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Publications (10 of 15) Show all publications
Elf, M., Lipson-Smith, R., Kylén, M., Saa, J. P., Sturge, J., Miedema, E., . . . Anåker, A. (2024). A Systematic Review of Research Gaps in the Built Environment of Inpatient Healthcare Settings. Health Environments Research & Design Journal, Article ID 19375867241251830.
Open this publication in new window or tab >>A Systematic Review of Research Gaps in the Built Environment of Inpatient Healthcare Settings
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2024 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, article id 19375867241251830Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).

METHODS: We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.

RESULTS: Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.

CONCLUSION: This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.

Keywords
built environment, evidence-based design, evidence-gap map, healthcare architecture, healthcare settings, hospital, systematic review
National Category
Nursing
Identifiers
urn:nbn:se:du-48643 (URN)10.1177/19375867241251830 (DOI)001234237300001 ()38807411 (PubMedID)
Available from: 2024-06-04 Created: 2024-06-04 Last updated: 2024-06-10Bibliographically approved
Klockar, E., Kylén, M., McCarthy, L., Koch, L. v., Gustavsson, C., Jones, F. & Elf, M. (2024). The Swedish Stroke Self-Efficacy Questionnaire: translation and cross-cultural adaptation. Journal of Patient-Reported Outcomes, 8, Article ID 55.
Open this publication in new window or tab >>The Swedish Stroke Self-Efficacy Questionnaire: translation and cross-cultural adaptation
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2024 (English)In: Journal of Patient-Reported Outcomes, E-ISSN 2509-8020, Vol. 8, article id 55Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To translate and cross-culturally adapt the Stroke Self-Efficacy Questionnaire (SSEQ) from English to Swedish and to evaluate psychometric properties of the questionnaire.

METHODS: A cross-sectional study design, where the translation followed a process including initial translation, synthesis, backward translation, expert committee, and pretest. Content validity was assessed using Content validity index (CVI). Psychometric assessments included floor-ceiling effects and internal consistency.

RESULTS: Language and cultural congruence were achieved, and content validity index scores were high (0.923-1). The psychometric evaluations provided acceptable outcomes concerning internal consistency, with Cronbach's alpha scores for the total scale (0.902), the activities subscale (0.861) and the self-management subscale (0.818) respectively. Ceiling effects were evident, but no floor effects.

CONCLUSION: This study found the Swedish version of the SSEQ promising as a tool for assessment of self-efficacy in a Swedish stroke care setting, although further psychometric assessments are recommended in future studies.

Keywords
Cross-cultural, Questionnaire, Rehabilitation, Self-efficacy, Stroke
National Category
Nursing Neurosciences
Identifiers
urn:nbn:se:du-48713 (URN)10.1186/s41687-024-00735-7 (DOI)38837039 (PubMedID)
Available from: 2024-06-11 Created: 2024-06-11 Last updated: 2024-06-11Bibliographically approved
Kylén, M., Sturge, J., Lipson-Smith, R., Schmidt, S. M., Pessah-Rasmussen, H., Svensson, T., . . . Elf, M. (2023). Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study. JMIR Research Protocols, 12, Article ID e52489.
Open this publication in new window or tab >>Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study
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2023 (English)In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 12, article id e52489Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors.

OBJECTIVE: The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability.

METHODS: The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data.

RESULTS: As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025.

CONCLUSIONS: We aim to determine how new environments could better support a person's control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This "taking charge" approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project's outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52489.

Keywords
accessibility, built environment, good quality and local care, meaningful activities, participation, participatory co-design, person-centered, self-efficacy, stroke rehabilitation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:du-47255 (URN)10.2196/52489 (DOI)001114840300008 ()37943590 (PubMedID)2-s2.0-85180295745 (Scopus ID)
Available from: 2023-11-16 Created: 2023-11-16 Last updated: 2024-01-17Bibliographically approved
Zingmark, M. & Kylén, M. (2023). Feasibility of a reablement-program in a Swedish municipality. Scandinavian Journal of Occupational Therapy, 30(1), 53-64
Open this publication in new window or tab >>Feasibility of a reablement-program in a Swedish municipality
2023 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 1, p. 53-64Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: While occupational therapists (OT) and physiotherapists (PT) have a central role in reablement, no structured approach for these professions has been described in Sweden.

AIMS/OBJECTIVES: The aim was to explore the feasibility of a reablement program developed to guide OTs and PTs in a Swedish municipality context.

MATERIAL AND METHODS: Eligible participants were OTs and PTs working with reablement. Feasibility was evaluated in terms of how OTs (n = 16) and PTs (n = 15) experienced the application of the program. Data were collected through web surveys during a pilot study over four months.

RESULTS: The program was implemented for 62 clients. Baseline assessments were conducted in 97% of all cases and follow-ups in 77%. The average duration of the program was 8 weeks and includeed 5 home visits and 3 contacts by phone. In 15 cases, a new goal was identified after follow-up. Collaboration was included with other professionals and relatives in 89% and 35% of the cases, respectively. The program was categorized as feasible to some extent in 34 cases and not feasible in 21 cases.

CONCLUSIONS AND SIGNIFICANCE: The program was feasible to some extent. To enhance feasibility, flexibility may be needed in order to tailor assessments according to the client's health status.

Keywords
Assessment, healthy ageing, home care, home-dwelling, intervention design, occupation-focus, restorative care
National Category
Occupational Therapy
Identifiers
urn:nbn:se:du-41843 (URN)10.1080/11038128.2022.2089229 (DOI)000819535600001 ()35771642 (PubMedID)2-s2.0-85133246880 (Scopus ID)
Available from: 2022-07-06 Created: 2022-07-06 Last updated: 2023-03-17Bibliographically approved
Elf, M., Slaug, B., Ytterberg, C., Heylighen, A. & Kylén, M. (2023). Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study. Health Environments Research & Design Journal, 6(4), 172-186
Open this publication in new window or tab >>Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study
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2023 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 6, no 4, p. 172-186Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke.

BACKGROUND: Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse.

METHODS: In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis.

RESULTS: Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings.

CONCLUSIONS: Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.

Keywords
built environment, person–environment fit, rehabilitation, shared–decision making, stroke
National Category
Nursing
Identifiers
urn:nbn:se:du-46174 (URN)10.1177/19375867231178313 (DOI)001008343500001 ()37287249 (PubMedID)2-s2.0-85162983148 (Scopus ID)
Available from: 2023-06-14 Created: 2023-06-14 Last updated: 2023-11-06Bibliographically approved
Klockar, E., Kylén, M., Gustavsson, C., Finch, T., Jones, F. & Elf, M. (2023). Self-management from the perspective of people with stroke – An interview study. Patient Education and Counseling, 112, Article ID 107740.
Open this publication in new window or tab >>Self-management from the perspective of people with stroke – An interview study
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2023 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 112, article id 107740Article in journal (Refereed) Published
Abstract [en]

Objective: Self-management support can improve quality of life, mood, self-efficacy, and physical function following a stroke. Knowledge of how people with stroke understand and experience self-management in different contexts is crucial to developing effective self-management support. This study explored how people with stroke understand and practice self-management during the post-acute phase. Method: A descriptive study using qualitative content analysis to explore data from semistructured interviews Results: Eighteen participants were interviewed. Most participants interpreted self-management as ‘taking care of their business’ and ‘being independent”. However, they encountered difficulties performing daily activities, for which they felt unprepared. Although interest in implementing self-management support increases, participants did not report receiving specific advice from healthcare professionals. Conclusion: People continue to feel unprepared to manage everyday activities after hospital discharge and must largely work things out for themselves. There is an overlooked opportunity to start the process of self-management support earlier in the stroke pathway, with healthcare professionals and people with stroke combining their skills, ideas and expertise. This would enable confidence to self-management to flourish rather than decrease during the transition from hospital to home. Practical implications: Individual tailored self-management support could help people with stroke more successfully manage their daily lives post-stroke. © 2023 The Authors

Place, publisher, year, edition, pages
Elsevier Ireland Ltd, 2023
Keywords
Content analysis, Qualitative, Self-management, Self-management support, Stroke, Stroke rehabilitation
National Category
Nursing
Identifiers
urn:nbn:se:du-45873 (URN)10.1016/j.pec.2023.107740 (DOI)000983762000001 ()37059027 (PubMedID)2-s2.0-85152146746 (Scopus ID)
Available from: 2023-04-20 Created: 2023-04-20 Last updated: 2024-06-10Bibliographically approved
Elf, M. & Kylén, M. (2023). The Home as a Place for Rehabilitation After Stroke: Emerging Empirical Findings. In: (Re)designing the Continuum of Care for Older Adults: The Future of Long-Term Care Settings (pp. 37-51). Springer International Publishing
Open this publication in new window or tab >>The Home as a Place for Rehabilitation After Stroke: Emerging Empirical Findings
2023 (English)In: (Re)designing the Continuum of Care for Older Adults: The Future of Long-Term Care Settings, Springer International Publishing , 2023, p. 37-51Chapter in book (Refereed)
Abstract [en]

Health care is moving toward integrated services where care and rehabilitation are provided at home rather than in institutions. This, together with the requirement that care must be person-centered, has proven to be a considerable challenge. Older adults living with complex health conditions such as stroke are vulnerable to change when their responsibility for care and rehabilitation becomes extensive. Health care tends to be governed by quick fixes rather than taking people’s own goals, resources, and life situations. Factors in the environment that can affect a person’s health and social, emotional, and physical aspects of daily life are crucial to consider in person-centered care. Nevertheless, the environment is often neglected in both research and clinical practice. This chapter addresses findings within the REARCH (Rehabilitation and Architecture) project. The project was initiated in response to Swedish law in 2018, making it more common for older adults with stroke to be rehabilitated at home rather than in a hospital. The purpose was to explore environmental factors to fulfill person-centered rehabilitation. The results are based on qualitative and quantitative data collected from patients and interdisciplinary care staff. We describe the challenges for people with stroke during rehabilitation and how their possibilities to engage in everyday life in their homes and immediate surroundings are influenced by environmental factors. Our contribution will improve the understanding of how environmental factors relate to everyday life and recovery at home. The discussion aims to guide evidence-based care models for rehabilitation at home. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

Place, publisher, year, edition, pages
Springer International Publishing, 2023
Keywords
Environment, Home, Person-centered care, Rehabilitation, Stroke
National Category
Nursing
Identifiers
urn:nbn:se:du-46130 (URN)10.1007/978-3-031-20970-3_3 (DOI)2-s2.0-85160176998 (Scopus ID)9783031209703 (ISBN)9783031209697 (ISBN)
Available from: 2023-06-08 Created: 2023-06-08 Last updated: 2023-06-08Bibliographically approved
Elf, M., Rasoal, D., Zingmark, M. & Kylén, M. (2023). The importance of context: a qualitative study exploring healthcare practitioners’ experiences of working with patients at home after a stroke. BMC Health Services Research, 23(1), Article ID 733.
Open this publication in new window or tab >>The importance of context: a qualitative study exploring healthcare practitioners’ experiences of working with patients at home after a stroke
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 733Article in journal (Refereed) Published
Keywords
Rehabilitation, ESD, Built environment, Person-environment fit, Person-centred care, Life-space
National Category
Health Sciences
Identifiers
urn:nbn:se:du-48611 (URN)10.1186/s12913-023-09735-7 (DOI)
Funder
Swedish Research Council Formas, 2015/389Swedish Research Council Formas, 2015/389The Swedish Stroke AssociationLund University
Available from: 2024-05-30 Created: 2024-05-30 Last updated: 2024-05-30Bibliographically approved
Elf, M., Rasoal, D., Zingmark, M. & Kylén, M. (2023). The importance of context-a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke. BMC Health Services Research, 23(1), Article ID 733.
Open this publication in new window or tab >>The importance of context-a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 733Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients' homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients' records.

METHODS: Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients' opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.

RESULTS: The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient's self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.

CONCLUSIONS: Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.

Keywords
Built environment, ESD, Life-space, Person-centred care, Person-environment fit, Rehabilitation
National Category
Occupational Therapy
Identifiers
urn:nbn:se:du-46428 (URN)10.1186/s12913-023-09735-7 (DOI)001024933200001 ()37415156 (PubMedID)2-s2.0-85164261156 (Scopus ID)
Available from: 2023-07-11 Created: 2023-07-11 Last updated: 2023-08-07Bibliographically approved
Kylén, M., Ytterberg, C., von Koch, L. & Elf, M. (2022). How is the environment integrated into post-stroke rehabilitation?: A qualitative study among community-dwelling persons with stroke who receive home rehabilitation in Sweden. Health & Social Care in the Community (5), 1933-1943
Open this publication in new window or tab >>How is the environment integrated into post-stroke rehabilitation?: A qualitative study among community-dwelling persons with stroke who receive home rehabilitation in Sweden
2022 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, no 5, p. 1933-1943Article in journal (Refereed) Published
Abstract [en]

Studies have shown a need to consider environmental factors to best support the rehabilitation and recovery process after a stroke. In addition, despite intentions to increase individuals' participation in care and rehabilitation, patients and family members report weak participation. The aim of this study was to explore how the environment was integrated into rehabilitation at home from the perspective of patients after a stroke. We conducted as a qualitative study with 17 patients rehabilitated at home. Data on the participants' experiences of the rehabilitation process and their perceptions of how the environment was considered in the process were collected via interviews and analysed using qualitative content analysis. The main category that was constructed from the data was "Partial integration of person- environment dynamics in the rehabilitation", which was informed by three subcategories: (a) I recover in my home: Challenges and opportunities in the environment, (b) Following a generic approach to therapy: Limited integration of the environment, and (c) Informed more than involved. Our study showed that the environment was integrated in a limited manner. The participants were more informed about than involved in their planning of the rehabilitation. The results are important for informing the ongoing development of rehabilitation at home and person-centred care strategies. 

Place, publisher, year, edition, pages
John Wiley and Sons Inc, 2022
Keywords
health and the environment; home care; housing and community care; rehabilitation; stroke rehabilitation
National Category
Nursing
Identifiers
urn:nbn:se:du-38307 (URN)10.1111/hsc.13572 (DOI)000697922900001 ()34541725 (PubMedID)2-s2.0-85115110896 (Scopus ID)
Available from: 2021-09-27 Created: 2021-09-27 Last updated: 2023-03-17Bibliographically approved
Projects
Rehabilitering i hemmet - utveckling av en hållbar modell som sätter personens behov och miljön i centrum (InHome)
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2887-3674

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