BackgroundTelenursing is an expanding service in most Western societies. Sweden is a front-line country, with all of its 21 counties connected to Swedish Healthcare Direct (SHD) 1177. The intention of the service is twofold: to make health care more efficient, while also making it more accessible and safe for patients. Previous research has shown, however, that the service is not used equitably. Gender, age, socio-economic, and ethnicity differences have been reported as determining factors for the use of the service and the advice given.AimThe aim of the study was to explore the communication between telenurses and callers in authentic calls to SHD 1177.MethodologyA qualitative method, using critical discourse analysis (CDA), was chosen. The approach was deductive, that is, the analysis was made in view of a predetermined framework of theory. Twenty calls were strategically chosen and included in the study.ResultsThe CDA resulted in five types of calls, namely a gatekeeping call, a gendered call, a call marked by impersonal traits, a call with voices of the life world, and finally a counter discourse call. The dominating patterns in the calls were of gatekeeping and biomedical character. Patterns of the societal gender order were found, in that representations of the reluctant male caller and the ideal female caller were identified, but also a call representing a counter discourse. The service seemed difficult to use for patients with low language proficiency.ConclusionTelenursing could potentially challenge inequalities in health care. However, the discourse of telenursing is dialectically related to neoliberal ideology and the ideology of medicine. It is also situated in a gendered context of ideal femininity and hegemonic masculinity. Through better awareness of gender biases and the callers’ different resources for making themselves heard, the communication between telenurse and caller might become more equal and thereby better suitable for all callers.

Introduction: Aim: The aim of the present study was to analyze authentic health calls to a telenursing site in Sweden regarding reasons for calling and outcome of the calls with focus on a gender perspective. Background: Telephone advice nursing is an expanding service in many Western countries. In Sweden, all regions are now connected to a national telenursing service. Healthcare in Sweden is stipulated by law to be equitable. This includes the teleursing service, which is a new actor in Swedish healthcare system, and which often is a citizen's first contact with healthcare. Methods:The study had a descriptive and comparative design. 800 authentic calls to SHD were analysed regarding reasons for calling, and outcome of the calls. Results:The results showed that men, and especially fathers, received more referrals to general practitioners than women. The most common caller was a woman fluent in Swedish (64%), and the least likely caller was a man non-fluent in Swedish (3%). All in all, 70% of the callers were women. When the calls concerned children, 78% of the callers were female. In total, 9% of the calls were made by a man calling for another person. Callers were predominately young (mean age 29 years for women and 33 for men). Conclusions:It is important that telenursing does not become a "feminine" activity, only suitable for young callers fluent in Swedish. Given the telenurses' gatekeeping role, there is a risk that differences on this first level of health care can be reproduced throughout the whole healthcare system. In striving for more equitable telenursing services, future research might investigate if campaigns encouraging men to call, and more frequent use of translators could enhance access to telenursing services.