusion the aim of this article has been to analyse conditions that promote or hinder local development of social work with ipv by examining the experiences of those working to integrate ipv into swedish personal social services. our results show that the respondents largely associated successful incorporation of ipv with the dedication of individual actors within their organisations. while carrying out their work, these staff members were described as being devoted to ipv beyond their professional obligations. as individual social workers taking a special interest in the area of ipv appeared as an important feature of organisational change, skill with regard to ipv came across as ’a matter of choice’ rather than a natural part of professional competence. the focus on personal commitment as a fundamental factor for organisational change within social services parallels the original idea of a social movement. however, change efforts associated with social movements are typically mobilized collectively, for instance in the form of workplace grassroots activism (cf. scully & segal, 2003). as organisational change in this context seems to be initiated and led by individuals rather than a collective, the results indicate that the respondents—or those mentioned by the respondents—bear more njsr – nordic journal of social research vol. 10, 2019 61 resemblance to the tempered radicals described by meyerson and scully (1995) than to grassroots activists. when questioning and challenging institutionalised practices from within organisations, these actors aim to transform what is considered as personal commitment into professional expertise. the potential success of individual efforts depends on the level of organisational support one receives (cf. ekström, 2018). in order to gain access to support, one needs to adapt to the norms, routines and beliefs that characterise one’s organisation (cf. powell & dimaggio, 1991; scott, 2005). in social services, this implies greater emphasis on professionalism and specialisation, while a more radical, macro-oriented approach towards ipv could be less likely to achieve legitimacy. this strive for increased legitimacy is mirrored by a similar process within the contemporary women’s shelter movement in which the function of service provider call for deemphasised activism in favour of professionalism (cf. mehrotra et al., 2016; wies, 2008). instigating organisational change may stir up opposition as making room for a new area of expertise can put the resources allocated to other areas at risk. professional legitimacy is one of the more significant objectives described in the interviews, and the respondents frequently request both organisational and professional specialisation regarding ipv. arguments for this revolve around increasing the overall quality of the work performed, creating a permanent space in the organisation for ipv and developing expertise in that area. specialisation being an evident trend and possibly becoming an institutionalised way of handling recognised social problems within the swedish personal social service (stranz et al., 2016), this request may indicate an influence of the internal logics of social services on the incorporation process of ipv. still, with limited municipal resources and organisational inertia, this request is likely to meet resistance. integrating a new area of work may also challenge long-standing organisational routines and beliefs. swedish social work rests on family support values, emphasising cooperation with and between parents, and preventive rather than protective services (leviner, 2014). ipv, on the other hand, is an area that highlights power, conflict and opposing interests within families. consequently, when staff try to integrate ipv into social work practice, they may question what appears as core values of swedish social work. as the high prevalence of ipv is an obvious argument when trying to instigate organisational change, pointing out the gendered aspects of the problem in a social service context may be interpreted as taking a political standpoint and, consequently, may be a barrier to integration of the issue of violence into social njsr – nordic journal of social research vol. 10, 2019 62 services. the swedish welfare state has been suggested to rest on principles of collectivism and accordance in reducing social problems and as being less apt to recognise social divisions and conflicts due to race, gender and disability (pringle, 2010). correspondingly, as ipv is being incorporated into the personal social service, the gender-based aspects have been somewhat defused. actors such as the national board of health and welfare use gender-neutral language in everything from regulations and guidelines to standardised measures and ipv assessment tools (stranz, vogel, & wiklund, 2015), as do numerous treatment centres and personal social service units focusing on ipv (mattsson, 2013). with the issue of ipv moving between the contexts of social movement on the one hand and the municipal social services on the other, in a time when the boundaries of these fields tend to overlap, different institutional logics may influence and transform the practices of both arenas. one obvious clash of rationalities is the strong reliance on personal devotion of the social workers who are struggling for professional legitimacy in the bureaucratic context of personal social services. providing support to victims of ipv is a mandatory part of municipal social work. yet, according to the present study, what is in fact an organisational obligation tends to rely on the commitment of individual social workers, putting them in an apparently difficult position. on the other hand, while ipv social work may well challenge institutionalised practises within the personal social service, change may go both ways with the issue of ipv being reframed to fit into the established framework of a social service context. when professionalism and legitimacy become an ideal within both nongovernment organisations and the social services, the boundaries of social movement become more difficult to distinguish. in order to better understand how ipv is transforming into a field involving both municipal social services and the women’s shelter movement there is a need for further studies of how strategies and perceptions have changed over time. as non-governmental organisations still play a significant part in the field of ipv in other nordic countries and anglo-saxon countries, it would be beneficial to examine this topic from a comparative perspective. references barrett, b. j., almanssori, s., kwan, d. l., & waddick, e. 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(2008). professionalizing human services: a case of domestic violence shelter advocates. human organization, 67(2), 221–233. https://doi.org/10.17730/humo.67.2.l43m2v54221711l3 njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 9, 2018 eldercare policies in scandinavia between 1993 and 2014: increased facilitation of family caregiving? christine thokle martens norwegian social research (nova) oslo metropolitan university, norway email: christinemartens@yahoo.com abstract this article asks whether legal rights provided through national legislation on services provision in scandinavia have become, over time, more accommodating to the role of family caregiving to elderly relatives. the study is based on a comparison and analysis of changes in legislation between 1993 and 2014 in the three scandinavian countries. it is limited to legislation on the right to eldercare services and on work-family facilitating policies in relation to the provision of care to an elderly relative. work-family facilitating policies are those policies that enable the combining of employment in the formal economy with caring for family members without large prohibitive costs for the caregiver. the main findings in this article are that the scandinavian countries strengthened the legal right to public care services between 1993 and 2014, but that there are few, if any, truly work-family facilitating policies. the existing schemes do not facilitate a combination of employment and care, but rather force the family caregiver to choose between them. the dilemma is whether to continue passively with a high, but declining, level of public service provision of eldercare, leaving unmet care needs to unpaid family carers, or to introduce work-family facilitating policies enabling remunerated family care in addition to extensive public services provision. keywords: work-family facilitation, eldercare, ageing population, nordic model, welfare mix, informal care introduction population ageing is one of the main drivers of societal change in scandinavia and other european countries, requiring policy reforms that support an increase in labour force participation combined with reforms ensuring a balance between work and family care. sweden, norway and denmark can be described as dualearner, or adult worker, countries (korpi, 2000; lewis & giullari, 2005). high female employment rates have been achieved by providing extensive public care services for the elderly and for children. these countries are also distinguished by a very high reliance on public spending on long-term care. it mailto:christinemartens@yahoo.com njsr – nordic journal of social research vol. 9, 2018 49 is, however, unclear to what extent the scandinavian model of extensive, public, long-term care will be sustainable over the next few decades without a greater role for family care provision. this article originates in the literature on familialism. to de-familialise care means, according to a large section of the scholarly literature, that the responsibility for care is removed from the family and with it the dependence on family members for care (esping-andersen, 1999; leitner, 2003). in the literature, the nordic welfare states are often considered de-familialised because of a more generous provision of public eldercare services than other welfare states. de-familialisation is also understood as economic independence from family relationships (lister, 1994). a decline in publicly provided care services would lead to a larger need for family care, which is incompatible with extensive labour force participation. so far, there is no agreement in the literature on the extent of work-family facilitation policies in these states (leitner, 2003, p. 363; saraceno, 2010, p. 38). the purpose of this article is to provide an empirical foundation for the future discussion of the degree and type of de-familialism in the nordic welfare states. whether and how national governments have put in place work-family facilitating policies to compensate for a possible decline in publicly provided eldercare, is an important question. thus, the research question is whether legal rights provided through national legislation on services provision in scandinavia have become, over time, more accommodating to the role of family caregiving to elderly relatives. this article’s empirical investigation does not relate to familialism but is limited to the concept of work-family facilitating policies. the article conducts a comparison and analysis of changes in legislation between 1993 and 2014 in the three scandinavian countries, limited to legislation on the right to eldercare services and on work-family facilitating policies in relation to the provision of care to an elderly relative. extensive public care services provision allows adults to enter into and stay in the workforce (esping-andersen, 1990, p. 28). although the welfare state relieves the family of care obligations, work and family are not two separate domains (revillard, 2006, p. 134; voydanoff, 2004, p. 398). the two spheres affect one another and can lead to work-family conflict and a double burden of employment and caring for children and elderly parents (daatland, veenstra, & lima, 2010; gautun, 2008; jakobsson, kotsadam, & szebehely, 2013; knijn & kremer, 1997; sand, 2010). greenhaus and beutell (1985) define work-family conflict as ‘a conflict in which the role pressures from the work and family domains are mutually incompatible in some respect’ (p. 77). consequently, work-family facilitation can be defined as ‘a form of synergy in which resources associated with one role enhance or make easier participation in the other role’ (voydanoff, 2004, p. 399). policies on public services provision constitute such work-family facilitating resources; they facilitate combining employment in the formal economy with caring for family members without large prohibitive costs for the caregiver. provision of public care services allows for participation in the workforce, and rights to flexible working hours, employment protection and benefits allow for family caregiving. njsr – nordic journal of social research vol. 9, 2018 50 figure 1. coverage levels of eldercare services. number of persons aged 65 and over living in residential care or receiving home help, as a percentage of the population 80 and over (source: nososco, 1995-2015) sweden: percentage of the population 75+ in 1993-1994. from 1998, short-term stays in institutions and home help in service housing are excluded. for 2007, 2009 and 2010, the percentages are estimated based on the coverage levels the preceding and succeeding years. norway: percentage of the population 75+ in 1993-1995. for 2009 and 2013, the percentages are estimated based on the coverage levels the preceding and succeeding years. denmark: percentage of the population 75+ in 1993-1995. from 2008, home help in service housing is excluded and there is a change in the statistics, probably excluding short-term stays. several studies to date have shown an overall decline in services provision in the scandinavian countries since the 1980s and 1990s (nielsen & andersen, 2006, pp. 59-60; otnes, 2015, pp. 53-54; trydegård & thorslund, 2010). comparative statistics on public eldercare services coverage in these countries show a tendency of converging coverage levels of eldercare between the three countries (nososco, 1995-2015). denmark has had the highest coverage level since 1993, while sweden has had the lowest (see figure 1). since 2008, both norway and denmark have shown a decline in coverage levels, converging towards the level of sweden. in all three countries, albeit to varying degrees, fewer recipients receive more care, and there has been an increased focus on medical assistance and bodily needs at the expense of practical help (daatland, 2014; lewinter, 2004; szebehely & trydegård, 2007, p. 211; vabø & szebehely, 2012, p. 132). needs assessments have become stricter and the definition of ‘need’ has been limited to medical assistance and physical needs. these developments have placed more responsibility for care provision on the family and the individual (vabø & szebehely, 2012, p. 134) and, thus, created significant tensions between care needs in the population and the ability of adult family members to provide eldercare. conceptual framework public eldercare services provision, including cash-for-care schemes, is defined as the provision of benefits and services financed by public bodies and regulated by national legislation. in scandinavia, public eldercare services provision is a municipal responsibility, but it is regulated by national njsr – nordic journal of social research vol. 9, 2018 51 governments through national legislation (andreotti, mingione, & polizzi, 2012, p. 1936). municipal care services are funded mainly through block grants from central government (i.e., grants not earmarked for care services in particular), in addition to local taxes, which are defined within a specific range that is set by central government (jensen & lolle, 2013; kmd, 2015; trydegård & thorslund, 2010). this formal division of responsibility implies a delegation of authority to the local governments. thus, the municipalities are simultaneously organisational tools for achieving national policy goals and autonomous units responsible for providing services to their citizens (grønlie, 2004). the legislation is here interpreted as an operationalisation of national policies. legislation can provide rights to the individual, or it can impose duties on public bodies like municipalities (dean, 2014). how these different ways of formulating legislation affect individual service recipients is illustrated by the conceptual model in figure 2. granting rights to individuals directly (linkages 1 and 2) leads to a standardization of services and restricts local discretion, as everyone in a particular situation will have a legal right to the same services (fimreite, 2003, p. 343). this requires objective inclusion criteria and unlimited resources to fulfil the rights. by imposing requirements on municipalities rather than granting legal rights (linkage 3), legislation indirectly affects the fulfilment of care needs and possibilities for work-family facilitation through municipal services provision (linkages 4 and 5). figure 2. conceptual model when the responsibility for services provision is divided between policy levels, the main principle is that the national level handles economic transfers and rights that are universalistic in character, such as specialist health care and the social security system. services provision and transfers that are prone to individual discretion and local conditions are handled at the local level (powell njsr – nordic journal of social research vol. 9, 2018 52 & boyne, 2001, p. 184). this structure normally means that national policies pose specific demands and performance criteria on local policies and services provision through, among others, legislation. to meet national performance criteria, the local level must develop strategies that correspond with local needs (van gestel & herbillon, 2010, p. 417). the organization of services provision can affect the strength of rights or, in other words, whether rights are strong or weak (hatland, 2007). a strong right is typically clear and unconditional, while weak rights are claims that have to be assessed on a discretionary basis. a weak legal right within municipal services provision is typically a right that is subject to municipal discretion. leira and saraceno (2002) label such rights ‘supply-conditioned rights’, meaning that the right is an expression of the government’s intent but is not necessarily an entitlement in the here and now (p. 75). this is the case when national legislation imposes requirements on municipal services provision, and municipal gatekeepers restrict the availability of services through discretionary assessments. weak legal rights prone to municipal discretion are often an area of contention. the demarcation criteria for having a claim to a benefit or service are not clear, which can lead to discrepancies between inhabitants’ perceived rights to a specific service and municipal assessments. this is typically the case when municipal assessments also depend on scarce municipal resources. analytical approach this article contains a comparison of legislation in sweden, norway and denmark. the study is limited to the period of 1993-2014 because of the data availability of statistics from nososco. the comparison is based on most similar systems designs. in such a design, it is assumed that the countries have many features in common, and these features can be ignored because they are believed to be equal (sartori, 2009, p. 156). these countries do share similarities, such as municipal autonomy and responsibility for service provision within the limits of national legislation and public provision of extensive social care services (edebalk & svensson, 2005, p. 35; kröger, 2001, p. 16). it is a widespread belief that the differences between the scandinavian countries’ service models ‘are outweighed by the similarities when compared to other countries in the world’ (sipilä et al., 1997, p. 39). the reason for including three welfare states in the analysis is to ascertain whether there is also a nordic model in the area of legislation on eldercare services provision and work-family facilitation policies. the remaining nordic countries (iceland and finland) were excluded because of the language barrier. the comparison rests on a thorough document analysis. the main databases for national policies and legislation in the three countries are lovdata.no, retsinformation.dk and svensk författningssamling. the current study used these databases to conduct a systematic review of each country’s legislation. first, the databases were searched for legal documents containing the words ‘care’, ‘leave of absence’, ‘relative’ and ‘work environment’. secondary data sources, such as government documents and academic articles, were consulted to aid the data search. second, when an act in one of the countries was found to contain a regulation on combining work and care or receiving care, a search for a corresponding right in the other countries was conducted. all identified relevant sections of each country’s legislation were downloaded into a database. upon ending the systematic review, the database of relevant sections of each act was systematized in a spreadsheet according to country, year and kind of right, and then translated into english. njsr – nordic journal of social research vol. 9, 2018 53 legal rights to public care services in 1993 table 1 presents legislation in sweden, norway and denmark in 1993 on the right to care services and municipal responsibility for service provision. only in sweden did people have a legal right to social assistance, but only if their needs could not be met in any other way (linkage 1 in figure 2). there was a legal right to health care services in norway, but not to social assistance. however, norwegians had a legal right to cash-for-care, which allowed recipients to pay for privately-arranged care services. danish legislation provided no legal rights to care services. table 1. national legislation on the right to public eldercare services in 1993. country, right, (legal source) sweden norway denmark care services care services care services the individual is entitled to assistance from the social services if their needs cannot be met in any other way (social services act, 1980 §6) the social services should provide home help, service and care, and day care. they shall provide home help and other easily accessible services to those in need. for elderly people with special needs, the municipality must establish homes with services (social services act, 1980 §§10, 20) the county shall offer good health care access to those residing in the county. the municipality may offer home care services to its citizens (health care act, 1982 §§3, 18; prop 1990/91:14) everyone has a right to necessary health care in the municipality where he/she lives (municipal health care act, 1982 §2-1) the municipality shall offer necessary health care services, including care, to its entire population by providing, among other things, home nursing and nursing homes (change of the municipal health care act, 1986; municipal health care act, 1982 §§1-1, 1-3) to those who cannot care for themselves, services can be provided in nursing homes or other institutions and as home care (social care act, 1964 §3) the public is obliged to aid everyone who stays in the country (social assistance act, 1992 §1) the municipality shall ascertain that there is a home care service that provides practical home assistance by home-helpers trained to carry out these duties. home care is provided for practical assistance and personal care to those who cannot provide this for themselves (social assistance act, 1992 §§50, 53) the municipality shall provide residential care to those who need it due to their health (social assistance act, 1992 §79) cash-for-care cash-for-care cash-for-care depending on extent of need, paid to care recipient (municipal decisions) allowance to pay for private care, € 85 /month (1995) (change of the social insurance act, 1991; social insurance act, 1966 §8-2) none in 1993, all three countries provided a right to social services through municipal services provision (linkage 3 in figure 2). swedish legislation stated that municipalities should provide home care services and aim for good housing for the elderly. the municipalities also had to establish residential care facilities. in norway, municipalities were obliged to offer necessary care services, including home care services and nursing homes. in denmark, the municipalities had to ensure that home care services and residential care were provided to those who could not provide these for themselves. in addition, some swedish municipalities provided a cash-for-care benefit to care recipients (linkage 4 in figure 2). njsr – nordic journal of social research vol. 9, 2018 54 legal rights to public care services in 2014 table 2 presents legislation on the right to care services and municipal responsibility for services provision in 2014. since then, swedish citizens have had a legal right to services from the municipality if their needs cannot be met in any other way (linkage 1 in figure 2). norwegian citizens have a right to necessary care services, but do not have an entitlement to a specific service (prop. 91 l, 2010-2011). furthermore, in norway, all persons who are in need of attendance and care because of durable illness or injury and who receive privately arranged care have a right to a cash-for-care benefit. danish citizens have a legal right to the services described in the social services act. table 2. national legislation on the right to public eldercare services in 2014. country, right, (legal source) sweden norway denmark care services care services care services those who cannot meet their needs themselves, or whose needs cannot be met in any other way, are entitled to assistance from social services (social services act, 2001 ch 4, §1) the social services shall endeavour to provide older people with good housing and shall provide home help and other easily accessible services to those in need. the municipality must establish sheltered homes with services and care for elderly people with special needs. (change of the social services act, 2010 ch 5 §5) patients and users have a right to necessary municipal health and care services (patients' rights act, 1999 §21a) the municipality shall ensure that its entire population is offered necessary health and care services, including home care services and nursing homes (municipal health and care services act, 2011 §§3-1, 3-2) everyone legally residing in the country is entitled to services stated in this act (social services act, 2014 §2) municipalities shall offer home care services for personal care, practical help and food delivery services to those who cannot provide this for themselves (social services act, 2014 §83) municipalities shall offer long-term accommodation in appropriate housing to persons in need of extensive care due to physical or mental impairments whose needs cannot be met in any other way (social services act, 2014 §108) cash-for-care cash-for-care cash-for-care depending on extent of need, paid to care recipient (municipal decisions) allowance to pay for private care, € 125 /month (2014) (social insurance act, 1997 §6-4) none as of 2014, the municipalities are held responsible for services provision in all three countries (linkage 3 in figure 2). swedish legislation states that the social services shall provide home help and other easily accessible services to those in need and that they shall establish residential care. in norway, the municipality is obliged to offer necessary health and care services to its entire population. these services should include home care services and nursing homes. the danish social services act states that the municipality shall offer care and support for personal needs, help and support for domestic practical chores and food delivery services to persons who cannot provide this for themselves due njsr – nordic journal of social research vol. 9, 2018 55 to physical or mental impairment. danish municipalities are also obliged to provide residential care. lastly, some swedish municipalities provide a cash-for-care benefit to care recipients (linkage 4 in figure 2). changes in the legal right to public care services between 1993 and 2014 in 1993, only sweden provided a legal right to care services, but by 2014, a legal right to social care services existed in all three countries. in this regard, legislation in the three countries has converged towards more legal rights for the individual. however, these rights are weak in the sense that they do not state specific rights to specific services. the rights depend on municipal services provision and municipal discretion. hence, they are supply-conditioned rights, meaning that they cannot be fulfilled unless there is an actual municipal services provision for them. there has been only minor change in the three countries’ legislation on public responsibility to offer care services, and the municipal unit remains the executive of this responsibility. all three countries stated the municipal obligation to offer home care services and residential care in both 1993 and 2014. the major difference between the countries in both 1993 and 2014 is with regard to who is entitled to the municipalities’ services provision. in sweden, services are to be offered to ‘those in need’. in norway, the municipality shall offer ‘necessary’ services, while danish municipalities must provide services to those who ‘cannot provide for themselves’. in all three countries, it is evident that the wording provides citizens with weak rights, as a large degree of discretion is left to the municipalities (erlandsson, storm, stranz, szebehely, & trydegård, 2013, p. 25; hjemmehjælpskommissionen, 2013, p. 37; kjellevold, 2012; vabo, 2012). both norway and sweden offer cash-for-care schemes. in norway, this is a legal right, while in sweden, it is subject to municipal discretion in terms of whether the right is introduced and in regard to both the assessment of need and the benefit size. in the two countries, the amounts are too small to constitute a real alternative to receiving extensive care services in kind. in sweden, the benefit varies between municipalities. in the capital, stockholm, the rates are € 125-495 per month, with the highest rate provided for round-the-clock care (stockholm.se, 2015). in norway, the benefit for privately arranged care was € 85 per month in 1994 and € 125 per month in 2014 (nav.no, 2015; otnes, 1996). legislation on work-family facilitation in 1993 table 3 provides an overview of national policies in 1993 facilitating the combination of employment and care provision to elderly relatives. such policies can represent a functional equivalent to policies that enhance the provision of municipal social services. in 1993, swedish and norwegian employees had a legal right to 30 and 20 paid days a year off work, respectively, in order to provide terminal care (linkage 2 in figure 2). danish employees had a legal right to a benefit when providing terminal care, which was not, however, accompanied by the right to time off. njsr – nordic journal of social research vol. 9, 2018 56 only the norwegian legislation provided the right to reduced working hours without pay for care responsibilities, but only if this was not to the disadvantage of the employer. the act does not state what constitutes a ‘disadvantage’. after the agreed period of reduced working hours, the employee could resume his or her former position. no similar employment protection was found in sweden or denmark. table 3. legislation concerning time off work, compensation for employees and compensation for family care provision in 1993. country, right, (legal source) sweden norway denmark terminal care terminal care terminal care up to 30 days; pay equal to sick-leave benefit (act on time off to care for a next of kin, 1988 §§4, 5, 20) up to 20 days; pay equal to sick-leave benefit (change of the social insurance act, 1990; social insurance act, 1966 § 3-24; working environment and employment protection act, 1977 §33b) duration and right to time off not stated; benefit tied to the carer’s sickleave benefit (change of the social assistance act, 1990; ministry of finance, 1990) care for a relative (acute and long-term) care for a relative (acute and long-term) care for a relative (acute and long-term) none right to reduced working hours without pay. to be agreed with employer (change of the working environment and employment protection act, 1982; working environment and employment protection act, 1977 §46 a) none carer allowance/ employed family carer carer allowance/ employed family carer carer allowance/ employed family carer employment as home care assistant, depending on extent of need, paid to caregiver (municipal decisions) the municipal health care service shall provide a carer allowance and respite care to persons with a particularly heavy care burden (change of the municipal health care act, 1986; municipal health care act, 1982 §1-3) none respite to family carers respite to family carers respite to family carers none the municipal health care services and the social services shall provide a carer allowance and respite care to persons with a particularly heavy care burden (change of the municipal health care act, 1986; municipal health care act, 1982 §1-3; social services act, 1991) home carers can occasionally provide relief to persons who care for a child or adult with physical or mental illnesses in the home (social assistance act, 1992 §52) in sweden, some municipalities provided the possibility of employment as a family carer (linkage 5 in figure 2). this was not a national scheme. the scope njsr – nordic journal of social research vol. 9, 2018 57 of the employment depended on the care recipient’s care needs. in norway, the municipality was obliged to offer a carer allowance to persons with a particularly heavy care burden (linkage 3 in figure 2). the allowance was called a salary, but carers were not employed as such; they had a temporary contract, and the pay did not include contributions towards pensions or sick leave benefits. the allowance was based on an individual overall assessment of the care recipient’s needs and was paid by the hour. denmark had no similar scheme. swedish municipalities were not obliged to provide respite to family carers until 1997. in norway, the municipality had an obligation to offer respite to persons with a particularly heavy care burden, while in denmark, a family carer could receive respite provided by municipal home carers. legislation on work-family facilitation in 2014 table 4 presents the regulations on support for family care as of 2014. in all three countries, employees have a right to time off work to provide terminal care, accompanied by benefits tied to the employee’s sick leave benefit. swedish and norwegian employees have a right to 100 and 60 days a year with remuneration, respectively. the danish social services act does not impose a time limit on either the absence or the benefit. the act’s regulation specifies, however, that the prognosis has to be a life expectancy of two to six months (guide on care services, 2015). the scandinavian countries provide every employee with the right to take time off due to urgent family matters, but this is limited to a few days a year. in sweden and denmark, this is restricted to when the employee is urgently required by the family due to illnesses and accidents. in norway, since 2010, every employee has the right to take off up to ten days a year to care for a relative. this right is directed primarily towards attending to specific care needs rather than to daily care. norwegian employees also have the right to work reduced hours due to care responsibilities, but without pay and only if this is not to the disadvantage of the employer. in sweden, there is no right to time off work to provide long-term care for a relative. nor does such a right exist in denmark, with one exception: danish employees are entitled to a leave of absence to care for a family member when the care needs would otherwise require a full-time carer or institutionalization. the municipality employs the caregiver and, while the leave is remunerated, it requires a specific illness or a severe handicap, has a time limit of six months and is hence not suited for care purposes related to general ageing and frailty. the reason the right was introduced in 2002 was to smoothen the transition period for the family in cases of abrupt illness or handicap and to ensure the continued workforce attachment of the relatives (bsf 187, 2001). these schemes are all related to linkage 2 in figure 2. sweden introduced the freedom of choice act in 2008, but its implementation is at the discretion of the swedish municipalities and, hence, it is not a national scheme (linkage 5 in figure 2). the act invites the care recipient to choose between a care provider and a family carer. the remuneration does not equate to a normal salary but is rather ‘a symbolic sum’ (sand, 2010). norwegian municipalities are obliged to offer a carer allowance to persons with a particularly heavy care burden (linkage 3 in figure 2). the scheme is national, but the municipalities assess both the need for the allowance and the rates, and the carer does not have an entitlement to the allowance. in other words, it is supply-conditioned. on average, in 2002, family carers were compensated for 10.5 hours per week and received € 10 per hour (helsetilsynet, 2009). the danish care recipient has been able to choose the care services provider since njsr – nordic journal of social research vol. 9, 2018 58 the introduction of the new social services act in 1998. however, the right to formal employment as family carers depends on a municipal assessment of care needs and approval from the municipality. in all three countries, the municipality is required to provide respite care to family carers. respite care usually consists of home care services or short-term stays in residential care facilities. table 4. legislation concerning time off work, compensation for employees and compensation for family care provision in 2014. country, right, (legal source) sweden norway denmark terminal care terminal care terminal care up to 100 days; pay equal to sickleave benefit (act on time off to care for a next of kin, 1988 §20; social insurance act, 2010 ch 47) up to 60 days; pay equal to sick-leave benefit (social insurance act, 1997 §91; working environment and employment protection act, 2005 §1210) duration not stated; tied to the carer’s sick-leave benefit (act on time off employment due to emergent family matters, 2006 §1; social services act, 2014 §§119-120) care for a relative (acute and long-term) care for a relative (acute and long-term) care for a relative (acute and long-term) ‘a certain number of days a year’ (act on time off employment due to emergent family matters, 1998 §§1-2) up to 10 days/year (working environment and employment protection act, 2005 §12-10) right to reduced working hours without pay. to be agreed with employer (working environment and employment protection act, 2005 §102) ‘when urgently required’ (act on time off employment due to emergent family matters, 2006 §1) care for a family member when the care needs equal full-time employment or institutionalization. up to 6 months, € 2,220 /month (2014) (act on time off employment due to emergent family matters, 2006 §1; bsf 187, 2001; social services act, 2014 §118) carer allowance/ employed family carer carer allowance/ employed family carer carer allowance/ employed family carer employment as home care assistant, depending on extent of need, paid to caregiver (municipal decisions) the municipality shall offer a carer allowance to persons with a particularly heavy care burden (municipal health and care services act, 2011 §3-6) a person entitled to care services can choose the provider. the municipality must approve the provider. salary paid to caregiver, depending on extent of need (social services act, 2014 §94) respite to family carers respite to family carers respite to family carers the social services shall offer respite care to provide relief to persons with a particularly heavy care burden (change of the social services act, 2009; social services act, 2001 ch5, §10) the municipality is responsible for respite care and providing relief to persons with a particularly heavy care burden (municipal healthand care services act, 2011 §3-2; patients' rights act, 1999 §2-8) the municipality shall offer respite care to spouses, parents or other next of kin caring for a person with reduced physical or mental abilities (social services act, 2014 §84) njsr – nordic journal of social research vol. 9, 2018 59 changes in legislation on work-family facilitation between 1993 and 2014 between 1993 and 2014, all three countries expanded the legal right connected to combining work and family obligations, but only in cases of short-term or acute need. norway has maintained the legal right to work reduced hours due to care obligations. although unpaid, it provides norwegian employees with a large degree of employment protection, which is not matched by swedish or danish legislation. although sweden has introduced the freedom of choice act, employment as a family carer is still at the discretion of the municipalities. in denmark, the possibility of employment as a family carer exists as a national scheme. hence, danes and swedes who are employed as family carers maintain their rights as employees in the social insurance system while providing family care. norwegians who receive the carer allowance do not maintain these rights. in all scandinavian countries, the right to schemes, such as carer allowances and employment as a family carer, depends on municipal provision. in sweden, it is entirely up to the municipality (linkage 5 in figure 2), while in norway and denmark, it is a national scheme and is, consequently, a supply-conditioned right (linkage 3 in figure 2). discussion and conclusion this article’s research question was whether legal rights provided through national legislation on services provision in scandinavia have become, over time, more accommodating to the role of family caregiving to elderly relatives. to answer the question, it has conducted a comparison and analysis of changes in legislation between 1993 and 2014 in the three scandinavian countries, limited to legislation on the right to eldercare services and on work-family facilitating policies in relation to the provision of care to an elderly relative. the purpose is to provide an empirical foundation for the future discussion of the degree and type of de-familialism in the nordic welfare states. changes in the coverage level of municipal eldercare services between 1993 and 2014 have shown a converging trend between the scandinavian countries. coverage levels are converging towards sweden, or the country with the lowest level. at the same time, national legislation in all three countries has strengthened the individual right to care services and reinforced the municipal obligation to provide such services. as of 2014, there is a legal right to care services, and in all three countries, the municipalities are obliged to offer both home care services and residential care. however, access is subject to municipal discretion, as legislation does not grant a specific right to a specific service under a specific circumstance. hence, whereas policy statements in national legislation increasingly reinforce the right to care services, coverage levels of eldercare are declining in municipal practice. these developments suggest that the discrepancy between national policy and local practice within eldercare has increased over the years. the organisation of eldercare in the scandinavian countries implies that the state has limited authority over services provision (spicker, 2008, p. 135). similarly, national legislation, funding systems and policy goals limit local government autonomy (hatland, 2007, p. 214). one alternative to present organisation of care services provision would be to move the responsibility for eldercare to the national level. another alternative would be direct state funding of municipal eldercare services. however, it is hard to imagine granting njsr – nordic journal of social research vol. 9, 2018 60 eldercare services without the use of discretion. as a result, irrespective of organisation, the right to these services would still be weak and subject to availability, because resources are limited also at the national level. the declining trend in coverage levels in denmark and norway suggests a stronger role for the family in eldercare, implying that the family is already important in sweden. for care recipients, public and family care can be thought of as functional equivalents, provided that care needs are met (saraceno, 2010, p. 41). for caregivers, this is less so. when providing care for a family member, carers may lose income, welfare protection and their attachment to the ordinary workforce. therefore, an important question is whether these developments are accompanied by national policies that facilitate combining employment in the formal economy with caring for elderly family members without large prohibitive costs for the caregiver. between 1993 and 2014, in all three scandinavian countries, the legal rights associated with combining work and family obligations expanded in cases of short-term or acute need. norway has kept the possibility of working reduced hours, which represents an employment protection for employees. at the same time, there is no legal right to compensation for loss of income, so the choice is between ordinary employment and unpaid caregiving. in both sweden and denmark, changes in legislation on employment as family carers was a result of changes in legislation on the freedom of choice of provider. the schemes in both countries are designed to provide choice to the care recipient, not to the care provider. as neither country has introduced the same employment protection as that afforded to norwegian employees, the danish and swedish care provider has to choose between maintaining an attachment to ordinary employment or providing (remunerated) care. the legislation in all three scandinavian countries demonstrates that employees have ‘a right’ to time off and ‘a right’ to compensation for providing short-term care. these regulations can be defined as exemptions from the ‘duty to work’ and as work-family facilitating. they are, however, not adapted to situations where an elderly relative requires long-term family care. corresponding schemes related to long-term family caregiving are not tied to workforce participation and are subject to municipal discretion. the wording of these supply-conditioned rights is different from the wording of the legal rights connected to short-term care obligations; instead of ‘employee’ and ‘right’, the words used are ‘relative’ and ‘apply’. as a result, the availability of these schemes to carers is affected by other factors, such as municipal finances and the applicant’s social network (jakobsson, kotsadam, syse, & øien, 2015; rauch, 2007, 2008). as of 2014, there are still few truly work-family facilitating schemes for eldercare provision in these countries. a caregiver has to factor in potentially large punitive costs when choosing between employment and caregiving. the meaning of de-familialisation is usually limited to removing the responsibility for care provision from the family, and thereby increasing the independence of both caregiver and care recipient (leitner, 2003; mclaughlin & glendinning, 1994, p. 65). another important element of de-familialisation is often overlooked: economic independence from family relationships (lister, 1994). this implies that care does not need to be removed from the family to obtain defamilialisation, but rather can be obtained by remunerating family care, albeit in combination with public care services provision. simply providing public care services that remove the responsibility for the provision of (extensive) care from the family does not create a choice but makes the degree of de-familialisation dependent on actual public services provision. the ageing scandinavian countries may benefit from introducing work-family facilitating policies that create an actual option for family caregivers to provide care without large njsr – nordic journal of social research vol. 9, 2018 61 prohibitive costs. this way, the degree of de-familialisation not only depends on public services provision but also includes the extent to which family members are economically independent. a limited extent of work-family facilitating policies for eldercare, coupled with the declining coverage levels of municipal care services, can jeopardize the high female employment rates and female economic independence from family relationships. it may also imply that the ageing scandinavian countries are gravitating towards what saraceno (2010) labels ‘familialism by default’. one possible explanation for the limited legal protection of family carers in scandinavia is related to the tenet of national governments that care is mainly a public responsibility. when the responsibility is public and provision is high, there would be no need for introducing work-family facilitating policies as a safety net for when needs are not met by the public care services. another explanation is that a strengthening of work-family facilitating policies can be interpreted as an attempt to retrench public responsibility for care services. in sweden, there are examples of municipalities not granting care services because of the availability of family members, pointing to the wording in the social services act (2001, ch 4, §1) that states services are for persons whose needs cannot be met in any other way. what is puzzling is that although there are large debates about the privatisation of care services provision and the value of personal choice in the scandinavian countries, there are no strong demands for being able to choose to provide care for elderly relatives or friends without large prohibitive costs. this is contrary to debates on parents’ rights to care for their children and inclusion of the voluntary sector in the care services. after decades of policies aimed at the provision of public care services relieving the family of a large care burden and contributing to the de-familialised profile of the scandinavian welfare state, the transition to policies that enable increased family responsibility for caregiving is challenging. the ageing of the population, the sustainability of the public welfare services and the dual-earner model limiting the caring potential of families are challenges that call for new solutions. the current dilemma of the nordic welfare states is whether to passively continue with a high, but 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(2010). rescaling of social welfare policies: lessons and future perspectives. in y. kazepov (ed.), rescaling social policies: towards multilevel governance in europe (pp. 415-428). surrey: ashgate publishing ltd. guide on care services (2015). guide no. 9341 of 8 may 2015. vejledning om hjælp og støtte efter serviceloven [guidance on assistance and support according to the social services act] (denmark). ministeriet for børn ligestilling integration og sociale forhold. voydanoff, p. (2004). the effects of work demands and resources on work‐to‐family conflict and facilitation. journal of marriage and family, 66(2), 398-412. https://doi.org/10.1111/j.1741-3737.2004.00028.x working environment and employment protection act. (1977). act no. 4 of 4 february 1977. lov om arbeidervern og arbeidsmiljø mv. (norway). arbeidsog sosialdepartementet. working environment and employment protection act. (2005). act no. 62 of 17 june 2005. lov om arbeidsmiljø arbeidstid og stillingsvern (norway). retrieved from https://lovdata.no/dokument/nl/lov/2005-06-17-62 https://doi.org/10.1111/j.1741-3737.2004.00028.x https://lovdata.no/dokument/nl/lov/2005-06-17-62 microsoft word eskelinen social space for self-organising njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol 9, 2018 social space for self-organising: an exploratory study of timebanks in finland and in the uk teppo eskelinen department for social sciences and philosophy university of jyväskylä email: teppo.h.i.eskelinen@jyu.fi abstract the article examines the challenges to self-organisation and upscaling of alternative economies from the viewpoint of defending and negotiating social space. timebanks in finland and the uk are presented as examples, analysing the difference of defending such social space in the contexts of a traditional welfare state (in the case of finland) and an austerity-driven government with a “big society” ideology (in the case of uk). both systems of government present different kinds of pressures on timebanks, pushing them to a given ontological categories and to action in accordance with pre-defined political goals. this difference, along with timebank reactions and the question of prospects of opening ontological space, is analysed through material from observation, interviews with timebanks activists and brokers, and survey data from timebank users. keywords: timebanks, community building, alternative economies, social ontology, governance, volunteerism introduction self-organised small-scale economic systems have recently received considerable attention (gibson-graham, 2008; healy, 2009; north, 2007). alternative exchange systems called timebanks are often seen as representative examples of these “community economies” (cahn, 2000; joutsenvirta, 2016). they combine social activism and alternative economic exchange with an egalitarian system of rewarding input, which recognises all 90 njsr – nordic journal of social research vol. 9, 2018 skills within the community as valuable. indeed, timebanks are seen by their activists and supporters as creating new, more locally controlled and more humane economic practices. timebanks see themselves as operating in the social space of “the commons”, transcending dichotomies such as government/market and voluntary/commercial (benkler, 2006; ostrom, 1990). indeed their system of organisation deviates from the organisational logic of governments, markets and ngos. further, their approach deviates from the commercial “sharing economy” (botsman & rogers, 2011), as timebanks insist on an alternative conception of value, whereas in fashionable “sharing economy” initiatives, value often turns out to hardly deviate from the capitalist conception. while some timebanks see themselves as complementary to the capitalist economy, others see themselves as articulating a set of values, which could eventually inform a comprehensive alternative to capitalism. while earlier scholarship on timebanks has focused mostly on their organisation (laamanen & den hond, 2015) and social impact (ozanne, 2010; seyfang, 2003), in this article i will analyse timebanks from the viewpoint of the possibility of operating within a distinct social domain. this social domain refers to a category of organisation, valuation and discourse, which cannot be reduced to existing categories (such as government/market or voluntary/commercial). crucially, even though timebanks see themselves as operating within the “commons” (bollier & helfrich, 2012; ostrom, 2010), they are unavoidably embedded in a wider societal context governed through other categories. this creates a constant need to negotiate their position. the question posed in this article then is, what kinds of external pressures timebanks face as they try to maintain, defend and negotiate this social space. this question will be explored by analysing data comprising of interviews, observation and documents. the analysis is based on an exploratory study on timebanks in two countries, finland and the united kingdom. this setting enables a discussion on the role of political systems in the formation of the social space available to timebanks, as any political system will need to decide how it perceives timebanks in terms of categorisation. the political systems discussed in relation to timebanks are the welfare state and “big society”. the former refers to the nordic tradition, combining high taxation and universal service provision, while the latter is a more recent political concept coined in the uk, referring to a combination of austerity and privatisation of public services with the promotion of community development and decentralised governance (coote, 2011; smith, 2010). 91 njsr – nordic journal of social research vol. 9, 2018 the article proceeds as follows: first, i will briefly introduce the practice and ideology of timebanking and its brief history in finland and in the uk. second, the issue of social space for self-organisation will be presented theoretically. section three consists of presentation of the data and the methodology of the study. in the following three sections, i will present the analysis: government responses to timebanks, along with notions on negotiating with commercial insurance companies. the penultimate section proceeds with an analysis of the reactions from the point of view of the timebanks to these external pressures. the article finishes with a conclusion. timebanking: ideology and background timebanking is based on a specific method of accounting in which time is used as “currency”. the currency is institutionalised through an accounting system, in which the provider of the service is credited and the recipient of the service is debited the duration of the provided service. members announce skills and needs, after which these skills and needs are “matched” by a “broker”, or by the members themselves (simon, 2010). practically, services range from everyday assistance around the house, such as minding pets, to professional services, such as language translation. the practice emerged as a method of communitybuilding (lasker & collom, 2011; seyfang, 2004), initially in the us in the 1980s. the purpose of timebanks is to provide a creative remedy to social symptoms of modernity – isolation and alienation. unhappy about the perceived paternalising attitude in public services and the disregard of the skills of “ordinary people”, timebanking activists aim to institutionalise an empowering do-it-yourself approach. one of the cultural root causes behind modern alienation appears to be the hegemonic conception of economic activity, which is based on the atomistic market subject, along with the dissociation of economic relations (producer/recipient, producer/product, etc.). timebanks, in contrast, emphasise the idea of coproduction, referring both to the importance of the conduct of the “recipient” of the service in determining the nature of the service (boyle & harris, 2009; parks et al., 1981) and to the role of social interaction more generally. the system emphasises the equal value of everyone’s time, with the implication that the capitalist market assesses value incorrectly (by creating arbitrary distinctions between valuable and non-valuable skills). the objective is to “recognise people as assets” (boyle, slay & stephens, 2010) in contrast to treating them as expenses. the purpose is not only to make use of idle skills but also to “rebuild the social fabric” (boyle & bird 2014, p. 17). timebanks are 92 njsr – nordic journal of social research vol. 9, 2018 typically community based: while there are hardly any limits to who can join a timebank, the members tend to be local people. in addition to making use of valuable and idle skills, thus creating new activity, timebanks also insist on an idea of value, which recognises existing but undervalued activity. recognising this undervalued activity means making the “core economy” visible. this concept refers to daily work in and around the household and the community and the role of such work as an essential part of the economy, rather than a set of fringe activities or non-productive activities (cahn, 2009; coote, 2010; goodwin et al., 2003; stephens, ryan-collins & boyle, 2008). to use timebanking pioneer edgar cahn’s metaphor, the core economy can be seen as the “operating system” of the more visible capitalist economy: one tends to ignore its importance until it is in disrepair (cahn, 2004, p. 53–55). yet crucially, timebanks do not see themselves as being confined to the realm of the core economy but rather seeing its proper recognition as one of their functions. while timebanking is based on a clearly articulated philosophy, this philosophy allows variation on the level of membership and organisation. first, a single timebank can have thousands of members or as little as below a hundred. also, membership can be either general or “targeted”. the latter means that members are sought specifically from a given target group. for instance, a timebank can have the purpose of integrating immigrants or people with given health issues to the community. second, timebanks’ mode of organisation varies. some timebanks have salaried co-ordinators (or “brokers”), while others are member operated and compensate all work for the timebank with “time currency” only. further, some timebanks are standalone timebanks, while others are embedded in ngos (collom, lasker & kyriacou, 2012). timebanks in the uk and finland in the uk, timebanks have existed since 1998 (timebanking uk, 2017), and, indeed, the uk is given status as the place of origin of timebanking in europe. the uk timebanks have developed into something of an institutionalised form of alternative economy. timebanking uk lists currently over 300 timebanks of different sizes and orientations (timebanking uk, 2017). almost all of them rely on salaried brokers; this is partly due to the preference for a more conventional model of organisation and partly to the level of digital literacy. complete selforganisation requires a completely digital system for skills/needs announcements, which not everyone is necessarily able to use, leading to 93 njsr – nordic journal of social research vol. 9, 2018 “platform exclusion”, particularly amongst the target groups of timebanks with a social-policy orientation. in finland, timebanking began in 2009, although somewhat similar systems have existed for a long time. stap (stadin aikapankki, the helsinki timebank) was founded in 2009 (stadin aikapankki, 2017). currently, about 20 timebanks are listed countrywide (suomen aikapankit, 2017), but, practically speaking, a large number of them are inactive, meaning that timebanking is geographically concentrated in the capital. stap is large and fully member operated.1 while it generally is a standalone timebank with no target group, one major ngo project, targeting people with mental/physical health issues, has used the timebank’s platform. in the absence of a salaried broker, the timebank noticeboard is fully digital. while the level of internet access in finland is generally high, the digitalised system of organisation might nevertheless create an implicit selective pattern in membership. indeed, members are socio-economically predominantly middle class, although this conceals variation. ideologically, finnish timebanks tend to emphasise a transformative, or political, approach and strictly member-run organisational preferences, while the uk timebanks see their function more in terms of social intervention. the social space and upscaling all community economies need social space for functioning. social space refers here to two separate, but connected issues. the first is what is termed ontological space. ontology can be defined as the study of what fundamentally exists and what wants to exist in the social world (lawson, 2015). social ontology is, then, the analysis of categories that organise the social world, assumptions regarding the dynamics of these categories and the emergence of new categories (lawson, 2015, p. 21–22). an underlying idea is that the existence of given social entities depends on social institutions (searle, 1995). second is the operating space amidst governance. systems of governance organise human activity by creating norms, laws, incentives and political goals, eventually aiming at the diffusion of the logics and priorities of governance into 1 as an exception, one project with salaried personnel and external funding used the stap accounting system. it was conducted 2013-16 (aika parantaa, 2017). 94 njsr – nordic journal of social research vol. 9, 2018 social life at large. any emerging organisation will have to negotiate its position in relation to the system of governance – in other words, what kinds of adaptation pressures it faces when being pushed to a given category and governed under it. to give an example, a “market” only exists after it is constructed in social practices that institutionalise its logic (callon & muniesa, 2005). inevitably embedded in social relations, the key question related to the existence of ”the market” is, then, whether it is recognised as an ontological entity. once recognised as such, the market comes to be seen as a natural system of valuation. it also becomes governed with specific terms. similarly, the question regarding the prospects of timebanking is what the prospects of establishing a distinct social sphere of valuation and governance (“community”, “commons”) are. if timebanks are seen as operating within such a distinct category, a specific approach is required; if not, they become easily interpreted and thus also governed in terms of pre-existing and dominant categories. indeed, reference to social ontology is vital in explaining government responses to timebanks. the ideology of timebanking insists that timebanks function in a sphere distinct from the hegemonic government/market dichotomy: commons, self-organised institutions, and “the community” (seyfang & smith, 2002). further, its very logic of functioning transcends key dichotomous categories of modern society and modern imagination. the most important dichotomous categorisation is public sphere/market sphere. the category of community also transcends the dichotomies of home/market and private/public. further, timebanking transcends the boundaries between commercial and voluntary, money and social activism and, in many cases, also professional assistance/helping out as a peer. the following question, in terms of both ontology and politics, is, then, what the conditions or prospects of the recognition of a distinct social or ontological space are, not being reduced to existing categories such as public service provision, volunteerism or commercial transactions. the issue needs to be analysed both in terms of government and market responses and in terms of reactions from timebank organisers to these responses. as timebanks cannot occupy a contained or isolated social space, they inevitably engage in implicit or explicit negotiations with these other spheres of organising. this negotiation is intensified by the attempts of timebanks to scale up further (boyle, coote, sherwood & slay, 2010). scaling up in community economies means that locally originated systems are institutionalised and diffused through knowledge aggregation (geels & raven, 95 njsr – nordic journal of social research vol. 9, 2018 2006, p. 378). yet, scaling up (utting, 2015), or “diffusion” (seyfang & longhurst, 2016), has various meanings. first, it can mean that a practice spreads geographically – in this case, more communities with timebanks. second, it can mean that practices are embedded in new kinds of institutions. for example, new ngos can discover timebanking as a method. third, it can mean substitution: some services previously exchanged only through the capitalist market are offered in timebanks, thus shifting timebanks towards small-scale entrepreneurship. fourth, it can mean growth of the volume of exchanges or members within an individual timebank or timebanking generally. while “diffusion success is dependent on a number of factors and … is beyond the control of any given actor (or set of actors) to simply ensure that these elements are aligned” (seyfang & longhurst, 2016, p. 20), all these forms of scaling up (diffusion) potentially imply different strategies and attract different responses from governments. the question of social space typically becomes acute when a system of an alternative economy no longer needs to be “shielded” (raven, 2012, p. 126) or contained in “protective spaces” (smith & raven, 2012) but rather embedded and diffused in wider society. yet, existing literature on these alternative economic systems, or “niches”, appears to see the conditions of upscaling to exist almost exclusively in the context of a disruption of the existing system of governance. for instance, gill seyfang and neel longhurst write in their study on the diffusion of economic alternatives: “landscape pressures and regime ‘crises’ can be a necessary precursor for niche innovations to gain influence” (2016, p. 3). while indeed true, this notion hardly contributes to understanding the prospects of institutionalising and upscaling timebanks in contexts with no acute regime crisis in sight. the regime in countries where timebanks have gained influence is quite stable, in whatever sense one wants to understand “regime”: the government (with an interest in taxation, workforce control, upholding market institutions and market discipline, social-policy interventions, social coherence and crime prevention), or the prevailing capitalist economic system (interested in commodification and upholding the market discipline in valuation). the analysis of external pressures to timebanks in terms of maintaining, defending and negotiating their social space has to be carried out in contexts without major disruptions. 96 njsr – nordic journal of social research vol. 9, 2018 data, method and epistemology the research data is comprised of interviews, observations and background materials. in finland, long-term observation and resulting field notes (kawulich, 2005) form the core of the data, while in the uk, the main data collection method was interviewing. therefore, the uk data is more exploratory, yet more systematic. observations in helsinki span a long period of time and include several sources of information (strauss & juliet 1994). indeed long-term observation over several years with a varying level of intensity was a practical possibility in finland because of the author’s residence. this observation took place in timebank member meetings and seminars on timebanking, including dialogue with politicians and government officials, etc. there was also regular contact with key timebank activists, who formed a loose group of 4–10 persons. timebank organisation and challenges with authorities were regularly discussed with this group. the field notes resulting from this observation are based on a wide range of sources, as is typical to observation: informal interviews, lectures, seminars, expert group meetings, newspaper articles, internet mailing lists and so forth (ralph, birks & chapman, 2014). in the uk, 10 brokers and/or active members from six timebanks in southeast london area were interviewed, along with a timebanking uk staff member and local council employees in southeast london. these timebanks, as is typical in the uk, were small timebanks with salaried brokers. in terms of organisation and membership selection, the sample included both standalone and embedded, and both targeted and non-targeted timebanks. the format of the interviews was unstructured. the method of interviewing extended to the realm of “creative interviewing”, understanding the interview as a “contextually bound and mutually created story” (holstein & gubrium, 1995). thus the interviews were also about sharing thoughts (douglas, 1985), committing intentionally the “capital offense of interviewing” (fontana & prokos, 2007, p. 40): answering questions from interviewees and allowing the interviews to have a dialogical format. this was done for purposes of ensuring the relevance of data, as the respondents were also asked to reflect on the particularities of their situation, which required comparisons with timebanking in finland in the context of this research. despite the absence of fixed questions, a set of key themes was discussed with each interviewee. in the interviews with the timebank brokers/members, questions focused on: a) practical organisation of the timebank, b) trust-building amongst members (existing and potential), c) possibilities and limits of scaling 97 njsr – nordic journal of social research vol. 9, 2018 up the activities and d) future challenges. the interview with the timebanking uk staff member covered future plans and prospects of timebanking generally, as well as general political issues of concern to timebanks in the uk. interviews with local council employees focused on how they see timebanks in relation to the council’s policy objectives. other material includes, first, member surveys. during the interviews (2016), the author was provided the member survey of a well-established and large southeast london timebank. in addition, the author carried out a stap member survey in 2014, which still has relevance. further, a large number of other material was used: ministry and council position papers on timebanking, info leaflets and other similar material produced by individual timebanks, material produced by timebanking uk and case studies available on the web pages of timebanking uk and timebanking usa (e.g. boyle & bird, 2014; dbis, 2015; dwp, 2015; forest time bank, 2010; simon, 2010; timebanking uk, 2017). the variety of types of material draws from an attempt to maximise relevant information by allowing several data collection methods. the interviews and observations served as primary data sources and were complemented by member surveys and documents. the applied methodology stresses a non-positivist approach: the social world needs to be analysed not only in the sense of “what happens” but also in the sense of how individuals make sense of it (miller & glassner, 2011). this is important because of the performativity in social sciences: if the timebanks are to establish their social space, this requires establishing this space also within the realm of language in order to make it “real” in social ontology. in this sense, “interpretation” can precede “event”, making them less separate also on the level of data collection. in the data analysis, interview data and observation notes were transcribed, followed by a thematic categorisation (on thematic analysis, e.g. guest, macqueen & namey, 2012). the data was then organised following the ontological categories and entities with which timebanks negotiate their social space. the resulting analysis is presented in the following chapters. the presentation is in the form of description of analysis results, presented as processed information rather than, for example, lengthy interview quotes. as the study is exploratory in nature, the narrative is not organised strictly as a balanced comparison; rather, each subchapter highlights the key points in both casestudy countries in light of the research question. 98 njsr – nordic journal of social research vol. 9, 2018 government responses: market and labour i will next analyse government responses to timebanking. by “government”, i refer to any branch of government or administration that pays attention to timebanks. while governments do respond to timebanking, there is no little need for high-level politicians or most departments in the administration to do this. in finland, the major issue timebanking has faced is tax liability. finnish tax officials announced, some years after the launch of the stap, that services exchanged through timebanks should be reported to the tax authority in their euro value, as the timebank generates economic benefits to its members (joutsenvirta, 2016). the existence of an accounting system was interpreted by the tax officials as an indication that timebanks resemble market exchange. timebank activists have constantly (and with little success) attempted to challenge this interpretation. “compensated labour” seems to be taken by the tax office as a non-negotiable category and is seen as challenging the very institutional basis of the welfare state. the position of the tax office thus creates a permanent obstacle to upscaling timebank activities in terms of substituting market activity as, in order to comply with the interpretation on tax liability, timebanks should see to it that all professional activities are excluded. the self-perception of the system of government in the country displays adherence to the welfare-state tradition. this tradition is based on a combination of high commodification within the market sphere and high decommodification within the sphere of social services, to use gösta esping-andersen’s terms (1990). as an implication, the taxation system penetrates the economy efficiently in order to cater for the generous public and decommodified sphere. practices resembling the market in any way are therefore easily interpreted by government officials as liable to taxation. in the uk, in contrast, taxation appears to have been no serious concern to timebanks at any point. yet the control of unemployed persons has been pushed quite far, and timebanks have faced pressure from job centres. job centres expect the unemployed to be full-time active job seekers, and they initially expressed suspicion of job seekers’ activities within timebanks. timebanking uk has managed to negotiate timebanking as an activity legitimately counting towards the required job-seeking time. although pushed by timebanking uk itself, this approach leads to a new form of control of the unemployed, as job seekers need to produce their timebank transcripts in job centres. today, many job centres actively direct unemployed people to local timebanks; some are even introducing their own timebanks to keep job seekers occupied. 99 njsr – nordic journal of social research vol. 9, 2018 the department of work and pensions (dwp) stated that “claimants involved in ‘timebanking’, or ‘time-exchange schemes’, are regarded as making a positive contribution to the community and are encouraged to do so … however, claimants must still meet the other conditions of entitlement … any participation in timebanking must be declared immediately to dwp” (2015). jobcentre work coaches are instructed to “check that the requirements of the opportunity will not prevent a job-seeker from meeting key labour market conditionality requirements” (dbis, 2015, p. 15). yet the position taken by the dwp does not and cannot completely do away with tensions related to the potential conflict between timebanks and the labour market. as market discipline requires non-interference in market competition, activities within timebanks are always potentially illegitimate from this perspective – in economics parlance, they might be seen to “create market disturbances”. for instance, an unemployed professional painter might use his/her skills to paint a house and earn time credits on the way, but there will most likely also be other painters searching for work, who will be unhappy about the unemployed painter “selling below market prices”. thus the recognition of the positive contribution of timebanking also masks a tension: the job centres are interested in both limiting the professional-type activity of the unemployed (to avoid market disturbance) and in encouraging professional activity (to uphold the employability of the unemployed). in a rhetorical attempt to overcome the tension, the department of business, innovation and skills says that job-centre staff can direct job seekers to timebanks “as a way to build up their experience” (italics added), thereby using the currently dominant labour policy discourse, which focuses on employability rather than employment directly. (on employability, see mitchell & muysken, 2008, chapter 5.) governing the volunteer sector in addition to subjecting timebanks to governance via economic categories (income, labour), timebanks can be governed by the government by pushing them into the “volunteer sector” category. this categorisation then pushes timebanks into another category of dominant social ontology. the volunteer sector should be seen as a governed domain: it does not mean only legitimate social space for spontaneous civic activity. the sector is governed through the means of planning, monitoring, target-setting, financial incentives and attempts to align the sector with government policies. this is particularly visible in the uk big society model. as community-level activity is not necessarily in line with 100 njsr – nordic journal of social research vol. 9, 2018 political objectives, big society governance involves attempts to align community activity to contribute towards government policy goals (alcock, 2010). the government’s relationship with the volunteer sector is not confined to its promotion. the government also actively shapes the sector by means of channelling financial assistance to volunteer organisations and by implementing specific volunteering strategies. there are explicit schemes to encourage and even commodify volunteering. yet volunteering is also seen as a tool to withdraw from funding public services. sometimes the co-existence of austerity and volunteerism is expressed as an explicit model, while on other occasions volunteerism is rather seen as a survival strategy for public services. in the words of an interviewed local council employee: “austerity is not going away. we have to find ways to live with it. if it requires establishing a ‘friends of the local library volunteer society’ to avoid closing down the local library; i think we should do that”. volunteering strategies very explicitly place timebanks within this governable category. interestingly, the uk government’s strategy to encourage and govern volunteerism gives rise to initiatives that both compete with timebanks and repackage their ideology in a more market-friendly language and form. for instance, a project called “spice” (spice, 2017) aims at generating volunteerism by creating incentives. this is done by giving vouchers to volunteers in accordance with “hours” earned in volunteering. the vouchers can be used to get reduced prices from local services, or, for example, free entry to museums. spice uses the time currency and co-production language of timebanks, but its idea is more in line with the government’s ambitions. in finland, similar attempts to categorise timebanks within the volunteer sector have not been seen, as the government interpretation of timebanking has been based on an economic vocabulary, emphasised by the preferred non-formal mode of organisation of timebanks, making it considerably more difficult for the authorities to govern the activities as volunteerism. pressures from commercial agents pressures on timebanks do not derive only from the government. timebanks also sometimes have to consider whether they enter into relations with commercial agents. for instance, despite their community-building ideology, timebank organisers do not necessarily find it easy to assure people they should let strangers with no professional status into their homes. this has led to a 101 njsr – nordic journal of social research vol. 9, 2018 general tendency to restrict the scope of offered services2, as well as a reliance on a private insurance scheme. timebanking uk points out that the first claim on its collective insurance scheme is still to be made, yet argues that the very existence of the scheme is significant in convincing people that timebanking activities are safe (2017). interestingly, the insurance company initially displayed a lack of understanding regarding timebanks, clearly overpricing the scheme. while the terms of the scheme were eventually renegotiated, the decision to buy private insurance opens a new arena of negotiation, in which timebanks have to defend their logic of operation against the logic of a capitalist market agent. insurance also defines some exchanges as out-of-bounds, including professional construction, electricity, etc., thus being in conflict with the timebank philosophy of making use of all idle and useful skills (cahn, 2004). timebanks ultimately have had to accept the limitations defined in the insurance terms. the felt need to rely on insurance highlights the importance of “social goods”, the most noteworthy of which is a high level of trust within the society. the welfare-state tradition appears to be better in the provision of such goods; in contrast with reliance on commercial insurance in uk timebanks, finnish timebanks have not felt a need for such external assurance but have relied on their internal ethical codes and conflict-resolving procedures. mutual trust amongst members is not only an outcome of suitable procedures within the timebank but the general societal atmosphere (equality, institutional quality) is also a significant contributing factor, as joining timebank activity means engaging in personal interaction with strangers. this general atmosphere, while being a major enabling/disabling factor, is extremely hard to change by the timebank activists themselves. interestingly, the finnish tax authority and the uk insurance company push quite similar limitations on professional activity in timebanks. while the former draws justification from reference to economic benefit and the latter from risk 2 one uk timebank broker said in the interview: “i will do anything but childcare. childcare is a can of worms.” another listed out-of-bounds issues to be “electricity, plumbing, gas, construction, handling money, pets, high places… we have to think in terms of what could happen.” these limitations are interesting as in the finnish context, many of these services, especially childcare and pet minding, are amongst the most used. 102 njsr – nordic journal of social research vol. 9, 2018 assessments, both create a pressure to contain timebanking activities to routine help around the house and other non-professional activities. timebank responses as timebanks always operate in the context of society with existing governance procedures, functioning, in general, and scaling up, in particular, force timebanks to make difficult choices regarding the terms of integration with existing orders of valuation, justification and governance. in the uk, timebanks have made an explicit and conscious effort to “sell” the timebanking concept to potential funders, as the salaried broker model of organisation creates a constant need for funding. this funding is typically sought from funds available to the volunteer sector. the felt need to convince funders has two kinds of consequences: first, not all timebanks focus on community building in the general sense but rather on given target groups. the target-group approach was seen by the interviewees either as a genuine reflection of the identity of uk timebanks or as the reality they have to live with, in other words, an unavoidable fundraising issue. when approaching potential funders, timebanks tend to present their work in terms of documentable social benefits. while timebanks are not social-policy instruments as such, the concept is easier to sell if portrayed as a creative remedy to some identified social ill. as timebanks are presented as amongst social interventions (and thus also competing for funding with other social-policy approaches), they also enter into comparisons with these “competitors”. second, timebanks tend to seek methods of justification, which effectively enable scaling up in the short term but might be an obstacle for pushing a transformative idea of value. several uk timebank brokers refer to the need to document the impacts of timebanking, especially showing that there are measurable outcomes on certain target groups. this clearly deviates from more ideological (and ambiguous) goals such as community building, creating an alternative conception of value, etc. interestingly, while several finnish timebank activists oppose the idea of reducing the value of timebanking to quantifiable figures, some of them, nevertheless, have referred to such tools as ultimate methods of justification when confronted by the tax authority. the most often-used impact assessment tool is the social return on investment (sroi) methodology (social value uk, 2017). it is mostly used to convince authorities that well-being generated by timebanking leads to diminished expenses in social services and health services. on the other hand, sroi is sometimes promoted as formalising an alternative conception of value (“social 103 njsr – nordic journal of social research vol. 9, 2018 value”). therefore, somewhat paradoxically, the methodology implies that value created in timebanking is both commensurable with other social interventions (as the returns on the social investment can be quantified) and incommensurable with capitalist value (as it entails a unique conception of value). it is indeed debatable whether sroi is indeed a strategic tool for defending the timebanks’ conception of value or a shift towards a capitalist conception of value. some timebanks in the uk have quite deliberately chosen the strategy of cooptation in the face of pressures from the government. for example, given their criticism of the market logic of valuation, one would assume that this also extends to criticising the control of the workforce in job centres. yet timebanks have not protested the approach chosen by job centres (which embrace timebanking but insist on conditionalities and reporting) but rather have seen it as a recognition of the social value of timebanking. as one timebank explains to potential unemployed members in an info sheet: “jobcentre plus may ask for information about what exchanges you have undertaken. don’t worry. every month, we give you a statement of your exchanges that you can show them” (forest time bank, 2010). another form of co-optation relates to accepting the government perception of timebanks as spaces for gaining and building experience that can then be utilised within the “economy proper”. timebank ideology does not accept making such sharp divisions between market and non-market as the market is seen as a misguided mechanism for determining the value and need for a given skill. advocacy for timebanking promotes exactly the value of operating outside the category of salaried labour: “any official objective of full employment – one that regarded paid employment as the only acceptable status for healthy adults of working age – undermines local efforts” (boyle, clark & burns, 2006, p. x-xi). the quoted statement is not in opposition to building experience, yet it emphasises valuing skills as such, rather than as means to achieve “real” employment in the future, as the concept “experience” indicates. in finland, timebanking involves more sense of activism. the need to challenge “conventional money” tends to be emphasised (ces, 2017a, 2017b). this is ideologically close to the “positive money” movement and other calls for radical monetary reform (lietaer, 2001; lietaer & belgin, 2011). yet, relying on input from activists can lead to challenges with institutional continuity. also, the taxation issue remains paralysing. before the intervention by the tax authority, the volume of exchanges was more than double the present level. currently, timebanks can try to live with the status quo and operate despite the tax office 104 njsr – nordic journal of social research vol. 9, 2018 ruling, as long as the tax office does not actively enforce taxation on timebanking by, for example, demanding lists of transactions. however, their suspicious legal status deters potential timebank members and thereby suppresses growth. several ngos in finland have expressed their interest in using the timebanking platform to recognise the input of their volunteers or to create embedded timebanks, but are concerned about the perception of timebanks as bordering on illegal. not many finnish timebanking activists appear to see the big society model as an ideal, despite its explicit recognition of timebanking. rather, the importance of the production of social goods is often emphasised. this is in line with the “partner state” approach in commons theory (bauwens, 2012; bauwens & kostakis, 2014). one proposal in this spirit is to implement taxation but on timebanks’ terms. stap already collects a “time tax”, a small levy in time currency subtracted from each transaction. this levy is used to compensate activists for necessary operations within the timebank (maintenance of software, member register, etc.). thus the time tax can be seen as a time-based funding for infrastructure maintenance in a self-governed system (eskelinen, kovanen & van der wekken, 2017). this model has been suggested as a possible basis for solving the taxation issue: for instance, a municipality could theoretically open a timebank account and receive similar levies in time currency. this would imply recognising the conception of value in timebanking, rather than solving the taxation issue by enforcing the capitalist conception of value. discussion and conclusions the analysis above shows that the ontological space available for timebanks is often limited. when aiming to scale up, timebanks often encounter pressures to compromise by assuming the narrative of some existing category. advocacy for timebanks also often relies on existing categories instead of insisting on the recognition of the logic and values of the commons (which would imply transcending the state/market dichotomy, as well as emphasising community and social interaction as bases of value). for instance, politicians sympathetic to timebanking in finland are considerably more prepared to demand freedom from tax liability (assigning timebanks to a volunteering category) than to support the time-tax model (which implies transcending existing categories). while, technically, timebanks are based on a uniform ideology worldwide, the strategic choices and dilemmas they face, and thereby also their operational choices, are shaped by local systems of governance and informal social institutions, rather than merely organisers’ autonomous preferences. the local 105 njsr – nordic journal of social research vol. 9, 2018 political context is reflected even in perceptions of typical activities within a timebank. when asked to provide an example of a typical exchange, timebank brokers in the uk refer almost invariably to gardening, while in finland, the typical exchange would be childcare (which would be seen as a safety/insurance issue in the uk). the chosen approach to these choices and dilemmas is also likely to shape the future forms of timebanking as timebanks are markedly open processes rather than fixed institutions. in finland, the high commodification/high decommodification welfare-state tradition of governance has been quick to see anything resembling “economic” as subject to taxation. indeed, the government has insisted that timebanks produce economic benefits for their members. on the other hand, the welfare state can also be enabling, especially by fostering a general atmosphere of mutual trust (larsen, 2007; rothstein, 2001). in the uk, in sharp contrast to finland, timebanks are actively endorsed by government bodies, in line with the big society ideology. yet this does not mean that timebanks do not face external pressures. these pressures come from both the government and the market and relate to labour-market conditionalities and insurance. further, within the big society framework, while the search for social space has not been a struggle for the recognition of timebanking as such, there have been challenges related to self-organisation amidst government attempts to govern the volunteer sector, insisting that timebanks fall within this category. also, the prospects of scaling up are different. on the basis of the typology presented in this article, it seems that the uk timebanks have expanded very successfully geographically, as well as in terms of being embedded in new institutions. timebanking in finland is geographically concentrated and suffers from the status of being perceived as bordering on illegal. generally, the taxation issue creates obstacles for scaling up in the sense of including new kinds of activities and attracting ngos to create embedded timebanks. yet, seeking a positive response from the government is no real solution as this involves pressures to accommodate timebanking within categories preferred by the government, as seen in the case of the uk. the social space of alternative economies is still in the making. it is easy to see timebanks as a method for encouraging small-scale community-based activity (helping neighbours, exchanging services, volunteering for the community, etc.), but seeing this as the exclusive rationale of timebanking fails to recognise its full essence. similarly, interpreting timebanks in terms of economic exchange (as the finnish tax office does) can be tempting but also misses significant 106 njsr – nordic journal of social research vol. 9, 2018 aspects. a more credible approach would place civic activism as its starting point: timebanks are precisely about transcending categories. the relationship of alternative economies (as transcending categories) with different forms of government calls for research in the future. this further research could take three possible directions to complement the exploratory research presented in this article: first, the ontological space available for timebanks could be compared with other alternative economies; second, research could be carried out with settings allowing proper country 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(2015). introduction: the challenge of scaling up social and solidarity economy. in p. utting (ed.), social and solidarity economy beyond the fringe (pp. 1–37). london: zed books. introduction to special issue public sector innovation conceptual and methodological implications njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 this article belongs to the special issue public sector innovation conceptual and methodological implications guest editors: ann karin tennås holmen (uis), maria røhnebæk (inn) introduction to special issue public sector innovation conceptual and methodological implications maria røhnebæk inland school of business and social sciences inland norway university of applied sciences email: maria.rohnebak@inn.no ann-karin tennås holmen* faculty of social sciences university of stavanger, norway email: annkarin.holmen@uis.no *corresponding author introduction in western welfare state contexts, innovation is increasingly promoted as vital for addressing a range of societal problems. this has been expressed in research and public policies and has implications for the ways in which social science research is designed and carried out (de vries et al., 2016; osborne, 2013; karakas, 2020; forskningsrådet, 2018). calls for innovation to address societal challenges imply that social science research is expected to play a more instrumental and active role in bringing about societal change, an idea often coined as expectations that bring a greater impact. thus, research projects are increasingly expected to result in innovations or contribute to the realisation of innovations introduced and/or implemented by collaborating partners. ii njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications the aim of this special issue is to provide space for discussions and reflections on the conceptual and methodological implications of increased attention to innovation in public policies and services. this special issue includes articles that, in different ways, shed light on the complex relationship between research and innovation, focusing particularly on innovation in the public sector. public sector innovation has emerged as a vital research field over the past two decades (chen et al., 2019; de vries et al., 2016; fuglsang & rønning, 2014; hartley, 2005; osborne & brown, 2013), but fundamental conceptual and methodological aspects of research on public sector innovation deserve more attention. reflections and discussions on the conceptual and methodological issues related to innovation are needed for various reasons. regarding the conceptual issues, one area of concern relates to the transfer of the innovation concept from a market context to the public sector. moreover, the policy and research discourse on innovation has been criticised for carrying a positive normativity based on the assumption that innovation is largely desirable and inherently ‘good’ (osborne, 2013). this may have limited the space for critical studies examining the contested and conflict aspects of innovation. furthermore, because research related to innovation tends to come with the expectations of researchers as contributors to innovations, various dilemmas may arise regarding researchers’ roles and potential role conflicts. being a researcher and contributor to innovation can pose challenges regarding objectivity, proximity and analytical distance. research into and involvement in innovation may entail demanding balancing acts that deserve critical methodological reflection. however, those research processes that engage with innovation may also enable experimentation with new methodological approaches that can make valuable contributions to the rethinking of methodological principles in social science research. hence, the aim of this special issue is to further develop research dialogues concerning public sector innovation and shed light on themes that have not yet been sufficiently addressed, such as critical examinations of the concept of public sector innovation and its performativity, critical discussions of how the phenomena can be studied, and critical explorations of the linkages between research and innovation. the articles in this special issue contribute to illuminating how the policy and research discourse concerning public sector iii njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications innovation contains blind spots and challenges, but they also highlight the potential for developing future research avenues in this field. this special issue presents a collection of articles grouped under two theme headings: 1) conceptualisation of public sector innovation and 2) the role of research and researchers in public sector innovation. we set the stage for these articles by briefly outlining the backdrop of the current public sector innovation discourse. public sector innovation the early writings on public sector innovation served largely to set the agenda, focusing on expressing the arguments for why innovation is crucial for improvements in the public sector (albury, 2005; borins, 2001). albury argued, for instance, that innovation ‘is not an optional luxury but needs to be institutionalised as a deep value’ (2005, p. 15). starting from this premise, he outlined a framework that was meant to support the implementation of ‘successful innovation in the public sector’. this, it was argued, relied on an understanding of the barriers to innovation and how they could be tackled. a range of studies and writings on public sector innovation have followed from these premises, leading a substantial part of public sector innovation research as centred on identifying the ‘drivers and barriers’ for innovation (de vries et al., 2016; ringholm & holmen, 2019). identifying the drivers and barriers was, for instance, central in the publin project, which was the first research project concerning public sector innovation supported by the eu through the fifth work programme (koch et al., 2006). researching the ‘drivers and barriers’ of public sector innovation can be important in many ways. for example, it contributes to the generation of knowledge about the specific characteristics of the public sector context for innovation compared with a private sector context (halvorsen et al., 2005). a need for more context-sensitive innovation models in the public sector has been identified (hartley, 2005, 2013). understanding the specific drivers and barriers that frame innovation in the public sector can be helpful here. moreover, research into the drivers and barriers may result in valuable insights for policymakers and practitioners on how to strengthen the public sector’s capacity for innovation. nevertheless, when searching for these ‘drivers and barriers’, the innovation concept itself remains unproblematised, and it is somewhat uncritically accepted as something that is desirable to strive for. iv njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications (ringholm & holmen, 2019; osborne & brown, 2011). the contested and conflicted aspects of innovation become linked to the surrounding ‘barriers’ rather than to potential controversies embedded in the content and outcomes of innovation itself. the need to highlight and analyse the underpinning discursive aspects of using the term ‘innovation’ in the public sector is a central concern that is addressed in this special issue (see particularly the article by langergaard and fuglsang). approaching public sector innovation as a discourse evokes discussions of how power is embedded in the language we use. the term discourse can be largely linked to the work of michel foucault, who understood discourse as ‘practices that systematically form the objects of which they speak’ (foucault, 1972, p. 49). this means that the language we use does not reflect the world to which it refers, but it plays an active part in creating and recreating the social world. although this may be self-evident, we are often not fully aware of the complex ways in which language is performative. thus, we do not always see how certain ways of defining and conceptualising the world set the premise for the way in which we perceive things and act. in the early 1990s, the term ‘development’ and the language distinguishing between ‘developing and developed’ nations were critically examined through discourse analyses, in what became known as ‘postdevelopment theories’ (escobar, 1991; ferguson, 1990). these postdevelopment theories challenged the way in which the vocabulary of ‘development’ produced and reproduced practices that continued to worsen the situation for developing countries, contributing to an enlargement—rather than narrowing—of the gaps between poorer and wealthy nations. by deconstructing the development discourse, these theorists asked for ‘alternatives to development’ rather than merely searching for ‘development alternatives’ (escobar, 1991). we can draw parallels to the innovation concept and its increasingly widespread use in public policies, public sector organisations and society at large. there is a need for discursive approaches to the concept that can create awareness and raise discussions on what kind of priorities and practices this language enables and which voices, concerns and practices the innovation discourse may displace. although there are reasons to explore and search for ‘innovation alternatives’, there might also be reasons to discuss ‘alternatives to innovation’. v njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications as described, the normative underlying premises have shaped the academic literature on public sector innovation, which has limited the room for critical discussions. first, the discourse has been shaped by the focus on identifying ‘drivers and barriers’, which has implicitly assumed innovation as being desirable. moreover, the innovation concept has gained ground through academic literature aiming to create awareness that innovation in the public sector may be more widespread than we tend to think (see, for instance, ringholm et al., 2013). as the argument goes, the public sector may be just as innovative as its private counterparts, but other terms such as ‘renewal’, ‘reforms’ and ‘improvement’ have been more commonly used in the past. the shift of vocabulary has led to increased awareness concerning the need for measuring public sector innovation (arundel et al., 2019) and to the more specific developments of public sector ‘innovation barometers’, which we find in denmark1 and in norway2 . altogether, this adds to a growing innovation discourse that increasingly shapes our understanding of what constitutes suitable practices for ensuring quality, effectiveness and viability in the public sector. we do not suggest that the increased focus on public sector innovation is wrong, but we invite more nuanced, problematising and critical academic discussions on innovation, including scrutiny of the concept itself. this special issue is meant as a contribution in this regard, which resonates with calls and arguments from other scholars such as osborne and brown (2011). they frame the innovation discourse as an ‘innovation imperative’ and problematised how this imperative is guided by an overly positive normativity (osborne & brown, 2013). moreover, langergaard (2012) has critically discussed how the ‘publicness’ of public sector innovation has been sidelined when compared with the focus on innovation. these issues have also been raised and discussed by kattel (2015) and by ringholm and holmen (2019) who problematised how the underlying dichotomy of drivers and barriers may conceal the power aspects of the innovation concept, limiting the ability to see how the impact of innovations may be perceived differently depending on the context and positioning of the actors. similar concerns have been raised by fuglsang and rønning (2014), who also addressed the often conflicted nature 1 https://www.innovationbarometer.org/ 2https://www.ks.no/fagomrader/innovasjon/innovasjonsledelse/innovasjonsbar ometeret-for-kommunal-sektor/ https://www.innovationbarometer.org/ https://www.ks.no/fagomrader/innovasjon/innovasjonsledelse/innovasjonsbarometeret-for-kommunal-sektor/ https://www.ks.no/fagomrader/innovasjon/innovasjonsledelse/innovasjonsbarometeret-for-kommunal-sektor/ vi njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications of public sector innovations and consequent need for more contextual research strategies. we find that the need for critical and reflexive academic debates on public sector innovation becomes increasingly important as the concept also becomes ever more embedded and entangled with social science research practices. the emergence of the innovation discourse brings forward ‘innovation’ as a central (catch-) phrase in policy documents, in tenders for commissioned research and in various research funding schemes nationally and internationally. we see a new landscape for social science research, one where researchers are increasingly expected to take on roles as innovators or contributors to innovation in collaborative arrangements. this connects to the developments in the public sector innovation literature. initially, the literature focused on bringing attention to the public sector as being (potentially) innovative itself rather than merely a facilitator and funder of innovation in private industries. to some extent, this assumes a somewhat introverted approach towards innovation as something that takes place within public sector organisations. however, the focus on open, networked and collaborative approaches to innovation has become substantial and largely influential, captured in various phrases such as collaborative innovation (bommert, 2010; hartley et al., 2013; sørensen & torfing, 2011), open innovation (chesbrough, 2006), service ecosystems/innovation ecosystems (chen et al., 2019), cocreation and coproduction (voorberg et al., 2015), codesign (bason, 2017, 2018) and innovation networks (gallouj et al., 2013). the arguments for more collaborative and networked forms of innovation are often linked to the need to meet complex and cross-cutting societal problems that cannot be handled by singular actors or within specific services or sectors. efforts to bring together a diversity of actors also imply expectations that social science researchers play a more active role as participants rather than mere observers. the implications of this, when it comes to changing roles for research and researchers, are also issues we want to raise with this special issue, and we present contributions that shed light on the experiences and reflections from the intersection of research and innovation (see particularly the article by gulbrandsen & høiland). vii njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications the collection of articles the articles collected in this volume approach public sector innovation from different points of departure. three articles critically examine and discuss the concept of innovation and its implications for research and discourses on public sector innovation, examining how innovation links to research and to shifts in researcher roles. the two articles on the innovation concept are mainly theoretical, but one draws on empirical case vignettes as illustrations (see fuglsang). the article addressing the roles of research in public sector innovation is based on the findings from a case study. in the opening article, which addresses the concept of innovation, langergaard calls for more critical reflections and discussions of the implications involved in labelling renewal and change in the public sector as ‘innovation’; she highlights the need for research dialogues that are more aware of what conceptualising involves— that is, how the use of language and labels directs our attention and shapes the way we perceive the world and, consequently, how we act in it. the author points to a lack of coherence in the way ‘innovation’ is understood in the literature, and she problematises the lack of explicit reflections on the diverse epistemological bases underpinning diverse forms of research in this field. the article suggests that a way forward is to encourage reflections and discussions along three dimensions of conceptualisation: epistemological, pragmatic and normative. the epistemological dimension relates to the question of how knowledge is understood, which opens up reflections on how the concept of innovation links to phenomena in the world. questions of epistemology also link to reflections on the nature of different forms of research concerning public sector innovation: does it aim to describe, explain, predict or direct? the pragmatic dimension deals with the more practical or instrumental aspects of public sector innovation. it links to discussions on how to make innovation in the public sector happen, which incentives are appropriate, how to identify and enhance drivers and how to tackle barriers and so forth. finally, the normative dimension links to the value-laden aspects of the innovation concept and how to deal with this from a research perspective. this article connects this normative dimension to theories on value creation and debates on public value. although langergaard’s article sets the stage for discussions on conceptualising public sector innovation viii njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications along three dimensions, she also underlines that the three dimensions are closely interconnected. the second article seeks to advance public sector innovation research by drawing on theoretical resources that have been scarcely integrated in the literature so far. more specifically, fuglsang introduces practice theory and argues that a practice-based approach to public innovation may enable more contextual studies of innovation that are suitable for capturing the often unpredictable and conflicting nature of innovation processes. a practice-based approach explores innovation as embedded in practices, which, in simplified terms, are understood as routine ways of doing things. the article explores what a practice-based approach to innovation means and seeks to grapple with the question of how innovation tends to be ingrained in practices while also disrupting these. the article focuses on innovation at the level of public service organisations, outlining two intertwined approaches: the apollonian and the dionysian. the apollonian practice is the purposeful speaking of actors’ plans and interests, as well as the rules of the game. in this type of innovation, actors align around a common idea structure. the process is formalised, structured and sequential. the dionysian practice is a more spontaneous, bricolage-like approach that brings people together in an open space of innovation. using two case vignettes, fuglsang shows how these modes of innovation are interdependent in a complex and paradoxical way that poses challenges for management. although we often expect innovation processes in the public sector to be universal, high-scale and highly aligned with policymakers’ decisions and ideas, this contribution shows that actors at different levels in public sector organizations may incorporate other ideas and considerations into the processes, thus making them more unpredictable. the practical lesson is that innovation leaders need to take into account the specific elements of each innovation process. there is no ‘one size fits all’ when it comes to innovation strategies. hence, the first two articles address and discuss how to conceptualise, theorise and study public sector innovation and deal with public sector innovation as a research field. the remaining article addresses the role of research in public sector innovation. ix njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications gulbrandsen and høiland take a critical point of departure, challenging the assumptions that public sector innovation is enabled through the coupling of research/researchers and public sector actors. the authors examine these assumptions in the context of the norwegian labour and welfare services (nav) by analysing the role of research in five innovation cases. the analysis explores the driving forces of the innovation projects and categorises the role of research into three phases of the processes. the analysis shows that research contributes either by providing new knowledge for immature ideas or innovations in the process or by delivering numbers and narratives to secure funding and legitimacy. three idealised relationships between research and innovation frame the case analysis; the cases are assessed in terms of whether they represent examples of 1) research to innovation, 2) research on innovation and 3) research in innovation. the findings are used to denote how research can contribute to these three forms of transformation in innovation processes. the current article contributes by conceptualising the potentially different roles of research in public sector innovation processes. overall, this special issue sheds light on the complex relationship between research and innovation in the public sector. the contributions address public sector innovation as a research field and provide insights, theories and perspectives on how to study, conceptualise and theorise phenomena in this field. second, the contributions address public sector innovation as diverse practices, providing insights and concepts that facilitate a discussion concerning the roles of research and researchers in these innovation practices. as editors, we hope that this special issue will encourage a continuous discussion about the conceptual and methodological issues of public sector innovation. x njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications references albury, d. 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(2013). innovative kommuner. cappelen damm akademisk. 13-30 sørensen, e., & torfing, j. (2011). enhancing collaborative innovation in the public sector. administration & society, 43(8), 842-868. https://doi.org/10.1177/0095399711418768 voorberg, w. h., bekkers, v. j. j. m., & tummers, l. g. (2015). a systematic review of co-creation and co-production: embarking on the social innovation journey. public management review, 17(9), 1333-1357. https://doi.org/10.1080/14719037.2014.930505 microsoft word moen identity njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol 9, 2018 identity and self-understanding among transgender women in norway vigdis moen* faculty of medicine and health sciences. department of public health and nursing norwegian university of science and technology (ntnu) email: vigdis.moen@ntnu.no *corresponding author ingvild aune faculty of medicine and health sciences, department of public health and nursing norwegian university of science and technology (ntnu) email: ingvild.aune@ntnu.no abstract aim: the aim of this study is to gain a deeper understanding of and more knowledge about the experience of transgender women in terms of identity and self-understanding. method: data are collected from six norwegian adult transgender women who have told their life stories. a narrative analysis is used to analyse the stories of the participants. the narrative focus is on themes relating to identity, selfunderstanding and belonging. results: the results of the study show that the participants exclusively have a female identity and sense of belonging. despite this, two of the participants prefer to live as males out of consideration for those in their surroundings. the self-understanding of the informants is expressed in different ways, depending on personality and life experience. conclusion: whether or not one has ‘come out of the closet’ seems to be important for both identity and self-understanding. the participants who are open about their identity seem more secure than those who are not. the more 69 njsr – nordic journal of social research vol. 9, 2018 acceptance and recognition they get from the social environment, the more it appears that the women in this study dare to be who they are. keywords: gender identity; self-understanding; belonging; coming out; significance of surroundings environment introduction transgender people are a diverse population of individuals who do not identify with their gender at birth (benestad, 2004; arntzen & kahrs, 2013). transgender identity concerns women and men who masculinise or feminise their bodies with cross-sex hormone treatment and/or gender-confirming surgery (bouman et al., 2017; benestad, 2004). the transgender phenomenon is complex, and there is great confusion about the different terms. most cisgender people, like the authors, are unfamiliar with the words that people in the transgender community use to describe themselves, their experiences and their most pressing issues (serano, 2016). transgenderism emerged as a term in 1969 (ekings & king, 1996) and has been – and still is – used in different ways. for some, the term is an umbrella term for all types of transgender people, including transsexuals, transvestites, etc. (ekings & king, 1996). for others, and especially in the united states, a transgender person is one who lives as the opposite sex without a desire for gender-confirming treatment (graugaard, 2001). the term transgender may be seen as a postmodern concept; whereas in one sense, gender implies a subjective, social and linguistic understanding of bodily gender, a postmodern understanding is based on a more philosophical perspective (stryker & whittle, 2006; sanger, 2010; ansara, 2010; aizura, 2012). transgender people experience a gender incongruence, which is a sense of conflict between somatic gender and the psychological component of gender (van der ros, 2014). every human being has a story. for some, the story is more complex than for others. many transgender people have encountered a number of challenges, such as disclosing their gender identity. mental suffering, such as anxiety and depression, is not uncommon, and there is a relatively high risk of suicide (hansen, 2001; winzer & bostrøm, 2007; the norwegian health directorate, 2015; bouman et al., 2017). the term identity in this article refers to gender identity. the definition of the term gender identity is the subjective and individual experience related to gender. this is a feeling of being unique and independent and a perception about a permanent connection between the person you are on one hand and body experience, body image and life experiences on the other (almås, 2004; the norwegian health directorate, 2015; almås & benestad, 2017; van der 70 njsr – nordic journal of social research vol. 9, 2018 ros, 2016). the term self-understanding may to some extent include the identity concept. however, self-understanding can be more directly linked to self-image and how one understands oneself as a human being. how one understands oneself can be conditioned by the response from the surrounding environment to a larger degree than identity. who we understand ourselves to be may be very different (henriksen & vetlesen, 2006; mead et al., 2015; røkenes & hanssen, 2012). it could be to see yourself as part of a social class, a family or a college. in this case, self-understanding is also linked to how the social environment responds to gender and gender belonging. the aim of this study is to gain a deeper understanding of and more knowledge about the experience of transgender women in terms of identity and self-understanding. methods participants this study is based on personal and, in some cases, intimate topics. therefore, the selection of participants is based on accessibility. only women wanted to participate and did so on a voluntary basis. the sample consists of six transgender women of different ages and in different stages of life. the variation in age and life cycle is an important factor when exploring possible differences. a sample that is too homogeneous makes it more difficult to discover nuances that could generate new knowledge or questions (malterud, 2011). the researcher (vm) recruited the informants from transgender interest groups. there was no relationship between the researcher and the informants. the inclusion criterium was that each participant had to be a transgender person of adult age with no psychiatric diagnosis besides their prospective transsexualism, according to the tenth revision of the international statistical classification of diseases and related health problems (icd-10) (world health organization, 2016). the participants received written and oral information about the aim of the study and the terms of confidentiality. they subsequently gave written informed consent. all the participants live in the same city, but come from different places in norway. all the names used in the study are pseudonyms. the youngest participant, siri (24), has a job in addition to studying to become a primary school teacher. she is considering taking a break from her studies until she has finished the gender-confirming treatment. she is single and has a few good friends. her contact with her parents and brother, who live elsewhere in the country, is good. karin (44) is a nurse and works full time in the healthcare sector. she is single and still in the closet, which means that she officially lives 71 njsr – nordic journal of social research vol. 9, 2018 as male and has not told anyone about her female identity. outside work, she has a limited social network. she has some contact with her siblings, who live elsewhere in the country. ingrid (60) is the oldest of the participants. she has finished her gender-confirming treatment and still lives with her wife. she has good contact with her children, other relatives and friends. she is partially disabled due to heart disease, and works in a print shop. turid (51) is a trained mason, but due to health problems has been on sick leave over the last year. she is married for the second time and has children from her first and second marriages. she has a good social network, and prefers an androgynous expression. marianne (50) is an it graduate. she is now disabled but works a little in a kindergarten. she has finished her gender-confirming treatment, lives in a lesbian relationship and has a son from a previous relationship with whom she stays in regular contact. apart from this, she has no contact with her family members. berit (34) is also an it graduate and works full time. she cohabits with a woman but is still in the closet. she has good contact with family and friends. narrative analysis a narrative analysis was selected to analyse the life story of the participants. this type of analysis can be conducted in different ways. the approach used in this study is a combination of a thematic analysis (riessman, 2008) and an analysis of contents (johansson, 2005). before starting the data collection, a list of factors the researcher wanted to address was compiled. the main factors were childhood and adolescence, point of coming out, family matters and sexuality. in this way, the participants revealed their stories through dialogue with the researcher and not in a monologue. when working through the written data, the text was classified according to key themes, such as ‘gender identity’. this is what riessman (2008) calls thematic analysis. johansson (2005) uses the term partial content, which means that one defines certain categories and analyses the content (i.e. content analysis). this is commonly used in the social sciences, such as sociology. the data is derived from the experiences and situations of the informants, and as analysts the researchers developed the thematic categories, presented in figure 1. 72 njsr – nordic journal of social research vol. 9, 2018 informant → code ↓ ‘siri’ 24 years old ‘karin’ 44 years old ‘ingrid’ 60 years old ‘turid’ 51 years old ‘marianne’ 50 years old ‘berit’ 34 years old gender identity female female female female female female self understanding ‘i just want to be myself’ ‘i wish to be a real person’ ‘there is no real stuff’ ‘i know who i am’ ‘finally i can be the person i have always been’ ‘i want to repress who i am’ coming out has come out still in the closet has come out has come out has come out still in the closet belonging belongs to the female gender feels like a female, chooses the male category belongs to the female gender belongs to the female gender belongs to the female gender feels like a female, chooses the male category figure 1 ethics the norwegian social science data services approved the research project (nsd, project no. 17831). the participants gave written consent. they were informed that the study will not have any consequences for possible hormonal or surgical treatment. in this respect, the participants were not patients, and the study did not require subsequent approval by the ethics committee. no medical intervention occurred, and only discussions about ‘who you are’ took place. the authors do not consider transgenderism a pathologic phenomenon. transgender people are human beings who face existential issues (henriksen & vetlesen, 2000; johannessen, kokkersvold, & vedeler, 1994; moen, 2008; 73 njsr – nordic journal of social research vol. 9, 2018 moen, 2010), like other people who encounter challenges in life. however, the challenges of transgender people can affect their mental health. therefore, it was important that the participants did not have a psychiatric diagnosis in addition to their gender identity challenges. the names used in the study are pseudonyms. professionals who deal with controversial issues, including those related to sexology, would be happy to give a voice to groups that usually do not get any attention in society. transgender people are vulnerable, and the results of this study may be used in the public debate and in policymaking to benefit this particular group. researchers ought to reflect on their own role as interviewers, listeners or interlocutors. they should be aware of the importance of both verbal and nonverbal communication, as well as the associated aspects of control and power. in this context, johansson (2005) points out that both reports and analyses are marked by researchers’ pre-understanding and professional background and that analyses of conversations should be considered. in their analysis, the authors of the current study have made an effort put aside hypotheses, preconceptions and the theoretical framework of reference. results and discussion identity and self-understanding the participants in this study identify themselves as women. however, there are differences with regard to self-understanding, how they understand themselves as human beings and how they choose to discuss their gender. kuper et al. (2012) state that understanding the self-defined identities of transgender individuals is important when judging how the self is represented in relation to others, for instance. the narratives of the transgender women in this study start in their early childhood; without exception they all have had transgendered feelings and experiences as long as they can remember. although their childhood memories can be interpreted as constructed narratives (lundby, 1998; monk, 2007; white, 2006), they should still be considered relevant in the context of identity questions (hines, 2007). the youngest participant, siri (24), begins her narrative in this way: i can remember fragments even when i was about 3 years old … and when i was 5 i had ideas about how i wished to be dressed. in school i identified with the girls, and i wanted the same hair style and clothes as them. i didn’t think clearly about being a girl at that time … i got conscious little by little, and when i was about 11 years old, i was very conscious about it. i also 74 njsr – nordic journal of social research vol. 9, 2018 thought i was lucky not to have a sister. if i had, i would all the time be reminded of what i couldn’t be … karin is 44 years old. she has kept her female identity secret her whole life. she grew up in a christian home, which may have influenced the development of her identity and self-understanding and may be a contributing factor to her still being in the closet. the hidden cross-dressing started when she was about 5 years old and continued during her adolescence. she states that: i was cross-dressing when i was home alone. i used the opportunity to borrow my sister’s clothes. it felt both funny and comfortable. but afterwards i felt ashamed and got a sense of guilt. i thought it was sinful and that the devil had tempted me. if i prayed to god, the need to crossdress might disappear … the other participants in the study had similar childhood experiences. for all human beings, identity develops and is affected by factors such as gender, sexuality, age, cultural and social belonging (almås & benestad, 2017; hines, 2007; røkenes & hansen, 2012). from a narrative perspective, it is essential to return to childhood experiences and attempt to redefine the self (monk, 2007). this is because one is interested in telling a new story about childhood, resurrecting abilities or talents that later became hidden or repressed (lundby, 1998; white, 2006). for a transgender woman, the ability or talent to be a woman may fall into this category. for some transgender people, it seems that the medical treatment process also affects the development of identity and self-understanding. how one experiences oneself can be different, depending on whether one has completed the treatment or not. generally, it seems that physical considerations mean a lot (davy, 2011). marianne (50) finished her treatment three years ago and describes the end of the treatment process as finally being able to live as the woman she had always been: ‘i’m so satisfied with my body, and especially with my boobs. i always wear low neck blouses to show a bit of them.’ for siri, who is undergoing medical evaluation, the body image seems to be different. she has a lot of dark hair all over her body, which prevents her from dressing as she wants. siri states that: it’s even worse in summertime … i’m longing for the transsexual diagnosis. then i can cover the expenses of removing this hated hair. boobs are important as well. i don’t like wearing an artificial limb … i don’t think it’s natural. 75 njsr – nordic journal of social research vol. 9, 2018 these examples reflect the perception about a permanent connection between the person you are and your body experience and body image (almås & benestad, 2017; davy, 2011; serano, 2016). karin (44) and berit (34) still live as males, hiding their female identity. they are struggling in ways that are both different and similar. they try to navigate in a hostile environment but do not struggle with identity issues. berit has always known that she is a woman but chooses not to show it. for 10 years she has lived with her girlfriend randi and knows that if she lets her female side come through, she will lose both randi and their joint network and future. ‘i’ve stopped cross-dressing as well … when i wear women’s clothes, the longing becomes too strong. i repress myself out of consideration for randi. that’s what i want just now.’ by choosing to maintain her family life, she has to make difficult choices about how to present herself to others. berit and karin have the nonphysical aspect in common. they choose to dress in a gender-neutral way and look into mirrors as rarely as possible. whereas berit has made a conscious choice to live as a male for now, karin faces a different struggle. when responding to the question of identity, she says: i feel like nobody … in no man’s land … always thinking about what’s right or wrong. i have a divided dream: on the one hand, i wish to live a “normal” life with my wife and children. on the other hand, i want to live as a woman all the time. i’m stuck between and can’t decide what to do. the statements of karin and berit may be seen as an expression of longing to be themselves, but they are trapped in the expectations of those in their surroundings (benestad & almås, 2001; moen, 2008; arntzen & kahrs, 2013). shame is a recurring theme in the participants’ narratives. for some, it is more pronounced than for others. in anthropology, the concept of ‘shame’ tends to be connected to the concept of ‘honour’, the interaction between the terms making them define each other (melhuus, 2002). the implication of this is that if the concepts of honour and shame are part of the same social phenomena, there is no shame without honour (arntzen & kahrs, 2013; melhuus, 2002). with regard to gender, such a perspective could be understood as expectations about what is feminine and masculine. the experience of shame can be linked to the failure to meet expectations, which are connected to culture and the frame of reference (frønes, 2002). the frame of reference links expectations to the understanding of what is feminine and masculine and the culturally defined honour of the gender roles. our culture is basically guided by traditional views, which means that one has to adapt one’s gender role to the rules of society (butler, 2006). shame is an abstract concept rooted in cognitive and emotional 76 njsr – nordic journal of social research vol. 9, 2018 processes. when it is profound and all-consuming, as in the case of karin, who is paralysed and unable to move on, one can imagine that she feels trapped in an emotional game in which the fear of other people’s disgust plays an important role. this is also an issue discussed by isaksen (2002). for transgender people, shame may represent an additional burden. all the participants in this study experienced feelings of shame with regard to their gender challenges. the feeling of shame was less evident for participants who had acknowledged their gender identity, for themselves and in relation to others. berit and karin recognise having a female identity, but they have both decided to live as males because of the expectations of those in their surroundings. however, whereas berit seems unruffled by continuing to live as a male, karin is open about her feelings and speaks about her shame. she has seen a therapist for a year and relates that shame has been a key subject in their conversations. ‘things have improved since the therapy. if somebody should discover it now, i don’t think it will be a catastrophe.’ one can use shame to suppress one’s own identity, letting oneself be guided by shame, as berit does. the stories of berit and karin show that shame prevents them from expressing their female identity and developing their self-understanding as women. it seems that shame influences their self-understanding and that their belonging to the female gender is suppressed out of consideration for others in their environment. this is in accordance with theories of self-understanding (henriksen & vetlesen, 2006; røkenes & hanssen, 2012). for karin, concern for both family and colleagues is important, while for berit the relationship with her partner is essential. however, to keep undermining oneself forever may seem hopeless. sooner or later, one will be confronted by one’s true self. according to allgeier and allgeier (2000) and almås and benestad (2017), the awareness of belonging to a gender becomes well developed between the ages of three and five. people who conceive themselves females but live in a male body show that gender identity is an inherent quality that sooner or later will emerge and reinforce the understanding of one’s gender (almås & benestad, 2017). this is one of several human traits that is possible to suppress for parts of one’s life, but sooner or later it will rise to the surface (cullberg, 2008). this may be compared to sexual orientation or sexual arousal patterns, which are also to be understood as inherent aspects that will sooner or later manifest themselves, although obviously in different ways (langfeldt, 1998). this view may be disputed, but it is supported by the participants’ narratives. ingrid (60) talks about her first memories, stating: i already knew before i started school. in the neighbourhood there was a girl who was the same age as me. i looked at her clothes and hair. i didn’t 77 njsr – nordic journal of social research vol. 9, 2018 understand why i wasn’t a girl, but thought that i would be when i grew up. i was so stupid and naïve. however, i knew that i couldn’t talk to my mother about it. “coming out” in this article, the term ‘coming out’ refers to recognising one’s gender identity and being honest about it with oneself and others (arcelus & bouman, 2018). in particular, ingrid and marianne are clear about how their female identity had to be revealed to those in their surroundings. at that time, they were adults of 50 and 45, respectively, and had lived in the closet their entire lives. marianne states that: it was in 2002. i couldn’t stand it anymore. i dressed as a woman and went to work. nobody knew anything. i think they got a shock. it was a relief, but at work i got lot a trouble afterwards … it is certainly unusual that someone just decides one day to go to work dressed in the clothes of a different gender than the one they presented themselves as belonging to the day before. rather than coming out, this may be a sign of desperation. this way of trying to get gender affirmation (benestad & almås, 2001; hines, 2007; wilchins, 2006) has caused marianne many problems, including losing her job. alcohol or drug problems are not unusual for people struggling with identity issues (semb et al., 2016). ingrid has had a drinking problem throughout her life and has undergone detoxification treatment and therapy several times. she is well now and relates what happened some years ago, stating that ‘ten years ago, i was hospitalised again. i suffered a complete breakdown. i went to the doctor and told him everything … i just had to get it out…’ ingrid has been sober since coming out and the beginning of her gender affirmative process. ‘i think i drank to forget who i was’, she says. marianne states that she also had a problem with alcohol for several years, but this is not a part of her life anymore. these examples show that some transgender people may have additional problems and that these problems may lessen or disappear as soon as one is able to accept being the person one actually is. according to the literature, the disappearance of mental problems once people are able to express themselves is not unusual. this is an important point that is often ignored in psychology and psychiatry, with people being refused hormones and surgery because they have stress-induced problems (hausman, 2006; the norwegian health directorate, 2015; van der ros, 2016). as mentioned, karin and berit still have not come out. when one is trying to manage gender and identity in a different way as an adult compared to earlier 78 njsr – nordic journal of social research vol. 9, 2018 in life, both social reactions and bodily challenges may cause further stress in the treatment process (almås & benestad, 2001; benestad, 2004; the norwegian health directorate, 2015). marianne, ingrid and turid have experienced this in different ways. for marianne, the social part has been the most difficult. she lost her job and most of her social network. three years ago, she and her girlfriend moved to a new place and tried to establish a new life. this is challenging at such a mature age, regardless of whether you have an identity issue. still, marianne is happy to finally live like the woman she has always been. she is also satisfied with the results of her bodily changes, and unless she reveals the truth herself nobody will know that this is a woman who has lived the greater part of her life as a male. the greatest challenge for ingrid and turid has been the bodily process. socially, they have been able to maintain most of their networks. their relationships with their children are good, and they still live with the same women they married before the transformation process. the bodily effect of hormonal treatment has not met the expectations for either of them. the reason for this is that they were both adults when starting the treatment; ingrid was 50 and turid was 48. accordingly, the doses of hormones they receive are considerable smaller than what younger people are given, which among other things means that breasts cannot be developed. ingrid, who is now 60 years old, has finished her gender treatment. she has received breast surgery and says ‘when i didn’t do it years ago, i’ve got to be thankful for what i’ve got now. it isn’t the real stuff, but better than nothing.’ today, ingrid looks like a dignified middle-aged woman, while turid has an androgynous look. she is very pleased about finally coming out and says she feels secure about the person she is. dayv (2011) details similar stories about trans women’s body changes. of the participants in this study, siri is the youngest. she is 24 and came out three years ago. as mentioned, she has experienced bodily challenges, but with adequate treatment these will become more manageable in the long run. ‘i just want to be myself’, she says. there are too few participants in this study to reveal differences between younger and older transgender women. however, by interpreting siri’s narrative in the light of a similar study by sally hines (2007), one may suggest that younger people go through a more comfortable process after coming out. there are two main reasons for this (roen, 2011). first, the body is more open to medical treatment at a younger age, which increases the desired effect of the treatment. this naturally implies a healthy starting point and a greater ability to endure hormonal treatment. second, younger people’s social networks are probably not so deeply rooted as those of older people. the 79 njsr – nordic journal of social research vol. 9, 2018 younger you are, the less chance that established relationships have been formed, especially those involving regular partners and work. hines (2007) points out that conditions other than physical and social factors are beneficial in the process of coming out and the subsequent treatment of young transgender people. for example, the increasing presence of international and national organisations for transsexuals urges political authorities to support demands for medical treatment. these organisations rely on different kinds of professional knowledge, such as psychology and sexology, to disseminate knowledge and influence attitudes. this effort contributes to more knowledge about the transgender phenomenon in society. younger transgender people also have other advantages that older people did not enjoy 30 or 40 years ago. one important factor is that access to the internet enables people to meet other people in similar situations and thus create networks (hines, 2007). her experience with internet networks was the reason siri dared to come out. for ingrid, turid and marianne, the reality was quite different. ingrid states that ‘the papers writing about christine jorgensen are burnt into my mind. at that point i became sure that something was wrong with me. but i was nearly thirty when i first heard the word transsexual.’ with regard to the bodily process, both marianne and ingrid are satisfied with their results and feel like it is a ‘coming home’. in their reflections of ‘the transgender journey’, aizura (2012) and lykke (2010) also discuss this aspect. they refer to america’s first transsexual woman, christine jorgenson, and other transgender women for whom the term ‘home’ has double significance. this is because many choose to undertake the journey through surgery before returning home as the woman or man they feel like. this illustrates that a permanent connection between person and body experience helps to create identity (almås & benestad, 2017; aizura, 2012). marianne and ingrid have both finished their gender-confirming treatment and feel like real women. belonging in this study, four of the participants belong to the female gender. the other two participants feel like females but prefer to live as males. the aspect of belonging, which here refers to gender belonging, concerns an individual’s experience of belonging to a category. depending on one’s surroundings, belonging can be confirmed in different ways. one can experience that he/she belongs to the female or male gender, whereas those in one’s surroundings respond to the feminine or masculine characteristics. the term belonging can to some extent be included in the notion of identity. the feeling of gender belonging is usually related to identity and social relations (almås & benestad, 80 njsr – nordic journal of social research vol. 9, 2018 2017). however, more detailed descriptions may provide further knowledge and a better understanding about the transgender phenomenon. therefore, the authors chose to take a closer look at the belonging perspective and see if the empirical information could facilitate a deeper understanding. belonging can be considered a part of one’s personal existential philosophy as well; to know who you are and how to become a person and social individual can be seen as one of the most imperative challenges in life (aronsen, 2002). the term gender belonging is connected to how gender is confirmed in human life. it can be described as feelings created through words and actions that are supportive and inclusive. gender identity is an individual’s internal gender experience. characteristics such as bodily gender, body image and patterns of sex can also reflect a complete understanding of the meaning of gender belonging (benestad, 2004). belonging can be considered a fundamental human need (karlsen, 2012). an established belonging reflects the correlation between our understanding of ourselves and how we are being understood by those in our surroundings. gender belonging may occur in this interaction process (almås & benestad, 2017). when a male body has a female identity, it cannot necessarily be understood and confirmed by others. this may complicate the discovery of belonging, both with regard to one’s own body and one’s surroundings. in such cases, one may discover a lack of correlation between the internal and external systems, and safe gender belonging becomes impossible. siri provides an example, stating that ‘i’m so tired of people who say “he” all the time! last summer i met a swedish boy who wondered if siri is a boy’s name in norway.’ this is an example of how the use of nouns may influence belonging and gender identity. the use of the ‘right’ noun clearly affects one’s ability to feel recognised as a certain gender. in social interactions, the use of the ‘wrong’ noun may create formidable barriers (ansara, 2010; mclemore, 2015). marianne looks very feminine, and it is impossible to tell that she has lived most of her life in a male body. she describes the problems connected to belonging that she experienced earlier in her life: in the beginning i understand that it was difficult for family and friends to call me marianne. but still, after several years, most of them say “he” and “mats” when talking about me. i think it’s because they want to be nasty! in any case that’s how i feel. therefore it was better to move far away and start a new life where no one knew me …. the examples of siri and marianne reflect different challenges related to belonging and show that gender identity as a confirmed condition not only 81 njsr – nordic journal of social research vol. 9, 2018 involves visible and external factors but can also be a result of the cultural and social context (moen, 2008). however, it seems easier to achieve gender identity confirmation following surgery and hormonal treatment. marianne has no difficulties being confirmed as a woman in her new environment. she describes herself as happily connected to other transgender women around her age. she is somewhat taller than the average woman, but she is slim and never had much body hair. the beard has been removed by laser treatment, and marianne now has her own hair and does not need a wig. her voice does not betray her because of treatment by a speech therapist. siri is being evaluated for treatment, and even if she uses makeup and has a feminine hair style, her masculine body still ‘betrays her’. the fact that surgery and hormonal treatment are required to achieve gender confirmation is also emphasised in hines’ (2007) research. most of the participants in her studies stress the significance of hormonal and/or surgical treatment as a condition for well-being and selfconfidence, both in a physical and mental sense. belonging connected to “born in the wrong body” being a transgender person is often defined as being born in ‘the wrong body’. to achieve a sense of belonging may also be a challenge when linguistic, social and medical constructions tend to reflect unusual phenomena that are not recognisable to those responsible for the constructions. the consequences of such thinking could be a simplification of the relationship between body and gender, based on anatomical body and dualistic gender theory (hausman, 2006; ekings & king, 1996). the psychiatric diagnosis f64.0 in icd-10 (world health organization, 2016) relies on the term ‘transsexualism’ and describes this as people ‘feeling like the opposite sex’. the authors believe one consequence of this is that the medical perspective and technology to a large extent control the understanding of transgender people and that the body has to be adjusted to match the traditional gender thinking. in this way, the understanding of being born in ‘the wrong body’ is maintained. siri states that: i think it’s rubbish to say that someone is born in the wrong body. i am a girl; it isn’t only what i feel like. i don’t think that my body is disgusting. i’m born with my body, and i have to make the best of it. siri’s reflections call to mind the philosopher merleau-ponty’s statement ‘i am not in front of my body, i am in my body, i am my body’. this statement reflects how the meaning of human existence can be understood through the body’s power of being-in-world (rendtorff, 2002). in hines’ study (2007), several participants view the term ‘wrong body’ as a cliché with which they do not feel comfortable and think that gender belonging 82 njsr – nordic journal of social research vol. 9, 2018 ought to be seen as a considerably more nuanced and complicated process. the empirical findings in both the current study and hines’ research show that gender identity is primarily a cognitive and emotional condition and not a feeling of being born into or confined to ‘the wrong body’. however, it seems like the diagnostication and treatment of transgender people are dominated by this perspective; one must have the f64.0 diagnosis of transsexualism in order to receive genital surgery in norway (van der ros, 2016; oslo university hospital, 2018). the authors believe that this may be a result of the culture’s binary gender thinking and the idea that genitals are the primary sign of gender belonging. according to the participants in this study, some members of the transgender community in norway claim that being a transsexual implies a desire to complete hormonal and surgical treatment because one feels exclusively like a women or a man. as non-transsexuals, the authors will not reject this opinion, but it seems that even people who define themselves as transsexuals in some cases do not want genital surgery. siri states that ‘i’m not sure if i want genital surgery ... i’ve heard about people who are not satisfied with the result. maybe if i once get enough money, i will go abroad to fix it ...’ this statement seems to indicate that there is an element of uncertainty connected to genital surgery procedures in norway. neither general attitudes towards transgender people nor medical priorities are helpful in broadening understanding in this area, which clearly requires further knowledge relating to sexual health and sexual rights (graugaard et al., 2006; moen, 2008; molander, 1996; ministry of children and equality, 2018) in general and to people who define themselves as transsexuals in particular. to some transgender people it may be a challenge if the image in the mirror does not reflect the inner identity and belonging. siri, who considers her beard the greatest challenge, says that it takes her several hours every morning to prepare her face before going to work. ingrid, who finished her treatment 10 years ago, reflects that: i couldn’t stand my body, and in particular the genitals … luckily, i now have got things fixed … on the other hand, after surgery i feel like a bluff. nothing is real not creation, but manipulation. now and then i struggle with such thoughts. however, there are many “real” women who have manipulated their bodies as well … the above examples illustrate that the body can be manipulated to make it correspond to the experienced identity. to some transgender people, changing the body image may be essential to achieve gender confirmation (benestad, 2004). accordingly, what is feminine is debatable, as is the question of what 83 njsr – nordic journal of social research vol. 9, 2018 characterises a woman. some people think that transgender women overcompensate with excessively feminine behaviour (hines, 2007). both the current study and hines’ (2007) research show that transgender women cannot be subject to generalisations in this respect. the participants in the current study want to live and express themselves as ‘ordinary’ women. none of them exaggerate or invent feminine manners. ‘that is what transvestites do’, say marianne and turid. belonging connected to the ‘trans’ term the term ‘trans’ can be discussed in relation to belonging, as the latter term refers to the experience of and need for belonging to a category (almås & benestad, 2017). in this context, the categories are male or female and reflect the need to be the male or female you feel you are. some people with a gender identity that does not correspond to their body have a huge challenge in terms of being understood in the way they understand themselves. some do not want to be understood or referred to as trans. for example, siri does not like the term because she does not ‘go from one condition to become something completely different’. besides, the male and female genders dominate our culture, excluding a third category. with the possibility of medical technology changing physical gender, it seems that many transgender people have seen this possibility as the only solution to their emotional dilemma (benestad & almås, 2001; van der ros, 2016). the term trans can hardly be considered anything other than a phenomenon that exists between two extremes, an understanding that siri, among others, does not feel comfortable with. moreover, the term has been chosen in the absence of a more suitable term (benestad, 2004). despite the limitations of the term, some transgender people are comfortable with it, particularly adults. to ingrid, marianne and turid, it felt like a relief to discover that a word could explain their challenges. over the last 20 years, transgender people have engaged in theoretical discussions about sex and gender. interdisciplinary studies of transgender people not only reveal different meanings of gender terms but also reflect theoretical diversity (benestad, 2004; carroll, 2000; hines, 2007; dayv, 2011; van der ros, 2014; serano, 2016). in norway and the nordic countries, queer theory does not reject the significance of gender and sexuality or downplay bodily and biological factors. queer theory stresses the construction of gender, body and sexuality, which can only be understood in the context of language and culture (moen, 2008; almås & benestad, 2017; van der ros, 2016) with an emphasis on gender and sexuality alternatives, that is, pluralistic gender 84 njsr – nordic journal of social research vol. 9, 2018 thinking. it stresses the significance of independent choice related to gender and sexuality. untraditional living is not emphasised, but the possibility of leading such a life is still seen as important. queer theories emphasise the diversity in how transgender people express themselves based on individual resources and differences (benestad & almås, 2001). however, a pluralistic gender interpretation could be problematic when transgender people define themselves as males or females. for this reason, traditional binary gender thinking may be more suitable in explaining and understanding people with such an identity. the participants in this study have different goals and are in different stages of their transgendering process. it seems that the four who have come out are more able to develop an identity, self-understanding and belonging than the two who have not. to remain at an ‘intermediary stage’ makes the challenge of defining oneself even more difficult (moen, 2008). however, there is also a need to view transgender narratives in a broader cultural context of life, embodiment and personhood (aizura, 2012). limitations the researchers have reflected on the fact that both personal and professional profiles shape the content of what we do. as cisgender people, the researchers could have ignored some details and signals in the participants’ stories. one’s own experiences may affect judgement, even though one should be selfreflective about one’s own limited perspectives. a transgender researcher might have recruited more informants and received more detailed information. this could have impacted the results of the study. this study has a limited sample size; however, the narratives were rich in content, as all the women discussed the topics extensively and offered comprehensive descriptions about their experiences. this enabled us to relate the findings to other contexts. only women wanted to participate in this study, and men’s voices are therefore missing. a more comprehensive study in which transgender men are included is required. conclusion the aim of this study was to gain a deeper understanding and more knowledge about the experience of transgender women regarding identity and selfunderstanding. the results of this study show that the participants exclusively have a female identity and belonging. despite the female identity, two of the participants preferred to live as males out of consideration for those in their surroundings. the self-understanding of the informants found different 85 njsr – nordic journal of social research vol. 9, 2018 expressions, depending on personality and life experiences. whether or not one has come out of the closet seems important for both identity and selfunderstanding. the participants who have come out of the closet seem to feel more secure than those who have not. the feeling of belonging is in this case connected to gender identity and social relations. the more recognition they get from their social environment, the more it appears that the women in this study dare to be themselves. gender identity may primarily be a cognitive and emotional condition and not a feeling of being born into or confined to ‘the wrong body’. implications for future research and practice the results of this study facilitate a deeper understanding of the different challenges for transgender women. there are several aspects regarding transgender women’s and men’s gender identity and self-understanding that are worth examining further. in addition, research may focus on the relationship with partners and close family, as well as on sexual identity and the experience of gender-confirming treatment. the results of this study confirm the need for more knowledge among therapists and in society in general. transgender people must be treated as individuals, both in society and in the primary and specialist health care services. references aizura, a. z. 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(2016). f64.0: transseksualisme [transsexualism]. international statistical classification of diseases and related health problems (icd10). retrieved from http://apps.who.int/classifications/icd10/browsw/2016/en microsoft word knutagã¥rd and kristiansen scaling up housing first pilots njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 10, 2019 scaling up housing first pilots – drivers and barriers1 marcus knutagård* school of social work lund university email: marcus.knutagard@soch.lu.se arne kristiansen school of social work lund university email: arne.kristiansen@soch.lu.se *corresponding author abstract there has been an increased interest in housing first services in sweden over the past few years. the model was first developed in new york by the organization pathways to housing. the growing interest in housing first as a response to ending long-term homelessness is seen not only in the us and canada, but also in europe. one reason for this is the mass of evidence showing high housing retention rates with housing first services as compared with traditional services. this article aims to analyse the drivers and barriers that hinder or facilitate the scaling up of housing first pilots. the research question is: is it possible to incorporate lessons learned from the housing first pilot into the existing system of homelessness services? in other words: is it possible to put new wine into old bottles? 1 knutagård & kristiansen (2016). scaling up housing first pilots – drivers and barriers. paper presented at the third isa forum of sociology, the futures we want: global sociology and the struggles for a better world, vienna, austria, july 10–14, 2016. an oral presentation with the same title was given in warsaw in september 2014 at the 9th european research conference: homelessness in times of crisis. 2 njsr – nordic journal of social research vol. 10, 2019 this is an ongoing research project on housing first services in sweden, with the specific focus on the housing first pilot in the city of helsingborg. the empirical material consists of in-depth interviews and focus group interviews with project managers, support workers and other stakeholders. the main results show that leadership is essential and a key driver for the scaling-up process. another driver is the importance of repeating the vision and goals of the idea to keep the story alive. a third key driver is that the staff has identified the housing first approach as a relative advantage and believes in the idea. the main barrier to the scaling-up process lies in the structures that maintain and surround the social housing programme. keywords: housing first, scaling up, social innovation, homelessness, institutional change, drivers and barriers introduction social innovations are often called upon as a solutions to the current challenges that humanity is facing: poverty, ageing populations and climate change. since the financial crisis of 2008, we have seen severe reductions in the provision of welfare services and a growing number of people who have been affected by evictions from their homes. some european countries have been more affected than others (rønning & knutagård, 2015; martinelli, 2012). the fragility of european social cohesion became even more evident on the 23 june 2016, when the uk voted on leaving the european union after a referendum was held. in this context, one can be critical towards the fact that social innovations are called upon in order to confront the challenges that we are facing. the dilemma is that social innovations are seen as a substitute for a retrenching public welfare rather than as a complement (brandsen et al., 2016a). how can small-scale innovations end homelessness? aren’t radical innovations what we need in order to transform existing institutions and create systemic change? in this article, we will take a closer look at how a social innovation, which has been implemented in a local welfare system, is being scaled up in order to tackle a persistent social problem: homelessness.2 the social phenomenon of homelessness is a relevant area of study, since it involves a specific group of the population that can be seen as one of the most excluded (arnold, 2004). a quick clarification on the contextual settings is that, even though sweden has a history of large-scale housing interventions, such as the million homes 2 the project was funded by plattformen, helsingborg city, during the period of 2014– 2016. 3 njsr – nordic journal of social research vol. 10, 2019 programme, the responsibility for the housing provision lies at the municipal level. at the time of this writing, a majority (240) of the 290 municipalities in sweden have a housing shortage and a diminishing rental market, especially public housing provided by the municipal housing companies (94% of the population live in a municipality with a housing shortage). since the beginning of the 1990’s, the national housing policy has witnessed a system shift, where several of the former housing institutions have been abolished (ministry of housing) (lindbom, 2001; sahlin, 2015). the swedish housing market is currently described as one of the most deregulated markets in the western world (lind & lundström, 2007). since the responsibility of the housing provision is decentralised, it is of even greater importance to focus on the local level in the analysis of how policies on the national level play out (cf. kazepov, 2010). in relation to homelessness, the urban context or the specific conditions in a city might be more relevant than the policies on the national level (brandsen et al., 2016a, p. 7). the aim of this paper is to analyse the drivers that facilitate and barriers that hinder the scale-up of housing first pilots. the case in helsingborg is about trying to scale up housing first within the existing social housing programme in the city. we ask if it is possible to incorporate lessons learned from the housing first pilot into the existing system of homelessness services. in other words: is it possible to put new wine into old bottles? background housing first began as a programme in new york in 1992. the programme was invented by sam tsemberis, the founder of the pathways to housing, as a response to the mainstream approach to homeless services, the so-called ‘staircase model’ or ‘continuum of care’. in the staircase model, clients have to prove that they are housing ready in order to move on to the next step. as part of this, abstinence from drug and alcohol use is a prerequisite, and the clients are expected to first accept treatment in order to ultimately obtain an independent apartment. for many, the staircase model has led to a feeling of uncertainty, not knowing for how long to stay or what to do in order to progress to the next step. it has often proven to be too difficult to climb all the steps, and many give up trying after failing to comply with all the rules (padgett et al., 2016). even the social workers have said that they do not want to place a homeless person in an independent apartment because they do not want to make them fail again. the demands are high, but the expectations are low (knutagård, 2009). independent housing can be seen as a goal in the staircase model. in 4 njsr – nordic journal of social research vol. 10, 2019 the housing first model, housing is a means; it is a precondition in order to be able to deal with other life challenges. this discrepancy between the two different models shows that they are based on two totally different logics. in housing first, housing is seen as a basic human right. this shows the importance of housing and the broader idea of the meaning of housing. having your own house is more than a roof over your head and walls around you. the meaning of housing can be connected to the concept of ontological security (padgett, 2007). this is a sense of stability and safety in which daily routines can be performed. having your own home makes it possible for an individual to be free from surveillance and to have control over his or her own front door. having your own home also makes it possible to construct identities (dupuis & thorns, 1998, p. 29). housing first has been described as an innovation (felton, 2003; rønning et al., 2013; knutagård, 2015; pleace, 2016). it has even been seen as resulting in a paradigm shift (padgett et al., 2016). in the recent literature, the model is seen as an innovation since it combines three central components: (1) consumer choice, (2) community-based, mobile support services, and (3) permanent scatter-site housing, that on their own have been considered innovative (padgett et al., 2016, p. 3). these three components are merged together with a fourth component, harm reduction, making the new combination an innovative practice.3 housing first is a model where homeless people are given an independent apartment in which the individual has the control over their own entry door. but, housing first is not only housing, it is an approach based on a philosophy around the importance of relationship building, empathy, service-user participation, etc. it is important to note that the scaling-up project in helsingborg is not primarily about arranging more housing first apartments; it is the ambition to transform an authoritarian and repressive approach into a more humane, empathetic, relationship building approach. housing first, as an innovative practice, was first introduced to and then diffused through sweden at the end of 2009. stockholm and helsingborg were the first two municipalities to offer housing first services. in 2010, the first tenants moved in (knutagård & kristiansen, 2013). since then, another 13 3 in the description of the philosophy behind the original model, eight core principles are identified: (1) housing as a basic human right, (2) respect, warmth, and compassion for all clients, (3) a commitment to working with clients for as long as they need, (4) scattered-site housing, independent apartments, (5) separation of housing and services, (6) consumer choice and self-determination, (7) a recovery orientation and (8) harm reduction (tsemberis, 2015, p. 18). 5 njsr – nordic journal of social research vol. 10, 2019 municipalities have started their own housing first services (knutagård, 2015). they began as small-scale pilots with 1–10 apartments, and over time, the number of flats has increased. in some municipalities, it has been more difficult than in others to acquire more apartments over time. the housing first services that have developed in sweden all differ, and they are all examples of how innovations are being translated into local contexts by change agents (institutional entrepreneurs) who receive or introduce the innovation in a new setting (hardy & maguire, 2008). although they differ in many respects, they do share commonalities and some core components (knutagård & kristiansen, 2013). interestingly, the housing first services all evidence great results in the housing stability and housing retention rates. the scaling-up process in a swedish context can be seen rather as a ‘scaling-out’ process where many housing first pilots emerge in different locations but in, more or less, the same size (iriss, 2016). in this article, we will focus on the housing first service in the city of helsingborg. we will, more specifically, focus on how the results from the evaluation of the housing first service is scaled up into the municipality’s social housing system (kristiansen & espmarker, 2012; kristiansen, 2013; knutagård & kristiansen, 2013). the evaluation showed that the housing first service in helsingborg worked well, with an almost 90% housing retention rate after a three-year period. from the time the first tenant moved in in september 2010 until the end of the project in may 2013, 19 persons had been part of the project, and only three persons had lost their apartments.4 during the same year (2013), the city added 30 new apartments to the social housing programme. in 2013, 25 apartments in the social housing programme were evicted due to arrears of rent or because of disturbances, etc. this major difference between the success of the housing first project and the failure of the existing social housing programme led to making the housing first project a permanent service in the city and generating support for scaling up the housing first project. the latter meant that the lessons learnt from the housing first pilot should be implemented in the entire social housing programme in the city. 4 in 2016, 49 people received housing through the housing first service in helsingborg since the start of 2010. six have been evicted, resulting in a housing retention rate of nearly 90%. 6 njsr – nordic journal of social research vol. 10, 2019 type of housing number of places fenix (emergency housing) 37 kronan (low threshold housing) 17 carnot (transitional housing) 32 training flats 95 social housing apartments 162 housing first apartments 32 total 375 table 1. type of housing and number of places in the social housing programme in the municipality of helsingborg in 2016. the evaluation of the project also showed that the tenants’ quality of life had improved in several ways (kristiansen, 2013). even though the target group for the project was open to all four homelessness situations, according to the national definition of homelessness, most of the clients came directly from the streets, night shelters or other forms of acute housing.5 the pilot also targeted those who had both serious drug use and mental health problems. theoretical framework social innovation as previously mentioned, housing first has been described as a social innovation, but what exactly does that mean? social innovation is very much a contested concept (rønning & knutagård, 2015). nevertheless, it is a widely popular one and a buzzword of our time. for many, the concept of innovation is a positive notion implying something new, most often a new technological device or a promising cure for the modern plagues that haunt mankind. the concept of social innovation is often presented as a new idea, even more recent than technological innovation. godin (2012) argues, however, that the concept of social innovation is much older, at least 200 years old. according to godin, social innovation was initially associated with socialism and had pejorative connotations. after the french revolution, the concept gradually became something positive. the second phase was ascribed to social reforms, and the 5 1. acute homelessness. 2. institutional care and category housing. 3. long-term housing solutions (e.g. the secondary housing market). 4. short-term insecure housing solutions (nbhw, 2017). 7 njsr – nordic journal of social research vol. 10, 2019 third phase is the one we are experiencing today, when the concept has reemerged as ‘alternatives to “established” solutions to social problems or needs’ (godin, 2012, p. 6). many attempts have been made to define social innovation. we will not attempt to present them all here, but let us consider three different definitions that exemplify the wide range of how the concept can be interpreted: a novel solution to a social problem that is more effective, efficient, sustainable, or just than existing solutions and for which the value created accrues primarily to society as a whole rather than private individuals. (phills et al., 2008, p. 36) [. . .] fostering inclusion and wellbeing through improving social relations and empowerment processes: imagining and pursuing a world, a nation, a region, a locality, a community that would grant universal rights and be more socially inclusive. (moulaert et al., 2013, p. 16) […] social innovations are those that, created mainly by networks and joint action in social realms beyond business and government routines, at any given moment, raise the hope and expectations of progress towards something ‘better’ (a more socially sustainable/democratic/effective society). (brandsen et al., 2016a, pp. 6–7) from the above definitions, we get a glimpse that some definitions are narrower while others are wider, inclusive and encompass almost everything. some definitions are more management-based and related to market-oriented rhetoric and neoliberal ideals of cost-effectiveness (klein, 2013). others are grounded in bottom-up, grassroots-oriented or community-based action for change. we can also make a distinction between definitions that allow for incremental change and definitions that, more or less, demand radical innovations that lead to systemic change (rønning & knutagård, 2015). our interest in social innovations lies within the field of welfare innovation. there is often a distinction between innovative private services and conventional services provided by bureaucratic public institutions. we argue, however, that the public sector has been significant in making innovations happen and making it possible for them to grow. it seems as if the divide between the private and public is outdated (cf. mazzucato, 2013). the civil society must be brought in and involve the people affected by the services provided. johnson (2010) elucidates the importance of open networks for creating innovations. he illustrates this with a model based on four quadrants (see fig. 1). johnson asks the question ‘which quadrant has the most impressive track record for generating good ideas?’ (p. 220). his answer is the so-called fourth quadrant: non-market/networked. the fourth quadrant consists of networks that do their work outside the market. the non-market component is crucial for creating fertile soil for innovations to grow. ‘when you introduce financial rewards into a 8 njsr – nordic journal of social research vol. 10, 2019 system, barricades and secrecy emerge, making it harder for the open patterns of innovation to work their magic’ (p. 233). johnson’s four different quadrants (pp. 219–221) represent four distinct environments where ‘good ideas’ can grow. 1 market/individual 2 market/network non-market/individual 3 non-market/network 4 fig. 1. the fourth quadrant from johnson (2010, p. 219). the idea behind johnson’s model is that he has plotted out around 200 innovations since gutenberg’s press. the first division that he makes is between individual inventors (individual) and groups (network) that collectively create innovations. the second distinction is made between those who planned to capitalize on their invention (market) and those who see their ideas as free to connect and build upon (non-market). sorting the different types of innovations in this way, johnson cites gutenberg as a representative of the first quadrant (market-based individual). in the second, he plots the vacuum tube (networked, market). in the third quadrant, we find the world wide web (individual, nonmarket). finally, in the fourth quadrant, we find the internet (networked, nonmarket). johnson’s view is interesting in comparison to mazzucato’s (2013) 9 njsr – nordic journal of social research vol. 10, 2019 argument that the state has been invaluable as a support and investment structure for innovations such as the internet. despite the lack of financial incentives, the fourth quadrant seems to be the place where innovations grow (johnson, 210, p. 231). scaling-up when the process of social innovation is described, the end goal is often that the innovation should become a mainstream practice and, in this way, replace the old approach. milat has defined the ‘scaling’ as: the ability of a health intervention shown to be efficacious on a small scale and or under controlled conditions to be expanded under real world conditions to reach a greater proportion of the eligible population, while retaining effectiveness. (2012, p. 5) in this article, we can replace a health intervention in the quote above with a social innovation, or more specifically, the housing first approach. from this perspective, the innovation needs to reach more people at the same time while being as effective as when it was delivered as a pilot. unfortunately, there is not a lot of research on social innovations that have been scaled up, especially not in the field of social work. fortunately, there is some evidence from other fields on the factors that enable or hinder the scaling-up process (greenhalgh et al., 2012; what works scotland evidence review, 2015). the challenge with the idea of making social innovations sustainable and replacing old systems with something new is that they, in turn, will sooner or later become obsolete, and ‘the longer an innovation is sustained, the less likely the organization will be open to additional innovations’ (greenhalgh et al., 2004, p. 582). social innovations are complex processes where something new is needed, but the end result should not be too fixed. in a european context, it is clear that evidence-based social innovations that can direct social policy are sought after. not only should they be evidence-based, they should also be ‘scalable’. contextual factors and the challenge of translating innovations from one setting to another make this idea problematic if one hopes to know that the innovation can be scaled up. brandsen et al. (2016a) states that ‘one cannot clearly predict what comes out of even a very promising innovation in the course of its development’ (p. 5). in our article, we connect the scale-up of social innovations with rogers’s (2003) theory of the diffusion of innovations. rogers argues that five attributes play a crucial role in the rate of adoption of an innovation. these five attributes are relative advantage, compatibility, complexity, trialability and observability (p. 10 njsr – nordic journal of social research vol. 10, 2019 221). relative advantage means that the adopters perceive the new innovation as better than the existing way of working. this also means that it is beneficial if the users of the innovation are involved in the process of developing the idea and the adaptation of the idea to a local context. the second attribute, compatibility, refers to how well the innovation is compatible with the adopters’ values, needs and experiences. the third attribute is complexity. the possibility for an innovation to diffuse and be scaled up relates to how easy it is to understand its use. the more complex, the harder it is to adopt. the fourth attribute is trialability, and it is easier to scale up an innovation that is easy to test or try out. if there are too many steps and organizational changes involved to be able to try out an innovation, then it is less likely to be adopted. the final attribute is observability. if it is easy for others to observe the results of the innovation, then it is more likely to be adopted. the scaling-up process is complicated, especially if we want to see a social innovation not only as a smallscale pilot, but also as an innovation that leads to systemic or institutional change (streeck & thelen, 2005). research design and methodology the project started at the beginning of 2015. the idea was to try and capture the possible changes or shifts in mindset among the social workers within the helsingborg social housing programme. this research project is connected to a comparative project where we compare the spread and growth of the different housing first pilots in sweden. the research design of the scaling-up project is based on a mixed-method case study design (george & bennett, 2005). the project consists of three different sub-studies. the empirical material that we have used for this paper comes primarily from the second study. the second sub-study consists of interviews with key stakeholders from the social services, housing companies and politicians (31 interviews in total). we have also interviewed managers, social workers, frontline staff and service users. the interviews were done shortly after the scaling-up project had started and all the staff had heard the ‘innovation narrative’ about the project (cf. what works scotland evidence review, 2015). at that stage, we also made site visits to all the different housing alternatives. the interviews focused on what the respondent identified as enabling or hindering factors when it came to implementing results from the housing first pilot into their own organisation. we conducted three focus groups and made a new set of site visits. the theme of the focus groups was how the support to homeless clients had changed since the project started in early 2015 (cf. wibeck, 2010). the first focus group consisted of all the managers at the different housing alternatives in 11 njsr – nordic journal of social research vol. 10, 2019 helsingborg. the other two focus groups had one representative support worker from all the different housing alternatives. in the first sub-study, we sent a questionnaire to all the support workers in the social housing programme in helsingborg. we also used some answers from this questionnaire related to the social workers’ views of housing first. the questionnaire was sent out to the respondents before they had received their training in motivational interviewing (mi) in january 2015 (miller & rollnick, 2013). mi is a conversational method commonly used in housing first programmes. the method aims to strengthen the users’ motivation based on their own terms. mi is also used to identify so-called ‘change talk’. in mi, ambivalence is highlighted as a major obstacle, as it is seen to lead to a relapse in drug abuse. the idea of this mi training was to give the staff the same kind of ‘language’ to use in their contact with the homeless clients. one part of the questionnaire consists of an interpersonal reactivity index (iri; davis, 1980). a follow-up questionnaire was sent out in june 2016. a peer support group called g7 conducted the third sub-study. three members of g7 have been part of the steering group of the scaling-up project since its inception, and they have been active as co-researchers. the idea behind the third study is to have persons who have personal experience with homelessness to design a way to research how people perceive their ‘home’ and housing situation. we also want to know if they have any thoughts on the support that social services provide. one part of the empirical material consists of a questionnaire that the g7 members have formulated on their own. the other consists of material that has been collected, including photographs of artefacts that the homeless clients think are important and represent what they perceive as being important aspects of a home (cf. radley, 2005). the photographs will be used in an exhibition and in a printed magazine on the concept of home. results scaling up housing first the decision to make housing first a permanent part of the social housing programme did not mean that all homelessness housing units (e.g. shelters, category housing, training flats, transitional housing) in helsingborg municipality would be housing first services. but the evaluation provided recommendations on how the lessons learned from the pilot could be used to develop the social housing programme. one recommendation was to develop a professional relationship building approach that the staff in the social housing programme 12 njsr – nordic journal of social research vol. 10, 2019 should use. another recommendation was to develop the possibilities of service user influence within the social housing programme, and thereby take advantage of the users’ own views and experiences in the development of the programme. a third recommendation was that the rules and control systems that existed within the social housing programme should be normalized, so that they would more resemble the rules and requirements that apply in the community and in the regular housing market. the first step in the scaling-up process was to gather all the staff from the different housing units for a two-day joint workshop. first, the intended change was revealed, and the evaluation of the housing first pilot was presented. the lessons learned were recounted by housing first tenants in collaboration with the authors of this article. the idea was to create a common vision of the scaling-up project (cf. zeldin et al., 2005). the second step was to give all the staff the same training in mi (miller & rollnick, 2013). this was done so the homeless clients would recognise a similar approach, whether they stayed at the emergency shelter or lived in a housing first apartment. a third step consisted of changing the rules at the different sites. the changes were fairly evident at the emergency shelter. they reduced their rules from a couple of pages to a handful. many of the different housing alternatives previously had zero-tolerance for drug and alcohol use. as a distinctive part of the scaling-up project, the units started to accept a harm reduction approach. instead of evicting someone from his or her housing because of a relapse into drug addiction or mental illness, homeless clients were able to remain in the housing unit. housing was no longer related to the individual client’s abstinence or if he or she complied with accepting treatment. this marks a significant shift in the logic of the organisations. a fourth step was to increase the collaboration among the various housing alternatives. if they had previously been part of a housing staircase model where the client climbed from step to step in order to ultimately get a rental contract, they were now all reorganised to be part of a ‘cluster’ of homelessness services. the idea was that individuals should be able to move from the emergency shelter directly to a housing first apartment. they should also be able to move from a training flat to a transitional housing unit if they, as service users, felt that they wanted more support or felt the need to have staff on site 24/7. the collaborative component was that, when a client was to move from one site to another, staff from the current housing unit would meet with the client and the staff from the residence the client was moving to. the idea was also that the clients could retain contact with the ‘old’ support workers, if they chose to. the underlying logic of this collaborative ‘handover’ was to transfer 13 njsr – nordic journal of social research vol. 10, 2019 the trusting relationship or alliance that had been established in one place to another (cf. clarke and stevens, 2008). barriers the picture that emerges from the empirical material is that there have been several barriers to the scaling-up process. one of the barriers is the everyday routine and how the work is organised. instead of talking about changing ways to build relationships with clients, a lot of the work is about organising a better work schedule, for example, preparing meals, dealing with staff shortages, and handling the reoccurring threats of violence or other threats from the clients towards the staff (this is more common at the shelter). one participant stated this clearly: so, my job in recent years have mostly been to call people and try to get together schedules and tweaking and puzzle and turn things inside and out. it’s not what should be the thing... (interview with social worker) in relation to the ambition of doing ‘handovers’, some of the staff were hindered from continuing with this collaborative work because they were prohibited from leaving the premises. one of the staff members was required to stay behind, and this new rule made it difficult to leave the housing unit to visit the other housing alternatives. previously, the staff from one site had sometimes dropped in for a coffee at another site. for some of the housing alternatives, this was no longer an option due to staff shortages. one interviewee stated it as follows: we must not leave the place, and before we could when we were at the other place [housing unit]. we could there. then, we could drive out and visit other places in the weekend, when it was a bit calmer, so we drove out and visited other sites. but now, we have been told that we shall be here and then you do that. (focus group interview with social workers) this organisational flaw can probably best be understood as an unintended consequence, but nevertheless a barrier to the plans for and practices of the scaling-up project. we have also noted a conflicting interest (or a lower rate of compatibility with rogers’s [2003] terminology), for some of the staff, between previous practices or ways of working (and memories of housing alternatives that no longer exist) and the new way of working. this has been particularly the case for staff who have had experience working in housing alternatives for older clients with both mental health and substance abuse problems. these units have often been organised around a philosophy of care and doing things together in an institutional-like setting. much of the work in this situation is to provide the client with daily training (cooking, cleaning etc.) and to do different activities with them. one participant stated this: 14 njsr – nordic journal of social research vol. 10, 2019 and then we worked much more with social care than we do now. and the meaning is, of course, also that there are not supposed to be as much social care anymore, but, somehow, i think it is needed – a little anyway. because, for me, it’s important that they, for example, can get some food sometimes. (focus group interview with social workers). drivers both in the interviews and focus groups, themes emerged that represent drivers. most of the interviewed staff felt that the introduction of the housing first approach can have a positive impact on them and their clients. they said that it is better and more rewarding to work utilizing the housing first approach, even though it is more difficult because of the organisational constraints. this was expressed by one participant: it is not always easy. it depends on where you work, but we have the way of thinking here in any case. we want them to go on from here to an apartment of their own, to independent lives, so we try. (focus group interview with social workers) statements such as ‘i have just felt that why have we not done like this before? it feels so obvious…’6 from the social workers show their readiness for taking on the new approach, but it is easier to do that when the clients have their own apartment. this view was often presented by the staff that work with housing first. they said that it is more worthwhile for the social workers to work with the housing first approach since they get so much back from their clients, both in the way they as individuals find stability in life, but also in the interaction between the social worker and the client. when you can establish a trusting relationship, the potential for change emerges: by creating relationships, it makes it possible for them to actually dare to say if they have had a relapse. it gives no such consequences as they get kicked out of their accommodation. they can get help instead. (interview with social worker) institutional change in a way, the scaling-up case can be seen as an institutional change in the way homelessness work is organised. this transformation in the way of working has components of all five types of institutional change that streeck & thelen (2005, p. 31) present. first, the scaling-up project can be seen as a form of displacement. the diffusion of housing first and the adoption of the model by local change agents (institutional entrepreneurs) results in the questioning of 6 interview with social worker. 15 njsr – nordic journal of social research vol. 10, 2019 the taken-for-granted way of working. housing first represents another form of logic, which leads to an environment where contradictory logics exist in the same organisation. it is important to note that the time was right for change. in previous research, social workers had expressed an openness to new ways of working since they could see the downside with the existing staircase model (knutagård, 2009). with rogers’s (2003) terminology, the housing first approach has the attribute of a relative advantage – housing first is seen as a better way of working than the staircase model. the compatibility with the values and needs of the social housing programme in helsingborg is also high, but not equally high in the surrounding organisational field. moreover, the harm reduction approach can often be more easily adopted by social workers than landlords. the second type of institutional change is layering. the layering process seems to be connected to those housing alternatives that are less compatible with the new approach. if the organisational constraints are stronger, a layering process might help to change the way of working, but in our estimation, it might be a more difficult transition. the third type is drift, which i also connected to the complex process of both sticking to the core principles at the same time as scaling up the model. in many cases, this leads to ‘programme drift’, where loyalty to the original model is altered (cf. padgett et al., 2016; salveron et al., 2006). drift can also be seen when the staff expresses an adoption of the new approach, but everyday routine supports the old approach. the opposite is also possible: the organisation keeps the same rules as previously, but the staff does not follow them and institutional drift occurs. in our case, one paradox emerged. before the introduction of housing first, homeless clients were often defined as not ‘housing ready’, and therefore needed another intervention prior to getting an independent apartment in the ordinary housing market (knutagård, 2009). the logic was that you first had to ‘learn how to live’ before you could advance to the next step (sahlin, 2005). homeless clients who came from a night shelter were considered far from being ready for their own apartment. they had to live collectively, the reasoning went, in some sort of category housing or transitional housing before they could even be considered for a training flat. after the introduction of the housing first approach, we then heard social workers say that housing first is for the clients with the most needs. housing first is for those who have tried everything else but failed, they said. even though this is not an overall discursive shift, the cases that we have identified so far indicate a reformulation of the situation in order to make it fit with the existing organisational cluster, which can legitimate the sorting of clients into different types of housing. now, clients that are ‘housing ready’ have to stay in housing 16 njsr – nordic journal of social research vol. 10, 2019 alternatives with more rules. in other words, the situation is the total opposite of how homeless people’s ‘readiness’ for an independent apartment is explained. theoretically, it would have been easier if housing first represented most of the housing alternatives in the city, but as shown in table 1, the housing first apartments represent only 8.5% of the entire social housing stock. the fourth type is conversion. this mode of change is visible in the manager’s ambition to change the social housing programme. since it is not possible to actually scale up the number of housing first apartments or the mobile support teams which are connected to the housing first service, the existing housing alternatives are being adapted in order to fit the housing first approach. this can be seen as pragmatic when some institutional structures are too difficult to change. the final mode of change is exhaustion, which consists of a rather gradual breakdown. this type of change is the least visible one in the social housing programme, but the most obvious one in the housing first service itself. there, it is impossible to legitimate the ‘old’ way of working when the results show that the new approach gets people housed – clients who were previously defined as hopeless cases. when a microcosmos, such as the scaling-up project in helsingborg, is subjected to all these types of transformative change at the same time, conflicting logics are then guaranteed to exist, representing a tricky barrier to overcome. discussion change takes time, but the scaling-up process has also been affected by changes in the broader context. context is important in all matters, but especially important in public service organizations (hartley, 2005). at the same time that the whole process of the scaling-up project started, ‘the house’ was closed down in 2014. the house was run by a non-governmental organization (ngo) and had begun as a place where homeless people could go and get some food. it was located in one of the industrial areas of the city. from the time the house started its operations, it also accepted homeless people for overnight stays. it transitioned into an emergency shelter with support from the city but was still run by the ngo. when the city decided to scale-up housing first, they also stopped funding the house, since they did not want that type of housing for homeless people. a consequence of closing the house was that the social services quickly had to find different housing alternatives for those who lived there. this exerted pressure on the existing housing units and a placement process that was not optimal. in 2016, two newly-built housing complexes were offered to the social housing programme. they consisted of 48 new apartments. 17 njsr – nordic journal of social research vol. 10, 2019 at approximately the same time, 30 contracts for training flats in a different area of the municipality had expired. thus, the manager of the social housing programme could not refuse the offer. the consequence was that the two complexes with the independent apartments were then offered to two different groups. one was for people with addiction with a zero-tolerance of substance or alcohol use. the other was for clients with mental health problems where a harm reduction approach was to be used – very contradictory philosophies. other contextual factors have been the difficult situation of eu migrants and, in the fall of 2015, the humanitarian crisis of refugees from wars in countries such as syria, iraq and afghanistan. however, there is no evidence that the humanitarian crisis has immediately affected the housing market or the homelessness services. new legislation passed in 2016 had an impact on the housing market, since it stipulated that the municipalities had to house the refugees that were placed in the municipality. during the spring of 2016, a new homelessness count was calculated in helsingborg. the statistics showed an increase in homelessness, which was disturbing considering all the efforts that had been made to find new housing. the count did show, however, that of the 72 acute homeless people (20 sleeping rough), 53 were ‘new’ homeless persons who had not been part of the previous year’s count. in comparison with 2015, there were 9 more homeless people, but 50 persons fewer than in the 2014 count. thus, in a way, it is complicated to connect the homelessness figures with the scaling-up project. yet, the impact of these contextual factors is important to analyse, since we can see that they interfere with the implementation of the housing first programme and, thus, are factors that indirectly or directly affect the shaping of the social innovation. equally important are the unintended consequences of the implementation of a social innovation such as housing first. the results of the housing first pilot led to changes in the general social housing programme: taking away extensive rules in transitional housing and changing the paths possible for homeless clients to take. the actual impact of the social innovation might be on a different level – even though it started off as a pilot, it might also have an effect on a structural level. conclusion the aim of this article is to analyse the drivers that facilitate and the barriers that hinder the scaling up of housing first pilots. we ask if it is possible to incorporate lessons learned from the housing first pilot into the existing system 18 njsr – nordic journal of social research vol. 10, 2019 of homelessness services. in other words: is it possible to put new wine into old bottles? in a way, the case of scaling up of housing first in helsingborg shows how an innovation that is tested in a local welfare system can produce great results and how policymakers can learn from those results and try to implement the innovation to scale up the method. leadership is essential for the scaling-up process. one of the core tasks for the leaders is to emphasize the importance of staff involvement and to make the change process transparent. staff involvement should be initiated as early as possible to avoid creating the perception of this being a top-down process (cf. essén & lindblad, 2013; sievanen, et al., 2011). looking back at the different interventions made, there are some aspects of staff involvement that could have been improved and, thus, would have been positive for the scaling-up process. the two initial staff days in the rural area of margretetorp (a small town on the west coast in southern sweden), when the project was launched, were important and gave the staff a sense of belonging with other social workers in the social housing programme. they also felt that they were all part of the change. however, the positive atmosphere and feelings of participation and engagement could probably have been more easily sustained if they would have had a few regular peer-to-peer meetings among the different sites (cf. talukder & quazi, 2011). this was one of the suggestions by the researchers at the start of the project, but it was not implemented. in the follow-up interviews and focus groups, the desire to connect and repeat the vision and goals (the ‘innovation narrative’) of the scaling-up project were expressed (barnett et al., 2011). it is interesting to note that a large part of the staff has been positive about the housing first concept from the start (both in the interviews and in the first survey). few have been averse to housing first. to shift the mindset of frontline staff may not be the biggest challenge. instead, the greatest resistance lies in the structures that maintain and surround the social housing programme, which means that the structure reproduces a mindset that contributes to discrimination against homeless people. examples are the difficulty of getting apartments for the social housing programme, the policy under which income support is not considered as a steady income and therefore excludes the recipients as tenants in the ordinary housing market, the difficulties in working with psychiatric services and the great challenge of creating jobs for those who are in the social housing programme. also, confidence in the housing first concept is perhaps greater among social workers than among those in power (both politicians and senior officials). 19 njsr – nordic journal of social research vol. 10, 2019 in many respects, the scaling-up project has been successful. it is somewhat surprising that it so quickly yielded positive and tangible results, both in terms of the reduction of evictions in the social housing programme, but also in how both clients and staff experience and describe the change. one explanation is, of course, that the management has been a driving force and believe in the idea, but just as important (perhaps most importantly), the success lies in that the staff has been supportive of and believed in the housing first approach. if the staff had been dominated by people who were negative towards the approach and wanted to maintain the treatment first philosophy, we would probably not have seen the changes that we can identify today. however, there is a real risk associated with the scaling-up project. if housing retention rate is seen as a positive outcome in ordinary apartments, a high ‘housing retention’ rate is not as positive if the client resides in an emergency shelter. another risk is the renaming of housing units. even though they operate under a totally different philosophy, they are renamed as housing first services. this is not something that we have seen so far in helsingborg. a greater risk for the city of helsingborg and other municipalities is that housing first programmes that are used on a small scale can contribute to the legitimization of maintaining the system of training flats and other forms of housing alternatives and indirectly hinder the scaling-up of the housing first programme. municipalities can say that they are working with a housing first approach at the same time as new training apartments that require abstinence are developed. even though the scaling-up project can be seen as successful in such a short time, it still shows limited impact on the overall housing policy in the city of helsingborg. but, housing first in helsingborg cannot be seen as a temporary fad. the housing first pilot started in 2010, and there is very little evidence that its approach will lose ground due to organisational fatigue. the local champions are important change agents, but they are very much dependent on the inspiration of other key actors in other local contexts and at different levels (brandsen et al., 2016b; johnson, 2010). two areas for future research would be, first, to identify key change agents within organizational settings, the intrapreneurs or the institutional entrepreneurs. these actors could, under the right conditions, help the scaling-up process – if they are given enough support and a mandate. it would be especially interesting to study what conditions are necessary for involving service users. second, it would be essential to analyse other examples of scaling-up processes and to see the long-term effects of the process on a structural level over time. what do organizations need to do in 20 njsr – 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(2005). the adoption of innovation in youth organizations: creating the conditions for youth–adult partnerships. journal of community psychology, 33(1), 121–135. https://doi.org/10.1002/jcop.20044 microsoft word pdf sogstad public-private innovation in health and social care njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 11, 2020 public-private innovation in health and social care: the implications of transaction costs maren sogstad* center for care research, department of health sciences in gjøvik ntnu email: maren.sogstad@ntnu.no eirin lodgaard sintef manufacturing: siv magnussen department of health sciences in gjøvik ntnu *corresponding author abstract in response to the continual pressure on health and social services worldwide, there has been a demand for innovation in this sector. one area of interest has been collaboration between public and private actors in developing new solutions for service delivery. so far, knowledge of how such private-public innovation (ppi) processes emerge has been limited. we studied barriers to ppi, focusing on how transaction costs influence the innovation process. we conducted a single case study, following the collaborative efforts of a norwegian municipality and a local fire and rescue company searching for new care service delivery models. the data consist of interviews with central stakeholders and documents from the ppi process. the findings add to the knowledge on barriers in public-private innovation by highlighting transaction costs as a factor influencing the ppi process. an increased awareness of transaction costs throughout the innovation process may be important in planning and resource allocation. findings from this case study may be useful in the development and implementation of innovative ideas. our case illustrates the need for organisational change in service innovation. a focus on transaction costs can provide a useful tool for analysing necessary structures and their consequences when beginning ppi initiatives. keywords: public-private innovation, health and social care, transaction costs, norway 130 njsr – nordic journal of social research vol. 11, 2020 introduction the continuous growth of the elderly population poses a challenge for health and social care services (eberstadt & groth, 2007). due to increased needs and a reduced workforce, new care service delivery models are sought, bringing calls for innovation. according to greenhalgh et al. (2004 p 582) innovation in service delivery can be defined ‘as a novel set of behaviors, routines, and ways of working that are directed at improving health outcomes, administrative efficiency, cost effectiveness, or users' experience and that are implemented by planned and coordinated actions’. collaborative innovation, where partners meet across organisational and cultural borders, is highlighted as a viable approach for innovations to address complex problems in public services (bommert, 2010; hartley et al., 2013). there has, therefore, been an increased focus on involving private actors in public innovation processes, leading to public-private innovation (ppi) (dittmer et al., 2008; evald et al., 2014; nissen et al., 2014). through the continuous transfer and discussion of ideas and knowledge, the partners in a ppi process work to develop creative solutions that the parties would be unable to reach individually (hartley et al., 2013; weihe et al., 2011). despite ppi’s promising potential, the process is often challenging, and the drivers and barriers in collaborative ppi processes are still not well understood (evald et al., 2014, fuglsang et al., 2015). given the call for more empirical research (torfing & triantafillou, 2016), this article focus on barriers to ppi based on an empirical case study. the case follows the collaborative efforts of a private fire and rescue company and the health and social services in a norwegian municipality to find new ways of care service delivery. this selected innovation initiative is a rare case of collaboration in care service development between a commercial actor and a municipality in norway, and it can thus provide valuable empirical and contextual knowledge. studying the case, we realised that the new service provision model developed by the actors involved elements of outsourcing. based on this observation, we found transaction cost theory (williamson, 1975) to be a useful approach that gives novel insight into barriers in the ppi process. while public-private interaction increases innovation, collaborative processes are timeand resource-intensive and entail transaction costs. the term ‘transaction costs’ refers to costs arising when one actor purchases a component or a service from another. these expenses are related to a broad 131 njsr – nordic journal of social research vol. 11, 2020 spectrum of activities, including organisation, administration and quality control. these activities are important to ensure the safe delivery of goods and services. transaction costs will be more thoroughly defined and discussed later in the paper. by analysing stakeholders’ perspectives and reflections in contracting events, we focus on how transaction costs act as a barrier to ppi. by focusing on cost-related barriers, the transaction cost perspective provides a novel understanding of barriers in ppi initiatives. this theme may be of special interest in the nordic context, which is characterised by a strong public health and social service sector with limited privatisation. theoretical framework ppi and collaborative innovation public-private innovation (ppi) is innovation developed by actors from both the public and private sectors working together throughout the innovation process. so far, few studies have focused on the drivers of and barriers to ppi. a literature review by fuglsang et al. (2015) described new types of innovation networks in public services as a common theme in ppi literature, but the literature tends to approach these networks from different research perspectives based on different contextual factors, leading to a fragmented field of science. through the theoretical perspective of innovation networks, the eu’s servppin project, which studied ppi networks, pointed to both internal and external factors for success; joint business cases, trust and flexible structures were shown to be important drivers, while expectation mismatch, different incentive systems and rigid public administration were emphasised as barriers (rubalcaba et al., 2011). cooperation between public and private actors tends to involve a strong interest in realising cost-effective and marketable solutions (rubalcaba et al., 2011). in healthcare, ppi networks are often goal oriented, with partners coming together for a particular reason. in addition, networks are often based on previous connections between key members. the servppin project showed that interaction between private, public and third sector organisations is important for the development and delivery of innovative services, and mixed forms of services are increasingly seen internationally (rubalcaba et al., 2011). the innovative capacity of the public sector is enhanced when private actors problematise established practices and ideas (hartley et al., 2013). nevertheless, the widespread tendency towards institutional separation and isolation from private actors is limiting the public benefits of ppi in service innovation (torfing & triantafillou, 2016). 132 njsr – nordic journal of social research vol. 11, 2020 ppi collaboration is often advantageous, but there is a constant risk that different barriers will disrupt ongoing collaborative processes. using institutional and organisational theories from public administration and governance, hartley et al. (2013) summarise three challenges that can disrupt or destroy collaborative processes. first, they point to factors that bring different actors together, such as a history or tradition of interaction, motivation to spend time and energy on collaboration and the challenges of previous negative experiences with collaboration. second, they address barriers preventing a transition from interaction to collaboration, such as conflicts of interest, mistrust and incompatible frameworks. finally, they highlight that it can be challenging when partners become too familiar with one another, acquiring the same world view (lock-in) and thus losing their innovation potential (hartley et al., 2013). this is in accordance with boschma’s (2005) findings on the importance of proximity in learning and innovation processes. examining economic geographers’ focus on the importance of geographical proximity, boschma discusses the dilemma of proximity across five dimensions—cognitive, organisational, social, institutional and geographical—concluding that both too much and too little proximity constitute a problem in innovation processes (boschma, 2005). furthermore, collaborative innovation processes benefit from equal power resources among stakeholders (rønning, 2015). when stronger actors dictate the premises for finding joint solutions, this can hamper dialogue and collaboration (gray, 1989). despite this pitfall, enthusiastic and convincing actors are necessary to achieve innovations (magnussen, 2016). simultaneously, the theory of public value adds the perspective of exploitation. if actors, especially private ones, are capable of exploiting the innovation process to their own advantage, this might be harmful (benington & moore, 2011). skilful leadership and management are important factors in overcoming these barriers and facilitating the collaborative process (crosby & bryson, 2010). transaction cost economics in the production of both goods and services, organisations are forced to decide what aspects of production should be performed in-house and what aspects should be bought or outsourced. transaction cost theory is a tool for analysing these decisions and is widely used to study institutional arrangements (klein, 2004). transaction cost theory originated from ronald coase’s (1937) study of the vertical and lateral integration of firms and was further developed by williamson (1975, 1985) into a theory and a set of tools for analysing economic transactions and their influence on economic organisations (klein, 2005). thus, 133 njsr – nordic journal of social research vol. 11, 2020 transaction cost theory poses the problem of economic organisation as a problem of contracting (bell, 2010). transaction costs in contracting work works like friction in physical systems, generating costs associated with cooperation in addition to the traditional production costs (williamson, 1975). the contracting is carried out within the frame of given institutions, establishing a set of laws, rules, customs and norms to guide human behaviour (north, 1995). different institutions, each with its own inherent governance structure, will generate different transaction costs. consequently, transaction cost theory pays attention to institutional influence, but it does not do so as holistically as the more sociological approaches used in institutional theory (roberts & greenwood, 1997). the partners collaborating in a ppi wish to achieve a win-win situation. their cooperation is thus not based on idealism. this draws attention to two behavioural conditions important in transaction cost theory: bounded rationality, in which individuals are constrained in their ability to act as fully informed rational agents due to limited cognitive capabilities; and opportunism, where individuals act out of self-interest and in a deliberately strategic way that is deleterious to lesser-informed parties to the contract. the pairing of these behavioural conditions within particular dimensions of the contracting environment gives rise to more complex, and therefore more costly, contracts to protect the partners from these challenges (donato, 2010). in health and social care markets, given the extent of informational deficiencies characterising this sector with regard to quality, appropriateness and outcomes, it has been argued that hybrid governance structures supported by relational contracting are the organisational form most likely to develop (allen et al., 2002; ashton, 1998; palmer & mills, 2003). several factors, including service features, uncertainty, risk and which transaction-specific investments must be made, will affect transaction costs (carr et al., 2009; feiock, 2007; tavares & feiock, 2014). health and social care take place in the interaction between a service provider and a service recipient. inadequate quality in service delivery could have serious consequences for recipients. therefore, the costs of regulating the purchase of services may be higher in this sector than in others. services that are part of a municipality’s core activities (fire services, crime prevention, etc.) are thus often produced by the municipality’s own organisation (blåka et al., 2012; tavares & camöes, 2007). these services are characterised by a high cost of opportunistic behaviour among contractors and challenges in monitoring quality. the transaction cost includes all costs generated as a result of 134 njsr – nordic journal of social research vol. 11, 2020 cooperation, such as idea generation, quality control and cooperation structures (mick and shay, 2016). however, it does not include costs directly associated with the production of services, or production costs. if the transaction costs are greater than the expected benefits of cooperation, new services are less likely to be offered. healthcare delivery is a complex sequence of transactions among patients, providers and other stakeholders. sometimes these exchanges are concrete and observable, but most of the time they are intangible and abstract (e.g. information, advice, comfort). in the chain of transactions, the potential for transaction costs exists at every juncture (stiles et el., 2001). based on this recognition, using the transaction cost approach to analyse new service delivery systems created through ppi may add new insight and understanding of ppi processes in healthcare. several studies point to different aspects of cost as barriers to innovation in general (hjalmarsson et al., 2014; schroll & mild, 2012; wang et al., 2012). however, we found no literature using transaction cost economics as a direct entrance to studying barriers to ppi. this article uses the theoretical perspective of transaction cost economics as an analytical framework through which to focus on contracting events and the influence of transaction costs in the ppi process. methods this article uses the qualitative research approach of case study to gain insight into the informants’ experiences, reflections and assessments. the case study approach was selected because it is well suited to investigate phenomena taking place in the ‘real world’ (yin, 2013). case studies help the researcher develop a nuanced view of reality by offering a detailed and multifaceted perspective on real-life situations (flyvbjerg, 2006). the chosen case is informative, both because it bears similarities to other ppi processes and because the selected municipality already had a long tradition of purchasing services from the private company in question, a fire and rescue company. prior to this case study, the authors had conducted a previous project in the municipality, and thus had good knowledge of the municipality and its organisation of health and social services. 135 njsr – nordic journal of social research vol. 11, 2020 introduction to the case in norway, the responsibility of public tasks, like education, health and social care and technical infrastructure, are delegated to the local governmental and administrative level, called municipalities. within the frames of nationally laws and expectations the municipalities have freedom to execute, develop and innovate their services. this case study followed a partnership between the health and care services in a medium sized municipality in eastern norway and a small local private fire and rescue company. the objective of this publicprivate initiative was to develop innovative solutions in the municipal health and care services by optimising use of competence and personnel. the innovation process studied was based on an established partnership, and thus the actors involved had already developed knowledge about and mutual trust for each other. through a creative process, the actors sought alternative service delivery solutions in which the fire and rescue company could take over some nonmedical tasks to free healthcare personnel to focus on performing health-related duties. in total, this ppi carried out five pilot projects, each of which focused on different aspects of care service delivery: security alarms, fire safety, meal service, drug delivery and ad hoc situations. data and data collection the data were derived from reports of working group meetings and qualitative interviews with stakeholders. the meeting reports were written as working documents for the project group and were distributed to group members and to the municipal healthcare manager. they listed the participants and summarised the discussions and decisions made. the reports were typically two pages in length and made it possible for the researchers to follow the progress, discussions and assessments made by the working group during the innovation process. in addition to analysing the reports, we performed semi-structured qualitative interviews with representatives from the public-private working group. we contacted the six group members by e-mail (two of them represented the fire and rescue company and four represented the municipality), presenting to them the purpose of the study and the main themes of the interview. four responded positively: the project leader, the health and care service manager (who eventually withdraw from the project group, but still had valuable information from the initial part of the process ) and the leader of the home care services from the municipality and the manager of the fire and rescue company. all in all, the informants provided a good representation of the stakeholders 136 njsr – nordic journal of social research vol. 11, 2020 involved. we developed an interview guide with open-ended questions that focused on the innovation process. the four in-depth interviews, all conducted face to face by the first and second authors, started with an introduction to the study. each interview lasted about one hour. the interviews were recorded and transcribed verbatim before analysis. analysis following schreiner (2012), we conducted content analysis inspired by grounded theory. content analysis is a data-driven method to systematically describe the meaning of data by aggregating it into a more digestible form. we used transaction costs as a sensitising concept, which means that the ways in which different aspect of transaction costs appeared in the data served as a point of departure for our analysis of the barriers to ppi processes. the concept of transaction cost did not define or delimit how the data were coded. initially, the data (both the interviews and reports) were divided into meaningful units and coded. then, initial codes were merged into thematic categories based on similarity, forming the coding frame. using the coding frame, relevant data were distinguished based on our interest in transaction costs as barriers to ppi. through theoretical coding, categories were grouped according to the phases in the innovation cycle (sørensen & torfing, 2011)—the generation of ideas, the selection of ideas and the implementation of ideas—and further condensed to form an understanding of the ppi process and its barriers. reliability the findings in this article are based on an analysis of documents and interviews with four key actors in one innovation process. thus, caution should be exercised in generalising the results. at the same time, the study can contribute valuable insight to a field that is currently based on limited empirical knowledge. according to flyvbjerg (2006), case studies based on experiences and empirical evidence are important steps on the way to knowledge. this article contributes to the understanding of some aspects of barriers to ppi based on transaction cost theory. further studies are necessary to gain a comprehensive understanding of the dynamics of ppi. 137 njsr – nordic journal of social research vol. 11, 2020 findings this section presents the elements and activities identified as generating transaction costs and their influence on the innovation process in the three stages of the innovation cycle: idea generation, idea selection and idea implementation. generation of ideas: motivation, curiosity and trust the starting point of the ppi process is the contracting moment. the municipal and fire and rescue company leaders agreed to enter into the project hoping to develop a mutually beneficial service product. according to transaction cost theory, the costs related to this idea-generating phase are transaction costs. at this point, the costs we identified were mainly related to salary for the personnel involved. a one-day idea-generating seminar was arranged, and a group of six persons was established to organise the project. additionally, the municipality spent some resources anchoring the project, both at the councillor level and further down in the organisation. however, the project partners did not reflect on aspects related to transaction costs in this phase. for instance, they did not establish a budget for the project. both actors seemed to have a mutual understanding that the project, including the generation of ideas and the implementation of the pilots, would entail some costs, but these costs were not visualised. the managers had the authority to make the decision to enter the ppi and to allocate resources to the project. this may be important with respect to the fact that transaction costs do not seem to be a barrier in this phase. when the leaders with the necessary authority decided to initiate the ppi, the employees took the project for granted and participated as asked. this top-down initiative may have motivated them to spend time and energy in the innovation process, as described by hartley et al. (2013). the fact that the participants knew and trusted each other seemed to reduce the transaction costs. curiosity and trust were important in this phase. the partners focused on the possibilities for a positive outcome. they cited different motivations for entering the innovation process. for the municipality, the continual pressure on its healthcare services was important. given increased demands and service volume, municipal leaders needed to look for new ways of service delivery. this need was well described by the health and care service manager: 138 njsr – nordic journal of social research vol. 11, 2020 ‘we wanted to see if this could be an opportunity…to maybe limit the use of overtime. because the home care services are using considerable resources beyond budget. the services have not grown in pace with the number of duties.’ (health and care service manager) the fire and rescue company was motivated by the possibility of creating new business. through the cooperation, it wished to increase the knowledge and expertise of its personnel in the hope of developing service products that might be interesting for a bigger market (i.e. other municipalities). the fire and rescue company is part of a large industrial cluster which is the main employer in the municipality. there is a long history of contact and collaboration between the industrial cluster and the municipality. the fire and rescue company and the municipality form a joint community with a common interest in creating additional value in the form of high-quality services for municipal residents and jobs in the municipality. such shared history and interests provided the partners with common goals for the ppi process. the two actors’ history of collaboration gave rise to mutual trust and the courage to commit to the project. in this initial phase of idea generation, both parties placed great emphasis on geographical proximity as a driver for innovation, as described by boschma (2005). ‘it is clear, geographical proximity means of course that it's easier to collaborate, easier to get to meet.’ (health and care service manager) ‘the availability then. the proximity. i think it meant something.’ (project leader) selection of ideas: coordination, testing and frustration during the project phase, the municipality and the fire and rescue company held regular project meetings. initially, they presented and discussed ideas and identified areas where more knowledge was needed. based on these needs, they initiated different service mappings as a basis for the five pilot projects described in the methods section (i.e. pilots on security alarms, fire safety, meal service, drug delivery and ad hoc situations). then they focused on follow-up and evaluation of the pilots. this phase of the innovation cycle can be described as the selection of ideas (sørensen & torfing, 2011). the transaction costs increased during this phase, as different challenges appeared, and various barriers were exposed. the barriers leading to transaction costs were characterised by three themes: quality control, project organisation and ‘lock-in’. 139 njsr – nordic journal of social research vol. 11, 2020 quality control in the development and execution of the pilots, several questions arose regarding legal issues, privacy, agreements, training, quality control and the need for new procedures. these questions became a central focus of the project group meetings. the minutes from the meetings summarise the group’s discussions and plans for handling the different questions, as well as the way in which group members distributed responsibility for further follow-up. the heavy workload and the constant need for collaboration and mutual clarification are clearly reflected in the minutes. we identified the following activities as generating transaction costs: developing agreements for the pilot services, developing agreements for privacy issues, developing new work routines for information sharing, developing new workflows for both the municipality and the fire and rescue company, establishing joint routines for discrepancy processing, training fire and rescue company personnel in communication with elderly users and creating a system for technical support. as a result of the cooperation and the new routines, there was also a need for a system for continuous follow-up and evaluation. the project leader, in particular, felt a great responsibility to ensure the quality of the services delivered and expressed the need for a system and regular meetings between the two partners: ‘i am so stressed about the follow-up, is everything function like it is supposed to? ...there are some faulty alarms and other things we need to discuss on a regular basis.’ (project leader) following the increased workload, the ppi process became burdensome. even though transaction costs were generated by the project at this stage, related to both work hours and the necessary infrastructure and equipment, they were not thematised by the group members. however, looking at the process from the outside, the volume and burden of transaction cost–generating processes emerge as a barrier to ppi. project organisation when the project was well established, the healthcare manager withdrew from the group, leaving the responsibility to carry on to the other members. without her, both the management of and responsibility in the group became unclear. a project leader stepped up, but a feeling of uncertainty about goals and authority, along with a high turnover of group members, made it challenging for members to determine responsibilities. maintaining the project and keeping the group 140 njsr – nordic journal of social research vol. 11, 2020 active required sustained efforts from the project leader. the project leader felt burdened by the need to promote and monitor the process. but i think the situation might have….[she stops to reflect, and continues]…so someone had to keep hold of it to make progress. (project leader) when the project leader took charge of the processes, the frontline employees became more passive. they expressed a lack of understanding of the process and disclaimed responsibility, as the following quote from the home care manager illustrates: if this is the best solution, it is up to the project group to find out, i think…so, it is the care manager's responsibility, i would think, to assess what it is we can instruct the service to perform in relation to purchasing services. (home care manager) thus, a lack of clear project management and clear involvement and responsibility downstream in the service organisation emerged as a barrier to the innovation process. the leaders did not succeed in establishing ownership of and enthusiasm for the project group among employees. while earlier studies have shown that power inequalities and the presence of strong individuals dictating the premises for finding joint solutions might hamper dialogue and collaboration (gray, 1989), this study indicates that there is a need for strong, enthusiastic and convincing actors with the force to steer the process (magnussen, 2016; rønning & knutagård, 2015). lock-in initially, the project had high hopes of finding new solutions, as the healthcare manager expressed: ‘we entered without being fully aware of what we wanted but spent a lot of time thinking out loud together. it could be that we came upon something new that we had not thought of at all.’ (health and care service manager) in the process, the focus remained on areas where the actors already had experience with cooperation. in the project phase, the municipality took an active role in promoting its wishes and needs while the fire and rescue company took a more passive role, primarily responding to the municipality’s suggestions and weighing in on what would be possible, given the company’s expertise and capacity. throughout the process, both the municipality and the fire and rescue company were thinking about service production in more traditional terms, and to a large 141 njsr – nordic journal of social research vol. 11, 2020 degree, both parties held the same worldview. they had a history of collaboration, and the fire and rescue company was familiar with many aspects of the municipality’s services. the two actors contributed similar knowledge regarding the non-medical tasks performed by the home care services. thus, the fire and rescue company was not able to problematise the established practice. the lack of novel input hampered creativity and the creation of new ideas. the benefit of knowing each other well, and the geographical, organisational, cognitive and social proximity (boschma, 2005; hartley, 2013) that initially made it easy for the parties to enter into cooperation, became barriers to innovation. this passive outcome of the ppi process may also be viewed as a tactic to reduce transaction costs. because the actors knew each other and had built trust over time, by continuing familiar patterns they reduced the necessary transaction costs in the collaboration. hence, in this case, the combination of a private and a public actor was not able to trigger innovation. the implementation phase: tradition, disappointment and resistance to change at the end of the project period, after evaluating the different pilot projects, the actors entered the implementation phase, in which they needed to decide if they wanted to implement any of the piloted services in their everyday practice. this phase corresponds to the implementation of new ideas in the innovation cycle (sørensen & torfing, 2011). in the implementation phase, the organisation of services and the evaluation of transaction costs appear to be important. organisation of services based on the results of the pilot for ad hoc services, as well as redirecting alarms from frequent users, the two parties signed a contract to implement the pilot as a regular service. however, local leaders were still uncertain as to how and when to use these new services and whether there actually was a need for them. the contract was of little help, being vague and lacking description of the scope of or need for the services. there was limited awareness of the contract at the lower levels of the service organisation. there also seemed to be uncertainty regarding how to develop and follow up the redirected alarm service. therefore, even though a contract was in place, the organisation of the services was unclear, which posed challenges for safety and quality, and the project leader expressed frustration regarding the quality routines of the new services. she was afraid they would fail due to a lack of routines and follow-up when the work of the project group ended. 142 njsr – nordic journal of social research vol. 11, 2020 i'm so stressed out about the follow-up…we see that the project is positive; we gain quality in the services. i am so afraid that it will go too far and that there will be too many unsolved matters that make it all a manager's decision that the service will be taken back to the municipality. that's what often makes things fail, that the parties do not talk and collaborate and take things as they come. (project leader) this quote illustrates the challenges in the transition from project to regular services and the necessary organisational changes and structures that need to be in place for the innovation to succeed. such structures typically generate transaction costs. the implementation of new models is known to be a challenging phase in the fulfilment of the innovation cycle (sørensen & torfing, 2011). evaluation of transaction costs while reflections on the transaction costs were absent during the initiation phase and unimportant in the project phase, they were an important part of the discussion when entering the implementation phase. the main reason ideas were rejected was that the cost of organising a task switch would exceed the potential benefits. as home care services perform multiple tasks in the same visit, new models dividing medical and non-medical tasks, as well as the following follow-up, information sharing and quality control, appeared to drive transaction costs and were not considered an effective use of resources. both actors pointed to the importance of evaluating transaction costs in decision-making, focusing on both direct costs in collaborating and costs related to quality control. as stated by the healthcare manager, ‘there is an economic aspect to this. we need to know that the service is equally good when routed to fire and rescue company and that the cost is not higher compared to what we can deliver ourselves.’ (health and care service manager) the fire and rescue company manager also pointed to the importance of mutually beneficial solutions: ‘it must be a win-win situation in everything so it's a win for both parties. it must be feasible in that respect. for both parties.’ (manager of the fire and rescue company) the budget for the home care services did not cover costs related to the new services. the home care services have a tradition of conducting multiple tasks and are run in a dynamic and flexible way. home care staff are used to handling acute situations such as illnesses and falls, which are usually dealt with by 143 njsr – nordic journal of social research vol. 11, 2020 reprioritising the workforce’s daily tasks. thus, the costs of such episodes are concealed as part of the total home care budget. with the new service, situations in which the home care services sought the fire and rescue company’s assistance triggered a bill from the fire and rescue company to the municipality, making the cost visible. hence, the new services challenged the traditional perception of the services as a whole and revealed a need for new ways of budgeting. in this phase, the inequalities between the two partners, with one being a public service provider and the other a private business, also became clearer. the most challenging inequality was their different understanding of the context. while the small fire and rescue company were used to execute a specific task in a restricted environment, the health and care services constitute a complex organisation with multiple actors and tasks. these differences made the expectations of innovation speed at odds. also, their different scope, the fire and rescue company wanting to expand their businesses and the health and care services goal to produce high quality services and public value, resulted in unclear expectations, insecurity and poorer collaboration. evaluation of the ppi process upon completion of the project, both parties expressed a certain degree of disappointment. they had both hoped to achieve more. the fire and rescue company manager expressed the following: ‘i had hoped for the project to generate more, from our point of view.’ (manager of the fire and rescue company) he continued by explaining what he considered the main challenge: ‘it is hard to find new and sustainable models, and there might be resistance to change, especially out in the performing services. in my view, the top management is positive to change, but the services are not following.’ (manager of the fire and rescue company) his statement points to the importance of having broad involvement and good information flow in innovative processes. the project leader also questioned whether service managers have the time and capacity in their hectic schedules to be a driving force in innovation and change processes. overall, the informants presented a picture of the innovation process as fragile, despite the involved parties’ histories of trust, mutual knowledge and positive experiences. this fragility was based partly on a lack of resources dedicated to the handling of transaction cost–generating activities. 144 njsr – nordic journal of social research vol. 11, 2020 institutional boundaries also challenged the two parties’ hopes that the innovation process would have a larger impact. in order to realise the collaboration’s potential, the home care services needed to reorganise their work. changing only certain parts of the services influenced the organisation and execution of other parts. home care services are characterised by a high level of complexity, which complicates any kind of reorganisation. in this case, the municipality’s resources were limited and the possibility for innovation seemed to be restricted to add-on innovations, in which new service solutions had a high degree of fit with established practices. major innovations requiring reorganisation seemed to be out of reach. reorganisation-related costs facilitate collaboration in service production and are part of the transaction costs; if innovation is to succeed, it is thus important to discuss transaction costs in ppi. discussion in this case study, we have followed a ppi process involving a municipality’s healthcare services and a private fire and rescue company. in our analysis, we used transaction costs as a sensitising concept to study barriers in the three phases of the ppi process, namely the generation of ideas, the selection of ideas and the implementation of ideas (sørensen & torfing, 2011). according to transaction cost theory, cooperation is less likely to take place if the transaction costs are higher than the expected benefits of cooperation. thus, evaluating transaction costs is an important part of deciding whether to cooperate (williamson & masten, 1995). following the innovation process between the municipality and the fire and rescue company, transaction cost– generating activities appeared in all phases of the project. initially, the actors were part of a joint community; their geographical and social proximity made it easy to come together and gave them a mutual interest in success. they shared a trust that was based on friendship, kinship and experience. this removed the need for preliminary negotiations and formal contracts related to the start-up of the project and reduced the transaction costs in this phase. our findings, based on transaction cost theory, thus extend the findings of hartley et al. (2013), showing the importance of actors’ history of collaboration, trust and motivation when entering an innovation project. during the idea-generating phase, it became clear that the partners were familiar with one another. as shown by hartley et al. (2013), familiarity hampers 145 njsr – nordic journal of social research vol. 11, 2020 creativity in the idea phase and diminishes the potential for innovation (‘lockin’). when partners know and understand each other well, familiarity makes cooperation easy and reduces transaction costs. however, this turns into a barrier for generating new ideas. the ppi process in question involved collaboration between only two partners. given the limited outcome, including additional actors representing different perspectives and ideas might have increased the chances of successful innovation. given the high level of motivation in this initial phase, the increased transaction costs generated by involving additional actors would most likely be accepted. as the innovation process proceeded, the transaction cost–generating activities increased. a great effort was made to establish routines and structures in order to ensure quality in service delivery during the pilot projects. the large amount of work involved in ensuring service quality seemed to be exhausting for the project group and made it harder to maintain motivation. moreover, it was questionable whether the project had access to sufficient resources. following the increased workload associated with quality control, transaction costs appeared as a serious barrier to the ppi in this phase of the project. project organisation is known to ease the execution of innovation processes in parallel with normal routines in the healthcare sector (andreassen et al., 2015). with adequate project organisation, the complexity that characterises the sector is reduced, leading to limited transaction costs. however, at the same time, project organisation is showed to delay the implementation of innovation, since the delegation of tasks and responsibilities in a project detaches innovation from normal routines (andreassen et al., 2015). in accordance with these findings, our analysis showed that project organisation of the ppi process led to less engagement among local leaders and frontline employees, hampering implementation and acting as a barrier to ppi. this shows the importance of local involvement in innovation initiatives, despite the potential resulting increase in transaction costs. in our case, the new care service solutions presented were ‘add-on’ services which functioned in parallel with established practices. because of the project’s limited authority and its disconnection from normal routines, the reorganisation needed to realise the potential of innovation did not happen. these results emphasise that health and social services management must be aware of the extensive changes that innovation might entail, and of the transaction costs actually involved when collaborating with private actors in new models of care service delivery. the servpinn project identified rigid public administration as 146 njsr – nordic journal of social research vol. 11, 2020 a barrier for innovation (rubalcaba, 2011). the transaction cost perspective can contribute to an increased understanding of this rigidity. transaction costs entail a wide range of costs related to idea generation, contract negotiation, restriction of services and infrastructure and quality control. an interesting finding in this case study was that transaction costs seem to be understood both as the actual objective costs related to the new organisation of services as well as the subjective experience of the workload needed in order to develop new service delivery models. furthermore, this subjective understanding of costs related to the restructuring of services emerged as an important barrier to innovation. finding new ways of service delivery requires changes to established work practices. in complex structures such as the organisation of health and social services, combining new models and established practice can be difficult and demanding (greenhalgh et al., 2004). in this case, the participants’ subjective understanding of the work and costs associated with new service provision models was more important than the objective costs. the participants acted based on a given understanding of reality, bound to their traditional framework. therefore, their assessments and decisions related to the development and implementation of new models appeared to be based on their subjective perception of potential transaction costs, rather than actual calculations. in the final stage, the actors were also challenged by insufficient institutional proximity, leading to an increased need for transaction cost–generating structures to secure quality in service production. the fundamental driver of the fire and rescue company was to make profit, while the municipal care services focused on quality in service delivery. traditionally, there is a resistance to the marketisation of care services in norway (vabø et al., 2013). this institutional mind-set may hamper creativity and the will to collaborate in finding new models of care service delivery. thus, this case study reinforces the conclusions of previous literature on proximity as both a driver and a barrier to innovation (boschma, 2005; hartley et al., 2013). a central finding in our case study was that even though transaction costs were present in all stages of the project, the actors first became aware of them when entering the implementation phase. in the phases of idea generation and idea selection, transaction costs were not visualised or discussed by the actors. this finding indicates that transaction costs did not hamper the innovation initiative in the first phase. if transaction costs were a barrier to innovative initiatives, this might prevent fruitful cooperation from taking place. simultaneously, not 147 njsr – nordic journal of social research vol. 11, 2020 addressing transaction costs in the first phase of the innovation process may lead to participation in innovation processes that cost more than the partners are willing to pay. given that the main goal of the ppi is to develop a positive outcome, evaluating potential transaction costs when entering ppis could enhance the basis for decision-making, thus ensuring the resources available for innovation are used efficiently. taking part in ppi initiatives is a balancing act between facilitating logical decision-making and following ideas, engagement and motivation in a more intuitive manner. conclusion this case study adds to the knowledge on barriers to public private innovation by highlighting transaction costs as an important factor throughout the ppi process. collaborative innovation theory originates from a social constructivist tradition (hartely et al., 2013). while collaborative innovation processes are complex and dynamic, the focus on transaction costs, representing an instrumental and rational tradition, may contribute to a complementary understanding of the barriers to ppi. an increased awareness of transaction costs throughout the innovation cycle may help elucidate 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(2013). case study research: design and methods. sage publications. microsoft word pdf frontline professionals performing collaborative njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 11, 2020 frontline professionals performing collaborative work with low-income families: challenges across organizational boundaries torunn alise ask department of sociology and social work university of agder email: torunn.a.ask@uia.no solveig sagatun* department of sociology and social work university of agder email: solveig.sagatun@uia.no *corresponding author abstract this article discusses certain challenges relating to interagency collaboration between the norwegian labour and welfare administration (nav) and child welfare services (cws). we have asked what obstacles to holistic work with lowincome families who receive measures from nav and cws simultaneously can be identified. the departure point is collaboration on a local project at the municipal level. the differences between the views of the individual services (and the mandates based on these views) with regard to parental obligations have proved challenging. using the theory of institutional logic, we have explored how different logics have influenced these services’ approaches to parenthood and the significance of these influences for interagency collaboration. we have also investigated how caseworkers1 in the two services have managed to create 1 in norway, nav and cws use different terms for the frontline workers in the services. we have chosen to use “caseworker” in this article. 67 njsr – nordic journal of social research vol. 11, 2020 reflective spaces for negotiating and bridging various understandings to create new ways of working together. in addition to collecting and analysing data, our task as researchers has been to facilitate joint working processes in the project. the article is based on interviews with caseworkers from both services, discussions during two workshops, and a subsequent dialogue seminar with employees from the two services. keywords: trailing research, interagency collaboration, holistic intervention, low-income families, parenthood, institutional logics. introduction although norway is a rich country, an increasing number of children are living in relative poverty (unicef, 2016). to reverse this trend, policy-makers and researchers have called for holistic approaches that can be used by the various welfare services responsible for these children and their families (fløtten & grødem, 2014; langeland, dokken, & barstad, 2016; malmberg-heimonen, tøge, rugkåsa, fossestøl, liodden, bergheim, gyüre & buzungu, 2019; ministry of children, equality and social inclusion, 2015; the governmental board and health supervision, 2013; the office of the auditor general in norway, 2013–2014). in this article, we focus on challenges related to a project called “new ways of working in interagency collaboration with low-income families,” aimed at developing and improving collaboration between the norwegian labour and welfare administration (nav) and child welfare services (cws) in this area on a local level. when parents and children in low-income families receive assistance from nav and cws simultaneously, this indicates that the families are economically disadvantaged and that there are concerns about the children’s care situation. these children and their parents have diverse needs related to their individual family circumstances, and these needs require multiple measures across organizational boundaries. however, welfare services for children and families with poor finances and challenging life situations are rarely integrated or coordinated; they often focus on separate problems or individual members of the family. therefore, new forms of collaboration and guidelines to improve the assistance provided to this group of children and their parents are required (ask & sagatun, 2015; gustavsen, meij, nilsen & braathen, 2012; malmbergheimonen et al., 2019; nav & bufdir, 2016; oterholm, 2018). 68 njsr – nordic journal of social research vol. 11, 2020 we identify some of the specific challenges relating to collaboration across these two services by highlighting how different approaches to parenthood have influenced efforts to develop coordinated support. we took a trailing research approach, whereby we followed the project over two years (innos 2013–2015,2 ask & sagatun, 2019). the data for our analysis mainly consist of statements from and discussions among frontline caseworkers and middle managers from nav and cws. we regard the study as a contribution to raising awareness of important issues that can be difficult to recognize and name in the day-to-day practical work of these services. theoretical framework welfare services handle many problems that can be characterized as “wicked problems” (rittel & webber, 1973). these are complex problems that do not have simple unambiguous solutions (vabø, 2014, p. 17). they span different areas of expertise. thus, effective solutions may require collaboration across services, which is the case with our subject of study. the theory of institutional logics can help us to understand certain challenges that services face in addressing such problems. alford and friedland (1985) first introduced institutional logics as an approach for exploring the interrelationships and contradictory practices and beliefs inherent in the institutions of modern western societies. since then, the theory has been developed further, and greater emphasis has been placed on the interactions between actors, organizations, and institutions (thornton & ocasio, 2008; thornton, ocasio, & lounsbury, 2012). the perspective entails an awareness of the socially constructed, historical patterns of practices, assumptions, values, beliefs, and rules that give meaning to a certain social reality. it concerns a set of presumptions and perceptions embedded in a particular field that guide the actions of the social actors in this field (thornton & ocasio, 2008; thornton et al., 2012). freidson (2001) has described organization/bureaucracy, market, and profession as ideal types of organizing businesses and has examined how 2 the research was part of the main project innovation and service development through evolving forms of collaboration (innos, 2013–2017), partly funded from the research council of norway. 69 njsr – nordic journal of social research vol. 11, 2020 these constitute contexts with different institutional logics that guide and control practice and practitioners. social classification and categorization are key mechanisms by which institutional logics might shape individual cognition (dimaggio, 1997). for example, the supports to be given to certain citizens or users are assessed in the context of the categories the respective institution, in this case nav or cws, perceives as its responsibility. the concept of an institution is ambiguous; it covers both general categories, such as the family and the state, and concrete businesses and organizations. the term is also used more generally to define enduring structures that create stability and meaning and shape and regulate behaviour (scott, 2008). regulative, normative, and cultural-cognitive elements are the central building blocks of institutional structures (scott, 2008, p. 49). cws and nav are organizations with overall institutional arrangements; they have defined purposes related to legislation and current policy, and they contain guidance based on their social mandates and social obligations for actions and interactions (oterholm, 2018; scott, 2008; thornton et al., 2012). institutions’ regulative aspects, which may include sanctioning activities, can be either informal or formalized and assigned to specialist actors (scott, 2008). the regulative aspects of nav and cws are examples of the latter. according to thornton et al. (2012, pp. 76–77), social actors are key to understanding institutional persistence and change. dominant institutional logics should not be understood as specific scripts for action but rather as core principles for organizing activities and channelling interests. this understanding relates to the concept of embedded agency (thornton et al., 2012). battilana and d’aunno (2009) argue that although structures and institutional pressures tend to reproduce the status quo, forms of institutional work and agency can also challenge institutions. the concept of institutional work provides a broader view of agency by highlighting the intentional and practical actions through which institutions are created, maintained, and disrupted, often through relatively mundane and ordinary activities (lawrence, suddaby, & leca, 2009, p. 1). we use institutional logics to call attention to the fact that nav and cws address parenthood on different grounds due to their institutional rationales as welfare organizations in separate policy areas. however, they have overlapping responsibilities on certain issues, such as the multifaceted problems faced by low-income families. these problems run across various sectors of society. by studying how caseworkers in these different services talk about their practices, 70 njsr – nordic journal of social research vol. 11, 2020 we highlight both important barriers and the institutional work that has been performed to overcome those barriers to collaboration. the latter corresponds to interagency cooperation, which, inter alia, is about finding common ground and recognizing mutual dependency across institutional boundaries when dealing with complex social problems (gray, 1989; willumsen, 2009). our analysis is inspired by these theoretical perspectives. based on our approach, we developed the following research questions: how can we understand the categorizations of parenthood in nav and cws? how have these categorizations influenced practice in relation to low-income families using both services? how might categorizations and subsequent practices affect obstacles to and opportunities for achieving a holistic approach to collaboration between nav and cws? existing research on the institutional logics of nav and cws nav is itself the result of an interorganizational reform that brought different agencies with historically different orientations together: the rule-orientated social security system, needs-orientated social services, and the resultsorientated employment office (andreassen & fossestøl, 2014, p. 177). referring to freidson (2001), andreassen and fossestøl (2014) argue that the prevailing logic within nav is dominated by organization, bureaucracy, and hierarchy. oterholm (2015) interviewed social workers in cws and nav to study whether and how the institutional framework for their professional practices affected differences in judgements regarding youths in need of support when leaving care. she found that social workers in nav were mainly influenced by a public logic in relation to a “generalised other,” while social workers in cws, although influenced by a public logic, were led by a private, or family-orientated, logic in relation to a “concrete other.” during her fieldwork in a cws office, vagli (2009, 2014) found that social workers predominantly used emotional language in their internal conversations and judgements relating to the categorization of children and parents for available measures. she had expected a more bureaucratic logic to appear and questions whether cws is sufficiently aware of its institutional embeddedness in a particular cultural and historical context. without discounting emotions or 71 njsr – nordic journal of social research vol. 11, 2020 elevating bureaucracy, she points out that it is a challenge for cws, on both institutional and individual levels, to be aware of and balance different logics. within a uk context, morris, white, doherty, and warwick (2017, p. 53) have argued that child welfare takes place in a moral context where parents are constructed as potentially culpable for problems exhibited by the child. this is particularly apposite when applied to judgements about parenting. they claim there has been a gradual shift in how families and parents are perceived and named in child welfare services. they are no longer seen to be struggling in the face of adversity but rather presented as wilfully failing to exercise good judgement, seize opportunities, and work hard. they are expected to collaborate to change their own situations, and less attention is paid to their social and economic circumstances. an increasing focus on risk assessments influences how families are seen and spoken about (morris et al., 2017). the common wisdom that can be taken from these studies is that organization and institutional affiliation matters, especially with respect to socially constructed systems of categorization that influence practice (thornton et al., 2012). in relation to our study, nav seems to be characterized by a bureaucratic and public logic, while the logic of cws seems more blurred and more influenced by a private logic where specific parental obligations are at stake. we recognize that different institutional logics can exist inside welfare services and can compete for dominance. agents in the field experience and express ambivalence in their professional practice. we emphasize that our study focuses on how different internal categorizations, in this case, connected to perceptions of parenthood, affect collaboration between two welfare services and how this influence is reflected in practice. materials and method the project in which we have been involved was initiated by a local nav office, and cws was invited to participate. the project was part of an established partnership between nav and the university, and it developed out of common research interests and development work (sagatun, 2013). the research was reported to the norwegian centre for research data (nsd). our methodological approach was trailing research, which defined our positions as researchers who contributed to clarifying potential room for action and supporting development and new ways of doing things (patton, 2011). we also 72 njsr – nordic journal of social research vol. 11, 2020 involved the opinions of partners from practice, thereby creating arenas for dialogue. we remained open-minded regarding their contributions at all stages of the research process (uggerhøj, 2012). the involvement of families receiving benefits from both services was crucial to the project, and 10 families gave their consent to participate (ask & sagatun, 2019)3. due to the scope of this article, direct citations from our interviews with the families are not prominent in the text. the main source material for this article consisted of interviews with caseworkers and further discussions and feedback from nav and cws employees during jointly organized events for the project. twenty caseworkers were interviewed in 10 pairs. each pair consisted of one caseworker from each service, and both caseworkers in each pair dealt with the same family. the caseworkers were interviewed separately from the families with the consent of the parents involved. all interviews were taped and transcribed, although the transcriptions were not verbatim. summarized accounts of the interviews with the families and caseworkers formed a basis for further discussion in two workshops and a seminar. the participants of these workshops were the caseworkers and certain middle managers from both services. the first workshop was an open session, and the second workshop was organized so that groups (of mixed nav and cws personnel) moved between stations and were given predetermined themes to discuss. the discussions were taped and transcribed. a seminar was also conducted, involving external and internal initiators, as well as a mixed group of employees from nav and cws, totalling about 40 people. the purpose of these events was to allow a space for participants to share, explore, and discuss their experiences and to identify and facilitate new forms of professional practice. we acted as interpreters and facilitators of conversations between participants with differing institutional contexts and, consequently, different starting points and sometimes different languages (uggerhøj, 2012). 3 all were single-parent families; nine out of 10 were single mothers. none of the adults had regular employment. 73 njsr – nordic journal of social research vol. 11, 2020 we recognize that researchers are actors themselves. many years ago, we, the authors, worked in the child protection area. subsequently, we worked on development and research projects, especially in nav. therefore, we are both insiders and outsiders (hammersley & atkinson, 1995). this gave us advantages and disadvantages regarding access to data, potential to influence responses, and bias in data interpretation. however, we see our methodological approach and our participation in the larger research group in the project innovation and service development through evolving forms of collaboration (innos) as strengthening the validity of the research (ask & sagatun, 2019). data analysis to analyse the data derived from the interviews and workshops and the written reports from the seminar, we used thematic analysis (thagaard, 2013). by paying attention to how the employees from nav and cws described their tasks and the need for collaboration, we identified how they talked about parenthood and expected parenting practices. this emerged as an important theme in the analysis. we examined their stated reasons and explanations for the prevailing approaches in relation to their institutional context and compared the statements of actors in the two services. we focused on the main patterns and nuances in these statements. limitations one challenge we faced was a high turnover in personnel. a lack of continuity and general time pressures in the services may have weakened the engagement of the actors and limited the effectiveness of the trailing research approach. another limitation of our data is that we did not study the services’ evaluations or decisions recorded in the parents’ or children’s records. practice relating to the conceptions of parenthood and dominant institutional logics of nav and cws the policy of “workfare,” with “the work line” (arbeidslinja) and slogans like “work first,” characterize the official rhetoric of nav. generally, this is a statement of consensus rather than controversy (ministry of labour and social affairs 2012, 2015). as a point of departure, these policies provide a direction for individual agency in nav (andreassen & fossestøl, 2014; røysum, 2013), including in 74 njsr – nordic journal of social research vol. 11, 2020 caseworkers’ meetings with adults who, for various reasons, are out of work, dependent on benefits, and parents of minors. cws ensure that children who are living in conditions that represent a risk to their health or development receive the help they need when they need it. this includes providing support to parents (nou, 2016: 16). “the child’s best interest” is the organization’s guiding and legitimating principle. however, this principle represents normative issues. research has highlighted that cws’s mandate of intervening in and regulating family life is based on values, power, knowledge, and special ways of interpreting children’s needs, parents’ obligations, and the service’s mission (morris et al., 2017; oterholm, 2018; vagli, 2009). to explore whether and how various aspects of institutional logics were communicated and how they may have influenced actors, we present examples of how the caseworkers described and reflected on their practices, especially in terms of approaches to parenthood. practice in nav in relation to low-income parents several statements highlighted the fact that the caseworkers were not expected to speak directly with the children. the primary task of nav is to map the parents’ situations and to categorize them to ensure the correct interventions. this approach subordinates the position of children. for some, their caseload contributed to this approach: “we who work with aap [work assessment allowance] have 220 users each.” another caseworker reported that “aap is very adult-orientated; we are not supposed to consider the children.” yet another caseworker elaborated on this: at nav, where the work line is the guiding principle, i think it is invasive to talk about children. i do not find it natural to talk about kids, to ask the parents about the children’s situation. in the survey form for employability assessment, there is no space to write anything about the situation of children. the following quotation substantiates this point: “we only focus on—or mostly focus on—measures such as work and activity.” in a broader sense, children were considered to be affected by the parents’ situations, and the work line was regarded as benefiting them: “to get parents into work can be good for the children.” however, such observations were rarely 75 njsr – nordic journal of social research vol. 11, 2020 linked to specific reflections on how the child was influenced by the parent’s or parents’ unemployment and the family’s economic situation. from these comments from nav employees, it is reasonable to conclude that families and children are viewed from within a narrow frame in the prevailing logic at nav. especially when caseworkers must manage an extensive number of cases, they are forced to adjust to the external demands of the work line and map a rather limited picture of the families that focuses on the grown-ups. in general, the data indicate that workfare, as an embedded guideline, limits the caseworkers’ approaches to parenting and causes them to prioritize initiatives that support work and other activities necessary to achieve self-sufficiency. we see that categorization of service users into predefined categories within the system influenced further mapping and led to the implementation of standardized measures. the term embedded agency (thornton et al., 2012) may be too strong as some caseworkers explicitly claimed that such institutional conditions limited their ability to provide adequate support to families and restricted their individual agency and their exercise of professional judgement (freidson, 2001). however, these conditions represented an obstacle to holistic and flexible cooperation across nav and cws. practice in cws in relation to low-income parents “the child’s best interest,” which is the overall guideline in cws, seems to be connected to “care first” as the expected direction for caseworkers to take in their approach to parenthood. in our data, this assumption is expressed in several statements from caseworkers, such as the following: “in our work, the focus is only on care and assessing whether it is good enough.” caseworkers use legislation, professional knowledge, internal discussions, and various other methods to assess whether a parent, in relation to a child or children, represents a “good” parent, a “bad” parent, or a parent who “could do better,” to use the words of morris et al. (2017, p. 53). during the first workshop, one caseworker said, why am i here? i do not have time to deal with these issues, although i recognize they are important. my obligation is to secure the best interests and welfare of the child, so i must prioritize other measures [measures other than cooperation with nav]. in one example reported by a caseworker, a mother with severe financial problems asked for assistance from cws, partly because she had experienced 76 njsr – nordic journal of social research vol. 11, 2020 a conflict with nav. however, cws’s attention immediately turned to what the service defined as the mother’s mental health problems and how they affected the children: “so we set aside the economic issues.” according to the caseworker, the mother felt cheated and was despairing. a statement from a middle manager at cws expresses a similar sentiment: “i think that financial support is not relevant to the care of children. you can be a good caregiver despite a low income. care is about attachment and relationships, not about how much money you have.” caseworkers from cws also expressed objections to including the family’s caseworker from nav in the family’s supervisory group (ansvarsgruppe). the argument made by cws was that such inclusion would likely give too much attention to economic conditions at the expense of other important factors concerning the children’s care situation. the data with the examples and quotations above indicate that cws does not perceive that concrete economic and material conditions lie within their area of responsibility and regards these conditions as peripheral to parenting. we can view these perceptions in the light of cws’s overall institutional conditions and regulative and normative elements (morris et al., 2017; scott, 2008; vagli, 2014). altogether, such approaches decrease the scope of action across organizational boundaries and highlights limitations and blind spots in cws’s perceptions of parenthood. categorizations of parenthood in nav and cws in relation to their institutional logics most of the caseworkers and middle managers in nav and cws involved in the project were social workers by profession. based on this, we could have expected that they would have a common professional logic. we found traces of this, but the main pattern in our data indicates that the impact of their different institutional contexts is profound (freidson, 2001). nav—parents as breadwinners the data, including the comments presented above, suggest that the overall institutional logic of nav is dominated by an organizational and bureaucratic structure. as such, it fits the picture that similar studies have drawn (andreassen 77 njsr – nordic journal of social research vol. 11, 2020 & fossestøl, 2014; oterholm, 2015). in our study, this logic translates to a view of parents as mainly breadwinners. parents become breadwinners through paid work, which is the prioritized and desirable way of overcoming child poverty (langeland et al., 2016). the mission of nav is to get people into work or other activities that will enable them to achieve economic self-sufficiency. this goal is mainly operationalized through standardized and rule-based working methods (røysum, 2013). these standardized methods are meant to ensure that nav users receive equal and fair treatment. aiming to provide equal treatment in this way can, however, be difficult to reconcile with a desire to provide each family with assistance tailored to their specific requirements. this is a pertinent issue because it may take many parents in the target group a long time to achieve the goal of paid work. the parents in these families often experience health problems and social problems over time. the view of employment as beneficial to people’s health supports the view of work as the overarching solution (ministry of labour and social affairs, 2015). ultimately, there are expectations that parents will adapt to the requirements, rules, and regulations embedded in the institution, according to which users who receive benefits should be motivated to work. cws—parents as caregivers compared to the bureaucratic logic of nav, we found that cws was dominated more by a professional logic in the sense that the caseworkers often referred to theoretical perspectives where they largely emphasized psychological knowledge concerning children’s development and needs. similarly, they focused on whether parents were aware of and able to attend to their children's needs. however, their approach seems to lead to an understanding of parents as mainly caregivers and entails a distance to other aspects of parenthood and to families’ multifaceted everyday lives. we therefore understand this approach as reflective of a limited professional logic. our reason for this interpretation is that the concrete financial situation of the parents did not appear to be mapped and evaluated as especially relevant to the child’s care situation. the issue of how financial issues might affect a parent’s self-image as a parent and his or her capacity and capability to exercise parental care was overlooked. this conclusion corresponds with findings from 78 njsr – nordic journal of social research vol. 11, 2020 comparable research (andenæs, 2004; kojan & fauske, 2011; morris et al., 2017; vagli, 2009). the understanding cws has of its mandate raises the question of how this service should cope with poverty and inequality as a part of children’s care situations. some statements from caseworkers in cws indicate that paying attention to poverty issues amounts to patronizing parents rather than recognizing the struggles such issues cause in families’ daily lives and that it could distract attention from cws’s mission. compared to research describing cws as influenced by a private or familyoriented logic (oterholm, 2015) and cws caseworkers’ assessments as dominated by an emotional language (vagli, 2014), our data provide a slightly different perspective. however, we must emphasize that we have investigated issues other than the aforementioned research, and different logics can exist without being mutually exclusive, or they might compete for dominance (thornton et al., 2012). challenges and bridging differences thornton et al. (2012) indicate that individuals who are embedded in a particular institutional logic are more likely to invoke knowledge that is part of that logic. in many ways, the empirical data we present in the previous sections supports this reasoning. the employees seemed aligned to the categorization of parents as mainly breadwinners in nav and caregivers in cws. on the one hand, it is not surprising that a review of the data shows that caseworkers mainly understood their tasks in relation to families in terms of the official descriptions of their services’ goals. as employees, they must be committed to striving to meet these goals. furthermore, the internal organization of tasks entails guidelines regarding the content and execution of their professional work (freidson, 2001; scott, 2008). on the other hand, emphasizing these standards is not incompatible with being open to supplementary and competing approaches, which may disturb dominant institutionalized categorizations (thornton et al., 2012). as explained in the section on our methods, the participating employees met during joint interviews, two workshops, and a dialogue seminar. their statements during these events provide examples of variations and nuances in their thinking that highlight efforts to bridge differences and implement change. 79 njsr – nordic journal of social research vol. 11, 2020 one caseworker from cws commented, “work is not only about wages… children, they feel ashamed when mum or dad does not go to work.” this reflection highlights the possible normative impact that the work-line approach has even on children. we also interpret it as a widened perspective on parenting as it brings into play issues that are connected to societal relationships outside the interactions between children and parents. in response to a discussion on data derived from interviews with parents who expressed the view that cws did not provide sufficient attention to the effects of economic hardship on their parenting practices, a middle manager from cws asked, “are we really that narrow-minded?” some subsequent reflections from caseworkers supported the parents’ viewpoint. since some cws caseworkers regarded economic affairs as relevant to their work with families, we can understand these statements as expressing competing perspectives within the same field. such internal tensions may provide a basis for thinking about how things could be done differently and how individuals can act as “change agents” in the organization (thornton & ocasio, 2008), in this case to widen a limited professional logic. such actions could also prepare common ground for interagency collaboration (willumsen, 2009). our data show that while nav caseworkers generally agreed with the work line as the guiding principle, they also expressed frustration in this regard. they communicated the view that efficiency requirements and the measurement of how many users were transferred into work or work-like activities every month limited them from following up on parents who had multifaceted problems. this was also seen as an obstacle to obtaining insights into the everyday lives of the children. the following quotation substantiates this claim: “nav does not pay close enough attention to parents who are struggling. things slip in a hectic schedule. we do not have the little wiggle room necessary to obtain tailored solutions.” this observation supports the findings of other research that shows that social workers are under pressure to work in a standardized and “simplified” way (røysum, 2013). in several of the joint interviews with family caseworkers from nav and cws, the nav caseworkers claimed that the conversation helped to expand their view of the parents’ situation. in one example, as a result, a mother was moved to a category that granted her an improved level of follow-up from her caseworker in nav. prior to the conversation, nav had placed her in a predefined category with standardized efforts that required minimal follow-up regarding a work placement. similarly, one caseworker from cws said, “cooperating with nav 80 njsr – nordic journal of social research vol. 11, 2020 is so important for illuminating other aspects of a parent’s situation.” one nav caseworker commented, “if we had more knowledge, more information about what they are struggling with . . . maybe we push too hard?” because of this broadening of their perspectives, some nav caseworkers argued that they should themselves follow up with parents rather than outsourcing the task to external actors, which was a widely implemented practice. many of the responses during the joint interviews began with statements such as “if we had only known this [earlier], we could have . . .” we interpreted such statements as indicating that a different and better choice or measure could have been implemented. one reflection from a caseworker at cws underlines this point: “through working together, we obtain greater knowledge about one another and we can be assured that we gain a partner and a collaborator, not an adversary.” a similar view is reflected in another quotation: “we do not have to wait for a problem to talk together.” suggestions were made about sharing expenditures in current cases and in response to parents’ requests. a more radical view was to have a common budget for working with these families. the idea of having regular “family meetings” gained significant support, as did making a holistic “family plan” with consent and cooperation from the family in question. the purpose should be to clarify how to provide parents and children with the services they need and are entitled to. caseworkers commented that the current situation in which comprehensive efforts are lacking results in humiliating experiences for parents who are sent back and forth between the services. most of the specific proposals represented small-scale initiatives. while these represent important institutional work (lawrence et al., 2009), they are not sufficient to change the bigger picture. however, the discussions made the complexity of the issues more apparent, and the caseworkers emphasized that top managers should contribute to establishing more interorganizational collaboration (willumsen, 2009). we understand these joint discussions and processes as recognition that different forms of knowledge from multiple actors are necessary to introduce new practices and that changes must be institutionalized to be implemented in practice. from our theoretical approach, we see these views as steps towards disturbing and altering the dominant institutional logics. 81 njsr – nordic journal of social research vol. 11, 2020 summary and conclusion in this article, we deliberately emphasize certain perspectives to clarify what we see as important issues in the discussion on developing a holistic approach to assisting low-income families. theoretical perspectives can counterbalance simplified answers to complex problems and help to highlight more fundamental challenges that need to be addressed both to understand and to change established practices. the prevailing logics of both services are embedded in the broader formation of current society (freidson, 2001; thornton et al., 2012). child poverty is a longstanding issue in the public sphere, and although there is cross-political agreement on the need to solve the problem, agreement on effective measures across public sectors is difficult to realize (fløtten & grødem, 2014; malmbergheimonen et al., 2019; vabø, 2014). nav and cws focus on different aspects of family life, and each service has a limited view of what a family’s life entails. the embedded logics of both nav and cws can reinforce a narrow perspective that focuses on the individual rather than seeing family poverty from a wider systemic perspective. in our view, this represents a major obstacle to achieving a holistic approach involving collaboration between the services. measures to address the issues are inadequate and, at worst, can keep families in a poverty trap. we found signs indicating that the services and the caseworkers themselves were trapped by institutional barriers to the extent that they did not see opportunities to expand the scope of their judgements and actions. the caseworkers had limited room to manoeuvre. demanding tasks and time pressures limited their ability to challenge the established institutional logic of their organization when necessary. nevertheless, initiatives to adjust and improve interagency collaboration for specific families were realized and, in general, a more flexible approach emerged over the course of the project. we regarded the interviews and workshops and the seminar as reflexive spaces for negotiation and as essential for an understanding of interdependence (uggerhøj, 2012; willumsen, 2009). barriers built into the structures themselves were acknowledged, although they were not thoroughly problematized. a stronger commitment from leaders was desired. the project demonstrates that neither the work-line approach nor intensive follow-ups to strengthen parent-child interactions are enough to provide the support low-income families need. the project collaboration was basically an 82 njsr – nordic journal of social research vol. 11, 2020 initiative to overcome the shortcomings. although we see the approaches as potentially complementary in collaborations between nav and cws, we argue that both mainly emphasize solutions at the individual level, particularly in relation to parents’ attitudes and actions. an extended view is necessary. from our study, we point to reducing bureaucratization and standardization and strengthening a broader professional logic (freidson, 2001) in and across the services. our trailing research was carried out from 2013 to 2015. the statistics show that the number of children living in families with persistently low incomes in norway further increased after this period (omholt (ed.), 2019). the challenges are still there. the question of how to meet these challenges has mainly been addressed by local initiatives (fløtten & grødem, 2014), including the project present here. one area for further research could be to explore what a reinforced professional logic might mean for developing comprehensive holistic services for and together with affected families. another suggestion is to look further into collaborative relationships to unpack the institutional work and frontline agency that might contribute to disrupting organizational boundaries and, eventually, institutional logics. in the wake of this project, a larger regional development project has been established, which includes more services and cross-sectorial ownership. a research project (2019–2023) with both qualitative and quantitative work packages is generated connected to the new project. while solutions and measures are needed on multiple levels, welfare services such as nav and cws must reach parents and 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[differentiation and integration—the dynamics of interprofessional cooperation?]. in e. willumsen (ed.), tverrprofesjonelt samarbeid i praksis og utdanning [interprofessional collaboration in practice and education]. oslo: universitetsforlaget. njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 9, 2018 a participatory discourse analysis of service users’ accounts of staffed meeting places in norwegian community mental health care lill susann ynnesdal haugen* department of psychosocial science university of bergen, norway email: lill.haugen@uib.no *corresponding author andreas envy department of psychosocial science university of bergen, norway email: andreasnv@hotmail.com tor-johan ekeland faculty of social science and history volda university college, norway email: tje@hivolda.no marit borg faculty of health sciences university college of southeast norway, norway email: marit.borg@usn.no norman anderssen department of psychosocial science university of bergen, norway research unit for general practice, uni research health, bergen, norway email: norman.anderssen@uib.no abstract since the 1960s, deinstitutionalisation has been salient in mental health reforms across the west. in norway, this culminated in the national action plan for mental health (19992008), where meeting places in community mental health care were deemed a prioritised strategy to counter social isolation among people in psychosocial hardships. however, during the same period in england, meeting places were beginning to be contested for mailto:lill.haugen@uib.no mailto:andreasnv@hotmail.com mailto:tje@hivolda.no mailto:marit.borg@usn.no mailto:norman.anderssen@uib.no njsr – nordic journal of social research vol. 9, 2018 14 contributing to social exclusion. this is an inquiry of meeting places in norway guided by the following research question: how do service users discuss their encounters with the spaces and people of meeting places? situated in community psychology and participatory research traditions, we engaged in a participatory discourse analysis of four focus group discussions with 22 service users from meeting places. we detail and discuss four central discursive constructions of meeting places against the backdrop of a civil society identified as fraught with sanism that stigmatises and excludes service users: a compensatory public welfare arrangement positioning service users as citizens with social rights; a peer community positioning service users as peers who share common identities and interests; spaces of compassion validating service users as fellow human beings who are precious in their own right; and greenhouses facilitating service users to expand their horizons of possibility. this inquiry implies that meeting places could mean everything to the people who attend them by facilitating opportunities considered less accessible elsewhere in their everyday lives in a sanist civil society. keywords: participatory research; community mental health care; mental health day centres; discourse analysis; service users; sanism; social democratic welfare state introduction since the 1960s, deinstitutionalisation and the building of community mental health care have been salient in mental health reforms across the west following several hundreds of years of exclusion from civil society (bachke & larsen, 2017; foucault, 1961/1988; hamre, fristrup, & christensen, 2016; lefrancois, menzies, & reaume, 2013). by the mid-1990s, the norwegian council for mental health (1995) had concluded that people with psychosocial hardships were still among the most neglected groups of the welfare state. since 1999, the norwegian national action plan for mental health (1999-2008) (ministry of health and care services, 1998) has been described as advocating a new direction for the everyday lives of people in psychosocial hardships through such efforts as strengthening community mental health care and the rights to citizenship of the social group administratively called ‘mental health service users’ (bergem & ekeland, 2006). the focus of this article is one of the prioritised areas of the action plan intended to counter social isolation and exclusion: meeting places (‘day centres’) in community mental health care (treffsteder/dagsenter) (ministry of health and care services, 1998). norwegian meeting places could be described as daytime and sometimes evening spaces where people in psychosocial hardships can spend their days with peers and professional staff on an easyaccess volunteer basis, participate in diverse activities located inside and/or outside of dedicated houses or apartments and share meals and coffee at fair prices. while meeting places were being prioritised in norway, the community mental health care politics in england of the early 2000s included a national assessment that concluded that meeting places appeared to be undereffective at achieving the assessment’s targets of increased participation in the labour market and mainstream services and, thus, by implication, contributed to social exclusion (social exclusion unit, 2004). such problematisations of meeting places constitute the background for discussing findings from the present analyses. additionally, a cochrane review of meeting places (‘mental health day centres’) did not find adequate randomised controlled trials, leading the authors njsr – nordic journal of social research vol. 9, 2018 15 to assert that compelling evidence for the continued provision of meeting places was lacking (catty, burns, comas, & pool, 2008). following the national social inclusion programme (2008) and economic recessions, meeting places and other community-based services have been reported to be shrinking across the united kingdom (mattheys, 2015). more recently, shrinking services have also been documented in relation to a modernisation reform in the swedish community mental health sector (andersson, eklund, sandlund, & markström, 2016). meeting places have been described as valued and favoured by people attending them (e.g., bachke & larsen, 2017; bryant, 2011; eklund & tjörnstrand, 2013; larsen & topor, 2017). in several inquiries, meeting places generally appear to be portrayed as being among a select few publicly available spaces where the people attending them can go and be together with other people during the daytime, outside of the private sphere (e.g., argentzell, leufstadius, & eklund, 2012; bryant, craik, and mckay, 2004; elstad & eide, 2009; pinford, 2000). the favouring of meeting places appears related to the systematic exclusion and subjugation that people labelled with mental health problems encounter in society. such exclusion is conceptualised as sanism or mentalism in the emerging field of mad studies, which is concerned with explorations of the history, colonisation, culture, human diversity and knowledge of mad people (lefrancois et al., 2013). the concept of sanism entails that ‘sanity’ is considered normal and right in society while being viewed as psychosocially different is automatically considered pathological and bad (lefrancois et al., 2013). the consequences of sanism are, thus, that psychosocially different people experience systematic under-privileging in society. the extent of sanist exclusion is well-documented across most domains and includes systematic barriers to accessing sustainable employment (evanslacko, knapp, mccrone, thornicroft, & mojtabai, 2013; social exclusion unit, 2004). thus, less expendable income causes public spaces of commerce (e.g., cafes) to also become less accessible. from a participatory research tradition within community psychology and based on discourse analysis, this article focuses on service users’ first-hand knowledge and accounts of meeting places, generated through four focus group discussions. the following research question guided our inquiry: how do service users discuss their encounters with the spaces and people of meeting places? staffed meeting places in norway guidelines from the norwegian directorate of health (2005, pp. 25-27) emphasise the facilitation of diverse meeting places tailored to local contexts and needs that promote ideals, such as social equality, service user involvement, community, validation/recognition and self-determined development. such diversity is also discussed in the reviewed literature (e.g., bachke & larsen, 2017; bryant, 2011). meeting places often operate as easy-access drop-in centres, although some require a first-time referral. the universal principle of the nordic social democratic welfare states prescribes that health and welfare services, such as meeting places, should be available to citizens based on need (brandal, bratberg, & thorsen, 2013). the social democratic discourse, which gained democratic momentum in the nordic countries over the twentieth century, is constituted of basic beliefs in redistributive justice through, for instance, taxation to compensate for unavoidable social inequalities and to promote human welfare through institutionalised solidarity (brandal et al., 2013). most meeting njsr – nordic journal of social research vol. 9, 2018 16 places appear to be provided by the municipal level of the welfare state, with some operated by third-sector non-governmental organisations (ngos) (kalseth, pettersen, & kalseth, 2008). meeting places are not required by law, and they may be vulnerable to political and economic changes (andersson et al., 2016). for instance, during the 2008 evaluation of the action plan funding period, meeting places were reported to be the second most used municipal community mental health service in norway, covering over 90% of the 428 municipalities at the time (kalseth et al., 2008). shortly thereafter, the number of municipalities that reported having a meeting place dropped to below 80% (osborg ose & slettebak, 2012). neoliberalism has been on the rise in the nordic countries (hedegaard, 2016). in short, following central neoliberal ideals, welfare arrangements that were originally politically designed to compensate for social inequalities in civil society (brandal et al., 2013) are often portrayed as state interventions that hinder ‘freedom of choice’ and ‘free markets’ unburdened by state regulation (fine, 2012; harvey, 2005; hedegaard, 2016). a prospective case study in a swedish city found few indications that the ‘freedom of choice’ reform implemented in the 2010s had benefited service users in meeting places (andersson et al., 2016; fjellfeldt, eklund, sandlund, & markström, 2016). on the contrary, it reported on changes such as reductions in time allowances for attending the service, satisfaction and staffing levels, as well as increases in administration, cutbacks and concerns for the future. as addressed in this case study, targets and outcomes of the reforms resonate with the market logic of new public management (npm) (fjellfeldt et al., 2016). npm draws on neoliberalism (harvey, 2005), and the main logic is to model the public sector to operate in line with market mechanisms to increase cost efficiency and productivity (ekeland, stefansen, & steinstø, 2011). a business that fails to operate costefficiently will eventually close down, which could also be the fate of underperforming public services in line with neoliberalism. theoretical and methodological lenses with bases in critical branches of community psychology (e.g., nelson, prilleltensky, & macgillivary, 2001), participatory research traditions related to service user involvement (borg & kristiansen, 2009) and discourse analysis (parker, 2014/1992), we accompany mad-identified scholars (e.g., lefrancois et al., 2013) in the struggle against a history of exclusion (foucault, 1961/1988). we hold that listening to current or former service users as legitimised knowers entails sophisticated, nuanced and robust knowledge maps over complex social terrains (e.g., brydon-miller, kral, maguire, noffke, & sabhlok, 2011). moreover, in agreement with critical scholars, we believe that it is increasingly vital to listen to the knowledge of the people who bear the ever-growing toll of social inequalities in the era of the neoliberal deregulation of welfare states and safety nets, both on empirical and ethical grounds (e.g., dencker-larsen & lundberg, 2016; fine, 2012). adhering to parker’s (2014 /1992, p. 5) foucauldian working definition, we understand discourses as statements that make up systems that generate certain objects and position subjects. in line with parker, our underlying interest is in the practical and real-life consequences that discourses make possible and generate. methodology this article is part of a project aimed at exploring and illuminating meeting places in norwegian community mental health care from a participatory njsr – nordic journal of social research vol. 9, 2018 17 community psychological perspective. as a team of co-researchers with firsthand knowledge of hardships and service use, as well as academic researchers from the fields of community psychology, social psychology and community mental health care, we co-produced this research project from the outset in 2012. initially, 10 persons with first-hand knowledge of psychological hardship and meeting places volunteered to participate in a collaborative research process. the full team developed the research topic of ‘meeting places’. later, three of the co-researchers participated in one or more of the following phases: conducting the focus group interviews, taking part in important parts of the analysis, disseminating knowledge by communicating with the municipalities that were involved and by co-authoring publications. while the present analysis is based on focus group interviews with service users of staffed meeting places, another report from the project is based on focus group interviews with members of staff from several staffed meeting places (ynnesdal haugen, envy, borg, ekeland, & anderssen, 2016). here, we centre on the first-hand knowledge of service users based on four separate focus group interviews. guided by the work of psychologist ian parker (2014/1992), we engaged in a participatory discourse analysis. recruitment and participants with assistance from the municipalities and ngos providing the meeting places in our selected region of western norway, the first and second authors visited roughly 10 meeting places in the fall of 2013 to recruit a variety of persons attending different meeting places. twenty-two participants volunteered to participate and provided their explicit informed consents. ethical approval for the project was obtained from the norwegian social science data service, the data protection official for research (project reference number: 33810/3/kh). approximately half of the participants typically attended meeting places in suburban or rural municipalities, while the remainder attended meeting places in a city municipality. the participants were six men and 16 women, aged between 27 and 67 years, with a majority being over 50 years. first visits to a meeting place occurred between 1985 and 2011, with the majority after the year 2000. not all, but many, participants stated that they had been in contact with other mental health services from less than a year to 15 years or more. while many reported being home when not at the meeting place, some also reported spending time with family and friends, exercising, attending church and cafes and engaging in paid and voluntary work. focus group discussions focus group interviews could be considered advantageous in facilitating discussions about shared but variable aspects of everyday life among persons from different places (malterud, 2012), which was relevant to this inquiry. we arranged four focus groups in agreed-upon locations, with each group comprising participants from two to five meeting places. the first and second authors moderated the focus groups, which lasted approximately 90 minutes. based on the participants’ preference, we actively moderated and facilitated conversations and discussions. following participatory principles (e.g., brydon-miller et al., 2011), the team codeveloped and revised the interview/topic guide during cycles of reflection between the focus groups. the guide was intended to encourage conversations about meeting places based on the following topics: the experience of simply njsr – nordic journal of social research vol. 9, 2018 18 being in meeting places; perspectives on ‘service use’ (first-hand knowledge, involvement and difference); being accepted and rejected in meeting places as compared with civil society; and interrelations of meeting places and the surrounding community and society. discourse analysis one of the co-researchers transcribed the audio-recorded focus group interviews verbatim. the participants’ anonymity and integrity were protected in the transcriptions. we translated the quotations used in the current article from raw transcriptions with norwegian dialects to a written english format in which we sought to limit transcription code and less relevant noise and interruptions to increase reader-friendliness. we show some transcription code to keep the quotations verbatim, such as underlining emphasised words in a sentence and marking irony with italics. in some instances, it was necessary to compress longer elaborations to include aspects of the full storyline. the reduction of noise and speech compression is indicated by three ellipses (…). an important early step in parker’s (2014/1992) outline of discourse analysis is to locate discursive constructions of relevant objects and subjects in a text (i.e., how subjects and objects are spoken of and produced in the text). the discursive constructions are then analysed as related to broader discourses. parker’s guidance is based on seven criteria and three auxiliary criteria that can be utilised to reconstruct the contours of discourses and their workings. these criteria entail (1) tracing textually (2) coherent systems of meaning (3) that construct certain discursive objects and (4) position subjects and are (5) located in history and sociocultural space. discourses can be traced to reflect on (6) other discourses and (7) themselves and to be implicated with (i) societal institutions, (ii) power relations and (iii) ideological effects (parker, 2014/1992, pp. 3-22). in accordance with participatory research traditions (borg & kristiansen, 2009), we arranged several capability-building seminars; in one of them, the aim was to facilitate what we have called participatory discourse analysis. the primary analysis team (co-researchers and first author) had access to the transcripts and suggested particularly interesting sections for discourse analysis in collaborative workshops. two analytic strategies guided our collaborations: (a) we formed free associations with words and segments of the sections, relating them to social phenomena and ideas on a path to identifying preliminary traces of discourses, in line with parker’s guidance; and (b) we collectively engaged in a speed analysis of a section with as many of parker’s criteria as possible in the timeframe of a workshop. the first author engaged in an analysis of the full material. because the full material was extensive, the first author started by engaging in a preliminary analysis using parker’s 10 criteria and the analytic work from the participatory workshops, where relevant, while consecutively reading each transcript. the different suggestions for discursive constructions of meeting places were gathered and grouped. the constructions were scrutinised for accountability in relation to the material, the surrounding society and service users. the preceding steps built the foundation for a thorough analysis of each of the discourses that meeting places were identified as drawing on, the subjects and the discourses’ sociohistorical ties. to enable a more nuanced analysis of the discursive constructions and discourses of meeting places and the surrounding civil society, the full research team reflexively reviewed the preliminary analysis in cycles. njsr – nordic journal of social research vol. 9, 2018 19 analysis sanism in civil society ‘pull yourself together!’ this comment was discussed as something commonly said to service users by people without service user experiences. such comments were discussed as making things worse, as ‘kristie’s’ passage below illustrates. we read the participants’ laughs and sarcasm as emphasising the ridiculousness of such comments. kristie: … if you have hurt your hand or … foot or something else that people can see … right. but, what’s in our hearts and up here [head] … people cannot [see], so when people say, ‘oh my goodness, you have to pull yourself together now’ … … interviewers and participants: mm, yes, that’s right [endorsing comments interrupting throughout]. kristie: right? interviewer l: it’s not that helpful [chuckles]. kristie: no, it isn’t! audrey: [laughs] patrick: it’s not possible! it’s not possible! kristie: it actually makes things kind of worse. audrey: just try it! [chuckles] interviewer l: yes. joel: yes, that’s right. kristie: because you so sincerely want to ‘pull yourself together’, right, but you cannot control it. here, we see the contours of a discourse of sanism in which people positioned as mentally ill appear to be blamed for not trying hard enough to emerge from their struggle. furthermore, they seem to be positioned as not knowing their own best interests, while the versions of reality of people positioned as sane are systematically privileged, allowing for paternalising corrections. although we observed glimpses of sanism in talk related to meeting places’ spaces, sanist exclusions were discussed as worse in civil society outside of meeting places. we view ‘anna’s’ following statement as an example of how pronounced the experience of sanist exclusion from civil society could be: ‘it feels like the walls surrounding people with mental health problems are moving from the institutions out to civil society’. sanism was discussed as especially tangible in attempts at interactions with civil society, as described by ‘joel’, a man in his 50s who lived in a rural municipality: joel: … in the café … i feel their gazes on my back, and… several service users: [endorsing, recognising] joel: i can hear them whispering in the background. several service users: [endorsing, recognising] june: oh, that’s so painful! njsr – nordic journal of social research vol. 9, 2018 20 discursive constructions of meeting places i) public welfare arrangement a central construction of meeting places was as a public welfare arrangement for service users who have been excluded from civil society and the labour market. traces of this construction can be read in this excerpt by ‘nicholas’, who discussed having been bullied during childhood and at his place of work, culminating in being pushed into a disability pension after he was diagnosed with a chronic disease: nicholas: and then i thought, when i got it, that there wasn’t anything [left] … it became a very monotonous life. but, after many years with different experiences, then it came to my homestead, this, this service. interviewer l: your meeting place. nicholas: … and then i have a place to go because i always make sure to get myself out the door … and it is important to me. because then, then you have some kind of purpose. but, i didn’t the first years, nothing was in place then. as alluded to above, meeting places appeared to be constructed as compensating for some qualities of work life, such as having a purpose to get out every day, and as possibly providing service users the opportunities to feel like contributing citizens who belong in society. as such, we traced the contours of a social democratic welfare discourse, which could be described as institutionalised solidarity to facilitate every citizen being ensured social rights and opportunities to live a good life (brandal et al., 2013). the public welfare arrangement and professionally employed staff were portrayed as irreplaceable in the everyday lives of many users. staff bore the formal responsibility for ensuring that everyone was included and cared for and were also responsible for organising and facilitating many routines and activities. this seemed related to the shortcomings of civil society and the situation of people positioned in distress who were described as already working hard ‘just’ to keep their heads above water. however, meeting places as welfare arrangements were not without dilemmas. service users could be positioned as passive objects to other people’s ends, such as staff’s work and fellow service users’ social needs. service users were, nevertheless, also positioned as equal citizens in setting agendas and working towards facilitating their needs and social rights through service user involvement. staff members were positioned as not always ‘liking’ the demands of service users but still accepting of democratic decisions. both in the current analysis of service users’ accounts and in the study based on staff accounts (ynnesdal haugen et al., 2016), concerns were raised about the future of public welfare arrangements with regard to economic matters. ii) peer community we also reconstructed meeting places as a peer community inhabited by people who understand and accept each other and share a distaste for sanism, as ‘june’s’ account demonstrates: june: you go free of having to sit and say, ‘yes, i’m on disability pension, i was put on disability pension over 20 years ago’. ‘you’re on disability pension?’, and … ‘just for mental health problems?’ … then, it’s good to be with people who know that there is no such thing as just mental health problems ... njsr – nordic journal of social research vol. 9, 2018 21 as illustrated through june’s account above and ‘wilma’s’ account below, we discerned the contours of a discourse of solidarity among service users: wilma: … but, once you’ve made your way over it [the high doorstep] and make it to a centre, or … yeah, we call it a day centre … interviewer l: mm. wilma: —and meet peers—you could be depressed and out of it, but when you get inside and meet ‘the gang’, as i call them—and we talk and stuff, then, yeah—it lets go. service user: lets go. [ongoing interruptions with endorsing comments while wilma talks] wilma: so, not always, like—it’s not some kind of miracle cure, but it really helps. and to get to talk with others with—who are in the same situation as you … service user: to socialise. wilma: —without sitting talking about the disease, but you know they understand … that you have a bad day, right … and many say what she [ruth] says, that it’s not that easy for family or others who aren’t ill to understand … ruth: not for those who work with it [either]. they say it themselves: ‘we can’t know what you’re thinking on the inside’ … as traced through wilma’s account, a discourse of solidarity among service users appeared to position service users as those who implicitly know, share and accept each other's ‘situation’, identity, and interests in everyday life. our analysis suggests that the peer community could imply exclusivity for people who self-identify as service users. upholding belongingness to the peer community might, as such, imply being delimited to a ‘service user identity’ and, thus, constitute a form of dependency. this said, outsiders to the peer community, including mental health professionals, were positioned as lacking understanding of service users’ lived situations and also being implicated in exacerbating their burdens, as discussed by ‘ruth’ below: ruth: … as bad of shape as i was in when i got out of the [mental] hospital, and … the level of critique i was faced with all the time, bombarded with [for not ‘pulling herself together’] then, i would have turned mad if i hadn’t had the meeting place to go to … iii) spaces of compassion in meeting places constructed as spaces of compassion, service users encountered care and validation. as discussed by ‘trudy’ below, spaces of compassion could even be viewed as saving lives: trudy: i believe i can at least say that i believe that these activity centres have saved many lives. loretta: yes. interviewer l: yes. trudy: i believe i can honestly say so. loretta: i absolutely agree with you. interviewer l: yes. trudy: they have saved many lives! loretta: yes, yes. trudy: and for sure, one life, just one life is precious, extremely precious … we traced accounts such as this to draw on a discourse of compassion in which life is unconditionally valued and recognised in its own right. the people who worked in such places appeared to be positioned as compassionate carers, njsr – nordic journal of social research vol. 9, 2018 22 even saviours, who helped people live a fuller life, as ‘molly’s’ quotation below testifies: molly: i could [leave the house] before, but ehm, after the rape and everything, i wasn’t able to … now, i turn off the lights when i’m home by myself, and it’s dark … so, if it hadn’t been for the ladies [staff] down there [meeting place], i’d be sitting at home … carers were also positioned to help people on their own terms, as in the following passage by ‘frank’: frank: … in the beginning, i could contact her ten times during the day … now … i call if i need to … to be that patient. i bombarded her with text messages in the middle of the night, it didn’t matter … and such a good person. it’s incredible that there are people working in a municipality who are so dedicated to their work … far beyond the job requirements … the continued positioning of service users as being in need of help could, nevertheless, limit their movement away from a disempowered help-seeking position. however, service users were also positioned as possible carers, whose care could be especially warming after they found their footing. this might imply that acts of kindness extending beyond the self-interests of a carer, such as ‘job requirements’, could position the carer as a fellow human being rather than, for instance, an ‘employee’ of a service. as such, a service user encountering a carer’s compassion might be positioned as a human being worthy of the compassion of another human being. iv) greenhouses meeting places were also reconstructed as inhabiting various spaces that resembled greenhouses, in that they facilitated growth conditions for people attending meeting places. greenhouses appeared to help people explore the world and themselves and to expand their constructions of personhood and horizons of possibility. we view this construction as drawing on a humanist developmental discourse, which is traced to involve bringing out the best in people (‘self-actualisation’) based on self-directed and self-determined transformations and people’s inner potentials. as ‘audrey’ and ‘patrick’ discussed in the following excerpt, freedom of movement could be reconstructed to facilitate transformations: audrey: … my friend ‘christina’ … has really grown … with her … artistic side … and she’s having an art exhibit now … and she has amazing paintings. patrick: yes, she has. … audrey: [christina] is someone who has blossomed without anyone pressuring her [voice cracks, touched]. two service users: mm, mm [endorsing]. audrey: no pressure/don’t press [dual meanings, soft whisper]. patrick: to the contrary, they’ve [staff] let her [grow] … with kindness and … warmth … so she … just like the porcupine … audrey: [chuckles] patrick: … awakens from hibernation … and like has become a blossoming person. instead of a person just sitting there not knowing … within this discourse, the last sentence might imply that individual change appears not only possible but also preferable. this could limit the range of possibilities for service users to just be. following mad studies (lefrancois et al., 2013), working for societal acceptance, rather than seeking to change njsr – nordic journal of social research vol. 9, 2018 23 people with psychosocial differences, should be a central concern for service users’ movements. nevertheless, the discussed change processes appeared to be constructed as being directed by the person’s self-determined needs and pace. in contrast, normative developmental pressures, such as becoming a ‘productive citizen’, were discussed as limiting rather than facilitating transformations. still, meeting places could be reconstructed as expanding the horizons of possibility concerning people’s livelihoods, such as christina’s art exhibit. moreover, the humanist developmental discourse appeared to position staff as facilitating many of the conditions of possibility for transformations through being there, being ready to see even small glimmers of something to build on and providing support, as ‘caroline’ described: caroline: … i see them [staff] as my angels. interviewer l: they’re your angels. wilma: yes, they surely are. [endorsing comments from several throughout] caroline: because they build you up again … they see the small piece, and build you up from there. interviewer l: yes. caroline: and they stand behind and support you. and you aren’t stigmatised in any way whatsoever, they only build you up … discussion generally, our analysis of service users’ accounts of meeting places appears to align with much of the reviewed literature in contouring meeting places’ importance in the everyday lives of the people who attend them. our analysis also resonates with the literature regarding the rejection and exclusion experienced in civil society by many people in psychosocial hardship (e.g., elstad & eide, 2009; hall & cheston, 2002; larsen & topor, 2017; pinford, 2000). as indicated in the introduction, problematizations of meeting places exist. a recent analysis of house rules in sheltered houses and meeting places in a norwegian city noted that the house rules may reproduce criticized institutional practices and identities for persons with mental illnesses and substance abuse problems (andersen, larsen & topor, 2016). also, studies about staffed meeting places in terms of well-being and functioning of users are not clear-cut (e.g., eklund, hansson, & ahlqvist, 2004; eklund & sandlund, 2014). such problematizations relate to a pronounced objection—that people become passive objects of service provision, obscured from participating in the labour market and mainstream society (e.g., social exclusion unit, 2004). we will discuss the findings in light of aspects of this objection. we organize this around the four central discursive constructions of meeting places identified in the analysis section, and we will keep an eye to the practical and real-life consequences for users of meeting places. i) compensatory public welfare arrangement positioning service users as citizens with social rights our analysis, as well as an inquiry by bryant et al. (2004), has identified occurrences where people attending meeting places were described as objects of service provision. however, in our analysis, such objectifications stood out as unintended consequences of meeting places constructed as staffed welfare njsr – nordic journal of social research vol. 9, 2018 24 arrangements that seemed to compensate for exclusion from the labour market and civil society. through our analysis of a social democratic discourse, meeting places and staff appeared to embody the universal principle by providing opportunities for social rights to a good life and the materialisation of such rights. as discussed in the literature (e.g., hall & cheston, 2002), our analysis suggests that civil society does not seem to be particularly inclusive towards people who are psychosocially different from the normativity of sanity, which is also in line with mad studies (chamberlin, 1990; lefrancois et al., 2013). in our focus groups, people described sanist comments and questions as resembling demands to legitimise one’s psychosocial hardships and entitlements to welfare benefits, implying that there were pressures towards becoming a productive citizen. in this article, and based on staff accounts (ynnesdal haugen et al., 2016) in another article from the same project, service users were positioned as defending staffed meeting places and resisting pressures for responsibilisation. in short, responsibilisation could be described as a neoliberal process in which, for instance, state responsibility becomes viewed as the responsibility of individuals (o'malley, 2009). the objections regarding meeting places could suggest the presence ofresponsibilisation by placing the responsibility for lower employment rates on people attending meeting places rather than viewing the unavailability of sustainable work and social acceptance of their differences as larger-scale social, economic and political matters. in this analysis and in, for instance, elstad and eide’s (2009) and pinford’s (2000) ethnographic studies, added pressure in addition to the hard work of keeping one’s head above water was described as entailing even heavier tolls, possibly with implications of increased hardship. this is, however, nuanced by studies suggesting that there appears to be a pattern of differing preferred occupations among users. some users in greater distress preferred to just be in the meeting place while others preferred to engage in more task-orientated occupations that were increasingly demanding (argentzell, håkansson, & eklund, 2012; horghagen, fostvedt, & alsaker, 2014; tjörnstrand, bejerholm, & eklund, 2011). ii) peer community positioning service users as peers who share common identities and interests one of the most predominant discursive constructions of meeting places in the focus group conversations was a peer community, described as a group of people who implicitly know distress, hardships and sanism. the significance and support of a peer community is discussed across studies inside and outside of meeting places (e.g., andvig & hummelvoll, 2016; hall & cheston, 2002; larsen & topor, 2017). we located a peer community in a discourse of solidarity among peers, drawing on ideas and values in the interests of service users and interrelated with service users’ movements that have been gaining momentum since the late 1970s (chamberlin, 1990). following our analysis, a peer community appeared to facilitate spaces for being temporarily ‘freed’ from distress and sanist demands. this aligns with bachke and larsen (2017), who point to a possible need for a society within the society for this group. thus, in relation to a potential ‘dependency’ on the peer community and to objections raised regarding participation in mainstream society (social exclusion unit, 2004), engaging in such spaces appears more appealing than engaging with a sanist civil society. njsr – nordic journal of social research vol. 9, 2018 25 iii) spaces of compassion validating service users as fellow human beings who are precious in their own right as a related topic, possibilities for just being in meeting places were analysed as being particularly facilitated by spaces of compassion and were localised in a discourse of compassion. here, service users were positioned as worthy of being accepted as a fellow person by other human beings without needing to do anything to earn it. space for service users to just be stands in stark contrast to local and global neoliberal production demands (harvey, 2005; hedegaard, 2016). altogether, the discourses of social democracy, solidarity and compassion appeared to facilitate spaces where productivity pressure is reduced while users are taking part in society by simply being with others who accept and understand them. in line with our analysis, reconstructing the hard work that could go into staying afloat at times of distress and the identification of a need for reduced pressure during distress also appear to resonate with the reviewed literature (e.g., bryant et al., 2004; elstad & eide, 2009; larsen & topor, 2017; rise, westerlund, bjørgen, & steinbekk, 2013; tjørnstrand et al., 2011). iv) greenhouses facilitating service users to expand their horizons of possibility in our analysis of greenhouses, located in a discourse of developmental humanism, the staff of meeting places appeared to provide support to the person when the person was ready to expand his horizons of possibility without normative pressuring. according to the literature, times of less distress seemed related to greater interest in self-determination and engagement in occupations (e.g., horghagen et al., 2014; rise et al., 2013). the literature’s critique of service users being made into passive objects in need of help (social exclusion unit, 2004) was also noted in our analysis of a discourse of compassion. however, our analysis also delineates that supportive spaces to just be with reduced external pressure and being temporarily freed from distress appeared important to accommodate the person in acquiring expendable capacity after the work needed for keeping one’s head above water and in venturing into expanding her horizons of possibility when ready and able. this is in line with an analysis and discussion of meeting places based on dialogues with users of a meeting place in southern norway (larsen, 2015). here, it is emphasized that it is important to establish an atmosphere of inclusion and equality. in relation to the objections regarding meeting places, our discussion suggests that reducing rather than increasing civil society pressures seemed to be in the interest of people in distress. limitations although we inquired about problematic aspects of meeting places, few were addressed in the focus groups. this might be due to a potential disadvantage with focus group interviews, where persons identifying with each other may quiet their dissent (malterud, 2012). however, in an era of rising neoliberalism and reductions in welfare services (fjellfeldt et al., 2016; hedegaard, 2016), limited problematisation could also be related to concerns raised by several service users in this inquiry and in other inquiries regarding the future of staffed meeting places (e.g., andersson et al., 2016; elstad & eide, 2009). as a njsr – nordic journal of social research vol. 9, 2018 26 community psychology and participatory inquiry, we consider it to have resonated with our aims that we have taken this threat seriously and sought to benefit the people our inquiry could affect (e.g., fine, 2012; nelson et al., 2001). in line with parker’s (2014/1992) discussions, the participatory discourse analysis we have detailed here presents only one possible discursive reading of the material and is intertwined with our team’s sociocultural positioning as norwegians and as persons with first-hand and academic knowledge of psychosocial hardships. given that language is here understood as an open system, other readers can and will analyse the material differently (parker, 2014/1992). furthermore, this article touches upon historical relations of the analysed discourses only to a limited extent, despite the importance of history in foucauldian discourse analysis (parker, 2014/1992). nevertheless, we still view as legitimate our collectively reached decisions to focus on the discourses’ present forms and implications for people attending meeting places. we consider the decisions to be legitimate given the tenets of qualitative research that emphasise that every analysis is unique and necessitates critical and reflexive tailoring of one’s lenses and craft (denzin & lincoln, 2011). another potential limitation is that discourse analysis, as a complex methodology, could have limited the co-researchers’ participation in the analytic process. however, through our many hours of negotiations and constructive disagreements in the analytic process, we consider that we have co-constructed the analysis and our version of participatory discourse analysis. while the purpose of the current analysis was to study ‘how service users discuss their encounters with the spaces and people of meeting places’, quite another line of inquiry is to study the effects of meeting places on meaningfulness and well-being (e.g., eklund et al., 2004). related to such alternative research questions, there is a need for methodologies other than discourse analysis (e.g., validated questionnaires; see nilsson, argentzell, sandlund, leufstadius, & eklund, 2011). future in-depth studies within the field might even combine research questions encompassing discourses, experiences and effects, thus necessitating a variety of methodologies. conclusion this participatory discourse analysis of service users’ accounts of meeting places, together with the reviewed literature, implies that meeting places could mean everything to the people who attend them by facilitating opportunities that were discussed as being less accessible elsewhere in their everyday lives (e.g., horghagen et al., 2014; pinford, 2000). until ordinary civil society can offer people in psychosocial hardships opportunities similar to staffed meeting places, our inquiry suggests that meeting places appear to be in the interest of the people who attend them. references andersen, a. j. w., larsen, i. b., & topor, a. p. 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'building up safe havens...all around the world': users' experiences of living in the community with mental health problems. health & place, 6, 201212. https://doi.org/10.1016/s1353-8292(00)00023-x rise, m. b., westerlund, h., bjørgen, d., & steinbekk, a. (2013). safely cared for or empowered in mental health care? yes, please. international journal of social psychiatry, 60, 134-138. https://doi.org/10.1177/0020764012471278 social exclusion unit. (2004). mental health and social exclusion. social exclusion unit report. retrieved from http://hdl.handle.net/10822/1039428 tjörnstrand, c., bejerholm, u., & eklund, m. (2011). participation in day centres for people with psychiatric disabilities: characteristics of occupations. scandinavian journal of occupational therapy, 18, 243-253. https://doi.org/10.3109/11038128.2011.583938 ynnesdal haugen, l. s., envy, a., borg, m., ekeland, t. j., & anderssen, n. (2016). discourses of service user involvement in meeting places in norwegian community mental health care: a discourse analysis of staff accounts. disability & society, 31(1-2), 1-18. https://doi.org/10.1080/09687599.2016.1139489 http://www.sintef.no/ https://doi.org/10.1016/s1353-8292(00)00023-x https://doi.org/10.1177/0020764012471278 http://hdl.handle.net/10822/1039428 https://doi.org/10.3109/11038128.2011.583938 https://doi.org/10.1080/09687599.2016.1139489 njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 8, 2017 earlier hospital discharge: a challenge for norwegian municipalities heidi gautun* centre for welfare and labour research oslo and akershus university college of applied sciences email: heidi.gautun@nova.hioa.no *corresponding author astri syse department of research statistics norway email: astri.syse@ssb.no abstract aim: in order to improve patient outcomes and minimize health care costs, many western countries are attempting to reduce the length of stay in hospitals by transferring responsibilities from specialist care to primary care. in norway, the coordination reform was implemented in 2012 to enhance this development. as a result, the number of patients discharged to the municipal health care services has increased significantly. we investigate the extent to which nurses in nursing homes and home care services feel equipped to provide adequate care for patients discharged from hospitals after the reform. data: altogether, 1,938 nurses representing around 80% of norwegian municipalities assessed their experiences of this reform. results: an increase in the number of poorly functioning patients discharged to the municipality services was reported. regardless of place of work, concerns were raised about limited resources in terms of personnel, equipment and competence, as well as an increase in hospital readmission rates. negative reports on care provision for recently discharged patients came most frequently from nurses in municipalities which generally had low incomes, diverted limited resources to the health care sector and relied heavily on home-based care. conclusion: insufficient transfer of resources to the home care services may have hampered the ability to fulfil the coordination reform’s intentions of providing safe care to patients in their own homes as an alternative to prolonged hospital stays. due to a marked increase in reported hospital readmissions, it is not obvious that shorter lengths of stays have reduced overall health care costs. keywords: coordination reform, hospital, length of stay, local care services, patient flow, municipal variations mailto:heidi.gautun@nova.hioa.no mailto:astri.syse@ssb.no njsr – nordic journal of social research vol. 8, 2017 2 introduction in order to ensure optimal use of health care resources and improve patient outcomes, many western countries are aiming to move significant portions of their health care from specialist care to primary care (deraas, berntsen, hasvold, & førde, 2011; holmås, kamrul islam, & kjerstad, 2013; purdy et al., 2012). this paper focuses on the overt political aim of reducing the length of stay (los) in somatic hospitals, which has been an explicit aim for health authorities in several countries for many years (clarke & rosen, 2001; kroneman & siegers, 2004; norwegian ministry of health and care services, 2008-2009). transferring care-taking responsibilities to local health and care services as soon as possible after somatic hospital treatment is considered to both reduce costs and to be more optimal for patients, as they generally prefer to be cared for in their own homes if such care can be provided safely (clarke & rosen, 2001; norwegian ministry of health and care services, 2008-2009). data from the organisation for economic co-operation and development (oecd) and european countries show major differences in los in hospitals, although it has been reduced over time in most countries (clarke & rosen, 2001; eurostat, 2015). this is also the case for the norwegian context, which we investigate in this paper. since the late 1980s, attempts have been made to reduce the use of specialist care in norway, in line with explicitly stated political aims, and los in hospitals has been gradually reduced (gautun, kjerstad, & kristiansen, 2001; norwegian ministry of health and care services, 2008-2009). in 2009, the average los in norwegian hospitals was less than five days (oecd, 2011). the oecd average was about seven days. there has been considerable growth in the norwegian municipal health and care services since the late 1980s in terms of both the number of users and the number of employees in these services. the municipality health care costs have increased significantly. the increase in costs has primarily come in home care services (gautun & skrødem, 2015). a reduced los in hospitals is only one reason for the observed growth in local health and care sectors. in parallel with the reduced los, a number of different reforms have been implemented which altogether have resulted in an increase in both the number of tasks and a change in municipalities’ service profiles. as an example, in 1988 the norwegian parliament transferred the responsibility for nursing homes from the county level (n=19) to the municipality level (n=428) as part of a general decentralization of primary health care services. this decentralization resulted in the municipalities becoming responsible for the entire primary health and care sector. concurrent with the transfer of nursing homes, a larger trend towards a general deinstitutionalization with an increased focus on home care services was put in motion (brevik, 2010). this increase in home care services has, however, only to a limited degree benefitted older age groups (brevik, 2010). many of the reforms and initiatives have actually resulted in a pronounced growth in the number of younger users in need of services outside an institution, as exemplified by the 1991 reform concerning individuals with general learning disabilities (“ansvarsreformen”), the 1998 reform focusing on mental health (“opptrappingsplanen”) and multiple reforms in the field of drug addiction (gautun & syse, 2013). the process of reducing the los in hospitals in norway has been expedited through the implementation of the norwegian coordination reform in january 2012 (norwegian ministry of health and care services, 2008-2009). to reduce the demand for specialized health care services, which was a central aim of the coordination reform, more focus has been aimed at preventive services in municipalities. increased efforts have been directed towards prevention in effort to reduce the number of seriously ill people and to catch problems early, thus njsr – nordic journal of social research vol. 8, 2017 3 managing a larger share of health problems at a local level and reducing the los at norwegian hospitals (norwegian ministry of health and care services, 2008-2009). municipal co-financing of many somatic specialized services was introduced in january 2012 as a financial incentive to increase the municipalities’ efforts locally (for 2011-11-18 nr 1115, §7-15). the municipal co-financing structure was, however, discarded in january 2015, as it did not have the intended effect (januleviciute, askildsen, kaarboe, siciliani, & sutton, 2015). under the same law, municipalities were legally obliged to bear the costs of hospitalized patients who had finished their treatment from the day such a notice was given. the cost per night was 4,000 norwegian kroner (nok) in 2012 and 4,387 nok in 2015 (national budget, 2012 and 2015). the number of hospital bed days has fallen significantly after the implementation of the reform (norwegian directorate of health, 2016). consequently, local care services are expected to handle both a greater total number of patients and more patients with more extensive needs than previously. an important prerequisite for the explicit aim of the coordination reform that patients will receive better health services if they are discharged faster to the local services, is that the municipalities are adequately prepared to provide the warranted services in terms of timeliness and quality. financial incentives have therefore been put in place to improve staffing in home care services and to upgrade nursing homes in municipalities to provide for patients with extensive medical needs, thus aiming to meet the predicted extra needs in the municipalities as a result of this change in responsibilities (norwegian ministry of health and care services, 2008-2009). at the same time, a greater share of the state’s resources has been transferred to the municipalities. the question remains as to whether such incentives and transfers have been sufficient, and whether municipalities have responded by allocating adequate resources to their health and care services. in this study, we assess whether employees in local care services believe that they have the warranted resources to provide adequate care to patients discharged from hospitals post-reform. we focus on resources in terms of personnel, competence and equipment. a literature review presented by the authors in 2013 suggests that most studies have evaluated the reform based either on register data, on interviews with management staff in hospitals and municipalities, or on analyses of the formal collaboration agreement between hospitals and municipalities (gautun & syse, 2013). official statistics provide information about changes in hospital admissions, los and readmissions (norwegian directorate of health 2016) and show reduced los, but these data lack information about where the patients are discharged. as such, we do not know the number of patients discharged to home care services and nursing homes. further, statistics show no changes in the number of readmissions in the period 2011-2015. however, there has been an increase in readmissions for older patients, whereas there has been a decrease for children. this increase may have influenced the local services, because the patient groups in nursing homes are older people and this population is also the largest group receiving home care services. the new health and care services act from 2012 commits municipalities and health enterprises to sign a cooperation agreement. the agreements aim to promote collaboration between municipalities and health enterprises. evaluations based on document analysis and interviews with informants at top levels in the administrations conclude that those agreements may constitute a useful framework for coordination between hospitals, but cannot replace the day-today dialogue in discharging patients from hospital to municipal services (gautun, martens, & veenstra, 2016). therefore, a survey among nurses working in nursing homes and home care services may give important additional information about whether changes in los and readmissions has increased the njsr – nordic journal of social research vol. 8, 2017 4 pressure on the local services. a survey may also give important information about whether employees in local care services believe that they have the warranted resources to provide adequate care to patients discharged from hospitals post-reform. this paper analyses data from a survey conducted with 1,938 nurses working in nursing homes or home care services 18 months after the reform was first implemented. as far as we know, this is still the first nationwide study conducted in norway to investigate employees’ experiences of changes resulting from the increased discharge of hospital patients. we aim to assess which services have received the greatest influx of patients from hospitals, how poorly functioning these patients are, and whether the nurses working in local health care services perceive that the services they work in are adequately staffed and have the necessary medical equipment to manage the increased influx. next, we focus on whether there are differences between nursing homes and home care services in perceived service provision. lastly, we examine whether there are variations in the experience of nurses based on characteristics of municipalities in terms of size, geographical location, age structure, general economic flexibility and budget constraints, as well as in terms of service profiles (home health versus institutionalized care). experiences in nursing homes versus home care services it may be hypothesized that the experiences of nurses post-reform will depend on work setting. efforts have been made since the early 1980s to deinstitutionalize care services, and hcs have expanded over the last three decades (gautun & grødem, 2015). prior to the coordination reform, nursing homes often represented an end-stage in the care trajectory for patients with too numerous and too advanced needs to be adequately cared for at home. as the coordination reform aims to transfer advanced care to local services, the position of nursing homes has been strengthened somewhat – and nursing homes have also been assigned a more temporary function – to accommodate poorly functioning patients unsuitable for home care services shortly after hospital discharge. it may be hypothesized that the different aims and organization of nursing homes and home care services will influence nurses’ experiences. whereas patients generally have more advanced needs in nursing homes, there are usually teams of nurses or other health care personnel available to provide advice. in home care services, nurses typically work independently (gautun & syse, 2013). one of our main aims, therefore, is to compare the situation experienced in these different settings post-reform. municipal variation pre-reform register data from statistics norway show that the financial situation of the local care setting was more optimal for smaller municipalities than larger municipalities, largely due to inherent characteristics of the previous financial reimbursement systems (gautun et al., 2001). as such, smaller municipalities may have been better equipped to finance necessary personnel, medical equipment and continuing education than larger municipalities following the reform. on the other hand, it may be the case that the supply of qualified health workers, who have become more in demand since the reform, has been more favourable in larger municipalities. research also shows that municipality characteristics, such as the population’s age structure and the municipality’s economic flexibility and service profiles, are associated with the care needs of the inhabitants, as well as the types and extent of services that are made available to them (langørgen, 2004). as an example, municipalities with a large njsr – nordic journal of social research vol. 8, 2017 5 share of older people may also have had great pressure on their services prior to the reform. as such, nurses in these settings may experience a more pronounced lack of resources to deal with the extra burden of additional discharged hospital patients. furthermore, health and care services are costly. it is reasonable to expect that nurses in municipalities with relatively high incomes may consider themselves to be in a better position to provide services to their patients than nurses working in municipalities with relatively low incomes. the same applies to the general economic flexibility of municipalities. lastly, the service profiles of municipalities, i.e. the extent to which they divert resources to local healthcare, and whether the provision is largely home-based or institutionalized, may impact the perceived adequacy post-reform. municipalities with an institutionalized focus may be better equipped to provide care for patients in need of more advanced care. municipalities with a strong focus on hcs may, on the other hand, be able to handle a larger number of patients. as such, we aim to assess how the characteristics of municipalities impact nurses’ perceptions post-reform. data and methods data in may 2013, 2,372 nurses working in nursing homes and/or home care responded to a web-based questionnaire administered to a maximum of 10,000 email addresses of members of the norwegian nurse association. altogether, two reminders were sent. due to incomplete email registers, an accurate response rate could not be calculated. initially, six qualitative interviews were undertaken with nurses in nursing homes and home care services in three different municipalities in norway. the interviews were performed face-to-face and recorded for later transcription. based on these qualitative interviews and following general survey design criteria of balanced positive/negative questions and balanced response options, a quantitative web-based questionnaire was designed. next, the survey questions and response options were piloted on a convenience sample of 12 nurses who had previously worked in either home care services or nursing homes. minor revisions were then made based on feedback from the pilot participants. the vast majority (97%) was employed in the municipality, whereas the remaining was employed in private enterprises or non-governmental organizations. around one fourth (23%) stated that they had leadership responsibilities within their services, whereas the remaining majority worked as executive nurses without leadership responsibilities. none of the respondents worked solely in administrative positions. the main aim of the questionnaire was to assess the experiences of municipality healthcare nurses associated with the earlier hospital discharge of patients that resulted from the coordination reform. we thus limited our sample to the 82% employed at the same place before and after the reform (n=1,938). in order to identify the characteristics of municipalities that may help to explain differences in perceived effectiveness in handling discharged patients, we linked our survey data to register data from statistics norway on such njsr – nordic journal of social research vol. 8, 2017 6 characteristics from the 2012 kostra database by means of unique municipality identifiers. more than 80% of norway’s 428 municipalities were represented in the study by one or more nurse (range=1-151). dependent variables changes in the number of patients discharged to nursing homes and home care services were assessed by the question, “has your service been receiving an increasing or a decreasing number of patients since the reform?” we assessed changes in the number of poorly functioning patients discharged to the services by the question, “has there been a change in the number of patients that have to be readmitted to hospitals within a week of discharge?” the response categories were: considerably fewer, fewer, no change, more and considerably more. for all measures, we used a simplified categorization in the analyses to facilitate multinomial analyses: no change (no change or missing), an increase (some or considerable increase) and a decrease (some or considerable decrease). we assessed the resource situation in the services using multiple questions. in terms of personnel, we used the following statements: a) “the service is sufficiently staffed to handle the patients we receive”; b) “the number of staff without formal qualifications is too high”; and c) “there is an adequate number of nurses on staff”. competence was assessed by the following statements: “i am less confident in the tasks i need to accomplish”, and “i need training and guidance to enable me to accomplish the new tasks”. in terms of medical equipment, we asked respondents to state their view on the following statement: “our service has the medical equipment needed to handle the discharged patients”. for all the above statements, the response categories were: fully agree, partly agree, indifferent, partly disagree and fully disagree. a simplified categorization was also used here in the analyses: indifferent (including missing), agree (partly or fully) and disagree (partly or fully). in addition, respondents were asked if they had been offered the chance to partake in various competency enhancing and/or educational measures relating to the reform. covariates our main interest was the degree to which the experiences of nurses varied across work place, i.e. home care versus services nursing homes, and across municipalities. categorizations and distributions are shown in tables 1 and 2. of the 1,938 nurses, 815 worked only in home care services, whereas 904 worked only in nursing homes. the remaining 219 worked in both settings, and were thus not included in the comparison. nurses identified the municipality they worked in, thus enabling us to extract information on their municipality, such as size, degree of centralization and geographic location. there are currently 428 municipalities in norway, varying in size from about 200 inhabitants to more than 600,000. while 75% of the municipalities have fewer than 10,000 inhabitants, the proportion of the population who live in small municipalities is only 28% (statistics norway). four levels of centralization are used by statistics norway, based on both municipality size and distance from a large city and ranging from completely decentralized (0) to fully centralized (3). nurses’ sex, age and years of work experience were included in the multivariate models. we only reported covariates which significantly influenced results. njsr – nordic journal of social research vol. 8, 2017 7 for a demographic profile on the need for health and care services, we used the share of inhabitants aged 80 and older. for general economic flexibility and budget constraints, we used two indexes: available incomes and unavoidable costs. for service profiles, we examined the net percentage of the total municipality budget used for health and care, and the relative percentage spent on institutionalized care versus home care services. for the latter variable, we created an index of the relative percentage spent on institutionalized care by dividing the relative percentage spent on institutionalized care by that spent on both institutionalized care (7-87%, mean 45%) and home care services (1288%, mean 48%). table 2 provides an overview of the range, median, mean, standard error (se) and 95% confidence interval (ci) of these continuous variables. to ease interpretation, the variables were dichotomized in the regression analyses, but linear parameterizations gave very similar results (not shown). the variable 'share of elderly 80+' could not be included at the same time as ‘budget for health and care’ due to collinearity. such collinearity was also observed for the variables ‘unavoidable costs’ and ‘available income’, and the latter variable was preferred in multivariate analyses as its effect tended to be more pronounced. methods to assess changes associated with the reform across work settings (nursing homes versus home care services) and municipalities, we employed descriptive statistics and univariate and multivariate multinomial logistic regression analyses to examine both positive and negative outcomes. the few individuals who gave no response on outcome variables were included in the reference category of ‘no change’ in the relevant analyses (table 3), while missing responses on covariates were handled by means of imputation. a robustness check excluding individuals with missing information gave virtually identical results. all analyses were undertaken in stata 13, and the statistical significance level was set at 5%. results descriptives the vast majority of nurses were female (94%). their mean age was 43.4 (range 23-69, s.e. 0.2), and the mean number of working years was 12.4 (range 1-44, s.e. 0.2). details on the age and work experience of nurses by work place are shown in table 1. around 47% of respondents were employed only in nursing homes, while 42% worked only in home care services. a total of 8% (n=161) worked in both places, whereas the remaining 3% (n=58) worked elsewhere. njsr – nordic journal of social research vol. 8, 2017 8 table 1. background characteristics (%) of nurses and their municipalities by work place (home care services vs nursing home). all nurses (n=1,938) only hcsa (n=815) only nhb (n=904) sex female 94 93 95 male 6 7 5 age group 23-29 years 12 13 12 30-39 years 27 28 27 40-49 years 28 31 25 50-59 years 25 23 26 60-69 years 7 5 9 missing 1 <1 1 work experience 1-4 years 20 19 21 5-9 years 25 27 25 10-14 years 19 19 19 15-19 years 13 15 11 20+ years 22 19 23 missing 1 1 1 inhabitants in work municipality <3,000 7 7 15 3,001-20,000 43 40 46 20,001-50,000 21 22 19 50,001+ 29 31 20 degree of centralization completely decentralized 12 11 11 mostly decentralized 7 5 9 mostly centralized 22 25 19 completely centralized 58 59 61 health region northern norway 10 9 9 mid norway 20 19 21 western norway 18 14 21 south-eastern norway (excl. oslo) 46 52 42 oslo 6 6 7 ahcs is short for home care services. bnh is short for nursing homes. the nurses represent centralized and decentralized municipalities of different sizes, and all four health regions in norway are represented (table 1). as both the municipalities and the health regions vary in size, this is reflected in the number of responses. njsr – nordic journal of social research vol. 8, 2017 9 table 2. descriptive statistics on municipality characteristics. range median mean s.e.a 95% cib number of inhabitants 668-613,285 20 995 84 901 3 708 77,628-92,174 degree of centralization 0-3 1,03 2,28 0,02 2.23-2.32 share of inhabitants age 80+ (%) 2.04-8.97 4,48 4,56 0,03 4.51-4.61 index of available income 0.81-1.99 0,91 0,93 0,002 0.93-0.94 index of unavoidable costs 0.76-1.70 0,84 0,88 0,003 0.87-0.88 percent of total budget diverted to health and care 19.0-54.0 30,85 30,45 0,11 30.23-30.67 degree of health care institutionalization 80+ (%) 5.59-63.43 36,69 35,56 0,18 32.21-35.91 as.e. is short for standard error. bci is short for confidence interval. table 2 presents further municipality characteristics: the share of inhabitants aged 80 and older ranged from 2-9%. in terms of economic flexibility and budget constraints, the available income index ranged from 0.81-1.99 and the unavoidable costs index ranged from 0.76-1.70. the net percentage of the total municipality budget used for health and care varied from 19-54%, whereas the relative percentage spent on institutionalized care varied from 6-63%. experiences in home care services versus nursing homes nearly 70% of respondents stated that there had been an increase in the number of patients discharged to their services after the coordination reform (table 3). the nurses reported a marked increase in the number of patients with cancer and/or in need of palliative care, as well as those with orthopaedic or geriatric needs, or suffering from infection or dementia. the most pronounced difference between reports from nurses in home care services and nursing homes were observed for patients with cancer or general geriatric problems, a population observed to a greater extent in home care services, whereas more patients with dementia were observed in nursing homes. after the reform, 78% of home care services nurses reported some or a considerable increase in the number of patients discharged to their services, whereas this was true for only 57% of nursing home nurses. similarly, a high proportion of nurses both in home care services (67%) and nursing homes (45%) reported an increase in the number of poorly functioning patients discharged to their services, as assessed by a question on readmission rates to hospitals within one week. these differences were statistically significant in both univariate and multivariate analyses (table 4). very few nurses reported a decrease in the number of poorly functioning patients post-reform, and the difference between nurses in home care services and nursing homes was not statistically significant (not shown). njsr – nordic journal of social research vol. 8, 2017 10 table 3. descriptive statistics on reported changes (%) in patient flows following the coordination reform, by work place.a home care services (n=815) nursing homes (n=904) how would you describe the number of patients you receive from hospitals today as compared to before the reform? no or minor change 20 40 significantly fewer 1 3 significantly more 78 57 which diagnostic groups comprise the majority of the increase?b cancer 67 49 palliation 57 57 orthopaedic 46 44 infections 46 42 geriatric 46 39 lung 39 40 dementia 36 46 how would you describe the number of patients readmitted quickly to hospitals today as compared to before the reform? no or minor change 30 49 significantly fewer 3 6 significantly more 67 45 the service is sufficiently staffed to handle the patients we receive fully or partly agree 32 29 indifferent 8 10 partly or fully disagree 60 61 the number of staff without formal qualifications is too high fully or partly agree 61 67 indifferent 16 13 partly or fully disagree 23 20 there is an adequate number of nurses on staff fully or partly agree 36 30 indifferent 8 9 partly or fully disagree 56 61 our service has the medical equipment needed to handle the discharged patients fully or partly agree 29 41 indifferent 21 15 partly or fully disagree 50 44 i am less confident in the tasks i need to accomplish fully or partly agree 33 39 indifferent 27 25 partly or fully disagree 40 36 i need guidance to enable me to accomplish the new tasks fully or partly agree 74 70 indifferent 14 16 partly or fully disagree 12 14 athis table highlights differences in nurses' perceptions across nh and hcs and, as such, only nurses working in either place have been included. all responses were provided at one point in time, with questions posted retrospectively. the number of missing responses ranged from n=17 (<1%) to n=75 (<5%). the missing responses were included in the mid-group, comprising the reference group 'no change' in the multinomial analyses. a robustness check excluding individuals with missing responses gave very similar results, both in terms of percentage distributions and the effect estimates resulting from the multivariate models. bthis list is based solely on those reporting 'significantly more' in the question above (n=1,307). as individuals could tick all boxes, the percentages do not add up to a hundred. njsr – nordic journal of social research vol. 8, 2017 11 table 4. multinomial multivariate estimates of the associations between nurses' characteristics and perceived changes following the coordination reforma amultinomial models of perceived changes post-reform. no significant differences were observed between nurses working in home care services (hcs) versus nursing homes (nh) for a reduced patient load, a reduction in rapid hospital readmissions, a sufficiently qualified staff, an inadequate medical equipment situation or in terms of feeling safe and competent. as such, these estimates are not shown (available on request). bthe univariate or for hcs nurses relative to nh nurses was virtually identical: 2.71 (95% ci 2.18-3.37). cthe univariate or for hcs nurses relative to nh nurses was identical: 2.43 (95% ci 1.99-2.98). dthe univariate or for hcs nurses relative to nh nurses was identical: 0.76 (95% ci 0.58-1.00). ethe univariate or for hcs nurses relative to nh nurses was virtually identical: 0.52 (95% ci 0.40-0.69). fthe univariate or for hcs nurses relative to nh nurses was virtually identical: 0.79 (95% ci 0.62-1.01). godds ratio. h95% confidence interval. there appeared to be relatively few differences between nurses in home care services and nursing homes in the assessment of the availability of resources in local services. a higher percentage of nurses in nursing homes (67%) than in home care services (61%) found the number of unqualified staff to be too high, and the difference was statistically significant in multivariate models (table 4). however, almost the same number of nurses in home care services and nursing homes disagreed (23% and 20%, respectively). in terms of the number of nurses on staff, a large proportion of nurses both in home care services and nursing homes (56% and 61%, respectively) stated that they disagreed that this was adequate, whereas approximately 36% and 30%, respectively, reported that they found it adequate. as such, there were no statistically significant differences between the two groups. also in terms of overall staffing, there was almost no difference between nurses in home care services and nursing homes: 32% in home care services and 29% in nursing homes reported that their service was adequately staffed to handle the patients received, whereas 60% and 61%, respectively, disagreed. younger respondents and respondents with little work experience found the medical equipment situation to be inadequate to a much larger extent than older respondents with longer work experience (not shown). this was true in both settings. however, there were also statistically significant differences between nurses in home care services and nursing homes in this area: whereas only 29% of nurses in home care services agreed that the medical equipment was adequate, 41% of nurses in nursing homes agreed that the medical equipment was adequate (table 4). in terms of competence, nursing home nurses reported feeling less confident more often than home care services nurses (39% versus 33%, p=0.03), whereas the proportion who reported that they disagree was fairly similar in the two settings (37% and 40%, respectively). regardless of setting, nurses with less work experience were more likely to report feeling less confident (or 1.6, p<0.01). in terms of training and guidance, more than 70% of nurses – or g p-value or p-value or p-value or p-value or p-value home care services (ref=nursing home) 2,69 < 0.001 2,43 < 0.001 0,76 0,05 0,53 < 0.001 0,79 0,05 male (ref=female) 1,33 0,25 0,96 0,85 0,79 0,39 0,83 0,50 0,87 0,59 age < 40 (ref=age 40+) 1,24 0,10 1,31 0,02 1,11 0,53 1,14 0,43 0,92 0,59 work experience < 10 yrs (ref=10+ yrs) 1,14 0,31 1,07 0,58 1,05 0,80 1,16 0,37 1,58 < 0.01 less confident f increased b increased c too many d adequate e influx of patients to service rapid hospital readmissions unqualified staff medical equipment confidence and competence njsr – nordic journal of social research vol. 8, 2017 12 regardless of setting – stated that they would benefit from such measures. as such, there was no difference between the nurses in this area. across most questions, only minor and statistically insignificant differences were observed across respondents’ characteristics, i.e. sex, age and work experience (table 4). respondents were also asked if they had been offered the chance to partake in various competency enhancing and/or educational measures to prepare for the reform. the most common measure that had been implemented (around 30%) was a telephone ‘hot line’ to hospitals where specific questions could be directed. in general, less than 20% had been offered continued education of some sort. however, few respondents had partaken in such measures and the variation in response rates was minor. thus, no meaningful analyses could be conducted. differences between municipalities table 5 presents effect estimates for municipality and nurse characteristics associated with the main outcome variables. univariate multinomial analyses showed that an increase in patient influx was reported most frequently by nurses in the smallest municipalities, in municipalities with low incomes or high unavoidable costs, or in municipalities which diverted a small percentage of their budget to health and care or had a large share of elderly patients (aged 80+). nurses in less central areas, however, reported an increase in patient influx less frequently (or 0.6, 0=0.03). in multivariate analyses, only the effects of municipality size, health and care budget and income remained similar. nurses in home care services below the age of 40 were also more likely to report an increased patient influx. none of the variables were statistically significant in multivariate analyses of a decrease in patient influx, and in univariate analyses only nurses in municipalities with an institutionalized care profile were likely to report this. multivariate analyses for an increase in rapid hospital readmissions showed a roughly similar pattern: nurses in municipalities with low incomes and low health and care budgets were most likely to report an increase. in univariate analyses, the same was true for municipalities with a large share of the elderly. here also, younger nurses working in home care services were most likely to report an increase. none of the variables reached statistical significance in univariate or multivariate analyses of a decrease in rapid readmissions. in the assessment of availability of resources in the local services, the only municipal characteristic predicted to have inadequate medical equipment was a low health and care budget. it was, furthermore, most commonly reported by younger nurses with relatively limited work experience. in the analysis of the opposite outcome, i.e. that the medical equipment situation was adequate, univariate analyses showed that this was reported less frequently in larger municipalities and more frequently in municipalities with limited unavoidable costs, however, these results did not hold up in the multivariate analysis. njsr – nordic journal of social research vol. 8, 2017 13 table 5. multinomial analyses of characteristics of municipalities and nurses associated with perceived changes in the work tasks after the coordination reforma aresults from multivariate models of perceived changes in the work situation of nurses post-reform. originally, all variables from tables 1 and 2 were included in the models for each outcome. some variables did not make a significant contribution for any of the study's outcomes portrayed here, and are thus not shown. this pertains to the variables centrality, health region, index of unavoidable costs, institutionalized health care profile and being male. a blank indicates that the variable did not contribute significantly in the particular analysis. multinomial models were set up, but only nonsignificant findings resulted in the multivariate analyses of a decrease in patient influx, a decrease in rapid hospital readmissions, having a qualified staff, an adequate situation with regard to medical equipment and feeling competent and confident. as such, these results are not shown (available on request). furthermore, as it is difficult to interpret linear variables, a dichotomized version is showed here. the results were very similar with a linear parametrization (available on request). bunivariate results were largely similar albeit slightly more pronounced for the variables included in the final model (available on request). in addition, nurses in less central municipalities were less likely to report an increase in patient influx (or 0.6, 0=0.03), whereas nurses in municipalities with high unavoidable costs (or 1.32, p=0.006) and with a high share of inhabitants 80+ (1.36, p=0.005) were more likely to report an increase. in analyses of a decrease in patient influx, only nurses in municipalities with an institutionalized care profile were likely to indicate this to be the case (or 2.54, p=0.006). cunivariate results were largely similar for the variables included in the final model (available on request). in addition, nurses in municipalities with a high share of inhabitants 80+ (1.33, p=0.006) were more likely to report an increase in rapid hospital readmissions. none of the variables reached statistical significance in univariate analyses of a decrease in rapid hospital readmissions. dunivariate results were largely similar albeit slightly less pronounced for the variables included in the final model (available on request). nurses in municipalities with limited unavoidable costs (or 0.67, p=0.002) and with a high share of inhabitants 80+ (0.75, p=0.03) were less likely to report that they had too many unqualified workers on staff, the latter somewhat surprising. in univariate analyses of having an adequately qualified staff, this was more likely to be reported by nurses in high-income municipalities (or 1.42, p=0.02). ethe univariate results were largely similar to those reported on in the multivariate analysis. in analysis of the opposite outcome, i.e. that the medical equipment situation was adequate, univariate analyses showed that this was less frequently reported in larger municipalities (or 0.70, p=0.02 and or 0.63, p=0.006 for the two largest categories, respectively) and more frequently in municipalities with limited unavoidable costs (or 1.45, p=0.005). fthe univariate results were somewhat weaker than those portrayed in the multivariate analysis. none of the other variables reached statistical significance in univariate analyses. for reports of not feeling less competent or confident, the only significant results were found for nurses working in municipalities with an institutionalized care profile, and these nurses were less likely to report feeling confident (or 0.73, p=0.005). godds ratio. hthe variable 'share of elderly 80+' could not be included simultaneously with the percentage of the municipality's 'budget for health and care' due to collinearity. in the analyses of rapid readmissions, the effect size of the other covariates was almost identical when the latter variable was swapped with the former (or 1.35, p=0.009). such collinearity was also observed for the variables 'unavoidable costs' and 'available income', and the latter variable was preferred in multivariate analyses as its effect tended to be more pronounced. looking at reports on adequately qualified staff, this was more likely to be reported by nurses in high-income municipalities. in terms of having unqualified staff, nurses in municipalities with low incomes were more likely to report this, as were nurses employed in larger municipalities. furthermore, it was most or g p-value or p-value or p-value or p-value or p-value # of inhabitants <10,000 1,36 0,03 1 ref 10,000-50,000 1,17 0,26 1,47 0,02 50000+ 1 ref 1,94 < 0.001 share of inhabitants age 80+ (cont.) h low available income (ref=high) 1,36 0,01 1,27 0,03 1,35 0,05 1,26 0,05 low budget for health and care (ref=high) 1,69 < 0.01 1,39 0,03 1,66 0,02 1,43 0,04 work in hcs (ref=nh) 2,74 < 0.001 2,44 < 0.001 0,76 0,05 age < 40 (ref=age 40+) 1,34 0,01 1,36 < 0.01 1.42 0.02 work experience < 10 yrs (ref=10+ yrs) 1.65 < 0.01 1,61 < 0.001 increased b increased c too many d inadequate e less confident f confidence and competence influx of patients to service rapid hospital readmissions unqualified staff medical equipment njsr – nordic journal of social research vol. 8, 2017 14 commonly reported by nurses working in home care services. in univariate analyses, nurses in municipalities with limited unavoidable costs and with a large share of elderly patients were, somewhat surprisingly, less likely to report that they had too many unqualified workers on staff. in terms of the number of nurses on staff, minor or no differences were observed across nurses in municipalities with different characteristics. in terms of overall staffing, the nurses working in the richest municipalities were most likely to agree that the overall staffing was adequate. in terms of competence, low levels of confidence were observed most often in low-income municipalities which diverted the least resources towards health and care, whereas the opposite was observed in municipalities relying heavily on institutionalized care. along the same lines, nurses working in municipalities relying on institutionalized care expressed the least need for guidance (not shown). discussion the vast majority of nurses in primary health and care services in norwegian municipalities report that they have received an increasing number of seriously ill patients from hospitals since the implementation of the coordination reform. the influx of additional patients is reported most frequently among nurses in home care services who report an upsurge in rapid hospital readmissions and who also appear to receive particularly poorly functioning patients. such reports may suggest that the home care services sector has been granted insufficient resources to fulfil the obligations explicitly stated in the coordination reform, i.e. to safely provide care for patients in their own homes as an alternative to the provision of such care in hospitals. a survey conducted prior to the coordination reform shows that variation in los between hospitals may be explained mainly by the capacity of primary health care providers (kjekshus, 2005). our findings may suggest that although the primary health care capacity has increased to meet the increased task load, it has not been sufficient to meet the actual demand. as such, the relative capacity may actually have diminished since the reform. primary health care services, regardless of their resource situation, are mandated to handle discharged hospital patients. as such, the municipalities must ensure that their services can accommodate the need. services with limited resources appear, however, to rapidly return to hospitals patients they feel inadequately equipped to handle. nurses in municipalities with a large number of residents with care needs, i.e. a large share of older individuals, and with limited economic flexibility report more frequently that there has been an increase in the number of readmissions. whereas nurses in the smallest municipalities report the largest influx of patients post-reform, they are the least likely to report staffing problems. this is in line with recent findings, which show that the staff shortage escalates with increasing municipality size (gautun et al., 2016). a majority of nurses report that the resources warranted to take on the new and additional tasks are currently largely lacking in terms of both personnel and equipment. more specifically, nurses indicate a need for a larger number of qualified personnel. medical equipment is particularly needed in home care services. regardless of work place, measures to raise competence levels are found lacking, as new tasks have been added while the ordinary tasks have become more numerous than previously. this is underscored by our finding that njsr – nordic journal of social research vol. 8, 2017 15 only a minority of nurses report that they have been offered competence enhancing measures post-reform, and that the measure most commonly reported is a basic telephone ‘hot line’ to hospitals for specific questions. nurses in low-income municipalities indicate that the number of unqualified staff is too high and those working in municipalities diverting the least resources towards health and care felt less competent and confident, whereas the opposite was observed in richer municipalities and in municipalities with a service profile heavily reliant on institutionalized care. along the same lines, nurses working in municipalities relying on institutional care expressed the least need for guidance. in general, however, nurses in municipalities where a considerable portion of the budget is allocated to the health and care sector appear to be less negatively affected by the reform. similarly, municipalities with fewer budget constraints and municipalities relying more heavily on institutionalized care appear to be better off than those with more severe budget constraints and care profiles more reliant on home care services. our findings on municipal variation align well with those observed across work places, and thus solidify the conclusion that the norwegian coordination reform has had a significant effect on home care services, and not in just a positive manner. in terms of future priorities, resources appear to be urgently needed to further strengthen home care services for the reform to be deemed successful. it may be that insufficient resources have been directed to the municipalities overall. however, municipalities may also have failed to prioritize home care services to the extent necessary to ensure adequate care to discharged patients. this study has focused on discharged patients’ follow-up care in the municipalities, which is one of the challenges resulting from the coordination reform. however, investigations of prevention and early intervention efforts in the municipalities are also warranted. to conclude, insufficient transfer of resources to home care services may have hampered the ability to fulfil the coordination reform’s intentions of providing safe care to patients in their own homes as an alternative to prolonged hospital stays. due to a marked increase in reported hospital readmissions, it is not obvious that shorter los has reduced overall health care costs. registry data suggest, however, that the number of hospital readmissions has been stable in the period 2011-2015 (melberg and hagen, 2016). this is a result of a combined readmission increase of the elderly and a corresponding decrease of children (norwegian directorate of health, 2016). the services investigated here primarily concern the elderly and, as such, our results are in line with the readmission upsurge for this age group. our cross-sectional results from around 18 months post-reform also need to be assessed from a patient perspective, and longitudinal follow-up studies are warranted in the continued monitoring of the coordination reform to assess whether things have changed for the better at a later stage. some negative short-term issues are to be expected from any reform implementation, and if such issues are quickly resolved, the final 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patel et al., 2007). for young people, not attending school or working may develop feelings of isolation and a lack of control, resulting in alienation from authority and community, which may further marginalize them (thompson et al., 2013). the rates of high-school dropouts is a national problem in countries all over the world and has an impact on both the individual and the society (lee et al., 2009). the termination of high school before completion is a result of many different factors on different levels – individual, institutional, social, and so on. as rumberger and lim (2009, p. 2) state, ‘it is virtually impossible to demonstrate a causal connection between any single factor and the decision to quit school’. in norway one of three drop out of school or do not complete high school within five years (nova, 2014). a norwegian study (ramsdal et al., 2013) reported that several young people who had dropped out of school had experiences of abandonment, academic demotivation, social marginalization and exclusion, and being lonely. some of them struggled with mental-health problems and substance abuse (langeland et al., 2014). they are often called ‘youth at risk’, defined as those experiencing complex difficulties and problems, necessitating services from at least two public agencies (nou, 2009, no. 22). young people, on the other hand, draw a picture of risk that involves themselves. they are concerned with loneliness, being overseen or being insignificant to anyone (follesø, 2011). the norwegian white paper on public health, ‘coping and possibilities’ (the norwegian ministry of health and care services, 2014-2015), underscores the importance of a national commitment to help more young people to complete high school. the focus on mental health in schools is to be further developed and to be given a stronger grounding in school. according to this white paper, there is a need for more knowledge and examples of good practices of how to work with the mental-health issues of children and adolescents in school. a nordic report (hyggen, 2015) on young people neither attending school nor working pointed to the importance of securing the implementation of their education and inclusion in the labour market. the report underlines the importance of acknowledging alternative routes to the labour market and allowing for more time to find their own way to acquire the skills they need. various ‘green care’ enterprises have, for example, been shown to have a beneficial effect on youth in vulnerable situations where there is a risk of social exclusion (granerud & eriksson, 2014; steigen, kogstad & hummelvoll, 2016). these enterprises represent alternative arenas in which people can work with animals, agriculture, and other nature-related tasks (kogstad, agdal & njsr – nordic journal of social research vol. 7, 2016 48 hopfenbeck, 2015). an alternative approach to inclusion of young people at risk is the model called individual placement and support. this model aims to help persons with mental-health problems to find and stay employed in ordinary jobs (drake & becker, 2006).the method has been tried out on young people with mental-health problems and it has achieved good results (bond et al., 2012; ellison et al., 2014). a report from the nordic council of ministers (halvorsen et al., 2012) has found that there are many projects and development works with good methods and results that are getting young people back to school and to work. however, few projects have been evaluated. therefore, the report recommends that more systematic knowledge concerning these development works is needed. the present article is one response to this request. the aim of this study has been to describe and interpret the experiences of young persons who are neither in school nor at work who have participated in inclusive theatre. the research questions were as follows: how do young people describe experiences with inclusive theatre related to self-image? how does participating in inclusive theatre affect young people’s experience of social belonging and participation? inclusive theatre inclusive theatre aims at stimulating emancipation and social participation (gürgens, 2004; gjærum & rasmussen, 2010; gjærum et al., 2010). it was originally designed as a theatrical activity for disabled people. the goal was to include disabled and well-functioning individuals in the same theatre. this was later expanded to include other often-marginalized groups who had few opportunities to participate in theatrical activities (gürgens, 2004). the purpose of inclusive theatre is both to provide social inclusion and to serve as a framework for the development of social skills and self-confidence. inclusive theatre also seeks to be a space for the greater visibility of marginalized groups, and giving them an opportunity to make their voices heard in the public arena (gürgens, 2004; wooster, 2009). in this way it can function as an empowering arena where the actors are liberated from their roles as marginalized persons (gjærum & rasmussen, 2010). inclusive theatre seems to have much in common with community-based theatre. wooster (2009) uses the concept ‘inclusive community theatre’. faigin and stein (2010) describe community-based theatre as a form of inclusive, socio-political theatre that takes a critical position toward social issues, aims to raise awareness, and works to resolve social frustrations and conflict. this form of theatre has a perspective of community-citizen empowerment and social justice (faigin & stein, 2010). theatre and creative arts in work with young people the use of theatre and performing arts programmes for the sake of the emancipation of different oppressed groups has been utilized among migrant communities (hawkins & georgokopolus, 2010), asylum seekers (horghagen & josephsson, 2010), and young people exposed to or perpetrating bullying (bhukhanwala, 2014). it has also been implemented in high schools to stimulate emotional development (larson & brown, 2007) and flourishing (kane, 2013) njsr – nordic journal of social research vol. 7, 2016 49 and to develop empowerment and social change for incarcerated and young people at risk (mohler, 2012). anticipated effects reported by mohler (2012) are that participating in ensemble theatre and performing arts had the potential to empower youth by increasing their sense of agency and creative autonomy. a literature review by daykin et al. (2008) has reported some evidence of positive outcomes following performing-arts interventions for young people. the review provided insight into some of the impact and processual issues associated with the arts for health initiatives. the strongest evidence was connected to the impact of drama on peer interaction and social skills, where they found the largest number of studies. a literature review by bungay and vella-burrows (2013) has found that a number of the studies reported on projects which were introduced with the purpose of helping to build communities and to increase social engagement. creative activities have also been used to promote behavioural change and healthy lifestyles. by participating in such programmes children and young people were less likely to abuse substances, exhibited improved behaviour, and developed a range of interpersonal skills. the most commonly reported outcome in all the studies reviewed was that of increased confidence. increased self-esteem, sense of achievement, empowerment, social skills, and positive behavioural changes were also consistently reported outcomes in the review. theoretical inspirations: pedagogy and theatre of the oppressed paulo freire’s (1970) views on democratic education were to help people fight back as a group and to participate in the process of counteracting selfoppression. freire’s ‘pedagogy of the oppressed’ has been an important basis for the empowerment ideology. according to this ideology a central goal is that disempowered groups break out of their suppressed situation and through consciousness-raising are able to fight difficult situations and to become equal, competent citizens in society (askheim, 2003). who (1998) understands empowerment as a practice in which people achieve greater control over their own decisions and practices affecting their health. today the concept of empowerment is widely used with a breadth of definitions. it mainly focuses on the individual level and is therefore often criticized for not taking social factors, such as social determinants of people’s health, into consideration (askheim, 2003; woodall et al., 2012). individual empowerment does not contribute to full empowerment in the sense of transforming the relations of power. wodall et al. (2012) claim that empowerment in a way has lost its links with its original roots concerning social justice and wider power structures through social and structural change. inspired by freire, augusto boal developed theatre of the oppressed to offer a theatrical space for people to come together to rehearse for reality, to engage in a critical dialogue, and to build a more humane environment (boal, 2003; 2006). boal is concerned with all sorts of oppression, socially, locally, and individually. his basic message is that participants can use the experience of theatre work to take the leading role in their own lives (boal, 1995). it is important to use theatre to encourage empowerment, power, and determination of individuals, groups, and in society as a whole (boal, 1995; 2006). boal argues that the arts have the capacity to allow people to observe themselves in action, to imagine themselves as actors and agents of change. theatre of the oppressed is both a theoretical framework and a practice. two core elements are praxis and the need for dialogue. praxis has to do with the simultaneous njsr – nordic journal of social research vol. 7, 2016 50 action and reflection necessary to transform the world. this makes it possible for persons to analyse what they do as they do it. boal claims that the theatre in its deepest sense is about our capacity to observe ourselves in action (boal 1998, p. 7). by developing our consciousness, we will be more human. boal is also occupied with the importance of dialogue to establish mutual learning, by involving performers and audience in the performance, communicating together. the project ‘i dare’: an example of inclusive theatre thirteen young people participated in this project: six men and seven women. the participants were called ‘actors’ (a term used hereafter). theoretically and practically the project was inspired by the work of augusto boal and pablo freire. it had a dialogical nature and aimed to stimulate the empowerment and emancipation of the actors. the project also aimed to improve concentration, to stimulate creativity, and to develop collaboration and trust in others. additional purposes were to practise being social and to experience a sense of belonging as an individual and as a group in society. the more long-term aim was to motivate the participants to attend school and to find employment. the project was financed by nav – the norwegian labour and welfare service – through the programme farve (development funds, work, and welfare). the project ‘i dare’ was planned to last for a school year and took place in 20082009. the project leader, a drama teacher, and other professional artists worked with the actors. the topics they taught were choral singing, photography, theatre, awareness training, drama, improvisation, writing practice, music, and film. the topics also included learning of practical skills such as bicycle maintenance, cooking, and management of personal finances. the actors and staff participated in several cultural activities during evenings and weekends. the last half year, the programme focused more intensively on the upcoming theatrical performance. during the project, actors and staff organized a variety of events and exhibitions with an audience present: a concert in the local cathedral, a photographic exhibition, teaching theatrical games for students at the university college, arranging a demonstration against the use of fur by boal’s method of ‘invisible theatre’. they produced music videos and a documentary about the events in the project. the project leader closely supervised the actors. they developed their own individual plan and set personal goals for the project participation. the project leader was available and encouraged the actors to take hold of their own personal and social problems. most of the elements of the creative activities the actors had worked on throughout the year were used in the performance, entitled hanging from a thin line. the actors were involved in all aspects of script writing, production, and performing. the roles were tailored to each actor. the performance was about the myths and prejudices against young people with mental-health problems who had fallen out of society's established norms and how they could empower themselves by combating their barriers. njsr – nordic journal of social research vol. 7, 2016 51 methodology participants all 13 actors agreed to participate in the study (aged 18 23 years, except for one at 27). when beginning in the project they had problems with loneliness, anxiety, and isolation, and they experienced little hope and meaning in life. they felt socially excluded, and some had problems with substance abuse. many struggled with mental-health problems and a lack of education, work experiences, and networks. several had problems with concentration and restlessness. only a few had finished high school. twelve of the actors completed the project. one actor quit in the final phase owing to experiencing too much pressure because of the high demands for participation. multi-stage focus-group interviews the multi-stage focus group is characterized by the same group exploring a focused problem, theme or phenomenon in depth through several meetings. through these dialogues, there are possibilities to ‘elevate’ the participants’ experiences to a higher level of abstraction. thus, the potential utility value of the knowledge exceeds the concrete situation in which it is created (hummelvoll, 2008). three multistage focus-group interviews with the actors were carried out. the meetings took place in the project’s localities. there were 11 participants who met in the first and second focus groups, and 12 in the third. two researchers were present: the first author led the interviews, and another health-professional researcher served as secretary and was responsible for observing the group process and making a summary at the end of each meeting. the summary aimed to investigate whether the views that emerged were properly understood. this often led to more nuanced views and clarifications. each focus-group interview lasted 90 minutes. the main focus was on the actors’ subjective experiences of participating in the project. before the second and the third interview, the actors received preliminary analyses. data analysis the focus-group interviews were recorded and transcribed verbatim. the researchers then used qualitative content analysis to analyse the data (graneheim & lundman, 2004), which they conducted in a stepwise manner. the transcribed text from the first focus group was condensed and an initial analysis was performed before the second and the third meeting. the second interview focused on topics initiated in the first interview. finally, the researchers summarized the main theme and categories, sub-categories, and codes generated in the analysis based on data from all three focus groups (see table 1). the researchers also identified codes and analytical traces. statements from the interviews were systematized by collecting statements that fitted together under the different codes. the researchers identified and named the categories and sub-categories, and then validated the categories towards the transcribed interview and used examples of statements to validate the categories. coherent perceptions, as well as majority and minority perceptions and opinions, were illuminated through abstractions and specific illustrations in relation to the content of the themes (hummelvoll, 2008). the researchers then presented a draft of the analysis to two of the actors and discussed and revised it on the basis of their views. njsr – nordic journal of social research vol. 7, 2016 52 ethical considerations ethical guidelines in line with the declaration of helsinki (world medical association, 2008) were followed in relation to confidentiality and anonymity. the researchers were particularly attentive to the ethical principles of informed consent, the right to privacy, respect for personal integrity, non-maleficence, and beneficence. they also received written informed consent from all participants. the right to withdraw without consequences for participation in the theatre project was emphasized. the researchers reported the study to the data protection official for research (nsd) and to the regional committee for medical and health research. the latter found, however, that the project had no obligation to report the project. methodological discussion the study of this project took place in 2008-2009. this may seem a long time ago, but the findings are just as relevant today as in 2009, because the dropout rate has been relatively stable (30%) for the last twenty years in norway (statistics norway, 2013). giving the actors a preliminary analysis between the focus-group meetings gave them the possibility to be involved in the analysis and to continue the reflections in the next meeting. this stimulated further dialogue and raised issues that could be further nuanced and deepened (andvig, 2014). an adjacent bias of multistage focus-group interviews is a pressure towards consensus, which means that the group expresses common understandings and attitudes when in fact divergent opinions exist. whether this bias is prominent or not can be assessed by considering to what extent statements and attitudes are countered or experiences are met with nuances and counterexperiences. the use of group interaction as data might allow exploration of insights that would otherwise remain hidden. a drawback might be that there were many participants in the focus groups, which could make the members of the group passive. active participation, openness and trust characterized the group process, however. disagreements were expressed and experiences were contradicted by opposite experiences (cf. hummelvoll & severinsson, 2005). findings the main theme is ‘a changed self-image’. the sub-themes are ‘increased self confidence’, ‘increased coping ability’, ‘responsibility’, and ‘connectedness to others and society’. njsr – nordic journal of social research vol. 7, 2016 53 table 1 overview of the findings, with main theme, themes content and examples of quotations main theme: an expanding positive sense of self theme content examples of quotations increased selfconfidence awareness of own resources increased confidence increased self-esteem ‘for my part, it is the knowledge that i have damn much inside… i have discovered incredible qualities in myself that i appreciate and can use.’ ‘learnt to care less what others think; dare to dance without caring about others. now i can give a shit about jante’s law* and be myself.’ ‘i have recovered enough that i know what i want. i recognise that it is possible for me to fulfil my wishes and that i have what it takes.’ increased coping ability energy and vitality personal growth courage ‘i‘ve got a lot more energy to go on with several tasks.’ ‘i have learnt a lot about myself, now i am more patient with myself.’ ‘i’ve got the courage to do a lot of things i’ve never dared to do before.’ responsibility being responsible for oneself being responsible for others ‘i like the new routines in my daily life: they help med take better care of myself.’ ‘i really feel responsible for making the performance, because so many people are dependent on me. i have to show up every day.’ connectedness to others and society experience of community and reciprocity safety and trust towards other people social participation ‘i am surprised that i have managed to get attached to the people who are here – i’ve got a relationship with them – we have a lot in common.’ ‘i’m surprised at how safe i feel now regardless of who it is.’ ‘i feel i’m part of society now. i’ve got new friends who understand me.’ * ‘jante’s law’ is a scandinavian term used to describe a prevalent culture that discourages individual success or expression. njsr – nordic journal of social research vol. 7, 2016 54 increased self-confidence the theme of ‘increased self-confidence’ consists of the sub-themes ‘awareness of one’s own resources’, ‘increased confidence’ and ‘increased selfesteem’. regarding ‘awareness of one’s own resources’, the actors learned that they had far more resources than they had imagined when they joined the project. they gradually experienced being capable persons. as one actor said, ‘i have learnt that i have held back much inside. i have discovered an incredible number of aspects of myself that i now can appreciate and use’. the actors experienced that the professionals believed in them and had confidence in them. these experiences confirmed that they had the resources to cope with the challenges they faced during the project. this affected their faith in themselves. one of the young women told about a powerful anxiety attack during an exercise on stage where she ran away and wanted to give up. when she came back the leader simply asked if she was ready for a new scene. then she went up on stage and continued. she appreciated that her anxiety attack was seen as a natural reaction, and learning that it was harmless. she claimed this experience gave her increased self-confidence. with respect to ‘increased self-esteem’, the actors talked about increased selfesteem after being involved in the project. they felt more valued according to their own standards. they related this to their experiences of the professionals’ respecting and appreciating them. for some of the actors, this was the first time in their lives they had experienced this respect and appreciation. as one of them described, ‘they gave us so much and they told us how much they appreciated working with us. we are not used to hearing that’. of special importance was the leader's ability to show respect and to see the individual. she understood their struggles and problems and noticed their potential. she inspired them to trust themselves. the actors also underscored the staff’s professionalism and that it was rewarding working with them. they felt honoured by this and that they were valuable. as one put it, ‘it is like being served strawberries; imagine that i could be seen as worthy of participating in this project!’ feeling more appreciated also involved becoming more visible, both for themselves and for others. when they had to reveal themselves through singing, dancing, art projects, and standing on stage, they were able to present an image of themselves that they were proud of. increased coping ability the theme of ‘increased coping ability’ involved ‘energy and vitality’, ‘personal growth’, and ‘courage’. several of the actors emphasized that being part of the project gave them the energy and vigour to participate in both school and theatrical activities. many had earlier struggled with a lack of energy to start the day. now they had something to look forward to and something to get up for every morning. however, a few became exhausted by all the new experiences and demands. the leader supported most of the actors by helping them to organize several unfinished tasks in their personal lives. most of them had found it difficult to communicate their needs to the public authorities. the leader accompanied them to various offices. they got help with managing their financial and medical problems, receiving adequate dental care, and beginning therapy with a psychologist. several expressed that they had forgotten the feeling of njsr – nordic journal of social research vol. 7, 2016 55 accomplishing such tasks and that this feeling gave them energy. two actors put it like this: i've done more in five weeks than in the last two years. i walk around with a very good conscience; all my concerns have somehow disappeared. it's no big deal to face challenges anymore. i have discovered that the challenges are there all the time and that i can face them as they appear. regarding the element of ‘personal growth’, several pointed out that they had gone through personal growth during the project. some expressed a feeling of beginning to live. they had developed greater sensory and body awareness. one described it this way: here i have had the possibility to crawl, to study, to fantasize, to be part of something. i have had the possibility to explore, to sense, to feel, and to breathe. my body has been allowed to tickle, to get goose bumps, and to shudder. some expressed the feeling of becoming grown up through participating in the project. they had developed greater understanding of and patience with themselves and others, and some used the term ‘self-development’. one said: i used to sit at home doing nothing, absolutely nothing, just walking around in a circle. now i do a lot every day; i go through a sort of self-development. i have become more positive and more ready for new things. some told about learning to manage the stress they experienced during all the artistic exposure. they pointed out how important it was to work on themselves. ‘to work on myself is the biggest job ever,’ one reported. the element of ‘courage’ was also critical. at the start of the project, they talked about everything they feared. they feared meeting other people, participating in theatrical games (cf. boal, 2003), being on stage, singing, and memorizing a text. yet they found themselves gaining the courage needed to meet these challenges. by participating in the theatrical games, each of them was challenged. they dared to plunge into it and to challenge their own limits. as one enthused, ‘we have been challenged in several areas, and we have met these challenges. we dared to do it!’ the actors emphasized the importance of safe professional leadership. the staff were present, kept their spirits up, and encouraged and helped them to set limits for themselves. most of the actors appreciated that they faced challenges and demands. they found that the challenges were not set too high, but adapted to their individual level of coping. they were able to grow within their own coping limits. one exception was the one who found the requirements for participation as being too ambitious. responsibility the theme of ‘responsibility’ encompassed the elements of ‘being responsible for oneself’ and ‘being responsible for others’. the actors elaborated the experience of ‘being responsible for oneself’ in several areas. one young woman described how important it was that the project required something of her: ‘i’ve learnt that nothing comes by itself: one must give in order to get njsr – nordic journal of social research vol. 7, 2016 56 something back’. ‘being responsible for oneself’ also had to do with being able to carry out the daily tasks of the project and it became important to create daily routines. many experienced that life had become more structured and orderly after joining the project. ‘it has been necessary to be predictable and to learn to take responsibility for myself’. they emphasized the importance of having a normal circadian rhythm and a firm structure of the day: i have become more a4. i get up in the morning and go to the mill (name of the locality), attend the programme, eat lunch, and continue the programme. i say ‘goodbye’ at three o'clock and come home and have dinner – every day. it has not been like that before, not at all. with respect to ‘being responsible for others’, the actors regarded the mandatory attendance in the programme as positive, and being called for and picked up if they did not turn up in the morning. however, after some time, they expressed a feeling of responsibility and a commitment to fulfil the programme, and they came by their own motivation. it became, for example, important to defy illnesses like the flu because they wanted to show up every day and participate in the development of the performance. ‘now we have learned that there are responsibilities and limits to take into account and not just think about ourselves’. connectedness to others and society ‘connectedness to others and society’ covered awareness of ‘experience of community and reciprocity’, ‘safety and trust towards other people’, and ‘social participation’. ‘experience of community and reciprocity’ was central to the actors’ involvement. in the beginning of the project, many of the actors described a feeling of being socially excluded and not fitting into society. they did not believe they were able to ‘fix an ordinary life’. a central line in the theatrical piece hanging from a thin line was ‘i’m longing for a normal life’. through the theatrical activities, they became familiar with each other and encountered different sides of each person. they expressed a feeling of being acknowledged by each other. the project was successful in establishing strong bonds of trust and reciprocity between them. ‘we are a close-knit and resourceful bunch.’ they changed from feeling alienated and alone to belonging to a group. ‘the group is like a family where i can be myself.’ they emphasized that they learned to listen to each other, to be tolerant, and to accept different opinions. they learned to be more respectful of what the others were going through. they became empowered by the relational activities and seemed to be more visible. nevertheless, a few actors were more restrained, periodically withdrawing from the community, and stayed alone more. actors and staff did a lot together: daily meals, visits to cultural events, theatrical games and exercises, and the development of the performance. by doing things together, they established a sense of community and togetherness between them. this togetherness also seemed to have significance for their feeling of connectedness. the actors were proud of what they had achieved together through the development and presentation of the theatrical performance. they felt that they had reached the audience. a large part of the audience were deeply touched by the performance. some cried during and after the performance. the actors also indicated that they cared about each other. they emphasized the experience of ‘being in the same boat’: they understood each other; they njsr – nordic journal of social research vol. 7, 2016 57 were peers. they commented on and noticed the others’ development. as one said, ‘when you see the eyes of the others there is a reason to smile’. they were moved by the development of the others. the element of ‘safety and trust towards other people’ was also salient. there was some evidence that the project had an impact on the actors’ relationships outside of the project. most of them talked about a new feeling of trust towards others: ‘i am surprised that i feel so safe when i am with other people no matter who it is’. they also told about getting better contact with people around them during the project’s duration. they had re-established contact with family and friends and acquired a healthier network. one of the young men reported that he had something to talk about: he could discuss his experiences from theatrical work, culture arrangements, and so forth with his family. attending cultural events – visiting the library, cafés, theatre, and concerts – contributed to the actors’ participation in the public sphere. it gave them training in participating as citizens in the community. ‘social participation’ was another defining experience. the feeling of being connected to others seemed to give the actors the courage and the ability to participate more in society. the actors found that they had developed a greater sense of social participation and of fitting into society. the following dialogue between three actors reflected this view: participation in the project means for me to be involved in the actual world and not trapped in my own. yes, for me too. the image i have of myself has changed; i do not look at myself as an outsider anymore; now we are insiders. we are ordinary youths. agreed. now we learn to respond to ordinary demands of society, what could be called common norms. three of the women rented a house and moved in together. they gave each other important support with regard to emotional and social issues, such as making new friends, addressing hobbies, making school plans, and attending therapy related to substance abuse and mental-health problems. two actors found each other in a romantic relationship. one of the men got a part-time job in a music store: ‘now they want me, it's cool! earlier i would not have been able to accept this offer. i wouldn’t have known how to apply for it’. nearly all of the actors applied for courses in high school for the next school year, planning to take exams in the subject norwegian. one applied for an art education in another nordic country. discussion the aim of this study has been to describe and interpret the experiences of young adults not attending school or going to work who participated in inclusive theatre as a means to empowerment, social belonging, and participation. the main finding was ‘an expanding positive sense of self’ that consists of four categories: increased self-confidence, increased coping ability, responsibility, and connectedness to others and society. we have organized the discussion into two main themes: 1) inclusive theatre as a contribution to empowerment and 2) inclusive theatre as a contribution to social belonging and participation. njsr – nordic journal of social research vol. 7, 2016 58 inclusive theatre as contribution to empowerment we may understand the main finding of an expanded positive sense of self both at the individual and the group levels. empowerment in general is both a goal and a means of attaining that goal (askheim, 2003). such goals might be positive outcomes of care and social support and may include increased emotional well-being, independence, a motivation to participate, and more effective coping strategies (ryan et al., 2012). we shall first look at the findings at the individual level of empowerment, namely, self-empowerment. individual empowerment has to do with activities and processes relating to the aim of increasing the person’s control over his or her life, and equipping the person with more self-confidence, a better perception of oneself, and increased knowledge and skills (askheim, 2003, p. 230). the findings in our study fit well with this understanding of individual empowerment. our findings suggest that the actors’ feelings of powerlessness dissipated. they became more acting subjects instead of passive recipients of help. they were met as partners (actors) who were responsible for their own lives. it was important that they had the possibility to participate in all decisions concerning the theatrical work and performance. it was also important that they became able to assert their needs in relation to public authorities with help from the staff. in this way the actors learnt to break patterns of beliefs like ‘it is no use of trying’ and to avoid necessary but unpleasant duties. for several of the actors it was a new experience that adult persons cared about them for an extended period. the combination of care and demands and clear adult role models influenced the actors in a positive way. it was important that the project not only focused on theatrical activities but also provided practical and social support. in this way the actors got help to meet basic needs by getting access to health and social services. this access connected them to appropriate networks and resources and helped them to master their everyday life (munford & sanders, 2014). actually being engaged in an ongoing, goaloriented project like this also includes several trivial aspects, like establishing daily routines in one’s own life, learning to cook, and so on. it helped them to experience more about living an ordinary life with routines and structure, which allowed for an association with adulthood and strengthen self-confidence (andvig, svanoe & borg, 2016). the interplay in this project between ‘mundane’ activities and the relations between the participants themselves and between the participants and the leaders are central to the project’s success. our findings are also in line with faigin and stein (2010), who underscore that theatrical settings focusing on openness and inclusion stimulate the sense of self. these authors relate to research on recovery processes that highlight how a sense of self can be affected when persons with mental-health problems are given possibilities to activate and acknowledge personal strengths. our findings demonstrate that the actors established a new self-image as competent young persons able to cope with a range of situations in everyday life and to learn practical skills and coping abilities. boal (1995) emphasizes that theatre is a space where people can rehearse possibilities for changing the image they carry of themselves and the world they live in. our findings suggest that the theatrical activities gave the actors the opportunity to test out identities and roles and to experiment with different selves. this finding is in line with munford and sanders (2014). according to ryan et al. (2012) empowerment on the individual level involves a process of redefining and negotiation self-identity both with one self and to society as a whole. njsr – nordic journal of social research vol. 7, 2016 59 our findings concerning ‘increased coping ability and responsibility’ in daily life are also in line with horghagen and josephsson (2010), who report that engagement in theatre facilitates personal growth by re-establishing daily routines and promoting feelings of control, self-esteem, and self-actualization. the findings also suggest that the actors and the professionals built relationships characterized by collaboration, openness, respect, and trust. these are all factors that are important conditions for developing empowerment (askheim, 2003). these findings are also in accordance with findings reported by bungay and vella-burrows (2013), kemp (2006), and mohler (2012). kemp (2006) reports that participating in theatrical activities promotes young people's self‐esteem and a positive sense of agency and thus creates opportunities for self‐expression, reflection, and self‐understanding. moreover, theatrical activities promotes the development of relationships between participants characterized by trust and reciprocity. the findings concerning ‘increased coping ability’ also illuminate the importance of learning to be aware of, express and handle one’s own emotions. the dramatic exercises and theatrical activities gave them the possibility to learn from real emotional episodes. according to larsson and brown (2007) the theatrical setting makes it possible for individuals to learn from each other how to manage emotions. to write and reflect on their experiences every day seemed to develop their self-reflectiveness, which is important in developing individual empowerment (boal, 2003, 2006; freire, 1970). the reading of texts of, for example, the author knut hamsun and daily writing exercises also stimulated school-related skills and motivated them to go back to school. we shall now look at our findings in relation to empowerment at the the group level. drury et al. (2015) relate the concept of empowerment at the group level to subordinated groups struggling to change their situation and in doing so becoming more conscious of the possibility of making positive changes. drury et al. claim that subordinated groups may come to see themselves as agents of their own transformation through their actions. as a group and as an ensemble the actors changed their collective self-image and became active parts of society by making art that aimed to influence their surroundings. this understanding is in line with freire’s ideas of empowerment such as critical consciousness-raising, liberation, and actions resulting from heightened awareness (freire, 1970). our findings illustrate the importance of developing artistic expressions based on the actors’ own life experiences. according to gjærum et al. (2010) the performance and the other exhibitions can be seen as a movement where the actors change their collective understanding as isolated from society to understanding themselves as actors and producers of art acclaimed by a broad audience. the authors emphasize that the daily processes and activities at the theatre keep and nurture this new role. according to horghagen and josephsson (2010) incorporating participants’ own stories into the performance facilitates the growth of respect and appreciation for themselves and each other, and may also be a foundation for their daring to trust others. by focusing the theatrical work on psychosocial issues regarding their own life situations, the actors also shared common experiences. their work throughout the year addressed challenges concerning such issues as stigma, isolation, feelings of social exclusion and oppression, and how to fight back as a group. by sharing stories they learned to see their own experiences as a source of knowledge – and to use them as material for the artistic and theatrical work. sharing stories also seemed to develop a mutual understanding of their life situations, and gave them the possibility to recognize their agency as a group njsr – nordic journal of social research vol. 7, 2016 60 who is able to transform their experiences and to share them with an audience outside the project. boal (1995, p. 16) emphasizes the importance of working on issues that are real and urgent in the lives of the actors, something in which ‘they have an investment, situations in which they venture their lives and their feelings, their moral and their political choices’. according to faigin and stein (2010) the commonalities in the lived experiences may serve as a mutually supportive function, creating an environment where processes of personal change can occur and group empowerment is enhanced. butler et al. (2013) hold that by, for example, sharing the performance, art, and concerts, the group affirms what they have learned and created. such documentation makes change more sustainable and confirms the participants’ newly developed views of themselves, communicates with others, and makes them part of society (butler et al., 2013). it was also essential that the audience included important adults and their peers, professionals from the norwegian labour and welfare service, teachers, persons who may have been affected by how they meet young people at school and in care systems (salmon & rikaby, 2014). inclusive theatre as contributing to social belonging and participation the findings concerning responsibility for others, being part in a joint project, the experience of community and reciprocity, and trusting others might be understood as social belonging. a sense of belonging can be defined as ‘a subjective feeling of value and respect derived from a reciprocal relationship to an external referent that is built on a foundation of shared experiences, beliefs or personal characteristics’ (mahar et al., 2013, p. 1031). a sense of belonging is related to a feeling of connectedness and fitting in somewhere, to a referent group, such as peers (mahar et al., 2013). according to these authors achieving a sense of belonging requires that the person perceives that he or she is valued, respected, and in other ways subjectively engaged. the findings illustrate that through the year of theatrical work the actors became an active part of the world around them and developed a feeling of having something in common. they developed a strong reciprocal relationship with other members of the group and with the staff. the members of the group learnt to communicate and cooperate with each other and to develop a feeling of community. they established themselves as an ensemble, working, playing and accomplishing something worthwhile together. gjærum and rasmussen (2010) emphasize the importance of creating a particular ‘us’ spirit, which is expressed through the fellowship of the group. the sense of belonging to such a fellowship prevailing at the theatre is, according to these authors, crucial to the actors’ selfunderstanding and self-image. mohler (2012) confirms the importance of having fun and play and claims that the opportunity to play is transformative. mohler elaborates that playing through the use of theatre games gives a break from the more serious aspects of the lives of the actors, and may assist the process of establishing a new kind of community with their peers based on the common experience of having fun. the experience of reciprocity through shared feelings, experiences, and understanding supported by the group is important in the creation of a sense of belonging (mahar et al., 2013). mahar et al. also emphasize the importance of having the power to self-determination and choosing whom you want to belong to. the findings show that there is a connection between feelings of community, social belonging, and social participation. faigin and stein (2010) emphasize that theatrical work offers a bridge between personal development and community integration for people with mental-health problems. they highlight that the inclusive nature of the theatrical setting connects the person to the local community. munford and sanders (2014) also focus this connection by pointing njsr – nordic journal of social research vol. 7, 2016 61 out that the feeling of being included in society and being able to exercise agency is connected to a sense of belonging and an ability to exercise citizenship. this is stimulated by being part of family and social networks, and having meaningful activities. however, the sense of reciprocity and belonging between the participants and between the participants and the leaders was to some extent put under pressure in the run-up to the performance. because of this pressure one participant dropped out because of stress. in this phase the leaders could have been more sensitive and taken more individual consideration with fewer demands on those who felt highly stressed. inclusive theatre has several aspects in common with other supported activities such as individual placement and support (ips) and green care for young people, such as the resource orientation, having the possibility to work with things you are interested in, getting support and supervision at the actual work place, gaining experience with coping, and being part of a community. young people’s experiences from participating in ips and green care are also in accordance with the actors who participated in this project. they too experienced increased coping ability, self-confidence, and a feeling of connectedness to others. yet one aspect seems to be different: inclusive theatre, in the form inspired by freire and boal, gives the participants the possibility to make their voices heard in the public arena, to work with resolving social frustrations and conflicts, and through consciousness-raising to be able to fight through difficult situations. implications for practice young people at risk have to be taken seriously by schools, nav, the workplace, and the health and social services. they need to be seen, understood, and followed up systematically. it is important that the follow-up is holistic and kept within the framework of everyday life. the support must stimulate the young people to take part in everyday life activities. the support must be adapted to the individual according to his or her life situation and potential. theatre and the use of several forms of art and exhibitions appear to work well as methods for social work with young people at risk. similar social-work projects could focus on young people at risk with other kinds of interests. it could be possible to develop other kinds of teamwork arrangements throughout a school year for young people. they could participate in groups together with adult teachers and coaches in activities, such as playing football, sailing, nature expeditions, and so on. a challenge for this endeavour would be to maintain the working form inspired by the liberating, inclusive ideology of augusto boal and paolo freire. projects over one year are not enough for this group of young people. we envisage that the project will go forward into a phase with increased demands and progressively connected to ordinary school and working life. at the same time, creative methods should have their place, but to a lesser extent. the youths are dependent on safe and predictive frames and long-term planning. njsr – nordic journal of social research vol. 7, 2016 62 implications for future research it would be interesting to see similar studies done on other related initiatives, such as alternative work training, development of alternative learning arenas outside of schools, and networks of support for youth in the process of being excluded. conclusion through increased self-esteem, the actors have explored opportunities to form their own development and to find a way to pursue further avenues as part of society. they have dared to meet the challenges which have provided them with good experiences and more meaning in their lives. they have gone through a social process of empowerment, recognizing, promoting, and strengthening their ability to satisfy their own needs, and involving a mobilization of the resources needed in order to feel in control of their own life. they have begun to believe in a future that includes education, work, and friends. acknowledgments we wish to thank professor anne lyberg for participating in the data collection and in discussing the preliminary data analysis. references andvig, e. 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(2009). creative inclusion in community theatre: a journey with odyssey theatre. journal of applied theatre and performance, 14(1), 79-90. world medical association (2008). the declaration of helsinki. ethical principles for medical research involving human subjects. retrieved from http:// www.wha.net/en/30publications/10policies/b3/. http://www.ssb.no/vgogjen http://www.wha.net/en/30publications/10policies/b3/ microsoft word harslã¸f, slomic, hã¥vold establishing individual care plans for rehabilitation patients njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 10, 2019 establishing individual care plans for rehabilitation patients: traces of self-targeting in the norwegian universal welfare state ivan harsløf * department of social work, child welfare and social policy oslo metropolitan university email: ivan.harslof@oslomet.no mirela slomic department of nursing and health promotion oslo metropolitan university email: mirela.slomic@hioa.no ole kristian sandnes håvold department of social work, child welfare and social policy oslo metropolitan university email: ole.havold@oslomet.no *corresponding author abstract several countries have introduced devices for coordination of complicated individual cases across care, health and welfare services. this study examined one such device: the individual care plan (icp), introduced in norway in 2001 to enhance user involvement and coordination across sectors and service providers. despite strong political imperatives, however, icps have remained significantly underused. to understand why, this study investigated the experiences with icps among staff in municipal coordinating units, tasked with organising rehabilitation efforts and caseworkers in local labour and welfare services. in focus groups, participants discussed the fictitious vignette of a patient with traumatic brain injury, a person clearly within the icp target group. they praised icps for advancing the rehabilitation process but acknowledged that they were applied too rarely. through abductive-retroductive recontextualisation, this study identified a practice of de-facto self-targeting: in some municipalities, patients had to request icps themselves. we argue that njsr – nordic journal of social research vol. 10, 2019 25 this mechanism may have emerged from ambiguous propensities of rehabilitation, simultaneously emphasising needs and potentials, and ultimately from ambiguities in the norwegian welfare model balancing universalism and local autonomy. keywords: critical realism, individual care plan, rehabilitation, social services, service universalism introduction to tackle the growing challenge of coordination and to enhance capacity in care, health and welfare services, recent decades have seen several countries launching initiatives to strengthen collaboration among actors representing different branches and levels of government (hanssen, helgesen & vabo, 2018; renner et al. 2018; rudkjøbing, strandberg-larsen, vrangbæk, andersen & krasnik, 2014). at the strategic level, agencies have entered into alliances, partnerships and formalised networks with each other and with nongovernmental actors. at the operational level, coordinating devices to manage individual cases have been established. in the law on patient rights (2001), the norwegian government has guaranteed the right to individual care plans (icps) for patients with extensive and long-term needs, thereby institutionalising coordination on the operational level (hanssen et al. 2018, p. 72). this initiative recalls similar efforts at service coordination in other nations, such as coordinated individual plans in sweden and individualised support plans for people with intellectual disabilities in several english-speaking countries, belgium and the netherlands (herps, buntinx, schalock, van breukelen & curfs, 2016). more generally, the icp resembles coordination devices for services for other social groups with extensive needs, such as municipal action plans drawn up for homeless persons in denmark (benjaminsen, 2017). icps should ensure the integration of services in cases involving several care providers and attune professionals to users’ needs and perspectives (normann, sandvin & thommesen, 2004). icps map patients’ needs and resources, set their priorities and goals, assess possible actions and measures, designate specific contact persons and clarify responsibility for the provision of different services. acknowledging that ‘[a]fter all, the user is not divided into sectors’ (ministry of health, 1998; our translation; section 3.2.3, para. 11), the device is considered to be instrumental in strengthening critical collaboration within and across care, health and welfare services. importantly, icps are meant to increase users’ control over their own cases. njsr – nordic journal of social research vol. 10, 2019 26 the law states that icps do not guarantee access to more services but ensure their coordination. in this sense, it constitutes a procedural rather than a material right (cf. hatland 2011).this right is further recognised in several related laws regulating the cross-sectoral fields of health, welfare and employment, particularly the 2006 law on work and welfare administration and the 2009 law on social services. this broad juridification demonstrates the importance of this device to national policymakers (grue & næss, 2012, p. 25). however, the provision of icps has been limited (kjellevold, 2014). a 2011 study estimated that as much as six times more icps should have been issued (bjerkan, richter, grimsmo, hellesø & brender, 2011). focusing on the case of patients with traumatic brain injury, this study explored experiences of icps among staff in municipal coordinating units tasked with organising rehabilitation and staff working with rehabilitation patients in local labour and welfare services. patients with traumatic brain injury generally face challenges in functioning and social and vocational participation, creating demand for a diverse set of closely coordinated services that icps can facilitate (andelic et al., 2009). this study examined the processes underlying the limited use of icps in a cross-sectoral context. few studies have considered such collaborative coordination devices from a cross-sectoral perspective, and there is a need to explore the mechanisms impeding their implementation (bjerkan et al., 2011; holum, 2012). adopting the approach of critical realism, we aimed to assess such mechanisms beyond the immediate empirical level. this approach suggests distinguishing between the empirical domain (what we experience and observe), the actual domain (what is happening) and the ‘real’ domain (the mechanisms behind what is happening) (danermark, ekström, jakobsen & karlsson, 2002). critical realism is intended to understand the causal powers of different material and immaterial entities. it argues that such powers may exist even if unexercised, and further, that they may be exercised but not actualised, i.e. producing an effect, due to other countervailing powers (o’mahoney & vincent, 2014). this approach is pertinent as coordination ultimately is an exercise of power (weber, 1971) that concerns not only the visible interactions among institutional actors but also their invisible mutual adjustments responding to or mutually anticipating choices and actions (vabo, 2010, p. 345). critical realism lends itself to the study of absence (bhaskar 2014), in this case, the absence of individual care plans. njsr – nordic journal of social research vol. 10, 2019 27 we used empirical data from a vignette study involving focus groups with staff in municipal coordinating units and labour and welfare services providing vocational rehabilitation. the former had primary importance as these units take decisions regarding icps. labour and welfare services typically enter at a later stage in the course of vocational rehabilitation. the vignette outlined the fictitious case of a patient with traumatic brain injury. to grasp the subject in more depth, we applied abduction and retroduction strategies. through these modes of inference, we recontextualised the case within the larger understanding of service allocation in a universal welfare state and discussed the conditions behind our empirical observations in the field. background the production and allocation of social services has been neglected in the general welfare state research, in which different systems of welfare have been appraised mainly through a focus on benefits (levels, duration and coverage) (jensen, 2011; martinelli, anttonen & mätzke, 2017). two partly inter-connected distinctions have arisen in the discussion on the principles of allocating welfare provisions, whether benefits or services: universal and targeted provision and centrally and locally organised systems. regarding the former distinction, comparative welfare scholars in the tradition from titmuss have proposed that the nordic welfare states approximate the universal ideal type (titmuss 1974; esping-andersen, 1990). in contrast to targeted welfare states that concentrate efforts on specially selected groups, the nordic countries are characterized by an approach that accommodates broad groups on the basis of citizenship. once an exclusively scientific concept, the notion of the nordic welfare states as universal has become integral to these states’ self-conceptions (øverbye, 2018). even amid rising demand for services, national authorities are increasingly embracing this idea (vike, 2018, p. 139). indeed, the notion of ‘service universalism’ is often applied to characterize nordic citizens’ access to health and welfare services irrespective of gender, age, social class and place of residence if they present a given need. however, to determine if the notion is valid, one should consider the actual service provision (vabø & szebehely, 2012, p. 122). regarding the distinction between centrally and locally organised systems, the nordic countries have been characterised as local autonomy centrally framed systems; while municipalities have a strong role in designing and delivering services, the state sets certain standards and ensures significant redistribution across territories (kazepov, 2010). this description fits the norwegian field of njsr – nordic journal of social research vol. 10, 2019 28 rehabilitation with services provided locally under terms stipulated at the central level (breimo, 2015, p. 14). while adhering to the principles of universalism, most welfare services are produced and delivered by relatively autonomous local authorities (vabo, 2014). norway has a long tradition of local autonomy, significantly strengthened by the introduction of block grant financing in 1986 (conferring municipalities with stronger financial control) and consolidated by the 1992 law of municipalities (conferring municipalities with stronger organizational control) (hanssen et al., 2018). the strong institution of icps as a right can be considered an attempt by the state to maintain universalist principles in the face of autonomous local authorities (vabo, 2014, p. 166). indeed, demonstrating the schism between universalism and local autonomy, local authorities long have openly objected to the state’s expansion of their citizens’ statuary rights to services (hatland, 2011). we, therefore, can conceive of the state and the municipalities as entities with countervailing causal powers. amid this negotiation of responsibilities, the county governor, the state’s representative in local governance, oversees the implementation of local coordinating units. regional audit reports (e.g. county governor of sørtrøndelag, 2013; county governor of buskerud, n.d.) have suggested that some municipalities have not satisfactorily established coordinating units, which are often not adequately visible to users and collaborating partners and sometimes lack staff training systems. regarding the lack of visibility, it should be noted that although the term unit invokes the image of a physical entity with an office address and position in an organisational chart, municipalities are free to set them up as they wish, including as part of existing structures. in practice, the coordinating units may operate as more virtual constructions (deloitte, n.d.). method and methodology this study considered the institutions set up to implement the goal set by national policy-makers to better coordinate services for users with complex needs. the primary entities considered were icps, the coordinating units charged with delivering them and their relationships to other entities such as labour and welfare services, general practitioners (gp) and the larger welfare state. we based the study on focus groups with professionals in municipal rehabilitation services and local labour and welfare services in south-eastern norway. focus group interviews, generally with three or four participants, were njsr – nordic journal of social research vol. 10, 2019 29 conducted in eight municipalities in 2015 and 2016.1 choosing to conduct focus groups instead of individual interviews served the interest in understanding the practices of the selected institutions (i.e. exploring the properties and relationships of the entities) rather than the practices of individual professionals. this study was part of a larger project exploring critical aspects of rehabilitation and the organisation of services. the project involved a user panel of representatives from user organisations who had personal experiences with traumatic brain injuries as patients or patients’ next of kin. we consulted the panel before the field study (during preparation of the vignette and the interview guide) and during the analysis of the preliminary results, as elaborated in the following sections. data collection relevant municipalities were identified based on information provided by specialised hospitals showing who had residents recently diagnosed with traumatic brain injury. possibly reflecting deficient implementation of the coordinating units (see the preceding considerations) in several municipalities, it proved difficult to identify these units in the local administrative structure and to find contact persons, let alone schedule interview appointments. we, therefore, could assume that municipalities where patients struggle to obtain icps due to the lack of well-functioning coordinating units were underrepresented in the data. the coordinating unit interviews arranged included both professional caseworkers and therapists working with rehabilitation patients (i.e. physiotherapists, occupational therapists and nurses). different professional groups (i.e. social workers and caseworkers with backgrounds in other social and administrative sciences) participated in the interviews with labour and welfare services staff (see appendix tables 1 and 2). as a point of departure for the interview, we used a vignette describing a hypothetical scenario involving a patient with traumatic brain injury. using vignettes is an appropriate alternative in situations where it is difficult to get data on decisionand judgment-making (morrison, stettler & anderson, 2004). to 1 due to last-minute cancelations, two focus group interviews with labour and welfare services staff had only two participants. although this sample size was too small to constitute a focus group, we judged the information generated to have value and retained it in the data. njsr – nordic journal of social research vol. 10, 2019 30 improve validity, the vignette, following wilks (2004), was developed in close collaboration with rehabilitation practitioners, as well as the project’s user panel. the vignette detailed a 34-year-old carpenter’s health condition (traumatic brain injury, cerebral haemorrhage and temporary paralysis in the left extremities), treatment and social situation (married, two children). his gp declared him 100% disabled for the time being. the vignette patient reflected a realistic case in terms of socio-demographics and cause of trauma based on epidemiological studies (brazinova et al., 2016) and was clearly in the target group envisaged in the law introducing icps (hagen & johnsen, 2013, p. 40n). the interview guide explored how the participants likely would handle the case. what concrete actions would they do? what information and documentation would they request from other actors and agencies? what mapping and evaluations would they undertake and commission? how would they judge the case patient’s potential for recovery and labour market reintegration? we used several probing questions to follow up on responses. analytical approach inspired by the philosophy of science position of critical realism, we adopted the analytical strategies of abduction and retroduction. unlike induction, abduction entails taking a point of departure in data derived from a theory-informed research agenda, but unlike deduction, the analysis is not tied to hypotheses formulated before data collection. abduction, therefore, is a ‘creative inferential process’ aimed at producing new hypotheses from unanticipated empirical observations (timmermans & tavory, 2012, p. 167). retroduction offers a framework for analysing such observations in a manner sensitive to the wider context of the phenomenon under study (bunt, 2016). retroduction entails recontextualisation, a mode of inference that assesses the properties of a certain phenomenon at a higher level of abstraction (danermark, et al., 2002). thematic analysis was conducted to construct common categories from the empirical data in the study participants’ accounts of using icps and related practices for handling cases. we condensed the initial codes into analytical categories describing the functions and the usage of icps in practice. in critical realism terminology, these procedures of making categories from observations represent an interpretive move from the empirical (what we observe) to the actual (a reading of the state of affairs) domain. this move involves ‘a process of inference from lay (first-order) to sociological (or second-order) accounts of the social world’ (scambler, 2002, p. 11). njsr – nordic journal of social research vol. 10, 2019 31 in making these inferences involving critical appraisal of first-order accounts (how the professionals described their practice of working with rehabilitation patients and using/not using the icp), we also drew on secondary literature (other studies from the field). moreover, we leaned on discussions with the user panel, whose comments on the data guided our analysis. going beyond the fixed corpus of interview data in such a manner, is suggested by smith and elger (2014, p. 120), in their account of the critical realist approach to the interview method. the approach is especially warranted when the primary data are derived from vignette-based interviews as this method carries the risk of not obtaining an accurate account of actual practice (wilks, 2004, p. 82). the next step of going from the actual to the real domain necessitates an interpretive discussion of these categories in light of relevant concepts and theories. critical realism views the social world as an open system, stratified into layers with emergent properties (o’mahoney & vincent, 2014). adopting the notion of open systems requires acknowledging that we face a dynamic social world in which institutional actors constantly make adjustments (danermark et al., 2002). understanding professional practice, therefore, requires considering the wider perspectives of the organisational and social contexts. given that macro factors are ‘interlocked with social activities’ (layder, cited in bunt, 2016, p. 5), the interpretive discussion becomes a process of teasing out these macro-level structures from micro-level observations.2 sayer (1992) suggests guiding this process by posing simple questions on the nature and preconditions of the phenomenon being studied. in this study, we asked: what do icps presuppose? what are their causal properties? how are they supported or suppressed within the larger social context? empirical analysis the individual care plan as a resource in the rehabilitation process the professionals participating in the focus group interviews generally approached the vignette case from a holistic perspective. they discussed 2 the critical realism analysis presented in this article is only partial. a full analysis would also include analytical moments of elimination and identification involving critical assessment of the plausible mechanisms suggested by the process of retroduction. such assessment might demand use of more refined perceptual instruments (bhaskar, danermark & price, 2018). njsr – nordic journal of social research vol. 10, 2019 32 aspects such as the person’s bodily impairments, physiotherapy, coping strategies, reduced capacity, need for income support and mental health treatment, support for his wife and family and potential for a gradual return to work. the participants all pointed to several services in addition to their own from which the patient and his family could benefit. they thus generally demonstrated a caring, supportive approach and considered the user’s problems and needs from many different angles. in the interviews with coordinating unit staff, icps stood out as significant resources for those users who received them. among other factors, the professionals considered icps to be a resource supporting a holistic approach towards users’ situations: what is so brilliant about the coordinating meetings and the individual care plan is that you get insight into the user’s situation in its entirety. because many general practitioners participate in the coordinating meetings, some may not be able to participate [in the meetings], but still they contribute by providing information. (cou4) this apparent characteristic of icps should be emphasised as previous research has suggested that the actors involved in rehabilitation think that the lack of a holistic approach causes setbacks in the rehabilitation process (harsløf, søbjerg nielsen & feiring, 2017). importantly, in the eyes of the professionals we interviewed, icps seemed to be instrumental in bringing users’ gp to collaborate with the other service providers. consequently, the gps attended meetings or were at least kept in the critical circulation of case information. sometimes gps even took on the role of coordinator. previous research has indicated that other actors involved in the rehabilitation process have difficulty obtaining constructive collaboration with gps (håvold, harsløf & andreassen, 2018). the involvement of gps facilitated by the icp framework, therefore, might make critical differences in approaches to cases and provide additional support for the rehabilitation process. the professionals praised icps for providing a setting that stimulated decisionmaking: it works. we never leave a meeting without making decisions. (cou4) however, other research participants emphasised that icps themselves were no guarantee of coordinated action: an individual care plan is great for those who need it when it is used. however, there are many such plans just lying in the drawer, and then they are not worth the paper they were written on. (cou5) njsr – nordic journal of social research vol. 10, 2019 33 an important relevant point emphasised by one interviewee (cou4) was that what ultimately mattered was not the plan but the services. when asked about the vignette patient, most coordinating unit professionals said that it would be appropriate to establish an icp in this case: he would ... the whole situation would profit by having a kind of structured plan regarding his follow-up. there is no doubt about that! (cou8) it’s great for those who get it, and probably many more ought to have it. (cou1) labour and welfare services staff may occasionally be invited into the icp process to coordinate decisions with implications for users’ economic maintenance and participation in return-to-work measures. from the perspective of the staff members working with this group of users, icps also appeared to constitute a salient resource for users. they stressed the need for a designated person to ‘pull the strings a little’ (lws8) to set in motion, follow up and coordinate various services. referring to the patient group (patients with traumatic brain injury) represented in the vignette, a focus group participant noted: this group has a very strong need for a coordinator who can help them find their way back into mainstream society where they are to go after rehabilitation. (lws7) while acknowledging the importance of collaborating with labour and welfare services in the case at hand, the professionals with the coordinating units critiqued communication with this agency as arduous: they are not easy to get hold of. … i’ve send reports to the caseworker, but i don’t get any response on whether she got them at all and whether she has looked at them. i don’t get anything back. (cou2) they [labour and welfare services] find it difficult to attend meetings … when they are here, they sort of ask us to focus on the economic issues … then i think we’re losing the inter-professional element. … then they are not involved in the case in its entirety. (cou3) in one municipality, labour and welfare services were formally integrated into the overall coordinating efforts and represented in the coordinating unit. the participants attributed the coordinating unit’s success in making concrete agreements on sharing responsibilities for individual cases to this arrangement. njsr – nordic journal of social research vol. 10, 2019 34 limited usage in some municipalities although the professionals saw icps as significant resources for users, several focus group participants acknowledged that they too seldom used icps. to be honest, there are not many in this patient group that have an individual care plan here. … so we have a big job ahead of us, but i reckon that as of today, this guy [from the vignette] wouldn’t have gotten an individual care plan. (cou8) remarkably, some focus group participants reported that they used icps more immediately after their introduction in the early 2000s. participant a: it was used much more before, i think, … when it was new, and we were instructed by the law to use it, i would almost say. participant b: well, we are still instructed by the law now. participant a: yes, i know that, but … at least among the users i’ve got, we used it much more before. (cou3) this exchange shows that while the professionals were aware that patients’ right to icps had been instituted, they in practice had a great deal of discretion in deciding whether to provide icps. arguably, the exchange gives insight into the dynamics in open systems, in other words, how the institutional actors adapted, from the response to the initial stimuli of the law’s introduction (‘when it was new’) to apparently longer-term resignation, drifting towards the previous equilibrium. labour and welfare service staff working on rehabilitation cases seldom mentioned the topic of icps or even the municipal coordinating units in the focus group discussions. we can tentatively attribute this absence to deficient implementation of visible coordinating units and the icp instrument. indeed, these staff members evinced a more general concern about the common lack of coordinating arrangements for the type of patient featured in the vignette: this is where things start becoming a little difficult. in a way, it is difficult to see who is to be the coordinator at any given point in time. soon there are many who are pointing at each other because it is not very clear who is to sit in the driver’s seat. (lws7) the observation that designating a coordinator often ended with different actors ‘pointing at each other’ also surfaced in a study on social workers working in specialised rehabilitation hospitals (harsløf et al., 2017). the reason might be that the coordinator carries large responsibilities being accountable for the various service providers’ efforts, or lack thereof, to implement the plan (breimo, normann, sandvin & thommesen, 2015). njsr – nordic journal of social research vol. 10, 2019 35 in addition to the problem of designating coordinators, the interviewees suggested several other reasons why icps were seldom applied. the professionals argued that drawing up these plans was cumbersome, and few employees possessed the skills and competencies to do so: you have to follow the formal lines of direction—it needs to be set up; it needs to be registered; it needs to be reported. it’s very complicated… a lot of the staff here don’t know how to do it. (cou1) it’s a lot of work. yes, if it’s done properly in collaboration with the patient, it takes a lot of time. (cou3) the interview material did not contain further information on the kinds of skills needed to implement icps, but the literature review and discussions with the user panel suggested that information and communications technology skills and knowledge about privacy laws were important, among others (cf. hollingen, 2008, pp. 29-31; kjellevold, 2002, p. 61). several interviewees stated that they did not take the initiative to draw up plans unless users actively requested them: it is only when the users are very determined that they want a plan that they get it... because we think that perhaps they would benefit from [an icp], but there is no one who encourages them if they do not ask for it. ... they have to be very determined, saying ‘i want to have this’ to get it. (cou3) in cases of severe injuries, we ought to use it [an icp] to a greater extent, but then someone has to initiate it. either the user ought to ask for it or a relative. (cou1) some municipalities seemed to have a practice requiring users to come forward and express a desire for icps. the material was not in full unison on this point. in one case (cou6), a research participant declared that contrary to this practice, she did much to actively persuade patients’ relatives to accept icps. however, our observation that the staff in some municipalities were reluctant to initiate icps without explicit requests from users or their relatives has been corroborated by experiences reported elsewhere (osgjelten & wirak, 2004, p. 48). a recontextualisation the individual care plan as a boundary object the critical realism approach discourages reifying the object studied. hence, whereas an empiricist would ask whether an icp has been established (treating njsr – nordic journal of social research vol. 10, 2019 36 it as a discrete event), critical realism encourages us to emphasise the perspectives of the research participants that argue that what ultimately matter are the services delivered through the plan. a plan just ‘lying in the drawer’ has no real value, while other local practices can facilitate coordination and user involvement even in the absence of a formal plan. critical realism also distances itself from post-structural positions solely focused on how the semiotics of planning devices construe users and their needs. leaning on the participants’ testimonies, therefore, it should be acknowledged that icps, when implemented, constitute a critical resource in users’ rehabilitation. the research participants credited icps for improving the conditions for decision-making, bringing holistic perspectives to bear on cases and facilitating collaboration among significant actors and organisations. theoretically, such causal properties can be understood with reference to the notion of boundary objects (star, 1988; star & griesemer, 1989). boundary objects are repositories of information that sustain common representations among actors with different professional backgrounds and institutional affiliations. these constructs are supposed to be sufficiently robust to be valid across actors while sufficiently adaptable to be useful to all the actors. icps approximate boundary objects as they assemble and structure comprehensive information about users’ aims and needs, the services and their potential and make this information available to all the participating actors. returning to the viewpoint that what really matters is the services (rather than the plan document itself), we can think of the icp-induced activities of mapping needs and measures and the emphasis on user involvement as likely facilitating better access to services; it may be easier to substantiate a claim for a service, when it is prescribed in an icp (see breimo et al., 2015, p. 45). icps’ nature as boundary objects might further reinforce this mechanism. rooted in a plan with institutional recognition across professions and sectors, a need articulated by one institutional actor can be more easily appreciated by another. this mechanism is an important causal property as it transforms the icp from a procedural right into a vehicle for realising material rights to services. a case of self-targeting? despite the general praise, it seems that in several cases, persons with complex needs, as in the vignette case, would be unlikely to receive icps. in some municipalities, icps are provided based on de-facto self-targeting: users have to request them and demonstrate strong motivation. patients with traumatic njsr – nordic journal of social research vol. 10, 2019 37 brain injury, however, likely have limited capacity for such self-direction due to their physical and mental state and the stressful social situation they find themselves in (finset, dyrnes, krogstad & berstad, 1995). to understand the observed reluctance to establish icps, we may first look at what is at stake for local service providers. according to leutz (1999), most efforts to integrate health and social services initially entail additional costs. regarding icps, we can think of the costs of the extra administrative work involved, efforts to bring service providers together and, as discussed, increased services that users might ultimately be able to access. the interviewees did not specifically refer to funding issues, but we note that they did mention a lack of suitably qualified personnel and the strain on municipal service providers working with icps. moreover, ensuring integration for some, leutz (1999) notes, necessarily involves fragmentation for others. even if we conceive of icps as relatively adaptable boundary objects, by contributing to the integration of services, the work situation of the service personnel involved is likely to become more fragmented. involvement in implementing icps, particularly as coordinators, sometimes makes personnel operate at the margins of their professional expertise. they must expand their knowledge and accommodate users’ specific situations (in this regard, see danermark, 2004, p. 31). moreover, the emphasis on strengthening user involvement through icps may itself be experienced as a threat to the professionals’ power (kortteisto, 2017). if we conceive of the practice of issuing icps as, in some municipalities, approximating de-facto self-targeting, we may ask what the conditions constituting this practice are. whereas conventional targeting identifies the neediest cases, self-targeting adds the twist that the claimant needs to act in a required manner in order to enter the target group. hence, self-targeting is ‘designed in such a way that only members of the target group find it worthwhile to participate … the incentives to participate are themselves the screen’ (haddad & kanbur, 1992, p. 374). undertaking the required activities may reflect needs but also the degree of motivation and capacity to make sufficient usage of services. in other words, self-targeting may be a means to ration icps and the services to which icps may ease access, favouring those with the potential to actively participate in the plan to self-reliance. in sum, icps appear to have critical causal properties important to rehabilitate patients but consequently put strain on service providers and local social njsr – nordic journal of social research vol. 10, 2019 38 services, which may explain the reluctance to implement icps and the practice of de-facto self-targeting identified in some municipalities. conclusion many countries have introduced devices intended to coordinate services for groups with complex and long-lasting needs. understanding how such devices are implemented and function is important to grasp the mechanisms through which social services are allocated. norwegian national policymakers have made icps an important initiative to foster cross-sectoral coordination and user involvement in complex patient cases. however, local application of icps has so far not reached the anticipated level. this study considers icps to be entities possessing causal properties within a system of interrelated institutions. we, therefore, identify mechanisms that may explain this underuse. the service professionals regarded icps as instrumental in creating momentum in physical and vocational rehabilitation. they viewed icps as facilitating more holistic approaches to cases and settings conducive to concrete decisionmaking. they reported that icps attract and gain commitment from important actors, such as gps, and enable better communication across sectors. to understand these causal properties of icps, we suggest considering them as boundary objects. as such, they potentially ease access to social services as claims articulated in plan documents are more easily recognised by actors in different sectors. however, corroborating findings from previous research (kjellevold, 2014; bjerkan et al. 2011), the service professionals acknowledged that even a person in the prime target group, such as the vignette patient, might be unlikely to receive an icp. it appears that in some municipalities, users—despite having limited capacity for self-direction—are expected to come forward themselves and demand icps, which the municipalities are reluctant to offer as a matter of course. we take such practices to indicate de-facto self-targeting; users, in a sense, are screened, and access is granted only to those capable of agitating for themselves. the empirical material suggests that establishing and operating icps requires time and certain competencies. screening may ration such scarce resources and ensure that the selected recipients have both the need and the potential to benefit from comprehensive services. while self-targeting can be explicitly adopted as a strategy to allocate scarce resources, we use the term metaphorically as part of a creative recontextualisation (jacobsen, 2015) of our observations from the field. further studies njsr – nordic journal of social research vol. 10, 2019 39 are needed to assess whether the notion of self-targeting is suitability for understanding the local allocation of rehabilitation services, preferably by investigating users’ experiences. further studies should also investigate whether practices accommodated by this concept are performed in other user– welfare state interfaces.3 in addition, researchers could consider how the insufficient implementation of icps is justified in wider municipal contexts. for instance, how does local social services management articulate expectations as regards the level of icps being drawn up? a potential macro-level factor lurking in the practice of coordinating services for rehabilitation patients is the schism between universalist principles and strong local autonomy in the norwegian welfare state. the universal welfare state kind of reckons without its host, establishing icps as a universal right in numerous healthcare, labour and welfare regulations while leaving it up to municipalities and ultimately service professionals to implement this measure, and carry the extra costs. however, considered at a more abstract level, we may be observing a self-maintaining (autopoietic) system that seems able to uphold the perception of a universal welfare state precisely by resorting to mechanisms of de-facto self-targeting in local service delivery. critical realism guides us to consider the nature of this service-planning device, the relationships among the service providers that constitute it and thus what is at stake in decisions involving it. the approach allows us to acknowledge that simply calling for new measures to ensure that all those entitled to icps receive them does not necessarily accommodate users’ needs without a corresponding increase in the availability of staff, including gps and labour and welfare service professionals to follow them through, let alone an increase in available social services. the open system approach entailed by critical realism makes sense of the observed practices, particularly how institutional actors adapt to systemic changes and gradually game the process (as exemplified in that coordinating 3 for example, a recent norwegian study gives reasons to ask whether self-targeting is practised in the allocation of aftercare services to young people ageing out of foster care (valset, 2018). unlike for icps, receiving aftercare is not a right, but child welfare services (cws) has been instructed to determine the needs in all individual cases. analysing administrative data, valset finds a curvilinear relationship between young adults’ resources (reflected in school performance, such as grades) and likelihood of receiving aftercare. she suggests that the remaining careleavers may ‘lack the knowledge and motivation for seeking further support from the cws at this age and then “sign out” of the system prematurely’ (valset, 2018, p. 13). njsr – nordic journal of social research vol. 10, 2019 40 unit that initially used icps frequently, ‘when it was new’, but later less so, despite the law being the same). however, even if we interpret self-targeting as a strategy adopted by single caseworkers, rather than an individualistic coping mechanism, the critical realism approach leads us to consider it to be the working of an institutional agent (the coordinating unit) within a larger social context (the municipal and ultimately national frameworks). in view of critical realism’s concern for absence (bhaskar 2014), the apparent lack of visible, well-functioning coordination units in some municipalities should be emphasized. hence, this lack may in itself contribute to the icps’ underuse; targeting oneself for the icp service becomes even more challenging when it is difficult to locate the service provider. moreover, in more traditional analytical approaches, the simultaneous existence of municipalities that readily offer icps and municipalities that exhibit selftargeting practices would be conceived of as phenomena cancelling out each other. however, critical realism guides us to infer that self-targeting exists as a latent mechanism even if it is not always exercised. as to the critical element in critical realism, this study gives reason to raise questions about the nordic welfare states’ self-conception regarding service universalism. when universal welfare rights proclaimed nationally are not sustained by sufficient local resources, it might result in de-facto self-targeting arrangements that mainly benefit users with strong self-direction or relatives who can act on their behalf. in norway, through measures introduced under headings such as ‘collaboration reform’,4 ‘coordination units’ and ‘individual care plans’, national policymakers have articulated a rather harmonious perspective on social services production and allocation, implying that recurring problems are solvable through better collaboration, coordination and planning. what is downplayed is the perspective that services are produced, delivered and consumed by actors who have something at stake (may & winter, 2007) and are dependent on inherently scarce resources, leaving it to local actors and ultimately service professionals, in their capacity as rationing agents, to cope with these societal contradictions (houston, 2001). 4 in english, this reform is usually called the coordination reform. however, the term collaboration is closer to its norwegian name, samhandlingsreformen (hanssen et al., 2018, p. 175). njsr – nordic journal of social research vol. 10, 2019 41 acknowledgements this research was part of the project transitions in rehabilitation: biographical reconstruction, experiential knowledge and professional expertise, financed by a grant from the research council of norway (grant no. 229082). we thank project leader tone alm andreassen and the team for their valuable contributions. we also thank may-britt solem for comments and support. finally, we thank the three reviewers and nordic journal for social research’s editorial team for their extensive and valuable comments. appendix table 1: overview of the focus group interviews with coordinating unit staff professional background of the study participants registred nurse physical therapist occupational therapist auxiliary nurse social worker, cultural worker or social educator cou1 city district, 24,000 inhabitants 1 1 1 cou2 city, 65,000 inhabitants 2 1 2 1 cou3 rural municipality, 10,000 inhabitants 1 2 1 1 cou4 city in a rural district, 25,000 inhabitants 2 1 1 cou5 city in a rural district, 30,000 inhabitants 1 1 1 2 cou6 city, 45,000 inhabitants 1 1 1 cou7 rural municipality, 52,00 inhabitants 2 1 cou8 city district, 27,000 inhabitants 2 2 1 table 2: overview of focus group interviews with local work and welfare services staff educational background of the interview participants master’s in social sciences* social work/social education health sciences law other lws1 city district, 48,000 inhabitants 2 1 lws2 suburban municipality, 60,000 inhabitants 1 1 1 2 lws3 rural municipality, 10,000 inhabitants 3 1 lws4 city, 80,000 inhabitants 1 2 1 1 lws5 rural municipality, 13,000 inhabitants 2 lws6 city in a rural district, 30,000 inhabitants 1 1 1 lws7 city, 50,000 inhabitants 1 1 1 lws8 city district, 45,000 1 1 njsr – nordic journal of social research vol. 10, 2019 42 * political science, sociology or criminology njsr – nordic journal of social research vol. 10, 2019 43 references andelic, n., hammergren, n., bautz-holter, e., bautz-holter, e., sveen, u., brunborg, c., & røe, c. 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[is selectivism better than universalism?] norsk sosiologisk tidsskrift, 2(1). https://doi.org/10.18261/issn.2535-2512-2018-01-04 microsoft word pdf ãÿverlien young peopleâ•žs experiences of violence and abuse njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 11, 2020 young people’s experiences of violence and abuse in same-sex relationships: understandings and challenges carolina øverlien* norwegian center for violence and traumatic stress studies (nkvts) dept. of social work, stockholm university email: carolina.overlien@nkvts.no abstract studies on youth intimate partner violence (ipv) issues have been increasingly published during the last few years. however, research on ipv in same-sex relationships among youths is limited. the aim of this article is to expand this knowledge base by exploring the voices of four youth exposed to ipv in same-sex relationships, investigating the similarities to violence in heterosexual relationships and shedding light on the complicating factor of sexuality. the listening guide analysis used in this article reveals that, although the dynamics of yipv are similar to heterosexual relationships, participants experience responses from their immediate social network that reflect heteronormativity and homophobia, and result in participants’ feeling like a burden. furthermore, the findings of the analysis show that dominant social discourses on men’s violence against women may become barriers to help-seeking. thus, professionals need to gain knowledge of the unique challenges experienced by sexual minority youths exposed to ipv to prevent the issue and support those that experience it. moreover, qualitative researchers need to further develop an understanding of the lives of youths exposed to ipv in same-sex relationships. keywords: same-sex relationship, youth intimate partner violence, listening guide analysis, heteronormativity, lgbt, homophobia 110 njsr – nordic journal of social research vol. 11, 2020 i had my best friend mimi who lived in the big city i had posted pictures on social media so she called me wondering why i had not told her i was in the city i don’t remember much of that day but it ended with him kicking me outside of the large department store i remember there were lots of people there i remember being all bloody i had bruises on my legs i had no family close by i called mimi i just cried the ‘i-poem’ above is from a research interview with magnus, a 21-year-old young male who experienced severe violence and abuse from his former boyfriend. the poem is applied in the analytical method used in the project reported in this article. furthermore, the poem shows how young people in same-sex relationships can become victims of intimate partner violence (ipv) and that ipv can take place in the midst of all us such, such as on a busy street outside of a department store.1 studies on young people’s exposure to ipv have increased during the last few years. particularly, research interest has focused on measuring the prevalence of ipv, screening its behavioural and mental health consequences and investigating its associated factors. studies have reported alarmingly high rates of adolescents and young people’s exposure to ipv (see, for example barter et al., 2017), increased risk of shortand long-term behavioural and mental health problems (barter and stanley, 2016) and associated risk factors, such as a partner being older (hellevik & øverlien, 2016). in addition to face-to-face physical, psychological and sexual violence, exposure to violence and abuse through social media, such as instagram and snapchat, has received increased attention in the literature in the last few years (barter et al., 2017; hellevik, 2018). 1 within this field of research, different concepts of age are used (e.g. adolescents, youth, young people and teenagers). in this study, the participants are 17–23 years old and, therefore, will be consistently referred to as ‘youth’ and ‘young people’. when referring to research where other age-related terms are mentioned, the respective concept will be used. in addition, in the literature, two main concepts are used for violence in young people’s relationships: ‘youth/teenage intimate partner violence (and abuse) and ‘(teen) dating violence’. i will use the term youth intimate partner violence (ipv) in this paper, when studies using other terms are not referred to. 111 njsr – nordic journal of social research vol. 11, 2020 although the number of studies has increased considerably (barrett, 2015), as noted by donovan and hester (2015) and messinger (2014), there is still a considerable lack of studies on violence and abuse in same-sex relationships, and many questions remain to be answered. i argue that this finding is particularly true for youth victims such as magnus.2 young people’s exposure to ipv in same-sex relationships has been recognized only recently. this recognition may be due to reticence among the lgbtq community (as suggested by donavan and hester [2015] and irwin [2008]). however, it may also be due to methodological challenges, such as small sample sizes, reluctance among young people to define themselves as gay, lesbian or bisexual and fear of homophobic reactions if consenting to participate in research (mcclennen, 2005). however, studies measuring ipv prevalence show that sexual minority youths experienced equal or higher risk for physical dating violence victimization compared with youths who identify themselves as heterosexual (cf. dank et al., 2014). a few qualitative studies have been conducted that provide insights into the nature and dynamics of sexual minority youths exposed to ipv. gillum and difluvio (2012) conducted focus groups in the us with 18 sexual minority youths between 18 and 24 years old. the participants described four themes that contributed to ipv in same-sex relationships: homophobia, negotiating stereotypical gender roles, assumed female connection and other relationship issues, such as jealousy. pentaraki’s (2017) study in northern ireland on 12 lgbt teenagers between 16 and 22 years old focused on barriers to helpseeking. in six individual and two focus group interviews, the young people identified numerous barriers, such as fear of double disclosure. in a us study, 11 focus groups were conducted on 86 victimized young men who identified themselves as either gay or bisexual. the narratives provided different dynamics of violence, such as escalation into increasingly severe violence over 2 the participants in the present study have experienced violence and abuse from their same-sex partners. therefore, the term ‘same-sex partner’ will be consistency used in this article. furthermore, the term ‘sexual minority youth’ will be used when discussing all youth with sexuality other than heterosexuality. however, when referring to studies where other groups are discussed or where the author uses different terms, these respective terms will be used. two female informants in this study have had intimate relationships with young men. ipv against bisexuals have received increased attention in the literature (cf. heimer et al., 2018) and will be addressed when discussing the case of tone (for a discussion on categories, see messinger, 2014). 112 njsr – nordic journal of social research vol. 11, 2020 time (kubicek et al., 2016). in a uk study, donovan and hester (2008) interviewed 67 adults with same-sex ipv experiences. in an analysis of the young adults, the authors emphasised the role of the education sector in addressing ipv issues. that is, the young informants lacked embeddedness in the lgbtq community and knowledge of what to expect in relationships. however, the us, the uk and northern ireland differ from scandinavia in terms of laws, policies and norms affecting the lives of sexual minority youths. norway and sweden are considered “gay-friendly” concerning laws and policies at all levels of society (ilga, 2015). a recent study conducted in norway concluded that the number of people with negative attitudes has declined from 20 percent in 2008 to nine percent in 2017 (bufdir, 2017). however, ignorance and prejudice remain as argued by gay rights groups, such as the swedish federation for lesbian, gay, bisexual, transgender, queer, and intersex rights (rfsl). many questions related to the understanding of ipv in sexual minority youths remain uninvestigated to a large extent as most research on young people has treated youth as a homogenous group. this research was conducted to contribute to the expanding knowledge base of ipv by interviewing youths with ipv experiences from their same-sex partners and examining the similarities of their experiences to those in heterosexual relationships. moreover, this study also aims to shed light on the complicating factors of sexuality. thus, the following research questions need to be addressed to achieve the aims of this study: 1. what are the young people’s experiences of ipv, and how do they understand it? 2. what are the specific challenges related to the issue of ipv, when experienced in same-sex relationships? and how does being young in a heteronormative society impact the ipv experience? concepts and theoretical framework intimate partner violence the world health organization (who) defines ipv as ‘…any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship’ (who, 2012: 1). research on youths with ipv experience has established the issue of digital violence, which is referred to in this study as a form of psychological violence and often with sexual 113 njsr – nordic journal of social research vol. 11, 2020 connotations (see øverlien et al., 2019). however, this article shows that one of the complicating factors of ipv is the different interconnections of various forms of violence and abuse, which contribute to multiple forms of contexts and victimhood of ipv. youth and heteronormativity youth is the period between childhood and adulthood, when young people explore opportunities in school, in the workplace and intimate/romantic relationships (arnett, 2000). during this stage, young people begin to form their identity, for example by finding one’s sexual identity. the desire for exploration and greater independence combined with limited experience may also bring young people in vulnerable positions that contribute to risk behaviours, such as extensively using alcoholic substances, experimenting with drugs and meeting strangers online for sexual encounters. in addition, research has found that young people report that they are not taken seriously by adults; that is, their negative experiences, violence and abuse, are not addressed, and their voices are neither heard nor respected (hellevik et al., 2015). sexual minority youths’ development of healthy and positive sexuality in a heteronormative society may include discrimination and homophobia, thus making this stage even more challenging (gillum and difulvio, 2012). their state of being young may place them in an inferior position in addition to being part of sexual minority groups. heteronormativity recognizes that heterosexuality is the norm, which may not only impact and complicate young people’s identity formation but also lead to bullying, ostracism, violence and abuse (marrow, 2004). in addition, heteronormative beliefs and notions of manhood and womanhood can place sexual minority youths in a vulnerable position (chung, 2007). based on the concept of ‘minority stress’, which is wellstudied in the literature (meyer, 2003), heteronormativity is one of the main external stressors that may greatly affect the lives of sexual minorities (for a critique, see donovan and hester, 2015 furthermore, when the dominant discourse (understood here as a network of norms expressed through talk), that structure the social organization of society and as a consequence is intimately connected to power, is heteronormative, all other experiences are excluded. methods the present study is part of two closely related studies on intimate relationships among young people conducted in sweden and norway. safeguarding 114 njsr – nordic journal of social research vol. 11, 2020 teenage intimate relationships (stir) is a study of teenage ipv and abuse that includes five european countries, namely, england, italy, bulgaria, cyprus and norway.3 the author of this current study leads the research conducted in norway (part of stir) and sweden.4 a total of 21 teenagers between 15 and 18 years and 18 young people between 18 and 23 years, all with ipv experiences, were interviewed in the studies in norway and sweden, respectively. the same interview guide, with minor adjustments, was used in both countries. one participant informant in norway and three in sweden had experienced ipv in a same-sex relationship. the four interviews were selected as data for the present study. young people with ipv experiences in heterosexual and, particularly, in samesex relationships can be considered as a ‘hard to reach’ population. in spite of a large network, support from organizations working with and for sexual minorities, and numerous meetings and contacts with key persons in that community, the researcher experienced serious difficulty recruiting participants. after more than two years of active recruitment, four participants were recruited through a support service for young people, school activity and an advertisement published in a newspaper and on facebook. the author and a doctoral student conducted two interviews, respectively, in a location chosen by the participants. to stimulate narratives, ‘teller-focused’ interviews were applied (hydén, 2014) using an interview guide organized in themes. as a result, the narratives were explorative rather than informed by theory. that is, the informants were asked to describe their experiences and possible challenges rather than providing them the definitions of such experiences and challenges. the stories told are perceived as co-constructions because they were told in interaction with the interviewer. hence, they are contextual, fluid and shaped by the time and situation they were told within (hydén, 2014; plummer, 1995; riessman, 1993). 3 the study was funded by the daphne iii programme of the european commission. the norwegian segment was also funded by the norwegian ministry of children and families. 4 the study was funded by the swedish crime victim compensation and support authority and children’s welfare foundation sweden . 115 njsr – nordic journal of social research vol. 11, 2020 as a method of analysis, i used the listening guide (doucet and mauthner, 2008; gilligan et al., 2003; woodcock, 2016) and its four stages of analysis. as described by woodcock (2016), the listening guide focuses on uncovering complexities by conducting multiple readings and using different stages of analytical tools. the stages of analysis help uncover the multitude of voices— at times contradicting—that individuals have about their experiences. i used the listening guide in the following manner: stage 1) listening to the plot—the basic grounded theory question was asked, ‘what is happening here?’ while developing master themes, listening to silences, pauses and changes in voice tone and focusing on my ’reader response’; stage 2) creating ipoems— omitting all texts other than those focused on ‘i’ (see ingress) to focus on the active ’i’, the narrator of the story and how he/she speaks about himself /herself and his/her social world; stage 3) searching for the relational narrated subject— exploring the subject’s social network and his/her relation to other subjects; and stage 4) reading structured subjects—shifting the attention to the power relations described, dominant ideologies and discourses that frame the narrative and the subject’s manner of negotiating and positioning him/herself with regard to these power relations. stages 1 and 2 were used to bring forward the violence and the subject’s understanding thereof (research question 1), whereas stages 3 and 4 were used to identify specific challenges related to the ipv in same-sex relationships (research question 2). ethical considerations ethical considerations were of utmost importance in the two projects. ethical guidelines were not used as a checklist but were considered throughout the entire project. the participants received written and oral information about the project before deciding whether to participate. the age limits for independent consent are 15 years in sweden and 16 in norway, respectively. thus, all four participants were qualified to give independent consent. the interviewer remained attentive to the risk of over-disclosure, possible distress caused by the interview and ongoing consent (if the participant wished to participate throughout the interview). one criterion for potential participants was that the abusive relationship had ended. participants’ personal identity information, such as names and locations, has been modified. 116 njsr – nordic journal of social research vol. 11, 2020 participants the four participants, namely, magnus, marcus, camilla and tone, had experienced ipv in a same-sex relationship, mostly during their first relationship. camilla and tone also had relationships with abusive young men. three of the participants grew up with their biological parents, whereas one, tone, lived in foster families during most of her life. they lived in the countryside, in medium-sized towns, and on the outskirts of a larger city. although they have different genders and possibly orientations, they did not want to label themselves. nevertheless, they all had an intimate relationship that differed from the majority. at 16 years old, magnus met roger, who was 8 years older, through an internet site. soon after they began seeing each other, roger started to control magnus and check his phone for messages and phone calls. shortly into the relationship, roger started to physically, psychologically and sexually abuse magnus. after five years, magnus broke up with roger. at 14 years old, marcus met pontus through the internet. pontus was 20 years old then and was sexually violent towards marcus the first time they met. the sexual violence escalated into severe violence when marcus was physically injured. the sexual violence was combined with psychological violence. two years after the breakup, marcus reported the abuse to the police and pontus was convicted of sexual abuse of a minor. after their separation, marcus continued to meet adult men on the internet and face-to-face, and several were abusive to him. at 17 years of age, camilla became acquainted with a girl in school, namely, hanna, with whom she immediately fell in love. they dated for two years. the abuse started with hanna’s need to control camilla. the violence took serious physical forms. for instance, hanna would hold a pillow over camilla’s mouth so she could not breathe. these instances were followed by affectionate actions and care. at the end of their final year of secondary school, camilla broke up with hanna. as a result, hanna told camilla that she would use all her contacts to ruin camilla’s life. when tone was 14 years old, she had a romantic relationship with another girl. although she described this relationship as ‘nice’, it was also abusive. after they broke up, she started dating a boy from her school of her same age. similarly, he was psychologically abusive to tone throughout their relationship. finally, tone broke up with him. however, he publicly shamed her by posting pictures 117 njsr – nordic journal of social research vol. 11, 2020 of her and her former girlfriend on facebook, with degrading words and insinuations. the posts quickly filled up with homophobic comments. tone was bullied after the posting of the pictures and was forced to leave her foster family. thus, she moved to another family in a new town. results the results of the four steps of the analysis are presented in this section. based on the research questions, this section has been divided into two parts, with sub-sections under each part. violence and abuse: experiences and understanding voices of victimization the interviews focused on violence and abuse experienced by young people. thus, various stories about different forms of victimization were gathered. the violence and abuse constituted physical, psychological, digital and sexual violence. these forms of violence and abuse were intertwined in most of the interviews. magnus was also asked about the type of violence he experienced from roger. magnus stated that psychological abuse was more difficult to live with than physical violence: i think the psychological [abuse] was much worse than the physical [violence]; it wore me down, it made me sadder…it happened all the time, while the physical could stop after one day. one week or one month could go by, and then the physical violence happened, but in between there were lots of psychological…i was ugly and disgusting and repulsive: ‘i can’t believe anyone wants to be friends with you’. as magnus explained, although the psychological abuse could occur for days, weeks or all the time, the physical and sexual violence could be described as incidents. these incidents took place over longer or shorter periods. magnus stated that roger demanded sex, which was always on his terms. however, over time, the abuse increased in frequency and length. camilla was asked to describe her relationship with hanna. similar to magnus, camilla talked about the pain of psychological abuse, jealousy, coercive control and serious physical violent effects of such control: she [hanna] made me think it was reasonable that she locked me in the bathroom…she would hold her hand over my mouth when i cried so there would be no sounds, but then i couldn’t breathe either, so i got the reflex 118 njsr – nordic journal of social research vol. 11, 2020 to throw up—once she forced her whole hand into my mouth so that i threw up…and we showered together afterwards since she got my vomit on her…and then suddenly it was all very affectionate again. the interconnection of different forms of abuse formed a pattern of violence and abuse that can be understood as constant and permeating every part of a person’s life. moreover, the cycle of violence progresses from psychological (making someone think she does not deserve to be heard), to physical (forcing one’s hands into another’s mouth), to showing remorse and tenderness (‘it was all very affectionate again’). this cycle has been described in the literature for more than four decades (see, for example donovan and hester, 2015; kelly, 2004: walker, 1979). in addition, based on the participants’ narratives, access to power can be unequal due to various reasons other than the gender of the abused. in magnus’s case, a difference in age and body size was noted. on the contrary, camilla’s case entailed class and familial financial inequalities. these differences created power imbalances that may have influenced their exposure to violence (see renzetti [1988] for a discussion on power in same-sex relationships). voices of self-blame and shame magnus talked about the psychological abuse—a form of violence he described as more difficult to endure than the physical because it “happens all the time”— and how the psychological abuse escalated into physical violence. i asked him to narrate a situation when days of psychological abuse ended with a violent episode: magnus: one day, we went to buy flowers, in a flower shop, and i don’t know why we started fighting, but then i was beaten again, down in some bushes. i remember all went black, and then i got the feeling. i was scared to death, but i had gotten used to it. it was almost natural…i was pushed down in some bushes, and he tried to strangle me. interviewer: this was outside, in public? magnus: yes, and i felt such incredible shame—you think, what do others who walk by think? i did connect with people, when it happened, when i was laying down in the bushes. people kind of looked at me, and then i thought, i looked at the people who looked at me, laying there, and they wondered ‘what kind of person is this?’ ‘do they have a relationship? and then just, ‘what are you doing, magnus?’ but then, i just kept being with roger. budden (2009) emphasised the social nature of shame and argued that shame is the ‘quintessential social emotion underlying social threat, comprising a family of negative feelings ranging from mild embarrassment to severe humiliation’ (p. 119 njsr – nordic journal of social research vol. 11, 2020 1033). in addition to his fear of his life, magnus feared the gaze of the people walking by, which made him feel ‘incredible shame’. for victims of violence and abuse, the central components of shame include the feelings of being unable to defend oneself, humiliated and judged by others; humiliation includes having observers witness one’s defeat (andrews et al., 2000). this feeling of shame was worsened by magnus’s self-directed question, ‘what are you doing, magnus?’ this question did not result in a reaction that changed his situation, such as magnus leaving the abusive partner, but resulted in magnus staying with his partner. shame, self-blame and guilt are emotions frequently discussed in the literature on ipv. although it may seem unreasonable, victims of violence and abuse may self-blame for being unable to protect themselves and their family from the abuse, and causing the abuse or staying in situations where abuse is likely to occur (kubany & watson 2003). after ending his relationship with pontus, marcus described how he met different older men, dated them and was repeatedly abused sexually. although blaming them for the abuse, marcus also self-blamed for ‘exposing himself’ to the risks of contacting people online and then meeting them for dates, sometimes in places away from his family and hometown. i exposed myself, i can’t accuse anyone for what happened, for the abuse—quite some time after. i had the attitude that i deserved it, kind of…it was something i chose to expose myself to. i am not sure why, but perhaps as a way to process what i had been through. voices of resistance parallel to any story of victimization is a story of resistance (wade, 2001; cavanaugh, 2003). when tone’s boyfriend posted pictures of her and her former girlfriend with homophobic comments on social media, tone was judged with hateful and sexist comments from others. she wrote to him and said, ‘if you continue doing this, i will report you to the police for harassment, bullying and extortion’: magnus’s boyfriend, roger, would check his phone every time they met as he did not allow magnus to contact other males on social media. when i was not with him i downloaded snapchat and stuff, and then when i was to meet him i was like, ‘remember to erase all text messages, take off all apps from the phone, take away this and that’. i had a list in my mind of all the things to take away…‘i am going to check your phone’ [in a different voice]. ‘but why do you have to do that?’, ‘don’t question me’ [in a different voice]. ‘oh, okay’. 120 njsr – nordic journal of social research vol. 11, 2020 magnus would erase everything on his phone that could anger roger. he would then download the applications immediately after leaving roger’s apartment and continue having contact with other individuals, particularly other men. although magnus was pleased for ‘tricking’ roger, he also expressed how roger’s constant coercive control caused great stress in his everyday life. challenges related to ipv in same-sex relationships the third stage in the analysis requires ‘reading for relational narrated subjects’ according to doucet and mauthner (2008), whereas the fourth step requires ‘reading for structured subjects’. when these stages were applied, all data describing the participants’ social relations and immediate networks and their understanding of their experiences in relation to power structures and dominant discourses were analysed. the analysis shows that numerous challenges were specifically related to ipv in same-sex relationships. responses from network: the interconnection between sexuality and abuse the four young participants described having supportive, unsupportive, and hostile social relations in regard to both their sexuality and their exposure to violence. they had been open about their sexuality at an early age and had already ‘come out’ when they were victimized. however, their family, close friends and classmates’ responses to their sexuality and deliberate and nondeliberate ‘coming out’ were intertwined with their partners’ abuse that they experienced. at the time of victimization, the four informants were teenagers. their parents’ responses to their same-sex partner and victimization were significant to them. the participants described a mix of reactions from friends and classmates when they admitted that they were attracted to their same sex. when magnus told his closest friends that he was gay, he was nervous about their response. this experience could be interpreted as magnus’s fear of rejection. however, they ‘laughed a little; they knew it sort of, and i didn’t mind them saying that they knew it; it was just a relief’. for the parents of three of the participants, the concern was that, as mentioned by magnus, ‘they would never become grandparents’. the reactions from camilla’s parents were stronger as they questioned her choice of a girl as a partner ‘when you could have any boy you want’. in addition, camilla chose a girl who is ‘not so…feminine, she didn’t care about her appearance…she was very much of a rebel’. in her investigation of 121 njsr – nordic journal of social research vol. 11, 2020 young women’s experiences of dating violence, chung (2007) argued that femininity can be expressed only in relation to a male in a heteronormative discourse on intimate relationships. according to her parents, camilla could have any boy she wanted. she may be understood as giving up part of her femininity by choosing a girl, who is ‘not so feminine’, making her choice even more problematic. however, the reactions from their classmates were significantly more hostile. magnus and marcus described how they were abused and expelled from locker rooms by other boys when they found out that magnus and marcus were attracted to males. in the following, marcus describes his experience when rumours spread that he had had intimate relations with an older boy when he was 14 years old. junior high was tough. i lost about half of my group of friends...they were gone in a heartbeat…i was expelled from the school locker rooms for the rest of junior high. magnus had similar experiences: i was chased home from school, and stuff like that—i was abused in school, in the locker rooms and other places… tone also experienced strong homophobic responses from classmates and other young people in the community. she had this to say regarding her exboyfriend’s posts on social media about her and her former girlfriend: he made a [public] facebook group…the group was targeted against me and her [her former girlfriend] and the thing was…we were going to a birthday party…we were four girls, they took pictures of her and me. it was really fun. we had done our makeup and put nice clothes on, and then he said i slept with these girls in the bathroom…i had had enough. i really struggled [mentally]. i have had trouble trusting people since then…that is one of the reasons i couldn’t live there anymore. as mentioned earlier, the homophobia became so severe that tone had to move to another foster family in another town. in her interview, tone mostly focused on the abuse from her former boyfriend using her bi-sexual identity against her. in recent literature reviews, heimer et al (2018), as well as messinger (2014), direct their focus on young bisexuals’ vulnerabilities to ipv, as studies have shown a particularly high prevalence of violence and abuse, both from same-sex partners and opposite-sex partners. as noted in heimer et al. (2018), one of the complexities may be the opposite partner’s homophobic views. in tone’s case, this complexity made her vulnerable to new abuse. 122 njsr – nordic journal of social research vol. 11, 2020 the participants reported positive responses from their closest friends. however, they also experienced being questioned, particularly by negative responses from parents, and ostracized in school. these experiences made them perceive themselves as a burden to their closest family. this perception played an important part in their victimization by their intimate partners. after marcus explained his ‘tough time in junior high’, the interviewer asked about his parents’ response to the incident. he replied: my younger brother had some medical issues, and my mother had just lost her job, so didn’t want to burden my family even more [with his sexuality]. i guess that was kind of stupid, but there and then, i didn’t want to cause any more trouble, and that went on for quite some time…and some of the reason[s] why i got involved with him [the violent boyfriend] was to confide in someone who was not family, sort of…and i bitterly regretted that afterwards. in this narrative, magnus describes how his feeling of ‘not wanting to cause any more trouble’ drove him to search for someone who could care for and understand him as a 14-year-old. in this context, ‘trouble’ is interpreted to refer to his sexuality and attacks experienced in school, in addition to the trouble at home, that is, his brother’s illness and mother’s unemployment. similar to marcus, camilla talked about her sexuality as a burden to her family and social networks. although she acknowledged saying ‘we never felt resistance [from the surrounding society]. no one was saying we were disgusting or anything’, she stated that: i still felt that i was different and that i had already pulled my card, and if i, besides being in a lesbian relationship, also was together with a girl who abused me, there was no way i would have had the courage to tell anyone about that. a phenomenon discussed in the literature on sexual minorities and ipv referred to as ‘double disclosure’ is relevant to this experience. that is, disclosing violence indirectly requires disclosure of the same-sex partner, which can constitute a barrier to help-seeking (donovan and hester, 2015; pentaraki, 2017). in camilla’s case, her attraction to females and relationship with a girl was already known; hence, she had ‘come out’. nevertheless, as she understood this identity as a burden to her immediate social networks and social relations, she found it difficult to place another burden upon them, that is, being victimized by her girlfriend. thus, this situation became a barrier to helpseeking, where she did not tell anyone about the abuse until the relationship was over. 123 njsr – nordic journal of social research vol. 11, 2020 dominant discourses render the violence invisible in line with gillum and difulvio (2012), the participants in this study shared ideas that violence and abuse are events that are happening in heterosexual relationships. it could be argued that youths, including sexual minority youths, growing up in a heteronormative society perceive violence as gendered; that is, men are the main perpetrators of violence against women. as a result, victimized sexual minority youths may not define their experience as violence and abuse (donovan & hester, 2015; heimer et al., 2018; holmberg & stjernqvist, 2005). as camilla explained: if i would have been with a guy, it would have been so much easier to make it visible to myself. i think…there is so much talk about men’s violence against women, and i sort of didn’t know that there could be violence in same-sex relationships, or i didn’t reflect upon that. so all the time, i made excuses such as ‘well, she is not feeling well’. she continues: violence committed by women is not something you really talk about ‘cause it is not a structural problem in the same way, and i guess i sort of didn’t know that women could behave like that. as described here by camilla, the discursive constraint, that it is men who are abusive to women, caused camilla to define her negative experiences in the relationship as events not related to violence and abuse. camilla’s girlfriend was struggling mentally. thus, camilla perceived this behaviour in the context of mental difficulties. however, the dominant social discourse on men’s violence against women may also impact professionals’ tendencies to ask about violence or define what is taking place as violence and abuse. magnus and roger went to a few sessions of couples counselling when magnus was in his last year of high school. magnus told the counsellor about the violence, but she failed to address it. as magnus stated, ‘it is the norm that it is the man that abuses the woman’. this norm may have had a bearing on what role the perpetration of violence had in the counseling of the young couple. discussion the first two stages of analysis in this article focused on answering the question ‘what is happening here’, identifying themes and creating i poems. these stages uncovered stories similar to those investigated by researchers of heterosexual violence. these stories narrate physical, psychological, digital and sexual violence as well as self-blame, shame and resistance. important dynamics of violence are aspects such as power imbalances, escalation of 124 njsr – nordic journal of social research vol. 11, 2020 violence and the overlapping of different forms of violence. as noted by researchers such as holmberg et al. (2005), messinger (2014) and heimer et al. (2018), the nature and dynamics of ipv in heterosexual and same-sex relationships are similar. however, the complicating factor of sexuality grounded in a heteronormative society becomes evident when stages three and four of the analysis were conducted to explore responses from immediate social networks and social relations and dominant ideologies and discourses. here, meyer’s (2003) concept of ‘minority stress’ becomes central, as the young person’s experience of heteronormativity becomes another layer of stress, in addition to the stress evoked by being subjected to violence and belonging to a sexual minority. homophobic exposure in school may lead to ostracism and being cast as deviant. this experience may force a young person to seek support elsewhere, which may result in detrimental consequences due to their limited experiences. if the young person has limited support from home or feels rejected by parents and peers, their feelings of being different and the risk of seeking support from people who will abuse them increase. furthermore, limited support and rejection from the young person’s peer network could lead to serious consequences on the dynamics of intimate relationships and abuse. that is, young couples may isolate themselves. this situation could constitute another barrier to help-seeking. it also underlines the importance for schools and other professional arenas to disclose the abuse and provide support. furthermore, the participants in the study have helped shed light on the issue of feeling like a burden to one’s immediate social network and its negative consequences, including being a barrier to help-seeking. if identifying as a gay, lesbian or bisexual is a burden to one’s family or leads to problems in school, such as being attacked in locker rooms, a young person may feel that revealing that he/she is also being victimized by an intimate partner represents an additional burden. thus, the young person may feel this scenario is impossible to place on those who care for him/her. based on the literature (see, for example øverlien et al., 2019), young people who experience violence and abuse are particular about who they disclose to. they are reluctant to disclose their experience of violence to someone who may not be able to ‘contain’ their story. this study found that society’s heteronormative understanding of violence as acts perpetrated by men against women could become a barrier to help-seeking due to two reasons. first, others may not identify undesirable events in the relationship as violence. second, the victim may not identify the negative aspects of the relationship as violence and abuse. 125 njsr – nordic journal of social research vol. 11, 2020 the participants’ experiences described in this study need to be understood within the context of their age. particularly, they are young people with commonalities shared by others in their age group, regardless of sexuality. furthermore, they were all in their teenage years when they experienced abuse. this stage is a time for identity formation, exploration and striving for greater independence. as studies on poly-victimization have shown, multiple exposures to various victimizations lead to serious harmful implications for children and adolescents (finkelhor et al., 2007). exposure to violence and abuse in one’s first intimate relationship while also enduring hostility, rejection and severe violation because of one’s newly discovered identity may negatively impact one’s relationships, mental health, school performance and ability to work. the complexities described were possible to uncover by using a method of analysis, the listening guide methodology, that allowed for repeated readings of the same data using different lenses and focusses of attention. for example, the creation of i poems established the subjective position, whereas ‘reading for structured subjects’ shifted the lens towards power relations and the subject’s position thereof. the method is time-consuming and not suitable for large datasets, and requires rich interview data. conclusion this study shows that although victims of ipv in heterosexual and same-sex relationships have several similarities, contextual challenges create unique conditions and vulnerabilities for ipv experienced by the lgbtq community that are not shared by heterosexual individuals. hence, qualitative studies are required to help us understand the dynamics of violence in intimate relationships among sexual minorities. similarly, other marginalized groups may have specific patterns that may not be shared with the majority and thus also need to be explored qualitatively. furthermore, future studies should differentiate between different groups of violence-exposed sexual minority youths. finally, professionals, such as social workers, need to gain knowledge of the unique challenges and strengths of sexual minority youths exposed to ipv. as argued by barrett (2015), professionals’ acceptance of the lgbtq’s identities is not sufficient. they must be ‘engaging in active efforts to reinforce the validity of lgb identity’ by ‘exploring the impacts of heterosexism and homophobia on lgb persons’ (p. 32) as well as affirming and working with the unique strengths and resilience of the lgbtq community. furthermore, we need professionals who actively ask youth about experiences of violence and abuse in their 126 njsr – nordic journal of social research vol. 11, 2020 relationships and whether the youth confirms that he/she has been abused or abusive. these experiences need to be validated and taken seriously. moreover, as noted by donovan and hester (2008), school is an important site for interventions in disclosing and reporting ipv in addition to addressing issues such as injustice, homophobia and discrimination and introducing alternative sexualities and relationships. the lives of young people can greatly improve with the help of professionals, researchers, ngos and policymakers 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(2016). the listening guide: a how-to-approach on ways to promote educational democracy. international journal of qualitative methods, 15(1): 110. https://doi.org/10.1177/1609406916677594 microsoft word steigen young adults v.1.1 njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol 9, 2018 young adults in nature-based services in norway—in-group and between-group variations related to mental health problems anne mari steigen* faculty of health and social sciences, inland university of applied sciences faculty of arts and social sciences, karlstad university email: anne.steigen@inn.no bengt eriksson faculty of health and social sciences, inland university of applied sciences faculty of arts and social sciences, karlstad university ragnfrid eline kogstad faculty of health and social sciences, inland university of applied sciences helge prytz toft norwegian national advisory unit on concurrent substance abuse and mental health disorders, innlandet hospital trust institute of clinical medicine, university of oslo daniel bergh centre for research on child and adolescent mental health, karlstad university *corresponding author abstract young adults with mental health problems who do not attend school or work constitute a significant welfare challenge in norway. the welfare services available to these individuals include nature-based services, which are primarily located on farms and integrate the natural and agricultural environment into their daily activities. the aim of this study is to examine young adults (16–30 years old) not attending school or work who participated in nature-based services in norway. in particular, the study analyses mental health problems among the participants and in-group variations regarding their symptoms of mental health problems using the hopkins symptoms checklist (hscl-10). this paper compares symptoms of mental health problems among participants in nature 111 njsr – nordic journal of social research vol. 9, 2018 based services with those of a sample from the general population and a sample of those receiving clinical in-patient mental healthcare. a questionnaire was developed for the study and was completed by 93 participants in nature-based services. the majority of these participants were recruited from the norwegian labour and welfare administration (nav), local mental health services, and school authorities. results indicate that just more than half of the respondents exhibited symptoms of mental health problems based on their hscl-10 scores. in general, they reported fewer symptoms than the clinical in-patient sample (18–30 years old) and more symptoms than the general population sample (18– 19 years old). among the participants in nature-based services, those recruited through nav and local mental health services exhibited no differences in symptoms. half of the participants older than 23 years in nature-based services had not completed upper secondary school. the participants, including those with symptoms of mental health problems and low expectations at the outset of their participation, generally expressed high satisfaction with the services. keywords: nature-based services, hscl-10, mental health problems, young adults introduction the aim of this study is to examine young adults (16–30 years old) not attending school or work who participated in nature-based services in norway. in particular, we focus on mental health problems among the participants and ingroup variations regarding their symptoms of mental health problems, as measured using the hopkins symptoms checklist (hscl-10). mental health problems are a leading cause of illness and disability worldwide (who, 2015, 2018) and are widespread among the adolescent and adult populations in norway (reneflot, aarø, aase, reichborn-kjennerud, tambs, & øverland, 2018). unless otherwise indicated, references to mental health problems in this paper are based on the hscl-10, which measures symptoms of anxiety and depression. we are well aware that mental health problems are comprised of additional parameters. however, for the aims of the current comparative research, the hscl-10 instrument is considered useful. when the concept of mental health problems is applied in a more general sense, and based on participants’ subjective reporting in the first part of the questionnaire, we refer to ailments that are troublesome, reduce quality of life, and reduce ability to function, but that are not necessarily manifested in psychiatric diagnoses. 112 njsr – nordic journal of social research vol. 9, 2018 there is growing concern of young adults’ mental health in norway. mental health problems may affect their ability to participate in different areas of society—for instance, in working life (nes & clench-aas, 2011). knowledge about how mental health problems among young adults in norway developed over time is limited. hence, there exists uncertainty about whether or not the prevalence of mental health problems among young adults has increased over the last three decades, although some international research indicates this is, indeed, the case (collishaw, maughan, natarajan, & pickles, 2010; potrebny, wiium, & lundegård, 2017). however, there are indications that at least the consequences of having mental health problems have increased among young adults in norway in recent years. for instance, the number of young adults receiving disability pensions in norway increased from 7,657 individuals in 2009 to 16,879 in 2018 namely for diagnoses of mental healthand behaviour-related problems (guldvåg, 2017; nav, 2018c). work assessment allowances given for the medical reason of mental health problems also increased during that time (nav, 2018b). in august 2018, almost 70% of the 26,260 recipients of work assessment allowance under the age of 30 suffered from mental health problems (nav, 2018a); this indicates that a large number of young adults in norway are not in school or employed due to mental health problems. according to a qualitative study conducted by ramsdal, bergvik, and wynn (2018), mental health problems are one reason young adults drop out of school. young adults with mental health problems can experience difficulty completing their education, and disappointments in school may intensify their mental health problems. the labour market’s increasing emphasis on communication competence and relational and social skills poses special challenges for this population. this might partly explain the increased public benefit costs related to mental health problems (berg & thorbjørnsrud, 2009; von soest & hyggen, 2013). norway offers various welfare services to young adults with mental health problems who are not in school and do not work. the services are offered through schools, local mental health services, and the norwegian labour and welfare administration (nav). nature-based services as social work interventions for young adults with mental health problems the welfare services offered to young adults with mental health problems outside school or work in norway include nature-based services usually termed green care or green work. these are offered through public services (e.g., nav, local and specialised mental health services, or schools) in collaboration with private providers (e.g., farms). in principle, nav offers green work, while 113 njsr – nordic journal of social research vol. 9, 2018 the public health sector and schools provide green care. however, the provided services possess strong similarities, and one service can simultaneously include green care and green work participants who are receiving identical interventions. this study treats nature-based services as a unified concept including both green care and green work. by our definition, these naturebased services often, although not necessarily always, use a farm setting to deliver specifically designed, structured, and facilitated services to individuals with defined needs (bragg & atkins, 2016). the nature-based services utilise no single model of organisation. in some cases, the service providers directly contract with and report to public health or welfare services. in other cases, third parties, such as nav, are responsible for securing the services and ensuring their quality. the services combine components from traditional labour-market measures with more flexible and personal adaptive solutions (kogstad, eriksson, granerud, hummelvoll, lauritzen, & batt-rawden, 2012). this strategy recalls a fundamental approach in social work: to find and adapt interventions that make it possible for an individual to overcome social problems (levin, 2004). these services share a connection to nature. for the most part, they are located on farms and utilise nature in their daily activities, including maintenance work, cooking, and caring for animals and plants (nav, 2011). previous research on nature-based services for people with mental health problems nature-based services are available for a range of various groups of participants worldwide (artz & davis, 2017; berget & braastad, 2008; elings & hassink, 2008; mallon, 1994; sahlin, matuszczyk, ahlborg, & grahn, 2012; toyoda, 2013). participation in nature-based services is found to be related to improved mental and physical health for participants with mental health problems, both in norway and internationally (berget & braastad, 2008; elings & hassink, 2008; ellingsen-dalskau, berget, pedersen, tellnes, & ihlebæk, 2016a; ellingsendalskau, morken, berget, & pedersen, 2016b; granerud & eriksson, 2014; hassink, elings, zweekhorst, van den nieuwenhuizen, & smit, 2010; kogstad, agdal, & hopfenbeck, 2014; pedersen, ihlebæk, & kirkevold, 2012a; steigen, kogstad, & hummelvoll, 2016). health-promoting factors in nature-based services for people with mental health problems include work tasks that facilitate experiences of mastery (granerud & eriksson, 2014) and flexibility—meaning, for example, that participants can participate irrespective of their daily functioning (hassink et al., 2010). support 114 njsr – nordic journal of social research vol. 9, 2018 from the social community, including the farmer and other participants, is important. this support helps participants feel safe and experience a sense of belonging while utilising the services (elings & hassink, 2008; hassink et al., 2010; pedersen et al., 2012a). participants appreciate their interactions with animals, as they may feel understood, accepted, and not judged by the animals as they otherwise might be by humans. in addition, participants feel valuable when caring for the animals (pedersen et al., 2012a). for many participants, nature represents a sanctuary in which they may escape from everyday stressors (ellingsen-dalskau, 2017). an increasing number of studies address nature-based services in norwegian and international contexts. nevertheless, scholars emphasise the need for more research, particularly on content regarding nature-based services, the groups who are offered these services, and the effects of the services (iancu, hoogendoorn, zweekhorst, veltman, bunders, & van balkom, 2015). most of the published research studies use qualitative approaches, although there are some studies focusing on nature-based services that use quantitative methods (ellingsen-dalskau et al., 2016a). most of the national and international quantitative research focuses on specific interventions, mostly within research experiments. for example, such an intervention may measure health outcomes from interacting with animals for a certain number of hours per week (berget, ekeberg, pedersen, & braastad, 2011; pedersen, martinsen, berget, & braastad, 2012b). consequently, the existing research does not provide much information about participants in nature-based services that are not part of research projects. moreover, to the best of our knowledge, there exists no previous study using quantitative approaches with a focus on young adults with mental health problems participating in nature-based services. in addition, no previous research studies on this topic have used comparative approaches. additional knowledge about participants in nature-based services may contribute toward the development of services adapted to participants and their needs. the aim of this paper is to examine mental health problems among young adults participating in nature-based services in norway. we focus on variations related to mental health problems among sub-groups of participants in relation to, for example, gender, age, and the circumstances of their recruitment. furthermore, this study utilises a comparative design. 115 njsr – nordic journal of social research vol. 9, 2018 method in this comparative study, data from a general population sample and a clinical in-patient sample of individuals receiving mental health care are analysed alongside the sample of participants in nature-based services. material and data collection in the nature-based services sample the study participants consisted of young adults 16–30 years old who only partly or never attend school or work and are enrolled in services due to mental health-related problems, drug-related problems, or both. they participated in any of the available nature-based services in norway, such as green care or green work. we excluded potential participants without norwegian language skills sufficient enough to understand the questionnaire. we recruited participants from all regions of norway. we mapped all naturebased services through nav, agricultural interest organisations, matmerk (a nongovernmental organisation responsible for authorisation of green care farms), and online searches. in spring 2013, we contacted approximately 600 services by phone to determine whether they had participants in the target group who met the inclusion criteria. in total, 148 nature-based services reported they had potential informants for our study. we calculated the number of questionnaires necessary to distribute based on the number of participants in the services. in addition, questionnaires for potential new participants were distributed. the service and nav leaders were responsible for distributing informative letters and questionnaires to potential informants. we also administered the service leaders a form to record the number of participants informed about the study so we were able to determine the response rate. unfortunately, many leaders did not return the form; consequently, the response rate could not be calculated using this method. in august 2014, we again contacted all 148 services by phone. some services did not have any new participants. approximately two-thirds of the service leaders determined that, after receiving the questionnaires and the informative letters, they did not have participants in the target group. thus, at the time we facilitated the second round of calls, only 48 services had relevant participants. when possible, we offered to allow the participants to respond to the questionnaire in structured, face-to-face interviews, and four participants at two services chose to do so. due to this small number, this data collection method likely did not influence the overall results. the first author conducted the interviews. a total of 93 participants living in sixteen of nineteen norwegian counties participated in the study (see figure 1 for details of the data collection). 116 njsr – nordic journal of social research vol. 9, 2018 figure 1: flow chart of the data collection process spring 2013: called all potential services. information sent to 148 services. 146 services with 1–10 participants each and two services with 20 participants each. 13 questionnaires excluded along the way due to not matching inclusion criteria (age). spring 2014: reminder letter autumn 2014: all services called again; sent out questionnaires to 48 services, 1–10 participants each 23 questionnaires returned december 2014: reminder letter january–march 2015: ongoing contact with services via email and phone recruited two new services interviewed 4 participants total received: 93 questionnaires 47 questionnaires returned 10 questionnaires returned 13 questionnaires returned 117 njsr – nordic journal of social research vol. 9, 2018 response rates challenges associated with accurately estimating the size of the population of young adults participating in nature-based services made it difficult to estimate the response rate. based on the information obtained during localisation of potential informants, we concluded that the size of the target group was smaller than initially anticipated. the information from service leaders in august 2014 indicated that the study population during the time of our data collection included 150–200 individuals. the questionnaire the questionnaire consisted of three parts. the first included questions about the participants, the second included questions about the nature-based services in which the participants were enrolled, and the third consisted of three standardised instruments related to mental health, social support, and sense of coherence. in this paper, we report on the two first parts of the questionnaire and the hopkins symptoms checklist-10 (hscl-10) (derogatis, lipman, richels, uhlenhuth, & covi, 1974; strand, dalgard, tambs, & rognerud, 2003), the latter of which is utilised in part three of the questionnaire. hscl-10 is a short version of the hopkins symptom checklist-25 (hscl-25) that is used to measure symptoms of depression and anxiety (derogatis et al., 1974; strand et al., 2003). studies targeted toward youth have widely utilised this instrument (haavet, sirpal, haugen, & christensen, 2010; kleppang & hagquist, 2016; strand et al., 2003; søgaard, bjelland, tell, & røysamb, 2003). the questionnaire consists of ten items describing common symptoms or problems. participants rate the extent to which these symptoms or problems bothered or distressed them during the previous week. examples of items include: 1) how much has ‘feeling suddenly scared for no reason’ bothered or distressed you in the past week? and 2) how much have ‘feelings of worthlessness’ bothered or distressed you in the past week? the participants selected their responses from four response alternatives: (1) not troubled, (2) slightly troubled, (3) quite troubled, and (4) very troubled. after summing the variable values (raw scores) for each person, we calculated a total score to be used in the analysis. additionally, we compared the value obtained by dividing the total score by the number of items with a cut-off score. previous studies commonly set this cut-off at 1.85 and considered individuals with mean scores higher than 1.85 as having symptoms of anxiety and depression (strand et al., 2003). to test psychometric properties, we conducted a rasch analysis of the hscl10. the scale shows satisfactory psychometric properties with a person 118 njsr – nordic journal of social research vol. 9, 2018 separation index of 0.869 (a working paper—available upon request from the first author—describes details of this analysis). as explained above, the concept of mental health problems used in this paper is primarily related to the results from the hscl-10, which specifically measures symptoms of anxiety and depression. this has also been done in other studies (see e.g. kleppang, thurston, hartz, & hagquist, 2017). this use of the hscl-10 to measure mental health problems does not deny that the concept can be, and usually is, interpreted in a wider sense. brief description of the clinical and the general samples the clinical sample consists of 31 individuals 18–30 years of age (mean = 24.74; sd = 3.44; median = 24). these participants were recruited from a specialised psychiatric centre in norway that treats patients with long-standing or treatment-resistant trauma, anxiety, eating disorders, and depressive disorders. the multidisciplinary clinical staff consists of psychiatrists, psychologists, nurses, art therapists, occupational therapists, social workers, and pastoral staff. the centre does not admit patients with severe selfdestructive behaviour, psychotic disorders, or substance use disorders (suds), although some patients had comorbid suds. data were collected at the start of a twelve-week rehabilitation programme. the data collection was active from march 2015 through april 2016. data were collected as part of a major study entitled darcy (for details on darcy, see toft, neupane, bramness, tilden, wampold, & lien, 2018). we used ten items corresponding to hscl-10 from the symptom checklist 90 revised (scl-90-r) (derogatis, 2010; siqveland, moum, & leiknes, 2016; strand et al., 2003), as this scale was used with the clinical sample. the scl90-r has five response categories: (0) not at all, (1) slightly, (2) medium, (3) much, and (4) very much (derogatis, 2010). we recoded the responses to allow for a comparison of mean values across the samples. we collapsed categories 2 (medium) and 1 (slightly), and recoded the response categories so they had values of 1–4, similar to the hscl-10 instrument used in the sample of participants in nature-based services. cronbach’s alpha was 0.869 for the scale with five response categories and 0.872 for the scale with four collapsed response categories. the scales with five and four response categories had a high correlation, with a pearson’s r = 0.993. we drew data for the general population sample from ungdata (data on young people), conducted by nova (norwegian social research) in cooperation with regional centres for drug rehabilitation (korus). ungdata is an annual crossnational data collection scheme designed to conduct youth surveys at the 119 njsr – nordic journal of social research vol. 9, 2018 municipal level in norway. the norwegian directorate of health, the ministry of children, equality and social inclusion, and the ministry of justice and public security are financers of ungdata (for more information, see nova, 2016). we analysed the 2014 ungdata data on young adults in the third grade of upper secondary school (18–19 years old) throughout norway. we included data exclusively from respondents who answered all the items measuring symptoms of anxiety and depression, resulting in a sample of 9,459 respondents (male = 3,829, female = 5,278, missing value for gender = 354). nova (2014) includes more information about the 2014 ungdata data. the ungdata survey includes nine items corresponding to nine items in hscl10. we use these nine items for comparison with the clinical and nature-based populations. ungdata 2014 does not include the item ‘feeling useless, of little worth’, thus we excluded this item from the hscl-9 scale items. first, we compared the clinical sample and the nature-based services sample based on all ten items in hscl-10 and obtained a cut-off score for the two samples. second, we compared all three samples based on the nine common hscl-10 items (hereafter, hscl-9). when using hscl-9, we were unable to calculate a cut-off score. statistical analysis we analysed all data using spss 24. ethics the norwegian regional ethics committee for southeast norway (2012/372) approved this study on young adults in nature-based services. the participants received a letter regarding the study, which informed them that participation was voluntary and that the published results would not identify individuals. we mailed pre-paid envelopes to the participants with instructions for returning the questionnaire. we also offered to let them respond to the questionnaire by phone, as we expected some potential respondents to possess difficulties concentrating, reading, and/or writing. however, none chose this option. initially, we asked the participants to sign a written consent form and return it along with the questionnaire. the service leaders informed us that this procedure might decrease some potential participants’ willingness to participate. therefore, we changed the procedures so that returning the questionnaire counted as providing consent. the ethical committee approved this method, and the participants who responded to the questionnaire in structured, face-to-face interviews signed written consent forms. 120 njsr – nordic journal of social research vol. 9, 2018 the distribution of the questionnaire by the service leaders could have posed an ethical difficulty due to the risk that some participants might have felt obliged to participate or respond in such a way they believed would please their leaders. however, we mitigated this risk by allowing all participants to return the questionnaire themselves (using pre-paid envelopes) as well as complete the questionnaire at home. the norwegian regional ethics committee for southeast norway (2014/2189) approved the clinical study. the fourth author informed all potential participants about the study, handed out written information, and distributed a consent form to each potential participant. the norwegian social science data services approved the ungdata study, which includes an anonymous survey and voluntary participation. for more information on the ethical considerations in ungdata, see nova (2016). results background variables and descriptive statistics of the sample from participants in nature-based services the sample included slightly more female participants (56%) than males (44%) and a mean age of 22.66 years (sd = 3.84). dividing the informants into three groups based on age revealed that the largest group was aged 21–25 years (table 1). the highest completed level of education was lower secondary school for approximately 57% of the sample, upper secondary school (vocational and specialisation in general studies) for 39%, and university for 4% (table 1). among the informants 23 years and older, 50% had not completed upper secondary school. additionally, 11% and 78% of the informants reported that drug-related problems and mental health problems, respectively, contributed to their reasons for participating in the service. combining these variables indicates that nearly all respondents who reported drug-related problems as a contributing reason also confirmed mental health problems contributed to their reason for participation. most informants accessed nature-based services through nav (71.4%), while others accessed them through local mental health services (14.3%), school (9.9%), and services (4.4%), such as child welfare (table 1). the participants possessed varying levels of knowledge regarding nature-based services when they started the programme; 37% had heard about nature-based services, approximately 57% had not, and 7% claimed they did not know whether or not they had heard about the services. the majority of participants (64.1%) reported 121 njsr – nordic journal of social research vol. 9, 2018 positive or no expectations before starting the service, while one-third (35.9%) reported negative or mixed expectations (table 1). table 1. background variables and descriptive statistics of the sample from nature-based services. *nav: norwegian labour and welfare administration variable categories n % gender (n = 93) female 52 56.0 male 41 44.0 age (mean = 22.66, sd = 3.84, mode = 16) (n = 89) 16–20 years old 27 30.3 21–25 years old 42 47.2 26–30 years old 20 22.5 highest completed education (n = 91) lower secondary school 52 57.1 upper secondary school (vocational and specialization in general studies) 35 38.5 higher education (university college and university) 4 4.4 mental health reasons for participation (n = 89) yes 69 77.5 no 20 22.5 drug-related reasons for participation (n = 90) yes 10 11.1 no 80 88.9 referral for a place at the service (n = 91) nav* 65 71.4 mental health service 13 14.3 school 9 9.9 other/don’t know 4 4.4 expectations for the stay (n = 92) positive or no expectations before start 59 64.1 negative or mixed expectations before start 33 35.9 duration of stay at the service (n = 91) 3 months or less 28 30.8 4–11 months 37 40.6 12 months or longer 26 28.6 frequency of attendance at the service (n = 89) 4–7 days a week 50 56.2 3 days a week or less 39 43.8 overall satisfaction with the service (n = 91) very or quite pleased 85 93.4 mixed 5 5.5 quite or very displeased 1 1.1 122 njsr – nordic journal of social research vol. 9, 2018 at the time of data collection, the duration of time the participants had been involved in the services ranged from one week to more than twelve months. regarding frequency of visits to the service, the majority of respondents attended their respective services four or more days a week (table 1). the majority of respondents (93.4%) reported feeling overall very or quite pleased with their respective services (table 1). comparative analysis of mental health by hscl-10 and hscl-9 between the three samples we used hscl-10 to measure the participants’ mental health (anxiety and depression symptoms) and found a mean value of 20.88 (sd = 8.46) among the respondents in the nature-based sample. we summed each participant’s answers to calculate a raw score and divided that score by the number of items answered to obtain a cut-off score, as suggested by strand et al. (2003). with a cut-off score of 1.85 (strand et al., 2003), slightly more than half of the participants reported symptoms of mental health problems (54.4%) (table 2). the clinical sample had a mean value of 24.81 (sd = 6.60) for hscl-10, and 80.6% of the clinical sample had scores higher than the cut-off score of 1.85 (table 2). table 2. comparison of reported symptoms of mental health problems (hscl-10) in the nature-based service sample and the clinical mental health sample. cut-off score on hscl-10 is 1.85, meaning those scoring higher than 1.85 are considered as having mental health problems. as previously mentioned, we selected nine items from the hscl-10 to compare all three samples (but without the possibility of calculating a cut-off score). on hscl-9, the nature-based sample had a mean value of 18.80 (sd = 6.66), the clinical sample had a mean value of 22.23 (sd = 5.88), and the general population sample had a mean value of 16.79 (sd = 6.02) (table 3). sample n mean [median] (sd) % over 1.85 nature-based service sample 93 20.88 [20] (8.46) 54.4 clinical mental health sample 31 24.81 [25] (6.60) 80.6 123 njsr – nordic journal of social research vol. 9, 2018 table 3. comparison of reported symptoms of mental health problems (hscl-9) in the nature-based service sample, the clinical mental health sample, and the general population sample. these findings indicate that the participants in nature-based services generally reported fewer symptoms of mental health problems than did the clinical sample, while they generally reported more symptoms than did the general population sample. in-group analysis of the participants in the nature-based services related to hscl-10. gender and age related to symptom score. considering hscl-10 scores and gender, female participants (mean = 23.2, sd = 8.55) reported significantly more symptoms of mental health problems than did male participants (mean = 17.80, sd = 7.39). the rate of participants with scores greater than the cut-off score also differed significantly by gender (table 4), supporting findings from previous studies (bremnes, martinussen, laholt, bania, & kvernmo, 2011; nova, 2014; von soest & hyggen, 2013; wichstrøm, 1999). an analysis of age differences in reported symptoms of mental health problems discovered statistically significant differences in the mean symptom scores (p < 0.05) between the youngest age group (16–20 years old) and the middle age group (21–25 years old). additionally, the number of participants with scores higher than the cut-off point in these two age groups differed significantly. we detected no significant differences between the participants aged 26–30 years old and the other two age groups (table 4). in-group variation related to recruitment criteria, recruitment sites and subjective expectations as mentioned previously, the participants were recruited through nav, local mental health services, school authorities, and smaller services, such as child welfare. the participants who were recruited through schools exhibited significantly fewer symptoms of mental health problems than those who were recruited through nav and mental health services (table 4). sample n mean [median] (sd) general population sample 9459 16.79 [16] (6.06) nature-based service sample 93 18.80 [18] (7.66) clinical mental health sample 31 22.23 [23] (5.88) 124 njsr – nordic journal of social research vol. 9, 2018 more than three of four participants subjectively reported mental health problems as contributing reasons for their participation. slightly more than half of the participants had scores for symptoms of mental health problems greater than the cut-off value of hscl-10. the available data did not determine differences in symptoms of mental health problems, as measured by hscl-10, related to whether drug-related problems were a contributing reason for participation (table 4). the respondents with positive expectations or no expectations prior to starting the services exhibited significantly fewer symptoms of mental health problems related to hscl-10 than did those with mixed or negative expectations (table 4). we found no significant differences related to hscl-10 scores between groups with different durations of participation in their respective services. table 4. statistical tests of differences in the groups related to hscl-10. variable categories (n) mean [median] (sd) % over 1.85 whole group 93 20.88 [20] (8.46) 54.4 gender male (52) 17.80 [17] (7.39)** 41.0 female (41) 23.2 [23] (8.55) 64.7 age 16–20 years old (27) 17.86 [13] (9.05)** 35.7 21–25 years old (42) 23.60 [23.5] (8.21) 65.0 26–30 years old (20) 20.95 [20] (6.62) 60.0 referral for a place at the service nav*** (65) 21.98 [20.5] (8.66)* 59.7 mental health service (13) 22.00 [21] (7.43) 61.5 school (9) 13.89 [12] (6.53) 11.1 other/don’t know (4) 16.25 [16] (7.23) 50.0 mental health reasons for participation yes (69) 23.48 [23] (8.07)** 68.2 no (20) 12.91 [12] (3.54) 9.1 drug-related reasons for participation yes (10) 24.0 [25.5] (7.67) 75.0 no (80) 20.49 [19] (8.54) 51.9 expectations for the stay positive or no expectations before start (59) 18.23 [17] (6.98)** 40.4 negative or mixed expectations before start (33) 25.41 [26] (9.08) 78.1 duration for stay at the service 3 months or less (28) 19.33 [15] (9.20) 44.0 4–11 months (37) 21.84 [21] (8.25) 64.9 12 months or longer (26) 21.44 [21] (8.06) 52.0 125 njsr – nordic journal of social research vol. 9, 2018 frequency of attendance at the service 4–7 days a week (50) 20.08 [17.5] (8.88) 46.0 3 days a week or less (39) 21.82 [21.5] (8.07) 63.2 differences in median values were calculated using mann–whitney and kruskal–wallis tests. significant results are marked with asterisks *p < 0.05, **p < 0.01. differences in proportions were calculated with two-tailed z-tests. significant differences in proportions (p < 0.05) are marked with brackets. cut-off score on hscl-10 is 1.85, meaning those scoring higher than 1.85 are considered as having mental health problems. *** nav: norwegian labour and welfare administration discussion in this study, we examined mental health problems among young adults not attending school or work who participated in nature-based services in norway using both in-group and between-group comparisons. mental health problems among young adults participating in naturebased services our results indicate that slightly more than half of the participants in the naturebased sample reported symptoms of mental health problems according to their hscl-10 scores. there is limited knowledge from previous research regarding mental health problems in this group. however, ellingsen-dalskau, berget, tellnes, and ihlebæk (2017) reported that more than 70% of participants (aged 19–65) in prevocational training on care farms in norway reported symptoms of anxiety and depression. this study used a different instrument for measuring mental health (not hscl-10), and thus the results are not directly comparable although they nevertheless support the finding that many participants in naturebased services in norway struggle with mental health problems. the results are additionally in line with the overall trend showing that the majority of young adults receive social insurance due to mental health problems (ellingsendalskau et al., 2017). furthermore, the results from this study indicate that 50% of the participants older than 23 years of age have not completed upper secondary school. overall, in norway, nearly 30% of young adults fail to complete upper secondary school within five years after initial enrolment (statistics norway, 2017). previous studies also report that participants in nature-based services generally have a low level of education (ellingsen-dalskau et al., 2017). some considerations are raised by the differences between hscl-10 scores and the number of participants who subjectively reported (in the first part of the questionnaire) mental health problems as a reason for participation. these differences might indicate that participants’ assessments of their own mental health is not always in accordance with standardised measurements of mental 126 njsr – nordic journal of social research vol. 9, 2018 health problems. however, the participants’ mental health might have also improved during participation. in addition, it is important to keep in mind that mental health problems may encompass challenges other than those measured by the hscl-10. expectations and satisfaction nearly all participants reported that they were pleased or very pleased with the nature-based services. these results are in accordance with previous studies using qualitative approaches on similar target groups in norway (ellingsendalskau et al., 2016b; granerud & eriksson, 2014; kogstad et al., 2014; pedersen et al., 2012a). an interesting proposal for further research would be to compare the satisfaction rates among this group with similar groups participating in other types of services. the participants’ expectations prior to attending the services might also have influenced their satisfaction with the services. nearly two-thirds of the participants had positive expectations, which might have resulted in high satisfaction with their respective services. the participants who had negative or mixed expectations reported more symptoms of mental health problems according to hscl-10 than those who had positive expectations. however, the participants expressed that they were pleased or very pleased with the services regardless of earlier expectations or symptoms of mental health problems. these findings are important, as positive experiences and subjective satisfaction with services could potentially contribute to increased self-esteem and thus play an important role in the recovery process. in-group differences in the nature-based sample related to mental health problems. the analysis did not show any positive correlation between duration of participation in the services at the time of data collection and symptoms of mental health problems. the group was not homogeneous, and those with the most severe problems at the outset might require a longer duration of participation. when considering recruitment, one might expect that participants recruited from local mental health services would have higher symptom scores than those recruited from nav, the latter of which focuses on clients who are expected to be able to return to work within a relatively short time. however, as previously mentioned, the findings indicate no differences in symptoms of mental health problems among people recruited through nav or through local mental health services. these results may indicate that it is not possible to classify the participants into clear categories based on the method of recruitment. a more 127 njsr – nordic journal of social research vol. 9, 2018 productive method may include focusing on participants’ individual adaptations, resources, strengths, and interests. an earlier study indicates that recruitment into nature-based services largely occurs by happenstance (steigen & kogstad, 2014). the overlap between the samples further confirms this observation. participants in nature-based services compared to the clinical and the general population samples overall, the participants in the nature-based services had higher scores for symptoms of mental health problems than did the general population sample, and lower scores than did the clinical sample. these results support the assumption that the nature-based group possesses different needs than do the other two samples. that is, these participants may benefit from low-threshold services as represented by the nature-based services in this study. even given the finding that the participants in nature-based services fall between the general population sample and the clinical sample along the hscl10 continuum, it is still difficult to achieve a congruent picture of this group. for instance, compared to the clinical sample, the nature-based sample showed greater variation in their duration of participation at the time of data collection, which might affect the differences between these groups in terms of reported symptoms of mental health problems. the standard deviation (sd) in these two group samples confirmed this possibility, with a higher sd in the nature-based services sample. the sd also indicates that there is an overlap between the samples (table 3). this further indicates that some individuals in the naturebased sample have the same symptom score as some of those in the clinical sample. the analysis demonstrates that the participants recruited through nav and local mental health services had a hscl-10 mean value closer to that of the clinical sample than that of others in the nature-based sample. the data suggest that nature-based services respond to different needs than do more specialised services. because we have limited insight into different client careers, we should also exercise caution when making judgements regarding initial problems in different groups. what would have happened if a person in the clinical group had instead received nature-based services at the outset and vice versa? methodological considerations we found data collection to be a primary challenge in this study. despite our diligent efforts to recruit as many informants as possible, we encountered significant challenges during this process. as a consequence, the small sample size constitutes a weakness in this study. the number of young adults 128 njsr – nordic journal of social research vol. 9, 2018 participating in nature-based services appears to be lower than we estimated during the first round of mapping all the services. other possible reasons for the low sample size include the unstable market for nature-based services in norway, leading to frequent changes in the number and types of services offered. in addition, many participants may have refused to participate due to personal problems that made completing the questionnaire challenging. ellingsen-dalskau et al. (2016a) conducted a quantitative study on participants aged 18–66 years in prevocational training programs on farms in norway and reported difficulty estimating the response rate due to similar challenges we encountered in our study. their participants had the same gender distribution as our population, but a wider age range (ellingsen-dalskau et al., 2016a). additionally, the majority of their respondents received services through nav (slightly more than 50%) or mental health care (40%) (ellingsen-dalskau et al., 2016a). strengths and difficulties a notable strength of this study is that it is the first quantitative study on this population both in norway, and, to the best of our knowledge, internationally. this study contributes unique and important data. additionally, comparing reported symptoms of mental health problems between participants in naturebased services, a general population sample, and a clinical mental health sample allows for the describing of the group of participants in nature-based services in a wide context in relation to other groups of young adults. as previously mentioned, this study faced problems related both to the recruitment process and the organisation of the services. distributing the questionnaires through a third party might have complicated the recruitment process, as service leaders might have failed to provide information about the study to all potential informants. finally, our study also demonstrates that the field of nature-based services poses special methodological challenges due to instability, a variety of services, and problems with comparisons. this aspect, to a large degree, complicates data collection, and future studies should address this complication. conclusion this study makes important contributions that may be considered in future studies conducted with nature-based services or other welfare services for young adults with mental health problems. it increases our knowledge about participants in nature-based services, particularly through the comparisons with 129 njsr – nordic journal of social research vol. 9, 2018 general and clinical population samples. the results from this study are also valuable for the development and adaptation of nature-based services toward meeting the needs of their participants. there is partial overlap in symptom scores between individuals in the nature-based sample and those in the clinical sample, while there is also some overlap in scores between the nature-based sample and the general sample. these overlaps increase the possibility that more individuals may experience the same satisfaction if offered nature-based services. this possibility warrants further investigation, as additional knowledge may improve the general understanding of what kinds of services are effective and for whom they are effective (hyggen, 2015). references artz, b., & davis, d. b. 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(1999). the emerge of gender difference in depressed mood during adolescence: the role of intensified gender socialization. developmental psychology, 35, 232–245. https://doi.org/10.1037/0012-1649.35.1.232 microsoft word pdf merrild and sand andersen changing politics of sameness njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 10, 2019 welfare transformations and expectations of sameness. living on the margins in denmark camilla merrild* the research unit for general practice, department of public health aarhus university email: chm@dcm.aau.dk rikke sand andersen department of anthropology and research unit for general practice aarhus university email: rsa@ph.au.dk *corresponding author abstract in denmark, as in other welfare societies worldwide, the organisation and ideology of welfare are becoming increasingly influenced by neoliberal ideas. in practice, this means that the original intention behind the provision of social support, which was grounded in the notion of social responsibility, is gradually being pushed aside by notions of responsibilisation, with concepts such as deservingness and work ethic appearing to dominate the discourse. based on long-term fieldwork and interviews conducted with socially disadvantaged danes living on social security, this article engages with the current debates regarding responsibility and highlights some of the challenges arising from living a life that diverges from what has been termed danish ‘in-between middleclassness’. we argue that the divergence between the promise of welfare, the current landscape of political regulation and expectations of individual responsibility leads to new forms of uncertainty, as experienced by those who depend on the services provided by the welfare state. one implication of this is that welfare seems to increasingly be tied to an agenda of sameness, whereby citizenship stems less from a imagination of sameness than from an expectation of sameness. njsr – nordic journal of social research vol. 10, 2019 67 keywords: denmark, sameness, social class, social inequality, the welfare state the changing politics of responsibilities in welfare societies this article explores how neoliberal transformations of the welfare state impinge upon the lives of people who depend on social security. this is achieved by attending to the suffering experienced by those who struggle with social problems and poor health, and who are dependent upon the danish welfare state. the promulgation of the social reform act in 1933 is often portrayed as the beginning of what eventually became known as the danish welfare state, a socially informed project based on notions of universalism and solidarity, which necessitated the provision of a broad range of welfare initiatives such as free education and health care for all, subsidised childcare and medication, and care for the sick and elderly (jöhncke, 2011). these welfare benefits are all funded by the redistribution of financial resources via taxation, which is organised according to the principle that those who earn the most must pay the most tax. hence, in terms of rights and opportunities, the tax system also serves as a form of financial redistribution based on principles of equality. simply put, this means that the institutional arrangements range from standardised welfare services, which all danes come into contact with at various points in their lives, to more specialised interventions and support directed towards those who fall outside the mainstream with regards to their life trajectory or expected norms (langer & højlund, 2011). in denmark, as in other welfare societies worldwide, the organisation and ideology of welfare are, however, becoming increasingly influenced by neoliberal ideas (bruun et al., 2016). neoliberalism is often described as a theory of political economic practices that proposes human wellbeing to be best advanced by liberating individual entrepreneurial freedoms and skills within an institutional framework characterised by strong private property rights, free markets and free trade, and where state interventions in the markets must be kept to a bare minimum (harvey, 2007, pp. 2-3). however, in many parts of scandinavia, neoliberal reforms are increasingly underpinned by cultural values such as individual responsibility and productivity, while ongoing changes seem to unfold through strengthening some of the existing state foundations (mik-meyer & villadsen, 2013). the role of states in what chomsky (1998) referred to as ‘the introduction of neoliberalism into the global order’ (p. 19) has been widely discussed by historians, philosophers and social scientists njsr – nordic journal of social research vol. 10, 2019 68 (chomsky, 1998; pedersen, 2011).1 in our analysis, we draw on bourdieu’s (1999) conceptualisation of the state as a ‘splintered space’ that acts in competing and contradictory ways depending on who initiates actions on behalf of the state. bourdieu (1998, pp. 1-10) eloquently described these state contradictions with reference to ‘the left’ and ‘the right’ hand of the state. in a recent paper by waquant (2009), the right hand is defined as representing the masculine and punitive side of the state, which is given to behavioural regulation, while the left hand is said to represent the feminine side, which is given to socially supportive policies and interventions. this perspective embraces the duality of many state institutions, which both provide a range of social or material support and also punish citizens for their failure to comply with social norms concerning personal responsibility. additionally, we draw on the work of norwegian anthropologist marianne gullestad (1992), who has written extensively about the scandinavian imagination of sameness. we suggest that the transformation of the welfare state under neoliberal rule means that it is no longer built on an imagination of sameness (gullestad, 1992, 2001), but rather on an expectation of sameness. here, we infer that the downplaying of differences by the prevailing egalitarian ethos has contributed to the welfare state’s disregard of the very different realities that danes experience in terms of the provision of welfare, with social security arguably being one of the most significant markers of this difference. recent studies exploring transformations of the danish welfare system have contributed substantial research into the interface between the state and ‘the making subjects’ (e.g. bruun et al., 2016; jöhncke, 2011; lien et al., 2001; mikmeyer & villadsen, 2013). focusing on social security and welfare-to-work programmes, järvinen and mik-meyer (2003) and mik-meyer and villadsen (2013) described in great detail how welfare state expectations concretise in imperative personal development schemes, which aim to shift social security recipients towards greater self-support. likewise, rytter (2018) vividly pointed out how integration policies and practices are strengthened by the introduction of welfare state programmes that aim to make refugees more independent through the provision of job training. focusing on another group of danes outside the workforce, ludvigsen (2016) illustrated how the welfare state subjects elderly citizens to various demands and requirements to remain fit and healthy, as well as to proactively maintain a good health status for as long as possible, by inserting behavioural demands (such as exercising, taking the 1 for an interesting danish case, see bruun (2018). njsr – nordic journal of social research vol. 10, 2019 69 correct medication, and so on) into their everyday lives (see also katz [2000] and lamb [2014] for a similar point). taken together, these studies demonstrate how, despite substantial changes in public spending, danish neoliberalism does not solely work against the state in the guise of cutbacks and austerity, but also through established welfare institutions. in fact, the authors illustrate how the allocation of social security in denmark is increasingly subject to the strict regulation of who, when and how welfare can be allocated. indeed, the provision of social security is increasingly articulated in the language of rights and responsibilities, which is ‘embedded in a discourse of individual responsibility’ (dencker-larsen & lundberg, 2016, p. 4). for instance, the social benefit reform that was implemented in 2013 reads, ‘social security recipients must work for their benefits, and if they are not available for work, there must be sanctions (…). hence there must be implemented a more goal-oriented and efficient availability and sanction system’ (beskæftigelesministeriet, 2013, pp. 6-7, our translation). in addition to the substantial reductions in social security for the poorest people in denmark, these sanctions are directed towards people outside the workforce. in practice, this means that, in order to receive social security, people are judged as either ‘job equipped’ (jobparat) or ‘activity equipped’ (aktivitetsparat). if a social security recipient is considered to be job equipped, then s/he has to actively apply for a wide range of available jobs and to document her/his job-seeking activity. if social security recipients remain unemployed for an extended period, they are expected to participate in welfareto-work programmes, which can involve job training and activation assigned by social services. for those categorised as being activity equipped, active job seeking is not required, although such social security recipients are expected to participate in an individual development process aimed at moving them closer to employment, which involves working in close cooperation with one or more social workers. if applying for an early disability retirement pension, an individual’s physical and mental ability to work are tested and they must also be medically verified, again in close cooperation with a social worker. four times a year, all social security recipients are required to attend a meeting at their local job centre, where their progress is discussed. if their obligations are judged to not have been met, their social security will be reduced based on the severity of the offence. the case of social security exemplifies how neoliberalism in denmark appears to be integrated into, and somehow merged with, the influential state that still maintains the power to regulate its citizens, despite political calls for state refraction and a minimal state. at the same time, however, traditional welfare ideologies emphasising similarities, equality and universalism hover in the background, highlighting current tensions between welfare njsr – nordic journal of social research vol. 10, 2019 70 principles and practices and embodying the contradictions so vividly described by both bourdieu (1998, 1999) and waquant (2009). in the remainder of this article, we will argue that the divergence between the promise of welfare, the current landscape of political regulation and expectations of individual responsibility leads to new forms of uncertainty, as experienced by those who depend on the welfare state. inspired by recent discussions of social suffering and its social or institutional embeddedness (e.g. wilkinson & kleinman, 2016), we draw attention to the dual role played by insistent regulation and highlight how it may add to the suffering of those dependent upon social security. we do so by presenting three portraits of people and situations that exemplify some of these complexities and contradictions of the system. moreover, they offer insights into what it means to be dependent on, and to live in the midst of, contemporary forms of ‘welfare’. we also consider how the constant demands of job training and personal development, which are intended to enable independent living, correspond to the central governance of the welfare state. the increased rationalisation inherent in social life, which weber (1920) foresaw in the protestant ethic and the spirit of capitalism, adds cumulatively to the suffering of marginalised citizens. the portraits we present illustrate the points made by weber (1920) nearly 100 years ago, which have been more recently explored in contemporary settings by wilkinson and kleinman (2016), namely how suffering in welfare societies must be viewed with reference to the regulatory powers of welfare institutions and the ways in which they impinge upon people’s lives and execute their power. however, we will first offer a few comments on our chosen methodology. a note on the methodology this article is based on two interconnected ethnographic research projects conducted among low-income danes during the period 2012–2017. both research projects involved fieldwork and both explored social differences in terms of health.2 the first research project was designed as a communitybased, comparative ethnographic fieldwork, and it focused on social differences in care-seeking practices (merrild, 2015). the fieldwork that informed the project was conducted in two socially distinct communities, and merrild engaged with twelve key informants and their families over a period of twelve months. six of 2 both projects were conducted by merrild in close cooperation with andersen. njsr – nordic journal of social research vol. 10, 2019 71 the key informants lived in a socially disadvantaged neighbourhood, while six lived in an area that was characterised by high social status. the present article draws on data revolving around the six informants who lived in the socially disadvantaged neighbourhood, who were recruited from the local community house. the second research project was designed as a longitudinal interview study, and it was conducted among socially disadvantaged people suffering from cancer (merrild and andersen, 2019). the aim of the second project was to explore the interactions between marginalised citizens and the health-care system. ten people participated in this second research project, and they were recruited through local general practice clinics. the primary research methods used were interviews, along with field visits, over a period of three to six months. the informants who we include in the present article were all outside the labour force and all lived on social security, which meant that they all had a low level of income. they were all highly dependent on a variety of welfare services, ranging from standardised arrangements, such as early retirement pension schemes, to more specialised and supportive interventions, such as individualised supportive and administrative supervision (i.e. housing assistance or participation in welfare-to-work schemes). through the chosen methods of participant observation (atkinson, 2015) and ethnographic interviews (spradley, 1979), merrild sought to develop an insight into the informants’ everyday lives, by participating in social situations with their family and friends, as well as by spending time at their homes, talking, drinking coffee and passing the time with computer games, puzzles, and games. she also participated in a variety of everyday activities, such as job training, gymnastics and grocery shopping. one of the most significant contributions of the participant observation approach is the ability to gain an understanding of how everyday life is lived and, thereby, to develop an insight into what it is like to be poor, sick and suffering in an affluent welfare state. immediately after every field visit and interview, substantial field notes were written, with the material produced taking the form of descriptions of people, situations, experiences and contexts. merrild engaged with some informants on a weekly basis and with others on a monthly basis, depending on the particular situation of each informant. although participant observation is unique in terms of facilitating an in-depth understanding of what shapes and influences people’s lives, it can also sometimes be a difficult method to apply. in both research projects, many of the informants were people who lived much of their lives at home and without many social interactions, which sometimes made participating in and observing everyday life difficult, since not much really happened. moreover, the informants in the second project were sick and njsr – nordic journal of social research vol. 10, 2019 72 suffering, which meant that the original intention of following them in their everyday lives had to be changed to a methodology of field visits and repeated interviews. despite these challenges and the constant ethical considerations, the decision to follow the informants over time and on a regular basis was grounded in the view that, when seeking to understand what living life in particular situations or contexts is like, a much more in-depth understanding can be gained by actually being there and developing a sense of what is really going on (atkinson, 2015). in addition to participant observation, merrild also interviewed all the key informants several times. the ethnographic interviews were semi-structured and revolved around the informants’ life story (growing up, previous working life, family life, etc.), everyday life (social and current family situation) and health and illness status. all the interviews were transcribed verbatim and the transcripts, along with the field notes, were reread several times to discover common themes across the two related projects. subsequently, the data derived from the two research projects were pooled and thematically coded using nvivo 11. the data were handled in accordance with the general data protection regulation (gdpr) and treated with both confidentiality and care. all the informants were provided with written information about the projects before they gave written informed consent to participate, and it was explained to them that they could withdraw from the research at any time and without penalty. the informants in the portraits presented below have been anonymised. the persons in the first and third portrait participated in the first research project, while jasmin, in the second portrait, participated in the second research project. however, the analysis rests on the combined data from both research projects. portrait 1: the insecurity of social security – ‘you get worried, you know what i mean?’ most of the people merrild worked with had experienced long-term unemployment and their lives were characterised by broken relationships, growing up surrounded by various forms of substance abuse, chronic illness, dropping out of school and poverty. for some, these conditions were inherited, in the sense that their lives replicated the social conditions that their families had experienced for generations. for others, their difficult situations had arisen due to a combination of unfortunate circumstances and occurrences in their lives, such as family feuds, failed relationships, serious chronic illness or simply being unable to cope with stress and pressure any longer. it seems fair to question how notions such as personal development and responsibility njsr – nordic journal of social research vol. 10, 2019 73 resonate in lives that are often fraught with suffering, disease, and social and family-related problems. johnny, a 58-year-old pipe fitter, is one of merrild’s key informants. for the past ten years he has been living on social security. he lost his job at a slaughterhouse due to cutbacks and, almost simultaneously, he began suffering from recurring venereal sores and erysipelas, which drove him into a deep depression that ultimately culminated in long-term unemployment and extended periods of sickness. for the first few years, he was so depressed and overweight that he never left his house. he just sat on his brown velour couch for months on end. he did not talk to anyone and he never went outside. it is hard to imagine johnny like that now; he is doing much better. he is usually cheerful and he jokes with everybody, his round, bear-like figure, greying hair and bushy beard giving him a friendly, kind, almost grandfather-like, appearance. johnny likes to talk, and when merrild visits him in his onebedroom apartment, where the curtains are always drawn and the table is covered by jigsaw puzzles with thousands of pieces (every visit, there is a new puzzle), they sit on the brown velour sofa and chat, for hours. having recovered from his depression and with his erysipelas attacks now substantially reduced, he is starting to get back on his feet and is currently participating in yet another clarification process initiated by social services. this means that he is attending a number of job training sessions to test his physical and mental capabilities, as well as to determine whether he is eligible for either flexible employment (subsidised by the state, which means working for reduced hours on tasks adapted to his ability to work) or, alternatively, an early disability retirement pension. however, johnny never knows when his erysipelas will break out and, over the past four to five months, he has had monthly attacks. therefore, he has been sick a lot and unable to go to work. when he does go to work, he is exhausted from having to stand up for long periods at a time. he worries that ‘they keep pushing him’ and that not being able to do what is expected of him will send him back into a depression. it is not because johnny does not want to work. when he describes his previous working life, he almost lights up with pride, and he seems to enjoy the job training, which mainly consists of packing various goods into boxes and doing other odd jobs assigned to him by social services. he vividly describes a particular job where they managed to repack even large shipments with tight deadlines. ‘we had to repack ten thousand boxes’, he tells me, ‘and we did it’. he is engaged in the workplace, even though it is only temporary, and he makes various suggestions about changing some of their procedures to help render the workflow more efficient and manageable. for instance, he suggested that they introduce morning meetings to review the njsr – nordic journal of social research vol. 10, 2019 74 day’s tasks so that the workers could be prepared for what needed to be done. he naturally assumes the role of the team leader, urging the others to get the job done. the week after he tells me about his innovative ideas for the workplace, he falls ill with a fever and his venereal sores and erysipelas flare up again, leaving him bedbound for more than a week. johnny is sick and most of the time he feels unwell. just getting to his job training, which is located less than a kilometre away from his apartment, is difficult and it takes him more than half an hour to walk because he has to stop to rest several times. when johnny talks about his situation, he is clearly agitated about how ‘they’ (his social worker, the social security system as a whole) impinge on his everyday life by means of obligations (testing of his ability to work), surveillance (monitoring of his physical status through medical examinations and records) and control (of his daily comings and goings). ‘they’ seem to be more concerned with checking and keeping an eye on him than with providing him with social support. in fact, the informants often described experiences akin what has been coined as the clientisation of recipients of social security (järvinen & mik-meyer, 2003), which refers to how social services are increasingly experienced as a system of control shaped by mistrust and surveillance. like johnny, the other informants also used a hostile tone when discussing social services, and there was a general sense of powerlessness against the interference of the welfare state. statements such as ‘it’s not up to me to decide that’ or ‘they don’t listen to me anyway’ imply a loss of control over their lives as well as a failure to live up to the moral obligation of contributing to the common good and upholding the welfare society. in johnny’s own words: i know that i used to make good money, and i really did earn a lot. i don’t anymore, and i can feel that. but really, i still think that … well, it’s when you start living on social security. it should just be for a brief period because you … it can make you sick … you have to think about it all the time. you get stressed and you also get worried, you know what i mean? faring well in (work) life despite johnny’s obvious agitation and contempt, he has very clear expectations as to what he wants and needs from the welfare system. somehow, he seems to be caught in the complex interplay of what mik-meyer and villadsen (2013) described as ambivalent and paradoxical governance of the welfare state, where the ideals of personal responsibility and reduced social benefits are combined with micromanagement techniques of power, which have been introduced into various state institutions. the issue of clientisation and the unequal patron-client relationship between the social security recipient and the state thus seems to work against not only the principles of individual njsr – nordic journal of social research vol. 10, 2019 75 responsibility, but also the idea of reciprocity between the state and its subjects, by articulating and imposing extensive governance strategies. for instance, social security recipients are obliged to complete prescribed job training as a means of earning the right to receive social security, and this is presented as an opportunity for personal development rather than a case of micromanagement and coercion. there is a strikingly unequal patron-client relationship between the welfare state and its beneficiaries, which places the social security recipient in a subordinate, dependent role (järvinen & mikmeyer, 2003) that is maintained by the power to sanction and control through financial means, but also through the provision of assistance and support with personal and professional development. mik-meyer and villadsen (2013), who have extensively studied the interactions between the danish welfare state and its beneficiaries, assert that: in the welfare provision of today, power takes both the shape of juridical sanctions and of attractive offers for self-development. when state institutions punish criminals, remove children at risk, or enforce sanctions upon welfare recipients the question of power is imminently urgent. it is less readily evident that power is at stake when institutions educate, counsel or ‘empower’ citizens (p. 3). the constant testing and assessment of people’s ability to work and hold down a job so as to determine the extent to which they are able to take care of themselves is accompanied by a constant pressure to develop new skills and qualifications, which, it is hoped, will eventually move them out of dependency. while the importance of enabling people to contribute to the common good initially appears to support political reform movements, pushing the central values of progressivity and the ability to manage life independently (bruun et al., 2016; järvinen & mik-meyer, 2003; pedersen, 2011), regimes of surveillance and distrust seem to directly counter such aims. thus, what actually constitutes ‘the welfare society’ is configured not just through processes of mutual identification and trust between a country’s inhabitants, but also by culturally defined mutual interests in certain economic and practical arrangements, such as participation in the workforce serving as an important marker of inclusion (bruun et al., 2016, pp. 27-28; jöhncke, 2011, p. 35). the right to receive welfare benefits under neoliberal rule increasingly comes with obligations and duties, which specify how to fit in and align with the progressivity of the state. reflecting on welfare and its significance in shaping what we consider to be ‘the good life’, langer and højlund (2011) suggested that we think of welfare as the forms of assistance and benefits that allow the public to ‘fare well’ through life. johnny’s story certainly reminds us that ‘welfare institutions are designed not only to take care of people’s basic needs but also njsr – nordic journal of social research vol. 10, 2019 76 to enable them to fare well in accordance with the dominant norms of society’ (gulløv, 2011, p. 22). following a similar line of thought, wilkinson and kleinman (2016) recently argued that: social suffering cannot be studied in the absence of committing to social interventions. such interventions, however, not only may relieve suffering; they can increase it (intentionally or unintentionally), and they can also fail. this landscape of implementation of programs and services is also the landscape of social suffering; it is fraught with moral difficulty and almost inevitably courts opposition and conflict (p. 16). welfare is indeed both cultural and moral. how people’s lives are enabled or supported in any given system indicates the subtle as well as the explicit expectations as to how they are supposed to orchestrate their lives. as explored above, this often leads to conflict, not just in terms of relational conflict, but also conflicts between possibilities, options and selves. johnny and his peers do not think of themselves as relevant objects of mistrust or surveillance; rather, the need to manage social security and dependency in this climate only adds to their suffering. now, let us turn to a further explanation of this issue in another portrait, which introduces us to jasmin. portrait 2: the temporality of life on social security – ‘i am protected for another few months’ since leaving school after the tenth grade, jasmin has been living on social security. her parents divorced when she was a teenager, after which she moved around a lot. her serious mental health issues started when she was around 18 years old. they were set in motion by a family tragedy that involved the murder of a close relative, which led to a series of depressive episodes. she has never been able to shake the tragedy, and she has been on and off sick leave ever since. now 27, she lives alone in a small apartment overlooking a lake. painstakingly clean and tidy, the apartment is decorated in shades of white and rose, which stands in stark contrast the dirty, ramshackle stairwell outside. her apartment offers no indication of her troubled life. last year, she was diagnosed with cervical cancer, which prompted yet another breakdown. the thought of never being able to have children left her feeling like she just did not want to live any more. now, however, she has finished her chemo therapy and is slowly getting better. she is almost back on her feet, slowly regaining her energy and not drinking anymore. once her energy fully returns, jasmin is planning to start training as a chauffeur. she wants to drive people who are ill to their hospital appointments. she loves to drive and, due to her own experience of being ill and having to go back and forth for hospital appointments and treatments, she feels that she may be able to help others. she reasons, ‘that way i can make a njsr – nordic journal of social research vol. 10, 2019 77 life for myself, where i am not dependent on anyone else, and where i can do something i enjoy’. she has a plan and, when she eloquently describes it in detail, it does not seem like the first time she has had to explain her future goals and ideas for progression, not to mention how she expects to achieve them. jasmin could be described as ‘an experienced social security recipient’. however, fulfilling all the obligations and requirements of the welfare system has become increasingly difficult. jasmin is worried about losing her social security benefits because social services want to send her to job training, but right now she just does not have the energy to attend. it is very stressful for her, since they will cut off her money. ‘but i am protected for another few months [due to the cancer], i know that’, she tells me. jasmin is clearly not feeling well, and it is difficult for social services to assess her ability to work. during the period that merrild met with jasmin, she became increasingly unstable. she forgot about appointments with her gp, with merrild and with community services. sometimes, when merrild showed up at her apartment, she was not there. sometimes, she opened the door dressed in her nightwear, looking dazed and confused, woken by the intrusion, even though it was past midday. she appeared to have sunk into a depression, isolating herself, refusing to answer her phone or open her door. she had broken down again, as had happened so many times before. like many of the other people living with long-term unemployment and social security that merrild worked with, jasmin was trying to deal with the knocks and bruises that life had given her. the similarities in the stories that merrild was told, in the ways people’s troubles were recounted, and in the circularity of the patterns described were striking. the stories all seemed to narrate a neverending string of social, mental and physical challenges, and they revolved around experiences of distrust and feelings of powerlessness in their dealings with, and dependency on, social services. these frustrations may be grounded in the sense that what was considered a right to welfare could be taken away from them. jasmin was trying to orient herself towards the future, to make plans and find direction in life, and thereby to live up to the neoliberal ideals of proactivity by taking responsibility for her life. having been dependent of welfare services for her entire life, however, she has, in a sense, been brought up by the welfare state, which has done everything it could to enable her to fare well. she has experienced the transition from care and support during her younger years to the increasing demands of personal development, independency and making a living on her own. in the face of this, her cancer has become a sanctuary, offering protection from the constant assessment of her ability to njsr – nordic journal of social research vol. 10, 2019 78 participate in the workforce – at least for a while. her suffering is social, brought on by a range of unfortunate situations, including her troubled adolescence, her life on social security, her psychological problems and the lack of fit between her circumstances and her expectations of the welfare state (and vice versa). middle-class denmark and the work ethic jasmin has lived a difficult life. it is a life that does not seem to reverberate with obligations of personal development and expectations of independency and making a contribution to the common good. she has always been dependent on the welfare state, although it is becoming increasingly difficult for her to fit in with the current conception of that welfare state, which seems to increasingly align with the danish middle-class, white-picket-fence ideal, often jokingly epitomised as consisting of a house, a dog and a station wagon. although generally described with an ironic ring to it, the connotations of a white-picketfence life encapsulate the ideals and expectations surrounding typical danish family life, where being able to buy a house, raise children and drive a nice car is highly valued, and where life is lived based on values such as thrift, hard work, honesty and aspiration. danes have thus been characterised as having an ‘inbetween middle-class consciousness’, considering themselves to have neither too much nor too little and that standing out from the norm, whether financially or otherwise, is embarrassing, if not inappropriate (faber, 2008, p. 100; linnet, 2011, p. 25). in a sense, middle-classness can be described as going about one’s daily business, taking care of one’s family, contributing to upholding the welfare society, ‘aiming for the ordinary’ (offersen, 2016) and maintaining a strong work ethic (dencker-larsen & lundberg, 2016). according to statistics, however, socioeconomic middle-classness is not unequivocal. for instance, although a recent survey study conducted in a major danish city showed that three out of four people categorised themselves as belonging to the middle class, this resonated poorly with the sociodemographic profile of the city (faber et al., 2012). likewise, a nationwide study identified significant socio-demographic diversity in areas such as income and education, and it suggested that approximately 25% of the adult danish population aged 18 to 59 years belong to the middle class, 10% to the upper class and 66% to the lower or working class (olsen et al., 2012). hence, although a selfperception of in-between middle-classness dominate the danish model of social relationships when viewed from a socioeconomic perspective, social diversity still exists in terms of finances, occupation, health and geography (diderichsen et al., 2011; faber et al., 2012; olsen et al., 2012). it may thus be argued that njsr – nordic journal of social research vol. 10, 2019 79 middle-classness refers more to a norm (jenkins, 2012), a sentiment or an imagination, as well as to a style of interaction and social organisation that downplays differences and underlines similarities of interest (gullestad, 1992, 2001), than to the dominance of an actual social class. the lives of the informants merrild worked with all differed substantially, but common to all of them was the fact that they seemed far removed from the middle-classness described above. however, johnny’s and jasmin’s situations demonstrate how the welfare state intervenes in people’s lives in ways that ignore how some lives diverge from the ideals of progressiveness, where people are expected to ‘fare well’ according to what has been described elsewhere as the middle-class ideal (e.g. faber, 2008; faber et al., 2012; linnet, 2011). with reference to the work of norwegian anthropologist marianne gullestad (1992), who has written extensively about the scandinavian imagination of sameness, we suggest that in contemporary danish (and perhaps scandinavian) welfare societies, citizenship is no longer built on an imagination of sameness (1992, 2001), but rather on an expectation of sameness. by this, we infer that the downplaying of differences by the prevailing egalitarian ethos has contributed to the welfare society’s disregard of the highly different realities that danes experience in terms of the provision of welfare, with social security arguably being a significant marker of such differences. however, the next and final portrait will indicate how these different realities are contested by those living on social security, which suggests that imaginations and expectations of sameness are complex and multifaceted. portrait 3: unemployment and marginalisation the grey buildings look tired and worn. facades partially painted in various pastel colours half-heartedly serve to break up the monotony, although the shades of grey encircling the parking lot remain overwhelming. the windows reveal nothing about who lives inside the apartments, since the curtains are mainly drawn or the blinds shut. one building houses the community house, where many of the residents who are unemployed gather during the day to hang out, chat or play cards. there are always people there, from around 10 a.m. until late in the evening. for those who do not work, it is a good place to meet. there is always someone to talk to. merrild often hung out with her key informants at the community house, which was a central field site during her fieldwork. on this particular day, johnny is there, together with brian, fanny, george, kirk and a few other people. sitting in a bright room with windows overlooking the parking lot, the mood is somewhat sombre today, with johnny and his neighbour, brian, seeming particularly annoyed. the meters on the njsr – nordic journal of social research vol. 10, 2019 80 buildings’ heaters are being read, and they are talking about how annoying it is that they have to sit around and wait for the janitor. johnny grumbles about how he is not going to sit at home and wait around, ‘if i’d been at work i wouldn’t have had to sit around, would i?’ he asks rhetorically. he adds, ‘i wouldn’t have been at home; i would have been at work. i told the janitor that i was going to the community house to play cards and i just couldn’t sit around and wait’. they all agree that they cannot simply be expected to sit around at home and wait. they also have things to do, and there is a vivid exchange of opinions about how they have important things in their lives too. this is just one small, everyday example that illustrates how the informants attempt to reconfigure their social situation according to mainstream middle-class society, where they, for instance, do not have time to sit at home and wait for the janitor. reconfigurations of this nature can be seen as ways of managing marginalisation and suffering within a public climate in denmark characterised by increasingly harsh debates regarding social welfare, which, in recent years, has been discussed with an increasingly critical tone (dencker-larsen & lundberg 2016). questions are being raised about the willingness and obligation of social security recipients to work and to contribute to the common good, as well as about what it means to be poor in an affluent society. a life spent on social security brings with it stigma and social exclusion (järvinen & mik-meyer, 2003; mik-meyer & villadsen, 2013), and it may add to the suffering of some of the most vulnerable people in the welfare state. as argued by danish anthropologist eva gulløv (2011): […] to fare well through life is connected to culturally specific expectations of how to be and what to become. it also encompasses designs and prescriptions of how to fare well that not only address material concerns but equally concern ideas and values, performative requirements and social judgements. in other words welfare calls for behavior that corresponds to the demands and expectations of a person’s cultural and social surroundings (p. 22). recognising the subtle ways in which people negotiate their self-worth with reference to the established normality of middle-classness in everyday occurrences or remarks, as exemplified by the conversation described above, may enrich our understanding of the practical and moral implications of living lives that diverge from middle-classness, and it could perhaps also remind us of the multiplicities of lives lived in what is considered to be egalitarian scandinavia. njsr – nordic journal of social research vol. 10, 2019 81 concluding discussion – suffering in a welfare society the lives of johnny and jasmin, although distinct and subjective, exemplify some of the challenges associated with living lives that diverge from ‘in-between middle-classness’. in their own ways, they exemplify how the suffering experienced by people living on the margins of the welfare state can be seen as conditioned by the complexities of equal worth, expectations to and from the state, morality and shame. moreover, they add to our understanding of how the practice of everyday life in denmark is marked by an obligation to take on social responsibility for preserving the common good, as established most prominently through participation in the workforce. the obligations related to living in a welfare society may hence be considered as a means of establishing deservingness and perhaps even belonging, a situation that naturally brings with it notions of othering and exclusion of those who do not (or cannot) fulfil such obligations. this article has offered examples of the different ways in which the socially marginalised are impacted by the political shifts and economic transformations of a state characterised by competing and contradictory forces (bourdieu, 1998, 1999). without taking our conclusions to the same length as those of waquant (2009), who argued that recent transformations in western democracies have recalibrated the structures of power in such a way as to reduce the legal system to one of many avenues through which precarious groups of people are managed, we add to the literature that exposes the increasing levels of uncertainty imposed on marginalised populations by welfare institutions and governing bodies (see also mik-meyer & villadsen, 2013; wilkinson & kleinman, 2009). following the approach of gullestad (1992, p. 195) and other scandinavian observers, we suggest that oppression and exploitation are now less open, although they are practiced in much more subtle and indirect (even unconscious) ways, particularly in scandinavia, and that recent transformations in the welfare state have resulted in a political and cultural climate in which the existence of poverty and suffering is subject to discussion and even questioning. as argued by weber (1920), and also recently explored in contemporary settings by wilkinson and kleinman (2016), regulation, rationalisation and the drive towards more effective modes of government are partly rooted in the struggle to relieve our pain and suffering (wilkinson & kleinman, 2016, p. 138). it is possible that the existence and noble intent of the welfare state has rendered us oblivious to the existence of the diverse of conditions and life chances available to large groups of people within society, chances that are influenced and conditioned by the social and economic organisation and regulation (i.e. the right and left hands) of that very same welfare state. weber’s njsr – nordic journal of social research vol. 10, 2019 82 (1920) notorious conceptualisation of the bureaucratisation of the social order as an iron cage, in which people are trapped in systems based purely on teleological efficiency, rational calculation and control, most certainly springs to mind here. additionally, one aim of this article has been to empirically add to gullestad’s (1992) argument that the notion of sameness may in fact help to conceal hierarchical relations within society, partly due to how egalitarian contexts offer ways of conceptualising existing social dissimilarities. with the danish egalitarian context serving as our point of departure, we have argued that ideals of imagined sameness, whereby people from different social classes cluster in the same areas, send their children to the same schools and pursue their social lives in familiar settings and situations, perhap blind us to the social differences that the welfare state was originally intended to reduce. with reference to the work of bourdieu (1984), danish citizens increasingly interact and surround themselves with people from similar social and cultural habitus and capital, resulting in the establishment of subtle social boundaries or what gullestad (1992, pp. 165-182) termed symbolic fences. raising a similar point but from a comparative perspective, we have suggested that people from different classes often orient themselves towards the ideals of egalitarianism, meaning that existing inequalities are rarely brought to our attention and are, in fact, often underplayed (merrild, 2018). this could be reinforced by middle-class notions of independency, personal development, and the willingness and inclination to progress and evolve, which have now become core principles of the welfare state and its services (bruun, krøijer, & rytter, 2016, p. 23; mik-meyer & villadsen, 2013). welfare policies can be seen to reflect an agenda of sameness, with the right to welfare being built less on an imagination of sameness than on an expectation of sameness, which consequently downplays the suffering often experienced by people who live socially disadvantaged and challenging lives. one consequence of this could be that the ideals of the welfare state have blinded us 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(2016). a passion for society. how we think about human suffering. berkeley, ca: university of california press. https://doi.org/10.1525/california/9780520287228.001.0001 microsoft word shammas and sandset the biopolitics of ethnonationalism fertility in defense of the welfare state njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 11, 2020 reproduction and the welfare state: notes on norwegian biopolitics victor lund shammas* work research institute oslomet email: contact@victorshammas.com *corresponding author tony joakim sandset centre for health sciences education, faculty of medicine university of oslo email: t.j.sandset@medisin.uio.no abstract norway has long been considered to be a bastion of social democracy due to its strong, protective, decommodifying welfare state. however, with the recent rise of neoliberalism and right-wing populist politics across the west, this northern european society has gradually shifted from keynesian fordism to a moderate form of neoliberalism. this political-economic pivot has also resulted in a transformation of what foucault termed biopolitics: a politics concerned with life itself. in early 2019, leading politicians in norway’s centre-right coalition government placed the problem of the declining fertility rate on the national agenda and framed the problem of biological reproduction in ways particular to their political-ideological perspectives. the conservative party discussed reproduction in terms of producerism, or the problem of supplying the welfare state with labouring, tax-paying citizens. the progress party emphasised ethnonational exclusion, engaging in racial denigration with the aim to ensure the reproduction of ‘ethnic norwegians’. the christian democrats highlighted a conservative christian ‘right to life’ topos amidst growing secularisation and pluralism. all three parties signalled a turn from traditional social-democratic ideologies. neoliberalism has proven to be malleable, able to fuse with a wide 2 njsr – nordic journal of social research vol. 11, 2020 range of biopolitical programmes including moral exhortations, ethnonational exclusion and religious discourse to approach the problem of reproduction. however, this post-social-democratic approach generally is unwilling to provide material security through large-scale social expenditures and universal welfare institutions, preferring instead to address the ‘hearts and minds’ of the populace. consequently, the fundamental cause of sub-replacement fertility—the gradual proliferation of ontological insecurity—remains unaddressed. keywords: biopolitics, foucault, ethno-nationalism, social democracy, neoliberalism, fertility introduction on the first day of 2019, norwegian prime minister erna solberg used her annual new year’s address to exhort the population to reproduce. doing so, the prime minister said, was important to increase the norwegian fertility rate and counteract what she perceived as a demographic threat to the very survival of the welfare state. ‘the wheels of our society keep turning because adults look after children’, prime minister solberg (2019) said. ‘and those who are able to work ensure that the elderly can be cared for’. however, the prime minister believed that in the near future, ‘we will encounter problems with this model. norwegians are having fewer children. in order to maintain our population, the average birth rate needs to be a little over two children per woman. today, the average birth rate is just 1.6. this means ... there will be fewer young people to bear the increasingly heavy burden of the welfare state. norway needs more children!’1 1 this essay offers an overview of a series of interlinked political developments that unfolded in norway in the first three months of 2019. this essay does not offer an exhaustive account of the media coverage of these developments but instead provides a schematic for reading and interpreting certain key statements by central political actors. while media sociology offers much to formalised journalistic analysis (see, e.g., benson & neveu, 2005), this essay extracts media statements and views them as signposts of a series of political-ideological routes taken by various norwegian political actors in recent years. the analysis draws on the authors’ close reading of the unfolding media debates. the selection followed a snowball sampling strategy in which the authors followed the ensuing debate on fertility rates as a political issue. the analysis consists of an intertextual reading influenced by literary studies, focusing on the intertextual, heteroglossic connections between the ongoing political debates. 3 njsr – nordic journal of social research vol. 11, 2020 this rousing natalist rhetoric drew on a topos long familiar to mainstream political scientists, demographers and political economists: the problems presumed to be posed by the aging population for the state’s capacity to provide adequate services, particularly the alleged imbalance between working-age taxpayers and increasingly long-lived pensioners drawing on costly (state-run) retirement plans and healthcare services in an unsustainable fashion. the norwegian fertility rate stood at 2.50 children per woman in 1970 but declined to 1.62 by 2017 (statistics norway, 2018). the prime minister’s homily on fertility instantiated what might be called a producerist biopolitics, aimed at creating what she described as a ‘sustainable welfare society’. however, crucially, her argument relied on a particular framing of demographic necessity that was, as we shall see, not entirely unproblematic. ten days after solberg’s speech, per-willy amundsen, a leading politician in the populist right-wing progress party—the prime minister’s governing coalition partner—threw a counterpunch. his reproach more narrowly targeted norway’s immigrant population, railing against its allegedly excessive fecundity. ‘i’m interested in having a sustainable population composition’, amundsen said (jensen, 2019). he then claimed that ‘ethnic norwegians have a sinking birth rate. like [prime minister] erna solberg, i believe we have to do something about it. but the solution is not a larger immigrant population. on the contrary, we need to ensure that the ethnically norwegian population is maintained’ (jensen, 2019). amundsen—a member of a party that, since its founding in the 1980s, had criticised this northern european country’s immigration policies as too liberal—claimed that solberg’s diagnosis, although generally correct, had overlooked a crucial ethno-racial component. certainly, fertility was low among ‘native’ norwegians, but immigrants compensated for this lack through uncontrollable fertility—fecundity run amok. to a party with a stated aim to maintain the demographic majority position of ‘ethnic norwegians’, this trend constituted a slow national-cultural act of self-destruction, a glacial replacement of ethnonational insiders by a series of ethno-racial others. amundsen’s proposed solution involved cutting state child benefits to families with four or more children. in norway, families are paid a monthly allowance known as barnetrygd (child benefits), intended to subsidise the costs of childrearing. although the allowance is a universal welfare policy and is not means-tested, it remains modest, providing on average a scanty 8% of a singleparent household’s earnings (norsk telegrambyrå, 2018). in other words, the allowance makes a non-negligible but far from significant contribution to the fiscal well-being of families with children. amundsen insinuated that immigrants beget offspring as a means to draw these (relatively insignificant) cash transfers 4 njsr – nordic journal of social research vol. 11, 2020 from the state, so capping payments at three children would remove this incentive for the so-called ‘foreign’ populations to reproduce, the norwegian progress party argued. amundsen seized the opportunity offered by solberg’s natalist new year’s address to expound on what he and his party considered to be a demographic threat to norwegian culture. his proposed cap on payments to households with three children would ‘first and foremost be of significance to large immigrant families that have a large number of children, where birth production is high’ (jensen, 2019). this phrase ‘birth production’ (fødselsproduksjon in norwegian) suggested a cold, rational, machinic fertility, a relentless and almost mechanical force. in particular, amundsen claimed, ‘somalis ... have a far greater number of births than ethnic norwegians do’ (jensen, 2019). the problem, amundsen mused, was not inadequate fertility itself, as the prime minister had claimed, but, instead, an ethno-racially and ethno-nationally skewed fertility pattern: too many children on ‘their’ side, too few children on ‘his’ own side. finally, almost three weeks after the new year’s address leading christian democrat kjell ingolf ropstad, a member of solberg’s governing coalition, entered the debate. as stout opponents of liberal abortion laws— particularly the right to selective or multifetal reduction, a procedure to lower the number of foetuses in multiple pregnancies—ropstad and the christian democrats drew the ire of the country’s pro-choice movement for opposing legislation permitting multifetal reduction measures. ‘if you’re able to bear one [child], you can manage two [children]’, ropstad said during a televised debate (aftenposten, 2019), drawing wide rebukes from liberal commentators and norwegian centrists and leftists alike. his comments were read as an undue encroachment on women’s right to self-determination and an attack on the safety of women and unborn foetuses.2 ropstad later backed down from his comments and apologised for any offense he might have caused: ‘my point is that we need to ease the way for these families. if it is the case that you really want to give birth to one child, then we as a society should ease the way for you to be able to give birth to two children’, the christian democrat said (aftenposten, 2019). 2 multiple pregnancies carry more risk than single gestations; in the words of one medical review, they ‘constitute significant risk to both mother and fetuses’ (norwitz, edusa & park, 2005, p. 338). 5 njsr – nordic journal of social research vol. 11, 2020 contextualising biopolitics why do these incidents matter? they illustrate the tensions and contradictions likely to exist within all coalition governments, typically held together by uneasy alliances and truces that often threaten to splinter and collapse. since january 2019, norway has been governed by a coalition composed of the centre-right conservative party, right-wing progress party, centrist liberal party and traditionalist christian democratic party. these parties are united in numerous political-economic concerns, including what can be broadly termed a neoliberal agenda favouring lower taxes and social spending, but they also exhibit significant cleavages. fertility is merely one significant flashpoint. moreover, the natalist question in norway raises more general issues of statecraft concerning what it means to occupy a position of biopolitical power in the late-modern era. the political figureheads discussed play on fertility as a means to mount a defence of the welfare state but, in various ways, also express contrasting and at times divergent political positions. their focus on fertility can be helpfully analysed using foucault’s (1990, 2008) well-known concept of biopolitics, which, as multiple scholars have pointed out, is a thorny and occasionally vague concept within his wider oeuvre (dean, 2013; lemke, casper & moore, 2011). foucault’s (2003) foundational definition, though, is reasonably clear: ‘biopolitics deals with the population, with the population as a political problem, as a problem that is at once scientific and political, as a biological problem and as power’s problem’ (p. 245). from this perspective, biopolitics is concerned with the figure of the population more than the individual body. a politics operating at the scalar level of the population shifts attention to a diverse set of objects that must be regulated, monitored and normalised in the policymaking process. for foucault (1990), these objects of concern include, inter alia, life expectancy, health, marriage age, birth rates and mortality rates. by focusing on these issues, we show how fertility rates have become a rhetorical site where the three coalition partners within the norwegian government use demographic trends to promote their specific brand of politics.3 foucault’s notion of biopolitics can be a useful analytical tool to highlight certain trends in contemporary norwegian politics. we do not offer a comprehensive analysis of the norwegian political landscape as such; instead, we assess how 3 the christian democrats joined solberg’s coalition government on 22 january 2019 at the peak of the unfolding debates discussed. 6 njsr – nordic journal of social research vol. 11, 2020 these three political parties use fertility as a rhetorical device to frame their respective brands of politics. moreover, we argue that the construction of fertility is entangled with the trope of ‘defending the welfare state’. each party deploys fertility as a means to bolster the concept of ‘the welfare state’, even as this entity comes to be understood along divergent ethical, political and economic lines. this article discusses these contradictory uses of biopolitics within the context of a social-democratic welfare state transitioning into a (moderate) form of a neoliberal political economy (see, e.g., shammas, 2018) in which the three parties discuss and mobilise ethnonationalism and individual responsibility to raise public, moral and political support for their political agendas. rather than assigning blame for various social ills to exponents of neoliberalism, these politicians strategically use what adorno (2000, p. 48) called ‘social blinding’— the misattribution of causal factors to non-causal forces, directing ‘resentment not against the causes but against those who really or supposedly profit from them’—to direct attention away from the curtailment of the welfare state and the roll-back of a protective, decommodifying political economy. as the retrenchment of the welfare state progresses, the relevance of these biopolitical concerns will only likely grow. the prime minister’s new year’s address clearly articulates individualised responsibility to correct falling fertility rates. in an attempt at levity, the norwegian prime minister quips that she does not ‘need to tell anyone how’ to raise the fertility rate and that the government is not ‘not thinking of issuing any orders’ (solberg, 2019). solberg thus excludes any attempts at structural interventions, for example, in labour and housing markets that might ease the issues facing young couples considering bringing children into the world. in contrast, the progress party predicates its position on ethnonationalist collectivism, suggesting antagonistic relationships between diverse ethnic groups. the tensions between these uneasy partners—the conservative party’s individualisation and the progress party’s ethnonationalism—illustrate the emerging entanglement of neoliberalism with ethnonationalism in this era. in capital, marx (1976) proposed that biological reproduction remains a fundamental political problem of capitalism: ‘the labour-power withdrawn from the market by wear and tear, and by death, must be continually replaced by, at the very least, an equal amount of fresh labour-power’ (p. 275). without the biological reproduction of working populations, there can be no social reproduction, which maintains and upholds the legitimacy of the capitalist economic order. enlightened capitalists, therefore, have a self-interested stake 7 njsr – nordic journal of social research vol. 11, 2020 in ensuring that workers are housed, clothed and fed and have a minimal level of satisfaction, so they continue to replenish the human stock capitalism uses in the processes of production and accumulation. more specifically, capitalism requires a biopolitics capable of supplying factories, warehouses, office towers and more with a steady flow of fresh, docile labour. the specifically socialdemocratic variation of this theory postulates that the welfare state demands replenishment of the population not merely through labour power—though this is included—but also through taxpayers and, more broadly, ‘prosocial’ citizens willing and able to enter into the relationships of mutuality that undergird universalist welfarism. productive reproduction: the conservative party the idea that the demographic forces threaten the norwegian welfare state stretches back to the 1990s. at the century’s end, third-way social democrats believed that low fertility combined with aging populations—or the ‘elderly wave’ (eldrebølgen), as it became known in public discourse—would undermine central pillars of the welfare state such as generous retirement provisions and other social protections and lead to shortages in labour-intensive sectors such as the public healthcare system. this widespread fear, driven by perceptions of demographic inevitability, resulted in a major overhaul of norway’s state pension system. in 2011, the so-called pension reform (pensjonsreformen) effectively reduced pension payments to lighten a fiscal burden made heavier by a series of governments unwilling to raise income taxes. it was against this backdrop that conservative party prime minister solberg took to the podium on the first day of 2019 to address the norwegian people: in the past, it was your family that took care of you when you were old. now, the local authorities and the health service are becoming increasingly important. but the solidarity between generations is still the same. the wheels of our society keep turning because adults look after children. and those who are able to work ensure that the elderly can be cared for. in the coming decades, we will encounter problems with this model. norwegians are having fewer children. (solberg, 2019) before linking the prime minister’s neoliberal framings more closely to foucault, we can use hannah arendt’s (1998) work on the tripartite unity of labour, work and action. arendt (1998, p. 8) stated that ‘labor [en]sures not only individual survival but [also] the life of the species. work and its product, the human artefact, bestow a measure of permanence and durability upon the futility of mortal life and the fleeting character of human time’. however metaphysical 8 njsr – nordic journal of social research vol. 11, 2020 arendt’s statement might seem, solberg’s speech highlights the intimate, antagonistic relationships among the individual, the welfare state and labour: too little or too much labour or people might threaten to undermine the entire system of which the people, state and labour are part. labour, in solberg’s speech, ensures the survival of not only the species but also the welfare state. labour and continual, correct reproductive metrics ensure a measure of permanence for the welfare state and endow the nation state with a certain durable quality. ‘labor and work, as well as action, are also rooted in natality in so far as they have the task of providing and preserve the world for, to foresee and reckon with, the constant influx of newcomers who are born into the world as strangers’ (arendt, 1998, p. 9). arendt’s statement is especially telling as solberg’s speech does speak about how labour and work are rooted in reproduction. solberg’s (2019) claim that ‘we all need to have on average, a little over two children’ to maintain the current population signals that reproduction is the bedrock upon which all (non-automated) production rests. another interesting biopolitical link lies in solberg’s notions of ‘generational solidarity’ and a ‘sustainable welfare state’. arendt (1998) stated that labour and work are rooted in natality as these universal, fundamental human activities ensure that the current generation can predict a constant flow of children. however, solberg’s biopolitical anxieties emerge as this flow might not be constant, as arendt so poetically shows. the biopolitical calculus of the birth rate, workforce size, elderly population needing state care and pensions and, finally, mortality rate might be at an unsustainable level for the welfare state. liberal and (later) neoliberal governments see the ‘problem of the population’ (foucault, 2007, p. 351) as a central issue, which can be related to metrics such as population size, birth rates, docile bodies and mortality rates (foucault, 2007). however, in the liberal and (now) neoliberal state for which solberg is a spokesperson, the population also becomes related to wages, prices and work possibilities (foucault, 2007). this calculus enmeshes wealth and populations, moving, transforming, increasing and diminishing them (foucault, 2007). the current moment seems to have applied foucault’s (2007) concern with an optimisation of the population as the state and the individual have aligned their interests to reach an ideal level of reproduction and production suited to producing optimal levels of surplus value. in light of these insights, solberg’s conservatism has a specifically socialdemocratic flavour. given its pro-market inclinations, though, it also promotes a hollow biopolitics, bereft of the traditional instruments of the fordist-keynesian welfare state: generous social spending, massive infrastructure projects, 9 njsr – nordic journal of social research vol. 11, 2020 nationalised industry, high marginal tax rates to redistribute income and wealth and inheritance taxes to prevent the formation of extremely wealthy intergenerational dynasties. what remains is largely rhetorical sermonising: exhortations to do better aimed at the individual (‘norway needs more children!’). there is little or no discussion on interventions in the housing and labour market, even though some of the fundamental constraints on fertility rates spring from what giddens (1990, p. 92) termed ‘ontological insecurity’,4 which has only risen with flexibilised labour relations and upwardly spiralling housing costs. both of these major structural factors, which interact to prevent the formation of childrearing families, are crucial to the formation of fertility rates at sub-replacement levels in norway and across the western world. however, the conservative party agenda largely precludes any consolidated decommodifying interventions into the economic life of ordinary citizens. the structural and political instruments capable of redressing demographic problems are excluded at the level of ideology. ethnonationalist anxiety: the progress party not all children born have equal worth. former minister of justice per willy amundsen noted: i am interested in us having a population composition that is sustainable. ethnic norwegians have a declining birth rate. prime minister erna solberg and i agree that we have to do something about this. but the solution is not a larger immigration population. on the contrary, we have to make sure that the ethnic norwegian population is maintained. i am very concerned that an increase in child benefits not become a hindrance to integration efforts. [child benefits] will become a hindrance to integration efforts if we reward immigrants who have a fourth, fifth or sixth child. (jensen, 2019) amundsen’s remarks recall similar pronatalist, racialising, individually responsibilising tropes found in other ethno-racially charged contexts. for instance, one israeli human rights activist noted that elements in israeli society are ‘afraid of the muslim womb’, and some israeli politicians view palestinian and israeli arab populations as a ‘demographic threat’ (nurit peled-elhanan, n.d.). similarly, in apartheid south africa, the state adopted demographic policies ‘explicitly designed to prevent … racial “swamping” of the minority by 4 giddens (1990, p. 92) defines ontological insecurity as ‘the confidence that most humans beings have in the continuity of their self-identity and in the constancy of the surrounding social and material environments of action’. 10 njsr – nordic journal of social research vol. 11, 2020 the majority population’, including encouraging ‘nonblack’ immigration to south africa and urging south african white women to bear more children (chimeredan, 1993, p. 32). racialised anxieties over allegedly excessive fecundity were also mobilised in the run-up to the bosnian war in the early 1990s. bosnian serb general ratko mladic ‘considered that the greatest danger to bosnian serbs was the muslim “demographic bomb”, meaning a muslim population explosion’ and claimed that ‘muslim women were ‘production machines, each with ten or twelve children’ (o’ballance, 1995, p. 197). these sentiments fed into the genocidal, anti-muslim ram plan, a military strategic document implemented by serbian president slobodan milošević to ‘aim our action at the point where the religious and social structure is most fragile. we refer to the women, especially adolescents, and to the children’ (tatum, 2010, p. 76). more peaceably but still dramatically, a key element of the thatcherite project of individual responsibilisation was to shame ‘unwed mothers’. after her tenure as prime minister, margaret thatcher claimed that single mothers are so irresponsible that it is ‘far better to put these children in the hands of a very good religious organisation, and the mother as well, so that they will be brought up with family values’ (british broadcasting corporation, 1998). similarly, at the height of us president reagan’s attack on ‘welfare queens’, who were supposedly irresponsible black women and mothers, the new york times (1976) summarised the alleged features of this shadowy figure: ‘she has 80 names, 30 addresses, 12 social security cards and is collecting veterans’ benefits on four non-existent deceased husbands. … her tax-free cash income alone is over $150,000’. the political left, greene (2018) wrote, attacked reagan for ‘stoking white voters’ latent racism’ with a ‘stereotype of a black woman having endless kids and cheating the system’. when the state has failed to provide full employment or uphold living standards, politicians have often turned to women’s bodies as favoured targets of moralistic sermonising and biopolitical regulation. ethno-racialisers and ethnonationalists have a long history of invoking racial anxieties, playing on the notion that fertility lies at the heart of the issue of foreigners overrunning the ‘homeland’. take, for instance, uk independence party leader nigel farage’s infamous ‘breaking point’ brexit poster, which tarnished european union membership with the spectre of an endless stream of immigrants. amundsen’s statement proposes a two-pronged strategy to safeguard the welfare state: (i) incentivise production of more offspring through direct fiscal manipulation; and (ii) extend those incentives only to those conforming to the parameters of his ‘ethnically norwegian’ population capable of realising a modest, constrained fertility rate, ideally no more than three children per 11 njsr – nordic journal of social research vol. 11, 2020 woman. this proposal contrasts, for instance, with far-right hungarian prime minister viktor orbán’s suggestion, only a month after amundsen’s proposal, that hungarian women who have four or more children be freed from the burden of paying income taxes. ‘in all of europe, there are fewer and fewer children, and the answer of the west to this is migration’, orbán said (walker, 2019). ‘they want as many migrants to enter as there are missing kids so that the numbers will add up. we hungarians have a different way of thinking. instead of just numbers, we want hungarian children. migration for us is surrender’. whereas the hungarian prime minister wants women to give birth to more than three children as an alternative to immigration, amundsen seeks to achieve a more modest fertility rate by tacitly penalising ethno-racial minorities seen as excessively fecund. despite important differences in the details of their proposals, both, in their own ways, use a biopolitical rationale to promote their own ethno-nationalists agenda. latent within this logic is the idea that norway is on its way to having a unsustainable population. amundsen, for instance, claims that current demographic trends guarantee that ‘ethnic norwegians’ will become a minority, destabilising the very sustainability of the welfare state. the use of the term ‘sustainable’ connects with the concept of carrying capacity in modern ecological theory (see, e.g., barrett & odum, 2000). amundsen’s statements make clear that norway can only carry so many immigrants before it reaches its maximum carrying capacity. the same logic applies to the number of ethnic norwegians; the welfare state cannot ‘carry’ too many immigrants while simultaneously reducing its ethnic norwegian population. amundsen completes his proposal by stating that it will ‘primarily affect immigrant families with large families, where the birth rates are high. this is particularly true for somalis, who are ranked in the top (in terms of birth rates) and have far higher birth rates than ethnic norwegians have. ... it is primarily ethnic norwegians that have declining birth rates. the solution is not to maintain high birth rates amongst immigrants by offering them high state sponsored benefits’ (jensen, 2019). amundsen starkly professes a logic of biopolitical power that can be linked directly to foucault’s (2003) notion that biopower is defined not by the sovereign’s ability to take lives but by regulation of the space between life and death. amundsen’s ethno-national biopolitics entails rolling out incentives and disincentives to shape the most intimate dimensions of human life including childbearing. in amundsen’s frame, the decision to intervene in citizens’ intimate lives differentiates population segments by ethnic background. amundsen explicitly predicates his biopolitics on a logic of ethnonationalism. 12 njsr – nordic journal of social research vol. 11, 2020 while foucault never directly connected biopolitics to ethnonationalism, he did draw a connection between racism and biopolitics. foucault (2003) brought biopolitics to bear on racism when he asked what racism ‘in fact is’ (p. 254). he answered: ‘it is primarily a way of introducing a break into the domain of life that is under power’s control: the break between what must live and what must die’ (foucault, 2003, p. 254). he further noted that racism has two functions. the first is ‘to fragment, to create caesuras within the biological continuum addressed by biopower’ (foucault, 2003, p. 255). the second function of racism, which has greater relevance to our case study, is to establish a relationship between my life and the death of the other that is not a military or warlike relationship of confrontation, but a biological-type relationship: ‘the more inferior species die out, the more abnormal individuals are eliminated, the fewer degenerates there will be in the species as a whole, and the more i—as species rather than individual— can live, the stronger i will be, the more vigorous i will be. i will be able to proliferate’. (foucault, 2003, p. 255) our point is not to directly connect amundsen’s proposal to a racist discourse but to highlight foucault’s (2003) insight that racism or, in our case, ethnonationalism in the service of biopolitics, creates a dimension of (bio)ethnic competition. amundsen singles out ethnic norwegians as in danger of becoming a minority while suggesting that declining birth rates among ethnic norwegians indicate an ‘unsustainable’ demographic development for norwegian culture and its welfare state. he thus constructs an ethnonationalism that does not propose killing the other (as in the serbian ram plan) but seeks to severely curtail the other. slightly reformulating foucault’s (2003, p. 255) statement that ‘the very fact that you let more die will allow you to live more’, amundsen’s proposal suggests that the more ‘we’ (ethnic norwegians) give birth, the more sustainable the welfare state is. conversely, the less the immigrant others reproduce, the more ‘we’ (ethnic norwegians) proliferate. amundsen’s statements are not thanatopolitical, a biopolitics of death and killing of the other. instead, they instantiate an ethno-nationalistic biopolitics that manipulates who should give birth, how often they should give birth and who should restrain (supposedly) excessive fertility. his biopolitics is not the ‘right to death’ but the ‘right over birth’, proclaimed in a putative defence of the welfare state. here, we might also note that the notion of ‘the right over birth’ can be linked to eugenics and social darwinism. social darwinism postulates that by nature, ‘superior races’ beat ‘inferior races’ through competition, and the individuals with the best hereditary material reproduce the most efficiently. social darwinism thus can be most easily reconciled with a neoliberalism that focuses on market 13 njsr – nordic journal of social research vol. 11, 2020 competition and a discourse that does not primarily rely on state interventions. eugenics, in contrast, is more focused on government policies aimed at selecting those fit for reproduction through social engineering. the former is compatible with neoliberalism, whereas the latter is less obviously so. amundsen’s statement, therefore, can be framed as a biopolitics that explicitly supports state interventions to secure what is perceived as a ‘sustainable fertility politics’. his position contrasts with prime minister solberg’s more individualising rhetoric of personal responsibility to correct falling birth rates. taken to their respective logical conclusions, which are not necessarily explicitly expressed in policy, amundsen’s ethnonationalist proposal suggests a eugenic logic, while solberg’s anti-structural, individual responsibilisation programme has a more social darwinian flavour. one final insight from foucault emphasises the gravity of introducing politically targeted birth disincentives. foucault (2003) stated that ‘broadly speaking, racism justifies the death-function in the economy of biopower by appealing to the principle that the death of others make one biologically stronger insofar as one is a member of a race or a population, insofar as one is an element in a unitary living plurality’ (p. 258). however, in ethnonational ideologies, thanatopolitics does not necessarily involve the death of the other; instead, restrictions, confinement and expulsion are laid upon the ethno-racial other in the name of ‘sustainability’. amundsen’s proposal then is an example of how coupling the biopolitics of birth with ethnonationalism produces not the death of the other, as foucault’s account of racism suggests, but a discourse in which the other is not born in the first place. conservative christian ethics: the christian democratic party the rise of populist ethnonationalism has reactivated familiar tropes from norway’s history of state lutheran christianity. sylvi listhaug, a leading figure in the progress party, prominently wore a crucifix during her tenure as minister of immigration and justice between 2015 and 2017. when questioned about this unusual display of religiosity in one of europe’s most secularised countries, listhaug replied: ‘the crucifix means a lot to me because it belonged to my grandmother. she received it as a gift from my grandfather when they were engaged’ (fossheim & talsnes, 2016). in november 2018, another prominent progress party politician, christian tybring-gjedde, emphasised the central importance of ‘our christian heritage’, noting that his party was ‘the foremost defender of these values in all policy 14 njsr – nordic journal of social research vol. 11, 2020 formation. the christian cultural heritage is the very foundation. it must be defended and retransmitted. at the same time, this means that other belief systems will have to occupy a less prominent place’ (tybring-gjedde, 2018). listhaug and tybring-gjedde’s statements both show, if only anecdotally, how ethnonational politics fuses a symbolic politics of religion and ancestry. indeed, tybring-gjedde ties the need to retransmit a christian cultural heritage to the issues of links between the older and younger generations and the literal, biological reproduction of protestant citizens. connecting tybring-gjedde’s proposal to the biopolitics of amundsen’s statements on limiting immigrant reproduction while raising the ethnic norwegian birth rate, this biopolitics of reproduction places a clear stress on increasing the christian ethnic norwegian birth rate while reducing the immigrant birth rate. if we take the progress party’s biopolitics seriously, tybring-gjedde’s (2018) notion that ‘other belief systems will have to occupy a less prominent place’ indicates that not only other belief systems but also other ethnic groups will have to occupy less prominent places due to the very drastic biopolitical intervention of limiting their number of children. restricting immigrants’ birth rates certainly will make them less visible and prominent within the demographic panopticon of census data, urban geography and other metrics of population demographics. as we have alluded, this biopolitics of reproduction does not consist of mastery over the ‘right to take life’ and perhaps not even the ‘right to life’; instead, it occupies a space between life and death, involving governance of who will and will not be born. reproduction has always been a space where potential life meets death. from the potential for death in labour to the promise of new life symbolised in the child, reproduction and power over reproduction constitute a third space within the biopolitical economy of governmentality. another instance of biopolitics arises in ropstad’s statement that ‘if you can carry one [child], then you can carry two [children]’. this statement expresses the christian democrats’ partial opposition to liberal abortion laws, particularly the right to selective or multifetal reduction. rather than the connection to productivity seen in the prime minister’s speech or the ethnonationalism embedded in the progress party’s proposal to restrict child benefits, ropstad’s statement embeds a conservative christian ethics within the biopolitics of reproduction. far from a unique stand within rightist christian conservatism, this position perhaps more telling partially contrasts with stance of coalition partners such as the progress party on the issue of immigrant reproduction. ropstad’s statement drew the ire of pro-choice groups, but his position springs from the christian democrats’ ideology. it strongly holds that it should be up to individual families to decide how many children they want and that ‘very serious 15 njsr – nordic journal of social research vol. 11, 2020 arguments’ should be made ‘before the state intervenes’ in the freedom of families to make reproductive decisions (christian democratic party of norway, 2017, p. 22). ropstad’s statement clearly expresses a biopolitics of ‘the right to life’—a conservative christian mantra—and his party’s position logically supports families’ right to independently decide how many children they want without state intervention. immigrants, therefore, should also be accorded this right, a position in clear opposition to the progress party’s proposal to limit birth rates among immigrant families with four or more children. ironically, the christian democrats’ biopolitics—while propounding that families should decide how many children they want and the state should create a supportive environment for families to have as many children as they want—still limits these reproductive choices. families may choose the number of children they want only within the logic of a conservative christian biopolitics. the freedom to choose remains only as long as it conforms to the constraints laid down by the party’s ideology. allowing multifetal abortion is a case in point: the autonomy of the family—including, crucially, the female body—is only biopolitically guaranteed so long as it remains within the ambit of a conservative christian view on the ‘right to life’. just as the progress party’s biopolitics of ethnonationalism aims to circumscribe the freedom to choose, the christian democrats’ view on legitimate state interventions forecloses certain reproductive actions while enabling others. conclusion in recent years, declining birth rates across the post-industrialised world have pointed the attention of social scientists, political leaders and social commentators to the so-called demographic transition, or the movement from high birth and mortality rates to lower mortality and birth rates. one underexplored origin of the formation of what we might call the ‘low-birth society’ is the neoliberalisation of the political economy since the 1980s. neoliberalism results in social insecurity; future life-course trajectories grow more uncertain as work becomes flexibilised, housing markets are liberalised, social security deteriorates, and universal welfare goods such as education and healthcare are commodified. in early 2019, these issues made a remarkable return to norway’s political agenda as governing centre-right politicians attempted to reverse the country’s turn to low birth rates in recent years. however, norway’s turn to neoliberalism in the political economy and, therefore, the biopolitical domain has not been total. income inequality remains relatively low, universal welfare goods are still widely available, and the welfare state continues to provide social 16 njsr – nordic journal of social research vol. 11, 2020 security to the sick, disabled, elderly and unemployed, albeit in a fashion that seems likely to deteriorate under the twin pressures of market efficiency and workfarist discipline. one unexpected manifestation of these developments is seen in the statistical tables on the declining fertility rates in this northern european country. as stressed in a statistics norway report, the country’s official statistics agency, one of the most powerful explanations of declining fertility rates in recent years has been ‘heightened economic insecurity’ (dommermuth & lappegård, 2017, p. 40). precluded by ideological affiliations from utilising the powerful statecentred tools available to the early social democrats, the centre-right politicians discussed have adopted a series of rhetorical biopolitical postures expressed through producerist moral exhortations, ethnonational exclusion and conservative christian discourse. as the welfare state has retreated, a form of sermonising biopolitics seems to have surfaced and taken its place. amidst this increasingly polarised community, three discourses— biopolitical producerism, ethnonationalist panic and conservative christianity— have entered and engaged with one another to fill the vacuum left by keynesian fordism. however, the defence of the welfare state in the name of neoliberalism seems likely to fail as only a politics of social democracy can re-create the social democracy for which these politicians seem to both tacitly and overtly long. in short, these physicians of the polity seem to prescribe the wrong cures for a wholly misdiagnosed illness. acknowledgements the authors would like to thank the anonymous reviewers for their kind, thoughtful and inspiring comments during the review of this article. we would also like to thank the editorial staff at the nordic journal of social research for their careful and diligent aid with the manuscript, helping us take it from manuscript to article form. references adorno, t. w. 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(2019, february 10). viktor orbán: no tax for hungarian women with four or more children. the guardian. retrieved from https://www.theguardian.com/world/2019/feb/10/viktor-orban-no-tax-forhungarian-women-with-four-or-more-children microsoft word 3482 tilpasset mal njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 20nn circle of security-parenting: a systematic review of effectiveness when using the parent training programme with multi-problem families tina gerdts-andresen* faculty of health and welfare østfold university college, norway email: tina.gerdts-andresen@hiof.no *corresponding author abstract introduction: circle of security-parenting (cos-p) is a simplified, relationship-based programme with the intention of developing parents’ observation and inferential skills related to understanding their child’s needs, increasing sensitivity to their child, aiding in emotional regulation, as well as decreasing any of their negative attributions to their child. cos-p is a widely used parenting programme that is gaining global popularity, as it is currently being delivered across several continents. despite being one of the most frequently used interventions in norwegian child protective services (cps), no research has been conducted on this programme’s effectiveness when used in the cps context. this study therefore aims to establish a systematic overview of the programme’s effectiveness for families within the cps system, regarding both caregivers and benefits for the children. method: the database searches were originally conducted in june 2018 and updated in april 2020, encompassing 13 international bibliographical databases. the search for grey literature was conducted, and the generated articles these were then manually searched. a non-statistical narrative approach was used to analyse the studies due to the heterogeneity of the outcome measures. research studies on the effectiveness of 2 njsr – nordic journal of social research vol. 12, 2021 cos-p intervention, where the participants reported a minimum of two specifically defined risk factors, were included for further analysis. results: seven studies met the inclusion criteria. the studies included in the review focus on a diversity of separate and isolated factors concerning caregivers but not the effect of the accumulation of risk factors and how this may or may not influence the potential effectiveness of cos-p. the findings’ strengths include some improvements in reducing parental stress, increasing self-efficacy and parenting skills, and promoting an understanding of child behaviour. there is no conclusive evidence that cos-p assists in increasing the security of the parent-child attachment relationship. discussion: given the limited number of studies, further research is needed to examine if cos-p improves child behaviour, if its effects can be sustained over time and if it is more effective for particular populations. keywords: attachment-based intervention, systematic review, multi-problem families, circle of security-parenting (cos-p), parental stress, secure attachment introduction circle of security-parenting (cos-p; cooper et al., 2009) is a widely used programme that is gaining global popularity. it is currently being delivered across several continents, and most nordic countries have implemented it as part of their early intervention foundation (eif guidebook, 2019; plauborg & jacobsen, 2017). however, empirical support for cos-p is still limited (mothander et al., 2018). since 2010, more than 2000 persons in norway, with competencies as psychologists, social workers, school nurses and child welfare workers, have been trained to use the cos-p training method as part of their daily work with at-risk families (bråten & sønsterudbråten, 2016). here, an atrisk family refers to one with known risk factors related to family characteristics or connected with the child’s environment, but the family appears unaffected in daily life. additionally, cos-p is listed as one of the most frequently used interventions in norwegian child protective services (cps) (christiansen et al., 2015). however, no research has been conducted on this intervention’s effectiveness when used in the cps context. in contrast to at-risk families, most of those involved with cps are multi-problem families that display multiple risk factors concerning the children’s welfare and wellbeing. this review therefore focuses on identifying studies where cos-p is used as a training 3 njsr – nordic journal of social research vol. 12, 2021 intervention for parents from multi-problem families. the aim is to establish a systematic overview of the cos-p programme’s effectiveness for those living in multi-problem families, with respect to both caregivers and benefits for the children. the research question is what change in effectiveness multi-problem families can expect from participating in the cos-p programme. circle of security-parenting cos-p is a simplified, relationship-based parenting programme originating from a far more comprehensive parental guidance programme, circle of security (cos). cos is available in two versions: cos virginia and cos international. cos virginia consists of an individual treatment model and a group model, whereas cos international comprises a treatment method (cos intervention) and a parent training method (cos-p; cooper et al., 2009). the research on the effectiveness of cos intervention forms the basis of the development of cos-p, where findings from studies of cos intervention have been applied to promote the possible effectiveness of cos-p. however, while cos-p shares the same theoretical framework and some resources, its model of implementation is very different, and so is any evidence of its effectiveness. summarised, cos intervention contains five elements: (1) conduct and videotape a pre-group assessment using the strange situation procedure (ssp) and the circle of security interview (cosi). (2) review and analyse ssp and cosi to create a treatment plan. (3) evaluate each group member’s core sensitivity. (4) select and assemble individualised video clips for review in the group. (5) use the manual to assist in facilitating multiple individualised video reviews with each client over the course of a 20-week minimum intervention. in comparison, cos-p contains two main elements: (1) facilitate video reviews using the cos-p manual, with eight weekly sessions. (2) use the cos-p fidelity journal to reflect on the experiences from the sessions (hoffman et al., 2006; powell et al., 2014). according to the cos website (https://www.circleofsecurityinternational.com), another main difference is that while only licensed clinicians can be trained in the cos intervention model – which includes ten days of training, an exam and at least one year of supervised practice – the cos-p programme can be conducted by anyone who completes a four-day training programme. 4 njsr – nordic journal of social research vol. 12, 2021 the parent training method, cos-p, is a universal structured programme that intends to help caregivers increase their capacity to serve as sources of security for their children, with the idea that this strengthens caregiver sensitivity and reduces the risk of insecure and disorganised attachment. the programme offers caregivers a theoretically based understanding of the complexity of the attachment system and how it contributes to infants’ and toddlers’ development of their sense of security and competence. childhood experiences of parental insensitivity, as well as insecure and disorganised attachment, are precursors of a variety of problematic developmental outcomes. for some outcomes – such as externalising problems, physiological dysregulation and other forms of developmental psychopathology – disorganised attachment brings a heightened risk, even in comparison to other types of insecure attachments (fearon et al., 2010; thompson, 2016). cos-p is an attachment-based intervention, stemming primarily from the work of psychologists john bowlby and mary ainsworth (ainsworth et al., 1978), and functions as a method of promoting safe attachment between caregivers and children to prevent child mental health problems (hoffman et al., 2006; powell et al., 2014). however, in contrast to the other cos programmes, cos-p does not measure the quality of attachment, as the programme focuses on increasing childcare providers’ awareness of attachment. the aims of cos-p include developing parents’ observation and inferential skills related to understanding their child’s needs, increasing sensitivity towards their child, aiding in emotional regulation, as well decreasing any of their negative attributions to their child (powell et al., 2014). the model is based on the belief that caregivers who are emotionally present with their children and helpful in processing strong feelings act to contain distress and help the children develop the ability to accomplish this themselves and become self-regulating. cos-p is described as a preventive psycho-educational parental guidance programme, primarily developed for the school health service, health centres and kindergarten. it targets the parents of the youngest children, as it is theorised that the intervention will be more effective, the earlier it is implemented (hoffmann et al., 2006; powell et al., 2014). cos-p is offered to parents who can choose to participate, either individually or in groups, in an intervention for enhancing attachment in early parent-child relationships. the parental training method is a pre-prepared manual programme that normally involves 6–8 guidance sequences. there is no formal requirement to adhere to the 5 njsr – nordic journal of social research vol. 12, 2021 official manual; however, in a survey of 423 norwegian supervisors, 92% reported following the manual and using the programme as taught in their work (brandtzæg & thorsteinson, 2014). despite the generally scarce scientific information available regarding the effectiveness of parenting education programmes developed specifically for families in the child welfare system, cos-p has been listed as not possible to be scientifically evaluated due to the limited research and considerable variability in its delivery (caruana, 2016). thus, based on the cos intervention research studies, there is an overall expectation of cosp’s effectiveness when the participants are at-risk parents; it is expected to improve caregiver skills, confidence, self-efficacy and wellbeing, as both models are based on the same theoretical framework (caruana, 2016; powell et al., 2014). however, questions have been raised about whether the expected effectiveness applies generally and if it is transferable to multi-problem families in the cps context. characteristics of families in multi-problem situations in recent decades, there has been extensive research on the risk factors’ effects on the development of psychopathology among children and adolescents (kolthof et al., 2014). the problems that such families experience include parenting issues, financial debt, psychiatric problems, troubled relationships, health and housing-related issues, intellectual disabilities, social class contrasts (e.g., poor, uneducated parents, lack of social support, many stressful life events) and repeated contacts with social authorities or the criminal justice system (bodden & decović, 2010; holwerda et al., 2014; sameroff, 2000). moreover, there is considerable overlap among the risk factors contributing to different disorders, such as depression, behavioural problems, substance abuse or schizophrenia (sameroff, 2000). a disorganised home (an environment with high noise levels, over-crowding and little regularity or routines) can also lead to unhealthy socioemotional development. this may result in children’s instability in school and in the home situation, which increases the risk of negative effects on their cognitive development (coldwell et al., 2006; evans, 2004). the problems in these families are described as multiple, varying and complex (kolthof et al., 2014; tausendfreund et al., 2016). the aspect of multiplicity means that the 6 njsr – nordic journal of social research vol. 12, 2021 families have to cope with several problems simultaneously. these problems exist in different areas of life, causing them to vary as life changes over time. furthermore, the problems are interwoven, modifying one another in many ways and leading to increasingly complex situations. the interaction between socioeconomic and psychosocial problems appears to be responsible for the difficulties that some families experience in their attempts to handle everyday life successfully (bodden & decović, 2010). the complexity of these families’ situations indicates that other stress-creating factors in life may need to be reduced before they enter reflection processes regarding how to behave towards their children, such as those offered in the cos-p programme. at the same time, it is reasonable to question whether the parents actually need such a programme or if their parenting skills would adjust accordingly if they would receive comprehensive help based on the multi-problem complexity of their situations. in addition to the problems in the families, their ability to solve their issues should also be taken into account as reciprocal conditions in change processes. thus, it is not the abundance of problems that distinguishes families in multi-problem situations; rather, it is their limited ability to solve their problems in a persistent way (spratt, 2011), which leads to encounters with the social authorities and the social welfare system. methods search strategy this review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (moher et al., 2009). the review followed the methodology outlined in the cochrane handbook for systematic reviews of interventions (higgins et al., 2019). the database searches were originally conducted in june 2018 and updated in march 2020, encompassing 13 international bibliographical databases: oria, cinahl, academic, pubmed, campell, proquest, ebscohost, wiley, social care online, sage, springerlinks, taylor & francis, and swemed. the search for grey literature entailed contacting both national and international coordinators of the programme and searching for ongoing, relevant projects, as well as examining the official website of cos international (https://www.circleofsecurityinternational.com/). 7 njsr – nordic journal of social research vol. 12, 2021 the following search terms were modified, where appropriate, to meet the search requirements of each database: “circle of security parenting or circle of security parenting or cos-p” and “interven* or program* or child services* or social services* or cps* or child welfare*” and “outcome* or evaluat* or effect* or experiment* or trial* or compare* or impact* or consequen* or research” and “multi-problem* or multiproblem* or risk* or at-risk* or high-risk*. the search included peer-reviewed studies, non-peerreviewed studies and grey literature (e.g., theses, research reports, conference papers) that identified the topic. eligibility criteria and study selection a population, intervention, comparators, outcome and study design (picos) framework was used to support the study selection process. the studies to be included in this review had to match predetermined criteria according to the picos approach (table 1). table 1: picos criteria for inclusion and exclusion of studies parameter inclusion criteria exclusion criteria population / problem research studies on the effectiveness of cos-p intervention, where participants report a minimum of 2 specifically defined risk factors. studies that examine the use of cosp in general, without identifying risk factors among the attendees studies targeting families with one, or none identified risk factors studies that examine the effectiveness of cos-p, where the attendees are others than parents (e.g. child care providers, foster parents) intervention circle of security parenting (cosp), both group and individual model program adhered closely to the manual, 6-10 week program period all other cos interventions, e.g. cos, cosi, and cos-hv4 program where the manual is partial or random followed. program period less than 6 weeks or longer than 10 weeks. comparators what effectiveness does the cos-p program have for participants living in a multi-problem situation outcome primary outcome measures: change in parenting skills and strengthening of the parent-child relationship. secondary outcome measures: benefits for the child, e.g. measured in changes in the child’s behavior study design randomized controlled trials, nonrandomized controlled trials, not controlled trials, and retrospective, prospective, or concurrent cohort studies. single case studies. peer-reviewed reviews, expert opinion, comments, letter to editor, conference reports. outcome measured solely on participants’ experience, without additional measures. studies with no outcomes reported. non-peer-reviewed implementation studies 8 njsr – nordic journal of social research vol. 12, 2021 initially, two reviewers screened the publications based on the title and the abstract to identify any clear irrelevance (e.g., family childcare providers, implementation studies) to the current review or any duplication. the publications that passed the first screening were screened again by the same two reviewers based on the full-text version, and disagreements were handled according to the cochrane collaboration’s “reliability and reaching consensus” tool (higgins et al., 2019). the studies that examined the use of cos-p in general, without identifying multiple risk factors among the attendees, were excluded. to be included, the studies should have examined the effectiveness of the cos-p programme when aimed at participants with at least two specifically defined risk factors affecting their lives. the studies targeting families with one or no identified risk factor were not included, as multi-problem families have more compound problems and are therefore expected to have specific needs. when the cos-p programme is aimed at multi-problem families, it is expected to be more targeted than when it addresses a broader category of at-risk parents that seeks to prevent their children’s maladjustment. only those studies where the cos-p programme adhered closely to the manual were included, and these had a programme duration that varied between 6 and 10 weeks. both individual and group interventions were included. as this is a systematic review of the intervention’s effectiveness, only the studies that measured effectiveness were included. self-reports of the participants’ experiences of cos-p, without observations or quantitative measures to examine the programme outcomes for the participants, were excluded. furthermore, a non-statistical narrative approach was used to analyse the studies due to the heterogeneity of the outcome measures. quality assessment strategy and risk of bias the quality of the included studies was assessed using the cochrane collaboration’s “risk of bias” tool, as adapted from higgins et al. (2019). this tool assesses five potential sources of bias: selection, performance, attrition, reporting and other biases. bias is assessed as a judgement (high, low or unclear) for individual elements from the five sources as a way to evaluate validity and the risk of overor under-estimating the true effectiveness of cos-p when used for multi-problem families. a random selection (three papers) was quality checked by a second independent reviewer to ensure reliable ratings. 9 njsr – nordic journal of social research vol. 12, 2021 data extraction the data were extracted from the included studies using a predetermined form, and any missing or unclear information was marked next to the relevant item. the extracted information included (1) study design, (2) sample characteristics, (3) setting, (4) intervention details, (5) outcome measures and (6) child age at baseline. secondary outcomes concerned other child development markers, such as cognitive development, psychomotor development, parent sensitivity and attachment classification. the extraction was performed by the author and thereafter controlled by three peers. disagreements were handled according to the cochrane collaboration’s “reliability and reaching consensus” tool (higgins et al., 2019). results study selection the initial systematic search in reference databases generated a total of 182 potentially relevant hits. two additional studies were identified from other sources, including manually searching reference lists. out of 72 unduplicated titles and abstracts, 29 articles were assessed (full text) for eligibility. seven original publications, published between 2014 and 2018, met the eligibility criteria and were selected for the systematic review (table 2). 10 njsr – nordic journal of social research vol. 12, 2021 table 2: prisma diagram describing the search and selection process 11 njsr – nordic journal of social research vol. 12, 2021 study characteristics the included studies examined interventions aimed at families experiencing difficulties with special needs in more than two areas. the areas of difficulty were as follows: low income, single-parent household, low educational level, exposure to violent crime, arrest for a crime, substance abuse, history of perpetrating child maltreatment, history of child maltreatment victimisation and ethnic minority status. some samples were further characterised by insecure attachment, risk of developmental delay or parental problems, among others. table 3 presents an overview of the occurrence and frequency of various participant characteristics. the parents’ ages ranged from 22 to 44 years, with the participants in five studies reported as mothers (cassidy et al., 2017; horton & murray, 2015; kohlhoff et al., 2016; maupin et al., 2017; perrett et al., 2015). one study reported the participants as fathers (pazzagli et al., 2014), while another included both mothers and fathers (mothander et al., 2018). horton and murray (2015) offered participation to both mothers and fathers; however, only mothers signed up. three studies also included families with more than one child (horton & murray, 2015; kohlhoff et al., 2016; maupin et al., 2017) but encouraged the participants to focus on their youngest child’s behaviour and their experiences with him or her. 12 njsr – nordic journal of social research vol. 12, 2021 t a b le 3 : p a rtic ip a n t c h a ra c te ris tic s 13 njsr – nordic journal of social research vol. 12, 2021 description of studies included studies the literature search identified eight articles focusing on the use of cos-p as an intervention for multi-problem families where at least two risk factors were identified. one study (kimmel et al., 2017) was excluded because it only explored the participants’ experiences. table 4 provides an overview of the seven included studies. none of the studies identified cos-p intervention use for families within the child welfare system; however, two studies (horton & murray, 2015; maupin et al., 2017) identified participants with active cps cases. in any country, no current evidence supports targeted applications of cos-p for multi-problem families or using the programme for families that need help from child services. however, this systematic review has identified seven studies that contribute to the work on identifying the effectiveness of cos-p among families living with multi-risk factors. all empirical studies were peer reviewed. additionally, the literature search identified no studies focusing on the use of cos-p in culturally or developmentally diverse populations, leading to the assumption that no empirical evaluation of cos-p in such populations has been conducted so far. intervention in six of the included studies (cassidy et al., 2017; horton & murray, 2015; kohlhoff et al., 2016; maupin et al., 2017; mothander et al., 2018; perrett et al., 2015), the intervention was conducted in the form of weekly group meetings under the condition that the participating caregivers had not been earlier involved in a cos intervention. pazzagli et al. (2014) conducted a single case study, where the intervention was administered in the form of individual sessions. 14 njsr – nordic journal of social research vol. 12, 2021 t a b le 4 : d e s c rip tio n o f in c lu d e d s tu d ie s 15 njsr – nordic journal of social research vol. 12, 2021 t a b le 4 c o n tin u e d 16 njsr – nordic journal of social research vol. 12, 2021 risk of bias evaluation studies on parenting programmes usually include small to medium sample sizes and are thus difficult to interpret, as they are not blinded and often rely on selfreported outcome measures. as all studies included here were conducted in clinics, bias might have been introduced in several places during the cos-p programme. as the researchers or the data collectors were also the group facilitators, subtle bias could have influenced the facilitators’ responses to the participants during the intervention and biased the participants’ responses during the data collection. however, in all the included studies, the authors considered the risk of bias to be low. outcomes all studies included an analysis of the effects of one or both of the outcomes that cos-p directly targets: child attachment (security, avoidance and organised versus disorganised classification) and caregivers’ responses to child distress (supportive and unsupportive responses). three of the studies (cassidy et al., 2017; pazzagli et al., 2014; perrett et al., 2015) also analysed the effects of the intervention on possible secondary outcomes, such as child behaviour problems (internalising and externalising), child executive functioning (inhibitory control and cognitive flexibility) or both. effect of the intervention on child attachment cassidy et al. (2017) found no significant effects of intervention on continuous attachment outcomes (e.g., security or avoidance). moreover, the rates of disorganised attachment did not differ between the treatment and the control groups. moderation of the intervention effect was explored by conducting an exploratory analysis to examine whether dimensions of adult attachment style (e.g., anxiety and avoidance) or maternal depressive symptoms moderated the intervention effect. an insignificant moderated effect was identified; maternal attachment avoidance moderated intervention effects on both child security and rates of disorganisation. when the mothers’ scores were one standard deviation (sd) above the mean on attachment avoidance, the children in the intervention group tended to be both more secure and less disorganised than the children in the control group. however, there was no main treatment effect on the security or the disorganisation of the mothers who had a mean score on attachment avoidance 17 njsr – nordic journal of social research vol. 12, 2021 the children of the mothers who scored one sd below the mean on attachment avoidance displayed less security than the children in the control group. there was no evidence of a main treatment effect on disorganisation in this group (cassidy et al., 2017). maternal attachment avoidance did not moderate the effects on child avoidance. no other variables moderated the intervention effects on child attachment. these included (1) maternal attachment anxiety on child security, child avoidance or disorganisation and (2) maternal depression symptoms on child security, child avoidance or disorganisation. neither of these was found by cassidy et al. (2017) and perrett et al. (2015). furthermore, maupin et al. (2017) did not find any effectiveness on the child– parent relationship. effect of the intervention on caregivers’ responses to child distress cassidy et al. (2017) found that the use of the cos-p intervention reduced the mothers’ unsupportive responses to child distress. however, the intervention did not alter the mothers’ supportive responses to child distress. the findings were not moderated by maternal attachment anxiety, maternal attachment avoidance or maternal depression symptoms. measuring individual differences in two commonly utilised emotion-regulation strategies, that is, reappraisal and suppression using the emotion regulation questionnaire (gross & john, 2003), horton and murray (2015) identified a small mean trend towards increasing reappraisal strategies and decreasing suppression among the study participants who attended the cos-p intervention sessions. these scores indicate a better implementation of beneficial emotion-regulation strategies. for the reappraisal strategies, five participants showed improvement, one stayed the same, and three had post-test scores that were lower than their pre-test scores. on suppression strategies, four participants showed improvement, one stayed the same, and four showed a negative development in this area. horton and murray (2015) identified four background variables that were qualitatively associated with reliable change on the measures concerning the effectiveness of cos-p. generally, participants with more education, no personal history of child maltreatment victimisation, less time in the residential 18 njsr – nordic journal of social research vol. 12, 2021 substance-abuse treatment programme and lower social desirability scores showed reliable change. in contrast, participants who had less education, a personal history of child maltreatment and more time in the residential programme were associated with a reduced effectiveness of the intervention. a history of perpetrating child maltreatment, the number of sessions attended and the number of children in the family had no impact on the intervention’s effectiveness. however, maupin et al. (2017) found the intervention ineffective in parental competency, including efficacy and satisfaction with their relationship with their child. pazzagli et al. (2014) reported a single case study of a father who took part in the cosp intervention in the context of conflict for the custody of his five-year-old daughter. he showed improvements in agency of self, capacity to use internal resources, parental stress and perception of his child’s functioning. reduction in parental stress was also reported by perrett et al. (2015), who used a waitlist-controlled design to evaluate the efficacy of cos-p in a small sample of mothers with young children (mean age: 3.5 years). furthermore, kohlhoff et al. (2016) found the intervention to be associated with a decreased level of caregiver helplessness and maternal stress, as well as a decreased feeling of fear, anger and rejection towards the child. mothers who participated in an intervention (maupin et al., 2017) reported significantly fewer depression symptoms compared with their symptoms before attending the cos-p programme, while mothander et al. (2018) reported positive changes in parents’ representations and responsiveness to their child after attending the intervention programme. the findings indicate that it is possible to enhance high-risk parents’ representations about themselves as parents and their caregiving through intervention. however, maupin et al. (2017) did not find any effectiveness for any of the reflective functioning scales, including prementalising, certainty about mental states, and interest and curiosity. effect of the intervention on child behaviour problems three studies (cassidy et al., 2017; pazzagli et al., 2014; perrett et al., 2015) analysed the effects of the cos-p intervention on child behaviour problems. all studies found the 19 njsr – nordic journal of social research vol. 12, 2021 intervention to have no significant effect on child internalising or externalising behaviour problems. cassidy et al. (2017) reported moderated effects, which showed that the children in the intervention group had fewer mother-reported internalising problems than the children in the control group when the mothers’ scores were one sd below the mean on attachment anxiety or on depression symptoms. there were no specific effects that predicted child internalising problems when the mothers had mean scores on attachment anxiety or depression symptoms, nor were intervention effects on internalising problems moderated by maternal attachment avoidance. for externalising problems, the intervention effect was not moderated by maternal attachment anxiety, attachment avoidance or depression symptoms (cassidy et al., 2017). both pazzagli et al. (2014) and perrett et al. (2015) measured the parental perception of their child’s emotional and behavioural problems. perrett et al. (2015) found that the majority of the participants reported that their children’s behaviour was within the normal range. however, four participants reported that their children’s behaviour was outside the normal range, with three participants reporting reduced problems after attending the cos-p programme. the improvement was maintained at a three-month follow-up. pazzagli et al. (2014) reported similar findings, where the participants progressed from reporting their children’s severe difficulties with attention, concentration and hyperactivity to reporting their children’s good behavioural and emotional functions after the participants attended the cos-p programme. effect of the intervention on child executive functioning only one of the studies (cassidy et al., 2017) analysed the effect of the cos-p intervention on child executive functioning and found no significant effect. after the study controlled for maternal age and marital status, the children of the mothers in the intervention group showed better inhibitory control than the children of the mothers in the control group. 20 njsr – nordic journal of social research vol. 12, 2021 discussion this systematic review on the effectiveness of cos-p as a training programme for caregivers from multi-problem families provides an overview of the programme’s potential effectiveness, both for the caregivers and with respect to benefits for the children. the findings’ strengths include some improvements in reducing parental stress, increasing self-efficacy and parenting skills, and promoting their understanding of child behaviour. however, there is no conclusive evidence that cos-p assists in increasing the security of the parent-child attachment relationship. as this systematic review shows, cos-p sessions in group settings have demonstrated some effectiveness and suitability for multi-problem caregivers who want to develop parenting skills, but little evidence supports the intervention’s effects on child behaviour or emotional regulation. while child behaviour changes have been measured in three included studies (cassidy et al., 2017; pazzagli et al., 2014; perrett et al., 2015), the child’s individual characteristics are generally not incorporated into cos-p evaluations because they are not directly taken into account in the programme. accordingly, the possibility that the reported change is due to general characteristics of a parenting group rather than to the specific content of cos-p cannot be ruled out. additionally, all but two studies (mothander et al., 2018; perrett et al., 2015) report an outcome that occurred immediately after the intervention ended, precluding the detection of possible “sleeper effects” found in intervention studies with long-term follow-up assessments (seitz, 1981). trials without a follow-up have no recourse for testing, regardless of whether the reported effect is the beginning of developmental changes in the lives of families affected by cos-p or the reported effect is short term and will wane over time as parents fall back into pre-intervention habits. cultural challenges for the cos-p programme this review highlights that in six out of the seven studies, there were participants from ethnic minority groups (table 3). however, none of the included studies identified the ethnic groups to which these participants belonged, mentioned any language barriers or reflected on whether there was a need for an adjustment of the cos-p programme due to cultural challenges. 21 njsr – nordic journal of social research vol. 12, 2021 cos-p is an overall prevention approach. with its theoretical basis on attachment and its focus on educating caregivers about the ways to enhance this attachment, cos-p aims to build on the parents’ pre-intervention understandings of their caring role, regardless of their skill level or the risk factors present, as it improves their knowledge of child development and behaviour (cooper et al., 2009). however, a variety of delivery methods may be required to achieve what is defined as necessary changes in multiproblem families. for instance, behavioural interventions and individualised training are considered more suitable for parents with intellectual disabilities, especially where they utilise home visits and skill-based strategies, such as modelling, visual aids and so on (feldman, 2010). for indigenous families, longer-term home-based programmes that focus on the needs and the strengths of parent and child have been more successful; if a mainstream programme would be adapted for this population, community involvement and consultation would be required to ensure its relevance and cultural support (mildon & polimeni, 2012). this systematic review did not find any current evidence of targeted applications of cos-p for culturally or developmentally diverse populations, which is a current limitation on its applicability for these groups. secure attachment is largely accepted as a quality of harmonious and healthy parent-child relationships, but its expression and forms are culturally specific and may be affected by external factors, such as poverty or parental stress, and these considerations need to be incorporated into any programme offered to multi-problem families. what works for whom cos-p was designed to increase caregivers’ sensitivity to child distress and reduce the risk of insecure and disorganised attachment. the examination of potential moderators of intervention efficacy allows insights into the important issue of “what works for whom”. as noted by rothwell (2005), it is important to consider interaction effects due to the potential for any intervention to affect subgroups of individuals differently. potential disordinal treatment-subgroup interactions would be particularly essential to consider due to their clinical implications for individual outcomes (byar, 1985). for example, secure attachment has been shown to predict aspects of executive functioning, including working memory, cognitive flexibility and inhibitory control, of preschool children (bernier et al., 2012). although secure attachment is linked to key dimensions of caregiving for children with regard to their executive functioning (ainsworth et al., 1978; bernier & 22 njsr – nordic journal of social research vol. 12, 2021 dozier, 2003; whipple et al., 2011), no study has shown cos-p’s reducing effects on this matter in the context of multi-problem families. based on this review, no conclusive evidence shows that the cos-p programme assists in increasing the security of parentchild attachment relationships when the participants live in multi-problem situations, although small sample sizes, measurement errors and sample characteristics are possible alternative explanations for this lack of positive change. with problems as complex as those described for families in multi-problem situations, it is reasonable to question whether a parent training method such as cos-p will contribute to necessary changes in multi-problem families and if so, in what context. this is particularly salient when considering the cognitive flexibility required for participation in the cos-p programme and the possible need to reduce other stress-creating factors in the families before the parents become emotionally and cognitively available for the reflection level that the cos-p programme requires. limitations although this study aimed to establish a systematic overview of the cos-p intervention’s potential effectiveness concerning both caregivers and benefits for children living with multi-problem families, some main limitations need to be addressed. first, none of the included studies targeted families in multi-problem situations. although the participants were dealing with two risk factors or more at the time of participation, nothing was mentioned about how the risk factors affected their daily life. with its theoretical basis on attachment and its focus on educating parents about the ways to enhance this attachment, cos-p is able to provide such an approach. it aims to build on the parents’ pre-intervention understandings of their caring role, regardless of their skill level or the risk factors present, by enhancing their knowledge of child development and behaviour (cooper et al., 2009). however, none of the studies questioned whether the families’ life situations would affect the outcomes. it is therefore not recommended that potential effectiveness be transferred to a general expectation of what families in multiproblem situations would gain from attending the cos-p programme. second, this review showed that the researchers or the data collectors in each study were also the group facilitators; thus, subtle bias could have influenced the facilitators’ 23 njsr – nordic journal of social research vol. 12, 2021 responses to the participants during the intervention and biased the participants’ responses during the data collection. as the data collection and evaluation were often not blinded and based on self-reported outcome measures, this would represent a major limitation to the ability to generalise the expected effectiveness of the cos-p programme. third, the participants reported a wide variety of risk factors, without the participant demographics being included in the study designs. the studies only measured the effects of participation in the cos-p programme in general. it was not possible to identify whether some risk factors would affect the programme’s effectiveness more than others. consequently, it was also not possible to provide a clear recommendation on which families, if any, would gain from participating in the cos-p programme while living in multi-problem situations. fourth, this review lacked information on the long-term effectiveness of participating in the cos-p programme. only two of the included studies had a follow-up design, with measures at 3 months (perrett et al., 2015) or 4 and 10 months (mothander et al., 2018) after participation in the cos-p programme. fifth, three of the studies did not include a control group in the study design (kohlhoff et al., 2016; maupin et al., 2017; pazzagli et al., 2014). this made it difficult to determine whether the effectiveness of participation in the cos-p programme, or lack thereof, could be expected when delivered to multi-problem families, as this could be the result of other external causes. further research is therefore needed to determine what effect, if any, participation in the cos-p programme may have for parents living in multi-problem situations. conclusion this systematic review on the effectiveness of cos-p as a parent training programme for caregivers from multi-problem families shows that despite some promising results of these trials, remarkably little has been published about this topic. there have been studies on separate and isolated factors affecting caregivers but none on the effect of the accumulation of risk factors and how this may or may not influence the potential 24 njsr – nordic journal of social research vol. 12, 2021 effectiveness of cos-p. a common denominator across the studies included in this review is an indication of a positive outcome in terms of parental stress reduction. given the limited number of studies, further research is needed before defining what positive effects multi-problem families can expect from participating in the cos-p programme. acknowledgements i thank dr. stefan sütterlin for valuable contribution with developing the design, performing analysis and presenting the data. i also thank my three colleagues who found time in their work schedule to participate in the data extraction process. a big gratitude to the reviewers, which contributed with valuable suggestions during the revision process. references ainsworth, m. d. s., blehar, m., waters, e., & wall, s. 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(2011). a dimensional approach to maternal attachment state of mind: relations to maternal sensitivity and maternal autonomy support. developmental psychology, 47(2), 396-403. https://doi.org/10.1037/a0021310 microsoft word pinar aslan njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 9, 2018 what works? family influences on occupational aspirations among descendants of middle eastern immigrants on the swedish labour market pinar aslan* department of social work and psychology the faculty of health and occupational studies university of gävle email: pinar.aslan@hig.se nader ahmadi the swedish agency for work environment expertise nader.ahmadi@mynak.se stefan sjöberg department of social work and psychology the faculty of health and occupational studies university of gävle, sweden stefan.sjoberg@hig.se eva wikström department of social work umeå university, sweden eva.wikstrom@umu.se *corresponding author 135 njsr – nordic journal of social research vol. 9, 2018 abstract in this article, we examine family influences on occupational aspirations among employed descendants of middle eastern immigrants. using a qualitative approach, we conducted 21 semi-structured interviews with native-born descendants of middle eastern immigrants. we present and analyse their interpretations of their parents’ experiences and living conditions before, during and after migration and demonstrate how these interpretations shaped their own occupational aspirations. we discuss parents’ high expectations of their children in relation to ethnic-community valuations of educational and occupational achievements. these high expectations may increase the chances of social mobility but can also become a negative pressure, especially if parents set high standards but cannot help their children to meet those expectations. in these cases, older siblings who possess valuable knowledge of the educational system and labour market can function as important transferrers of resources. keywords: labour market participation, descendants of immigrants, family relations, social capital, cultural capital introduction in almost every western european country, descendants of immigrants are generally in a less favourable labour-market position than descendants of natives (gorodzeisky & semyonov, 2017; oecd, 2017). nordic governments are aware that the social exclusion of individuals with an immigrant background is a substantial risk to social cohesion, and so tackling the social exclusion of those individuals is a high-priority goal in the nordic countries (nordiska ministerrådet, 2012). labour-market inclusion is an important step towards realizing this goal, and several steps have been taken to increase the educational and occupational integration of individuals with an immigrant background (government offices of denmark, 2016; government offices of sweden, 2015; norwegian government offices, 2016). individuals with non-western backgrounds (i.e., outside western europe and north america) face particular challenges in entering and participating in the labour market (heath, 2010; segendorf & teljosuo, 2011; statistics sweden, 2010). the gaps between immigrants and the native-born population in unemployment, employment rates and earnings are generally greater for nonwestern immigrants and their descendants than for those of western ancestry (hermansen, 2013; schröder, 2010; statistics sweden, 2010). as zhou and kim 136 njsr – nordic journal of social research vol. 9, 2018 (2006) emphasize, some immigrant groups face less favourable ‘opportunity structures’ in the host society than others. among these groups, non-western immigrants are most subjected to disadvantageous opportunity structures (liebig & widmaier, 2009). previous studies have emphasized the intergenerational transmission of social exclusion and negative labour-market outcomes among non-western immigrants and their children (rooth & ekberg, 2003; sernhede, 2007; solon, 1999). factors such as class background, discrimination against the ethnic group, the social and economic incorporation of pre-existing ethnic communities and the welfare-state arrangements of the receiving country affect opportunities for labour-market participation by non-western immigrants and consequently the resources they are able to transmit to their children (kim & zhou, 2006). previous studies have shown that individuals with non-western immigrant parents generally have lower employment rates and lower earnings, are in lessqualified occupations and tend to be less well equipped with resources that are valuable on the labour market (behtoui, 2006; crul & mollenkopf, 2012). nevertheless, many studies show that non-western immigrant parents often have high expectations of their children in terms of educational and occupational attainment, regardless of social background (feliciano & lanuza, 2016; hofferth & moon, 2016; taylor & krahn, 2013). these high expectations can be seen as an element of migration biographies. the concept of migration biographies describes a connection between the experiences and living conditions of immigrants before, during and after migration, which influence the adaptation of both immigrants and their children to host societies (crivello, 2015; spierings, 2015). as pointed out by louie (2004, p. 123), children ‘become both witnesses and participants in the migration process’; their lives are affected by the difficulties and challenges their parents face on account of migration. ethnic discrimination, less-extensive social networks and exclusionist labour-market structures put many non-western immigrants in a vulnerable position on the labour market (arai & vilhelmsson, 2004; behtoui, 2006; lemaître 2007). as a result, many of them are socially excluded and experience a loss of status after migration (gang & zimmermann, 2000; van ours & veenman, 2003). the high expectations of non-western immigrant parents may derive from an ambition to help their children compensate for this loss of status and to make the sacrifices of migration worthwhile (dreby & stutz, 2012). immigrant parents from nonwestern countries, including those of working-class background in the home country and with no formal education, often express an ‘immigrant optimism’ in entering a new country, expecting their children to make use of new educational 137 njsr – nordic journal of social research vol. 9, 2018 and occupational opportunities (louie 2004; 2012). non-western immigrant parents’ expectations for their children to inherit family ideals and exhibit upward mobility may be viewed as part of collectivist family systems. collectivism here refers to a high degree of interdependence between individuals in a group that exhibits a sense of mutual obligation and of attending to the needs of others in forming and accomplishing goals (hofstede, 1980; rudy & grusec, 2006). this is in contrast to the concept of individualism, which valorises individual autonomy in relation to group belonging. in countries with comprehensive and developed welfare states, such as sweden, individualism has been described as an institutionalized mechanism of everyday life (beck & beck-gernsheim, 2009), whereas places with less-developed welfare institutions, as in the middle east, have more collectivistic relations and value systems (ahmadi, 1998; ayçiçegi-dinn & caldwell-harris, 2011; hofstede, 1980). with increased globalization, however, the understanding of an individualism/collectivism dichotomy ought to be relational rather than fixed in regard to countries and cultures (rothbaum & trommsdorff, 2007). as hofstede (1980) argues, the individualist and collectivist value systems should not be understood as systems coupled with specific geographical locations but rather as being dependent on situation and context. in societies in which the welfare state is relatively weak, people more often depend on one another and form strong, cohesive in-groups. in societies in which the state takes responsibility for citizens’ welfare, relationships between individuals are comparatively looser and people more autonomous. the individualism/collectivism dichotomy should be seen as poles of a continuum that people move between in distinct societies, depending on social settings (cf. grønseth, 2010). collectivist values can contribute to the social mobility of the descendants of immigrants, as values placed on upward mobility may compel these individuals to pursue higher education and occupational attainments (phalet & schönpflug, 2001), but collectivist values may also result in intergenerational value discrepancies and force descendants of immigrants to negotiate between an individualistic outer space and collectivist family values (merz, özeke-kocabas, oort, & schuengel, 2009). while parents’ high expectations may increase their children’s opportunities for educational attainment (feliciano & lanuza, 2016), there is also the risk of transferring unrealistic expectations in light of the structural obstacles that descendants of immigrants face in school and on the labour market (cf. lindgren, 2016). in this study, we focused on these factors from the perspective of the descendants of middle eastern immigrants – that is, individuals born in sweden, 138 njsr – nordic journal of social research vol. 9, 2018 both of whose parents immigrated from the middle east. the birth countries of the parents were turkey, iraq, syria, palestine, pakistan and lebanon. one relevant feature of these countries is that, due to having less-developed welfare states, they represent a category of countries that, in comparison to sweden, exhibit a higher degree of collectivism as regards social relations and family value systems (ayçiçegi-dinn & caldwell-harris, 2011; hofstede, 1980). this enabled us to analyse the implications of collectivist features that characterise the social contexts of our participants. in addition, as a group, these individuals face many similar challenges. like many others with a background in non-western countries, individuals with a middle eastern background are at risk of social and economic exclusion in sweden (gorodzeisky & semyonov, 2017; statistics sweden, 2010; westin, 2015). we also know that negative attitudes among swedes are most frequently directed against those with a background in the middle east (ahmadi & palm, 2018; ahmadi, palm, & ahmadi, 2016) and that these individuals face discrimination in recruitment (carlsson, 2010). there is a possible link between the increased negative attitudes against middle eastern individuals and worldwide social and political developments related to the islamic state and fear of terrorism. this is underscored by a recent study describing increased negative attitudes against muslims in sweden (ahmadi & palm, 2018). in light of the disadvantaged situation that these individuals face as a group, it is important to study influences on their labour-market participation. this is particularly important considering that, due to conflicts in the middle east, descendants of middle eastern immigrants are a fast-growing group in the nordic countries. many earlier studies have focused on the labour-market exclusion of descendants of immigrants. in this study, in order to investigate the influences on their labour-market participation, we chose to focus on individuals who had entered the labour market. we consider this to be an important subject today, as sweden and many other countries are seeking ways to promote labourmarket integration of immigrants and their children. this article aims to examine family influences on occupational aspirations among middle eastern immigrants’ descendants who are in employment. the concept of aspiration deals with participants’ ambitions in reaching their occupational goals. we focus on the perceptions of the descendants of middle eastern immigrants because individuals’ aspirations are affected by modes of 139 njsr – nordic journal of social research vol. 9, 2018 perception – that is, views, assessments, and feelings (cf. emirbayer & williams, 2005). we posed two research questions: 1) how do perceptions of parents’ migration biographies influence the occupational aspirations of descendants of middle eastern immigrants? 2) how do family members influence the occupational aspirations of descendants of middle eastern immigrants? the production and re-production of cultural capital in a context of migration in analysing our material, we used the concept of cultural capital introduced by french anthropologist pierre bourdieu (1986). according to broady (1998), cultural capital consists of symbolic resources that are acknowledged and sought by the majority but are available only to some, as they are handled by institutions with specific entry requirements. as such, cultural capital can be seen as resources that allow entrance and integration into widely recognized institutions, such as the educational system and the labour market. this type of capital is therefore highly regarded in society as a whole and organizes relations of dominance (dumais, 2002; stempel, 2005). our definition of cultural capital is that it (1) takes the form of qualifications, skills and formal or informal knowledge used to gain ground on the labour market, (2) may come in the form of the possession of objects that verify these qualifications, skills and knowledge and (3) is of a relational character, meaning that the value of these acquirements depends on the context in which they were produced, deployed and employed (nohl, schittenhelm, schmidtke, & weiss, 2014). thus, cultural capital comes in three forms: (1) an embodied state, as engraved dispositions of thought, behaviour and taste; (2) an institutionalized state, as credentials and qualifications acquired in widely recognized institutions; (3) an objectified state, as objects that verify these credentials and qualifications (holt, 1998; jæger & breen, 2016). an embodied form of cultural capital that was acquired in the home country can be maintained among immigrant parents even after migration. cultural capital in its institutionalized form might lose value after migration because the institutions that grant qualifications and credentials are subject to distinct laws regarding the evaluation and production of cultural capital (bourdieu & passeron, 1979). in its embodied form, however, as engraved dispositions of 140 njsr – nordic journal of social research vol. 9, 2018 thought, behaviour and action in the minds and bodies of individuals, cultural capital can be preserved (gordon & liu, 2015; robb, dunkley, boynton, & greenhalgh, 2007; panda, 2012). in the present study, the transmission of these embodied forms of cultural capital from parents to their children was discerned through the interpretations of the children. following this line of thought, we considered the participants’ interpretations of their parents’ migration biographies and accumulation of symbolic resources in relation to conditions, situations and contexts. an important aspect of accumulating cultural capital is support of others. bourdieu (1986) emphasizes that resources do not necessarily lead to attainment; for this to occur, resources must be mobilized through the support of family, friends and relatives. he does not, however, elaborate on the type of support that allows for production of cultural capital. in relation to this, we considered active transmissions of cultural capital within the family (cf. jæger & breen, 2016) – that is, formal and informal forms of knowledge, skills and qualifications among family members transmitted to descendants of middle eastern immigrants. finally, we also considered the accumulation of cultural capital by using resources other than existing cultural capital in the family. researchers have argued that the socioeconomic situation of parents tends to be transmitted to their children. while this is true at a general level, this line of thought is problematic when considering the descendants of immigrants who exceed the socioeconomic situation of their parents (cf. luthra & soehl, 2015; luthra & waldinger, 2013). against this background, we examined ways of producing cultural capital in relation to the intergenerational transmission of values as well as parental engagement, support and motivations as perceived by the descendants of middle eastern immigrants. method qualitative semi-structured interviews were conducted in september 2015 and january 2016 with 21 individuals (nine male, 12 female), all aged between 25 and 35 years and born in sweden, with both parents born in middle eastern countries. each interview lasted between 30 and 90 minutes. preliminary themes and interview questions were formulated on the basis of earlier research and the theoretical framework and were used tentatively to focus the interviews on the main areas of research. we used open-ended 141 njsr – nordic journal of social research vol. 9, 2018 questions primarily in order to allow the discovery of unexpected areas of interest (bryman, 2012). among other things, we asked the participants to describe their families, the educational and occupational background of family members and the nature of their relationships with these individuals. we asked the participants about their employment and career aspirations and how they believed these matters were perceived and influenced by family members. these questions, along with others, provided information on the participants’ interpretations of their parents’ migration biographies and of influences from family members. the participants chose the form of communication and the environment in which the interview took place. some preferred to be interviewed in person (n=7), while others preferred skype or telephone interviews. although some scholars have warned that virtual interviewing may inhibit a trustful interviewer/interviewee relationship (fontana & frey, 2008), technological advances in recent decades have created a very similar environment between virtual interviewing and face-to-face interaction (iacono, symonds, & brown, 2016). because not all interviewees could attend a face-to-face interview and some were not sufficiently familiar with skype, telephone interviews were offered as an alternative. telephone interviews preclude observation of facial expressions and body language, but we aimed to compensate for this by explaining and asking for explanations in a more detailed manner. providing various options of interviewing methods can be an advantage, as it increases participants’ motivation for taking part in a study. all interviews were audio recorded and transcribed to written text. the interviews were conducted, transcribed and analysed in swedish. the quotations extracted from the transcripts and used to demonstrate findings in this article were translated from swedish with the help of a native englishspeaking professional. the interviews were conducted in swedish by the first author, who has a middle eastern background but is fluent in the swedish language. according to fontana and frey (2008), understanding the language and cultural background of the interviewees is important for qualitative interviewing. the middle eastern background of the interviewer thus increased our understanding of added nuances of meaning and cultural interpretations that might otherwise have gone unnoticed. these interpretations involved, for example, collectivistic features in the family and community. an awareness of how various situations were potentially influenced by collectivist aspects increased the possibility of detecting the undertones of the participants’ descriptions and explanations, enabling relevant follow-up questions. in order 142 njsr – nordic journal of social research vol. 9, 2018 to foster a reflexive research process, however, all four authors reflected on and analysed the data material in joint discussions. sampling procedure participants were initially recruited through advertising in social media. as this did not produce enough participants, an advertisement was placed in one of sweden’s largest cost-free newspapers, which reaches approximately 1.2 million individuals in central and southern sweden. this led to a significantly larger sample size and allowed us to obtain a more varied sample with respect to social background, gender and parents’ country of origin. as in most qualitative studies, this type of sampling methodology implies a self-selection bias; the recruitment of participants for the study becomes dependent on individuals’ interest in participating in the study. prior to expressing their interest in the study, the participants were informed that the study would deal with the labour-market participation of the descendants of immigrants. after expressing their interest in participating, they were given more detailed information about the research aim, the research questions and the interview themes. this limited a self-selection bias as regards the research questions. the sample was purposeful, meaning that we recruited participants according to our research aim (coyne, 1997). our aim was to study family influences on occupational aspirations, and so all participants were employed and had been so for at least six months. we were not selective with respect to the educational and occupational backgrounds of the participants, but the majority of the individuals who expressed an interest in participating happened to be university graduates (n=17); of the remainder, three had vocational training and one had completed secondary education. all of them had managed to enter the labour market, either in professional positions (n=16), as managers (n=2) or in other employed or self-employed work (n=3). we are aware that our sample was biased, as we interviewed individuals who were already established on the labour market and not those who were unemployed; however, the influences that lead to labour-market exclusion for descendants of middle eastern immigrants were not the focus of this study. regarding parents’ backgrounds, some of our participants had parents with neither an educational nor a working background in the host country, some had parents with no educational background but a high level of labour-market participation and others had highly-educated parents with a high level of labourmarket participation over time. consequently, our sample gave us the 143 njsr – nordic journal of social research vol. 9, 2018 opportunity to shed light on how resources are produced for individuals with various social backgrounds and to contextualize the question of intergenerational social mobility. ethical considerations the ethical guidelines of the swedish research council were taken into consideration at all stages of the research process. before starting data collection, we were granted approval from the regional ethics review board (registration number 2015/025). participants gave their consent after being informed of the aim and conditions of their participation, including anonymization of participants and the right to withdraw from the study at any time during the research process. analytical strategy the interview recordings were transcribed and then analysed with an abductive thematic approach, meaning that we moved back and forth between theory and empirical findings (dubois & gadde, 2002). we started by scanning the transcripts and searching for meaning units – that is, sections of the texts relevant to the research questions. coding was performed with version 7.5.4 of the atlas.ti computer software for qualitative data (rambaree & faxelid, 2013). we reread the transcripts with the meaning units in mind and kept a codebook including the frequencies and meanings of as well as links between codes (silverman, 2015). to bring structure to this list of codes, we created a ‘network view’ in atlas.ti, which is a graphical view of all the codes and the links between them. this network view allowed us to work visually, facilitating our analysis of the relationship between codes (cf. friese, 2014) and the collecting of codes into themes. four themes were found: parents as role models (n=9 interviews); parental engagement and support (n=12 interviews); active transmission of cultural capital by siblings (n=12 interviews); and influences of collectivist values in the family and ethnic community (n=13 interviews). results in the sections that follow, we describe and discuss family influences on occupational aspirations, drawing on our interviews with the descendants of 144 njsr – nordic journal of social research vol. 9, 2018 immigrants from the middle east. we aimed not to represent such individuals as a collective but rather to analyse occupational aspirations in relation to figures and backgrounds, that is, interpretations of parents’ migration biographies, family values and the accumulation of cultural capital in the family. parents as role models the accumulation of cultural capital among these descendants of middle eastern immigrants was intimately bound up with notions of possibilities and obstacles on the labour market. when achieved occupational attainments are common in a family, it becomes natural for children in that family to believe that it is possible for them to attain the same (cf. bourdieu & passeron, 1979). this circumstance was in play for our participants, but notions of possibilities were contextual and derived from their interpretations of their parents’ migration biographies. the participants described their parents as individuals who had managed to obtain favourable labour-market positions despite facing difficulties on the labour market, which became a motivational force for the participants. one example of this outlook appeared in an interview with a 26-year-old selfemployed man [ip11]. his parents had migrated to sweden in the 1970s and, despite lacking educational credentials, had managed to find stable jobs in the host country as a special pedagogue and a nursery school teacher. the participant considered this a great accomplishment: ip11: they came to sweden with nothing, really – and they managed to build a safe environment for the whole family in a society where they didn’t even speak the language. this is what has inspired and sustained me now [that] i’m an entrepreneur. what matters and what has inspired me is that nothing is impossible, and you can go wherever you want if you struggle hard. this participant [ip11] assessed his parents’ occupational attainments in relation to a wider context: to a history characterized by migration and by his parents’ achievements in relation to difficulties in the host country, specifically, language barriers. these findings suggest that interpretations of parents’ migration biographies can create a vision of opportunities for descendants of middle eastern immigrants. the production of cultural capital, then, does not necessarily occur as a direct effect of parents’ educational and occupational positions but may also occur in light of the circumstances in which those positions are acquired. witnessing their parents’ going through difficulties while still managing to achieve occupational goals led to the drive and ambition required to overcome structural difficulties of their own. the participants perceived their parents as role models, not necessarily in terms of wanting to 145 njsr – nordic journal of social research vol. 9, 2018 achieve the same occupational position as them but in the sense of overcoming difficulties. this was further illustrated by a 25-year-old male café owner [ip19] whose parents had migrated to sweden in the late 1980s. his mother was unemployed throughout his childhood, but he described how his father had managed to achieve economic success after years of hard work: ip19: if i had to name someone [as my role model], it’d be my dad. my dad came to sweden with no job, seven children, not knowing the language, nothing. he got a job as a dishwasher and managed to go from that to opening a grill, then a pizzeria, then starting more businesses and expanding to become a wholesaler. the participants described their relations with their parents as being pervaded by a sense of pride and inspiration derived from perceptions of their parents’ migration biographies. this suggests that assessments of parents’ migration biographies enable an intergenerational transmission of resources. the participants described their parents’ occupational accomplishments as a reference point when assessing their own opportunities on the labour market. a similar pattern emerged among participants with parents who had obtained higher educational diplomas before migration and hence faced the risk that those educational credentials and work experiences would be less valued in the host country than in the home country (gang & zimmermann, 2000). when describing influences on their own occupational aspirations, the participants highlighted their parents’ occupational accomplishments in relation to this risk. the driving force of the intergenerational transmission of cultural capital was more properly the conditions surrounding the accumulation of resources than the resources themselves. this was evident in an interview with a 28-year-old woman [ip22] who worked as a manager at a residential-care home. her mother was a psychiatrist prior to migration and had managed to find jobs in line with her educational degree: ip22: my biggest inspiration is her [the mother]; she came to sweden not speaking the language, and with a foreign degree, but she struggled hard. and now she’s one of the best in her line of business. the outlook presented by the participant above [ip22] sheds light on the relational character of cultural capital. interpretations of parents’ resources and difficulties in relation to migration again allowed for an intergenerational transmission of cultural capital. here, migration became a form of capital in itself, which activated the transmission of an embodied form of cultural capital from parents to children. the parents’ accomplishment in transforming an embodied form of cultural capital (that was accumulated in the home country) into an institutional form of cultural capital in the host country became a source 146 njsr – nordic journal of social research vol. 9, 2018 of inspiration for the participants. interpreting their parents’ migration biographies as examples of overcoming difficulties on the labour market motivated the participants and gave them confidence; they believed that, if their parents had managed to enter the labour market despite a difficult position as migrants, it was certainly possible for them, as they did not have language barriers to overcome and their educational credentials were not ‘foreign’. this optimism regarding upward mobility, projected to them via parents, sometimes contrasted with the structural difficulties that the descendants of middle eastern immigrants faced. a 27-year-old male teacher [ip10], whose parents had both managed to enter the labour market soon after arriving in sweden, gave one example of such an experience. the man’s parents had a long experience of labour-market participation in the host country, and at the time of the interview his mother worked as a professional arabic interpreter and his father at a residential-care home for unaccompanied refugee children. his parents had optimistic expectations of the host country, which had been communicated to him since he was a child. he described how both of them had imprinted on him a sense that everything is possible in sweden, especially with a university education, but he reflected on how his ethnic background sometimes became a hindrance to him despite his educational credentials: ip10: it’s sad when you have to confront your parents by saying ‘you were wrong’. sometimes, education doesn’t help; you could be qualified for a job but be passed over because of your ethnic background. . . . this is how i and many of my friends felt. a degree increases our odds, of course, but they’re never equal to the odds of native children. while parental achievements were a source of inspiration and motivated the participants in terms of educational and occupational aspirations, these achievements could also become a source of stress. this was especially the case among the participants who experienced a negative pressure from their parents. an example of this was seen in an interview with a 25-year-old female psychologist [ip8]. upon migration, her father possessed a degree in psychology education and her mother a degree in industrial design engineering. the participant described how both her parents had attained labour-market positions in the host country that corresponded to their educational background, although only after overcoming many obstacles. during the interview, she reflected on how her parents’ attainments put pressure on her and her sister: ip8: we had to aspire to a high-status job, which requires higher education. . . . and when i studied theatre and literature alongside my psychology classes, my dad was like ‘i can’t sleep at night’. . . . it was the 147 njsr – nordic journal of social research vol. 9, 2018 same for my sister; she obtained a bachelor’s degree in economics . . . but then was like, ‘i didn’t even want to do this. i wanted to become a teacher’. the participants felt a sense of obligation to fulfil their parents’ expectations in terms of educational and occupational attainments. however, these expectations were not always in harmony with their own interests. when this was the case, parental expectations contributed to an accumulation of cultural capital but did not necessarily lead to a sense of personal fulfilment among the participants. parental engagement and support many of our participants had surpassed the socioeconomic positions of their parents. they assessed their parents’ positions on the labour market as having been limited by a lack of opportunities due to migration, but they had optimistic attitudes regarding their own occupational attainments. these participants emphasized that their parents had pushed them towards educational and occupational ambitions, which they believed had contributed to their attainments. parental involvement in the form of moral support and encouragement thus became a family resource that contributed to the production of cultural capital. surpassing the socioeconomic position of parents occurred through an accumulation of cultural capital, which was fostered by intergenerational values put into education and by interpretations of parents’ migration biographies. this was illustrated by a 25-year-old male compliance specialist working at a bank [ip7], whose parents had migrated to sweden in the late 1980s with no educational background. during his upbringing, his father had been chronically ill and his mother long-term unemployed. he described his parents as being a driving force in his own accumulation of cultural capital: ip7: my dad, he always encouraged us to study . . . because he never had the chance himself. and mum too, she was so supportive. . . . when i decided to become a lawyer, they were like, ‘always do more’. . . . they couldn’t help me do it, but they pushed me. sania ali, dahlstedt and hertzberg (2018) have described how the labourmarket exclusion of immigrant parents is not always reproduced in the next generation but can have the reverse effect by encouraging children to strive to ‘compensate’ for their parents’ difficulties. some of the participants in this study described their own labour-market attainments as a compensation for their parents’ lack of opportunities. this outlook was mediated to them by their parents, as illustrated by a 32-year-old man [ip16] working at the employment office: 148 njsr – nordic journal of social research vol. 9, 2018 ip16: i think, because mum was illiterate, she’s had an inferiority complex for a long time. she’s tried to learn but failed. so, she’s pushed me and my younger brother, like, ‘make something of your lives; study, be independent, don’t go into the restaurant business’. dad was the same, like, ‘don’t follow in our footsteps’, so i think we got a lot of this from our parents. the reversed influence of parents’ educational and occupational positions was fostered by interpretations of the parents’ migration biographies, which inhabited a context of time and place. the participants made a clear distinction between themselves and their parents in terms of structural opportunities, and it was this differentiation that allowed for the reversed influence. this was illustrated by a 32-year-old teacher [ip5] who explained why he had abandoned his undesirable lifestyle and finished his secondary education after years of falling behind: ip5: my father and i, we sat down and talked. and we sort of connected when he told me about how he wished he’d had the educational opportunities that i had in sweden. he told me how precious it was in comparison… and, like, i gained some perspective. as highlighted in the introduction, the descendants of middle eastern immigrants may feel a responsibility to ‘climb the social ladder’ in order to justify their parents’ migration-related sacrifices. among our participants, this outlook fostered a sense of obligation to acknowledge and make use of opportunities that their parents did not have; thus, the descendants’ occupational aspirations were ambitious and involved plans for social mobility. these findings suggest that parental involvement, regardless of socioeconomic status and social background, can contribute to the accumulation of cultural capital. nevertheless, active transmission of cultural capital in the home is important for the accumulation of such capital. it may be difficult for the descendants of middle eastern immigrants to fulfil their parents’ high expectations if the parents push their children but cannot help. in the next section, we show that active transmission of cultural capital can come via siblings instead of parents and that such transmission may compensate for the parents’ lack of assistance in schoolwork and labour-market participation. active transmission of cultural capital by siblings having successfully negotiated the educational system and gained access to the labour market, some of our participants’ older siblings had accumulated cultural capital that could be transferred within the family. siblings provided homework assistance as well as support and recommendations related to 149 njsr – nordic journal of social research vol. 9, 2018 labour-market participation, from filling out cvs to giving advice on how to behave during an interview. when parents fell short in terms of giving tangible forms of support, siblings played a role in filling the void and became an important source of cultural capital. this was exemplified by a 32-year-old male teacher [ip5] and a 25-year-old male economist [ip20]: ip5: my sister helped me with my homework whenever i needed help . . . when i went to my first job interview . . . my brother told me how to behave, like, ‘look the recruiter in the eye, give a firm handshake, try to answer the questions honestly’. ip20: it was more or less my sister who helped me make the right choice. . . . i don’t think they [the parents] understood. should i choose social science? should i choose tech? they don’t know the difference . . . i knew my sister wanted what’s best for me, and she had the knowledge, so she was the one i turned to. in an interview with the 25-year-old compliance specialist [ip7] mentioned in the previous section, it appeared that his parents set high standards in regard to educational attainments but could not help him meet those standards. his older siblings, on the other hand, had qualifications, skills and both formal and informal knowledge in relation to school and the labour market, which they transmitted to the younger brother: ip7: my brothers helped me. when i was four years old, for example, they taught me the multiplication table, so when i started school, the teachers considered me a genius. . . . they helped me [after graduation], even though they didn’t know as much about the labour market as swedish parents. the quotation above illustrates how active transmission of cultural capital by siblings could be converted into educational performance as well as occupational attainments, thereby enabling further accumulation of cultural capital by these descendants of middle eastern immigrants. similar findings have been presented by crul, holdaway, de valk, fuentes & zaal (2013), who showed that older siblings in immigrant families often provide advice as well as emotional and practical support to their younger siblings in their educational careers. here, we show that such support may help descendants of middle eastern immigrants to form occupational aspirations and to realize those aspirations. influences of collectivist values in the ethnic community in the earlier sections of this article, we described perceptions of high parental expectations among our participants and a sense of obligation to fulfil those 150 njsr – nordic journal of social research vol. 9, 2018 expectations. this can be better understood in relation to participants’ descriptions of collectivist values in their families and their ethnic communities. in this section, we highlight ways of producing cultural capital in relation to these collectivist values. a symbolic value was placed on educational and occupational attainments in the ethnic communities of the participants and their parents; people who managed to ‘make something of themselves’ were respected and highly valued. against this background, the participants described their parents’ expectations as, on the one hand, based on hopes of a better future for their children but, on the other, representing a desire to obtain social status among ethnic-group peers. participants’ descriptions of their occupational aspirations were infused by a desire to make their families proud and obtain social status. one 35-year-old woman [ip12], who had just been promoted to manager at a wood-processing company, illustrated how such collectivistic values could intensify the desire to ascend on the labour market: ip12: you want your family to be proud of you, to acknowledge that you’ve done something of value. . . . my husband, my parents, my relatives, my family . . . i think it makes them respect you somehow. some of it might be a cultural thing. . . . in my family, they’ve always considered me a person worth listening to. people come to me and ask for my opinion on different things. this is very important to me. the quotation above suggests that accumulation of cultural capital, in the form of educational credentials and access to valued labour-market positions, can organize relations of power in the family and among relatives because others consider the participant to be a person ‘worth listening to’. these findings suggest that it is possible to accumulate cultural capital through extra efforts that are inspired by intergenerational values placed on education and occupational attainment and by a quest for increased individual agency. obtaining a job that the community considered ‘good’ increased the status of parents as well as children, as illustrated by a 25-year-old woman [ip4] working in social services: ip4: it sounds good to say to friends, ‘my daughter works in social services’. it was considered a high-status thing to work at an administrative authority. they felt like, ‘we’ve succeeded because our daughter got a degree and a good job’. so, it’s a status thing. the occupational aspirations of the participants were influenced by an interdependence with family members and other members of their ethnic community. this was exemplified by a 26-year-old man [ip13] who described why it was so important to his parents that he went to university and by a 32year-old man [ip5] who, after years of struggling in school and having casual 151 njsr – nordic journal of social research vol. 9, 2018 jobs, eventually got a teaching degree and perceived a shift in how family members and members of his ethnic community treated him after he became a teacher: ip13: i think a lot of this [getting a degree] is because, in our ethnic community, they like to brag about their children. and if you have something to be proud of, you can absolutely brag about it. ip5: my mum, she liked to tell her friends about me . . . our culture is a lot about living as a community . . . with neighbours, relatives, and so on . . . and they talk about what their sons do. before, she never talked about what i do, but now it’s like, ‘xx does this’. relatives phoned me up and said they were proud . . . such things encouraged me . . . and still, when i meet people in the street, they greet me by saying ‘hello, ustad’, which means ‘teacher’ in arabic. they say that as a way of showing respect in the home country . . . you don’t address teachers by name; you call them ‘teacher’. portes and zhou (1993) discuss possibilities of social mobility among descendants of immigrants with respect to parents’ expectations and to ethnic communities. they argue that, in light of their subjection to discrimination and unequal access to resources in host societies, immigrants’ children may have a better chance of educational and occupational attainments by remaining integrated within ethnic communities with achievement orientations and high levels of group solidarity. the results presented here are in line with these arguments and suggest that the collectivist values of the family and ethnic community may contribute to an accumulation of cultural capital among descendants of middle eastern immigrants. as indicated by our 25-year-old compliance specialist [ip7], however, such orientations can also have a negative impact: ip7: i chose to become a lawyer, and that was only considered ‘okay’ . . . it wasn’t ‘wow’ to them. . . . my brother was a lawyer, so they already had a lawyer. they wanted me to be a doctor; they talked about that all the time. while our findings support the argument presented by portes and zhou (1993), they also demonstrate that a strong orientation towards achievement may lead to feelings of inadequacy among descendants of immigrants. findings presented by bankston and zhou (2002) illustrate a similar pattern, with children of asian immigrants showing high levels of school performance but low levels of self-esteem. thus, although an interdependence between family members and a high level of ethnic solidarity may increase descendants’ chances of achieving occupational attainments, this needs to be considered in relation to aspects of personal wellbeing. 152 njsr – nordic journal of social research vol. 9, 2018 conclusion in this study, we examined family influences on the occupational aspirations of descendants of middle eastern immigrants in sweden who have managed to enter the labour market. our results indicate that intergenerational transmission of cultural capital in the family positively influences the occupational aspirations of descendants of middle eastern immigrants and that perceptions of parents’ migration biographies are important in acquiring cultural capital. we discovered that an embodied form of cultural capital was deployed in the transmission process in terms of thoughts, behaviours and actions related to parents’ educational and occupational backgrounds prior to migration. these embodied forms of cultural capital contributed to the accumulation of institutionalized and objectified forms of cultural capital among descendants of middle eastern immigrants in the form of credentials from the educational system and the labour market and objects that verify those credentials. active transmission of cultural capital, in terms of sharing knowledge, attitudes and practices, occurred mainly between siblings, who filled the void when parents lacked the ability to provide substantial support. parents’ pivotal role in shaping and supporting the participants’ occupational aspirations was manifested through the participants’ perceptions of their parents’ migration biographies. our empirical results suggest that the accumulation of cultural capital among descendants of middle eastern immigrants occurs mainly in relation to three aspects of the parents’ migration biographies. first, there is the parents’ ability to transform an embodied form of cultural capital, acquired in the home country, into an institutionalized form in the host country. this allowed the participants to see possibilities and motivated them to put in extra effort, believing that if their parents could ‘make it’ with fewer resources than themselves, so could they, despite facing structural obstacles on the labour market. thus, parents’ migration biographies may become a source of resilience for descendants of middle eastern immigrants when they face negative treatment and discrimination on the labour market. second, our empirical results demonstrate a desire to ‘make up’ for parents’ lack of opportunities in the host country and to compensate by obtaining prestigious positions. obtaining these positions also strengthened participants’ positions of power in the family, which further contributed to their occupational aspirations. here, the accumulation of cultural capital was induced by a strong drive and ambition. the intergenerational values placed on educational and occupational attainment as a result of the migration process have been 153 njsr – nordic journal of social research vol. 9, 2018 discussed by other scholars in relation to the so-called ‘immigrant bargain’ (cf. crul, schneider, keskiner, & lelie, 2017; louie, 2004; 2012). the concept of the immigrant bargain describes immigrant parents’ expectations of the host country in relation to their children’s occupational attainments. third, and related to the former two aspects, we found that parents’ migration biographies were infused with collectivist values that propelled parents’ engagement and support as well as their desire to obtain social status through the participants’ accumulation of cultural capital. some of our findings also indicate negative family influences. parents’ high expectations and a sense of obligation to the family may lead to feelings of distress for the descendants of middle eastern immigrants, especially when those expectations are not in line with the descendants’ own desires and interests and when they are hindered by many structural obstacles to labourmarket attainment. an inconsistency between parents’ high expectations and descendants’ possibilities of meeting those expectations may be due to immigrant parents’ optimism regarding their children’s opportunities in the host country (cf. kao & tienda, 1995). the details and implications of an inconsistency between immigrant parents’ expectations of their children and their children’s personal levels of wellbeing remain to be investigated. while certain features in the transmission of cultural capital among our participants may also apply to descendants of the native born, we have demonstrated some aspects that distinguish descendants of middle eastern immigrants. the distinction here is not in the accumulation of cultural capital as such, but in why and how cultural capital is accumulated – that is, the mechanisms of accumulation. the motivation provided by the participants’ perceptions of their parents’ migration biographies and of collectivist values in the family helps explain how our participants, despite facing ethnic penalties on the labour market, had high occupational aspirations and managed to acquire cultural capital. these aspects also expand our understanding of how cultural capital may be acquired regardless of a socioeconomically disadvantaged background. in studies researching the transmission of cultural capital within the family, the accumulation of cultural capital has generally been linked to parents’ socioeconomic status (cf. bodovski, jeon, & byun, 2017; redford, johnson, & honnold, 2009). our results concur with those of other studies that demonstrate that many descendants of immigrants exceed the socioeconomic status of their 154 njsr – nordic journal of social research vol. 9, 2018 parents (crul et al., 2017; konyali, 2017; luthra & soehl, 2015; luthra & waldinger, 2013; oecd, 2016; rezai, 2017). we suggest that the breaking of the ‘reproduction cycle’, i.e. of reproducing parents’ socioeconomic status, is bound up with perceptions of parents’ inclusion or exclusion in the host country, with active transmission of cultural capital in the family and with a collectivist value system. while some of our participants grew up in socioeconomically disadvantaged families and faced many obstacles in education and on the labour market, their parents’ migrant trajectories implied expectations of social mobility. these expectations were shaped by collectivist values in the families and ethnic communities of the participants, implying that children’s occupational attainments were a source of pride for the entire family. such collectivist values propelled the transmission and accumulation of cultural capital between parents, siblings and the participants. as argued in the introduction to this article, collectivist family values may not be as explicit in native swedish families, which are shaped more by individualistic value systems. thus, we argue that, while the acquirement of cultural capital may follow the same procedures, the mechanisms that propel transmission and accumulation of cultural capital may differ in native-born and immigrant families. in light of our results, we would like to see a sharper focus on the intergenerational aspect of immigrants’ integration into the nordic countries, especially considering scholars’ discussions of how welfare-state arrangements influence labour-market participation by immigrants and their descendants (bean et al., 2012; crul & mollenkopf, 2012; schröder, 2010). the possibility of converting migration biographies into a positive drive may be greatly affected by institutional arrangements of the welfare state. some scholars have argued that ‘generous’ welfare-state contexts, such as in sweden, create disincentives for immigrants to participate on the labour market, as they become dependent on welfare benefits (see, e.g., koopmans, 2010). in contrast to such arguments, we have demonstrated a strong drive and ambition to achieve labour-market participation among the descendants of middle eastern immigrants in this study, projected to them via their parents. our participants did not feel obliged to find work at the earliest opportunity, regardless of their parents’ socioeconomic situations, but were encouraged to achieve their occupational aspirations. in an environment that protects the family from poverty, immigrants’ descendants may prioritize the accumulation of cultural capital rather than simply finding a job at any cost. the implications of the welfare-state context on immigrant parents’ approach to their children’s labour-market participation has, however, not been the focus of this study and remains to be investigated. in order to 155 njsr – nordic journal of social research vol. 9, 2018 investigate this further, future studies need to include interviews with immigrants’ descendants who are excluded from the labour market. this may provide richer and more nuanced insights into how occupational aspirations may be linked to intergenerational aspects and the characteristics of diverse welfare-state contexts. references ahmadi, f., & palm, i. 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(2006). community forces, social capital, and educational achievement: the case of supplementary education in the chinese and korean immigrant communities. harvard educational review, 76(1), 1–29. https://doi.org/10.17763/haer.76.1.u08t548554882477 microsoft word pdf health equity and universal provision in norway ny med justeringer njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research vol. 11, 2020 health equity and universal provision in norway: a case study lydia mehrara* department of social studies faculty of social sciences university of stavanger email: lydia.mehrara@nord.no *corresponding author dr. susan young social policy practice and research consortium faculty of health and medical science the university of western australia email: susan.young@uwa.edu.au abstract this article reports on a qualitative study undertaken to explore the policy-practice nexus of health policy in norway in relation to the provision and delivery of maternal health services to migrant women. the research used a case study approach focusing on a particular programme which provided maternal health services to migrant women and collected data through review and analysis of policy documentation, observation of this programme, and discussions with people responsible for implementing health policy. while norway is well known for its universal policy principles, which in the main enable good access to services, the case study indicated that there are some limitations in policy and practice. we use the principle of proportionate universalism to comment on and make recommendations for policy makers and practitioners in this area, to better attend to the principle of equity in service access and usage. the article provides an overview of the norwegian health policy systems, structures and provisions; describes the service provision from a specific programme providing maternal health services to migrant women in stavanger, norway; and concludes with some recommendations which emerge from the findings. keywords: maternal health, migrant women, migrant health, social policy, social work, norway, wpr framework 40 njsr – nordic journal of social research vol. 11, 2020 background and introduction this study reports on data from a study conducted in 2017 to explore the application of a universalist provision of maternal health services to migrant women. this is an important area of research because migration not only poses new challenges for the welfare state in its delivery of health services, it also has consequences for the health of the migrants. health policy in norway derives from its social democratic principles with the assumption that equality of provision equals equality of access and thereby of outcomes. however, this thinking is problematic. although norway has not experienced the same magnitude of people movements as some of its neighbouring countries, non-western migration to norway has increased (tronstad, nygaard, & bask, 2018, p. 16). the consequent changes in diversity have meant institutions in norway have had to consider how they will meet different cultural needs (regjeringen, 2017; tronstad et al., 2018). to avoid misconceptions, in this article the term ‘migrant’ includes both documented and undocumented women as for certain maternal health provisions undocumented women may access some pregnancy-related services. access to these services are designated as ‘absolutely necessary’ (kvamme & ytrehus, 2015, p. 3), and as such constitute emergency treatment rather than the types of services women may choose to or be recommended to access, such as the programme to be described later in this paper. however, it may well be that some of the attendees of the programme were undocumented. a local municipality-based programme offering health services and resources to migrants was used as a case study to explore the application of health policy in the area of migrant maternal health. observations of the programme were carried out over a period of four months in early 2017; discussions were held with policy makers, programme directors and managers and policy documentation were reviewed. the structure of investigation was guided by the two principal research questions, listed in the methods section, which concern norwegian health policy’s considerations and provisions of maternal health services for migrant women. the findings and discussions were set within the larger norwegian health policy context applying a critical policy analysis framework (bacchi, 2009) to both analyse the findings around the research questions, and articulate suggestions for future policy research and policy development. the study concluded that, despite the social democratic intent of ensuring equality through equal provision, the implementation of the 41 njsr – nordic journal of social research vol. 11, 2020 policy faced a number of challenges which needed to be addressed to ensure equality of access. it raised the issue of the equity-equality nexus and prompted a question for policy: to what extent can equality tolerate diversity, or, to re-phrase it, what unequal measures are necessary to achieve equity and what does this mean for the social democratic ideal? reflecting on these questions, this article presents the argument that a targeted or proportional universalism (carey, crammond, & de leeuw, 2015) is necessary to address the different needs of diverse groups of people, such as migrant women, at the same time as affording them equal or universal access and benefit. this article begins by providing context to the issue being studied by introducing the significance of migration to maternal health and goes on to describe the current migration circumstances in norway and norway’s health policy. an account of the methodology used, and description of the case example in the findings section follows. the subsequent discussion examines the norwegian policy position in maintaining its type of welfare state in relation to health, by considering the experiences of a localised service for migrant women. the paper concludes with some reflections on targeted or proportionate universalism as an aspect of a social democratic system which could contribute to both local and national policy development. migration and maternal health maternal care and women’s right to their reproductive health for legal migrants in most european countries has been found to present challenges for the countries’ service delivery systems, and have implications for the health outcomes of migrant women. research reports challenges for service delivery systems, health outcomes, help seeking and differential access patterns (darj & lindmark, 2002; dejin-karlsson & östergren, 2004; ny, 2007; rechel et al., 2011). migration further increases the vulnerability of pregnant women and their new-born children, with reeske and razum (2011, p. 139) maintaining that “health differentials during pregnancy, birth, the neonatal period and the first year of life are sensitive indicators of social inequalities”. multiple studies illustrate the concerns. utilization of prenatal and antenatal care by migrant women is less frequent in comparison to non-migrant women (nørredam & krasnik, 2011); they begin antenatal visits later in their pregnancy; and make fewer appointments (reeske & razum, 2011). induced abortions among non-western migrants are greater than non-migrant women, which may indicate lack of knowledge of preventative measures in reproductive health (nørredam & krasnik, 2011). other disparities exist in 42 njsr – nordic journal of social research vol. 11, 2020 such unfavourable birth outcomes as: still births; low birth weights; preterm birth, congenital defects or malformations; and an increased risk of maternal and infant mortality (reeske & razum, 2011). there is a growing recognition among these studies and others that the cause of these disparities go beyond the legal and physical access to health services, and in fact suggest a problem of knowledge, accessibility, appropriateness, or quality for migrant women. while studies have examined the health concerns and outcomes for migrant women, very little research appears to have explored how the more implicit and informal social determinants, such as ethnicity and culture linked to migrant women’s health, contribute to positive or negative outcomes, or whether these have been addressed in health policy. this is particularly the case in norway where there appear to be no studies conducted on the effects of health policy on migrant women’s health. international immigration in the norwegian context up until the late 1970s migrants comprised a very small percentage of the norwegian population. but norway’s immigrant intake has changed from the latter part of the twentieth century to accommodate refugee and asylum seeker arrivals as well as the more common migration for work and education purposes. persons with immigrant backgrounds constituted 16.8% of norway’s total (5,258,317) population (ssb, 2017b) as of january 1st 2017, comprising 724, 987 immigrants and 158,764 norwegian-born to immigrants: a total of 883,751. approximately 50% of this population is aged between 2040 years of age, and less than 9% over 60 years of age, making it younger than the average population (ssb, 2017c). a significant number of this young migrant population are women of average childbearing age (20-44 years old). the source countries of more than half a million immigrants in 2017 were from asian, latin american and african countries as well as other non-european countries (tronstad et al., 2018, p. 16). the health systems in these areas differ markedly from that in norway, along with very different cultural beliefs and behaviours in relation to maternal health. settlement patterns show oslo, the capital, and its surrounding regions to have the highest concentration of migrants, with rogaland county on norway’s south-west coast having the fourth highest in january 2017 (ssb, 2017c). stavanger, the location of this study, is one of the larger municipalities in rogaland county. moreover, stavanger is known as the oil capital of norway, 43 njsr – nordic journal of social research vol. 11, 2020 and has “percentage-wise, the largest foreign population” in the country (gjerstad, johannessen, nødland, skeie, & vedøy, 2016 p. 172). the migrant population is largely an even distribution between work migrants, their families, refugees and asylum seekers (gjerstad et al., 2016). as of january 1st 2017, there were 19,791 women of immigrant and norwegian-born to migrant background, who were of childbearing age (20-44 years of age) living in rogaland county (ssb, 2017a). this represents more than half the entire (37,985) female migrant population in the region (ssb, 2017a). these features of the municipality made it a strategically advantageous location to carry out a policy analysis on migrant maternal health services. norwegian health policy system the foundations of norway’s social democratic welfare state rest on the principles of community, equality, mutual respect and trust (esping-andersen, 1996) using progressive taxation to reduce economic inequality and to finance generous public services (pierson & leimgruber, 2010). its principle of universalism, offering all citizens equal access to services as a national priority (kangas & kvist, 2012; ringard, sagan, saunes, & lindahl, 2013), results in lower levels of inequality between the poor and the rich, and between men and women (kangas & kvist, 2012) than in other jurisdictions. such measures and the commitment to “redistributive policies (both economic and social) and full-employment policies, such as the social democratic parties, are generally more successful in improving the health of populations” (navarro & shi, 2001 p. 181). thus, norway’s low levels of inequality, higher satisfaction with life, and the population’s overall high quality of health has been attributed to the country’s comprehensive and accessible health and welfare programs (kangas & kvist, 2012). norway operates a decentralised system for service provision as illustrated in figure 1. 44 njsr – nordic journal of social research vol. 11, 2020 figure 1 – tegra as a health service provider adapted from figure 2.1 in ringard et al. (2013, p. 17) an intricate set of relationships exists. primary health care and hospital related services are separate from but responsible to the ministry of health, and do not indicate systematic collaborative relationships or partnerships. furthermore, the decentralised system assumes that primary service provision operates most efficiently at the most local level possible and is therefore the responsibility of municipalities. in stavanger, maternal health services are offered by three main bodies: physicians including general practitioners and gynaecologists; primary care centres; and the stavanger universitetssjukehus hospital. the municipality of stavanger has six public health clinics called the ‘helsestasjon’ that offer free primary health services to families and children living across the city’s seven boroughs. as indicated in figure 1, potentially, unless there are specific initiatives, these services can and do operate independently from each other. all services are provided with no specific cultural or ethnic considerations, although the high level of migrants is acknowledged through the availability of interpreter services (helsenorge, 2015). a health programme called tegra, which stands for ‘integration’, is run by the stavanger municipality. this program offers a range of maternal health workshops and other activities to migrant women and their families. this 45 njsr – nordic journal of social research vol. 11, 2020 program was selected as the case study for this research. the detailed rationale for its selection as the site of study is presented in the subsequent methods section, while a full description of tegra is provided in the findings section. methods anecdotal narratives suggested that migrant women were not able to satisfactorily access some of the maternal health services which were part of norway’s universal health system. therefore, this research used an exploratory process to examine the nexus between policy and practice in norway in relation to the provision and delivery of maternal health services to migrant women. having been conducted within a program setting certain time frames for the scope and design of the research, a case study approach was employed to provide as detailed an account as possible of one example of health provision to migrant mothers, in order to explore the application of norwegian health policy. the research questions that enabled this exploration were: how does norwegian health policy provide maternal health services to migrant women? how have these policies enabled accessibility and acceptability of maternal health services to migrant women? design an instrumental case study approach (stake 1995; as cited in baxter & jack, 2008, p. 549) was employed as the main focus was health policy and practice rather than the specific situation itself. as a research approach, instrumental case studies explore a complex phenomenon within its context, by way of gathering and interpreting data from various sources to answer “how” and “why” questions (baxter & jack, 2008, p. 545) allowing for the “multiple facets of the phenomenon to be revealed” (baxter & jack, 2008, p. 543). thus, they provide for a more holistic understanding, and strengthen findings through data triangulation, enhancing their credibility and trustworthiness. a case study design was selected for its ability to identify aspects of a phenomenon for further research as is fitting with an exploratory approach. while recognizing that findings could not be generalized, it was considered that examining a specific example of practice as illustration of policy could 46 njsr – nordic journal of social research vol. 11, 2020 indicate areas worthy of further investigation. the programme tegra was selected for exploration as stavanger is in a region with one of the largest migrant populations in the country and could be expected to provide useful information and indicate questions for future research. further, tegra was selected as the site for the case study as compared to one of stavanger’s health clinics because of its extended services beyond preand post-natal group workshops and its customization for migrant women. data sources and collection as the policy-practice nexus was the main focus for the study, policy documentation formed the main data source. these were supplemented by discussions with policy makers, programme managers and other health professionals in stavanger. national and local policy documents provided information about the overall health policy principles and structures and the policy framework within which tegra and the municipality operated. unstructured discussions were held with local policy makers and other health professionals, in which they were asked to describe how health policy was implemented and enacted in stavanger. in keeping with an exploratory study, these descriptions filled in the detail of what is usually summarised in official documents and provided some history to health provisions and reasons for establishing tegra. observations of workshops and activities run by tegra provided ancillary data, which were considered in light of the policy documentation and comments from policy makers from the board of health and social welfare. the researcher attended four workshops and group activities at tegra during a four-month period with the permission of the health officials and tegra organisers. while not a participant, the researcher did interact with the programme leaders and participants who were informed about the study, and all of whom agreed to her presence. notes were taken of the activities and information provided. no structured interviews or discussions were conducted with the workshop participants and organisers, and any conversations held were for the purposes of clarifying or confirming information. no participant or organiser was cited or quoted in this study. another study may well wish to interview participants for their feedback on the appropriateness and effectiveness of the workshops and activities, and this would add to further knowledge. 47 njsr – nordic journal of social research vol. 11, 2020 trustworthiness of the data was addressed through the multiple sources of data as well as through researcher and supervisor reflection. being mindful that all researchers in qualitative research affect the research, the researcher’s position as a female was noted as potentially influencing the research. these discussions explored the likely influences of her positionality on the findings which were scrutinised for any examples of such influence and revised accordingly. analysis bacchi’s (2009) what’s the problem represented to be? (wpr) framework consisting of six critical questions, as presented below in figure 2, was adopted as the analytical framework for the study and hence applied to all data: policy documents, discussions and observations. founded on the four traditions of social constructionism, post-structuralism, feminism and governmentality, bacchi’s model aims to ‘work backwards’ and deconstruct any public policy to deduce implicit discourses underlining the construction and representation of ‘problems’(bacchi, 2012). the wpr was used both as an analytical tool, as well as a frame for how the analysis is presented and developed in the discussion section. this approach to the presentation of discussions is critical, because the chronology imposed by the framework is an integral part of the process of the policy analysis in this report. therefore, the aim in applying this analytical framework to the case study and other data was to critically review the connections between the policy and tegra’s services, as an example of a programme for maternal migrant health. 48 njsr – nordic journal of social research vol. 11, 2020 figure 2 – the six questions of bacchi’s (2009, p. 48) ‘what’s the problem represented to be?’ (wpr) framework for policy discourse analysis ethics the norwegian centre for research data (nsd) did not require ethics approval be sought for this project. nevertheless, ethical practice applied in the informing of all contacts (advisors and health care personnel) about the purpose and significance of this study and in ensuring all data were treated with sensitivity and integrity, and importantly that all people associated with tegra were treated with respect and dignity. a visual illustration of the research design is presented in figure 3. 1 • what’s the ‘problem’ represented to be in a specific policy or policy proposal? 2 • what presuppositions or assumptions underpin this representation of the ‘problem’? 3 • how has this representation of the ‘problem’ come about? 4 • what is left unproblematic in this problem representation? where are the silences? • can the ‘problem’ be thought about differently? 5 • what effects are produced by this representation of the ‘problem’? 6 • how/where has this representation of the ‘problem’ been produced, disseminated and defended? • how has it been (or could it be) questioned, disrupted and replaced? 49 njsr – nordic journal of social research vol. 11, 2020 figure 3 – illustration of research design findings tegra, a case example addressing migrant maternal health in stavanger this section offers a presentation of the case study, and in doing so the context for the analysis in the discussion section. to begin, figure 1 locates tegra as a municipally funded health programme in the stavanger kommune. history of tegra tegra’s initial focus was to contribute to the national action plans against female genital mutilation (fgm) in the early 2000s as part of the o.k. initiative (translated as care and knowledge against female circumcision) (norwegian ministries, 2008). furthermore, in line with o.k’s initiative, tegra aimed to increase the cultural competency of healthcare professionals and other service providers working with immigrant women and families, especially dealing with sensitive topics such as fgm. tegra’s culturally diverse team highlighted the importance of multicultural understanding in effectively addressing sensitive health issues such as fgm prevention practice (helsesøstre, 2007). data sources • policy documents • observations of four tegra workshops • discussions with: policy makers in health and social welfare board of stavanger; allied health professionals in the municipality and workers involved with tegra findings • amalgamation and presentatio n of all qualitative data in an instrumental case study. • providing the context for policy analysis in discussion section discussion • organization and interrogation of data using an analytical framework guided by the six questions in bacchi’s (2009) wpr framework for policy discourse analysis (figure2) conclusion • discussion on the broader implications of the findings 50 njsr – nordic journal of social research vol. 11, 2020 commencing in december 2002 at the central health clinic in stavanger (stavanger kommune, 2016a; sykepleierforbund, 2014), tegra focuses on working with immigrant families, in particular with women and children to prevent their social isolation. the program operated mostly through volunteer work (helsesøstre, 2007), until it was recognized by the udi (the norwegian directorate of immigration) in 2004 and received funding for two years. in 2007, after a year’s pause (helsesøstre, 2007), the project received formal recognition from the municipality and was integrated into the public health system (sykepleierforbund, 2014). tegra today in addition to working on the national action plans against fgm in norway, tegra also organizes free childbirth preparation (fødselsforberedende kurs) and postnatal (barselgrupper) group workshops for immigrant families living in stavanger. the workshops are held several times throughout the year, and families can request to have interpreters free of charge (stavanger kommune, 2016b). in 2016, there were 12 pre-natal groups, with a total of 172 pregnant women from 56 different nationalities; and 8 post-natal groups, with a total of 104 families from 46 different nationalities who participated. tegra is one of few providers of maternal health services in stavanger, however, it is the only provider that specialises in migrant women’s health. nevertheless, the intention of all maternal health service providers is to ensure that all mothers have equal access to maternal services, and information to obtain optimal pregnancy outcomes. the norwegian directorate for health (n.d) strongly recommends that all municipal health centres offer prospective and new parents the opportunity to take part in group consultations. the purpose of a group-based initiative is to enable parents in the same situation to share their knowledge and experience about childcare and parenting with each other, and to also have the chance to meet and create a social network with other parents in their community. all the health clinics in stavanger offer these post-natal group workshops. maternal health services and tegra in addition to having a midwife and a gp, every pregnant woman is assigned a helsesøster (health nurse) or health visitor from their local public health clinic. after report of delivery, the woman’s health visitor pays her a single home visit during which the mother is provided with information about the post-natal group courses (barselgrupper) at her local health clinic. if she has 51 njsr – nordic journal of social research vol. 11, 2020 a migrant background and is not fluent in norwegian, the health visitor also provides her with information about tegra at the central city health clinic. since these courses are voluntary, it is the mother’s responsibility to make an appointment and register her interest for attending either one of the courses. the post-natal group courses offered at the city’s six clinics aim to enhance maternal and child health and have existed long before tegra was developed. however, their accessibility to migrant women who did not speak norwegian has been limited, and hence migrant women’s attendance at the courses has been very low. women who wished to participate but did not speak norwegian had the option of purchasing private courses in their language for a fee. this is not a feasible option for many, and as a consequence of accessibility, many migrant women have not been able to benefit from this service. the workshops tegra’s operations differ from and supplement the city-wide programs. they are targeted at migrant women, and provide information about the norwegian health care systems as well as answer questions for people unfamiliar with these ways of working. common questions concern the prominent role of midwives compared to gynaecologists, and different postdelivery practices, such as being discharged after three days and walking soon after birth; practices that differ from those in some other countries. other information is intended to inculcate migrant women into the norwegian system and approaches. these include discouraging women from opting for caesarean delivery and emphasizing the benefits of natural birth using scientific evidence. tegra staff have found that a significantly high number of migrant women prefer caesarean delivery based on their cultural norms and the stigma against natural birth in their home countries. breastfeeding is another practice some migrant women reject, and the role of men in attending to infants is also a new concept to some. these differences are in part cultural and in part reflect western market and other influences in non-western countries, such as perceptions that formula milk is preferable to breast milk (muula, 2007; stevens, patrick, & pickler, 2009), and surgical procedures preferable to natural births. such cultural norms which are passed down the generations are contrary to those of the health system in the host country and can create division and resentment if handled without sensitivity. cultural sensitivity 52 njsr – nordic journal of social research vol. 11, 2020 tegra's organisers intend to be as culturally inclusive and responsive as possible. while genuinely attempting to provide useful information in engaging ways, presenters at the workshops would sometimes lapse into generalities. some examples included characterising the help provided from tegra as akin to the ‘watering wells’ used in some countries for women to gather and exchange information and provide support, or disregarding specific cultural prohibitions, such as recommending the use of pork liver pâté (‘leverpostei’ in norwegian) as infant food to an audience inclusive of muslim women. generalising can become stereotyping, not all migrant women have experience of ‘watering wells’, and additional options to pork liver pâté could be recommended to acknowledge cultural diets. other potential but unintended cultural offences could occur such as illustrated by a demonstration of breastfeeding techniques via video and then repeated by a nurse using props being performed in front of male class attendants. at this workshop, it was evident that some men were uncomfortable as they frequently glanced away during this part of the course. given the diverse range of nationalities and ethnicities of attendees, being able to provide culturally specific and appropriate information is a challenge requiring detailed knowledge and understanding. language in addition to the range of cultural and religious backgrounds of attendees, language is another consideration, which is recognised through the free provision of interpreters on request. observation of this in action found the courses to be facilitated by powerpoint presentations, videos, handouts, and props with the presenters pausing regularly to allow for interpreters to translate the content and allow for questions to be asked and thoughts to be shared. although all stavanger health clinics offer post-natal workshops in norwegian, sykepleierforbund (2014) suggests that immigrant women have a much lower turn up rate to the city-wide program. several factors such as language barriers and lack of knowledge have been suggested as contributing factors for the difference (sykepleierforbund, 2014). it may be that the attendance is more regular and that more women are attracted to tegra than in the city-wide programme because of free access to interpreters. however, this has its limits. it would be impractical to have potentially up to 57 different interpreters in the classes, even should trained interpreters be available in stavanger to cover all language groups. furthermore, a common practice of employing male interpreters to work in the culturally sensitive areas 53 njsr – nordic journal of social research vol. 11, 2020 of childbirth, breast feeding and other gynaecological matters for some groups could present barriers to participation. timing and location there are other limitations which face the tegra organisers including the timetabling of the courses and its location. morning and afternoon classes on one day a week do not readily attract those workers on shift work, a common occupation condition for migrant workers making male partner attendance difficult. the central city location is convenient for public transport, but sometimes lengthy journeys, and having to travel with other children create unneeded barriers. accessibility and availability a major potential barrier is that of the lack of connection between the hospitals, clinics, health visitors and midwives. tegra is the only programme that covers all the topics associated with preand post-natal information over a period of time, which enables women to ask the questions as they emerge from their experiences or gestational changes. if they miss or do not attend the courses, they have to make special arrangements to call the clinics, ask their midwives or health visitor, or the hospitals after birth. figure 1 illustrates the lack of organisational affiliation between the state-run hospitals and the primary care centres in norway. subsequently, hospitalbased midwives and other care providers are not associated with municipally run programs such as tegra. as a result, the quality of and sensitivity to culturally relevant care, and level of awareness is likely to vary across these institutions, because the care providers are trained according to different guidelines. although examples cited above indicate that staff at tegra are not fully conversant with culturally appropriate protocols, it is possible that larger institutional organisations such as hospitals may be less so, despite the provision of interpreter services (helsenorge, 2015). accessibility to information about tegra suffers from a similar restriction. women can find out about tegra if their practitioners (gps or midwives) inform them about it. otherwise, information available on the municipality’s website is restricted to a very short outline about the course and instructions on how to register, again only in norwegian and english. norwegian norms 54 njsr – nordic journal of social research vol. 11, 2020 finally, the content presented in tegra has been selected and organized by norwegian practitioners according to norwegian notions of good practice. in other words, the program is founded upon a mono-cultural understanding of maternal health needs, which reflects norwegian norms, mores and expectations. the focus is not on addressing any specific issues affecting migrant women or on making the norwegian course content more culturally sensitive to the needs of women from diverse backgrounds. discussion in this section, the six questions from bacchi’s (2009) “what’s the problem represented to be?” (wpr) critical policy analysis framework (figure 2) were used to tease out the policy implications of the tegra example of providing maternal health services to migrant women in norway. first two questions –the ‘problem’ and its presuppositions one of the initial challenges to using this framework was presented by the first two questions: what’s the problem represented to be? and what are the underpinning assumptions? in other applications of this framework, for example drug policy (lancaster & ritter, 2014), how drug use is constructed politically and through language, reveals much about ideology, partisanship, moral judgements, how the problem is conceptualised, is it a criminal justice or health matter and so on. in the case of the provision of health services in a universalist state such as norway, the ‘problem’ is that this is not considered to be a problem. here, everyone, with very few exceptions, has access to health services. the ‘problem’ becomes how the service provision itself is represented, or, how accessible are the services, and is that accessibility equal? on the surface, all women have equal access to services. but, as has been shown in the findings, the way services are provided mean that barriers exist in the form of cultural appropriateness, sensitivity and relevance. the what’s the problem represented to be framework is usually applied to policy texts and subject to critical analysis. here health policy documents were used, supplemented by observations of the tegra programme and discussions with policy practitioners. social activities such as described in the case study, are also considered to be text (ricoeur, 1971) and so are also able to be included in bacchi’s framework. the observed and dialogic data were able to add a qualitative depth to the written policy documentation. while the ‘problem’ of access to the provision of maternal health services by migrant women is not represented as such in the policy documents, observational and 55 njsr – nordic journal of social research vol. 11, 2020 discursive data indicate tegra’s organisers considered it to be so, hence the development of the programme. third question – a historical overview historically too, in reference to bacchi’s (2009) third question concerning the historical genesis of the issue (figure 2), tegra’s provision of its current services emerged from a national culturally specific policy to act against the practice of female genital mutilation (fgm). where fgm certainly was constructed nationally as a problem, even though, as braun (2009) explores, as a problem it is variously represented, being able to access maternal health services was not. hence the program was originally established and was funded to work with fgm. it was later that tegra organisers themselves constructed the ‘problem’ of migrant women’s access to maternal health services as needing to be addressed in the absence of a suitable national framework at the time. it was not until 2007 that norway released its policy on reducing social inequalities in health (ministry of health and care services, 2007), having accepted in 2003 that there was a need to do so (strand, brown, torgersen, & giaever, 2009). largely defining social inequalities as related to economics, noting that norway has a stratified society “where the most privileged people, in economic terms, have the best health” (ministry of health and care services, 2007 p. 5), the policy targets “income, childhood conditions, employment and working environment, health behaviour, health services and social inclusion” (ministry of health and care services, 2007 p. 6). norway’s commitment to universalism is one in which “social equity is promoted through a distributive social security system” (strand et al., 2009 p. 12). the general needs for the whole population are supplemented by strong social transfer programmes to ensure income inequality in particular does not lead to other inequalities. this is the cornerstone of the health strategy. while not rejecting the universalist principle, the strategy acknowledges that some targeting is necessary, although not by using a means-testing approach which potentially “stigmatises” people (ministry of health and care services, 2007 p. 7). how otherwise to identify the most vulnerable groups for specific remedies is not stated, reiterating instead that still the most effective measures to overcome inequalities are through universal provisions. ‘immigrants’ are among those groups identified as potentially vulnerable, showing higher levels of health concerns such as mental health issues, and specific diseases such as hepatitis, malaria and tuberculosis. maternal health is also identified as potentially cause for concern, but that section concludes 56 njsr – nordic journal of social research vol. 11, 2020 by stating “further studies need to be undertaken to clarify socioeconomic factors and health among immigrants in norway” (ministry of health and care services, 2007 p. 28). although being an immigrant is identified in the strategy as requiring attention, and so could be considered itself to be a health risk factor, it could be argued that relying on a universalist provision does not satisfactorily address the specific needs of immigrants, and more especially immigrant women and mothers. while in this context the terms “equity” and “equality” are used interchangeably (whitehead & dahlgren, 2007 p. 4), it is questionable as to whether the norwegian position on addressing inequalities fully reflects the rawlsian (rawls, 1972) concept of ‘fairness’ in its construction of equity. the rawlsian principle of interdependence requires that resources and goods are distributed in such a way to ensure that the least advantaged members of society should be the greatest beneficiaries from public resources. notwithstanding the commitment to attend to specific needs for specific groups, the overall principle that universal provision is the best solution to achieving social equity stands in this strategy. universal provision does not guarantee universal access, or that those services are relevant or culturally sensitive. fourth question – the limitations the way by which these problems have been constructed, pointing to bacchi’s (2009) fourth question (figure 2), illustrates a central issue for a universalist welfare state. if social equity in health is defined using population wide measures founded (largely) on economic assessments, the strategy targets are likely to overlook specific groups in society such as migrants and migrant women who are not defined by their economic status in relation to health. by focusing on the more generally available health services through societally available institutions such as hospitals, gps and clinics whose mandate is to ensure the services are available to all, there is no guarantee that these services ensure that all people access them. this is the gap that tegra sought to fill for migrant women in their need for specific maternal health services. their additional goal was to encourage social inclusion, an aim that finds expression in the national strategy in the form of an education-to-work design, believing that economic inequality results in poorer health, and dropping out of education is a precursor to lower income and/or unemployment. this design feature is not an aspect which would readily fit into any of the provisions from health services. 57 njsr – nordic journal of social research vol. 11, 2020 the aaaq model from the un committee on economics, social and cultural rights (cescr), (world health organization, 2007) is useful here to identify how well a policy may be assessed as meeting the four interrelated and partially overlapping elements of: availability, accessibility, acceptability and quality (aaaq). while the services to specifically address maternal and child health needs in the national strategy (ministry of health and care services, 2007 p. 38) are available, they do not target the specific needs of migrant mothers for their own health care and knowledge. as mentioned above, gps, hospitals and clinics all provide post-natal care for example and so are available, but their acceptance by non-norwegian speaking migrant women as well as potentially their knowledge of these services may be questionable. this is not a comment on their quality, rather more one of whether or not these generalised services are those best suited to women who come from cultures which have different maternal health customs and expectations. fifth question – the effects following her foucauldian trajectory, bacchi’s (2009) fifth question (figure 2) enquires much more specifically into the discursive, subjectification and lived effects of the problematisations. the national strategy (ministry of health and care services, 2007) is also applicable here, for although it allowed for some targeting to attend to potential inequalities, the discursive subject, in this case, is all women who need to access maternal health services, and that through provision of the universal services, all women may have their needs met. the effects on the subjects themselves is not necessarily one of blame or accusation for not accessing the provided services, but more of blindness to the particulars of their needs – a blindness tegra organisers recognised in their decision to target migrant women. nevertheless, this provision is framed from a mono-cultural and ‘white’ oriented norwegian perspective, with the potential consequence that women and their families, especially the men, withdraw from the workshops and presentations. cultural awareness and responsiveness (seeleman, essink-bot, stronks, & ingleby, 2015) is a necessary extension to the universal principles of service provision for specific groups. this is not only for the specific health outcomes for migrant mothers and their children, but more broadly as part of the larger integration initiative. acknowledging the needs of these migrant women through policy and enhancing their relationship with a health system that is respectful of their cultures, their integration can be promoted in norwegian society by way of increased trust and participation in the system. however, the opposite is 58 njsr – nordic journal of social research vol. 11, 2020 highly likely as well, where their exclusion by disregarding their migrant milieus can lead to their isolation. bacchi’s wpr framework primarily focuses on policy analysis and the representation of problems in policies. but she also reflects on the “effects of a given policy in terms of ‘lived life’” where the primary focus is on “the effects of problem representations on the micro-level” (cort, 2011 p. 29). some of these effects can be inferred from the possible embarrassment of men to the breastfeeding information sessions, or the use of male interpreters for women’s gynaecological health matters. possibly some participants may be less inclined to attend future courses because of this, so affecting the acceptability of the provisions, but more importantly resulting in both lack of appropriate information about the norwegian systems and services, as well as potentially missing out on necessary preventive services. sixth question – opportunities and challenges the final question in bacchi’s wpr framework (2009) (figure 2), returns the gaze to the institutions and agencies which sustain the representation of the problem, and leads to the mobilisation of resources to effect change. as goodwin (2011) articulates, this is the point at which there is the possibility of seeing the policy in a new light having uncovered “knowledge that is critically different from the existing system of meaning” (goodwin, 2011 p. 174). here targeted or proportionate universalism may be a policy direction of worth. although noted as having acknowledged the necessity of some targeting, the national strategy (ministry of health and care services, 2007), remains committed to the distributive mechanisms of the welfare state in achieving equity. this strategy built on earlier policy directions, which relied heavily on the role played by municipalities through their health service provisions (tallarek née grimm, helgesen, & fosse, 2013). such a decentralised approach must trust that the overall aim of national policies is both understood and supported at the local level. oversight is maintained through nonintrusive or directive means, leaving the lesser-acknowledged policy needs either invisible (and so unaddressed) or dependent on local initiatives. tegra was one such initiative, but the extent to which similar initiatives and programmes that attend to maternal health provision for migrant women around the country is unknown, leading to asking a question about how equal health services are for a specific population. whitehead and dahlgren (2007 p. 11), define social inequities in health (sih) as those “fair arrangements that allow equal geographic, economic and 59 njsr – nordic journal of social research vol. 11, 2020 cultural access to available services for all in equal need of care”. such an articulation neither specifies the ‘cultural’ aspect, nor includes migration (castañeda et al., 2015; davies, basten, & frattini, 2006; international organisation for migration, 2017). arguably, leaving decisions about these provisions to local municipalities could well lead to inequalities in provision and access, to say nothing of the more specific cultural needs. for all the challenges faced by tegra and the inadequacies of the programme in certain respects, the municipality of stavanger has sought to meet its obligations, and more, in women’s health. but it might be questioned as to whether leaving these crucial decisions to municipalities is enough to ensure that the principle of universalism is not undermined by the need for targeted services. the concept of targeted or proportionate universalism may be usefully considered here. carey and colleagues (2015), constructed a heuristic using subsidiarity principles from reviewing literature on universal and targeted policy frameworks to propose a mechanism for use by national governments to meet their policy objectives. an adaptation of the heuristic is reproduced in table 1. table 1proportionate universalism heuristic general universalism federal government responsibility: universal protections for all (e.g. sanitation) specific universalism federal government responsibility: universal protections for citizens (e.g. health care, education) positive selectivism state government in partnership with other sectors (community and business): targeted policies and programmes based on differing levels of need particularism local government responsibility in partnership with other sectors (community and business) tailored services for different cultural, ethnic or otherwise differentiated groups adapted from carey et al (2015 p. 5) operating from the imperative that decisions and actions are taken as close as possible to where they are to be implemented (the subsidiarity principle), different levels of government thereby have differing responsibilities. while norway’s arrangements of counties, municipalities and the national government differ from a federal system, it could be said to have similar locational responsibilities. hence, the national government sets policy including laws, such as the health and care services and public health act of 2011, specifying expectations and roles, for example intersectoral cooperation 60 njsr – nordic journal of social research vol. 11, 2020 (ringard et al., 2013). additionally, these laws allocate responsibilities, such as requiring municipalities to monitor health inequalities and ideally employ a local coordinator to advance such coordination (van der wel, dahl, & bergsli, 2016). thus, actions to address needs identified in the national strategy of 2007 (ministry of health and care services, 2007) were codified in 2011 with directions to municipalities. concern at national level continued with the release of a white paper on public health in 2015 although as van der wel (2016) and colleagues note details are lacking as to the specifics required to reduce inequalities. rogaland county could represent the positive selectivism governance arrangements through allocated roles from the ministry of health and care services. dental care providers for instance are a responsibility of counties rather than municipalities (ringard et al., 2013). this represents an example of positive selectivism, as it is where community and business interests combine, although this remains unexamined in this study. as the locus closest to the delivery of service, municipalities can enact particularist principles. the stavanger municipality has a relationship through its clinic system, with tegra, having agreed to fund them in 2007. although the municipality cannot take the credit for the work of tegra, especially the choices made as to how programmes should be implemented and offered to migrant women, it has a certain responsibility. this may be that tegra’s work forms part of its reporting responsibilities in relation to intersectoral collaboration and other expectations. conclusion the study reported here started because of observations in social work practice that some migrants from non-european countries had little knowledge of and hesitation in accessing maternal health services. a resultant exploratory research project then concerned how well the principles of universalism as a main policy orientation in all norwegian service provision met the needs of mothers from very different health systems. a question about the policy-practice nexus was formulated to explore the intersections between what services were provided and how they were delivered. given the then paucity of research in norway about this issue, a decision was made to examine this nexus through an in-depth observation of a programme operating to provide maternal health services to migrant women in an area which had a large population of migrant women from predominantly noneuropean countries. applying a policy analysis framework to this programme 61 njsr – nordic journal of social research vol. 11, 2020 in its policy setting has enabled some insights into the tensions present between operating a universal system for people who are not native-born norwegians. universalism assumes all people are able to equally access the services provided. within the universalist system, some targeting is implemented in the recognition that certain groups have additional and special needs. the examination of maternal health provision to migrant women has shown that this group was not necessarily an identified group for targeted services at a national level, and that municipalities were awarded the discretion to decide what services should be provided and how. the tegra example has shown that despite targeting at the local level, social equity cannot be guaranteed. although tegra is an illustration of progress in addressing inequality in one municipality in norway, the underpinnings and processes involved in the problem representation at policy level pose limitations to its effectiveness as there remain gaps in culturally responsive and appropriate services which lead to social inequity. the assumption that everyone has equal access under a universalist system, has inadvertently resulted in a degree of ambiguity in the ethos of equity and equality, leading to a questioning of equality within a universal system. in other words, how much inequality of provision in the interests of equity, can a universalist system tolerate? the answer to this question is for another research study, but this study has revealed that in this location and this reported programme, there are gaps in the theoretically equitable healthcare system, through which a fraction of the population, particularly people from migrant backgrounds could fall. hence, this approach to equity imposes a weakness on the principle of universalism and has the potential to further deepen inequality. nonetheless, designed to fill an identified need at a local level, the experience of this programme has the potential to inform policy development and practice at a national level. drawing on the principle of subsidiarity and the form of particularism as described by carey et al (2015), amendments to the tegra programme in the form of greater cultural responsiveness and understanding could provide some guidance to similar locally based programmes elsewhere in norway. equally in the publishing of this analysis, it is likely that other programmes operating independently in other municipalities may have additional and different suggestions for culturally responsive strategies to contribute to a national health policy which seeks to preserve universalism at the same time as ensuring particular groups have their needs met. to conclude, in addition to offering an essential contribution to understanding migrant maternal health policy in norway, this exploratory study’s greater 62 njsr – nordic journal of social research vol. 11, 2020 purpose serves to trigger further discussion and research in this increasingly important arena in norway where the migrant population in on the rise. acknowledgements first and foremost, i thank my supervisor and mentor dr. susan young for her guidance throughout the many stages involved in producing this work. i also extend my gratitude to all those who enabled this opportunity through their continued support. furthermore, we both thank the reviewers and editors at the nordic journal of social research for their valuable feedback, and last but not least the faculty of social sciences at the university of stavanger for supporting this publication. funding this article was made possible by funding from the university of stavanger 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(2007). the right to healthjoint fact sheet who/ohchr/323. 1-2. retrieved from http://www.who.int/mediacentre/factsheets/fs323_en.pdf “we don’t feel like we are part of the project”: an analysis of tensions in the development and implementation of a public sector innovation project in norway njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 “we don’t feel like we are part of the project”: an analysis of tensions in the development and implementation of a public sector innovation project in norway hilde svrljuga sætre* department of business administration western norway university of applied sciences email: hilde.svrljuga.setre@hvl.no *corresponding author mai camilla munkejord department of business administration western norway university of applied sciences email: mai.camilla.munkejord@hvl.no abstract some of the extant literature on collaborative public sector innovation seems to assume that collaboration per se implies a positive outcome. recent research, however, has demonstrated that innovation processes may take different shapes and trajectories depending on, for example, the collaborating actors’ diverging (or converging) perceptions of the given situation. in this article, we seek to contribute to understanding the nature of potential challenges in public sector innovation processes. we interviewed seven key actors involved in developing and implementing a new introduction programme for refugees in a municipality in norway. the interviews explored how the innovation process evolved and how the different actors experienced their participation in the process. in this article, we use the classic four ‘moments of translation’ approach proposed by callon (1986) to shed light on the main tensions that arose for the project team in the 18 months after the project was launched. these challenges related to why the innovation was realised, how such an innovation should be operationalised, for whom the innovation was targeted and whose innovation project the project was initially. in conclusion, we argue that to address the tensions that may arise in any collaborative project, innovation leaders must establish a ‘structure for collaboration’ that includes a space in which to acknowledge and potentially solve emerging challenges. 202 njsr – nordic journal of social research vol. 12, 2021 keywords: public service innovation, collaborative innovation, actor-network theory, social enterprise introduction collaborative perspectives have long been central in public sector innovation studies (sørensen & torfing, 2011). these studies have typically explored how collaboration across different perspectives, experiences, knowledge bases and competencies drives innovation (sørensen & torfing, 2011). some of the extant literature on collaborative public sector innovation portrays collaboration as harmonious and appears to assume that collaboration per se implies a positive outcome. contrary to this assumption, it has been argued that the collaborative innovation literature overlooks individual actors’ significance and that new perspectives are needed to understand how some actors, but not others, manage to translate innovative visions into new practices in specific contexts (meijer, 2014; windrum, 2008). drawing on translation theory, røvik (2007) introduced the concept of the ‘capable translator’. a capable translator is an actor with detailed knowledge of a new idea, of the context from which the idea is exported and of the context in which the idea seeks realisation. the ‘capable translator’ must possess specific personal traits, knowledge bases and skills that he or she employs to convince others of his or her understanding of the novel idea (røvik, 2007). in applying translation approaches to public sector innovation processes, research has demonstrated that innovation processes may take different shapes and trajectories depending on the collaborating actors’ diverging (or converging) perceptions of what the problem actually is and how it should best be solved (e.g., gray & ren, 2014; magnussen, 2016; myklebø, 2019). in this article, we seek to further understand the nature of the potential challenges facing public sector innovation processes. methodologically, we interviewed seven key actors involved in developing and implementing a new introduction programme for refugees in a municipality in norway. the interviews explored how the innovation process evolved and how the different actors experienced their participation in it. the initiative was defined as a collaborative innovation project and obtained funding from the county administration and norwegian directorate of diversity and integration (imdi). in this article, we neither explore this new introduction programme’s content nor the participants’ experiences. rather, using the classic four ‘moments of translation’ approach proposed by callon (1986), we analyse the experiences 203 njsr – nordic journal of social research vol. 12, 2021 of the key actors involved in developing and implementing the programme to shed light on the main tensions that arose in the project team in the first 18 months after the project’s launch. in particular, we discuss tensions related to why innovation was realised, how such innovation should be operationalised, for whom the innovation was targeted and whose innovation project the project was initially. in conclusion, we argue that to address the tensions that may arise in any collaborative project, it is crucial to establish a ‘structure for collaboration’ that includes a communicative space in which to acknowledge and potentially solve emerging challenges and oppositional views among the collaborating actors. the remainder of this article proceeds as follows: first, the background and context for the new introduction programme under investigation are described. the theoretical framework is then outlined, as are the methodological choices and considerations. the main findings are presented next, followed by the discussion and concluding remarks. background and context for nearly 20 years, the introduction programme for refugees has been offered in norway as an integrative initiative aimed at enabling refugees to quickly find work or enter education or training (djuve & kavli, 2015, 2018). according to the introduction act (2005), participants should be offered norwegian language and social studies classes and on-the-job training or other working life preparations. participation in the introduction programme is both a right and a duty for refugees, who receive an introduction benefit1 while taking part in the programme. the introduction programme is offered in the municipality in which the refugee is settled and is a collaborative effort, normally between two public sector organisations: the refugee integration office and the adult education centre (myklebø, 2019). the refugee integration office generally assumes responsibility for refugees’ working life preparations and overall learning ambitions during their participation in the introduction programme, while the adult education centre is responsible for delivering norwegian language and social studies classes. due to disappointing introduction programme results in many parts of the country 1 an income support payment 204 njsr – nordic journal of social research vol. 12, 2021 (e.g., bredal & orupabo, 2014; djuve & kavli, 2015; kavli et al., 2007), various initiatives have been encouraged recently, including new introduction programmes, developed by the municipalities at the urging of the imdi. in policy papers, the government has also called for innovation in the introduction programmes, especially for women with no formal qualifications, such as through social entrepreneurship (ministry of education and research, 2019). the project under scrutiny is being carried out in the ‘seaside municipality’, a medium-sized municipality of 25,000–40,000 inhabitants. the head of this municipality’s refugee integration office and her colleagues remarked that the introduction programmes for refugees in the area had had disappointing results in terms of both participants’ relatively low scores on the norwegian exams and too few participants obtaining paid work after completing the programme. in 2018, the head and the municipal business advisor contacted a group of researchers2 to discuss how to address this problem. a decision was reached to apply for funding to develop and implement a new introduction programme for refugee women. this new introduction programme was to have two core principles: empowerment, to highlight the participants as ‘competent and skilled persons’, and communicative language teaching, to position linguistic interaction as both a means and a goal. to operationalise these principles, the project proposed establishing a social enterprise in which participants could learn language and work-related knowledge while practising a task in which they already had expertise: cooking. funding to run a pilot project was obtained from the imdi and the county administration. the main target group for the pilot project was refugee women with little or no formal qualifications and an interest in cooking. the leader of the refugee integration office became the project leader for the pilot. in the fall of 2018, the project leader recruited a programme coordinator (a chef), two norwegian language teachers and 10–12 participants, including both literate and illiterate refugee women. in january 2019, even before the new programme coordinator had started, the programme was launched by the project leader. cooking took place within a public sector social enterprise established alongside the new introduction programme. this social enterprise’s aim was to provide a training context for the introduction 2 researchers from the research institutions norce and western norway university of applied sciences. 205 njsr – nordic journal of social research vol. 12, 2021 programme participants and potentially a future workplace for some of them. customers were made aware of the enterprise via social media marketing, and they supported it by ordering food for various occasions. during the first year of the pilot, the programme coordinator and the language teachers received some training from an invited expert on how to implement a communicative teaching approach. at the time of writing this article, the pilot project had been running for two years. the project was initiated by the project leader, who travelled to other municipalities for inspiration and learning, established contact with researchers, contributed to writing the applications and was formally listed as the project leader in these applications. however, the respective roles of the collaborating organisations and their employees were neither defined prior to nor during the implementation of the project. as will be illustrated in the analysis, this caused some challenges. theoretical framework innovation refers to the development and implementation of novel ideas that deviate from established and habitual practices (hartley et al., 2013; osborne & brown, 2011). innovation is not only about inventing ‘something new’ but also about developing and implementing this ‘new’ element such that it becomes accepted in a given context (fuglesang, 2010). while private sector innovation has long received scholarly attention, research on public sector innovation only emerged in the 1990s (kattel et al., 2013). public sector innovation can be defined as efforts or processes that enhance the capacity of public sector organisations to address social or societal problems, such as by improving the content or organisation of services (damanpour & schneider, 2009). by applying a translation perspective to our analysis, we can explore how and why tensions emerge in the innovation process and how different key actors manage them. according to the actor-network approach (ant), any diffusion of innovation depends on the mobilisation of support for an idea or practice in a network. this mobilisation is done by building relevant alliances to realise the innovation (callon, 1986). however, conflicting interests may emerge, placing the realisation of the innovation at risk by impeding the ‘capable translator’ from creating necessary alliances. thus, a ‘capable translator’ must possess some degree of power. however, this can foster power asymmetries, which may prevent certain actors from voicing their opinions or bringing new 206 njsr – nordic journal of social research vol. 12, 2021 ideas to the table (torfing et al., 2009). as torfing argues (2016, p. 133), entering ‘a dialogue of the deaf’ in which leaders cannot hear others’ voices can be detrimental to the collaborative process. to understand the tensions described by the key actors in the innovation project under investigation in this article and why they came about, we employ callon’s (1986) four ‘moments of translation’. callon’s first phase is problematisation, which refers to a ‘translator’ defining an observed social problem. the translator must convince others that his or her solution is the most appropriate for addressing the problem. it is important for the translator to establish a system of alliances and to render him or herself a natural facilitator within this system to continuously influence translation. the second phase, interessement, entails a set of actions by which the translator imposes his or her views on the actors involved in translation. to do so, the translator will seek to prevent others from defining the problem or the solution to the problem differently, such as by preventing competing definitions from being voiced (callon, 1986). the third phase, enrolment, involves assigning roles to the collaborating partners in the translation process and ensuring their willingness to accept their roles when the translator’s definition has become the prevailing definition for the initiative. the final phase, mobilisation, concerns the degree to which the collaborating actors play their roles as defined during enrolment and the degree to which innovation is carried out as defined during problematisation, thereby making the innovation incontestable and credible (callon, 1986). however, dissidence is prone to arise. while dissidence may in some instances spur unintended and innovative solutions, in other instances, as will be illustrated in this article, it may constitute a bottleneck. research design and methods to answer our research questions, we used a qualitative design. we interviewed all relevant actors involved in developing and implementing the introduction programme in the ‘seaside municipality’, including the project owner, the project leader and the programme coordinator, who were all employed by the refugee integration office, and the norwegian language teachers and principal, who were employed by the adult education centre (see table 1). the interviews focused on the informants’ experiences of their involvement in the project, focusing on aspects such as collaboration, tensions, roles and changes. 207 njsr – nordic journal of social research vol. 12, 2021 the data for this article were collected over a period of six months. the main source of data, in addition to reading project proposals, was in-depth interviews conducted with the key actors of this project. the interviews were conducted face-to-face in ‘seaside municipality’ in 2019 and via zoom or microsoft teams in 2020 due to the onset of the covid-19 pandemic. the recordings lasted from one to one-and-a-half hours. all interviews were transcribed verbatim. the interviewees’ names and the name of the municipality and social enterprise have been anonymised. table 1 professions and functions of the informants informant profession function 1 director of municipal welfare services project owner 2 leader of refugee integration services* project leader 3 project coordinator* coordinator of cooking training, manager of the social enterprise, coordinator of the introduction programme 4 principal of the adult education centre leader of the teachers, mediator between the adult education centre and refugee integration office 5 language teacher norwegian language teacher (chose to quit at an early stage) 6 language teacher norwegian language teacher 7 language teacher norwegian language teacher * these informants were interviewed twice, first separately and then, some months later, together. 208 njsr – nordic journal of social research vol. 12, 2021 permissions and ethical considerations we obtained permission to perform this study from the norwegian centre for research data (project number omitted). it should be noted that the second author assisted the project leader and her team in writing the applications for funding. while financial support to develop and implement the programme was obtained from imdi and the county administration, the municipality also received funding from the regional research council to conduct a follow-up study of the first semester of developing and implementing this new introduction programme. the second author was part of the team undertaking that follow-up study and a co-author of the report resulting from this project. the report did not lead to any major changes to the development and implementation of the new introduction programme. we applied a thematic analysis of the data (braun & clarke, 2006, 2019). after completing their initial analysis independently, the authors met for a two-day analysis workshop in spring 2020. on the first day of the workshop, we discussed the preliminary findings by identifying any issues that the actors of the collaboration project had agreed upon and any that had caused tensions. we found that all informants agreed on the overarching goal of the introduction programme, but that the employees of the refugee integration office and adult education centre entered the project with diverging expectations about how the new introduction programme should be developed. on the second day of the workshop, a more theoretically informed analysis was performed to identify tensions among the different actors involved in the project related to why innovation was realised, how such innovation should be operationalised, for whom the innovation was targeted, and whose innovation project the project was. callon’s moments of translation was found to be a fruitful analytical framework for understanding and explaining our findings. main findings our findings suggest that the actors involved in the project shared the overarching goal of the new introduction programme; that is, supporting the participants to learn more norwegian and eventually find paid work. despite this agreement on the goal, throughout the development and implementation period, four central tensions arose that seemed to threaten the entire initiative. these tensions arose during the problematisation, interessement and enrolment 209 njsr – nordic journal of social research vol. 12, 2021 phases identified by callon (1986), potentially preventing advancement to the crucial mobilisation phase. problematisation: why should we do this project in the first place? according to callon (1986), problematisation involves the translator observing a social problem and striving to gain support for his or her solution to the problem. the translator must reinforce the importance of translation and establish a network of alliances, becoming a natural facilitator in this network. the data show diverging perceptions of the problem among the employees at the adult education centre and the employees at the refugee integration office. that is, they differed in their understandings of why the innovation project had been developed. according to the refugee integration office employees, the alternative introduction programme was launched in response to a ‘crisis’. as the project owner, the director of municipal welfare services, said: we faced a great challenge in including [refugees] in the labour market […]. the [language] results were not that good either. […] we were not that pleased with [the adult education centre], and they [the adult education centre] were probably not so pleased with us either. […] we realised that things needed to be done differently […] to not have an entire generation that would depend on welfare benefits. (1) on the other hand, the adult education centre employees, including the principal and the norwegian language teachers, did not agree that there had been a ‘crisis’. nevertheless, they considered the new introduction programme ‘valuable’ and an ‘important alternative’ for the defined target group. this view is clearly expressed in the following quote: i believe that [the new introduction programme] is important, especially for women with families […] and with little or no education who are about to embark on a long educational journey [in norway] and eventually get a permanent job. […] it is important that there is an alternative introduction programme for them where they can carry out practical work while at the same time being trained not only in the norwegian language. (4) a possible explanation for these diverging perceptions was raised by the project leader, as expressed in the following quote: 210 njsr – nordic journal of social research vol. 12, 2021 i have always felt a strong commitment [to the project] myself, but have i been able to convey this commitment or ownership to the whole team? why is everybody not as enthusiastic about the new introduction programme as i am? (2) the data suggest that over the first 14–16 months of the innovation project, the project leader struggled to establish a common understanding of why the innovation was being implemented. from the start, the refugee integration office was strongly motivated to improve the existing introduction programme due to poor results. the solution, according to the project leader, was to develop a new introduction programme building on the participants’ qualifications (empowerment) and a new pedagogical model (communicative language teaching) to be implemented in a social enterprise that would provide the opportunity for refugee women to prepare food for real customers. however, the adult education centre employees did not perceive the situation in the same way. they felt the quality of the programmes already offered was good and that the steps being taken in the new introduction programme were not particularly ‘innovative’ because, they said, similar steps had already been attempted. importantly, as the project leader herself suggested, the why of the project was not adequately conveyed to all actors involved in the implementation of the new introduction programme. according to the project leader, because she thought the need for this new initiative was ‘obvious’, she had initially taken for granted that the other actors involved would share her enthusiasm. interessement 1: how can the communicative teaching approach be operationalised? callon (1986) characterised interessement as a set of actions by which the translator imposes his or her viewpoint on the actors that were united in the problematisation phase. the second tension identified in the data relates to how communicative teaching was to be operationalised. this issue, according to our informants, was heavily debated during the first 18 months of implementation and involved professional disagreement between the employees of the refugee integration office and the adult education centre. the refugee integration office employees, although they had no formal education in how to teach norwegian as a foreign language, voiced the importance of following the conservative communicative teaching approach 211 njsr – nordic journal of social research vol. 12, 2021 proposed by the expert. the core idea was that language teaching should be directly related to cooking practices. the norwegian language teachers were thus expected to teach the participants the language (e.g., words, phrases and grammar) for cooking (e.g., following and writing recipes) and for selling food to customers (e.g., taking and delivering orders). this represented a move away from traditional blackboard teaching using formal textbooks to a taskoriented ‘learning-by-doing’ approach. from the perspective of the language teachers, this communicative teaching approach was too time consuming. they said they would prefer to use a textbook at least some of the time but that none of the existing textbooks were considered ‘communicative enough’ by the expert. therefore, the language teachers had to spend considerable time developing ‘tasks’ (i.e., communicative exercises that the participants would complete and then glue into their notebooks). a language teacher explained: we have to prepare different tasks so that the participants can cut and glue them together in their notebooks. [the participants] are dead tired of it, right? they are tired of cutting and pasting instead of having a real book. (5) despite the strong reluctance on the part of the language teachers to follow the advice of the expert, the issue of how they could practice the communicative approach in a meaningful way and ensure they had enough time to prepare their classes was, according to the language teachers, never really discussed between the refugee integration office and the adult education centre. instead, for more than a year, the project leader and project owner remained determined that the ‘pure’ form of the communicative approach should be implemented. by the time of the follow-up interview in the spring of 2020, however, the project leader had begun to reconsider her position on this topic. she said: from the very start, we were quite clear about the fact that we wanted to implement this [communicative teaching] method in the project. (…). this was mentioned in the project description. the training offered by the expert was supposed to create the basis for how the norwegian teaching was to be 212 njsr – nordic journal of social research vol. 12, 2021 done in this programme. as the project leader, i feel responsible for making sure that we do what we wrote in the project description and for executing the project in the best possible way. so, i think that we should give it [communicative teaching] a try. but there is this resistance from the language teachers. i feel that they have been reluctant to change, reluctant to try something new and make it work... (2) in the same interview, the project leader reflected on her initial haste bringing in the communicative teaching approach without first carefully evaluating whether the expert’s version of the method would fit the introduction programme or discussing it with the language teachers: despite it being one of the most important things about this introduction programme, we had not really thought through how to do the communicative norwegian teaching […]. we knew very well that (teaching norwegian) is not our profession, not our competency […], but we really fell in love with the expert. […] however, we had not reflected on whether the language teachers would be allowed by him to use books. actually, we did not know about that at all. (2) finally, the teachers’ resistance was being taken into consideration by the project leader, and the whole project team could start to discuss how to operationalise the communicative approach in a way that better suited the teachers’ experiences and needs. it should be noted here that neither the principal of the adult education centre nor the norwegian language teachers were against communicative teaching. they were just concerned that the method conveyed by the expert was too time consuming and that it was ill-suited for the mixed group of participants in this introduction programme. this leads us to another tension identified during the interessement phase. interessement 2: who should be the target group for the new introduction programme? from the start, the project leader argued that the new introduction programme should be available for any refugee woman with an interest in cooking, regardless of her proficiency in norwegian language and regardless of whether or not she was literate (acquainted with the latin alphabet). this mix of participants was seen as a problem by the norwegian teachers because, according to them, their teaching would either be too elementary for the 213 njsr – nordic journal of social research vol. 12, 2021 women with the highest educational level or much too complicated for those who were illiterate. worse, the teachers argued that with these broad inclusion criteria, any illiterate women would remain illiterate, as there would not be enough time to teach them the basics. the principal of the adult education centre described this problem as follows: i tried to explain this early on […], but my objections were overruled: there should have been specific criteria for being eligible for the programme […] but everyone can join, everyone from the highly skilled to the illiterate. you know, that is a strange lumping together. the language teachers found this too tough, right? because there are [participants] who do not speak norwegian at all and others who speak norwegian quite well. some are educated, while others have never touched a pencil! (4) in line with this, one of the language teachers explained as follows: when you put illiterate individuals who have not learned the alphabet [together with participants who are literate], then you deprive them of their rights, right? i feel that we are preventing some of the participants from excelling. i have tried to confront [the refugee integration office] with this. well, we all have […] we found that the participants did not get what they were entitled to. that was our biggest frustration. (6) despite this feedback from the adult education centre employees, the project leader, even in the second interview in spring 2020, insisted that it was crucial to continue to include illiterate and literate women in the same class: yes, we have faced resistance from the language teachers and even from the expert and the researchers regarding whether we should include illiterate women in classes. however, to include illiterate women is important to us [the refugee integration office], and we will not give up on this. (2) this position on the part of the project leader made it difficult for the adult education centre to contribute to redefining the how of the innovation project. enrolment: whose project is it anyway? according to callon (1986), enrolment entails the clear identification and assignment of a set of interdependent roles to actors who accept them. for the innovation project under scrutiny, this process was not completed. moreover, the project leader did not establish a common understanding of whose project the new introduction programme was: was the project a joint 214 njsr – nordic journal of social research vol. 12, 2021 collaborative project between the refugee integration office and the adult education centre as equal partners (egalitarian) or was it solely a refugee integration office project to which the adult education centre should be happy to contribute (hierarchical)? this tension existed from the very beginning of the project. the principal of the adult education centre explained: so much was already developed before we were involved in this. that is not good. it would have been better to involve the adult education centre from the very start […] i mean, some of us have been in this game for quite some time, and we have a lot of experience from different projects, so had we been listened to from the very start, it would have facilitated implementation, and we could have taken ownership of the project, which would have been important. (4) this perception of the adult education centre employees that they were not truly accepted by the refugee integration office as equal partners in the project was echoed by the language teachers. seemingly, all the involved adult education centre employees had an egalitarian understanding of the collaboration project’s structure. as one of them explained: we, the teachers, don’t feel like we are part of the project. we show up, we carry out our job, and then we leave again. if we had been invited to the project team at an earlier stage, it could have been different because then we could have developed this whole thing together. […] it is so obvious that this is a ‘refugee integration office project’. it is the refugee integration office that owns it, and this is what will be written in the history books. (6) these views were to a large extent confirmed by the project leader, as illustrated by the following quote: the adult education centre was invited on board at an early phase, but it is obvious that we (the refugee integration office) were in the driver’s seat. like, we wrote the applications, we got the funding […]. so, well, in that sense, we were never really equal partners, right? in a way, we were the ones leading the project. (2) the project leader added that the project idea had been launched in her organisation and that, before sending the applications for funding, it was discussed several times whether to invite the adult education centre to join as a partner. the project owner positioned the refugee integration office as the lead partner in the project and stated that they could have chosen to 215 njsr – nordic journal of social research vol. 12, 2021 collaborate with another education centre. the refugee integration office thus saw the project as hierarchically structured. they saw themselves as leading the project and considered the adult education centre a client rather than an equal partner. the project owner said: in a way, we were in a client–supplier relationship with them, and we could make specific demands regarding norwegian education. we were never obliged to purchase [the teaching of norwegian language] from them. (1) as far as we can tell from our analysis of the interviews, the adult education centre and the refugee integration office had diverging logics related to what being involved in this ‘collaboration project’ entailed. thus, the refugee integration office viewed the collaboration process as hierarchical and positioned themselves as the main driver with de facto decision-making power. the adult education centre, on the other hand, thought the collaboration project should have been egalitarian between ‘equal partners’ and tried to act accordingly. discussion while extant research tends to cast collaboration as harmonious (i.e., that collaboration per se often leads to positive outcomes), as this article highlights, in addition to requiring engagement in collaboration and a shared overarching goal, innovation projects need all relevant actors to have a mutual understanding of the project logic; that is, whether collaboration should be hierarchical or egalitarian. without this, tensions are likely to arise. callon (1986) characterises innovation processes as having four phases: problematisation, interessement, enrolment and mobilisation. problematisation involves the translator defining a problem, proposing a solution and striving to create alliances in which she or he becomes the natural facilitator. in the project under scrutiny, according to the project leader, the problem was the poor results of the traditional introduction programme and the solution was to develop a new introduction programme building on the participants’ qualifications (empowerment), a new pedagogical model (communicative teaching approach) and a social enterprise that could provide real-life work experience. the project leader recruited supporters within her own organisation, motivated a team of researchers to join the process, obtained funding to finance the pilot project from various sources and enrolled the adult education centre to deliver the language component of the programme. 216 njsr – nordic journal of social research vol. 12, 2021 however, the project leader failed to ensure that the adult education centre employees shared her understanding of what the problem was; that is, why the new introduction programme was necessary in the first place. therefore, although the adult education centre and the refugee integration office shared a common understanding of the overarching goal of the new introduction programme, the adult education centre did not agree with the problem as defined by the project leader. second, to succeed with interessement, the project leader had to convince the actors in the network of her viewpoints (callon, 1986). however, while the project leader established her problematisation of how to realise the project, she did not invite the employees of the adult education centre to voice their opinions. thus, the refugee integration office alone conducted the preplanning and application process, with few meetings organised between the project leader, programme coordinator and norwegian language teachers in the first 18 months of the introduction programme. consequently, there were a lack of opportunities for the implementing actors to discuss emerging issues, such as suitable criteria for participant selection and how to shape the teaching approach and programme content. no forum through which dissidence could be acknowledged and potentially solved was ever established. as a result of the lack of structures for collaboration, the refugee integration office avoided critical input and reinforced a power imbalance. thus, while it was well known that the adult education centre teachers and principal had reservations about the teaching approach (the how) and target group (for whom), at no time over the course of this study were these issues openly discussed. the resulting situation was considered so challenging for the first set of language teachers that they decided to leave the project after one year. a new set of language teachers was subsequently recruited, but still no structure for collaboration was established. it was only later, with the intervention of the covid-19 pandemic, that the disagreements between the refugee integration office and adult education centre began to be openly discussed in digital meetings. callon’s (1986) enrolment phase refers to the assignment of defined and interdependent roles to actors of an innovation project. importantly, these actors must also accept these roles. as our data suggest, however, enrolment was not truly carried out in the project under scrutiny. first, it was not specified whether the new introduction programme was an egalitarian collaboration project or a refugee integration office–led project. in the applications, the 217 njsr – nordic journal of social research vol. 12, 2021 project was represented as a collaboration between two public sector organisations. in reality, however, the project was run predominantly as a refugee integration office project. these challenges prevented the process from reaching the mobilisation phase. a lack of structures for collaboration our data demonstrate that the development and implementation of the new introduction programme lacked clear structures for collaboration. this may partly explain why the tensions presented and analysed in this article persisted over time. as suggested in the extant literature, structures for collaboration should be developed to enable the collaborating partners to agree on important issues, such as why the project is being implemented, what roles each actor plays, what knowledge and skills they can bring to the table and how to manage dissidence among the collaborating partners (torfing, 2016). the role of the leader is crucial to address potential barriers and disagreements. as has been illustrated, if these are not addressed, they may foster challenges. the lack of structures for collaboration and continued inattention to adult education centre employees’ concerns regarding the teaching approach and target-group composition (a mix of illiterate and literate participants in the same class) led to the withdrawal of the first two norwegian language teachers from the project. despite this, the project leader remained enthusiastic about the initial project ideas; however, for this project, being an ‘enthusiastic leader’ (magnussen, 2016) was not enough to create and sustain a strong collaborative innovation environment. as the project leader explained, her conviction that the why, how, for whom and by whom were ‘obvious’ meant she did not discuss these with the adult education centre employees. in addition, the project owner talked about the adult education centre as a ‘service provider’ that could be exchanged with another partner if necessary. the two public sector organisations involved in this innovation project thus held different project logics. the refugee integration office regarded and implemented the project as a hierarchical collaboration, with them in the driver’s seat. conversely, the adult education centre assumed they would be equal partners in the project with the refugee integration office. according to our informants, these diverging understandings and their implications were never openly discussed. it should be noted, however, that the principal of the adult education centre did not 218 njsr – nordic journal of social research vol. 12, 2021 initiate any meetings between the leader of the refugee integration office and herself to address these issues. we would like to note that we do not view callon’s theoretical model as the only relevant theoretical framework that can shed light on our data. additionally, we have not used his framework in a normative way (e.g., to suggest that following his model ensures success). rather, callon’s perspectives have been used in this article as a useful tool to highlight the possible opportunities and pitfalls of the innovation project under scrutiny. what happened to the social enterprise? the ‘international cuisine’ social enterprise was one area on which all collaborating partners could agree. its intentions were to empower participants by offering real-life experience, create value for the community by educating future workers for a local labour market and, ideally, reduce the share of refugees depending (entirely) on welfare benefits. while our data suggest the social enterprise operated primarily as a catering firm in which the participants prepared food while using their mother tongues or body language, all involved partners, including the participants, agreed that the social enterprise served as a meaningful arena for language and practice education. conclusion this study highlights that although collaborative innovations are often portrayed as harmonious, sharing the overarching goal of an innovation project is not sufficient to prevent tensions from arising. the innovation project studied in this article included an ‘international cuisine’ social enterprise. although representing a form of organisational hybridity, the social enterprise was never a source of tension for the key actors of this project. however, as elaborated, a number of other tensions did emerge. our results indicate that it is important for the innovation process to openly discuss and agree on what ‘collaboration’ means in a project. moreover, to realise an innovation project and deal with emerging tensions, it is crucial to address and clarify why innovation is being realised, how to operationalise such innovation, for whom the innovation is targeted and whose innovation project the project is. additionally, it could be useful to conceptualise the innovation process as including the phases defined by callon (1986); 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(2008). innovation and entrepreneurship in public services. in p. windrum & p. koch (eds.), innovation in public sector services: entrepreneurship, creativity and management (pp. 3-20). edward elgar. https://doi.org/10.4337/9781848441545 microsoft word publisering 3594 revidert test njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 20nn a scoping review of practitioner research on sensitive topics håvard haugstvedt faculty of social sciences university of stavanger email: havard.haugstvedt@uis.no abstract practitioner research, which involves professionals such as social workers, educators, and nurses, is an approach that may help establish contact with hard-to-reach targets while also exposing the researcher to potentially sensitive and ethically challenging situations and dilemmas. through a scoping review of the scholarly literature, this paper explores evidence of the effects that research on sensitive topics may have on the researcher and how the researcher can prepare for this. twenty-four peer-reviewed articles were analysed using thematic analysis, which provided the following four themes: researcher competency, researcher vulnerability, researcher role, and participant vulnerability. in addition, peer support, formal support measures, and research and time management were found to potentially counteract the adverse effects of conducting qualitative research on sensitive topics. the findings of this scoping review strongly suggest that practitioner researchers investigating sensitive issues should partner with professional research institutions from the beginning of the research process to end. in addition, strengthening the research methodology used during the bachelor’s degree educations of professionals such as social workers might help to develop more resilient practitioner researchers. this must, however, be weighed against other necessary courses. keywords: practitioner research, qualitative research, sensitive topics, social work research introduction several approaches within qualitative research are carried out through interactions between the researcher and the subjects of the research. this enables the researcher to approach close the topic closely. being close to the human experience that the study 152 njsr – nordic journal of social research vol. 11, 2020 addresses is a requirement of qualitative data collection (kirkevold & bergland, 2007, p. 67). however, this closeness may also expose the researcher to situations that may cause emotional reactions (davis, 2000; seidman, 2006, p. 68). these reactions may be explained by the subjectivity of qualitative research, in which the researcher is a part of the experience and interacts with and interprets what’s ‘going on’ (austin & sutton, 2014; patton, 1999). like qualitative research in general, practitioner research encompasses many different traditions, movements, and methodologies. however, it is distinguished from other more traditional forms of research because it is usually conducted by practitioners as a part of their daily work (ellis & loughland, 2016). practitioner research is often described as being carried out by a professional with substantial insight into the community, as well as the community members who are the subjects of the research (drake & heath, 2010). often, the researcher’s position is simplified as either that of an insider or outsider. however, this distinction has been contested by some scholars (brown, 1996; drake & heath, 2010), who have emphasized that there is a higher level of complexity and nuance involved, such as an insider-outsider position. this might be former a social worker or police officer, now working as a researcher. vaswani (2018) argues that practitioner researchers are in a position to provide access to individuals and groups that may be hard for others to reach because practitioner researchers interact with them or their organization on a daily basis. connecting closely with one’s research participants is more difficult when researching within one’s own organization or professional social context (tietze, 2012), especially in regard to vulnerable service users or clients. this article understands practitioner research as research carried out by active or former practitioners who are close to or part of organizations that provide services to client or patient groups (drake & heath, 2010; meghan, 2019; shaw & lunt, 2018). additionally, the point of departure for this work is the position of being a practitioner researcher — a former social worker engaged in exploring a specific practice field within the social work profession. according to parsons (1969, p. 331), professionals perform certain specialized functions for others in society based on a high level of specialized competence, with attendant fiduciary responsibility. clearly, researching the same subject that they provide services 153 njsr – nordic journal of social research vol. 11, 2020 for may cause tension among the professionals themselves. this alternation between roles may also cause uncertainty regarding who the professionals are at different times, potentially affecting others’ expectations of them. in professional life, work role expectations include behaviour, appearance, and emotional display (hochschild, 2003). additionally, being part of a research project in one’s own organization may also raise some ethical concerns, such as the power dynamics between the researcher and potential participants (riese, 2019). however, this may also constitute a beneficial flipside-of-the-coin situation; if the researcher is well known to participants, those participants might open up more and experience the process as safer. overall, this paints a picture of practitioner research as complex, with a myriad of roles and expectations to be managed and potential ethical pitfalls to consider at the design stage of the research project. a lack of confidence in research knowledge and skills has been found among practising social workers, negatively influencing them and deterring them from undertaking practitioner research (harvey et al., 2013). there may be additional concerns when researching sensitive topics, which are understood as those matters that people prefer not to discuss publicly due to the perceived risk associated with self-disclosure (sydor, 2013), such as researching victims of domestic abuse or engaging with violent offenders. although topics of a sensitive nature vary in their particulars, they may cause the researcher to experience unpleasant emotions. because some individuals may also be hard to reach (flanagan & hancock, 2010, p. 1), cooperating with communities, professionals, and other organisations working with them (bonevski et al., 2014, p. 24) may create access to these individuals and groups. the comprehensive public welfare policies found in the nordic countries include social security, healthcare, and education and thus involve professionals such as social workers, nurses, psychologists, and educators (normann et al., 2014, p. 21). because these services are free to the majority of the population (hoydal, 2018), the practitioners employed by them are in a position to establish closer relationships with hard-to-reach groups. the nordic context is therefore of particular interest because its vast welfare system could suggest the use of practitioners to carry out research on sensitive topics or hard-to-reach participant groups. 154 njsr – nordic journal of social research vol. 11, 2020 while both practitioner research and researching sensitive topics are not new research subjects, this article aims to identify and explore patterns in research conducted in the fields of social work, children and youth work, nursing, and clinical psychology, in which sensitive and unpleasant topics regularly surface as a part of practice. these professional contexts are what make practitioner research interesting. while sensitive topics themselves may be challenging to explore, as shown above, the complexity of the various roles and expectations within practitioner research makes this approach of particular relevance in exploring sensitive and ethically challenging topics. this review of peer-reviewed literature examines the evidence regarding the stated challenges involved in conducting research on sensitive topics, pitfalls, dilemmas, and strategies in practitioner research. in this way, it explores the findings of past research studies to discover researchers’ negative experiences, as well as considering how one might prepare for or prevent these experiences. the findings of this scoping review may help strengthen practitioners’ motivation to engage in practitioner research on hard-toreach participants by helping prepare them for the task, execute the research, and protect both themselves and their research participants during the process research question: how does conducting qualitative research on sensitive and ethically challenging topics affect the researcher and participant, and how can the practitioner researcher prepare for this? methodology the research question will be answered through a scoping review of the literature on practitioner research on sensitive or ethically challenging topics. while scoping reviews are related to systematic reviews, some differences set them apart. a scoping review aims to map the body of literature on a specific topic, while a systematic review aims to present the best available research on a specific question and evaluate the strength of the included studies (pham et al., 2014, p. 372). however, both must present a rigorous, transparent methodology that includes a search strategy, inclusion criteria, and selection process (munn et al., 2018; pham et al., 2014). because scoping reviews employ more expansive inclusion criteria, they typically include a larger amount of research than 155 njsr – nordic journal of social research vol. 11, 2020 systematic reviews (pham et al., 2014). thus, a scoping review can serve as a precursor to a more specific targeted systematic review (munn et al., 2018, p. 4). inclusion criteria because this scoping review aims to uncover the scholarly literature on practitioner research involving sensitive and ethically challenging topics, the search process began by applying these terms as search words. the criteria guiding the selection process for articles were as follows: the studies must have been conducted by practitioner researchers on a sensitive or ethically challenging issue; they must have departed from or within organizations providing services; and they must have described experiences, dilemmas, challenges, or recommendations as part of their findings and discussion. the terminology used to describe research strategy differed, and variations such as ‘action research’, ‘insider research’, and others did occur. review articles that provided insight into the above were deemed valuable and worth including in this scoping review. to secure the most recent findings, studies published prior to the year 2000 were excluded. research carried out outside of or disconnected from the practice field or its organizations and services was excluded from this review. search strategy data collection was conducted through a systematic search of the following databases: academic search premier, cinahl with full text, eric, medline, socindex with full text, and scopus. the first search strategy used a combination of the following terms in all databases: ‘sensitive topic or sensitive information or sensitive research or sensitive question*’ and ‘practitioner research or practitioner researcher’. the search was limited peer-reviewed articles. see table 1 for details. 156 njsr – nordic journal of social research vol. 11, 2020 table 1 this method identified only 35 articles, two of which were identified as relevant to the aim of this scoping review. a second strategy was used, producing similar results. see table 2 for details. table 2 because the search strategies mentioned above proved ineffective, a much widerreaching search using fewer criteria was conducted. see table 3 for details. table 3 157 njsr – nordic journal of social research vol. 11, 2020 this search retrieved 17 new studies, as well as the four identified in the earlier search strategies. three additional studies matching the criteria were found through other sources, bringing the total number of included articles to 24. the search process is shown in figure 1. figure 1 figure 1 – flow diagram, adapted from prisma (preferred reporting items for systematic reviews and meta-analyses) flow diagram by moher et al. (2009) results in total, 24 studies were included in this scoping review. table 4 shows all included studies organized by publication year. 158 njsr – nordic journal of social research vol. 11, 2020 table 4 159 njsr – nordic journal of social research vol. 11, 2020 analysis thematic analysis is widely used in qualitative research to uncover patterns or themes in data (braun & clarke, 2006). this analytical approach has also been applied to review articles (pool et al., 2019; yousif & passo, 2016) and is recommended as an important stage in review protocols (stenberg et al., 2018). one derivative of thematic analysis is thematic synthesis (thomas & harden, 2008), which is often applied to literature reviews to identify and further develop descriptive themes into analytical themes. while thematic synthesis provides the analytical structure for this scoping review, it was influenced by braun and clarke’s (2006) step-by-step method, which involves going back and forth between codes and themes to ensure consistency, not establishing themes solely based on a few vivid examples. after all 24 selected studies were reviewed, initial codes were generated for the analysis. in the next step, the codes were reviewed, and themes were identified. in the third stage, descriptive themes were developed into overarching analytical themes: ‘researcher vulnerability’, ‘researcher competency’, ‘researcher role’, and ‘participant vulnerability’. some codes could be placed in several categories; for example, the topics ‘boundary issues in qualitative research’ and ‘blurring of roles’ both offer challenges and make the researcher vulnerable to pressure, stress, or incorrect expectations on the part of participants. this problem of overlapping categories could be prevented if the research preparations (a part of researcher competency) were to include information that clearly defines what the research is about (and is not about) and what the participant may expect. also, in face-to-face meetings and interviews, the researcher could employ a set of skills during analysis and communication with the participant, which might adjust the participant’s understanding of who and what the researcher is and is not and clarify blurred roles or uncertainties about the research agenda. 160 njsr – nordic journal of social research vol. 11, 2020 findings figure 2 theme 1: researcher competency the theme ‘competency’ includes several subthemes. one dimension within competency involves the skills needed to actually carry out research. the scoping review found skills at three levels: ‘communication skills’, ‘empathic skills’, and ‘emotional management’. researchers need communication skills to deal with participants’ feelings and engage in small talk to relax the participant (ashton, 2014; elmir et al., 2011; murphy & nightingale, 2002), while proficiency with interview techniques is essential in exploring their experiences (thompson & russo, 2012). unforeseen situations can arise when engaging with research participants, and being able to de-escalate potentially threatening situations has been recognised as a skill that researchers should possess (bashir, 2018). the researcher must also be able to analyse and adapt to participants’ nonverbal communications, both to show empathy and to continue the interview (ashton, 2014; elmir et al., 2011; murphy & nightingale, 2002). there seems to be a consensus regarding the ability to demonstrate empathy in interview situations and provide the necessary support to participants, both in the interviews and after the research, if needed. when exposed to the participants’ stories and feelings, the researcher might feel overwhelmed. some findings have revealed the need to be able to manage one’s own feelings when conducting this kind of research (ashton, 2014), while also showing 161 njsr – nordic journal of social research vol. 11, 2020 that disclosing details about oneself may help the participants feel less intimidated. revealing personal information about oneself was also highlighted as a potential risk that could render the researcher more vulnerable in the process (elmir et al., 2011). in addition to managing one’s emotions during research, some evidence was found to support the value of self-care actions between or after research activities (coles et al., 2014). another dimension of competency is researcher preparation. after once again reviewing the codes and themes, two sub-subthemes emerged within ‘preparation competency’: ‘interview preparation’ and ‘support preparation’. most of what has been organised into this subtheme relates to how the researcher can design and execute the interview in a manner that is well thought through and safe for the researcher. this involves evaluating whether the research should be conducted by one researcher alone or with support from other researchers, how the researcher’s background could affect the participants (gabriel et al., 2017), and how to establish protocols for dealing with boundary issues (dickson-swift et al., 2006). careful preparation for the interview should also consider the participant as a vulnerable part of the research, who should be taken into account in the research planning (elmir et al., 2011; mccosker et al., 2001; murphy & nightingale, 2002). time management and the intensity of conducting the actual interviews were also recognised as components of research preparation that are critical to ensuring the researcher’s well-being (coles et al., 2014). the other subtheme of preparation relates to the potential need for the support of both participants and researchers during the research and after it was conducted. supervision, debriefing, peer support, and group sessions were suggested as means that might strengthen the researcher during the research process, making it easier to conduct challenging interviews and deal with the participants’ emotions and trauma (bashir, 2018; coles et al., 2014; flanagan, 2012; gabriel et al., 2017; thompson & russo, 2012). some findings could easily be placed in more than one category or theme, such as the legal actions that both participants and researchers might experience when conducting research on illegal acts. this was exemplified in an article by volker (2004) that concerned nurses who had received requests for assisted dying from terminally ill patients. such a situation puts the participant at risk of having his/her identity revealed should the research team be subpoenaed by the federal government (the us, in this 162 njsr – nordic journal of social research vol. 11, 2020 case). researchers themselves may be subject to legal prosecution if they do not respond to the subpoena. to manoeuvre around these legal issues, volker (2004) presented a study design in which research packages mailed to a large sample of nurses included anonymous recipient response packages. regarding ethical competency, pain (2011) found it important to have a well-thoughtthrough approach to practitioner research methodology and ensure that this approach resonates with the ethics of social work. pain (2011) also stressed that the researcher’s attitude toward power dynamics is a key ethical issue. several studies found a need for ethical reflection throughout the entire research process (coy, 2006; mitchell et al., 2010; pain, 2011; thompson & russo, 2012) and moving beyond simple ethical codes of conduct (fraser, 2007; hewitt, 2007; lunt & fouché, 2010). guillemin and gillam (2004) found that applications to committees seeking ethical approval were written in a language that gave the impression that the researchers were competent and concerned with ethical dilemmas. guillemin and gillam (2004) called this ‘procedural ethics’, which they distinguished from microethics in researcher practice. in practice, microethics can involve an unpredictable situation in which the researcher must make on-the-spot decisions. practitioner research may involve small-scale studies in the form of evaluations of interventions in which the practitioner researcher was involved, thus increasing the potential for conflicts of interest (lunt & fouché, 2010). while several studies acknowledged the dual role of the practitioner researcher as potentially challenging (lunt & fouché, 2010; mitchell et al., 2010), the role was also found to mitigate the study’s negative impacts on participants because a relationship of trust may already exist (coy, 2006). two studies also identified a lack of ethical consideration in practitioner research (bryan & burstow, 2018; mitchell et al., 2010). confidentiality, anonymity, informed consent, and the right to withdraw consent were not considered by researchers in the execution of their research. the findings from mitchell et al.’s (2010) study revealed the attitude that research in schools cannot harm the pupils and that consent to participate in studies is effectively granted when parents sign their children up at the start of school. bryan and burstow (2018) also found that anonymity is explicitly undesirable because it limits the 163 njsr – nordic journal of social research vol. 11, 2020 possibility of following up on the answers provided by pupils on questionnaires about bullying and well-being at school. on the positive side, mitchell et al. (2010) found nine studies that followed the basic ethical principles of research, including in terms of how they gained access to participants, how consent was obtained, and how the research design aimed to ensure anonymity and confidentiality throughout the process. overall, the level of necessary competency identified in this scoping review demands knowledge and oversight of both planning and execution, as well as the ethical risks and tripwires that can be encountered. if the practitioner researcher has a low level of competence in professional research, including a poor understanding of the recruitment process, interviewing, and the analysis and reporting of data, then the researcher, the results, and the participants may all be negatively impacted. researcher vulnerability is explored further in the following section. theme 2: researcher vulnerability researcher vulnerability is naturally difficult to measure or divide into levels of severity. however, the analysed articles indicated various degrees of emotional unpleasantness. stress, upsetting information, and traumatised participants (ashton, 2014; bashir, 2018; coles et al., 2014; dickson-swift et al., 2006, 2008; hassan, 2016; mccosker et al., 2001; murphy & nightingale, 2002) might be less stressful topics for one researcher, while another researcher might experience burnout and vicarious traumatisation (coles et al., 2014; dickson-swift et al., 2006, 2008; elmir et al., 2011; gabriel et al., 2017; mccosker et al., 2001). stress can be defined as ‘an emotional experience accompanied by predictable biochemical, physiological, and behavioral changes’ (baum, 1990). at the far end of the scale is burnout syndrome, which is characterised by significant physical and/or psychological exhaustion, a high level of depersonalization (toward participants and/or clients), and a lack of achievement or professional accomplishment (maslach & jackson, 1981). this highlights not only the substantial variation in emotional unpleasantness experienced by qualitative researchers involved in research on sensitive topics but also the fact that lesser degrees of unpleasantness can evolve over time into more serious and chronic issues. some articles also thematised the fact that the social researcher role itself was perceived differently by and was sometimes unclear to the participants in the studies (dickson-swift et al., 2006; elmir et al., 2011; hassan, 2016); 164 njsr – nordic journal of social research vol. 11, 2020 for example, participants would question whether the researcher was a therapist or counsellor or was a ‘spy’. this confusion has the potential to create unpleasantness and stress for both participants and researchers because research on sensitive topics demands a certain level of participant comfort to reveal sensitive matters (elmir et al., 2011). the scholarly literature also recognised the interview location as a source of stress or discomfort when conducting research on sensitive topics (bashir, 2018; coles et al., 2014). feeling connected to the participants was also found to generate negative emotional responses in the researchers (bashir, 2018; gabriel et al., 2017). theme 3: researcher role the third theme identified through the analysis was ‘the role of the researcher’ in practitioner research. several studies identified ethical dilemmas related to the dual roles of the practitioner who steps out of his/her role as a practitioner to engage in research in the same workplace, thus creating the possibility for more dilemmas than might be experienced by the professional researcher (fraser, 2007; mitchell et al., 2010). these blurred roles were especially challenging in qualitative research because this concerned confidentiality and anonymity (lunt & fouché, 2010) when, for example, evaluation research was conducted within the practitioner researcher’s own organisation. in a study of public health nurses, clancy (2011), herself a nurse, became aware of her own physical reaction to being an intrusion into clinical practice that disturbed the nurse and patient she was observing. upon reflection, clancy found that her own reactions might act as a reminder of the vulnerability of everyone involved in the research because she was prompted to question the justification of her presence itself. mitchell et al. (2010) also noted that some researchers in practitioner research found the dual role to be a preferred standpoint for research. coy (2006) discovered that the role of practitioner researcher provided an opening and access to hard-to-reach targets. in contrast, several studies identified in a review laid out the dilemmas of the dual role, though these dilemmas were not stated specifically or described thoroughly, nor was it made clear how they were addressed (mitchell et al., 2010). while professional ethical codes of conduct were found to serve as general guidelines, they were also largely inapplicable to the researcher (lunt & fouché, 2010). while there was some discussion of the blurred and overlapping roles of the practitioner researcher, some evidence suggested that participants might experience the research process as therapeutic. research being 165 njsr – nordic journal of social research vol. 11, 2020 conducted by a familiar professional might also help reduce the number of people to whom the participant reveals sensitive information (vaswani, 2018). this might be a way of taking care of and protecting potentially vulnerable participants. theme 4: participant vulnerability the fourth theme identified in the analysis was ‘participant vulnerability’ in practitioner research. in their study of school leaders and their thoughts regarding ethical awareness in school research, bryan and burstow (2018) found that anonymity was undesirable because part of the research required them to go back and talk to the pupils about their answers regarding bullying and well-being in school. clancy (2011) revealed similar findings in which practitioner researchers did not ensure participant anonymity and confidentiality due to their dual roles. a study by pain (2011) found that the power dynamics between client and social worker or therapist touched upon ethical dilemmas in practitioner research because these power dynamics cannot be completely overcome when recruiting participants. this may create a problematic position for clients when deciding whether to give informed consent to participate. participants’ fear of the negative consequences of denying or withdrawing consent in this context was recognized by lunt and fouché (2010). similarly, others have found it necessary to explicitly inform participants that consent can be withdrawn (thompson & russo, 2012). researching children (vaswani, 2018) and children’s sexuality (flanagan, 2012) demands a sensitive approach. in an attempt to reduce the power imbalance between herself and the children participating in her research, vaswani (2018) used photoelicitation and shared with the children how and what was to be discussed. also, in smallsample-size case studies, it may be challenging to report the results in a rich manner that does not reveal the identity of the participants (tietze, 2012). recommendations eight articles provided recommendations to support the researcher and/or participants and safeguard those involved from unpleasant experiences when dealing with sensitive research topics. the recommendations also suggested the value of striving to maintain ethical standards and conduct good ethical practices in practitioner research. the suggestions were either stated specifically as suggestions in the articles or were 166 njsr – nordic journal of social research vol. 11, 2020 extracted as part of the thematic analysis. the suggestions can be divided into two main categories, or subthemes — supervision and increased researcher competence — which are interlinked to some extent. supervision in practitioner research was a common theme throughout the suggestions in the studies (bashir, 2018; coles et al., 2014; flanagan, 2012; gabriel et al., 2017; thompson & russo, 2012). partnering with a professional research community or individual partner throughout the entire research process was also advised (mitchell et al., 2010; pain, 2011) to ensure ethical oversight and allow for greater research flexibility, especially when dealing with ethical dilemmas (coy, 2006; lunt & fouché, 2010). bryan and burstow (2018) identified the need for a better understanding of the dimensions of research ethics in research conducted through schools. similar findings by fraser (2007) noted that ethical considerations should be measured before research is conducted in the field. as pointed out above, professional ethical codes of conduct may also serve as general ethical guidelines for practitioner research (lunt & fouché, 2010), but there is also a need to establish both guidelines and procedures to deal with the ethical dilemmas that occur during the research process. discussion and implications for practice in the nordic context this article is written from a norwegian perspective, and the nordic context was addressed briefly in the introduction. the nordic welfare system aims to provide the entire population with similar services, and practitioners in this field (social workers, nurses, and others) are of particular interest regarding practitioner research. however, the findings of this scoping review may be transferable to other countries with similar legislation. in norway, respect for the human dignity and vulnerability of those involved in research is regulated both ethically and legally through the national committee for research ethics in the social sciences and the humanities (nesh) and the norwegian centre for research data. the national guidelines for research ethics state that when dealing with vulnerable groups, researchers must place particular emphasis on the requirements regarding information and consent (nesh, 2016, p. 25). this becomes increasingly important when conducting practitioner research in which clients and other service users serve as informants. 167 njsr – nordic journal of social research vol. 11, 2020 social work is conventionally described as ‘one of few professions where one will execute both control and compassionate solidarity, as in child protective services and the welfare services’ (levin, 2004, p. 11). this uneven power relationship may place unjust pressure on potential research participants, as noted by lunt and fouché (2010), thus forcing quick and hasty decisions about whether to participate. this ethical dilemma is also recognised in research outside of this paper’s scope, such as in primary care (wilson et al., 2008). the role and expectations of the practitioner researcher may be at the core of the issues highlighted in this scoping review because they connect with many of the aspects highlighted in the findings. additionally, social workers, teachers, and nurses share the goal of ensuring the well-being, growth, and safety of their clients or pupils (sivenbring & malmros, 2020). this goal might not necessarily be in accordance with the goal of the practitioner research project, thus creating inner conflicting expectations in which the practitioner researcher struggles with how to both carry out the research and take care of the participant and himor herself at the same time. this expands the inner conflict presented by hochschild (2003) and kahn et al. (1964), among others. kahn et al. (1964) state that a core element in all types of roles and personal conflicts in organisational life was experiencing two or more sets of pressures such that compliance with one would make compliance with the other challenging. the current subject, practitioner research, adds another component, or role, to this already complex interplay of personal and professional factors. for the professionals mentioned in this study, those who support and care for others (sivenbring & malmros, 2020), this might manifest as a strong ethical dilemma and create uncertainty and stress. as the analysis showed, it is challenging to include ethics in every part of a research project. the formal ethical considerations reportedly followed by some studies are a starting point, but they must be followed by ethical practitioner researchers at every step of the research process. there is also evidence that the ethical guidelines within which social workers, among others, conduct their professions are not enough to ensure sufficient ethical consideration when undertaking research. the analysis found indications of an overall lack of research competency in practitioner research. several articles highlighted recommendations of support for practitioner researcher and participants when dealing with sensitive research topics. these findings can point the practitioner researcher in the direction of partnering with a mentor or supervisor (perhaps 168 njsr – nordic journal of social research vol. 11, 2020 a professional research community, such as a university) for supervision and recommendations in all stages of the research. because several authors represented low-level research competency as a challenge in the practitioner research field and found that the poor planning and execution of research may lead to unpleasant experiences for both parties, the recommendation of strong partnerships and academic supervision is this review’s main take-home message. by engaging closely with a professional research institution, practitioner researchers might strengthen their competency and secure both themselves and their participants in the research process. supervision from senior researchers might also help practitioner researchers engaged in more novel research better grasp the complexity of combining these two roles. if the practitioner researcher and the findings and insights that surface from their research are to be taken as seriously as other research strategies, efforts should be made to heighten the researcher’s competency and skills. if not, the valuable cooperation between researcher and practice institutions may not be utilised, and hard-to-reach targets may be left out of traditional research projects’ grasp. one solution might be to strengthen and increase the amount of research methodology in bachelor’s degree curricula. however, when conducting this scoping review, bachelor’s degree curricula were not assessed or explored, and therefore, the author of this manuscript is unsure how much attention these topics currently receive during bachelor’s studies in norway or other nordic countries. while strengthening research methodology is one available option, it must be weighed against all other subjects and topics in these educational programmes. concerns have already been raised about theoretical academic disciplines consuming too much time in norwegian nursing education (caspersen, 2017) and danish teacher education (rambøll management consulting, 2012). a debate about this is welcome, and the author of this scoping review hopes the findings presented will bring insight and discussion to both practitioners and researchers. research over the next decade will hopefully venture down the avenues mapped out by this scoping review and potentially influence educational institutions, the practice field, and its professionals. to aid both professionals and participants, the evolution of practitioner research should include the development of a comprehensive and understandable merger between professional ethics and research ethics, along with strong partnerships with research communities. 169 njsr – nordic journal of social research vol. 11, 2020 limitations the findings are limited because the search methodologies in the included reviews were not thoroughly presented. however, all included articles were peer reviewed and were found through recognised databases and sources. the larger body of included articles contains original empirical data. as the author of the scoping review, i strived to avoid adding or removing any meaning to or from the original content of the identified articles. to address my subjectivity, identified articles were analysed twice, with similar results. conclusion through an investigation of 24 peer-reviewed studies, this scoping review found evidence of some very challenging issues that have arisen within practitioner research on sensitive topics, such as exposure to participants’ trauma and the blurred roles between practitioner and researcher. these dilemmas surface due to the complexity of roles and tasks within practitioner research. specifically, the role-related expectations regarding behaviour, appearance, and the display of emotions in accordance with both the practitioner and researcher roles are of relevance to understanding this challenging research. this should be followed up on in future studies of practitioner research, with a specific focus on the connection and complexity of both roles and the way in which these are juggled within research settings. also, like qualitative research in general, practitioner research on sensitive topics demands certain skills in planning, executing, and taking care of both the participants and oneself as a researcher. one must develop the capacity to reflect upon ethical dilemmas mid-research and resolve other issues with fellow researchers afterward. peer support and supervision from professional research communities, such as a university, might help 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(2016). it agility research review: thematic analysis and categorization of literature (proceedings no. 205). pacis. https://aisel.aisnet.org/pacis2016/205/ . the relationship between research and innovation in the public sector – an analysis of five cases from labour and welfare services njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 this article belongs to the special issue public sector innovation conceptual and methodological implications guest editors: ann karin tennås holmen (uis), maria røhnebæk (inn) the relationship between research and innovation in the public sector – an analysis of five cases from labour and welfare services magnus gulbrandsen* tik centre for technology, innovation and culture university of oslo email: magnus.gulbrandsen@tik.uio.no *corresponding author gry cecilie lunder høiland tik centre for technology, innovation and culture university of oslo, norway / faculty of economics and management ntnu, norway email: gry.c.l.hoiland@ntnu.no abstract many public agencies promote renewal in the public sector through projects that require a productive combination of research and innovation activities. however, the role of research in innovation processes is a neglected theme in the public sector innovation literature. we address this gap through an analysis of five cases from the norwegian labour and welfare administration. we find few examples of innovations based directly on research, but several examples of research on innovations and on more complex co-evolutionary processes of the two activities. research seems to be particularly important for the diffusion and scaling up of innovations. we find that research has an impact on innovation in later phases of the innovation process through the 47 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications formalisation of practice-based and unsystematic knowledge, codification of experiences, and legitimation to ensure political support and funding. this new conceptualisation contributes to the public sector innovation literature and may help improve policies that set up a rather limited role for research. keywords: public sector innovation, the chain-linked model, relationship between research and innovation, research policy, innovation policy. introduction research and innovation—separately and together—are major instruments for addressing societal challenges in western welfare states. linkages between research actors and organisations in industry and the public sector have emerged as a central topic in the academic literature. even if research is expected to make a societal impact, including an impact on innovation processes, this literature has repeatedly warned against simple linear models. for example, many scholars, including mowery et al., warn against the notion that innovation is mostly based on ideas emerging from research (2004). the underlying argument is that research, the systematic creation of new knowledge, and innovation, the practical implementation of new ideas to generate some form of value, are fundamentally different activities, even if they benefit one another at times or have some overlap. in this paper, we ask how the relationship between research and innovation can be characterised in the context of public sector innovation. the relationship has been weakly conceptualised in the public sector innovation literature, and we focus on the link between the way research influences innovation processes and the role of research in different phases of innovation. we study areas in which governments emphasize research-based knowledge and innovation, basing our empirical analysis on five innovation processes in the norwegian labour and welfare administration (nav). in the next section, we discuss some central writings on the relationship between research and innovation. the subsequent section contains notes on our empirical data and method, followed by a presentation of the five cases. then we proceed to analyse three types of relationships in the material: research-based innovations, research carried out on innovations, and more complex ways in which innovating public organisations become engaged in 48 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications r&d in various innovation phases. in the final section, we conclude that the role of research as a clear source of ideas for innovation is probably exaggerated, while its impact on other aspects of innovation processes might be undervalued. these findings have important implications for science and innovation policies targeting the public sector. theoretical perspectives innovation represents the introduction of novelty to a practical setting, such as launching a new product or service or implementing a new organisational form. innovation is a much broader and more complex phenomenon than “invention” or “research breakthroughs” (fagerberg, 2005). innovation processes are often lengthy, unpredictable, and hard to manage (van de ven et al., 1999; pavitt, 2005; garud et al., 2013). although empirical studies find many similarities between firms and public organisations in how innovation plays out through different stages (van de ven et al., 1999), public sector innovation is mostly theorised as distinct from private sector innovation (hartley, 2005; høiland, 2018). both are motivated by value creation, conceptualised as economic values and competition for survival in the private sector, and democratic governance, shared cultural values, and concern for citizens in the public sector (fuglsang & rønning, 2014; bason, 2010). as a result of innovation’s high visibility on political agendas (mazzucato, 2018) and the request for evidence-based policymaking (greenhalgh & russell, 2009; howlett, 2009), governments increasingly view innovation and research as essential tools for developing public services and making them research-based (e.g., ministry of health and care services, 2014). perspectives on the role of research and development (r&d) in innovation have changed over time. early work most often framed innovation as advanced technological change involving r&d, while later perspectives tied r&d to an organisational capacity to use external knowledge and to evaluate and monitor external developments (cohen & levinthal, 1989). furthermore, collaborative and systemic perspectives have argued that firms’ innovation activities in many industries have co-evolved with external public research, but due more to the research-based education activities in universities than inventions originating from academic research (rosenberg & nelson, 1994). 49 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications historical investigations have shown the importance of applied and missionoriented research organisations for innovation (e.g., gulbrandsen & nerdrum, 2009, for norway). however, the question of how r&d relates to innovation is barely addressed in the public sector innovation literature (devries et al., 2016), despite policy assumptions that the sector’s collaboration with research organisations will increase the likelihood of innovation (cf. sørensen & torfing, 2011; torfing et al., 2016). the literature has looked into the nature of public sector innovation with themes such as typologies, antecedents, barriers and facilitators (e.g., devries et al., 2016; hartley, 2005; fuglsang & rønning, 2014). implementation studies have sometimes investigated how researchor evidence-based knowledge is utilised in sectors such as health, welfare, and education (e.g., heaton, et. al., 2016; parkes, et. al, 2014; harrison & graham, 2012; rycroft-malone et al., 2011). nevertheless, this tradition either does not deal specifically with how research is related to innovation activities and processes, or implicitly assumes that research is the source of the idea for the innovation. process perspectives offer a more detailed view of how the relationship between r&d and innovation plays out over time. theoretical and empirical investigations highlight that innovation processes involve a multitude of actors, including r&d providers, and that partnerships may shift over time (e.g., van de ven et al., 1999). furthermore, even if innovation processes rarely progress linearly and neatly, certain phases can be identified, such as idea/initiation, development, and implementation/diffusion (garud et al., 2013). although individual action and organisational decisions can be important, innovation processes are often influenced by complex combinations of wider institutional factors, such as market forces and the forces of scientific and technological developments (kline & rosenberg, 1986; garud et al., 2013). a process perspective implies a shift from seeing innovations as specific outcomes to a focus on the change or transformation processes that are involved in innovation (garud et al., 2013). kline & rosenberg (1986), in their widely used “chain-linked model” of innovation, argue that innovation and research are largely independent of one another. innovation starts with a need, a problem, a potential market, or something similar and an “analytic design” develops in response. what follows 50 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications is a set of stages in which the design or idea is developed, tested, redesigned, and implemented, but the stages are not neatly ordered, and a return to “earlier” stages is very common. research, on the other hand, starts with a question for which there is no clear existing answer. in most cases, this involves a qualitatively different “need” than that of innovation, as research is rooted in knowledge gaps and the potential for original contributions to theoretical, methodological, empirical, and applied challenges. research output can take the form of a publication, a lecture, or something else, which then becomes available library material, databases, teaching initiatives, deliverables to project partners, and more. we have used the chain-linked model to set up three idealised relationships between research and innovation with the public sector in mind. the first we have called research-to-innovation, which denotes instances where research produces a result or an idea that forms the starting point of an innovation process. kline and rosenberg (1986) argue that this is an important but also rare phenomenon, as most innovation processes have other origins and driving forces. the second relationship is termed innovation-to-research or research-oninnovation. innovation can create direct opportunities for research, as in the case of new scientific instruments and data. more frequently, various innovation-related practices are a key object of study in many research fields where the aim is to understand, explore, and explain important societal phenomena. for example, scientists may study service provision in healthcare, welfare, or education to gain insights into central social processes. finally, we have named the third idealised relationship research-in-innovation. when an innovation process halts because there is a lack of knowledge, the participants will (most often) search through available knowledge stocks (texts, asking people, etc.). only if this does not provide an adequate answer, research is needed. this can happen at different stages of an innovation process (e.g., the idea itself requires more knowledge), or in development and implementation. in this relationship, research activities are to some extent initiated by innovation needs, but not necessarily directly by market forces or purely practical considerations. these three types can represent an analytical scheme for looking more closely at the relationship between research and 51 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications innovation in the public sector, and we will return to them after presenting the data material and the five cases. to conclude, innovation studies have enjoyed policy influence based on arguments and findings that innovation and technological change are related to economic growth and societal change. however, the field’s more complex message—that research is primarily a source of indirect learning and competence building rather than a source of inventions and ideas that can be commercialised and implemented—is often lost when translated into policies (berman, 2012). consequently, warnings have appeared in the innovation literature against policies and perspectives that focus on research and commercialisation as primary drivers of innovation. although innovation activities can, at times, be traced back to earlier research, ideas of a causal, or stage-wise relationship, or a clear division of labour, have been repeatedly denounced (cf. balconi et al., 2010). there is concern that policies may place unrealistic or detrimental demands on science or emphasise only a few, highrisk forms of innovation (rosenberg & nelson, 1994). in the context of governments emphasising innovation and evidence-based policies in the public sector, this concern remains relevant. public sector innovation processes are often seen as more complex and heterogeneous than private sector innovations (bugge & bloch, 2016). as such, the concern of a “too linear” understanding of research-innovation relations may be even more pressing for public sector innovation, which has diverse objectives and concerns public values such as democracy, safety, trust, and meeting societal challenges (bason, 2010). three analytical lenses for our empirical analysis emerge from this brief literature review. first, there are several theoretically founded relationships between research and innovation in the literature, and we have set up three idealised ones. second, innovation processes most often have distinct phases, and we will explore the relationship between research and innovation in these. third, a process perspective implies an interest in how research activities have an impact on the innovation process itself rather than on specific innovation outcomes. 52 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications research setting and methods the directorate of labour and welfare (nav) is responsible for providing employment and welfare services and administers one-third of norway’s national budget. there are high expectations that policy decisions about welfare and employment should be based on documented effects and the best available science. in nav, a substantial proportion of the r&d budget is allocated to work inclusion services, with the specific assumption that these investments will lead to better employment services, more efficient use of public resources, and improved work inclusion outcomes. in this paper, we draw upon an ongoing study of innovations and the impact of research in nav. using an explorative approach (eisenhardt, 1989), we interviewed a large number of civil servants in leadership and coordinator positions at nav’s headquarters and some of their research partners. interviewees were not selected because they represented the five cases analysed in this article, but because they were involved in the use of research and coordination of innovation more generally. the interviews employed a guide asking in-depth but open-ended questions, probing for examples about practices and processes of knowledge acquisition, research collaborations, and policy development in nav. the interviews were recorded and transcribed and lasted between 60 and 90 minutes. both authors read the transcripts several times, discussed them, and coded themes inductively in nvivo. for this paper, we read through the interviews and identified five service innovation cases that all illustrated some aspects of the relationship between research and innovation in nav. we selected 15 interviews that all referred to at least one of these five cases, and we reviewed a large number of documents through access to the nav internal network. we also used secondary sources such as final and interim research reports. the internal documents included calls for research and descriptions of research results and were either directly related to the cases or helpful for understanding how nav conceptualises research-innovation linkages. none of the interviewees had been directly responsible for the five service innovations, but they had in various ways been involved in funding decisions, other support, coordination of r&d, or similar tasks. table 1 gives an overview of the data sources. 53 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications for modifying a theoretical model rather than testing certain propositions, we used a dialogical approach to study the interplay between empirical data and theory (rule & john, 2015). having inductively and thematically coded our interviews prior to this paper, we created a new set of codes categorizing directions and forms of interactions as well as examples of innovations and the use of research. we looked for mentions of research when participants talked about innovations and vice versa. table 1: data sources. data sources description 5 interviews leaders & coordinators @directorate r&d department 5 interviews leaders & coordinators @directorate service development department 5 interviews researchers @research organisations 69 documents internal documents nav 26 documents research reports we found many indications that the role of research varied between different innovation processes. following the dialogic approach (rule & john, 2015), we started comparing our codes to our three stylised relations inspired particularly by kline and rosenberg (1986), classifying them accordingly in our last cycle of coding. reflecting upon our data’s fit and lack of fit, we sought to develop a refined understanding of the relationship between innovation and research in public sector settings. the findings are based on an analysis of a handful of innovation processes within nav, an organisation that emphasises evidence-based decisions. caution should therefore be taken in generalisations, but our modified understanding of the research-innovation relationship may be relevant for other evidence-focused parts of the public sector, such as health and education. even if welfare services may be less tailored to randomized controlled trials as in medicine and less influenced by powerful professional values and positions, these aspects were nevertheless highlighted by many interviewees. all the same, further studies are needed to develop a more comprehensive understanding of the relationship between innovation and research in the public sector. 54 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications the cases and research-innovation relationships this section contains a brief description of each case and a first analysis of the main patterns of research-innovation relationships in each. case 1: supported employment in nav nav is responsible for providing employment services to people with the need to find or maintain a job. supported employment (se) is an internationally recognized work inclusion method for our purpose, an innovation (or set of innovations) aiming to support people in gaining employment in mainstream jobs instead of vocational rehabilitation through sheltered workshops. it prescribes several principles, including the enlistment of “job specialists” who closely follow up on the service user. early se principles in norway can be found in the 1990s in an earlier labour agency. in 2012, a public committee consisting of researchers, policymakers and other experts nominated se as the preferred model of work inclusion, calling for more r&d collaborations for developing better se services and suggesting that nav itself could take over more of the work inclusion services (nou, 2012). as such, se in nav is a case in which a top-down initiative drives the innovation process, but with research influence on early priorities and framings. its further fate can be traced through several innovation phases and research projects, from the need to develop the method in the context of nav to the testing, redesign and implementation taking place since 2012. working to develop and provide se services through internal agency resources, nav has leaned on researchers in major parts of the process. researchers were commissioned to collaborate in developing and implementing se methods in selected nav offices (spelkavik et al., 2016a). a number of research projects were procured to evaluate and test the method more broadly (spelkavik et al., 2016b; schönfelder, 2020; bakkeli, 2020). as a part of designing manuals for implementing and securing the quality of se services in nav, for example, researchers were involved in evaluating se manuals and in providing knowledge-based input for simplifications and improvements to support se quality, effectiveness, and cost efficiency. case 2: individual placement and support individual placement and support (ips) is a related case of a work inclusion innovation in nav. compared to se, ips represents a different strategy with 55 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications another implementation agenda and different actors. it is a specific evidencebased supported employment approach based on extensive research through randomised controlled trials (rcts), and the approach has a manual and fidelity scale that should be followed strictly (drake et al., 1999). as such, it is an example of an innovation where the initial idea had strong links to international research efforts. when the 2012 public expert committee approved supported employment methodology in employment services (nou 2012), ips surfaced as a welldocumented evidence-based approach in the international research community. as part of a national initiative to implement ips services on a large scale, the first rct of evidence-based ips in norway was done as commissioned research starting in 2012 (sveinsdottir et al., 2019). in close collaboration with nav and health institutions, researchers experimented with ips as a new work inclusion approach. six pilot offices utilised the ips models as part of the rct. results in 2016 revealed the ips pilots to be significantly more effective than traditional methods (reme et al., 2016). ips thus became a benchmark for evidence-based policy in nav, which has further developed the method through trials for other user groups and implemented it nationwide in continuous collaborations with ips researchers. case 3: motivational interviewing because many nav frontline counsellors are not formally educated within social work, the ministry of labour assigned the development, implementation, and evaluation of a programme for better client follow-up to the directorate in 2009. the programme was developed based on international research on counselling techniques, and nav commissioned researchers to evaluate the implementation process and the effect of a pilot on counselling practices. the researchers found that the conversation method called motivational interviewing (mi) was warmly approved by frontline workers (malmbergheimonen, 2014). the method itself was initially developed by clinical psychologists and published scientifically from the late 1980s, but the first nav variant had only weak and indirect links to these efforts. counsellors in nav offices nationwide received training, and the counselling method was widely implemented. seeking further evidence of the effects of mi on employment outcomes, the directorate’s r&d department ordered a systematic review by the national institute of public health (2017). the review found no evidence that the method improved employment outcomes. more 56 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications recently, two randomised trials have been set up in collaboration with research institutes and partly funded by the research council. case 4: holf model for follow-up of low-income families acting on a call from the ministry of labour, nav commissioned a systematic review in 2014 from a research institute that showed a lack of research on effective measures against child poverty in norway. the directorate decided to initiate an r&d project to develop and test a new model for relevant nav services. using the findings of the systematic review, as well as considerations of frontline experiences, a pilot called holf (holistic follow-up of low-income families) was developed in a collaboration between the directorate and frontline offices and not based directly on research. however, as a part of this innovation process, the r&d department procured research to evaluate and advise the process of development, to test its effect using rcts, and to evaluate the process of implementation. the purpose of the research collaboration was to determine whether the intervention worked and should be implemented nationwide. the evaluation indicated that frontline employees perceived more systematic follow-up of service recipients (malmbergheimonen 2019), but because the rct results did not show any significant effects, holf was put on hold. case 5: the hedmark model for reduced sick leave aiming to solve the problem of their region’s holding the highest sick leave rate in norway, the manager of a regional nav office in 2013 initiated the development and implementation of a new model related to nav’s routines for handling sick leave benefits. an effect evaluation found that after the introduction of the model, the region had the largest reduction in sick leave in the country. nav decided to launch a trial to introduce the model in three new regions. the latter experiment was delegated to external researchers for process evaluations, although some routines of the model were diffused before the launch of the trial and evaluations (proba samfunnsanalyse, 2016). the process evaluation was positive and influenced the diffusion of the model nationally. in parallel to the external research evaluation, nav’s own r&d department conducted an effect evaluation (nav-rapport nr 3-2017), which also concluded that the model should be implemented nationwide. 57 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications driving forces of innovation in nav we found four categories of driving forces in the cases. the first is when innovation processes are initiated by political agendas and handed down as administrative orders to the directorate of labour and welfare (nav) from the ministry of labour and social affairs. processes initiated in this way often appear as a mix of political priorities surrounding societal problems and existing knowledge, but may in some cases originate from established research results and media publicity. this top-down process is an important part of the two supported employment cases: motivational interviewing and low-income family follow-up methods. the second driver of innovation, exemplified in the hedmark model, is a need defined at the operational level of the organisation. here, the process starts with an everyday or local problem experienced by middle-line managers or frontline employees, and solutions are enacted or proposed by the same actors. a third driver for innovation is related to the first two: innovation as prescribed by the ministry or based on detected problem areas in the welfare system, which end up in nav as directives to be followed up on or as initiatives that might be scaled up or diffused. although these processes use existing knowledge, competence, and collaborations among civil servants in the ministry and the directorate, research is often needed. for this research to be sufficiently relevant and useful, a knowledge infrastructure needs to be in place. the establishment of a separate r&d department in nav was, according to the interviewees, driven by an observed need for more relevant and higher quality research, as well as a more systematic procurement and use of it. the size of nav and the opportunity to follow ongoing experiments with a possible control group set-up make it interesting for researchers to become engaged in innovation-related work as well. all our cases except the hedmark model contain some elements of such ministry-initiated processes targeting specific challenges. only ips can clearly be defined as an innovation process that (to some degree) was initiated by research. the approach, with its fidelity scale, emerged from international results of randomised controlled trials, although later r&d responded to nav calls for studying and monitoring the various experiments with ips. in the other cases, a new kind of relationship between 58 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications nav and researchers seems to have emerged, in which research over time moves from such a responsive mode to more of a source of new ideas. examples are the holf and mi cases, as well as the more general supported employment work apart from ips. table 2: innovation cases case description driving force of innovation process role of research in the innovation process 1: supported employment (se) a work inclusion method with the goal to support people in achieving steady, meaningful employment in mainstream jobs, not vocational rehabilitation through sheltered workshops political agenda (reduce unemployment) and orders from the ministry and detected problem areas in the organisation idea for the effort partly inspired by research, but main role to develop and implement the approach 2: individual placement and support (ips) a supported employmentderived method and an evidence-based approach to work inclusion. ips has been extensively researched and proven to be effective internationally compared to standard employment services international research results, political agenda (reduce unemployment) and orders from the ministry and detected problem areas in the organisation idea for the service strongly inspired by research, early stage test design (randomised controlled trial) and research follow-up through implementation 3: motivational interviewing (mi) a communication method to improve counselling sessions with clients a combination of orders from the ministry (perceived competence gap among frontline employees) and detected problem areas in the organisation idea came from a review of relevant research; innovation developed and implemented by nav; research used for measuring effects (rct); further implementation depending on research results 4: holf a method for “holistic follow-up” of low-income families political agenda (reducing child poverty), ministerial initiative and initial internally funded r&d project research primarily used to evaluate and advise the development and implementation process; rct to test effects leading to decision to discontinue the hedmark model a model to decrease sick leave in the norwegian labour market mid-managerial driven based on detected problem areas in the organisation innovation developed by nav and effect tested by nav, then central routines introduced nationally – research involved to influence further development before national implementation 59 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications table 2 shows an overview of our innovation cases, a summary of their main driving forces, and an indication of the overall role of research in the innovation process. in sum, we find that political decisions, ministry initiatives, and managerial problem-solving appear as important drivers of innovation. still, we find that research activities were a part of the innovation processes in all the cases, even though it was only in the ips case that they provided the initial idea or framing. research in welfare innovation processes the previous section showed that our data support perspectives highlighting the indirect and process aspects of the research-innovation relationship. here, we analyse these relationships in detail, using the three idealised types that we developed in our theory section based on innovation process perspectives inspired by kline and rosenberg (1986), as well as the phases of garud et al. (2013). research-to-innovation we found that in four of the cases, research was part of the early phase (emergence of the idea) of the innovation process. as mentioned, the innovation process that is easiest to categorise as research-to-innovation is ips, which was initiated by two major research projects involving social scientists in collaboration with nav. the source was collaborative research but also earlier independent academic research. the ministry of social affairs funded the collaborative projects, which involved a complex randomised controlled setup, then delegated them to nav for day-to-day research partnerships and support. nav interviewees clearly attributed the starting point of ips to research results. the projects delivered strong support for this new approach to work inclusion, indicating that ips (and possibly se more generally) was the most effective work inclusion method available. this resulted in an emphasis on diffusing ips, a multi-year task in collaboration with several research organisations that also catalysed the implementation of other se innovations. even if this seems like a clear case of research leading to innovation, the interviews indicate a more complicated backstory. the general introduction of supported employment-related services in labour agencies from the 1990s 60 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications and onward was essential for the ips process, suggesting that research-toinnovation may depend upon a certain maturity or absorptive capacity (cf. cohen & levinthal, 1990). the three cases of supported employment (se), motivational interviews (mi), and holistic low-income family support (holf) to some extent used systematic reviews of relevant research in the early stages of the innovation processes. both the ips and se cases were based on international research, though their diffusion to the nav/norway context differed. in the case of mi, international research literature inspired the idea. in holf, a systematic review showed a lack of knowledge in the field of child poverty, indicating a need to develop new services. research-on-innovation we see some examples of research-on-innovation in our interviews, much of it funded by third parties like the research council of norway. however, interviewees from nav rarely mentioned such projects as important for their innovation cases, even if they knew about them and even if cases such as supported employment were the main topic of these projects. most of their examples of useful research came from projects they had commissioned themselves through their r&d department. this could indicate that within a large public organisation, many different relationships between research and innovation occur simultaneously, and that the challenges of learning and spreading information within the organisation can be considerable. furthermore, research-on-innovation projects often require close collaboration between (parts of) nav and the research organisations. some research programmes may require “user involvement”, and issues of data access, availability and privacy can necessitate long-term and committed partnerships. this seemed to work fairly well, and the interviews indicate that some of the sub-regions in nav had been particularly active in making their data, processes, and employees available for external research. although the research aimed to understand work inside nav and how its clients were doing, collaboration also ensured competence building and diffusion of research results and perspectives to nav personnel. as such, a longer-term impact could be an influence on innovation within nav. 61 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications tensions in these relationships were as expected: researchers worried about spending a lot of time “anchoring” a project with nav when the success of support from a competitive programme was low, while nav complained that sometimes they were contacted immediately before an application deadline. over time, some of the research projects on nav innovations funded by third parties have developed into the co-evolutionary type of partnership analysed in the next section. research-in-innovation the third stylised relationship takes place when research is called upon at various stages of the innovation process in cases in which existing knowledge cannot solve apparent problems. major parts of the innovation processes— particularly later stages—in our cases can be categorised here, and a main phenomenon is to call for research to evaluate effects or monitor implementation. in the hedmark model case, the innovation was initiated internally, and external research was called upon late in the process to evaluate the implementation of the innovation in other regions. research entered earlier in the innovation processes in the two supported employment cases (se and ips). here, research was commissioned to solve problems that arose during the development of the method to fit the national context. it was also used to test for effects and decide whether and how to implement the methods. the ips research results legitimatised se methods at top political levels and in the ministry of labour and the ministry of finance, securing further funding and a continued existence and national diffusion. in addition, the holf case for helping low-income families had a strong emphasis on early collaboration between practice and research. the directorate’s r&d department initiated a nationwide development and testing of holf in 2015. because of a lack of evidence-based instruments for the target group, the project also aimed to test for effects to improve its knowledge for later scaling-up to nav in its entirety. the testing was done in collaboration with researchers and through a sample of randomly selected nav offices. one of the aims was to test, develop and form the basis for concrete recommendations and broader implementation in nav and collaborative services. 62 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications for the motivational interview case, research had an important role during the innovation process. the idea for the innovation was derived from international research after an internal initiative and piloted in collaboration with a research team before being implemented through extended training practices nationwide. later evaluations by external researchers were again procured, primarily to evaluate its effect more systematically to legitimize its continuation. the four cases of se, ips, holf, and mi display stronger relations over time between researchers and practitioners during formalised innovation processes in nav. we found that the directorate connects researchers more and more to innovation processes in the operational parts of the organisation, and increasingly earlier. the idea is that by following the processes from the beginning, the knowledge will be more systematic and easier to diffuse than for the usual bottom-up innovations. these examples of research within innovation processes demonstrate four important roles for the research activities. first, they provide an updated knowledge base of existing research and best practices in the field. second, they provide more systematic knowledge about innovations initiated by frontline or local offices or by central management, which makes it easier to diffuse or scale up innovations. third, they provide a collaborative “laboratory” for experimenting with and further developing innovations and related activities like training. fourth, researchers evaluate the effects of service innovations to legitimise innovations’ continued financing and diffusion. the material indicates that innovation processes are often initiated and implemented decoupled from research, but that research is increasingly perceived as important for further development, evaluation, testing, adjustments, and legitimacy. phases and research-innovation relationships in sum, we see that the relationship between research and innovation varies between the phases of innovation processes. in the idea phase, research is primarily one source—out of several—of inspiration for ideas that may be developed into innovations. in the development phase, research provides useful knowledge in the form of systematic reviews, mapping of initial conditions and preparation for possible randomized controlled trials (rcts), and assistance to develop generic or international concepts and solutions to a 63 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications local context. this phase often sees close contact between researchers and the ones working with innovation. finally, in the implementation phase, the main role of research is to provide insight into “what works,” ranging from large-scale rcts to smaller-scale monitoring and formative/follow-up studies. here, several interviewees stressed how the independence of the research becomes an asset for the legitimacy of the innovations. we will return to this aspect in the concluding discussion. the boundaries between the phases are not clear in several of the cases, mostly because development and implementation are often closely linked. there are also several types of implementation, from the first iteration in a smaller part of the welfare system to a scaling up of an innovation to the whole system. there may be a new phase of development and adaptation between these two forms of implementation. as such, our cases—even if they represent single innovations—are not single outcomes but “families” of solutions tied to larger challenges like unemployment and poverty. it is also possible that the increase in collaboration between innovation coordinators and external research organisations, including the emphasis on getting researchers engaged earlier in the process, contributes to blurred boundaries between phases as new external knowledge and ideas enter the process more often. discussion and conclusion in this paper, we have explored the relationship between research and innovation in public sector innovation. innovation scholars have repeatedly denounced the idea of a causal or instrumental relationship between research and innovation. instead, they have proposed that the relationship is multifaceted and that the two processes are different and often independent from one another. however, little is known about the topic from the public sector innovation literature, and it is therefore relevant from both a policy and academic perspective to explore the relationship between research and innovation. our approach has been an empirically and theoretically informed analysis of data from an ongoing study of service innovation and the impact of research in nav. the data from nav supports the general claim in the traditional innovation literature that the relationship between research and innovation is neither 64 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications linear nor instrumental. in four of our five cases of innovations, research played an initiating or inspirational role in some way, but the backstory is more complicated than a scientific breakthrough leading to an innovation. political decisions or managerial problem-solving seem to be more important driving forces of innovation. there are many examples of independently funded research that take nav innovations and their contexts as the empirical object of study. this seems to have limited direct influence on innovation processes, although we observe that over time, such research often becomes collaborative and harder to distinguish from the third and most important category in our material: the innovation processes that encounter problems that are resolved by procuring research. we have called this linkage researchin-innovation. in our five cases, research contributes primarily by either providing new knowledge to help develop immature ideas and innovations-in-the-making, by studying the innovation to gain more systematic knowledge to prepare for diffusion or scaling-up, or by delivering numbers and narratives that secure funding and legitimacy. we can visualise these research contributions as three different types of impacts (see table 3). the first is where research helps to transform informal, practical, and decentralised information into systematic data, which often happens when innovation processes are followed over time by researchers. the second is a shift from tacit to codified knowledge, a process necessary for making the innovation into an organisational practice (for example, through training personnel and creating guidelines) and a move from a geographically or organisationally bounded experiment to a national system. the third impact we may call a shift from innovation as an organisational practice to innovation as a political currency. this is when researchers provide the arguments needed for new political decisions and more top-down funding required for the diffusion and scaling up processes of the innovation in question. the high importance placed on research for creating political legitimacy and for scaling up is perhaps the most surprising finding of our small-scale exploratory study, as these points are only discussed to a limited extent in traditional impact and public sector innovation literature. 65 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications table 3. stylised summary of role of research in phases of innovation processes innovation phase function of research for innovation type of research impact of research idea/invention inspiration for idea/framing and conceptualisation of possible solutions; baseline for later evaluations more or less systematic review of existing research; understanding specific contexts formalisation and systematisation (creating ties between local knowledge and research knowledge) development supporting development and implementation research-based evaluations supporting development, action research, monitoring, and preparation for rcts codification (transforming knowledge into manuals, checklists, training, etc.) implementation/ dissemination dissemination or scaling up to wider organisation; supporting increases in public funding randomised controlled trials; effect evaluations legitimisation (turning knowledge into political currency) if we look at these impacts considering the three relationships between research and innovation discussed in the theory and analysis sections, we observe that all of them are primarily tied to what we have called research-ininnovation. co-evolving research and innovation activities provide systematisation of data, codification, and politically usable evidence. research-on-innovation might also ideally provide systematisation and codification, but this was not mentioned by the interviewees, perhaps because this research was seen as more remote from daily and strategic decisions. some other nuances in the data should be brought up. for example, we observed that temporality is complex: research and innovation are linked together in varying and flexible sequences of activities, and it is sometimes difficult to say whether one activity drives or initiates the other. it is not clear whether the research-innovation relationship follows a specific cycle or goes through somewhat predictable stages. one possible pattern is that a template for an innovation emerges from new political decisions and a lack of relevant knowledge, and that research comes into the process earlier when the starting point is a top-down decision. however, there are exceptions even in our small data set. 66 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications we also see that working with innovations to some extent can have an impact on research—an issue for further studies—and that nav has put much effort into funding ambitious projects and research units in exchange for bringing them closer to the welfare and labour context. although we find relatively few signs of short-termism or problematic dependencies in commissioned research, the line between commissioned r&d and independently funded research through research councils and other third-party actors may have become more blurred. in our terminology, this signals a convergence between the research in and research on innovation categories. we have argued that research may have an impact through formalisation, codification, and legitimation of innovation processes. this importance for innovation may rest on the perceived independence and trustworthiness of the research, which can pose challenges in strongly collaborative settings. this is an issue for later studies. this paper contributes to the public innovation literature by adding insights into how the research system may be relevant for innovation processes (cf. sørensen & torfing, 2011; torfing et al., 2016) in other ways than as a source of inventions and ideas to be implemented (e.g., heaton et al., 2016; parkes et al., 2014; harrison & graham, 2012). in the context of modern governments emphasising research-based knowledge and innovation in the public sector, a nuanced conceptualisation of such relationships is particularly valuable. 67 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications references bakkeli, v., frøyland, k., & spjelkavik, ø. 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(1999). the innovation journey. oxford university press. towards a practice-based approach to public innovation – apollonian and dionysian practice-approaches njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 this article belongs to the special issue public sector innovation conceptual and methodological implications guest editors: ann karin tennås holmen (uis), maria røhnebæk (inn) towards a practice-based approach to public innovation – apollonian and dionysian practiceapproaches lars fuglsang* department of social sciences and business roskilde university, denmark email: fuglsang@ruc.dk *corresponding author abstract this paper discusses how a practice-based approach to public innovation can provide an alternative, critical means of looking at public innovation. it unravels two ways practices can exist in relation to public innovation: apollonian and dionysian practiceapproaches. the apollonian practice-approach is purposeful, speaking of the actors’ plans and interests and the rules of the game. in contrast, the dionysian is a more spontaneous, bricolage-like approach to innovation that gathers people in an open space of innovation. given these contrasting approaches further illustrated through two case vignettes, the paper argues that public innovation transpires not only through purposeful practices and plans but also more contextual public services changes. research needs to capture both of these approaches and explore their impact on innovation. the paper concludes by outlining a research strategy for investigating practice-approaches in public service innovation and how a practice-based approach can add to our understanding of public service innovation. keywords: public innovation, collaborative innovation, practice-based theory, bricolage, public-private collaboration. 2 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications introduction public innovation literature tends to describe innovation as consensusoriented processes that engage various stakeholders in developing new, joint solutions to common problems (torfing, 2016; wegrich, 2019). the literature describes several activities of co-creating, co-constructing, co-innovating, coproducing and co-designing public services in light of new networked and collaborative governance arrangements involving multiple actors (bryson et al., 2017; osborne et al., 2016). however, to not lose sight of the rich interests and experiences that actors invest in these practices and relationships, as well as the risks they run, there is a need to find research vocabulary that captures and identifies the wider practices of innovation and collaboration, including the potential tensions and dynamics between them (fuglsang and rønning, 2015). accordingly, this paper discusses how a practice-based approach to public innovation can provide an alternative, critical way of looking at public innovation. the paper explores how such an approach avoids some pitfalls of stressing only the normative and consensus-oriented descriptions of innovation. there is a need to describe the wider context of innovation. building on previous research on innovation, the paper further proposes to distinguish between two practice-approaches to innovation, which, for the purpose of the paper, are referred to as apollonian and dionysian practiceapproaches. a practice-based approach takes organised activities as the unit of analysis (nicolini and monteiro, 2017). practices are theorised as routinised ways of doing things that order heterogeneous elements into coherent sets (gherardi, 2006). practices hang together via bodily and mental activities, emotions, material things, understandings, know-how (reckwitz, 2002) and teleoaffective structures (schatzki, 2016). innovation integrates these elements in new ways to form new practices. taking an innovation-as-practice approach contributes to public innovation research by exploring innovation as an outcome of any intervention that has a significant bearing on practices (cass and shove, 2017). since practices are intertwined with other practices in complex ways, interventions that affect practices and may lead to innovation could come from multiple directions. for example, medical doctors’ or schoolteachers’ practices depend on both 3 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications professional practices and family practices, citizens’ health practices, transportation practices, and so on. this paper places special emphasis on how actors external to the public sector become involved in public innovation activities in order to better capture the wider context of such practicedynamics. the paper is conceptual and asks the following research questions: what does it mean to state that innovation is practice-based? how can we deal with the issue that innovation is both contained in and disrupts practicestructures? the core of the paper is the unravelling of two different ways in which public innovation activities can transpire in practices: apollonian and dionysian practice-approaches. these practice constructs extend previous research on service innovation as either structured, formalised and contained or less formalised and emergent (fuglsang and sørensen, 2011; skålén et al., 2015). the apollonian practice-approach is a structured approach whereby innovation is contained in formalised processes and plans within a practice context. the dionysian practice-approach is a more playful, spontaneous and bricolage-like approach to innovation that brings people together in an open space of innovation. the two metaphors are ideal types used as sensitising devices to bring the practice dynamics of innovation to the fore. the paper is structured as follows: section 2 describes how innovation is defined in the literature, situating the paper in the tradition of networked/collaborative innovation. section 3 focuses on the practice-based approach, which conceptualises four (apollonian and dionysian) practiceapproaches to innovation. section 4 presents two brief case vignettes to situate the practice-based perspective in a practical context. the concluding section discusses the paper’s contribution and future avenues for research. innovation in the public sector innovation is usually defined as the realisation of a new idea in practice such that it has an impact on an organisation or in the market. according to the innovation research tradition (cf. oslo manual; oecd, 2005), an innovation needs not to be new to society to count as innovation. however, it must be perceived as new by a significant number of relevant actors in an organisation (hartley, 2006). innovation represents step-changes or ‘jumps’ in the way problems are viewed and solved (hartley, 2006; sundbo, 1997) and must be perceived by key stakeholders as a way of changing practice in a significant 4 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications and lasting way to be considered innovation. innovations can, however, be small, incremental step-changes or larger, radical changes. finally, innovation is not the same as improvement – an innovation may or may not be perceived as an improvement. innovation has been described as driven by single entrepreneurs as well as research and development; however, this paper adopts an understanding of innovation as open, interactive, distributed processes involving many actors who change over time (fuglsang, 2008). service innovation processes are also described in the literature as combinations of 1) structured, formalised and sequential processes and 2) more informal and emergent processes (skålén et al., 2015). in the private sector, innovation can be driven by the interpretations of management and employees of market changes and competitive opportunities. in the public sector, innovation can be driven by fiscal constraints, the political system and the demands of users/citizens for high-quality public services, as well as employees’ problem-solving activities (fuglsang and rønning, 2015). the public sector has traditionally been regarded as bureaucratic, professionoriented and not very innovative, with silos between different areas and tasks that make it difficult to adopt outside ideas and innovations and significantly create step-changes that change the rules of the game. however, lately, there has been a greater focus on innovation in the public sector as a special way of developing policies, public services and public value. the literature on public innovation links innovation to three governance paradigms (hartley, 2005; torfing and triantafillou, 2013). the first is traditional public administration (tpa), where innovations come about as large universal innovations (hartley, 2005) developed by policymakers. the second governance-innovation nexus is new public management (npm), which represents the introduction of management and competition principles from the private sector; innovation concerns changing organisational form. finally, there is the newer type of network-based governance (hartley, 2005), where innovation takes place on all levels through interactive and networked processes involving many interdependent actors across sectors. this paper assumes the relevance of the latter approach. the literature further describes collaboration as a driver of public innovation (sørensen and torfing, 2012; torfing, 2019). relevant innovations are more 5 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications likely to emerge from exchanges of experiences, ideas and opinions among interdependent organisational actors than single actors alone (torfing, 2019). a critique of this approach, however, suggests that collaboration can lead to conflicts of interest or create over-alignment among actors. neither is good for innovation as it prevents action or hinders critical dialogue concerning change (wegrich, 2019). notably, public employees are not easily mobilised for collaborative innovation processes and do not quickly, spontaneously or simultaneously make sense of new, innovative roles. it has been suggested that leadership is a key activity that may provide the overall narratives of change and that leaders can act as convenors of relevant actors, facilitators and catalysts of innovation processes (torfing, 2019). nevertheless, a better understanding and analysis of the relationship between collaboration and innovation is still lacking. what processes of collaboration and coordination can spur innovation, as seen from a practice-based perspective? the concepts of collaborative innovation, networked governance and new public governance are closely related to several other concepts that also emphasise co-creation activities between relevant actors. the literature mentions different activities of co-production, co-creation, co-design, coinitiation, co-construction, co-innovation and value co-creation (osborne et al., 2016; voorberg et al., 2015). one contribution from the literature involves emphasising the user’s role as a citizen and service recipient (grönroos, 2019; osborne, 2018; osborne et al., 2016). in service production, the user must do part of the work, such as schoolchildren doing their homework. co-production can also involve more deliberate, organised and rule-based forms of user participation in service delivery. some authors distinguish between co-creation and co-production. co-creation denotes co-innovation with users, whereas coproduction denotes co-implementation of services (voorberg et al., 2015). the literature also draws on the service marketing literature to further capture how users can invite the service provider into his/her value-creation process (grönroos, 2019; osborne, 2018), such as a patient telling a doctor about a treatment’s value or loss of value. how public innovation activities capture users’ value creation, given the asymmetric power relations in public services, provides a further puzzle concerning networked and collaborative innovation. practice-based approach to innovation a practice-based approach stresses the messy reality of everyday life and the actual practices of innovation, emphasising the difficulties in containing the 6 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications knowledge, values and interests involved in an innovation process within a single practice structure (fuglsang, 2018) as innovation is dependent on and affects various intertwined practices. in the recent practice-based literature (building on anthony giddens and pierre bourdieu), practices are defined as ways of doing, saying and ordering heterogeneous elements into coherent sets (gherardi, 2006) established over time. they hang together through bodily and mental activities, emotions, material things, understandings, knowhow (reckwitz, 2002), and teleoaffective structures, that is, socially acceptable ends, beliefs and tasks (schatzki, 2002). they are also described as being constituted by procedures, background understandings and emotionally charged engagements integrated into a unified practice (echeverri and skålén, 2011; warde, 2005). practices evolve and transpire in organisational life in and around organisations. they are stable and mutually coordinated over time and contain deep and partly tacit knowledge on how to define and solve problems. however, practices can be complex and ‘compound’ (warde, 2015), that is, influenced by multiple underpinnings, which makes the coordination of individual performances and collective practices difficult (warde, 2015) since practices are developed and reformulated in social and individual contexts. the outcome of a practice can be fuzzy and unpredictable on account of these intersections. the actors involved must gain access to knowledge about how a practice can be carried out from other practitioners; and they rely on individual tastes, habits and resources, as well as those of others. knowledge about how a practice should be performed is not necessarily a clearly formulated system of ideas on which everyone agrees and is available in its entirety and can be maintained consistently. sometimes, practitioners must improvise without solid ideas about how a practice should be carried out. furthermore, different practices mutually intersect in wider practice-bundle arrangements (schatzki, 2016) and where many new constellations are emerging. pantzar and shove (2010) describe innovation as the integration of mental images, skills and material resources to form new practices. actors may draw on congruent or incongruent elements of practices, which may create or destroy the intended value of a practice (echeverri and skålén, 2011), for example, when different perceptions of a practice clash. these ideas illustrate that practices must be understood as incomplete, dynamic, collective and intertwined phenomena. they evolve in constrained but pragmatic ways as actors attempt to create and re-create the value and 7 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications purpose inherent to a practice (e.g. the value of playing music or providing home-help to an elderly person). innovation can be understood as interventions that lead to the creation of new practices, but innovation processes are not necessarily contained and stabilised inside-out in one single clear practice structure. the scope for practice development differs from context to context, raising questions about how the contributions of various actors and interventions in practice development can be effectively described. thus, practice-based theory potentially provides an alternative understanding of innovation as something that transpires in many types of activities rather than in structured innovation processes. what the innovation concept adds to the lens through which we view practice is the notion that certain interventions can introduce ‘significant differences into the world’ (schatzki 2019, p. 82). whether they count as innovations is, however, dependent on whether the relevant actors ascribe such meaning to them. the distinction between the apollonian and the dionysian practice-approaches to innovation can be utilised to illustrate two types of approaches for developing and implementing innovations. this distinction has a long theoretical history. it has been used in organisational research (cf. mcgillivray, 2005; westwood, 2004) to describe two extreme organisational experiences in governance and self-governance: the controlled and the subversive. the concepts have also been used to describe the social trend for youth culture to worship the dionysian principle (maffesoli, 1998). likewise, it has been used in anthropology to describe certain cultures’ celebration of breaking from cognitive routines (benedict, 1961). for nietzsche (2000), the apollonian and dionysian approaches referred to artistic practices of creation that mimic dreams or intoxication, respectively represented by the visual arts and music. however, in some of these different approaches, metaphysical generalisations are prevalent. for the purposes of this paper, the concepts are used more metaphorically as labels for two public innovation practice-approaches. these metaphors advantageously capture the complex interdependence between the contained and subversive dimensions of innovation. the apollonian approach represents a structured, controlled approach to innovation within a practice through which innovation can occur along controlled sequential stages. the dionysian approach signifies a more spontaneous, bricolage-like approach to innovation that brings people together in an open space of innovation, potentially in a more rebellious manner. the apollonian practice-approach can describe 8 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications processes of innovation in which actors discipline themselves to be oriented towards specific structures of ideas and purposes of change. conversely, in the dionysian approach, actors are less contained by the structures and ideas inherent to certain practices. instead, these form a heterogeneous, compound set of resources and underpinnings that actors can draw upon. it is tempting to describe innovation in tpa as dominated by the apollonian practice-approach, since public innovation is politically controlled and governed by public rules and ethos and professional practice-systems. however, whether this accurately describes how policies and practices are formed in any organisation is questionable (carstensen, 2011). nonetheless, the apollonian approach can still drive professional actions. actors who see themselves as subsumed under injunctions of publicly recognised practices may aim to develop and change them in a structured manner. however, the dionysian metaphor describes the complexity of practices and difficulties in creating new practices in a straight-forward way since innovation has the potential to cause turbulence (ansell and trondal, 2018), chaotic states, contradictions and paradoxes with which employees and managers must deal. it also denotes the attraction to other injunctions, such as aesthetic practices (strati, 1992) – e.g. smells, tastes or visual impressions – that attract or repel practitioners. for instance, gherardi (2009, p. 543) reported how, in a study of us nursing homes, it appeared that staff members were routinely required to perform tasks that they viewed as repugnant and disgusting, such as the removal of faeces. such aesthetic aspects can be seen as organisational life facts that affect the approach and resolution of problems. to nuance the framework somewhat, it is relevant to subdivide the dionysian innovation approach into three aspects: the pragmatic, aesthetic and subversive. table 1 summarises these four aspects of innovation processes (one apollonian and three dionysian). following the general literature on innovation, because we assume that innovation takes place as a collective process, it is relevant, for example, to develop categories for how actors in these approaches potentially align around a common innovation activity; how the practice-approaches organise the innovation process; what kinds of innovation leadership and power they provide to support the innovation process; and the imagined impact of these innovation processes, (e.g. whether they produce incremental or systemic/radical innovations). following the above reflections, in the apollonian practice, actors align around a practice 9 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications and structure of ideas (e.g. a professional practice or broader teleoaffective structures), and the innovation process is contained within this structure of practice. in the pragmatic (dionysian) approach, actors align around a common set of resources, and the innovation process is about solving problems on the spot more informally, thus building structures from events in a bricolage-like manner. in the aesthetic (dionysian) approach, actors assemble around a common taste, and the innovation process constitutes joyful or distasteful events. in the subversive (dionysian) approach, actors provoke changes, thus leading to new unpredictable innovations. table 1 four practice-approaches to innovation apollonian dionysian (pragmatic) dionysian (aesthetic) dionysian (subversive) collaboration and alignment alignment around a common practice and structure of ideas alignment around a common cocreated repertoire alignment around a common taste alignment around a will to change and push limits the innovation process building innovations inside-out from structures of ideas in a sequential way building structures from events unfolding innovation and creativity through aesthetic events and joy/repugnance provoking change leadership and power containing innovation activities within a formalised, structured process and practice protecting people’s access to and dialogue with their resources influencing and manipulating people’s taste influencing people’s sense of boundaries impact and visibility of innovation high, predictable low medium high, unpredictable 10 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications these four practice-approaches (table 1) outline how innovation processes may happen. as suggested, the different approaches can be simultaneously present in the same case, and actors can shift their attention between them over time. this intertwining of different practiceapproaches to innovation is also described in the general innovation literature. however, the practice-based model, rather than looking for single factors that can explain innovation, suggests that there are intertwined complex and paradoxical ways leading to innovation; this is rarely described in the innovation literature. case vignettes the method applied for the case-vignettes was a qualitative-interpretative one, meaning that an exploratory research strategy was applied. the case study approach was undertaken as a means of asking ‘how’ and ‘why’ questions, allowing for investigation of the broader setting and context of a particular phenomenon beyond the single practice (flyvbjerg, 2006). interviews were conducted with core actors in two case organisations (table 2), and key documents and videos were analysed. interviews were taped and partly transcribed. respondents were asked to talk about incidents and experiences involving innovation, following a phenomenological-interpretivist research tradition (fuglsang, 2017). case reports were written for the two cases and approved by the case organisations. the two case vignettes, as presented here, are not full case studies but illustrative cases used to locate the framework in a practical context, enabling further reflections on future research avenues. the focus was on investigating the experiences of innovation in the case organisations. the cases were selected as part of an eu h2020 project on value co-creation in public services (see disclaimer). here, public services were interpreted in a broad sense both as specific service functions produced or co-produced by publicsector organisations and, more broadly, as public tasks that can also be developed and carried out by external actors. 11 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications table 2 data collected for the case vignettes type of material material case 1 material case 2 interviews one semi-structured interview with the 1) the ceo and 2) design and method director from the llorganisation. one semi-structured interview with a chief consultant at a university hospital collaborating with the ll-organisation. one semi-structured interview with the design and method director from the llorganisation. one semi-structured interview with the senior project leader from the llorganisation. one semi-structured interview with the ceo and founder. one semi-structured interview with a person employed on special flexible conditions (supported by the government). one semi-structured interview with 1) the director of communications and 2) the department manager of the collaborating partner organisation. documents a written description of the innovation methodology of the living lab, provided by the ll-organisation (31 pages). a written description of the specific ll project around a hospital, provided by the llorganisation (79 pages). three videos where the ceo and founder lectures about the organisation and its worldview. three documents describing the organisation and its partners. an article authored by a journalist. the organisation’s website. notes/observations notes from a kick-off meeting. observation of a guided tour in the neighbourhood, including the activity house where the organisation is located. 12 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications the cases were selected based on the following criteria. both organisations work with collaborative innovation processes and see themselves as part of wider systemic changes creating value for society at large (i.e., public value for society). both case organisations are private organisations working in the context of public innovation. thus, they are believed to be critical cases of intersecting practices. the two organisations also differ in some important respects, thereby presenting the robustness of the data across case contexts. case 1 is an organisation that works directly within the public innovation sector. case 2 is an organisation that works more independently, with a vision of producing societal/public value by collaborating with public and private enterprises case 1 – transforming public health care case 1 studied a consultancy house that has developed a distinct methoddriven approach to public innovation to spur innovation in public health. it has evolved in the context of a middle-sized danish municipality. the method is very structured and comprises three innovation labs: a core lab involving key decision-makers from host organisations in the initial set-up of an innovation process; a trusted user lab engaging employees and citizens in service design processes to develop solutions to the strategic problems outlined by decisionmakers in the core lab; and a scale lab for co-implementing innovations with real users. the case study included an innovation lab set up in a smaller town and its hospital to change health care priorities and solutions. the process was prepared in consultation with the main stakeholders, the hospital and the municipality. in this case, citizens were selected to become part of three ‘street labs’ from different parts of the town. informational meetings were held with citizens, and a dinner was organised as a community event. the street labs became the basis for involving citizens in formulating 13 insights and 4 visions of health care. citizens from the street labs further tested possible solutions to these visions created in collaboration with the local university and the hospital. apollonian approach case 1 thus involved working with a clear and distinct innovation method supposed to create significant changes in health care practices, making it easier for patients to stay at home and consult with the hospital. the 13 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications consultancy house asked the host organisation (the hospital) to frame the problem, thus seeking to create ownership of the innovation process and contain it within the wider system of practices of the hospital in order to change these. however, the case organisation was convinced that there is a need for fundamental changes in the healthcare system to enable changes in citizens’ healthcare behaviour: we just need to find great solutions which are as radical as possible in relation to the organisation and solve the fundamental problems (head of design and method). we need to change the entire operation of the society […] you have to interpret the law to the edge. […] ... how can we as a society tackle those issues (increasing numbers of ageing and elderly)? we have to do things differently; there is not enough money (ceo). the case organisation thus positioned itself as a catalyst for such overall changes, albeit within the overall structure of a predesigned method that ensures that the main stakeholders control the process. by collaborating with public health organisations, it aims to develop new and distinctive solutions that have a bearing on people’s practices. as a consultancy house, the case organisation specialises in organising an innovation process professionally. it essentially argues that there is a need to involve experts to organise and control systematic innovation in public innovation processes in order to significantly impact practices. dionysian-pragmatic approach however, the innovation process is not easily controlled. a more open and pragmatic approach is emphasized because the journey towards the overall goal is highly uncertain, and outcomes may be blurred. the municipality, which is one of the main stakeholders, is not easy to convince; reference must be made to potential financial benefits: we try walking into the city council and say: ‘we have created a project with some private people’ ‘when does it end?’ ‘never’ ‘what is the cost of it?’ ‘we don’t know’ ‘what do we get out of it?’ ‘nobody knows’ good luck with that [...] what we have to prove towards [the town] is that the external financing sources are large. [the town] has a better chance of a larger share of the investments in the future than other municipalities (ceo). 14 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications the settings in which the project takes place can be confusing and heterogeneous, so improvisation and pragmatism are needed to navigate alternative injunctions from the host organisations’ practitioners and use them as resources at hand rather than remaining too firm about specific ideas, as the excerpt below demonstrates: we were totally shocked when we entered the meeting: there were 17 people, three from the municipality, three from [the case organisation] and the rest from [the hospital]. there was an incredible number of hospital people, from all professional backgrounds [...] i had no idea what was going on there, it was very surprising. because we had not agreed on this setting [...] p leaned forward – he’s a very charismatic director – and said, ‘please finish this conversation, so we can get to talking about something entirely different’, and i was fine saying, ‘let’s not bother then’ [...], and he says ‘we are building a city!’ (ceo). dionysian-aesthetic approach this approach to innovation is influenced by more aesthetic practices, meaning that it is difficult to just argue for the systematised innovation process as a needed and important process. for example, the strict system-driven innovation method is essentially rather boring: …should be called system-driven, really boring bureaucratic innovation (ceo). involving the citizens in the street labs was not straightforward; it entailed some work to attract them, which was ethical as well as aesthetic in nature. several of the interviewees stressed the importance of a community event where they served chilli con carne for the citizens, as well as other ‘tricks’: then we had an evening where people came to eat chilli con carne; some had a barbeque, different events and activities where people could join voluntarily and discuss these things – kind of a community meeting […] we used different tricks for different areas. (chief consultant at a university hospital) thus, recruiting people for innovation sometimes requires tricks that make the practice set-up for the innovation more compounded and complex. thus, a boring innovation process can be transformed into a social event that people may enjoy. 15 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications dionysian-subversive approach riot aspects are visible, related to the focus on pushing or transgressing the limits of the healthcare system without knowing exactly where to go. this kind of wild entrepreneurship, which the ceo called ‘provocations’, has to be constantly balanced with containing the innovation process within the extant practices: it is about balancing the provocation. some can handle being provoked a lot more than others, and if you provoke the professionals at the wrong time with the wrong provocation, they will just leave. then nothing will move forward. however, the interviews show that the provocations are of great importance to the innovation activities as a way of prompting innovation. in the interview, the ceo also provoked the interviewers by offering surprising views and demonstrating a strong willingness to break boundaries. the consultancy house was founded without a clear idea of how the public sector would develop but was based on the feeling that ‘intelligent’ services were needed after a major municipal reform: ‘after the structural reform in which the municipalities were merged, we thought: “the world needs a new consultancy house”’ (ceo). however, it was only through concrete interactions with the municipality that certain needs were formulated, such as seeing the city as a living lab for healthcare changes with a commitment to asking citizens. case 2 – towards new inclusive forms of co-production the organisation studied in case 2 does not directly produce public services, but it seeks to define a new space for inclusiveness and co-production that impacts public service organisations and public value creation. among others, the organisation studied in case 2 has collaborated with a public activity centre and a hostel centre that provides temporary accommodation for adult homeless citizens who have problems with dependence on alcohol or drugs or both. the organisation is a honey-producing social enterprise promoting a philosophy of co-production and inclusive community. a source of inspiration that was stressed in the interviews was donna haraway’s (2016) philosophy of inter-connections across and between sectors, species, spaces and social communities. the enterprise rents beehives to public, private and social organisations in the capital of denmark. it also conducts beekeeping and honey production 16 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications courses in schools and non-profit housing organisations and organises workshops and events at its location situated between a public prison, a home for homeless people and an activity centre for people with alcohol and drug problems. the organization has also worked with two homeless persons from an employment centre, a collaboration that was terminated. apollonian approach the organisation promoted an overall vision and task of systemic and paradigmatic change. the founder spoke of a needed paradigm shift in how all organisations and all life forms operate and organise themselves. a paradigm shift means a fundamental shift in the way we organise production to deal with problems of climate change as well as changes in the labour market. ‘the direction we are going is creating institutions where we are changing people from being consumers to being co-producers’ (ceo). referring to haraway (2016, p. 136), the founder/ceo describes the emerging new practices as follows: ‘we must insist on lives lived and stories told for flourishing and abundance, in the teeth of rampaging destruction and impoverishment. we must cultivate the ability to re-imagine wealth, learn practical healing of bodies, minds and spaces and stitch together improbable collaborations.’ the ceo argued that through pollination and a relationship with humans, honeybees could stimulate curiosity, spur people to cut across boundaries and challenge normal categories of consumption and production. as such, bees, humans and plants become multi-species teams across societal sectors and silos, connected by meaningful relationships. dionysian-pragmatic approach although this paradigm is specifically adopted as a driver of change and innovation, honey production is just one way to start. a paradigm change must occur through many changes that link people together in an enabling manner: it is easier to act your way into new ways of thinking than to think your way into new ways of acting…we can create structures now that will allow new systems to emerge. this pragmatism does not change the commitment to the overall broad goal but rather lies in the method of innovation. there is no one way of creating 17 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications inclusiveness but many possible paths. the indignation concerning how bad things are creates an impetus for diverse groups to join in a journey of change in which diverse and surprising talents constitute a set of resources for change. dionysian-aesthetic approach the aesthetic, artistic dimension of community and community building is strongly stressed by this enterprise through its emphasis on honey, bees and flowers and by inviting volunteers with artistic skills such as brewing the ‘most fantastic mjød (mead)’ or ‘ideas of how to make baklava with honey from the rooftops. … all these peculiar artistic passions that people have outside the conventional work market, outside any conventional measurement of what growth should be’ (ceo). honey is not ‘seen as a product in itself, but as an invitation to plant a flower, to see the environment in a new way, to connect the homeless person or the refugee from syria with the buttered toast and honey that you might enjoy in your kitchen with your children’ (video 1). dionysian-subversive approach how to reach the overall goal is described as an act of ‘staying with the trouble’. the ceo argues that we are living in times of ecological destruction and impoverishment, which call for new ways of organising and producing. this is framed within the mindset of donna haraway (2016), who introduced the concepts of making-kin and making-with, or sympoiesis, which are necessary if we are ‘to stay with the trouble’ of current times (haraway, 2016). to make kin is to engage in logical relations across species based on the notion of sympoieses, that is, ‘collectively producing systems that do not have self-defined spatial or temporal boundaries’. the reference to harraway implies a rejection of the system boundaries usually placed between people, public/private organisations, humans and non-humans. summary of the two case vignettes both cases contain elements of the apollonian and dionysian approaches to innovation. they both depart from the aim of making radical changes by introducing changes that are contained within a practice structure. in case 1, the change process was contained in host organisations (the public hospital, the municipality), and in case 2 in wider goals of co-production and ‘sympoiesis’. however, both cases are in continuous dialogues with people and resources about what these changes should look like and how to carry 18 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications them out. there is an element of chaos, riot and paradox in both cases because they need to innovate themselves through to changes without knowing exactly where they are going. the aesthetic dimension is a clear aspect of change that guides action in one of the two cases, whereas it is a more limited resource in the other case. discussion and conclusion this paper examined two intertwined ways in which innovation can transpire in public service practices: the apollonian and dionysian practice-approaches. the apollonian approach describes actors as aligned around a practice structure or ‘teleoaffective’ structures, seeking to contain innovation within these structures. the dionysian approach depicts actors as aligned around heterogeneous sets of ideas and materials that build structures from events, navigating through the emotional and aesthetic bonds of attachment and having the will to change without knowing exactly where they are going. the paper contributes to practice-based research by pointing out the need to deal with these wider practice-dynamics. practice-based research has mostly focused on the innovation of practice (cf. brown and duguid, 1991; pantzar and shove, 2010). arguably, there is a need to apply practice-based research to uncover the actual practices of innovation, especially, how these practices are not limited to local and situated changes but take place in larger systemic contexts. the framework suggests an intersection between contained, formal innovation practice-approaches and more informal wide-ranging engagements in practices. the answer to what it means to say that innovation is practicebased, in response to the first research question, is that practice-approaches co-exist in complex, paradoxical ways that pose challenges for management and public democracy and for the identification of interventions that lead to requested significant changes. our second research question was: how can we deal with the issue that innovation is both contained in and disrupts practice-structures? the case vignettes show that innovation activities are contextually embedded nexuses of actions in which public-sector actors potentially lose authority. more specifically, in a traditional public administration framework, one would expect public innovation activities to be universal, large-scale and aligned around 19 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications policymakers’ policies and ideas and contained in professional practices. however, in the cases, practices are compound, mutually intertwined, and complex; hence, innovation transpires not only in local practices and encircled nexuses of intervention and change but also in actions outside the scope of policymaking. provocations and aesthetic, pragmatic techniques that sometimes go under the radar of policy are used to prompt action in these larger contexts. collaborative approaches to innovation spur actions that are interconnected with other actions in complex chains of events. the answer to the research question is that research must comprehend and conceptualise these larger chains of actions much better and capture the broader set of emotions, visions and beliefs that make them hang together (schatzki, 2016, 2019). one avenue for research is to investigate how public democracy can be conceptualised and maintained in such larger innovation contexts. what are the robust forms of democratic decision-making in system-wide innovation processes? are, for example, hybrids of representative and participative democracy relevant? or do we need new concepts to describe how democracy (and power) is embedded in practice-dynamics? research needs to scrutinize how decision-making is distributed across these processes, how responsibility is shared across many actors, where the responsibility of policymakers lies, and what types of leadership and management are required. future research should investigate the broad, rich interest in public innovation activities not limited to actors’ alignment around specific practices. future avenues of research along these lines can include the following two approaches. first, more empirical research is needed to understand the intertwined innovation practices that go beyond collaborative or consensusoriented approaches. we need to know more about how practices impact each other and how interactions between actors across various practices can be described conceptually; how practices with formal authority and direct policy power in, for example, healthcare are intertwined with family practices, transportation practices, eating practices, experience practices, and so on. zooming in on small nexuses of change but also zooming out to view the larger structures and finding relevant concepts to describe them is required (nicolini, 2009; schatzki, 2016). second, since innovation in the public sector is especially complex, with no single actor or single solution appearing to be able to solve every problem while enabling policymakers to remain in control, 20 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications further research is needed to understand and reconceptualise how management, leadership and democracy can transpire in such structures. the strength of the practice-based view is its ability to speak to both policymakers and managers. it can speak to policymakers by highlighting contextual interventions required for certain practices to change; it can speak to managers by identifying contextual innovation activities that go unnoticed by management and policy. the approach limitation is reached when practicebased analysis leads to endless descriptions of innovative practices, thereby losing sight of the bigger picture. this is why practice-based theory needs to develop sharp practice-dynamics conceptualisations that can speak to and be picked up by policymakers and managers. a further limitation of the present study is that it deals with only two case vignettes to obtain the substance of the concepts. full and detailed case studies are needed to explore the wider, rich context in which public innovation occurs – to abductively conceptualise pivotal practice-dynamics in decision-making processes concerning the nature of interventions that lead to significant changes. disclaimer this project received funding from the european union’s horizon 2020 research and innovation programme under grant agreement no 770356. this publication reflects the author’s views only, and the agency cannot be held responsible for any possible use of the information contained therein. 21 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications references ansell, c., & trondal, j. 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(2004). comic relief: subversion and catharsis in organizational comedic theatre. organization studies, 25(5), 775-795. https://doi.org/10.1177/0170840604042414 microsoft word tilpasset mal 3821 njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2020 possible tensions between individual needs and collective treatment methods for substance use disorders and addiction yngve herikstad* faculty of health and welfare sciences østfold university college email: yngve.herikstad@hiof.no *corresponding author haakon tuman falck faculty of health and welfare sciences østfold university college mia kristin hoel faculty of health and welfare sciences østfold university college anders dechsling faculty of health and welfare sciences faculty of education østfold university college email: anders.dechsling@hiof.no abstract the inpatient collective treatment model has strong historical roots in the treatment of people with substance use disorders in norway. it focusses on safe and drug-free environments that support growth and development in individuals admitted for treatment, emphasising the community as method idea. however, little is known about how flexible such treatment approaches are when adjusting to individual treatment needs. here, we 176 njsr – nordic journal of social research vol. 11, 2020 explore how such individual treatment needs are safeguarded within the framework of collective inpatient institutional settings by interviewing treatment staff members who hold a bachelor’s degree in social or health sciences (n= 5). the focus of our analysis is on exploring the possible challenges that may occur as a result of competing conflicts between individualised person-centred treatments in institutional settings that aim to build strong communities. our findings here are summarised in three major themes: (a) individual treatment needs face possible neglect with strong adherence to the treatment programme, (b) too rigid an interpretation of community as method may lead to attributional errors and a possible rejection of the client and (c) the collective paradigm faces important challenges regarding individuals with cognitive deficits. to the best of our knowledge, this study is the first to shed light on the tensions regarding individualised person-centred treatment arrangements within the collective treatment paradigm. thus, our findings may provide increased awareness and better understanding of this problem and should inform future research questions, as well as professional education and clinical practices. future research should focus on how to balance individualised treatment within the framework of inpatient collective treatment. in addition, important clinical implications relate to how such individualised person-centred treatment may contribute to better treatment quality and outcomes in programmes applying the community as method idea. keywords: substance use disorders, collective treatment, inpatient treatment, community as method, individual treatment, cognitive deficits, therapeutic alliance introduction the treatment of people with substance use disorders has different designs in the norwegian healthcare system. since 2004, the responsibility for the treatment of various substance use disorders has been transferred from the local municipalities to the centralised and specialised healthcare systems provided by the state. a new sector called tsb (a norwegian abbreviation for transdisciplinary specialised treatment) within specialised state healthcare now provides integrated specialised treatment to people with substance use disorders (ose & pettersen, 2014; ravndal, 2007). tsb has different layers of intervention, including acute detoxification, outpatient treatment, shortand long-term inpatient treatment and post-treatment care of various lengths. among these, long-term inpatient treatment is by far the largest, accounting for 177 njsr – nordic journal of social research vol. 11, 2020 around 80% of tsb’s total costs. further, long-term inpatient treatment within tsb consists of both public and private institutions, where private institutions provide around 60% of the total number of treatment days/nights. the institutions are designed in various ways, and within tsb, people with substance use disorders can be offered different kinds of treatments, such as therapeutic community models or inpatient collective treatment with different kinds of aftercare arrangements (ose & pettersen, 2014; ravndal, 2007; steiro et al., 2009). the inpatient collective treatment model has strong roots in the treatment of people with substance use disorders in norway, especially for adolescents but also for adults. the collective paradigm, as we label it here, places a strong emphasis on the potential of the collective group as a key treatment component and has its roots in the hassala movement of the 1970s in sweden (kolltveit & lange-nielsen, 2013). traditionally, the norwegian collective treatment model has had a strong ideological basis of implementing methods of social pedagogy and focussing on therapeutic relationships and the institutional community as a basic method. further, the collective treatment model’s ideology comprises the basic assumption that the building of relationships with co-clients and treatment staff in a safe environment and establishing a strong sense of affiliation with the institutional community will strongly influence growth and development (kristoffersen et al., 2011; ravndal, 2007). thus, although the collective treatment approach is mainly a scandinavian phenomenon, it is influenced by what therapeutic communities label community as method (de leon, 2000; de leon & wexler, 2009; kolltveit & lange-nielsen, 2013; national institute on drug abuse [nida], 2015). people living together in a drug-free environment is considered a key component. de leon (2000) emphasised that living in such therapeutic communities, together with other people who engage in own and others’ change processes, is an important factor concerning their effort to change their destructive patterns of substance abuse and identity building. 178 njsr – nordic journal of social research vol. 11, 2020 mutuality in help processes is a key feature, and the therapeutic environment that is being shaped in such arrangements provides multiple opportunities for changing one’s lifestyle and identity through various activities, social interactions, bonding, support and so forth (nida, 2015). the collective treatment model also emphasises the community as method idea by arranging the environment so that the treatment staff live with the clients, participating in the daily lives and routines of the institution (ravndal, 2007). one challenge for the concept of community as method may come from an emphasis on how clients adjust to the institutional framework and specific social rules of conduct in the institution. if the goal is to build a prosocial environment that represents strong affiliation and allows clients to experience safety and support, adherence to the institutional rules of conduct is important. however, a lack of flexibility in adherence could also be characterised as a pitfall. research on treatment outcome predictors suggests that rigidity of treatment components may attenuate alliance and increase resistance in clients (wampold, 2015). further, resistance and a lack of therapeutic alliance may represent challenges to the client’s acceptance of treatment. for instance, chen et al. (2015) found that young people who had dropped out of therapeutic community treatment generally experienced what the authors labelled antagonistic interactions between adolescents and staff. the informants described unjustified punishment and rigidity concerning the institutional rules and a lack of sensitivity from staff members regarding their situation. this resulted in the adolescents engaging in even more resistance, which evoked further reactions and so forth, and finally, their dropping out of treatment (chen et al., 2015). the antagonistic interactions described above are in accordance with what brorson et al. (2013) found in their systematic review regarding important risk factors for people with substance use disorders who drop out of treatment. in addition to patient-related risk factors, such as cognitive deficits, personality 179 njsr – nordic journal of social research vol. 11, 2020 disorders and young age, they identified therapeutic alliance as a crucial factor (brorson et al., 2013). thus, a rigid emphasis on the community as method in a collective treatment model may face challenges regarding important treatment principles (i.e. therapeutic alliance) in the treatment of people with substance use disorders and other patient groups. both domestic and international guidelines state that treatment efforts and interventions should be arranged according to the client’s current health situation and thus be individually assessed, arranged and adjusted (helsedirektoratet, 2011, 2017; nida, 2014). for instance, nida in the united states points out that treatment should be individually tailored to the person’s unique needs, and this tailoring should address the person as a whole rather than just focussing on substance use issues (nida, 2014, pp. 9–10). thus, treatment plans and the therapeutic arrangement of the environment to facilitate change should be adjusted from the starting point of identified needs on an individual level. for instance, by using national data from a range of therapeutic communities in the united states (n = 345), dye et al. (2012) found that a great portion of the therapeutic communities in the sample admitted clients with various co-occurring disorders. in addition, approximately 50% of the therapeutic communities report that they provide integrated care or treatment. this is an interesting finding, and it shows how the therapeutic communities are adapting and possibly evolving towards a more individual treatment position through a greater use of professionals and various therapeutic interventions within the therapeutic community model (i.e. psychotherapy) and decreasing the confrontational aspect traditionally emphasised in such treatment (dye et al., 2012). in other words, the increased focus on and awareness of individual treatment needs call for an increased understanding that such needs require individual treatment arrangements. however, this balancing between important treatment components (i.e. community as method) and individual adjustments may be demanding. for instance, the client’s need for individual adjustments in 180 njsr – nordic journal of social research vol. 11, 2020 the treatment may stand in direct opposition to the programme’s expectations for the client regarding participation in activities, group treatments and so on, and this may represent important distortions to the institutional community that must be addressed. the complex and problematic co-occurrence of various mental health challenges and substance use problems represents multiple and complex challenges regarding treatment efforts. such dual and complex recovery issues are addressed by ness et al. (2014). in their review, they identify important facilitators and barriers in recovery processes, describing the lack of tailored help as one such important barrier in four out of seven identified studies. thus, how such complex issues are identified and met by professionals on an individual level, suggesting an understanding of the person’s life situation and their need for individualised and tailored help, is considered important in recovery processes (ness et al., 2014). recovery is seen as an individual and dynamic process (slade et al., 2012), and an important feature of the treatment effort is that the treatment or treatment provider should adapt to the person. traditionally, in the treatment of people with substance use disorders and mental illnesses, the opposite has been the case, where such treatment has adopted the view that the client should adapt to the programme (slade, 2009). the conflict or trade-off between individualised treatment and the benefits of community as method represents a frequently discussed, yet not systematically researched, problem field for practitioners. for instance, making important facilitations to individualise and tailor treatment will entail challenges in preserving the community as method idea. this paper aims to contribute to a better understanding of this problem field by exploring the possible tension between the collective treatment model’s emphasis on the community as method and individual treatment needs, how such needs are met and safeguarded in the treatment of the individual in proportion to the institutional 181 njsr – nordic journal of social research vol. 11, 2020 community and what kind of challenges treatment staff face in cases where individual treatment needs must be handled with intervention efforts other than those the collective treatment model posits. method participants we recruited five informants from two private institutions in norway that provide inpatient collective treatment for youth with drug abuse behaviour. the informants had different backgrounds respecting both education and experience and different positions in their respective institutions. three informants had previously established professional relations with the interviewers (authors 2 and 3), while the other two had no such relations. inclusion and exclusion criteria to qualify for the study, the informants were required to be working with clients in institutions providing collective treatment. in addition, they needed to have a bachelor’s degree in health and social science and have worked in their institutions for more than a year. we emphasised variations in the group of informants regarding educational and professional background, sex, and position. data collection and analysis we interviewed the informants using a semi-structured interview procedure. the themes that made up the framework of the interview covered important areas of topics relevant to the research question. the interviews aimed to address personal aspects regarding education and experience, as well as organisational issues. they covered important aspects regarding strengths and weaknesses in the collective treatment’s emphasis on the group as method and how individualised treatment issues are safeguarded. in addition, issues regarding 182 njsr – nordic journal of social research vol. 11, 2020 how the treatment focussed on the prevention of individual-level dropout were addressed. further, the semi-structured interview procedure allowed for indepth exploration of important ethical normative aspects. issues regarding outcomes were also of interest. the resulting framework comprised the interview guide, which we tested with a pilot and evaluated prior to the first interview. the interviews were conducted in offices at the institutions, which served as familiar settings for the informants. the second and third authors were present in all the interviews but alternated their roles in the different interviews. the interviewer asked and followed up the questions and conversation while the other author took notes. we used an analogue tape recorder throughout the interviews, which was approved by all the informants. the second and third authors transcribed the data from the tape recorder, while the first and last authors analysed the data thematically according to the guidance provided by braun and clarke (2006). the interviews were conducted in norwegian. the quotes provided in the results and discussion section were translated by the first and last authors. to reduce the risk of a biased data analysis, we separated the collection and analysis of the data between different authors. to ensure validity and reduce the risk of bias in the analysis process, we applied braun and clarke’s (2006) guidance for conducting thematic analysis of qualitative data. ethical considerations the project (including tape recording) was approved by the norwegian centre for research data (nsd). the data were stored safely, and we followed both the national authority’s and local institution’s guidelines. all participants read a 183 njsr – nordic journal of social research vol. 11, 2020 letter of information and signed the written consent form prior to participation. the interview guide did not contain questions that might elicit negative emotions in the participants; however, they were informed that they could exit the interview at any time without giving a reason and that it would not affect them negatively regarding their relation to the interviewers. results and discussion the thematic analysis resulted in the three following themes: (a) individual needs versus the treatment programme enshrined in the institutional framework, (b) individual lack of motivation and utilisation of treatment efforts and (c) cognitive deficits and treatment methods. we present and discuss the results within these themes chronologically. individual needs versus the treatment programme enshrined in the institutional framework a central principle in professional health and social services is that the interventions and facilitations of such services should be based on the individual needs of the client (helsedirektoratet, 2011, 2017; nida, 2014). this means that, for people with substance use disorders, careful and integrated individual assessment of multiple, important life areas must occur to identify important and specific treatment needs on a personal level, both prior to and upon admission to treatment. this is conducted to ensure that necessary professional help is provided for the individual. however, when committing to treatment in an inpatient institutional setting, the treatment programme will often be enshrined in the institutional framework. this would be particularly important in an inpatient collective treatment model, where prioritised treatment activities have their basis in the regular routines of the day, such as mandatory group activities, group treatment, phase-based treatment progression and affiliation with the group as 184 njsr – nordic journal of social research vol. 11, 2020 a key feature of the treatment ideology (kolltveit & lange-nielsen, 2013; ravndal, 2007). our findings suggest that there is a tension between individual facilitation or design of adequate treatment and the institutional treatment programme implemented for all admitted clients, where the adolescent didn’t manage to tune into a group. didn’t manage to utilise the group therapy, and then our challenge regarding the individual needs becomes so big that we’re not able to help the person here. it is important to address such individual issues, but at the same time, such a narrow focus can indeed represent a threat to the integrity of the treatment ideology and programme. one participant highlighted: if it is only the group [focus], we lose the individual [focus], and if it is too much focus on the individual, then . . . we don’t lose the group, but in a way we lose a lot of the instruments in running a group, thus this balancing act . . . to be able to see both sides, is very difficult, and my experience probably is that we’re more likely to preserve the group rather than the individual [focus]. this tension is critical when it comes to the individual client that displays needs that the institutional setting or programme does not properly meet. certain hallmarks regarding the group as a whole concern knowledge that is clearly important to include in the structure of the treatment programme. the understanding of community as method means that the whole group provides safe and drug-free environments that facilitate strong and supportive relationships (de leon, 2000; de leon & wexler, 2009; kristoffersen et al., 2011; ravndal, 2007). however, people with substance use disorders are a heterogeneous group, displaying a variety of symptoms and often co-occurring 185 njsr – nordic journal of social research vol. 11, 2020 disorders (dye et al., 2012). this requires not only an emphasis on group hallmarks but also the dynamics and interaction of individual factors in relation to treatment factors. hence, the issues regarding attrition from treatment may also be considered a hallmark in the treatment of substance use disorders. for instance, in their systematic review, brorson et al. (2013) found that dropping out of treatment is more common than completion is, and the variables that affect clients dropping out of treatment must be analysed from an individual perspective. specifically, brorsson et al. (2013) found that cognitive deficits, low treatment alliance, personality disorder and young age are important risk factors for dropping out of treatment, suggesting that careful assessment and monitoring of the therapeutic alliance are key factors in preventing such dropout. our findings suggest that collective treatment involves challenges regarding how complex individual needs are handled in the institution. this often results in action that refers to other, more suitable admissions that better fit the individual rather than prioritising treatment interventions in the institutional setting in which the person displays problems. in some cases, these challenges can result in what chen et al. (2015) labelled an antagonistic relationship: he has destroyed enough and now he has to leave, now he should pack his bag—and that becomes very hard. . . . mhm, . . . and i have also been a part of that. individual lack of motivation and utilisation of treatment efforts the staff in an inpatient treatment programme are naturally trained in how group affiliation and the structure of phase-based treatment progression may represent important motivational factors for the clients. they are also aware of how the group and co-clients can provide important support and affirmation to the single client who struggles. our participants addressed this by focussing on co-living therapeutic organisation and group affiliation as important aspects 186 njsr – nordic journal of social research vol. 11, 2020 regarding the shaping of relationships and supportive environments in cooperation with the clients. one interviewee referred to ‘support. the group is doing well in supporting the others, and . . . yes. i think the institutional community, to be able to recognise oneself, support, sharing of experiences’; such statements were commonly made by the participants. how the institutional community can be an important tool in helping others persevere in the treatment is obviously an important feature of the basic therapeutic assumption. however, our interpretation suggests that the treatment ideology, as well as the integrity and preservation of the treatment programme, may also present a risk of neglecting critical individual issues that need special attention. the belief in the treatment programme’s strength and its ability to help people with substance use disorders change their lives may also represent a possibility to make fundamental attribution errors (ross, 1977). this happens when situational factors are neglected or underestimated and there is too much focus on inner factors and individual traits in causal inferences about behaviour. lack of motivation or utilisation of treatment efforts, for instance, will easily be assigned to the client and not the environmental factors of the treatment programme: it is like professional judgements about utilisation of the treatment, about what we do here, because our model is kind of set, so to speak. but it happens that we admit clients that are too ill to be here, and then we have to take action. but as long as they are still here waiting to be admitted somewhere else, we have to try our best to make individual adjustments, not press our programme upon the person. i think we’re pretty good at that. this statement may illustrate our point regarding attribution. other, similar statements are present in our material. often, the client will display behaviour that is regarded as contradictory to adequate treatment progression, leading to interpretations about that person’s motivation and utilisation of the treatment. in addition, such interpretations will sometimes lead to inferences about causality, stating that the lack of motivation and utilisation is due to individual 187 njsr – nordic journal of social research vol. 11, 2020 characteristics. then, to provide adequate help for the person, temporary adjustments and actions are made towards alternative treatment programmes elsewhere. from an ideological point of view, this position makes sense. some clients may disturb important treatment processes for the institutional community and other clients, and it is crucial to take actions to prevent such problems, both to protect other clients and their treatment progression and important aspects of the treatment programme. from an individual point of view, however, this is a problematic issue. the treatment programme is at risk of turning rigid, without displaying the necessary abilities to adjust to the individual’s treatment needs. in such cases, the risk of increased resistance is present, possibly attenuating the therapeutic alliance. as mentioned above, issues of resistance and therapeutic alliance are important factors for how the client accepts the treatment, and they can also function as risk factors for those dropping out of treatment (brorson et al., 2013). in making attributional errors like this, the critical focus is placed on the individual, not the features of the treatment. by not asking how to adjust the treatment to provide necessary help—and instead, attributing causality to an untreatable condition inside the individual that cannot be addressed by this particular treatment programme—this leads to possible rejection and admission into another treatment programme that is regarded as a better fit: so it is about investigating what exists instead of, may another unit provide a better fit dependent on group size, gender, aspects of the treatment, or is it . . . that the person cannot even be in a group treatment programme? then this must be addressed together with the principles for the admission, and we see that these youth are unable to utilise the group treatment or the methods that we use mostly. this is a process that unfortunately often takes too long, especially in cases when we have youths under compulsory admission. then it is extra challenging. 188 njsr – nordic journal of social research vol. 11, 2020 cognitive deficits and treatment methods in substance use treatment it is common among patients to have cognitive deficits(brorson et al., 2013), and there are reasons to believe that there are many unrecorded cases (van duijvenbode & vandernagel, 2019). in some individuals, it might be difficult to assess whether cognitive deficits are caused by innate or acquired factors (e.g. substance abuse in early adolescents). however, the description of the individual’s present situation is important regarding treatment. to the informants’ knowledge, they had each worked with clients with cognitive deficits. one even stated, ‘a lot of clients have cognitive deficits, and when you are able to detect it, you should adjust’. when asked in the interview, none of the informants had a clear answer regarding how to deal with these individuals. the lack of a plan was evident insofar as prevalent answers were to ‘talk’ to their superiors, co-workers and the individuals’ peers. one informant emphasised sticking to the institution’s form: ‘use the group, mirroring, mentalise, again and again and again. if they aren’t too weak, they will eventually learn and correct themselves’. this informant also pointed out that it can be a tough culture in these groups, and when dealing with members who have cognitive deficits, they should be careful: ‘we just have to adjust. start with ourselves, then the adolescents, and hope it turns out fine’. the examples above show a lack of consensus within institutions regarding how to address these clients as members in the group of collective treatment. individual adjustments need to be made within the collective paradigm. the informants addressed limitations concerning these problems and possible solutions to them. however, it seems that the solutions are outside the collective treatment paradigm, as several informants stated that if they are not able to help clients within the paradigm, they have to ‘think about what else is out there’ or ‘think of other solutions’. 189 njsr – nordic journal of social research vol. 11, 2020 all the informants suggested mentalisation therapy as one of the key components of their treatment. mentalisation is defined as a process of making sense of the subjective states and mental processes in others and the self, both psychologically and physically (bateman & fonagy, 2010). individuals with cognitive deficits may have impairments in various mental processes, such as attention, decision making, judgement, , planning and reasoning (schofield, 2018). hence, the processes that mentalisation therapy relies on may be beyond the range of some individuals with cognitive deficits, which leads back to the first theme regarding individual needs. although we have addressed the individual needs versus treatment foundations, we think it is important to emphasise this paradox, which manifests when a treatment method that is based on mentalisation is used for people who may lack the ability to mentalise. when addressing the topic of possible weaknesses concerning the use of mentalisation, the informants revealed a consensus that individuals with cognitive deficits do not always experience a favourable outcome. the informants addressed topics like misunderstanding and resistance towards the method and that these clients not necessarily benefit from the such techniques: the ones with cognitive deficits do not always benefit from it, . . . and it is unfortunate if they're too weak to fit in with a regular group of adolescents. because it is a high temperature, and everything moves quickly [the informants use of the term “high temperature” we interpret as covering meanings of various emotional expressions (i.e resistance, agitation) displayed by participants due to group processes]. another informant stated that, if the individual does not understand the premises, for example, why use groups and so forth, then the individual should not be there: ‘in that case, it would almost be an abuse’. 190 njsr – nordic journal of social research vol. 11, 2020 limitations this study had some limitations. first, the sample was small, and thus, as in all qualitative research, the findings may not be generalisable. further, this study focussed on how treatment staff experience issues regarding the problem field of individualised treatment and community as method; hence, we did not interview clients receiving the treatment. thus, our findings lack important information relating to the client’s perspective. however, important issues/elements were mentioned by the participants, which indicates that there is reason to investigate these issues further. another limitation is that, although interviews were read in random order, anchor or primacy effects (mumma & wilson, 1995) from the first interview read may have biased the authors when analysing the rest of the interviews. a final possible weakness to mention here might relate to translational issues. none of the authors have english as their native language, and the translations of the informants’ quotations should be read with this in mind. summary and conclusion our aim was to explore the tensions between implementing the collective treatment model’s emphasis on community as method and treating the needs of individuals enrolled in the treatment. using a semi-structured interview procedure and analysing in a thematic order, we found indications that these tensions are present and that there are important issues to be further addressed. our study revealed the three following major themes: (a) individual treatment needs face possible neglect with strong adherence to the treatment programme enshrined in the institutional framework, (b) too rigid an interpretation of community as method may lead to attributional errors and possible rejection of 191 njsr – nordic journal of social research vol. 11, 2020 the client and (c) a lack of consensus within the institutions concerning how to adjust to cognitive deficits within the collective paradigm. these themes illustrate important challenges that may occur when attempting to adequately adjust treatment for people with substance use disorders based on carefully and individually assessed needs. moreover, our study addressed how the identified challenges may apply to treatment programmes that emphasise the community as method and adherence to the treatment programmes enshrined in the institutional framework. in our analysis, such challenges were present, and informants displayed a certain lack of consensus in how they described various issues concerning the obvious tension in the space between the collective paradigm and individual treatment needs. these tensions have important ethical aspects regarding the individual patient, as we have clarified in this paper, as well as ethical aspects regarding the collective group. as mentioned above, some patients will display disruptive behaviour within the institutional setting, representing challenges and possible danger to other clients’ treatment processes. the ethical dilemma in these cases is complex. however, as discussed in this paper, we suggest that such ethical aspects should be explored from the individual point of view. the central principle in the treatment of people with substance use disorders is the facilitation of treatment interventions based on careful assessment of the individual treatment needs. this also applies in cases where the client clearly disrupts own and others’ treatment processes. in other words, careful ethical considerations should include that the collective group is a key component of the treatment programme and that individual treatment needs are not neglected to protect various treatment components or interventions. in cases where the client is admitted into another treatment facility that is considered better able to provide adequate treatment for that person, this should be a result of careful assessment from an individual point of view, ensuring that important treatment needs are safeguarded. such processes should imply thorough considerations 192 njsr – nordic journal of social research vol. 11, 2020 of important ethical aspects and aim to prevent unwanted rejection of the client due to attributional factors. the importance of the therapeutic alliance is considered a key element in the treatment of people with substance use disorders, and this issue was also stated by our informants. however, the safeguarding of individual treatment needs will require flexibility in the adherence to the treatment programme, and such a lack of flexibility in adherence may face challenges regarding resistance in clients and possibly lead to therapeutic relationships that are antagonistic. our findings then suggest both important research questions to be further addressed and clinical implications. such important research questions should, for example, focus on how to address and assess individual treatment needs and how to design adequate individualised treatment within such collective institutions. one particular research question to be addressed further should be focusing on how to apply adequate approaches and tailored treatment within the collective treatment setting for clients who have cognitive impairments. as presented in our study, consistency in how to meet such individuals’ specific treatment needs and plans regarding this issue seems to be lacking and calls for further investigation. an important implication from a clinical perspective is how institutions should adapt to the increased emphasis on individualised treatment and adjust accordingly by demonstrating flexibility in their adherence to the treatment programme. 193 njsr – nordic journal of social research 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(2015). how important are the common factors in psychotherapy? an update. world psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238 microsoft word ellingsen-dalskau mal rev njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 understanding the relationship between subjective health complaints and satisfaction with life for people in prevocational training in norway lina h. ellingsen-dalskau* department of public health science norwegian university of life sciences email: lina.dalskau@nmbu.no *corresponding author bente berget norce norwegian research centre as department of sociology and social work the university of agder, norway email: bebe@norceresearch.no gunnar tellnes department of community medicine and global health university of oslo, norway school of health sciences kristiania university college, norway email: gunnar.tellnes@medisin.uio.no camilla ihlebæk department of public health science norwegian university of life sciences faculty of health and welfare østfold university college email: camilla.ihlebak@nmbu.no 49 njsr – nordic journal of social research vol. 12, 2021 abstract background and aim: in norway, a large part of the population is dependent on disability benefits. the main reasons for this are related to long-term musculoskeletal pain and psychological complaints. prevocational rehabilitation, aimed at increasing participation in working life, targets people in need of a sheltered vocational environment. this group has been found to report a very high level of health complaints. therefore, a better understanding of the psychological mechanisms affecting satisfaction with life for people who experience subjective health complaints could be important for tailoring more optimal vocational rehabilitation initiatives for these individuals. this study aimed to investigate the possible mediator role of basic psychological need satisfaction, described in self-determination theory, in the relationship between subjective health complaints and satisfaction with life. methods: a total of 201 adult participants attending prevocational training on care farms in norway answered a questionnaire, including demographic questions and standardised instruments on subjective health complaints, basic psychological need satisfaction and satisfaction with life. analyses were conducted using a structural equation model. results: most of the participants had been out of work for more than one year, had a high prevalence of subjective health complaints and a low level of satisfaction with life. the structural equation model showed that basic psychological need satisfaction mediated the negative association between psychological health complaints and satisfaction with life. conclusion: the results indicate that even though health complaints remain, prevocational programs can counteract some of the negative associations between subjective health complaints and satisfaction with life by creating contexts that support basic psychological needs that are important for well-being and functioning. providing clients with understanding, guidance, positive feedback, meaningful tasks and a close, supportive social community, has been found to facilitate satisfaction of basic psychological needs in prevocational training on care farms. 50 njsr – nordic journal of social research vol. 12, 2021 keywords: self-determination theory, basic psychological needs, vocational rehabilitation, return to work, care farms, psychological complaints, musculoskeletal pain introduction in norway, more than one out of 10 people (10.4%) between the ages of 18 and 67 are recipients of disability benefits from the norwegian labour and welfare administration (nav). this is similar to the numbers reported in 2010 by oecd (2010) where it was found that norway had a higher level of disability benefit recipients compared to most of the nordic countries and almost twice the average level reported in the other oecd countries (5.7%) (oecd, 2010). this is a concern, because employment has been associated with obtaining economic resources as well as being central to an individual’s level of satisfaction with psychosocial needs, identity, social roles and status (blustein, 2008; waddell & burton, 2006). additionally, not working may have severe negative consequences for an individual’s psychological and physical health, such as experiencing more psychological distress and long-term illness (blustein, 2008; waddell & burton, 2006). therefore, several initiatives have been taken in norway, as well as other nordic countries, to develop vocational rehabilitation services to increase participation in working life (thorsen et al., 2015). prevocational training on care farms prevocational training is one such initiative. prevocational training, also known as transitional employment, offers a temporary adapted and sheltered work environment for individuals with reduced capabilities to find work (nav, 2020b). the aim is to convey the basic expectations of ordinary employment and improve vocational and social skills, enabling individuals to eventually move on to vocational rehabilitation and competitive employment at a later stage (liberman, 2008; nav, 2020b; rossler, 2006). in norway, a number of care farms offer prevocational training. care farms are commercial farms providing practical and varied farming activities adjusted to the clients’ interests and capacities to promote health to a variety of different client groups (hassink & van dijk, 2006; hine et al., 2008; ihlebæk et al., 2016; pedersen et al., 2016). on these farms, health promotion helps ensure that the clients become active in maintaining and developing their own health (who, 2016) by experiencing support 51 njsr – nordic journal of social research vol. 12, 2021 from others, improving their coping ability, developing skills and gaining capabilities within the context of a green environment (sempik et al., 2010). this is also in line with the prevocational training aim of providing individuals with basic vocational and social skills to eventually make the transfer to competitive employment. thus, prevocational training on care farms is an innovative and diverse rehabilitation initiative, contributing to the variety of services offered within the norwegian welfare system. the clients are referred from different health and social care agencies, comprising health care institutions at the municipal level and nav. clients visit the farms one to five days a week. the service is typically run by the farmer or the farmer’s spouse (ellingsen-dalskau et al., 2016); it entails a variety of practical work tasks, including livestock farming, forest management, the cultivation of grains, fruits or vegetables or helping to run other businesses on the farm, such as working in a farm shop or café (pedersen et al., 2016). subjective health complaints as with prevocational programs in general, prevocational training on care farms supports people in need of a sheltered work environment that are often dependent on social security benefits. being out of work and receiving social security benefits may be related to some of the highest self-reported number of symptoms in the norwegian population, including musculoskeletal pain and psychological and gastrointestinal complaints (kjeldsberg et al., 2013). these symptoms are known as subjective health complaints, and they constitute subjective complaints with few or no objective findings (eriksen & ihlebæk, 2002). most people experience subjective health complaints as normal everyday complaints. however, for some, these complaints become severe and long-lasting (ihlebæk et al., 2002). the negative consequences associated with high numbers of health complaints include an increase in functional problems and a reduction in general health, sleep quality, psychological health, health-related quality of life and self-rated health (bruusgaard et al., 2012; kamaleri, natvig, ihlebaek, benth, & bruusgaard, 2008; kamaleri, natvig, ihlebaek, & bruusgaard, 2008; kjeldsberg et al., 2013; ree et al., 2014; tveito et al., 2004). studies have also found a higher number of subjective health complaints to be related to unemployment, longer periods of sickness 52 njsr – nordic journal of social research vol. 12, 2021 absence, and being a recipient of social security benefits (kjeldsberg et al., 2013; poulsen et al., 2013; roelen et al., 2010; tveito et al., 2002). the two main reasons for long-term sick-leave and disability in norway are related to musculoskeletal pain and psychological complaints (brage et al., 2010; ihlebæk et al., 2007; waddell, 2006). furthermore, a longitudinal study by kamaleri et al. (2009) showed that an increased number of pain sites predicted future disability 14 years after the complaints were reported. thus, for people in prevocational training, subjective health complaints may complicate their ability to return to work, which has been found to be a complex and long-lasting process (øyeflaten et al., 2012). however, very few research studies have attempted to identify the psychological mechanisms that can clarify and explain how subjective health complaints may influence the lives of people in prevocational training. as the common goal of vocational training is not necessarily to cure participants’ symptoms, but rather to facilitate mastery of their working life, a better understanding of these mechanisms could be useful for tailoring prevocational training on care farms. this insight could also prove valuable for optimisation of work rehabilitation services in general. self-determination theory the three basic psychological needs described by the self-determination theory— competence, relatedness and autonomy—may be useful for gaining a better understanding of how living with a high level of subjective health complaints influences one’s well-being (deci & ryan, 2000, 2008a). competence is the need to be effective in dealing with the environment; relatedness reflects the need to be connected to and to care for others; and autonomy is the universal desire to experience volition and be causal agents in one’s life (deci & ryan, 2000). according to self-determination theory, humans’ natural tendency for growth, optimal motivation and function is promoted through contexts that support the satisfaction of these basic psychological needs (deci & ryan, 2000, 2008a; ryan & deci, 2000). a vast and growing body of empirical literature has shown the benefits of basic psychological need satisfaction, both in general and in specific life domains (deci & ryan, 2008b). researchers have found that this satisfaction facilitates autonomous and internal motivation, which have been 53 njsr – nordic journal of social research vol. 12, 2021 persistently related to psychological health, self-esteem, well-being, the experience of meaningfulness, flow and daily well-being (deci & ryan, 2008b; gagné & deci, 2005; kowal & fortier, 1999; sheldon et al., 1996). farholm et al. (2016) also noted the importance of experiencing need satisfaction in vocational rehabilitation to improve well-being and return to work. however, contexts that do not support satisfaction of basic psychological needs undermine self-motivation, performance and wellness (reis et al., 2000; turner et al., 2009). the importance of basic psychological need satisfaction for function and well-being underlie the current aim to investigate basic psychological need satisfaction as a possible mediator in the relationship between musculoskeletal pain and psychological complaints, and satisfaction with life for clients in prevocational training on care farms in norway. we hypothesise that musculoskeletal pain and psychological complaints have a negative association with satisfaction with life, in line with research showing the negative consequences of subjective health complaints on function and well-being. furthermore, we hypothesise that basic psychological need satisfaction mediates the relationship between subjective health complaints and satisfaction with life, where more complaints are expected in association with lower satisfaction of basic psychological needs and satisfaction with life. methods recruitment and participants the participants in this study were clients in prevocational training on norwegian care farms. in 2011, questionnaires were mailed to all care farms in norway, and the farmers were asked to distribute these questionnaires to clients ranging in age from 18 to 66 (working age population) who received welfare benefits from nav and who had participated in prevocational training for at least one month. this resulted in a sample of 201 adult participants attending prevocational training from 65 different care farms. the sample consisted of 86 (43%) men and 115 (57%) women, with a mean age of 35.7 years (standard deviation [sd] 11.9, range: 19–65 years). the lack of a register of care farm clients made it difficult to calculate an exact response rate. however, based on information obtained from the care farmers, a conservative estimate indicated that 54 njsr – nordic journal of social research vol. 12, 2021 approximately 45% of the clients who received the questionnaires from the farmers responded to the survey. measurements descriptive questions the questionnaire contained questions about the participants’ demographic characteristics and background information, including sex, age, marital status, level of education and time out of work. subjective health complaints the participants answered the questions in the subjective health complaints inventory, shown to be a reliable and valid instrument (ihlebæk et al., 2004). using a 4-point scale (0 = not at all, 1 = a little, 2 = some and 3 = severe), the participants indicated how they had experienced 29 common health complaints during the last 30 days (eriksen et al., 1999). the complaints can be divided into five subscales: musculoskeletal pain, psychological complaints, gastrointestinal problems, allergies and flu (eriksen et al., 1999). in this study, we only used the musculoskeletal pain subscale (headache, neck pain, upper back pain, lower back pain, arm pain, shoulder pain, migraine and leg pain during physical activity) and psychological complaints subscale (extra heartbeats, heat flashes, sleep problems, tiredness, dizziness, anxiety and sadness/depression) in the main analysis. we then summarised individual item answers on the musculoskeletal pain subscale (α = .83) and the psychological complaints subscale (α = .82) to create two variables reflecting the level of severity of these complaints (eriksen et al., 1999). basic psychological needs the participants answered the questions in the general need satisfaction scale (deci & ryan, 2000; gagné, 2003), which research studies have defended as valid and reliable for measuring need satisfaction in several domains in life (johnston & finney, 2010; la guardia et al., 2000; van den broeck et al., 2010; vlachopoulos & michailidou, 2006). the participants evaluated 21 items indicating the extent of how their basic psychological need for competence (6 items), relatedness (8 items) and autonomy (7 items) were generally satisfied in their lives, rated on a likert scale ranging from 1 (not at all true) to 7 (completely true). the subscales consisted of items, such as “i often do not feel very 55 njsr – nordic journal of social research vol. 12, 2021 capable” (competence), “people in my life care about me” (relatedness) and “i feel pressured in my life” (autonomy). afterwards, we calculated the mean scores of the subscales of autonomy (α = .64), competence (α = .64) and relatedness (α = .81). the cronbach’s alpha scores (cronbach, 1951) of autonomy and competence were somewhat lower than the recommended values, indicating overall acceptable/good internal consistency (suggested range from .70 to .95) (tavakol & dennick, 2011). these low values could indicate a poor interrelatedness between the items or, alternatively, that competence and autonomy are heterogeneous constructs (tavakol & dennick, 2011). however, because these are standardised scales, and because the cronbach’s alpha values were just below .70, all the items were included in the analysis. satisfaction with life lastly, the participants answered the questions of the satisfaction with life scale (diener et al., 1985), which is a valid and reliable measure of the global cognitive judgement of satisfaction with life (pavot et al., 1991). the participants indicated on a 7-point likert scale ranging from 1 (strongly disagree) to 7 (strongly agree) their agreement with five items, such as “in most ways my life is close to my ideal” and “the conditions of my life are excellent”. the total score ranges from 5 to 35, and it can be divided into six categories reflecting one’s satisfaction with life (diener, 2006). three categories are below the neutral mid-point of 20: extremely dissatisfied (5–9), dissatisfied (10–14) and slightly dissatisfied (15–19). three categories are above the neutral mid-point: slightly satisfied (21–25), satisfied (26–30) and extremely satisfied (31–35). we also summarised the items to create a score reflecting the participants’ overall satisfaction with life (α = .90). statistical analysis we performed statistical tests using spss version 23.0, with the level of statistical significance set to 0.05. a structural equation model, where numerous linear models can be fit simultaneously (byrne, 2010), was used to examine the mediator function of basic psychological need satisfaction in the relationship between subjective health complaints and satisfaction with life (figure 1 and figure 2). structural equation modelling was preferred because it provides a graphic statistical model that describes the underlying structure of the variables in a transparent way. structural equation models take a 56 njsr – nordic journal of social research vol. 12, 2021 confirmatory approach (byrne, 2010), which means that models should be constructed based on relevant theoretical and empirical information (hox & bechger, 1998). in relation to the sample size, although somewhat debated, it has been suggested that an overall sample size of around 200 is considered sufficiently large (kline, 2011). therefore, our sample size of 201 participants and the application of the selfdetermination theory indicated that structural equation modelling could be a useful way to investigate the relationships between the variables. we created the models using analysis of moments structure (amos) version 23.0. structural equation modelling the structural equation model had three levels, which were created to investigate the possible mediator role of basic psychological need satisfaction in the relationship between subjective health complaints and satisfaction with life (baron & kenny, 1986) (figure 1 and figure 2). the first level in the model consisted of the exogenous variables, musculoskeletal pain and psychological complaints. the second level in the model consisted of the latent mediating variable: need satisfaction. this was a composite score created from the mean scores on the subscales measuring satisfaction of the three basic psychological needs of competence, relatedness and autonomy. the last level in the model consisted of the endogenous variable: satisfaction with life. to avoid excluding cases with missing values (16.3%) from the analysis, the missing values (1.4% in total) were imputed using expectation maximisation (em) (peters & enders, 2002; sterne et al., 2009). we then ran the full model including the pathways between all the exogenous and endogenous variables, calculating and reducing until only significant regressions remained. next, we calculated a multigroup invariance test exploring the differences between men and women. this showed significant gender differences; therefore, we separately analysed men and women, resulting in two parsimonious models, one for men (figure 1) and one for women (figure 2). finally, we reran the parsimonious models using the original data, resulting in virtually similar models. ethics this study was approved by the norwegian regional ethics committee for southeast norway (2010/2042) and the norwegian social science data services. informed written consent was obtained from all the participants included in the study. furthermore, all the 57 njsr – nordic journal of social research vol. 12, 2021 procedures performed in this study involving human participants were in accordance with the 1964 declaration of helsinki and its later amendments or comparable ethical standards. results descriptive statistics a large proportion of participants had low levels of education, with 86.1% reporting having completed only lower or upper secondary school; moreover, the majority of the participants lived alone (table 1). more than 62% reported having been out of work for more than one year and more than 16% had never been employed (table 1). table 1. proportion (%) of women and men in categories related to marital status, level of education and time out of work variables total (n = 201) n (%) women (n = 115) n (%) men (n = 86) n (%) marital status* unmarried 128 (63.3) 60 (53.1) 68 (79.1) divorced/separated 27 (13.6) 15 (13.3) 12 (14) spouse/partner/cohabitant 44 (22.1) 38 (33.6) 6 (7) education* lower secondary school (up to 9 years) 81 (40.9) 47 (42) 34 (39.5) upper secondary school (10–12 years) 92 (46.5) 48 (42.9) 44 (51.2) university/college (more than 12 years) 17 (8.6) 11 (9.8) 6 (7) other 8 (4) 6 (5.4) 2 (2.3) time out of work* 0–6 months 19 (9.7) 11 (9.9) 8 (9.6) 6–12 months 22 (11.2) 14 (12.5) 8 (9.5) 1–2 years 33 (16.9) 18 (16) 15 (17.8) 2–5 years 40 (20.4) 23 (20.5) 17 (20.2) more than 5 years 49 (25) 27 (24.1) 22 (26.2) no work experience 33 (16.8) 19 (17) 14 (16.7) *indicates missing values in category (range of missing from 1–2.6%) subjective health complaints a total of 99.5% of the participants reported having experienced at least one health complaint during the last 30 days. both women and men reported a high number of health complaints (m = 11.7, sd = 6.2) (t(198) = -2.81, non-significant [n.s.]), and more than 63% had experienced 10 or more complaints in the last 30 days. the most commonly reported single complaints for both men and women were headache, tiredness, anxiety, 58 njsr – nordic journal of social research vol. 12, 2021 sadness/depression and sleep problems. however, women had a significantly higher prevalence of headache (80.0% women and 52.3% men) and tiredness (79.1% for women and 61.6% for men) in comparison to men. the overall prevalence of psychological complaints was 90.0% (94.8% for women and 83.7% for men); it was 86.0% for musculoskeletal pain (92.2% women and 77.9% men). moreover, 81.0% (88.7% women and 72.1% men) of the participants reported having both musculoskeletal pain and psychological complaints. the mean severity scores for psychological complaints (m = 7.7, sd = 4.89) and musculoskeletal pain (m = 6.6, sd = 5.45) were included in the structural equation model (table 2). women had significantly higher mean severity scores than men on both psychological complaints (t(198) = -2.82, p < .005) and musculoskeletal pain (t(197) = -3.29, p < .001). structural equation models table 2 presents the mean, sd, range and pearson’s correlation coefficients for the variables included in the models. except for the non-significant correlation between musculoskeletal pain and relatedness, the correlation coefficients indicate that the variables are significantly related in the hypothesised direction. this supports our hypothesis that musculoskeletal pain and psychological complaints are negatively associated with satisfaction with life, and that basic psychological need satisfaction is related to subjective health complaints and satisfaction with life. table 2 59 njsr – nordic journal of social research vol. 12, 2021 figure 1 structural equation model for men with standardised regression weights (β) showing the pathways between the variables, musculoskeletal pain and psychological complaints, need satisfaction and satisfaction with life. r² values are given for each of the two dependent variables. e represents the measurement error associated with the latent and observed variables. regression weights followed by * are significant at a .05 level, and those followed by ** are significant at a .01 level. all the pathways displayed in the structural equation model for men were significant at the .05 or .01 level (figure 1). the first exogenous variable, musculoskeletal pain, was positively associated with the mediator variable, need satisfaction (β = .04). the second exogenous variable, psychological complaints, was negatively associated with need satisfaction (β = -.14). furthermore, need satisfaction was positively associated with satisfaction with life (β = 7.01). a total of 57% of the variance in need satisfaction was explained by musculoskeletal pain and psychological complaints, and 51% of the variance in satisfaction with life was explained by need satisfaction. 60 njsr – nordic journal of social research vol. 12, 2021 figure 2 structural equation model for women with standardised regression weights (β) showing the pathways between the variables, musculoskeletal pain and psychological complaints, need satisfaction and satisfaction with life. r² values are given for each of the two dependent variables. e represents the measurement error associated with the latent and observed variables. regression weights followed by * are significant at a .05 level, and those followed by ** are significant at a .01 level. all the pathways displayed in the model for women were significant at the .05 or .01 level (figure 2). the first exogenous variable, musculoskeletal pain, was unrelated to any of the outcome variables in the model. the second exogenous variable, psychological complaints, was negatively associated with the mediator variables, need satisfaction (β = -.07) and satisfaction with life (β = -.36). furthermore, need satisfaction was positively associated with satisfaction with life (β = 5.16). a total of 18% of the variance in need satisfaction was explained by psychological complaints, and 39% of the variance in satisfaction with life was explained by the combination of psychological complaints and need satisfaction. the statistical tests chi-square (x2), relative/normed chi-square (x2/df), tucker-lewis index (tli), comparative fit index (cfi) and root mean square error of approximation (rmsea) were used to evaluate the model fit for the structural equation models. the fit statistics indicated an overall acceptable to good fit of the models to the data for both men, as seen in figure 1 (x2 (7) = 9.34, p > .05; x2/df = 1.33, tli = .981, cfi = .991, rmsea = .063) and women, as seen in figure 2 (x2 (8) = 12.56, p > .05; x2/df = 1.57, tli = .959, cfi = .978, rmsea = .071). 61 njsr – nordic journal of social research vol. 12, 2021 discussion as expected, the results showed that people in prevocational training on care farms in norway had a high level of subjective health complaints and a low level of satisfaction with life. furthermore, the structural equation models showed that a high level of psychological complaints had a negative association with satisfaction with life, and that this relationship was mediated by satisfaction with basic psychological needs, competence, relatedness and autonomy for both men and women. contrary to what we hypothesised, we did not find the same relationship for musculoskeletal pain and satisfaction with life. level of subjective health complaints, satisfaction with life and time out of work first, the high level of subjective health complaints is in accordance with kjeldsberg et al. (2013), who found that unemployed individuals and recipients of social security benefits represent segments of the population with a high number of symptoms. psychological complaints were most commonly reported in our study, with a prevalence of 90%, which is high compared to the 65% prevalence in the normal population (ihlebæk et al., 2002). this is in accordance with steigen et al. (2018) who, in their sample of young adults attending nature-based services in norway, found that more than 50% reported mental health problems. in the current study participants also commonly reported musculoskeletal pain, and the degree of comorbidity between musculoskeletal pain and psychological complaints was high, as more than 80% of the participants had both types of health complaints. the scores on satisfaction with life were accordingly low. more than two-thirds of the sample fell beneath the neutral mid-point of the scale, which is lower than what is usually found in western countries (pavot & diener, 1993). almost one-third of participants were classified as dissatisfied with their life, and one in five were extremely dissatisfied. these findings indicate that most clients in prevocational training on care farms struggle in multiple areas of life (diener, 2006). as expected for clients in prevocational programs, most of the participants in the current study had been out of work for more than one year. one in five had been out of work for 62 njsr – nordic journal of social research vol. 12, 2021 two to five years and one in four for more than five years. this is considerably longer than clients in other vocational rehabilitation clinics in norway (øyeflaten et al., 2016). in addition, 16% of the participants had no work experience at all. therefore, the high level of subjective health complaints, the low level of satisfaction with life, the weak connection to the ordinary work force, as well as a generally low education level indicate that these individuals experience several health and functional problems connected to a more challenging return to work process (bruusgaard et al., 2012; gjesdal & bratberg, 2003; kamaleri, natvig, ihlebaek, benth, & bruusgaard, 2008; kamaleri, natvig, ihlebaek, & bruusgaard, 2008; kamaleri et al., 2009; piha et al., 2010; poulsen et al., 2013; ree et al., 2014; tveito et al., 2002; tveito et al., 2004). the mediator role of basic psychological needs furthermore, results from the structural equation models corroborate earlier findings that a high level of subjective health complaints may have negative consequences, as a high degree of psychological complaints was negatively associated with satisfaction with life. we identified satisfaction of the three basic psychological needs, competence, relatedness and autonomy, as a mediator in this relationship. individuals with a higher severity of psychological complaints reported less satisfaction of basic psychological needs and lower satisfaction with life. this fits well with the self-determination theory framework, which views positive human growth and function as a result of contexts that support the satisfaction of basic psychological needs (deci & ryan, 2000; ryan & deci, 2000). in line with this theory, the associations indicate that a high degree of psychological health complaints may create a context that makes it difficult for individuals to satisfy their basic psychological needs for competence, relatedness and autonomy, which is associated with a lower satisfaction with life. the mediator function of basic psychological need satisfaction was similar for men and women. the only significant difference was that the negative association between psychological complaints and basic psychological need satisfaction was stronger for men than women. this could also explain why the relationship between psychological complaints and satisfaction with life was fully mediated for men, while the same relationship was only partially mediated for women. therefore, it seems that men with a high degree of psychological complaints find it more difficult to satisfy their basic 63 njsr – nordic journal of social research vol. 12, 2021 psychological needs than women, making them more vulnerable when experiencing those psychological complaints. this is in line with the findings of gjesdal et al. (2008), who found that, of people on certified sick leave with a psychiatric diagnosis, men had a higher risk of transitioning to a disability pension than women. this gender difference could be explained by the differences in vulnerability, risk factors and coping mechanisms that exist between men and women in relation to experiencing and developing mental health problems (rosenfield & mouzon, 2013). for example, women usually have larger primary social networks and they engage in close social ties more often than men (rosenfield & mouzon, 2013), which could provide women with an alternative way of satisfying their basic psychological needs. somewhat surprisingly, musculoskeletal pain did not influence basic psychological need satisfaction and satisfaction with life in the same way as psychological complaints did. however, the strong relationship between psychological complaints and basic psychological needs may reflect the similarity of these concepts, as they both represent mental processes. other factors or mechanisms related to physical functioning could be more relevant to understanding how musculoskeletal pain influences satisfaction with life. this is supported by øyeflaten et al. (2016), who identified poor physical function as a mediator in the relationship between musculoskeletal pain and fear avoidance beliefs for patients in vocational rehabilitation. the psychosocial dimension of subjective health complaints the findings from the current study indicate that a lack of basic psychological need satisfaction represents one important psychological mechanism that influences satisfaction with life when people have a high level of psychological health complaints. this provides a better understanding of why subjective health complaints may lead to poor function, reduced quality of life and problems related to work participation as reported in earlier research. it also underlines an important psychosocial component of having a high degree of subjective health complaints. from the self-determination theory perspective, the results indicate that a focus on basic psychological need satisfaction in the context of prevocational programs could help reduce some of the negative influences that psychological complaints may have on satisfaction with life by facilitating autonomous motivation, function and well-being, even though the complaints remain 64 njsr – nordic journal of social research vol. 12, 2021 (deci & ryan, 2000, 2008a; ryan & deci, 2000). this is in line with farholm et al. (2016), who found that providing support for autonomy, competence and relatedness improved well-being, physical activity and return to work for patients in vocational rehabilitation. two studies have investigated basic psychological needs for clients in prevocational training on care farms. these studies found that doing something useful and meaningful in a flexible, but structured work environment, as well as being part of a supportive social community providing understanding, acknowledgement, positive feedback and guidance, was important for creating a need supportive context (ellingsen-dalskau, berget et al., 2016; ellingsen-dalskau, morken et al., 2016) methodological considerations some limitations should be considered when interpreting the results of this study. first, the study’s cross-sectional design means that causality cannot be inferred (sedgwick, 2014). therefore, the direction of the pathways between the variables in the structural equation models could also go in the opposite direction. however, the application of the self-determination theory framework is a strength of the study, ensuring a sound rationale for the postulated direction of the relationships in the models (hox & bechger, 1998). another limitation was the lack of an official register of care farm clients at the time of this study was conducted. thus, we had to rely on the farmers to distribute both the invitations to participate and the questionnaires to the clients. consequently, we do not have exact information about the response rate or the clients who refused to participate in the study. a few farmers communicated that they did not ask attendees with a very low functional level to participate, as they considered it to be too much of a burden for those individuals. this means that we cannot know if the participants are representative of farm-based prevocational training clients in norway. still, the extensive national mapping of prevocational programs, the close follow-up of the farmers during the recruitment process, together with clear written inclusion criteria, may have ensured a higher degree of sample representativeness. therefore, the results could be applicable for clients in prevocational training on care farms, and they could also have relevance for individuals in other types of prevocational programs or for people who have been out of work for a long time and struggle with a high level of subjective health complaints. however, the prevalence of subjective health complaints and satisfaction with life may not be as transferable, whilst the associations between the variables found in the 65 njsr – nordic journal of social research vol. 12, 2021 structural equation models may be more transferable, as these results are less likely to be influenced by a possible selection bias (rothman, 2012). finally, it should be noted that these data were collected in 2011; thus, the relevance of the findings could be impacted. however, these prevocational programs are still provided at care farms in norway, where the same training is offered to the same group of clients. therefore, a better understanding of the relationship between subjective health complaints, basic psychological need satisfaction and satisfaction with life for this group of people is still relevant and important. conclusion the clients in prevocational training on care farms in this study had a high level of psychological health complaints, which was negatively associated with satisfaction with life. satisfaction of basic psychological needs was found to be an important mediator of this association. based on the self-determination theory, the study’s findings indicate that psychological health complaints may lead to reduced function, well-being and problems related to work participation for these individuals by creating a context where basic psychological needs are difficult to satisfy. this seems to be especially true for men, where the association between psychological complaints and psychological need satisfaction was particularly strong. therefore, prevocational programs should focus on offering basic psychological need supportive environments to counteract some of the negative consequences related to having a high degree of psychological health complaints and to facilitate well-being and functioning. providing clients with understanding, guidance, positive feedback, meaningful tasks and a close supportive social community has been found to be important for the satisfaction of basic psychological needs in the prevocational training context on care farms. this could potentially aid the process of returning to ordinary work for individuals who have been out of work for a long time and struggle with a high level of psychological complaints. more effective and diverse work rehabilitation services will contribute to a viable welfare system and facilitate social integration and security by enhancing return to work. 66 njsr – nordic journal of social research vol. 12, 2021 references baron, r. m., & kenny, d. a. 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(2016). subjective health complaints, functional ability, fear avoidance beliefs, and days on sickness benefits after work rehabilitation: a mediation model. bmc musculoskeletal disorders, 17(1), 1-12. https://doi.org/10.1186/s12891-016-1084-x making the best of it: adolescents’ perceptions of how their home and neighbourhood spheres shape their lives njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 making the best of it: adolescents’ perceptions of how their home and neighbourhood spheres shape their lives vibeke krane * center for social entrepreneurship and social innovation university of southeastern norway. e-mail: vibeke.krane@usn.no *corresponding author ellen andvig faculty of health sciences university of southeastern norway, drammen, norway e-mail: ellen.andvig@usn.no abstract adolescents’ homes are fundamental components of their living conditions and essential for their everyday life, health, well-being and development. previous research has focused on how housing affects adolescents through investigating certain aspects of adolescent health and future outcomes. in this qualitative study, we explored lowincome family adolescents’ subjective experiences of their homes and in what ways their experiences of housing influenced their everyday lives. seven participants aged between 12 and 20 years were recruited through a housing project. the participants were interviewed using individual in-depth interviews. the data were analysed using a thematic analysis and organised into four themes: 1) housing features affecting social life and privacy, 2) moving around, 3) the importance of neighbourhood and 4) worries and dreams. the findings show how the housing standards affected adolescents’ social life and privacy. house moves could provide new opportunities but also lead to a lack of continuity in relationships. the neighbourhood was highlighted as a public sphere, providing access to places and friends. adolescents’ worries and dreams concerning housing conditions are also presented. the results show how housing is central in shaping adolescents’ social relationships, the importance of access to neighbourhood spheres and how adolescents adapt to their situation. the findings further reveal the important underlying processes to facilitate a greater understanding of the role of housing in low-income family adolescents’ lives. njsr – nordic journal of social research 112 vol. 12, 2021 keywords: adolescent, low income, housing, social relationship, subjective experience background children and adolescents spend more time in the home environment than in any other physical setting. thus—and in line with an ecological perspective— children’s and adolescents’ homes are fundamental components of their living conditions and are crucial experiences of their environments as they grow up (bronfenbrenner & morris, 1998). the united nations convention on the rights of the child (1989) article 27 states, ‘the right of every child to a standard of living adequate for the child’s physical, mental, spiritual, moral and social development’. article 27 further elaborates that children’s rights involve the living conditions and housing necessary for the child’s development. these rights are an acknowledgement of children’s and adolescents’ homes as an essential prerequisite for their positive development. ‘home’ has been defined as the location where people are settled psychologically, socially, culturally and physically, involving both symbolic and emotional aspects (hauge, 2009, p. 28). hayward (1977) identifies the core dimensions of meaning that are considered home: self-identity, close relationships, a social network, a place of privacy and refuge, continuity, a personalised place, a base of activities, the childhood home and a physical structure. because of the digital revolution and social media, norwegian adolescents spend more time at home in their spare time (bakken, 2019), making the home an even more central area of their lives. during the covid-19 pandemic, there is also a huge shift toward doing more at home as well. in recent decades, housing has received growing attention from social scientists as an important context for children’s and adolescents’ lives (clair, 2018; coley et al., 2013; leventhal & newman, 2010). a distinction is frequently made in housing research between two perspectives of the home, that is, between interactions in the household and the house itself (leventhal & newman 2010). traditionally, the child development literature focusing on the home environment has explored the interactions and experiences that are available to the child in the home. the second focus in this stream of literature concerns the effect of the house itself, as captured by the physical, financial and practical features of the home (leventhal & newman, 2010). however, there is a dynamic interplay between the condition of the house itself and the interactions in the household, and these concepts are interconnected. housing njsr – nordic journal of social research 113 vol. 12, 2021 is also related to other aspects of living conditions and operates as a type of gatekeeping mechanism in facilitating or inhibiting access to neighbourhood public services, such as schools, public transport, health and social services (clair, 2018). in this respect, the home represents a physical structure that regulates and defines the relationship between the adolescent and society. in the current article, we will use the terms ‘house’ and ‘house standard’ to refer to the material house. the term ‘household’ will be used to refer to the house and its occupants as a unit. the term ‘home’ will be used as a concept to cover the material, social, relational and emotional dimensions related to housing. the norwegian housing context norway has been described as a ‘homeowner nation’ (vassenden et al., 2012). close to 80% of households in norway comprise houses that are owner occupied or cooperatively owned (sandbæk, 2013). however, lowincome families are far less likely to own their homes. families with an income below 60% of the national median income are commonly classified as lowincome families (omholt, 2016). those who are not homeowners have to enter the private rental market because there is very limited availability of social housing, with only 4% of norwegian house stocking being publicly owned (sandlie & gulbrandsen, 2017). social housing is reserved for the socially and economically worst-off (hauge, 2009), and there is a strong association between low-income and poor households. the number of children growing up in low-income families in norway has increased over the past decade, with approximately 9–10% of norwegian children being raised in low-income families (povlsen et al., 2018). low-income families are more likely to experience poor housing conditions, which includes cramped living conditions where children less likely to have their own rooms and more financial worries (omholt, 2016; sandbæk, 2012). low-income families are often socially stigmatised and regarded as unattractive tenants (vassenden et al., 2012); this often results in residential mobility, with frequent moving being more common among these low-income families. in what ways does housing affect adolescents’ lives? numerous housing studies have found that adolescent health and outcomes are affected by various housing-related aspects, such as physical housing quality, overcrowding, residential mobility and the type of neighbourhood (clair, 2018; leventhal & brooks-gunn, 2000; leventhal & newman, 2010). njsr – nordic journal of social research 114 vol. 12, 2021 poor physical housing quality is usually measured in terms of structural deficiencies, such as a lack of plumbing and heating, and maintenance deficiencies and dampness, along with the presence of bugs, dust mites and rats. numerous studies have explored the effects of poor housing quality on children’s physical health (leventhal & newman, 2010). a limited number of studies has shown how housing quality may indirectly influence children’s development by contributing to negative family interactions in terms of increased stress and conflict among family members. evans et al. (2001) find an association between poor quality houses and socioemotional functioning and psychological symptoms among children and adolescents. moreover, poor quality housing has been associated with reduced educational outcomes, especially among adolescents (coley et al., 2013). other studies have shown that improvement in housing quality is associated with improvements in school achievement and lower dropout rates for adolescents (haurin et al., 2012). overcrowding relates to the number of rooms available to individual members of a household, where a ratio greater than one person per room is considered evidence of overcrowding (leventhal & newman, 2010). overcrowding involves a lack of personal space or privacy, or enforced intimate proximity to other people in the home and disturbed sleep. numerous studies have shown a relationship between overcrowding and children’s poor physical health. some studies have also found a relationship between crowded housing conditions and emotional and behavioural problems among children (coley et al., 2013; leventhal & newman, 2010). moreover, studies have found associations between cramped housing conditions and educational outcomes, with children living in crowded houses having lower educational achievements and lower levels of completed schooling, with adolescents having their own rooms showing better educational outcomes (clair, 2018; leventhal & newman, 2010). the neighbourhood effects on child and adolescent outcomes have been widely explored in the social sciences, but there is no consensus on the effects because these are intertwined with individual and family variables in complex processes. a review of neighbourhood effects has shown a link between neighbourhood socioeconomic standards (ses) and educational achievement, behavioural problems and juvenile delinquency (leventhal & brooks-gunn, 2000). a study by sarti et al. (2019) finds that children from poor families actively make use of public spaces in their outside environment to shape their daily lives and development to ensure that financial strains, even though present, can be managed. in a swedish context, significant njsr – nordic journal of social research 115 vol. 12, 2021 neighbourhood effects have been identified in relation to school choice and children’s prospects of work and a well-paying career as an adult (malmberg et al., 2014). a finnish study has explored the impact of neighbourhoods on parents’ subjective well-being (poikolainen & honkanen, 2020), finding that parents emphasised the natural environment, social networks and well-being and safety of their children in the neighbourhood as important components for their own subjective well-being. residential mobility, or home moves, refers to the frequency with which families move their residence. the impact of home moves on children and adolescents has been explored in several studies (clair, 2018; gambaro & joshi, 2016; leventhal & newman, 2010). the findings suggest that moving affects children in different ways, depending on their age, the timing of the move and family structure. behavioural problems, poorer mental health and lower experiences of well-being have been associated with home moves (clair, 2018). moving may lead to school change and a lack of continuity in schooling, which can cause problems in educational achievement and school dropout (leventhal & newman, 2010). however, for some adolescents, positive effects may arise because of moving, for example, to a ‘better’ neighbourhood or to better-quality housing (clair, 2018). frequent moves are typically described as residential instability, and it has been reported that adverse outcomes are likely to increase in relation to a rising number of moves (leventhal & newman, 2010; gambaro & joshi, 2016). taken together, a growing body of research has found associations between housing standards and the health, deficits, problems and outcomes of children (aged 0–11) and adolescents (aged 12–19) (clair, 2018; leventhal & brooksgunn, 2000; leventhal & newman, 2010). these studies show that children and adolescents from low-income families are far more exposed to poor physical housing quality, overcrowding, poor neighbourhoods and residential mobility. however, most of these studies have used a quantitative design and involve statistical associations found between housing features and future outcomes for children and adolescents. because children’s outcomes are the result of complex processes, these associations cannot be understood as causal. hence, qualitative studies are suitable for shedding light on some of these complex processes, yet qualitative studies exploring adolescents’ subjective perspectives on housing and their everyday lives are rare. moreover, there are few studies covering the nordic housing context for adolescents. njsr – nordic journal of social research 116 vol. 12, 2021 in the current study, we have focused on how seven norwegian adolescents from low-income families experienced housing and how it has affected their everyday lives. to shed light on some of the complex processes involved in relation to housing and adolescents’ lives, we chose a qualitative design. to explore these issues, we raised the following research question: how does low-income family adolescents experience the influence of housing on their everyday lives? methodology study context for the present study, the participants were recruited through an innovation housing project running from 2018 to 2020 in a middle-sized norwegian town. the projects’ aim is to develop and pilot new strategies in relation to housing solutions for low-income families living in difficult housing conditions. the project manager recruited the participants through their parents, who participated in this project. methods the present study has a qualitative, explorative and interpretive design, here aiming to capture the subjective experiences of adolescents concerning housing. individual qualitative interviews were used to collect data. such indepth interviews are useful in exploring an individual’s subjective experiences (brinkman & kvale, 2015). the study takes a hermeneutic stance, which acknowledges that meaning emerges through interpretive interactions and that phenomena are always multidimensional and multifaceted (crotty, 1998). seven adolescents were included in this study. adolescents from the seven low-income families who participated in the housing project were asked to participate. the inclusion criteria involved participants aged between 12 and 20 years old and who were living in difficult housing conditions, and whose parents were involved in the housing project. the first author was the interviewer; she used a thematic interview guide to ask questions in relation to experiences of home, neighbourhood, moving, friends, school and the relevant financial situation. the interviews took place in the period from 2018 to 2019, and six interviews took place in the participants’ homes. the seventh interview took place at the housing project’s office. the interviews lasted from 30 to 70 minutes. the interviewer explained the purpose of the interviews and highlighted the importance of the participants njsr – nordic journal of social research 117 vol. 12, 2021 expressing their own experiences and perspectives. the interviews were open ended, and the interviewer encouraged the participants to speak freely. analysis the interviews were transcribed verbatim. the transcribed text was analysed inductively, aiming to grasp the participants’ subjective experiences, here by using a thematic analysis (braun & clarke, 2006). the inductive approach had a bottom-up perspective, where the themes were extracted from the data. in this respect, the themes can be understood as recurring patterns that grasp the participants’ experiences. both authors read all the transcripts to become familiar with the data, noting their initial thoughts, ideas and emerging themes. subsequently, the material was separately coded line by line by the two authors using the research questions as a guide. meaningful elements such as quotes and descriptions of the emerging themes were identified, listed, organised and sorted into tentative themes. the tentative themes were discussed between the two authors and then revised. the data were examined and discussed with the authors several times to complete categorisation into four main themes. ethics in accordance with the personal data act, the norwegian social science data services (nsd) was notified, and approval for the project was granted. parents and participants were informed of the purpose of the study through written and oral information provided by the leader of the housing project. the implications of participation were explained, and the requirements for voluntary participation was underlined. written consent for participation from the participants and the parents of those under 16 years old was obtained. the participants were paid 200 norwegian kroner (nok) for their participation as compensation for their effort and time spent in the interview. this payment was approved by the nsd. the first author, who has received specialised education and training in interviewing children, interviewed the participants. it is of special ethical importance to be aware of how to interview children to avoid potential harm (morrow & richards, 1996). personal details and names have been changed in this article to ensure confidentiality. participants ari was 13 years old and lived with his mother and older sister. he had been living in his current home, a social housing unit, for two to three years. ari and his sister had their own rooms, but their mother had to sleep in the living room. njsr – nordic journal of social research 118 vol. 12, 2021 he had moved around a lot between different municipalities and had also lived in foster care for some years. beatrice was 13 years old and lived with her mother and older sister. her grandparents lived abroad, and beatrice was born and lived the first year of her life in the country where her grandparents lived. both beatrice and her sister had their own rooms. her father had recently moved to the same district as beatrice. lila was 12 years old and living with her parents and older brother. she also had two adult siblings who visited and stayed overnight quite frequently. she shared a room with her older brother and her two adult siblings when they came to visit. the family came to norway as refugees. she had lived in the same house for six years and could not remember where she lived before that. david was 17 years old. he lived part time with his father and part time with his mother, swapping homes every other week. in total, he had seven siblings, including half-siblings and step-siblings in both homes. he had moved around a lot and was not sure how many times he had moved. his father’s house was spacious, and each of the children had their own room. his mother’s various houses had been crowded and in bad condition. eve had just turned 20 years old and was david’s older sister. she used to swap homes every other week during her childhood, whereas now, because she was an adult, she swapped houses when she felt like it. she always had her own room in her father’s house. at the time of the interview, she was sleeping in the hallway in her mother’s new house. amber was 14 years old and lived with her mother and three younger siblings. the family came to norway as refugees approximately six6 years ago. she moved from her country of origin to a nearby country and ha moved twice in norway. at the time of the interview, she had her own room. malika was 12 years old and amber’s younger sister. she used to share a room with her siblings, but at the time of the interview, she had a room of her own. she could vaguely remember that she lived somewhere in transit as a refugee. njsr – nordic journal of social research 119 vol. 12, 2021 findings the thematic analyses generated four overarching themes: 1) housing features affecting social life and privacy, 2) moving around, 3) the importance of neighbourhood and 4) worries and dreams. housing features affecting social life and privacy all participants described how housing features and the quality of the house affected their social life. they described how the layout of the house facilitated or inhibited socialising and interactions with both family and friends. they also highlighted the importance of having privacy and space for themselves. spending time with family some of the participants talked about how they appreciated spending time with their family in their home environment. beatrice explained how she experienced the open-plan style of her house: ‘i think it is more fun when it’s open plan because then you can talk to each other instead of shouting to each other between the rooms’. lila described how she spent time with her family in their living room: ‘i think family life is really good… we sit together and watch tv series together… one new episode each day...’. however, the participants also gave reasons why the standard of housing could inhibit socialising with friends. ari admitted, ‘i am embarrassed … i think it is really old fashioned and i want it to be more up to date… and we only have two bedrooms, it is really small… so i never bring friends home’. david disclosed how he never invited friends to a house he used to live in: ‘i did not bring any friends over… because it was rather crowded…. i think they would have wondered why we had such a small house when we were so many people…’. having privacy and being able to socialise in their own room all the participants highlighted the importance of having their own room. they emphasised how their room was a place to withdraw to and have some privacy, but also a place to socialise in and invite friends to. based on experiences during her childhood, eve explained the following: i think when you are a family as large as ours it is important to find a house which has enough rooms for everybody…. we lived in a house where my brother and i shared a room. the room was big…, but we were supposed to share it…. it did not provide much privacy. my stepdad made two walls…. and we slept on each side of the walls…. so it is possible to do something about it…. but if my brother fell asleep before me and i was awake it was like ‘sssshhh’…. so it could easily turn into a quarrel. njsr – nordic journal of social research 120 vol. 12, 2021 malika said, ‘if you want to be alone… you can hang out there (in her room)…. i am not there always but if i am annoyed with my siblings i can go there…’. their rooms could also be places to spend time together with friends. some of the participants described how their parents arranged their rooms to facilitate socialising with friends. beatrice commented, ‘so my room is really nice, and i am glad i got the largest room because i have more friends coming over’. ari explained how they had arranged the rooms in their apartment: ‘my sister has her own room, and i have one too now. my mum and i used to share a room, but i am getting older, so i wanted my own room, and now mum sleeps in the living room’. moving around all the participants had moved several times, and some had moved multiple times. the participants explained how moving home could provide new opportunities and better housing. however, they also described how frequent moving could lead to a lack of continuity regarding friendships and school connectedness. home moves provide new opportunities several of the participants described how they looked forward to moving because they thought it would lead to better housing quality, less cramped living conditions and the possibility of having their own rooms. they also highlighted the opportunity that moving provided to live in a better neighbourhood. some of the participants described how moving was undertaken in an attempt to escape from bullying. amber looked at moving as an opportunity to move away from their current neighbours, who constantly complained about them: ‘i think moving is kind of fun… it will be a new home… and then the neighbours will stop complaining at us’. lila had hopes for a room of her own: ‘so mum and dad are trying to find a house… so we can move. and then i will get a room of my own’. beatrice discussed her experience of bullying and how moving away had helped: ‘sometimes i came home crying, because i was bullied. but when i started at the school i attend now i felt that i would be more at home… and i do… i am ok here … i still get bullied, but not much …. and i feel more relaxed here in this house …’. eve moved multiple times, explaining, ‘… we moved from our last home because of the young ones. maybe they will get better friends here ... that is why we moved to a new neighbourhood’. njsr – nordic journal of social research 121 vol. 12, 2021 home moves lead to a lack of continuity all the participants had been to more than one primary school because of moving, and some had attended multiple schools. they described how this situation had led to a lack of continuity in friendships, with some of the participants describing how it had been difficult to blend into new neighbourhoods and different schools, leading to issues of bullying. david explained how he had experienced the effect of multiple moves on friendships: ‘it is kind of annoying not living in the same place for a long time… you don’t get time to know the neighbourhood if you move around all the time… you don’t get time to get friends in the area and things like that…’. ari described how it had been difficult for him to get friends: …and i moved back to mum. i went to one school for a while, but i didn’t feel good there. … i did not have any friends there and i felt that they bullied me… so we moved, and i started at a different school…. i was there only for a couple of months… and then i went to a third school…. but i don’t spend time with my friends in my spare time because they are not allowed by their parents to spend time with me… the importance of neighbourhood the participants highlighted their neighbourhoods as important settings in their everyday lives. they described how they appreciated that their neighbourhoods gave them access to both nature and towns where they could spend time and participate in activities. they also emphasised the importance of having friends living in their neighbourhoods. access to nature, towns and places of entertainment several of the participants described how they appreciated living close to nature and how they spent time in diverse locations. both amber and malika described how they went for evening walks in locations close to their house. malika said, ‘i like walking around…. we go for an evening walk to a viewpoint over there…. it is fun…. and wonderful … fresh air in the evening… and it is so quiet… and we take pictures when there’s a sunset…’. beatrice described how she appreciated that her house lay close to a forest: ‘i love the forest. sometimes i just like to go out and look at the forest, and i think it is neat that the way to secondary school goes through a forest… there is a path…’. njsr – nordic journal of social research 122 vol. 12, 2021 the participants also appreciated how their homes were close to town, to varying possibilities of entertainment and to school. ari explained that he valued his home being close to many interesting places in town: ‘it is really close to things; the cinema, the beach. it is really nice here. it is neat to walk in the narrow streets. i really like living in this neighbourhood’. lila stated, ‘i really like it very much here…. it is in the middle part of the street…. i can cycle around … and there is a shop close by … and it is really close to school…’. closeness to friends the participants also highlighted the importance of living close to other children and friends. however, closeness to friends appeared to be more important for the adolescents when they were younger. beatrice explained, ‘i think it is important that children live next to each other… because then they can play together. when i lived in that other house, there were many children living close by… i liked it…’. david explained why he preferred to be at his father’s place: ‘where dad lives it is only 5 to 7 minutes to my friends—it is better, instead of going really far to meet my friends’. ari explained how he found it challenging to live far away from friends: ‘i live quite far away… and it takes a long time getting to school, and if my friend who lives close to school should think of planning something together… we don’t bother… so i can’t be part of that’. worries and dreams all the participants expressed some worries about their housing conditions. in contrast to their worries, all the participants had detailed descriptions in relation to how their dream houses should be laid out. worrying about housing conditions and the economic situation at home the participants had experienced cramped living conditions or houses infested with bugs, mice and other pests. several of the participants described how they shared their parents’ financial worries and concerns about the housing standards. lila explained how she was worried about the state of the electricity in the house she lived in: ‘it happens frequently that the light goes out…. some time njsr – nordic journal of social research 123 vol. 12, 2021 ago, we heard a loud sound like a bomb, and we got really scared… and it was black in the light socket… it was really dangerous’. eve described how their last house had been in bad condition: ‘in the basement… it was full of woodlice… and things like that. bad quality… and on the first floor it was really cold and draughty’. amber found it challenging that they had complaints from the neighbours: ‘if we make just a small sound, everybody can hear it… and they start complaining’. her sister malika said, ‘we have to take care… only speak in a low voice… we can’t speak as loud as we want to…’. ari explained why he worried about their cramped house: ‘i have really guilty conscious … i think i have it all the time…. i get that easily… i have a guilty conscious because mum has to sleep on the sofa in the living room… i want her to have her own room’. beatrice described her family’s financial worries: ‘money is a bit difficult… mum has to pay for this house… she has to pay all the bills: water bills, internet bills and all that.... and it is difficult… we also need money for food…. i don’t think too much about it, but i don’t know about mum…’. ari said, ‘i know that mum don’t have enough money for everything i ask for … and i ask for a lot of things…’. david revealed, ‘i worry a lot about costs.... i often ask dad ‘how are you doing now?’ do you have any money now’? if i need something, football shoes or gloves or something… i don’t ask him when he doesn’t have money’. their dream houses the participants were asked what the house of their dreams would look like. they all had strikingly detailed descriptions of this house, and some of them said that they had constructed their dream house several times in computer games. all the participants highlighted that their dream house should be spacious, include a room for each child in the family, and that it should have a nice garden and swimming pool. amber said, ‘this is just a dream house… but it should have a swimming pool and a place for a barbecue and a big garden…. and at least five bedrooms … one for each child … because then we wouldn’t have to argue’. njsr – nordic journal of social research 124 vol. 12, 2021 lila expressed her wish as follows: ‘i would like a room of my own… all mine…. and a big swimming pool outside and a balcony and two floors’. malika had a more modest wish for her room: ‘i would like my own closet … because now i share it with amber… she has a closet in my room’. however, she also dreamed of a big house: ‘i would have two floors… and outside i would like to have a swimming pool…’. discussion in this section, we discuss the findings of adolescents’ subjective experiences of their home and how housing influenced their everyday lives in terms of how housing is important in shaping social relationships, the importance of access to differing neighbourhood spheres and how adolescents adapt to their situation. whereas most of the research on housing has focused on adolescents’ health, deficits, problems and future outcomes, the participants in our study were more concerned with how the home environment facilitated social interactions and relationships. the findings show how the physical outlay of the house, residential mobility and type of neighbourhood sphere could, in combination, act to facilitate or inhibit social interactions and relational development. several studies have focused on how cramped living conditions can affect children’s and adolescents’ physical health and educational performance (clair, 2018; leventhal & newman, 2010), whereas our participants were more concerned with how the cramped living conditions affected their social life. our findings underline how the home is a key component of the microsystems influencing the lives of adolescents, showing how the home might promote or inhibit social interactions, both within the family and with peers. this finding is also in line with research pointing to ‘close relationships’ and ‘social networks’ as some of the core dimensions in the concept of home (hayward, 1977). some of the participants described how they did not bring friends home because they were embarrassed by their house. the findings show how bad and cramped housing conditions in low-income families can inhibit social interactions with friends for adolescents. this finding is in line with that of sarti et al.’s (2019), showing how the physical conditions of a house can inhibit the development of social interactions and relationships with peers at home. the importance of having enough space and a room of their own was highlighted by all the participants in their descriptions of their current house, as well as in their ‘dream house’. their own room was viewed as a place to invite friends and develop social relationships, but also as a place to njsr – nordic journal of social research 125 vol. 12, 2021 withdraw to and regulate closeness and distance in family life. both the development of social relationships and having personal space are important aspects of youth development. adolescents who do not have their own room form a small minority in norway (sandbæk, 2012). furthermore, there has been a development over the past decade in which children and adolescents in norway are spending more time at home (bakken, 2019). our findings underline how the quality and physical outlaying of the house are essential in adolescents’ possibilities to establish and develop social relationships. this shows how the home has a paramount role in adolescents’ lives by tying together space, relationships and daily living. the participants described how frequently moving could be challenging because they had to develop new social relationships and adapt to new schools. clair (2018) states that the negative consequences of home moves are more prevalent for adolescents, becoming more pronounced with advancing age. it has been suggested that residentially mobile adolescents may have particular difficulty gaining acceptance into prosocial and highachieving friendship networks because of a resulting decrease in social capital (haynie et al., 2006). in our study, several participants spontaneously revealed that they had been exposed to bullying. social support and positive relationships with peers and teachers have been identified as protective factors against the negative consequences of bulling (breivik et al., 2017). because residential instability makes it difficult to establish and maintain such stable relationships, adolescents who move often may be especially vulnerable to bullying. thus, the challenges around fitting into a new school and developing new peer relationships may be especially important to understand as the underlying mechanisms that can lead to such negative consequences following moving. in our study, the participants described how they engaged in the public spheres in their neighbourhoods. this finding is in line with the findings of other studies, where children living in cramped living conditions and poverty are actively using public spheres and that this engagement may compensate for deficiencies at home (sarti et al., 2019). an important issue identified by the participants was the need to live close to their friends. the social environment and possibility for their children to easily make friends have also been highlighted as important positive neighbourhood features by parents (poikolainen & honkanen, 2020). this finding shows that the neighbourhood works as a type of gatekeeping mechanism in forming and maintaining social relations. the social life of children and adolescents unfolds in their local njsr – nordic journal of social research 126 vol. 12, 2021 context, which is supported by research on socialising processes involving children and adolescents linking such processes to the situated and geographical context where they grow up (de visscher et al., 2012). this finding underlines the importance of public spheres in providing not only access to experiences of nature and range of activities, but also for facilitating socialising with peers. some of the participants in the current study had experienced living in bad physical conditions, involving mould, dampness and bugs. studies in a norwegian context have shown that cramped living conditions and problems with heating and noise are more common in social housing (skog hansen & lescher-nuland, 2011; brattbakk et al., 2015). poor-quality housing has been associated with adolescent emotional and psychological problems (coley, 2013; evans, 2001). the participants in our study did not have specific emotional or psychological problems. however, some of them expressed some worries concerning their parents’ financial challenges. this finding is in line with other studies that also show that children from low-income families tended to be aware of the financial challenges and housing problems facing the family (clair, 2018; sarti et al., 2019). in line with our study, the children in these situations were reported as wanting to protect their parents by adapting to the situation. this behaviour may be an indication of a willingness of children and adolescents to adapt and suppress the expression of their needs and wishes for material goods to protect their parents (thorød, 2008). however, the participants also described how their parents sometimes made specific arrangements for their benefit. it is also worth mentioning that several of the participants did not mention any financial worries. in the present study, the participants displayed positive and optimistic views toward the home and housing. despite revealing some worries about certain challenges with poor housing quality, cramped living conditions and frequent moving, the participants seemed to highlight the positive sides of their housing conditions, describing how they were coping and trying to make the best of their situation. these findings are in line with sarti et al.’s (2019) findings, which show, perhaps counterintuitively, that children from poor families were quite optimistic and positive about their lives. the optimistic attitudes indicated that the participating adolescents appeared to be coping and were resourceful in their response to their situation in terms of how they interpreted their surroundings. these findings are in contrast to the unidirectional negative effects of low income on adolescents’ well-being that are generally presented njsr – nordic journal of social research 127 vol. 12, 2021 in the relevant literature, illustrating how deficiencies and resourcefulness could go hand in hand. limitations and strengths a strength of the current study is the participants’ age span and diversity of cultural backgrounds. this may contribute to the variation and trustworthiness of the data. the older participants contributed with both retrospective perspectives from their childhood and current perspectives on their own and younger siblings’ experiences. the younger participants brought in their present perspectives. the participants’ diverse cultural backgrounds reflect the high number of immigrants among low-income families. their cultural background was not a specific focus for the interviews; however, we were struck by the similarities of the adolescents’ perspectives across cultural backgrounds. a limitation in using in-depth interviews as a data collection method for exploring the participants’ experiences lies in how this approach is suitable for grasping ‘true lived experiences’. stories shared in interview settings are always a product of the interaction between the interviewer and participant (klevan et al., 2016). in the present study, the adolescents were rather brief in their explanations and story sharing. however, a strength is the first authors’ special education and experience in working with adolescents; indeed, her broad experience in interviewing adolescents may have led to richer dialogues. conclusion the current study has shown how exploring low-income family adolescents’ own perspectives on housing revealed a resourcefulness among these adolescents, further underlying the processes that are important to their development and current well-being. the adolescents described their home and neighbourhood sphere first and foremost as a prerequisite in developing social relationships. the current study has revealed in-depth insights lowincome family adolescents’ perspectives on how the housing standards and location of their home and neighbourhood are directly associated with their social lives. these findings support the children’s rights elaboration of how adequate housing is essential for children’s and adolescents’ social development (the united nations convention on the rights of the child, 1989). moreover, the findings are a contribution to existing housing studies that mainly focus on deficits and future outcomes for adolescents. njsr – nordic journal of social research 128 vol. 12, 2021 future research on housing for low-income families should explore how to involve adolescents’ perspectives in finding solutions to difficult living conditions. the current study underlines the importance of exploring the everyday lives of adolescents from low-income families in a contextual way; specifically, there is a need to look beyond family interactions and explore the relevant contextual factors and how these influence adolescents’ lives. policy makers and social and child welfare services should be aware of how cramped houses, residential instability and the quality of neighbourhood spheres available influence adolescents’ possibilities to develop and maintain valuable social relationships. this calls for public investments and new solutions to ensure low-income families have access to decent, stable and affordable homes. by listening to the adolescents and facilitating the provision of adequate housing, it is likely that it will be possible to promote more stable relationships and better social support, which, as the evidence strongly indicates, are factors that are essential to their development and well-being. acknowledgements this study was founded by the university of south-eastern norway with support from the norwegian state housing bank. the authors would like to thank the participants for contributing to this study through sharing their 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(2012). man må ha en plass å bo. en sosiologisk studie av vanskeligstilte i et boligeierland [you need a place to live. a sociological study of people in poverty in a land of home owners]. international research institute of stavanger rapport iris2012/029 making the best of it: adolescents’ perceptions of how their home and neighbourhood spheres shape their lives vibeke krane * ellen andvig abstract moving around acknowledgements exploring social innovation (si) within the research contexts of higher education, healthcare, and welfare services—a scoping review njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 exploring social innovation (si) within the research contexts of higher education, healthcare, and welfare services—a scoping review anne marie lunde husebø* department of public health university of stavanger, norway faculty of health sciences, research group of nursing and health sciences, stavanger university hospital e-mail: anne.m.husebo@uis.no *corresponding author marianne storm department of public health, faculty of health sciences university of stavanger, norway faculty of health sciences and social care molde university college, norway. e-mail: marianne.storm@uis.no atle ødegård faculty of health sciences and social care molde university college, norway nordland research institute, norway e-mail: atle.odegard@himolde.no charlotte wegener department of communication and psychology, aalborg university, denmark e-mail: cw@hum.aau.dk marie aakjær centre for leadership and experience design, absalon univeristy college, denmark e-mail: maaa@pha.dk anne lyngby pedersen department of communication and psychology, aalborg university, denmark e-mail: alp@socsci.aau.dk 73 njsr – nordic journal of social research vol. 12, 2021 maja boelsmand østergaard department of communication and psychology aalborg university, denmark e-mail: mboe@socsci.aau.dk elisabeth willumsen department of public health, faculty of health sciences university of stavanger, norway molde university college, norway e-mail: elisabeth.willumsen@uis.no abstract introduction: nordic countries face societal challenges for which social innovation may represent solutions. the aim of this scoping review is to explore the concept of social innovation within the research contexts of higher education, healthcare, and welfare services. method: a scoping review methodology was used, including a literature search and the identification of eligible studies published between 2007 and 2019, in addition to data extraction and synthesis. forty-three studies were included in this review. results: across the research contexts, social innovation is conceptualized as a set of novel, creative, human-centred, and value-driven processes aiming to bring about change. qualitative research methods dominate social innovation research. in welfare services, social innovation concerns the relationship between policy and praxis, new forms of leadership and management, and the promotion of societal inclusion and cohesion. social innovation in healthcare comprises the use of technology to digitalize service, enhance patients’ well-being, and improve service quality. in higher education, social innovation research focuses on educational reforms involving non-profit stakeholders. discussion: social innovation is a multifaceted concept related to change at the organizational or societal level, often with various stakeholders working together to create improvements. the lack of a common definition and framework of social innovation makes this concept difficult to measure or quantify, reflecting the dominance of qualitative research methods in the selected research contexts. across these research contexts, social innovation can be defined and used for various research purposes, which are often political and value-based, with the latter connected to the common good and people’s well-being. moreover, few social innovation studies have been performed in nordic countries. keywords: social innovation, higher education, healthcare, welfare services, scoping review 74 njsr – nordic journal of social research vol. 12, 2021 introduction this scoping review explores the concept of social innovation (si) as it appears in three specific contexts: higher education, healthcare, and welfare services. in this study, welfare services are understood as social services provided to citizens to meet societal needs. exploring the concept of si is useful because si has become a significant concept in policy and management rhetoric, often put forward as a crucial element in strategies aimed at making better use of scarce resources. in addition, the expectation that si can drive societal change and maintain welfare services under economic constraints has become evident in public and academic discourses. in fact, sis seem to be gaining importance over technical innovations in dealing with societal challenges (howaldt & kopp, 2012). while innovation carries technological and economical connotations, si emphasises valuecreation beyond fiscal growth, including better health, wellbeing, and safety of the si target group. some analytical definitions use the term ‘social’ to distinguish sis from technical innovations (borzaga & bodini, 2014). moreover, this term often refers to the ways in which this value can be achieved through new ways of working (together) as well as empowering actors (i.e., professionals and citizens) to take part in the production of welfare (avelino et al., 2019). a popular definition of this concept came from murray et al. (2010), who defined si as ‘new ideas (products, services and models) that simultaneously meet social needs and create new social relationships or collaborations. in other words, they are innovations that are both good for society and enhance society’s capacity to act’ (p. 3). as this definition implies, the concept of si is often understood as processes that spring from real-life problem-solving, but it simultaneously addresses a basic level of capacity-building in groups, organizations, or society (murray et.al, 2010). in addition, si is deemed relevant when addressing challenges concerning societal changes (macro level), social needs, and people’s wellbeing (micro level) (mulgan, 2015; nicholls et al., 2015). such innovations are not only beneficial for society because they solve problems in practice, but they also enhance society’s capacity to act. this means that they generate newer, better infrastructures and competencies for innovation beyond the demands of the actual situation (caulier-grice et al., 2012). si is thus associated with social change for ‘the common good’, indicating that si is meant to create social value and must be experienced as useful in a given field of practice (mulgan, 2015). 75 njsr – nordic journal of social research vol. 12, 2021 the diagnoses of societal challenges vary, yet there seems to be agreement regarding the role of si: its potential in empowering and mobilising civic creativity in addition to problem-solving. this agreement is especially manifested in policy discourses across the eu (avelino et al., 2019). policy documents emphasise the social dimension of societal challenges and the immediate social challenges that shape the process of social interaction to improve individuals’ well-being (commission of the european communities, 2008). hence, si is regarded as a response that ‘can offer a way forward in coping with the societal challenges and the crisis that eu is facing (bureau of european policy advisers [bepa], 2011, p. 7). the somewhat optimistic assumptions that si can ‘save’ welfare states, however, seem to underestimate the systemic complexities of these challenges (rittel & webber, 1973). in fact, there is a growing concern in both theory and practice regarding the systemic level of si and ways in which systems are rewired, which is considered crucial for lasting change and for understanding the concept (mulgan, 2012). si is a complex, contested concept, and knowledge about its nature, management, and facilitation in specific contexts is limited. thus, further research is necessary to develop knowledge about how si appears within different scholarly contexts, how (and if) it is conceptualized, the methods researchers apply, and the foci of relevant research. nordic countries are facing some of the same societal challenges affecting other european societies, including increased income inequality and a higher risk of poverty (fritzell et al., 2012). the nordic welfare states are experiencing cutbacks on? public spending/budgets, and innovative public service models are needed (norwegian institute of public health, 2019). hence, si combined in healthcare, higher education, and welfare services may become a strategy for addressing the societal challenges facing these nordic welfare systems. globally, in welfare fields such as higher education, healthcare, and welfare services, work practices are continually evolving due to changing demographic, political, and economic circumstances. the need for alternative conceptions of traditional processes and product models of innovation is relevant because the contexts of welfare innovations mainly take place as part of everyday interactions between people. the concept of innovation is often 76 njsr – nordic journal of social research vol. 12, 2021 associated with technological development and private enterprises associated with products and markets, and it does not easily translate to health and welfare services in the public sector (hartley, 2005). a literature review on innovation within healthcare, education, and welfare services in europe noted the following distinctive features of innovation in these contexts : i) the relational dimension, as the relationship between the user and the service provider is direct; ii) the processual dimension, as the process of innovating and the diffusion of the innovation are never fully accomplished; and iii) the interactional dimension, as the generating and dissemination of innovation unfold within a complex system and among different systems, contexts, and implementing environments (crepaldi et al., 2012). therefore, innovation in various welfare fields is often initiated in specific contexts, and its value is evaluated by the actors in each of these contexts (tanggaard & author, 2016). with the growing interest in si, there has also been increased attention toward not only the social ends (problem-solving) but also the social means (new ways of collaborating and the mobilization of new actors). these new social means often involve changes in power relations, enforced ethical considerations, and the need for situated decision-making by various professionals working with individuals in need of care, support, and/or learning (author, 2016). since the outcomes of innovations are not solely new and measurable, products, services, or processes accordingly become a mix of human-to-human interactions, methods of collaborating during problemsolving, and the quality of relations between the innovation stakeholders (author, 2014). although si requires distinct professional competencies and a managerial strategy, it also involves sensemaking and commitment, the support of experimentation, critical dialogue, and risk-taking in expansive learning environments (fuller & unwin, 2004; fuller et al., 2018). despite a growing interest in the social aspects of innovation, there is still little knowledge about the practice of si (phillips et al., 2019) nor consistency in the use of the concept across eu policy and national policies (krlev et al., 2020). in the same vein, there is no reliability in discussions of this concept across scholarly fields. additionally, mulgan et al. (2013), stated that social innovation is ‘theoretically underdeveloped with few, if any, accepted concepts or causal relationships’ (p. 426). accordingly, in this paper, we will ask the following: how is si conceptualized and studied in the contexts of higher education, healthcare, and welfare services, and what are the foci of the related 77 njsr – nordic journal of social research vol. 12, 2021 research? thus, the aim of this scoping review is to contribute to a description of research on si across these three scholarly fields. materials and method scoping review design the study applied a scoping review method following the framework of arksey and o’malley (2005). this framework suited our aim of making a broad mapping of the concept of si in an interdisciplinary context and allowed the inclusion of studies that applied various methodological approaches. it comprises five steps: 1) identifying the research question, 2) performing a literature search to identify relevant studies, 3) selecting relevant studies, 4) charting the data, and 5) synthesizing the data (arksey & o’malley, 2005). identification of research questions the study’s scope and research question were discussed and developed by the authors during a workshop in march 2017. the starting point for the workshop involved this question: what definitions and meanings does the term si take on, and what knowledge gaps must be addressed in future si research? the scope of this study included exploring and describing the concept of si, which resulted in the following research questions: 1) which methodological approaches were applied in the various studies analysed? 2) how has si been conceptualized in research within the contexts of higher education, healthcare, and welfare? 3) how does si unfold as a process within the welfare research contexts of higher education, healthcare, and welfare services? literature search the scoping study method requires a comprehensive approach. therefore, all kinds of literature and studies within si that intersected the contexts of interest were initially determined to be relevant (arksey & o’malley, 2005). to obtain an overview of the three research fields, a literature search was performed using google scholar, resulting in a high number of retrieved titles (n = 103,300). this led to a more restricted, manageable approach to our search strategy, which involved a second, identical search performed during march 78 njsr – nordic journal of social research vol. 12, 2021 2017 in the databases of scopus, the web of science, cumulative index of nursing and allied health literature (cinahl), and political science by a university librarian together with two co-authors (alp, mbø). broad search terms such as ‘education’, ‘health’, and ‘welfare’ were applied in combinations with ‘si’ in all of the searches (table 1). subsequently, we decided to narrow ‘education’ to ‘higher education’ and to include only studies that explored and/or reported on higher education in the health and welfare sectors. the first author (amlh) conducted a second, updated search in the same databases in august 2019, which yielded 173 new records. all of these searches were limited to the documents’ titles or abstracts. the publication period was set to january 2007–august 2019. table 1 search history the searches identified 828 records. after screening the titles and removing duplicates, 290 abstracts were included in the study selection stage (table 1). study selection this stage began with two of the authors sorting the identified records from the initial search (n = 655) into different files in google docs (alp, mbø), with each file representing one of the three research contexts. in each file, titles and abstracts were sorted under the predefined headings of ‘education’, 79 njsr – nordic journal of social research vol. 12, 2021 ‘health’, and ‘welfare’ to aid further review. the records identified in the updated literature search (n = 173) were subsequently added to the bibliographical files from the first search. during study selection, the authors worked in pairs according to their research context of interest and professional expertise: higher education (cw, mkaa), healthcare (amlh, ms), and welfare (ew, aø). first, each pair independently read the identified records, which was followed by a joint review of abstracts eligible for full-text examination. disagreement regarding eligibility was resolved through dialogue. across the three research contexts, the texts of 290 abstracts were selected to be read in full. next, full-text versions of eligible abstracts were obtained and independently read by each pair to determine which articles met the inclusion criteria. inclusion and exclusion criteria the criteria for the inclusion and exclusion of articles were made post hoc based on our increasing familiarity with the literature following a comprehensive reading of abstracts. in reading the abstracts, we developed an overall idea of the focus of each paper. during this process, the documents were sorted into two categories: ‘research about si’ and ‘documents that define si’. we then developed the following refined criteria for inclusion: 1. si on an individual, group, or organizational level within the context of higher education, health, or welfare; 2. education innovations within social work, healthcare, or higher education (bachelor’s degree); 3. welfare innovations, including social services, the public sector, and civil society; 4. health innovations within the health care system; 5. peer-reviewed articles; 6. empirical studies; and 7. case studies. the final and more detailed criteria for inclusion further guided the abstract evaluation process, thus studies that reported on urban environmental innovations, workplace development innovations, or innovations in the development of medicines were excluded. in addition, scientific papers that described innovation without the social context or described si as limited to policy were excluded. beyond this, we excluded review articles, book chapters, study protocols, and non-empirical studies. 80 njsr – nordic journal of social research vol. 12, 2021 data extraction and charting in step 4, the authors extracted and charted data from each research context in a pairwise manner. data was extracted from each of the identified articles and coded according to the following descriptive information: author(s), country of origin, research context, study population, and research methods. this information is charted in table 2. data synthesis in step 5, each pair of authors synthesised the results from each article in text paragraphs. in a synthesis workshop, all authors read the text paragraphs from each research context (higher education, healthcare, welfare services) to elaborate on and identify common themes across these contexts (to be discussed in the final section). results a total of 43 empirical studies were included, eight in the research context of higher education, 13 in the healthcare research context, and 22 in the welfare services research context. the included studies were published between 2010 and 2019. six of the studies had been performed in nordic countries (andersen & bilfeldt, 2017; bjerregaard et al., 2018; gawell, 2014; johansson & stefansen, 2019; rantamaki & kattilakoski, 2019; svensson & bengtsson, 2010), and all addressed the welfare services research context. three of the studies featured multiple study sites across various countries (bjerregaard, et al., 2018; casanova et al., 2019; giraud et al., 2014). none of the studies were performed in african countries. for detailed information regarding the study origins and other characteristics, see table 2. across the studies included, numerous methods, definitions, and theoretical frameworks were employed, and a variety of study aims were presented. in the following section, the findings of this review will be presented according to the three research questions. 81 njsr – nordic journal of social research vol. 12, 2021 table 2. characteristics of included studies 82 njsr – nordic journal of social research vol. 12, 2021 83 njsr – nordic journal of social research vol. 12, 2021 84 njsr – nordic journal of social research vol. 12, 2021 85 njsr – nordic journal of social research vol. 12, 2021 86 njsr – nordic journal of social research vol. 12, 2021 87 njsr – nordic journal of social research vol. 12, 2021 88 njsr – nordic journal of social research vol. 12, 2021 applied methodology the characteristics of the methodological approaches used in the studies are presented in table 2. more detail on the research methods is provided below. higher education four of the included studies were based on qualitative methods—either interviews or case studies (kickul et al., 2012; nandan et al., 2015; pittcatsouphes & berzin, 2015; traube et al., 2017). one study reported on an educational intervention (cavalcante et al., 2016), and one study adopted a four-step methodological approach to supporting and enabling a theoryinformed learning design (alden rivers et al., 2015). another study was based on a quantitative survey of teachers situated in vocational and professional schools (tafel-viia et al., 2012), and one was a think piece on social work education (traube et al., 2017). healthcare qualitative research designs were applied in the majority of the studies regarding healthcare. these studies combined the qualitative methods of 89 njsr – nordic journal of social research vol. 12, 2021 document analysis, interviews, observation, and the use of smart technology and social media platforms to create communication data. five studies applied a case study design (farmer et al. 2018; huq, 2019; norman & yip, 2012; okada et al., 2014; windrum et al., 2017). seven studies (ballard et al. 2017; cheema & mehmood, 2019; de freitas et al., 2017; grindell et al., 2018; vechakul et al., 2019; shrimali & sandu, 2015; xiao et al., 2015) were qualitative interview studies. two studies used a quantitative research design, involving methods such as surveys and the quantification of technology users’ behaviour (gravili, 2013; kitamura et al., 2016). welfare services most of the studies applied a qualitative methodology and, more specifically, case studies comprising methods like participatory observations, semistructured interviews, fieldwork, website analysis, process analysis, and document analysis (bjerregaard et al. 2018; cools & oosterlynck, 2019; dai et al., 2019; de rosa, 2017; gawell, 2014; giraud et al., 2015; johansson & stefansen, 2019; lindsay et al., 2019; rantamaki & kattilakoski, 2019; sabato et al., 2017; sabato and verschraegen, 2019; shier & handy, 2016; svensson & bengtsson, 2010; weinzierl et al., 2016; visentin, 2018; xie et al., 2019). three of these studies also included findings from previous survey data (grohs, scneiders & heinze, 2015; 2017; meričkova et al., 2015) or register data (kim et al., 2019. the studies of lindsay et al. (2019) and rantamaki and kattilakoski (2019) used longitudinal case study designs, whereas andersen and bilfeldt (2017) applied an action research design in their two studies. conceptualization of si higher education in the research context of higher education, si was defined by novelty and improvement, a definition requiring every new practice to be more effective than its pre-existing alternatives (cavalcante et al., 2016; jiang & thagard, 2014; kickul et al., 2012; nandan et al., 2015; pitt-catsouphes & berzin, 2015; rivers et al., 2015; tafel-viia et al., 2012; traube et al., 2018). also found was an interest in distinguishing si from related terms, such as ‘social entrepreneurship’ (kickul et al., 2012), as well as in distinguishing ‘social intrapreneurship’ (i.e., an entrepreneurial behaviour exhibited by employees within an organization) from ‘social entrepreneurship’ (i.e., innovative, community-based approaches to social work that have been nationally replicated) (nandan et al., 2015). nandan et al. (2015) also provided a more elaborate definition, with si described as ‘a novel mechanism that increases 90 njsr – nordic journal of social research vol. 12, 2021 the welfare of the individuals who adopt it compared with the status quo’ (p.6) . moreover, social innovations were defined as creative products and changes that are motivated by social needs and bring value to society by meeting those needs (jiang & thagard, 2014). healthcare within the healthcare context, most of the studies provided a definition of si or placed themselves within an si theoretical framework. si was explained as a creative process involving community members or users (cheema & mehmood, 2019; farmer et al., 2018; grindell et al., 2017; vechakul et al., 2015) and as creating opportunities to explore si in existing service delivery programs, professional work, and values, directions, and insights (gravili, 2013; huq, 2019; shier & turpin, 2019). ballard et al. (2017), de freitas et al. (2017) windrum et al. (2017), cheema and mehmood (2019), and huq (2019) considered si to refer to new responses to pressing social needs. sis were found to create new social relationships; they were ‘social’ in both their ends and their means and could include products, production processes, or technologies. in addition, si could be a principle, idea, piece of legislation, or social movement in addition to being community-based, which includes microentrepreneurship, or serve as an evaluation approach, an intervention or a combination thereof (cheema & mehmood, 2019; grindell et al., 2018; huq, 2019; shier & turpin, 2019). a common understanding among such studies was that si is a set of technical innovations in which innovators, users, and communities collaborate using digital technologies to co-create knowledge and solutions to a wide range of social needs. moreover, si was considered in relation to initiatives and how involved participants become and interact collaboratively to leverage power through, for example, the use of digital technologies. despite building on si processes and presenting their study as a si study, three studies did not provide an explicit definition of si or discuss their research within an si theoretical framework (kitamura et al., 2016; norman & yip, 2012; okada et al., 2014). welfare services in the welfare services research context, almost all of the included studies employed definitions of si and/or presented models of si (bjerregaard et al., 2018), except for weinzierl et al. (2016), grohs et al. (2017), visentin (2018), and dai et al. (2019)— although the latter study was related to value-based 91 njsr – nordic journal of social research vol. 12, 2021 social change. several authors elaborated on different approaches to define si, and concluded si as being loosely defined or multifaceted (casanova et al., 2019; cools & oosterlynck, 2019; gawell, 2014; giraud et al., 2015; johansson & stefansen, 2019; lindsay et al., 2018; sabato & verschraegen, 2019; svensson & bengtsson, 2010). the social aspect of the innovation was seen as central along with socially oriented services for solving social problems—at the individual level and societal level—to support improved social outcomes and evaluations (andersen & bilfeldt, 2017; de rosa, 2017; kim et al., 2019; rantamaki & kattilakoski, 2019; sabato et al., 2017; sabato & verschraegen, 2019; shier & handy, 2016; xie et al., 2019). another dimension, ‘process’, consists of openness and the active involvement of many stakeholders, including civil society and end users, in interactions that pursue change and novelty (meričkova et al., 2015). the transformation of relationships between involved stakeholders has resulted in new concepts regarding si, such as co-creation, social entrepreneurship and intrapreneurship, and social enterprise. furthermore, these concepts have contributed to the dynamic character of si (gawell, 2014; grohs et al., 2015, 2017; meričkova et al., 2015; sabato et al., 2017). si emphases in the included studies higher education within the educational context, the focus is was twofold: the first was on si for networking, educational change, and solving social issues, while the second was on si in academic programmes (i.e., to prepare students for si, to spearhead societal change in the community, and to stimulate creativity and problem-solving). a majority of the studies focused on educational reforms and the conditions of their successful or not-so-successful implementation (kickul et al., 2012; pitt-catsouphes & berzin, 2015; tafel-viia et al., 2012; traube et al., 2017). the practice of si was also seen as offering promising approaches to social issues. pitt-catsouphes and berzin (2015) employed insights and tactics that have emerged in the si field and used them to strengthen current macro practices, alden rivers et al. (2015) proposed a theoretical framework to support the embedding of si education in existing academic programmes. moreover, one study provided implications for the programmatic challenges of integrating social business concepts and initiatives into curricula and pedagogy (kickul et al., 2012). 92 njsr – nordic journal of social research vol. 12, 2021 in addition, some studies focused on recommendations for si actors, who were often seen as educators who can prepare students to recognize and implement new sis in their communities (kickul et al., 2012), and on recommendations for social workers, who were seen as capable of leading and facilitating social changes that could have lasting impacts on communities (nandan et al., 2015). cavalcante et al. (2016) reported on a study aimed to promote problemsolving and creative thinking among students as a means of si. this study also aimed to enhance students’ knowledge and their willingness to help build society and shape key societal values. another study took an explicit learning approach asking how si education can be defined, which learning theories best support si education, how such learning theories relate to existing models of learning in higher education, and what implications an si pedagogy may have in learning design (alden rivers et al., 2015). stavreva-kostadinova (2018) found that the encouragement of self-inclusion, volunteering, and active implementation in educational group sessions helps students develop opportunities to participate actively and meaningfully in social innovation teams. healthcare the foci of the si studies regarding healthcare were found to involve digital technology, healthcare policy driving shifts in healthcare practices, and the use of si to meet societal needs related to aging populations, family and reproductive health, youth mental health, and substance and addiction services. the purpose of these studies was also to assess and evaluate si within service delivery and interprofessional work. in gravalli et al. (2013), grindell et al. (2018), kitamura et al. (2014), and norman et al. (2012), si appeared to be an innovative use of diverse digital tools to meet a social need. norman et al. (2012) illustrated how social media and online resources have been used to overcome literacy barriers in youth to promote mental health. grindell et al. (2018) demonstrated the usefulness of the istep as a motivational tool and increased awareness of engaging in physical activity across generations, whereas gravili et al. (2013) demonstrated a case of si as digital communication regarding medical issues among medical doctors as well as between doctors and their patients. beyond this, kitamura et al. (2014) promoted si as a provision of medical resources and information to aid cancer survivors. in windrum et al. (2017), ballard et al. 93 njsr – nordic journal of social research vol. 12, 2021 (2017), shier and turpin (2019), and huq (2019), si was connected to policy, system and institutional change, and the implementation of programmes in mental health, healthcare, and social services organizations. in addition, si appeared as processes engaging public and private actors, family caregivers, and service users to meet health and societal needs. okada and igarashi (2014) aimed to deepen the societal understanding of social issues related to dementia using an innovative design process. in a study by vechakul et al. (2015), innovation appeared in the context of health and social care organizations and sectors, with the aim of applying human-centred design (hcd) to create innovative products, services, and strategies. xiao et al. (2015) combined smartphone technology with social digital activity to engage community residents in current health challenges and social problems. de freitas et al. (2017) identified social innovation support strategies for patients and families to cope with rare diseases. farmer et al. (2018) described a grassroots initiative aimed at improving the oral health of community members using si theory to implement innovative ideas from community-based processes. elsewhere, cheema and mehmood (2019) described how challenges to maternal and reproductive health services in remote and rural communities in developing countries could be approached using an si model. welfare services the studies included in the welfare services context appeared to mainly explore the interplay between policy intentions and implementation related to si. for instance, giraud et al. (2015) focused on the discourses underlying different types of innovations and showed that the contexts of local policy and si change simultaneously with the development of the welfare state. gawell (2014) found that a combination of social entrepreneurship, welfare services, and public management contribute to the problematisation and alignment of the emerging field of si. grohs et al. (2015) argued for a dual perspective, accounting for both organizational form and specific styles of action. at the same time, they highlighted the institutional embeddedness of social entrepreneurship and the potential of new actors in established governance arrangements. in another study, grohs et al. (2017) focused specifically on this institutional embeddedness and suggested an institutionalization of civic commitment. 94 njsr – nordic journal of social research vol. 12, 2021 elsewhere, shier and handy (2016) focused on direct social service nonprofit organisations—addressed through cross-sector partnerships—as particularly related to the role of nonprofits in meeting the emerging needs of service user groups. two studies focused on si in the form of user-driven and co-creative processes. for example, meričkova et al. (2015) highlighted local governments and civil society in the fields of welfare and the environment, whereas svensson and bengtsson (2010) stated that sources of si are major contributors to economic growth and welfare services, illustrating that the management of si combined with user innovation could facilitate innovation diffusion and the acquisition of resources. concerning the development of policy goals and government structures, sabato et al. (2017) investigated how si was used to advance distinct eu policy goals related to welfare system reforms in the field of poverty and social exclusion during the period 2006–2014. a study by sabato et al. (2019) examined how the eu supports si local initiatives, including both micro and macro perspectives related to the multi-level governance (mlg) concept. on the other hand, casanova et al. (2018) concentrated on multidisciplinary case and care management and analysed the delivery of a family-based care model. johansson and stefansen (2019) studied the implementation of ‘the barnahus model’ in both the nordic region and broader european context, indicating that this model seems to be implemented quite differently across countries. weinzierl et al. (2016) investigated how the si case ‘housing first’ complemented and modified the governance structures of the welfare state to better combat homelessness and promote social cohesion. in addition, kim et al. (2019) investigated the interaction between teamwork and parent engagement, whereas bjerregaard et al. (2018) focused on how collaboration processes unfold in an ageing society across countries facing similar societal problems. dai et al. (2019) examined support and recognition from the government, the market economy, and general society in creating innovations in local contexts. elsewhere, rantamaki and kattilakoski (2019) studied how vulnerable rural communities have managed to change the direction of mainstream development, addressing the withdrawal of welfare services. xie et al. (2019) explored how children evaluated the effects of using robots for educational functions, self-care, and parental care. in another study, de rosa (2017) highlighted the functions of technological factors in welfare services across europe, showing how different types of innovations used a function of 95 njsr – nordic journal of social research vol. 12, 2021 ‘disruptive technology’. visentin (2018) studied the emerging logic of welfaresharing, particularly in terms of service design and the social processes involved. lindsay et al (2018) focused on how co-governance and comanagement as a model could improve services for single parents. beyond this, cools and oosterlynck (2019) showed how to implement a socially innovative service developed by local actors of work trajectories for foreign language newcomers in belgium. andersen and bilfeldt (2017) presented how action research may be an interesting approach to the study of si and empowerment within the welfare system to create possibilities for positive change. summarising and comparing results table 3 provides an overview of the results. to summarise, qualitative research methods dominated the field of si research. si as a novel and value-based concept was found as prominent and related to addressing social needs and values. in addition, si processes comprised creativity, engagement, social inclusion, and cohesion, focusing on change and innovation at both the micro and macro level for the benefit of society. 96 njsr – nordic journal of social research vol. 12, 2021 table 3. summary of results 97 njsr – nordic journal of social research vol. 12, 2021 discussion the aim of this study was to investigate how si unfolds within three research contexts. our study results have identified an array of methodological approaches, definitions, and conceptual understandings of si as well as complex si emphases. later in this article, the results will be discussed in relation to common methodological approaches used in si research, how we can understand si as a social concept across interprofessional contexts, and how si unfolds within welfare research. considering methodological approaches in si research the complexity of si may cause problems for researchers trying to apply research methods in its study. this review suggests that research on si is in its early stages and that possible next steps could include the development of a broader range of research methods. to guide this development, there seems to be a need for conceptual evolution and clarification regarding the 98 njsr – nordic journal of social research vol. 12, 2021 definition of si, especially when considering the vague nature of the concept. the development of conceptual models of si may form an interesting point of departure for the development of si interventions. as the present review has revealed, si is used in different contexts and at different levels, including the policy level, organizational level, and relational level. this necessitates the question of how conceptual clarification distinguishing these different levels could improve research efforts. for example, this could include examining how stakeholders perceive si at the organizational level, what kinds of changes are regarded as innovative, how these changes come about, and what values drive organizational change. based on the review results, it is unsurprising that attempts to measure si are still in a very early stage, and few attempts have been made to this end (caulier-grice et al., 2012; mulgan et al., 2013). on a related note, explorative and qualitative approaches dominate the research field of si. for example, quantitative studies were few in the sample of included studies, a finding supported by other researchers (nicolls et al., 2015). moreover, the results here showed that the methods applied in the welfare context are more diverse than those applied in higher education and healthcare. in addition, the lack of si research within the welfare fields of higher education and health care in nordic countries may reflect a lesser focus on scientific, empirical investigations for the benefit of non-empirical, theoretical discourses. as argued above, the development of si research methodology may focus on the development of conceptual models. the qualitative approach found in much of the si literature has likely contributed to these possibilities. as shown in this review, it should be possible to develop conceptual si models within different contexts and at different levels, with certain core model elements revealing the inner meaning of si. this review partly supports the notion that si can be defined somewhat differently across various contexts. several conceptual models may be developed based on different theories and experiences. for example, a researcher focusing on organizational elements (e.g. resources, leadership, competencies) may include other concepts in a model in comparison to a researcher focusing on team elements (e.g. members, characteristics, processes). hence, the development of a research instrument, such as a questionnaire, will look quite different depending on which conceptual model is developed and how it is operationalized. in summary, these results may 99 njsr – nordic journal of social research vol. 12, 2021 provide information about very different aspects si. this is basically an issue of validity— that is, the question of what is being measured. without a sound contextual understanding of the meaning of si (e.g., content, process, value), the concept is shrouded in confusion. how can we understand innovation as a social concept across research contexts? in this review, only four of the included si studies were performed in nordic countries, and all of these were within the research context of welfare. one reason could be that the global economic crises that hit the eu in 2008 had less impact on nordic countries, which may reflect the eu's commitment to welfare development and research in countries that faced recession and thus had a greater need for change, including in terms of social innovation. additionally, the economic crises may mirror the role of the nordic welfare model, in which the state and local government play a pivotal role and the principles of universality and egalitarianism constitute ideals and, consequently, a robust financial base for the citizens’ welfare (pedersen & kuhnle, 2017), and possibly less strain for change. however, new si research initiatives are present in nordic countries. a recent review by jungsberg et al. (2020) on community-driven si in rural areas in nordic countries adds to our understanding of si from a nordic perspective, as the authors points to important characteristics of innovation actors and suggest a building capacity for si implementations among local innovators. our findings showed that si is not a straightforward concept and that it has been used to describe policy goals related to national, regional, community, and organization change (societal level). moreover, si has been used to describe partnerships involving specific service user groups and stakeholders in collaborative work (individual level). in the included studies, si was not always defined, and when it was, this was done in a variety of ways. thus, there seems to be significant uncertainty about what the concept actually entails (murray et al., 2010). according to caulier-grice et al. (2012), si must do the following: 1) represent something new for their site, market, or users or represent a new application; 2) include implementation—not just new ideas; 3) meet a current social need; 4) show higher functionality than existing solutions and create measurable improvement; and 5) empower the recipients of services, create new roles and relationships, develop new tools, and strengthen these services' abilities to deliver accurate solutions. although social innovation has positive connotations and is meant to protect the common good (tidd & bessant, 2014), it is important to be critical and ask 100 njsr – nordic journal of social research vol. 12, 2021 oneself who will benefit from the innovation in question as well as what disadvantages it entails and for whom. this review revealed that within all three research contexts, the concept of si is associated with value creation although this concept is connected to a degree of uncertainty in terms of a lack of agreement on definition and delineation, outcomes, and processes of involvement. moreover, innovation as a change strategy in higher education, healthcare, and welfare mayinvolve the recognition and application of perspectives and concepts that have not been developed in terms of this context. we believe that social innovation can embrace these social aspects and contribute to a more nuanced understanding of innovation related to interpersonal interactions. therefore, social innovation can be an appropriate approach and supplement to traditional theories of innovation (caulier-grice et al., 2012). additionally, the meaning of si is often blurred by its intersection with other similar concepts, such as social entrepreneurship, social intrapreneurship, and co-creation, which involve both organizations and actors (grohs et al., 2015). social entrepreneurship is also central in the context of higher education, where it functions as a value-based service development to enrich student welfare while familiarizing them with si and providing tools to conduct si. within the healthcare context, the majority of the studies examined here applied si frameworks emphasizing value-based processes, digital technologies, user involvement and collaboration between stakeholders, and creativity. in other words, si is a multifaceted concept and can be used for various—often political—value-based and research agenda purposes, thus valuing the common good (borzaga & bodini, 2014). si can be understood as central in discussions related to where and how innovation arises and who can and is allowed to contribute in the innovation, as well as those regarding democracy and public value creation (author, 2020). how does si unfold in welfare research? across research contexts, si unfolds at different levels: at the societal level, si is connected to policy, systemic, and institutional change and implementation; it may strengthen current macro practice and complement or progressively modify the governance structures of the welfare state (weinzierl et al., 2015; windrum et al., 2017). studies of individual-level si in this review were mainly founded within the research contexts of higher education and healthcare. the latter was reported in studies aiming to develop interventions for improved 101 njsr – nordic journal of social research vol. 12, 2021 student performance, participation in workplace innovations (e.g., stavrevakostadinova, 2018), and patient care. it appears that si associated with technology is more prominent within the healthcare context and is less prevalent in higher education. in the latter context, si involves networking— that is, creating social relationships between groups such as teachers, social workers, and students; stimulating creativity; and increasing student capacities for si processes. common findings across the three research contexts included understanding si as involving three dimensions—relational, processual, and interactional— which is in line with the meta-study of crepaldi et al. (2012). the processual and interactional dimensions of si were revealed in the studies to be significant across various contexts and levels. in the processual dimension, the sis are ongoing interplays dependent on a context; in the interactional dimension, there is a requirement of human relations and co-creation to make si work within and between complex systems. however, the relational si dimension in higher education seems more bottom-up-oriented when compared with the healthcare and welfare contexts, where the drivers of si are policy and industry. although policy also appears to play an important role within higher education, it may remain in the background of the discourse in favour of a larger interest in the relational and processual dimensions. this suggests that certain dimensions of si are sensitive to context. strengths and limitations of the review the methodological strengths of this scoping review included the involvement of several researchers knowledgeable within the research fields of interest. moreover, the review collaboration involved two workshops and digital meetings for the authors to discuss, illuminate, and establish a sound and rigid review methodology to produce trustworthy results. however, certain limitations should be recognized. the broad approach of our literature search with a limited use of keywords and databases may have resulted in missing relevant articles, even though we included a search of reference lists. in addition, we excluded all document types other than peer-reviewed articles. in the current review, systematically identifying grey literature within three research contexts was a challenging task expected to result in an unmanageable amount of data. however, the inclusion of grey and white literature is recommended in a scoping review and may have broadened the understanding of this research field, especially in terms of si in the nordic context. finally, an evaluation of a possible risk of bias in the included studies 102 njsr – nordic journal of social research vol. 12, 2021 was not performed due to great variation in the primary data sources and a lack of well-established quality assessment criteria (whittemore et al., 2014). conclusion and implications in summary, this scoping review illustrates how the concept of si is used and understood within and across the research contexts of higher education, healthcare, and welfare services. clearly, si as a concept has gained prominence in these research fields and in eu policy during the last ten years. despite this development, nordic empirical studies, especially within higher education and health care services research, are still limited. thus, future research may focus on the role of the nordic welfare model in the development of si within nordic countries. the findings of this review also suggest that the ‘social’ component of si is a relevant but problematic suggestion as to how welfare should be understood and exercised. si may appear to be yet another ‘buzzword’ serving diverse political agendas, while it cannot be meaningfully encapsulated by only one definition. we suggest that empirical and conceptual development takes place in term of the common si dimensions identified in this review: relational, processual, and interactional. despite its various definitions and, in some studies, deficient definitions, si holds the potential to emphasise collaborative, creative, and value-based aspects of innovation. thus, further studies could work toward identifying generic elements of si as well as empirically exploring its uses and effects in various social contexts—within and beyond higher education, healthcare, and social work. references alden rivers, b., armellini, a., maxwell, r., allen, s., & durkin, c. 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(2014). reconfiguring boundaries in social innovation: cocreating new meaning and practice in a prison context. phd-thesis, professionshøjskolernes videndatabase, denmark. retrieved april 6 2021 from: https://www.ucviden.dk/da/publications/reconfiguringboundaries-in-social-innovation-co-creating-new-mea microsoft word 3734-tilpasset mal njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 20nn standardised functional assessment in long-term care for older people: perspective of finnish care workers vilhelmiina lehto-niskala* faculty of social sciences (health sciences) and gerontology research center tampere university, finland email: vilhelmiina.lehto-niskala@tuni.fi *corresponding author outi jolanki faculty of social sciences (health sciences) tampere university, finland department of social sciences and philosophy and gerontology research center university of jyväskylä, finland email: outi.jolanki@tuni.fi jaakko valvanne faculty of medicine and life sciences and gerontology research center tampere university, finland jaakko.valvanne@tuni.fi marja jylhä faculty of social sciences (health sciences) and gerontology research center tampere university, finland email: marja.jylha@tuni.fi 28 njsr – nordic journal of social research vol. 12, 2021 abstract objective measures and documentation are increasingly used in the care for older people to promote efficiency and productivity. a standardised assessment of functional capacity is one such measure. in this study, we examined the meanings given to standardised functional assessment by care workers who provide long-term care for older people. gathered from eight finnish long-term care facilities, the data consisted of one-on-one interviews with practical and registered nurses (n = 24). in the data analysis, we employed the discursive approach. we identified three discourses in the care workers’ talks that differed in the meaning given to standardised functional assessment in the process of care: part of the bureaucracy, a missed opportunity and a threat to person-centred care. care workers described these assessments as constituting a routine part of their job but expressed uncertainty about their role and the practical benefits in actual care work. they even called into question these assessments’ relevance to quality care delivery. to be a meaningful part of care practice, it is essential that there be a shared understanding of the rationale behind functional assessments in the care organisation and that care workers themselves can see the outcomes of these assessments in their daily work. keywords: functional assessment, long-term care, policy, aged, nursing care, residential facilities introduction over the past 10–15 years, the drive to increase efficiency and productivity has brought major organisational changes in health and social care in the nordic countries, with wideranging effects on daily care work, especially on the care for older people (anttonen & häikiö, 2011; dahl, 2009; nilsson et al., 2018; strandell, 2019; szebehely & meagher, 2018; trydegård, 2012; vabø, 2006). these changes can be viewed as part of the new public management (npm) doctrine, which emphasises the importance of productivity, standardisation and measured outcomes in the public sector (adcroft & willis, 2005; dahl, 2009; trydegård, 2012). vabø (2006) states that for care workers, this shift in emphasis has meant spending more time on using standardised documentation and quality measurement tools instead of working beside older persons. it has also been suggested that with these changes in the organisation and management of care, care 29 njsr – nordic journal of social research vol. 12, 2021 workers now have less autonomy and flexibility on the job (dahl, 2009; henriksson & wrede, 2008; trydegård, 2012). at the same time, the idea of person-centred care has affirmed its place in the care for older people (finlex, 2012; norwegian ministry of health and care services, 2016). this concept highlights older persons’ selfdetermination and partnership with caregivers (mccormack, 2003; mccormack et al., 2012; mcgilton et al., 2012). measuring performance and outcomes are central to the npm doctrine (adcroft & willis, 2005). we maintain that in the context of older people’s care, an integral part of the ongoing drive towards greater efficiency is the increased use of assessment tools. among the various instruments that are used (stoop et al., 2019), many include assessments of functional capacity. the development of standardised functional assessment indexes originated from the need to evaluate impairment caused by disease (guralnik & lacroix, 1992; katz et al., 1970; mahoney & barthel, 1965). these indexes have been used to predict adverse outcomes and a further decline in functioning, evaluate quality of life in older populations (guralnik & lacroix, 1992), facilitate communication (lawton, 1971) and assess rehabilitation (lawton, 1971; mahoney & barthel, 1965). some functional assessment instruments are research-specific, while others are used for practical care situations (guralnik & ferrucci, 2003; guralnik & lacroix, 1992). today, the assessment of functioning among older persons is an essential part of determining their service needs and evaluating the quality and efficiency of care. the resident assessment instrument (rai) is one of the best-known comprehensive assessment tools for long-term care (ltc) and includes a component for functional assessment (finne-soveri et al., 2010; hawes et al., 1997; zimmerman et al., 1995). the rai is intended to improve the quality of care and to develop individualised care plans, but it can also be used at the management level for benchmarking purposes (finne-soveri et al., 2010) and even to determine resource utilisation and care home payments (hawes et al., 1997). while nursing home staff members have mainly taken a positive view on the rai (hansebo et al., 1998; jogerst et al., 2002; parmelee et al., 2009), the assessment process has been regarded as time-consuming (armstrong et al., 2016; hansebo et al., 1998; jogerst et al., 2002; parmelee et al., 2009) and not reflective of the actual care or the assessed person (armstrong et al., 2016; hansebo et al., 1998; parmelee et al., 2009). armstrong et al. (2016) have argued that the rai represents a 30 njsr – nordic journal of social research vol. 12, 2021 new way of governing with market-based principles and is oriented more towards medical conditions and less towards caring and social relationships. this study was conducted in finland where ltc for older people consists of nursing home care, assisted living with 24-hour care, and ltc wards in hospitals and in health care centres (johansson, 2010). the use of ltc increases with age, especially in the last years of life (forma et al., 2007, 2017). as in other nordic countries, finnish policies are aimed at reducing ltc and allowing older people to live at home for as long as possible (ministry of social affairs and health, 2013). as a result, most older people have significant care needs by the time they move into an ltc facility. in finland, the responsibility for the organisation of ltc for older people and the management of access to care rests with municipalities (finlex, 2012), but practical care provision is often outsourced to private organisations. private care services purchased and paid directly by customers are marginal. standardised structured multi-dimensional assessments, including assessments of functional capacity (stoop et al., 2019), are routinely conducted for admission to home care or ltc in finland. these assessments are also used on a regular basis during care to update recipients’ care plans and to determine care needs (finlex, 2012; ministry of social affairs and health, 2017; voutilainen & vaarama, 2005). currently, one of the most common instruments in finnish ltc is rai, which was first used in the country in the early 2000s (finne-soveri et al., 2010). since then, objective measures and increased documentation, both closely linked to npm principles, have become regular features in the care for older people. the assessments are mainly performed by care professionals, yet to our knowledge, no research has been conducted concerning their views on the role and the use of these assessments. previous research has reported the validity and reliability of functional assessment instruments (hawes et al., 1995; hirdes et al., 2008; mor et al., 2003; richards et al., 2000; sainsbury et al., 2005), but only a few studies have explored care professionals’ views on these assessments’ benefits and feasibility. there is a lack of knowledge on whether care workers who conduct the assessments and are mainly responsible for the caring process consider these assessments useful in their everyday work. in fact, little is known about the role of these assessments in the organisation and practice of care in general. to gain a deeper 31 njsr – nordic journal of social research vol. 12, 2021 understanding of care workers’ views, we interviewed them for this study to explore the meanings they assigned to standardised functional assessments. methods design we chose a qualitative method of data collection by conducting face-to-face interviews and applying a discursive approach to data analysis. standardised assessment tools are used in several countries around the world as ways of improving the efficiency and arguably, the quality of care for older people. we were interested to find out whether the care workers using these tools in their daily work shared this view or whether they had other complementary or contrasting opinions. the discursive approach is particularly useful in data-driven explorative research whose aim is to unravel the meanings of a given topic, without any predefined assumptions on what these meanings might be (wiggins & potter, 2017). our analysis focused on how the care workers’ talks portrayed standard functional assessment as part of their job. our approach shares phelan’s (2011) advocated idea that studying care workers’ talks about their daily work makes it possible to unravel taken-for-granted views about care practices and opens new and different perspectives on care work and daily life in ltc. additionally, our premise is that care professionals’ understanding and way of talking about their work both reflect and affect practices in the care for older adults (phelan, 2011). participants using purposive sampling, we gathered the data in 2016 from eight ltc facilities for older persons in two municipalities in southern finland. we wanted to collect data from both institutional care (nursing homes and long-term hospital wards) and assisted living settings. four out of the eight participating facilities provided institutional care and four provided assisted living with 24-hour care. two of them were public and six were private facilities, but all were service providers for municipalities. the facilities are described in more detail elsewhere (lehto et al., 2017). the manager of each care facility was asked to nominate three care workers to participate in the study. the care workers had to be registered or practical nurses, as 32 njsr – nordic journal of social research vol. 12, 2021 both usually participate in care work in finland. practical nurses are health and social care professionals with a protected occupational title and three-year training. practical nurses provide, plan and assess care (finnish national agency for education, 2017). the responsibility for nursing and medication management in ltc facilities rests mainly with registered nurses, who also participate in the personal care for residents alongside practical nurses. despite the different roles and duties of registered nurses and practical nurses, both conduct functional assessment as a regular part of their jobs, so the two groups were not separated for the analysis. in total, 24 nurses were interviewed (table 1). before the interview, the participants were informed about their voluntary participation and their right to withdraw their consent at any time. data collection the first author conducted semi-structured one-on-one interviews in finnish with the care workers in the ltc facilities. all interviewees were informed about the study’s main goals and that the interviewer was a researcher and a registered nurse with ltc experience. an interview guide focusing on functioning and rehabilitation was used but not rigidly followed; the purpose was to allow the interviewees to concentrate on the themes that they thought were most important. functional assessment was addressed in connection with the item that asked whether the interviewee evaluated the functioning of residents. if the interviewee mentioned a specific instrument such as rai, the interviewer would follow up and probe more deeply. these questions included how, why and for whom the assessment was conducted. lasting from less than half an hour to an hour, the interviews were audio recorded and transcribed verbatim. the transcribed interviews totalled 63,680 words. 33 njsr – nordic journal of social research vol. 12, 2021 table 1. research data: 24 semi-structured interviews name type of facility occupation gender years in current position age (years) joanna nh rn female 1–5 n/a emma nh pn female 1–5 29 eeva nh pn female 1–5 24 elsi nh pn female > 5 n/a juulia nh rn female 1–5 59 irene nh pn female > 5 50 amanda al rn female 1–5 28 moona al pn female > 5 56 tiina al pn female > 5 44 paula al pn female 1–5 26 elisa al pn female > 5 n/a miia al pn female 1–5 41 veera ltc ward pn female 1–5 60 helena ltc ward pn female > 5 64 maija ltc ward pn female > 5 52 olivia ltc ward rn female > 5 55 birgitta ltc ward pn female > 5 59 leila ltc ward pn female > 5 25 josefiina al pn female < 1 24 meri al pn female < 1 24 miranda al pn female 1–5 40 tuomas al pn male 1–5 32 kaarina al pn female 1–5 48 eveliina al rn female 1–5 34 rn = registered nurse, pn = practical nurse, nh = nursing home, ltc = long-term care, al = assisted living with 24-hour care, n/a = not available 34 njsr – nordic journal of social research vol. 12, 2021 data analysis the transcribed interviews were read through several times to gain an in-depth knowledge of the data. the first author conducted the coding process for the analysis, which involved identifying and marking the interview excerpts that somehow referred to functional assessment and then coding these marked excerpts. at this point, a code could consist of a single word or sentence, but as the analysis proceeded, the codes became more elaborate and comprised several sentences or turns of talk. after the preliminary coding, the data were re-read several times to map differences and similarities in the interview talks. the aim of the process was to identify variations in the talks, that is, the different ways of talking about the meaning of functional assessment in care work. we discussed the findings at different stages of the analysis to formulate a mutual understanding of the interpretations. the interviews were conducted in a flexible manner, giving the interviewees the opportunity to elaborate on and emphasise aspects of their own choice. the extracts presented in the results section were chosen to illuminate the different aspects brought forward in the nurses’ talks. to cover the variations in their talks, we present the data extracts that convey views expressed in several interviews, as well as less common views. in the extracts, ‘omitted talk’ refers to comments that are not directly related to functional assessments. all names are pseudonyms. ethical considerations our research plan was approved by the ethics committee of the local hospital district (reference number r16003). written informed consent was obtained from all interviewees. anonymity was ensured at all stages of the study. the data are stored digitally and can only be accessed by the first author. the study is reported in accordance with the consolidated criteria for reporting qualitative studies (coreq) checklist (tong et al., 2007). all authors agreed on the coherence and integrity of the final analysis. the principles of openness and transparency were adhered to throughout the study. 35 njsr – nordic journal of social research vol. 12, 2021 results twenty-four nurses from eight ltc facilities participated in this study. the analysis showed that care workers’ views on functional assessments could not be portrayed simply as positive or negative attitudes but as discourses describing their understandings about the practicalities of care work, administrative routines, ideal care and the meaning of standard functional assessment in all these aspects. discourses illuminate how different ways of talking portray and explain the topic at hand in a certain way, while refuting other portrayals and explanations (wiggins & potter, 2017). we identified three discourses that differed in the meaning assigned to standard functional assessment in the process of care: (1) part of the bureaucracy, (2) a missed opportunity or (3) a threat to person-centred care. in the following subsections, we present the discourses and their distinctive characteristics. in their talks, the participants typically pondered different aspects of the assessments and therefore often resorted to more than one discourse while still emphasising certain aspects. we found no differences between care workers working in private and public facilities or between those working in assisted living and institutional care settings. functional assessment as part of the bureaucracy the care workers often described functional assessment as a routine part of their work. rather than a practical useful tool, they described it as an obligation dictated or directed by a third party, such as representatives of municipal or other authorities. in this kind of talk, the focus was on the instrumental and practical aspects of assessment, as reflected in the connections drawn with staff ratios, financial incentives and service fees. additionally, the participants listed reasons for making the assessment, the people involved and the assessment schedule. 36 njsr – nordic journal of social research vol. 12, 2021 the participants said that they were required to make the assessments at a specified frequency. functional assessment was described as an obligatory, recurring part of their job. the position of care workers is thus reduced to a rather mechanical role in the system, simply following the instructions from the concerned authorities: vl-n: who, who conducts the assessment? elisa: well, we do, us nurses; we make the assessment again and again. it’s our job. typically, the assessment was portrayed as a regular part of the practical dayto-day job. the participants also discussed some of the benefits of standard assessments, describing them as beneficial to care processes, such as writing up care plans. almost all the care workers mentioned rai when asked whether they assessed their residents’ functioning. both the facility’s management and municipal and other authorities were described as in charge of gathering information and providing direction and regulation: vl-n: what’s your view – for whom would you say that rai is conducted here? paula: well, of course, it should be done for the resident. but sometimes, you have a sense that it’s actually done for the care facility. [omitted text] it affects the care facility if… yeah, i mean they’ll get more. i don’t quite remember exactly how it works, but anyway, the care facility will benefit if the residents get higher scores. even when the regulative instance was not explicitly mentioned, it came across indirectly in the care workers’ talks that regulative forces required these assessments. in these cases, the interviewees often used the pronoun ‘they’, referring to anonymous actors who dictated the use of and the rationale behind the assessment tools. this was commonly accepted as part of the job, but in some instances, care workers indicated that they had been given false hopes about the assessments, as described in the following extract: 37 njsr – nordic journal of social research vol. 12, 2021 vl-n: well, maybe about rai, why would you say it’s used here? olivia: it’s, rai is like, here to stay. i mean it’s the most widely used [assessment] in all of finland. [omitted text] they always tell us that if we conduct these rai evaluations well and with care, you know, do them well and carefully, that will be reflected in like, the nursing care intensity. and erm, then like the last argument they have is that if the scores show that we have a very high work load on our ward, then we’ll get more resources. and, during the time i’ve worked here, we’ve never received more [resources] based on rai scores. and we’ve noticed how the caring intensity has continued to increase all the time. in this discourse, functional assessment was described as a routine part of the job, based on rules and directives rather than residents’ needs. thus, the rationale did not stem from the logic of care work itself, but the assessments were dictated and imposed by the authorities who remained anonymous. the promise of improved efficiency and more resources remained vague and unwarranted. to summarise, in the care workers’ talks, functional assessments belonged to the realm of admission rules and financial resources. they were part of the bureaucracy over which the care workers had no control. functional assessment as a missed opportunity when asked, some participants pondered the rationale for functional assessments but had difficulty in finding it. in this discourse, standard functional assessments were described as potentially beneficial but poorly used practice in care work. in their talks, the care workers deliberated on whether assessments would be useful in care work and if so, in what way, as illustrated in the following excerpt: vl-n: so why in your opinion is rai used here? miia: umm. well. i don’t know whether rai is, whether it’s something that the municipal authorities actually require of us. perhaps we [at this care facility] could use it; we do conduct rai assessments, but perhaps it could be put to better use. they always tend to remain there for six months, on the computer. you know, they’re not like, really used in the end, in the practice of care work. 38 njsr – nordic journal of social research vol. 12, 2021 miia’s response gives an ambiguous meaning to functional assessment in care work. similarly, even though the assessments may potentially be useful, the role of care workers and the practical benefits of the assessments remain unclear. the preceding extract is an example of how the participants tried to make sense of the assessments, pointing out that the results were not used or that they were not sure whether and how they were used. the following extract shows joanna’s attempt to answer the question of why rai is used. her hesitation and use of filler words like ‘umm’ and ‘well’ indicate her difficulty in giving a definitive answer: vl-n: umm, what about rai? why would you say it is used here? joanna: umm… well, it has, like rai is… in my opinion, it’s not like, used as much as, as much as it should be, and the benefits we get, they’re not really visible here in our daily [work]. as joanna’s answer shows, in this discourse, the care workers indicated that functional assessments could be used more frequently, but their benefits in actual daily work remained invisible to the care workers who collected the information. sometimes, they were even described as pointless, as exemplified by the following extract from birgitta’s interview: vl-n: what would you say, who is it [the standardised assessment] conducted for? birgitta: well, i’ve asked myself the same question. i don’t know. we’ve been discussing this thing and you know, said, ‘let’s just get them done, but no one’s ever going to read them’. as this excerpt shows, the care professionals struggled to express the meaning of functional assessment as part of their job. they did not explicitly denounce the assessment process as pointless but considered the rationale behind functional assessment. while assessment was accepted as a potentially useful tool in care, its practical effects remained invisible. therefore, functional assessment was perceived as a missed opportunity. 39 njsr – nordic journal of social research vol. 12, 2021 functional assessment as a threat to person-centred care in this discourse, the practice of assessing residents’ functional capacity was contrasted with the recognition of residents as individuals. in this kind of talk, functional assessment was thus described as a de facto obstacle to good quality care: vl-n: do you evaluate the functional capacity of patients here? helena: yeah, well, i mean, we’ve all sorts of measurement instruments. but that sometimes feels like, i feel bad about judging someone based on their point score. that’s bad, a bad way of thinking. after all, it’s a human being but measured in terms of point scores. his score was low; that’s pretty bad. we didn’t use to do that. we appreciated people as people. as the preceding extract illustrates, the care workers compared functional assessments with their own understandings of good care and negotiated the justification of standardised assessments. functional assessment, described as part of their routine paperwork, was explained as a separate task that detracted from the time available for proper care work, which for the interviewees meant spending time and talking with residents. by emphasising that they perceived and approached residents as human individuals rather than scores and points, as well as by pointing out that functional assessment could never provide a full and true picture of the person, the care workers depicted the assessment tools as detrimental to good quality care work. in this discourse, spending time with residents was portrayed as more important than conducting functional assessments: vl-n: umm, well, still further about rai, what would you say, why do you use it here? emma: yes, well, i’m allowed to say anything here, right [laughter]? i mean we don’t, like in our daily care work, we don’t use it at all. it’s like, more about we do our documenting in pegasos [digital patient information system] and in conversations, and like in our multidisciplinary team, we do this on a personal, face-to-face basis rather than going to see [the 40 njsr – nordic journal of social research vol. 12, 2021 assessment] made by another nurse. [text omitted] you get a much better insight just by doing your own care work. in this interview, emma interestingly started her account with the comment that she was allowed to say anything in the interview situation. our interpretation is that she was reminding both herself and the interviewer that the conversation was confidential, which was made clear to her at the start of the interview. thus, her comment implied that what she was about to say was something that she would not say in some other situation. in fact, she made the point that functional assessments played no role in daily care work at all, but the residents’ situations were evaluated with quite different means. in this kind of talk, functional assessments were described as overlooking important skills and abilities of older persons and as failing to capture relevant aspects of residents’ individual characteristics. in contrast to the rai tool, the care workers depicted themselves as having the ability to understand and to bring forth residents’ individual needs and preferences: vl-n: well, maybe about rai, why do you think you use it here? olivia: [text omitted] i still think that rai doesn’t answer the questions that i think are relevant. or i mean it does but somehow in a formal, structured way. it simplifies. somehow, i think the results don’t say anything about the individual. nothing at all. i mean you could have a great poet there. right here. you could have someone who could do amazing art if you’d give them a pencil. you wouldn’t see that in the rai scores. when applying this discourse, the care workers stressed the importance of really knowing the residents and their abilities. in this context, compared with less structured and less formal ways of obtaining this knowledge, standard functional assessment was depicted as not a useful tool but an obstacle to quality person-centred care. 41 njsr – nordic journal of social research vol. 12, 2021 discussion in this study, we examined ltc care workers’ views on standardised functional assessments using the data collected in semi-structured interviews. the analysis was based on a discursive approach (wiggins & potter, 2017), which allowed us to explore in detail the care workers’ descriptions of standardised assessments as part of their daily work and the meaning that they assigned to these assessments in the context of actual care. in line with phelan (2011), we found the discursive approach a useful tool for unravelling the taken-for-granted content of care practices, which might remain invisible in other types of analyses. we identified three different discourses that the care workers used in constructing the meaning of functional assessments and their role in the care process. first, functional assessment was presented as part of bureaucracy and routine paperwork, relating to the means and goals of municipal authorities and the care facility’s management. second, functional assessment was described as a missed opportunity; it was a potentially useful way of supporting person-centred care, but that potential was not realised. third, the participants contrasted care work that used standardised assessments and point scores with holistic care work that approached older people as individuals. as a result, functional assessment was even presented as a threat to person-centred care. when asked about functional assessment, many participants mentioned rai. although rai should ideally serve as a guide for understanding disabilities and the individual’s functional potential (finne-soveri et al., 2010; hawes et al., 1997), the care workers in our study questioned this view and noted that the assessments conflicted with the principle of recognising older persons as individuals. they reflected on the practice of functional assessment in terms of their understanding of good care, which emphasised the individual and a person-centred approach (mccormack, 2003; mccormack et al., 2012; mcgilton et al., 2012). in earlier studies, nursing home personnel likewise recognised that rai could contribute to quality of care and nursing documentation, but they expressed scepticism about the instrument’s ability to give a true and full picture of an older individual (armstrong et al., 2016; hansebo et al., 1998; parmelee et al., 2009). our study’s results not only support but also add to these findings. some participants contested the idea of using scores to arrive at an assessment of the individual person. 42 njsr – nordic journal of social research vol. 12, 2021 conducting the assessments was described as a waste of time and pointless, stealing time that they could otherwise have spent on face-to-face interactions with residents. this is again consistent with previous studies’ findings (hansebo et al., 1998; jogerst et al., 2002; parmelee et al., 2009). on a general abstract level, functional assessments were recognised as potentially useful in care work. in other words, if they were used differently, assessments could have the potential to improve care work, but none of the discourses portrayed them as belonging to the core of the practice of care or based on the needs of individual ltc residents. rather, the participants distanced themselves from functional assessments and described them as something additional to the nurse’s main duties (cf. armstrong et al., 2016). occasionally, they were depicted as part of routine paperwork, something that has continued to increase and expand in recent years and is threatening to reduce care workers’ interaction with residents (tainio & wrede, 2008; vabø, 2006). in the nurses’ view, the fundamental goals of their work are to alleviate suffering and increase the wellbeing of their patients. from this perspective, standardised assessments conflict with the logic of care. conducting functional assessments was described as a practice dictated from the outside by municipal authorities or the care facility’s management. a number of earlier studies have also drawn attention to the growth of bureaucracy and standardisation in care work (dahl, 2009; trydegård, 2012; vabø, 2006) and highlighted the increase in moral stress among care workers (kiljunen et al., 2017; o’dwyer, 2013; trydegård, 2012; vabø, 2006). functional assessment indexes were originally developed for the purposes of predicting adverse outcomes and further decline in functioning, assessing the quality of life in older populations (guralnik & lacroix, 1992), facilitating communication with others (lawton, 1971) and assessing the outcomes of rehabilitation (lawton, 1971; mahoney & barthel, 1965). the introduction of standardised functional assessments in ltc since the early 2000s can be regarded as part of the npm movement and its emphasis on rationalisation, quality standards and performance measures (adcroft & willis, 2005; armstrong et al., 2016). in the context of care for older people, the rationale for the use of these indexes, as explained in several policy papers and studies, is to plan care for individual recipients and survey their care needs, govern the process of care provision and allocate resources, as well as monitor the quality of care (finlex, 2012; finne-soveri 43 njsr – nordic journal of social research vol. 12, 2021 et al., 2010; voutilainen & vaarama, 2005). assessment instruments, particularly rai, have been associated with the doctrine of evidence-based medicine, which prefers standardised evidence over anecdotal and contextual knowledge, but serious questions have been raised about the suitability of the approach to ltc (armstrong et al., 2016). in our study, the care workers’ talks revealed the contrast between managerial goals and the ideal of good care for the individual. while the care workers largely accepted the stated purposes of standardised assessments, they did not see whether and how these purposes were met in practice. our study was not intended to assess the relevance or usefulness of standardised assessments as such, and our findings indicate nothing about the extent to which the purposes of assessments in ltc are met. instead, our study suggests that the rationale for these assessments, as presented in policy papers and administrative guidelines, is at odds with the experiences of ltc workers. care workers have an unclear understanding about these assessments’ role in the practice of care and question their relevance to quality care delivery. some care workers even consider assessment a source of moral stress. these views likely have an impact on not only daily care work but also the motivation and well-being of care workers. our findings call for a reconsideration of the role and practices of standardised functional assessments in ltc. to be a meaningful part of care, it is essential that there be a shared understanding of the rationale for measures and assessments in the care organisation and that care workers can see the practical outcomes and effects of these assessments in their daily work. limitations the data for this study were gathered from both practical and registered nurses in eight ltc facilities in finland, selected with purposive sampling. we recognise that the two groups of care workers have different educational backgrounds and partly varying responsibilities. however, both are involved in personal care for ltc residents and conduct functional assessments. we also recognise that care cultures and guidelines can vary among finnish care facilities, and they most certainly do among different countries. our detailed analysis reveals the variations in the meanings given to assessment tools in care work, as indicated in the interviews with care workers,and calls into question the taken-for-granted meanings of assessment tools. however, this kind of 44 njsr – nordic journal of social research vol. 12, 2021 approach can neither show which views are the most common and which are the rarest nor establish how widely shared they are among care workers in general. nevertheless, our sample provides useful insights into the care staff’s perspectives about functional assessments and their role in care work. the results shed light on how the use of standardised instruments fits into the daily work of ltc care staff and their views on good care. despite the relatively small sample, the themes raised and discourses identified in the interviews offer a consistent picture of staff views and perceptions. conclusions and implications in this article, we have discussed care workers’ views on the role and status of standardised functional assessments in ltc practices. ltc nurses described functional assessment as a routine part of their work but detached from their core duties of caregiving, even a threat to what they considered the most important part of their work. they recognised the official administrative purpose of functional assessments and their potential usefulness yet admitted their unclear understanding of whether and how the results of the assessments were used. from the care workers’ point of view, the results of standardised assessments remained invisible in daily work, and in practice, these neither contributed to nor advanced good care. as far as the participants were concerned, functional assessment might have value in the nursing care for older people, but at the time of the interviews, it was not an instrument that could help achieve good care. standardised assessments in ltc can be understood as following the npm doctrine that emphasises quality standards, outcomes and performance measures, even in the context of health and social care. our findings suggest that as far as care workers are concerned, the practice of standardised assessments is at odds with the goal of good and personalised care. they draw attention to the problems of applying the npm concept to the care for older people. the divergence between the managerial goals of functional assessments and care workers’ views will likely 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(2005) toimintakykymittareiden käyttö ikääntyneiden palvelutarpeen arvioinnissa [use of measures of functional capacity in the assessment of service needs among older people] (stakes, reports 7/2005). the national research and development centre for welfare and health (stakes). wiggins, s., & potter, j. (2017). discursive psychology. in c. willig & w. rogers (eds.), the sage handbook of qualitative research in psychology (pp. 93109). sage publications. https://doi.org/10.4135/9781526405555.n6 zimmerman, d. r., karon, s. l., arling, g., clark, b. r., collins, t., ross, r., & sainfort, f. (1995). development njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 does context matter? voluntary work in long-term care laila tingvold* centre for care research norwegian university of science and technology (ntnu), norway email: laila.tingvold@ntnu.no *corresponding author oddvar førland centre for care research, western norway western norway university of applied sciences email: oddvar.forland@hvl.no abstract introduction: increased voluntary work in long-term care (ltc) is encouraged in white papers in norway as well as in many other western states. this is due to the growth in the number of service recipients and a subsequent economic burden for the state. voluntary work in nursing homes and home care services take place in different spatial contexts, but little attention has been paid to how the different contexts may potentially influence the possibilities for voluntary work. the aim of this study is to obtain new knowledge of the significance of context in recruitment of volunteers in ltc. method: a cross-sectional study was conducted among leaders in nursing homes and home services in 50 municipalities across all regions of norway. descriptive analysis was used. results: according to the leaders, home care services had less voluntary work than nursing homes. respondents from home care scored “poor flow of information” and “low interest in the municipality” as major hinderances, more so than respondents from nursing homes did. discussion: nursing homes typically have many residents under one roof following a similar schedule. thus, volunteer-run activities are held more easily at set times and incorporated into the daily life of the institutions. on the 156 njsr – nordic journal of social research vol. 12, 2021 other hand, home dwellers in home care stay in a more individualised setting with more autonomy and can opt out of activities that nursing home residents would normally join. skill acquisition, networking and socializing are common motivations for volunteering, and a nursing home setting may be an easier context to obtain this. the governmental endeavour for increased voluntary work in ltc can be seen as an effort to meet expected rises in public expenditure. however, the realism can be debated due to substantial challenges on the future potential of volunteerism in ltc, especially in the home care context. keywords: voluntary work, volunteers, nursing homes, home care, long-term care, ageing-in-place introduction in norway, a call for volunteers to contribute to long-term care (ltc) services has been repeatedly made in recent decades. official policy documents and white papers state that new forms of cooperation between public and private sectors must be sought (ministry of health and care services, 2013, p. 11; ministry of health and care services, 2006, p. 41; ministry of health and care services, 2017, p. 61; ministry of health and care services, 2015, p. 47). similar requests are put forward internationally and reflect an overall concern with the ageing of the population, a growth in demand and expenses for care services and a future deficit of health staff (groenou & de boer, 2016; hussein & manthorpe, 2005). despite the fact that the general participation in voluntary organisations in norway is high (folkestad et al., 2015; jegermalm et al., 2019), a study showed that voluntary work in the ltc sector is relatively modest (andfossen, 2016). this might indicate a discrepancy in expectations between the present strong call for the contribution of volunteers and a relatively stable low prevalence in ltc. several important issues seem to be overlooked in official documents. one such issue concerns which tasks and types of activities volunteers are supposed to carry out in ltc. however, white paper no. 25 (2005-2006) specifies the importance of enhancing the quality of care by increasing volunteer social and cultural activities in nursing homes and home care services (ministry of health and care services, 2006; ministry of health and care services, 2018). yet, two issues that remain largely undebated 157 njsr – nordic journal of social research vol. 12, 2021 concern the recruitment of volunteers and the coordination of their effort along with the staff in municipal care services. how is the bringing in of volunteers to be organised in a field with professional care workers? studies so far indicate that voluntary work in ltc is offered and organised differently in municipalities (rønning, 2011a; solbjør et al., 2014; andfossen 2020) or between organisations (greenfield et al., 2016). for example, a survey of recruitment and follow-up of ltc volunteers in norway found that less than half of the 429 municipalities had any organised activity in recruiting new volunteers in the care sector (johansen & lofthus, 2011). a survey mapping voluntary work for the elderly in oslo also showed variations in how districts recruited volunteers (romsaas, 2011). districts that actively developed a culture for cooperation with volunteers reported more contact and communication between volunteers and service suppliers at all levels (romsaas, 2011). furthermore, the division of tasks between professional care, volunteers and informal carers appears somewhat blurred and causes coordination challenges (tingvold & skinner, 2019; skinner et al., 2020; fredriksen et al, 2020); systems of cooperation are put into operation in a multitude of ways (hoad, 2002), triggering questions on the best volunteer management in differentiated settings (la cour, 2019; hager & brudney 2015). lack of procedures to inform ltc service recipients about the availability of volunteers had also been found (luijkx & schols, 2018), as well as a lack of routines for sharing information between professional carers and volunteers (fensli et al., 2012a; ingebretsen, 2005). these studies show that introducing volunteers into ltc services might be a more complicated task than suggested by various governments. it is particularly expected that more difficulties could arise in introducing and running activities by volunteers in nursing homes, as these institutions are formalised in the domain of professional care workers and access is more regulated and restricted. further, it may be expected that the proportion of individual volunteers to care recipients are higher in private homes due to easier access to neighbours, friends and others in the local community. given these facts, little attention has been given to the study of voluntary work in the context of location (i.e., in home care or nursing homes) despite the fact that they are structures governed by different approaches and different models for care. thus, the focus of this paper is to address the following research question: what types and amounts of voluntary work are found in nursing homes and home care sectors in a selection of norwegian municipalities? what factors are seen as hindrances to voluntary work among managers of 158 njsr – nordic journal of social research vol. 12, 2021 nursing homes and managers of home care services and how can these differences be understood? for this study, “voluntary work” is defined as the unpaid contributions that are given without reward or compensation that benefit individuals or groups outside family and close friends (førland, 2015; snyder & omoto, 2008). individual unpaid work carried out by volunteers through voluntary organisations and volunteer centrals is also included, as well as work done by those who do voluntary, unpaid work independently of formal organisations. unpaid work, informal care or help given to members of one’s family, friends or neighbours is not defined as voluntary work in this study. the term “service recipients” in this research denotes persons receiving public care, either in nursing homes or in home care services. background the welfare state and the norwegian long-term care norway is placed within the nordic welfare model, characterised by a high degree of governmental control, tax-financed interventions and welfare programmes (christensen & wærness, 2018; esping-andersen, 1990; kautto, 2010). ltc services consist of nursing homes (nh) and home care (hc) services, and both branches are a part of a comprehensive infrastructure of statutory services administered by local authorities (municipalities). nh constitute a principal public care alternative and are regarded as vitally important, particularly for the oldest citizens with advanced chronic illnesses and multiple diagnoses (næss et al., 2013). nh are generally associated with severe loss of health (physical and/or psychological), but they are also connected to the loss of a private home, individual status and freedom to shape everyday life (bergland & kirkevold, 2006; malmedal et al., 2009; ågotnes, 2016). nh in norway have previously been under criticism for not offering enough assistance to their residents, and the quality of care has been repeatedly discussed (malmedal et al., 2009). one study found that staff were not sufficiently present during meals and did not provide enough assistance to the residents in the areas of personal care, hygiene and psychosocial care (slagsvold, 1999). after several years of intellectual and practical activity to improve the facilities, researchers stated that quality in nursing homes remains a major concern (kjøs et al., 2010). recent studies suggest that general care is at a relatively high level, while physical and social activities in nursing homes is relatively low (førland & rostad, 2019). in response to these 159 njsr – nordic journal of social research vol. 12, 2021 concerns, campaigns have been launched to increase the level of activities in nursing homes. it is assumed by the government that volunteers can be involved in such tasks (helseog omsorgsdepartementet, 2013; helse-og omsorgsdepartementet 2017) and contribute to improved services. home care (hc) constitutes the second – and currently the largest – branch of ltc in norway. its services originated in the third sector in the beginning of the 1970s, consisting of national and local associations of women and local churches undertaking voluntary work. vabø and szebehely (2012) claimed that voluntary organisations have played a role in pressuring the state to take responsibility for the care of elderly individuals. in norway, hc services have since developed from providing mostly practical assistance to elderly care receivers at the outset; it is now comprised of advanced medical tasks and care (fjørtoft et al., 2020). this is a consequence of political reforms aimed to move the responsibility for general medical follow-up tasks from the specialist level – in hospitals – to the general level within the municipalities (ahgren, 2014; gautun & syse, 2017). the number of hc recipients have grown considerably over the last decades. the user groups have become diverse and represent all age groups, from young children to elderly individuals at the end of life. central beneficiaries of home care are people with physical disabilities, mental illnesses and handicaps, drug-related disorders and progressive illness. nursing home recipients in long-term care are increasingly frail elderly individuals characterised by multi-morbidities, cognitive failure and polypharmacy (helvik et al., 2010) leading to an increased need for advanced nursing competence (bing-jonsson et al., 2016). more time is spent on caring for the acutely and critically ill as well as on documentation and reporting, which leaves professionals with less time for direct social contact with residents (vabø, 2012). against this background, official documents such as white paper no. 25 (20052006) specified the importance of enhancing the number and types of social and cultural activities in long-term care (helse – og omsorgsdepartementet, 2006). this was followed up through recent governmental documents (e.g., white paper 15 (2017–2018) “a full life – all your life. a quality reform for older persons”; helseog omsorgsdepartementet, 2017). a recent study confirmed that the three most common activities involving voluntary work are cultural activities, social activities and visiting schemes and can be interpreted 160 njsr – nordic journal of social research vol. 12, 2021 as complementary to the formal ltc services as well as constructed to increase the well-being of residents (skinner et al., 2018). contextual differences between home care and nursing homes in sociological theory, nursing homes are institutions that contain a formal and informal structure with permanence and duration (repstad, 1991). material conditions such as physical and architectural structure provide frameworks and guidelines for the social structure in the nursing home. the degree of privacy for institutional residents is determined by the construction of the building in addition to how dependent the residents are on help from employees to perform daily functions. repstad (1991) argued that other important organizational structures in nursing homes are the division of labour among employees, power and control, direction of communication and the firmness of the structure (i.e., to what extent it is deemed acceptable to deviate from the existing communication and power structures, allowing flexibility and improvisations). nursing homes are institutions – either publicly owned or owned by private organizations – for persons with lower levels of functions characterised by multi-morbidity and complex medical conditions (gulla, 2018). nursing homes are also run with strict guidelines and rules of operation. the residents must follow these requirements on the premises of the institution. many residents are living under the same roof and receive ltc services from the same staff members; they must adapt to the daily routines guiding the pace of the institution. for example, there are set times for when meals are served, when medication is given, when the physician is visiting, and so on. there are also generally set times for social and cultural activities. the residents have their own rooms that ideally have a “homelike” look (hauge, 2004). however, the residents are often too sick to regulate who is coming and going in and out of their “home”, and staff are likely to enter accordingly. the residents in nh are mostly fully dependent on the care staff for carrying out daily functions such as personal care, assistance to move and attending social activities; residents therefore have asymmetric relations to the care staff (garsjø, 2008). in comparison, care recipients living in their own home are in their personal space and hold property rights. the owner can independently make decisions as to the appearance of the home and has autonomy and independence to decide who can access it (twigg, 1999). he/she is also free to form rules for the house and its members and to decide both how the home will be 161 njsr – nordic journal of social research vol. 12, 2021 maintained and what behaviour is expected from guests. upon illness and old age, the home dweller may have to accept assistance and leave the independence to others, making the home environment potentially more challenging to handle (haak et al., 2011). home care staff primarily perform their work tasks individually and make judgements alone by taking an autonomous role looking after the specific and changing needs of home dwellers (vabø, 2012). a visit from the home care lasts from 10-40 minutes, depending on the task for which assistance is required (førland et al., 2017). shaping different settings for both ageing and receiving care, these contextual variables for nursing homes and individual homes consist of different organizational features, codes of conduct and power relations (scharlach, 2017) and also different operational setting to volunteers. the volunteers and their motives volunteers’ motives seem to have become more complex and varied in recent years, as have the group of volunteers themselves (bussell & forbes, 2001; clary & snyder, 1999). prior to 1990, most voluntary work was based on membership in national voluntary organizations whose members shared common values. over the last decade, volunteers are less attached to organizations and motives for volunteering are increasingly related to personal development for the volunteer (wollebæk & sivesind, 2010; wollebæk & selle, 2002) as a form of “organized individualism” (wollebæk & sivesind, 2010). habermann (2007) studied motives for volunteering in a danish context and found a large variation. motives included volunteering for a case one has sympathy for, learning (i.e., volunteers wanting to acquire new skills), identity (i.e., volunteers are a part of an identity and a meaning-forming project), values (i.e., to be able to transmit specific values and beliefs, such as religious beliefs, humanitarian ideals or ethical obligations), influence (i.e., volunteers looking for influence or recognition as a central person in a local community), companionship (i.e., desire for social affiliation with other people) or career (i.e., the work provides an experience that can be of use in the workplace). haberman pointed out that the motives can be complex and composed in different manners; as an example, altruistic values can coincide in an individual with self-esteem thinking (habermann, 2007). a similar panorama of motives was found in studies of the norwegian volunteer centrals, and these encompassed situations such as realizing important humanitarian, religious or political values, learning (i.e., acquiring new skills), social reasons (i.e., the desire to belong to a group), work training (i.e., improving skills or preparing for paid employment) and so on (lorentzen et al., 1995). 162 njsr – nordic journal of social research vol. 12, 2021 with this background in mind, the purpose of this research is to discuss the scope and type of volunteer activities in long-term care, as well as the leader’s perceptions of barriers for volunteer recruitment. this study argues that possibilities for voluntary work must be understood in the context of locality, the theoretical frameworks for “homes”, “institutions”, motives to volunteer and the development of the welfare state. method in 2015, survey data was collected over a two-month period in a sample of 50 norwegian municipalities. the municipalities constituted a municipal panel – recruited by the centre for care research – to assist with data for research. the municipalities constitute a stratified selection of small, medium and large municipalities across the country. an electronic questionnaire was developed based on a review of available literature concerning volunteering in norwegian long-term care services. for the literature study. we initially searched for all possible written material on voluntary work in norwegian long-term care. this topic was sparsely investigated, so we searched broadly at first, subsequently selecting research reports and papers with data from norway and the nordic settings. all referenced hindrances (barriers) and success criteria to voluntary work were highlighted while reviewing the literature, and these were kept in a separate document. the research group discussed the hindrances and the success criteria and grouped similar expressions of hindrances/success criteria together. as a part of the questionnaire preparation, five qualitative interviews were carried out with experienced managers in ltc services from five different municipalities. this was done in order to strengthen the questionnaire items’ relevance and framing. the questions consisted of what sort of ongoing voluntary activities the ltc service had, how the activities were organised, the level of contact between ltc services and the volunteers, estimations of weekly contribution from volunteers (volume), if and what sort of training was offered to volunteers and so on. the interviews contributed to informing the survey questionnaire. drafts of the questionnaire were tested among leaders and staff who held the responsibility for voluntary work in nursing homes and the home care sector. prior to the distribution of the questionnaire, a comprehensive recruitment process was undertaken to ensure that we 163 njsr – nordic journal of social research vol. 12, 2021 recorded the opinions of the leaders holding the responsibility for coordinating the voluntary work. the electronic questionnaire consisted of primarily closed-end, multiple-choice questions. it was stated at the beginning of the questionnaire that questions would be asked about voluntary activities that were organised in cooperation with the formal services/municipalities. voluntary activities were defined as activities or services that were carried out using unpaid labour. cooperation was defined as municipal involvement, such as economic support or direct municipal coordination of voluntary activities. measures and analyses the study used a screening question which asked whether the service location had any activities with volunteer involvement in the last four weeks regarding the following thirteen areas: social activities, cultural activities, library/reading services, physical activities, visiting schemes, food delivery, practical assistance, day centres, helplines/counselling services, transport/taking out services, self-help groups, activities certified by volunteer organisations and other activities. an additional three questions were used in order to give an indication of the volume of voluntary contributions detected by staff in each of these activity/service categories. for each of the categories, respondents were initially asked to give an estimate of how many times voluntary activities were held in the unit in the last four weeks, followed by how many volunteers contributed each time, and finally, how long the activities lasted each time. the results were recalculated into the average number of hours spent by volunteers doing unpaid work per week for purposes of interpretation. the only data reported in the article came from ltc units that reported activity in the different categories and gave an estimate of the number of hours. the number of respondents from nursing homes and home care units and mean hours per month are summarised in tables 2 and 3 below. potential hindrances to voluntary work were reviewed in the literature study with emphasis on norwegian studies. afterwards, categories of various hindrances were developed and discussed in the research group as well as with managers responsible for voluntary work. finally, the following categories were included as potential hindrances in the study: lack of volunteers, poor flow of information between the stakeholders, highly vulnerable/weak recipients of care, uncertainty regarding financial support, lack of coordination 164 njsr – nordic journal of social research vol. 12, 2021 by the municipal ltc services, cooperation overdependent on key persons, low interest in the municipal ltc services, competence among volunteers, excessively high cost of organising the cooperation, long distances between the centre and outskirts, difficulty for voluntary workers to get access to the place where care service is located, and professionals regarding voluntary work as threatening to their own work. the category of other reasons was included in addition to these categories so as to allow the respondents to describe in their own words the hindrances that were not mentioned in the list. all respondents were asked background questions about their service location, position, length of service and professional background/education. descriptive analysis was used, including frequency distributions on prevalence of different types of voluntary work, mean number of hours of voluntary work per week and barriers to successful cooperation with voluntary workers considered by managers. differences between the two sectors in activities and barriers was calculated via chi-square tests with holm adjustment for multiple testing. spss ibm version 22 was used for these analyses. table 1 survey response rates long-term care unit respondents non-respondents response rate (%) nursing home 128 34 79 home care 94 35 73 other* 22 3 88 total 244 72 77 *examples of ‘other’ were ltc units with both institutional and home care services, sheltered housing, day centres etc. 165 njsr – nordic journal of social research vol. 12, 2021 results type and amount of voluntary work in nursing homes and home care services the response rate was 77% involving 244 participants. there were no notable differences between the response rates among the nh and hc units. among the respondents, 67% were educated nurses, 17% were other health/care professions and 16% had other types of education. the prevalence of voluntary work activities is presented in table 2 below. table 2 shows how common voluntary work in the different categories is, while table 3 summarises the hours (mean) spent per week on the different activities in nursing homes and home services. table 2 prevalence of different types of voluntary work in nursing homes and home care category nursing homes (n=128), % (n) home care (n=94), % (n) pvalue pvalue holm cultural activities (music, dance, theatre, etc.) 80 (102) 36 (34) <0.001 0.001 social activities (trips, social gatherings, etc 67 (86) 36 (34) <0.001 0.001 visiting schemes 56 (72) 30 (28) <0.001 0.003 physical exercise and activities 30 (38) 27 (25) 0.662 1.000 library/reading services 27 (35) 9 (8) <0.001 0.003 joy of life-certified activities 27 (34) 7 (7) <0.001 0.003 transport/taking out services 15 (19) 28 (26) 0.026 0.132 day centres 5 (7) 14 (13) 0.035 0.142 helplines/counselling services 4 (5) 3 (3) 1.000 1.000 food delivery for care recipients living at home 23 (22) <0.001 0.001 practical assistance for care recipients living at home (e.g. snow clearing, food shopping)* 14 (13) <0.001 0.001 self-help groups (for anxiety, grief, loneliness, etc.) 2 (3) 4 (4) 0.463 1.000 other activities 27 (34) 6 (6) <0.001 0.002 166 njsr – nordic journal of social research vol. 12, 2021 table 3 mean number of hours of voluntary work per week in nursing homes and home care category nursing homes (mean) nursing homes n= home care (mean) home services n= day centres 38.3 6 17.5 11 joy of life-certified activities 15.4 32 11.1 5 cultural activities (music, dance, theatre, etc.) 8.9 99 3.1 28 social activities (trips, social gatherings, etc 8.1 84 7.0 31 physical exercise and activities 5.0 37 2.5 20 transport/taking out services 4.8 16 3.8 20 visiting schemes 4.4 65 3.1 20 self-help groups (for anxiety, grief, loneliness, etc.) 2.2 3 0.3 2 library/reading services 1.1 32 2.8 7 helplines/counselling services 0.4 4 0.6 2 food delivery for care recipients living at home 12.0 17 practical assistance for care recipients living at home (e.g. snow clearing, food shopping)* 3.1 11 other activities 6.0 27 2.2 5 the results show that more voluntary work takes place in nh as compared to the hc sector (table 2). the most common activities that are organised both in nh and hc with the contribution of volunteers are in the category of cultural and social activities, followed by visiting schemes. in nursing homes, physical activities and exercise, library services and joy of life-certified activities approved by a volunteer organisation are also frequent. in hc, transportation, physical activities and food delivery are also activities frequently run by volunteers. the categories food delivery and practical assistance were only relevant to respondents in the home care field. the activities in day care centres as well as transport and taking out services are more commonly organised in hc than in nh. 167 njsr – nordic journal of social research vol. 12, 2021 table 3 indicates that for most activities, more time was spent in nursing homes compared to home care services. however, the number of institutions varied considerably. in this study, the activity involving volunteer effort with the highest mean hours in both nursing homes and home care related to activities in day centres; 38.3 mean hours were recoded from nursing homes and 17.5 hours per week were recorded from home care. this is followed by joy of lifecertified activities, with 15.4 hours per week in nursing homes and 11.1 for home care. for all activities in both nursing homes and home care, nursing homes had a higher number of mean hours. hindrances to voluntary work the respondents were asked to select the three most common hindrances to successful cooperation with volunteers. table 4 shows that lack of volunteers was the most important barrier recorded by the managers from both hc and nh. lack of coordination from the municipal care services was equally seen as a common hindrance by respondents from both groups. respondents from the hc scored poor flow of information as a hindrance more often than the respondents from the nh (p = 0.035). the same applies to low interest in the municipality, scored as an even greater hindrance by respondents from home care than the respondents from the nursing homes (p = 0.009). respondents from the nh scored cooperation overdependent on particular individuals as a more frequent hindrance than respondents from the hc (p = 0.015). for other categories, there are only small variations between the responses given by the two sectors. with correction for multiple testing by holm’s procedure, all p-values are ≥ 0.118. however, our results shed some light on voluntary work in the two sectors and this will be discussed below in relation to the topics of volunteer recruitment and coordination procedures. 168 njsr – nordic journal of social research vol. 12, 2021 table 4 three most important barriers to successful cooperation with volunteers. presented in percent what would you consider to be the three most important barriers to successful cooperation with voluntary workers at the nursing home/home care sector where you are employed total (n=222) nursing homes (n=128) home services (n=94) pvalue lack of volunteers 76 77 76 0.875 poor flow of information between the stakeholders 36 30 44 0.035* lack of coordination by the municipal care services 34 36 32 0.569 co-operation overdependent on key persons 28 34 19 0.015* too vulnerable/weak recipients of care 21 21 21 1.000 uncertain financial support 20 23 15 0.128 low interest in the municipality 16 10 23 0.009* competence among the volunteers 14 15 13 0.700 overhigh costs of organising the cooperation 10 9 11 0.822 other reasons 8 9 6 0.466 long distances between centre/outskirts 7 8 6 0.796 it is hard for the voluntary workers to get access to the place where the care service is located 6 4 9 0.246 the professionals regard voluntary work as threatening to their own work 5 9 1 0.015* 169 njsr – nordic journal of social research vol. 12, 2021 discussion the three most commonly involved activities in voluntary work within nh and hc settings are cultural activities, social activities and visiting schemes. however, the prevalence of voluntary work in long-term care is distributed differently. in our study, respondents reported that volunteers spent more time (measured as mean hours per week) in nursing homes compared to the home care sector. as for the variation between the two sectors, it can be assumed that service recipients in hc might have less demand for volunteers, as they are generally younger than residents in nh. however, it is known that recipients of hc have increasingly complex, high-care needs independent of their age, including psychiatric health problems and addiction (førland & folkestad, 2016; hamran & moe, 2012; otnes, 2015). so younger reservice recipients do not necessarily equate to less demand for support and care. the two sectors experienced an assortment of common hindrances. most respondents reported lack of volunteers as a main barrier. the difficulties of initiating and recruiting volunteers in care is also evident in other norwayand internationally-based studies (andfossen, 2016; bussell & forbes, 2001). it is argued that a coordinator is needed to mobilize, recruit and assume the responsibility for the contribution from volunteers (hillestad & tessem, 2015). managers assuming this role needs to receive training in how to understand and manage volunteers (wilson & pimm, 1996) and develop procedures for recruitment (disch & vetvik, 2009; hoad, 2002; netting, nelson jr, borders, & huber, 2004). respondents from the hc reported low interest in the municipality as a more frequent barrier than the respondents from nh. this indicates that recruitment initiatives might be particularly low in this branch of long-term care. it may also reflect the complexity of the home context where voluntary work crosses between many boundaries: formal and informal, micro and macro, public and private as well as medical and social care (burau et al., 2007). as an example, decisions are still somewhat unclear as to who should assume responsibility for the various needs of a home dweller and how tasks should be shared among the different providers (e.g. home care service, volunteers, informal carers). knowledge is sparse regarding factors that influence the decision of who provides help and care to elderly people living at home (hellström & hallberg, 2004). another factor that may potentially explain low interest in the community can be the volunteer’s lack of willingness or ability to visit home dwellers with increasingly complex health conditions (bing-jonsson et al., 2016). handling difficult situations with vulnerable home dwellers may prove to 170 njsr – nordic journal of social research vol. 12, 2021 be a demanding task for volunteers to take on, especially when they are operating on their own in individual homes without support from other volunteers or care staff (solbjør et al., 2014; tingvold & olsvold, 2018).). the respondents from the hc services reported poor flow of information as a more important barrier than respondents from nhs. reforms over recent years have triggered changes in how home care staff carry out their work. staff are directed increasingly towards serving a specific need of the home dweller (e.g., cleansing a wound, bringing medication, giving a bath) and do not have the same flexibility to consider various needs on the spot and place priority when entering the houses of the home dwellers (vabø, 2012). less time spent with home dwellers gives less time to observe the resident, register changing needs (vabø, 2012) and communicate about psychosocial needs (vik & eide, 2012). a lack of procedures for how staff in home care can involve volunteers in providing care for lonely older people is missing, as well as knowledge about how this cooperation can be organised (hoad, 2002; rønning, 2011). confidentiality is also discussed as a hindrance in regards to the sharing of personal information, as staff are afraid of passing on sensitive information about home dwellers to volunteers (øhrn, 2019). furthermore, coordinators of voluntary work may be reluctant to send volunteers to home dwellers with complex or demanding care needs, such as mental illnesses, substance abuse and terminal illness (tingvold & olsvold, 2018). coordinators may consider whether or not it is justifiable to send volunteers out to visit a service recipient with such challenging health and care needs. in a study, coordinators were concerned about those volunteers who visited care receivers in their homes; the volunteers had less opportunity to seek guidance and support in an unexpected event, as compared to volunteers in a nursing home with staff members present at all times (tingvold & olsvold, 2018). additionally, service recipients with complex health situations in both nursing homes and home care have changing – and often unpredictable – days; this leads to changing opinions in terms of whether a volunteer should perform a visit or not (tingvold & skinner, 2019). it is unknown whether or not home dwellers are more hesitant to admit volunteers in their private homes – as compared to meeting volunteers in nursing homes. however, a staff member who was interviewed in the pilot of this study claimed that – compared to home dwellers – it was easier to include nursing home residents in voluntary activities. she stated: 171 njsr – nordic journal of social research vol. 12, 2021 at the nursing home, everyone lives in the same building. so you just knock on a door and say to [name of the person who lives there]: 'it's a lovely day so now we're going outside.' you don't do that in the home care service. this quote illustrates that contextual framework matters, and the autonomy of service recipients are considered differently where home dwellers are concerned. it is within their rights to refuse visits and decide when the visit or activity is over. as mentioned previously, home dwellers represent a large group of people with different needs and reasons for receiving care. hence, it is difficult to offer them a fixed, set activity or a common approach to contact. in comparison, voluntary work in nursing homes is often scheduled at fixed times of the day and is embedded in the daily or weekly routines of the nh. the decision to take part is not necessarily left to the residents. the motives of the volunteers and how they interact with the contextual framework are relevant to our findings. similar to staff in hc, volunteers need to function independently in a private home. the volunteer does not know how the health of the home dweller is from one day to the next and must make individual decisions on how to respond to care needs or situations that might arise. in comparison, there are always staff members present in nhs. in addition to this, there are often several volunteers taking part in the same activity, making similar observations that they can subsequently discuss. the volunteers in this context can assist each other if there is need for support, and they can also ask staff for clarification or assistance. if the motive for the volunteer is to socialise, gain work experience, increase learning skills or language, the opportunity to achieve this would be far better in an environment where the volunteer can get support, advice and information (i.e., in a nursing home). a recent article discussed engagement, motivation and barriers to volunteering among post-world war ii baby-boomers and concludes that more flexible forms of involvement of volunteers need to be accommodated in the future (hansen & slagsvold, 2020). for volunteering in ltc, such flexibility can be hard to accomplish. this is especially true in the case of home care, as the contact between a volunteer and a service recipient is often more personal in comparison to volunteer activities in nursing homes that are directed towards a group of residents. a theme in the investigation of volunteering motivations in actual situations is that volunteer behaviours do not depend solely on the person or on the situation; rather, they depend on the interaction 172 njsr – nordic journal of social research vol. 12, 2021 of person-based dynamics and situational opportunities (clary & snyder, 1999). finally, we wish to relate the topic of recruitment of volunteers in ltc to broader trends of development in the welfare state and the ageing policy. every four years, the norwegian government publishes a perspective report to the parliament (perspektivmeldingene) concerning future challenges for the country and the government. since the early 2000s, these reports have emphasized an increase in costs connected to changes in age composition as well as how this will increase demand for health and long-term care services; it mentions that relatively fewer workers will have to shoulder the burden of an increased older non-working population (ministry of finance, 2017). healthy and active ageing as well as increased informal work are seen as two solutions that can mitigate the challenges posed for public finances as a result of increased longevity (ministry of health and care services, 2015). the growing interest for the potentials of voluntary work in ltc can be perceived as a response to such discourses of sustainability of the welfare state, both in norway and in many other countries (broese van groenou & boer, 2016; fyfe & milligan, 2003; hussein & manthorpe, 2005). by prioritizing home care, ageing in place and volunteerism, it can be asserted that policymakers are attracted to the possibility of cost savings over expensive institutional care (grabowski, 2006). in most countries – including norway – informal caregiving, and especially family caregiving, is a backbone in ltc. their volume of caregiving is under substantial pressure for several reasons; the number of children per dependent elderly is decreasing, the labour market participation among women and older people is increasing and the professional competence required in ltc is expanding in addition to the uncertainty of the home dweller to accept contributions from volunteers. in the predominant way of narrating the potential of volunteerism, these patterns seem to be neglected. the realism of strengthening the role of volunteers in ltc – especially in the home care context – can be debated and seen as wishful thinking as the challenges are quite obvious. strengths and limitations the strength of the study lies in the new insight provided into healthcare professionals’ perceptions, specifically those of voluntary service contributions in a contextual perspective. prior to this study, a lack of quantitative data was present in regard to the following: how management and staff in ltc were experiencing voluntary work in nursing homes and home care, which activities 173 njsr – nordic journal of social research vol. 12, 2021 volunteers were involved in and how often volunteers were involved in those activities. self-reported estimates by volunteers themselves may have yielded different, and perhaps higher, levels of involvement. a qualitative study with both service recipients and volunteers would have provided deeper insight in the subject matter. a limitation of our data set is that our survey did not differentiate between individual volunteers and volunteers within formal organizations. volunteer perspectives (those representing both formal organisations and individual volunteers) should be studied carefully in future research, particularly those concerning the importance of context in ltc service voluntary work. conclusion different challenges are connected to contributions from volunteers in the two aforementioned branches of long-term care. nursing homes in norway are institutions driven by formal rules and procedures. volunteer activities are organised to fit the schedules and take place in common rooms suitable for social gatherings with several residents at the same time. volunteers may benefit from partaking in activities with several volunteers in a social network. on the other hand, home dwellers stay in more individualised contexts in their own houses with more autonomy to make their own decisions. given that home care services are going to serve most of the elderly in the future – as suggested by political authorities – our findings indicate some concerns. first, we pose the following question: are volunteers willing to volunteer in the homes of the elderly – without support from others present in the home – who have various, potentially complex care needs? second, we postulate that voluntary work in the context of private homes is dependent on the willingness and autonomy of the home dweller to accept contributions from volunteers. in a home care setting, the roles and tasks among the home dweller, next of kin, care services and volunteer are more informal and are often blurred compared to the nursing home setting. on a societal level, the government strives for increased voluntary work in ltc. in the context of an expected increased home care sector, this can be seen as an effort to meet expected rises in public expenditure. however, the realism in this effort can be debated. an increased focus is needed in acknowledging the various contexts in which volunteers operate, especially regarding the large variation of health and care needs among home dwellers. volunteering in groups of two or more, voluntary activities taking place outside private homes in local communities, providing 174 njsr – nordic journal of social research vol. 12, 2021 volunteers with sufficient information about the home dwellers and discussing expectations carefully beforehand can potentially aid this dire situation. funding this work was funded by the research council of norway through the helsevel programme (health, care and welfare services research) as part of the research project, ‘voluntary work in norwegian long-term care prevalence, forms, interaction with professionals and potentials for the future’. acknowledgements during the formation of this research, the first author was a visiting scholar to the university of california at berkeley, and wishes to thank professor andrew scharlach, school of social welfare, uc berkeley for the valuable comments and discussions. many thanks are also in order for marianne sundlisæter skinner and maren kristine raknes sogstad, who helped with factors of research from tables and comments to the first draft. additionally, great thanks are given to tore wentzel larsen, who provided statistical assistance. 175 njsr – nordic journal of social research vol. 12, 2021 references ahgren, b. 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(phd), university of bergen, bergen. https://doi.org/10.17585/noasp.12.41 enhancing credibility: a qualitative study of being on sick leave with a stress-related psychiatric diagnosis njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 enhancing credibility: a qualitative study of being on sick leave with a stress-related psychiatric diagnosis lena ede department of social and psychological studies karlstad university, sweden lena.ede@telia.com ulla rantakeisu* department of social and psychological studies karlstad university, sweden ulla.rantakeisu@kau.se *corresponding author abstract in the western world mental health problems are increasing and in sweden these problems are the most common reason for sick leave. diagnoses of adjustment disorders and reactions to severe stress are increasing the fastest out of all mental health problems. the aim of this study is to contribute new insights into employees’ experiences and management of being on sick leave with a stress-related psychiatric diagnosis. the empirical material consisted of individual interviews with 26 employees who were on sick leave from at least part-time employment because of a stress-related diagnosis. the grounded theory method was used to analyse the results. in the generated model, we propose that sick-listed employees engage in enhancing credibility in relation to themselves and others, here attempting to come across as credible and, thus, avoiding disbelief and the negative attributions of being on sick leave with a psychiatric diagnosis. the interviewees shared the general concern that being perceived as either healthier or sicker than the case may be, as well as greater sensitivity to what others might think, which was manifested as being on guard and controlling their behaviour and emotional display. to return to work, the sick-listed employees tended to re-evaluate their previous performance at work and saw the illness as self-inflicted and as the result of not having been capable of drawing the line between work and leisure. mailto:ulla.rantakeisu@kau.se 182 njsr – nordic journal of social research vol. 12, 2021 keywords: sick leave, stress-related mental health problems, credibility, emotional labour, grounded theory introduction mental health problems are increasing in the western world (oecd 2016) and are the most common reasons for sick leave in sweden. diagnoses of adjustment disorders and reactions to severe stress are increasing faster than any other psychiatric diagnosis (försäkringskassan [social insurance agency], 2017). hence, the intention of the current study is not to explain the causes behind stress-related mental health problems, which other studies have done (aronsson et al., 2017; sverke et al., 2016; bryngelsson, 2013), but to increase our understanding of what it is like to be on sick leave. research surveys have shown that there is a lack of qualitative studies of the experience of being on sick leave with a stress-related psychiatric diagnosis from the perspective of the afflicted employee (vingård, 2020; aronsson & lundberg, 2015). however, there are a number of studies indicating poorer personal finances, risk of social isolation, and difficulties in returning to work, which are all aggravated by the duration of sick leave (osha, 2019; hees et al., 2012; gellerstedt, 2011; hesselius, 2007). therefore, the aim of the current study is to contribute new insights into employees’ experiences and management of being on sick leave with a stress-related psychiatric diagnosis. in the scandinavian welfare model (esping andersen, 1990), sick leave provides a formal right to be absent from work to recover from an injury or illness, but it also involves the obligation to rehabilitate and return to work and have self-sufficient income (lindqvist, 2000). in recent decades in sweden, this obligation has been tightened through the so-called rehabilitation chain, in which there are scheduled checkpoint review meetings and the social insurance agency’s medical evaluation model, which involves specific sick leave recommendations for various diagnoses (försäkringskassan, 2014). the work capacity strategy is applied more clearly in healthcare insurance through this shift from a focus on illness to work capacity. a medical diagnosis is no longer sufficient for sick listing unless the illness also leads to an incapacity to work (nord, 2018; seing et al., 2011). concurrent with the amendments above, there have also been changes in the social conceptions of sick listing practice (johnson, 2010). concepts such as morality, taking undue advantage of the system and fraud have become 183 njsr – nordic journal of social research vol. 12, 2021 commonplace in the public debate (junestav, 2009). previously, sick listing was seen as the result of a poor work environment and the sick-listed person as a victim of circumstances, but now, the discussion has turned into defining sick leave as a way of making a living and the sick listed as abusers of the insurance system (johnson, 2010). these two social policy developments have increased the emphasis on the obligation to work and actively taking responsibility for rehabilitation rather than passively receiving financial reimbursement (nord, 2018). in addition, sick-listed employees with psychiatric diagnoses are burdened in two ways: first, they risk being ascribed the denigrating attributes associated with mental disorders. second, there is the historical notion of the mentally ill as unpredictable, unreliable, dangerous and violent (angemeyer & dietrich, 2006; pescosolido et al., 1999), along with the notion that a mental health problem is not a ‘real disease’ (johnson, 2010). studies have noted that mental health issues and illnesses based on patients’ self-reports without clear, visible symptoms are trivialised and considered less legitimate reasons for being sick listed (knapstad et al., 2014; newton et al., 2013). these are disorders on the bottom rungs of the medical ladder, and patients are not taken seriously by doctors (werner & malterud, 2003; album & westin, 2008) or by the social insurance agency and public employment service officers (svensson et al., 2003). indeed, other studies have described sick-listed employees’ struggles to gain legitimacy and recognition for their conditions (aronsson et al., 2015; eriksson et al., 2008; wessel et al., 2012). the fact that stress-related mental problems have been predominant among psychiatric diagnoses in sweden since the beginning of the 2000s (försäkringskassan, 2020) accentuates the issue of work capacity assessment in relation to sick-listed employees. research has shown that the view of mental health problems as hypochondria (johnson, 2010) combined with the social insurance agency’s stricter emphasis on work capacity has caused sick-listed employees to feel questioned by the authorities and others (lännerström et al., 2013), partly in terms of the seriousness of their conditions and partly in their efforts to recover (flinkfeldt, 2016). in other words, sick-listed people with mental health problems run the risk of being viewed as averse to working, cheaters (johnson, 2010) or as being healthier (flinkfeldt, 2016) or sicker (angemeyer & dietrich, 2016) than they are. whatever the case may be, being on sick leave involves potentially being categorised by others as cheaters or malingerers, which may contribute to a 184 njsr – nordic journal of social research vol. 12, 2021 sense of being stigmatised (goffman, 1963/2014), in turn resulting in stress, status loss and lower self-esteem (aronsson et al., 2015; knapstad et al., 2014; eriksson et al., 2008). one way of dealing with this is to adjust one’s behaviour to match the social norms and perceptions of the sick listed in the appropriate way (flinkfeldt, 2016; lännerström et al., 2013; wessel et al., 2012; werner & malterud, 2003). this behaviour, which goffman (1959/2009) terms impression management, involves being constantly alert to making the expected impression and presenting oneself in the best of light. methods the empirical material was collected in the spring of 2010 as part of a larger research project funded by the norwegian research council, here with the aim to study the social aspects of sick leave in sweden and norway. the current article is based on the interviews conducted in sweden by the first author together with another researcher, both of whom were members of the swedish research team. the interviews were transcribed by the interviewers and used in three articles, including the present one. in total, the interviews were conducted with 26 individuals (15 women and 11 men) who were on sick leave from at least part-time permanent employment because of a stressrelated psychiatric diagnosis1 and who had been on leave for at least 60 and no more than 365 days. apart from the criterion of being on sick leave, the selection was made based on having an even gender and age distribution. the sample, which was based on the most common psychiatric sick leave diagnoses, was selected by the research group, including a physician, in consultation with two case managers from the social insurance agency. for confidentiality reasons, initial contact with the selected interviewees was made by two case managers from the social insurance agency. by phone, they were informed about the study, told that participation was voluntary and were asked for participation. a total of 40 individuals were contacted, and of these, 14 declined for health reasons. when consent was given, the contact details were forwarded to the research group. then, the two researchers 1 the sick-listed individuals in the study belonged to the following diagnosis groups (according to icd-10): f32 (depressive episode), f43.0 (acute stress reaction), f43 (adjustment disorder and reaction to severe stress), f43.9 (stress reaction/crisis reaction), f43.8 (fatigue syndrome) and z73.0 (burn out). they were diagnosed on the basis of these symptoms by their general practitioner. 185 njsr – nordic journal of social research vol. 12, 2021 conducting the interviews contacted the interviewees to make an appointment for the interview. occasionally, a third person in the research group was involved. the research group estimated that the 26 individuals interviewed were sufficient to answer the research question, which is why no further contacts were made. all interviews were individual and typically conducted in the homes of the interviewees—in a few cases, in the workplace and at the university—and lasted between 1.5 and 2.5 hours. in accordance with the guidelines for classic grounded theory (cgt) (glaser, 1998), the interview guide was fairly open although thematised. we wanted the interviewees’ own stories of what it was like being on sick leave with a stress-related psychiatric diagnosis, and great emphasis was placed on letting the interviewees talk freely about their sick leave experiences. the interviews were recorded and transcribed immediately after the interview by the interviewers/researchers, and the name of each interviewee was replaced with a fictive name. a great number of professions and educational levels were represented and evenly distributed between the private and public sectors (e.g., teacher, social worker, auxiliary nurse, engineer, photographer, security guard, printmaker). all of them had different types of service jobs or jobs involving frequent contact with people other than colleagues, and they belonged to various age groups, from 29 to 58 years old. analysis the cgt method was used in the analysis. cgt is characterised by adopting an explorative and inductive approach towards discovering what is perceived as a problem in the attempt to understand the respondents’ actions (glaser, 1998). because our study aims to seek new knowledge through the self-lived experiences of being on sick leave, cgt offered a suitable approach for the analysis. the steps in the analysis were taken in accordance with the principles of cgt, involving careful reading of the interview transcripts, open coding, selective coding and continuous comparisons of different events, that is, indicators that can be interchangeable, and finally conceptualising and generating a model presenting the results (glaser, 1998). when the interviewees’ central problem emerged, that is, how to credibly avoid the risk of being attributed negative associations of long-term sick leave and a psychiatric diagnosis, the open coding was concluded, and we moved on to selective coding, which was delimited to finding data related to the core category. the core category (i.e., the main concern) emerging from the empirical material was termed enhancing credibility. the crystallisation of enhancing credibility can be 186 njsr – nordic journal of social research vol. 12, 2021 understood as a process consisting of three phases: healing of self, situational adjustment of self and reconstructing self. these phases were reported by all the respondents, even if there were variations within the healing of self, for example. ethical considerations ethical aspects were given great emphasis because the interviews might touch on delicate areas. in compliance with the law on ethical review (sfs 2003), an application was submitted to the ethical review board in uppsala, which was approved on 17 february 2010, reg.no. 2010/014. in connection with each interview, the interviewees were provided with contact details to members of the research group, one of whom was a physician. all the interviewees were informed in person that they could withdraw from the interview at any point; they also signed a consent form results the results of the generated model and the central concepts are presented in figure 1. figure 1: enhancing credibility figure 1: model for reducing the risks of the negative attributions of sick leave and psychiatric diagnoses. a three-phase process of enhancing credibility. • withdrawing • processing healing of self • concealing • displaying • juggling situational adjustment of self • self-examining reconstructing self 187 njsr – nordic journal of social research vol. 12, 2021 enhancing credibility in the generated model, we propose that employees on sick leave engage in enhancing credibility in relation to themselves and others, here attempting to act in what others would believe is credible, thus avoiding disbelief and the negative attributions being on sick leave with a psychiatric diagnoses. this takes place in a process of three phases without strict borders. the first phase, healing of the self, involves withdrawing from others to recover at home. somatic and cognitive disorders need attention and healing, and at the same time, the new experience of being on sick leave with a psychiatric diagnosis needs to be processed in relation to the previous experience of being gainfully employed. the second phase, situational adjustment of self, involves adjusting one’s behaviour and the information provided about the situation when meeting others to avoid being discredited. this is done by concealing, displaying or juggling. in the third phase, reconstructing self, the causes for the sick leave and the previous approach to work are reconsidered during a self-examining process. healing of self healing of self refers to the acute and subsequent phase of being on sick leave when rest and acceptance of the new situation are needed, partly because of extreme tiredness—the body is exhausted and in need of rest— and partly because of social reasons that push one to escape from confronting others. this involves withdrawing to home to care for and heal one’s somatic and cognitive ailments in the form of aches, attention deficiency and memory loss. at the same time, the reason for the sick leave is processed, along with how to handle the new situation. withdrawing healing the self involves an active choice, given the circumstances, to withdraw to one’s home to save what is left of one’s energy after a pressing situation at work that has been occurring for an extended time period. a characteristic feature of the interviewees’ accounts is that they have experienced an increasing workload, which has led to work-related conflicts with superiors (ede & starrin, 2014). they have informed managers and superiors of their situation regarding getting on better terms and conditions at work but to no avail. to meet the employer’s ideals and their own demands on performing well, several of them have shouldered their own duties, as well as 188 njsr – nordic journal of social research vol. 12, 2021 the duties of others, in an accelerating accumulation of tasks. such behaviour may be understood as meaningful in the current work situation that is characterised by individualised responsibility for meeting and maintaining the requirements and quality of work through individual unicity, flexibility and social competence (see, e.g., garsten et al., 2011). at the same time, it is a health hazard. withdrawing to home means drawing a line for others to protect the self from further ordeals: ‘i stay away from people, because if can’t cope with myself, i can’t cope with others either—so, sure, i isolate’ (ingvar). processing healing of the self is also about processing the new experience of being on sick leave, which is different from being at work. this means struggling with the social perceptions of sick listing and psychiatric diagnosis in relation to a changed view of themselves. this indicates a clear contradiction between their previous self-image as being a strong professional and being a weak professional. ingrid described a bitter awakening when she saw this shift from strong to weak: at first, i needed to take it in. what do i think, and what happened? being on sick leave is a confirmation of not having the strength. i have heard this since childhood—such a person is someone who doesn’t want to work and is on sick leave all the time. but i will not be on sick leave because i’m the strong kind. david also did not want to acknowledge his new position as sick listed because this meant being a burden to others. the norm of making a livelihood is strong, and this norm is emphasised by the work capacity strategy in the social insurance system. doris was very aware of her position as being sick listed and did not want to identify as such. others refused to acknowledge the psychiatric diagnosis, which was experienced as a degradation of their own value: ‘no way this is me. it was an absolutely shattering thought’ (maria). it was also common to grapple with the loss of status following the diagnosis and/or being on sick leave. conceptions are partly formed through the way work as a central institution structures life. at work, the interviewees were strong and loyal until their whole beings were drained of energy: ‘i don’t know if i ever will be who i was before. don’t know if i want to either—a person who always pitch whatever the cost’ (gunnel). being on sick leave with a psychiatric diagnosis means being in a position in which a certain self-image cannot be maintained but runs the risk of 189 njsr – nordic journal of social research vol. 12, 2021 being replaced with an image of a vulnerable, insecure and weakened individual. possibly, the gap between being healthy and at work and being sick and on sick leave is greater when individual responsibility and the power of initiative are increasingly emphasised in work organisations. if recognition of performance at work is ruled out, the issue of identity emerges, revealing one’s experienced shortcomings. also, the new social context differs radically from time period before the sick leave began. there is a clear difference between the previous self-perception as strong and the present sense of weakness. situational adjustment of the self situational adjustment on sick leave entails adjusting to what others are assumed to expect to avoid intrusive questions or a lack of understanding. the interviewees shared a great sensitivity to what others thought, which was manifested in their being on guard and controlling their behaviour and emotional display. the norms of behaviour that seemed important to follow varied depending on the situation. three types of adjustments were identified: first, concealing the predicament to avoid detection; second, displaying the situation to gain recognition as a valuable person despite the sick leave; and, third, juggling appearances to the diverse needs of a situation when various and contradictory impressions should be displayed at the same checkpoint interview2. concealing the invisibility of the situation makes it possible to conceal both the sick leave and diagnosis to avoid being misunderstood. this was done by avoiding situations in which sick leave may be revealed and by resorting to white lies to escape talking about the predicament. christer said that when placed in a situation of having to explain his sick leave, he resorted to a white lie to avoid revealing the diagnosis: ‘it was very embarrassing, that’s why i lied. i said it was stomach problems. at first, it felt awful to lie, but gradually it became easier’. others blamed it on high blood pressure or backache or chose not to 2 checkpoint review meetings were introduced in the general insurance act (afl 3) in 2003 as a demand placed on the social insurance agency to evaluate medical conditions, work capacity and rehabilitation potential. the purpose was to assess the right to financial support and to draw up a rehabilitation plan (seing et al., 2011). 190 njsr – nordic journal of social research vol. 12, 2021 say anything at all but instead ventured the risk of encountering prejudiced opinions about sick leave, which was also experienced in contexts where a diagnosis was unknown. an invisible illness can also mean encountering disbelief in the illness and being treated as a fraud. ‘i can’t be laughing and talking on the phone in town’, as helena said, ‘somebody could see me and think i’m not ill’. karin explained the difference between a visible illness or injury and the invisibility of her condition: this is different from a broken leg, which takes six weeks to mend and you know that from the day on which the cast is removed, there may be two weeks until the leg is as it was before. (…) everyone sees it and knows that it hurts and how uncomfortable and awkward it is with the leg. with my illness, no one knows anything. i would rather have broken both legs and arms, too, come to that, then enduring this because then i would know that i’ll recover soon and that it would happen. the feeling of being disbelieved is the worst. on the one hand, they hoped not to be perceived as healthier than they were because this would mean being regarded as lazy or a cheater. conversely, they hoped not to be sicker than the case because the psychiatric diagnosis signalled a humiliating weakness. at the core of this was the problem of relating to two conceptions of sick leave and psychiatric diagnosis: as strong and, hence, lazy or as ill and, hence, weak. if the norm of strength as ‘healthy but lazy’ is placed at one end of the axis, the other end holds ‘weak enough to be excluded’ from any work. this problem is aggravated by the fact that the illness itself was devaluating and seen as self-inflicted. the absence of pronounced social circumstances causing the illness enabled linking the sick leave to the individual, who then became synonymous with being weak or having caused the illness. displaying situational adjustment involves the active pursuit of support by choosing to disclose the situation to gain recognition and be respected as a credible person with an illness, which, although invisible, seriously impacts one’s health. the pursuit may target professional support—individual or in a group— or the support of family, friends and acquaintances. by carefully choosing to whom the truth can be revealed, independence is displayed, even if the choice is made in uncontrollable circumstances. doris would carefully choose her 191 njsr – nordic journal of social research vol. 12, 2021 confidants: ‘i have the true friends to thank for my road to recovery’, she said, with emphasis on the word ‘true’. physicians explained the bodily healing process to the interviewees, which meant that they had an understanding of their illness. as gustav put it, ‘i used to think that others should pull themselves together. i have really tried, but it doesn’t work, and it’s difficult to understand for anyone who hasn’t been there’. others participated in various forms of group therapy that were appreciated and useful, particularly hearing the stories of others and relating to them: ‘i was not alone’ (eva). support was also provided by fitness friends, hunting friends or friends in various associations. in a safe, social context, courage to share can be mustered, and the interviewees had also been treated with egoboosting respect and warmth in these social contexts. most of interviewees were, at the time of the interview, back at work for a quarter of a normal workweek. for most of them, this was not a voluntary choice but a consequence of the social insurance agency’s scheduled checkpoint meetings. the interviewees struggled to regain the concentration required to solve tasks, and a supportive environment seemed to be a prerequisite for successful return. stefan had returned to work part time and could testify that his superiors cared for him and showed that they wanted him back. johan was also working half time and said that his colleagues were very supportive: ‘if i have a really bloody awful day but still managed to go to work, then i say so and then they know. they back me up, if needed’. juggling there are particular events related to situational adjustment of self when personal appearance is especially troubling in the rehabilitation process of the sick listed. these are the required checkpoint review meetings with the social insurance agency case manager, the employer or a doctor. the interviewees were clearly aware of the various actors’ different social positions in relation to themselves and the need to appear ill but in different ways. there were aspects they wanted to share with or keep from various actors, but the balance of power in which the sick-listed employee might feel insecure and powerless made it difficult to control the situation. helena explained the balancing act of appearing as sufficiently ill and sufficiently healthy in the same meeting as follows: 192 njsr – nordic journal of social research vol. 12, 2021 if i appear to be too happy, the doctor might not see me as sick and might end my sick leave, and if i appear to be sad, my superior might not want me back. in the same meeting, i must show two different faces, but there is no difference in how i feel when i’m supposed to prove that i’m ill or in how i feel when i’m supposed to prove that i’m well. it’s a struggle to show that i can manage but not too much. and that i’m ill but not too ill. in the checkpoint review meetings that several of the interviewees referred to, they tried to demonstrate their capacity, but the nature of that capacity had varying characteristics in relation to the doctor, case manager and employer. if the appearance was not accepted, there might be repercussions in the form of sanctions, such as no extension of their sick leave or not being able to return to work. in such meetings, it is clearly important for the sick listed to be what they profess to be, but there is also the dilemma of having to present different versions of themselves in the same context. johanna struggled with having to present herself as ill—and, in her own eyes, as weak—in relation to the doctor and the case manager, which was not the image she had previously presented to her superior and which she wanted him to retain: it is very hard to show a side of me that my boss has not seen before. he got to see a weakness that i’ve never shown because i’ve tried to appear very capable of getting a higher salary. in his eyes, i wanted to be a high achiever, and now, that has been blown to bits. reconstructing self reconstructing self refers to the new experiences of illness and sick leave that contributed to the interviewees’ re-evaluation of previous conceptions and approaches towards work. through self-examining their activity, they sought answers to the causes of sick leave, and new insights emerged. previous attitudes towards work and lifestyles were reconstructed, and their self-images were reshaped and modified. self-examining the view that illness was self-inflicted was common among the interviewees. ‘my sick leave was caused by my personality’ (birger). the previous approach to work was now seen as bordering on the pathological, as maria explained: this insight came at a cost for me, but it was necessary. i didn’t know where the brake was. i only knew about accelerating. i have always been balanced on the brink of my limit of competence. i must learn to draw the line. i’ll start 193 njsr – nordic journal of social research vol. 12, 2021 by taking care of myself and realising that everything might not be my responsibility. (…) yes, i accept the blame, but i’m also responsible. only i can do something about it. i became aware of what i was doing when this happened. what triggers me to get going. self-examining activity can also involve questioning one’s previous career choice: ‘if my work makes me ill, i’ll try something else’, as doris said. when our interviewees started rehabilitation, they learned that the cause of illness was primarily their inability to listen to bodily signals and draw the line between work and leisure. their activities focused on stress-reducing techniques and new mindsets regarding settling for ‘good enough’. in this way, people on sick leave can be burdened for failing to cope with work in an individualized way. johanna explained the following: what we talk about in the [therapy] group is, on the one hand, the need to shrug off capability and get a picture of how to be. that’s slightly paradoxical: you should be good at not being good. there were many accounts of changes made in their daily lives in an effort to recover. these included changed habits and health-promoting measures such as food, sleep, exercise and more social contact with people labelled ‘energyproviding’ people, that is, individualand relationship-centred activities to change themselves and their attitudes towards their previous lifestyles. the common factor is that they were all expected to change their approach towards work because this was the main reason for their sick leave. discussion the aim of the current study was to contribute new insights into employees’ experiences and management of being on sick leave with a stress-related psychiatric diagnosis. the results show that enhancing credibility is central to the sick listed in the process of creating and verifying their self-image to avoid the risk of being ascribed the negative attributions associated with sick leave and psychiatric diagnoses. this process has three phases. the first phase, healing of self, involves withdrawing from other people to recover at home and process the new experience of being on sick leave in relation to being gainfully employed. having been a healthy and strong individual, the afflicted must confront a self 194 njsr – nordic journal of social research vol. 12, 2021 image impaired by being weak because of a status-lowering diagnosis, as well as a position of dependency, that is, being incapable of coping. being strong reflects an important quality in working life, indicating ambition, while being weak signals falling behind in an age when the duty to work is emphasised (allvin et al., 2006; garsten et al., 2011). the second phase, situational adjustment of self, involves adjusting one’s appearance to avoid being viewed as healthy, which might suggest laziness or sick leave cheating, or conversely, to avoid being perceived as mentally ill and, thus, of an unsound mind or being too weak. this adjustment is similar to what is found in a study by werner and malterud (2003), which shows that patients with medically inexplicable illnesses have to fight a battle for their credibility in claiming a medical condition, even though it does not show. the wish to make a good impression can be explained in terms of goffman’s dramaturgical perspective and the concept of impression management (1959/2009), which he defines as the way an individual constantly attends to their expected impression according to prevailing norms and to appearing at their very best to escape being miscredited. the interviewees in our study were invariably observant of their appearance and intent on displaying what they thought would be the expected appearance and feelings so that they could seem credible in each situation. they shared great awareness of the importance of presenting themselves in the expected way. to understand the frustration demonstrated in their enhancing credibility, we turn to hochschild (1983/2012) and her theory on ‘emotional labour’. sick-listed employees exert great self-control by disciplining and suppressing genuine and spontaneous feelings when meeting others to ensure that the ‘appropriate’ feelings are displayed. happiness, for example, seems to be an emotion that needs suppressing to avoid suspicion of being healthy and a fraud. conversely, excessive sadness or crying must also be avoided because such a display can be seen as weakness and a reason for being excluded from work. long-term discrepancies between genuine feelings and surface acting creates emotional dissonance, which hochschild (1983/2012) argues may have a negative impact on health and well-being if it continues. efforts to conceal certain emotions while displaying others are frustrating and may result in an emotional dissonance, delaying recovery. there are studies showing that emotional dissonance leads to emotional exhaustion (jeung et al., 2018; rustad indregard et al., 2017), but the issue of whether emotional dissonance may prolong sick leave needs 195 njsr – nordic journal of social research vol. 12, 2021 further study. there are also studies highlighting several causes of delayed recovery and prolonged sick leave, such as social isolation and concern about personal finances and unemployment (hees et al., 2012; gellerstedt, 2011; hesselius, 2007). the third phase of the process, reconstructing the self, involves selfexamination regarding the causes of the sick leave. the individual’s previous approach to work has to be redefined as a failure and in need of change, a self-judgement that coincides with and is strengthened by the individualcentred rehabilitation system with therapy sessions conveying the message that the cause of their sick leave lies in their inability to draw the line between work and leisure; this raises their awareness of the importance of ‘relearning’ to fit into a work organisation with the help of stress-reducing coping strategies and of new mindsets such as ‘good enough’. the origin of the illness seems to be their previous approach to work. this kind of reconstruction of self does not allow for extended individual room for acting but rather more restrictions. the conditions set at work increase the demands for the ability to plan, organise and manage duties, which means that it rests on the individual to formulate and manage the drawing of lines. for some, this may mean a sense of freedom. for others, however, it may lead to insurmountable demands and sick leave because the conditions at work differ greatly. consequently, reconstructing the self involves attempts to meet the demands of modern boundaryless work (see allvin et al., 2006; garsten et al., 2011). we argue that there has been a shift in emphasis regarding both responsibility and level—from employer and organisation of work to the individual employee. to fit in at work again, sick-listed employees must reassess their previous work performance and reshape themselves to match the requirements of work. combined with the stricter health insurance emphasis on work capacity (nord, 2018), the changes made in work organisations are consolidated and can be maintained because it is up to the employees to change so that they can fit in and retain their employability. finally, in the current analysis, individual experiences emerge as analytically abstracted and linked to the underlying conceptions of normality and deviation in the context. the self-images presented in the efforts to enhance credibility must be understood in relation to the various negative conceptions of being on sick leave with a psychiatric diagnose and that recovery and readjustment of self take place against the background of such norms. 196 njsr – nordic journal of social research vol. 12, 2021 the current study has practical implications for social work because there are frail social relationships, on the one hand, and trusting social relationships, on the other hand, to which the individuals on sick leave can relate. thus, it is not accessibility to different treatments or the joint efforts of various professional roles that may benefit one’s return to work—the required checkpoint review meetings may seem problematic—but the highlighted aspect of significance emerging from the study is instead the quality of the social relationships, which ideally should be trusting and personalised. limitations although the results of this cgt analysis are only applicable to the respondents involved in the current article and though the empirical material dates back to 2010, we maintain that it still has great relevance and topicality because the urgent issues of stress-related mental problems remain today (eurofond, 2018), probably even more so with the pandemic. recent studies confirm that employees on sick leave with a psychiatric diagnosis still acts to legitimise their sick leave to avoid the stigma and shame of their situation (strömbäck et al., 2020). thus, the generalisability of our proposed credibility-enhancing process model will have to be explored in future studies. a well-conducted grounded theory analysis should have the level of abstraction required to ensure that the readers of the present article note the central concepts and the potential for modifiability by further research (glaser, 1998). 197 njsr – nordic journal of social research vol. 12, 2021 references album, d., & westin, s. 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(2012). when do patients feel wronged? empirical study of sick-listed patients' experiences with healthcare encounters. european journal of public health, 3(2), 230-235. https://doi.org/10.1093/eurpub/cks030 conceptualising public sector innovation: introducing the lens of the epistemological, pragmatic and normative dimensions njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 this article belongs to the special issue public sector innovation conceptual and methodological implications guest editors: ann karin tennås holmen (uis), maria røhnebæk (inn) conceptualising public sector innovation: introducing the lens of the epistemological, pragmatic and normative dimensions luise li langergaard* department of people and technology roskilde university email: luiseli@ruc.dk *corresponding author abstract innovation is a relatively new concept in the public sector, and there is currently no broad agreement regarding how to understand and conceptualise it. this article assumes that a central role for research is to critically scrutinise and discuss what research does—or could do—when applying the concept of public sector innovation, especially because innovation has become a powerful organising metaphor for policy and practice. the article initiates a meta-conceptual inquiry and discussion of public sector innovation as a research concept, suggesting a method of conceptual clarification for future research by breaking the concept down into different dimensions. methodologically, the article conducts a meta-conceptual analysis and inquiry into research positions and discussions in public sector innovation, thus reflecting the academic activity/enterprise of conceptualising. by discussing selected literature from the public sector innovation field, three conceptual dimensions emerge: epistemological, pragmatic and normative dimensions. these dimensions refer to questions about what kind of knowledge the concept of public sector innovation represents, what its pragmatic or practical implications are and which normative or value dimensions the concept implies. finally, the concluding discussion highlights questions for research(ers) to address in future reflections on the conceptualisation of public sector innovation. 25 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications keywords: public sector innovation, conceptualisation, innovation theory, public value, network governance introduction innovation has become a core concept pushing towards change and development in the public sector and ‘is increasingly viewed as an appropriate and intelligent answer to some of the key governance challenges of our time’ (agger et al., 2015, p. 3). it has become imperative for public sectors to demonstrate that they are innovative and adaptive to the new innovation agenda. indeed, innovation has been promoted as a path towards more efficient, effective and responsive public services, and it has been suggested as a solution to various social and political challenges (albury, 2005; damanpour & schneider, 2009; de vries et al., 2016; hartley & moore, 2008; kattel et al., 2014; king & martinelli, 2005, p. 1; moore, 2005, p. 44; mulgan & albury, 2003), such as ageing populations, ambitious goals to reach climate targets and currently a number of challenges emerging under the covid-19 pandemic (opsi, 2020). innovation is said to equip the public sector to better deal with wicked problems that are too complex to be dealt with merely by known solutions models or by increasing the funding (chen et al., 2020; torfing, 2019). however, innovation is also a relatively new concept in the public sector, and currently, there is no widely accepted definition of what counts as innovation in this area (pollitt, 2011). as pollitt (2011) points out, innovation is not a concrete object; it is a concept, or rather a word that labels a concept. this applies not only to public sector innovation, but also to the concept of innovation more generally. the concept of innovation itself has a long history and has seen a change in meaning over time, from being associated with ‘disorder, anarchy, confusion and disillusion’ (godin, 2015, p. 1) to today, where the term has much more positive connotations (godin, 2008, 2015). despite its long history, there is no consensus on what innovation means more generally, especially not in the public sector context (pollitt, 2011). some researchers stress the lack of theorisation and theoretical frameworks in public sector innovation (chen et al., 2020; de vries et al., 2014), which calls for further inquiry and discussion at the meta-theoretical and meta-conceptual levels. therefore, the current article attempts to critically scrutinise and discuss what research does—or could do—when working with the concept of public sector 26 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications innovation, especially because this concept has become a powerful organising metaphor for policy and practice. concepts and academic work have implications not only in the world of academia, but also for practice and policy. thus, it matters what we understand as innovation in the public sector and how we address it conceptually and practically. public sector innovation is a concept stretching between academia, policy and practice, but it also involves conceptual and theoretical plurality. the research dialogues on public sector innovation suffer from disintegration, being an interdisciplinary research field where researchers have different understandings of the same concept. there are various definitions and implicit understandings of innovation, but there is little dialogue on how and why it should be defined or conceptualised in certain ways (there are exceptions to this, e.g., osborne and brown (2011) and hartley (2014), which will be included in the analysis). therefore, the criteria for what a ‘good’, ‘appropriate’ or ‘relevant’ concept could be are rarely discussed. the present article aims to explore and unfold the concept of public sector innovation in a way that enables a meta-conceptual reflection and shared dialogue on the enterprise of conducting research on public sector innovation and on why we should conceptualise it in certain ways. this inquiry into the public sector innovation concept is relevant because concepts not only reflect reality in a descriptive way but are also performative and have implications for practice and in the ways they constitute the object of research that they refer to (callon, 2010). thus, it matters how we conceptualise. the analytical entry point of this article is to ask the following: which questions can the concept of public sector innovation be an answer to? what does this imply in terms of knowledge, practical interests and value orientations? more specifically, these questions lead to three specific dimensions of conceptualising: epistemological, pragmatic and normative dimensions. these three dimensions were selected because they underline some of the differences in academic concepts of public sector innovation, namely the role of the concept in knowledge production, researchers’ interest in exploring and implementing innovation (a pragmatic, practical dimension) and the possible association of innovation with value creation, improvement or ideas about the ‘good’ society (a normative dimension). the current article unfolds these dimensions through a discussion of the selected conceptualisations of and debates on public sector innovation to understand how researchers apply and 27 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications work with the concept. the ambition is not to provide a comprehensive review of the field, but to discuss the selected contributions that illuminate some of the conceptual differences and points of intersection. the present article contributes to academic debates by focusing not only on the concept of public sector innovation, but also on the academic activity of conceptualising to enable reflection and dialogue on what researchers do when they develop the concept of public sector innovation. the present article is structured as follows: the next section examines why innovation is seen as a relevant and timely concept. then, the methodological approach is presented, followed by the analysis and discussion of the different dimensions of conceptualisation. finally, there is a discussion of the ways for research to move forward in conceptualising, which is done by specifying some guiding questions. why should the public sector be innovative? the following section addresses the emergence of the innovation concept in relation to the public sector and provides some context for the analysis. this is relevant for understanding what this concept is supposed to be an answer to (practically or academically). as mentioned in the introduction, the innovation concept is still relatively new in the public sector, and its emergence and development is a relevant context for understanding current conceptualisations in the field. over time, change and development within the public sector and the services provided by this sector have been understood and conceptualised in different ways following paradigmatic changes in research, policy and practices in the public sector (langergaard, 2011; hartley, 2005). the public administration paradigm has focused on policy implementation (sannerstedt, 2003) and on large-scale changes and improvements initiated by politicians developing new policy frameworks and changes in legislation (hartley, 2005, pp. 29–30). the introduction of new public management in the 1980s and 1990s consolidated the idea that the public sector should continuously develop and renew itself, which led to the introduction of the concept and practice of innovation in the public sector (buchheim et al., 2020; sørensen & torfing, 2011a). in the meantime, the overall paradigmatic framework of public administration research has developed towards a greater dominance of networked governance, now containing a broader variety of perspectives that go beyond new public 28 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications management and an unreflective adoption of the concept of private sector innovation. today, we can see a stronger emphasis on collaboration, interorganisational networks and coproduction (bommert, 2010; hartley, 2005; sørensen & torfing, 2011b; torfing, 2019), and here, innovation has also recently been included in the growing body of research specifically focusing on value creation and public value (benington, 2011; benington & moore, 2011; crosby et al., 2017). the introduction of innovation as a term for public sector change and development has been accompanied by certain narratives about why we need public sector innovation; these present the idea that contemporary societal challenges call for innovative solutions and organisations. innovation is presented as a necessity if the public sector is to meet current and future societal challenges related to, for example, changing demographics and citizens’ increasing demands for quality, flexibility and control of public services (bason, 2010; de vries et al., 2014; fuglsang & rønning, 2014; moltesen & dahlerup, 2008; sørensen & torfing, 2011a). innovation is portrayed as a cost-saving alternative to blind, across-the-board cuts and as helping address wicked problems that cannot be solved by standard solutions or by increasing expenditures alone (chen et al., 2020; torfing, 2019). from an organisational perspective, innovation is thought to enhance the problemsolving capacity of governmental organisations (de vries et al., 2016) and is considered a source of organisational change, growth and effectiveness (damanpour & schneider, 2009). furthermore, innovation is said to be important because of the dynamic, volatile conditions that make societies change their requirements of government, public organisations and public managers; however, organisations still need to adapt to such unstable conditions (buchheim et al., 2020; hartley, 2011). at first glance, innovation may appear very promising and is portrayed as a general solution, or a panacea (kattel et al., 2014). it can even be said to be a ‘hurrah’ word (langergaard, 2011) or a magic concept (pollitt, 2010: pollitt & hupe, 2017). these arguments for why the public sector should be innovative indicate that there is a normative dimension to the concept and that it might be considered desirable, but also that researchers are interested in innovation because it can help them understand how to solve problems or make more general improvements. the question, then, is how researchers can address such questions in relation to public sector innovation. in this context, the current 29 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications article proposes a meta-conceptual approach to the public sector innovation concept and to the act of conceptualisation, as discussed below. methodological approach methodologically, the present article deploys a meta-conceptual analysis and inquiries into discussions on the concept of innovation in the field of public sector research; it reflects on the academic activity of conceptualising and theorising by inquiring into the activity of conceptualising, just as philosophy/theory of science is a reflection on the criteria for conducting science and producing knowledge (langergaard et al., 2006). such questions are addressed here not as ‘isms’ but as an inquiry into some of the underlying assumptions about theorising or conceptualising that may not be explicit in the literature. one could see this as a hermeneutic inquiry, or an attempt to understand the approaches to public sector innovation and understand what kinds of questions the concept is supposed to be an answer to. the meta-conceptual dimensions by which the discussion and analysis are conducted are also found in the philosophy of science discussions about knowledge, practice and values/normativity and here are interpreted specifically in relation to public sector innovation research. similar discussions can be found in relation to theorising in organisation studies. through conversations with thinkers in organisation studies, hansen and madsen (2019) find that the actual act of theorising becomes elusive and that what one does when theorising is difficult to communicate to others. similarly, there is little explicit discussion about the act of conceptualising in public sector innovation studies. because the field seems to be more concerned with the concepts and definitions of public sector innovation than with developing theories of innovation, the present article focuses on conceptualisation, even though the considerations and concerns are closely related to the activity of theorising as well. the word ‘concept’ originates from ‘concipere’, meaning to conceive, to take in and hold or to grasp (etymonline.com, n.d.). this indicates an activity, an act of making graspable. it is this active role that is assumed here. the aim is not to provide a comprehensive review of the field or include all possible positions. the selected literature encompasses literature reviews that provide some form of overview or state-of-the-art look at the field. further, 30 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications specific contributions that engage in reflections and discussions about how to conceptualise innovation are included as examples to unfold and exemplify the conceptual dimensions. the included literature addresses public sector innovation mainly from a public administration perspective, discussing innovation in relation to the public sector in general rather than from the perspective of specific sectors or professions. some literature from the expanding field of public value is also included, mainly as a perspective on the normative dimension, but because this literature is vast, it will not be elaborately treated in its own right. before moving on to the analysis, i present a few remarks on the three dimensions. epistemology relates to theories of knowledge (audi, 1998). in relation to public sector innovation, pollitt (2011) sees social science in general and public administration in particular as ridden with epistemological differences, ranging from nomothetic approaches to more ideographic ones, which he also finds in public sector innovation research. nomothetic approaches strive to discover the underlying (causal) mechanisms and laws, often with the aim to control and predict. ideographic approaches work more along a hermeneutic or interpretative line, with a stronger emphasis on the subtleties of context and interpretation (pollitt, 2011). the lack of paradigmatic consensus among innovation researchers complicates the process of theory building (buchheim et al., 2020) and is also reflected in conceptualising. not all approaches in the field are equally explicit about their position, but further inquiry may elucidate the differences to be discussed, pointing out pathways for future research. the practical or pragmatic implications of ‘innovation’, here relating to the argument for why we need such a concept, also differ. pragmatism denotes a range of positions in the philosophy of science, which also represent various meanings and epistemological approaches (goodman, 1995; haag, 2003). the point here is not to embrace all these pragmatic philosophies, but rather to emphasise the practical dimension as separate: namely the practical implications of using concepts, where the meaning of a concept lies in its use (haag, 2003). finally, the analysis examines the normative dimension of innovation concepts in the public sector. this will be approached by exploring how the concepts of public sector innovation rest on implicit or explicit normative assumptions and how they link to improvement and value creation. 31 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications conceptualising public sector innovation the meta-conceptual analysis represents an explicit reflection on the criteria for the concept and what is required of a ‘good’ or appropriate concept of public sector innovation (see langergaard 2019 for a similar discussion on the concept of social entrepreneurship). the simple question to begin with is as follows: what do we as researchers want to achieve with the concept? should a concept, for example, mirror or order empirical reality as accurately as possible, should it work as a ‘tool’ for management, or should it be a driver for strengthening the democratic and public dimensions of the public sector? epistemological dimension epistemology is the theory of knowledge and justification of knowledge. in philosophy, epistemological questions address the notions of truth and the different ways of understanding what knowledge is and can be, as well as what we cannot know about. in the current article, the epistemological dimension concerns the type of knowledge reflected in the concept, for example, if the concept is seen as intended to describe, interpret or explain a certain phenomenon. this involves reflections about the relationship between the concept and phenomenon, such as whether the concept is meant to mirror an empirical phenomenon as accurately as possible. is it concerned with what is out there, and if so, how is empirical reality thought to relate to the concept? or is the conceptualisation aimed at understanding in a more hermeneutic sense the intersubjective construction of meaning? to provide examples of how we can view different epistemological approaches, we can examine schumpeter’s concept of innovation, which aims at explanation and is closely linked to a specific question: how does economic development take place (schumpeter, 2008)? schumpeter’s theory was developed as a supplement and challenge to the neoclassical economics of his time and their focus on the economy as a static system. the focus on equilibrium, according to schumpeter, led to difficulties in explaining how economic development was possible (swedberg, 2006). an example is included because we also see explanatory approaches to public sector innovation in the academic field. here, they generally occur in connection with a widespread interest in explaining how innovation occurs but often without a broader theoretical framework, as seen in schumpeter (2008). as gow (2014) explains, theories use concepts to organise raw material into variables, 32 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications abstract categories concerning causal variables and outcome variables. this is one understanding of what a concept is (or does) and its role in theory that is present in public sector innovation research. several review articles identify the dominant research interest as studying how innovation occurs and uncovering its determinants or antecedents (buchheim et al., 2020; de vries et al., 2016; gieske et al., 2016), often expressed in terms of barriers and drivers for innovation (becheikh et al., 2007; bekkers et al., 2013). we find arguments for the need for consistent concepts of innovation to develop measuring tools. chen et al. (2020) suggest a typology and emphasise the operationalisation of innovation types, including potential measures, in more detail (chen et al., 2020). this indicates an interest in developing the concepts and tools to measure innovation and make statistics, where operationalisation is a central feature of a ‘good’ or ‘appropriate’ concept that can enable consistent measurements and general insights about how innovation occurs. in a review of the literature on the barriers to public sector innovation, cinar et al. (2019) formulate their research questions in general terms, such as what the specific barriers in public sector innovation are, how they can be classified and their interrelationship (cinar et al., 2019). this indicates that innovation is seen as a general category referring to a certain empirical phenomenon, which can be delimited and identified across various contexts. when public sector innovation is conceptualised in such general ways, there is no concern for contextual factors, such as the specifics of national welfare or political systems, or for the differences between subsections of the public sector, such as a core focus on service provision or authority functions. we also find other kinds of reflections on why we need to conceptualise in certain ways. practice-based theoretical understandings of innovation, for example, insist that to understand how development and innovation actually take place in public sector organisations, we need to recognise certain activities as forms of innovation. bricolage and ad hoc innovation, which are not always planned but can be recognised as innovations a posteriori, are terms for certain types of innovation activities seen in public sector services, which differ in various ways from strategically planned, deliberate and radical changes (fuglsang & sørensen, 2011). fuglsang and sørensen (2011) argue that innovation research tends to grasp only the more formalised aspects of innovation and that these more informal, everyday work processes, which entail new ways of solving tasks and dealing with day-to-day challenges, 33 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications should be included in innovation theories. in terms of conceptualising, these reflections show how fuglsang and sørensen (2011) seek to develop a concept that reflects reality; certain practices are already taking place that we need a concept for. they argue that innovations can be embedded in organisational practices, despite the actors not referring to the activities as innovation. to capture this, they argue for expanding the concept of innovation to include bricolage. here, one can identify a descriptive research interest, where concepts are intended to capture and describe some practical reality. compared with the aims of measuring or finding general insights about barriers and antecedents, this approach seems to call for a greater sensitivity to practice and context and appears to be a more inductive approach, where it is important that the concepts capture features of empirical reality and actual practices. this is a way of conceptualising that aims to describe rather than predict, and this approach does not seem to have a specific instrumental or management agenda. the above approaches seem less aware of the performative dimensions of a concept and show less interest in the implications for practice and what they may mean for public sector management when it comes to organising them in line with specific concepts of innovation. concepts also have practical implications, which we can become more aware of when conceptualising. pragmatic dimension we can also understand the ways of conceptualising as aimed at making the reality that we gain insights into more manageable. we can see the pragmatic (and practice-oriented) dimension of conceptualising regarding what the concept is thought or supposed to do, such as to further the management of innovation processes in public sector organisations. this could also be called an instrumental dimension, and sometimes, this is implied in the abovementioned attempts to uncover the general insights about antecedents, drivers and barriers. this also implicitly or explicitly lies behind the prevalent interest in incentive structures (potts & kastelle, 2010), determinants or antecedents, drivers and barriers (becheikh et al., 2007; bekkers et al., 2013; buchheim et al., 2020; de vries et al., 2016; gieske et al., 2016; torfing, 2019), which not only teach us how innovation occurs, but also control, manage and attempt to promote innovation in public sector organisations. for example, cinar et al. (2019) see 34 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications knowledge about the barriers to innovation as an important success factor in innovation management and, thus, are clear about the additional practical (or instrumental) purpose of their pursuit of knowledge and conceptualisation of innovation. this illustrates that the conceptual dimensions are interconnected. hartley (2014) also suggests ‘eight and a half propositions’ for how to stimulate public sector innovation to encourage new approaches to innovation among managers, policy makers and academics. torfing (2019) and sørensen and torfing (2011b) argue that multiactor collaboration is a key driver of public sector innovation. thus, collaborative innovation is promoted as helping make the public sector better at solving certain types of problems, which is the knowledge we wish to acquire. there is also an interest in drivers, and it seems to be assumed that we want more innovation. in this sense, there is also a normative agenda, which we return to below. when innovation is understood more broadly as a solution, this seems to encourage pragmatic approaches to the concept, where it is thought to be instrumental in fostering certain practices and where innovation research is concerned with how to make innovation happen or how to manage it. if innovation is thought to be a necessity for organisations, the obvious question is how to achieve innovation. all these approaches want to do something with innovation, which is why they are interested in the concept, yet there seem to be two related—but still separate—arguments involved. one is that innovation will make the public sector better at solving its tasks (and innovation can then be a solution to various problems), while the other is that certain features of reality necessitate adaptability. this argument is seen in the literature on public sector innovation, when, for example, innovation is said to be important because of the dynamic, volatile conditions that make societies change their requirements of government, public organisations and public managers, while organisations need to adapt to such unstable conditions (buchheim et al., 2020; hartley, 2011). here, innovation is not so much an explanatory concept but rather a more general and not clearly specified ‘tool’ used to adapt and survive; however, this reveals little of the direction of change related to innovation. du gay and vikkelsø (2017) emphasise the lost specification of change in organisation theory, meaning that change (and innovation) has become represented as a broad, generic organisational imperative, without specification or connection to particular contexts and organisational purposes. paulsen (2011) states that such argumentation can become nihilist and simply used to promote change for the sake of change. this leads to discussions 35 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications about another concern regarding the pragmatic dimension when conceptualising innovation: the distinction between innovation and other concepts of change. osborne and brown (2011) insist on a distinction between developmental change and innovation as discontinuous change, explicitly arguing that we need two different concepts because the two types of change require different types of management. this clearly focuses on the practical difference between the two concepts (change and innovation). often, the pragmatic dimension is an underlying concern related to making innovation happen or managing it in certain ways, as exemplified above, because innovation is sometimes considered a solution. however, the questions of the desirability of innovation and its effect as improvement lead us into the normative dimension. normative dimension the normative dimension addresses the why of public sector innovation, more specifically in relation to its evaluative or value dimension. normativity can be seen as the common feature of everything that ‘ought to be’, here distinct from what ‘is’ (dancy, 2000). there are different ways of approaching normativity. moral philosophy and ethics deal with the justification of moral or ethical norms and claims, including claims of morality, etiquette and debates on how these can be justified (copp, 2001). in public sector innovation, the normative dimension often relates to explicit or implicit assumptions about what the public sector ought to do or be, how innovation relates to that and whether innovation helps improve the public sector (according to values or norms, either assumed or specified). the normative dimension can also involve assumptions or claims related to the desirability or value of innovation. pollitt (2011) emphasises that innovation is a fashionable concept with a strongly positive normative undertone, suggesting that innovation is inherently good (osborne & brown, 2011) and defined as leading to improvements (mulgan & albury, 2003, p. 3). the mere assumption that innovation will lead to desirable outcomes but without further specification or justification has been described as a ‘pro-innovation bias’ (hartley, 2016) or ‘the innovation imperative’ (osborne & brown, 2011). from this perspective, innovation is necessarily valuable or effective, hence bring forth an unquestioned need to accelerate innovation in the public sector to tackle current economic and social challenges. this rather prevalent normative assumption and the equation of innovation and improvement has 36 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications been contested by some researchers (e.g., brown & osborne, 2013; hartley, 2005, 2011, 2014; osborne & brown, 2011; torfing, 2019); these researchers argue that although the innovation process may be considered essential for improving public services, this does not mean that any specific innovation is positive or will lead to improvement (osborne & brown, 2011). any innovation carries a risk of failure or partial failure. improvement can occur without innovation in continuous efforts of improvement which are based on doing things better, whereas innovation is based on doing things differently (hartley, 2014, 2011). this exemplifies a normative distinction in conceptualising innovation, which can be discussed in terms of either value or improvements. another extensive strand of public sector innovation research relevant to the normative dimension is the vast and growing literature on public value. public value was first introduced by moore in 1995 as a conceptual framework for managers (benington & moore, 2011), seen by some researchers as associated with the affirmation of managerial ingenuity and expertise (williams & shearer, 2011), for others as a way of thinking that is both postbureaucratic and postcompetitive (o’flynn, 2007). thus, just like public sector innovation, public value is a concept with a contested meaning. some of this literature relates public value to innovation. chen et al. (2020), for example, define public service innovation as ‘the development and implementation of a novel idea by a public service organisation (pso) to create or improve public value within an ecosystem’ (p. 1677). gieske et al. (2016) present a similar definition of innovation that includes the creation of public value. public value has increasingly emerged as a term in politics and public administration literature and public sector improvement programmes (williams & shearer, 2011). in this sense, public value is associated with an improvement of public services, but also with performance measurement (moore, 2014) and attempts to conceptualise the value created by the public sector. the concept relates to normative ideas about what the public sector is and ought to be. that being said, public value is not always explicitly linked to innovation, and some research has focused only on public value without connecting it to innovation. however, when the two concepts are connected, this also has implications for the normative dimension of conceptualising public sector innovation. public value research has broadened its perspectives (hartley et al., 2017) and is often portrayed today as a new paradigm associated with networked governance (benington, 2011; stoker, 2006), where public value 37 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications management practice is based on the systems of dialogue and the exchange in networks. here, public value is more than a summation of the individual preferences of service users: it is built collectively through deliberation involving elected and appointed government officials and key stakeholders (stoker, 2006). benington (2011) argues that public value can be interpreted as both safeguarding and enriching the public sphere while delivering what the public values. hartley et al. specify ‘at least three, sometimes disparate, components of public value in contemporary public management thought: the notion of public value contributing to the public sphere; the notion of public value as the addition of value through actions in an organisational or partnership setting and the heuristic framework of the strategic triangle (the public value proposition, the authorising environment and operational resources which a public manager has to align to achieve public value)’ (2017, p. 671). each of these has a different theoretical basis and addresses specific research questions. linking them to public sector innovation also provides different perspectives regarding the normative dimensions of conceptualising. the first notion, which for example benington (2011) represents, sees public value as providing an alternative and improved construct to explain public welfare through the contribution of the public sphere. public value is closely linked to democratic processes and defined through democratic practices (hartley et al., 2017). the second notion conceptualises public value as created or added through the activities of public organisations and their managers; it focuses on the added value relevant to societal outcomes. what counts as valuable is sometimes presented in terms of the normative aspirations for a ‘good society’. connecting the conceptualisations of public sector innovation to the literature on public value opens up ways of explicitly discussing—and perhaps providing a normative justification for—the value dimensions of the public sector. this implies deliberations of what the public sector is and should do and, thus, also what innovation should help develop. for example, there is an explicit link to the public sphere and the political and democratic dimensions of the public sector. when discussing how to understand value in terms of democratic processes (as a procedural justification for when something can be considered valuable or desirable) or in terms of the attempts to specify the role of management or citizens in improvement processes, this also provides a framework for the conceptualisation of innovation and what can be considered relevant public sector developments. 38 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications concluding discussion: questions for the future based on discussions of current research on public sector innovation, the current article has identified three dimensions—an epistemological, pragmatic and normative—which can hopefully guide future reflections. the three dimensions refer to different but interrelated questions to reflect upon in relation to conceptualising innovation; these include the question of whether public sector innovation should be understood mainly as a concept for describing and understanding certain activities, which can be empirically identified in public organisations, or whether it can also be seen as a tool to guide practice. finally, there is the normative question of whether public sector innovation should be understood as leading positive developments in the sector, which is also related to understandings of the role and political aspects of the public sector. different suggestions for why the public sector should be innovative (if at all) also call for different conceptions because they are basically answers to different questions or challenges. engaging with these meta-conceptual questions enables us to separate the dimensions and reflect on what the conceptualisation consists of. we can then more explicitly discuss the criteria for a ‘good’ or ‘adequate’ concept of public sector innovation. in relation to the epistemological dimension, researchers could ask themselves whether innovation is intended as a concept for explaining, describing, predicting or interpreting. what is the role of context? can we use the concept of innovation as a general context-independent variable? these are traditional methodological questions, but they are not always addressed explicitly in the literature on public sector innovation. these questions are interrelated with the question of why we need such a concept in the first place. is it merely to ensure accuracy in empirical studies aiming at generalisable knowledge of the drivers and barriers of innovation? do we wish to explain to predict? is innovation a tangible entity, something that we can find ‘out there’ in a more realistic sense? much research seems to assume this. the literature included in the current paper contains little reflection on the performative dimensions of the concept, namely how it not only describes or explains, but also contributes to constituting the phenomenon of innovation in the public sector. what are the implications of introducing this particular concept in this context, and what kinds of practices and discourses does it constitute? these critical perspectives seem largely absent from the field of public sector innovation. a more detailed analysis of the implications of conceptualising the public sector in certain ways is needed. thus, it is not only a question of what 39 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications the assumed empirical phenomenon is, but also of how the concept constitutes reality (in a more social constructivist or critical manner). the next question is what the practical implications of our knowledge are and whether it has practical significance in how we conceptualise or distinguish innovation from other phenomena. if the answer to why we need a concept of public sector innovation is that it strengthens the public sector’s problemsolving capacity, then we need to be explicit about how this practical dimension relates to the way we conceptualise. this view points to more practical knowledge about how innovation relates to and can help solve specific problems, such as wicked problems. some of the research linking public sector innovation to collaboration, networked governance and partnerships addresses innovation in this way. some studies explicitly show interest in innovation as something to use, not just know about, such as a management tool and for managing specific types of discontinuous change processes. however, is innovation just assumed to be valuable, or should the concept also indicate when it is valuable or not? do we need the concept to understand or control the public sector or to strengthen it as a democratic institution? these questions indicate the interconnection between the epistemological, pragmatic and normative dimensions of conceptualising. the normative dimension relates to the distinction between innovation and improvement or value creation. as we have seen, some scholars explicitly include improvement in the definition of innovation, while others just assume that it is desirable and inherently good. others again argue that innovation does not always lead to improvement and that the two should be distinguished because what counts as improvements can be contested and depend on positioning and perspectives. the normative dimension of the concept can be viewed in relation to whether individual innovations imply an improvement and whether innovation research should formulate the criteria for improvement, thereby becoming explicitly normative. the dimension can also relate more generally to the main role of the public sector and whether innovation should strengthen it as a public sector (e.g., with a specific obligation to ensure justice, rights and citizenship; eriksen, 1999; langergaard, 2011). this relates to the political and value dimensions of the concept, and when innovation is conceptualised as leading to value creation, these normative dimensions must be defined. this is also a normative question of how we should understand value (justify what is valuable) in a public sector context. engaging with such 40 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications questions includes concerns about the democratic role of the sector, how innovation contributes to develop and/or transform it into a more public sector and how this is understood. this can be defined in a procedural way, where some strands in public value research stress that the public interest or common good is constituted and defined through democratic procedures (benington, 2011; hartley et al., 2017). all three dimensions are relevant to reflect upon when navigating the field of public sector innovation. as mentioned in the introduction, there is no agreement on what counts as innovatory and how innovation should be conceptualised, and we cannot just assume that we know what public sector innovation means. innovation has become a powerful organising metaphor with implications for practice and, thus, also political implications (because the sector is democratically governed). neglecting the normative dimension involves the risk of the depoliticisation of public sector innovation as a concept and an organisational and political phenomenon. the political and democratic context of the public sector calls for conscious ways of conceptualising that avoid the pitfalls of the unintentional depoliticisation of the sector and its services. 41 njsr – nordic journal of social research vol. 12, 2021 special issue: public sector innovation conceptual and methodological implications references agger, a., damgaard, b., krogh a. h., & sørensen, e. 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(2011). appraising public value: past, present and futures. public administration, 89(4), 1367-1384. https://doi.org/10.1111/j.14679299.2011.01942.x the construction of ‘socially marginalised greenlanders’ as a target group in danish welfare policy and practice njsr nordic journal of social research www.nordicjsr.net njsr – nordic journal of social research 2021 the construction of ‘socially marginalised greenlanders’ as a target group in danish welfare policy and practice1 maj nygaard-christensen* department of psychology and behavioural sciences/ centre for alcohol and drug research aarhus university email: mnc.crf@psy.au.dk *corresponding author bagga bjerge department of psychology and behavioural sciences/ centre for alcohol and drug research aarhus university email: bb.crf@psy.au.dk abstract this paper examines the emergence of ‘socially marginalized greenlanders’ as a distinct target category in danish welfare policy and practice. it builds on analysis of policies targeting greenlandic minorities in denmark and interviews with welfare professionals in charge of implementing these. the paper shows how greenlandic minorities are represented as characterized by markers of difference viewed to set them apart from other socially marginalized citizens. these relate to 1) structural differences that impact on the ability to receive and benefit from welfare services, 2) to the perceived cultural origins of the problems that socially marginalised greenlanders face, and, finally, 3) to the excessive social problems associated in policies and by professionals with an upbringing in greenland. the paper shows how policies and welfare professionals both reject and continuously resort to the notion of the target group as distinct from other socially marginalized citizens. in continuation of this, the analysis further shows how ambivalences and contradictions are not so much found 1 research for this paper was funded by a research grant from offerfonden [eng.: the victim’s foundation]. den grønlandske fond [eng: the greenlandic foundation] further supported preliminary research. njsr – nordic journal of social research vol. 12 2021 133 between the levels of policy and practice, as other studies of policy implementation processes have demonstrated, as they are inherent within all policy and considerations about how to understand the target group they articulate. keywords: greenlanders, social work, welfare policy, categorization, postcolonialism, social marginalization, stereotypes introduction it looks as if socially marginalised greenlanders have a harder time profiting from social interventions. … there is a much larger proportion, when you think about all greenlanders in denmark, there is a much larger proportion of these who are homeless. so, something indicates that they have very complex problems, and that they profit quite poorly from social interventions. (welfare professional in charge of coordinating strategies targeting marginalised greenlanders) in danish welfare practice and policy reports on social marginalisation, citizens with a greenlandic background are regularly pointed to as a group that stands out as especially vulnerable to social exclusion in denmark (baviskar, 2015; rambøll 2008; socialstyrelsen, 2003, 2013). among other sources, this is documented in statistical findings that show a significant overrepresentation of greenlandic minorities among the homeless, social benefit recipients, citizens enrolled in drug and alcohol treatment, victims of violence and other forms of crime, and those with little or no higher education (baviskar, 2015, 2016). the understanding of greenlandic minorities as extraordinarily marginalised compared to other disadvantaged citizens is echoed among welfare professionals who further describe ordinary services as inadequate for securing the access of greenlandic minorities to appropriate welfare assistance. in response to this problem, a range of policy and practice initiatives have been crafted over the past decade and a half to improve services to greenlanders in the danish welfare system. taking our empirical point of departure from policy documents and strategies as well as interviews with professionals within the field, we examine policies and professionals’ perspectives on greenlandic minorities in the danish welfare system. analytically, we draw on studies on the complex relations between policy and practice and on social categorisations in policy-making in order to explore the ways in which policies and professionals define ‘socially marginalised greenlanders’ as a distinct target group that requires unique forms of intervention. across the material, three themes are identified which njsr – nordic journal of social research vol. 12 2021 134 demonstrate how marginalised greenlanders are identified as a specific target group with assumed shared characteristics: structural barriers, culture, and excessive social problems. as indicated in the quotation above, greenlanders in the danish welfare system are typically represented as a group that is especially vulnerable. both policies and professionals thus describe a target group characterised by ‘markers of difference’ (keskinen, 2017, p. 154) that set them apart from the majority population and other marginalised citizens, as well as non-marginalised greenlanders in denmark. on the one hand, highlighting these perceived differences allows for a contextualisation of social problems rarely seen in other services to citizens with complex problems (bjerge et al., 2019). on the other hand, we will show how this contextualisation sometimes privileges a culturally focused framing of the challenges associated with the target group that risks concealing other explanations for the overrepresentation of greenlandic minorities among socially marginalised citizens. finally, the article demonstrates the problematic nature of singling out ‘socially marginalised greenlanders’ as a group in need of intervention. we go to the heart of this tension by discussing how the process of defining target groups is never clear-cut. policies and professionals’ statements about greenlandic target groups alternate between emphasising their distinctiveness, at times resorting to stereotypes, and soon afterwards rejecting such claims of difference. background – greenlandic minorities in denmark some 16,000 greenlanders currently live in denmark. greenlanders who move to denmark do so for a variety of reasons, for instance, to accompany a spouse, partner, or parent(s) or to pursue education or employment opportunities, while others move to denmark without a clearly formulated plan (cf. flora, 2017). the majority of greenlanders who move to or live in denmark mostly get by on the same terms as the majority population. however, a minority of greenlanders is highly overrepresented among socially marginalised citizens. among welfare professionals working with socially marginalised citizens, greenlandic clients are often described as a group that stands out as especially difficult to reach through ordinary welfare services (nygaard-christensen & bjerge, 2019). a 2015 statistical mapping of greenlanders in denmark estimated that the proportion of homeless among citizens with a greenlandic background was nearly 50 times higher than among the danish majority population, amounting to 6% of greenlanders njsr – nordic journal of social research vol. 12 2021 135 living in denmark (baviskar, 2015, pp. 11, 47). moreover, five times as many received social benefits and 10 times as many received alcohol treatment (baviskar, 2015, pp. 11, 47). furthermore, socially marginalised greenlanders are exposed to crime three times as much as the majority population, especially as victims of crime (baviskar, 2015). greenlandic encounters with the danish welfare system have a long history. it is beyond the scope of this article to cover such encounters in greenland. instead, we focus exclusively on recent welfare attempts to support marginalised greenlanders living in denmark. in 1878, a boarding house for greenlanders was established in a copenhagen residential area that functioned as a pension house for greenlanders arriving to study in denmark (rud, 2009; togeby, 2003). today, greenlandic houses exist in the four largest cities. they function as cultural venues which host events relating to greenlandic society and help greenlanders moving to denmark. moreover, they form part of the broader institutional landscape through which services targeting socially marginalised greenlanders in denmark are currently implemented in collaboration with private and municipal actors. another central institution that offers targeted services to greenlanders is kofoeds skole, an institution that offers training and rehabilitation to people with various social problems, ranging from unemployment to homelessness and problematic substance use. in the 1970s, the school began to single out greenlandic students as constituting a distinct target group (meldgaard, 2011). this was due in part to the proportion of greenlanders at kofoeds skole, which in the 1970s included some 16% of the students and towards the 1980s comprised 6% of greenlanders living in denmark (meldgaard, 2011, 168). moreover, the identification of greenlanders as a particular target group was due to a sense that the services required to assist them were different from those needed by other students. around the turn of the millennium, the focus on greenlandic students intensified (meldgaard, 2011), much in line with the development of some of the first broader strategies aimed at establishing a more concerted focus on what is now termed ‘socially marginalised greenlanders.’ two defining moments can be identified as central in framing current policy directions, which have had an impact on the formation of services within the field. the first was the 2003 formulation of the ‘white paper for socially njsr – nordic journal of social research vol. 12 2021 136 marginalised greenlanders’ (1)2. the second occurred a decade later with the formulation of the ‘greenlander strategy 2013-2016’ (10). both were nationallevel policy responses to the growing focus on the ‘special needs’ of greenlandic minorities, both at the political level and among professionals who requested better tools to respond to these problems (7). both the ‘white paper’ and the ‘greenlander strategy’ were accompanied by funds from the special pool for the social area (satspuljemidler) to support new initiatives specifically targeting this citizen group (7). in addition to these broader strategies, a series of studies of the target group was conducted at the municipal (3, 5, 8, 14, 16) or regional (4) level, and the conditions of greenlanders in denmark were documented through statistical mapping and qualitative findings (2, 12, 13). perspectives of socially marginalised greenlanders themselves were relayed in qualitative reports (11, 15). finally, guidelines with suggestions for how to approach greenlandic clients were produced (5) as well as evaluations of concrete interventions (6, 17, 18). one characteristic of the development of the strategies and services such as the ‘greenlander strategy’ and the subsequent services resulting from it is that many professionals in charge of implementing strategies have been directly or indirectly involved in developing policies. in other words, there is an ongoing dialogue and significant overlap between professionals and policy makers within the field of marginalised greenlanders. an array of different private, voluntary, and municipal services are currently in charge of implementing these strategies. these range from counselling to drop-in centres and alcohol treatment, as well as municipal services, such as social workers with greenlandic language skills, and cross-sectoral networks that aim at supporting collaboration between the different sectors working with socially marginalised greenlanders. analytical framework – categorisations and stereotypes in policies and practice an often-repeated criticism within policy analysis is that decision-making and policy planning take place far from the ‘crowded offices’ of the professionals working with a given problem or group of citizens in their daily practices (scott, 1998; lipsky, 2010; mosse, 2005). therefore, much policy research has focused on the mismatches and 2 the policies referred to are numbered from 1-18 and are shown in figure 1. this will be explained further in the section on data and methodology. njsr – nordic journal of social research vol. 12 2021 137 inconsistencies between problem representations at the levels of policy and practice. this is often referred to as a ‘vale of implementation’ (deleon & deleon, 2002, p. 469). such studies have demonstrated how policies have ‘gone sour’ and risk never having an impact in practice (kettle, 1993; meyer & rowan, 1977) showing how ‘actors … devote their energies to maintaining coherent representations regardless of events’ (mosse, 2005, p. 2). that is, people working within policy implementation spend a lot of time supporting policy representations that are not necessarily relevant to practice. in contrast to such analyses and critiques, policies and strategies directed towards marginalised greenlanders have, as shown above, been developed in close collaboration between policy makers and professionals in the field. in fact, in some instances, welfare professionals are themselves policy makers or at least contribute significantly to the development of policies. further, as will be shown in the analysis, professionals’ representations often mirror those of policies when they engage in discussions of marginalised greenlanders. therefore, we draw analytically on research that includes both perspectives on policy production and implementation as a dialectic process (tate, 2020, p. 84; moore, 1978). that is, we examine the emergence of ‘marginalised greenlanders’ as a distinct target population and discuss what such representations entail with a view to both policy documents and professionals in charge of implementing them (see also mosse, 2005). hence, we regard the policies in focus not as finished end products but as ‘a continuous process of contestation’ (wright & reinhold, 2011, p. 86). here, the contestation is not so much between differently positioned interest groups, but more present as an inherent part of ongoing policy and practice conversations about how to understand and best assist the target group. scrutinising the specific content of the categorisations of marginalised greenlanders, we also take inspiration from the growing body of studies of the social construction and categorisation of target groups (bacchi, 2009; bjerge et al., 2020; schneider & ingram, 1993, 2015; harrits & møller, 2011; møller & harrits, 2013). using generalisations and grouping citizens into different categories by emphasising collective features and bypassing individual variations are inevitable parts of njsr – nordic journal of social research vol. 12 2021 138 defining a target group. generalisations about certain problems can thus be viewed as necessary in order to formulate societal interventions and to enable professionals to ‘manage complexity, by foregrounding certain kinds of knowledge and information and selectively erasing others’ (yarrow, 2008, p. 440). however, as has also been documented, such practices risk reducing the complexity of a group to a specific ‘kind of …’, hierarchically organised in relation to other social groups (bacchi, 2009; dovidio et al., 2010. that is, the categorisation of a target group as distinct from others inevitably involves making claims about what sets it apart from others (harrits & møller, 2011). schneider and ingram describe this process as referring to ‘1) the recognition of the shared characteristics that distinguish a target population as socially meaningful, and 2) the attribution of specific, valence-oriented values, symbols, and images to the characteristics’ (1993, p. 335). harrits & møller further point to an unresolved dilemma inherent in the categorisation of target groups: ‘categories are on the one hand necessary for the potential acknowledgement of suppression and need, but at the same time always carry with them stigma and further suppression (2011, p. 243).’ indeed, schneider and ingram describe such social construction of target groups as ‘stereotypes about particular groups of people that have been created by politics, culture, socialization, history, the media, literature, religion and the like’; stereotypes that can be both positively and negatively constructed (1993, 335). in policy categorisations, stereotypes are typically constructed through the use of binaries, although often emphasising the more negative characteristics associated with the perceived ‘problem group’ (bacchi, 2009; fairclough, 2006). one side of such binary oppositions is represented as common-sensical and superior (bacchi, 2009), e.g. ‘socially excluded’ versus ‘socially included’, or ‘passive’ versus ‘active’. often, however, one side of these binaries is not visible in policies. instead, it works as a silent or implicit opposition, positioned in contrast to taken-for-granted ideas about what constitutes ‘normal’ or ‘good’ ways of living; terms like ‘socially marginalised’, ‘unemployed’, or ‘victim’ are cases in point (cf. nielsen, 2012; møller & harrits, 2013). it should become clear in the analysis that professionals also draw on such oppositions in the process of singling out marginalised greenlanders as a distinct target category. what schneider and ingram njsr – nordic journal of social research vol. 12 2021 139 (1993) refer to as stereotypes, harrits and møller describe as ‘social categories’, which, they argue, work to inform political categories and legitimise policy interventions (2013, p. 157). they thereby distinguish between a ‘political category’, which ‘describes the subject in a target population and is identifiable in the texts”, and a social category, which ‘consists of references to culturally shared knowledge about social categories or even as references to stereotypical behaviour’ (2013, p. 159). a further effect of this is that the definition of target groups risks building on ‘assumptions and imaginations about the needs, knowledge and lives of groups of people that are most often diverse and heterogeneous (møller & merrild, 2019, p. 1157).’ altogether, drawing on such analytical frameworks enables us to further understand the composition of different elements that constitute particular manners of problematising and categorising socially marginalised greenlanders and ways to assist them both in policies and in practice. data and methodology the empirical data for the article consist of two types of data that are analytically separated out for our description of the methodology. first, we examined 18 documents (see figure 1) produced between 2003 and 2019, a period in which national, municipal, and private organisations began to specify ‘socially marginalised greenlanders’ as a distinct policy category in need of intervention. we applied an explorative, descriptive analysis of key documents consisting of white papers, guidelines, strategies, and reports. data were identified through an extended research process, which included the identification of inter-contextual links between references to documents focusing on socially marginalised greenlanders (cf. fairclough, 2006). for example, if one strategy referred to another strategy or report or repeated specific categories similar to those in other documents, these documents were subsequently included in the analysis. further, we contacted well-established professionals and experts within the field and asked them to indicate key documents. we did not conduct a systematic search but used different sources and expert knowledge to gain an overview of the documents. njsr – nordic journal of social research vol. 12 2021 140 figure 1 overview of policies 1. ‘white paper on socially marginalized greenlanders’. [hvidbog om socialt udsatte grønlændere i danmark) (2003), socialstyrelsen 2. ‘greenlanders in denmark – an overlooked minority’ [grønlændere i danmark en overset minoritet] (2003), lise togeby, aarhus universitetsforlag 3. ‘small steps – big changes. an investigation of homelessness in the group of greenlanders in copenhagen’ [små skridt store forandringer. en undersøgelse af hjemløshed i gruppen af grønlændere i københavn] (2005), center for kulturanalyse 4. ‘the social conditions of greenlanders at funen’ [grønlænderes sociale vilkår på fyn] (2005), the greenlandic house 5. ‘socialt udsatte grønlændere i aalborg ’ [socially marginalised greenlanders in aalborg] (2006), aalborg kommune 6. ‘danish teaching for socially marginalized greenlanders’ [danskundervisning for socialt udsatte grønlændere] (2007), styrelsen for specialrådgivning og social service 7. ‘evaluation of the follow-up to the white paper on socially marginalized greenlanders in denmark’ [evaluering af opfølgningen på hvidbogen om socialt udsatte grønlændere i danmark] (2008), rambøll 8. ‘marginalized greenlanders in aarhus. a report based on examination of socially marginalized greenlanders in aarhus municipality’ [udsatte grønlændere i århus. en rapport på baggrund af undersøgelse af socialt udsatte grønlændere i århus kommune] (2008), aarhus kommune 9. ‘from slippery ice to solid ground: an inspirational catalogue about targeted interventions to newly arrived greenlanders with social problems’ [fra glat is til fast grund: et inspirationskatalog om særlige indsatser for nyankomne grønlændere med sociale problemer] (2010), socialt udviklingscenter sus 10. ‘the greenlander strategy 2013-2016’ [grønlænderstrategien 2013-106] (2013), socialstyrelsen 11. ‘in greenland i am too danish, and in denmark i am “just” greenlandic: challenges for marginalized greenlanders in denmark’ [‘i grønland er jeg for dansk, og i danmark er jeg “bare” grønlænder’ : udfordringer for udsatte grønlændere i danmark] (2014), rådet for socialt udsatte 12. ‘equal treatment of greenlanders in denmark’ [ligebehandling af grønlændere i danmark] (2015), institut for menneskerettigheder 13. ‘greenlanders in denmark – a register based mapping’ [grønlændere i danmark en registerbaseret kortlægning] (2015), sfi det nationale forskningscenter for velfærd. njsr – nordic journal of social research vol. 12 2021 141 14. ‘you use too many words!’ report on inclusion of young greenlanders in aalborg – a group case in viso’ [‘i bruger alt for mange ord!’ rapport om inklusion af unge grønlændere i aalborg – en gruppesag i viso] (2016), socialstyrelsen 15. ‘marginalized greenlandic women in denmark – an investigation of the women’s life circumstances, problems, resources and needs’ [udsatte grønlandske kvinder i danmark en undersøgelse af kvindernes livssituation, problemer, ressourcer og behov] (2016), rådet for socialt udsatte 16. ‘between greenland and denmark: an account of greenlandic women in aarhus’ [mellem grønland og danmark. en beretning om grønlandske kvinder i aarhus] (2016), reden aarhus 17. ‘status on initiatives in denmark concerning efficient support to marginalized greenlanders’ in the special pool for the social area [status på initiativerne i danmark om “effektiv støtte til udsatte grønlændere” i satspuljeaftalen 2017-2020] (2017), socialstyrelsen 18. ‘transition and peer support to marginalized greenlanders in denmark. mid term evaluation’ [overgangsog peerstøtte til udsatte grønlændere i danmark. midtvejsevaluering] (2019), vive – det nationale forskningsog analysecenter for velfærd second, we examined 30 qualitative semi-structured interviews with professionals working in private, voluntary, and municipal services, either primarily targeting greenlanders or targeting marginalised citizens, many of whom are greenlanders. some professionals were in charge of coordinating services and strategies directed towards the group, while the majority were frontline workers interacting with clients on a daily basis. interviews focused on professionals’ experiences of working with marginalised greenlanders, their perceptions of the developments of policies and services within the field, and their understandings of the group. the interviews were conducted between 2017 and 2020 and lasted approximately one hour, and all interviews were subsequently transcribed3. the two kinds of data were coded separately. however, we applied a similar coding strategy to the data: rather than using preconceived categories (hsieh & shannon, 2005, p. 1279), we first conducted an open coding of documents and interviews, in which we identified themes and keywords. we then discussed the first impressions of the data and their representations of 3 the qualitative study was approved by the danish data protection agency. all participants provided informed consent to participate, and they were assured confidentiality. the interviewer described the purpose of the interview to the interviewees, and the interviewees were assured anonymity. njsr – nordic journal of social research vol. 12 2021 142 marginalised greenlanders and the problems and solutions related to these representations (bacchi, 2009). subsequently, we conducted a more detailed coding of documents in nvivo. this approach allowed us to identify themes, patterns, and keywords to support an overall content analysis of the documents and the interviews (cf. bjerge et al., 2019; hsieh & shannon, 2005; shore & wright, 1997). finally, we compared the codes from the documents and the interviews to find patterns in how marginalised greenlanders as a target group were represented in policies and by professionals. three overall themes emerged in the coding: 1) structural differences that were seen to impact the ability to receive and benefit from welfare services, 2) descriptions of the perceived ‘cultural’ origins of the problems that socially marginalised greenlanders face, and, finally, 3) the excessive social problems or traumas associated by professionals with an upbringing in greenland. below, we explore the content of each of these themes. structural barriers a main concern in policy and among professionals working with greenlandic minorities is the barriers they encounter when trying to access services in the danish welfare system. as danish citizens, greenlanders have the same rights to social services as the majority population when living in denmark. however, reports have pointed to barriers that might impede their ability to fully benefit from these rights (11). these include a lack of knowledge about the danish welfare system and linguistic difficulties in encounters with the welfare system. it is further noted that due to their danish citizenship, greenlandic minorities ‘aren’t offered an integration intervention upon arriving in denmark’ (8; see also 1, 11). it has further been suggested that the lack of so-called integration services might hinder citizens’ opportunities to receive danish language training (9). some reports go as far as to suggest that because of this, their ‘danish citizenship might be a hindrance rather than of help’ in terms of integration (1; see also 8, 9, 16). attention to such structural barriers stretches back to some of the first studies of the status of greenlanders in denmark. in a power and democracy study, lise togeby described greenlandic minorities as a ‘hidden’ population within danish society: greenland is a part of the danish kingdom, which gives denmark a special responsibility for ensuring that greenlanders are included as njsr – nordic journal of social research vol. 12 2021 143 citizens on equal terms as the rest of the citizens in danish society. against this background, the lack of knowledge of the conditions of greenlanders in denmark is surprising. in the holy name of equality, we have made the greenlanders in denmark invisible (2). according to this argument, the group is, paradoxically, not recognised on its own terms – as greenlanders – precisely because danish society disregards differences between the danish majority population and greenlandic minorities, with the broader aim of ensuring their inclusion. more recent policies have documented the effects of this invisibility for citizens in need of welfare assistance, describing how citizens may go for long periods without receiving any formal help – ranging from social benefits to housing – after moving from greenland to denmark (15). this is echoed among welfare professionals, as seen in the following interview excerpt: i’ve also met some who disappeared over a period of years. we found out that this person was missing. i mean disappeared, not missing, but disappeared. like, hasn’t received any public assistance for three years. and it was like, ‘what have you lived off for all those years?!’ well, she had lived on the street. received whatever help friends can offer, and then you think … ‘but what has she gone through?’ right, to survive? (social worker employed in intervention specifically targeting greenlandic minorities) as has been thoroughly documented in reports, due to their danish citizenship, greenlanders are not registered as ‘greenlandic’ upon moving to denmark (16) and thereby do not register as anything other than danish citizens. linguistic barriers and a lack of knowledge about the danish welfare system further add to this ‘invisibility’ (8, 9, 10), as does some welfare professionals’ lack of knowledge about rights that could support more appropriate help. for instance, policy reports have documented how, in practice, greenlandic minorities’ right to free interpretation services in the danish welfare system often comes to rely on social workers’ or health staff members’ discretion or knowledge of this possibility (1, 3, 8, 11). this is echoed in interview findings with welfare professionals: well, recently i accompanied a client to the hospital, where she was told that if she wanted an interpreter she had to know that she would get billed afterwards. and not … we had just left there when i find out that legally, faroese and greenlandic citizens are exempted from that. so that’s annoying, right? (social worker employed in intervention targeting greenlandic minorities) njsr – nordic journal of social research vol. 12 2021 144 thus, the right to interpretation services, for instance, may be lost somewhere between citizens’ or professionals’ knowledge of the right or willingness to either request or offer the service, as suggested here by another social worker: so i think [lacking the ability to demand an interpreter] … has been an obstacle for many citizens’ integration process, that they don’t dare say it, because they expose themselves to a degree, and because they have so much faith in authorities that they don’t feel they can say it. that it’s up to others to decide. … and it has also been interesting to see how often the system tries to get around it [offering translation services in greenlanders’ encounters with the welfare system when a citizen speaks no or little danish]. (social worker employed in an intervention targeting greenlandic minorities) above, we see how the need for targeted services to greenlandic minorities is to a degree legitimised with reference to the setup of the welfare system itself. this relates not so much to any perceived characteristics of the target group itself, but to the way in which greenlandic minorities’ status as neither foreign nor fully danish (11), with all the rights that that entails, obstructs their ability to access and profit from services. the promotion of culturally framed interventions the sense that greenlandic minorities too often fall through the cracks of the danish welfare system is further attributed to perceived cultural characteristics viewed as setting them apart from other socially marginalised citizens, as seen in the following interview excerpt: it’s really difficult for some of them to come down here [to denmark] and meet the kind of treatment system that we have. and it’s not because i’m saying there is anything wrong with the treatment system. i’m just saying that it isn’t certain to be geared to work with people who have a different cultural background. … up there you have completely different cultural values, cultural ways of being together, which are much more grounded in nature and community norms and strengths. (employee in job training intervention to socially marginalised citizens) here, then, it is perceived cultural difference rather than structural gaps that obstruct citizens’ ability to benefit from services. in some policy reports, perceived cultural differences are highlighted as a main barrier preventing citizens from profiting fully from welfare support. thus, one report states that ‘they are marked by the same multi-social problems as socially marginalised danes, but are at the same time, cultural strangers … greenlanders are njsr – nordic journal of social research vol. 12 2021 145 culturally, historically, demographically, and geographically very far from danes (6).’ in a similar manner, the white paper frames differences between opportunities of greenlandic minorities and those of other socially marginalised citizens as cultural: ‘the problem is … that greenlanders based on their cultural and social background have a series of needs which differ from those of other danes’ (1). it further links social marginalisation directly to these cultural differences, stating that it is ‘up for debate whether enough is known about what constitutes a unique “greenlandic identity”, and what this means for the social breakdown’ (1). while the issue of culture is highlighted in most policy documents and all interviews conducted with professionals, it is also treated with ambivalence. thus, even while insisting on differences, the white paper argues that ‘the typical greenlander in denmark does not exist. many greenlanders are well integrated into danish society, with a spouse, children, and work (1).’ another report engages critically with dominant descriptions of ‘the greenlandic folk character’ as being opposed to ‘the typically danish’ and rejects stereotypical narratives about greenlanders as ‘intuitive, relaxed, empathetic and impulsive’, but, as noted above, it also describes greenlandic minorities as ‘cultural strangers’ (6). in this way, documents move back and forth between emphasising and soon afterwards rejecting culturally framed explanations for the social problems experienced by greenlandic minorities. likewise, how such perceived cultural differences come to expression is fraught with contradiction, as seen, for instance, in the way greenlandic minorities are simultaneously described as reserved and as overly social. these documents reveal a strong focus on the social environments, networks, and practices of greenlanders, pointing among others to a strong need for socialising as characteristic of the target group. for instance, a ‘tradition for sharing one’s apartment with friends and family’ is problematised because it is viewed as a ‘barrier towards housing-related development’ of the citizen (3, p. 18), and risks contributing to extending the time in which individuals may go without housing and income (11) and to a worsening of alcohol or drug use (15). paradoxically, however, this description operates alongside a characterisation of greenlandic minorities as quiet or reserved. for instance, greenlanders are described as ‘often more withdrawn’ in comparison with other socially marginalised citizens in encounters with welfare professionals (11, p. 23). similarly, reports problematise greenlandic clients’ lack of njsr – nordic journal of social research vol. 12 2021 146 participation and unwillingness to make demands or thoroughly explain social or health problems to social workers (4, 16). the silence of greenlandic clients, one report cautions, should not be understood as ‘acceptance and understanding of what has been said’, but ‘could just be a greenlandic politeness in the face of an overwhelming danish flow of talk, which they might not even really understand (11, p. 23).’ the white paper does not only attribute this ‘silence’ to linguistic barriers. instead: the silence reflects a lack of faith in one’s own opportunities, a lacking trust in the understanding of danish authorities, and a lack of will to verbalise problems that it might not be possible to solve anyway. it is therefore possible that, to a certain degree, the contentment expressed [by the greenlandic citizen] could be interpreted as a result of a silence that conceals a degree of powerlessness (1). in some reports, this silence or reservation is in turn viewed as a result of the colonial relationship between denmark and greenland and related difficulties in regard to speaking up against a colonial ruler (2, p. 74). this perceived silence is viewed as contributing to the inability of socially marginalised greenlanders to exercise agency over their own situation. in practice, these struggles over how to make sense of greenlandic clients’ problems and needs result in markedly different proposals for what appropriate interventions might look like. group-based interventions are often promoted in response to an understanding of greenlandic minorities as particularly loyal towards other greenlanders (3, 5, 7, 16). thus, it is suggested that facilities and drop-in centres should offer opportunities for interventions that target greenlanders collectively, instead of at the level of the individual (7). one report cautions, in relation to this, that ‘it can be discussed if the gathering of greenlanders is problematic in an integrational perspective’, but continues by arguing that ‘it has been assessed that the need for being together … is absolutely central, especially regarding the most marginalised part of the group’ (3, p. 7). however, the opposite is also the case when reports or professionals emphasise the ‘silence’ or reservation of the target group. thus, a report notes that greenlanders sometimes ‘need air’ (3, p. 72) and that these dual needs must be attended to in services. likewise, a professional employed in a health intervention cautioned against group-based interventions with greenlandic minorities in relation to drug or alcohol use: njsr – nordic journal of social research vol. 12 2021 147 i think it’s because if you are going into treatment for alcohol or drug use …, then it’s often group based; you often sit a number of people together and talk about personal stuff like feelings and so on, and many of them, they really don’t like that. … generally, a lot of people don’t like that. but i think especially greenlanders don’t like it. it’s not because you necessarily have to have a special offer for greenlanders, but on the other hand, linguistically, if there was something, if there was an offer in greenlandic that took into consideration what is … what kind of greenlandic mentality is it that you need to take into consideration. what it is we need to get a hold of. what kinds of emotions you have to talk about. (employee in health offer to socially marginalised citizens) as this illustrates, policy proposals and professionals do not agree on how to understand the target group defined in such interventions. likewise, although attention to the cultural background of clients is repeatedly pointed to as intrinsic to the development of appropriate interventions, explanations about what perceived cultural differences mean in practice are continuously unsettled. thus, one social worker, when prompted to reflect on such culturally framed explanations, responded: we just haven’t succeeded in describing it properly yet. i mean, it’s definitely an aspect of what it means to be socially marginalised. that’s difficult for everyone. … so yes, it is most definitely really, really, really complex and … but what to call it ... i don’t know. (social worker employed in job training to intervention for socially marginalised citizens) these somewhat contradictory positions – often within a single report or interview – show how the issue of culture is continuously negotiated and contested at the level of both policy and practice. excessive social problems and the limits of targeted services finally, the social problems associated with greenlandic clients are characterised as different in character – and as excessive – in comparison with those of other socially marginalised citizens, in particular with a view to clients’ experiences prior to moving to denmark. according to the white paper, ‘abuse and violence also form part of a greenlandic everyday life in greenland’ (1). another report suggests that ‘a majority has, prior to coming to denmark, experienced a childhood marked by problems such as alcohol use, incest, violence, and suicide’ (6, p. 6), further suggesting that ‘they bring that history with them’ (6, p. 8). this is further viewed to impact welfare encounters njsr – nordic journal of social research vol. 12 2021 148 between danish professionals and greenlandic clients and to influence the former’s ability to properly respond to clients’ problems and needs, as suggested in the white paper: ‘the greenlandic client may have had an upbringing in greenland that is so traumatising that it can be difficult for a danish social worker to relate to it’ (1). among welfare professionals, there is growing attention to perceived differences between the social problems experienced by greenlandic minorities and how they are seen as distinct in relation to other socially marginalised citizens: if you look at greenlanders in relation to social marginalisation …, maybe there’s an additional step [of marginalisation] that our social interventions simply haven’t been capable of … we simply don’t have social interventions that can capture that or have the concepts to talk about. it’s not something about greenlanders that’s particular, but something about our interventions that we haven’t figured out yet. (social worker in charge of implementing strategies for greenlandic minorities). the idea of additional layers of complexity is echoed in professionals’ characterisations of greenlandic minorities as distinct from other marginalised citizens, which positions them differently in terms of accessing and benefitting from services: they have a hard time taking care of themselves and … they have enormous debts. they drink up their money if it isn’t under administration. they can’t find out how to go to the doctor by themselves and they can’t … see that they need to see a doctor. so like, they are marginalised in all kinds of ways. (social worker employed in a greenlandic association in denmark) while ‘socially marginalised greenlanders’ are thus continuously singled out as a distinctive target group, understandings about appropriate interventions in the group are less clear-cut. both policies and social workers, however, repeat the need for professionals with specialised knowledge about the target group: ‘our advantage is’, said one social worker, ‘that we have a history with this target group. … you need to have a particular understanding in order to work with this group’. in this instance, ‘a particular understanding’ or history with the target group facilitates such specialised knowledge. many policies further emphasise how the ‘specific needs’ of greenlandic clients should be met by welfare professionals with specialised knowledge about greenland and greenlandic culture and language. this idea has informed documents since the first formulation of ‘greenlander strategies’, as seen in the white paper, which recommended ‘that municipalities and counties where there are many njsr – nordic journal of social research vol. 12 2021 149 greenlandic clients receive more and qualified consultancy support from a person with deeper knowledge about greenlandic affairs than what is present today’ (1). as already noted, professionals supported the idea of targeted services to greenlandic minorities. however, the notion of greenlandic clients as distinct from other socially marginalised citizens also caused uncertainty and sometimes outright irritation, for instance, in questions about what types of demands social workers could put on clients. this was seen in considerations about the degree to which the target group should be treated differently from, for instance, other socially marginalised citizens: but this is what provokes me sometimes when you work with greenlandic minorities; the leash they get is so long, i mean. and we put so few demands, i mean now i’m saying exactly how i feel about it. and other communities, especially muslim, they have to do this and they have to do that. … and we don’t put those demands at all to greenlanders. because … and it’s not only the citizenship, it is everything else under the surface, right? and we’ve talked about … this guilty conscience that i sometimes hear social workers and treatment providers say, like ‘but we feel bad for them’. we just feel a bit more pity towards the greenlanders. (social worker employed in intervention targeting greenlanders) as described above, strategies for improving the access of greenlandic minorities to welfare services have led to a range of different interventions and service offers targeting them. however, even while insisting on the necessity of such interventions, both policies and professionals suggest that there are limitations to their effectiveness if clients are exempted from the demands normally accompanying, for instance, social benefits. the idea of greenlandic minorities having a ‘longer leash’ than other clients was echoed by other social workers, suggesting that at times, targeted interventions are viewed with some resistance if they are assessed as unfair in relation to demands and requirements placed on other disadvantaged citizens. discussion above, we have examined how ‘socially marginalised greenlanders’ have been singled out as a distinct target group in danish welfare policy and by professionals. this is done with reference to structural, cultural, and social differences viewed in such a way as to set clients apart from other socially marginalised citizens in denmark. as demonstrated above, the definition of njsr – nordic journal of social research vol. 12 2021 150 ‘socially marginalised greenlanders’ as a distinct target group goes beyond more objectively observed differences, such as structural barriers, towards the attribution of specific characteristics that evoke either cultural or social differences. in this way, strategies targeting greenlanders, more often than ordinary strategies targeting citizens with complex problems (bjerge et al., 2020), approach the individual client as situated in – and caught up in – wider cultural, historical, and social contexts. these contexts are regarded as contributing factors in relation to many of the problems and challenges experienced by greenlandic clients, but also as key in the formulation of welfare responses to them (bacchi, 2009; schneider & ingram, 1993; bjerge et al., 2020; møller & harrits, 2013). in other words, ‘culture and cultural difference are thus characterized at once as both source of dysfunction and therapeutic panacea’ (santiago-irizarry, 1996, p. 9; see also johansen, 2011). it is worth considering whether aspects of individual clients’ behaviour, problems, or needs are perhaps too easily categorised under the label of ‘greenlandic culture’. in an analysis of ethnic minority patients in the danish psychiatric system, katrine schepelern johansen (2011) suggests that clients’ problems and needs were often understood in the context of ‘culture’, especially when they appeared unfamiliar or difficult to categorise for staff. hence, ‘for some staff members, categorizing some aspects of patients’ behaviour or problems as cultural or ethnic is a way of saying that this is beyond the limits of what they can or want to deal with professionally’ (johansen, 2011, p. 178). moreover, she suggests, ‘categorizing a patient as non-danish was often based on a diffuse feeling of not being able to establish a proper relationship with the patient’ (johansen, 2011, p. 178). in a similar manner, we have seen above how the nature of greenlandic clients’ problems is sometimes described as beyond the capacity of the individual social worker to relate to – as unintelligible – and as being of a different nature from those of other socially marginalised citizens. likewise, attempts to make sense of the ‘problem’ of socially marginalised greenlanders with reference to cultural differences draw on what møller and harrits (2013) referred to as social categories, often building on assumptions or common-sense ideas about ‘greenlandic culture’ (cf. møller & merrild, 2019; nielsen, 2012). it is worth noting, of course, that ‘culture’ is only viewed as being of relevance in regard to welfare interventions if clients are of other ethnic backgrounds (cf. johansen, 2011; nielsen, 2012). this means that differences between greenlandic minorities and other socially marginalised citizens may sometimes be exaggerated, sometimes with the latter as a ‘silent opposition’ njsr – nordic journal of social research vol. 12 2021 151 (bacchi, 2009; fairclough, 2006; nielsen, 2012) as described above, and sometimes explicitly, as demonstrated in the example below: yes, and then you could say that many danish, ethnically danish, substance users or socially marginalised citizens are somehow raised in the institution. the danish system, right? so they know where to go. it’s really easy, because maybe they have a harder time doing all the house-related stuff, but they know how to say if they need help, where greenlanders maybe live more in their own local communities of assistance (hjælpesamfund), so they don’t get around to asking for help. (social worker employed in intervention targeting homeless citizens) here, greenlandic clients’ difficulties in navigating the danish welfare system are contrasted with ethnically danish clients, who are in turn described as clients who ‘know where to go’ or ‘know how to say if they need help’ and whose knowledge about and access to services is therefore straightforward. this, of course, overlooks the difficulties other socially marginalised citizens might experience in relation to expressing demands for the right type of assistance or ‘knowing where to go’ (bjerge et al., 2019). the relation between policy and practice examined in this article differs from the top-down policies often examined in policy analyses (scott, 1998; mosse, 2005; lipsky, 2010; moore, 1978). this means that some professionals hold much more influence over the content of policies – as when network meetings among professionals working with greenlandic minorities are used to discuss what future policy initiatives might look like – than other areas of policy making regarding socially marginalised citizens (cf. tate, 2020; bjerge et al., 2020). as suggested by a social worker employed in an advisory capacity, this tendency has been reinforced by fewer demands for legitimisation and documentation than seen in other interventions for socially marginalised citizens: i mean it has been a tendency that when you had to make homeless strategies or substance use strategies or social strategies, you had to make long background stories and long passages about change theory and justifying the spending of money and what it all has to led to, where, in the area of marginalised greenlanders, it has been like, now the old strategy has expired, and then we earmark some money for the next one. and then we figure out within the network what needs to be prioritised. it has been more like, this area needs to be prioritised, and then the people who work with it probably know best what the money should be spent on. … we haven’t really seen any demands for documentation until the most recent strategy in 2017. … that is the first time we have seen any documentation demands from njsr – nordic journal of social research vol. 12 2021 152 politicians in relation to the greenlander area. and that’s really unusual when you think about how much we have talked about ‘effect’ since 2007, 2008, that demand just hasn’t been there in the area of greenlander strategies. while this means that policy understandings are close to those of professionals, it also means that social categories informing them tend to flow more freely between policy and practice. in this sense, the policies examined in this paper and their representations of ‘socially marginalised greenlanders’ are not fixed or settled end-products that give shape to a clearly defined target group, nor are policy representations coherent (cf. mosse, 2005). instead, uncertainty, contradiction, and ambivalences are laid bare and remain unresolved within policies, as well as in interviews with welfare professionals. concluding remarks this paper has offered an examination of limitations as well as potential benefits surrounding the singling out of ‘socially marginalised greenlanders’ as a separate target group (bacchi & goodwin 2016). on the one hand, turning a particular group of people of concern into a concrete policy ‘problem’ enables the formulation of concrete practical interventions, or, in other words, something that can be acted upon (cf. schneider & ingram, 1993; bacchi, 2009; bacchi & goodwin, 2016; møller & harrits, 2013). at the same time, insisting too rigidly on the particularities of the group risks alienating greenlandic clients further and risks overshadowing more diverse representations that foreground the experiences of greenlandic minorities. to be sure, more recent policies and reports increasingly highlight such experiences, but as demonstrated in this paper, there remains a tendency to evoke culturally framed explanations in attempts to understand processes of social marginalisation relating to greenlandic minorities. as the paper has also shown, both policies and welfare professionals relate ambivalently to such claims of difference, oftentimes rejecting them but soon after resorting to the notion of ‘culture’ as that which constitutes greenlandic clients as different from other socially marginalised citizens with similar problems. njsr – nordic journal of social research vol. 12 2021 153 references bacchi, c. 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