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Pajalic Z, Olsen SEG, Hamre A, Strøm BS, Clausen C, Saplacan D, Kulla G. Home living older adults' subjective perceptions, evaluation, and interpretations of various welfare technology: A systematic review of qualitative studies. PUBLIC HEALTH IN PRACTICE 2024; 7:100470. [PMID: 38314397 PMCID: PMC10834993 DOI: 10.1016/j.puhip.2024.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/27/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024] Open
Abstract
Objectives This paper aims to map home-living older adults' subjective perceptions, evaluations, and interpretations of various welfare technologies. Study design Systematic literature review. Methods The study was designed as a systematic literature review of qualitative studies. This systematic literature review was carried out according to the PRISMA statement and was prospectively registered in PROSPERO registration number CRD42020190206. The international electronic bibliographic databases included AMED, Academic, CINAHL, Cochrane Reviews, EMBASE, Google Scholar, MEDLINE via PubMed, Scopus, and Web of Science. The scientific evidence was synthesized using qualitative analysis. All aspects of the study method followed COREQ guidelines. Results Following a detailed systematic search and screening of 1405 studies, 10 were included in the systematic review. The study shows that implementing Welfare Technology seems to prolong older adults' independent living in their own homes and was perceived as a complement to face-to-face contact with health care providers. Conclusions This study indicated that older adults consider accepting Welfare Technology as it contributes to a sense of security and empowerment in their everyday lives.
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Affiliation(s)
- Zada Pajalic
- Faculty of Health Sciences Sustainable Healthcare and Welfare Technology (SHWT) VID Specialized University, Oslo, Norway
| | - Sofia Elisabeth G Olsen
- Faculty of Health Sciences Sustainable Healthcare and Welfare Technology (SHWT) VID Specialized University, Oslo, Norway
| | - Annabel Hamre
- Faculty of Health Sciences Sustainable Healthcare and Welfare Technology (SHWT) VID Specialized University, Oslo, Norway
| | | | | | - Diana Saplacan
- Robotics and Intelligent Systems (ROBIN) Research Group, University of Oslo, Norway
| | - Gunilla Kulla
- Faculty of Health Sciences, Western Norway University of Applied Sciences, Forde, Norway
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Oelschlägel L, Moen A, Dihle A, Christensen VL, Heggdal K, Österlind J, Steindal SA. Implementation of remote home care: assessment guided by the RE-AIM framework. BMC Health Serv Res 2024; 24:145. [PMID: 38287394 PMCID: PMC10825998 DOI: 10.1186/s12913-024-10625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Welfare technology interventions have become increasingly important in home-based palliative care for facilitating safe, time-efficient, and cost-effective methods to support patients living independently. However, studies evaluating the implementation of welfare technology innovations are scarce, and the empirical evidence for sustainable models using technology in home-based palliative care remains low. This study aimed to report on the use of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to assess the implementation of remote home care (RHC) a technology-mediated service for home-living patients in the palliative phase of cancer. Furthermore, it aimed to explore areas of particular importance determining the sustainability of technologies for remote palliative home-based care. METHODS A secondary analysis of data collected by semi-structured interviews with patients with cancer in the palliative phase, focus groups, and semi-structured interviews with healthcare professionals (HCPs) experienced with RHC was performed. A deductive reflexive thematic analysis using RE-AIM dimensions was conducted. RESULTS Five themes illustrating the five RE-AIM dimensions were identified: (1) Reach: protective actions in recruitment - gatekeeping, (2) Effectiveness: potential to offer person-centered care, (3) Adoption: balancing high touch with high tech, (4) Implementation: moving towards a common understanding, and (5) Maintenance: adjusting to what really matters. The RE-AIM framework highlighted that RHC implementation for patients in the palliative phase of cancer was influenced by HCP gatekeeping behavior, concerns regarding abandoning palliative care as a high-touch specialty, and a lack of competence in palliative care. Although RHC facilitated improved routines in patients' daily lives, it was perceived as a static service unable to keep pace with disease progression. CONCLUSIONS A person-centered approach that prioritizes individual needs and preferences is necessary for providing optimal care. Although technologies such as RHC are not a panacea, they can be integrated as support for increasingly strained health services.
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Affiliation(s)
- Lina Oelschlägel
- Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway.
- Department of Public Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Moen
- Department of Public Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alfhild Dihle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Vivi L Christensen
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Kristin Heggdal
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| | - Jane Österlind
- Department of Healthcare Sciences/Palliative Research Center, Marie Cederschiöld University, Stockholm, Sweden
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
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Persson J, Larsson R, Erlingsdottir G, Rydenfält C. How Digital Systems Are Used in Swedish Home Care Nursing Practice: A Qualitative Interview Study to Identify Challenges and Opportunities. Comput Inform Nurs 2023; 41:586-594. [PMID: 36649078 PMCID: PMC10437456 DOI: 10.1097/cin.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study investigates how digital technology is used (or not used) in home care nursing, to identify challenges and opportunities that can move the digitalization of home care nursing forward. The use of digital technology in daily practices of home care nursing was analyzed based on semistructured interviews in four Swedish home care organizations. The results correspond to the two initial stages of a design thinking process: (1) knowledge about users and the use context , presented as an up-to-date description of how digital technology has affected home care nursing practice, and (2) definition of areas for improvement , presented as challenges and opportunities. We identified the following areas to proceed with in the subsequent stages of designing home care nursing digitalization: (1) nurses' ability to access information and conduct documentation in the field, particularly how new digital systems are integrated with existing routines and systems; (2) the multitude of communication processes that nurses must manage, including communication channels that are used and the level of synchronicity; (3) an increasingly complex digital working environment, where evaluating existing systems and routines is one way to learn where improvements can be most efficient.
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Supporting people living with dementia in novel joint activities: Managing tablet computers. J Aging Stud 2023. [DOI: 10.1016/j.jaging.2023.101116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Palos-Sánchez PR, Baena-Luna P, García-Ordaz M, Martínez-López FJ. Digital Transformation and Local Government Response to the COVID-19 Pandemic: An Assessment of Its Impact on the Sustainable Development Goals. SAGE OPEN 2023; 13:21582440231167343. [PMID: 37064821 PMCID: PMC10090959 DOI: 10.1177/21582440231167343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
This paper analyzes how Digital Transformation (DT) processes have influenced the Attitude of local governments (LGs) toward the COVID-19 pandemic and their effect on achieving the United Nations' Sustainable Development Goals (SDGs). The data were collected from LGs in Spain (n = 124) through a questionnaire in which the IT skills of their workers, the DT processes, budgets, degree of regulatory compliance, and implementation of trust seals were measured, together with the IT security measures adopted. The contrast between the proposed model and the results showed that the direct influence of IT security influences the government's attitude toward COVID-19 and DT implementing actions to achieve SDGs. The findings of this work are of great value both for the actors involved in the design and implementation of public policies and for those responsible for local governance in their objective to improve citizens' experience of the services provided and in exceptional situations such as the one experienced as a result, of-COVID-19.
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Östlund B, Malvezzi M, Frennert S, Funk M, Gonzalez-Vargas J, Baur K, Alimisis D, Thorsteinsson F, Alonso-Cepeda A, Fau G, Haufe F, Di Pardo M, Moreno JC. Interactive robots for health in Europe: Technology readiness and adoption potential. Front Public Health 2023; 11:979225. [PMID: 36992891 PMCID: PMC10042286 DOI: 10.3389/fpubh.2023.979225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
IntroductionSocial robots are accompanied by high expectations of what they can bring to society and in the healthcare sector. So far, promising assumptions have been presented about how and where social robots are most relevant. We know that the industry has used robots for a long time, but what about social uptake outside industry, specifically, in the healthcare sector? This study discusses what trends are discernible, to better understand the gap between technology readiness and adoption of interactive robots in the welfare and health sectors in Europe.MethodsAn assessment of interactive robot applications at the upper levels of the Technology Readiness Level scale is combined with an assessment of adoption potential based on Rogers' theory of diffusion of innovation. Most robot solutions are dedicated to individual rehabilitation or frailty and stress. Fewer solutions are developed for managing welfare services or public healthcare.ResultsThe results show that while robots are ready from the technological point of view, most of the applications had a low score for demand according to the stakeholders.DiscussionTo enhance social uptake, a more initiated discussion, and more studies on the connections between technology readiness and adoption and use are suggested. Applications being available to users does not mean they have an advantage over previous solutions. Acceptance of robots is also heavily dependent on the impact of regulations as part of the welfare and healthcare sectors in Europe.
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Affiliation(s)
- Britt Östlund
- Department of Biomedical Engineering and Health Systems, Royal Institute of Technology (KTH), Stockholm, Sweden
| | - Monica Malvezzi
- Department of Information Engineering and Mathematics, University of Siena, Siena, Italy
- *Correspondence: Monica Malvezzi
| | - Susanne Frennert
- Internet of Things and People Research Center, Malmö University, Malmö, Sweden
| | - Michael Funk
- Cooperative Systems, Faculty of Computer Science, University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | - Florian Haufe
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Massimo Di Pardo
- SPW, Research and Innovation Department, Centro Ricerche Fiat (CRF), Orbassano, Italy
| | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
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Emilsson M, Karlsson C, Svensson A. Experiences of using surveillance cameras as a monitoring solution at nursing homes: The eldercare personnel's perspectives. BMC Health Serv Res 2023; 23:144. [PMID: 36765321 PMCID: PMC9912642 DOI: 10.1186/s12913-023-09130-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND As the number of older people increases, so does the need for care. However, the workforce in eldercare cannot increase at the rate required to match the needs. Welfare technologies, such as surveillance cameras, can replace physical visits and be used at night to monitor older people in order to keep them safe, while not disturbing their sleep. The aim of the paper is to analyze obstacles and opportunities associated with implementation and use of surveillance cameras at nursing homes from the perspectives of the practitioners who use the technology, their working environment and the conditions of the older people with cognitive impairment who live in nursing homes. METHODS Individual semi-structured interviews were conducted with the eldercare personnel at nursing homes to understand their experiences of implementation and use of surveillance cameras. The transcribed interviews were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) was used as a guidance tool. RESULTS The results show that the eldercare personnel experienced lack of adequate information, education and support related to using surveillance cameras. Several benefits are highlighted, such as better working environment and that the residents were not unnecessarily disturbed at night. However, the results also show that it is important to clarify that surveillance cameras cannot replace the human presence. CONCLUSIONS The conclusions from this study are the importance of prerequisites for implementation, and that using surveillance cameras contributed to improvements in the working environment at night and created possibilities to maintain security and integrity for older people living in nursing homes.
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Affiliation(s)
- Maria Emilsson
- grid.412716.70000 0000 8970 3706Department of Health sciences, Section of Nursing Graduate Level, University West, SE-461 86 Trollhättan, Sweden
| | - Christina Karlsson
- grid.412716.70000 0000 8970 3706Department of Health sciences, Section of Nursing Undergraduate Level, University West, SE-461 86 Trollhättan, Sweden
| | - Ann Svensson
- School of Business, Economics and IT, Division of Informatics, University West, SE-461 86, Trollhättan, Sweden.
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van Leersum CM, Konrad KE, Siebrand E, Malik ZB, den Ouden MEM, Bults M. Engaging older adults with a migration background to explore the usage of digital technologies in coping with dementia. Front Public Health 2023; 11:1125834. [PMID: 37124775 PMCID: PMC10140574 DOI: 10.3389/fpubh.2023.1125834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background Coping with dementia can imply particular challenges for people with a migration background due to diversity in their life course, personal characteristics, and living environment. Some of the services available for people with dementia include digital technologies for care, providing health services, and maintaining or increasing participation, independence, and safety. This study aimed to explore the role of digital technology in coping with dementia in the lives of older adults with a migration background, and the possibilities to engage and collaborate with older adults. Methods This study combined a qualitative interview-based approach with citizen science principles in the design and execution of a project studying the use of Anne4Care. Results and discussion Participants valued that technology should provide health benefits and fit into aspects of their daily lives. Anne4Care was considered helpful in staying independent and connecting to loved ones in their country of birth. The participants needed to learn new competencies to work with the device, and not all had the material prerequisites, such as an internet connection. Still, this learning process was considered purposeful in their life, and the virtual assistant could be integrated into care and daily practices. The involvement of the older adults with dementia as co-researchers made them feel valuable and as equal partners during this research. An important prerequisite for the involvement of older adults with a migration background was existing relations with carers and care organizations. Conclusion Digital care technologies to cope with dementia can become a valuable part of care practices in the lives of older adults with a migration background. Involving older adults in the development of technology, acknowledging their expertise and needs, and working together in short iterations to adapt the technology for their specific needs and situations were experienced as valuable by the researchers, older adults, and care professionals.
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Affiliation(s)
- Catharina M. van Leersum
- Science, Technology, and Policy Studies, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands
- *Correspondence: Catharina M. van Leersum,
| | - Kornelia E. Konrad
- Science, Technology, and Policy Studies, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands
| | - Egbert Siebrand
- Ethics and Technology Research Group, Saxion University of Applied Science, Deventer, Netherlands
| | - Zohrah B. Malik
- Technology, Health and Care Research Group, Saxion University of Applied Science, Enschede, Netherlands
| | - Marjolein E. M. den Ouden
- Technology, Health and Care Research Group, Saxion University of Applied Science, Enschede, Netherlands
| | - Marloes Bults
- Technology, Health and Care Research Group, Saxion University of Applied Science, Enschede, Netherlands
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Larsson R, Erlingsdóttir G, Persson J, Rydenfält C. Teamwork in home care nursing: A scoping literature review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3309-e3327. [PMID: 35862714 PMCID: PMC10084131 DOI: 10.1111/hsc.13910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/22/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Due to an increased number of complex multi- and long-term ill patients, healthcare and nursing provided in patients' homes are expected to grow. Teamwork is important in order to provide effective and safe care. As care becomes more complex, the need for teamwork in home care nursing increases. However, the literature on teamwork in the patients' home environment is limited. The aim of this study is to describe the scope of the current literature on teamwork in home care nursing and outline needs for future research. Seven electronic databases were systematically searched and 798 articles were identified and screened. Seventy articles remained and were assessed for eligibility by two of the authors. Eight themes were identified among the 32 articles that met the inclusion criteria. Studies concerned with teamwork regarding isolated tasks/problems and specific teamwork characteristics were most common. Methods were predominantly qualitative. Multiple method approaches and ethnographic field studies were rare. Descriptions of the context were often lacking. The terms 'team' and 'teamwork' were inconsistently used and not always defined. However, it is apparent that teamwork is important and home care nurses play a crucial role in the team, acting as the link between professionals, the patient and their families. Future studies need to pay more attention to the context and be more explicit about how the terms team and teamwork are defined and used. More research is also needed regarding necessary team skills, effects of teamwork on the work environment and technology-mediated teamwork.
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Affiliation(s)
- Roger Larsson
- Department of Design SciencesLund UniversityLundSweden
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10
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Kuoppamäki S. The application and deployment of welfare technology in Swedish municipal care: a qualitative study of procurement practices among municipal actors. BMC Health Serv Res 2021; 21:918. [PMID: 34488740 PMCID: PMC8420029 DOI: 10.1186/s12913-021-06944-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Welfare technology has been launched as a concept to accelerate digital transformation in care services, but the deployment of these technologies is still hindered by organisational resistance, lack of infrastructure, and juridical and ethical issues. This paper investigates decision-making among municipal actors in the application and deployment of welfare technology from a procurement process perspective. The study explores the perceptions and negotiations involved in purchasing welfare technology at each stage of the procurement model, revealing the impact of technical, economic, juridical and ethical competence on the mapping, planning, procurement, implementation and management of welfare technology. Methods The study presents empirical findings from qualitative interviews conducted among municipal actors in Sweden. Semi-structured interviews were gathered in 2020 among procurement managers, IT managers, and managers in social administration in three different municipalities (n = 8). Content analysis and systematic categorisation were applied resulting in the division of procurement practices into sub-categories, generic categories and main categories. Results Challenges in the application and deployment of welfare technology occur at all stages of the procurement model. In mapping and planning, barriers are identified in the need analysis, requirement specification and market analysis. In the procurement stage, economic resources, standardisation and interoperability hinder the procurement process. Implementation and management are complicated by supplier assessment, legislation, cross-organisational collaboration and political strategy. Building on these findings, this study defines ‘procurement competence’ as consisting of technical, economic, juridical and ethical expertise in order to assess and evaluate welfare technology. Technical and ethical competence is needed in early stages of procurement, whereas juridical and economic competence relates to later stages of the model. Conclusions Procurement competence is associated with the application and deployment of welfare technology in (1) assessment of the end-user’s needs, (2) estimation of the costs and benefits of welfare technology and (3) management of juridical and legislative issues in data management. Economic and juridical decisions to purchase welfare technology are not value-neutral, but rather associated with socially shared understandings of technological possibilities in care provision. Optimisation of procurement processes requires a combination of capabilities to introduce, apply and deploy welfare technology that meets the demands and needs of end-users.
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Affiliation(s)
- Sanna Kuoppamäki
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.
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Co-Design as Learning: The Differences of Learning When Involving Older People in Digitalization in Four Countries. SOCIETIES 2021. [DOI: 10.3390/soc11020066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Involving older people through co-design has become increasingly attractive as an approach to develop technologies for them. However, less attention has been paid to the internal dynamics and localized socio-material arrangements that enact this method in practice. In this paper, we show how the outcomes that can be achieved with user involvement often pertain to learning, but their content can differ significantly based on how the approach is implemented in practice. Combining explorative, qualitative findings from co-design conducted in four countries (Canada, the Netherlands, Spain, and Sweden), we illustrate how different types of learning occurred as design workshops engaged the experiences and skills of older people in different ways. Our findings make visible how learning can be a core outcome of co-design activities with older adults, while raising awareness of the role of the power relations and socio-material arrangements that structure these design practices in particular ways. To benefit from the full wealth of insights that can be learned by involving older people, deeper knowledge is needed of the implicit features of design, the materials, meanings, and power aspects involved.
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Rydenfält C, Persson R, Arvidsson I, Holgersson C, Johansson G, Östlund B, Persson J. Exploring Local Initiatives to Improve the Work Environment: A Qualitative Survey in Swedish Home Care Practice. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/1084822320986933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Home care for the elderly constitutes a large and growing part of the social welfare system. Though, home care work is associated with a number of work environment-related challenges, including an increased risk for injuries, musculoskeletal disorders, high levels of sick leave and staff turnover, as well as stress and high workload, research is sparse. The present study explores local initiatives to improve the work environment initiated by the home care organizations themselves, and asks whether or not these initiatives affected gender equality. A qualitative web survey was sent to Swedish home care organizations, with open questions about change initiatives intended to have a positive effect on the work environment. There is an impressive amount of local work environment-related change initiatives going on. 80 categories of change initiatives were identified in answers from 178 units. However, these change initiatives were seldom evaluated or made accessible to stakeholders outside the organization. Main themes were concerned with work organization, digitalization, and planning, which largely follows trends in society (ie, digitalization, teamwork), rather than the actual needs identified by research (eg, musculoskeletal disorders). Despite apparent gender-related challenges, little of the work was associated with gender equality. The results indicates that there is a huge learning potential as the identified initiatives can serve as inspiration for others. However, to fully take advantage of these type of initiatives, more systematic evaluations are required.
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Affiliation(s)
| | | | | | | | | | - Britt Östlund
- KTH Royal Institute of Technology, Stockholm, Sweden
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Rydenfält C, Holgersson C, Östlund B, Arvidsson I, Johansson G, Persson R. Picking low hanging fruit - A scoping review of work environment related interventions in the home care sector. Home Health Care Serv Q 2020; 39:223-237. [PMID: 32538305 DOI: 10.1080/01621424.2020.1772936] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Home care for elderly people is an important part of the social welfare system. The sector employs many people, especially women, and work environment issues are common. This review explores the scientific literature on organizational interventions that target the home care work environment. Altogether, 16 studies of varying quality met the inclusion criteria. The interventions identified involved organizational change, education and training, digitalization and scheduling. Many interventions were concerned with changing specific behaviors or with introducing new technology rather than tackling complex issues such as sick leave, stress or gender inequality. Employee participation increased the likelihood of success.
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Affiliation(s)
| | - Charlotte Holgersson
- Department of Industrial Economics and Management, KTH Royal Institute of Technology , Stockholm, Sweden
| | - Britt Östlund
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology , Stockholm, Sweden
| | - Inger Arvidsson
- Division of Occupational and Environmental Medicine, Lund University , Lund, Sweden
| | - Gerd Johansson
- Department of Design Sciences, Lund University , Lund, Sweden
| | - Roger Persson
- Department of Psychology, Lund University , Lund, Sweden
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Chang F, Eriksson A, Östlund B. Discrepancies between Expected and Actual Implementation: The Process Evaluation of PERS Integration in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4245. [PMID: 32545871 PMCID: PMC7344572 DOI: 10.3390/ijerph17124245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022]
Abstract
Recent studies prove that when implementing new technology technology-driven and one-size-fits-all approaches are problematic. This study focuses on the process of implementing personal emergency response system (PERS) at nursing homes. The aim is to understand why the implementation of PERS has not met initial expectations. Multiple methods were used in two Swedish nursing homes, including document analysis, questionnaires (n = 42), participant observation (67 h), and individual interviews (n = 12). A logic model was used to ascertain the discrepancies that emerged between expected and actual implementation, and the domestication theory was used to discuss the underlying meanings of the discrepancies. The discrepancies primarily focused on staff competence, system readiness, work routines, and implementation duration. Corresponding reasons were largely relevant to management issues regarding training, the procurement systems, individual and collective responsibilities as well as invisible work. The uptake of technology in daily practice is far more nuanced than a technology implementation plan might imply. We point out the importance of preparing for implementation, adjusting to new practices, and leaving space and time for facilitating implementation. The findings will be of use to implementers, service providers, and organizational managers to evaluate various measures in the implementation process, enabling them to perform technology implementation faster and more efficiently.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, SE-142 58 Stockholm, Sweden; (A.E.); (B.Ö.)
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Nilsen ER, Stendal K, Gullslett MK. Implementation of eHealth Technology in Community Health Care: the complexity of stakeholder involvement. BMC Health Serv Res 2020; 20:395. [PMID: 32393265 PMCID: PMC7212667 DOI: 10.1186/s12913-020-05287-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background The implementation of any technology in community health care is seen as a challenge. Similarly, the implementation of eHealth technology also has challenges, and many initiatives never fully reach their potential. In addition, the complexity of stakeholders complicates the situation further, since some are unused to cooperating and the form of cooperation is new. The paper’s aim is to give an overview of the stakeholders and the relationships and dependencies between them, with the goal of contributing this knowledge to future similar projects in a field seeing rapid development. Methods In this longitudinal qualitative and interpretive study involving eight municipalities in Norway, we analysed how eHealth initiatives have proven difficult due to the complexity and lack of involvement and integration from stakeholders. As part of a larger project, this study draws on data from 20 interviews with employees on multiple levels, specifically, project managers and middle managers; healthcare providers and next of kin; and technology vendors and representatives of the municipal IT support services. Results We identified the stakeholders involved in the implementation of eHealth community health care in the municipalities, then described and discussed the relationships among them. The identification of the various stakeholders illustrates the complexity of innovative implementation projects within the health care domain—in particular, community health care. Furthermore, we categorised the stakeholders along two dimensions (external–internal) and their degree of integration (core stakeholders, support stakeholders and peripheral stakeholders). Conclusions Study findings deepen theoretical knowledge concerning stakeholders in eHealth technology implementation initiatives. Findings show that the number of stakeholders is high, and illustrate the complexity of stakeholders’ integration. Moreover, stakeholder integration in public community health care differs from a classical industrial stakeholder map in that the municipality is not just one stakeholder, but is instead comprised of many. These stakeholders are internal to the municipality but external to the focal actor, and this complicating factor influences their integration. Our findings also contribute to practice by highlighting how projects within the health care domain should identify and involve these stakeholders at an early stage. We also offer a model for use in this context.
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Affiliation(s)
- Etty R Nilsen
- University of South-Eastern Norway (USN), Post Office Box 235, 3603, Kongsberg, Norway.
| | - Karen Stendal
- University of South-Eastern Norway (USN), Post Office Box 235, 3603, Kongsberg, Norway
| | - Monika K Gullslett
- University of South-Eastern Norway (USN), Post Office Box 235, 3603, Kongsberg, Norway
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