Psychometric properties and cut-off scores for the Swedish version of the Negative Acts Questionnaire: The full scale and short version.

The present study investigates the psychometric properties and cut-off scores of a Swedish version of the Negative Acts Questionnaire, the most frequently used instrument to measure exposure to workplace bullying. Based on a probability sample of the Swedish workforce (n = 1853), we investigate the validity of both the full version (NAQ-R) and the short version (SNAQ). We suggest optimal cut-offs for the NAQ-R and SNAQ, and for the subscales measuring work- and person-related bullying. Based on the cut-off scores we provide estimates of prevalence in a Swedish context. The factor structure and psychometric properties are comparable to the Norwegian original and the English versions of the instrument. We also tested the criterion validity using 11 outcome and antecedent variables to bullying, and all provided support for its validity. The identified cut-off scores differentiate clearly when tested against the 11 variables used to test criterion validity in the study. The results showed that the Swedish version of the NAQ-R, including the SNAQ, is a valid measure of workplace bullying. To our knowledge, this study is the first study presenting statistical cut-offs for the NAQ-R subscales as well as investigating both the NAQ-R and the SNAQ simultaneously. The present study also provides some criticism against and suggestions for improving the NAQ-R, aiming to capture even more of the overall experience of exposure, ability to defend oneself, overall duration, and on- and offline exposure.

Witnessing workplace bullying - protocol for a systematic review and meta-analysis of individual health and well-being outcomes.

BACKGROUND: Most research on workplace bullying has examined the impact of the mistreatment on those exposed. Although bullying also is assumed to have significant ripple effects on bystanders, the empirical evidence for this line of research is highly fragmented and inconclusive. The overarching aim of this planned systematic review and meta-analysis is therefore to determine whether witnessing bullying of others at the workplace is associated with health problems and lower well-being among the observers. To achieve this aim, the review includes an assessment of which theoretical frameworks and methodological designs used in research so far and shed light on which confounders, mediators, and moderators that have been accounted for. METHODS: A systematic review and meta-analysis will be conducted. Electronic databases will be searched using pre-defined search terms to identify relevant studies. Eligible studies should report empirical findings on any individual outcome variable assessed among witnesses to workplace harassment and bullying or any overlapping concept. Primary observational studies with cross-sectional or prospective research design, case-control studies, and studies with experimental designs will be included. Qualitative interviews and case studies will be excluded. The methodological quality of the included studies will be assessed with a previously established checklist for studies on workplace bullying. The quality of evidence for an association between witnessing bullying and potential outcomes will be evaluated in accordance with the GRADE system. A random effects meta-analysis will be conducted with the Comprehensive Meta-Analysis software, version 3. DISCUSSION: We expect that findings on outcomes of bystanding to workplace bullying will provide practitioners with an understanding of the effects workplace bullying may have also on non-targets and the workplace as a whole. Such information is important regarding the development and implementation of effective measures and interventions against bullying. In addition, the review will increase our understanding of existing research gaps and enable us to make recommendations to address them. Our work aligns with the sustainable development agenda to protect workers and reduce inequalities at the workplace. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 342006.

When the Going Gets Tough and the Environment Is Rough: The Role of Departmental Level Hostile Work Climate in the Relationships between Job Stressors and Workplace Bullying.

In line with the work environment hypothesis, the present study investigates whether department-level perceptions of hostile work climate moderate the relationship between psychosocial predictors of workplace bullying (i.e., role conflicts and workload) and exposure to bullying behaviours in the workplace. The data were collected among all employees in a Belgian university and constitutes of 1354 employees across 134 departments. As hypothesized, analyses showed positive main effects of role conflict and workload on exposure to bullying behaviours. In addition, the hypothesized strengthening effect of department-level hostile work climate on the relationship between individual-level job demands and individual exposure to bullying behaviours was significant for role conflict. Specifically, the positive relationship between role conflict and exposure to bullying behaviours was stronger among employees working in departments characterized by a pronounced hostile work climate. In contrast to our predictions, a positive relationship existed between workload and exposure to bullying behaviours, yet only among individuals in departments with low hostile work climate. These findings contribute to the bullying research field by showing that hostile work climate may strengthen the impact of role stress on bullying behaviours, most likely by posing as an additional distal stressor, which may fuel a bullying process. These findings have important theoretical as well as applied implications.

Workplace bullying and tiredness at work: A cross-lagged prospective study of causal directions and the moderating effects of a conflict management climate.

OBJECTIVES: To prospectively investigate the reciprocal associations between tiredness at work (TAW) and exposure to bullying behaviors and to determine the role of conflict management climate (CMC) as a moderator of these associations. METHODS: A two-wave national probability sample of employees in Sweden (18 months between waves, 921 participated at both waves) measuring TAW, workplace bullying, and CMC. Structural equation modelling was used to test four hypotheses about the longitudinal associations between feeling tired at work and bullying, and CMC as a moderator for the two directions. RESULTS: In the analyses of cross-lagged effects, tiredness was significantly associated with an increase in subsequent bullying (ß = 0.08, P = .01). Exposure to bullying was not associated with changes in tiredness. CMC moderated the association between tiredness and subsequent bullying (ß = -0.13, 95% CI [-0.19, -0.08]), showing an increased risk of exposure to bullying behaviors following tiredness when CMC was low and decreased risk when CMC was high. CONCLUSIONS: TAW is a risk factor for subsequent bullying. Finding ways to help employees to reduce tiredness not only will help them perform better at work but also reduce the risk of them becoming targets of bullying. A strong CMC can act as a buffer if a tired person provoke aggression from co-workers.

The last resort: Workplace bullying and the consequences of changing jobs.

This study investigated the consequences of changing jobs for employees subjected to workplace bullying. First, we hypothesized that bullied employees would be more likely to change jobs than non-bullied employees. Moreover, we hypothesized that changing jobs would result in a reduction of exposure to bullying behaviors and an alleviation of mental health problems for those bullied at baseline. The study was based on a longitudinal probability sample of the whole Swedish workforce (n = 1,095). The time lag was 18 months. The results supported all hypotheses except one. Those employees who were bullied at baseline were more likely to have changed jobs at follow-up. Also, for the changers there was a reduction in exposure to subsequent bullying. The actual drop in exposure to bullying behaviors was significant and substantial. This gives further support for the work environment hypothesis, suggesting the work context may be a more important cause than individual characteristics. As for mental health problems, the association between bullying and subsequent anxiety was not significant for those changing jobs, suggesting that leaving a toxic workplace may reduce anxiety relatively quickly. However, depression symptoms were not affected by the change of jobs, and the association between bullying and subsequent depression was the same 18 months later. The conclusion is that changing jobs can be a useful, last resort on an individual level, improving the situation for the victim of bullying. However, it is important to note that it does not solve any underlying organizational problems and risk factors.

Experiences from leading parental education groups: Perceived difficulties and rewards as an indication of skill acquisition.

Developing skills in a professional setting is linked to practical experience. The relationship between experience and acquisition of skills can be seen as a transition from novice to expert. In a nursing setting, this has been studied using the Dreyfus model of skill acquisition. The aim was to investigate how experience influences midwives' and child healthcare nurses' views of difficulties and rewards in working with parental education groups. The study has a cross-sectional design with a mixed methods approach. A total of 437 midwives and child healthcare nurses answered a web-based survey. First, a qualitative analysis was carried out, and then patterns of experience were analysed. The results showed that less experience as a leader corresponds to a greater focus on one's own role and on personal benefits from working with parents, but not on the specific context of the group. With experience, leaders had a greater focus on the group itself and rewards of making it function well. Not being able to take the current group and the specific context into account when working as a leader reduces possibilities of achieving a well-functioning group and the goals of the parental education.

Mental Health Problems as a Risk Factor for Workplace Bullying: The Protective Effect of a Well-Functioning Organization.

This study examined a strain-stressor association, when mental health problems may lead to subsequent workplace bullying, and a mechanism of how this can happen. I hypothesized that the association between mental health problems and bullying depends on the perceived role clarity and order in the organization, and that sickness presenteeism (SP) mediates this association. The study is based on a longitudinal probability sample drawn from the total number of employees in Sweden. Workplace bullying, mental health, SP, and role clarity and order in the organization were assessed using a questionnaire. The results showed that mental health problems are associated with an increased risk for subsequent bullying, consistent with previous findings. However, this risk depends on the level of role clarity and order in the organization. The results also show a partial indirect effect via SP. This means that if one has mental health problems and persists in coming to work although one should have stayed at home, the risk of bullying increases. The indirect effect depends also on the level of order in the organization. The findings suggest that individual deficits, such as mental health problems, are associated with subsequent bullying only if organizational deficits are also present.

Killing two birds with one stone: how intervening when witnessing bullying at the workplace may help both target and the acting observer.

OBJECTIVE: This study examines under which conditions being an observer of bullying can be detrimental to health and well-being. It was hypothesized that health-related problems following observations of bullying are determined by (1) whether the observer has been exposed to bullying her/himself and (2) whether the observer have tried to intervene in the bullying situation that they witnessed. METHODS: The study was based on a longitudinal probability survey of the Swedish workforce, with an 18-month time lag between assessment points (N = 1096). RESULTS: Witnessing bullying at work were associated with an increase in subsequent levels of mental distress among the observers, although this association became insignificant when adjusting for the observers' own exposure to bullying. Intervening against bullying moderated the relationship between observations of bullying and mental health problems. Observers who did not try to intervene reported a significant increase in mental health problems at follow-up, whereas there were no significant changes in levels of mental health problems among those who did intervene. CONCLUSIONS: the findings suggest that observer interventions against bullying may be highly beneficial for both the targets and observers of bullying. Organizations should therefore invest in ways to increase constructive bystander behavior in negative social situations at the workplace.

Maternal depression symptoms during the first 21 months after giving birth.

AIMS: The first year after childbirth involves a major transition for women, which can accentuate inadequacies and feelings of powerlessness, making them vulnerable to depression. The aim of this study was to investigate the prevalence and frequency of maternal postpartum depressive symptoms at different times after giving birth (0-21 months). METHODS: Data were collected cross-sectionally using a web questionnaire containing the Edinburgh Postnatal Depression Scale (EPDS). A total of 888 mothers with children in the age range 0-21 months responded. RESULTS: The results showed different levels of depression over the range of months included in the study. The overall prevalence using EPDS ⩾ 12 was 27.8%. There were higher levels at 9-12 months and 17-21 months. The highest levels of symptoms of depression were found at nine, 12, and 17 months after birth, and the lowest levels at two and 16 months. CONCLUSIONS: Many mothers experience symptoms of depression after giving birth that can continue well beyond the child's first year. We have identified different levels of depression at different points in time after giving birth, with highs and lows throughout the first 21 months. This highlights a need to screen for depression more than once during the first years, as well as a closer cooperation between midwives and child healthcare nurses in supporting mothers in the transition to motherhood. This is an important aspect of public health, which not only involves mothers with symptoms of depression, but also their ability to care for their child and a possible negative impact on the child's development.

Gender Matters: Workplace Bullying, Gender, and Mental Health.

The aim of this study was to examine the role of gender in the process of workplace bullying. In particular, we examined how gender affects reported prevalence rates and health consequences of bullying. In addition, we pay particular attention to if the measurement method - self-labelling or behavioural experience methods - affects potential gender differences. A longitudinal study, with two measurement points 18 months apart, was conducted in Sweden (n = 1854 at T1; n = 1096 at T2). It was a probability sample out of a population of all 3.3 million people in Sweden working at workplaces with ten or more employees. The results showed a slightly higher tendency for women to self-label as bullied (8% vs. 6%), while a higher proportion of men than women could be labelled as bullied based on the negative acts they had been exposed to (21% vs. 14%). Exposure to negative acts was associated with more subsequent mental health problems for both men and women, whereas self-labelling was associated with mental health problems for men only. Mental health problems at baseline also increased the risk of bullying for both men and women; however, the measurement method affected if the effect was stronger for men or women. Overall, the study advances our understanding of the role of gender in bullying, in particular highlighting the importance of the measurement method for understanding such gender differences.

Fatherhood group sessions: A descriptive and summative qualitative study.

The aim of this qualitative study of fatherhood group sessions offered as part of child health care services for new parents was to examine the activities, roles, and topics initiated by the leader and describe fathers' participation. Eight new fathers took part in three audio- and video-recorded sessions led by a male leader. Three qualitative content analysis approaches were used to analyze the data. The analysis showed that the group leader took on four leadership roles, mainly that of discussion leader, but also expert, friend, and organizer. When the group leader acted as discussion leader, fathers participated by discussing challenges and changes in their new situation. Challenges were related to raising the child, partner relationships, everyday life, and gender equality. Fathers also discussed changes in their partner relationships and an increased focus on practicalities in daily life. Fatherhood groups can help new fathers form social networks and can create space for fathers to work through challenging topics, such as gender equality in parenting. The discussion leader's choice of role is crucial to creating the space for such discussions.

Child health care nurses' use of teaching practices and forms of knowledge episteme, techne and phronesis when leading parent education groups.

This study explores child health care nurses' pedagogical knowledge when supporting parents in their parenthood using various teaching practices, that is how to organise and process the content during parent education groups in primary health care. The aim is to identify teaching practices used by child health care nurses and to analyse such practices with regard to Aristotle's three forms of knowledge to comprehensively examine child health care nurses' use of knowledge in practice. A qualitative methodological design alongside the analysis of video-recordings was used. The results showed that child health care nurses used four teaching practices: lecturing, demonstration, conversation and supervision. Their use of episteme was prominent, but they also seemed to master techne in combination with episteme during the first three teaching practices. During the conversation teaching practice, the child health nurses rarely succeeded. Consequently, they missed opportunities to identify mothers' expressed concerns and to act in the best interests of both the mothers and their infants by the use of phronesis. In health care, however, theoretical episteme is superordinate to productive knowledge or phronesis, which also became evident in this study. Nevertheless, more interactive pedagogical practices are needed if more use of phronesis is to become a reality in parent education groups.

Exposure to bullying behaviours and support from co-workers and supervisors: a three-way interaction and the effect on health and well-being.

PURPOSE: Workplace bullying can be very stressful and it has detrimental effects on health and well-being which makes it an important area of study. Social support has traditionally been seen as important in moderating work-related stress. It was hypothesised that the negative association between exposure to bullying behaviours, and health and well-being is moderated by (a) perceived support from close co-workers and (b) perceived supportive leadership. In the study, we also investigated a three-way interaction between exposure to bullying behaviours, perceived support from close co-workers and perceived supportive leadership. This association has not been studied before and add new knowledge to the research field. METHODS: We used a moderated moderation analysis of workplace bullying, co-worker support and supervisor support using cross-sectional data from a work environment survey with 1383 respondents (75% response rate). RESULTS: The moderated moderation analysis confirmed the moderating effect of perceived co-worker support but not the moderating effect of perceived supervisor support. There was a three-way interaction, but not in the case of the lowest 12.6% of perceived supervisor support scores. CONCLUSIONS: These results indicate that the negative effect of workplace bullying on health and well-being is weaker if victims perceive that they have co-worker support, but this protective effect seems to be conditional on the perceived level of supervisor support. In other words, lack of supportive leadership may block the beneficial effect of perceived co-worker support.

Parents' reasons for not attending parental education groups in antenatal and child health care: A qualitative study.

AIMS AND OBJECTIVES: To explore expectant and new parents' reasons not to participate in parental education (PE) groups in antenatal care or child health care. BACKGROUND: In Sweden, expectant and new parents are offered PE groups in antenatal care and in child health care. Although many parents feel unprepared for parenthood, an urgent task is to attract parents to attend the PE groups. DESIGN: A total of 915 parents with children aged 0 to 21 months answered a web questionnaire with open questions about (a) reasons not to participate; (b) anything that could change their mind; and (c) parenting support instead of PE groups. This was analysed using content analysis. The study follows the SRQR guidelines. RESULTS: Parents expressed private reasons for not attending PE groups. Some parents also asked for more heterogeneity regarding content and methods, as well as accommodation of parents' different interests. Other parents asked for like-minded individuals who were in similar situation to themselves. Lack of information or invitations from antenatal care or child health care, or that PE groups were unavailable, were additional reasons for not participating in groups. CONCLUSIONS: Reasons for not attending PE groups were multifaceted from personal, self-interested and norm-critical reasons, to that the groups were not available or that the parents were not aware of their existence. RELEVANCE TO CLINICAL PRACTICE: Parents of today are a diverse group with different interests and needs. Nevertheless, all parents need to feel included in a way that makes participation in PE groups relevant for them. Thus, it is important for leaders to be aware of structures and norms, and to be able to create a group climate and a pedagogy of acceptance where group members value each other's differences. However, to attract parents to participate in PE groups, it is necessary for clinical practice to work on individual, group and organisational levels.

Leaders' limitations and approaches to creating conditions for interaction and communication in parental groups: A qualitative study.

The aim of this study was to describe and understand parental group (PG) leaders' experiences of creating conditions for interaction and communication. The data consisted of 10 interviews with 14 leaders. The transcribed interviews were analysed using thematic analysis. The results showed that the leaders' ambition was to create a parent-centred learning environment by establishing conditions for interaction and communication between the parents in the PGs. However, the leaders' experience was that their professional competencies were insufficient and that they lacked pedagogical tools to create constructive group discussions. Nevertheless, they found other ways to facilitate interactive processes. Based on their experience in the PG, the leaders constructed informal socio-emotional roles for themselves (e.g. caring role and personal role) and let their more formal task roles (e.g. professional role, group leader and consulting role) recede into the background, so as to remove the imbalance of power between the leaders and the parents. They believed this would make the parents feel more confident and make it easier for them to start communicating and interacting. This personal approach places them in a vulnerable position in the PG, in which it is easy for them to feel offended by parents' criticism, questioning or silence.

Walk the talk: Leader behavior in parental education groups.

Expectant and new parents are offered parental education groups as a way to support their transition to parenthood. Group leadership in these groups has been found to be challenging. Using a qualitative and summative design, the aim of the present study was to investigate how health professionals describe their role in parental education groups compared to their actual behavior. Thirteen health professional leaders in antenatal and child health services were interviewed. These descriptions were compared with the leaders' actual behavior in video and audio-recordings of 16 different group sessions. The results revealed that regardless of how the leaders described their role, they acted as experts and left little time to parents for discussions and active participation. In particular, leaders who described themselves as discussion leaders did not "walk the talk"; that is, they did not do what they said they do when leading groups. That could be explained by lack of professional awareness, group leadership, and pedagogical skills. In order to provide high-quality parental support, leaders need training in group leadership and pedagogy combined with supervision and support on a regular basis.

Facilitating and inhibiting factors in transition to parenthood - ways in which health professionals can support parents.

BACKGROUND: The transition to parenthood is an overwhelming life event. From a theoretical perspective, transition to parenthood is a developmental transition that contains certain phases and patterns. AIM: This study aim was twofold (i) discover, describe and comprehend transitional conditions that parents perceive as facilitating and inhibiting during transition to parenthood and to (ii) use that knowledge to develop recommendations for professional interventions that support and facilitate transition to parenthood. DESIGN: Meleis transition theory framed the study's deductive qualitative approach - from planning to analysis. METHODS: In a secondary analysis, data were analysed (as per Meleis transition theory) from two studies that implemented interviews with 60 parents in Sweden between 2013 and 2014. Interview questions dealt with parents' experiences of the transition to parenthood - in relation to experiences with parent-education groups, professional support and continuity after childbirth. ETHICAL ISSUES: A university research ethics board has approved the research. RESULTS: These factors facilitated transition to parenthood: perceiving parenthood as a normal part of life; enjoying the child's growth; being prepared and having knowledge; experiencing social support; receiving professional support, receiving information about resources within the health care; participating in well-functioning parent-education groups; and hearing professionals comment on gender differences as being complementary. These factors inhibited transition to parenthood: having unrealistic expectations; feeling stress and loss of control; experiencing breastfeeding demands and lack of sleep; facing a judgmental attitude about breastfeeding; being unprepared for reality; lacking information about reality; lacking professional support and information; lacking healthcare resources; participating in parent-education groups that did not function optimally; and hearing professionals accentuate gender differences in a problematic way. CONCLUSION: Transition theory is appropriate for helping professionals understand and identify practices that might support parents during transition to parenthood. The study led to certain recommendations that are important for professionals to consider.

With or without the group: Swedish midwives' and child healthcare nurses' experiences in leading parent education groups.

The aim of the study was to describe and to understand midwives' and child healthcare nurses' experiences of working with parent education groups through their descriptions of the role and what they find rewarding and challenging in that work. Data were collected through three open-ended questions from a web survey: 'How do you refer to your role when working in parent education?', 'What is the biggest challenge or difficulty for you when working in parent education?' and 'What is most rewarding when working in parent education?' The answers were analysed by using qualitative content analysis and correlation analysis. The results show that the midwives and child healthcare nurses either included or excluded the group when describing their role as leaders and their influence on parents. The same applies to what they found rewarding and what was difficult and challenging for them in working with the groups. Primarily, the leaders who excluded the group expressed a lack of competence on a professional level in managing groups and using the right teaching methods to process the knowledge content. One important question to deal with is how to best support midwives and nurses in child healthcare to be prepared for working with parent education groups. One obvious thing is to provide specialized training in an educational sense. An important aspect could also be providing supervision, individually or in groups.

The role as moderator and mediator in parent education groups--a leadership and teaching approach model from a parent perspective.

AIMS AND OBJECTIVES: To investigate the didactic and social leadership in parent education groups based on a parent perspective, and to conceptualise parent experiences of the leader roles in these groups. BACKGROUND: Leadership in parent education groups has been associated with a lack of confidence in one's ability to function in that role. Research on how it can be delivered to produce a favourable outcome is scarce. It can be difficult to abandon the role of expert and let participants set their own learning agenda. To facilitate these processes requires leadership skills, knowledge of group dynamics as well as pedagogical skills. DESIGN: Qualitative interview study. METHODS: Semi-structured interviews with parents (25 participants, 21 interviews). Transcripts were analysed using, first, thematic analysis, then comparative analysis. RESULTS: The study resulted in a four-field model, The Leadership - Teaching Approach model. It consists of the dimensions 'Teaching approaches' ('Knowledge is imparted' and 'Knowledge is jointly constructed'), and 'Leadership approaches' ('Instrumental approach' and 'Investigative approach'). CONCLUSIONS: Using an investigative approach is necessary to get a well-functioning group that can help the expectant and new parents in the transition to parenthood. Supervision can help develop an awareness of one's professional role as a nurse and leader of a parent education group. RELEVANCE TO CLINICAL PRACTICE: The actions and choices of nurses as leaders of parent groups have an impact on how the participants perceive and take in the content and purpose of the group, and whether they perceive it as meaningful. Getting support in reflecting about one's role as a leader in this context can help create a learning environment in which the participants can become engaged in the activities and be strengthened by the experience.