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Nilsing Strid E, Wallin L, Nilsagård Y. Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals. Scand J Prim Health Care 2024; 42:201-213. [PMID: 38241166 PMCID: PMC10851800 DOI: 10.1080/02813432.2023.2301556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 12/28/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored. DESIGN This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research. SETTING AND PARTICIPANTS The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals. RESULTS Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice. CONCLUSION To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04799860.
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Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Nilsagård
- University Health Care Research Center, Örebro University, Örebro, Sweden
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Rudman A, Boström AM, Wallin L, Gustavsson P, Ehrenberg A. The use of the evidence-based practice process by experienced registered nurses to inform and transform clinical practice during the COVID-19 pandemic: A longitudinal national cohort study. Worldviews Evid Based Nurs 2024; 21:14-22. [PMID: 38084830 DOI: 10.1111/wvn.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, many registered nurses (RNs) worked on the frontline caring for severely ill patients. They did so with limited knowledge of how to treat and prevent the disease. This extreme situation puts pressure on RNs to find evidence on which to base the care of their patients. AIMS To examine: (1) the extent to which evidence-based practice (EBP) process was applied by Swedish RN cohorts 15-19 years after graduation during the pandemic, (2) whether there was any change to their EBP process from pre-pandemic to late pandemic, (3) the relationship between RNs' use of the EBP process and the duration of exposure to work situations severely affected by the COVID-19 pandemic, and (4) whether level of education, position and care setting were associated with the extent of RNs' EBP process. METHODS In 2021, the level of EBP activities was investigated among 2237 RNs 15-19 years after graduation. The scale used to measure EBP consisted of six items of the EBP process. Unpaired t-tests or one-way analysis of variance (ANOVA) were used in the analysis. RESULTS RNs used the EBP process to a moderate extent to inform and transform their clinical practice. There was a minor but significant decrease in practicing the EBP process from pre-pandemic to late in the pandemic. RNs who were most affected by the pandemic scored higher on the scale than less-affected colleagues. RNs in nonclinical positions reported more EBP activities, as did RNs in management positions. RNs working in outpatient settings reported more EBP activities than their colleagues in hospitals. LINKING EVIDENCE TO ACTION It is imperative that RNs hone their skills in EBP if they are to be prepared for future healthcare crises. Healthcare providers have a duty to facilitate the development of EBP and, in this regard, RNs in clinical positions in hospitals need particular support.
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Affiliation(s)
- Ann Rudman
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Petter Gustavsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Gyllensten H, Tistad M, Fridberg H, Wallin L. Analysis on personnel costs and working time for implementing a more person-centred care approach: a case study with embedded units in a Swedish region. BMJ Open 2023; 13:e073829. [PMID: 37821128 PMCID: PMC10582865 DOI: 10.1136/bmjopen-2023-073829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES Our aim was to describe the time and costs used during the implementation of a more person-centred care (PCC) approach as part of ordinary practice. DESIGN A case study with embedded units. SETTING Region Dalarna, Sweden. PARTICIPANTS The Department for Development (DD) staff who provided a central support function in the implementation and six healthcare units: nephrology, two geriatric care and rehabilitation units, two psychiatry units and primary care. INTERVENTIONS More PCC. PRIMARY AND SECONDARY OUTCOME MEASURES Working days and related salary costs reported by categories indicating costs for implementation strategies, service delivery, and research/development costs. RESULTS The healthcare units logged on average 5.5 working days per staff member. In the healthcare units, 6%-57% of the time reported was used for implementation strategies, 40%-90% for service delivery and 2%-12% for research/development. Of the time reported by the DD, 88% was assigned to implementation strategies. Costs associated with reported time indicated 23% of costs for this implementation occurred in the DD. Using the budgeted cost, this proportion increased to 48%. The budget for the DD corresponded to SEK 2.30 per citizen per year and 0.009% of the total healthcare budget of the region. CONCLUSIONS The study found that a large part of resources used for this implementation of more PCC occurred in the DD, although at least half of the costs occurred in the healthcare units. Moreover, the cost of providing a central support function corresponds to a tiny proportion of the total health budget.
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Affiliation(s)
- Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care, Gothenburg, Sweden
| | - Malin Tistad
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Helena Fridberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lars Wallin
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Gustavsson C, Nordqvist M, Bruhn ÅB, Bröms K, Jerdén L, Kallings LV, Wallin L. Process evaluation of an implementation intervention to facilitate the use of the Swedish Physical Activity on Prescription in primary healthcare. BMC Health Serv Res 2023; 23:996. [PMID: 37715160 PMCID: PMC10504760 DOI: 10.1186/s12913-023-09974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/27/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The Swedish Physical Activity on Prescription (PAP-S) is a method for healthcare to promote physical activity for prevention and treatment of health disorders. Despite scientific support and education campaigns, the use has been low. The aim of this study was to perform a process evaluation of an implementation intervention targeting the use of the PAP-S method in primary healthcare (PHC). Specifically, we wanted to evaluate feasibility of the implementation intervention, and its effect on the implementation process and the outcome (number of PAP-S prescriptions). METHODS This was a longitudinal study using the Medical Research Council guidance for process evaluation of a 9-month implementation intervention among healthcare staff at three PHC centres in Sweden. Data was collected by: participatory observations of the implementation process; questionnaires to the staff before, after and 6 months after the implementation intervention; interviews after the implementation intervention; and number of PAP-S prescriptions. RESULTS During the implementation intervention, the workplaces' readiness-to-change and the healthcare staff's confidence in using the PAP-S method were favourably influenced, as was the number of PAP-S prescriptions. After the implementation intervention, the number of PAP-S prescriptions decreased to about the same number as before the implementation intervention, at two out of three PHC centres. Four of the six implementation strategies appeared to impact on the implementation process: external facilitation; leadership engagement by a committed workplace management; local PAP-S coordinator taking a leading role and acting as local champion; educational outreach concerning how to use the PAP-S method. CONCLUSION The implementation intervention was not sufficient to produce sustained change of the healthcare staff's behaviour, nor did it achieve favourable long-term outcome on the number of PAP-S prescriptions. The healthcare staffs' sparse knowledge of the PAP-S method prior to the implementation intervention hampered the implementation. More hands-on education in how to use the PAP-S method introduced early in the implementation process is imperative for successful implementation of the PAP-S method. The findings also suggest that committed workplace management and local PAP-S coordinators, taking leading roles and acting as local champions, need to be firmly established at the PHC centres before the external facilitator withdraws. TRIAL REGISTRATION Registered in the ISRCTN registry with study registration number: ISRCTN15551042 (Registration date: 12/01/2016).
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Affiliation(s)
- Catharina Gustavsson
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
| | - Maria Nordqvist
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
| | - Åsa Bergman Bruhn
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Kristina Bröms
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
| | - Lars Jerdén
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Lena V. Kallings
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences (GIH), Box 5626, 114 86 Stockholm, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
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Strid EN, Wallin L, Nilsagård Y. Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study. BMC Prim Care 2023; 24:122. [PMID: 37328813 PMCID: PMC10273504 DOI: 10.1186/s12875-023-02079-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is moderate to strong evidence of the effectiveness of health-promotion interventions, but implementation in routine primary health care (PHC) has been slow. In the Act in Time project implementation support is provided for a health promotion practice using individually targeted lifestyle interventions in a PHC setting. Identifying health care professionals' (HCPs') perceptions of barriers and facilitators helps adapt implementation activities and achieve a more successful implementation. This study aimed, at a pre-implementation stage, to describe the expectations of managers, appointed internal facilitators (IFs) and HCPs on implementing a healthy lifestyle-promoting practice in PHC. METHODS In this qualitative study five focus group discussions with 27 HCPs and 16 individual interviews with managers and appointed IFs were conducted at five PHC centres in central Sweden. The PHC centres are participating in the Act in Time project, evaluating the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice. A deductive qualitative content analysis based on the Consolidated Framework for Implementation Research (CFIR) was followed using inductive analysis. RESULTS Twelve constructs from four of five CFIR domains were derived: Innovation characteristics, Outer setting, Inner setting, and Characteristics of individuals. These domains are related to the expectations of HCPs to implement a healthy lifestyle-promoting practice, which includes facilitating factors and barriers. The inductive analysis showed that the HCPs perceived a need for a health-promotion approach to PHC. It serves the needs of the patients and the expectations of the HCPs, but lifestyle interventions must be co-produced with the patient. The HCPs expected that changing routine practice into a healthy lifestyle-promoting practice would be challenging, requiring sustainability, improved structures, cooperation in inter-professional teams, and a common purpose. A collective understanding of the purpose of changing practice was vital to successful implementation. CONCLUSIONS The HCPs valued implementing a healthy lifestyle-promoting practice in a PHC setting. However, changing routine methods was challenging, implying that the implementation strategy should address obstacles and facilitating factors identified by the HCPs. TRIAL REGISTRATION This study is part of the Act in Time project, registered in ClinicalTrials.gov with the number NCT04799860 . Registered 03 March 2021.
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Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Nilsagård
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Bergström A, Hoa DP, Nga NT, Hoa T, Tu TT, Lien PTL, Trang T, Wallin L, Persson LÅ, Eriksson L. A facilitated social innovation: stakeholder groups using Plan-Do-Study-Act cycles for perinatal health across levels of the health system in Cao Bang province, Vietnam. Implement Sci Commun 2023; 4:24. [PMID: 36899419 PMCID: PMC9999598 DOI: 10.1186/s43058-023-00403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Universal coverage of evidence-based interventions for perinatal health, often part of evidence-based guidelines, could prevent most perinatal deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to the implementation of evidence-based guidelines, but successful use of social innovations relies on the engagement of communities and health system actors. This proof-of-concept study aimed to assess whether an earlier successful social innovation for improved neonatal survival that employed regular facilitated Plan-Do-Study-Act meetings on the commune level was feasible and acceptable when implemented on multiple levels of the health system (52 health units) and resulted in actions with plausibly favourable effects on perinatal health and survival in Cao Bang province, northern Vietnam. METHODS The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided the implementation and evaluation of the Perinatal Knowledge-Into-Practice (PeriKIP) project. Data collection included facilitators' diaries, health workers' knowledge on perinatal care, structured observations of antenatal care, focus group discussions with facilitators, their mentors and representatives of different actors of the initiated stakeholder groups and an individual interview with the Reproductive Health Centre director. Clinical experts assessed the relevance of the identified problems and actions taken based on facilitators' diaries. Descriptive statistics included proportions, means, and t-tests for the knowledge assessment and observations. Qualitative data were analysed by content analysis. RESULTS The social innovation resulted in the identification of about 500 relevant problems. Also, 75% of planned actions to overcome prioritised problems were undertaken, results presented and a plan for new actions to achieve the group's goals to enhance perinatal health. The facilitators had significant roles, ensuring that the stakeholder groups were established based on principles of mutual respect. Overall, the knowledge of perinatal health and performance of antenatal care improved over the intervention period. CONCLUSIONS The establishment of facilitated local stakeholder groups can remedy the need for tailored interventions and grassroots involvement in perinatal health and provide a scalable structure for focused efforts to reduce preventable deaths and promote health and well-being.
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Affiliation(s)
- Anna Bergström
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Institute for Global Health, University College London, London, UK.
| | - Dinh Phuong Hoa
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam.,Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Thu Nga
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Trieu Hoa
- Provincial Reproductive Health Bureau, Provincial Health Bureau, Cao Bang, Vietnam
| | - Tran Thanh Tu
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Pham Thi Lan Lien
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Tran Trang
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
| | | | - Leif Eriksson
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
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Tistad M, Bergström A, Elf M, Eriksson L, Gustavsson C, Göras C, Harvey G, Källberg AS, Rudman A, Unbeck M, Wallin L. Training and support for the role of facilitator in implementation of innovations in health and community care: a scoping review protocol. Syst Rev 2023; 12:15. [PMID: 36721192 PMCID: PMC9887841 DOI: 10.1186/s13643-023-02172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/13/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Implementing and sustaining innovations in clinical practice, such as evidence-based practices, programmes, and policies, is frequently described as challenging. Facilitation as a strategy for supporting implementation requires a facilitator, i.e. an individual with a designated role to support the implementation process. A growing number of studies report that facilitation can help tackle the challenges in implementation efforts. To optimise the potential contribution of facilitation as a strategy to improve the implementation of new practices, there is a need to enhance understanding about what training and support is required for individuals in the facilitator role. The objective of this scoping review is to map how facilitators have been trained for, and supported in, the facilitator role in implementation studies in health and community care. Specifically, the review aims to examine what is reported on training and support of facilitators in terms of learning outcomes, content, dose, mode of delivery, learning activities, and qualifications of the trainers and how the facilitators perceive training and support. METHODS This scoping review will follow the guidance of the Joanna Briggs Institute and the PRISMA Extension for Scoping Review checklist. We will include articles in which (a) facilitation is deployed as an implementation strategy, with identified facilitator roles targeting staff and managers, to support the implementation of specified innovations in health or community care, and (b) training and/or support of facilitators is reported. We will exclude articles where facilitation is directed to education or training in specific clinical procedures or if facilitation supports the implementation of general quality improvement systems. All types of peer-reviewed studies and study protocols published in English will be included. A systematic search will be performed in MEDLINE (Ovid), Embase (embase.com), Web of Science Core Collection, and CINAHL (Ebsco). DISCUSSION The proposed scoping review will provide a systematic mapping of the literature on the training and support of implementation facilitators and contribute useful knowledge within the field of implementation science to inform future facilitation initiatives. SYSTEMATIC REVIEW REGISTRATION Registered at Open Science Framework (registration https://doi.org/10.17605/OSF.IO/M6NPQ ).
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Affiliation(s)
- Malin Tistad
- School of Health and Welfare, Dalarna University, Falun, SE 791 88, Sweden. .,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
| | - Anna Bergström
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala, SE 751 85, Sweden
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, SE 791 88, Sweden
| | - Leif Eriksson
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala, SE 751 85, Sweden
| | - Catharina Gustavsson
- School of Health and Welfare, Dalarna University, Falun, SE 791 88, Sweden.,Center for Clinical Research Dalarna-Uppsala University, Nissers väg 3, Falun, SE 791 82, Sweden.,Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Camilla Göras
- School of Health and Welfare, Dalarna University, Falun, SE 791 88, Sweden
| | - Gill Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Ann-Sofie Källberg
- School of Health and Welfare, Dalarna University, Falun, SE 791 88, Sweden
| | - Ann Rudman
- School of Health and Welfare, Dalarna University, Falun, SE 791 88, Sweden
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, SE 791 88, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, Falun, SE 791 88, Sweden
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Eldh AC, Hälleberg-Nyman M, Joelsson-Alm E, Wallin L. Facilitating facilitators to facilitate-Some general comments on a strategy for knowledge implementation in health services. Front Health Serv 2023; 3:1112936. [PMID: 37138952 PMCID: PMC10149731 DOI: 10.3389/frhs.2023.1112936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/23/2023] [Indexed: 05/05/2023]
Abstract
Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators' activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Correspondence: Ann Catrine Eldh
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
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Sedelius H, Tistad M, Bergsten U, Dehlin M, Iggman D, Wallin L, Svärd A. Professionals’ perspectives on existing practice and conditions for nurse-led gout care based on treatment recommendations: a qualitative study in primary healthcare. BMC Prim Care 2022; 23:71. [PMID: 35392809 PMCID: PMC8988383 DOI: 10.1186/s12875-022-01677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
Background Gout affects nearly 2 % of the population and is associated with repeated painful flares of arthritis. Preventive urate-lowering therapy is widely available, but only one third of patients receive adequate treatment. Lack of knowledge among healthcare professionals and patients within primary healthcare are implicated as partial explanations for this undertreatment. Nurse-led care has proved to be an effective model when treating patients with gout, but there is a need for more knowledge about factors that can be expected to influence the future implementation of such care. The aim of this study was to describe factors influencing existing gout care in primary healthcare and the conditions for a future implementation of nurse-led gout care based on national treatment recommendations. Methods In this qualitative study, focus group discussions with 56 nurses and physicians and individual interviews with eight managers were conducted at nine primary healthcare units in central Sweden. A deductive qualitative content analysis based on the main constructs of the framework Integrated Promoting Action on Research Implementation in Health Services was followed by an inductive analysis within the frames of the main constructs: innovation, recipients and context. Results Gout-related contacts with primary healthcare was described as being patient initiated, diagnostics was in some respects complex and nurse-led care was experienced as a favourable primary healthcare model in general (innovation). Gout was seen as a low-priority condition with acute flares and there was inadequate knowledge of gout, including preventive treatment (recipients). Primary healthcare was perceived as having a holistic but fragmented responsibility for gout care, recommendations against keeping waiting lists complicated follow-up appointments and a need for motivation and support when introducing new practices was emphasised (context). Conclusion In this study, investigating the perspective of professionals, several factors were found to influence existing gout care. It will be crucial to target these factors in the development of a future implementation strategy. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01677-z.
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Fridberg H, Wallin L, Tistad M. Tracking, naming, specifying, and comparing implementation strategies for person-centred care in a real-world setting: a case study with seven embedded units. BMC Health Serv Res 2022; 22:1409. [PMID: 36424611 PMCID: PMC9685853 DOI: 10.1186/s12913-022-08846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector face two intertwined and complex challenges. First, making sense of PCC as an intervention with complex innovation characteristics and second, staging implementation of PCC by choosing appropriate implementation strategies. We aimed to explore one of these challenges by tracking, naming, specifying, and comparing which strategies and how strategies were enacted to support the implementation of more PCC in a real-world setting represented by one health care region in Sweden. METHODS A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification. RESULTS Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%. CONCLUSIONS Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.
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Affiliation(s)
- Helena Fridberg
- grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lars Wallin
- grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden ,grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Malin Tistad
- grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden ,grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Fridberg H, Wallin L, Tistad M. Operationalisation of person-centred care in a real-world setting: a case study with six embedded units. BMC Health Serv Res 2022; 22:1160. [PMID: 36104690 PMCID: PMC9476689 DOI: 10.1186/s12913-022-08516-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although person-centred care (PCC) is growing globally in popularity it is often vague and lacks conceptual clarity and definition. The ambiguity stretches from PCC’s underlying philosophical principles and definitions of the concept to how it is operationalised and practised on the ground by health care professionals. We explore how the PCC model by the Gothenburg University Centre for Person-centred Care (GPCC) was operationalised in a real-world setting by using a set of recommendations by Fixsen and others that define and structure the core components of innovations in four distinct but interrelated components: philosophical principles and values, contextual factors, structural elements and core practices. Thus, this study aimed to increase knowledge about core practices in PCC in six health care units in real-world circumstances. Methods A case study with six embedded health care units was conducted from 2016 to 2019. We collected data from three sources: interviews (n = 12) with change agents, activity logs and written documents. Data were triangulated, and core practices were identified and deductively coded to the PCC model’s structural elements: initiating, working and safeguarding the partnership with patients. Results We identified operationalisations of PCC in line with the three structural elements in the GPCC model at all included health care units. A range of both similarities and dissimilarities between units were identified, including the level of detail in describing PCC practices, when these practices were conducted and by whom at the workplace. The recommendations for describing the core components of PCC also helped us identify how some operationalisations of PCC seemed more driven by contextual factors, including a new regulation for planning and documenting care across health care specialities. Conclusions Our findings show how PCC is operationalised in different health care units in a real-world setting based on change agents’ understanding of the concept and their unique context. Increased knowledge of PCC and its philosophical principles and values, contextual factors, structural elements and core practices, is necessary to build a common understanding of the PCC-concept. Such knowledge is essential when PCC is operationalised as part of implementation efforts in health care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08516-y.
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Strid EN, Wallin L, Nilsagård Y. Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the "Act in Time" Mixed Methods Process Evaluation Study. JMIR Res Protoc 2022; 11:e37634. [PMID: 35984700 PMCID: PMC9440414 DOI: 10.2196/37634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background There is growing evidence that noncommunicable diseases (NCDs) can be attributable to unhealthy lifestyle habits. However, there has been little application of this knowledge in primary health care (PHC). Objective This study aims to evaluate the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a PHC setting. This practice is based on national guidelines targeting unhealthy lifestyle habits with a potential risk for NCDs. Methods A pre-post implementation study design with a control group is used in a PHC setting in central Sweden. The Medical Research Council guidelines for process evaluation of complex interventions will be applied. The implementation process and outcomes will be assessed using a mix of qualitative and quantitative methods. A strategic sample of up to 6 PHC centers will be included as intervention centers, which will receive a 12-month multifaceted implementation strategy. Up to 6 matched PHC centers will serve as controls. Core components in the implementation strategy are external and internal facilitators in line with the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Astrakan change leadership model. Data will be collected at baseline, during the implementation phase, and 4-6 months after the implementation strategy. Questionnaires will be sent to roughly 500 patients in every PHC center and 200 health care professionals (HCPs) before and after implementation. In addition, purposeful sampling will be used for interviews and focus group discussions with managers, HCPs, patient representatives, and internal and external facilitators. Use of data from medical records and activity logs will be an additional data source. Results Recruitment of PHC centers began in March 2021 and ended in Spring 2022. Based on the planned timeline with the 12-month implementation strategy and 4-6-month follow-up, we expect to collect the final data in Summer 2023. Conclusions This study will explain implementation process and outcomes using a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a real-world PHC context. The study is expected to provide new knowledge about the role of facilitators and their contribution to implementation outcomes. These findings can guide policy makers, managers, and PHC staff to integrate health promotion and disease prevention in PHC and provide methodological support to facilitators. Trial Registration ClinicalTrials.gov NCT04799860; https://clinicaltrials.gov/ct2/show/NCT04799860 International Registered Report Identifier (IRRID) DERR1-10.2196/37634
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Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Nilsagård
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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13
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af Winklerfelt Hammarberg S, Björkelund C, Nejati S, Magnil M, Hange D, Svenningsson I, Petersson EL, André M, Udo C, Ariai N, Wallin L, Wikberg C, Westman J. Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trial. BMC Prim Care 2022; 23:198. [PMID: 35945493 PMCID: PMC9361666 DOI: 10.1186/s12875-022-01803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022]
Abstract
Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study was to compare the long-term effectiveness of care management and usual care for primary care patients with depression on depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and 24 months after the start of the intervention. Methods Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control) in the regions of Västra Götaland and Dalarna, Sweden. Patients ≥18 years with newly diagnosed mild to moderate depression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed a structured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care manager followed up symptoms and treatment, encouraged behavioral activation, provided education, and communicated with the patient’s general practitioner as needed. Patients at control centers received usual care. Adjusted mixed model repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptoms and remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specific questionnaire). Results The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) but not 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differences in remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from the primary care center. Conclusions Patients with depression who had a care manager maintained their 6-month improvements in symptoms at the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients with care managers also had significantly more confidence in primary care and belief in future support than controls. Trial registration ClinicalTrials.gov identifier: NCT02378272. Submitted 2/2/2015. Posted 4/3/2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01803-x.
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14
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Elf M, Klockar E, Kylén M, von Koch L, Ytterberg C, Wallin L, Finch T, Gustavsson C, Jones F. Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study. JMIR Res Protoc 2022; 11:e37672. [PMID: 35522476 PMCID: PMC9123550 DOI: 10.2196/37672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients’ confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided. Objective The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context. Methods We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design. Results Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022. Conclusions This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management. International Registered Report Identifier (IRRID) DERR1-10.2196/37672
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Affiliation(s)
- Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Erika Klockar
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Maya Kylén
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Neuro Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Catharina Gustavsson
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Fiona Jones
- Faculty of Health and Social Care Sciences, Kingston University and St George's, University of London, London, United Kingdom
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Andersen RD, Genik L, Alriksson‐Schmidt AI, Anderzen‐Carlsson A, Burkitt C, Bruflot SK, Chambers CT, Jahnsen RB, Jeglinsky‐Kankainen I, Kildal OA, Ramstad K, Sheriko J, Symons FJ, Wallin L, Andersen GL. Pain burden in children with cerebral palsy (CPPain) survey: Study protocol. Paediatric and Neonatal Pain 2022; 4:12-22. [PMID: 35546915 PMCID: PMC8975236 DOI: 10.1002/pne2.12049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
Pain is a significant health concern for children living with cerebral palsy (CP). There are no population‐level or large‐scale multi‐national datasets using common measures characterizing pain experience and interference (ie, pain burden) and management practices for children with CP. The aim of the CPPain survey is to generate a comprehensive understanding of pain burden and current management of pain to change clinical practice in CP. The CPPain survey is a comprehensive cross‐sectional study. Researchers plan to recruit approximately 1400 children with CP (primary participants) across several countries over 6‐12 months using multimodal recruitment strategies. Data will be collected from parents or guardians of children with CP (0‐17 years) and from children with CP (8‐17 years) who are able to self‐report. Siblings (12‐17 years) will be invited to participate as controls. The CPPain survey consists of previously validated and study‐specific questionnaires addressing demographic and diagnostic information, pain experience, pain management, pain interference, pain coping, activity and participation in everyday life, nutritional status, mental health, health‐related quality of life, and the effect of the COVID‐19 pandemic on pain and access to pain care. The survey will be distributed primarily online. Data will be analyzed using appropriate statistical methods for comparing groups. Stratification will be used to investigate subgroups, and analyses will be adjusted for appropriate sociodemographic variables. The Norwegian Regional Committee for Medical and Health Research Ethics and the Research Ethics Board at the University of Minnesota in USA have approved the study. Ethics approval in Canada, Sweden, and Finland is pending. In addition to dissemination through peer‐reviewed journals and conferences, findings will be communicated through the CPPain Web site (www.sthf.no/cppain), Web sites directed toward users or clinicians, social media, special interest groups, stakeholder engagement activities, articles in user organization journals, and presentations in public media.
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Affiliation(s)
- Randi Dovland Andersen
- Department of Research Telemark Hospital Skien Norway
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway
| | - Lara Genik
- Department of Psychology University of Guelph Guelph ON Canada
| | - Ann I. Alriksson‐Schmidt
- Department of Clinical Sciences Lund Skåne University Hospital Orthopedics Lund University Lund Sweden
| | - Agneta Anderzen‐Carlsson
- University Health Care Research Center and Swedish Institute for Disability Research Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Chantel Burkitt
- Gillette Children's Specialty Healthcare Saint Paul MN USA
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
| | - Sindre K. Bruflot
- Telemark Chapter of the Norwegian Cerebral Palsy Association Skien Norway
| | - Christine T. Chambers
- Departments of Psychology & Neuroscience and Pediatrics Dalhousie University Halifax NS Canada
- Centre for Pediatric Pain Research IWK Health Centre Nova Scotia Canada
| | - Reidun B. Jahnsen
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway
- Department of Clinical Neurosciences for Children Oslo University Hospital Oslo Norway
| | | | - Olav Aga Kildal
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway
- Department of Child and Adolescent Health Services Telemark Hospital Trust Skien Norway
| | - Kjersti Ramstad
- Department of Paediatric Neurology Oslo University Hospital Oslo Norway
| | - Jordan Sheriko
- Department of Pediatrics Dalhousie University Halifax NS Canada
- Rehabilitation Services IWK Health Halifax NS Canada
| | - Frank J. Symons
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
| | - Lars Wallin
- School of Education, Health and Social Studies Dalarna University Falun Sweden
| | - Guro L. Andersen
- The Cerebral Palsy Registry of Norway Vestfold Hospital Trust Tønsberg Norway
- Department of Clinical and Molecular Medicine Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
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Tistad M, Wallin L, Carlström E. A comparison of three organisational levels in one health care region in Sweden implementing person-centred care: coupled, decoupled or recoupled in a complex organisation. BMC Health Serv Res 2022; 22:196. [PMID: 35164765 PMCID: PMC8842547 DOI: 10.1186/s12913-022-07548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Establishing more substantial patient involvement in the health care has become fundamental to Western health care services. Person-centred care (PCC) has been developed as a way of working that involve the patients and family members. However, the implementation of PCC in clinical practice has proven to be challenging. The aim of this study was to explore the congruence of managers’ perceptions and understanding of various aspects of PCC across three organisational levels in one health care region in Sweden in terms of coupling, decoupling and recoupling. Methods A policy on increased patient participation in health care was adopted in one health care region in Sweden. This policy was embodied in the form of PCC and a support strategy for the implementation was put in place. Participants representing three organisational levels (senders: politicians, n = 3; messengers: senior management, n = 7; and receivers: middle- and frontline managers, n = 13) were interviewed and documents collected. A deductive qualitative content analysis was performed and findings from the three organisational levels compared. Results Descriptions of PCC at all the three organisational levels included health care provided in partnership between provider and patient. However, messengers and receivers also included aspects of how work was organised as part of the concept. Representatives at all levels expected high-quality care while reducing health care costs as an outcome, however, messengers and receivers also anticipated improvements in the work environment and reduced staff turnover. Strategies to support implementation included continuation and enhancement of existing routines that were considered person-centred and development of new ones. A need to make PCC less ‘fuzzy’ and ambiguous and instead communicate a more tangible care process was described. Representatives among messengers and receivers also suggested that no actions were needed because the practice was already considered person-centred. Conclusion The findings indicated that congruence between organisational levels existed in some aspects, suggesting coupling between policy and practice. However, also incongruences were identified that might be due to the fuzziness of definitions and the application of PCC in practice, and the difficulty in assessing the level of patient-centredness in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07548-8.
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Affiliation(s)
- Malin Tistad
- School of Health and Welfare, Dalarna University, SE 791 88, Falun, Sweden. .,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, SE 791 88, Falun, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Carlström
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Saarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project. BMC Health Serv Res 2022; 22:153. [PMID: 35123454 PMCID: PMC8817652 DOI: 10.1186/s12913-022-07549-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Although transition programs have been evaluated for adolescents with chronic conditions, these have rarely involved process evaluations. Indeed, outcomes of complex interventions are dependent on how the intervention is implemented in practice and evaluations of implementation process are therefore pivotal. The aim of this study was to evaluate the extent to which a transition program for adolescents with congenital heart disease was delivered as intended. Research questions were 1) to what level of fidelity was the program delivered? and 2) what potential moderating factors affected the delivery of the program and overall fidelity? Methods A mixed methods design was used, where a process evaluation was embedded in the STEPSTONES randomized controlled trial in Sweden. The implementation fidelity framework by Carrol (2007) and Hasson (2010) was used to design, collect and analyze data. Quantitative data consisted of intervention records on adherence and were analyzed with descriptive statistics. Qualitative data on moderators affecting fidelity were collected through interviews, log-books and focus group interviews with healthcare professionals implementing the intervention and participatory observations of the implementation process. Data were analyzed with deductive content analysis. Triangulation was used to integrate quantitative and qualitative data within the fidelity framework. Results Six out of eight components of the transition program were delivered to an extent that adhered to the program theory or achieved a high level of fidelity. However, components involving peer support had a low attendance by the participating sample (32.2%), and the joint transfer meeting was challenging to implement, despite achieving high adherence. Moderators affecting the implementation process were the adolescent’s and healthcare professional’s engagement in the intervention, contextual factors and a lack of standard operating procedures for all components in the program. Conclusion Barriers and facilitators for a future implementation of transition programs have been illuminated in this study. The use of an implementation fidelity framework in the process evaluation proved successful in providing a comprehensive evaluation of factors affecting the implementation process. However, implementation fidelity must be considered in relation to adaptations to the local and personal prerequisites in order to create interventions that can achieve fit. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07549-7.
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Wolf E, Månsson S, Wallin L, Priebe G. Child Sexual Abuse-Challenging Conditions for Adult Oral Health: A Qualitative Study. JDR Clin Trans Res 2021; 8:23800844211053775. [PMID: 34704485 PMCID: PMC9772891 DOI: 10.1177/23800844211053775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim was to analyze perceptions of oral health in adults who have been exposed to child sexual abuse. Eleven participants (10 women), 19 to 56 y of age, who had experienced sexual abuse as children were purposively selected and interviewed in-depth. The participants were encouraged to describe how they perceived the effect of the sexual abuse on their oral health as adults. The interviews were recorded digitally and transcribed verbatim. The collected material was analyzed according to qualitative content analysis. The theme "challenging conditions for maintaining oral health" was identified, comprising 2 categories: first, "the emotional significance," with the subcategories 1) emotional barriers and 2) powerful relief, and second, "the obstacles to oral health," with the subcategories 1) daily self-care with complications and 2) dental appointments with difficulties. The findings indicate that the experience of sexual abuse during childhood can have a negative impact on oral care in adulthood. The informants stated that oral health was of utmost importance but also associated with strong emotions. There were obstacles to maintenance of oral health that were difficult to surmount.Knowledge Transfer Statement:The study provides access to the attitudes of survivors of child sexual abuse regarding oral health and the needs and obstacles that they experience. This is important knowledge for dental professionals to optimize dental care.
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Affiliation(s)
- E. Wolf
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - S. Månsson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - L. Wallin
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - G. Priebe
- Department of Psychology, Lund University, Lund, Sweden
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Fritz J, Almqvist L, Söderlund A, Wallin L, Sandborgh M. Patients' health outcomes after an implementation intervention targeting the physiotherapists' clinical behaviour. Arch Physiother 2021; 11:22. [PMID: 34625120 PMCID: PMC8501639 DOI: 10.1186/s40945-021-00116-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background A behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach. Methods An explorative and comparative pre−/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used. Results There were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support. Conclusion It is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients’ outcomes in this study. Most of the patients’ health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach. Trial registration The study protocol was retrospectively registered in ClinicalTrials.gov. ID NCT03118453, March 20, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-021-00116-z.
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Affiliation(s)
- Johanna Fritz
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden.
| | - Lena Almqvist
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Maria Sandborgh
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden
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Fridberg H, Wallin L, Tistad M. [The innovation characteristics of person-centred care as perceived by healthcare professionals: an interview study employing a deductive-inductive content analysis guided by the consolidated framework for implementation research. BMC Health Serv Res 2021; 21:904. [PMID: 34479553 PMCID: PMC8414852 DOI: 10.1186/s12913-021-06942-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Person-centred care (PCC) is promoted as an innovation that will improve patients' rights and increase their participation in healthcare. Experience shows that the implementation of PCC is challenging and often results in varying levels of adoption. How health care professionals (HCPs) perceive an innovation such as PCC is an important factor to consider in implementation. Yet, such studies are scarce. Thus, in a sample of healthcare units in a region in Sweden, involved in a transition to PCC, we aimed to investigate HCPs' perceptions of PCC. METHODS An interview study was conducted in 2018 during the implementation of PCC with HCPs (n = 97) representing diverse vocational roles in six healthcare contexts. Data were collected via focus groups (n = 15), dyadic interviews (n = 5), and individual interviews (n = 22) and analysed using a deductive-inductive content analysis. The deductive approach was guided by the Consolidated Framework for Implementation Research (CFIR), followed by an inductive analysis to describe HCPs' in-depth perceptions of PCC in relation to each of the CFIR constructs. RESULTS Eight constructs from two of the CFIR domains, Intervention characteristics and Inner setting, were used to code HCPs' perceptions of PCC. One construct, Observability, was added to the coding sheet to fully describe all the data. The constructs Relative advantage, Complexity, Compatibility, Observability, and Available resources were discussed in depth by HCPs and resulted in rich and detailed data in the inductive data analysis. This analysis showed large variations in perceptions of PCC among HCPs, based on factors such as the PCCs ethical underpinnings, its operationalisation into concrete working routines, and each HCPs' unique recognition of PCC and the value they placed on it. CONCLUSIONS We identified nine CFIR constructs that seem pertinent to HCPs' perceptions of PCC. HCPs report an array of mixed perceptions of PCC, underlining its complex nature. The perceptions are shaped by a range of factors, such as their individual understandings of the concept and the operationalisation of PCC in their local context. Stakeholders in charge of implementing PCC might use the results as a guide, delineating factors that may be important to consider in a wide range of healthcare contexts.
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Affiliation(s)
- Helena Fridberg
- School of Health and Welfare, Dalarna University, Falun, Sweden.
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Malin Tistad
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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21
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Gustafsson IB, Winblad U, Wallin L, Fredriksson M. Factors that shape the successful implementation of decommissioning programmes: an interview study with clinic managers. BMC Health Serv Res 2021; 21:805. [PMID: 34384416 PMCID: PMC8361631 DOI: 10.1186/s12913-021-06815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As a response to many years of repetitive budget deficits, Region Dalarna in Sweden started a restructuring process in 2015, and implemented a decommissioning programme to achieve a balanced budget until 2019. Leading politicians and public servants took the overall decisions about the decommissioning programme, but the clinical decision-making and implementation was largely run by the clinic managers and their staff. As the decommissioning programme improved the finances, met relatively little resistance from the clinical departments, and neither patient safety nor quality of care were perceived to be negatively affected, the initial implementation could be considered successful. The aim of this study was to investigate clinic managers' experience of important factors enabling the successful implementation of a decommissioning programme in a local healthcare organization. METHODS Drawing on a framework of factors and processes that shape successful implementation of decommissioning decisions, this study highlights the most important factors that enabled the clinic managers to successfully implement the decommissioning programme. During 2018, an interview study was conducted with 26 clinic managers, strategically selected to represent psychiatry, primary care, surgery and medicine. A deductive content analysis was used to analyze the interviews. By applying a framework to the data, the most important factors were illuminated. RESULTS The findings highlighted factors and processes crucial to implementing the decommissioning programme: 1) create a story to get a shared image of the rationale for change, 2) secure an executive leadership team represented by clinical champions, 3) involve clinic managers at an early stage to ensure a fair decision-making process, 4) base the decommissioning decisions on evidence, without compromising quality and patient safety, 5) prepare the organisation to handle a process characterised by tensions and strong emotions, 6) communicate demonstrable benefits, 7) pay attention to the need of cultural and behavioral change and 8) transparently evaluate the outcome of the process. CONCLUSIONS From these findings, we conclude that in order to successfully implement a decommissioning programme, clinic managers and healthcare professions must be given and take responsibility, for both the process and outcome.
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Affiliation(s)
- Inga-Britt Gustafsson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
- Dalarna County Council, Falun, Sweden.
- Centre for Clinical Research, Falun, Dalarna, Sweden.
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Lars Wallin
- Dalarna County Council, Falun, Sweden
- Centre for Clinical Research, Falun, Dalarna, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Mio Fredriksson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
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22
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Saarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Mechanisms of impact and experiences of a person-centred transition programme for adolescents with CHD: the Stepstones project. BMC Health Serv Res 2021; 21:573. [PMID: 34112174 PMCID: PMC8194131 DOI: 10.1186/s12913-021-06567-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background During the past decade there has been some evaluation of transition programmes for adolescents with chronic conditions. However, this has rarely involved process evaluations focusing on mechanisms leading to outcomes, thus hampering implementation of these complex interventions. Our aim was to (I) describe adolescents’ and parents’ experiences of participating in a person-centred transition programme aiming to empower them in transition to adulthood and (II) explore the mechanisms of impact. Methods A qualitative process evaluation was performed, embedded in a randomized controlled trial evaluating the effectiveness of a transition programme for adolescents with congenital heart disease in Sweden. A purposive sample of 14 adolescents and 12 parents randomized to the intervention group were interviewed after participation in the programme. Data were analysed deductively and inductively in NVivo v12. Results Experiences of participation in the transition programme were generally positive. Meeting a transition coordinator trained in person-centred care and adolescent health and embarking on an educational process based on the adolescents’ prerequisites in combination with peer support were considered key change mechanisms. However, support to parents were not sufficient for some participants, resulting in ambivalence about changing roles and the unmet needs of parents who required additional support. Conclusions Participants experienced increased empowerment in several dimensions of this construct, thus demonstrating that the transition programme was largely implemented as intended and the evidence-based behaviour-change techniques used proved effective in reaching the outcome. These findings can inform future implementation of transition programmes and illuminate challenges associated with delivering a complex intervention for adolescents with chronic conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06567-1.
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Affiliation(s)
- Markus Saarijärvi
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Lars Wallin
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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23
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Kitson AL, Harvey G, Gifford W, Hunter SC, Kelly J, Cummings GG, Ehrenberg A, Kislov R, Pettersson L, Wallin L, Wilson P. How nursing leaders promote evidence-based practice implementation at point-of-care: A four-country exploratory study. J Adv Nurs 2021; 77:2447-2457. [PMID: 33626205 DOI: 10.1111/jan.14773] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 12/18/2022]
Abstract
AIMS To describe strategies nursing leaders use to promote evidence-based practice implementation at point-of-care using data from health systems in Australia, Canada, England and Sweden. DESIGN A descriptive, exploratory case-study design based on individual interviews using deductive and inductive thematic analysis and interpretation. METHODS Fifty-five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016. RESULTS Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence-based practice implementation. Nursing leaders actively promote evidence-based practice implementation, work to influence evidence-based practice implementation processes and integrate evidence-based practice implementation into everyday policy and practices. CONCLUSION The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence-based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence-based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship-focused approaches nursing leaders take towards promoting evidence-based practice implementation. IMPACT This study explored how nursing leaders promote evidence-based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence-based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness.
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Affiliation(s)
- Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Wendy Gifford
- Faculty of Heaslth Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Sarah C Hunter
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Janet Kelly
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | | | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
| | - Roman Kislov
- Faculty of Business and Law, Manchester Metropolitan University and School of Health Sciences, The University of Manchester, Manchester, UK
| | - Lena Pettersson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Paul Wilson
- Schoolf of Health Sciences, The University of Manchester, Manchester, UK
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Fridberg H, Wallin L, Wallengren C, Kottorp A, Forsman H, Tistad M. Development and evaluation of the measurement properties of a generic questionnaire measuring patient perceptions of person-centred care. BMC Health Serv Res 2020; 20:960. [PMID: 33081770 PMCID: PMC7574493 DOI: 10.1186/s12913-020-05770-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/28/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Implementation of person-centred care (PCC) is a challenging undertaking. Thus, a call has been issued for a robust and generic instrument to measure and enable evaluation of PCC across settings and patient groups. This study aimed to develop a generic questionnaire measuring patients' perceptions of PCC. Further aims were to evaluate its content and measurement properties using a mixed-methods approach entailing Rasch and qualitative content analyses. METHODS The study was conducted in three iterative phases. Phase one included six key informants to gain a broad view of the concept. Phase two entailed a Delphi study involving two rounds with eight experts who generated ratings on relevance, readability, comprehensiveness and suggestions for revision. Data were analysed using the Item Content Validity Index in conjunction with qualitative comments to improve the questionnaire. Phase three was performed using a mixed-methods design. Quantitative data were collected from patients (n = 553) responding to the questionnaire who were recruited from six in- and outpatient care units in a health care region in Sweden. Data was analysed using the Rasch measurement model. Qualitative data were based on the respondents' free-text comments, cognitive interviews (n = 10) and field notes, and then analysed with deductive content analysis. RESULTS A questionnaire was developed and operationalised based on the information given by key informants in phase one and then validated for its content by experts in phase two. In phase three Rasch analyses revealed problems with targeting, thresholds and two misfitting items. These problems were corroborated by data from the qualitative analyses, which also revealed some issues of wording and interpretation of items. When thresholds were resolved and two items removed, the questionnaire met the assumptions of the Rasch model. CONCLUSIONS Experts gave the questionnaire content high ratings and it met measurement requirements assumed by the Rasch model after revisions. Those problems on targeting that remain need to be addressed in future studies. Meanwhile, we regard the questionnaire as of sufficient quality to be useful in benchmarking PCC.
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Affiliation(s)
- Helena Fridberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Catarina Wallengren
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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25
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Rudman A, Boström AM, Wallin L, Gustavsson P, Ehrenberg A. Registered Nurses' Evidence-Based Practice Revisited: A Longitudinal Study in Mid-Career. Worldviews Evid Based Nurs 2020; 17:348-355. [PMID: 33043561 PMCID: PMC7702166 DOI: 10.1111/wvn.12468] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/08/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To improve patient outcomes and patient safety and to reduce costs in health care, the implementation of evidence-based practice (EBP) is crucial. AIMS To examine the use of the EBP process in Swedish health care. Specifically, to examine whether professional career development (years of experience, years in current position, specialist education, care setting) is associated with RNs' practice of EBP activities and changes in the extent of practicing the EBP process between early and mid-career. METHODS In this observational longitudinal study, the extent of EBP activities was investigated in three national cohorts of 2,474 RNs. Nurses rated their own EBP levels 11-15 and three years after graduation. Six items measured the respondents' extent of practicing the EBP process. Comparisons of EBP levels between subgroups were tested using unpaired t-tests or one-way ANOVAs. RESULTS On average, RNs used the EBP process occasionally every half year. RNs with specialist education reported a higher extent of EBP activities as did RNs who worked in outpatient and home care settings. There was a significant increase in the extent of EBP activities 11 to 13 years after graduation compared to three years after graduation. LINKING EVIDENCE TO ACTION The findings raise some central questions for practice: How well equipped are RNs to practice the EBP process? What is needed to facilitate EBP in clinical settings? Building on the findings of this study, managers in clinical practice need to develop supportive organizational structures that facilitate EBP. This study suggests that mid-career RNs increased the extent of practicing the EBP process over time compared to previous reported practice in their first years as RNs. However, the level of EBP activities was low to moderate, and this modest increase took 11 to 13 years to achieve. To enhance the practice of EBP in nursing care, educational and organizational factors need to be considered.
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Affiliation(s)
- Ann Rudman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Petter Gustavsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ehrenberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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26
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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27
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Saarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Factors affecting adolescents' participation in randomized controlled trials evaluating the effectiveness of healthcare interventions: the case of the STEPSTONES project. BMC Med Res Methodol 2020; 20:205. [PMID: 32746862 PMCID: PMC7398069 DOI: 10.1186/s12874-020-01088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/27/2020] [Indexed: 01/10/2023] Open
Abstract
Background Recruitment of adolescents to intervention studies is a known challenge. For randomized controlled trials (RCT) to be generalizable, reach must be assessed, which means ascertaining how many of the intended population actually participated in the trial. The aim of this study was to evaluate the reach and representativeness of an RCT evaluating the effectiveness of a complex intervention for adolescents with chronic conditions. Methods A mixed methods sequential explanatory design was employed. Firstly, quantitative cross-sectional data from the RCT, patient registries and medical records were collected and analysed regarding baseline differences between participants and non-participants in the trial. Secondly, qualitative data on their reasons for participating or not were collected and analysed with content analysis to explain the quantitative findings. Results Participants showed larger differences in effect sizes and a significantly more complex chronic condition than non-participants. No other statistically significant differences were reported, and effect sizes were negligible. Reasons for declining or accepting participation were categorized into three main categories: altruistic reasons, personal reasons and external reasons and factors. Conclusions Integration of quantitative and qualitative findings showed that participation in the RCT was affected by disease complexity, the perceived need to give back to healthcare and research and the adolescents’ willingness to engage in their illness. To empower adolescents with chronic conditions and motivate them to participate in research, future intervention studies should consider developing tailored recruitment strategies and communications with sub-groups that are harder to reach.
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Affiliation(s)
- Markus Saarijärvi
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Lars Wallin
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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Abstract
Complex interventions of varying degrees of complexity are commonly used and evaluated in cardiovascular nursing and allied professions. Such interventions are increasingly tested using randomized trial designs. However, process evaluations are seldom used to better understand the results of these trials. Process evaluation aims to understand how complex interventions create change by evaluating implementation, mechanisms of impact, and the surrounding context when delivering an intervention. As such, this method can illuminate important mechanisms and clarify variation in results. In this article, process evaluation is described according to the Medical Research Council guidance and its use exemplified through a randomized controlled trial evaluating the effectiveness of a transition program for adolescents with chronic conditions.
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Affiliation(s)
- Markus Saarijärvi
- Institute of Health and Care Sciences, University of Gothenburg, Sweden.,Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Lars Wallin
- Institute of Health and Care Sciences, University of Gothenburg, Sweden.,School of Education, Health and Social Studies, Dalarna University, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Sweden
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Fritz J, Wallin L, Söderlund A, Almqvist L, Sandborgh M. Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods. Implement Sci 2019; 14:94. [PMID: 31684977 PMCID: PMC6827232 DOI: 10.1186/s13012-019-0942-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022] Open
Abstract
Background In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. Methods An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used. Results The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking. Conclusions The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.
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Affiliation(s)
- Johanna Fritz
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden.
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden
| | - Lena Almqvist
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden
| | - Maria Sandborgh
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden
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Björkelund C, Svenningsson I, Westman J, Petersson EL, Hange D, Holst A, Wallin L, Udo C. [Effects of a care manager organization for care of people with mild-moderate depression in Swedish primary care]. Lakartidningen 2019; 116:FSH3. [PMID: 31688945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
By strengthening accessibility and continuity and support via a care manager for primary care patients with depression corresponding to 20-30% of a nursing service, patients recovered significantly faster and to a greater extent than in primary care-as-usual. Return to work occurred significantly earlier in the first three months, and net sick leave period was significantly shorter during the following 4-6 months. To introduce a collaborative care organizational change where the care manager is the hub and coordinates care for the patient and makes it possible to adapt the care according to the patient's needs throughout the care process, is thus the individual effort shown to have the greatest efficiency in Swedish primary care to increase the quality of care of depression. This approach, where the clinic and academy work closely and continuously in the development and evaluation phases, makes it possible to rapidly develop new ways of working where consideration is given to the complexity of primary care and the complexity of care needs and care efforts.
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Affiliation(s)
- Cecilia Björkelund
- Institute of medicine - Primary Health Care/Public Health and Community Medicine Gothenburg, Sweden Institute of medicine - Primary Health Care Gothenburg, Sweden
| | - Irene Svenningsson
- Goteborgs Universitet - Enehten för allmänmedicin, institutionen för medicin Goteborg, Sweden Goteborgs Universitet - Enehten för allmänmedicin, institutionen för medicin Goteborg, Sweden
| | - Jeanette Westman
- KI - Institutionen för Neurobiologi, Vårdvetenskap och Samhälle (NVS), H1, Sektionen för omvårdnad Stockholm, Sweden KI - Institutionen för Neurobiologi, Vårdvetenskap och Samhälle (NVS), H1, Sektionen för omvårdnad Stockholm, Sweden
| | - Eva-Lisa Petersson
- Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden
| | - Dominique Hange
- Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden
| | - Anna Holst
- Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden
| | - Lars Wallin
- Hogskolan Dalarna Akademin Utbildning Halsa och Samhalle - Falun, Sweden Hogskolan Dalarna Akademin Utbildning Halsa och Samhalle - Falun, Sweden
| | - Camilla Udo
- Hogskolan Dalarna - Falun, Sweden Hogskolan Dalarna - Falun, Sweden
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Gifford W, Lewis KB, Eldh AC, Fiset V, Abdul-Fatah T, Aberg AC, Thavorn K, Graham ID, Wallin L. Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada. Pilot Feasibility Stud 2019; 5:103. [PMID: 31452925 PMCID: PMC6701101 DOI: 10.1186/s40814-019-0485-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/05/2019] [Indexed: 02/01/2023] Open
Abstract
Background Leadership is critical to supporting and facilitating the implementation of evidence-based practices in health care. Yet, little is known about how to develop leadership capacity for this purpose. The aims of this study were to explore the (1) feasibility of delivering a leadership intervention to promote implementation, (2) usefulness of the leadership intervention, and (3) participants’ engagement in leadership to implement evidence-based fall prevention practices in Canadian residential care. Methods We conducted a mixed-method before-and-after feasibility study on two units in a Canadian residential care facility. The leadership intervention was based on the Ottawa model of implementation leadership (O-MILe) and consisted of two workshops and two individualized coaching sessions over 3 months to develop leadership capacity for implementing evidence-based fall prevention practices. Participants (n = 10) included both formal (e.g., managers) and informal (e.g., nurses and care aids leaders). Outcome measures were parameters of feasibility (e.g., number of eligible candidates who attended the workshops and coaching sessions) and usefulness of the leadership intervention (e.g., ratings, suggested modifications). We conducted semi-structured interviews guided by the Implementation Leadership Scale (ILS), a validated measure of 12-item in four subcategories (proactive, supportive, knowledgeable, and perseverant), to explore the leadership behaviors that participants used to implement fall prevention practices. We repeated the ILS in a focus group meeting to understand the collective leadership behaviors used by the intervention team. Barriers and facilitators to leading implementation were also explored. Results Delivery of the leadership intervention was feasible. All participants (n = 10) attended the workshops and eight participated in at least one coaching session. Workshops and coaching were rated useful (≥ 3 on a 0–4 Likert scale where 4 = highly useful) by 71% and 86% of participants, respectively. Participants rated the O-MILe subcategories of supportive and perseverant leadership highest for individual leadership, whereas supportive and knowledgeable leadership were rated highest for team leadership. Conclusions The leadership intervention was feasible to deliver, deemed useful by participants, and fostered engagement in implementation leadership activities. Study findings highlight the complexity of developing implementation leadership and modifications required to optimize impact. Future trials are now required to test the effectiveness of the leadership intervention on developing leadership for implementing evidence-based practices.
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Affiliation(s)
- Wendy Gifford
- 1Center for Research on Health and Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada.,2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada
| | - Krystina B Lewis
- 1Center for Research on Health and Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada.,2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada
| | - Ann Catrine Eldh
- 3Faculty of Medicine, Department of Medicine and Health, Linköping University, SE-581 83, Linköping, Sweden
| | - Val Fiset
- 2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada
| | - Tara Abdul-Fatah
- 2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada
| | - Anna Cristina Aberg
- 4School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, Falun, Sweden.,5Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Kednapa Thavorn
- 6Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario Canada.,7School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario Canada
| | - Ian D Graham
- 7School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario Canada.,8Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario Canada
| | - Lars Wallin
- 4School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, Falun, Sweden.,9Department of Health Care Science, University of Gothenburg, Gothenburg, Sweden.,10Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Saarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Transition program for adolescents with congenital heart disease in transition to adulthood: protocol for a mixed-method process evaluation study (the STEPSTONES project). BMJ Open 2019; 9:e028229. [PMID: 31377699 PMCID: PMC6687006 DOI: 10.1136/bmjopen-2018-028229] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Today, the majority of young persons living with chronic conditions in high-income countries survive into adulthood and will need life-long medical follow-up. Therefore, transition programmes have been developed to facilitate transfer to adult care, and to support self-management and independence during adulthood. The Swedish Transition Effects Project Supporting Teenagers with chrONic mEdical conditionS (STEPSTONES) project aims to evaluate the effectiveness of a person-centred transition programme for empowering adolescents with congenital heart disease in transition to adulthood. To understand how the transition programme causes change and how outcomes are created, process evaluation is imperative to assess implementation, context and mechanisms of impact. This protocol aims to describe the process evaluation of the STEPSTONES transition programme. METHODS AND DESIGN Medical Research Council guidance for process evaluation of complex interventions will be the guiding framework for this mixed-method study. The combination of qualitative and quantitative data will capture different aspects of programme delivery. The sample will consist of participants in the STEPSTONES randomised controlled trial (RCT), persons implementing the programme and healthcare professionals. Quantitative data will consist of protocols and routine monitoring documents from the RCT, data collected from patient registries and sociodemographic data to assess the implementation of the intervention. This data will be analysed with quantitative content analysis, along with descriptive and inferential statistics. Qualitative data will consist of participatory observations, logbooks and interviews with persons implementing the programme, participants and healthcare professionals. Analyses will be performed using qualitative content analysis to investigate mechanism of impact, context and delivery. Quantitative and qualitative data will be integrated in the final stage by using a triangulation protocol according to mixed-method guidelines. ETHICS AND DISSEMINATION The study is approved by the Regional Ethical Review Board in Gothenburg, Sweden. Results will be presented in open access, peer-reviewed journals and at international scientific conferences.
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Affiliation(s)
- Markus Saarijärvi
- Institute of Health and Care Sciences, Goteborgs Universitet, Goteborg, Sweden
- Department of Public Health and Primary Care, KU Leuven, Leuven, Vlaanderen, Belgium
| | - Lars Wallin
- Institute of Health and Care Sciences, Goteborgs Universitet, Goteborg, Sweden
- School of Education, Health and Social Studies, Hogskolan Dalarna, Falun, Dalarna, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, Goteborgs Universitet, Goteborg, Sweden
- Department of Public Health and Primary Care, KU Leuven, Leuven, Vlaanderen, Belgium
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Goteborgs Universitet, Goteborg, Sweden
- Centre for Person-Centered Care, Goteborgs Universitet, Goteborg, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, Goteborgs Universitet, Goteborg, Sweden
- Department of Pediatric Cardiology, Drottning Silvias barn- och ungdomssjukhus i Goteborg, Goteborg, Sweden
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Svenningsson I, Petersson EL, Udo C, Westman J, Björkelund C, Wallin L. Process evaluation of a cluster randomised intervention in Swedish primary care: using care managers in collaborative care to improve care quality for patients with depression. BMC Fam Pract 2019; 20:108. [PMID: 31351444 PMCID: PMC6660943 DOI: 10.1186/s12875-019-0998-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/17/2019] [Indexed: 11/10/2022]
Abstract
Background The collaborative care model with a care manager has previously generated beneficial results for patients with depression in terms of decreased burden of depression symptoms. A care manager function has been tested in Sweden in the PRIM-CARE RCT with successful results. The aim of the present study was to evaluate the process of implementing care managers in collaborative care for patients with depression in Swedish primary health care in the PRIM-CARE RCT. Methods The study followed UK Medical Research Council guidance for process evaluation. Field notes from the implementation of the PRIM - CARE RCT were used, as well as data collected from five focus group discussions with General Practitioners (n = 29) and three focus group discussions with care managers (n = 11). Data were analysed with content analysis. Results Training sessions, careful preparation and extensive initial support to the care manager and staff at the Primary Care Centres were important ingredients in the implementation. The close access to facilitators, the recurrent peer support meetings, and the weekly newsletter strengthened the care manager function. Conclusions A complex intervention adapted to the Swedish primary care context focusing on a care manager function for patients with depression could be performed through a stepwise implementation process. Financial support from the health care regions included in the study helped to reduce the impact of identified barriers. This process evaluation has revealed new and important knowledge for primary care development concerning infrastructure and organization building, knowledge sharing, and facilitating factors and barriers. Trial registration NCT02378272 Care Manager – Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM – CARE). Registered March 4 2015. Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12875-019-0998-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Svenningsson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.
| | - E-L Petersson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - C Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Center for Clinical Research, Dalarna, Sweden.,Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - J Westman
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - C Björkelund
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - L Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Center for Clinical Research, Dalarna, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Orton M, Andersson Å, Wallin L, Forsman H, Eldh AC. Nursing management matters for registered nurses with a PhD working in clinical practice. J Nurs Manag 2019; 27:955-962. [DOI: 10.1111/jonm.12750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Marie‐Louise Orton
- Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
- Department of Quality and Patient Safety Karolinska University Hospital Stockholm Sweden
| | | | - Lars Wallin
- School of Education, Health and Social Studies Dalarna University Falun Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies Dalarna University Falun Sweden
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences Linköping University Linköping Sweden
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
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Mocumbi S, McKee K, Munguambe K, Chiau R, Högberg U, Hanson C, Wallin L, Sevene E, Bergström A. Ready to deliver maternal and newborn care? Health providers' perceptions of their work context in rural Mozambique. Glob Health Action 2019; 11:1532631. [PMID: 30387378 PMCID: PMC6225433 DOI: 10.1080/16549716.2018.1532631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique. Constraints relate to lack of human and financial resources and weak health systems, however limited resources alone do not explain the variance. Understanding the healthcare context ahead of implementing new interventions can inform the choice of strategies to achieve a successful implementation. The Context Assessment for Community Health (COACH) tool was developed to assess modifiable aspects of the healthcare context that theoretically influence the implementation of evidence. Objectives: To investigate the comprehensibility and the internal reliability of COACH and its use to describe the healthcare context as perceived by health providers involved in maternal care in Mozambique. Methods: A response process evaluation was completed with six purposively selected health providers to uncover difficulties in understanding the tool. Internal reliability was tested using Cronbach’s α. Subsequently, a cross-sectional survey using COACH, which contains 49 items assessing eight dimensions, was administered to 175 health providers in 38 health facilities within six districts in Mozambique. Results: The content of COACH was clear and most items were understood. All dimensions were near to or exceeded the commonly accepted standard for satisfactory internal reliability (0.70). Analysis of the survey data indicated that items on all dimensions were rated highly, revealing positive perception of context. Significant differences between districts were found for the Work culture, Leadership, and Informal payment dimensions. Responses to many items had low variance and were left-skewed. Conclusions: COACH was comprehensible and demonstrated good reliability, although biases may have influenced participants’ responses. The study suggests that COACH has the potential to evaluate the healthcare context to identify shortcomings and enable the tailoring of strategies ahead of implementation. Supplementing the tool with qualitative approaches will provide an in-depth understanding of the healthcare context.
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Affiliation(s)
- Sibone Mocumbi
- a Department of Obstetrics and Gynaecology, Faculty of Medicine , Universidade Eduardo Mondlane (UEM) , Maputo , Mozambique.,b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Kevin McKee
- c School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - Khátia Munguambe
- d Department of Public Health , Faculty of Medicine, Universidade Eduardo Mondlane (UEM) , Maputo , Mozambique.,e Centro de Investigação em Saúde de Manhiça (CISM) , Manhiça , Mozambique
| | - Rogério Chiau
- e Centro de Investigação em Saúde de Manhiça (CISM) , Manhiça , Mozambique
| | - Ulf Högberg
- b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Claudia Hanson
- f Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,g Department of Disease Control , London School of Hygiene and Tropical Medicine , London , UK
| | - Lars Wallin
- c School of Education, Health and Social Studies , Dalarna University , Falun , Sweden.,h Department of Neurobiology, Care Sciences and Society, Division of Nursing , Karolinska Institutet , Stockholm , Sweden.,i Department of Health and Care Sciences , The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Esperança Sevene
- e Centro de Investigação em Saúde de Manhiça (CISM) , Manhiça , Mozambique.,j Department of Physiological Science, Clinical Pharmacology , Faculty of Medicine, Universidade Eduardo Mondlane (UEM) , Maputo , Mozambique
| | - Anna Bergström
- b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.,k Institute for Global Health , University College London , London , UK
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Fritz J, Wallin L, Söderlund A, Almqvist L, Sandborgh M. Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability. Disabil Rehabil 2019; 42:3467-3474. [PMID: 30999779 DOI: 10.1080/09638288.2019.1596170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore the effects on and sustainability of physiotherapists' clinical behavior when using facilitation to support the implementation of a behavioral medicine approach in primary health care for patients with persistent musculoskeletal pain.Methods: A quasi-experimental pre-/post-test trial was conducted. Fifteen physiotherapists were included in the experimental group, and nine in the control group. Based on social cognitive theory and the Promoting Action on Research Implementation in Health Services framework, facilitation with multifaceted implementation methods was used during a six-month period. Clinical behaviors were investigated with a study-specific questionnaire, structured observations, self-reports and patient records. Descriptive and non-parametric statistical methods were used for analyzing differences over time and effect size.Results: A sustained increase in self-efficacy for applying the behavioral medicine approach was found. Clinical actions and verbal expressions changed significantly, and the effect size was large; however, changes were not sustained at follow-ups. The behavioral changes were mainly related to the goal setting, self-monitoring and functional behavioral analysis components. No changes in clinical behavior were found in the control group.Conclusion: Tailored multifaceted facilitation can support the implementation of a behavioral medicine approach in physiotherapy in primary health care, but more comprehensive actions targeting sustainability are needed.Implications for rehabilitationTailored multifaceted facilitation can support the implementation of an evidence based behavioral medicine approach in physiotherapy.Facilitation can be useful for increasing self-efficacy beliefs for using behavioral medicine approach in physiotherapist's clinical practice.Further research is required to establish strategies that are effective in sustaining behavioral changes.
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Affiliation(s)
- Johanna Fritz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Lena Almqvist
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Maria Sandborgh
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Hälleberg Nyman M, Forsman H, Wallin L, Ostaszkiewicz J, Hommel A, Eldh AC. Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care-A process evaluation of an implementation intervention in the orthopaedic context. J Eval Clin Pract 2019; 25:282-289. [PMID: 29411463 DOI: 10.1111/jep.12879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery. METHODS A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed. RESULTS Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit. CONCLUSION To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.
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Affiliation(s)
- Maria Hälleberg Nyman
- School of Health Sciences, Örebro University, Örebro, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research, Barwon Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Ami Hommel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Department of Orthopaedics, Skaane University Hospital, Lund, Sweden
| | - Ann Catrine Eldh
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Wikström E, Dellenborg L, Wallin L, Gillespie BM, Erichsen Andersson A. The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action. Am J Infect Control 2019; 47:251-257. [PMID: 30449454 DOI: 10.1016/j.ajic.2018.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Even though hand hygiene and aseptic techniques are essential to provide safe care in the operating room, several studies have found a lack of successful implementation. The aim of this study was to describe facilitative mechanisms supporting the implementation of hand hygiene and aseptic techniques. METHODS This study was set in a large operating room suite in a Swedish university hospital. The theory-driven implementation process was informed by the literature on organizational change and dialogue. Data were collected using interviews and participant observations and analyzed using a thematic approach. The normalization process theory served as a frame of interpretation during the analysis. RESULTS Three facilitating mechanisms were identified: (1) commitment through a sense of urgency, requiring extensive communication between the managers, operating room professionals, and facilitators in building commitment to change and putting the issues on the agenda; (2) dialogue for co-creation, increasing and sustaining commitment and resource mobilization; and (3) tailored management support, including helping managers to develop their leadership role, progressively involving staff, and retaining focus during the implementation process. CONCLUSIONS The facilitating mechanisms can be used in organizing implementation processes. Putting the emphasis on help and support to managers seems to be a crucial condition in complex implementation processes, from preparation of the change process to stabilization of the new practice.
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Affiliation(s)
- Ewa Wikström
- Department of Business Administration, School of Business, Economics, and Law, University of Gothenburg, Gothenburg, Sweden
| | - Lisen Dellenborg
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Wallin
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Sweden
| | - Brigid M Gillespie
- School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia; Gold Coast Hospital and Health Service, Queensland, Australia
| | - Annette Erichsen Andersson
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital Mölndal, Gothenburg, Sweden.
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Harvey G, Gifford W, Cummings G, Kelly J, Kislov R, Kitson A, Pettersson L, Wallin L, Wilson P, Ehrenberg A. Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries. Int J Nurs Stud 2018; 90:21-30. [PMID: 30551080 DOI: 10.1016/j.ijnurstu.2018.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved. OBJECTIVES The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them. DESIGN The study employed a qualitative descriptive approach. SETTINGS Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden. PARTICIPANTS 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries. METHODS Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis. RESULTS Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice. CONCLUSIONS National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice.
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Affiliation(s)
- Gill Harvey
- Adelaide Nursing School, University of Adelaide, Australia.
| | | | | | - Janet Kelly
- Adelaide Nursing School, University of Adelaide, Australia
| | - Roman Kislov
- Alliance Manchester Business School, University of Manchester, UK
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lena Pettersson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
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Seers K, Rycroft-Malone J, Cox K, Crichton N, Edwards RT, Eldh AC, Estabrooks CA, Harvey G, Hawkes C, Jones C, Kitson A, McCormack B, McMullan C, Mockford C, Niessen T, Slater P, Titchen A, van der Zijpp T, Wallin L. Facilitating Implementation of Research Evidence (FIRE): an international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implement Sci 2018; 13:137. [PMID: 30442174 PMCID: PMC6238407 DOI: 10.1186/s13012-018-0831-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. METHODS A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering. RESULTS Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time. CONCLUSIONS This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and "doses" of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors. TRIAL REGISTRATION Current Controlled Trials ISRCTN11598502 . Date 4/2/10. The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 223646.
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Affiliation(s)
- Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Karen Cox
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Nicola Crichton
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Science, Department of Nursing, Linkoping University, Linkoping, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | | | - Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Claire Hawkes
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carys Jones
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia Australia
| | | | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Theo Niessen
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Shore Rd, Belfast, Northern Ireland
| | - Angie Titchen
- Institute of Nursing and Health Research, Ulster University, Shore Rd, Belfast, Northern Ireland
| | - Teatske van der Zijpp
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Rycroft-Malone J, Seers K, Eldh AC, Cox K, Crichton N, Harvey G, Hawkes C, Kitson A, McCormack B, McMullan C, Mockford C, Niessen T, Slater P, Titchen A, van der Zijpp T, Wallin L. A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar. Implement Sci 2018; 13:138. [PMID: 30442165 PMCID: PMC6238283 DOI: 10.1186/s13012-018-0811-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Facilitation is a promising implementation intervention, which requires theory-informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice. METHODS This realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Data were collected over four time points using multiple qualitative methods: observation (372 h), interviews with staff (n = 357), residents (n = 152), next of kin (n = 109) and other stakeholders (n = 128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing. RESULTS The content and approach of the two facilitation programmes prompted variable opportunities to align and realign support with the needs and expectations of facilitators and homes. This influenced their level of confidence in fulfilling the facilitator role and ability to deliver the intervention as planned. The success of intervention implementation was largely dependent on whether sites prioritised their involvement in both the study and the facilitation programme. In contexts where the study was prioritised (including release of resources) and where managers and staff support was sustained, this prompted collective engagement (as an attitude and action). Internal facilitators' (IF) personal characteristics and abilities, including personal and formal authority, in combination with a supportive environment prompted by managers triggered the potential for learning over time. Learning over time resulted in a sense of confidence and personal growth, and enactment of the facilitation role, which resulted in practice changes. CONCLUSION The scale and multi-country nature of this study provided a novel context to conduct one of the few trial embedded realist-informed process evaluations. In addition to providing an explanatory account of implementation processes, a conceptual platform for future facilitation research is presented. Finally, a realist-informed process evaluation framework is outlined, which could inform future research of this nature. TRIAL REGISTRATION Current controlled trials ISRCTN11598502 .
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Affiliation(s)
- Jo Rycroft-Malone
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Kate Seers
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Science, Department of Nursing, Linkoping, and Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Linkopings University, Stockholm, Sweden
| | - Karen Cox
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Nicola Crichton
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Claire Hawkes
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia Australia
| | - Brendan McCormack
- Division of Nursing, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Theo Niessen
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Shore Rd Belfast, Ulster, Northern Ireland
| | - Angie Titchen
- Institute of Nursing and Health Research, Ulster University, Jordanstown, UK
| | - Teatske van der Zijpp
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lars Wallin
- Faculty of Medicine and Health Science, Department of Nursing, Linkoping, and Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Linkopings University, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Holst A, Ginter A, Björkelund C, Hange D, Petersson EL, Svenningsson I, Westman J, André M, Wikberg C, Wallin L, Möller C, Svensson M. Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study. BMJ Open 2018; 8:e024741. [PMID: 30420353 PMCID: PMC6252772 DOI: 10.1136/bmjopen-2018-024741] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective. DESIGN Cost-effectiveness analysis. SETTING 23 PCCs in two Swedish regions. PARTICIPANTS Patients with depression (n=342). MAIN OUTCOME MEASURES A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-Åsberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: ∆Cost/∆QALY and ∆Cost/∆DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping. RESULTS Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were €368 (healthcare perspective) and €6217 (societal perspective) for the intervention patients and €246 (healthcare perspective) and €7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was €6773 (healthcare perspective) and from a societal perspective the CM programme was dominant. DISCUSSION The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level. TRIAL REGISTRATION NUMBER NCT02378272; Results.
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Affiliation(s)
- Anna Holst
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Ginter
- Department of Public Health and Community Medicine/Health Metrics, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Irene Svenningsson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Jeanette Westman
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Malin André
- Department of Public Health and Caring Sciences-Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Carl Wikberg
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Wallin
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christina Möller
- Primary Health Care Head Office, Närhälsan, Region Västra Götaland, Hisings Backa, Sweden
| | - Mikael Svensson
- Department of Public Health and Community Medicine/Health Metrics, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gifford WA, Squires JE, Angus DE, Ashley LA, Brosseau L, Craik JM, Domecq MC, Egan M, Holyoke P, Juergensen L, Wallin L, Wazni L, Graham ID. Managerial leadership for research use in nursing and allied health care professions: a systematic review. Implement Sci 2018; 13:127. [PMID: 30261927 PMCID: PMC6161344 DOI: 10.1186/s13012-018-0817-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background Leadership by point-of-care and senior managers is increasingly recognized as critical to the acceptance and use of research evidence in practice. The purpose of this systematic review was to identify the leadership behaviours of managers that are associated with research use by clinical staff in nursing and allied health professionals. Methods A mixed methods systematic review was performed. Eight electronic bibliographic databases were searched. Studies examining the association between leadership behaviours and nurses and allied health professionals’ use of research were eligible for inclusion. Studies were excluded if leadership could not be clearly attributed to someone in a management position. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments. Narrative synthesis was conducted. Results The search yielded 7019 unique titles and abstracts after duplicates were removed. Three hundred five full-text articles were reviewed, and 31 studies reported in 34 articles were included. Methods used were qualitative (n = 19), cross-sectional survey (n = 9), and mixed methods (n = 3). All studies included nurses, and six also included allied health professionals. Twelve leadership behaviours were extracted from the data for point-of-care managers and ten for senior managers. Findings indicated that managers performed a diverse range of leadership behaviours that encompassed change-oriented, relation-oriented and task-oriented behaviours. The most commonly described behavior was support for the change, which involved demonstrating conceptual and operational commitment to research-based practices. Conclusions This systematic review adds to the growing body of evidence that indicates that manager-staff dyads are influential in translating research evidence into action. Findings also reveal that leadership for research use involves change and task-oriented behaviours that influence the environmental milieu and the organisational infrastructure that supports clinical care. While findings explain how managers enact leadership for research use, we now require robust methodological studies to determine which behaviours are effective in enabling research use with nurses and allied health professionals for high-quality evidence-based care. Trial registration PROSPERO CRD42014007660 Electronic supplementary material The online version of this article (10.1186/s13012-018-0817-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wendy A Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Douglas E Angus
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa A Ashley
- Canadian Nurses Association, Ottawa, Ontario, Canada
| | - Lucie Brosseau
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet M Craik
- Canadian Association of Occupational Therapists, Ottawa, Ontario, Canada
| | | | - Mary Egan
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.,Elisabeth Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Linda Juergensen
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Sahlgrenska Academy, Department of Health Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, Stockholm, Sweden
| | - Liquaa Wazni
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian D Graham
- Sahlgrenska Academy, Department of Health Care Sciences, University of Gothenburg, Gothenburg, Sweden.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Eriksson L, Nga NT, Hoa DTP, Duc DM, Bergström A, Wallin L, Målqvist M, Ewald U, Huy TQ, Thuy NT, Do TT, Lien PTL, Persson LÅ, Selling KE. Secular trend, seasonality and effects of a community-based intervention on neonatal mortality: follow-up of a cluster-randomised trial in Quang Ninh province, Vietnam. J Epidemiol Community Health 2018; 72:776-782. [PMID: 29764902 PMCID: PMC6109254 DOI: 10.1136/jech-2017-209252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/03/2018] [Accepted: 04/28/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little is know about whether the effects of community engagement interventions for child survival in low-income and middle-income settings are sustained. Seasonal variation and secular trend may blur the data. Neonatal mortality was reduced in a cluster-randomised trial in Vietnam where laywomen facilitated groups composed of local stakeholders employing a problem-solving approach for 3 years. In this analysis, we aim at disentangling the secular trend, the seasonal variation and the effect of the intervention on neonatal mortality during and after the trial. METHODS In Quang Ninh province, 44 communes were allocated to intervention and 46 to control. Births and neonatal deaths were assessed in a baseline survey in 2005, monitored during the trial in 2008-2011 and followed up by a survey in 2014. Time series analyses were performed on monthly neonatal mortality data. RESULTS There were 30 187 live births and 480 neonatal deaths. The intervention reduced the neonatal mortality from 19.1 to 11.6 per 1000 live births. The reduction was sustained 3 years after the trial. The control areas reached a similar level at the time of follow-up. Time series decomposition analysis revealed a downward trend in the intervention areas during the trial that was not found in the control areas. Neonatal mortality peaked in the hot and wet summers. CONCLUSIONS A community engagement intervention resulted in a lower neonatal mortality rate that was sustained but not further reduced after the end of the trial. When decomposing time series of neonatal mortality, a clear downward trend was demonstrated in intervention but not in control areas. TRIAL REGISTRATION NUMBER ISRCTN44599712, Post-results.
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Affiliation(s)
- Leif Eriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Nguyen T Nga
- Research Institute for Child Health, Hanoi, Vietnam
| | | | - Duong M Duc
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Anna Bergström
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Målqvist
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Uwe Ewald
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Tran Q Huy
- Department of Medical Services Administration, Ministry of Health, Nursing office, Hanoi, Vietnam
| | - Nguyen T Thuy
- Vietnam-Sweden Uong Bi General Hospital, Uong Bi, Vietnam
| | - Tran Thanh Do
- National Institute of Nutrition (NIN), Ministry of Health, Hanoi, Vietnam
| | | | - Lars-Åke Persson
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- London School of Hygiene & Tropical Medicine, London, UK
| | - Katarina Ekholm Selling
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Schön UK, Grim K, Wallin L, Rosenberg D, Svedberg P. Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study. Int J Qual Stud Health Well-being 2018; 13:1421352. [PMID: 29405889 PMCID: PMC5804774 DOI: 10.1080/17482631.2017.1421352] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. METHOD The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. RESULTS The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. CONCLUSION The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.
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Affiliation(s)
- Ulla-Karin Schön
- a School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - Katarina Grim
- a School of Education, Health and Social Studies , Dalarna University , Falun , Sweden.,b Institution for Social Work , Karlstad University , Karlstad , Sweden
| | - Lars Wallin
- a School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - David Rosenberg
- c Department of Social Work , Umeå University , Umeå , Sweden
| | - Petra Svedberg
- d School of Social and Health Sciences , Halmstad University , Halmstad , Sweden
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Barenfeld E, Dahlin-Ivanoff S, Wallin L, Gustafsson S. Promoting aging migrants' capabilities: A randomized controlled trial concerning activities of daily living and self-rated health. AIMS Public Health 2018; 5:173-188. [PMID: 30094279 PMCID: PMC6079055 DOI: 10.3934/publichealth.2018.2.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/29/2018] [Indexed: 01/16/2023] Open
Abstract
The aim was to evaluate the 6-month and 1-year effects of a person-centered group-based health-promoting intervention on independence in daily activities and self-rated health. The study was an RCT with follow-ups at 6 months and 1 year. A total of 131 independent living people (70+) who have migrated to Sweden from Finland or Western Balkan region were included. Participants were independent in activities of daily living and cognitively intact. They were randomized to an intervention group receiving four weekly group-meetings and a follow-up home visit, or a control group (no intervention). An overall chi-squared test was performed and the odds ratio calculated. A high proportion of the participants maintained independence in activities of daily living and improved or maintained self-rated health. However, no significant differences were found between the groups. The result indicates that the intervention was offered too early in the aging process to be able to detect effects. Methodological challenges were met during both the recruitment and implementation phases. In response to lessons learned, a multicenter design is recommended for future research in order to strengthen the findings. Furthermore, this study has contributed with experiences on both opportunities and challenges in terms of research with and about older people aging in the context of migration, as is discussed.
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Affiliation(s)
- Emmelie Barenfeld
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology Sahlgrenska Academy, Centre for Ageing and Health—AgeCap, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational therapy and Physiotherapy, The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Synneve Dahlin-Ivanoff
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology Sahlgrenska Academy, Centre for Ageing and Health—AgeCap, University of Gothenburg, Gothenburg, Sweden
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Gustafsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology Sahlgrenska Academy, Centre for Ageing and Health—AgeCap, University of Gothenburg, Gothenburg, Sweden
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Gustavsson C, Nordqvist M, Bröms K, Jerdén L, Kallings LV, Wallin L. What is required to facilitate implementation of Swedish physical activity on prescription? - interview study with primary healthcare staff and management. BMC Health Serv Res 2018; 18:196. [PMID: 29562922 PMCID: PMC5863486 DOI: 10.1186/s12913-018-3021-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/16/2018] [Indexed: 12/02/2022] Open
Abstract
Background The method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare. Methods Eighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis. Results We identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management’s beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling. Conclusion The study provides knowledge regarding requirements to facilitate the implementation of SPAP in healthcare. There was limited knowledge among health professionals regarding core components of SPAP and how to practise the method, which speaks for in-depth training in the SPAP method. The findings highlight the importance of forming policies and guidelines and establishing organisational supporting structures, and ensuring that these are well known and approved in all parts of the healthcare organisation. Electronic supplementary material The online version of this article (10.1186/s12913-018-3021-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catharina Gustavsson
- Center for Clinical Research Dalarna, Department of Public Health and Caring Sciences, Uppsala University, Nissers vag 3, SE-79182, Falun, Uppsala, Sweden. .,School of Education, Health and Social Studies, Dalarna University, SE-79188, Falun, Sweden. .,School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE- 721 23, Västerås, Sweden. .,Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22, Uppsala, Sweden.
| | - Maria Nordqvist
- Center for Clinical Research Dalarna, Department of Public Health and Caring Sciences, Uppsala University, Nissers vag 3, SE-79182, Falun, Uppsala, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE- 721 23, Västerås, Sweden
| | - Kristina Bröms
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22, Uppsala, Sweden.,Centre for Research & Development, Uppsala University, Region Gävleborg, CFUG, SE-801 88, Gävle, Sweden
| | - Lars Jerdén
- Center for Clinical Research Dalarna, Department of Public Health and Caring Sciences, Uppsala University, Nissers vag 3, SE-79182, Falun, Uppsala, Sweden.,School of Education, Health and Social Studies, Dalarna University, SE-79188, Falun, Sweden
| | - Lena V Kallings
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22, Uppsala, Sweden.,Department of Sport and Health Sciences, Swedish School of Sport and Health Sciences (GIH), Box 5626, SE-114 86, Stockholm, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, SE-79188, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-177 70, Stockholm, Sweden.,Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 40530, Gothenburg, Sweden
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Björkelund C, Svenningsson I, Hange D, Udo C, Petersson EL, Ariai N, Nejati S, Wessman C, Wikberg C, André M, Wallin L, Westman J. Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial. BMC Fam Pract 2018; 19:28. [PMID: 29426288 PMCID: PMC5807835 DOI: 10.1186/s12875-018-0711-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022]
Abstract
Background Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden. Methods In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged ≥ 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU). Outcome measures: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle. Results One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [− 0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group. Conclusions Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients. Trial registration Identifier: NCT02378272. February 2, 2015. Retrospectively registered.
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Affiliation(s)
- Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 454, 40530, Göteborg, Sweden.
| | - Irene Svenningsson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - Nashmil Ariai
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catrin Wessman
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Wikberg
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin André
- Department of Public Health and Caring Sciences - Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jeanette Westman
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Erichsen Andersson A, Frödin M, Dellenborg L, Wallin L, Hök J, Gillespie BM, Wikström E. Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study. BMC Health Serv Res 2018; 18:2. [PMID: 29301519 PMCID: PMC5753493 DOI: 10.1186/s12913-017-2783-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room. METHODS The study was set in an operating department of a university hospital. The intervention was underpinned by theories on organizational learning, culture and person centeredness. Qualitative process data were collected via participant observations and analyzed using a thematic approach. RESULTS Doubts that hand-hygiene practices are effective in preventing hospital acquired infections, strong boundaries and distrust between professional groups and a lack of psychological safety were identified as barriers towards change. Facilitated interprofessional dialogue and learning in "safe spaces" worked as mechanisms for motivation and engagement. Allowing for the free expression of different opinions, doubts and viewing resistance as a natural part of any change was effective in engaging all professional categories in co-creation of clinical relevant solutions to improve hand hygiene. CONCLUSION Enabling nurses and physicians to think and talk differently about hospital acquired infections and hand hygiene requires a shift from the concept of one-way directed compliance towards change and learning as the result of a participatory and meaning-making process. The present study is a part of the Safe Hands project, and is registered with ClinicalTrials.gov (ID: NCT02983136 ). Date of registration 2016/11/28, retrospectively registered.
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Affiliation(s)
- Annette Erichsen Andersson
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden. .,Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Maria Frödin
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisen Dellenborg
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden
| | - Lars Wallin
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.,School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Solna, Sweden
| | - Jesper Hök
- GPCC Implement, University of Gothenburg, Gothenburg, Sweden
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Nathan, Australia.,Gold Coast University Hospital and Health Service, Southport, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Sweden
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Lind S, Wallin L, Brytting T, Fürst C, Sandberg J. Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders’ perceptions. Health Policy 2017; 121:1194-1201. [DOI: 10.1016/j.healthpol.2017.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022]
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