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Wallin, Lars
Publications (10 of 33) Show all publications
Rycroft-Malone, J., Seers, K., Eldh, A. C., Cox, K., Crichton, N., Harvey, G., . . . Wallin, L. (2018). A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar. Implementation Science, 13(1), Article ID 138.
Open this publication in new window or tab >>A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar
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2018 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, no 1, article id 138Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Facilitation is a promising implementation intervention, which requires theory-informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice.

METHODS: This realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Data were collected over four time points using multiple qualitative methods: observation (372 h), interviews with staff (n = 357), residents (n = 152), next of kin (n = 109) and other stakeholders (n = 128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing.

RESULTS: The content and approach of the two facilitation programmes prompted variable opportunities to align and realign support with the needs and expectations of facilitators and homes. This influenced their level of confidence in fulfilling the facilitator role and ability to deliver the intervention as planned. The success of intervention implementation was largely dependent on whether sites prioritised their involvement in both the study and the facilitation programme. In contexts where the study was prioritised (including release of resources) and where managers and staff support was sustained, this prompted collective engagement (as an attitude and action). Internal facilitators' (IF) personal characteristics and abilities, including personal and formal authority, in combination with a supportive environment prompted by managers triggered the potential for learning over time. Learning over time resulted in a sense of confidence and personal growth, and enactment of the facilitation role, which resulted in practice changes.

CONCLUSION: The scale and multi-country nature of this study provided a novel context to conduct one of the few trial embedded realist-informed process evaluations. In addition to providing an explanatory account of implementation processes, a conceptual platform for future facilitation research is presented. Finally, a realist-informed process evaluation framework is outlined, which could inform future research of this nature.

TRIAL REGISTRATION: Current controlled trials ISRCTN11598502 .

Keywords
Context, Facilitation, Implementation, Older people, PARIHS, Realist process evaluation, Urinary incontinence
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28905 (URN)10.1186/s13012-018-0811-0 (DOI)000450649900002 ()30442165 (PubMedID)2-s2.0-85056669640 (Scopus ID)
Available from: 2018-11-19 Created: 2018-11-19 Last updated: 2018-12-06Bibliographically approved
Erlandsson, K., Doraiswamy, S., Wallin, L. & Bogren, M. (2018). Capacity building of midwifery faculty to implement a 3-years midwifery diploma curriculum in Bangladesh: a process evaluation of a mentorship programme. Nurse Education in Practice, 29, 212-218
Open this publication in new window or tab >>Capacity building of midwifery faculty to implement a 3-years midwifery diploma curriculum in Bangladesh: a process evaluation of a mentorship programme
2018 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 29, p. 212-218Article in journal (Refereed) Published
Abstract [en]

When a midwifery diploma-level programme was introduced in 2010 in Bangladesh, only a few nursing faculty staff members had received midwifery diploma-level. The consequences were an inconsistency in interpretation and implementation of the midwifery curriculum in the midwifery programme. To ensure that midwifery faculty staff members were adequately prepared to deliver the national midwifery curriculum, a mentorship programme was developed. The aim of this study was to examine feasibility and adherence to a mentorship programme among 19 midwifery faculty staff members who were lecturing the three years midwifery diploma-level programme at ten institutes/colleges in Bangladesh. The mentorship programme was evaluated using a process evaluation framework: (implementation, context, mechanisms of impact and outcomes). An online and face-to-face blended mentorship programme delivered by Swedish midwifery faculty staff members was found to be feasible, and it motivated the faculty staff members in Bangladesh both to deliver the national midwifery diploma curriculum as well as to carry out supportive supervision for midwifery students in clinical placement. First, the Swedish midwifery faculty staff members visited Bangladesh and provided a two-days on-site visit prior to the initiation of the online part of the mentorship programme. The second on-site visit was five-days long and took place at the end of the programme, that being six to eight months from the first visit. Building on the faculty staff members' response to feasibility and adherence to the mentorship programme, the findings indicate opportunities for future scale-up to all institutes/collages providing midwifery education in Bangladesh. It has been proposed that a blended online and face-to-face mentorship programme may be a means to improving national midwifery programmes in countries where midwifery has only recently been introduced.

Keywords
Capacity building, Mentorship, Midwifery faculty staff members, Process evaluation
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27269 (URN)10.1016/j.nepr.2018.02.006 (DOI)000429755000033 ()29448231 (PubMedID)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-06-08Bibliographically approved
Björkelund, C., Svenningsson, I., Hange, D., Udo, C., Petersson, E.-L., Ariai, N., . . . Westman, J. (2018). Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial.. BMC Family Practice, 19(1), Article ID 28.
Open this publication in new window or tab >>Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial.
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2018 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, no 1, article id 28Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden.

METHODS: In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged ≥ 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU).

OUTCOME MEASURES: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle.

RESULTS: One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [- 0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group.

CONCLUSIONS: Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients.

TRIAL REGISTRATION: Identifier: NCT02378272 . February 2, 2015. Retrospectively registered.

Keywords
Care manager, Collaborative care, Depression, Primary care, Quality-of- life, Sick-leave
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27207 (URN)10.1186/s12875-018-0711-z (DOI)000425172300001 ()29426288 (PubMedID)
Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-03-01Bibliographically approved
Holst, A., Ginter, A., Björkelund, C., Hange, D., Petersson, E.-L., Svenningsson, I., . . . Svensson, M. (2018). Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study. BMJ Open, 8(11), Article ID e024741.
Open this publication in new window or tab >>Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 11, article id e024741Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective.

DESIGN: Cost-effectiveness analysis.

SETTING: 23 PCCs in two Swedish regions.

PARTICIPANTS: Patients with depression (n=342).

MAIN OUTCOME MEASURES: A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-Åsberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: ∆Cost/∆QALY and ∆Cost/∆DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping.

RESULTS: Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were €368 (healthcare perspective) and €6217 (societal perspective) for the intervention patients and €246 (healthcare perspective) and €7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was €6773 (healthcare perspective) and from a societal perspective the CM programme was dominant.

DISCUSSION: The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level.

TRIAL REGISTRATION NUMBER: NCT02378272; Results.

Keywords
care manager, collaborative care, depression, health economic analysis, intervention, primary care
National Category
Health Sciences
Research subject
Health and Welfare, Care Manager - Vårdsamordnare som spindeln i nätet för patienter med depression i primärvården
Identifiers
urn:nbn:se:du-29216 (URN)10.1136/bmjopen-2018-024741 (DOI)30420353 (PubMedID)
Available from: 2018-12-28 Created: 2018-12-28 Last updated: 2018-12-28Bibliographically approved
Seers, K., Rycroft-Malone, J., Cox, K., Crichton, N., Edwards, R. T., Eldh, A. C., . . . Wallin, L. (2018). Facilitating Implementation of Research Evidence (FIRE): An international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implementation Science, 13(1), Article ID 137.
Open this publication in new window or tab >>Facilitating Implementation of Research Evidence (FIRE): An international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework
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2018 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, no 1, article id 137Article in journal (Refereed) Published
Abstract [en]

Background

Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice.

Methods

A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention.

Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering.

Results

Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time.

Conclusions

This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and “doses” of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors.

Trial registration

Current Controlled Trials ISRCTN11598502. Date 4/2/10.

The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 223646.

Keywords
Facilitation, Implementation, PARIHS, Urinary incontinence, Context, Older people, RCT
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29011 (URN)10.1186/s13012-018-0831-9 (DOI)000450649900001 ()30442174 (PubMedID)2-s2.0-85056628999 (Scopus ID)
Available from: 2018-12-04 Created: 2018-12-04 Last updated: 2019-01-02Bibliographically approved
Kislov, R., Cummings, G., Ehrenberg, A., Gifford, W., Harvey, G., Kitson, A., . . . Wilson, P. (2018). From research evidence to "evidence by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries. In: : . Paper presented at Evidence Live Symposium, Oxford UK.
Open this publication in new window or tab >>From research evidence to "evidence by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries
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2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29207 (URN)
Conference
Evidence Live Symposium, Oxford UK
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
Kislov, R., Cummings, G., Ehrenberg, A., Gifford, W., Harvey, G., Kitson, A., . . . Wilson, P. (2018). From research evidence to "research by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries. In: : . Paper presented at International Organizational Behavior in Healthcare Conference, Montreal, May 13-16 2018.
Open this publication in new window or tab >>From research evidence to "research by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries
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2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29208 (URN)
Conference
International Organizational Behavior in Healthcare Conference, Montreal, May 13-16 2018
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
Lind, S., Sandberg, J., Fürst, C. J. & Wallin, L. (2018). Implementation of Integrated Palliative Care Outcome Scale in acute care settings: a feasibility study. Palliative & Supportive Care, 16(6), 698-705
Open this publication in new window or tab >>Implementation of Integrated Palliative Care Outcome Scale in acute care settings: a feasibility study
2018 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 16, no 6, p. 698-705Article in journal (Refereed) Published
Abstract [en]

Objective

Although hospitals have been described as inadequate place for end-of-life care, many deaths still occur in hospital settings. Although patient-reported outcome measures have shown positive effects for patients in need of palliative care, little is known about how to implement them. We aimed to explore the feasibility of a pilot version of an implementation strategy for the Integrated Palliative care Outcome Scale (IPOS) in acute care settings.

Method

A strategy, including information, training, and facilitation to support the use of IPOS, was developed and carried out at three acute care units. For an even broader understanding of the strategy, it was also tested at a palliative care unit. A process evaluation was conducted including collecting quantitative data and performing interviews with healthcare professionals.

Result

Factors related to the design and performance of the strategy and the context contributed to the results. The prevalence of completed IPOS in the patient's records varied from 6% to 44% in the acute care settings. At the palliative care unit, the prevalence in the inpatient unit was 53% and the specialized home care team 35%. The qualitative results showed opposing perspectives concerning the training provided: Related to everyday work at the acute care units and Nothing in it for us at the palliative care unit. In the acute care settings, A need for an improved culture regarding palliative care was identified. A context characterized by A constantly increasing workload, a feeling of Constantly on-going changes, and a feeling of Change fatigue were found at all units. Furthermore, the internal facilitators and the nurse managers’ involvement in the implementation differed between the units.

Significance of the results

The feasibility of the strategy in our study is considered to be questionable and the components need to be further explored to enhance the impact of the strategy and thereby improve the use of IPOS.

Keywords
Implementation; palliative care; integrated palliative care outcome scale; acute care settings; facilitation
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26806 (URN)10.1017/S1478951517001158 (DOI)000454774900010 ()29352836 (PubMedID)
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2019-01-18Bibliographically approved
Erichsen Andersson, A., Frödin, M., Dellenborg, L., Wallin, L., Hök, J., Gillespie, B. M. & Wikström, E. (2018). Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study. BMC Health Services Research, 18(1), Article ID 2.
Open this publication in new window or tab >>Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study
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2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, no 1, article id 2Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room.

METHODS: The study was set in an operating department of a university hospital. The intervention was underpinned by theories on organizational learning, culture and person centeredness. Qualitative process data were collected via participant observations and analyzed using a thematic approach.

RESULTS: Doubts that hand-hygiene practices are effective in preventing hospital acquired infections, strong boundaries and distrust between professional groups and a lack of psychological safety were identified as barriers towards change. Facilitated interprofessional dialogue and learning in "safe spaces" worked as mechanisms for motivation and engagement. Allowing for the free expression of different opinions, doubts and viewing resistance as a natural part of any change was effective in engaging all professional categories in co-creation of clinical relevant solutions to improve hand hygiene.

CONCLUSION: Enabling nurses and physicians to think and talk differently about hospital acquired infections and hand hygiene requires a shift from the concept of one-way directed compliance towards change and learning as the result of a participatory and meaning-making process. The present study is a part of the Safe Hands project, and is registered with ClinicalTrials.gov (ID: NCT02983136 ). Date of registration 2016/11/28, retrospectively registered.

Keywords
Aseptic technique, Co-creation, Hand hygiene, Implementation, Interprofessional learning, Knowledge translation, Operating room
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26928 (URN)10.1186/s12913-017-2783-1 (DOI)000419595200001 ()29301519 (PubMedID)
Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-03-22
Gifford, W. A., Squires, J. E., Angus, D. E., Ashley, L. A., Brosseau, L., Craik, J. M., . . . Graham, I. D. (2018). Managerial leadership for research use in nursing and allied health care professions: a systematic review. Implementation Science, 13, Article ID 127.
Open this publication in new window or tab >>Managerial leadership for research use in nursing and allied health care professions: a systematic review
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2018 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, article id 127Article, review/survey (Refereed) Published
Abstract [en]

Background: Leadership by point-of-care and senior managers is increasingly recognized as critical to the acceptance and use of research evidence in practice. The purpose of this systematic review was to identify the leadership behaviours of managers that are associated with research use by clinical staff in nursing and allied health professionals.

Methods: A mixed methods systematic review was performed. Eight electronic bibliographic databases were searched. Studies examining the association between leadership behaviours and nurses and allied health professionals' use of research were eligible for inclusion. Studies were excluded if leadership could not be clearly attributed to someone in a management position. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments. Narrative synthesis was conducted.

Results: The search yielded 7019 unique titles and abstracts after duplicates were removed. Three hundred five full-text articles were reviewed, and 31 studies reported in 34 articles were included. Methods used were qualitative (n = 19), cross-sectional survey (n = 9), and mixed methods (n = 3). All studies included nurses, and six also included allied health professionals. Twelve leadership behaviours were extracted from the data for point-of-care managers and ten for senior managers. Findings indicated that managers performed a diverse range of leadership behaviours that encompassed change-oriented, relation-oriented and task-oriented behaviours. The most commonly described behavior was support for the change, which involved demonstrating conceptual and operational commitment to research-based practices.

Conclusions: This systematic review adds to the growing body of evidence that indicates that manager-staff dyads are influential in translating research evidence into action. Findings also reveal that leadership for research use involves change and task-oriented behaviours that influence the environmental milieu and the organisational infrastructure that supports clinical care. While findings explain how managers enact leadership for research use, we now require robust methodological studies to determine which behaviours are effective in enabling research use with nurses and allied health professionals for high-quality evidence-based care.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Leadership, Managers, Administrators, Research use, Evidence-based practice, Allied health, Nursing
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28684 (URN)10.1186/s13012-018-0817-7 (DOI)000445741600001 ()30261927 (PubMedID)2-s2.0-85054063041 (Scopus ID)
Available from: 2018-10-11 Created: 2018-10-11 Last updated: 2018-10-16Bibliographically approved
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