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Wallin, Lars
Publications (10 of 46) Show all publications
Saarijarvi, M., Wallin, L. & Bratt, E.-L. (2020). Process evaluation of complex cardiovascular interventions: How to interpret the results of my trial?. European Journal of Cardiovascular Nursing, 19(3), Article ID 1474515120906561.
Open this publication in new window or tab >>Process evaluation of complex cardiovascular interventions: How to interpret the results of my trial?
2020 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 19, no 3, article id 1474515120906561Article in journal (Refereed) Published
Abstract [en]

Complex interventions of varying degrees of complexity are commonly used and evaluated in cardiovascular nursing and allied professions. Such interventions are increasingly tested using randomized trial designs. However, process evaluations are seldom used to better understand the results of these trials. Process evaluation aims to understand how complex interventions create change by evaluating implementation, mechanisms of impact, and the surrounding context when delivering an intervention. As such, this method can illuminate important mechanisms and clarify variation in results. In this article, process evaluation is described according to the Medical Research Council guidance and its use exemplified through a randomized controlled trial evaluating the effectiveness of a transition program for adolescents with chronic conditions.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2020
Keywords
Mixed methods, process evaluation, randomized controlled trial, research methods, implementation science
National Category
Nursing Cardiac and Cardiovascular Systems
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-32233 (URN)10.1177/1474515120906561 (DOI)000513407100001 ()32054300 (PubMedID)2-s2.0-85079700796 (Scopus ID)
Available from: 2020-03-12 Created: 2020-03-12 Last updated: 2020-03-19Bibliographically approved
Gifford, W., Lewis, K. B., Eldh, A. C., Fiset, V., Abdul-Fatah, T., Åberg, A. C., . . . Wallin, L. (2019). Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada. Pilot and Feasibility Studies, 5(1), Article ID 103.
Open this publication in new window or tab >>Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada
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2019 (English)In: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 5, no 1, article id 103Article in journal (Refereed) Published
Abstract [en]

Background: Leadership is critical to supporting and facilitating the implementation of evidence-based practices in health care. Yet, little is known about how to develop leadership capacity for this purpose. The aims of this study were to explore the (1) feasibility of delivering a leadership intervention to promote implementation, (2) usefulnessof the leadership intervention, and (3) participants’ engagement in leadership to implement evidence-based fall prevention practices in Canadian residential care.

Methods: We conducted a mixed-method before-and-after feasibility study on two units in a Canadian residential care facility. The leadership intervention was based on the Ottawa model of implementation leadership (O-MILe) and consisted of two workshops and two individualized coaching sessions over 3 months to develop leadership capacity for implementing evidence-based fall prevention practices. Participants (n = 10) included both formal (e.g., managers) and informal (e.g., nurses and care aids leaders). Outcome measures were parameters of feasibility (e.g., number of eligible candidates who attended the workshops and coaching sessions) and usefulness of the leadership intervention (e.g., ratings, suggested modifications). We conducted semi-structured interviews guided by the Implementation Leadership Scale (ILS), a validated measure of 12-item in four subcategories (proactive, supportive, knowledgeable, and perseverant), to explore the leadership behaviors that participants used to implement fall prevention practices. We repeated the ILS in a focus group meeting to understand the collective leadership behaviors used by the intervention team. Barriers and facilitators to leading implementation were also explored.

Results: Delivery of the leadership intervention was feasible. All participants (n = 10) attended the workshops and eight participated in at least one coaching session. Workshops and coaching were rated useful (≥ 3 on a 0–4 Likert scale where 4 = highly useful) by 71% and 86% of participants, respectively. Participants rated the O-MILe subcategories of supportive and perseverant leadership highest for individual leadership, whereas supportive and knowledgeable leadership were rated highest for team leadership.

Conclusions: The leadership intervention was feasible to deliver, deemed useful by participants, and fostered engagement in implementation leadership activities. Study findings highlight the complexity of developing implementation leadership and modifications required to optimize impact. Future trials are now required to test the effectiveness of the leadership intervention on developing leadership for implementing evidence-based practices.

Keywords
Implementation leadership, Fall prevention, Evidence-based practice, Nursing, Residential care
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30627 (URN)10.1186/s40814-019-0485-7 (DOI)31452925 (PubMedID)2-s2.0-85083265837 (Scopus ID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2020-05-06Bibliographically approved
Kislov, R., Cummings, G., Ehrenberg, A., Gifford, W., Harvey, G., Kitson, A., . . . Wilson, P. (2019). From research evidence to "Evidence by proxy".: Organisational enactment of evidence-based healthcare. In: : . Paper presented at 79th Annual Meeting of the Academy of Management, August 9-13, 2019, in Boston, Massachusetts, United States.
Open this publication in new window or tab >>From research evidence to "Evidence by proxy".: Organisational enactment of evidence-based healthcare
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31434 (URN)
Conference
79th Annual Meeting of the Academy of Management, August 9-13, 2019, in Boston, Massachusetts, United States
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2019-12-20Bibliographically approved
Kislov, R., Wilson, P., Cummings, G., Ehrenberg, A., Gifford, W., Kelly, J., . . . Harvey, G. (2019). From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries. PAR. Public Administration Review, 79(5), 684-698
Open this publication in new window or tab >>From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries
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2019 (English)In: PAR. Public Administration Review, ISSN 0033-3352, E-ISSN 1540-6210, Vol. 79, no 5, p. 684-698Article in journal (Refereed) Published
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30082 (URN)10.1111/puar.13056 (DOI)000483717900007 ()2-s2.0-85065200893 (Scopus ID)
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-09-20Bibliographically approved
Fritz, J., Wallin, L., Söderlund, A., Almqvist, L. & Sandborgh, M. (2019). Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods.. Implementation Science, 14(1), Article ID 94.
Open this publication in new window or tab >>Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods.
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2019 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, no 1, article id 94Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences.

METHODS: An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used.

RESULTS: The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking.

CONCLUSIONS: The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.

Keywords
Clinical competence, Implementation science, Knowledge translation, Physiotherapy, Primary health care, Self-regulation, Social learning theory
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31127 (URN)10.1186/s13012-019-0942-y (DOI)000494477200001 ()31684977 (PubMedID)2-s2.0-85074548087 (Scopus ID)
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2019-12-09
Fritz, J., Wallin, L., Söderlund, A., Almqvist, L. & Sandborgh, M. (2019). Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability. Disability and Rehabilitation
Open this publication in new window or tab >>Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability
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2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: To explore the effects on and sustainability of physiotherapists’ clinical behavior when using facilitation to support the implementation of a behavioral medicine approach in primary health care for patients with persistent musculoskeletal pain.

Methods: A quasi-experimental pre-/post-test trial was conducted. Fifteen physiotherapists were included in the experimental group, and nine in the control group. Based on social cognitive theory and the Promoting Action on Research Implementation in Health Services framework, facilitation with multifaceted implementation methods was used during a six-month period. Clinical behaviors were investigated with a study-specific questionnaire, structured observations, self-reports and patient records. Descriptive and non-parametric statistical methods were used for analyzing differences over time and effect size.

Results: A sustained increase in self-efficacy for applying the behavioral medicine approach was found. Clinical actions and verbal expressions changed significantly, and the effect size was large; however, changes were not sustained at follow-ups. The behavioral changes were mainly related to the goal setting, self-monitoring and functional behavioral analysis components. No changes in clinical behavior were found in the control group.

Conclusion: Tailored multifaceted facilitation can support the implementation of a behavioral medicine approach in physiotherapy in primary health care, but more comprehensive actions targeting sustainability are needed.Implications for rehabilitation Tailored multifaceted facilitation can support the implementation of an evidence based behavioral medicine approach in physiotherapy. Facilitation can be useful for increasing self-efficacy beliefs for using behavioral medicine approach in physiotherapist’s clinical practice. Further research is required to establish strategies that are effective in sustaining behavioral changes.

Keywords
clinical competence, evidence-based practice, musculoskeletal pain, physiotherapy, primary health care, self-efficacy
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29978 (URN)10.1080/09638288.2019.1596170 (DOI)000465891500001 ()30999779 (PubMedID)2-s2.0-85064690361 (Scopus ID)
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-05-17Bibliographically approved
Harvey, G., Gifford, W., Cummings, G., Kelly, J., Kislov, R., Kitson, A., . . . Ehrenberg, A. (2019). Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries. International Journal of Nursing Studies, 90, 21-30
Open this publication in new window or tab >>Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries
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2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 90, p. 21-30Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved.

OBJECTIVES: The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them.

DESIGN: The study employed a qualitative descriptive approach.

SETTINGS: Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden.

PARTICIPANTS: 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries.

METHODS: Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis.

RESULTS: Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice.

CONCLUSIONS: National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice.

Keywords
Evidence-based practice, Facilitation, Facilitators, Implementation, Knowledge translation, Leadership, Managers
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29100 (URN)10.1016/j.ijnurstu.2018.09.017 (DOI)000461265700005 ()30551080 (PubMedID)2-s2.0-85058064165 (Scopus ID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-03-28Bibliographically approved
Harvey, G., Gifford, W., Cummings, G., Kelly, J., Kislov, R., Kitson, A., . . . Ehrenberg, A. (2019). Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries. In: : . Paper presented at Knowledge Utilization Colloquium 2019, 25-28 June 2019, Montebello, Quebec, Canada.
Open this publication in new window or tab >>Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31433 (URN)
Conference
Knowledge Utilization Colloquium 2019, 25-28 June 2019, Montebello, Quebec, Canada
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2019-12-20Bibliographically approved
Barenfeld, E., Wallin, L. & Björk Brämberg, E. (2019). Moving from knowledge to action in partnership: A case study on program adaptation to support optimal aging in the context of migration. Journal of Applied Gerontology, 38(8), 1096-1120
Open this publication in new window or tab >>Moving from knowledge to action in partnership: A case study on program adaptation to support optimal aging in the context of migration
2019 (English)In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 38, no 8, p. 1096-1120Article in journal (Refereed) Published
Abstract [en]

This case study explored how a researcher-community partnership contributed to program adaptations when implementing person-centered group-based health promotion services to older people who have migrated to Sweden. The study was conducted over 3 years and various data sources were used: focus groups, individual interviews, documents, and archive material. Findings from different data sources and partners' perspectives were triangulated to an overall case description using an iterative process. Adaptations were shaped through a dynamic process, negotiating toward suitable solutions that culminated in actions taken to adapt or inhibit adaptations. The negotiations were driven by the interplay within and between three reasons to adapt. The partners' opportunities to influence the negotiation process depended on establishing common ground to shape adaptations. Practical implications are provided on how to move from knowledge to action when implementing person-centered group-based health promotion to support optimal aging in the context of migration.

Keywords
emigrants and immigrants; health promotion; implementation; older adults; researcher–community partnership
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25957 (URN)10.1177/0733464817727110 (DOI)000473175600002 ()28853322 (PubMedID)2-s2.0-85068233444 (Scopus ID)
Available from: 2017-09-04 Created: 2017-09-04 Last updated: 2019-07-22Bibliographically approved
Orton, M.-L., Andersson, Å., Wallin, L., Forsman, H. & Eldh, A. C. (2019). Nursing management matters for registered nurses with a PhD working in clinical practice. Journal of Nursing Management, 27(5), 955-962
Open this publication in new window or tab >>Nursing management matters for registered nurses with a PhD working in clinical practice
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2019 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 5, p. 955-962Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate what registered nurses (RNs) with a PhD working in clinical practice experience in terms of their role, function and work context.

BACKGROUND: Previous studies have shown that RNs with a graduate degree contribute to better and safer care for patients. However, little is known about what further academic schooling of RNs, at PhD level, means for clinical practice.

METHOD: Qualitative design, with semi-structured interviews and inductive content analysis.

RESULTS: The main areas of responsibilities for RNs with a PhD working in clinical practice were related to practice development and implementation of research results. In their work, they experienced barriers to the full use of their competence; the expectations and prerequisites of the organization were not clearly defined, and they often lacked a mandate to create conditions for quality improvement of nursing care.

CONCLUSIONS: RNs with a PhD can contribute to evidence-based practice (EBP), clinical training as well as the development of clinical research. Their roles and responsibilities need to be clarified and for this, they need support from managers.

IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should partner with RNs with a PhD to support the EBP process and help structure nursing practice in more efficient ways. 

Keywords
clinical practice, content analysis, doctoral degree, nursing care, qualitative
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29316 (URN)10.1111/jonm.12750 (DOI)000478812200009 ()30656787 (PubMedID)2-s2.0-85066033400 (Scopus ID)
Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2020-03-03Bibliographically approved
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