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Fjordkvist E, Eldh AC, Winberg M, Joelsson-Alm E, Hälleberg Nyman M. First-line managers' experience of guideline implementation during the COVID-19 pandemic. J Adv Nurs 2024. [PMID: 38644671 DOI: 10.1111/jan.16204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/23/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024]
Abstract
AIM(S) To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic. DESIGN A descriptive, qualitative study. METHODS Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis. RESULTS First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines. CONCLUSION A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation. IMPACT During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future. REPORTING METHOD This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.
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Affiliation(s)
- Erika Fjordkvist
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Madeleine Winberg
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- University Health Care Research Center and Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Vestala H, Bendtsen M, Midlöv P, Kjellgren K, Eldh AC. Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension - a randomized controlled trial in primary care. Scand J Prim Health Care 2024; 42:225-233. [PMID: 38214748 PMCID: PMC10851821 DOI: 10.1080/02813432.2023.2301567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE To estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only). DESIGN A parallel group, non-blinded, randomized controlled trial, conducted October 2018-February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement. SETTING 31 primary healthcare centers in Sweden. SUBJECTS 949 patients treated for hypertension. MAIN OUTCOME MEASURES The effects on preference-based patient participation, that is, the match between a patient's preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression. RESULTS At baseline, 43-51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for 'managing treatment myself' at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months. CONCLUSION The interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care.
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Affiliation(s)
- Hanna Vestala
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Patrik Midlöv
- Center for Primary Healthcare Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karin Kjellgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- University of Gothenburg Centre for Person-Centered Care, University of Gothenburg, Gothenburg
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
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Åsberg K, Eldh AC, Löf M, Bendtsen M. "Simply complicated": Uncovering the processes of lifestyle behavior change among college and university students with access to a digital multiple lifestyle intervention. Digit Health 2024; 10:20552076241245905. [PMID: 38601184 PMCID: PMC11005484 DOI: 10.1177/20552076241245905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
Background One approach to promoting healthy lifestyle behaviors is to target students with digital interventions. One of these is the digital intervention Buddy. This study aimed to understand why college and university students' chose to participate in a digital multiple lifestyle behavior intervention trial (Buddy), and their subsequent experiences of the behavior-change process. Methods College and university students taking part in a trial of the Buddy intervention were individually interviewed after completing the 4-month intervention. Participants were guided to narrate their experiences and actions that followed signing up. Altogether, 50 interviews were conducted via telephone. The verbatim transcribed texts were analyzed qualitatively. Results The analysis generated seven personas, which illustrated the students' different levels of engagement with the intervention and the behavior-change process. These were: the Occupied, the Kickstarter, the Aimless, the Reflective, the Goal-oriented, the Compliant, and the Personally developed. Buddy worked best for students who had clear ideas about what they wanted to change and why, and who were aware of their needs, and those who could translate information and reflection into action and had the mental and physical energy needed to make changes. Conclusions The progress of behavior change depends on the interaction between the digital mode of delivery, the intervention materials of Buddy, the individual's expectations, needs, and skills, and their current life situation. This suggests that designing lifestyle interventions could benefit from more often considering the various personas' different intentions, knowledge, and contexts. By doing so, interventions are likely to emerge that can better match different needs in the target population.
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Affiliation(s)
- Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Ringberg M, Eldh AC, Ardern CL, Kvist J. Athletes' experiences of using a self-directed psychological support, the BAck iN the Game (BANG) smartphone application, during rehabilitation for return to sports following anterior cruciate ligament reconstruction. BMC Sports Sci Med Rehabil 2023; 15:113. [PMID: 37726848 PMCID: PMC10507891 DOI: 10.1186/s13102-023-00731-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Following anterior cruciate ligament reconstruction (ACLR), many athletes do not return to their sport, often driven by concerns about re-injury. Psychological support strategies might help, but are not routinely included in rehabilitation after ACLR. The BAck iN the Game (BANG) intervention is a 24-week eHealth program delivered via smartphone application (app), beginning directly after ACLR, with a self-directed approach that aims to target the specific challenges athletes encounter in rehabilitation. AIM To describe athletes' experiences of using the BANG app during rehabilitation, to support returning to sport following ACLR. METHOD Participants were athletes, in contact and/or non-contact pivoting sports, who had ACLR with the goal to return to sports. Semi-structured, individual interviews were conducted 6-10 months after their ACLR; all had access to the BANG intervention. Verbatim transcripts were analysed with a qualitative content analysis. RESULTS The 19 participants were 17-30 years, mean 21.6 years (SD 3.5); 7 men and 12 women. The analysis generated three main categories. (A) Interacting with the app illustrated how, when, or why the participants engaged with the app. The app was helpful because of its varying content, the notifications served as reminders and participants stopped using the app when no longer needing it. (B) Challenging experiences with the app illustrated that the app itself came with some difficulties e.g., content not appearing with the right timing and material not tailored to their sport. (C) Supportive experiences with the app reflected how the app facilitated the participants' rehabilitation progress; it included positive aspects of the app content and navigation, boosting their confidence to return to sport, and motivated them to continue with rehabilitation. CONCLUSION The analysis of the interviews illustrates athletes' awareness in interacting with, and the challenging and supportive experiences of using the app. The BANG app might provide support for returning to sport, primarily psychological support, as an adjunct to regular physiotherapy-guided rehabilitation. Athletes' experiences of the BANG app could be improved by healthcare professionals providing additional advice about when to use which content and why. TRIAL REGISTRATION ClinicalTrials.gov, NCT03959215. Registered 22 May 2019.
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Affiliation(s)
- Magnus Ringberg
- Unit of Physiotheray, Department of Health, Medicine and Caring Science, Linköping University, Linköping, SE-581 83 Sweden
| | - Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22 Sweden
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | - Clare L Ardern
- Unit of Physiotheray, Department of Health, Medicine and Caring Science, Linköping University, Linköping, SE-581 83 Sweden
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia V5Z 1M9 Canada
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3086 Australia
| | - Joanna Kvist
- Unit of Physiotheray, Department of Health, Medicine and Caring Science, Linköping University, Linköping, SE-581 83 Sweden
- Stockholm Sports Trauma Research Center, Dept of Molecular Medicine & Surgery, Karolinska Institute, Stockholm, SE-171 77 Sweden
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Hurtig C, Bendtsen M, Årestedt L, Uhlin F, Eldh AC. Patient participation in end-stage kidney disease care: variation over time and effects of staff-directed interventions - a quasi-experimental study. BMC Nephrol 2023; 24:265. [PMID: 37691126 PMCID: PMC10494352 DOI: 10.1186/s12882-023-03313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Among those elements establishing decent quality of care from a patient perspective, opportunities to participate in accord with one's individual needs and preferences are central. To date, little is known the extent of preference-based patient participation in kidney care, and what facilitates optimal conditions. This study investigated i) preference-based patient participation in kidney care over time, and ii) the effects of interventions designed to enhance person-centred patient participation. METHODS A quasi-experimental study was conducted across nine kidney care sites in southeast Sweden. A cohort of 358 patients with stage IV chronic kidney disease (eGRF 15-19 ml/min) or V (eGRF < 15 mL/min) entered the study. Of these, 245 patients (with kidney replacement therapy or intermittent outpatient visits only) completed a survey on patient participation at four time points: every six months from August 2019 to May 2021, patients reported their preferences for and experiences of participation using the validated Patient Preferences for Patient Participation tool, the 4Ps. Between the first and second data collection points, interventions were provided for designated staff to facilitate person-centred participation, using two strategies for two subgroups at three sites each: the managers receiving a bundle of information via e-mail on patient participation in a standard dissemination procedure (three sites), or an additional half-year support program for implementation offered to 1-2 staff per site (three sites), with no intervention for a control group (three sites). The differences in 4Ps data between groups were analysed using multilevel ordinal regression. RESULTS Over time and across all sites, most patients' experiences of participation fully or almost fully matched their engagement preferences (57%-90%). Still, up to 12% of patient reports indicated that their preferences and experiences were insufficiently matched: in these cases, the patients had preferred to be more involved than they had experienced, for example, in making healthcare plans and setting health-related goals. The interventions did not affect the levels of preference-based participation, but patients in the control group sites had slightly more consistent matches. CONCLUSIONS Living with kidney failure necessitates patient engagement, but opportunities to participate in accordance with one's preferences are not fully provided for all patients. Additional efforts to support a common understanding and to ensure person-centred patient participation is still needed.
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Affiliation(s)
- Caroline Hurtig
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Liselott Årestedt
- Department of Health and Caring Sciences, Linnaeus University, 391 82, Kalmar, Sweden
| | - Fredrik Uhlin
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Nephrology, Region Östergötland, 581 85, Linköping, Sweden
- Department of Health Technologies, Tallinn University of Technology (TalTech), 19086, Tallinn, Estonia
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, 751 22, Uppsala, Sweden
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Winberg M, Hälleberg Nyman M, Fjordkvist E, Joelsson-Alm E, Eldh AC. Patients' experiences of urinary retention and bladder care - A qualitative study in orthopaedic care. Int J Orthop Trauma Nurs 2023; 50:101034. [PMID: 37437464 DOI: 10.1016/j.ijotn.2023.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Urinary retention is a common complication associated with hip surgery. There are easily available, evidence-based clinical practice guidelines prescribing how to prevent both urinary retention and other voiding issues, by means of bladder monitoring and risk assessments. A detected lack of adherence to such guidelines increases risks for unnecessary suffering among patients but a greater understanding of patients' experiences can benefit tailored interventions to address quality and safety gaps in orthopaedic nursing and rehabilitation. PURPOSE The aim was to describe patients' experiences of urinary retention, bladder issues, and bladder care in orthopaedic care due to hip surgery. METHOD This was a qualitative study with a descriptive design: content analysis with an inductive approach was applied to interviews (n = 32) and survey free-text responses (n = 122) across 17 orthopaedic units in Sweden. RESULTS The patients had received no or limited details for the recurrent bladder care interventions (such as bladder scans and prompted voiding) while at the hospital. They relied on the staff for safe procedures but were left to themselves to manage and comprehend prevailing bladder issues. Despite the patients' experiences of bladder issues or the risk of urinary retention postoperatively, the link to hip surgery remained unknown to the patients, leaving them searching for self-management strategies and further care. CONCLUSIONS Patients' perspectives on bladder care, urinary retention and bladder issues can serve as a means for increased understanding of procedures and issues, reinforcing improved implementation of guidelines, including person-centred information. Safer bladder procedures imply further patient engagement, highlighted in guidelines.
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Affiliation(s)
- Madeleine Winberg
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83, Linköping, Sweden.
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82, Örebro, Sweden; Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden.
| | - Erika Fjordkvist
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82, Örebro, Sweden; Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden.
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83, Linköping, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden.
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Lantz ACH, Gunningberg L, Eriksson G, Eldh AC, Wenemark M, Pöder U. Evaluation of patient participation in relation to the implementation of a person-centered nursing shift handover. Worldviews Evid Based Nurs 2023; 20:330-338. [PMID: 37431567 DOI: 10.1111/wvn.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/28/2023] [Accepted: 05/28/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND It has been suggested that nursing shift-to-shift handover should be a more team-based dialogue with and for the patient rather than about a patient. AIM The aim of this study was to evaluate patient participation in relation to the implementation of the person-centered handover (PCH). METHOD A pretest-posttest design was used without a comparison group, including patients from nine units in a university hospital at pretest (n = 228) and after implementing PCH (posttest, n = 253) per the framework integrated-Promoting Action on Research Implementation in Health Services. The PCH is inspired by an Australian bedside handover model. The Patient Preferences for the Patient Participation tool was used to rate the preference for and experience of participation on 12 items, combined into three levels of preference-based participation (insufficient-fair-sufficient). RESULTS There were no differences regarding experience or preference-based participation between patients at pretest-posttest; however, posttest patients experienced participation in the item Reciprocal communication to a lesser extent than the pretest patients. Only 49% of the posttest group received PCH; of those not receiving PCH, some would have wanted PCH (27%), while some would have declined (24%). Patients receiving PCH had sufficient participation (82%), to a greater extent, regarding the item Sharing one's symptoms with staff than patients at pretest (72%). Patients receiving PCH also had sufficient participation, to a greater extent, than patients at posttest who did not receive, but would have wanted PCH, regarding four items: (1) sharing one's symptoms with staff, (2) reciprocal communication, (3) being told what was done, and (4) taking part in planning. LINKING EVIDENCE TO ACTION Most patients want to be present at PCH. Therefore, nurses should ask for the patients' preferences regarding PCH and act accordingly. Not inviting patients who want PCH could contribute to insufficient patient participation. Further studies are needed to capture what assistance nurses would want in identifying and acting in alignment with patient preferences.
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Affiliation(s)
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marika Wenemark
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Unit of Public Health and Statistics, Region Östergötland, Linköping, Sweden
| | - Ulrika Pöder
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Eldh AC, Hälleberg-Nyman M, Joelsson-Alm E, Wallin L. Facilitating facilitators to facilitate-Some general comments on a strategy for knowledge implementation in health services. Front Health Serv 2023; 3:1112936. [PMID: 37138952 PMCID: PMC10149731 DOI: 10.3389/frhs.2023.1112936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/23/2023] [Indexed: 05/05/2023]
Abstract
Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators' activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Correspondence: Ann Catrine Eldh
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
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Drott J, Fomichov V, Nordén M, Larsson AL, Sandström P, Björnsson B, Eldh AC. Patient preferences and experiences of participation in surgical cancer care. Worldviews Evid Based Nurs 2022; 19:405-414. [PMID: 35607906 PMCID: PMC10946456 DOI: 10.1111/wvn.12589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/11/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Quality cancer care necessitates opportunities for patient participation, supposedly recognizing the individual's preferences and experiences for being involved in their health and healthcare issues. Previous research shows that surgical cancer patients wish to be more involved, requiring professionals to be sensitive of patients' needs. AIMS To explore preference-based patient participation in surgical cancer care. METHODS A cross-sectional study was conducted. The Patient Preferences for Patient Participation tool (4Ps) was used, which includes 12 attributes of preferences for and experiences of patient participation. Data were analyzed with descriptive and comparative statistical methods. RESULTS The results are based on a total of 101 questionnaires. Having reciprocal communication and being listened to by healthcare staff were commonly deemed crucial for patient participation. While 60% of the patients suggested that taking part in planning was crucial for their participation, they had experienced this only to some extent. Learning to manage symptoms and phrasing personal goals were items most often representing insufficient conditions for preference-based patient participation. LINKING EVIDENCE TO ACTION To support person-centered surgical care, further efforts to suffice preference-based participation are needed, including opportunities for patients to share their experiences and engage in the planning of healthcare activities.
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Affiliation(s)
- Jenny Drott
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Department of Surgery in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Victoria Fomichov
- Unit for Public Health and Statistics, County Council of ÖstergötlandLinköping UniversityLinköpingSweden
| | - Maria Nordén
- Department of Urology in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Anna Lindhoff Larsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Per Sandström
- Department of Surgery in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Bergthor Björnsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
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Eldh AC. Six Honest Serving Matters, Teaching Us All We Need to Know About Context in Knowledge Implementation? Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-country Analysis". Int J Health Policy Manag 2022; 11:1574-1576. [PMID: 34814680 PMCID: PMC9808327 DOI: 10.34172/ijhpm.2021.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/02/2021] [Indexed: 01/12/2023] Open
Abstract
While context is a vital factor in any attempt to study knowledge translation or implement evidence in healthcare, there is a need to better understand the attributes and relations that constitute context. A recent study by J. Squires et al investigates such attributes and definitions, based on 39 stakeholder interviews across Australia, Canada, the United Kingdom, and the United States. Sixteen attributes, comprising 30 elements suggested as new findings, are proposed as the basis for a framework. This commentary argues for the need to incorporate more perspectives but also suggests an initial taxonomy rather than a framework, comprising a wider range of stakeholders and an enhanced understanding of how context elements are related at different levels and how this affects implementation processes. Aligning with person-centred care, this must include not only professionals but also patients and their next of kin, as partners in shaping more evidence-based healthcare.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Enlund KB, Pettersson A, Eldh AC. Dog Owners' Ideas and Strategies Regarding Dental Health in Their Dogs-Thematic Analysis of Free Text Survey Responses. Front Vet Sci 2022; 9:878162. [PMID: 35591871 PMCID: PMC9113195 DOI: 10.3389/fvets.2022.878162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Periodontal disease is the most common disease in dogs over 3 years of age. In dogs, as in humans, daily tooth brushing, as a means of active dental home care, is considered the gold standard for prophylaxis and prevention of periodontal disease progression. However, the performance of adequate tooth brushing is insufficient in dogs. There is no full account as to why dog owners fail to comply with this routine, but in order to facilitate better practice, a further understanding of dog owner's perspectives is needed. The aim of this study was to investigate dog owners' ideas and strategies regarding their dogs' dental health. In a large-scale Swedish survey regarding dental health in dogs, dog owners' free text comments (n = 8,742) from a concluding open-ended query were analyzed using qualitative methods. Many different notions concerning dental health in dogs were identified, of which perceived importance of different diets and chewing being the most prominent. Five common themes represented dog owners' ideas and strategies regarding dental health in their dogs: what is considered to cause dental problems; what is deemed not to promote dental health; how to prevent dental problems; what impedes proper dental care, and; needs for increased knowledge and support. Contrary to existing research and knowledge in the field, the respondents commonly trusted that diet procure good dental health in the dog, as does chewing on bones. Seemingly, a range of misconceptions flourish among dog owners, indicating a need to share information and experiences, as well as support to bridge barriers to tooth brushing and other aspects that can enhance dog owners' knowledge and practice. In addition, this study highlights the need for randomized controlled trials on effects of diets and supplements on different aspects of dental health; calculus, periodontal disease, and dental fractures, including dogs of different breeds, sizes and ages. Further research is also needed with respect to which strategies that best aid dog owners, by whom the support is best provided, when, and at what time point.
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Affiliation(s)
- Karolina Brunius Enlund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
- *Correspondence: Karolina Brunius Enlund
| | - Ann Pettersson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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12
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Nilsson E, Sverker A, Bendtsen P, Eldh AC. A Human, Organization, and Technology Perspective on Patients' Experiences of a Chat-Based and Automated Medical History-Taking Service in Primary Health Care: Interview Study Among Primary Care Patients. J Med Internet Res 2021; 23:e29868. [PMID: 34661544 PMCID: PMC8561406 DOI: 10.2196/29868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/02/2021] [Accepted: 07/27/2021] [Indexed: 01/26/2023] Open
Abstract
Background The use of e-visits in health care is progressing rapidly worldwide. To date, studies on the advantages and disadvantages of e-consultations in the form of chat services for all inquiries in primary care have focused on the perspective of health care professionals (HCPs) rather than those of end users (patients). Objective This study aims to explore patients’ experiences using a chat-based and automated medical history–taking service in regular, tax-based, not-for-profit primary care in Sweden. Methods Overall, 25 individual interviews were conducted with patients in the catchment areas of 5 primary care centers (PCCs) in Sweden that tested a chat-based and automated medical history–taking service for all types of patient inquiries. The semistructured interviews were transcribed verbatim before content analysis using inductive and deductive strategies, the latter including an unconstrained matrix of human, organization, and technology perspectives. Results The service provided an easily managed way for patients to make written contact with HCPs, which was considered beneficial for some patients and issues but less suitable for others (acute or more complex cases). The automated medical history–taking service was perceived as having potential but still derived from what HCPs need to know and how they address and communicate health and health care issues. Technical skills were not considered as necessary for a mobile phone chat as for handling a computer; however, patients still expressed concern for people with less digital literacy. The opportunity to take one’s time and reflect on one’s situation before answering questions from the HCPs was found to reduce stress and prevent errors, and patients speculated that it might be the same for the HCPs on the other end of the system. Patients appreciated the ability to have a conversation from almost anywhere, even from places not suitable for telephone calls. The asynchronicity of the chat service allowed the patients to take more control of the conversation and initiate a chat at any time at their own convenience; however, it could also lead to lengthy conversations where a single issue in the worst cases could take days to close. The opportunity to upload photographs made some visits to the PCC redundant, which would otherwise have been necessary if the ordinary telephone service had been used, saving patients both time and money. Conclusions Patients generally had a positive attitude toward e-visits in primary care and were generally pleased with the prospects of the digital tool tested, somewhat more with the actual chat than with the automated history-taking system preceding the chat. Although patients expect their PCC to offer a range of different means of communication, the human, organization, and technology analysis revealed a need for more extensive (end) user experience design in the further development of the chat service.
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Affiliation(s)
- Evalill Nilsson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Annette Sverker
- Department of Activity and Health and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Medical Specialists in Motala and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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13
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Martinsson C, Uhlin F, Wenemark M, Eldh AC. Preference-based patient participation for most, if not all: A cross-sectional study of patient participation amongst persons with end-stage kidney disease. Health Expect 2021; 24:1833-1841. [PMID: 34337836 PMCID: PMC8483194 DOI: 10.1111/hex.13323] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/22/2021] [Accepted: 07/15/2021] [Indexed: 01/25/2023] Open
Abstract
Background Patient participation is considered central for good healthcare. Yet, the concept is not fully understood when it comes to patients' experiences of participation in conjunction with their preferences, particularly in long‐term healthcare. The aim of this study was to investigate the extent and variation of preference‐based patient participation in patients with end‐stage kidney disease (ESKD). Methods A cross‐sectional study was conducted with 346 patients in renal care. The main variables were patients' preferences for and experiences of patient participation, determined using the Patient Preferences for Patient Participation tool, the 4Ps. Analyses identified the degree of match between preferences and experiences, that is, the preference‐based patient participation measure. Results Overall, 57%–84% of the patients reached a sufficient level of preference‐based patient participation on the items, while 2%–12% reached an insufficient level. A mismatch indicated either less or more participation than preferred; for example, 40% had less experience than preferred for taking part in planning, and 40% had more than preferred for managing treatment. Conclusion This study shows that, although many patients reach a sufficient level of preference‐based patient participation, this is not the case for all patients and/or attributes. Further opportunities for a mutual understanding of patients' preferences are needed for healthcare professionals to support person‐centred patient participation. Patient or Public Contribution The 4Ps is manufactured in collaboration with people with experience of the patient role, and persons living with ESKD were engaged in identifying their preferences and experiences of participation in renal care.
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Affiliation(s)
- Caroline Martinsson
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Uhlin
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Nephrology, Region Östergötland, Linköping, Sweden.,Department of Health Technologies, Tallinn University of Technology (TalTech), Tallinn, Estonia
| | - Marika Wenemark
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Unit of Public Health and Statistics, Region Östergötland, Linköping, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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14
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Eldh AC, Joelsson-Alm E, Wretenberg P, Hälleberg-Nyman M. Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION-a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers' implementation strategy. Implement Sci 2021; 16:65. [PMID: 34174917 PMCID: PMC8233619 DOI: 10.1186/s13012-021-01135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications. Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging. METHODS Twenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support. Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care. During the implementation intervention, all events are recorded, and the facilitators keep diaries. Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation. Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes. DISCUSSION The OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers. TRIAL REGISTRATION The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83, Linköping, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden.
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset, SE-118 83, Stockholm, Sweden
| | - Per Wretenberg
- Faculty of Health and Medicine, Department of Orthopedics, Örebro University, SE-701 82, Örebro, Sweden
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82, Örebro, Sweden
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15
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Wärdig R, Olofsson F, Eldh AC. Conceptualizing patient participation in psychiatry: A survey describing the voice of patients in outpatient care. Health Expect 2021; 24:1443-1449. [PMID: 34058044 PMCID: PMC8369099 DOI: 10.1111/hex.13285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/13/2021] [Accepted: 05/13/2021] [Indexed: 01/03/2023] Open
Abstract
Background While increasingly discussed in somatic care, the concept of patient participation remains unsettled in psychiatric care, potentially impeding person‐centred experiences. Objective To describe outpatient psychiatric care patients’ conceptualization of patient participation. Design An exploratory survey. Setting and participants Patients in four psychiatric outpatient care units. Variables Patients conceptualized patient participation by completing a semi‐structured questionnaire, including optional attributes and free text. Data were analysed using statistics for ordinal data and content analysis for free text. Results In total, 137 patients (69% of potential respondents) completed the questionnaire. The discrete items were favoured for conceptualizing patient participation, indicating a primary connotation that participation means being listened to, being in a reciprocal dialogue, learning about one's health care and managing one's symptoms. Additional free‐text responses acknowledged the attributes previously recognized, and provided supplementary notions, including that patient participation is about mutual respect and shared trust. Discussion What patient participation is and how it can be facilitated needs to be agreed in order to enable preference‐based patient participation. Patients in outpatient psychiatric care conceptualize participation in terms of both sharing of and sharing in, including taking part in joint and solo activities, such as a reciprocal dialogue and managing symptoms by yourself. Conclusion While being a patient in psychiatric care has been associated with a lack of voice, an increased understanding of patient participation enables person‐centred care, with the benefits of collaboration, co‐production and enhanced quality of care. Patient contribution Patients provided their conceptualization of patient participation in accordance with their lived experience.
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Affiliation(s)
- Rikard Wärdig
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Olofsson
- Department of Psychiatry in Norrköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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16
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Eldh AC, Sverker A, Bendtsen P, Nilsson E. Health Care Professionals' Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study. JMIR Hum Factors 2020; 7:e21698. [PMID: 33315014 PMCID: PMC7769692 DOI: 10.2196/21698] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/19/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite a growing body of knowledge about eHealth innovations, there is still limited understanding of the implementation of such tools in everyday primary care. OBJECTIVE The objective of our study was to describe health care staff's experience with a digital communication system intended for patient-staff encounters via a digital route in primary care. METHODS In this qualitative study we conducted 21 individual interviews with staff at 5 primary care centers in Sweden that had used a digital communication system for 6 months. The interviews were guided by narrative queries, transcribed verbatim, and subjected to content analysis. RESULTS While the digital communication system was easy to grasp, it was nevertheless complex to use, affecting both staffing and routines for communicating with patients, and documenting contacts. Templates strengthened equivalent procedures for patients but dictated a certain level of health and digital literacy for accuracy. Although patients expected a chat to be synchronous, asynchronous communication was extended over time. The system for digital communication benefited assessments and enabled more efficient use of resources, such as staff. On the other hand, telephone contact was faster and better for certain purposes, especially when the patient's voice itself provided data. However, many primary care patients, particularly younger ones, expected digital routes for contact. To match preferences for communicating to a place and time that suited patients was significant; staff were willing to accept some nuisance from a suboptimal service-at least for a while-if it procured patient satisfaction. A team effort, including engaged managers, scaffolded the implementation process, whereas being subjected to a trial without likely success erected barriers. CONCLUSIONS A digital communication system introduced in regular primary care involved complexity beyond merely learning how to manage the tool. Rather, it affected routines and required that both the team and the context were addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggested including ethical perspectives on eHealth tools, providing an important but novel aspect of implementation.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Annette Sverker
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Medical Specialists in Motala and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Evalill Nilsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,e-Health Institute, Department of Medicine and Optometry, Linneaus University, Kalmar, Sweden
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17
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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18
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Eldh AC, Holmefur M, Luhr K, Wenemark M. Assessing and reporting patient participation by means of patient preferences and experiences. BMC Health Serv Res 2020; 20:702. [PMID: 32727451 PMCID: PMC7391651 DOI: 10.1186/s12913-020-05574-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/23/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although patient participation is strongly associated with high quality of healthcare, valid means to measure and report a comprehensive notion of patient participation are scarce. The Patient Preferences for Patient Participation (4Ps) is a new healthcare practice and research tool, comprising patients' preferences as well as experiences. The 4Ps employs 12 items for the patient to conceptualise patient participation. The aim of this paper is to describe how the two perspectives of patient participation, namely preferences and experiences, can be combined to visualise and report preference-based patient participation. METHODS With four response alternatives in each section, the 4Ps offers sixteen possible combinations of degree of match per item. Theoretical and clinical principles fostered a tentative order of six ranks and three levels of preference-based patient participation. To test the standard, statistical analyses for ordinal data were performed, using data from a randomised controlled trial evaluating an intervention aiming to improve patient participation. Further, structures for visualising the preference-based patient participation of individuals and groups were suggested. RESULTS Data from the 4Ps demonstrated the individuals' preference-based patient participation, indicating either a match or a mismatch for each item. Mismatches represented either the experience of participation surpassing the patient's preferences, or the patient's preferences for patient participation not being established. At group level, the suggested approach for visualising and reporting the 4Ps demonstrated that the intervention group had a significantly higher proportion of sufficient preference-based patient participation for certain items than the control group. These results had not been identified earlier, when using the preferences and experiences of patient participation as separate measures. CONCLUSIONS Ways to easily acquaint stakeholders with patients' preferences for patient participation are needed, in order for healthcare staff to better use resources to match the basic requirements of individuals and groups. While the 4Ps can guide professionals to patient participation as framed in legislations, concept analyses and by patients, a visualisation of the results is needed to capture preference-based patient participation. The proposed route to representing degree of match in preferences and experiences may also be relevant to other dimensions of quality of healthcare.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE751 22 Uppsala, Sweden
| | - Marie Holmefur
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, S701 82 Örebro, Sweden
| | - Kristina Luhr
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, S701 82 Örebro, Sweden
| | - Marika Wenemark
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Unit of Public Health and Statistics, Region Östergötland, S581 85 Linköping, Sweden
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Årestedt L, Martinsson C, Hjelm C, Uhlin F, Eldh AC. Context Factors Facilitating and Hindering Patient Participation in Dialysis Care: A Focus Group Study With Patients and Staff. Worldviews Evid Based Nurs 2020; 17:457-464. [DOI: 10.1111/wvn.12452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Liselott Årestedt
- Faculty of Health and Life Sciences Department of Health and Caring Sciences Linnaeus University Kalmar Sweden
| | - Caroline Martinsson
- Department of Medical and Health Sciences Division of Nursing Linköping University Linköping Sweden
| | - Carina Hjelm
- Department of Medical and Health Sciences Division of Nursing Linköping University Linköping Sweden
| | - Fredrik Uhlin
- Department of Nephrology and Department of Medical and Health Sciences Division of Drug Research Linköping University Linköping Sweden
| | - Ann Catrine Eldh
- Department of Medical and Health Sciences Division of Nursing Linköping University Linköping Sweden
- Department of Public Health and Caring Science Uppsala University Uppsala Sweden
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20
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Eldh AC, Rycroft-Malone J, van der Zijpp T, McMullan C, Hawkes C. Using Nonparticipant Observation as a Method to Understand Implementation Context in Evidence-Based Practice. Worldviews Evid Based Nurs 2020; 17:185-192. [PMID: 32558215 DOI: 10.1111/wvn.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The uptake of evidence-based knowledge in practice is influenced by context. Observations are suggested as a valuable but under-used approach in implementation research for gaining a holistic understanding of contexts. AIM The aim of this paper is to demonstrate how data from observations can provide insights about context and evidence use in implementation research. METHODS Data were collected over 24 months in a randomised trial with an embedded realist evaluation in 24 nursing homes across four European countries; notes from 183 observations (representing 335 hours) were triangulated with interview transcripts and context survey data (from 357 staff interviews and 725 questionnaire responses, respectively). RESULTS Although there were similarities in several elements of context within survey, interview and observation data, the observations provided additional features of the implementation context. In particular, observations demonstrated if and how the resources (staffing and supplies) and leadership (formal and informal, teamwork, and professional autonomy) affected knowledge use and implementation. Further, the observations illuminated the influence of standards and the physical nursing environment on evidence-based practice, and the dynamic interaction between different aspects of context. LINKING EVIDENCE TO ACTION Although qualitative observations are resource-intensive, they add value when used with other data collection methods, further enlightening the understanding of the implementation context and how evidence use and sharing are influenced by context elements. Observations can enhance an understanding of the context, evidence use and knowledge-sharing triad in implementation research.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Medicine and Health, Linkoping University, Linkoping, Sweden.,Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Jo Rycroft-Malone
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Teatske van der Zijpp
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Claire Hawkes
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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21
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Eldh AC. Facilitating patient participation by embracing patients' preferences-A discussion. J Eval Clin Pract 2019; 25:1070-1073. [PMID: 30916440 DOI: 10.1111/jep.13126] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Uppsala University, Uppsala, Sweden
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Årestedt L, Martinsson C, Hjelm C, Uhlin F, Eldh AC. Patient participation in dialysis care-A qualitative study of patients' and health professionals' perspectives. Health Expect 2019; 22:1285-1293. [PMID: 31560830 PMCID: PMC6882253 DOI: 10.1111/hex.12966] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/20/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE End-stage renal disease (ESRD) affects a multitude of aspects in the patient's daily life, often entailing their own involvement in various aspects of the treatment. Although patient participation is a core health-care value, what the concept signifies is not yet fully known. The purpose of this paper is to conceptualize patient participation in dialysis care, depicting patients' and health-care professionals' perspectives. DESIGN This explorative study employed qualitative interviews and content analysis. SETTING AND PARTICIPANTS Seven focus group discussions engaging 42 key informants were performed, including patients, staff and managers with experience of dialysis care. RESULTS In dialysis care, patient participation connotes a sharing of information and knowledge, the learning of and planning of care, including partaking in shared decisions with regards to treatment and management, and being involved in the management of one's own health-care treatment and/or self-care activities. Although these attributes were illustrated by all stakeholders, their significance varied: patients suggested that their preferences regarding primary aspects of participation vary, while staff considered patients' performance of dialysis to be the ultimate form of participation. Further, while patients considered multiple ways to execute participation, staff suggested that aspects such as sharing information were a route to, rather than actual, involvement. CONCLUSIONS Without a common understanding to denote the idea of patient participation, staff and patients are exposed to a potential deficit in terms of facilitating patient participation in everyday encounters of dialysis treatment. Further studies and means to serve a mutual understanding are needed.
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Affiliation(s)
- Liselott Årestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Caroline Martinsson
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Carina Hjelm
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Fredrik Uhlin
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden.,Department of Nephrology, University Hospital, Linköping, Sweden.,Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Ann Catrine Eldh
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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23
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Gifford W, Lewis KB, Eldh AC, Fiset V, Abdul-Fatah T, Aberg AC, Thavorn K, Graham ID, Wallin L. Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada. Pilot Feasibility Stud 2019; 5:103. [PMID: 31452925 PMCID: PMC6701101 DOI: 10.1186/s40814-019-0485-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/05/2019] [Indexed: 02/01/2023] Open
Abstract
Background Leadership is critical to supporting and facilitating the implementation of evidence-based practices in health care. Yet, little is known about how to develop leadership capacity for this purpose. The aims of this study were to explore the (1) feasibility of delivering a leadership intervention to promote implementation, (2) usefulness of the leadership intervention, and (3) participants’ engagement in leadership to implement evidence-based fall prevention practices in Canadian residential care. Methods We conducted a mixed-method before-and-after feasibility study on two units in a Canadian residential care facility. The leadership intervention was based on the Ottawa model of implementation leadership (O-MILe) and consisted of two workshops and two individualized coaching sessions over 3 months to develop leadership capacity for implementing evidence-based fall prevention practices. Participants (n = 10) included both formal (e.g., managers) and informal (e.g., nurses and care aids leaders). Outcome measures were parameters of feasibility (e.g., number of eligible candidates who attended the workshops and coaching sessions) and usefulness of the leadership intervention (e.g., ratings, suggested modifications). We conducted semi-structured interviews guided by the Implementation Leadership Scale (ILS), a validated measure of 12-item in four subcategories (proactive, supportive, knowledgeable, and perseverant), to explore the leadership behaviors that participants used to implement fall prevention practices. We repeated the ILS in a focus group meeting to understand the collective leadership behaviors used by the intervention team. Barriers and facilitators to leading implementation were also explored. Results Delivery of the leadership intervention was feasible. All participants (n = 10) attended the workshops and eight participated in at least one coaching session. Workshops and coaching were rated useful (≥ 3 on a 0–4 Likert scale where 4 = highly useful) by 71% and 86% of participants, respectively. Participants rated the O-MILe subcategories of supportive and perseverant leadership highest for individual leadership, whereas supportive and knowledgeable leadership were rated highest for team leadership. Conclusions The leadership intervention was feasible to deliver, deemed useful by participants, and fostered engagement in implementation leadership activities. Study findings highlight the complexity of developing implementation leadership and modifications required to optimize impact. Future trials are now required to test the effectiveness of the leadership intervention on developing leadership for implementing evidence-based practices.
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Affiliation(s)
- Wendy Gifford
- 1Center for Research on Health and Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada.,2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada
| | - Krystina B Lewis
- 1Center for Research on Health and Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada.,2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada
| | - Ann Catrine Eldh
- 3Faculty of Medicine, Department of Medicine and Health, Linköping University, SE-581 83, Linköping, Sweden
| | - Val Fiset
- 2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada
| | - Tara Abdul-Fatah
- 2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada
| | - Anna Cristina Aberg
- 4School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, Falun, Sweden.,5Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Kednapa Thavorn
- 6Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario Canada.,7School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario Canada
| | - Ian D Graham
- 7School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario Canada.,8Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario Canada
| | - Lars Wallin
- 4School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, Falun, Sweden.,9Department of Health Care Science, University of Gothenburg, Gothenburg, Sweden.,10Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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24
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Lindström Egholm C, Helmark C, Christensen J, Eldh AC, Winblad U, Bunkenborg G, Zwisler AD, Nilsen P. Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database. BMJ Open 2019; 9:e028291. [PMID: 31196902 PMCID: PMC6576126 DOI: 10.1136/bmjopen-2018-028291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate use of data from a clinical quality registry for cardiac rehabilitation in Denmark, considering the extent to which data are used for local quality improvement and what facilitates the use of these data, with a particular focus on whether there are differences between frontline staff and managers. DESIGN Cross-sectional nationwide survey study. SETTING, METHODS AND PARTICIPANTS A previously validated, Swedish questionnaire regarding use of data from clinical quality registries was translated and emailed to frontline staff, mid-level managers and heads of departments (n=175) in all 30 hospital departments participating in the Danish Cardiac Rehabilitation Database. Data were analysed descriptively and through multiple linear regression. RESULTS Survey response rate was 58% (101/175). Reports of registry use at department level (measured through an index comprising seven items; score min 0, max 7, where a low score indicates less use of data) varied significantly between groups of respondents: frontline staff mean score 1.3 (SD=2.0), mid-level management mean 2.4 (SD=2.3) and heads of departments mean 3.0 (SD=2.5), p=0.006. Overall, department level use of data was positively associated with higher perceived data quality and usefulness (regression coefficient=0.22, p=0.019), management request for data (regression coefficient=0.40, p=0.008) and personal motivation of the respondent (regression coefficient=1.63, p<0.001). Among managers, use of registry data was associated with data quality and usefulness (regression coefficient=0.43, p=0.027), and among frontline staff, reported data use was associated with management involvement in quality improvement work (regression coefficient=0.90, p=0.017) and personal motivation (regression coefficient=1.66, p<0.001). CONCLUSIONS The findings suggest relatively sparse use of data in local quality improvement work. A complex interplay of factors seem to be associated with data use with varying aspects being of importance for frontline staff and managers.
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Affiliation(s)
- Cecilie Lindström Egholm
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and the Region of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbaek University Hospital, Holbaek, Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Roskilde, Denmark
| | - Jan Christensen
- Department of Occupational and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann Catrine Eldh
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gitte Bunkenborg
- Department of Anesthesiology, Holbaek University Hospital, Holbaek, Denmark
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and the Region of Southern Denmark, Odense, Denmark
| | - Per Nilsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Orton M, Andersson Å, Wallin L, Forsman H, Eldh AC. Nursing management matters for registered nurses with a PhD working in clinical practice. J Nurs Manag 2019; 27:955-962. [DOI: 10.1111/jonm.12750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Marie‐Louise Orton
- Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
- Department of Quality and Patient Safety Karolinska University Hospital Stockholm Sweden
| | | | - Lars Wallin
- School of Education, Health and Social Studies Dalarna University Falun Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies Dalarna University Falun Sweden
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences Linköping University Linköping Sweden
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
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26
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Hälleberg Nyman M, Forsman H, Wallin L, Ostaszkiewicz J, Hommel A, Eldh AC. Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care-A process evaluation of an implementation intervention in the orthopaedic context. J Eval Clin Pract 2019; 25:282-289. [PMID: 29411463 DOI: 10.1111/jep.12879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery. METHODS A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed. RESULTS Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit. CONCLUSION To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.
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Affiliation(s)
- Maria Hälleberg Nyman
- School of Health Sciences, Örebro University, Örebro, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research, Barwon Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Ami Hommel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Department of Orthopaedics, Skaane University Hospital, Lund, Sweden
| | - Ann Catrine Eldh
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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27
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Seers K, Rycroft-Malone J, Cox K, Crichton N, Edwards RT, Eldh AC, Estabrooks CA, Harvey G, Hawkes C, Jones C, Kitson A, McCormack B, McMullan C, Mockford C, Niessen T, Slater P, Titchen A, van der Zijpp T, Wallin L. Facilitating Implementation of Research Evidence (FIRE): an international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implement Sci 2018; 13:137. [PMID: 30442174 PMCID: PMC6238407 DOI: 10.1186/s13012-018-0831-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. METHODS A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering. RESULTS Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time. CONCLUSIONS This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and "doses" of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors. TRIAL REGISTRATION Current Controlled Trials ISRCTN11598502 . Date 4/2/10. The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 223646.
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Affiliation(s)
- Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Karen Cox
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Nicola Crichton
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Science, Department of Nursing, Linkoping University, Linkoping, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | | | - Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Claire Hawkes
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carys Jones
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia Australia
| | | | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Theo Niessen
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Shore Rd, Belfast, Northern Ireland
| | - Angie Titchen
- Institute of Nursing and Health Research, Ulster University, Shore Rd, Belfast, Northern Ireland
| | - Teatske van der Zijpp
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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28
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Rycroft-Malone J, Seers K, Eldh AC, Cox K, Crichton N, Harvey G, Hawkes C, Kitson A, McCormack B, McMullan C, Mockford C, Niessen T, Slater P, Titchen A, van der Zijpp T, Wallin L. A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar. Implement Sci 2018; 13:138. [PMID: 30442165 PMCID: PMC6238283 DOI: 10.1186/s13012-018-0811-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Facilitation is a promising implementation intervention, which requires theory-informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice. METHODS This realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Data were collected over four time points using multiple qualitative methods: observation (372 h), interviews with staff (n = 357), residents (n = 152), next of kin (n = 109) and other stakeholders (n = 128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing. RESULTS The content and approach of the two facilitation programmes prompted variable opportunities to align and realign support with the needs and expectations of facilitators and homes. This influenced their level of confidence in fulfilling the facilitator role and ability to deliver the intervention as planned. The success of intervention implementation was largely dependent on whether sites prioritised their involvement in both the study and the facilitation programme. In contexts where the study was prioritised (including release of resources) and where managers and staff support was sustained, this prompted collective engagement (as an attitude and action). Internal facilitators' (IF) personal characteristics and abilities, including personal and formal authority, in combination with a supportive environment prompted by managers triggered the potential for learning over time. Learning over time resulted in a sense of confidence and personal growth, and enactment of the facilitation role, which resulted in practice changes. CONCLUSION The scale and multi-country nature of this study provided a novel context to conduct one of the few trial embedded realist-informed process evaluations. In addition to providing an explanatory account of implementation processes, a conceptual platform for future facilitation research is presented. Finally, a realist-informed process evaluation framework is outlined, which could inform future research of this nature. TRIAL REGISTRATION Current controlled trials ISRCTN11598502 .
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Affiliation(s)
- Jo Rycroft-Malone
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Kate Seers
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Science, Department of Nursing, Linkoping, and Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Linkopings University, Stockholm, Sweden
| | - Karen Cox
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Nicola Crichton
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Claire Hawkes
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia Australia
| | - Brendan McCormack
- Division of Nursing, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Theo Niessen
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Shore Rd Belfast, Ulster, Northern Ireland
| | - Angie Titchen
- Institute of Nursing and Health Research, Ulster University, Jordanstown, UK
| | - Teatske van der Zijpp
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lars Wallin
- Faculty of Medicine and Health Science, Department of Nursing, Linkoping, and Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Linkopings University, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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29
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Luhr K, Holmefur M, Theander K, Eldh AC. Patient participation during and after a self-management programme in primary healthcare - The experience of patients with chronic obstructive pulmonary disease or chronic heart failure. Patient Educ Couns 2018; 101:1137-1142. [PMID: 29290329 DOI: 10.1016/j.pec.2017.12.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 12/22/2017] [Accepted: 12/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patient participation is facilitated by patients' ability to take responsibility for and engage in health issues. Yet, there is limited research as to the promotion of these aspects of patient participation in long-term healthcare interactions. This paper describes patient participation as experienced by patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF); the aim was to describe if and how a self-management programme in primary healthcare influenced patient participation. METHODS Patients who had participated in a self-management programme were interviewed in nine focus groups (36 patients). Data was analysed using qualitative content analysis. RESULTS Patients described equality in personal interactions, opportunities to share and discuss, and a willingness to share and learn to facilitate patient participation in a self-management programme. Consequently, patient participation was promoted by a match between the individuals' personal traits and the context. CONCLUSION Features facilitating patient participation by means of sharing and assimilating knowledge and insights should be included in self-management programmes and in the care for patients with COPD and CHF. PRACTICE IMPLICATIONS A self-management programme can complement regular primary care regarding enhanced understanding of one's disease and support patient participation and the patient's own resources in self-management.
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Affiliation(s)
- Kristina Luhr
- University Health Care Research Center, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Marie Holmefur
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Kersti Theander
- Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
| | - Ann Catrine Eldh
- Division of Nursing, Department of Medical and Health Sciences, Linköping University, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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30
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Svensson C, Alvåsen K, Eldh AC, Frössling J, Lomander H. Veterinary herd health management-Experience among farmers and farm managers in Swedish dairy production. Prev Vet Med 2018; 155:45-52. [PMID: 29786524 DOI: 10.1016/j.prevetmed.2018.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
A preventive herd health approach will most likely reduce incidences of clinical and subclinical disease. Swedish veterinary organizations offer specific veterinary herd health management (HHM) programs, but these services are not used to a large extent. The aim of this study was to investigate dairy farmers' experience of HHM and the conditions for collaboration with veterinarians in HHM. Six focus group discussions were conducted in March 2015 in West Sweden. In total, 33 dairy farmers participated. The recordings were transcribed and coded using thematic analysis, and the transcripts were reviewed to identify potential factors indicating barriers for farmers to engage a veterinarian in HHM. The participants reported HHM to be important, but they had difficulty defining the actions included in the concept. They described a wide range of their work duties as preventive. The farmers' list of potential contributions by the veterinarians in HHM was strikingly short compared to the considerable number of preventive measures they performed themselves. Four main obstacles for farmers and farm managers to engage a veterinarian in HHM on their farm were identified in the analysis: "costs", "veterinary knowledge, skills, and organization", "farmer attitudes", and "veterinarian-farmer relationships". Costs were proposed as the main reason against engaging a veterinarian in HHM and included a high veterinary bill, low cost-benefit of veterinary services, and high costs to implement advice. Poor veterinary competence in HHM and poor knowledge about effective measures, practical farming, and farm economics were other important obstacles. Veterinarians were perceived to insufficiently describe their services and their benefits, and several participants felt they had never been offered veterinary HHM. Although veterinary HHM may be initiated by the farmer, the participants expected the veterinarian to have special responsibility for the initiation. A firm trust between farmer, staff, and veterinarian was considered crucial for veterinary HHM, but such trust takes a long time to build and can easily be disrupted by, for example, a veterinarian's poor communication skills or lack of time. Our findings suggest that Swedish dairy farmers and herd managers find disease prevention important and that they perform a wide range of tasks to prevent disease in their animals. However, they do not see what role the veterinarian can play, and veterinarians were mainly associated with treating unhealthy cows. In order to increase the use of veterinary HHM programs the services and potential benefits of such programs need to be communicated more proactively.
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Affiliation(s)
- C Svensson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| | - K Alvåsen
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - A C Eldh
- Division of Nursing, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - J Frössling
- Department of Disease Control and Epidemiology, National Veterinary Institute, Uppsala, Sweden; Department of Animal Environment and Health, Swedish University of Agricultural Sciences, Skara, Sweden
| | - H Lomander
- District Veterinary Organization, Swedish Board of Agriculture, Tibro, Sweden
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Fredriksson M, Halford C, Eldh AC, Dahlström T, Vengberg S, Wallin L, Winblad U. Are data from national quality registries used in quality improvement at Swedish hospital clinics? Int J Qual Health Care 2017; 29:909-915. [DOI: 10.1093/intqhc/mzx132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/14/2022] Open
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Eldh AC, Olai L, Jönsson B, Wallin L, Denti L, Elf M. Supporting first-line managers in implementing oral care guidelines in nursing homes. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2057158517713379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.
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Affiliation(s)
- Ann Catrine Eldh
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Faculty of Medicine and Health, Linköping University, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Lena Olai
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Birgitta Jönsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway
| | - Laris Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- University of Gothenburg, Göteborg, Sweden
| | - Leif Denti
- University of Gothenburg, Göteborg, Sweden
| | - Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- School of Architecture, Chalmers University of Technology, Göteborg, Sweden
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Luhr K, Eldh AC, Nilsson U, Holmefur M. Patient preferences for patient participation: Psychometric evaluation of The 4Ps tool in patients with chronic heart or lung disorders. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2057158517713156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Patient Preferences for Patient Participation tool (The 4Ps) was developed to aid clinical dialogue and to help patients to 1) depict, 2) prioritise, and 3) evaluate patient participation with 12 pre-set items reiterated in the three sections. An earlier qualitative evaluation of The 4Ps showed promising results. The present study is a psychometric evaluation of The 4Ps in patients with chronic heart or lung disease ( n = 108) in primary and outpatient care. Internal scale validity was evaluated using Rasch analysis, and two weeks test–retest reliability of the three sections using kappa/weighted kappa and a prevalence- and bias-adjusted kappa. The 4Ps tool was found to be reasonably valid with a varied reliability. Proposed amendments are rephrasing of two items, and modifications of the rating scale in Section 2. The 4Ps is suggested for use to increase general knowledge of patient participation, but further studies are needed with regards to its implementation.
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Affiliation(s)
- Kristina Luhr
- University Health Care Research Center, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ann Catrine Eldh
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Medical and Health Sciences, Linköping University, Sweden
| | - Ulrica Nilsson
- Faculty of Medicine and Health, Örebro University, Sweden
| | - Marie Holmefur
- Faculty of Medicine and Health, Örebro University, Sweden
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Hälleberg Nyman M, Forsman H, Ostaszkiewicz J, Hommel A, Eldh AC. Urinary incontinence and its management in patients aged 65 and older in orthopaedic care - what nursing and rehabilitation staff know and do. J Clin Nurs 2017; 26:3345-3353. [PMID: 27982485 DOI: 10.1111/jocn.13686] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2016] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe what nursing and rehabilitation staff know and do with regard to urinary incontinence and risk of urinary incontinence in patients 65 years or older undergoing hip surgery. BACKGROUND Urinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent urinary incontinence, there are indications that these guidelines are not applied in hospital care. DESIGN A qualitative study with descriptive design was conducted in two orthopaedic units. METHODS Forty-six interviews and 36 observations of care were conducted from January-October 2014 and analysed with qualitative content analysis. RESULTS Enrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses' role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures. CONCLUSIONS Urinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing urinary incontinence. RELEVANCE TO CLINICAL PRACTICE An increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.
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Affiliation(s)
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Joan Ostaszkiewicz
- School of Nursing and Midwifery, Deakin University, Melbourne, Vic., Australia
| | - Ami Hommel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Department of Orthopaedics, Skaane University Hospital, Lund, Sweden
| | - Ann Catrine Eldh
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Eldh AC, Almost J, DeCorby-Watson K, Gifford W, Harvey G, Hasson H, Kenny D, Moodie S, Wallin L, Yost J. Clinical interventions, implementation interventions, and the potential greyness in between -a discussion paper. BMC Health Serv Res 2017; 17:16. [PMID: 28061856 PMCID: PMC5219812 DOI: 10.1186/s12913-016-1958-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/16/2016] [Indexed: 11/17/2022] Open
Abstract
Background There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between ‘intervention’ and ‘implementation’, yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. Discussion To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. Conclusion Semantics provide opportunities for improved precision in depicting what is ‘intervention’ and what is ‘implementation’ in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse.
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Affiliation(s)
- Ann Catrine Eldh
- School of Education, Health and Social Studies, Dalarna University, FALUN, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, UPPSALA, Sweden. .,Department of Medical and Health Sciences, Linköping University, SE-581 83, LINKÖPING, Sweden.
| | | | | | | | - Gill Harvey
- University of Adelaide, Adelaide, Australia.,University of Manchester, Manchester, United Kingdom
| | - Henna Hasson
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Deborah Kenny
- University of Colorado, Colorado Springs, Colorado, USA
| | | | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, FALUN, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jennifer Yost
- School of Nursing, McMaster University, Hamilton, Canada
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Eldh AC, Wallin L, Fredriksson M, Vengberg S, Winblad U, Halford C, Dahlström T. Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey. BMJ Open 2016; 6:e011562. [PMID: 28128099 PMCID: PMC5128910 DOI: 10.1136/bmjopen-2016-011562] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. METHODS Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. RESULTS A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with 'Colleagues' call for local results' (p=<0.001), 'Management Request of Registry data' (p=<0.001), and it was said to be 'Simple to explain the results to colleagues' (p=0.02). Using stepwise regression, 'Colleagues' call for local results' was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. CONCLUSIONS While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- School of Health and Social Science, Dalarna University, Falun, Sweden
| | - Lars Wallin
- School of Health and Social Science, Dalarna University, Falun, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sofie Vengberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Christina Halford
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tobias Dahlström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Abstract
This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making.
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Tistad M, Palmcrantz S, Wallin L, Ehrenberg A, Olsson CB, Tomson G, Holmqvist LW, Gifford W, Eldh AC. Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness. Int J Health Policy Manag 2016; 5:477-486. [PMID: 27694661 DOI: 10.15171/ijhpm.2016.35] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 03/27/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. METHODS Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. RESULTS Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. CONCLUSION Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.
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Affiliation(s)
- Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Susanne Palmcrantz
- Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Ehrenberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Christina B Olsson
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Swede.,School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Göran Tomson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lotta Widén Holmqvist
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Swede.,Mörby Academic Primary Healthcare Center, Stockholm County Council, Stockholm, Sweden
| | - Wendy Gifford
- International Health Systems Research, Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Ann Catrine Eldh
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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van der Zijpp TJ, Niessen T, Eldh AC, Hawkes C, McMullan C, Mockford C, Wallin L, McCormack B, Rycroft-Malone J, Seers K. A Bridge Over Turbulent Waters: Illustrating the Interaction Between Managerial Leaders and Facilitators When Implementing Research Evidence. Worldviews Evid Based Nurs 2016; 13:25-31. [PMID: 26788694 DOI: 10.1111/wvn.12138] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process. AIMS To describe the interaction between managerial leaders and IFs and how this enabled or hindered the facilitation process of implementing urinary incontinence guideline recommendations in a local context in settings that provide long-term care to older people. METHODS Semistructured interviews with 105 managers and 22 IFs, collected for a realist process evaluation across four European countries informed this study. An interpretive data analysis unpacks interactions between managerial leaders and IFs. RESULTS This study identified three themes that were important in the interactions between managerial leaders and IFs that could hinder or support the implementation process: "realising commitment"; "negotiating conditions"; and "encouragement to keep momentum going." The findings revealed that the continuous reciprocal relationships between IFs and managerial leaders influenced the progress of implementation, and could slow the process down or disrupt it. A metaphor of crossing a turbulent river by the "building of a bridge" emerged as one way of understanding the findings. LINKING EVIDENCE TO ACTION Our findings illuminate a neglected area, the effects of relationships between key staff on implementing evidence into practice. Relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change. In order to support implementation, staff assigned as IFs as well as stakeholders like managers at all levels of an organisation should be engaged in realising commitment, negotiating conditions, and keeping momentum going. Thus, communication is crucial between all involved.
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Affiliation(s)
| | - Theo Niessen
- Associate Professor, Fontys University of Applied Sciences, Faculty of Nursing, Eindhoven, The Netherlands
| | - Ann Catrine Eldh
- Senior lecturer, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Researcher, Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claire Hawkes
- Senior Research Fellow-Emergency Care, Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Christel McMullan
- Research Fellow, Public Health, Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Carole Mockford
- Senior Research Fellow, Royal College of Nursing Research Institute, Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lars Wallin
- Professor, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Associate Professor, Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Brendan McCormack
- Head of the Division of Nursing, School of Health Sciences, Queen Margaret University, East Lothian, UK
| | - Jo Rycroft-Malone
- Professor and Head of School, Bangor University, UK, and School of Healthcare Sciences, Bangor, UK
| | - Kate Seers
- Director, RCN Research Institute and Professor of Health Research, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Eldh AC, Tollne A, Förberg U, Wallin L. What Registered Nurses Do and Do Not in the Management of Pediatric Peripheral Venous Catheters and Guidelines: Unpacking the Outcomes of Computer Reminders. Worldviews Evid Based Nurs 2016; 13:207-15. [DOI: 10.1111/wvn.12130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Ann Catrine Eldh
- Associate Professor, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Affiliated Researcher, Department of Neurobiology, Care Sciences and Society; Division of Nursing, Karolinska Institutet; Stockholm Sweden
| | - AnnaMaria Tollne
- Clinical teacher; Astrid Lindgren Children's Hospital; Stockholm Sweden
| | - Ulrika Förberg
- Lecturer, Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Lars Wallin
- Professor, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Associate Professor, Department of Neurobiology, Care Sciences and Society, Division of Nursing; Karolinska Institutet; Stockholm Sweden
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Eldh AC, Fredriksson M, Vengberg S, Halford C, Wallin L, Dahlström T, Winblad U. Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden. BMC Health Serv Res 2015; 15:519. [PMID: 26607344 PMCID: PMC4660812 DOI: 10.1186/s12913-015-1188-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 11/18/2015] [Indexed: 11/11/2022] Open
Abstract
Background With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. Methods We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). Results In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. Conclusions If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1188-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE751 22, Uppsala, Sweden. .,School of Health and Social Science, Dalarna University, SE791 88, Falun, Sweden.
| | - Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE751 22, Uppsala, Sweden.
| | - Sofie Vengberg
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE751 22, Uppsala, Sweden.
| | - Christina Halford
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE751 22, Uppsala, Sweden.
| | - Lars Wallin
- School of Health and Social Science, Dalarna University, SE791 88, Falun, Sweden. .,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE171 77, Stockholm, Sweden.
| | - Tobias Dahlström
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE751 22, Uppsala, Sweden.
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE751 22, Uppsala, Sweden.
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Palmcrantz S, Tistad M, Eldh AC, Holmqvist LW, Ehrenberg A, Tomson G, Olsson CB, Wallin L. Assessing feasibility and acceptability of study procedures: getting ready for implementation of national stroke guidelines in out-patient health care. BMC Health Serv Res 2015; 15:517. [PMID: 26596624 PMCID: PMC4657360 DOI: 10.1186/s12913-015-1177-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Even though Swedish national guidelines for stroke care (SNGSC) have been accessible for nearly a decade access to stroke rehabilitation in out-patient health care vary considerably. In order to aid future interventions studies for implementation of SNGSC, this study assessed the feasibility and acceptability of study procedures including analysis of the context in out-patient health care settings. Methods The feasibility and acceptability of recruitment, observations and interviews with managers, staff and patients were assessed, as well as the feasibility of surveying health care records. Results To identify patients from the the hospitals was feasible but not from out-patient care where a need to relieve clinical staff of the recruitment process was identified. Assessing adherence to guidelines and standardized evaluations of patient outcomes through health care records was found to be feasible and suitable assessment tools to evaluate patient outcome were identified. Interviews were found to be a feasible and acceptable tool to survey the context of the health care setting. Conclusion In this feasibility study a variety of qualitative and quantitative data collection procedures and measures were tested. The results indicate what can be used as a set of feasible and acceptable data collection procedures and suitable measures for studying implementation of stroke guidelines in an out-patient health care context. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1177-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Palmcrantz
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Malin Tistad
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Ann Catrine Eldh
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Lotta Widén Holmqvist
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden. .,Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
| | - Anna Ehrenberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Göran Tomson
- International Health Systems Research, Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Christina B Olsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,Mörby Academic Primary Healthcare Center, Stockholm County Council, Stockholm, Sweden.
| | - Lars Wallin
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
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Abstract
BACKGROUND Current research shows a relationship between healthcare architecture and patient-related outcomes. The planning and designing of new healthcare environments is a complex process. The needs of the various end users of the environment must be considered, including the patients, the patients' significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modeling utilizing system dynamics in the predesign phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction and then interviewed them about their experience. METHODS An explorative and qualitative design was used to describe participants' experiences of participating in the group-modeling projects. Participants (N = 20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analyzed by qualitative content analysis. RESULTS Two themes were formed, representing the experiences in the group-modeling process: "Participation in the group modeling generated knowledge and was empowering" and "Participation in the group modeling differed from what was expected and required the dedication of time and skills." CONCLUSIONS The method can support participants in design teams to focus more on their healthcare organization, their care activities, and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.
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Affiliation(s)
- Marie Elf
- Department of Nursing, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Ann Catrine Eldh
- Department of Nursing, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Inga Malmqvist
- School of Architecture, Chalmers University of Technology, Göteborg, Sweden
| | - Kerstin Öhrn
- Department of Nursing, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet (KI), Karolinska University Hospital, Stockholm, Sweden
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Duong DM, Bergström A, Wallin L, Bui HTT, Eriksson L, Eldh AC. Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam: a qualitative study. BMC Public Health 2015; 15:814. [PMID: 26297314 PMCID: PMC4546163 DOI: 10.1186/s12889-015-2142-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the Neonatal health - Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention. METHODS A secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naïve understanding and structured analysis. RESULTS The three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups. CONCLUSIONS This study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities' engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.
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Affiliation(s)
- Duc M Duong
- Hanoi School of Public Health, 138 Giang Vo Street, Ba Dinh District, Ha Noi, Vietnam.
- International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden.
| | - Anna Bergström
- International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden.
- Division of Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Nobels vag 9, SE-171 77, Stockholm, Sweden.
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, SE-791 88, Falun, Sweden.
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Ha T T Bui
- Hanoi School of Public Health, 138 Giang Vo Street, Ba Dinh District, Ha Noi, Vietnam.
| | - Leif Eriksson
- International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden.
| | - Ann Catrine Eldh
- School of Education, Health and Social Studies, Dalarna University, SE-791 88, Falun, Sweden.
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
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Eldh AC, van der Zijpp T, McMullan C, McCormack B, Seers K, Rycroft-Malone J. ‘I have the world's best job’ - staff experience of the advantages of caring for older people. Scand J Caring Sci 2015; 30:365-73. [DOI: 10.1111/scs.12256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/16/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Ann Catrine Eldh
- School of Education; Health and Social Studies; Dalarna University; Falun Sweden
- Department of Neurobiology; Care Sciences and Society; Division of Nursing; Karolinska Institutet; Stockholm Sweden
| | | | - Christel McMullan
- Public Health; Epidemiology and Biostatistics; School of Health and Population Sciences; University of Birmingham; Birmingham UK
| | - Brendan McCormack
- School of Health Sciences; Queen Margaret University; Musselburgh UK
| | - Kate Seers
- Warwick Medical School; University of Warwick; Coventry UK
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Eldh AC, Wallin L. How Single Is "Single" - Some Pragmatic Reflections on Single Versus Multifaceted Interventions to Facilitate Implementation: Comment on "Translating Evidence Into Healthcare Policy and Practice: Single Versus Multifaceted Implementation Strategies - Is There a Simple Answer to a Complex Question?". Int J Health Policy Manag 2015; 4:699-701. [PMID: 26673184 DOI: 10.15171/ijhpm.2015.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/16/2015] [Indexed: 11/09/2022] Open
Abstract
An earlier overview of systematic reviews and a subsequent editorial on single-component versus multifaceted interventions to promote knowledge translation (KT) highlight complex issues in implementation science. In this supplemented commentary, further aspects are in focus; we propose examples from (KT) studies probing the issue of single interventions. A main point is that defining what is a single and what is a multifaceted intervention can be ambiguous, depending on how the intervention is conceived. Further, we suggest additional perspectives in terms of strategies to facilitate implementation. More specifically, we argue for a need to depict not only what activities are done in implementation interventions, but to unpack functions in particular contexts, in order to support the progress of implementation science.
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Affiliation(s)
- Ann Catrine Eldh
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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Fredriksson M, Eldh AC, Vengberg S, Dahlström T, Halford C, Wallin L, Winblad U. Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research. Implement Sci 2014; 9:189. [PMID: 25544124 PMCID: PMC4307376 DOI: 10.1186/s13012-014-0189-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 12/04/2014] [Indexed: 12/22/2022] Open
Abstract
Background Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement’s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results The politicians’ and administrators’ perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians’ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0189-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. .,School of Health and Social Science, Dalarna University, 791 88, Falun, Sweden.
| | - Sofie Vengberg
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Tobias Dahlström
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Christina Halford
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Lars Wallin
- School of Health and Social Science, Dalarna University, 791 88, Falun, Sweden. .,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83, Huddinge, Sweden.
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
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Eldh AC, Fredriksson M, Halford C, Wallin L, Dahlström T, Vengberg S, Winblad U. Facilitators and barriers to applying a national quality registry for quality improvement in stroke care. BMC Health Serv Res 2014; 14:354. [PMID: 25158882 PMCID: PMC4153899 DOI: 10.1186/1472-6963-14-354] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/18/2014] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Eldh AC, Luhr K, Ehnfors M. The development and initial validation of a clinical tool for patients' preferences on patient participation--The 4Ps. Health Expect 2014; 18:2522-35. [PMID: 24938672 DOI: 10.1111/hex.12221] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 12/15/2022] Open
Abstract
AIMS To report on the development and initial testing of a clinical tool, The Patient Preferences for Patient Participation tool (The 4Ps), which will allow patients to depict, prioritize, and evaluate their participation in health care. BACKGROUND While patient participation is vital for high quality health care, a common definition incorporating all stakeholders' experience is pending. In order to support participation in health care, a tool for determining patients' preferences on participation is proposed, including opportunities to evaluate participation while considering patient preferences. METHODS Exploratory mixed methods studies informed the development of the tool, and descriptive design guided its initial testing. The 4Ps tool was tested with 21 Swedish researcher experts (REs) and patient experts (PEs) with experience of patient participation. Individual Think Aloud interviews were employed to capture experiences of content, response process, and acceptability. RESULTS 'The 4Ps' included three sections for the patient to depict, prioritize, and evaluate participation using 12 items corresponding to 'Having Dialogue', 'Sharing Knowledge', 'Planning', and 'Managing Self-care'. The REs and PEs considered 'The 4Ps' comprehensible, and that all items corresponded to the concept of patient participation. The tool was perceived to facilitate patient participation whilst requiring amendments to content and layout. CONCLUSIONS A tool like The 4Ps provides opportunities for patients to depict participation, and thus supports communication and collaboration. Further patient evaluation is needed to understand the conditions for patient participation. While The 4Ps is promising, revision and testing in clinical practice is required.
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Affiliation(s)
- Ann Catrine Eldh
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Kristina Luhr
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden.,Family Medicine Research Centre, Örebro County Council, Örebro, Sweden
| | - Margareta Ehnfors
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Eriksson L, Duc DM, Eldh AC, Vu PNT, Tran QH, Målqvist M, Wallin L. Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam. BMC Pregnancy Childbirth 2013; 13:234. [PMID: 24330472 PMCID: PMC3866580 DOI: 10.1186/1471-2393-13-234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 12/11/2013] [Indexed: 12/02/2022] Open
Abstract
Background In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. Methods Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. Results Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators’ lack of health knowledge was regarded as a deficit for assisting the groups’ assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. Conclusions This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.
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Affiliation(s)
- Leif Eriksson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85, Uppsala, Sweden.
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