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  • 1.
    Nilsing Strid, Emma
    et al.
    University Health Care Research Center, Örebro University, Örebro.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Nilsagård, Ylva
    University Health Care Research Center, Örebro University, Örebro.
    Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals2024Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 42, nr 1, s. 201-213Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored.

    DESIGN: This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research.

    SETTING AND PARTICIPANTS: The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals.

    RESULTS: Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice.

    CONCLUSION: To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT04799860.

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  • 2.
    Rudman, Ann
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm.
    Boström, A. -M
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Gustavsson, P.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    The use of the evidence-based practice process by experienced registered nurses to inform and transform clinical practice during the COVID-19 pandemic: A longitudinal national cohort study2024Ingår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 21, nr 1, s. 14-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: During the COVID-19 pandemic, many registered nurses (RNs) worked on the frontline caring for severely ill patients. They did so with limited knowledge of how to treat and prevent the disease. This extreme situation puts pressure on RNs to find evidence on which to base the care of their patients. Aims: To examine: (1) the extent to which evidence-based practice (EBP) process was applied by Swedish RN cohorts 15–19 years after graduation during the pandemic, (2) whether there was any change to their EBP process from pre-pandemic to late pandemic, (3) the relationship between RNs' use of the EBP process and the duration of exposure to work situations severely affected by the COVID-19 pandemic, and (4) whether level of education, position and care setting were associated with the extent of RNs' EBP process. Methods: In 2021, the level of EBP activities was investigated among 2237 RNs 15–19 years after graduation. The scale used to measure EBP consisted of six items of the EBP process. Unpaired t-tests or one-way analysis of variance (ANOVA) were used in the analysis. Results: RNs used the EBP process to a moderate extent to inform and transform their clinical practice. There was a minor but significant decrease in practicing the EBP process from pre-pandemic to late in the pandemic. RNs who were most affected by the pandemic scored higher on the scale than less-affected colleagues. RNs in nonclinical positions reported more EBP activities, as did RNs in management positions. RNs working in outpatient settings reported more EBP activities than their colleagues in hospitals. Linking Evidence to Action: It is imperative that RNs hone their skills in EBP if they are to be prepared for future healthcare crises. Healthcare providers have a duty to facilitate the development of EBP and, in this regard, RNs in clinical positions in hospitals need particular support. © 2023 The Authors. Worldviews on Evidence-based Nursing published by Wiley Periodicals LLC on behalf of Sigma Theta Tau International.

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  • 3.
    Bergström, Anna
    et al.
    Uppsala University, Uppsala; University College London, London, UK.
    Hoa, Dinh Phuong
    Vietnam National Children's Hospital, Hanoi, Vietnam; Hanoi University of Public Health, Hanoi, Vietnam.
    Nga, Nguyen Thu
    Vietnam National Children's Hospital, Hanoi, Vietnam.
    Hoa, Trieu
    Provincial Health Bureau, Cao Bang, Vietnam.
    Tu, Tran Thanh
    National Children's Hospital, Hanoi, Vietnam.
    Lien, Pham Thi Lan
    National Children's Hospital, Hanoi, Vietnam.
    Trang, Tran
    National Children's Hospital, Hanoi, Vietnam.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Persson, Lars-Åke
    London School of Hygiene & Tropical Medicine, London, UK.
    Eriksson, Leif
    Uppsala University, Uppsala; .
    A facilitated social innovation: stakeholder groups using Plan-Do-Study-Act cycles for perinatal health across levels of the health system in Cao Bang province, Vietnam2023Ingår i: Implementation Science Communications, E-ISSN 2662-2211, Vol. 4, artikel-id 24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Universal coverage of evidence-based interventions for perinatal health, often part of evidence-based guidelines, could prevent most perinatal deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to the implementation of evidence-based guidelines, but successful use of social innovations relies on the engagement of communities and health system actors. This proof-of-concept study aimed to assess whether an earlier successful social innovation for improved neonatal survival that employed regular facilitated Plan-Do-Study-Act meetings on the commune level was feasible and acceptable when implemented on multiple levels of the health system (52 health units) and resulted in actions with plausibly favourable effects on perinatal health and survival in Cao Bang province, northern Vietnam.

    METHODS: The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided the implementation and evaluation of the Perinatal Knowledge-Into-Practice (PeriKIP) project. Data collection included facilitators' diaries, health workers' knowledge on perinatal care, structured observations of antenatal care, focus group discussions with facilitators, their mentors and representatives of different actors of the initiated stakeholder groups and an individual interview with the Reproductive Health Centre director. Clinical experts assessed the relevance of the identified problems and actions taken based on facilitators' diaries. Descriptive statistics included proportions, means, and t-tests for the knowledge assessment and observations. Qualitative data were analysed by content analysis.

    RESULTS: The social innovation resulted in the identification of about 500 relevant problems. Also, 75% of planned actions to overcome prioritised problems were undertaken, results presented and a plan for new actions to achieve the group's goals to enhance perinatal health. The facilitators had significant roles, ensuring that the stakeholder groups were established based on principles of mutual respect. Overall, the knowledge of perinatal health and performance of antenatal care improved over the intervention period.

    CONCLUSIONS: The establishment of facilitated local stakeholder groups can remedy the need for tailored interventions and grassroots involvement in perinatal health and provide a scalable structure for focused efforts to reduce preventable deaths and promote health and well-being.

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  • 4.
    Gyllensten, Hanna
    et al.
    University of Gothenburg, Gothenburg; .
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Karolinska Institute, Stockholm.
    Fridberg, Helena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. University of Gothenburg, Gothenburg.
    Analysis on personnel costs and working time for implementing a more person-centred care approach: a case study with embedded units in a Swedish region2023Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 10, artikel-id e073829Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Our aim was to describe the time and costs used during the implementation of a more person-centred care (PCC) approach as part of ordinary practice.

    DESIGN: A case study with embedded units.

    SETTING: Region Dalarna, Sweden.

    PARTICIPANTS: The Department for Development (DD) staff who provided a central support function in the implementation and six healthcare units: nephrology, two geriatric care and rehabilitation units, two psychiatry units and primary care.

    INTERVENTIONS: More PCC.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Working days and related salary costs reported by categories indicating costs for implementation strategies, service delivery, and research/development costs.

    RESULTS: The healthcare units logged on average 5.5 working days per staff member. In the healthcare units, 6%-57% of the time reported was used for implementation strategies, 40%-90% for service delivery and 2%-12% for research/development. Of the time reported by the DD, 88% was assigned to implementation strategies. Costs associated with reported time indicated 23% of costs for this implementation occurred in the DD. Using the budgeted cost, this proportion increased to 48%. The budget for the DD corresponded to SEK 2.30 per citizen per year and 0.009% of the total healthcare budget of the region.

    CONCLUSIONS: The study found that a large part of resources used for this implementation of more PCC occurred in the DD, although at least half of the costs occurred in the healthcare units. Moreover, the cost of providing a central support function corresponds to a tiny proportion of the total health budget.

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  • 5.
    Strid, Emma Nilsing
    et al.
    Örebro University, Örebro.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Nilsagård, Ylva
    Örebro University, Örebro.
    Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study2023Ingår i: BMC Primary Care, E-ISSN 2731-4553, Vol. 24, nr 1, artikel-id 122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is moderate to strong evidence of the effectiveness of health-promotion interventions, but implementation in routine primary health care (PHC) has been slow. In the Act in Time project implementation support is provided for a health promotion practice using individually targeted lifestyle interventions in a PHC setting. Identifying health care professionals' (HCPs') perceptions of barriers and facilitators helps adapt implementation activities and achieve a more successful implementation. This study aimed, at a pre-implementation stage, to describe the expectations of managers, appointed internal facilitators (IFs) and HCPs on implementing a healthy lifestyle-promoting practice in PHC.

    METHODS: In this qualitative study five focus group discussions with 27 HCPs and 16 individual interviews with managers and appointed IFs were conducted at five PHC centres in central Sweden. The PHC centres are participating in the Act in Time project, evaluating the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice. A deductive qualitative content analysis based on the Consolidated Framework for Implementation Research (CFIR) was followed using inductive analysis.

    RESULTS: Twelve constructs from four of five CFIR domains were derived: Innovation characteristics, Outer setting, Inner setting, and Characteristics of individuals. These domains are related to the expectations of HCPs to implement a healthy lifestyle-promoting practice, which includes facilitating factors and barriers. The inductive analysis showed that the HCPs perceived a need for a health-promotion approach to PHC. It serves the needs of the patients and the expectations of the HCPs, but lifestyle interventions must be co-produced with the patient. The HCPs expected that changing routine practice into a healthy lifestyle-promoting practice would be challenging, requiring sustainability, improved structures, cooperation in inter-professional teams, and a common purpose. A collective understanding of the purpose of changing practice was vital to successful implementation.

    CONCLUSIONS: The HCPs valued implementing a healthy lifestyle-promoting practice in a PHC setting. However, changing routine methods was challenging, implying that the implementation strategy should address obstacles and facilitating factors identified by the HCPs.

    TRIAL REGISTRATION: This study is part of the Act in Time project, registered in ClinicalTrials.gov with the number NCT04799860 . Registered 03 March 2021.

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  • 6.
    Eldh, Ann Catrine
    et al.
    Linköping University, Linköping; Uppsala University, Uppsala.
    Hälleberg-Nyman, Maria
    Örebro University, Örebro.
    Joelsson-Alm, Eva
    Karolinska Institutet, Stockholm; Södersjukhuset, Stockholm.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Facilitating facilitators to facilitate-Some general comments on a strategy for knowledge implementation in health services2023Ingår i: Frontiers in health services, ISSN 2813-0146, Vol. 3, artikel-id 1112936Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators' activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks.

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  • 7.
    Gustavsson, Catharina
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala universitet.
    Nordqvist, Maria
    Uppsala universitet.
    Bergman Bruhn, Åsa
    Högskolan Dalarna, Institutionen för kultur och samhälle, Arbetsvetenskap.
    Bröms, Kristina
    Uppsala universitet.
    Jerdén, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala universitet.
    Kallings, Lena V.
    Uppsala universitet ; GIH.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Process evaluation of an implementation intervention to facilitate the use of the Swedish Physical Activity on Prescription in primary healthcare2023Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, nr 1, artikel-id 996Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The Swedish Physical Activity on Prescription (PAP-S) is a method for healthcare to promote physical activity for prevention and treatment of health disorders. Despite scientific support and education campaigns, the use has been low. The aim of this study was to perform a process evaluation of an implementation intervention targeting the use of the PAP-S method in primary healthcare (PHC). Specifically, we wanted to evaluate feasibility of the implementation intervention, and its effect on the implementation process and the outcome (number of PAP-S prescriptions).

    Methods This was a longitudinal study using the Medical Research Council guidance for process evaluation of a 9-month implementation intervention among healthcare staff at three PHC centres in Sweden. Data was collected by: participatory observations of the implementation process; questionnaires to the staff before, after and 6 months after the implementation intervention; interviews after the implementation intervention; and number of PAP-S prescriptions.

    Results During the implementation intervention, the workplaces’ readiness-to-change and the healthcare staff’s confidence in using the PAP-S method were favourably influenced, as was the number of PAP-S prescriptions. After the implementation intervention, the number of PAP-S prescriptions decreased to about the same number as before the implementation intervention, at two out of three PHC centres. Four of the six implementation strategies appeared to impact on the implementation process: external facilitation; leadership engagement by a committed workplace management; local PAP-S coordinator taking a leading role and acting as local champion; educational outreach concerning how to use the PAP-S method.

    Conclusion The implementation intervention was not sufficient to produce sustained change of the healthcare staff’s behaviour, nor did it achieve favourable long-term outcome on the number of PAP-S prescriptions. The healthcare staffs’ sparse knowledge of the PAP-S method prior to the implementation intervention hampered the implementation. More hands-on education in how to use the PAP-S method introduced early in the implementation process is imperative for successful implementation of the PAP-S method. The findings also suggest that committed workplace management and local PAP-S coordinators, taking leading roles and acting as local champions, need to be firmly established at the PHC centres before the external facilitator withdraws.

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  • 8. Squires, Janet E.
    et al.
    Graham, Ian D.
    Santos, Wilmer J.
    Hutchinson, Alison M.
    Backman, Chantal
    Bergström, Anna
    Brehaut, Jamie
    Brouwers, Melissa
    Burton, Christopher
    de Candido, Ligyana Korki
    Cassidy, Christine
    Chalmers, Cheyne
    Chapman, Anna
    Colquhoun, Heather
    Curran, Janet
    Varin, Melissa Demery
    Doering, Paula
    Rose, Annette Elliott
    Fairclough, Lee
    Francis, Jillian
    Godfrey, Christina
    Greenough, Megan
    Grimshaw, Jeremy M.
    Grinspun, Doris
    Harvey, Gillian
    Hillmer, Michael
    Ivers, Noah
    Lavis, John
    Li, Shelly-Anne
    Michie, Susan
    Miller, Wayne
    Noseworthy, Thomas
    Rader, Tamara
    Robson, Mark
    Rycroft-Malone, Jo
    Stacey, Dawn
    Straus, Sharon
    Tricco, Andrea C.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Watkins, Vanessa
    The Implementation in Context (ICON) Framework: A meta-framework of context domains, attributes and features in healthcare2023Ingår i: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 21, nr 1, artikel-id 81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background There is growing evidence that context mediates the effects of implementation interventions intended to increase healthcare professionals’ use of research evidence in clinical practice. However, conceptual clarity about what comprises context is elusive. The purpose of this study was to advance conceptual clarity on context by developing the Implementation in Context Framework, a meta-framework of the context domains, attributes and features that can facilitate or hinder healthcare professionals’ use of research evidence and the effectiveness of implementation interventions in clinical practice.

    Methods We conducted a meta-synthesis of data from three interrelated studies: (1) a concept analysis of published literature on context (n = 70 studies), (2) a secondary analysis of healthcare professional interviews (n = 145) examining context across 11 unique studies and (3) a descriptive qualitative study comprised of interviews with heath system stakeholders (n = 39) in four countries to elicit their tacit knowledge on the attributes and features of context. A rigorous protocol was followed for the meta-synthesis, resulting in development of the Implementation in Context Framework. Following this meta-synthesis, the framework was further refined through feedback from experts in context and implementation science.

    Results In the Implementation in Context Framework, context is conceptualized in three levels: micro (individual), meso (organizational), and macro (external). The three levels are composed of six contextual domains: (1) actors (micro), (2) organizational climate and structures (meso), (3) organizational social behaviour (meso), (4) organizational response to change (meso), (5) organizational processes (meso) and (6) external influences (macro). These six domains contain 22 core attributes of context and 108 features that illustrate these attributes.

    Conclusions The Implementation in Context Framework is the only meta-framework of context available to guide implementation efforts of healthcare professionals. It provides a comprehensive and critically needed understanding of the context domains, attributes and features relevant to healthcare professionals’ use of research evidence in clinical practice. The Implementation in Context Framework can inform implementation intervention design and delivery to better interpret the effects of implementation interventions, and pragmatically guide implementation efforts that enhance evidence uptake and sustainability by healthcare professionals.

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  • 9.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Karolinska Institutet, Huddinge.
    Bergström, Anna
    Uppsala University, Akademiska sjukhuset, Uppsala.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Eriksson, Leif
    Uppsala University, Akademiska sjukhuset, Uppsala.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna-Uppsala University, Falun; Uppsala University, Uppsala.
    Göras, Camilla
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Harvey, Gill
    College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
    Källberg, Ann-Sofie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Rudman, Ann
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Unbeck, Maria
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Huddinge.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Training and support for the role of facilitator in implementation of innovations in health and community care: a scoping review protocol.2023Ingår i: Systematic Reviews, E-ISSN 2046-4053, Vol. 12, nr 1, artikel-id 15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Implementing and sustaining innovations in clinical practice, such as evidence-based practices, programmes, and policies, is frequently described as challenging. Facilitation as a strategy for supporting implementation requires a facilitator, i.e. an individual with a designated role to support the implementation process. A growing number of studies report that facilitation can help tackle the challenges in implementation efforts. To optimise the potential contribution of facilitation as a strategy to improve the implementation of new practices, there is a need to enhance understanding about what training and support is required for individuals in the facilitator role. The objective of this scoping review is to map how facilitators have been trained for, and supported in, the facilitator role in implementation studies in health and community care. Specifically, the review aims to examine what is reported on training and support of facilitators in terms of learning outcomes, content, dose, mode of delivery, learning activities, and qualifications of the trainers and how the facilitators perceive training and support.

    METHODS: This scoping review will follow the guidance of the Joanna Briggs Institute and the PRISMA Extension for Scoping Review checklist. We will include articles in which (a) facilitation is deployed as an implementation strategy, with identified facilitator roles targeting staff and managers, to support the implementation of specified innovations in health or community care, and (b) training and/or support of facilitators is reported. We will exclude articles where facilitation is directed to education or training in specific clinical procedures or if facilitation supports the implementation of general quality improvement systems. All types of peer-reviewed studies and study protocols published in English will be included. A systematic search will be performed in MEDLINE (Ovid), Embase (embase.com), Web of Science Core Collection, and CINAHL (Ebsco).

    DISCUSSION: The proposed scoping review will provide a systematic mapping of the literature on the training and support of implementation facilitators and contribute useful knowledge within the field of implementation science to inform future facilitation initiatives.

    SYSTEMATIC REVIEW REGISTRATION: Registered at Open Science Framework (registration https://doi.org/10.17605/OSF.IO/M6NPQ ).

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  • 10.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Carlström, Eric
    Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    A comparison of three organisational levels in one health care region in Sweden implementing person-centred care: coupled, decoupled or recoupled in a complex organisation2022Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikel-id 196Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Establishing more substantial patient involvement in the health care has become fundamental to Western health care services. Person-centred care (PCC) has been developed as a way of working that involve the patients and family members. However, the implementation of PCC in clinical practice has proven to be challenging. The aim of this study was to explore the congruence of managers' perceptions and understanding of various aspects of PCC across three organisational levels in one health care region in Sweden in terms of coupling, decoupling and recoupling.

    METHODS: A policy on increased patient participation in health care was adopted in one health care region in Sweden. This policy was embodied in the form of PCC and a support strategy for the implementation was put in place. Participants representing three organisational levels (senders: politicians, n = 3; messengers: senior management, n = 7; and receivers: middle- and frontline managers, n = 13) were interviewed and documents collected. A deductive qualitative content analysis was performed and findings from the three organisational levels compared.

    RESULTS: Descriptions of PCC at all the three organisational levels included health care provided in partnership between provider and patient. However, messengers and receivers also included aspects of how work was organised as part of the concept. Representatives at all levels expected high-quality care while reducing health care costs as an outcome, however, messengers and receivers also anticipated improvements in the work environment and reduced staff turnover. Strategies to support implementation included continuation and enhancement of existing routines that were considered person-centred and development of new ones. A need to make PCC less 'fuzzy' and ambiguous and instead communicate a more tangible care process was described. Representatives among messengers and receivers also suggested that no actions were needed because the practice was already considered person-centred.

    CONCLUSION: The findings indicated that congruence between organisational levels existed in some aspects, suggesting coupling between policy and practice. However, also incongruences were identified that might be due to the fuzziness of definitions and the application of PCC in practice, and the difficulty in assessing the level of patient-centredness in clinical practice.

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  • 11.
    af Winklerfelt Hammarberg, Sandra
    et al.
    Karolinska Institutet, Stockholm, Academic Primary Health Care Centre, Region Stockholm, Stockholm.
    Björkelund, Cecilia
    Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Nejati, Shabnam
    Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Magnil, Maria
    Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Hange, Dominique
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg.
    Svenningsson, Irene
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg.
    Petersson, Eva‑Lisa
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg.
    Udo, Camilla
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Division of Health Care Science, Marie Cederschiöld University, Stockholm; Center for Clinical Research Dalarna, Uppsala University, Falun.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Westman, Jeanette
    Karolinska Institutet, Stockholm; Academic Primary Health Care Centre, Region Stockholm, Stockholm; Uppsala University, Uppsala.
    Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12‑ and 24‑month follow‑up of a pragmatic cluster randomized controlled trial2022Ingår i: BMC Primary Care, E-ISSN 2731-4553, Vol. 23, nr 1, artikel-id 198Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In previous studies, we investigated the effects of a care manager intervention for patients withdepression treated in primary health care. At 6 months, care management improved depressive symptoms, remission,return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study wasto compare the long-term effectiveness of care management and usual care for primary care patients with depressionon depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and24 months after the start of the intervention.Methods: Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control)in the regions of Västra Götaland and Dalarna, Sweden. Patients ≥18 years with newly diagnosed mild to moderatedepression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed astructured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care managerfollowed up symptoms and treatment, encouraged behavioral activation, provided education, and communicatedwith the patient’s general practitioner as needed. Patients at control centers received usual care. Adjusted mixedmodel repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptomsand remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specificquestionnaire).Results: The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) butnot 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differencesin remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from theprimary care center.Conclusions: Patients with depression who had a care manager maintained their 6-month improvements in symptomsat the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients withcare managers also had significantly more confidence in primary care and belief in future support than controls.

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  • 12.
    Saarijärvi, Markus
    et al.
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Moons, Philip
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
    Gyllensten, Hanna
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bratt, Ewa-Lena
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
    Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project2022Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikel-id 153Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Although transition programs have been evaluated for adolescents with chronic conditions, these have rarely involved process evaluations. Indeed, outcomes of complex interventions are dependent on how the intervention is implemented in practice and evaluations of implementation process are therefore pivotal. The aim of this study was to evaluate the extent to which a transition program for adolescents with congenital heart disease was delivered as intended. Research questions were 1) to what level of fidelity was the program delivered? and 2) what potential moderating factors affected the delivery of the program and overall fidelity?

    METHODS: A mixed methods design was used, where a process evaluation was embedded in the STEPSTONES randomized controlled trial in Sweden. The implementation fidelity framework by Carrol (2007) and Hasson (2010) was used to design, collect and analyze data. Quantitative data consisted of intervention records on adherence and were analyzed with descriptive statistics. Qualitative data on moderators affecting fidelity were collected through interviews, log-books and focus group interviews with healthcare professionals implementing the intervention and participatory observations of the implementation process. Data were analyzed with deductive content analysis. Triangulation was used to integrate quantitative and qualitative data within the fidelity framework.

    RESULTS: Six out of eight components of the transition program were delivered to an extent that adhered to the program theory or achieved a high level of fidelity. However, components involving peer support had a low attendance by the participating sample (32.2%), and the joint transfer meeting was challenging to implement, despite achieving high adherence. Moderators affecting the implementation process were the adolescent's and healthcare professional's engagement in the intervention, contextual factors and a lack of standard operating procedures for all components in the program.

    CONCLUSION: Barriers and facilitators for a future implementation of transition programs have been illuminated in this study. The use of an implementation fidelity framework in the process evaluation proved successful in providing a comprehensive evaluation of factors affecting the implementation process. However, implementation fidelity must be considered in relation to adaptations to the local and personal prerequisites in order to create interventions that can achieve fit.

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  • 13.
    Strid, Emma Nilsing
    et al.
    Örebro University, Örebro.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Nilsagård, Ylva
    Örebro University, Örebro.
    Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the "Act in Time" Mixed Methods Process Evaluation Study2022Ingår i: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 11, nr 8, artikel-id e37634Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is growing evidence that noncommunicable diseases (NCDs) can be attributable to unhealthy lifestyle habits. However, there has been little application of this knowledge in primary health care (PHC).

    OBJECTIVE: This study aims to evaluate the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a PHC setting. This practice is based on national guidelines targeting unhealthy lifestyle habits with a potential risk for NCDs.

    METHODS: A pre-post implementation study design with a control group is used in a PHC setting in central Sweden. The Medical Research Council guidelines for process evaluation of complex interventions will be applied. The implementation process and outcomes will be assessed using a mix of qualitative and quantitative methods. A strategic sample of up to 6 PHC centers will be included as intervention centers, which will receive a 12-month multifaceted implementation strategy. Up to 6 matched PHC centers will serve as controls. Core components in the implementation strategy are external and internal facilitators in line with the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Astrakan change leadership model. Data will be collected at baseline, during the implementation phase, and 4-6 months after the implementation strategy. Questionnaires will be sent to roughly 500 patients in every PHC center and 200 health care professionals (HCPs) before and after implementation. In addition, purposeful sampling will be used for interviews and focus group discussions with managers, HCPs, patient representatives, and internal and external facilitators. Use of data from medical records and activity logs will be an additional data source.

    RESULTS: Recruitment of PHC centers began in March 2021 and ended in Spring 2022. Based on the planned timeline with the 12-month implementation strategy and 4-6-month follow-up, we expect to collect the final data in Summer 2023.

    CONCLUSIONS: This study will explain implementation process and outcomes using a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a real-world PHC context. The study is expected to provide new knowledge about the role of facilitators and their contribution to implementation outcomes. These findings can guide policy makers, managers, and PHC staff to integrate health promotion and disease prevention in PHC and provide methodological support to facilitators.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT04799860; https://clinicaltrials.gov/ct2/show/NCT04799860.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37634.

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  • 14.
    Fridberg, Helena
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. University of Gothenburg.
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Karolinska Institute, Stockholm.
    Operationalisation of person-centred care in a real-world setting: a case study with six embedded units2022Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikel-id 1160Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Although person-centred care (PCC) is growing globally in popularity it is often vague and lacks conceptual clarity and definition. The ambiguity stretches from PCC's underlying philosophical principles and definitions of the concept to how it is operationalised and practised on the ground by health care professionals. We explore how the PCC model by the Gothenburg University Centre for Person-centred Care (GPCC) was operationalised in a real-world setting by using a set of recommendations by Fixsen and others that define and structure the core components of innovations in four distinct but interrelated components: philosophical principles and values, contextual factors, structural elements and core practices. Thus, this study aimed to increase knowledge about core practices in PCC in six health care units in real-world circumstances.

    METHODS: A case study with six embedded health care units was conducted from 2016 to 2019. We collected data from three sources: interviews (n = 12) with change agents, activity logs and written documents. Data were triangulated, and core practices were identified and deductively coded to the PCC model's structural elements: initiating, working and safeguarding the partnership with patients.

    RESULTS: We identified operationalisations of PCC in line with the three structural elements in the GPCC model at all included health care units. A range of both similarities and dissimilarities between units were identified, including the level of detail in describing PCC practices, when these practices were conducted and by whom at the workplace. The recommendations for describing the core components of PCC also helped us identify how some operationalisations of PCC seemed more driven by contextual factors, including a new regulation for planning and documenting care across health care specialities.

    CONCLUSIONS: Our findings show how PCC is operationalised in different health care units in a real-world setting based on change agents' understanding of the concept and their unique context. Increased knowledge of PCC and its philosophical principles and values, contextual factors, structural elements and core practices, is necessary to build a common understanding of the PCC-concept. Such knowledge is essential when PCC is operationalised as part of implementation efforts in health care.

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  • 15.
    Andersen, Randi Dovland
    et al.
    Department of Research Telemark Hospital Skien Norway; Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway.
    Genik, Lara
    Department of Psychology University of Guelph Guelph ON Canada.
    Alriksson-Schmidt, Ann I
    Department of Clinical Sciences Lund Skåne University Hospital Orthopedics Lund University Lund Sweden.
    Anderzen-Carlsson, Agneta
    University Health Care Research Center and Swedish Institute for Disability Research Faculty of Medicine and Health Örebro University Örebro Sweden.
    Burkitt, Chantel
    Gillette Children's Specialty Healthcare Saint Paul MN USA; Department of Educational Psychology University of Minnesota Minneapolis MN USA.
    Bruflot, Sindre K
    Telemark Chapter of the Norwegian Cerebral Palsy Association Skien Norway.
    Chambers, Christine T
    Departments of Psychology & Neuroscience and Pediatrics Dalhousie University Halifax NS Canada; Centre for Pediatric Pain Research IWK Health Centre Nova Scotia Canada.
    Jahnsen, Reidun B
    Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway; Department of Clinical Neurosciences for Children Oslo University Hospital Oslo Norway.
    Jeglinsky-Kankainen, Ira
    Department of Health and Welfare Arcada University of Applied Sciences Helsinki Finland.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Pain burden in children with cerebral palsy (CPPain) survey: Study protocol2022Ingår i: Paediatric & neonatal pain, ISSN 2637-3807, Vol. 4, nr 1, s. 11-21Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Pain is a significant health concern for children living with cerebral palsy (CP). There are no population-level or large-scale multi-national datasets using common measures characterizing pain experience and interference (ie, pain burden) and management practices for children with CP. The aim of the CPPain survey is to generate a comprehensive understanding of pain burden and current management of pain to change clinical practice in CP. The CPPain survey is a comprehensive cross-sectional study. Researchers plan to recruit approximately 1400 children with CP (primary participants) across several countries over 6-12 months using multimodal recruitment strategies. Data will be collected from parents or guardians of children with CP (0-17 years) and from children with CP (8-17 years) who are able to self-report. Siblings (12-17 years) will be invited to participate as controls. The CPPain survey consists of previously validated and study-specific questionnaires addressing demographic and diagnostic information, pain experience, pain management, pain interference, pain coping, activity and participation in everyday life, nutritional status, mental health, health-related quality of life, and the effect of the COVID-19 pandemic on pain and access to pain care. The survey will be distributed primarily online. Data will be analyzed using appropriate statistical methods for comparing groups. Stratification will be used to investigate subgroups, and analyses will be adjusted for appropriate sociodemographic variables. The Norwegian Regional Committee for Medical and Health Research Ethics and the Research Ethics Board at the University of Minnesota in USA have approved the study. Ethics approval in Canada, Sweden, and Finland is pending. In addition to dissemination through peer-reviewed journals and conferences, findings will be communicated through the CPPain Web site (www.sthf.no/cppain), Web sites directed toward users or clinicians, social media, special interest groups, stakeholder engagement activities, articles in user organization journals, and presentations in public media.

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  • 16.
    Sedelius, Helene
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Centre for Clinical Research Dalarna-Uppsala University, Falun, Sweden; .
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Bergsten, Ulrika
    R&D Department at Region Halland, Halmstad, Sweden.
    Dehlin, Mats
    Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg SE, Gothenburg, Sweden.
    Iggman, David
    Centre for Clinical Research Dalarna-Uppsala University, Falun, Sweden.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Svärd, Anna
    Centre for Clinical Research Dalarna-Uppsala University, Falun, Sweden.
    Professionals' perspectives on existing practice and conditions for nurse-led gout care based on treatment recommendations: a qualitative study in primary healthcare2022Ingår i: BMC Primary Care, E-ISSN 2731-4553, Vol. 23, nr 1, artikel-id 71Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Gout affects nearly 2 % of the population and is associated with repeated painful flares of arthritis. Preventive urate-lowering therapy is widely available, but only one third of patients receive adequate treatment. Lack of knowledge among healthcare professionals and patients within primary healthcare are implicated as partial explanations for this undertreatment. Nurse-led care has proved to be an effective model when treating patients with gout, but there is a need for more knowledge about factors that can be expected to influence the future implementation of such care. The aim of this study was to describe factors influencing existing gout care in primary healthcare and the conditions for a future implementation of nurse-led gout care based on national treatment recommendations.

    METHODS: In this qualitative study, focus group discussions with 56 nurses and physicians and individual interviews with eight managers were conducted at nine primary healthcare units in central Sweden. A deductive qualitative content analysis based on the main constructs of the framework Integrated Promoting Action on Research Implementation in Health Services was followed by an inductive analysis within the frames of the main constructs: innovation, recipients and context.

    RESULTS: Gout-related contacts with primary healthcare was described as being patient initiated, diagnostics was in some respects complex and nurse-led care was experienced as a favourable primary healthcare model in general (innovation). Gout was seen as a low-priority condition with acute flares and there was inadequate knowledge of gout, including preventive treatment (recipients). Primary healthcare was perceived as having a holistic but fragmented responsibility for gout care, recommendations against keeping waiting lists complicated follow-up appointments and a need for motivation and support when introducing new practices was emphasised (context).

    CONCLUSION: In this study, investigating the perspective of professionals, several factors were found to influence existing gout care. It will be crucial to target these factors in the development of a future implementation strategy.

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  • 17.
    Rudman, Ann
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Melander, Sara
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Lindström, Veronica
    Falk, Lotta
    Hörberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Rasoal, Dara
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Dahlgren, Anna
    Boström, Anne-Marie
    Gustavsson, Petter
    Dahl, Oili
    Sjuksköterskor i frontlinjen av COVID-19 pandemin: Vilka blev konsekvenserna? Teknisk rapport om enkät och datainsamling2022Rapport (Övrigt vetenskapligt)
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  • 18.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Klockar, Erika
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Department of Health Sciences, Lund University, Lund.
    von Koch, Lena
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm; Theme Neuro Karolinska University Hospital, Stockholm.
    Ytterberg, Charlotte
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Finch, Tracy
    Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna, Uppsala University, Falun; Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Jones, Fiona
    Faculty of Health and Social Care Sciences, Kingston University and St George's, University of London, London, United Kingdom.
    Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study2022Ingår i: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 11, nr 5, artikel-id e37672Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients' confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided.

    OBJECTIVE: The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context.

    METHODS: We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design.

    RESULTS: Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022.

    CONCLUSIONS: This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management.

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  • 19.
    Fridberg, Helena
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg.
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm.
    Tracking, naming, specifying, and comparing implementation strategies for person-centred care in a real-world setting: a case study with seven embedded units2022Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikel-id 1409Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector face two intertwined and complex challenges. First, making sense of PCC as an intervention with complex innovation characteristics and second, staging implementation of PCC by choosing appropriate implementation strategies. We aimed to explore one of these challenges by tracking, naming, specifying, and comparing which strategies and how strategies were enacted to support the implementation of more PCC in a real-world setting represented by one health care region in Sweden.

    METHODS: A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification.

    RESULTS: Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%.

    CONCLUSIONS: Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.

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  • 20. Eldh, Ann Cathrine
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Evidensbaserad praktik inom omvårdnad2021Ingår i: Omvårdnad på avancerad nivå: Kärnkompetenser inom sjuksköterskans specialistområden / [ed] Edberg A-K, Ehrenberg A, Wijk H, Öhlén J., Lund: Studentlitteratur AB, 2021, 2, s. 261-281Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 21.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Eldh, Ann Catrine
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Evidensbaserad vård2021Ingår i: Omvårdnad på avancerad nivå: Kärnkompetenser inom sjuksköterskans specialistområden / [ed] Edberg A-K, Ehrenberg A, Wijk H, Öhlén J., Lund: Studentlitteratur AB, 2021, 2, s. 225-257Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 22. Gustafsson, Inga-Britt
    et al.
    Winblad, Ulrika
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Dalarna County Council, Falun; Centre for Clinical Research, Falun.
    Fredriksson, Mio
    Factors that shape the successful implementation of decommissioning programmes: an interview study with clinic managers2021Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, nr 1, artikel-id 805Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: As a response to many years of repetitive budget deficits, Region Dalarna in Sweden started a restructuring process in 2015, and implemented a decommissioning programme to achieve a balanced budget until 2019. Leading politicians and public servants took the overall decisions about the decommissioning programme, but the clinical decision-making and implementation was largely run by the clinic managers and their staff. As the decommissioning programme improved the finances, met relatively little resistance from the clinical departments, and neither patient safety nor quality of care were perceived to be negatively affected, the initial implementation could be considered successful. The aim of this study was to investigate clinic managers' experience of important factors enabling the successful implementation of a decommissioning programme in a local healthcare organization.

    METHODS: Drawing on a framework of factors and processes that shape successful implementation of decommissioning decisions, this study highlights the most important factors that enabled the clinic managers to successfully implement the decommissioning programme. During 2018, an interview study was conducted with 26 clinic managers, strategically selected to represent psychiatry, primary care, surgery and medicine. A deductive content analysis was used to analyze the interviews. By applying a framework to the data, the most important factors were illuminated.

    RESULTS: The findings highlighted factors and processes crucial to implementing the decommissioning programme: 1) create a story to get a shared image of the rationale for change, 2) secure an executive leadership team represented by clinical champions, 3) involve clinic managers at an early stage to ensure a fair decision-making process, 4) base the decommissioning decisions on evidence, without compromising quality and patient safety, 5) prepare the organisation to handle a process characterised by tensions and strong emotions, 6) communicate demonstrable benefits, 7) pay attention to the need of cultural and behavioral change and 8) transparently evaluate the outcome of the process.

    CONCLUSIONS: From these findings, we conclude that in order to successfully implement a decommissioning programme, clinic managers and healthcare professions must be given and take responsibility, for both the process and outcome.

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  • 23. Kitson, Alison L
    et al.
    Harvey, Gillian
    Gifford, Wendy
    Hunter, Sarah C
    Kelly, Janet
    Cummings, Greta G
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Kislov, Roman
    Pettersson, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. The Sahlgrenska Academy, University of Gothenburg.
    Wilson, Paul
    How nursing leaders promote evidence-based practice implementation at point-of-care: A four-country exploratory study.2021Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 77, nr 5, s. 2447-2457Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: To describe strategies nursing leaders use to promote evidence-based practice implementation at point-of-care using data from health systems in Australia, Canada, England and Sweden.

    DESIGN: A descriptive, exploratory case-study design based on individual interviews using deductive and inductive thematic analysis and interpretation.

    METHODS: Fifty-five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016.

    RESULTS: Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence-based practice implementation. Nursing leaders actively promote evidence-based practice implementation, work to influence evidence-based practice implementation processes and integrate evidence-based practice implementation into everyday policy and practices.

    CONCLUSION: The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence-based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence-based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship-focused approaches nursing leaders take towards promoting evidence-based practice implementation.

    IMPACT: This study explored how nursing leaders promote evidence-based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence-based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness.

  • 24. Saarijärvi, Markus
    et al.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. University of Gothenburg.
    Moons, Philip
    Gyllensten, Hanna
    Bratt, Ewa-Lena
    Mechanisms of impact and experiences of a person-centred transition programme for adolescents with CHD: the Stepstones project.2021Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, nr 1, artikel-id 573Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: During the past decade there has been some evaluation of transition programmes for adolescents with chronic conditions. However, this has rarely involved process evaluations focusing on mechanisms leading to outcomes, thus hampering implementation of these complex interventions. Our aim was to (I) describe adolescents' and parents' experiences of participating in a person-centred transition programme aiming to empower them in transition to adulthood and (II) explore the mechanisms of impact.

    METHODS: A qualitative process evaluation was performed, embedded in a randomized controlled trial evaluating the effectiveness of a transition programme for adolescents with congenital heart disease in Sweden. A purposive sample of 14 adolescents and 12 parents randomized to the intervention group were interviewed after participation in the programme. Data were analysed deductively and inductively in NVivo v12.

    RESULTS: Experiences of participation in the transition programme were generally positive. Meeting a transition coordinator trained in person-centred care and adolescent health and embarking on an educational process based on the adolescents' prerequisites in combination with peer support were considered key change mechanisms. However, support to parents were not sufficient for some participants, resulting in ambivalence about changing roles and the unmet needs of parents who required additional support.

    CONCLUSIONS: Participants experienced increased empowerment in several dimensions of this construct, thus demonstrating that the transition programme was largely implemented as intended and the evidence-based behaviour-change techniques used proved effective in reaching the outcome. These findings can inform future implementation of transition programmes and illuminate challenges associated with delivering a complex intervention for adolescents with chronic conditions.

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  • 25. Fritz, Johanna
    et al.
    Almqvist, Lena
    Söderlund, Anne
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Sandborgh, Maria
    Patients' health outcomes after an implementation intervention targeting the physiotherapists' clinical behaviour.2021Ingår i: Archives of physiotherapy, ISSN 2057-0082, Vol. 11, nr 1, artikel-id 22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach.

    METHODS: An explorative and comparative pre-/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used.

    RESULTS: There were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support.

    CONCLUSION: It is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients' outcomes in this study. Most of the patients' health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach.

    TRIAL REGISTRATION: The study protocol was retrospectively registered in ClinicalTrials.gov . ID NCT03118453 , March 20, 2017.

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  • 26.
    Fridberg, Helena
    et al.
    Högskolan Dalarna, Institutionen för lärarutbildning, Pedagogiskt arbete.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Sahlgrenska Academy at the University of Gothenburg.
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Karolinska Institute, Stockholm.
    The innovation characteristics of person-centred care as perceived by healthcare professionals: an interview study employing a deductive-inductive content analysis guided by the consolidated framework for implementation research.2021Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, nr 1, artikel-id 904Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Person-centred care (PCC) is promoted as an innovation that will improve patients' rights and increase their participation in healthcare. Experience shows that the implementation of PCC is challenging and often results in varying levels of adoption. How health care professionals (HCPs) perceive an innovation such as PCC is an important factor to consider in implementation. Yet, such studies are scarce. Thus, in a sample of healthcare units in a region in Sweden, involved in a transition to PCC, we aimed to investigate HCPs' perceptions of PCC.

    METHODS: An interview study was conducted in 2018 during the implementation of PCC with HCPs (n = 97) representing diverse vocational roles in six healthcare contexts. Data were collected via focus groups (n = 15), dyadic interviews (n = 5), and individual interviews (n = 22) and analysed using a deductive-inductive content analysis. The deductive approach was guided by the Consolidated Framework for Implementation Research (CFIR), followed by an inductive analysis to describe HCPs' in-depth perceptions of PCC in relation to each of the CFIR constructs.

    RESULTS: Eight constructs from two of the CFIR domains, Intervention characteristics and Inner setting, were used to code HCPs' perceptions of PCC. One construct, Observability, was added to the coding sheet to fully describe all the data. The constructs Relative advantage, Complexity, Compatibility, Observability, and Available resources were discussed in depth by HCPs and resulted in rich and detailed data in the inductive data analysis. This analysis showed large variations in perceptions of PCC among HCPs, based on factors such as the PCCs ethical underpinnings, its operationalisation into concrete working routines, and each HCPs' unique recognition of PCC and the value they placed on it.

    CONCLUSIONS: We identified nine CFIR constructs that seem pertinent to HCPs' perceptions of PCC. HCPs report an array of mixed perceptions of PCC, underlining its complex nature. The perceptions are shaped by a range of factors, such as their individual understandings of the concept and the operationalisation of PCC in their local context. Stakeholders in charge of implementing PCC might use the results as a guide, delineating factors that may be important to consider in a wide range of healthcare contexts.

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  • 27.
    Wallin, Lars
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    von Thiele Schwarz, Ulrica
    Hasson, Henna
    Tillförlitlig och relevant kunskap för sjuksköterskor: Om vetenskap och beprövad erfarenhet2021Bok (Övrigt vetenskapligt)
  • 28.
    Fridberg, Helena
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Sahlgrenska Academy at the University of Gothenburg.
    Wallengren, C.
    Kottorp, A.
    Forsman, Henrietta
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Tistad, Malin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Karolinska Institutet.
    Development and evaluation of the measurement properties of a generic questionnaire measuring patient perceptions of person-centred care2020Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, nr 1, artikel-id 960Artikel i tidskrift (Refereegranskat)
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  • 29. Saarijärvi, Markus
    et al.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. University of Gothenburg.
    Moons, Philip
    Gyllensten, Hanna
    Bratt, Ewa-Lena
    Factors affecting adolescents' participation in randomized controlled trials evaluating the effectiveness of healthcare interventions: the case of the STEPSTONES project2020Ingår i: BMC Medical Research Methodology, E-ISSN 1471-2288, Vol. 20, nr 1, artikel-id 205Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Recruitment of adolescents to intervention studies is a known challenge. For randomized controlled trials (RCT) to be generalizable, reach must be assessed, which means ascertaining how many of the intended population actually participated in the trial. The aim of this study was to evaluate the reach and representativeness of an RCT evaluating the effectiveness of a complex intervention for adolescents with chronic conditions.

    METHODS: A mixed methods sequential explanatory design was employed. Firstly, quantitative cross-sectional data from the RCT, patient registries and medical records were collected and analysed regarding baseline differences between participants and non-participants in the trial. Secondly, qualitative data on their reasons for participating or not were collected and analysed with content analysis to explain the quantitative findings.

    RESULTS: Participants showed larger differences in effect sizes and a significantly more complex chronic condition than non-participants. No other statistically significant differences were reported, and effect sizes were negligible. Reasons for declining or accepting participation were categorized into three main categories: altruistic reasons, personal reasons and external reasons and factors.

    CONCLUSIONS: Integration of quantitative and qualitative findings showed that participation in the RCT was affected by disease complexity, the perceived need to give back to healthcare and research and the adolescents' willingness to engage in their illness. To empower adolescents with chronic conditions and motivate them to participate in research, future intervention studies should consider developing tailored recruitment strategies and communications with sub-groups that are harder to reach.

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  • 30. Fritz, J.
    et al.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Sahlgrenska Academy.
    Söderlund, A.
    Almqvist, L.
    Sandborgh, M.
    Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability2020Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 42, nr 24, s. 3467-3474Artikel i tidskrift (Refereegranskat)
    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.

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  • 31.
    Wallin, Lars
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Carlström, Eric
    Woolf, Axel
    Implementering av personcentrerad vård: kunskapsunderlag, medarbetarskap och organisation2020Ingår i: Personcentrering inom hälso- och sjukvård: Från filosofi till praktik / [ed] Inger Ekman, Lund: Studentlitteratur AB, 2020Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 32. Petersson, Eva-Lisa
    et al.
    Svenningsson, Irene
    Udo, Camilla
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Implementeringsprocessen2020Ingår i: Vårdsamordnare vid psykisk ohälsa i primärvården: Forskning, organisation och implementering, Göteborg: Göteborgs universitet , 2020Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 33.
    Saarijarvi, Markus
    et al.
    Univ Gothenburg, Inst Hlth & Care Sci, POB 457, S-41317 Gothenburg, Sweden.;Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Leuven, Belgium..
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. University of Gothenburg; Karolinska Institute.
    Bratt, Ewa-Lena
    Univ Gothenburg, Inst Hlth & Care Sci, POB 457, S-41317 Gothenburg, Sweden.;Queen Silvia Childrens Hosp, Dept Pediat Cardiol, Gothenburg, Sweden..
    Process evaluation of complex cardiovascular interventions: How to interpret the results of my trial?2020Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 19, nr 3, artikel-id 1474515120906561Artikel i tidskrift (Refereegranskat)
    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.

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  • 34.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Boström, Anne-Marie
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gustavsson, Petter
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Registered nurses’ evidence-based practice revisited: A longitudinal study in mid-career.2020Ingår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 17, nr 5, s. 348-355Artikel i tidskrift (Refereegranskat)
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  • 35. Kislov, Roman
    et al.
    Wilson, Paul
    Cummings, Greta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, Wendy
    Kelly, Janet
    Kitson, Alison
    Pettersson, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Harvey, Gill
    The chain of codified knowledge: Organisational enactment of evidence-based healthcare in four high-income countries.2020Ingår i: Transitions and boundaries in the coordination and reform of health services: Building knowledge, strategy and leadership. / [ed] Nugus, P., Rodriguez, C, Denis, J-L. & Chenevert, D., Cham, Switzerland: Palgrave Macmillan, 2020Kapitel i bok, del av antologi (Refereegranskat)
  • 36. Bergström, Anna
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. University of Adelaide, Adelaide, Australia.
    Eldh, Ann Catrine
    Graham, Ian
    Gustafsson, Kazuko
    Harvey, Gillian
    Hunter, Sarah
    Kitson, Alison
    Rycroft-Malone, Jo
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. The Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    The use of the PARIHS framework in implementation research and practice: A citation analysis of the literature2020Ingår i: Implementation Science, E-ISSN 1748-5908, Vol. 15, nr 1, artikel-id 68Artikel i tidskrift (Refereegranskat)
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  • 37. Gifford, Wendy
    et al.
    Lewis, Krystina B.
    Eldh, Ann Catrine
    Fiset, Val
    Abdul-Fatah, Tara
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala University.
    Thavorn, Kednapa
    Graham, Ian D.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. University of Gothenburg; Karolinska Institutet.
    Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada2019Ingår i: Pilot and Feasibility Studies, E-ISSN 2055-5784, Vol. 5, nr 1, artikel-id 103Artikel i tidskrift (Refereegranskat)
    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.

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  • 38. Kislov, Roman
    et al.
    Cummings, Greta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, Wendy
    Harvey, Gill
    Kitson, Alison
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wilson, Paul
    From research evidence to "Evidence by proxy".: Organisational enactment of evidence-based healthcare2019Konferensbidrag (Refereegranskat)
  • 39. Kislov, R.
    et al.
    Wilson, P.
    Cummings, G.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, W.
    Kelly, J.
    Kitson, A.
    Pettersson, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institute; Sahlgrenska Academy.
    Harvey, G.
    From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries2019Ingår i: PAR. Public Administration Review, ISSN 0033-3352, E-ISSN 1540-6210, Vol. 79, nr 5, s. 684-698Artikel i tidskrift (Refereegranskat)
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  • 40. Fritz, Johanna
    et al.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet, Stockholm / Sahlgrenska Academy, University of Gothenburg.
    Söderlund, Anne
    Almqvist, Lena
    Sandborgh, Maria
    Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods.2019Ingår i: Implementation Science, E-ISSN 1748-5908, Vol. 14, nr 1, artikel-id 94Artikel i tidskrift (Refereegranskat)
    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.

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  • 41. Harvey, Gill
    et al.
    Gifford, Wendy
    Cummings, Greta
    Kelly, Janet
    Kislov, Roman
    Kitson, Alison
    Pettersson, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wilson, Paul
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries2019Konferensbidrag (Refereegranskat)
  • 42. Harvey, Gill
    et al.
    Gifford, Wendy
    Cummings, Greta
    Kelly, Janet
    Kislov, Roman
    Kitson, Alison
    Pettersson, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Göteborgs universitet; Karolinska institutet.
    Wilson, Paul
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries2019Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 90, s. 21-30Artikel i tidskrift (Refereegranskat)
    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.

  • 43. Barenfeld, Emmelie
    et al.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Björk Brämberg, Elisabeth
    Moving from knowledge to action in partnership: A case study on program adaptation to support optimal aging in the context of migration2019Ingår i: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 38, nr 8, s. 1096-1120Artikel i tidskrift (Refereegranskat)
    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.

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  • 44. Orton, Marie-Louise
    et al.
    Andersson, Åsa
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Göteborgs universitet.
    Forsman, Henrietta
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Linköpings universitet; Uppsala universitet.
    Nursing management matters for registered nurses with a PhD working in clinical practice2019Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, nr 5, s. 955-962Artikel i tidskrift (Refereegranskat)
    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. 

  • 45. Svenningsson, I
    et al.
    Petersson, E-L
    Udo, Camilla
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Westman, J
    Björkelund, C
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Center for Clinical Research; Karolinska institutet, Göteborgs universitet.
    Process evaluation of a cluster randomised intervention in Swedish primary care: using care managers in collaborative care to improve care quality for patients with depression.2019Ingår i: BMC Family Practice, E-ISSN 1471-2296, Vol. 20, nr 1, artikel-id 108Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The collaborative care model with a care manager has previously generated beneficial results for patients with depression in terms of decreased burden of depression symptoms. A care manager function has been tested in Sweden in the PRIM-CARE RCT with successful results. The aim of the present study was to evaluate the process of implementing care managers in collaborative care for patients with depression in Swedish primary health care in the PRIM-CARE RCT.

    METHODS: The study followed UK Medical Research Council guidance for process evaluation. Field notes from the implementation of the PRIM - CARE RCT were used, as well as data collected from five focus group discussions with General Practitioners (n = 29) and three focus group discussions with care managers (n = 11). Data were analysed with content analysis.

    RESULTS: Training sessions, careful preparation and extensive initial support to the care manager and staff at the Primary Care Centres were important ingredients in the implementation. The close access to facilitators, the recurrent peer support meetings, and the weekly newsletter strengthened the care manager function.

    CONCLUSIONS: A complex intervention adapted to the Swedish primary care context focusing on a care manager function for patients with depression could be performed through a stepwise implementation process. Financial support from the health care regions included in the study helped to reduce the impact of identified barriers. This process evaluation has revealed new and important knowledge for primary care development concerning infrastructure and organization building, knowledge sharing, and facilitating factors and barriers.

    TRIAL REGISTRATION: NCT02378272 Care Manager - Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM - CARE). Registered March 4 2015. Retrospectively registered.

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  • 46. Hälleberg Nyman, Maria
    et al.
    Forsman, Henrietta
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ostaszkiewicz, Joanne
    Hommel, Ami
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care: A process evaluation of an implementation intervention in the orthopaedic context2019Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, nr 2, s. 282-289Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    RATIONALE, AIMS, AND OBJECTIVES:

    The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery.

    METHODS:

    A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed.

    RESULTS:

    Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit.

    CONCLUSION:

    To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.

  • 47. Lind, S.
    et al.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Göteborgs universitet.
    Furst, C. J.
    Beck, I.
    The integrated palliative care outcome scale for patients with palliative care needs: Factors related to and experiences of the use in acute care settings2019Ingår i: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 17, nr 5, s. 561-568Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveImplementation of patient-reported outcome measures for patients with palliative care needs is characterized by both enablers and barriers. The ways in which healthcare professionals experience the use of assessment tools is important. Our aims were to explore factors contributing to or hindering patients with palliative care needs in assessing their symptoms with the Integrated Palliative Care Outcome Scale (IPOS) and to explore healthcare professionals' experiences of the use of IPOS in acute care settings.MethodData were collected as a part of the evaluation of the feasibility of an implementation strategy for introducing IPOS. Data from three participating acute care units were included. We used descriptive and analytical statistics; a qualitative content analysis was also performed.ResultA total of 309 patients were eligible to be offered assessment of symptoms with IPOS. Of these 69 (22%) had completed IPOS. A significant positive association was found between healthcare professionals' participation in training sessions and completed IPOS. The experiences of IPOS were split into two categories: "IPOS acting as a facilitator" and "barriers to the use of IPOS." The use of IPOS was described as contributing to person-centered care of patients with palliative care needs and inspiration to improved routines. Healthcare professionals' feelings of uncertainty about how to approach severely ill patients and their family members appear to have hindered their use of IPOS.Significance of resultsWe found an association between healthcare professionals' participation in training sessions and patients who completed IPOS, indicating the need for a high degree of attendance at the training to achieve successful implementation. The healthcare professionals expressed feelings of insecurity concerning the use of IPOS indicating a need for further education and clinical support in its use of IPOS. Nevertheless, use of IPOS was considered to contribute to improved care of patients with palliative care needs.

  • 48. Wikström, Ewa
    et al.
    Dellenborg, Lisen
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Göteborgs universitet; Karolinska institutet.
    Gillespie, Brigid M
    Erichsen Andersson, Annette
    The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action2019Ingår i: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 47, nr 3, s. 251-257Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Even though hand hygiene and aseptic techniques are essential to provide safe care in the operating room, several studies have found a lack of successful implementation. The aim of this study was to describe facilitative mechanisms supporting the implementation of hand hygiene and aseptic techniques.

    METHODS: This study was set in a large operating room suite in a Swedish university hospital. The theory-driven implementation process was informed by the literature on organizational change and dialogue. Data were collected using interviews and participant observations and analyzed using a thematic approach. The normalization process theory served as a frame of interpretation during the analysis.

    RESULTS: Three facilitating mechanisms were identified: (1) commitment through a sense of urgency, requiring extensive communication between the managers, operating room professionals, and facilitators in building commitment to change and putting the issues on the agenda; (2) dialogue for co-creation, increasing and sustaining commitment and resource mobilization; and (3) tailored management support, including helping managers to develop their leadership role, progressively involving staff, and retaining focus during the implementation process.

    CONCLUSIONS: The facilitating mechanisms can be used in organizing implementation processes. Putting the emphasis on help and support to managers seems to be a crucial condition in complex implementation processes, from preparation of the change process to stabilization of the new practice.

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  • 49. Bergström, Anna
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Graham, Ian
    Gustafsson, Kazuko
    Harvey, Gill
    Kitson, Alison
    Rycroft-Malone, Jo
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    The use of the PARIHS framework in implementation research and practice: A citation analysis of the literature2019Konferensbidrag (Refereegranskat)
  • 50. Saarijärvi, Markus
    et al.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Göteborgs universitet; Karolinska institutet.
    Moons, Philip
    Gyllensten, Hanna
    Bratt, Ewa-Lena
    Transition program for adolescents with congenital heart disease in transition to adulthood: protocol for a mixed-method process evaluation study (the STEPSTONES project)2019Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 9, nr 8, artikel-id e028229Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Today, the majority of young persons living with chronic conditions in high-income countries survive into adulthood and will need life-long medical follow-up. Therefore, transition programmes have been developed to facilitate transfer to adult care, and to support self-management and independence during adulthood. The Swedish Transition Effects Project Supporting Teenagers with chrONic mEdical conditionS (STEPSTONES) project aims to evaluate the effectiveness of a person-centred transition programme for empowering adolescents with congenital heart disease in transition to adulthood. To understand how the transition programme causes change and how outcomes are created, process evaluation is imperative to assess implementation, context and mechanisms of impact. This protocol aims to describe the process evaluation of the STEPSTONES transition programme.

    METHODS AND DESIGN: Medical Research Council guidance for process evaluation of complex interventions will be the guiding framework for this mixed-method study. The combination of qualitative and quantitative data will capture different aspects of programme delivery. The sample will consist of participants in the STEPSTONES randomised controlled trial (RCT), persons implementing the programme and healthcare professionals. Quantitative data will consist of protocols and routine monitoring documents from the RCT, data collected from patient registries and sociodemographic data to assess the implementation of the intervention. This data will be analysed with quantitative content analysis, along with descriptive and inferential statistics. Qualitative data will consist of participatory observations, logbooks and interviews with persons implementing the programme, participants and healthcare professionals. Analyses will be performed using qualitative content analysis to investigate mechanism of impact, context and delivery. Quantitative and qualitative data will be integrated in the final stage by using a triangulation protocol according to mixed-method guidelines.

    ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board in Gothenburg, Sweden. Results will be presented in open access, peer-reviewed journals and at international scientific conferences.

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