Norwegian Labour and Welfare Administration

Collaboration between healthcare services is essential for the quality and continuity of care for persons with chronic pain. Collaboration meetings using digital solutions can be useful in overcoming collaboration challenges. However, there is a scarcity of studies on conducting digital collaboration meetings across services, particularly across healthcare levels for patients with chronic pain. Therefore, the aim of the study was to develop recommendations for how to plan and conduct digital collaboration meetings across care levels and services for patients with chronic pain. A qualitative study collecting data from a development process for digital collaboration meeting recommendations was conducted between October 2022 and June 2023. Data were collected at workshops, discussions in the clinic and research group meetings. The analysis focused on topics that generated the most discussions during the development process. The discussions leading to the recommendations were categorised into three themes: ‘Patient-centeredness in the digital collaboration meeting’, ‘A common action plan’ and ‘Good meeting climate’. The main discussions included what it meant to place the patient at the centre of the activities, whether the patient should be present when professionals discussed the interprofessional assessments, whether clinical notes and suggestions for action should be distributed before the digital collaboration meeting, and how to ensure well-led meetings with clear agendas. A set of recommendations for how to plan and conduct digital collaboration meetings across care levels and services for patients with chronic pain was developed. Due to practical issues and differing opinions, the final recommendations offer flexible approaches to meet different levels of preparedness before the meeting. The recommendations are ready to be further tested as collaboration meetings are implemented more widely.

Abstract Reversing an outsourcing decision and retaking control of the development and operations of IT systems can be a viable option for organizations facing outsourcing-related challenges, such as problematic vendor relationships, high costs, or the recognition of software development as a core competence. Despite its increasing practical importance, backsourcing has received little attention in the software engineering literature. This paper presents an in-depth case study of a large public organization that successfully backsourced the development of the majority of its large portfolio of software systems. Based on interviews with 61 representatives of the backsourcing organization and its vendors and an analysis of corporate documentation, we present the rationale for backsourcing, the six main guiding principles shaping the approach, and the outcomes and lessons learned from the initiative. The primary reason for backsourcing in the case organization was cost reduction. The IT department led the effort, granting various application areas considerable autonomy in the practical implementation of backsourcing. The effort was characterized by close and constructive collaboration with the outsourcing vendors, who were being phased out, an incremental approach to assuming responsibility for the applications, and the concurrent implementation of agile development at scale. Over three years, the organization successfully backsourced over 100 systems and established an agile development organization with over 300 people. As a result of backsourcing, the organization reported an increased sense of system ownership, increased personnel motivation, faster deliveries, and better quality-in-use. We were unable to find clear evidence of significant cost savings. Key challenges included managing the change effort, building and retaining the necessary competencies, and addressing organizational tensions resulting from the IT department’s central role in the backsourcing effort.

Alzheimer's disease is a progressive neurodegenerative disorder characterized by the deterioration of memory and higher-order cognitive functions, underscoring the importance of its early detection. The present study investigates the automatic identification and classification of Alzheimer's disease from MRI scans by leveraging advanced deep-learning techniques. A dataset of 12,020 MRI images was employed, partitioned into four diagnostic categories: mild, moderate, non-demented, and very mild. To ensure both accuracy and computational efficiency, rigorous preprocessing was applied-images were uniformly resized and normalized, while Contrast-Limited Adaptive Histogram Equalization (CLAHE) and a suite of geometric and photometric augmentations were used to enhance feature visibility and bolster model generalization. Multiple convolutional neural network (CNN) architectures were evaluated, including ResNet-50, VGG-16, VGG-19, DenseNet-201, Inception-V3, MobileNet-V2, Xception, and EfficientNet-V2. In addition, hybrid ensemble frameworks were constructed by fusing ResNet-50 with VGG-16, VGG-19, Inception-V3, and MobileNet-V2 backbones, and integrating these with machine-learning classifiers such as XG-Boost, k-Nearest Neighbors, and Random Forests. By combining deep, hybrid, and ensemble approaches, this work aims to detect subtle patterns across MRI sequences and thereby enhance the predictive accuracy of Alzheimer's disease classification.

ABSTRACT Despite policies in Nordic countries advocating ageing-in-place and holistic, person-centred care, fiscal constraints have pressured homecare services to prioritise physical and somatic care at the expense of social care provision. This has limited professional caregivers’ roles, with practical and emotional aspects of care being largely removed from their remit. This study examines how home care workers use coping strategies to navigate high workloads and the diverse, shifting needs and personal behaviour of clients. Such coping involves both socially negotiated ‘collective rules’ and embodied forms of ‘emotion work'. Our study comprises ethnographic data from Danish and Norwegian home care services. Through shadowing care workers, we observed how they adapt coping strategies to their informal categorisations of clients. In doing so, care workers often prioritise meeting the emotional and social needs of vulnerable clients at the expense of clients perceived by care workers as more resourceful or ‘demanding’. The marginalisation of social care and the necessity for informal prioritisations due to time constraints place significant moral burdens on care workers. This not only diminishes recognition of their vital contributions to client well-being but also obscures unmet care needs and moral dilemmas that should warrant open discussion.

It is commonly assumed that the attitudes of street level bureaucrats (SLBs) towards benefit recipients influence the discretionary decisions they make. Although discretion in the policy process has been a contentious issue, the impact of bureaucrats’ attitudes has received limited scholarly attention. This study investigates the impact of attitudes on discretionary decision-making and whether the impact of attitudes is conditioned by the SLBs’ perception of recipients’ conduct, when sanctioning non-compliance of requirements among social assistance recipients. The study employs survey data from 925 bureaucrats within the Norwegian Labour and Welfare Administration, measuring four attitude components: cognitive, positive affective, negative affective, and behavioral attitudes. A vignette experiment allows assessing how sensitive discretionary decision-making is to SLBs’ perceptions of recipient conduct. The findings indicate that cognitive attitudes significantly impact discretionary decision-making and are sensitive to SLBs’ perceptions of the recipients’ personal responsibility. Prejudiced cognitive attitudes (viewing recipients as dishonest, manipulative, unpredictable, or stubborn) are associated with a greater tendency to attribute non-compliance to a lack of willingness, irrespective of external circumstances. The study contributes to a deeper understanding of discretionary decision-making and sheds light on the complex dynamics between SLBs’ attitudes and their perceptions of client attributes, offering new insight for public policy and administration.

Background Despite labour market measures aimed at promoting work inclusion, the employment rate of people with disabilities in Norway remains lower in comparison to the general population. In addressing this discrepancy between policy and reality, our paper focuses on how disability is understood within the Norwegian Labour and Welfare Administration (NAV). Objective Our objective was to investigate frontline workers’ attitudes towards job-seeking graduates with disabilities and their suitability in different types of employment positions. Method We conducted a factorial survey experiment in which 1510 frontline workers evaluated 11701 vignettes describing graduate jobseekers with varying characteristics and types of disability. Multilevel linear regression analyses were performed to assess the effects of vignette variables and respondent characteristics on these evaluations. Results Results indicate that frontline workers within NAV are positive towards facilitating inclusive practices, but rate jobseekers with disabilities as significantly less likely to gain employment compared to those without. Personality traits and ethnicity also influence these ratings, indicating that perceptions of the successful jobseeker reflect ableist ideals that exist within the labour market. Conclusion We discuss our findings in light of street-level bureaucracy, arguing for increased attention towards the tension frontline workers face in promoting inclusion while simultaneously meeting employer expectations.

Objective Private health insurance is becoming more common in Norway. The aim of this study was to investigate GPs’ opinions on private health insurance, and their experiences from consultations where health insurance can affect decisions about referring. Design A web based cross-sectional survey. Setting Norwegian general practice. Subjects All GPs in Norway were in 2019 invited to participate in an online survey. Main outcome measures The GPs’ opinions and experiences regarding health insurance were reported as proportions. Multiple logistic regression was used to test associations between how frequently GPs refer patients without further considerations and variables concerning their characteristics, opinions, and experiences. Results Of 1,309 GPs (response rate 27%), 93% stated that private health insurance raises the risk of overtreatment and 90% considered such insurance to contribute to inequality in health. Frequently being pressured to refer in the absence of a medical indication was reported by 42%. Moreover, 28% often or always chose to refer patients without further consideration, and this was associated with perceptions of pressure with an adjusted odds ratio (AOR) of 3.80, 95% confidence interval (CI) 2.73–5.29, and unpleasant reactions from patients following refusals (AOR 1.63, 95% CI 1.14–2.33). Conclusion Although most participating GPs associated private health insurance with overtreatment and inequality in health, more than one in four choose to refer without further consideration. GPs’ experience of pressure to refer and negative reactions from patients when they consider referrals not to be medically indicated, raises the risk of medical overuse for patients holding private health insurance.

Abstract As long as welfare arrangements have been in existence, there has been a strong belief that high‐benefit generosity leads to welfare reliance. In this study, we investigate whether an increase in welfare generosity in Norway resulted in higher social assistance (SA) uptake and decreased engagement in paid work. By utilizing high‐quality administrative data and employing a difference‐in‐difference design, we find no overall effects on SA or work activity. However, we do observe a significant reduction in work activity and an increase in SA for specific predefined high‐risk groups, which are believed to be particularly responsive to financial incentives. Thus, we discover evidence of unfavorable effects for child families, non‐Western immigrants, and the combined group of non‐Western immigrant child families. These latter findings are interpreted in light of the particular socioeconomic circumstances of these groups.

The Norwegian public sector has been quick to explore generative AI. Early adoption and experimentation in the public sector can act as unique probes into both strengths and shortcomings of this technology, provided adequate mechanisms are in place to relate instructive feedback to public debates on how societies should govern the challenges that arise. We call for increased collaboration through public-academic crossdisciplinary partnerships and bolstered frameworks for engagement and change agency.

Abstract Background Health anxiety has been expected to increase as a consequence of the COVID-19 pandemic. However, few longitudinal studies have examined health anxiety in the general population during this period. The aim of this study was to longitudinally examine health anxiety before and during the COVID-19 pandemic in an adult, working population in Norway. Methods We included 353 participants aged 18-70 years with two or more measurements of health anxiety (743 measurements) from the pre-pandemic period (2015 to 11.03, 2020) and/or during the COVID-19 pandemic (12.03, 2020 - 31.03, 2022). We measured health anxiety with the revised version of the Whiteley Index-6 scale (WI-6-R), and the effect of the COVID-19 pandemic on health anxiety scores was estimated with a general estimation equation analysis. Age, sex, education, and friendship were included in subgroup analyses. Results We found no significant change in health anxiety during the COVID-19 pandemic compared to the pre-pandemic period in our adult, working population, with a non-significant change of 0.06 points on WI-6-R (95 % CI -0.34 - 0.46). No significant effect of the COVID-19 pandemic on health anxiety scores was found in any subgroup analysis. Conclusions Health anxiety remained stable, with no significant change observed between the pre-pandemic period and the first 2 years of the COVID-19 pandemic in an adult, working population in Norway. This corresponds to other longitudinal studies examining mental health in general during the pandemic. The implications from our study can add to public health decision-making and prioritising of healthcare support in times of pandemics, where other consequences of COVID-19, such as social and economic burdens, may require targeted intervention over anxiety about health. Key messages • Health anxiety in an adult, working population remained stable during COVID-19. • Other consequences of the pandemic may require targeted intervention over anxiety about health.