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Chan PSF, Fang Y, Xie YJ, Wong MCS, Nilsen P, Leung SF, Cheung K, Wang Z, Yeoh EK. Applying the Consolidated Framework for Implementation Research to investigate factors of implementing alcohol screening and brief intervention among primary care physicians and nurses in Hong Kong, China: an exploratory sequential mixed-method study. Implement Sci Commun 2024; 5:52. [PMID: 38711156 PMCID: PMC11071187 DOI: 10.1186/s43058-024-00590-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/28/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China. METHODS This was a sequential mixed-method study. In-depth interviews of 21 physicians and 20 nurses working in the primary care settings from the public and private sectors were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential factors not covered by the CFIR. A questionnaire was then developed based on the qualitative findings to investigate factors associated with SBI implementation among 282 physicians and 295 nurses. RESULTS The in-depth interviews identified 22 CFIR constructs that were facilitators or barriers of SBI implementation in Hong Kong. In addition, the stigmatization of alcohol dependence was a barrier and the belief that it was important for people to control the amount of alcohol intake in any situation was mentioned as a facilitator to implement SBI. In the survey, 22% of the participants implemented SBI in the past year. Factors associated with the SBI implementation echoed most of the qualitative findings. Among physicians and nurses in both sectors, they were more likely to implement SBI when perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics but less likely to do so when perceiving SBI implementation to be complicated and of higher cost, and drinking approved by the Chinese culture. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice and better leadership engagement in the public sector, but not in the private sector. Perceiving a stronger need and greater importance to implement SBI were associated with higher likelihood of SBI implementation among physicians, but not among nurses. Perceiving better organizational culture supporting SBI was positively associated with SBI implementation among nurses, but not among physicians. CONCLUSIONS There was a significant gap between SBI evidence and its implementation. Some strategies to improve SBI implementation may be different between physicians and nurses and between those in the public and private sectors. The CFIR is a useful framework for understanding facilitators and barriers of SBI implementation in primary care settings.
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Affiliation(s)
- Paul Shing-Fong Chan
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Martin Chi-Sang Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sau-Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Eng-Kiong Yeoh
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Hodson N, Powell BJ, Nilsen P, Beidas RS. How can a behavioral economics lens contribute to implementation science? Implement Sci 2024; 19:33. [PMID: 38671508 PMCID: PMC11046816 DOI: 10.1186/s13012-024-01362-y] [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] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Implementation science in health is an interdisciplinary field with an emphasis on supporting behavior change required when clinicians and other actors implement evidence-based practices within organizational constraints. Behavioral economics has emerged in parallel and works towards developing realistic models of how humans behave and categorizes a wide range of features of choices that can influence behavior. We argue that implementation science can be enhanced by the incorporation of approaches from behavioral economics. Main body First, we provide a general overview of implementation science and ways in which implementation science has been limited to date. Second, we review principles of behavioral economics and describe how concepts from BE have been successfully applied to healthcare including nudges deployed in the electronic health record. For example, de-implementation of low-value prescribing has been supported by changing the default in the electronic health record. We then describe what a behavioral economics lens offers to existing implementation science theories, models and frameworks, including rich and realistic models of human behavior, additional research methods such as pre-mortems and behavioral design, and low-cost and scalable implementation strategies. We argue that insights from behavioral economics can guide the design of implementation strategies and the interpretation of implementation studies. Key objections to incorporating behavioral economics are addressed, including concerns about sustainment and at what level the strategies work. CONCLUSION Scholars should consider augmenting implementation science theories, models, and frameworks with relevant insights from behavioral economics. By drawing on these additional insights, implementation scientists have the potential to boost efforts to expand the provision and availability of high quality care.
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Affiliation(s)
- Nathan Hodson
- Price School of Public Policy, University of Southern California, Los Angeles, USA.
- Warwick Medical School, Unit of Mental Health and Wellbeing, Division of Health Sciences, University of Warwick, Coventry, UK.
- Department of Medical Social Sciences, Feinberg School of Medicine Northwestern University, Chicago, USA.
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Per Nilsen
- Department of Health, Medicine, and Caring Sciences (HMV), Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine Northwestern University, Chicago, USA
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Chicago, USA
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Öhlschuster M, Comiskey D, Kavanagh M, Kickinger F, Scaldaferri C, Sigler M, Nilsen P. On the prediction of SAV transmission among Norwegian aquaculture sites. Prev Vet Med 2024; 224:106095. [PMID: 38232517 DOI: 10.1016/j.prevetmed.2023.106095] [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] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Abstract
Pancreas Disease (PD) is a viral disease that affects Atlantic salmon (Salmo salar) in Norwegian, Scottish and Irish aquaculture. It is caused by salmonid alphavirus (SAV) and represents a significant problem in salmonid farming. Infection with SAV leads to reduced growth, mortality, product downgrading, and has a significant financial impact for the farms. The overall aim of this study is to evaluate the effect of various factors on the transmission of SAV and to create a predictive model capable of providing an early warning system for salmon farms within the Norwegian waters. Using a combination of publicly available databases, specifically BarentsWatch, and privately held PCR analyses a feature set consisting of 11 unique features was created based on the input parameters of the databases. An ensemble model was developed based on this feature set using XG-Boost, Ada-Boost, Random Forest and a Multilayer Perceptron. It was possible to successfully predict SAV transmission with 94.4% accuracy. Moreover, it was possible to predict SAV transmission 8 weeks in advance of a 'PD registration' at individual aquaculture salmon farming sites. Important predictors included well boat movement, environmental factors, proximity to sites with a 'PD registration' and seasonality.
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Affiliation(s)
| | - D Comiskey
- Zoetis, Cherrywood Business Park, Loughlinstown, D18 T3Y1 Dublin, Ireland
| | - M Kavanagh
- Zoetis, Cherrywood Business Park, Loughlinstown, D18 T3Y1 Dublin, Ireland
| | | | | | - M Sigler
- Zoetis, Jutogasse 3, 4675 Weibern, Austria
| | - P Nilsen
- Pharmaq Analytiq, Thormøhlensgate 53D, Bergen 5006, Norway.
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Leijon M, Algotson A, Bernhardsson S, Ekholm D, Ersberg L, Höök MJS, Klüft C, Müssener U, Garås ES, Nilsen P. Generation Pep - study protocol for an intersectoral community-wide physical activity and healthy eating habits initiative for children and young people in Sweden. Front Public Health 2024; 12:1299099. [PMID: 38435288 PMCID: PMC10904517 DOI: 10.3389/fpubh.2024.1299099] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Background There is overwhelming evidence for the preventive effects of regular physical activity and healthy eating habits on the risk for developing a non-communicable disease (NCD). Increasing attention has been paid to community-wide approaches in the battle against NCDs. Communities can create supportive policies, modify physical environments, and foster local stakeholder engagement through intersectoral collaboration to encourage communities to support healthy lifestyles. The Pep initiative is based on intersectoral community-wide collaboration among Sweden's municipalities. Primary targets are municipality professionals who work with children and young people as well as parents of children <18 years. The goal is to spread knowledge and create commitment to children's and young people's health with a special focus on physical activity and healthy eating habits to facilitate and support a healthy lifestyle. The overarching aim of the research project described in this study protocol is to investigate factors that influence the implementation of the Pep initiative in Sweden, to inform tailored implementation strategies addressing the needs and local prerequisites of the different municipalities. Methods The project includes a qualitative and a quantitative study and is framed by a theoretical model involving four complementary forms of knowledge, explicitly recognized in the Pep initiative: knowledge about the issue; knowledge about interventions; knowledge about the context; and knowledge about implementation. Study 1 is a focus group study exploring barriers and facilitators for implementing the Pep initiative. The study will be carried out in six municipalities, selected purposively to provide wide variation in municipality characteristics, including population size and geographical location. Data will be analyzed using thematic analysis. Study 2 is a cross-sectional web-based survey investigating the implementability of the Pep initiative in Sweden's 290 municipalities. Conditions for implementing different areas of the Pep initiative will be examined in terms of the acceptability, appropriateness, and feasibility, three predictors of implementation success. Data will be analyzed using non-parametric statistics. Discussion The findings of the two studies will increase understanding of the prerequisites for implementing the Pep initiative in Swedish municipalities, which will provide valuable input into how implementation of the Pep initiative can best be facilitated in the different municipality settings.
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Affiliation(s)
- Matti Leijon
- Generation Pep, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Albin Algotson
- Department of Management and Engineering, Faculty of Science and Engineering, Linköping University, Linköping, Sweden
| | - Susanne Bernhardsson
- Region Västra Götaland, Research, Education, Development, and Innovation Primary Health Care, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - David Ekholm
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | | | | | - Carolina Klüft
- Generation Pep, Stockholm, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Müssener
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Nilsen P. Artificial intelligence in nursing: From speculation to science. Worldviews Evid Based Nurs 2024; 21:4-5. [PMID: 38240405 DOI: 10.1111/wvn.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Per Nilsen
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Kirk JW, Lindstroem MB, Stefánsdóttir NT, Andersen O, Powell BJ, Nilsen P, Tjørnhøj-Thomsen T. Influences of specialty identity when implementing a new emergency department in Denmark: a qualitative study. BMC Health Serv Res 2024; 24:162. [PMID: 38302985 PMCID: PMC10836004 DOI: 10.1186/s12913-024-10604-0] [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] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The Danish Health Authority recommended the implementation of new types of emergency departments. Organizational changes in the hospital sector challenged the role, identity, and autonomy of medical specialists. They tend to identify with their specialty, which can challenge successful implementation of change. However, investigations on specialty identity are rare in implementation science, and how the co-existence of different specialty identities influences the implementation of new emergency departments needs to be explored for the development of tailored implementation strategies. The aim of this study was to examine how medical specialty identity influences collaboration between physicians when implementing a new emergency department in Denmark. METHODS Qualitative methods in the form of participants' observations at 13 oilcloth sessions (a micro-simulation method) were conducted followed up by 53 individual semi-structured interviews with participants from the oilcloth sessions. Out of the 53 interviews, 26 were conducted with specialists. Data from their interviews are included in this study. Data were analysed deductively inspired by Social Identity Theory. RESULTS The analysis yielded three overarching themes: [1] ongoing creation and re-creation of specialty identity through boundary drawing; [2] social categorization and power relations; and [3] the patient as a boundary object. CONCLUSIONS Specialty identity is an important determinant of collaboration among physicians when implementing a new emergency department. Specialty identity involves social categorization, which entails ongoing creation and re-creation of boundary drawing and exercising of power among the physicians. In some situations, the patient became a positive boundary object, increasing the possibility for a successful collaboration and supporting successful implementation, but direct expressions of boundaries and mistrust were evident. Both were manifested through a dominating power expressed through social categorization in the form of in- and out-groups and in an "us and them" discourse, which created distance and separation among physicians from different specialties. This distancing and separation became a barrier to the implementation of the new emergency department.
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Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | | | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Nilsen P, Kirk JW, Thomas K. Editorial: Going beyond the traditional tools of implementation science. Front Health Serv 2023; 3:1343058. [PMID: 38179218 PMCID: PMC10764611 DOI: 10.3389/frhs.2023.1343058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Hvidovre University Hospital, Hvidovre, Denmark
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Nilsen P, Svedberg P, Neher M, Nair M, Larsson I, Petersson L, Nygren J. A Framework to Guide Implementation of AI in Health Care: Protocol for a Cocreation Research Project. JMIR Res Protoc 2023; 12:e50216. [PMID: 37938896 PMCID: PMC10666006 DOI: 10.2196/50216] [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: 06/23/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) has the potential in health care to transform patient care and administrative processes, yet health care has been slow to adopt AI due to many types of barriers. Implementation science has shown the importance of structured implementation processes to overcome implementation barriers. However, there is a lack of knowledge and tools to guide such processes when implementing AI-based applications in health care. OBJECTIVE The aim of this protocol is to describe the development, testing, and evaluation of a framework, "Artificial Intelligence-Quality Implementation Framework" (AI-QIF), intended to guide decisions and activities related to the implementation of various AI-based applications in health care. METHODS The paper outlines the development of an AI implementation framework for broad use in health care based on the Quality Implementation Framework (QIF). QIF is a process model developed in implementation science. The model guides the user to consider implementation-related issues in a step-by-step design and plan and perform activities that support implementation. This framework was chosen for its adaptability, usability, broad scope, and detailed guidance concerning important activities and considerations for successful implementation. The development will proceed in 5 phases with primarily qualitative methods being used. The process starts with phase I, in which an AI-adapted version of QIF is created (AI-QIF). Phase II will produce a digital mockup of the AI-QIF. Phase III will involve the development of a prototype of the AI-QIF with an intuitive user interface. Phase IV is dedicated to usability testing of the prototype in health care environments. Phase V will focus on evaluating the usability and effectiveness of the AI-QIF. Cocreation is a guiding principle for the project and is an important aspect in 4 of the 5 development phases. The cocreation process will enable the use of both on research-based and practice-based knowledge. RESULTS The project is being conducted within the frame of a larger research program, with the overall objective of developing theoretically and empirically informed frameworks to support AI implementation in routine health care. The program was launched in 2021 and has carried out numerous research activities. The development of AI-QIF as a tool to guide the implementation of AI-based applications in health care will draw on knowledge and experience acquired from these activities. The framework is being developed over 2 years, from January 2023 to December 2024. It is under continuous development and refinement. CONCLUSIONS The development of the AI implementation framework, AI-QIF, described in this study protocol aims to facilitate the implementation of AI-based applications in health care based on the premise that implementation processes benefit from being well-prepared and structured. The framework will be coproduced to enhance its relevance, validity, usefulness, and potential value for application in practice. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50216.
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Affiliation(s)
- Per Nilsen
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Margit Neher
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Monika Nair
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Lena Petersson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Brulin E, Lidwall U, Seing I, Nyberg A, Landstad B, Sjöström M, Bååthe F, Nilsen P. Healthcare in distress: A survey of mental health problems and the role of gender among nurses and physicians in Sweden. J Affect Disord 2023; 339:104-110. [PMID: 37433382 DOI: 10.1016/j.jad.2023.07.042] [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: 03/19/2023] [Revised: 06/16/2023] [Accepted: 07/08/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION The present article aimed to investigate 1) if mental health problems (depression and burnout including the dimensions; emotional exhaustion, mental distance and cognitive and emotional impairment) differed between nurses and physicians in Sweden, 2) if any differences were explained by differences in sex compositions, and 3) if any sex differences were larger within either of the two professions. METHOD Data were derived from a representative sample of nurses (n = 2903) and physicians (n = 2712) in 2022. Two scales were used to assess burnout (KEDS and BAT) and one to assess depression (SCL-6). The BAT scale has four sub-dimensions. Descriptive statistics and logistic regression were used to analyse each scale and dimension separately. RESULTS Results showed that 16-28 % of nurses and physicians reported moderate to severe symptoms of burnout. The prevalence differed between occupations across the scales and dimensions used. Nurses reported higher scores on KEDS while physicians reported higher scores on BAT including the four dimensions. Also, 7 % of nurses' and 6 % of physicians' scores were above the cut-off for major depression. The inclusion of sex in the models changed the odds ratios of differences between doctors and nurses in all mental health dimensions except mental distance and cognitive impairment. LIMITATIONS This study was based on cross-sectional survey data which has some limitations. CONCLUSION Our study suggests that the prevalence of mental health problems is prominent among nurses and physicians in Sweden. Sex plays an important role in the difference in the prevalence of mental health problems between the two professions.
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Affiliation(s)
- Emma Brulin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Sweden.
| | - Ulrik Lidwall
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department for Analysis, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Ida Seing
- Department of Behavioural Sciences and Learning, Linköping University, Sweden
| | - Anna Nyberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Bodil Landstad
- Faculty of Human Sciences, Mid Sweden University, Sweden; Unit of Research, Education and Development, Östersund Hospital, Sweden
| | - Malin Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Fredrik Bååthe
- Institute for Studies of the Medical Profession, LEFO, Oslo, Norway; Institute of Stress Medicine at Region Västra Götaland, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
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Wang Y, Wong ELY, Nilsen P, Chung VCH, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci 2023; 18:43. [PMID: 37726779 PMCID: PMC10507824 DOI: 10.1186/s13012-023-01296-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND A proliferation of theories, models, and frameworks (TMFs) have been developed in the implementation science field to facilitate the implementation process. The basic features of these TMFs have been identified by several reviews. However, systematic appraisals on the quality of these TMFs are inadequate. To fill this gap, this study aimed to assess the usability, applicability, and testability of the current TMFs in a structured way. METHODS A scoping review method was employed. Electronic databases were searched to locate English and Chinese articles published between January 2000 and April 2022. Search terms were specific to implementation science. Additionally, hand searches were administered to identify articles from related reviews. Purpose and characteristics such as the type of TMF, analytical level, and observation unit were extracted. Structured appraisal criteria were adapted from Birken et al.'s Theory Comparison and Selection Tool (T-CaST) to conduct an in-depth analysis of the TMFs' usability, applicability, and testability. RESULTS A total of 143 TMFs were included in this analysis. Among them, the most common purpose was to identify barriers and facilitators. Most TMFs applied the descriptive method to summarize the included constructs or the prescriptive method to propose courses of implementation actions. TMFs were mainly mid-range theories built on existing conceptual frameworks or demonstrated grand theories. The usability of the TMFs needs to be improved in terms of the provision of conceptually matched strategies to barriers and facilitators and instructions on the TMFs usage. Regarding the applicability, little attention was paid to the constructs of macro-level context, stages of scale-up and sustainability, and implementation outcomes like feasibility, cost, and penetration. Also, fewer TMFs could propose recommended research and measurement methods to apply the TMFs. Lastly, explicit hypotheses or propositions were lacking in most of the TMFs, and empirical evidence was lacking to support the claimed mechanisms between framework elements in testability. CONCLUSIONS Common limitations were found in the usability, application, and testability of the current TMFs. The findings of this review could provide insights for developers of TMFs for future theoretical advancements.
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Affiliation(s)
- Yingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Vincent Chi-Ho Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yue Tian
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Birken SA, Wagi CR, Peluso AG, Kegler MC, Baloh J, Adsul P, Fernandez ME, Masud M, Huang TTK, Lee M, Wangen M, Nilsen P, Bender M, Choy-Brown M, Ryan G, Randazzo A, Ko LK. Toward a more comprehensive understanding of organizational influences on implementation: the organization theory for implementation science framework. Front Health Serv 2023; 3:1142598. [PMID: 37720844 PMCID: PMC10501605 DOI: 10.3389/frhs.2023.1142598] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
Introduction Implementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. To advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework. Methods The process of distilling organization theory constructs into domains involved concept mapping and iterative consensus-building. First, we recruited organization and implementation scientists to participate in an online concept mapping exercise in which they sorted organization theory constructs into domains representing similar theoretical concepts. Multidimensional scaling and hierarchical cluster analyses were used to produce visual representations (clusters) of the relationships among constructs in concept maps. Second, to interpret concept maps, we engaged members of the Cancer Prevention and Control Research Network (CPCRN) OTIS workgroup in consensus-building discussions. Results Twenty-four experts participated in concept mapping. Based on resulting construct groupings' coherence, OTIS workgroup members selected the 10-cluster solution (from options of 7-13 clusters) and then reorganized clusters in consensus-building discussions to increase coherence. This process yielded six final OTIS domains: organizational characteristics (e.g., size; age); governance and operations (e.g., organizational and social subsystems); tasks and processes (e.g., technology cycles; excess capacity); knowledge and learning (e.g., tacit knowledge; sense making); characteristics of a population of organizations (e.g., isomorphism; selection pressure); and interorganizational relationships (e.g., dominance; interdependence). Discussion Organizational influences on implementation are poorly understood, in part due to the limitations of extant frameworks. To improve understanding of organizational influences on implementation, we distilled 70 constructs from nine organization theories into six domains. Applications of the OTIS framework will enhance understanding of organizational influences on implementation, promote theory-driven strategies for organizational change, improve understanding of mechanisms underlying relationships between OTIS constructs and implementation, and allow for framework refinement. Next steps include testing the OTIS framework in implementation research and adapting it for use among policymakers and practitioners.
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Affiliation(s)
- Sarah A. Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Cheyenne R. Wagi
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Alexandra G. Peluso
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Michelle C. Kegler
- Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jure Baloh
- College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Manal Masud
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Terry T-K Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Matthew Lee
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Mary Wangen
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Miriam Bender
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States
| | - Mimi Choy-Brown
- College of Education and Human Development, School of Social Work, University of Minnesota, St. Paul, MN, United States
| | - Grace Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Aliza Randazzo
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Linda K. Ko
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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Steerling E, Siira E, Nilsen P, Svedberg P, Nygren J. Implementing AI in healthcare-the relevance of trust: a scoping review. Front Health Serv 2023; 3:1211150. [PMID: 37693234 PMCID: PMC10484529 DOI: 10.3389/frhs.2023.1211150] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Abstract
Background The process of translation of AI and its potential benefits into practice in healthcare services has been slow in spite of its rapid development. Trust in AI in relation to implementation processes is an important aspect. Without a clear understanding, the development of effective implementation strategies will not be possible, nor will AI advance despite the significant investments and possibilities. Objective This study aimed to explore the scientific literature regarding how trust in AI in relation to implementation in healthcare is conceptualized and what influences trust in AI in relation to implementation in healthcare. Methods This scoping review included five scientific databases. These were searched to identify publications related to the study aims. Articles were included if they were published in English, after 2012, and peer-reviewed. Two independent reviewers conducted an abstract and full-text review, as well as carrying out a thematic analysis with an inductive approach to address the study aims. The review was reported in accordance with the PRISMA-ScR guidelines. Results A total of eight studies were included in the final review. We found that trust was conceptualized in different ways. Most empirical studies had an individual perspective where trust was directed toward the technology's capability. Two studies focused on trust as relational between people in the context of the AI application rather than as having trust in the technology itself. Trust was also understood by its determinants and as having a mediating role, positioned between characteristics and AI use. The thematic analysis yielded three themes: individual characteristics, AI characteristics and contextual characteristics, which influence trust in AI in relation to implementation in healthcare. Conclusions Findings showed that the conceptualization of trust in AI differed between the studies, as well as which determinants they accounted for as influencing trust. Few studies looked beyond individual characteristics and AI characteristics. Future empirical research addressing trust in AI in relation to implementation in healthcare should have a more holistic view of the concept to be able to manage the many challenges, uncertainties, and perceived risks.
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Affiliation(s)
- Emilie Steerling
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Elin Siira
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Per Nilsen
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Nilsen P, Seing I, Sekhon M, Kallemose T, Tjørnhøj-Thomsen T, Stefánsdóttir NT, Vrangbæk K, Andersen O, Kirk JW. Acceptability of restrictions in the COVID-19 pandemic: a population-based survey in Denmark and Sweden. Front Public Health 2023; 11:988882. [PMID: 37601192 PMCID: PMC10434523 DOI: 10.3389/fpubh.2023.988882] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Denmark and Sweden initially adopted different responses to the COVID-19 pandemic although the two countries share many characteristics. Denmark responded swiftly with many mandatory restrictions. In contrast, Sweden relied on voluntary restrictions and a more "relaxed" response during the first wave of the pandemic. However, increased rates of COVID-19 cases led to a new approach that involved many more mandatory restrictions, thus making Sweden's response similar to Denmark's in the second wave of the pandemic. Aim The aim was to investigate and compare the extent to which the populations in Denmark and Sweden considered the COVID-19 restrictions to be acceptable during the first two waves of the pandemic. The study also aimed to identify the characteristics of those who were least accepting of the restrictions in the two countries. Materials and methods Cross-sectional surveys were conducted in Denmark and Sweden in 2021. The study population was sampled from nationally representative web panels in the two countries, consisting of 2,619 individuals from Denmark and 2,633 from Sweden. The questionnaire captured key socio-demographic characteristics. Acceptability was operationalized based on a theoretical framework consisting of seven constructs and one overarching construct. Results The respondents' age and gender patterns were similar in the two countries. The proportion of respondents in Denmark who agreed with the statements ("agree" alternative) that captured various acceptability constructs was generally higher for the first wave than the second wave of the pandemic. The opposite pattern was seen for Sweden. In Denmark, 66% in the first wave and 50% in the second wave were accepting of the restrictions. The corresponding figures for Sweden was 42% (first wave) and 47% (second wave). Low acceptance of the restrictions, defined as the 25% with the lowest total score on the seven acceptability statements, was associated with younger age, male gender and lower education levels. Conclusion Respondents in Sweden were more accepting of the restrictions in the second wave, when the country used many mandatory restrictions. In contrast, respondents in Denmark were more accepting of the restrictions in the first wave than in the second wave, implying an increased weariness to comply with the restrictions over time. There were considerable socio-demographic differences between those who expressed low acceptance of the restrictions and the others in both countries, suggesting the importance of tailoring communication about the pandemic to different segments of the population.
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Affiliation(s)
- Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ida Seing
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Mandeep Sekhon
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Nina Thórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Neher M, Petersson L, Nygren JM, Svedberg P, Larsson I, Nilsen P. Innovation in healthcare: leadership perceptions about the innovation characteristics of artificial intelligence-a qualitative interview study with healthcare leaders in Sweden. Implement Sci Commun 2023; 4:81. [PMID: 37464420 DOI: 10.1186/s43058-023-00458-8] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Despite the extensive hopes and expectations for value creation resulting from the implementation of artificial intelligence (AI) applications in healthcare, research has predominantly been technology-centric rather than focused on the many changes that are required in clinical practice for the technology to be successfully implemented. The importance of leaders in the successful implementation of innovations in healthcare is well recognised, yet their perspectives on the specific innovation characteristics of AI are still unknown. The aim of this study was therefore to explore the perceptions of leaders in healthcare concerning the innovation characteristics of AI intended to be implemented into their organisation. METHODS The study had a deductive qualitative design, using constructs from the innovation domain in the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted with 26 leaders in healthcare. RESULTS Participants perceived that AI could provide relative advantages when it came to care management, supporting clinical decisions, and the early detection of disease and risk of disease. The development of AI in the organisation itself was perceived as the main current innovation source. The evidence base behind AI technology was questioned, in relation to its transparency, potential quality improvement, and safety risks. Although the participants acknowledged AI to be superior to human action in terms of effectiveness and precision in some situations, they also expressed uncertainty about the adaptability and trialability of AI. Complexities such as the characteristics of the technology, the lack of conceptual consensus about AI, and the need for a variety of implementation strategies to accomplish transformative change in practice were identified, as were uncertainties about the costs involved in AI implementation. CONCLUSION Healthcare leaders not only saw potential in the technology and its use in practice, but also felt that AI's opacity limits its evidence strength and that complexities in relation to AI itself and its implementation influence its current use in healthcare practice. More research is needed based on actual experiences using AI applications in real-world situations and their impact on clinical practice. New theories, models, and frameworks may need to be developed to meet challenges related to the implementation of AI in healthcare.
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Affiliation(s)
- Margit Neher
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden.
| | - Lena Petersson
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
| | - Per Nilsen
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Division of Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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15
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Albers B, Rapley T, Nilsen P, Clack L. Editorial: Tailoring in implementation science. Front Health Serv 2023; 3:1233597. [PMID: 37389149 PMCID: PMC10304283 DOI: 10.3389/frhs.2023.1233597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Bianca Albers
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zürich, Switzerland
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- NIHR ARC North East-North Cumbria, Newcastle, United Kingdom
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lauren Clack
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zürich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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16
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Kwong MH, Ho L, Li ASC, Nilsen P, Ho FF, Zhong CCW, Chung VCH. Integrative oncology in cancer care - implementation factors: mixed-methods systematic review. BMJ Support Palliat Care 2023:spcare-2022-004150. [PMID: 37173126 DOI: 10.1136/spcare-2022-004150] [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: 12/28/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Integrative oncology (IO) appears to be beneficial to patients with cancer, but its implementation remains a challenge. Guided by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behaviour (COM-B) model, this systematic review identified the barriers to and facilitators of IO implementation in conventional cancer care settings. METHODS We searched eight electronic databases from their inception until February 2022 for qualitative, quantitative or mixed-methods empirical studies reporting the implementation outcomes for IO services. Critical appraisal approach was tailored according to study types. The identified implementation barriers and facilitators were mapped onto TDF domains and the COM-B model, and subsequently onto the behavioural change wheel (BCW) for formulating behavioural change interventions. RESULTS We included 28 studies (11 qualitative, 6 quantitative, 9 mixed-methods and 2 Delphi studies) of satisfied methodological quality. The main implementation barriers were the lack of IO knowledge, the absence of funding and healthcare professionals' low level of IO receptiveness. The key implementation facilitators were the dissemination of evidence on IO clinical benefits, the equipping of professionals with IO service delivery skills and the provision of a supportive organisational climate. CONCLUSION Multifaceted implementation strategies are needed to address the determinants influencing IO service delivery. Based on our BCW-based analysis of the included studies, the key behavioural change techniques are: (1) educating healthcare professionals about the value and application of traditional and complementary medicine; (2) ensuring access to actionable clinical evidence on IO effectiveness and safety and (3) designing guidelines on communicating traditional and complementary medicine interventions with patients and caregivers for biomedically trained doctors and nurses.
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Affiliation(s)
- Ming Hong Kwong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Leonard Ho
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Angus S C Li
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Östergötland, Sweden
| | - Fai Fai Ho
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Claire C W Zhong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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17
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Ingvarsson S, Sandaker I, Nilsen P, Hasson H, Augustsson H, von Thiele Schwarz U. Strategies to reduce low-value care - An applied behavior analysis using a single-case design. Front Health Serv 2023; 3:1099538. [PMID: 36926508 PMCID: PMC10012739 DOI: 10.3389/frhs.2023.1099538] [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: 11/15/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023]
Abstract
Introduction Implementation science has traditionally focused on the implementation of evidence-based practices, but the field has increasingly recognized the importance of addressing de-implementation (i.e., the process of reducing low-value care). Most studies on de-implementation strategies have used a combination of strategies without addressing factors that sustain the use of LVC and there is a lack of information about which strategies are most effective and what mechanisms of change might underlie these strategies. Applied behavior analysis is an approach that could be a potential method to gain insights into the mechanisms of de-implementation strategies to reduce LVC. Three research questions are addressed in this study: What contingencies (three-term contingencies or rule-governing behavior) related to the use of LVC can be found in a local context and what strategies can be developed based on an analysis of these contingencies?; Do these strategies change targeted behaviors?; How do the participants describe the strategies' contingencies and the feasibility of the applied behavior analysis approach? Materials and methods In this study, we used applied behavior analysis to analyze contingencies that maintain behaviors related to a chosen LVC, the unnecessary use of x-rays for knee arthrosis within a primary care center. Based on this analysis, strategies were developed and evaluated using a single-case design and a qualitative analysis of interview data. Results Two strategies were developed: a lecture and feedback meetings. The results from the single-case data were inconclusive but some of the findings may indicate a behavior change in the expected direction. Such a conclusion is supported by interview data showing that participants perceived an effect in response to both strategies. Conclusion The findings illustrate how applied behavior analysis can be used to analyze contingencies related to the use of LVC and to design strategies for de-implementation. It also shows an effect of the targeted behaviors even though the quantitative results are inconclusive. The strategies used in this study could be further improved to target the contingencies better by structuring the feedback meetings better and including more precise feedback.
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Affiliation(s)
- Sara Ingvarsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ingunn Sandaker
- Department of Behavioral Science, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Division of Public Health, Linköping University, Linköping, Sweden
| | - Henna Hasson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden
| | - Hanna Augustsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden
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18
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Skagerström J, Fernemark H, Nilsen P, Seing I, Hårdstedt M, Karlsson E, Schildmeijer K. Challenges of primary health care leadership during the COVID-19 pandemic in Sweden: a qualitative study of managers' experiences. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print:389-401. [PMID: 36786773 PMCID: PMC10427971 DOI: 10.1108/lhs-08-2022-0089] [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] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/11/2022] [Accepted: 11/21/2022] [Indexed: 02/15/2023]
Abstract
PURPOSE At the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work. DESIGN/METHODOLOGY/APPROACH The authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis. FINDINGS Data analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization's capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus. ORIGINALITY/VALUE Looking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises.
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Affiliation(s)
- Janna Skagerström
- Regional Executive Office, Region Ostergotland, Linkoping, Sweden and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hanna Fernemark
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden and Primary Health Care Center, Lambohov, Region Ostergotland, Linkoping, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ida Seing
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Maria Hårdstedt
- Vansbro Primary Health Care Center, Region Dalarna, Falun, Sweden and Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Elin Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Fu BQ, Zhong CCW, Wong CHL, Ho FF, Nilsen P, Hung CT, Yeoh EK, Chung VCH. Barriers and Facilitators to Implementing Interventions for Reducing Avoidable Hospital Readmission: Systematic Review of Qualitative Studies. Int J Health Policy Manag 2023; 12:7089. [PMID: 37579466 PMCID: PMC10125127 DOI: 10.34172/ijhpm.2023.7089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/11/2022] [Accepted: 01/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Avoidable hospital readmission is a major problem among health systems. Although there are effective peri-discharge interventions for reducing avoidable hospital readmission, successful implementation is challenging. This systematic review of qualitative studies aimed to identify barriers and facilitators to implementing peri-discharge interventions from providers' and service users' perspectives. METHODS We searched four databases for potentially eligible qualitative studies from databases' inception to March 2020, and updated literature search for studies published between January 2020 to October 2021. Barriers and facilitators to implementing peri-discharge interventions were identified and mapped onto the Consolidated Framework for Implementation Research (CFIR) constructs. Inductive analysis of the CFIR constructs was performed to yield thematic areas that illustrated the relationship between various facilitators and barriers, generating practical insights to key implementation issues. RESULTS Thirteen qualitative studies were included in this systematic review. Key issues were clustered in the CFIR constructs of Design Quality and Complexity of the intervention, strength of Network and Communication, being responsive to Patient Needs with sufficient Resource support, and External Incentives. The three thematic areas were rationality of the interventions, readiness and effort of multidisciplinary implementation teams, and influence of external stakeholders. Common barriers included (i) limited resources, (ii) poor communication among team members, (iii) incompatibility between the new intervention and existing work routine, (iv) complicated implementation process, (v) low practicality of supporting instruments, and (vi) lack of understanding about the content and effectiveness of the new interventions. Common facilitators were (i) information sharing via regular meetings on implementation issues, (ii) organizational culture that values quality and accountability, (iii) financial penalties for hospitals with high avoidable readmissions rates, (iv) external support offered via quality improvement programs and community resources, and (v) senior leadership support. CONCLUSION This study synthesized commonly-presenting barriers and facilitators to implementing peri-discharge interventions among different healthcare organizations. Findings may inform development of implementation strategies in different health systems after appropriate tailoring, based on a consensus-based formative research process.
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Affiliation(s)
- Becky Q Fu
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Claire CW Zhong
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charlene HL Wong
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Fai Fai Ho
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Per Nilsen
- Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, Sweden
| | - Chi Tim Hung
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eng Kiong Yeoh
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent CH Chung
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Nilsen P, Andréasson S. Four decades of screening and brief alcohol intervention research: the peg and the hole. Eur J Public Health 2023; 33:3. [PMID: 36351007 PMCID: PMC9897999 DOI: 10.1093/eurpub/ckac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sven Andréasson
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Karlsson N, Skagerström J, O'Donnell A, Abidi L, Thomas K, Nilsen P, Lid TG. Relationship Between Educational Level and Attitudes Towards Alcohol Conversations in Healthcare: A Cross-Sectional Survey Conducted in Four European Countries. Int J Public Health 2023; 68:1605634. [PMID: 37035102 PMCID: PMC10079867 DOI: 10.3389/ijph.2023.1605634] [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: 11/28/2022] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives: To examine the association between educational level and attitudes towards alcohol conversations in healthcare using population-based surveys of adults in England, the Netherlands, Norway, and Sweden; and to compare attitudes towards alcohol conversations in healthcare between these four countries. Methods: Cross-sectional surveys were conducted amongst adults in the general population in England (n = 3,499), the Netherlands (n = 2,173), Norway (n = 1,208), and Sweden (n = 3,000). Logistic regression analysis was used to examine associations between attitudes towards alcohol conversations in healthcare and educational level, key demographic variables, alcohol consumption, and country of residence. Results: In all four countries, low educational level (p < 0.001) and male gender (p < 0.001) were associated with holding negative attitudes towards discussing alcohol in healthcare. Risky drinkers had more negative attitudes than low risky drinkers towards discussing alcohol in healthcare (p < 0.001) in all countries except England (p = 0.48), and also reported low levels of perceived honesty and confidence in healthcare (p < 0.001). Conclusion: These findings highlight the importance of considering patients' socio-economic status when developing and implementing alcohol prevention interventions in healthcare.
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Affiliation(s)
- Nadine Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Nadine Karlsson,
| | - Janna Skagerström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Research and Development Unit in Region Östergötland, Linköping, Sweden
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Latifa Abidi
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Chung VC, Ho FF, Lao L, Liu J, Lee MS, Chan KW, Nilsen P. Implementation science in traditional, complementary and integrative medicine: An overview of experiences from China and the United States. Phytomedicine 2023; 109:154591. [PMID: 36610171 DOI: 10.1016/j.phymed.2022.154591] [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] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The introduction of traditional, complementary and integrative medicine (TCIM) services into health systems has been advocated by the World Health Organization, but there is a paucity of reviews synthesising the experiences of (i) implementing TCIM services in conventional healthcare settings and (ii) introducing evidence-based practice in TCIM. Knowledge of the first issue will assist policymakers to innovate implementation interventions in their own health system contexts. Addressing the second issue will facilitate the closure of the evidence-practice gap in TCIM and improve the translation of research evidence into health outcome benefits. PURPOSE The aim of this study was to identify, describe and analyse publications on these two key TCIM policy issues via an overview from an implementation science perspective. METHODS Publications describing international experiences of implementing TCIM services or evidence for TCIM practices were identified by searching MEDLINE, EMBASE and Global Health databases in November 2021. The findings were summarised using a narrative synthesis approach. RESULTS Sixty-three relevant publications were included in the analysis. Current experiences in China and the United Sates (US) reflect varying policy priorities at different stages of implementing TCIM services. In the US, where TCIM have yet to be introduced into mainstream healthcare settings, implementation interventions were designed to facilitate the provision of specific, evidence-based TCIM modalities via referrals from conventional clinicians. The application of these strategies at the health system, regulatory, financial, community, provider and patient levels provided a comprehensive picture of how TCIM implementation may be facilitated via multi-level interventions. In China, the major form of TCIM is traditional Chinese medicine (TCM), for which service provision has already been adopted at all levels of healthcare. With the high volume of clinical research that has been generated in the past several decades, a key policy question at this stage is how to translate TCM-related clinical evidence into practice. The development of clinical practice guidelines (CPGs) is the main implementation intervention, but adherence by TCM clinicians has been poor, due to the conflict between classical individualised practice and CPG standardisation. While tailoring interventions to facilitate CPG uptake is indicated, concurrent innovations in TCM clinical research methods would improve the compatibility between classical and CPG-based practice. CONCLUSION Policymakers managing different stages of TCIM implementation will benefit from the experiences of practitioners in the US and China. Multi-level implementation interventions launched in the US provide ideas for the initial introduction of TCIM into a conventional medicine-dominated health system. As TCIM service provision and related clinical research become more common, China's experience will inform how clinical evidence related to TCIM may be disseminated and implemented to improve service quality.
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Affiliation(s)
- Vincent Ch Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Fai Fai Ho
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Lixing Lao
- Virginia University of Integrative Medicine, Fairfax, VA, United States
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Myeong Soo Lee
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kam Wa Chan
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lindberg C, Fock J, Nilsen P, Schildmeijer K. Registered nurses' efforts to ensure safety for home-dwelling older patients. Scand J Caring Sci 2022; 37:571-581. [PMID: 36582025 DOI: 10.1111/scs.13142] [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: 06/07/2022] [Revised: 10/23/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The international development of health care, an ageing population and rapid technical development mean that more care is being performed in patient homes. This care environment is often unpredictable and involves both formal and informal caregivers, making it potentially unsafe. There is sparse knowledge about how patient safety is protected in home health care in Sweden and how registered nurses work to prevent risks and promote safe care. AIM The aim of the study was to explore registered nurses' efforts to reduce perceived risks for home-dwelling older patients and ensure safe home health care. METHOD We used a qualitative design with individual interviews with 13 registered nurses working in municipalities in southeast Sweden. The narratives were analysed with inductive content analysis. FINDINGS The findings showed that the registered nurses tried to secure a safe care environment and took an active role in care, striving to stay one step ahead of the patient. These three types of efforts are likely interdependent, suggesting they are all needed to reduce perceived risks for home-dwelling older patients and ensure patient safety in home health care. CONCLUSIONS It is a challenge for registered nurses to maintain patient safety when performing care in patient homes. Continuity of care is required and must be based not only on self-reliance among registered nurses but also on trusting relationships with patients, next of kin, colleagues and other personnel, as well as on the development of organisational conditions adapted to patient needs.
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Affiliation(s)
- Catharina Lindberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Jenni Fock
- Centre for Healthcare Development, University Hospital Linköping, Linköping, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Ingvarsson S, Nilsen P, Hasson H. Low-Value Care: Convergence and Challenges Comment on "Key Factors That Promote Low-Value Care: Views From Experts From the United States, Canada, and the Netherlands". Int J Health Policy Manag 2022; 11:2762-2764. [PMID: 36404499 PMCID: PMC9818099 DOI: 10.34172/ijhpm.2022.7017] [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] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/19/2022] [Indexed: 11/21/2022] Open
Abstract
Interest has increased in the topic of de-implementation, ie, reducing so-called low-value care (LVC). The article "Key Factors That Promote Low-Value Care: Views From Experts From the United States, Canada, and the Netherlands" by Verkerk and colleagues identifies national-level factors affecting LVC use in those three countries. This commentary raises three critical points regarding the study. First, the study does not clearly define the national level. Secondly, national-level factors might not be relevant for all types of LVCs and thirdly, the study's rather limited sample makes it difficult to draw firm conclusions. We also include some critical comments related to some of the study's findings in relation to results of our recently published scoping review of the international literature on de-implementation and use of LVC and an interview study with primary care physicians on LVC use. Finally, we provide some suggestions for further research that we believe is needed to improve understanding of LVC use and facilitate its de-implementation.
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Affiliation(s)
- Sara Ingvarsson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for implementation and evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden
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Hammarström S, Bernhardsson S, Nilsen P, Elisson J, Frostholm E, Lindroth M. Ask me, listen to me, treat me well and I shall tell: a qualitative study of Swedish youths' experiences of systematic assessment of sexual health and risk-taking (SEXIT). Sex Reprod Health Matters 2022; 30:2146032. [PMID: 36476113 PMCID: PMC9733687 DOI: 10.1080/26410397.2022.2146032] [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] [Indexed: 12/12/2022] Open
Abstract
Sexual ill health among young people, in terms of sexually transmitted infections (STIs), unintended pregnancy, transactional sex and sexual violence, is a global public health concern. To that end, the SEXual health Identification Tool (SEXIT) was developed. The purpose of this study was to explore the visitors' experiences of a youth clinic visit when SEXIT was used. A purposively selected sample of 20 participants (16-24 years of age) was recruited from three Swedish youth clinics using SEXIT. Participants were interviewed individually in March and April 2016, and data were analysed using inductive qualitative content analysis. The analysis resulted in four main categories describing the participants' experiences of using SEXIT: "Issues of concern" includes descriptions of the items in SEXIT as important; "Enabling disclosure" describes how SEXIT serves as an invitation to talk and facilitates disclosure of negative experiences; "Road to change" captures experiences of the conversation with the healthcare professional; and "Managing power imbalance" describes experiences regarding the response and attitudes of the healthcare professional as well as the participants' fears of being judged. The categories are connected by the overarching theme "Ask me, listen to me, treat me well and I shall tell". This study contributes knowledge on young people's experiences of a tool-supported dialogue on sexual health and risk-taking initiated by the healthcare professional. Structured questions in a written format, as a basis for dialogue, are appreciated and experienced as a functioning way of addressing sexual ill health and risk-taking at Swedish youth clinics.
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Affiliation(s)
- Sofia Hammarström
- Academic Researcher, Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden; Development Manager, Region Västra Götaland, Knowledge Centre for Sexual Health, Gothenburg, Sweden; Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden. Correspondence:
| | - Susanne Bernhardsson
- Associate Professor, Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Nilsen
- Professor, Department of Health, Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Jennie Elisson
- Registered Midwife, Region Västra Götaland, Mölnlycke Youth Clinic, Mölnlycke, Sweden
| | - Ellinor Frostholm
- Registered Midwife, Region Västra Götaland, Youth Clinics Central Administration, Gothenburg, Sweden
| | - Malin Lindroth
- Associate Professor, Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
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Lang G, Ingvarsson S, Hasson H, Nilsen P, Augustsson H. Organizational influences on the use of low-value care in primary health care - a qualitative interview study with physicians in Sweden. Scand J Prim Health Care 2022; 40:426-437. [PMID: 36325746 PMCID: PMC9848255 DOI: 10.1080/02813432.2022.2139467] [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] [Indexed: 11/05/2022] Open
Abstract
AIM The aim was (1) to explore organizational factors influencing the use of low-value care (LVC) as perceived by primary care physicians and (2) to explore which organizational strategies they believe are useful for reducing the use of LVC. DESIGN Qualitative study with semi-structured focus group discussions (FGDs) analyzed using qualitative content analysis. SETTING Six publicly owned primary health care centers in Stockholm. SUBJECTS The participants were 31 primary care physicians. The number of participants in each FGD varied between 3 and 7. MAIN OUTCOME MEASURES Categories and subcategories reporting organizational factors perceived to influence the use of LVC and organizational strategies considered useful for reducing the use of LVC. RESULTS Four types of organizational factors (resources, care processes, improvement activities, and governance) influenced the use of LVC. Resources involved time to care for patients, staff knowledge, and working tools. Care processes included work routines and the ways activities and resources were prioritized in the organization. Improvement activities involved performance measurement and improvement work to reduce LVC. Governance concerned organizational goals, higher-level decision making, and policies. Physicians suggested multiple strategies targeting these factors to reduce LVC, including increased patient-physician continuity, adjusted economic incentives, continuous professional development for physicians, and gatekeeping functions which prevent unnecessary appointments and guide patients to the appropriate point of care. . CONCLUSION The influence of multiple organizational factors throughout the health-care system indicates that a whole-system approach might be useful in reducing LVC.KEY POINTSWe know little about how organizational factors influence the use of low-value care (LVC) in primary health care.Physicians perceive organizational resources, care processes, improvement activities, and governance as influences on the use of LVC and LVC-reducing strategies.This study provides insights about how these factors influence LVC use.Strategies at multiple levels of the health-care system may be warranted to reduce LVC.
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Affiliation(s)
- Gabriella Lang
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- CONTACT Gabriella Lang Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, SE 171 77, Sweden
| | - Sara Ingvarsson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Henna Hasson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden
| | - Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hanna Augustsson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden
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Ingvarsson S, Hasson H, von Thiele Schwarz U, Nilsen P, Powell BJ, Lindberg C, Augustsson H. Strategies for de-implementation of low-value care-a scoping review. Implement Sci 2022; 17:73. [PMID: 36303219 PMCID: PMC9615304 DOI: 10.1186/s13012-022-01247-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/07/2022] [Accepted: 10/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background The use of low-value care (LVC) is a persistent problem that calls for knowledge about strategies for de-implementation. However, studies are dispersed across many clinical fields, and there is no overview of strategies that can be used to support the de-implementation of LVC. The extent to which strategies used for implementation are also used in de-implementing LVC is unknown. The aim of this scoping review is to (1) identify strategies for the de-implementation of LVC described in the scientific literature and (2) compare de-implementation strategies to implementation strategies as specified in the Expert Recommendation for Implementing Change (ERIC) and strategies added by Perry et al. Method A scoping review was conducted according to recommendations outlined by Arksey and O’Malley. Four scientific databases were searched, relevant articles were snowball searched, and the journal Implementation Science was searched manually for peer-reviewed journal articles in English. Articles were included if they were empirical studies of strategies designed to reduce the use of LVC. Two reviewers conducted all abstract and full-text reviews, and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data-charting form. The strategies were first coded inductively and then mapped onto the ERIC compilation of implementation strategies. Results The scoping review identified a total of 71 unique de-implementation strategies described in the literature. Of these, 62 strategies could be mapped onto ERIC strategies, and four strategies onto one added category. Half (50%) of the 73 ERIC implementation strategies were used for de-implementation purposes. Five identified de-implementation strategies could not be mapped onto any of the existing strategies in ERIC. Conclusions Similar strategies are used for de-implementation and implementation. However, only a half of the implementation strategies included in the ERIC compilation were represented in the de-implementation studies, which may imply that some strategies are being underused or that they are not applicable for de-implementation purposes. The strategies assess and redesign workflow (a strategy previously suggested to be added to ERIC), accountability tool, and communication tool (unique new strategies for de-implementation) could complement the existing ERIC compilation when used for de-implementation purposes. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01247-y.
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Affiliation(s)
- Sara Ingvarsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden.
| | - Henna Hasson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden.,Unit for implementation and evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, Stockholm, Sweden
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Public Health, Linköping University, Linköping, Sweden
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA.,Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA.,Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Clara Lindberg
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden
| | - Hanna Augustsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden.,Unit for implementation and evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, Stockholm, Sweden
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Nilsen P, Reed J, Nair M, Savage C, Macrae C, Barlow J, Svedberg P, Larsson I, Lundgren L, Nygren J. Realizing the potential of artificial intelligence in healthcare: Learning from intervention, innovation, implementation and improvement sciences. Front Health Serv 2022; 2:961475. [PMID: 36925879 PMCID: PMC10012740 DOI: 10.3389/frhs.2022.961475] [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] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/22/2022] [Indexed: 06/18/2023]
Abstract
Introduction Artificial intelligence (AI) is widely seen as critical for tackling fundamental challenges faced by health systems. However, research is scant on the factors that influence the implementation and routine use of AI in healthcare, how AI may interact with the context in which it is implemented, and how it can contribute to wider health system goals. We propose that AI development can benefit from knowledge generated in four scientific fields: intervention, innovation, implementation and improvement sciences. Aim The aim of this paper is to briefly describe the four fields and to identify potentially relevant knowledge from these fields that can be utilized for understanding and/or facilitating the use of AI in healthcare. The paper is based on the authors' experience and expertise in intervention, innovation, implementation, and improvement sciences, and a selective literature review. Utilizing knowledge from the four fields The four fields have generated a wealth of often-overlapping knowledge, some of which we propose has considerable relevance for understanding and/or facilitating the use of AI in healthcare. Conclusion Knowledge derived from intervention, innovation, implementation, and improvement sciences provides a head start for research on the use of AI in healthcare, yet the extent to which this knowledge can be repurposed in AI studies cannot be taken for granted. Thus, when taking advantage of insights in the four fields, it is important to also be explorative and use inductive research approaches to generate knowledge that can contribute toward realizing the potential of AI in healthcare.
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Affiliation(s)
- Per Nilsen
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Julie Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Monika Nair
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Carl Savage
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Carl Macrae
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, United Kingdom
| | - James Barlow
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Lina Lundgren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Augustsson H, Casales Morici B, Hasson H, von Thiele Schwarz U, Schalling SK, Ingvarsson S, Wijk H, Roczniewska M, Nilsen P. National governance of de-implementation of low-value care: a qualitative study in Sweden. Health Res Policy Syst 2022; 20:92. [PMID: 36050688 PMCID: PMC9438133 DOI: 10.1186/s12961-022-00895-2] [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: 04/03/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The de-implementation of low-value care (LVC) is important to improving patient and population health, minimizing patient harm and reducing resource waste. However, there is limited knowledge about how the de-implementation of LVC is governed and what challenges might be involved. In this study, we aimed to (1) identify key stakeholders' activities in relation to de-implementing LVC in Sweden at the national governance level and (2) identify challenges involved in the national governance of the de-implementation of LVC. METHODS We used a purposeful sampling strategy to identify stakeholders in Sweden having a potential role in governing the de-implementation of LVC at a national level. Twelve informants from nine stakeholder agencies/organizations were recruited using snowball sampling. Semi-structured interviews were conducted, transcribed and analysed using inductive thematic analysis. RESULTS Four potential activities for governing the de-implementation of LVC at a national level were identified: recommendations, health technology assessment, control over pharmaceutical products and a national system for knowledge management. Challenges involved included various vested interests that result in the maintenance of LVC and a low overall priority of working with the de-implementation of LVC compared with the implementation of new evidence. Ambiguous evidence made it difficult to clearly determine whether a practice was LVC. Unclear roles, where none of the stakeholders perceived that they had a formal mandate to govern the de-implementation of LVC, further contributed to the challenges involved in governing that de-implementation. CONCLUSIONS Various activities were performed to govern the de-implementation of LVC at a national level in Sweden; however, these were limited and had a lower priority relative to the implementation of new methods. Challenges involved relate to unfavourable change incentives, ambiguous evidence, and unclear roles to govern the de-implementation of LVC. Addressing these challenges could make the national-level governance of de-implementation more systematic and thereby help create favourable conditions for reducing LVC in healthcare.
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Affiliation(s)
- Hanna Augustsson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden.
| | - Belén Casales Morici
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Department of Business Studies, Uppsala University, Uppsala, Sweden
| | - Henna Hasson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Sara Korlén Schalling
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Sara Ingvarsson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Wijk
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Marta Roczniewska
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Per Nilsen
- Division of Public Health, Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
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Kirk JW, Stefánsdóttir NÞ, Powell BJ, Lindstroem MB, Andersen O, Tjørnhøj-Thomsen T, Nilsen P. Oilcloth sessions as an implementation strategy: a qualitative study in Denmark. BMC Med Educ 2022; 22:571. [PMID: 35870916 PMCID: PMC9308909 DOI: 10.1186/s12909-022-03635-w] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of this study was to explore healthcare professionals, managers, and other key employees' experiences of oilcloth sessions as a strategy when implementing new emergency departments in Denmark, based on their participations in these sessions. The study addresses the importance of securing alignment in implementation strategies. Too often, this does not get enough attention in the literature and in practice. In this study, alignment among components was achieved in an educational implementation strategy called oilcloth sessions. METHODS The study is based on participants' observations of 13 oilcloth sessions and follow-up via 53 semi-structured interviews with the board of directors, managers, and key employees from the present emergency department and different specialty departments. Data were analysed deductively using Biggs and Tang's model of didactic alignment. RESULTS The analysis showed the complexity of challenges when using oilcloth sessions as a strategy when implementing a new emergency department described in terms of three phases and nine main themes (a-i): the preparation phase: (a) preparing individually and collectively, (b) objectives, (c) involving participants, (d) selecting cases; the execution phase: (e) using materials, (f) facilitating the sessions, (g) temporal structures; evaluation: (h) following up on the sessions, (i) adapting to the context. CONCLUSIONS This study shows that it is important to ensure alignment among elements in implementation strategies. Thus, oilcloth sessions with high alignment are useful if the challenges experienced are to be overcome and the strategy will be experienced as a useful way to support the implementation of a new emergency department from the participants' point of view. Bigg and Tang's didactic model is useful as an analytical framework to ensure alignment in implementation strategies in general.
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Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.
- Department of Public Health, Nursing, Aarhus University, 8000, Aarhus C, Denmark.
| | - Nina Þórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, 1455, Copenhagen K, Denmark
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
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Petersson L, Larsson I, Nygren JM, Nilsen P, Neher M, Reed JE, Tyskbo D, Svedberg P. Challenges to implementing artificial intelligence in healthcare: a qualitative interview study with healthcare leaders in Sweden. BMC Health Serv Res 2022; 22:850. [PMID: 35778736 PMCID: PMC9250210 DOI: 10.1186/s12913-022-08215-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 04/04/2022] [Accepted: 06/20/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Artificial intelligence (AI) for healthcare presents potential solutions to some of the challenges faced by health systems around the world. However, it is well established in implementation and innovation research that novel technologies are often resisted by healthcare leaders, which contributes to their slow and variable uptake. Although research on various stakeholders' perspectives on AI implementation has been undertaken, very few studies have investigated leaders' perspectives on the issue of AI implementation in healthcare. It is essential to understand the perspectives of healthcare leaders, because they have a key role in the implementation process of new technologies in healthcare. The aim of this study was to explore challenges perceived by leaders in a regional Swedish healthcare setting concerning the implementation of AI in healthcare. METHODS The study takes an explorative qualitative approach. Individual, semi-structured interviews were conducted from October 2020 to May 2021 with 26 healthcare leaders. The analysis was performed using qualitative content analysis, with an inductive approach. RESULTS The analysis yielded three categories, representing three types of challenge perceived to be linked with the implementation of AI in healthcare: 1) Conditions external to the healthcare system; 2) Capacity for strategic change management; 3) Transformation of healthcare professions and healthcare practice. CONCLUSIONS In conclusion, healthcare leaders highlighted several implementation challenges in relation to AI within and beyond the healthcare system in general and their organisations in particular. The challenges comprised conditions external to the healthcare system, internal capacity for strategic change management, along with transformation of healthcare professions and healthcare practice. The results point to the need to develop implementation strategies across healthcare organisations to address challenges to AI-specific capacity building. Laws and policies are needed to regulate the design and execution of effective AI implementation strategies. There is a need to invest time and resources in implementation processes, with collaboration across healthcare, county councils, and industry partnerships.
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Affiliation(s)
- Lena Petersson
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden.
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Per Nilsen
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Margit Neher
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden.,Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Julie E Reed
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Daniel Tyskbo
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
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Birken SA, Ko LK, Wangen M, Wagi CR, Bender M, Nilsen P, Choy-Brown M, Peluso A, Leeman J. Increasing Access to Organization Theories for Implementation Science. Front Health Serv 2022; 2:891507. [PMID: 36925845 PMCID: PMC10012830 DOI: 10.3389/frhs.2022.891507] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022]
Abstract
Background Organization theories offer numerous existing, highly relevant, yet largely untapped explanations of the organizational dynamics underlying evidence-based intervention (EBI) implementation. Rooted in ideas regarding power, autonomy, and control, organization theories can explain how and why organizations adopt, implement, and sustain EBI use. Although they have gained visibility, organization theories remain underused in implementation research, perhaps due to their inaccessibility to implementation scientists. To improve access to organization theory among implementation scientists, we summarized organization theories with relevance to implementation science. Methods Led by the Cancer Prevention and Control Research Network (CPCRN) Organization Theory for Implementation Science workgroup, we employed a modified Delphi process to reach a consensus among 18 experts at the intersection of organization and implementation science regarding organization theories with relevance to implementation science. From texts that described the organization theories, using standardized abstraction forms, two investigators independently abstracted information regarding constructs, propositions regarding how or why constructs might influence implementation, the potential relevance of organization theories' propositions for implementation, and overviews of each theory. The investigators then reconciled discrepancies until reaching consensus. A third investigator reviewed reconciled abstraction forms for accuracy, coherence, and completeness. Findings We identified nine organization theories with relevance to implementation science: contingency, complexity, institutional, network, organizational learning, resource dependence, sociotechnical, and transaction cost economics. From the theories, we abstracted 70 constructs and 65 propositions. An example proposition from institutional theory is: "Coercive, mimetic, and normative pressures contribute to organizations…within an organizational field [becoming increasingly similar]." These propositions can be operationalized as levers to facilitate EBI implementation. Conclusions To increase use in the field, organization theories must be made more accessible to implementation scientists. The abstraction forms developed in this study are now publicly available on the CPCRN website with the goal of increasing access to organization theories among an interdisciplinary audience of implementation scientists through the CPCRN Scholars program and other venues. Next steps include consolidating organization theory constructs into domains and translating the resulting framework for use among researchers, policymakers and practitioners, aiding them in accounting for a comprehensive set of organization theory constructs thought to influence EBI implementation.
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Affiliation(s)
- Sarah A. Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Linda K. Ko
- Washington School of Public Health, Health Systems and Population Health, Seattle, WA, United States
| | - Mary Wangen
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Cheyenne R. Wagi
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Miriam Bender
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States
| | - Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mimi Choy-Brown
- School of Social Work, College of Education and Human Development, University of Minnesota, St. Paul, MN, United States
| | - Alexandra Peluso
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jennifer Leeman
- School of Nursing, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
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Ingvarsson S, Hasson H, Augustsson H, Nilsen P, von Thiele Schwarz U, Sandaker I. Management strategies to de-implement low-value care-an applied behavior analysis. Implement Sci Commun 2022; 3:69. [PMID: 35752858 PMCID: PMC9233807 DOI: 10.1186/s43058-022-00320-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a lack of knowledge about management strategies being used to de-implement low-value care (LVC). Furthermore, it is not clear from the current literature what mechanisms are involved in such strategies and how they can change physicians' behaviors. Understanding the mechanisms is important for determining a strategy's potential impact. Applied behavior analysis focuses on processes involved in increasing and decreasing behaviors. Therefore, the aim of this study is to understand what management strategies are being used to de-implement LVC and the possible mechanisms involved in those strategies, using concepts from applied behavior analysis. METHOD We applied a qualitative study design using an inductive approach to understand what management strategies are in use and then employed applied behavior analysis concepts to deductively analyze the mechanisms involved in them. RESULTS We identified eight different management strategies intended to influence LVC. Five of the strategies were developed at a regional level and had the potential to influence physicians' LVC-related behaviors either by functioning as rules on which LVC to de-implement or by initiating local strategies in each health care center that in turn could influence LVC practices. The local strategies had a stronger potential for influencing de-implementation. CONCLUSION Both strategies at a systemic level (regional) and on a local level (health care centers) must be considered to influence LVC-related behaviors. Strategies at the center level have a specific opportunity to impact LVC-related behaviors because they can be tailored to specific circumstances, even though some of them probably were initiated as an effect of strategies on a regional level. Using applied behavior analysis to understand these circumstances can be helpful for tailoring strategies to reduce LVC use.
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Affiliation(s)
- Sara Ingvarsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, SE, Sweden.
| | - Henna Hasson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, SE, Sweden.,Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, 171 29, Stockholm, SE, Sweden
| | - Hanna Augustsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, SE, Sweden.,Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, 171 29, Stockholm, SE, Sweden
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Division of Public Health, Linköping University, Linköping, Sweden
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, SE, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Ingunn Sandaker
- SCBE Research Group, Department of Behavioral Science, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, NO-0130, Oslo, Norway
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Bernhardsson S, Boman C, Lundqvist S, Arvidsson D, Börjesson M, Larsson MEH, Lundh H, Melin K, Nilsen P, Lauruschkus K. Implementation of physical activity on prescription for children with obesity in paediatric health care (IMPA): protocol for a feasibility and evaluation study using quantitative and qualitative methods. Pilot Feasibility Stud 2022; 8:117. [PMID: 35650617 PMCID: PMC9158137 DOI: 10.1186/s40814-022-01075-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical inactivity is a main cause of childhood obesity which tracks into adulthood obesity, making it important to address early in life. Physical activity on prescription (PAP) is an evidence-based intervention that has shown good effect on physical activity levels in adults, but has not been evaluated in children with obesity. This project aims to evaluate the prerequisites, determinants, and feasibility of implementing PAP adapted to children with obesity and to explore children's, parents', and healthcare providers' experiences of PAP. METHODS In the first phase of the project, healthcare providers and managers from 26 paediatric clinics in Region Västra Götaland, Sweden, will be invited to participate in a web-based survey and a subset of this sample for a focus group study. Findings from these two data collections will form the basis for adaptation of PAP to the target group and context. In a second phase, this adapted PAP intervention will be evaluated in a clinical study in a sample of approximately 60 children with obesity (ISO-BMI > 30) between 6 and 12 years of age and one of their parents/legal guardians. Implementation process and clinical outcomes will be assessed pre- and post-intervention and at 8 and 12 months' follow-up. Implementation outcomes are the four core constructs of the Normalization Process Theory; coherence, cognitive participation, collective action, and reflexive monitoring; and appropriateness, acceptability, and feasibility of the PAP intervention. Additional implementation process outcomes are recruitment and attrition rates, intervention fidelity, dose, and adherence. Clinical outcomes are physical activity pattern, BMI, metabolic risk factors, health-related quality of life, sleep, and self-efficacy and motivation for physical activity. Lastly, we will explore the perspectives of children and parents in semi-structured interviews. Design and analysis of the included studies are guided by the Normalization Process Theory. DISCUSSION This project will provide new knowledge regarding the feasibility of PAP for children with obesity and about whether and how an evidence-based intervention can be fitted and adapted to new contexts and populations. The results may inform a larger scale trial and future implementation and may enhance the role of PAP in the management of obesity in paediatric health care in Sweden. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04847271 , registered 14 April 2021.
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Affiliation(s)
- Susanne Bernhardsson
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden. .,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Charlotte Boman
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
| | - Stefan Lundqvist
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
| | - Daniel Arvidsson
- Department of Food and Nutrition and Sport Science, Faculty of Education, Center for Health and Performance, University of Gothenburg, Gothenburg, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine & Center for Health and Performance, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria E H Larsson
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hannah Lundh
- Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Nilsen
- Division of Health and Society, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Katarina Lauruschkus
- Faculty of Medicine, Institution of Health Sciences, Lund University, Lund, Sweden
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Wong CH, Zhong CC, Chung VC, Nilsen P, Wong EL, Yeoh EK. Barriers and Facilitators to Receiving the COVID-19 Vaccination and Development of Theoretically-Informed Implementation Strategies for the Public: Qualitative Study in Hong Kong. Vaccines (Basel) 2022; 10:vaccines10050764. [PMID: 35632520 PMCID: PMC9143598 DOI: 10.3390/vaccines10050764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
Objectives: enhancing uptake of COVID-19 vaccines is an important tool for managing the pandemic. However, in Hong Kong, the COVID-19 vaccination rate in the general population was unsatisfactory during the early phase of the vaccination program. This two-part study aimed to (i) identify barriers and facilitators to receiving vaccinations, and (ii) develop theoretically-informed implementation strategies for promoting uptake. Methods: in part 1, 45 Hong Kong residents who differed in their willingness to vaccinate (willing (n = 15), were unwilling (n = 15), and were hesitant (n = 15)), were interviewed individually in February 2021. They were invited to express their perceptions of receiving the COVID-19 vaccination. The theoretical domains framework (TDF) was applied to guide the interviews and analyses. Behavioral diagnoses from these findings were then used to develop theoretically-informed implementation strategies in part 2, composed of behavior change techniques (BCTs) informed by the established BCT taxonomy. Results: in part 1, the five main barriers were (i) concerns on severe and long-term side effects; (ii) low confidence in the safety and effectiveness due to concerns of their accelerated development; (iii) unclear information on logistical arrangements of the vaccination program; (iv) insufficient data on safety and effectiveness; and (v) perceived low protection ability conferred by the vaccines. The five main facilitators included (i) healthcare professionals’ recommendations; (ii) news from TV, radio, and newspapers as main sources of trustworthy information; (iii) vaccine-related health education delivered by healthcare professionals; (iv) expectations of resuming to a normal social life; and (v) perceived benefits outweighing risks of mild and short-term side effects. Conclusions: seven implementation strategies were developed in part 2 based on the results above, namely (i) providing trustworthy vaccine-related information and scaling up the promotion; (ii) encouraging healthcare professionals to recommend vaccinations; (iii) giving incentives; (iv) using social influence approaches; (v) allowing a selection of COVID-19 vaccine brands; (vi) increasing accessibility for vaccinations; and (vii) emphasizing social responsibility.
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Affiliation(s)
- Charlene Hl Wong
- Faculty of Medicine, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (C.H.W.); (C.C.Z.)
| | - Claire Cw Zhong
- Faculty of Medicine, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (C.H.W.); (C.C.Z.)
| | - Vincent Ch Chung
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (E.L.W.); (E.-k.Y.)
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- Correspondence: ; Tel.: +852-22528453; Fax: +852-26453098
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden;
| | - Eliza Ly Wong
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (E.L.W.); (E.-k.Y.)
| | - Eng-kiong Yeoh
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (E.L.W.); (E.-k.Y.)
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Nilsen P. Theories, models, and frameworks in implementation science. Implement Sci 2022. [DOI: 10.4324/9781003109945-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Nilsen P, Neher M, Ellström PE, Gardner B. A learning perspective on implementation. Implement Sci 2022. [DOI: 10.4324/9781003109945-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Nilsen P, Fernemark H, Seing I, Schildmeijer K, Skagerström J. Seven lessons from the coronavirus pandemic for primary health care: A qualitative study of registered and assistant nurses in Sweden. Scand J Caring Sci 2022; 36:1197-1205. [PMID: 35466416 PMCID: PMC9115448 DOI: 10.1111/scs.13082] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/28/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
Aim The aim of this study was to explore lessons from the pandemic by registered and assistant nurses in Swedish primary health care (PHC) of potential relevance for the future operation of PHC. Methods Twenty‐one semi‐structured interviews were conducted with registered and assistant nurses. We used a purposeful sampling strategy to achieve a diverse sample with regard to size and location of PHC centres. Data were analysed using qualitative content analysis. Results Analysis yielded two categories: lessons from the pandemic pertaining to PHC personnel and patient behaviours (adaptability of the personnel; importance of hygiene and maintaining physical distance; and importance of being attentive to illness symptoms) and lessons from the pandemic related to primary healthcare work routines (effectiveness of digital job meetings; advantages of digital patient consultations; importance of keeping infectious patients separate from other patients; and the need to allow only pre‐booked patient appointments). Conclusions The seven sub‐categories represent seven lessons from the pandemic. The lessons generated both instrumental knowledge, which the nurses could apply in work‐related decisions, and conceptual knowledge which yielded improved understanding of problems and potential solutions for PHC.
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Affiliation(s)
- Per Nilsen
- Division of Health and Society Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Hanna Fernemark
- Division of Health and Society Department of Health, Medicine and Caring Sciences Primary Health Care Centre, Lambohov Linköping University Linköping Sweden
| | - Ida Seing
- Department of Behavioral Science and Learning Linköping University Linköping Sweden
| | - Kristina Schildmeijer
- Department of Health and Caring Sciences Faculty of Health and Life Sciences Linnaeus University Kalmar Sweden
| | - Janna Skagerström
- Research and Development Unit in Region Östergötland Linköping Sweden
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Pedersen BS, Kirk JW, Olesen MK, Grønfeldt BM, Stefánsdóttir NT, Brødsgaard R, Tjørnhøj-Thomsen T, Nilsen P, Andersen O, Bandholm T, Pedersen MM. Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients-the WALK-Copenhagen project (WALK-Cph). Pilot Feasibility Stud 2022; 8:80. [PMID: 35397574 PMCID: PMC8994315 DOI: 10.1186/s40814-022-01033-z] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mobility interventions can prevent functional decline among older patients, but implementation of such interventions may be complicated by barriers in the clinical setting. The WALK-Copenhagen project (WALK-Cph) is aimed at promoting a 24-h mobility among older medical patients during hospitalization. The WALK-Cph intervention was co-designed by researchers and stakeholders to tailor the intervention to the clinical context. The aim of this study was to investigate the feasibility and implementation fidelity of the WALK-Cph intervention before evaluating clinical effectiveness in a randomized controlled trial (ClinicalTrials.gov NCT03825497). METHODS The WALK-Cph intervention consisted of six components: a welcome folder explaining the importance of in-hospital activity, a WALK-plan prescribing up to three daily walking sessions during and after hospitalization, a WALK-path in the hallway that patients were motivated to use daily, exercise posters in the hallways and bedrooms, self-service on beverages and clothes, and discharge with a WALK-plan. The present study reports on phase 2 of WALK-Cph and consists of a feasibility and a fidelity component. The study was conducted at the two WALK-Cph intervention departments after the initiation of the WALK-Cph intervention. A cohort of older medical patients (+65) was recruited for the feasibility study to assess recruitment and data collection procedures and the method for assessment of activity. Simultaneously, implementation fidelity was assessed by observing clinical practice and intervention delivery at the intervention departments. RESULTS A feasibility cohort of 48 patients was included. Inclusion was considered feasible with recruitment rates between 62% and 70% of all eligible patients. Also, data collection was conducted without obstacles, and all patients accepted to wear activity monitors. The fidelity observations showed that three of the six intervention components were partially implemented as planned whereas three components were not implemented as planned. CONCLUSION The WALK-Cph intervention was found feasible, and although the intervention was not implemented with fidelity, the level of fidelity was considered sufficient to continue with further testing of the WALK-Cph intervention in a large-scale trial. TRIAL REGISTRATION ClinicalTrials.gov NCT03825497 (retrospectively registered). Protocol PubMed ID (PMID): 29523569.
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Affiliation(s)
- Britt Stævnsbo Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Maren Kathrine Olesen
- Department of Endocrinology, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Birk Mygind Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Nina Thórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Rasmus Brødsgaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Per Nilsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark.,The Emergency Department, Copenhagen University Hospital, Amager and Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Stefánsdóttir NT, Nilsen P, Lindstroem MB, Andersen O, Powell BJ, Tjørnhøj-Thomsen T, Kirk JW. Implementing a new emergency department: a qualitative study of health professionals' change responses and perceptions. BMC Health Serv Res 2022; 22:447. [PMID: 35382815 PMCID: PMC8985264 DOI: 10.1186/s12913-022-07805-w] [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: 12/15/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study is two-fold. It explores how managers and key employees at the Emergency Department (ED) and specialist departments in a university hospital in the Capital Region of Denmark respond to the planned change to a new ED, and how they perceive the change involved in the implementation of the new ED. The study investigates what happens when health professionals are confronted with implementation of policy that changes their organization and everyday work lives. Few studies provide in-depth investigations of health professionals’ reactions to the implementation of new EDs, and particularly how they influence the implementation of a nationwide organizational change framed within a political strategy. Methods The study used semi-structured individual interviews with 51 health professionals involved in implementation activities related to an organizational change of establishing a new ED with new patient pathways for acutely ill patients. The data was deductively analyzed using Leon Coetsee’s theoretical framework of change responses, but the analysis also allowed for a more inductive reading of the material. Results Fourteen types of responses to establishing a new ED were identified and mapped onto six of the seven overall change responses in Coetsee’s framework. The participants perceived the change as particularly three changes. Firstly, they wished to create the best possible acute patient pathway in relation to their specialty. Whether the planned new ED would redeem this was disputed. Secondly, participants perceived the change as relocation to a new building, which both posed potentials and worries. Thirdly, both hopeful and frustrated statements were given about the newly established medical specialty of emergency medicine (EM), which was connected to the success of the new ED. Conclusions The study showcases how implementation processes within health care are not straightforward and that it is not only the content of the implementation that determines the success of the implementation and its outcomes but also how these are perceived by managers and employees responsible for the process and their context. In this way, managers must recognize that it cannot be pre-determined how implementation will proceed, which necessitates fluid implementation plans and demands implementation managements skills.
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Affiliation(s)
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Emergency Department, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, 1455, Copenhagen K, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Department of Public Health, Nursing, Aarhus University, 8000, Aarhus C, Denmark
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Karlsson N, Skagerström J, O'Donnell A, Abidi L, Thomas K, Nilsen P, Lid TG. Public perceptions of how alcohol consumption is dealt with in Swedish and Norwegian health care. Nordisk Alkohol Nark 2022; 38:243-255. [PMID: 35310609 PMCID: PMC8899254 DOI: 10.1177/1455072520985981] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
Aims: The aims of this study were to evaluate and compare popular beliefs and attitudes regarding alcohol conversations in healthcare in Sweden and Norway; and to explore which factors were associated with different levels of support for alcohol-prevention work in the two countries. Methods: Population-based cross-sectional surveys were conducted in Sweden (n = 3000) and Norway (n = 1208). Logistic regression was used to identify the characteristics of participants who were supportive of routine alcohol screening and brief intervention delivery. Results: A higher proportion of Swedish respondents agreed to a large extent that healthcare professionals should routinely ask about alcohol consumption. In addition, a higher proportion of Swedish respondents compared to respondents from Norway agreed that healthcare providers should only ask about patient’s alcohol consumption if this was related to specific symptoms. There were similar correlates of being supportive of routine alcohol screening and brief intervention delivery in both countries. Support was lower in both countries amongst moderate and risky drinkers, and among single adults or those on parental leave, but higher amongst older individuals. Having had an alcohol conversation in healthcare increased the level of support for alcohol prevention in routine healthcare among risky drinkers. Conclusions: There is a high level of support for preventative alcohol conversations in routine healthcare in Norway and Sweden, although there was a lower proportion of respondents who were positive to alcohol prevention in routine healthcare in Norway compared to Sweden. Experiencing alcohol conversation may positively affect risky drinkers’ attitudes towards and support for alcohol prevention. Thus, more frequent alcohol conversations in routine healthcare may also result in increased level of support for alcohol prevention among risky drinkers.
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Affiliation(s)
| | - Janna Skagerström
- Linköping University, Sweden; and Research and Development Unit in Region Östergötland, Linköping, Sweden
| | | | | | | | | | - Torgeir Gilje Lid
- Stavanger University Hospital, Norway; and University of Stavanger, Norway
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Andersen P, Holmberg S, Årestedt K, Lendahls L, Nilsen P. Factors associated with increased physical activity among patients prescribed physical activity in Swedish routine health care including an offer of counselor support: a 1-year follow-up. BMC Public Health 2022; 22:509. [PMID: 35292017 PMCID: PMC8925134 DOI: 10.1186/s12889-022-12940-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study addresses knowledge gaps in research regarding influences of routine health care delivery of physical activity on prescription (PAP). The aim was to investigate if patient and health care characteristics are associated with increased physical activity 1 year after prescription among patients offered counselor support in addition to health care professionals' prescription. The study was conducted in primary and secondary care in a Swedish health care region. METHODS All PAP recipients during 1 year were invited (N = 1503) to participate in this observational prospective study. Data were collected from medical records and questionnaires (baseline and follow-up). Descriptive statistics and multiple logistic regression analysis were used. The outcome variable was increased physical activity after 1 year. Study variables were patient and health care characteristics. RESULTS Three hundred and fifty-five patients with complete follow-up data were included. The mean age was 62 years (SD = 14; range, 18-90) and 68% were females. Almost half (47%) had increased physical activity 1 year after PAP. Multiple logistic regression analysis showed that increased physical activity at follow-up was positively associated with lower baseline activity, counselor use, and positive perception of support. Counselor users with low baseline activity had higher odds ratio for increased physical activity at follow-up than non-users (OR = 7.2, 95% CI = 2.2-23.5 vs. OR = 3.2, 95% CI = 1.4-7.5). Positive perception of support was associated with increased physical activity among counselor users but not among non-users. CONCLUSIONS An increase in physical activity after PAP was related to low baseline activity, positive perception of support, and use of counselor support after PAP. Qualified counseling support linked to PAP seems to be important for achieving increased physical activity among patients with lower baseline activity.
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Affiliation(s)
- Pia Andersen
- Department of Research and Development, Region Kronoberg, SE-351 88, Växjö, Sweden. .,Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, SE-581 83, Linköping, Sweden.
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, SE-351 88, Växjö, Sweden.,Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, SE-221 00, Lund, Sweden.,Faculty of Health and Life Sciences, Department of Medicine and Optometry, Linnaeus University, SE-391 82, Kalmar, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, SE-391 82, Kalmar, Sweden.,The Research Section, Region Kalmar County, SE-391 26, Kalmar, Sweden
| | - Lena Lendahls
- Department of Research and Development, Region Kronoberg, SE-351 88, Växjö, Sweden.,Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, SE-391 82, Kalmar, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, SE-581 83, Linköping, Sweden
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Fernemark H, Skagerström J, Seing I, Hårdstedt M, Schildmeijer K, Nilsen P. Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden. BMJ Open 2022; 12:e055035. [PMID: 35135771 PMCID: PMC8829841 DOI: 10.1136/bmjopen-2021-055035] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore how the COVID-19 pandemic changed the working conditions of physicians in Swedish primary healthcare. DESIGN This is a descriptive, qualitative study with individual semistructured interviews. Data were analysed using inductive content analysis. SETTING Swedish primary healthcare units in both rural and urban areas. PARTICIPANTS A total of 11 primary care physicians fulfilled participation. RESULTS Two main categories emerged: 'work organisation and routines' and 'psychosocial work environment', containing three and five subcategories, respectively. The pandemic enforced changes in work organisation and routines. Increased flexibility, including more patient-oriented delivery of care, and novel means of interorganisational and intraorganisational interactions were perceived as positive by physicians. The pandemic also caused several changes in physicians' psychosocial work environment. Increased workload, information overload, as well as ethical considerations and feelings of uncertainty made the work environment stressful for physicians. CONCLUSIONS The COVID-19 pandemic affected the working conditions of physicians in Swedish primary healthcare in numerous ways. The pandemic enforced changes in work organisation and routines for physicians in primary healthcare. Further research is needed to investigate how the pandemic will affect primary healthcare in the longer term. Learning from the pandemic is important because this will not be the last crisis that primary care and its healthcare professionals will face.
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Affiliation(s)
- Hanna Fernemark
- Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Center, Lambohov, Region Östergötland, Linköping, Sweden
| | - Janna Skagerström
- Unit for Research and Development, Region Östergötland, Linköping, Sweden
| | - Ida Seing
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Maria Hårdstedt
- Vansbro Primary Health Care Center, Region Dalarna, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | | | - Per Nilsen
- Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Nilsen P, Thor J, Bender M, Leeman J, Andersson-Gäre B, Sevdalis N. Bridging the Silos: A Comparative Analysis of Implementation Science and Improvement Science. Front Health Serv 2022; 1:817750. [PMID: 36926490 PMCID: PMC10012801 DOI: 10.3389/frhs.2021.817750] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Background Implementation science and improvement science have similar goals of improving health care services for better patient and population outcomes, yet historically there has been limited exchange between the two fields. Implementation science was born out of the recognition that research findings and effective practices should be more systematically disseminated and applied in various settings to achieve improved health and welfare of populations. Improvement science has grown out of the wider quality improvement movement, but a fundamental difference between quality improvement and improvement science is that the former generates knowledge for local improvement, whereas the latter is aimed at producing generalizable scientific knowledge. Objectives The first objective of this paper is to characterise and contrast implementation science and improvement science. The second objective, building on the first, is to highlight aspects of improvement science that potentially could inform implementation science and vice versa. Methods We used a critical literature review approach. Search methods included systematic literature searches in PubMed, CINAHL, and PsycINFO until October 2021; reviewing references in identified articles and books; and the authors' own cross-disciplinary knowledge of key literature. Findings The comparative analysis of the fields of implementation science and improvement science centred on six categories: (1) influences; (2) ontology, epistemology and methodology; (3) identified problem; (4) potential solutions; (5) analytical tools; and (6) knowledge production and use. The two fields have different origins and draw mostly on different sources of knowledge, but they have a shared goal of using scientific methods to understand and explain how health care services can be improved for their users. Both describe problems in terms of a gap or chasm between current and optimal care delivery and consider similar strategies to address the problems. Both apply a range of analytical tools to analyse problems and facilitate appropriate solutions. Conclusions Implementation science and improvement science have similar endpoints but different starting points and academic perspectives. To bridge the silos between the fields, increased collaboration between implementation and improvement scholars will help to clarify the differences and connections between the science and practice of improvement, to expand scientific application of quality improvement tools, to further address contextual influences on implementation and improvement efforts, and to share and use theory to support strategy development, delivery and evaluation.
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Affiliation(s)
- Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Thor
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Miriam Bender
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Boel Andersson-Gäre
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Nick Sevdalis
- Health Service & Population Research Department, Centre for Implementation Science, King's College London, London, United Kingdom
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45
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Kirk JW, Nilsen P, Andersen O, Powell BJ, Tjørnhøj-Thomsen T, Bandholm T, Pedersen MM. Co-designing implementation strategies for the WALK-Cph intervention in Denmark aimed at increasing mobility in acutely hospitalized older patients: a qualitative analysis of selected strategies and their justifications. BMC Health Serv Res 2022; 22:8. [PMID: 34974829 PMCID: PMC8722331 DOI: 10.1186/s12913-021-07395-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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Selecting appropriate strategies to target barriers to implementing interventions represents a considerable challenge in implementation research and practice. The aim was to investigate what categories of implementation strategies were selected by health care practitioners and their managers in a co-design process and how they justified these strategies aimed at facilitating the implementation of the WALK-Cph intervention. METHODS The study used a qualitative research design to explore what implementation strategies were selected and the justifications for selecting these strategies. Workshops were used because this qualitative method is particularly well suited for studying co-design processes that involve substantial attention to social interaction and the context. Data were 1) analyzed deductively based on the Proctor et al. taxonomy of implementation strategies, 2) categorized in accordance with the ERIC compilation of implementation strategies by Powell et al., and 3) analyzed to examine the justification for the selected strategies by the Proctor et al. framework for justifications of implementation strategies. RESULTS Thirteen different types of implementation strategies were chosen across two hospitals. The deductive analysis showed that selection of implementation strategies was based on pragmatic and theoretical justifications. The contents of the two types of justifications were thematized into nine subthemes. CONCLUSION This study contributes with knowledge about categories and justification of implementation strategies selected in a co-design process. In this study, implementation strategies were selected through pragmatic and theoretical justifications. This points to a challenge in balancing strategies based on practice-based and research-based knowledge and thereby selection of strategies with or without proven effectiveness.
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Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.
- Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark.
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Department of Orthopedic Surgery, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
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Nilsen P, Svedberg P, Nygren J, Frideros M, Johansson J, Schueller S. Accelerating the impact of artificial intelligence in mental healthcare through implementation science. Implementation Research and Practice 2022; 3:26334895221112033. [PMID: 37091110 PMCID: PMC9924259 DOI: 10.1177/26334895221112033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The implementation of artificial intelligence (AI) in mental healthcare offers a potential solution to some of the problems associated with the availability, attractiveness, and accessibility of mental healthcare services. However, there are many knowledge gaps regarding how to implement and best use AI to add value to mental healthcare services, providers, and consumers. The aim of this paper is to identify challenges and opportunities for AI use in mental healthcare and to describe key insights from implementation science of potential relevance to understand and facilitate AI implementation in mental healthcare. Methods The paper is based on a selective review of articles concerning AI in mental healthcare and implementation science. Results Research in implementation science has established the importance of considering and planning for implementation from the start, the progression of implementation through different stages, and the appreciation of determinants at multiple levels. Determinant frameworks and implementation theories have been developed to understand and explain how different determinants impact on implementation. AI research should explore the relevance of these determinants for AI implementation. Implementation strategies to support AI implementation must address determinants specific to AI implementation in mental health. There might also be a need to develop new theoretical approaches or augment and recontextualize existing ones. Implementation outcomes may have to be adapted to be relevant in an AI implementation context. Conclusion Knowledge derived from implementation science could provide an important starting point for research on implementation of AI in mental healthcare. This field has generated many insights and provides a broad range of theories, frameworks, and concepts that are likely relevant for this research. However, when taking advantage of the existing knowledge basis, it is important to also be explorative and study AI implementation in health and mental healthcare as a new phenomenon in its own right since implementing AI may differ in various ways from implementing evidence-based practices in terms of what implementation determinants, strategies, and outcomes are most relevant. Plain Language Summary: The implementation of artificial intelligence (AI) in mental healthcare offers a potential solution to some of the problems associated with the availability, attractiveness, and accessibility of mental healthcare services. However, there are many knowledge gaps concerning how to implement and best use AI to add value to mental healthcare services, providers, and consumers. This paper is based on a selective review of articles concerning AI in mental healthcare and implementation science, with the aim to identify challenges and opportunities for the use of AI in mental healthcare and describe key insights from implementation science of potential relevance to understand and facilitate AI implementation in mental healthcare. AI offers opportunities for identifying the patients most in need of care or the interventions that might be most appropriate for a given population or individual. AI also offers opportunities for supporting a more reliable diagnosis of psychiatric disorders and ongoing monitoring and tailoring during the course of treatment. However, AI implementation challenges exist at organizational/policy, individual, and technical levels, making it relevant to draw on implementation science knowledge for understanding and facilitating implementation of AI in mental healthcare. Knowledge derived from implementation science could provide an important starting point for research on AI implementation in mental healthcare. This field has generated many insights and provides a broad range of theories, frameworks, and concepts that are likely relevant for this research.
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Affiliation(s)
| | - Petra Svedberg
- Halmstad University School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens Nygren
- Halmstad University School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | | | | - Stephen Schueller
- Psychological Science, University of California Irvine, Irvine, CA, USA
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Svedberg P, Reed J, Nilsen P, Barlow J, Macrae C, Nygren J. Towards successful implementation of artificial intelligence in healthcare practice: A research program (Preprint). JMIR Res Protoc 2021; 11:e34920. [PMID: 35262500 PMCID: PMC8943554 DOI: 10.2196/34920] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Julie Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Per Nilsen
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - James Barlow
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Carl Macrae
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, United Kingdom
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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48
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Lid TG, Karlsson N, Thomas K, Skagerström J, O'Donnell A, Abidi L, Nilsen P. Addressing Patients' Alcohol Consumption-A Population-Based Survey of Patient Experiences. Int J Public Health 2021; 66:1604298. [PMID: 34795555 PMCID: PMC8592895 DOI: 10.3389/ijph.2021.1604298] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To identify the proportion of the population that had experienced that alcohol was addressed in health care the previous year, to explore experiences and perceived effects of addressing alcohol, and to investigate the proportion of risky drinkers in the population. Methods: Cross-sectional national web-based survey with 1,208 participants. Socio-demographic data, alcohol consumption (AUDIT-C), and experiences with alcohol conversations were investigated. Results: Approximately four in five respondents had visited health care the past 12 months, and one in six reported having experienced addressing alcohol. Women and older respondents were less likely to report having experienced alcohol conversations compared to other groups. Risky drinkers were not more likely to have experienced an alcohol conversation, but reported longer duration of alcohol conversations and more frequently perceived addressing alcohol as awkward or judgmental. Almost a third of respondents were classified as risky drinkers. Conclusion: The proportion experiencing addressing alcohol in routine health care is low, also among risky drinkers, and risky drinkers more frequently experienced the conversations as judgmental. More sensitive and relevant ways of addressing alcohol in health care is needed.
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Affiliation(s)
- Torgeir Gilje Lid
- Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Nadine Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Amy O'Donnell
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Latifa Abidi
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Seing I, Thórný Stefánsdóttir N, Wassar Kirk J, Andersen O, Tjørnhøj-Thomsen T, Kallemose T, Vedung E, Vrangbæk K, Nilsen P. Social Distancing Policies in the Coronavirus Battle: A Comparison of Denmark and Sweden. Int J Environ Res Public Health 2021; 18:10990. [PMID: 34682734 PMCID: PMC8536108 DOI: 10.3390/ijerph182010990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022]
Abstract
Social distancing measures have been a key component in government strategies to mitigate COVID-19 globally. Based on official documents, this study aimed to identify, compare and analyse public social distancing policy measures adopted in Denmark and Sweden regarding the coronavirus from 1 March 2020 until 1 October 2020. A key difference was the greater emphasis on laws and executive orders (sticks) in Denmark, which allowed the country to adopt many stricter policy measures than Sweden, which relied mostly on general guidelines and recommendations (sermons). The main policy adopters in Denmark were the government and the Danish Parliament, whereas the Public Health Agency issued most policies in Sweden, reflecting a difference in political governance and administrative structure in the two countries. During the study period, Sweden had noticeably higher rates of COVID-19 deaths and hospitalizations per 100,000 population than Denmark, yet it is difficult to determine the impact or relative effectiveness of sermons and sticks, particularly with regard to broader and longer-term health, economic and societal effects.
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Affiliation(s)
- Ida Seing
- Department of Behavioral Science and Learning, Linköping University, SE 581 83 Linköping, Sweden
| | - Nina Thórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, DK-2650 Hvidovre, Denmark; (N.T.S.); (J.W.K.); (O.A.); (T.K.)
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, DK-2650 Hvidovre, Denmark; (N.T.S.); (J.W.K.); (O.A.); (T.K.)
- Department of Public Health, Nursing, Aarhus University, DK-8000 Aarhus, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, DK-2650 Hvidovre, Denmark; (N.T.S.); (J.W.K.); (O.A.); (T.K.)
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, DK-1455 Copenhagen, Denmark;
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, DK-2650 Hvidovre, Denmark; (N.T.S.); (J.W.K.); (O.A.); (T.K.)
| | - Evert Vedung
- Institute for Housing and Urban Research (IBF), Uppsala University, SE 751 20 Uppsala, Sweden;
- Department of Government, Uppsala University, SE 751 20 Uppsala, Sweden
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark;
- Department of Political Science, University of Copenhagen, DK-1353 Copenhagen, Denmark
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, SE 581 83 Linköping, Sweden;
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Kirk JW, Nilsen P, Andersen O, Stefánsdóttir NT, Grønfeldt B, Brødsgaard R, Pedersen BS, Bandholm T, Tjørnhøj-Thomsen T, Pedersen MM. Adaptations and modifications to a co-designed intervention and its clinical implementation: a qualitative study in Denmark. BMC Health Serv Res 2021; 21:1108. [PMID: 34656126 PMCID: PMC8520628 DOI: 10.1186/s12913-021-07142-4] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a long-standing debate in implementation research on whether adaptations to evidence-based interventions (EBIs) are desirable in health care. If an intervention is adapted and not delivered as conceived and planned, it is said to have low fidelity. The WALK-Cph project was developed based on the assumption that involving stakeholders in co-design processes would facilitate the fidelity of an intervention to increase the mobility of acutely admitted older medical patients and its implementation in two hospitals in Denmark. The purpose of this study is to describe and analyse adaptations and modifications that were made to the co-designed WALK-Cph intervention and its implementation. METHODS This study used a qualitative design. An ethnographic field study was performed using participant observations, workshops and semi-structured interviews. Data were analysed twice using the Framework Method. The first analysis was based on the frameworks from Stirman, Moore and Proctor. The second analysis, a retrospective modifications analysis, was based on the Adaptation-Impact Framework. RESULTS Many different types of adaptations and modifications were made to the WALK-Cph intervention and its implementation plan. Most of the modifications were made on the contents of the intervention. In total, 44 adaptations and modifications were made, of which 21 were planned (adaptations) and 23 were made haphazardly (modifications). Most of the content and context adaptations and modifications made on the intervention had a mixed result regarding enhanced fidelity. The retrospective modifications analysis showed that modifications were ongoing and both situationally and contextually shaped. CONCLUSIONS Although an extensive co-design process was carried out to facilitate the fidelity of the WALK-Cph intervention, this study showed that many adaptations and modifications were still made to both the intervention and its implementation plan. It could indicate that the co-design process had a small effect or that adaptations and modifications are ongoing and both situationally and contextually shaped, which challenge the assumption and the desire to be able to plan and control changes.
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Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark. .,Department of Public Health, Nursing, Aarhus University, Nordre Ringgade 1, 8000, Aarhus, Denmark.
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Linköping University, Sandbäcksgatan 7, 582 25, Linköping, Sweden
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Nina Thórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Birk Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Rasmus Brødsgaard
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Britt Stævnsbo Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.,Copenhagen Neuromuscular Center, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen Ø, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.,Department of Orthopedic Surgery, and Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
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