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  • 1.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Sturge, J.
    Meijering, L.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    A 5-day codesign sprint to improve housing decisions of older adults: lessons learned from Sweden and the Netherlands2023Ingår i: International Journal of Social Research Methodology, ISSN 1364-5579, E-ISSN 1464-5300Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The use of codesign methods is becoming increasingly common practice to involve and engage research participants in health research. Through codesign, end-users and stakeholders can contribute their own perspectives and experiences to solve a common problem. This article describes how a 5-day codesign sprint can be used to find solutions to improve housing decisions of older adults. Based on case studies in Sweden and the Netherlands, we identified similarities, differences, and patterns across the two contexts. By sharing methodological experiences across projects, opportunities are created for other researchers to build on the method and to integrate a creative process into traditional health research methods. We conclude that a 5-day codesign sprint can effectively and efficiently engage older adults and people with dementia in creative housing decision solutions, and we provide recommendations for future codesign sprint projects. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

  • 2.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University, Lund.
    Sturge, Jodi
    University of Twente, Twente, Netherlands.
    Lipson-Smith, Ruby
    Western Sydney University, Westmead, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
    Schmidt, Steven M
    Lund University, Lund.
    Pessah-Rasmussen, Hélène
    Skåne University Hospital, Malmö; Lund University, Lund.
    Svensson, Tony
    Högskolan Dalarna, Institutionen för information och teknik, Byggteknik.
    de Vries, Laila
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Bernhardt, Julie
    The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study2023Ingår i: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 12, artikel-id e52489Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

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

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  • 3.
    Fakhfakh, Maya
    et al.
    VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale Quebec, QC, Canada; Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada.
    Blanchette, Virginie
    Department of Human Kinetic and Podiatric Medicine at Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada; VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale Quebec, QC, Canada.
    Plourde, Karine V
    VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale Quebec, QC, Canada.
    Gadio, Souleymane
    VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale Quebec, QC, Canada.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Jones, Allyson
    Faculty of Rehabilitation Medicine, University of Alberta, AB, Canada..
    Meijering, Louise
    Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, the Netherlands.
    Giguère, Anik
    VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale Quebec, QC, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.
    Légaré, France
    VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale Quebec, QC, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.
    Canadian older adults' intention to use an electronic decision aid for housing decisions: a cross-sectional online survey2023Ingår i: JMIR Aging, E-ISSN 2561-7605, Vol. 6, artikel-id e43106Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Older adults experiencing disabilities such as loss of autonomy face the decision of whether to stay at home or move to a healthcare facility such as a nursing home. Thus, they may need support for this difficult decision.

    OBJECTIVE: We assessed Canadian older adults' intention to use an electronic decision aid (eDA) for making housing decisions and identified the factors that influenced their intention.

    METHODS: We conducted a cross-sectional study using an online survey targeting older adults across the 10 Canadian provinces and 3 territories. We included respondents from an online panel who were aged 65 years or older, understood English or French, had access to an electronic device with an internet connection and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the online survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence and facilitating conditions). We also assessed e-Health literacy using subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify factors influencing the intention to use the eDA.

    RESULTS: Of the 11,972 eligible panellists, 1,176 met the eligibility criteria and 1,000 (85%) respondents completed the survey. The mean age was 72.5 ± 5.59 years. Most respondents were male (54.8%), white (90.6%), English-speakers (62.9%) and living in Ontario or Quebec (62.8%) in urban areas (85%). Mean scores for subjective e-Health literacy were 27.8 ± 5.88 out of 40 and for objective e-Health literacy, 3.00 ± 0.97 out of 5. In our sample, the intention score was 4.74 ± 1.7 out of 7. Mean scores of intention constructs out of 7 were 5.63 ± 1.28 for facilitating conditions, 4.94 ± 1.48 for performance expectancy, 5.61 ± 1.35 for effort expectancy and 4.76 ± 1.59 for social influence. In the final model, factors associated with intention included mother tongue (β = .30; P <.001), objective e-Health literacy (β = -.06; P =.03), performance expectancy (β = .55; P <.001), social influence (β = .37; P <.001) and facilitating conditions (β = .15; P <.001).

    CONCLUSIONS: Findings from this pan-Canadian online survey suggest that Canadian older adults' intention to use an eDA to make housing decisions are similar to findings in other studies using UTAUT. Factors identified as influencing intention were mother tongue, objective e-Health literacy, performance expectancy, social influence and facilitating conditions. These will guide future strategies for implementing the eDA.

  • 4.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Slaug, Björn
    Lund University.
    Ytterberg, Charlotte
    Karolinska Institutet, Huddinge; Karolinska University Hospital, Stockholm.
    Heylighen, Ann
    KU Leuven, Belgium.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University, Sweden.
    Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study2023Ingår i: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 6, nr 4, s. 172-186Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

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  • 5. Palm, Klas
    et al.
    Kronlid, Carl
    Brantnell, Anders
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Identifying and Addressing Barriers and Facilitators for the Implementation of Internet of Things in Distributed Care: Protocol for a Case Study2023Ingår i: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 12, artikel-id e44562Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The internet of things (IoT) is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. This study aims to identify the facilitators and barriers associated with implementing IoT solutions in health care within a Scandinavian context. It addresses the pressing need to adapt health care systems to the demographic changes occurring in Scandinavia. The vision of “Vision eHealth 2025,” a long-term strategic direction for digitalization in Sweden, serves as the background for this project. The implementation of IoT solutions is a crucial aspect of achieving the vision’s goal of making Sweden a global leader in using digitalization and eHealth opportunities by 2025. IoT is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. Previous research has shown that there is a gap in our understanding of social and organizational challenges related to IoT and that the implementation and introduction of new technology in health care is often problematic.

    Objective: In this study, we will identify facilitating and hindering factors for the implementation of IoT solutions in social and health care.

    Methods: We will use an explorative design with a case study approach. The data collection will comprise questionnaires and qualitative interviews. Also, a literature review will be conducted at the start of the project. Thus, quantitative and qualitative data will be collected concurrently and integrated into a convergent mixed methods approach.

    Results: As of June 2023, data for the review and 22 interviews with the stakeholders have been performed. The co-design with stakeholders will be performed in the fall of 2023.

    Conclusions: This study represents a unique and innovative opportunity to gain new knowledge relevant and useful for future implementation of new technology at health care organizations so they can continue to offer high-quality, person-centered care. The outcomes of this research will contribute to a better understanding of the conditions necessary to implement and fully use the potential of IoT solutions. By developing cocreated implementation strategies, the study seeks to bridge the gap between theory and practice. Ultimately, this project aims to facilitate the adoption of IoT solutions in health care for promoting improved patient care and using technology to meet the evolving needs of health care.

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  • 6.
    Aronsson, Jennie
    et al.
    University of Plymouth, Plymouth, Devon, UK..
    Nichols, Andy
    University of Plymouth, Plymouth, Devon, UK..
    Warwick, Paul
    University of Plymouth, Plymouth, Devon, UK..
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Nursing students' and educators' perspectives on sustainability and climate change: An integrative review2023Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To identify and synthesize research on the awareness, attitudes and action related to sustainability and climate change from the perspective of nursing students and educators globally.

    Design: Integrative review.

    Methods: The review was guided by Whittemore and Knafl. Included studies were appraised using the Mixed Methods Appraisal Tool. A deductive content analysis based on Elo and Kyngäs' methodology was employed.

    Data Sources: CINAHL, MEDLINE, EMBASE, Web of Science, British Education Index, GreenFILE and Scopus were searched up to the 8th November 2022.

    Results: Thirty-two studies were included in the review. Two studies included nursing educators in their samples, the rest focused solely on students. Findings suggest that whilst some students were aware of sustainability issues and felt that nurses have a responsibility to mitigate climate change, others showed limited awareness and believed that nurses have more important priorities. A global interest was seen among students for increased curricular content related to sustainability and climate change. Waste management and education of others were suggested actions students can take; however, barriers included lack of confidence and limited power.

    Conclusion: There is a need for sustainability education within nursing curricula, accompanied by student support.

    Implications for the Profession: The review acts as a starting point to make sustainable healthcare and climate change mitigation integral aspects of nursing.

    Impact: Sustainability education within nursing curricula can positively impact on sustainable healthcare and climate change mitigation. More research is needed on the perspectives of nursing educators.

    Reporting Method: The review is reported according to the PRISMA guidelines.

    Patient or Public Contribution: No Patient or Public Contribution.

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  • 7.
    Mauritzson, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin J
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Older Adults' Experiences, Worries and Preventive Measures Regarding Home Hazards: A Survey on Home Safety in Sweden2023Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, nr 2, artikel-id 1458Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Home safety is important for preventing injuries and accidents among older adults living at home. Feeling safe at home is also essential for older adults' well-being. Thus, this study aimed to explore older adults' perceptions of safety in their homes by examining their experiences, worries and preventive measures in relation to a range of potential home-based health and safety hazards. The study was a national cross-sectional telephone survey of 400 randomly selected adults over 70 years of age living at home in ordinary housing in Sweden. Participants were asked for their experience of, worry about, and preventive measures taken regarding fifteen home hazards. Data were also collected on background variables including age, health, and cohabitation status. Falls and stab/cut injuries were the most experienced hazards and worry was highest for burglary and falls, while preventive measures were most common for fire and burglary. While older adults' experience and worry regarding home hazards were associated with preventive measures, these associations were not strong and other factors were associated with preventive behaviour. Further identification of the main determinants of older adults' preventive behaviour can contribute to policy for effectively reducing home accidents.

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  • 8.
    Klockar, Erika
    et al.
    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. Lund University.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna - Uppsala University, Falun; Uppsala University.
    Finch, Tracy
    Northumbria University, Newcastle upon Tyne, UK..
    Jones, Fiona
    Kingston University and St George's, University of London, London, UK..
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Self-management from the perspective of people with stroke – An interview study2023Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 112, artikel-id 107740Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 9.
    Tuvemo Johnson, Susanna
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Alfred Nobells 23, S-14183 Huddinge, Sweden..
    Flink, Maria
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Alfred Nobells 23, S-14183 Huddinge, Sweden.;Karolinska Univ Hosp, Womens Hlth & Allied Hlth Professionals Theme, Stockholm, Sweden..
    Peterson, Elizabeth
    Univ Illinois, Dept Occupat Therapy, Chicago, IL USA..
    Gottberg, Kristina
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Alfred Nobells 23, S-14183 Huddinge, Sweden..
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Johansson, Sverker
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Alfred Nobells 23, S-14183 Huddinge, Sweden.;Karolinska Univ Hosp, Womens Hlth & Allied Hlth Professionals Theme, Stockholm, Sweden..
    Kierkegaard, Marie
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Alfred Nobells 23, S-14183 Huddinge, Sweden.;Acad Specialist Ctr, Stockholm Hlth Serv, Ctr Neurol, Stockholm, Sweden..
    Ytterberg, Charlotte
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Alfred Nobells 23, S-14183 Huddinge, Sweden.;Karolinska Univ Hosp, Womens Hlth & Allied Hlth Professionals Theme, Stockholm, Sweden..
    Self-management of falls in people with multiple sclerosis: A scoping review2023Ingår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 37, nr 2, s. 162-176Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Falls are common in people with multiple sclerosis. There is rising interest in how the multifactorial and chronic nature of fall risk among people with multiple sclerosis can be addressed through self-management. Thus, the aims were to investigate the extent and the scope of publications on self-management of falls in people with multiple sclerosis, and to identify how the concept of self-management was defined and used. Data sources A systematic literature search in Medline, Cochrane, Web of Science and PsycInfo was conducted to identify publications until July 2022. Review methods Published methodological guidance was followed. Articles targeting: (1) people with multiple sclerosis, (2) falls, and (3) self-management were selected. Of 1656 records, 203 publications were assessed for eligibility, of which 173 did not meet the inclusion criteria, and 16 publications did not contain empirical data. The type of publication, study focus, and study design was extracted. If applicable, key findings, self-management tasks and skills, and the definition of self-management were extracted. Results Fourteen original articles met all inclusion criteria. Ten articles represented six different fall prevention interventions. Three publications were randomized controlled trials. Self-management content was variable and not comprehensive in nature. None of the 14 publications included a self-management definition. Conclusion The limited number of original articles and the even fewer intervention studies show that the research on self-management of falls in people with multiple sclerosis is in its infancy. To progress in the research area of self-management of falls, a more robust, consensus-based description of self-management frameworks and activities is needed.

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  • 10.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    The Home as a Place for Rehabilitation After Stroke: Emerging Empirical Findings2023Ingår i: (Re)designing the Continuum of Care for Older Adults: The Future of Long-Term Care Settings, Springer International Publishing , 2023, s. 37-51Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

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

  • 11.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Rasoal, Dara
    Lund University.
    Zingmark, Magnus
    Lund University; Health and Social Care Administration, Östersund; Umeå University.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    The importance of context-a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke2023Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, nr 1, artikel-id 733Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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  • 12.
    Anåker, Anna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Morichetto, Hanna
    Liljewall Architects, Gothenburg, Sweden.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    The physical environment is essential, but what does the design and structure of stroke units look like?: A descriptive survey of inpatient stroke units in Sweden2023Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, nr 2, s. 328-336Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The design of the physical environment is a critical factor in patient care and is known to influence health, well-being, clinical efficiency, and health-related outcomes. To date, there has been no general review of the physical environment of modern Swedish stroke units.

    Aim: To explore the physical environment of inpatient stroke units in Sweden and describe the design and structure of these units. Methods: This was a cross-sectional study. Data were collected in Sweden from April to July 2021 via a survey questionnaire.

    Results: The layout of the stroke units varied broadly, such as the number of single-bed and multi-bed rooms. More than half the stroke units comprised spaces for rehabilitation and had an enriched environment in the form of communal areas with access to computers, games, books, newspapers, and meeting places. However, they offered sparse access to plants and/or scenery.

    Conclusions: Healthcare environments are an essential component of a sustainable community. From a sustainability perspective, healthcare facilities must be built with high architectural quality and from a long-term perspective. Research on the physical environment in healthcare should contribute to improved quality of care, which can be achieved through building healthcare facilities that support the performance of care and recovery. Therefore, mapping of areas of interest for further investigation is crucial.

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  • 13.
    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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  • 14. Aronsson, Jennie
    et al.
    Nichols, Andy
    Warwick, Paul
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Awareness and attitudes towards sustainability and climate change amongst students and educators in nursing: A systematic integrative review protocol.2022Ingår i: Nursing Open, E-ISSN 2054-1058, Vol. 9, nr 1, s. 839-844Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: This review identifies and synthesizes literature related to the awareness of and attitudes towards sustainability and climate change from the perspective of nursing students and educators.

    DESIGN: A systematic integrative review.

    METHODS: The review will follow the five stages outlined by Whittemore and Knafl: problem identification, literature search, data evaluation, data analysis and presentation. The data analysis will be based on inductive content analysis developed by Elo and Kyngäs. Principles of the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) will also inform the review process.

    RESULTS: This review will offer insights about sustainability and climate change in relation to an important target population: the future nursing workforce and those educating its members. Findings might inform curriculum development, potentially contributing to a nursing profession that looks after the health of the planet and the health of the population inhabiting it.

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  • 15.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Exploring the design of physical environments for older adults – a qualitative study on staff perceptions of outdoor areas2022Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Although the importance of the design of physical care environments for older adults and healthcare staff of residential care facilities (RCFs) is well recognized, few studies have taken the staff perspective regarding how environmental factors influence its users. This study considers healthcare staff perceptions of older adults’ RCFs with a focus on outdoor areas. 

    Methods: Twenty RCFs in Sweden were purposively sampled to obtain facilities with varying building design, type of ownership, year of construction, building size and geographic location. Ten healthcare staff from each facility were randomly selected and recruited by the care home managers. Healthcare staff completed the Staff Perception of Older People’s Residential Care Environments (SPORE) questionnaire. In this study, only written responses to open-ended questions on the physical care environment were analysed, using qualitative content analysis. 

    Results: The importance of outdoor areas for the well-being of older adults was emphasised, and several requirements and deficiencies in the physical features of such areas were identified. Concerns were expressed about the lack of accessibility to outdoor areas. Physical features that can provide support for older adults when using outdoor areas, such as ramps and stable surfaces, were limited, as was their maintenance. 

    Conclusions: This study shows the importance of taking the users’ needs into account when planning and designing RCFs for older adults. There is potential for improving the design of outdoor areas in order to provide safe and supportive physical care environments and to facilitate care delivery.

  • 16.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    Ytterberg, Charlotte
    Karolinska Institutet, Huddinge; Karolinska University Hospital, Stockholm.
    von Koch, Lena
    Karolinska Institutet, Huddinge; Karolinska University Hospital, Stockholm.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    How is the environment integrated into post-stroke rehabilitation?: A qualitative study among community-dwelling persons with stroke who receive home rehabilitation in Sweden2022Ingår i: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, nr 5, s. 1933-1943Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 17.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University, Department of Health Sciences, Lund, Sweden.
    von Koch, Lena
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Wottrich, Annica Wohlin
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Living with the aftermaths of a stroke in the era of the COVID-19 pandemic: the significance of home and close surroundings2022Ingår i: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 76, artikel-id 102852Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Stay-at-home recommendations to reduce the spread of the COVID-19 virus have had a major impact on people's everyday lives. However, while the evidence indicates that such recommendations have caused distress, anxiety, and fear among the public, little is known about how persons living with complex health conditions, e.g., disability after stroke, have experienced and handled the situation. We interviewed fourteen participants (7 women, 7 men) aged 61-91 years living in ordinary housing during summer 2020 to explore how people who recovered after a stroke experienced their everyday lives in their homes and close surroundings during the COVID-19 pandemic recommendations. Three intertwined themes were constructed from the narrative data and the iterative thematic analysis: (1) Places within and out of reach, (2) Upholding activities-strategies and structures, and (3) Adapting to new circumstances. The findings suggest that places within reach were important to maintain activities and provide structure in daily life. The participants seemed to make use of their previous experiences of adjusting to new circumstances after stroke when adapting to living under the stay-at-home recommendations. In addition, feeling that they now shared the restrictions with all other people in society seemed to ease their situations. Access to nature and spaces in the close surroundings was essential for staying socially connected and receiving support in daily life. The significance of the home and the neighbourhood for health experiences among people who recently have had a stroke should inform rehabilitation interventions both during and after pandemics and environmental planning.

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  • 18. Alvarez-Nieto, Carmen
    et al.
    Richardson, Janet
    Navarro-Peran, M. Angeles
    Tutticci, Naomi
    Huss, Norma
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Anåker, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Aronsson, Jennie
    Baid, Heather
    Lopez-Medina, Isabel M.
    Nursing students' attitudes towards climate change and sustainability: A cross-sectional multisite study2022Ingår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 108, artikel-id 105185Artikel i tidskrift (Refereegranskat)
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  • 19.
    Kierkegaard, Marie
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Academic Specialist Center, Region Stockholm, Stockholm, Sweden.
    Peterson, Elizabeth
    Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA.
    Tuvemo Johnson, Susanna
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Gottberg, Kristina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Sverker
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Flink, Maria
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.
    Ytterberg, Charlotte
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.
    Online self-management fall prevention intervention for people with multiple sclerosis: a feasibility study protocol of a parallel group randomised trial2022Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 7, artikel-id e061325Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Falls among people with multiple sclerosis (PwMS) are common and associated with injuries, fear of falling and low health-related quality of life. Considerations of behavioural, environmental, psychological and physical influences (including ambulation status) are needed to meet fall prevention needs for PwMS. Thus, using a codesign process involving key stakeholders a novel online self-management fall prevention intervention was created specifically for ambulatory and non-ambulatory PwMS. The feasibility, acceptability, fidelity and outcome of this complex intervention will be explored. Findings will inform a future full-scale randomised controlled trial.

    METHODS AND ANALYSIS: A mixed-method design will be used. Forty-eight PwMS, stratified for ambulation level, will be randomised to control (n=24) or intervention (n=24). Both groups will receive a brochure about fall risk factors and fall prevention. The intervention is group-based (eight PwMS in each group); will be delivered online; and involve six, 2-hour weekly sessions and a booster session 8 weeks after the sixth session. Each intervention group will be led by a trained facilitator. Data collection will be performed at baseline, and after seven and 18 weeks. Outcome measures will capture data on fall prevention behaviours, fear of falling, falls self-efficacy, social and everyday activities, perceived impact of MS and number of falls. Feasibility of recruitment process, data collection procedures, outcome measures, and delivery, and intervention acceptability, fidelity and outcomes will be evaluated. Both quantitative and qualitative methods will be used.

    ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Swedish Ethical Review Authority (registration number 2021-04817). Results will be disseminated in peer-review journals, at conferences, research meetings, in social media and through the patient organisation Neuro Sweden.

    TRIAL REGISTRATION NUMBER: NCT04317716.

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  • 20.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    Schön, Ulla-Karin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Stockholm University.
    Pessah-Rasmussen, Hélène
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Patient Participation and the Environment: A Scoping Review of Instruments2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 4, artikel-id 2003Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Patient participation and the environment are critical factors in achieving qualitative healthcare. We conducted a systematic scoping review using Arksey and O’Malley’s framework to identify instruments intended to measure patient participation. We assessed those instruments’ characteristics, which areas of the healthcare continuum they target, and whether environmental factors are considered. Instruments were considered eligible if they represented the patient perspective and measured patient participation in healthcare. The search was limited to articles written in English and published in the last 10 years. We extracted concepts (i.e., patient empowerment, patient participation, and patient-centeredness) based on the framework developed by Castro et al. and outcomes of significance regarding the review questions and specific objectives. The search was conducted in PsycINFO, CINHAL/EBSCO, and PubMed in September 2019 and July 2020. Of 4802 potential titles, 67 studies reported on a total of 45 instruments that met the inclusion criteria for this review. The concept of patient participation was represented most often in these studies. Although some considered the social environment, no instrument was found to incorporate and address the physical environment. Thirteen instruments were generic and the remaining instruments were intended for specific diagnoses or healthcare contexts. Our work is the first to study instruments from this perspective, and we conclude that there is a lack of instruments that measure aspects of the social and physical environment coherently as part of patient participation. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

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  • 21.
    Mauritzson, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Perceptions and experiences of safety at home: a survey among older adults in Sweden2022Ingår i: 26th Nordic Congress of Gerontology. Abstracts: Change and continuity, 2022, s. 277-277Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction

    Home safety is important to prevent injuries and accidents in older adults living at home. Feeling safe at home is also essential for frail older adults’ well-being. "Ageing in place" is a term focusing on enabling older adults to stay in their ordinary homes, rather than in special housing. But when older adults continue living at home, more injuries and accidents can occur. The aim of this study was to explore older adults’ experiences, preventive measures, and feelings of safety in their home in relation to a range of potential home-based health and safety hazards.

    Methods and Materials

    The study had a cross-sectional design and was based on a national telephone survey among 400 adults over 70 years of age, living at home in ordinary housing in Sweden. Descriptive and comparative statistics were used to analyse the data.

    Results

    The participants rated the importance of feeling safe at home as high, and seldom felt unsafe. Higher age, greater frequency of feeling unsafe at home or in the neighbourhood, access to support, better health, importance of safety and living alone were associated with level of worry or for having taken preventive measures against some but not all hazards in the home.

    Conclusions

    Taking preventive measures is not always is not always associated with experiences or level of worry. Age, feelings of safety, access to support, health and living alone or not, are all factors that can influence level of worry or for taking preventive measures or not against specific hazards in the home.

  • 22.
    Mauritzson, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Preventing accidents and injuries: older adults' experiences, worries, and preventive measures regarding home hazards2022Ingår i: 36th Annual Conference of the European Health Psychology Society. Abstracts: Charting new territories in health psychology, 2022, s. 707-707Konferensbidrag (Refereegranskat)
  • 23.
    Eriksson, Gunilla
    et al.
    Karolinska Institutet, Stockholm.
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Karolinska Institutet, Stockholm.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Fors, Uno
    Stockholm University, Stockholm.
    von Koch, Lena
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Ytterberg, Charlotte
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Guidetti, Susanne
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Study protocol of a non-randomised controlled trial evaluating the effectiveness of the F@ce 2.0 programme: a person-centred, ICT-supported and interdisciplinary rehabilitation intervention after stroke2022Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 8, artikel-id e058748Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Knowledge is missing on use of information and communication technology (ICT), for example, mobile phones/tablets in rehabilitation after stroke. F@ce 2.0 is a person-centred, interdisciplinary intervention supported by ICT. The components of F@ce 2.0 intend to increase performance in daily activities and participation in everyday life for patients with stroke and their significant others. Based on previous feasibility studies, a full-scale evaluation is planned in Sweden. The aim is to implement and evaluate F@ce 2.0, regarding performance of daily activities and participation in everyday life, in comparison with ordinary rehabilitation among persons who have had stroke and significant others. Second, to increase knowledge about how the programme leads to a potential change by studying the implementation process and mechanisms of impact. METHODS AND ANALYSIS: Twelve rehabilitation teams (intervention n=7; control n=5) will recruit patients (n=160) who receive rehabilitation at home after stroke and their significant others. F@ce 2.0 is an 8-week intervention where patients, together with the team, formulate three activity goals regarding what they need and want to do in daily lives. The patients will receive short messages service (SMS) each morning reminding about goals, and in the evening to rate their performance during the day. Primary outcomes for patients: self-efficacy measured by the Self-Efficacy Scale; perceived performance in daily activities measured by the Canadian Occupational Performance Measure. Significant others: perceived caregiver burden measured by Caregiver Burden Scale. Qualitative interviews with team members delivering, patients receiving intervention and significant others will explore experiences of F@ce 2.0. A process evaluation applying a case-study design using mixed methods will be conducted. ETHICS AND DISSEMINATION: Approved by the Swedish Ethical Review Authority, Stockholm. Knowledge will be created for using ICT for rehabilitation of people after stroke in self-selected activities. Dissemination will include peer-reviewed publications, presentations at conferences, and information to stakeholders. TRIAL REGISTRATION NUMBER DETAILS: NCT04351178 . © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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  • 24. Aronsson, Jennie
    et al.
    Anåker, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Richardson, Janet
    Sustainability in Clinical Practice: A Cross-National Comparative Study of Nursing Students in England and Sweden2022Ingår i: Journal of Nursing Education, ISSN 0148-4834, E-ISSN 1938-2421, Vol. 61, nr 7, s. 390-393Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Delivering health care negatively influ-ences the environment and contributes to climate change. This study examined how nursing students in England and Sweden can make changes in clinical practice to enhance environmental sustainability. Method: Third-year under-graduate nursing students at English and Swedish universities responded to open-ended questions on the Sustainability Attitudes in Nursing Survey. Data were analyzed using inductive content analysis. Results: Students in both countries identified lack of confidence as the main barrier to challenging unsustainable practice, followed by a resistance to change in practice. English students predominantly changed their own behavior or influenced the practice of others. Swedish students either changed their own behavior or their own attitudes to sustainability. Conclusion:There is a need to ensure students have confidence to act as change agents to enhance sustainable practice in the clinical environment.

  • 25.
    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, ISSN 1929-0748, 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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  • 26.
    Anåker, Anna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    von Koch, Lena
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Eriksson, Gunilla
    Karolinska Institutet, Stockholm; Uppsala University, Uppsala.
    Sjöstrand, Christina
    Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm; Chalmers University of Technology, Gothenburg.
    The physical environment and multi-professional teamwork in three newly built stroke units2022Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, nr 7, s. 1098-1106Artikel i tidskrift (Refereegranskat)
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  • 27.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Sturge, Jodi
    Ayoub, Maria
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    Jones, Allyson
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Karolinska Institutet & Stockholm University.
    Meijering, Louise
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    The Role of Information and Communication Technology (ICT) for Older Adults’ Decision-Making Related to Health, and Health and Social Care Services in Daily Life—A Scoping Review2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 1, artikel-id 151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Information and communication technology (ICT) can potentially support older adults in making decisions and increase their involvement in decision-making processes. Although the range of technical products has expanded in various areas of society, knowledge is lacking on the influence that ICT has on older adults’ decision-making in everyday situations. Based on the literature, we aimed to provide an overview of the role of ICT in home-dwelling older adults’ decision-making in relation to health, and health and social care services. A scoping review of articles published between 2010 and 2020 was undertaken by searching five electronic databases. Finally, 12 articles using qualitative, quantitative, and mixed-method designs were included. The articles were published in journals representing biology and medicine, nursing, informatics, and computer science. A majority of the articles were published in the last five years, and most articles came from European countries. The results are presented in three categories: (i) form and function of ICT for decision-making, (ii) perceived value and effect of ICT for decision-making, and (iii) factors influencing ICT use for decision-making. According to our findings, ICT for decision-making in relation to health, and health and social care services was more implicitly described than explicitly described, and we conclude that more research on this topic is needed. Future research should engage older adults and health professionals in developing technology based on their needs. Further, factors that influence older adults’ use of ICT should be evaluated to ensure that it is successfully integrated into their daily lives. 

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  • 28.
    Miedema, Elke
    et al.
    Division of Architectural Theory and Method, Department of Architecture and Civil Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden.
    Lindahl, Göran
    Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    The Swedish Health Promoting Healthcare network and the built environment2022Ingår i: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 37, nr 1, artikel-id daab101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Health Promoting Hospitals (HPH) networks, founded by the World Health Organisation, support the introduction of health promotion in healthcare. This development involves the creation of a health promoting built environment. However, few studies have explored the HPH in relation to the built environments, and it is unclear how HPH-networks incorporate the built environment in their work. The study therefore examined the Swedish HPH-Network in relation to the built environment. The mixed-method study included data from (i) key online material from the Swedish network, (ii) a survey with open-ended questions of representatives of the networks' workgroups and (iii) semi-structured interviews with the built environment workgroup. The study showed that the built environment is unevenly and incoherently incorporated in the network. Moreover, there is more attention for healing and healthy rather than health-promotive strategies, indicating a knowledge gap. Descriptions of the health promoting built environment are diverse, and address design features, design strategies or indicate places for health promotion interventions. The descriptions of the built environment are combined with various HPH goals and population groups. To utilize the built environment as a resource for HPHs, the networks should consider incorporating the built environment in documents and action plans at all organizational levels.

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  • 29. Bernhardt, Julie
    et al.
    Lipson-Smith, Ruby
    Davis, Aaron
    White, Marcus
    Zeeman, Heidi
    Pitt, Natalie
    Shannon, Michelle
    Crotty, Maria
    Churilov, Leonid
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Why hospital design matters: A narrative review of built environments research relevant to stroke care2022Ingår i: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 17, nr 4, artikel-id 17474930211042485Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports health care in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behaviour. Contrary to many new ward design approaches, single bed rooms are neither uniformly favoured, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing and we highlight emerging collaborative multi-stakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.

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  • 30. Shaw, Emily
    et al.
    Walpole, Sarah
    McLean, Michelle
    Alvarez-Nieto, Carmen
    Barna, Stefi
    Bazin, Kate
    Behrens, Georgia
    Chase, Hannah
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Woollard, Robert
    AMEE Consensus Statement: Planetary health and education for sustainable healthcare.2021Ingår i: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 43, nr 3, s. 272-286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet. The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals. This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE). To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.

  • 31. Lipson-Smith, R.
    et al.
    Pflaumer, L.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Blaschke, S. -M
    Davis, A.
    White, M.
    Zeeman, H.
    Bernhardt, J.
    Built environments for inpatient stroke rehabilitation services and care: A systematic literature review2021Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 8, artikel-id e050247Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff. Design A convergent segregated review design was used to conduct a systematic review. Data sources Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020. Eligibility criteria for selecting studies Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff. Data extraction and synthesis Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies. Results Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being. Conclusions Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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  • 32.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Swall, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Anåker, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    von Koch, Lena
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Does the physical environment matter? - A qualitative study of healthcare professionals' experiences of newly built stroke units.2021Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 16, nr 1, artikel-id 1917880Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Organized care in specialist stroke units is fundamental for achieving better outcomes for persons with stroke. Although the importance of the physical environment for health and well-being is well recognized, research regarding how environmental features can influence stroke care is limited. The aim was to elucidate healthcare professionals' experiences of the physical environment in newly built stroke units with respect to stroke care.Methods: Healthcare professionals (n = 42) representing eight professions participated in semi-structured, face-to-face interviews. Qualitative content analysis was used.Results: The physical environment both facilitated and restricted the professionals' ability to provide stroke care. Five categories were identified: "Working towards patient engagement in single rooms", "Hampered rehabilitation in an environment not always adapted to patients' difficulties", "Addressing patients' psychosocial needs in the environment", "Ensuring patient safety by using the environment in accordance with individual needs", and "Collaboration and task fulfilment-a challenge due to care unit design".Conclusions: The healthcare professionals viewed the physical environment mainly in relation to stroke patients' specific needs, and several environmental features were considered poorly adapted to meet these needs. The physical environment is essential to high-quality care; thus, the process of planning and designing stroke units should be based on existing evidence.

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  • 33. Sturge, J.
    et al.
    Klaassens, M.
    Jones, C. A.
    Légaré, F.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Weitkamp, G.
    Meijering, L.
    Exploring assets of people with memory problems and dementia in public space: A qualitative study2021Ingår i: Wellbeing, Space and Society, ISSN 2666-5581, Vol. 2, artikel-id 100063Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: With more people with dementia living at home, neighborhoods and public spaces are being recognized as dementia care settings. Further, there is a shift from emphasizing the loss and decline of a person with dementia to a focus on strength and capacity. The aim of this paper is to identify assets that contribute to the well-being of people with memory problems and dementia living in a community context in the Netherlands. Methods: A deductive content analysis, based on the Asset-Based Community Development (ABCD) framework, was used to analyze qualitative data collected through walking interviews and in-depth interviews with eight participants. The participants included six women and two men and ranged from 59 to 93 years of age. Findings: We identified an inventory of physical, social and institutional assets that contribute to participants’ well-being. These assets are divided into two categories that relate to well-being: a) assets to navigate public space, and b) assets to support social inclusion and encounters. We observed that it was not one isolated type of asset that contributed to well-being, but more a combination of different assets. Moreover, we found that participants used assets to gain a sense of relief, confidence and support their sense of belonging and inclusion. Conclusion: These findings inform an asset-based perspective of people living with memory problems and dementia that can promote engagement to support dementia-informed community development, public space design, and healthcare innovations to improve the well-being of people with a range of memory problems who live at home. © 2021 The Author(s)

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  • 34.
    Sturge, Jodi
    et al.
    University of Groningen, the Netherlands.
    Nordin, Susanna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Patil, Divya Sussana
    Manipal Academy of Higher Education, India.
    Jones, Allyson
    University of Alberta, Canada.
    Légaré, France
    Laval University, Canada.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Meijering, Louise
    University of Groningen, the Netherlands.
    Features of the social and built environment that contribute to the well-being of people with dementia who live at home: A scoping review2021Ingår i: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 67, artikel-id 102483Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This scoping review summarizes findings from 23 qualitative articles on how social and built environments contribute to the well-being of people with dementia who live at home. Through thematic analysis, two themes were identified: i) connection to society and supportive relationships and ii) interaction with natural environments and public space. Features of the social and built environment contribute to well-being both positively and negatively. Future research should explore how these features intersect in an urban-rural context as a basis to inform the development of dementia-friendly initiatives. Moreover, involving people with dementia in the design of features of built environments, such as infrastructure, will result in more inclusive communities.

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    Article Sturge et al 2021
  • 35.
    Anåker, Anna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Spante, Marianne
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Nursing students' perception of climate change and sustainability actions - A mismatched discourse: A qualitative, descriptive exploratory study.2021Ingår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 105, artikel-id 105028Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Climate change is described as the biggest global challenge for human health in the upcoming decade. Nurses play a central role in mitigating the effect of climate change on the healthcare sector and adapting to the phenomenon. Therefore, nursing students must be prepared for a new professional role keeping climate change in mind; consequently, it is important to study students' perceptions of climate change and sustainability.

    OBJECTIVES: To explore nursing students' perceptions of climate change and sustainability and examine how they perceive their role as nursing students in working towards a more sustainable development within the healthcare sector.

    DESIGN: It is a qualitative, descriptive exploratory study.

    SETTINGS: A nursing program at a university in central Sweden.

    PARTICIPANTS: Nursing students.

    METHODS: Individual in-depth interviews and one group interview were conducted for the study.

    RESULTS: The main findings revealed that students saw themselves living in a mismatched discourse. They perceived the future of humanity as gloomy but thought that sustainability is the society's joint obligation to achieve the right to a good life for all people equally.

    CONCLUSIONS: Nursing students perceived themselves as important actors in the work of climate change and sustainability. Thus, nursing education needs to integrate the impact of climate change on healthcare and promote sustainability into the curriculum for preparing students to take responsibility for sustainability in society.

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  • 36.
    Flink, Maria
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm; Theme of Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden.
    Lindblom, Sebastian
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme of Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden.
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Laska, Ann Charlotte
    Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Bertilsson, Bo Christer
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Wärlinge, Carmen
    Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.
    Hasselström, Jan
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    von Koch, Lena
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Neuro, Karolinska University Hospital, Stockholm, Sweden.
    Ytterberg, Charlotte
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme of Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden.
    Person-centred care transitions for people with stroke: study protocol for a feasibility evaluation of codesigned care transition support.2021Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 12, artikel-id e047329Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Care transitions following stroke should be bridged with collaboration between hospital staff and home rehabilitation teams since well-coordinated transitions can reduce death and disability following a stroke. However, health services are delivered within organisational structures, rather than being based on patients' needs. The aim of this study protocol is to assess the feasibility, operationalised here as fidelity and acceptability, of a codesigned care transition support for people with stroke.

    METHODS: This study protocol describes the evaluation of a feasibility study using a non-randomised controlled design. The codesigned care transition support includes patient information using videos, leaflets and teach back; what-matters-to me dialogue; a coordinated rehabilitation plan; bridged e-meeting; and a message system for cross-organisational collaboration. Patients with stroke, first time or recurrent, who are to be discharged home from hospital and referred to a rehabilitation team in primary healthcare for continued rehabilitation in the home will be included. One week after stroke, data will be collected on the primary outcome, namely satisfaction with the care transition support, and on the secondary outcome, namely health literacy and medication adherence. Data on use of healthcare will be obtained from a register of healthcare contacts. The outcomes of patients and significant others will be compared with matched controls from other geriatric stroke and acute stroke units, and with matched historic controls from a previous dataset at the intervention and control units. Data on acceptability and fidelity will be assessed through interviews and observations at the intervention units.

    ETHICS AND DISSEMINATION: Ethical approvals have been obtained from the Swedish Ethical Review Authority. The results will be published open-access in peer-reviewed journals. Dissemination also includes presentation at national and international conferences.

    DISCUSSION: The care transition support addresses a poorly functioning part of care trajectories in current healthcare. The development of this codesigned care transition support has involved people with stroke, significant other, and healthcare professionals. Such involvement has the potential to better identify and reconceptualise problems, and incorporate user experiences.

    TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov id: NCT02925871. Date of registration 6 October 2016.

    PROTOCOL VERSION: 1.

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  • 37. Sturge, Jodi
    et al.
    Meijering, Louise
    Jones, C Allyson
    Garvelink, Mirjam
    Caron, Danielle
    Nordin, Susanna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Légaré, France
    Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study.2021Ingår i: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 10, nr 1, artikel-id e19244Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options.

    OBJECTIVE: We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users' mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options.

    METHODS: Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed.

    RESULTS: The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021.

    CONCLUSIONS: This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults' autonomy, and, ultimately, inform SDM about housing options.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19244.

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  • 38. Lindblom, S.
    et al.
    Flink, M.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Laska, A. C.
    von Koch, L.
    Ytterberg, C.
    The manifestation of participation within a co-design process involving patients, significant others and health-care professionals2021Ingår i: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 24, nr 3, s. 905-916Artikel i tidskrift (Refereegranskat)
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  • 39. Shannon, Michelle M
    et al.
    Nordin, Susanna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Bernhardt, J
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Chalmers University of Technology; Karolinska Institute.
    Application of Theory in Studies of Healthcare Built Environment Research2020Ingår i: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 13, nr 3, s. 154-170Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 40.
    Shannon, Michelle
    et al.
    Florey Institute Behavioural Neuroscience: Melbourne, VIC, Australia .
    Lipson-Smith, Ruby
    Florey Institute, Behavioural Neuroscience: Melbourne, VIC, Australia .
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Olver, John
    Rehabilitation Division of Epworth Hospital. Clinical Sciences School of Monash University, Melbourne, Australia.
    Bernhardt, Julie
    Florey Institute of Neuroscience and Mental Health, University of Melbourne - Austin Campus: Heidelberg, VIC, Australia .
    Bringing the single versus multi-patient room debate to vulnerable patient populations: a systematic review of the impact of room types on hospitalized older people and people with neurological disorders2020Ingår i: Intelligent Buildings International, ISSN 1750-8975, E-ISSN 1756-6932, Vol. 12, nr 3, s. 180-198Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Single-patient rooms are commonly recommended in acute hospital environments. People with neurological disorders, and those who are older, have complex clinical presentations requiring support and recovery for physical, cognitive, and social consequences of their brain injury, and/or chronic health problems. It is currently unknown what type of patient room, or what physical characteristics in such rooms, might be most desirable for the recovery of such people. We explored how hospital single-patient rooms are similar to or different from multi-bed rooms, and how the impact of room type has been measured in this group of people. A systematic mixed studies review was conducted to interrogate these questions. We identified 182 studies (mostly quantitative in design), 19 of which proceeded to formal data extraction. The findings show lack of clarity of salient physical characteristics in either room type for our review population. Importantly, apart from some signal of infection control benefits, our findings do not show evidence to support the use of single-patient rooms with older people and people with neurological disorders for other important outcomes. More investigation of the under-recognized potential of the patient room environment for shaping patient physical, cognitive, and social well-being in specific hospitalized populations is required.

  • 41. McKimm, Judy
    et al.
    Redvers, Nicole
    El Omrani, Omnia
    Parkes, Margot W
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Woollard, Robert
    Education for sustainable healthcare: Leadership to get from here to there.2020Ingår i: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 42, nr 10, s. 1123-1127Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The current global crises, including climate, COVID-19, and environmental change, requires global collective action at all scales. These broad socio-ecological challenges require the engagement of diverse perspectives and ways of knowing and the meaningful engagement of all generations and stages of personal and professional development. The combination of systems thinking, change management, quality improvement approaches and models, appreciative/strength-based approaches, narratives, storytelling and the strengths of Indigenous knowledges, offer synergies and potential that can set the stage for transformative, strengths-based education for sustainable healthcare (ESH). The need for strong leadership to enact a vision for ESH is outlined here with the intent to enable and nurture the conditions for change, ultimately improving health and well-being across generations.

  • 42. Lindblom, Sebastian
    et al.
    Ytterberg, Charlotte
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Flink, Maria
    Perceptive Dialogue for Linking Stakeholders and Units During Care Transitions - A Qualitative Study of People with Stroke, Significant Others and Healthcare Professionals in Sweden2020Ingår i: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 20, nr 1, artikel-id 11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 43.
    Elf, Marie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Chalmers Univ Technol.
    Anåker, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Marcheschi, Elizabeth
    Sigurjonsson, Asgeir
    Ulrich, Roger S.
    The built environment and its impact on health outcomes and experiences of patients, significant others and staff-A protocol for a systematic review2020Ingår i: Nursing Open, E-ISSN 2054-1058, Vol. 7, s. 895-899Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 44.
    Elf, Marie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Kylén, M.
    Marcheschi, E.
    The home as a place for rehabilitation-What is needed?2020Ingår i: Architecture for Residential Care and Ageing Communities: Spaces for Dwelling and Healthcare / [ed] Sten Gromark, Björn Andersson, Taylor & Francis Group, 2020, s. 252-266Kapitel i bok, del av antologi (Refereegranskat)
  • 45.
    Elf, Marie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Chalmers Tekniska Högskola; Karolinska institutet.
    Lindahl, Göran
    Chalmers Tekniska Högskola.
    Anåker, Anna
    Karolinska institutet.
    A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments2019Ingår i: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 12, nr 3, s. 107-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

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  • 46. Shannon, Michelle M
    et al.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Churilov, Leonid
    Olver, John
    Pert, Alan
    Bernhardt, Julie
    Can the physical environment itself influence neurological patient activity?2019Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, nr 10, s. 1177-1189Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 47.
    Miedena, Elke
    et al.
    Chalmers Tekniska Högskola.
    Lindahl, Göran
    Chalmers Tekniska Högskola.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Chalmers Tekniska Högskola.
    Conceptualizing health promotion in relation to outpatient healthcare building design: a scoping review2019Ingår i: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 12, nr 1, s. 69-86Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 48.
    McKee, Kevin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Nordin, Susanna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Developmentand initial validation of the Staff Perception Of Residential care Environments (SPORE) instrument2019Konferensbidrag (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 49.
    Anåker, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    von Koch, Lena
    Karolinska institutet.
    Heylighen, Ann
    Katholieke Universiteit Leuven, Leuven, Belgium.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Chalmers.
    "It's lonely": Patients' experiences of the physical environment at a newly built stroke unit2019Ingår i: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, nr 3, s. 141-152Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

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

    BACKGROUND:

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

    METHOD:

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

    RESULTS:

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

    CONCLUSIONS:

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

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  • 50. Lawrence, Maggie
    et al.
    Asaba, Eric
    Duncan, Elaine
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Chalmers University of Technology.
    Eriksson, Gunilla
    Faulkner, James
    Guidetti, Susanne
    Johansson, Birgitta
    Kruuse, Christina
    Lennon, Olive
    Stroke secondary prevention, a non-surgical and non-pharmacological consensus definition: results of a Delphi study2019Ingår i: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 12, nr 1, artikel-id 823Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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