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- Gustavsson, Catharina, et al.
(författare)
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What is required to facilitate implementation of Swedish physical activity on prescription? - interview study with primary healthcare staff and management
- 2018
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare.METHODS: Eighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis.RESULTS: We identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management's beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling.CONCLUSION: The study provides knowledge regarding requirements to facilitate the implementation of SPAP in healthcare. There was limited knowledge among health professionals regarding core components of SPAP and how to practise the method, which speaks for in-depth training in the SPAP method. The findings highlight the importance of forming policies and guidelines and establishing organisational supporting structures, and ensuring that these are well known and approved in all parts of the healthcare organisation.
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| 2. |
- Bartusch, Cajsa, 1965-, et al.
(författare)
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Exploring variance in residential electricity consumption : Household features and building properties
- 2012
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Ingår i: Applied Energy. - : Elsevier. - 0306-2619 .- 1872-9118. ; 92, s. 637-643
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Tidskriftsartikel (refereegranskat)abstract
- Improved means of controlling electricity consumption plays an important part in boosting energy efficiency in the Swedish power market. Developing policy instruments to that end requires more in-depth statistics on electricity use in the residential sector, among other things. The aim of the study has accordingly been to assess the extent of variance in annual electricity consumption in single-family homes as well as to estimate the impact of household features and building properties in this respect using independent samples t-tests and one-way as well as univariate independent samples analyses of variance. Statistically significant variances associated with geographic area, heating system, number of family members, family composition, year of construction, electric water heater and electric underfloor heating have been established. The overall result of the analyses is nevertheless that variance in residential electricity consumption cannot be fully explained by independent variables related to household and building characteristics alone. As for the methodological approach, the results further suggest that methods for statistical analysis of variance are of considerable value in indentifying key indicators for policy update and development.
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| 3. |
- Bartusch, Cajsa, 1965-, et al.
(författare)
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Introducing a demand-based electricity distribution tariff in the residential sector : demand response and customer perception
- 2011
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Ingår i: Energy Policy. - : Elsevier. - 0301-4215 .- 1873-6777. ; 39:9, s. 5008-5025
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Tidskriftsartikel (refereegranskat)abstract
- Increased demand response is essential to fully exploit the Swedish power system, which in turn is an absolute prerequisite for meeting political goals related to energy efficiency and climate change. Demand response programs are, nonetheless, still exceptional in the residential sector of the Swedish electricity market, one contributory factor being lack of knowledge about the extent of the potential gains. In light of these circumstances, this empirical study set out with the intention of estimating the scope of households’ response to, and assessing customers’ perception of, a demand-based time-of-use electricity distribution tariff. The results show that households as a whole have a fairly high opinion of the demand-based tariff and act on its intrinsic price signals by decreasing peak demand in peak periods and shifting electricity use from peak to off-peak periods.
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| 4. |
- Bartusch, Cajsa, 1965-, et al.
(författare)
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Potential of hourly settlements in the residential sector of the Swedish electricity market : Estimations of risk reduction and economic result
- 2010
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Ingår i: International Journal of Green Energy. - : Taylor & Francis. - 1543-5075 .- 1543-5083. ; 7:3, s. 224-240
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Tidskriftsartikel (refereegranskat)abstract
- Increased demand response is essential in order to boost the effectiveness of the Swedish power market. The all-embracing installation of automatic meter reading systems enables power suppliers to introduce hourly settlements in the residential sector. The aim of the study has been to assess the impact of electricity retailers’ physical and financial risk in customer segments with different heating systems as well as to estimate the potential of the electricity contract ”Fixed price with the right to return” in terms of economic consequences and risk management. The results show that households whose main heating system consists of a geothermal heat pump constitute the largest physical price and volume risk of suppliers. The gain of introducing hourly settlements in the residential electricity market has furthermore proven to be manifold from both an economic and risk reducing point of view.
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| 7. |
- Fritz, Johanna, et al.
(författare)
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Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods
- 2019
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Ingår i: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. Methods An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used. Results The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking. Conclusions The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.
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| 8. |
- Fritz, Johanna, et al.
(författare)
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Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability
- 2020
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 42:24, s. 3467-3474
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To explore the effects on and sustainability of physiotherapists' clinical behavior when using facilitation to support the implementation of a behavioral medicine approach in primary health care for patients with persistent musculoskeletal pain. Methods: A quasi-experimental pre-/post-test trial was conducted. Fifteen physiotherapists were included in the experimental group, and nine in the control group. Based on social cognitive theory and the Promoting Action on Research Implementation in Health Services framework, facilitation with multifaceted implementation methods was used during a six-month period. Clinical behaviors were investigated with a study-specific questionnaire, structured observations, self-reports and patient records. Descriptive and non-parametric statistical methods were used for analyzing differences over time and effect size. Results: A sustained increase in self-efficacy for applying the behavioral medicine approach was found. Clinical actions and verbal expressions changed significantly, and the effect size was large; however, changes were not sustained at follow-ups. The behavioral changes were mainly related to the goal setting, self-monitoring and functional behavioral analysis components. No changes in clinical behavior were found in the control group. Conclusion: Tailored multifaceted facilitation can support the implementation of a behavioral medicine approach in physiotherapy in primary health care, but more comprehensive actions targeting sustainability are needed.
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| 9. |
- Fritz, Johanna, 1974-
(författare)
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Implementation of a behavioural medicine approach in physiotherapy : Determinants, clinical behaviours, patient outcomes and the implementation process
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Current research shows that a behavioural medicine approach in physiotherapy increases the ability to participate in daily activities and decreases sick leave in patients with persistent musculoskeletal pain. A behavioural medicine approach means that the physiotherapist systematically considers biopsychosocial factors of importance for the patient's activity and participation. Active patient involvement is central, and behaviour change techniques are used. One in seven of the patients in primary health care suffers from persistent musculoskeletal pain. Therefore, primary health care needs to implement a behavioural medicine approach in physiotherapy. However, the implementation of new methods is challenging. It is important to increase the knowledge about how to implement a behavioural medicine approach into physiotherapy clinical practice to make recommended treatment available to more patients with persistent musculoskeletal pain. The overall aim of this thesis was therefore to develop and evaluate methods for supporting the implementation of a behavioural medicine approach in physiotherapy for patients with persistent musculoskeletal pain.In study I, determinants of using a behavioural medicine approach in physiotherapy were identified using a qualitative multiple-case study design. An implementation intervention was developed based on these determinants and on theoretical assumptions regarding behaviour change and learning. The implementation intervention was tested in a quasi-experimental trial for six months and evaluated by focusing on physiotherapists' clinical behaviour changes in study II and the effects on patients' health in study III. In study IV, a process evaluation was conducted with a mixed methods design to explain the impact mechanisms of the implementation intervention. Altogether, 28 physiotherapists, 159 patients and three managers participated in the project.The determinants identified in study I were associated with the physiotherapist, the patient and the workplace. An implementation intervention was developed based on these determinants and on assumptions in the social cognitive theory, the constructivist learning theory, and the Promoting Action on Research Implementation in Health Services (PARIHS) framework. The implementation intervention consisted of outreach visits, peer coaching, educational materials, individual goalsetting, video feedback, self-monitoring in a diary, the stimulation of manager support and an information leaflet for patients. Immediately after the implementation period, the physiotherapists significantly changed their clinical behaviour, but these changes were not sustained. The patients treated by these physiotherapists achieved no further health improvement compared to a control group. Outreach visits, peer coaching, educational material and individual goalsetting were perceived by the physiotherapists as the most useful methods and supported the implementation through multiple learning methods, action planning, processing experiences, synergy effects with self-efficacy beliefs, and extrinsic motivation.In conclusion, this thesis contributes to an increased understanding of the complexity regarding what affects the implementation of a behavioural medicine approach in physiotherapy and the promising methods and their impact mechanisms that support this implementation. A distinction between achieving clinical behaviour changes and sustaining these changes is highlighted. This implies that an implementation intervention needs to support both factors in order for the implementation of a behavioural medicine approach to benefit the patients. The thesis also illustrates how combined theoretical perspectives can inform an implementation intervention in physiotherapy in a useful way.
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| 10. |
- Fritz, Johanna, et al.
(författare)
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Implementation of a behavioural medicine approach in physiotherapy – a process evaluation.
- 2017
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Ingår i: World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017..
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Konferensbidrag (refereegranskat)abstract
- Background: A behavioural medicine approach in physiotherapy for patients with persistent musculoskeletal pain is recommended based on evidence. The approach aims at an individually tailored treatment targeting motor behaviour, cognition, disability and active patient involvement. The behavioural medicine approach is complex and it is challenging in implementation to achieve clinically relevant behaviours in physiotherapy. Process evaluation is an essential part of designing and testing implementation interventions to improve the quality of the implementation. However, studies evaluating the implementation process of a behavioural medicine approach in physiotherapy are sparse.Purpose: To explore the implementation process of a behavioural medicine approach in physiotherapy.Methods: Qualitative and quantitative methods were used. 15 physiotherapists working in six primary health care units were consecutively included. A theory based implementation intervention was tailored to the participating individual physiotherapists. Active and multifaceted implementation strategies were used during a total of seven days spread over a six months implementation period. The main implementation strategies were external facilitation and peer-learning. Ten two-hours outreach sessions were offered to each unit. The physiotherapists were encouraged to use individual goal setting and video recordings of treatment sessions to facilitate feedback and reflection during the sessions with the external facilitator. Process data were collected using semi-structured interviews, self-reports of time allocation for different implementation strategies and documented individual goals. Qualitative content analysis and quantitative frequency scorings were used for data analyses.Results: In median the physiotherapists participated in 9 (3-10) out of 10 sessions with the external facilitator. Discussing clinical experiences of the behavioural medicine approach together with the external facilitator was perceived as valuable. These discussions stimulated reflection and problem solving, and was also experienced as a reminder for practicing skills in behavioural medicine. Video recordings of treatment sessions were used by ten of the physiotherapists at 17 out of 57 possible sessions. Video recordings were experienced as too complicated to use in relation to the gains. Lack of time was also considered as a barrier for using video recordings. Individual goal-setting from one session to the next with the external facilitator was frequently used by all the participants. Relevant skills for the goals were practiced in between the sessions. However, goal setting was not considered important by the physiotherapists. In median the physiotherapists spent 3.25 (0-9.5) hours for peer discussions. Peer discussions were a strategy that the physiotherapists wanted to continue with, even after the implementation intervention period. Even though the physiotherapists had permission from the manager to spend time on the implementation intervention, it was challenging for the physiotherapists to prioritize the implementation intervention before patient care.Conclusion(s): External facilitation and peer discussions were perceived as important strategies for stimulating practice of behavioural medicine skills in physiotherapy. Further, peer discussions could stimulate sustainability of the implementation. The physiotherapists needed support to use the designated time for the implementation.Implications: Quantitative and qualitative analyses of the implementation process is useful for understanding the mechanisms of impact for the implementation intervention, how outcomes were achieved and for future replications.
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