This dissertation examines the emergence, evolution, and realization of Swedish urban policy from 1988 to 2023 through a conjunctural analysis. It explores the contradiction between uneven spatial development and the pursuit of a hegemonic order, wherein the (re)production of sociospatial inequalities continually challenges the conditions necessary for hegemony. Urban policy is conceptualized as a hegemonic project aimed at regulating these tensions by producing consent in marginalized areas through various practices and technologies.

Methodologically, the conjunctural analysis employed in this study aligns with a ”historical and structural” ethnographic approach, incorporating policy documents, government reports, evaluations, and elite interviews. The study design spans multiple temporalities and contexts to trace the evolution of urban policy. Additionally, counter-hegemonic projects are identified to illuminate key tensions and forms of resistance. Periodization serves as an analytical strategy, delineating shifts in urban policy into four phases: condensation, consolidation, fragmentation, and revanchism. Over time, Swedish urban policy has assumed an increasingly repressive character, with the production of consent becoming more coercive.

The study identifies four primary modalities through which consent is produced in urban policy: (1) representation of urban problems and hegemonic visions, (2) governance through diverse policy instruments and arrangements, (3) activation of surplus populations via labor market measures, and (4) incorporation of marginalized groups through democratic initiatives and participatory innovations.

The dissertation concludes with a critical analysis of two structural contradictions impeding a more socially just urban policy: hegemony without economy and democracy without hegemony. The former highlights the absence of an ”economic nucleus” capable of redistributing the value generated within the urban political economy, exacerbating economic inequality. The latter reveals how urban policy initiatives designed to incorporate marginalized groups have been implemented through top-down institutional frameworks lacking a robust social base. This contradiction highlights a persistent tension between form and substance within liberal democracies, resulting in limited consent and constrained prospects for transformative change. Addressing these contradictions is essential for advancing a more socially just urban policy framework.

Aim: To explore the co-creation of self-care and the use of eHealth among older adults with chronic illness, their informal carers, and healthcare professionals. Methods: This thesis employed various qualitative methods across four studies. Study I aimed to clarify the concept of “self-care monitoring” from a patient perspective through a concept analysis based on a systematic search of peer-reviewed articles from four databases. Study II aimed to describe patients’ and informal carers’ experiences of self-care management and the use of telemonitoring applications, using semi-structured telephone interviews analyzed by qualitative content analysis. Study III aimed to co-create and test a video feedback tool for self-care at home, using an experience-based co-design approach that facilitated collaboration between pairs of older adults, researchers, and service designers through three iterative steps: workshops, development and refinement, and usability testing. Data were analyzed using thematic analysis, employing both inductive and deductive approaches. Study IV aimed to describe healthcare professionals’ experiences of motivating self-care, utilizing individual narrative interviews analyzed by a phenomenological-hermeneutic approach. Results: Study I clarified the concept of “self-care monitoring”, resulting in the definition: “Self-care monitoring is an activity that means a person has to pay attention and be confident and needs routines for tracking symptoms, signs, and action.” Study II described self-care management with telemonitoring at home, captured by the theme “Developing the capability to perform self-care with technology as both an intruder and an invited guest.” Telemonitoring supported skill acquisition and engagement with healthcare professionals but also introduced uncertainties in symptom interpretation and exclusion. Study III co-created and tested two new self-care exercises within the video feedback tool: “Breathing exercises” and “Picking up from the floor.” Older adults found the exercises and feedback valuable for learning, particularly in highlighting movement variability through performance comparison. Study IV described healthcare professionals’ experiences of motivating self-care, revealing “Co-creating sustainable self-care responsibilities” as the main theme, encompassing empowerment through mutuality, reassigning responsibility, and using oneself as a creative tool. Conclusion: This thesis highlights co-created self-care as a dynamic, empowering process shaped by collaboration, shared responsibility, and active engagement among older adults with chronic illness, informal carers, and healthcare professionals. Engagement in self-care strengthens through interactive approaches like peer support, video feedback, and telemonitoring, enhancing motivation, confidence, and adherence. Future research should focus on long-term engagement strategies and integrating eHealth into primary care to improve co-created self-care.

Aim: This study aimed to explore midwives’ experiences and views of amniotomy and its prevalence and complications in Sweden.

Methods: Study I was a qualitative study in which 16 midwives participated in individual interviews. Data were analysed using content analysis. Studies II, III, and IV were quantitative, for which register data from the Swedish Pregnancy Register were used, covering 95% of all births in Sweden. Analyses were performed using descriptive and comparative statistics, as well as simple and multiple logistic regression.

Results: Midwives discourage a routine use of amniotomy and want a clear indication of when to perform it. The decision, whether an amniotomy would support or interfere with the physiological process of labour was sometimes difficult for the midwives. The decisions were customized to each woman, based on the midwife’s knowledge and experience, but also regulated, and affected by the working environment. The overall prevalence of amniotomy in Sweden was 40%, and variations between hospitals were observed. A decrease in the prevalence of amniotomy was seen for women belonging to Robson groups 1 and 3. Increasing rates of induced labours thus resulted in an unaltered overall prevalence. The severe complication of umbilical cord prolapse is rare in Sweden, affecting 0.13% of labours with amniotomy. Higher parity, a baby in non-cephalic presentation, induction of labour, previous caesarean section and the presence of polyhydramnios were identified as risk factors for umbilical cord prolapse for labours with amniotomy. Severe perineal trauma is more common for both nulliparous and multiparous women who undergo amniotomy, thus amniotomy was not identified as a significant risk factor when adjusting for other risk factors. Women with severe perineal trauma have a longer duration between the amniotomy and the birth, compared to women without severe perineal trauma, regardless of parity. A longer duration between the amniotomy and the birth of the baby thus decreased the odds for severe perineal trauma for nulliparous women with amniotomy.

Conclusion: This thesis provides evidence about amniotomy from different perspectives, including midwives and register data. The midwives’ experienced and viewed amniotomy as both a simple everyday task and as an intervention demanding respect. Midwives want a clear indication of when to perform amniotomy and express an unwillingness to have a routine use. Almost half of the women who give birth in Sweden undergo amniotomy, however, variations in the prevalence between hospitals were observed. The prevalence of amniotomy remained stable for all births during the years 2017-2020, but a decrease was seen for women with spontaneous onset of labour. Umbilical cord prolapse is a rare complication to amniotomy. Women with higher parity, previous caesarean section, polyhydramnios, a baby in a non-cephalic presentation and induced labours should be carefully evaluated in the decision-making of amniotomy. Amniotomy is frequently used in labours where other, confirmed risk factors for severe perineal trauma are present. Amniotomy is thus not a significantrisk factor for severe perineal trauma when adjusting for the risk factors inregression analysis.