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Shannon, M. M., Nordin, S., Bernhardt, J. & Elf, M. (2020). Application of Theory in Studies of Healthcare Built Environment Research. Health Environments Research & Design Journal, Article ID 1937586719901108.
Open this publication in new window or tab >>Application of Theory in Studies of Healthcare Built Environment Research
2020 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, article id 1937586719901108Article in journal (Refereed) Epub ahead of print
Abstract [en]

We aimed to examine the nature and extent of theory application in studies of built environment attributes and impact on adults in healthcare facilities. Many varied theories are described when providing the rationale for research into built environments in healthcare. Uncertainty exists around the right theory to frame a research question, alignment with measurement tools, and whether healthcare setting makes a difference. This poses challenges to researchers seeking to build the evidence base for built environment design that benefits patients and staff. Our multidisciplinary review team scoped the literature to determine how theories are used to inform research investigating the impact of the built environment of healthcare on adults. When researchers recorded theory at development of the study question, in data collection, and in data analysis/interpretation, we called this explicitly theory-based application. Synthesis occurred using a narrative approach. Overall, we found 17 diverse theories named in studies. Explicitly theory-based use occurred with eight theories, comprising 47% of all theories used. Five theories were named more frequently in studies out of all theories identified. In 20% of studies, theory was not used explicitly during the research inquiry. We argue that researchers must continue to strive toward explicit use of theories, similar to development of other health interventions that employ multifactorial components.

Keywords
built environment, health facilities, psychosocial health, research-informed design, review, theories
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31879 (URN)10.1177/1937586719901108 (DOI)000510129900001 ()31994904 (PubMedID)2-s2.0-85078754572 (Scopus ID)
Available from: 2020-02-14 Created: 2020-02-14 Last updated: 2020-03-18Bibliographically approved
Lindblom, S., Ytterberg, C., Elf, M. & Flink, M. (2020). Perceptive Dialogue for Linking Stakeholders and Units During Care Transitions - A Qualitative Study of People with Stroke, Significant Others and Healthcare Professionals in Sweden. International Journal of Integrated Care, 20(1), Article ID 11.
Open this publication in new window or tab >>Perceptive Dialogue for Linking Stakeholders and Units During Care Transitions - A Qualitative Study of People with Stroke, Significant Others and Healthcare Professionals in Sweden
2020 (English)In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 20, no 1, article id 11Article in journal (Refereed) Published
Abstract [en]

Introduction: Care transitions are a complex set of actions that risk poor quality outcomes for patients and their significant others. This study explored the transition process between hospital and continued rehabilitation in the home. The process is explored from the perspectives of people with stroke, significant others and healthcare professionals in Stockholm, Sweden. Method: Focus group interviews (n = 10), semi-structured individual interviews (n = 23) and interviews in dyad (n = 4) were conducted with healthcare professionals, people with stroke and significant others, altogether 71 participants. Data was collected and analyzed using Grounded Theory. Results: One core category "Perceptive dialogue for a coordinated transition", and two categories "Synthesis of parallel processes for common understanding" and "The forced transformation from passive attendant to uninformed agent" emerged from the analysis. The transition consisted of several parallel processes which made it difficult for the stakeholders to get a common understanding of the transition as a whole. Enabling a perceptive dialogue was as a prerequisite for the creation of a common understanding of the care transition. Conclusion: This study elucidates that a perceptive dialogue with patients/significant others as well as within and across organizations is part of a coordinated and person-centred transition. There is an extensive need for increased involvement of patients and significant others regarding dialogue about health conditions, procedures at the hospital and preparation for self-management after discharge.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-32609 (URN)10.5334/ijic.4689 (DOI)000523257600011 ()32256255 (PubMedID)2-s2.0-85083294810 (Scopus ID)
Available from: 2020-05-05 Created: 2020-05-05 Last updated: 2020-05-06Bibliographically approved
Elf, M., Anåker, A., Marcheschi, E., Sigurjonsson, A. & Ulrich, R. S. (2020). The built environment and its impact on health outcomes and experiences of patients, significant others and staff-A protocol for a systematic review. Nursing Open
Open this publication in new window or tab >>The built environment and its impact on health outcomes and experiences of patients, significant others and staff-A protocol for a systematic review
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2020 (English)In: Nursing Open, E-ISSN 2054-1058Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim This review will identify, evaluate and synthesize the literature related to evidence-based design of healthcare environments and to identify impacts of the built environment on the outcomes and experiences of patients, significant others and staff. Design A mixed-method systematic review of literature 2010-2018. Methods Database searches for evidence in peer-reviewed journals will be conducted electronically using CINAHL, Medline, SCOPUS and Web of Science. , full-text screening and data extraction will be completed independently by the reviewers. Quality assessment will follow Swedish Agency for Health Technology Assessment and Social Services Assessment. Results This review will offer knowledge for informed decisions about the design of the healthcare environment. The review is comprehensive, includes a large volume of literature various research designs and will highlight the knowledge gap in evidence-based design and provide a breadth of knowledge about the built environments and its impact on health and well-being.

Keywords
built environment, evidence-based design, health facilities, health outcomes, healthcare users, physical environment
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31858 (URN)10.1002/nop2.452 (DOI)000508999000001 ()2-s2.0-85078754777 (Scopus ID)
Available from: 2020-02-17 Created: 2020-02-17 Last updated: 2020-03-18Bibliographically approved
Elf, M., Lindahl, G. & Anåker, A. (2019). A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments. Health Environments Research & Design Journal, 12(3), 107-118
Open this publication in new window or tab >>A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments
2019 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 12, no 3, p. 107-118Article in journal (Refereed) Published
Abstract [en]

Aim: The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans.

Background: Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although, large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment.

Methods: A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted.

Results: The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence.

Conclusions: Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.

Keywords
Conceptual planning, Construction, Space programming, Design development, Evidence-based design, Post-occupancy evaluation.
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28290 (URN)10.1177/1937586718796643 (DOI)000475784900008 ()30205707 (PubMedID)2-s2.0-85058944272 (Scopus ID)
Available from: 2018-08-10 Created: 2018-08-10 Last updated: 2020-03-03Bibliographically approved
Shannon, M. M., Elf, M., Churilov, L., Olver, J., Pert, A. & Bernhardt, J. (2019). Can the physical environment itself influence neurological patient activity?. Disability and Rehabilitation, 41(10), 1177-1189
Open this publication in new window or tab >>Can the physical environment itself influence neurological patient activity?
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2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 10, p. 1177-1189Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate if a changed physical environment following redesign of a hospital ward influenced neurological patient physical and social activity.

METHODS: A "before and after" observational design was used that included 17 acute neurological patients pre-move (median age 77 (IQR 69-85) years Ward A and 20 post-move (median age 70 (IQR 57-81) years Ward B. Observations occurred for 1 day from 08.00-17.00 using Behavioral Mapping of patient physical and social activity, and location of that activity. Staff and ward policies remained unchanged throughout. An Environmental Description Checklist of each ward was also completed.

RESULTS: Behavioral Mapping was conducted pre-/post-move with a total of 801 Ward A and 918 Ward B observations. Environmental Description Checklists showed similarities in design features in both neurological wards with similar numbers of de-centralized nursing stations, however there were more single rooms and varied locations to congregate in Ward B (30% more single-patient rooms and separate allied health therapy room). Patients were alone >60% of time in both wards, although there was more in bed social activity in Ward A and more out of bed social activity in Ward B. There were low amounts of physical activity outside of patient rooms in both wards. Significantly more physical activity occurred in Ward B patient rooms (median = 47%, IQR 14-74%) compared to Ward A (median = 2% IQR 0-14%), Wilcoxon Rank Sum test z = -3.28, p = 0.001.

CONCLUSIONS: Overall, patient social and physical activity was low, with little to no use of communal spaces. However we found more physical activity in patient rooms in the Ward B environment. Given the potential for patient activity to drive brain reorganization and repair, the physical environment should be considered an active factor in neurological rehabilitation and recovery. Implications for Rehabilitation Clinicians should include consideration of the impact of physical environment on physical and social activity of neurological patients when designing therapeutic rehabilitation environments. Despite architectural design intentions patient and social activity opportunities can be limited. Optimal neurological patient neuroplasticity and recovery requires sufficient environmental challenge, however current hospital environments for rehabilitation do not provide this.

Keywords
Behavioral Mapping, Physical environment, brain injury, healthcare design, neurological, neuroplasticity, physical activity, social activity
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26956 (URN)10.1080/09638288.2017.1423520 (DOI)000465208200006 ()29343110 (PubMedID)
Available from: 2018-01-23 Created: 2018-01-23 Last updated: 2019-06-10Bibliographically approved
Miedena, E., Lindahl, G. & Elf, M. (2019). Conceptualizing health promotion in relation to outpatient healthcare building design: a scoping review. Health Environments Research & Design Journal, 12(1), 69-86
Open this publication in new window or tab >>Conceptualizing health promotion in relation to outpatient healthcare building design: a scoping review
2019 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 12, no 1, p. 69-86Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: This review explored different conceptualizations of health promotion in the context of, and in relation to, outpatient building design.

BACKGROUND: Today's healthcare organizations are implementing holistic healthcare approaches such as health promotion, while simultaneously increasing their outpatient services. These health promotion approaches, focused on empowering people to take control of their health, are expected to have implications for the outpatient healthcare building design. Yet there is limited knowledge what these may be. A review of the literature on the current state of the art is thus needed to enable and support dialog on future healthcare building design.

METHOD: A scoping review of 4,506 papers, collected from four databases and three scientific journals in 2015, resulted in 14 papers relating health promotion to building design and outpatient healthcare. From the subsequent content analysis, multiple common themes and subthemes emerged.

RESULTS: The review reveals diverse range of health promotion interpretations, three health promotion perspectives (health behavior, health equity, and sense of coherence), associated design approaches, design objectives, health-related outcomes, building features, and solutions.

CONCLUSIONS: While diverse health promotion perspectives might merely represent variations in focus, these differences become problematic when relating to building design. To support further dialogs on development of health promotion in, and in relation to, the build environment, there is a need to strengthen the health promotion vocabulary. Further research is needed to compare different design approaches and how these can be combined to minimize contradicting implications for building design.

Keywords
Health promotion, built environment, scoping reveiw
National Category
Health Sciences Architecture
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28291 (URN)10.1177/1937586718796651 (DOI)000462081400005 ()30203663 (PubMedID)2-s2.0-85058928925 (Scopus ID)
Available from: 2018-08-10 Created: 2018-08-10 Last updated: 2019-04-11Bibliographically approved
McKee, K., Nordin, S. & Elf, M. (2019). Developmentand initial validation of the Staff Perception Of Residential care Environments (SPORE) instrument. In: : . Paper presented at The International Association of Gerontology and Geriatrics European Region Congress 2019 (IAGG-ER). 23-25 May 2019 in Gothenburg.
Open this publication in new window or tab >>Developmentand initial validation of the Staff Perception Of Residential care Environments (SPORE) instrument
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Staff perceptions of the health care environment influence the delivery of person-centred care.  Little research has examined staff perceptions of health care environments, in part because of a lack of validated instruments.  This study reports the development and initial validation of the Staff Perception Of Residential care Environments (SPORE) instrument for use in residential care facilities for older people (RCFs).

Items developed in a British project on the design of care environments were translated and adapted for the Swedish care context as SPORE (24 items, 5 sub-scales).  In a study of the physical environment and quality of care, 200 staff recruited from 20 RCFs sampled from across Sweden completed a questionnaire containing SPORE, the Person-centred Care Assessment Tool (PCAT), the Person-centred Climate Questionnaire – staff version (PCQ-S), and the Sheffield Care Environment Assessment Matrix –Sweden (SCEAM-S).

All SPORE sub-scales were normally distributed with good internal consistency reliability (Cronbach αs=.85-.88). Correlations between SPORE and PCAT sub-scales ranged from .301-.503, and between SPORE and PCQ-S sub-scales from .353-.557.  RCF-level analyses (N=20) indicated that scores on SCEAM overall environment quality correlated significantly with all SPORE sub-scales (range=.496-.700).  The SCEAM Comfort sub-scale was correlated with all SPORE sub-scales (range=.509-.721), while the SCEAM Privacy sub-scale was correlated (r=.428) with the SPORE Staff Facilities sub-scale.  The SPORE Working and Caring for Residents sub-scale was correlated with SCEAM cognitive support (r=.502) and physical support (r=.566) sub-scales.

The SPORE instrument demonstrated good psychometric properties and its sub-scales an excellent range of associations with staff perceptions of person-centred care and with objective assessments of the physical environment.  Further validation is required, but the SPORE instrument has potential for understanding how staff perceptions of the RCF environment relate to the delivery of person-centred care.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30275 (URN)
Conference
The International Association of Gerontology and Geriatrics European Region Congress 2019 (IAGG-ER). 23-25 May 2019 in Gothenburg
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2020-01-01Bibliographically approved
Anåker, A., von Koch, L., Heylighen, A. & Elf, M. (2019). "It's lonely": Patients' experiences of the physical environment at a newly built stroke unit. Health Environments Research & Design Journal (3), 141-152
Open this publication in new window or tab >>"It's lonely": Patients' experiences of the physical environment at a newly built stroke unit
2019 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, no 3, p. 141-152Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

The aim of this study was to explore patients' experiences of the physical environment at a newly built stroke unit.

BACKGROUND:

For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients' health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce.

METHOD:

This study used a qualitative design. Patients ( n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis.

RESULTS:

Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows.

CONCLUSIONS:

The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients' experiences could be a starting point when designing new healthcare environments and inform evidence-based design.

Keywords
evidence-based design; healthcare facilities; nursing; rehabilitation; single-room design
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28774 (URN)10.1177/1937586718806696 (DOI)000475784900010 ()30336696 (PubMedID)2-s2.0-85058959552 (Scopus ID)
Available from: 2018-10-19 Created: 2018-10-19 Last updated: 2020-03-03Bibliographically approved
Lawrence, M., Asaba, E., Duncan, E., Elf, M., Eriksson, G., Faulkner, J., . . . Lennon, O. (2019). Stroke secondary prevention, a non-surgical and non-pharmacological consensus definition: results of a Delphi study. BMC Research Notes, 12(1), Article ID 823.
Open this publication in new window or tab >>Stroke secondary prevention, a non-surgical and non-pharmacological consensus definition: results of a Delphi study
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2019 (English)In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 12, no 1, article id 823Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Evidence supporting lifestyle modification in vascular risk reduction is limited, drawn largely from primary prevention studies. To advance the evidence base for non-pharmacological and non-surgical stroke secondary prevention (SSP), empirical research is needed, informed by a consensus-derived definition of SSP. To date, no such definition has been published. We used Delphi methods to generate an evidence-based definition of non-pharmacological and non-surgical SSP.

RESULTS: The 16 participants were members of INSsPiRE (International Network of Stroke Secondary Prevention Researchers), a multidisciplinary group of trialists, academics and clinicians. The Elicitation stage identified 49 key elements, grouped into 3 overarching domains: Risk factors, Education, and Theory before being subjected to iterative stages of elicitation, ranking, discussion, and anonymous voting. In the Action stage, following an experience-based engagement with key stakeholders, a consensus-derived definition, complementing current pharmacological and surgical SSP pathways, was finalised: Non-pharmacological and non-surgical stroke secondary prevention supports and improves long-term health and well-being in everyday life and reduces the risk of another stroke, by drawing from a spectrum of theoretically informed interventions and educational strategies. Interventions to self-manage modifiable lifestyle risk factors are contextualized and individualized to the capacities, needs, and personally meaningful priorities of individuals with stroke and their families.

Keywords
Delphi, Secondary prevention, Stroke
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31507 (URN)10.1186/s13104-019-4857-0 (DOI)000500364100020 ()31870411 (PubMedID)2-s2.0-85077179027 (Scopus ID)
Available from: 2020-01-01 Created: 2020-01-01 Last updated: 2020-03-04
Nordin, S., Dahlberg, L., McKee, K. & Elf, M. (2019). Technology to support decision-making for older people with dementia. In: : . Paper presented at IAGG 2019 The International Association of Gerontology and Geriatrics European Region Congress 2019, 23-25 May, Gothenburg.
Open this publication in new window or tab >>Technology to support decision-making for older people with dementia
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29866 (URN)
Conference
IAGG 2019 The International Association of Gerontology and Geriatrics European Region Congress 2019, 23-25 May, Gothenburg
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-04-11Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7044-8896

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