| 1. |
- Bendtsen, Preben, et al.
(author)
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Referral to an electronic screening and brief alcohol intervention in primary health care in Sweden : Impact of staff referral to the computer
- 2011
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In: International Journal of Telemedicine and Applications. - : Hindawi Limited. - 1687-6415 .- 1687-6423. ; 918763
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Journal article (peer-reviewed)abstract
- The aim of this paper was to evaluate whether primary health care staff's referral of patients to perform an electronic screening and brief intervention (e-SBI) for alcohol use had a greater impact on change in alcohol consumption after 3 month, compared to patients who performed the test on their own initiative. Staff-referred responders reported reduced weekly alcohol consumption with an average decrease of 8.4 grams. In contrast, self-referred responders reported an average increase in weekly alcohol consumption of 2.4 grams. Staff-referred responders reported a 49 reduction of average number of heavy episodic drinking (HED) occasions per month. The corresponding reduction for self-referred responders was 62. The differences between staff- and self-referred patient groups in the number who moved from risky drinking to nonrisky drinking at the followup were not statistically significant. Our results indicate that standalone computers with touchscreens that provide e-SBIs for risky drinking have the same effect on drinking behaviour in both staff-referred patients and self-referred patients. Copyright © 2011 Preben Bendtsen et al.
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| 2. |
- Carlfjord, Siw, et al.
(author)
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Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care
- 2012
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In: Health Promotion International. - : Oxford University Press. - 0957-4824 .- 1460-2245. ; 27:2, s. 167-176
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Journal article (peer-reviewed)abstract
- The aim of this study was to evaluate two implementation strategies for the introduction of a lifestyle intervention tool in primary health care (PHC), applying the RE-AIM framework to assess outcome. A computer-based tool for lifestyle intervention was introduced in PHC. A theory-based, explicit, implementation strategy was used at three centers, and an implicit strategy with a minimum of implementation efforts at three others. After 9 months a questionnaire was sent to staff members (n= 159) and data from a test database and county council registers were collected. The RE-AIM framework was applied to evaluate outcome in terms of reach, effectiveness, adoption and implementation. The response rate for the questionnaire was 73%. Significant differences in outcome were found between the strategies regarding reach, effectiveness and adoption, in favor of the explicit implementation strategy. Regarding the dimension implementation, no differences were found according to the implementation strategy. A theory-based implementation strategy including a testing period before using a new tool in daily practice seemed to be more successful than a strategy in which the tool was introduced and immediately used for patients.
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| 3. |
- Carlfjord, Siw, et al.
(author)
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Computerized lifestyle intervention in routine primary health care : Evaluation of usage on provider and responder levels
- 2009
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In: PATIENT EDUCATION AND COUNSELING. - : Elsevier BV. - 0738-3991. ; 75:2, s. 238-243
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to evaluate the use of a computerized concept for lifestyle intervention in routine primary health care (PHC). Methods: Nine PHC units were equipped with computers providing a lifestyle test and tailored printed advice regarding alcohol consumption and physical activity. Patients were referred by staff, and performed the test anonymously. Data were collected over a period of I year. Results: During the study period 3065 tests were completed, representing 5.7% of the individuals visiting the PHC units during the period. there were great differences between the units in the number of tests performed and in the proportion of patients referred. One-fifth of the respondents scored for hazardous alcohol consumption, and one-fourth reported low levels of physical activity. The majority of respondents found the test easy to perform, and a majority of those referred to the test found referral positive. Conclusion: The computerized test can be used for screening and intervention regarding lifestyle behaviours in PHC. Responders are positive to the test and to referral. Practice implications: A more widespread implementation of computerized lifestyle tests could be a beneficial complement to face-to-face interventions in PHC.
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| 4. |
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| 5. |
- Carlfjord, Siw, et al.
(author)
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Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory
- 2010
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In: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 11:60
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Journal article (peer-reviewed)abstract
- BACKGROUND: Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.METHODS: A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.RESULTS: The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.CONCLUSION: When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.
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| 6. |
- Carlfjord, Siw, et al.
(author)
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Staff perspectives on the use of a computer-based concept for lifestyle intervention implemented in primary health care
- 2010
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In: HEALTH EDUCATION JOURNAL. - : Health Education Authority. - 0017-8969 .- 1748-8176. ; 69:3, s. 246-256
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to evaluate staff experiences of the use of a computer-based concept for lifestyle testing and tailored advice implemented in routine primary health care (PHC). Design: The design of the study was a cross-sectional, retrospective survey. Setting: The study population consisted of staff at nine PHC units in the county of Ostergotland, Sweden. Method: After a computer-based concept for lifestyle intervention had been in operation for 1 year, a questionnaire was distributed to all staff members. The questions concerned experiences of and attitudes to the concept, and comments on addressing lifestyle issues in PHC. Results: Of the 291 potential respondents, 59 per cent returned the questionnaire. Eighty-five per cent found it positive to refer to the computer-based test, and 93 per cent of those who had read the written advice generated by the computer agreed with the advice provided. Seventy-five per cent thought that the concept could have an effect on a patients lifestyle, and 78 per cent had confidence in the computer-based test. Staff at smaller PHC units had more positive attitudes (p = 0.003) and referred a higher proportion of their patients to the computer-based test than staff at larger units (p = 0.000). Follow-up rates showed no significant differences between the categories. Staff believed that inclusion of more lifestyle areas, e. g. smoking and dietary habits, would make the test more useful. More time, education and the establishment of lifestyle practices were issues suggested in order to enhance the focus on lifestyle factors. Conclusion: Staff members have confidence in the computerized test and consider it a valuable tool. A development towards more lifestyle areas will make it even more useful.
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| 7. |
- Carlfjord, Siw, 1959-
(author)
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The Challenge of Changing Practice : Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.
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| 8. |
- Leijon, Matti, et al.
(author)
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Improvement of physical activity by a kiosk-based electronic screening and brief intervention in routine primary health care : Patient-initiated versus staff-referred
- 2011
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In: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 13:4, s. e99-
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Journal article (peer-reviewed)abstract
- Background: Interactive behavior change technology (eg, computer programs, Internet websites, and mobile phones) may facilitate the implementation of lifestyle behavior interventions in routine primary health care. Effective, fully automated solutions not involving primary health care staff may offer low-cost support for behavior change. Objectives: We explored the effectiveness of an electronic screening and brief intervention (e-SBI) deployed through a stand-alone information kiosk for promoting physical activity among sedentary patients in routine primary health care. We further tested whether its effectiveness differed between patients performing the e-SBI on their own initiative and those referred to it by primary health care staff. Methods: The e-SBI screens for the physical activity level, motivation to change, attitudes toward performing the test, and physical characteristics and provides tailored feedback supporting behavior change. A total of 7863 patients performed the e-SBI from 2007 through 2009 in routine primary health care in Östergötland County, Sweden. Of these, 2509 were considered not sufficiently physically active, and 311 of these 2509 patients agreed to participate in an optional 3-month follow-up. These 311 patients were included in the analysis and were further divided into two groups based on whether the e-SBI was performed on the patient's own initiative (informed by posters in the waiting room) or if the patient was referred to it by staff. A physical activity score representing the number of days being physically active was compared between baseline e-SBI and the 3-month follow-up. Based on physical activity recommendations, a score of 5 was considered the cutoff for being sufficiently physically active. Results: In all, 137 of 311 patients (44%) were sufficiently physically active at the 3-month follow-up. The proportion becoming sufficiently physically active was 16/55 (29%), 40/101 (40%), and 81/155 (52%) for patients with a physical activity score at baseline of 0, 1 to 2, and 3 to 4, respectively. The patient-initiated group and staff-referred group had similar mean physical activity scores at baseline (2.1, 95% confidence interval [CI] 1.8-2.3, versus 2.3, 95% CI 2.1-2.5) and at follow-up, (4.1, 95% CI 3.4-4.7, vs 4.2, 95% CI 3.7-4.8). Conclusions: Among the sedentary patients in primary health care who participated in the follow-up, the e-SBI appeared effective at promoting short-term improvement of physical activity for about half of them. The results were similar when the e-SBI was patient-initiated or staff-referred. The e-SBI may be a low-cost complement to lifestyle behavior interventions in routine primary health care and could work as a stand-alone technique not requiring the involvment of primary health care staff. © Matti Leijon, Daniel Arvidsson, Per Nilsen, Diana Stark Ekman, Siw Carlfjord, Agneta Andersson, Anne Lie Johansson, Preben Bendtsen.
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| 9. |
- Nilsen, Per, et al.
(author)
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Implementation of a computerized alcohol advice concept in routine emergency care
- 2009
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In: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 17:2, s. 113-121
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Journal article (peer-reviewed)abstract
- Background: There is a growing body of evidence for computer-generated advice for many health behaviours. This study evaluated the implementation of a computerized concept to provide tailored advice on alcohol in a Swedish emergency department (ED). Aim: The aim was to evaluate the usage of the concept over 12 months: participation rate among the ED population; representativeness of the participants; and participation development over time. Methods: The target population was defined as all patients aged 18-69 years given a card from ED triage staff with a request to conduct a computerized test about their alcohol use. After completing the 5-10-min programme, the patient received a printout, containing personalised alcohol habit feedback, as calculated by the computer from the patients answers. Data for this study were primarily obtained from the computer programme and ED logs. Results: Forty-one percent of the target population completed the computerized test and received tailored alcohol advice. The number of patients who used the concept showed a slight decreasing trend during the first half of the year, leveling off for the second half of the year. Conclusion: A computerized concept for provision of alcohol advice can be implemented in an ED without unrealistic demands on staff and with limited external support to attain sustainability.
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