LinköpingUniversityMedicalDissertationsNo.1190= = = = My Home is my Castle:== ResidentialWellbeingand PerceivedSafetyinDifferent TypesofHousingAreasin Sweden = AgnetaKullberg = = = = DivisionofCommunityMedicine,SocialMedicineandPublicHealthScience DepartmentofMedicalandHealthSciences LinköpingUniversity,Sweden= = = = = = = Linköping2010 = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = @AgnetaKullberg,2010 = Coverpictures/illustration:AgnetaKullberg&KjellJohansson = = = PrintedinSwedenbyLiUTryck,Linköping,Sweden,2010 = = ISBN9789173933490 ISSN03450082 = = = = = = = = = = = = = = = = = = = = = = “Theconnectionbetweenthehealthandthedwellingsofthepopulationisone= ofthemostimportantthatexists”.= = FlorenceNightingale,1860 = = = = = = = = = = = = = = = = = = = = = Contents= CONTENTS ABSTRACT=..................................................................................................................=1 LISTOFPAPERS........................................................................................................3 INTRODUCTION=.......................................................................................................5 BACKGROUND..........................................................................................................7 TowardsimprovedhousingstandardsinSweden.........................................7 Housingandtherelationshipwithhealthandsafety=....................................9 Residentialwellbeing........................................................................................13 Housingandsafetydimensions.......................................................................13 Safetyasanobjectivecondition....................................................................15 Safetyasasubjectivephenomenon.............................................................16 Safetypromotion.................................................................................................18 Communitybasedsafetypromotionprogrammes=.......................................19 Summingupbackground=..................................................................................23 AIMS...........................................................................................................................25 MATERIALSANDMETHODS.............................................................................26 Empiricalsetting..................................................................................................26 Datasources..........................................................................................................29 Focusgroupinterviews.................................................................................29 Questionnaire..................................................................................................30 Questionsusedinthepapers........................................................................31 Policereportedcrimerecords.......................................................................33 SafeCommunityprogramme:datafromtheapplicationdocument.....33 Dataanalyses=........................................................................................................34 PaperI...............................................................................................................34 PaperII.............................................................................................................34 PaperIII............................................................................................................35 = Contents= PaperIV............................................................................................................37 Characteristicsofthe4papersincludedinthethesis...............................39 Ethicalconsiderations....................................................................................39 MAINRESULTS.......................................................................................................40 Nonresponse........................................................................................................40 PaperI....................................................................................................................42 PaperII...................................................................................................................43 PaperIII.................................................................................................................45 PaperIV.................................................................................................................47 DISCUSSION............................................................................................................=52 Neighboursandinteractionamongpeopleinanarea.................................52 Safetyrelatedconcerns=.......................................................................................53 Perceivedareareputation...................................................................................56 Physicalqualityoftheresidentialenvironment...........................................59 Actionstoachievesafeneighbourhoods........................................................60 Methoddiscussion...............................................................................................63 Summary................................................................................................................67 CONCLUSIONSANDFUTURERESEARCH....................................................69 SVENSKSAMMANFATTNING..........................................................................70 ACKNOWLEDGEMENTS......................................................................................72 REFERENCES............................................................................................................=75 APPENDIXA:INTERVIEWGUIDEFORFOCUSGROUPINTERVIEWS 93 APPENDIXB:QUESTIONSUSEDINTHEPAPERS......................................94 = Abstract ABSTRACT Background:= Safety in the housing environment is a basic human need and may be a prerequisite for health but studies from the= perspective of the residents are limited in the literature.= Although historically public health= research has recognized the housing environment as an important determinant of health, there is a need for more research on how housing conditionsinfluenceresidentialwellbeing.Aim:=Theoverallaimofthisthesis wastoexaminefactorsandconditionsassociatedwithresidentialwellbeing andperceivedsafetyindifferenttypesofhousingareasandtocomparesafety promotioninterventiondesignsbasedonresidentsselfexpressedsafety=needs with corresponding designs developed by local= government professionals. Materialsandmethods:Apostalsurvey(responserate56%,n=2476)and11 focusgroups(57participants)wereconductedamongtheresidentsin3=small scalehousingareaswithdetachedhousesand3=housingareaswithblocksof flatsin=a=Swedishmunicipality.Theareasweregeographicallycontiguous=as each of the smallscale areas bordered on an area with blocks of flats. The studymunicipalityisadesignatedmemberofWHOSafeCommunitynetwork thathavesignedup=toworkinlinewiththeindicatorsdevelopedbyWHO CollaboratingCentreonCommunitySafetyPromotion.Narrativedatafroma= postal questionnaire were used to analyze the= lay perspective and= identify featuresperceivedtobenecessarytofeelsafebyresidentsinareaswithblocks= offlatsandsmallscalehousingareas.Quantitativedatawereused=toexamine correlatesoflocalsafetyrelatedconcernsthroughafactoranalysis.Logistic regression analysis examined associations between highlevel scores= of the safetyrelateddimensionsfoundandarealevelcrimerateandbeinga=victim ofcrime,areareputation,gender,age,education,countryofbirth,household civilstatusandtypeofhousing.Toexaminehowselfassessedareareputation= isassociatedwithsocialtrustandresidentialwellbeing,a=multilevellogistic regressionanalysiswasperformedusingquantitative=data,controllingforthe= random effect of neighbourhood and individuallevel sociodemographic factors. Data from focus group interviews were analyzed= to identify mechanisms of how neighbourhood= reputation was established. The quality function deployment (QFD) technique was used in a= case study to integrate= residents’= demands= into the design of safety= promotion interventions in housing areas. The resulting design was then= compared with the safety intervention programme designed by professionals at the municipality 1 Abstract administrativeoffice.Theresultsfromthiscomparisonwere=theninvestigated to identify improvements for the indicators for= Safe Homes in the Safe Community programme. Results:= The residents’= narratives showed that a= stable social structure in the housing area was perceived to be the central factorinasafetysupportiveresidentialenvironment.Whereasmaintenanceof good and reassuring relations was emphasized in smallscale housing areas,= supportformanagementofpoororevenfearprovokingneighbourrelations wasrequestedfromareas=with=blocksofflats.Thecrimerateswerelowerand= safetyrelated concerns were less in= smallscale housing areas.= Three composite dimensions (CD) of perceived residential safety were identified:= structural= indicators of social disorder (CD 1); contact with disorderly behaviour(CD2);andexistentialinsecurity(CD3).Arealevelcrimeratesand individuallevelvariableswere=associated=withdimensions(CD1)and(CD3), but only individuallevel variables were associated with dimension (CD 2). The level of residential wellbeing andsocial trust was higher in smallscale= areas.Thehousingareareputationwas=foundtobestronglyassociatedwith=