Fragmented care trajectories in municipal healthcare: Local sensemaking of digital documentation

Objective

Since the 1990s, almost all healthcare organisations have had electronic health records (EHR) to organise and manage treatment, care and work routines. This article aims to understand how healthcare professionals (HCPs) make sense of digital documentation practice.

Methods

Based on a case study design, field observations and semi-structured interviews were conducted in a Danish municipality. A systematic analysis based on Karl Weick's sensemaking theory was applied to investigate what cues HCPs extract from timetables in the EHR and how institutional logics frame the enactment of documentation practice.

Results

The analysis uncovered three themes: making sense of planning, making sense of tasks and making sense of documentation. The themes illustrate that HCPs make sense of the digital documentation practice as a dominant managerial tool designed to control resources and work routines. This sensemaking leads to a task-oriented practice which centres on delivering fragmented tasks according to a timetable.

Conclusion

HCPs mitigate fragmentation by responding to a care professional logic, where they document to share information and carry out invisible work outside of timetables and scheduled tasks. However, HCPs are focused on solving specific tasks by the minute with the possible consequence that continuity and their overview of the service user's care and treatment disappear. In conclusion, the EHR system eliminates a holistic view of care trajectories, leaving it up to HCPs to collaborate in an effort to obtain continuity for the service user.

How digital health documentation transforms professional practices in primary healthcare in Denmark: A WPR document analysis

Historically, recordkeeping has been an essential task for health professionals. Today, this mandatory task increasingly takes place as digital documentation. This study critically examines problem constructions in practical documents on digital documentation strategies in Danish municipal healthcare and how these problem constructions imply particular solutions. A document analysis based on the approach presented in Bacchi's "What's the problem represented to be?" was applied. Forty practical documents in the form of guidelines, strategies, and quality control documents were included. The analysis uncovered three problem representations: lack of coherence between health services in a complex healthcare system, lack of assessable data for management and political prioritization, and inefficiency in the healthcare system. The proposed solution is a digitalized and standardized practice that transforms recordkeeping in the municipalities. However, municipal healthcare is at risk of being fragmented due to digital documentation's focus on the organizational management of health with task-oriented practices supplied by an anonymous health professional. We find that digital documentation functions as an organizational micromanagement approach that assigns the health professional a subject position as an employee acting according to the organization's framework rather than the profession's normative framework.

Continuity of care in Danish peer-led patient online communities on social media. A survey study

Background

Patients in the Danish healthcare system and other Western countries experience a lack of ‘continuity of care’ due to inadequate communication and sharing of clinical information. ‘Continuity of care’ is often defined as informational, managerial and relational failures. A lack of continuity is particularly problematic for patients with chronic conditions as they are often highly dependent on longitudinal and complex treatment processes. Some of these patients have formed self-organised groups on social media in order to share their personal experiences with the health care system and discuss health related problem with peers. The aim of this paper is to understand the role peer-led online communities (PLOC) play for patients with chronic conditions experiences of continuity of care.

Methods

The material consists of survey data from patients with chronic conditions participating in peer-led online communities on the experience of continuity of care in the Danish healthcare system. A link to the survey was posted in the public online community “Chronic Influencers” (Instagram 10,000 followers), and in the closed Facebook group “Chronic pain patients” (Facebook, 2,200 members). The questionnaire was posted three times between 10 and 30 March 2022.

Results

207 respondents answered all questions in the survey of which 95% were women. Most of them (62 %) were between 36 and 55 years. 37 % live with chronic conditions for more that 20 years. 72 % of the respondent experience lack of continuity with the healthcare system, often with regard to information or communication with health professionals and they look for peers’ advices or experiences in the online groups. 68 % felt recognized by the peers in the online community in another way than in the meeting with the healthcare system.

Conclusions

Patients use PLOC to find and exchange experiences from other patients with chronic conditions about their treatment and especially daily life with chronic conditions.

Key messages

• Patients participating in peer-led online communities provide online support and recognition to each other than that provided by the healthcare system.

• Patients use peer-led online communities to read about other patients’ experiences with chronic conditions and learn about their treatment and daily life.

Public trust and mistrust of climate science: A meta-narrative review

This systematic meta-narrative literature review aims to explore the narratives of trust evident in literature on public (mis)trust relating to climate science published up until May 2021, and to present the main findings from these papers. We identified six narratives of trust: attitudinal trust, cognitive trust, affective trust, contingencies of trust, contextual trust and communicated trust. The papers' main findings spanned theoretical conclusions on the importance of positionality to trust and morality to trustworthiness, to qualitative findings that the scientific community was mainly trusted, to quantitative findings that explored how trust functioned as an independent, dependent or mediating variable. This literature review sheds important light on the interrelationship between climate science and publics, highlights areas for further research, and in its characterisation of trust narratives provides a language for conceptualising trust that can further interdisciplinary engagement.

The contribution of professions to the governance of integrated care: Towards a conceptual framework based on case studies from Denmark

OBJECTIVE

Good governance of integrated care is key to better health care, but we know little about how professions can help make this happen. Our aim is to introduce a conceptual framework to analyse how professions contribute to the governance of integrated care, and to apply the framework to a secondary analysis of selected case studies from Denmark.

METHODS

We developed a framework, which identified the what, how and why of the contribution professions make to the governance of integrated care. We included five qualitative Danish studies, using coordination as an indicator of integrated care. We adopted a thematic approach in our analysis, combining deductive and inductive elements.

RESULTS

Health professions engage in highly diverse activities, which fall into closely connected clusters of more formal or more informal coordination. Professions apply many different adaptive mechanisms at different levels to fit coordination into local contexts. Professions are driven by interlocking rationales, where a common focus on patients connects organizational and professional concerns.

CONCLUSIONS

Our analytical framework emerges as a useful tool for analysis. The contribution of professions to the governance of integrated care needs greater attention in health policy implementation as it can promote more effective governance of integrated care.

Dilemmas of nudging in public health: an ethical analysis of a Danish pamphlet

Nudging has been discussed in the context of public health, and ethical issues raised by nudging in public health contexts have been highlighted. In this article, we first identify types of nudging approaches and techniques that have been used in screening programmes, and ethical issues that have been associated with nudging: paternalism, limited autonomy and manipulation. We then identify nudging techniques used in a pamphlet developed for the Danish National Screening Program for Colorectal Cancer. These include framing, default nudge, use of hassle bias, authority nudge and priming. The pamphlet and the very offering of a screening programme can in themselves be considered nudges. Whether nudging strategies are ethically problematic depend on whether they are categorized as educative- or non-educative nudges. Educative nudges seek to affect people's choice making by engaging their reflective capabilities. Non-educative nudges work by circumventing people's reflective capabilities. Information materials are, on the face of it, meant to engage citizens' reflective capacities. Recipients are likely to receive information materials with this expectation, and thus not expect to be affected in other ways. Non-educative nudges may therefore be particularly problematic in the context of information on screening, also as participating in screening does not always benefit the individual.

Dilemmas in delivering health promotion activities: findings from a qualitative study of mental health nurses in Denmark

OBJECTIVE

Recent studies have shown that people with mental illnesses have higher mortality and morbidity rates due to long-term conditions and lifestyle diseases. This knowledge has led to health promotion initiatives in mental health care to improve the physical health of people with mental illness. This article explores how mental health nurses experience working with health promotion activities in mental healthcare practices.

DESIGN

We adopted a qualitative research design using an interactive approach. Qualitative content analysis was used to develop the analytical framework.

PARTICIPANTS

Focus groups (n=7; n=5) were conducted with two groups of mental health nurses who attended health specialist training sessions in Denmark in the spring and fall of 2018.

RESULTS

The findings showed that working with health promotion activities in mental health care created two dilemmas for the mental health nurses: (1) dilemmas related to health promotion that involved discrepancies between the health promotion activities that were offered and patients' autonomy and wishes, and (2) system-related dilemmas stemming from working with screening for risk factors and documentation programmes. The mental health nurses developed different strategies to navigate these dilemmas, such as devising interview techniques for the screening questions and bending guidelines.

CONCLUSIONS

Mental health nurses found it challenging to implement health promotion activities in mental health care, although they generally found these activities meaningful. The findings show that new health promotion activities need to be adapted to nurses' existing mental healthcare practices; however, this may require some adaptation of existing nursing practices.

Exploring the use of nudging in public health lifestyle interventions: A literature review

Background

The concept of nudging has been imported from behavioral economics into the public health context to correct 'unhealthy behaviours' and produce health-promoting behavior changes in individuals. However, there is lack of clarity as to what constitutes a nudge and whether nudging techniques in public health lifestyle interventions are effective. The aim of this literature review is to identify nudging techniques used in public health lifestyle interventions and to investigate whether nudging techniques induce expected healthy lifestyle changes in interventions that relate to diet, exercise, sleep, alcohol and smoking.

Methods

A systematic literature review on the concept “nudging” in public health lifestyle interventions was conducted, applying a free text search strategy on a set of search terms in three databases: PubMed, CINAHL and PsycINFO. Articles meeting the inclusion criteria were included in our data set, and we performed a meta-synthesis to construct interpretative explanations.

Results

66 original studies published in international peer-reviewed journals were identified. The findings showed that most nudging interventions involved diet/nutrition (n = 55), were carried out as single experiments, lasted for a short period of time and that the majority had the intended effects. Specific nudging techniques were identified and sorted into eight broader categories. The most commonly used nudging technique involved making healthier food items more apparent and accessible than less healthy foods.

Conclusions

The synthesis showed that these studies were limited with regard to their design, target groups, duration of the intervention, measures of effectiveness and critical reflection on ethical issues.

Key messages

Nudging may be effective in producing immediate behavioral changes; however, there is little evidence that nudging interventions result in lasting behavioral changes outside the setting of the studies. Further critical discussions about the implications of nudging in public health lifestyles intervention are required.

How professions make intersectoral governance happen in the context of Denmark

Background

Intersectoral governance is recognised as key to achieving better healthcare, but our understanding of how to make this happen is limited. Earlier studies on individual professionals fail to acknowledge the resources of health professions as collective actors and pay very little attention to professional agency to support intersectoral governance. The aim is to add new knowledge on how professions contribute to intersectoral governance in healthcare.

Methods

The study develops a novel conceptual framework, distinguishing between the what, the how and the why of professional agency. The study is based on a secondary analysis of five qualitative case studies of coordination in Denmark, conducted 2011-8 and with a total of 89 hours observations, 18 focus groups, 36 interviews. The case selection identified studies from different organisational settings. Coordination was the key indicator of intersectoral governance and used for coding and for drawing up a data display for more systematic analysis.

Results

Health professions engage in a wide range of coordination activities; this includes documenting, monitoring, meeting, giving practical support and teaching. Health professions employ diverse mechanisms to adapt coordination activities to local contexts; this is about flexibility and combining mechanisms in a highly tailored way. When they engage in coordination activities, health professions draw on two different rationales: one relates to better healthcare services for patients, the other to professional interests, including work conditions.

Conclusions

Health professions engage in coordination that spans sectors, organisations and/or professional groups; thus professions are key to making intersectoral governance happen.

Key messages

Health professions have many resources highly relevant for coordination. Policy and administrative decision makers need to better support health professions to strengthen intersectoral governance.

Nudging in Public Health Lifestyle Interventions: A Systematic Literature Review and Metasynthesis

Nudging is increasingly used in public health interventions in Western societies to produced health-promoting behavior changes; however, there is lack of clarity as to what constitutes a nudge, scant knowledge of the effectiveness of nudging techniques in public health lifestyle interventions and a number of ethical and value-based concerns. The aim of this review is to address these research lacunae and identify the characteristics of nudges in empirical research on public health interventions intended to induce healthy lifestyle changes, including whether they are effective. We conducted systematic searches for relevant articles published between January 2008 and April 2019 in three databases, PubMed, CINAHL and PsycINFO, and combined this with a metasynthesis to construct interpretative explanations. A total of 66 original studies met the inclusion criteria. The findings of the systematic review showed that most nudging interventions involved diet/nutrition, most were carried out as single experiments, and the majority had the intended effects. Specific nudging techniques were identified with respect to the broader nudging categories of accessibility, presentation, using messages and pictures, technology-supported information, financial incentives, affecting the senses, and cognitive loading; several studies included more than one nudging technique. Although many nudging techniques had the intended effects, it is unclear whether they would work outside the study setting. The synthesis revealed that the studies lacked critical reflection on the assumptions about health that were implicit in nudging interventions, the cultural acceptability of nudges, the context-free assumptions of nudging theory, and the implications of these aspects for the public health context.

Interprofessional collaboration in health promotion: changing tasks as leverage for innovation

Background

Increasing demand for interprofessional collaboration calls for change in organisational practice and interactions of professionals. Health promotion is a particularly interesting area for observing these changes, because it involves professionals with different disciplinary backgrounds usually also working in different sectors. In Denmark new health promotion strategies in organisations were introduced to engage professionals in new tasks and establish interprofessional ways of working. Our research aimed to explore how these strategies impact in professional practices, using a cookery project for children as a case study, which involved care assistants and school teachers.

Methods

A qualitative case study was conducted to investigate how care assistants from a nursing home and school teachers implemented a cookery project in a Danish school; the focus was on joint care and teaching situations among the two professions and their users. Our data consisted of documents, participatory observations, and interviews with professionals; a sociological institutional framework was applied to analyse the data.

Results

Institutional changes and the demand for joint care and teaching activities in the cooking project fostered new interprofessional collaboration. Three themes of new professional activities emerged: 1) ‘interplay’ related to making different generations collaborate on the tasks involved in the cookery session, 2) ‘care’ concerned with caregiving activities, and 3) ‘learning” focused on schooling on healthy food and cooking. The activities were related to traditional and new roles in professional practices of both groups.

Conclusions

Changes in professional practices evolved in an informal manner from new tasks and ‘lived’ experiences in the cookery project. The specific practical tasks of health promotion offer an important leverage for future interprofessional collaborations.

Implementation of health promotion activities in mental health care in Denmark

Background

People suffering from serious mental illness face a high risk of lifestyle-related health problems, and higher mortality and morbidity rates than the rest of the population. The solution to the problem has been to integrate health promotion initiatives in mental health care. In Denmark psychiatric departments have implemented a new strategy and mental health nurses are now asked to screen for risk factors. The aim of this study is to explore how mental health nurses experience working with the screening of risk factors amongst patients with mental illnesses as part of their health promotion activities.

Methods

We employed a qualitative research design using an interactive approach. Two focus group interviews (n = 7; n = 5) were conducted with mental health nurses attending a mental health specialist training in Denmark in 2018. The interviews lasted 1 ½ hours, were recorded and transcribed verbatim. Data were organized using NVivo 12 software and a qualitative content analysis was used to describe experiences in a conceptual form.

Results

The implementation of health promotion activities in mental health care created two different types of dilemmas for the mental health nurses: 1) dilemmas related to health promotion that involved discrepancies between patients’ autonomy and wishes, and the health promotion activities that were offered; 2) system-related dilemmas originated from structural factors and working with screening for risk factors. The mental health nurses developed various strategies and found new solutions to navigate these dilemmas.

Conclusions

Mental health nurses found it challenging to implement health promotion activities in mental health care, although they generally found these activities meaningful. They developed new strategies to overcome the dilemmas.

Key messages

Health promotion initiatives need to be adapted to mental health nurses’ existing mental healthcare practices in order for them to be meaningful. Screening of risk factors is insufficient as a health promotion activity in mental health care.

Associations between degrees of task delegation and adherence to COPD guidelines on spirometry testing in general practice - a national cross-sectional study

Background

The healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care.

Methods

We carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics.

Results

GPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively).

Conclusion

Delegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4270-3) contains supplementary material, which is available to authorized users.

Adolescents' participation in their healthcare: A sociomaterial investigation of a diabetes app

OBJECTIVE

This article explores how a diabetes app called Diapplo affected adolescents' participation in their healthcare by investigating adolescents' meaning-making in relation to their use of the app.

METHODS

Using a qualitative single case-study design, we adopted a multimethod responsive approach to data generation that included written data from the app development process, individual and group interviews and observations of the adolescents in the clinical situation. This article presents the results from a qualitative content analysis of group and individual semi-structured interviews conducted with five adolescents diagnosed with type 1 diabetes during and after the four-week test phase of a prototype of the app.

RESULTS

The adolescents appreciated the diabetes app's design and interface and having an overview of their blood glucose values. However, they stated that the app's content only partly met their needs and they considered several of its features unnecessary. They would have liked the app to have a social platform and emphasized that the app should be compatible with their blood glucose monitors and pumps for them to continue using it.

CONCLUSIONS

The participants in our study highlighted the value of social platforms integrated in health apps for patient participation, as well as their preference for health app features that reduced the effort of managing their chronic condition and facilitate greater knowledge. Theories of sociomateriality and material participation helped to account for the challenges of integrating users' perspectives, suggesting the value of early, comprehensive identification and prioritization of users' values when developing mobile health technologies.

How Intersectoral Health Promotion Changes Professional Practices: A Case Study From Denmark

Intersectoral health promotion (IHP) has pushed health professions to engage in new tasks and interprofessional ways of working. We studied how care assistants from a nursing home and school teachers implemented a cookery project targeted at children ("Cool Beans") as an example of an IHP project in Denmark. Our aim was to examine the impact of the IHP project on the practices of the professions involved. We used a qualitative case study to investigate joint care and teaching situations with the two professions and their users. Our data consisted of documents, participatory observations, and informal interviews (17 hours) as well as semistructured interviews with professionals (n = 4). We used a sociological institutional framework to analyze the professional practices emerging in joint care and teaching situations and identified three themes of new professional activities: (1) "interplay" related to making different generations collaborate on the tasks involved in the cookery session; (2) "care" concerned with caregiving activities; and (3) "learning" focused on schooling on healthy food and cooking. We conclude that changes in professional practices occurred informally and were induced by the concrete activities in the cookery project. The specific, practical tasks of the IHP project thus offered an important leverage for future interprofessional collaborations.

Work motivation, task delegation and job satisfaction of general practice staff: a cross-sectional study

BACKGROUND

Recent research has shown that a high degree of task delegation is associated with the practise staff's overall job satisfaction, and this association is important to explore since job satisfaction is related to medical as well as patient-perceived quality of care.

OBJECTIVES

This study aimed: (1) to investigate associations between degrees of task delegation in the management of chronic disease in general practice, with chronic obstructive pulmonary disease (COPD) as a case and the staff's work motivation, (2) to investigate associations between the work motivation of the staff and their job satisfaction.

METHODS

The study was based on a questionnaire to which 621 members of the practice staff responded. The questionnaire consisted of a part concerning degree of task delegation in the management of COPD in their respective practice and another part being about their job satisfaction and motivation to work.

RESULTS

In the first analysis, we found that 'maximal degree' of task delegation was significantly associated with the staff perceiving themselves to have a large degree of variation in tasks, odds ratio (OR) = 4.26, confidence interval (CI) = 1.09, 16.62. In the second analysis, we found that this perceived large degree of variation in tasks was significantly associated with their overall job satisfaction, OR = 2.81, confidence interval = 1.71, 4.61.

CONCLUSION

The results suggest that general practitioners could delegate highly complex tasks in the management of COPD to their staff without influencing the staff's work motivation, and thereby their job satisfaction, negatively, as long as they ensure sufficient variation in the tasks.

Dealing with cancer: a meta-synthesis of patients' and relatives' experiences of participating in psychosocial interventions

The aim was to synthesise patients' and relatives' experiences of participating in a psychosocial intervention related to having cancer. The study was a meta-synthesis inspired by Noblit & Hare's 'meta-ethnography' approach. We systematically searched six databases and included 33 studies in the meta-synthesis. Inclusion criteria were qualitative studies with relevance to the synthesis topic. The meta-synthesis conceptualised the way in which participants develop their way of living with cancer, and the role psychosocial interventions play in helping them to live through the illness. Five themes symbolising the participants' core experiences were identified: (1) Emotional relief and a sense of well-being, (2) normalisation of experiences and a sense of control, (3) shared experience and a sense of community, (4) a safe place and (5) transformation and adaptability. The findings indicated that psychosocial interventions were used to try to deal with the changes in the human conditions caused by cancer. Sharing their experiences and forming social relationships helped the participants adapt to cancer. An existential perspective may provide a nuanced understanding of patients' and relatives' experiences of participating in psychosocial interventions.

Relations between task delegation and job satisfaction in general practice: a systematic literature review

Background

It has for years been discussed whether practice staff should be involved in patient care in general practice to a higher extent. The research concerning task delegation within general practice is generally increasing, but the literature focusing on its influence on general practitioners' and their staff’s job satisfaction appears to be sparse even though job satisfaction is acknowledged as an important factor associated with both patient satisfaction and medical quality of care. Therefore, the overall aim of this study was 1) to review the current research on the relation between task delegation and general practitioners' and their staff’s job satisfaction and, additionally, 2) to review the evidence of possible explanations for this relation.

Methods

A systematic literature review. We searched the four databases PubMed, Cinahl, Embase, and Scopus systematically. The immediate relevance of the retrieved articles was evaluated by title and abstract by the first author, and papers that seemed to meet the aim of the review were then fully read by first author and last author independently judging the eligibility of content.

Results

We included four studies in the review. They explored views and attitudes of the staff, encompassing nurses as well as practice managers. Only one of the included studies also explored general practitioners' views and attitudes, hence making it impossible to establish any syntheses on this relation. According to the studies, the staff’s overall attitude towards task delegation was positive and led to increased job satisfaction, probably because task delegation comprised a high degree of work autonomy.

Conclusions

The few studies included in our review suggest that task delegation within general practice may be seen by the staff as an overall positive issue contributing to their job satisfaction, primarily due to perceived autonomy in the work. However, because of the small sample size comprising only qualitative studies, and due to the heterogeneity of these studies, we cannot draw unambiguous conclusions although we point towards tendencies.

Storytelling as part of cancer rehabilitation to support cancer patients and their relatives

Previous research on psychosocial support for cancer-related concerns has primarily focused on either patients or their relatives, although limited research is available on how patients and their relatives can be supported together. The aim of this article is to explore the use of storytelling as a part of a residential cancer rehabilitation intervention for patients together with their relatives, with a specific focus on their management of cancer-related concerns. Ten pairs participated in the intervention and data were generated through ethnographic fieldwork, including participant observations, informal conversations and follow-up interviews conducted one month after completing the intervention. Analysis was performed drawing on narrative theory combined with social practice theory. The results demonstrate that the use of storytelling and metaphors intertwined with other course activities, such as dancing and arts & crafts, provided the patients and their relatives with strategies to manage cancer-related concerns, which they were later able to apply in their everyday lives. The study results may be useful to other professionals in clinical practice for rehabilitation purposes for addressing issues of fear and worry.

Management of Overweight during Childhood: A Focus Group Study on Health Professionals' Experiences in General Practice

Background. Because of the increasing prevalence of overweight and obesity in childhood in the Western world, focus on the management in general practice has also increased. Objective. To explore the experiences of general practitioners (GPs) and practice nurses participating in a randomised controlled trial (RCT) comparing two management programmes in general practice for children who are overweight or obese. Methods. Three focus groups with GPs and nurses participating in the RCT. Transcribed data were analysed using systematic text condensation followed by thematic analysis. Results. Health professionals considered it their responsibility to offer a management programme to overweight children. They recognised that management of overweight during childhood was a complex task that required an evidence-based strategy with the possibility of supervision. Health professionals experienced a barrier to addressing overweight in children. However, increasing awareness of obesity in childhood and its consequences in society was considered helpful to reach an understanding of the articulations concerning how best to address the issue. Conclusions. Health professionals in general practice recognised that they have a special obligation, capacity, and role in the management of obesity in childhood. Implementation of future management programmes must address existing barriers beyond an evidence-based standardised strategy.

Outcome of supportive talks in a hospital setting: insights from cancer patients and their relatives

BACKGROUND

In psychosocial cancer rehabilitation, relatives are often central to patients' experiences and management of their cancer disease, and they need to be actively involved in rehabilitation. To address this need we developed a psychosocial rehabilitation intervention. As part of the intervention, lung or gynecological cancer patients and a relative as a pair were offered three supportive talks initiated on the date of admission and completed within 2 months.

OBJECTIVE

The objective of this study was to qualitatively assess the outcome of supportive talks from the pairs' perspectives and to provide a nuanced understanding of psychosocial support offered to pairs in a hospital setting in Denmark.

METHODS

Using a qualitative approach, we conducted semi-structured interviews with pairs receiving supportive talks and pairs receiving usual care. The interviews focused on the pairs' experiences of psychosocial supportive talks in a hospital setting. A constant comparative analysis was applied to identify themes related to the ways the pairs experienced the talks.

RESULTS

The analysis revealed two main themes: 'appreciation of the supportive talks' and 'the influence of the hospital setting'. The majority of pairs valued the focus on relationship and interpersonal communication, although they appreciated various aspects of the talks. The hospital setting provided valuable resources (trained nurses and medical expertise), but existing clinical routines challenged the implementation of the supportive talks.

CONCLUSIONS

The supportive talks were appreciated as psychosocial support in line with the objective, or as information on cancer treatment and routine care. The implementation of a new rehabilitation practice was challenged by the influence of the hospital setting.

Understanding change in medical practice: the role of shared meaning in preventive treatment

Health care organizations are experiencing a rising demand for change in the organization of preventive health services. Many initiatives designed to cater for change fail to achieve their aim. To understand how organizational dynamics in health care organizations influence the adoption of new initiatives, I explored the implementation of motivational interviewing, a health behavior concept that was introduced into ten general practice clinics in Denmark. Within an institutional framework I explored how modern ideas of prevention related to this concept were translated into medical practices. Using a qualitative multiple-case study design, I examined the institutionalization process in different clinical settings. I found that clinics constructed various types of preventive routines and thereby imposed new meaning on the health behavior concept. In adopting the concept, clinics developed a new routine against the background of existing practice, (re)producing an alternative, self-contained routine that diverged from their usual medical practice.