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- Eriksson, Leif
(författare)
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Knowledge Translation in Vietnam : Evaluating facilitation as a tool for improved neonatal health and survival
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Neonatal mortality remains a problem worldwide, despite the existence of low-cost and evidence-based interventions. Unfortunately, the translation of these interventions into practice is deficient.The aim of this thesis was to study aspects of knowledge translation (KT) before and during the Neonatal Knowledge Into Practice (NeoKIP) trial in Quang Ninh, Vietnam. Over a period of three years, this trial evaluated the use of facilitators from the Women’s Union who supported maternal and newborn health groups (MNHG) comprised of eight local stakeholders, as an intervention for improved neonatal survival.In the first two studies (before intervention) we assessed primary health care staff’s knowledge and material preparedness regarding evidence-based neonatal care and explored how primary health care staff translated knowledge into practice. The last two studies (during intervention) were process evaluations aimed at describing the implementation, process and mechanism of the NeoKIP intervention.Primary health care workers achieved 60% of the maximum score in the knowledge survey. Two separate geographical areas were identified with differences in staff levels of knowledge and concurrent disparities in neonatal survival, antenatal care and post-natal home visits. Staff perceived formal training to be the best way to acquire knowledge but asked for more interaction between colleagues within the healthcare system. Traditional medicine, lack of resources, low workload and poorly paid staff constituted barriers for the development of staff knowledge and skills.Eleven facilitators were trained to cover eight facilitator positions. Of the 44 MNHGs, 43 completed their activities to the end of the study. In total, 95% of the monthly meetings with a MNHG and a facilitator were conducted with attendance at 86%. MNHGs identified 32 unique problems, mainly families’ knowledge/behavior, and implemented 39 unique actions, mostly regarding communication. MNHGs experienced that the group was strategically composed to influence change in the communes and facilitators were identified as being important to sustaining activities over time. The facilitators’ lack of health knowledge was regarded as a deficit in assisting the MNHGs, but their performance and skills increased over time.This low-cost model, building on local stakeholder involvement, has the capacity to be scaled up within existing healthcare structures.
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- Målqvist, Mats, 1971-
(författare)
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Who can save the unseen? : Studies on neonatal mortality in Quang Ninh province, Vietnam
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Globally, neonatal mortality has remained basically unchanged for the last three to four decades and every year almost four million newborns die before reaching one month of age. This persistent mortality is related to an invisibility of the newborn child in policies and statistics and a neglect of health care decision-makers, planners and practitioners to deliver a perinatal continuum of care. In recent years attention has however been brought to the unchanged neonatal mortality in an effort to improve survival. The present thesis seeks to increase understanding of obstacles for better neonatal survival. The studies performed are undertaken as sub-studies to the NeoKIP project in Quang Ninh province in northern Vietnam, a randomized controlled trial of knowledge implementation for improved neonatal survival (Neonatal Health – Knowledge Into Practice, ISRCTN 44599712). In the first paper we investigated and discussed the scope of invisibility of neonatal mortality through measuring the accuracy of official statistics on neonatal deaths. The second paper reports an inquiry of determinants of neonatal mortality by use of a population-based case-referent design. Paper III and IV analyse delivery care utilization and care seeking patterns prior to and at delivery using narratives and GIS technique. There was a substantial under-reporting of neonatal mortality in the official statistics, with study results showing a four times higher neonatal mortality rate in Quang Ninh province than reported to the Ministry of Health. This neonatal mortality rate of 16/1000 live births (as compared to 4.2/1000 in official reports) was unevenly distributed in the province, showing large geographical discrepancies. In the rural and remote areas of Vietnam education level is lower and the concentrations of ethnic minorities and poor households are higher. Ethnic minority belonging was associated with a more than doubled risk of neonatal death compared to the hegemonic group of Kinh (OR 2.08 CI 95 % 1.39 – 3.10). This increased risk was independent of household economic status or maternal education level. Neonatal mortality was also associated with home deliveries, non-attendance to antenatal care and distance to the health care facilities. However, ethnic minority mothers still had an increased risk of experiencing a neonatal death even if they attended antenatal care, delivered at or lived close to a health facility. The invisibility of the neonatal period in health information systems hides the true width of the neonatal mortality challenge. By not acknowledging the problem, the marginalization of already disadvantaged groups continues, leaving ethnic minority babies with an elevated risk of dying during the first month in life. This example of ethnic inequity highlights the importance to target those most in need. The studies of the present thesis should therefore be looked upon as a contribution to the struggle to illuminate the global burden of neonatal mortality.
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- Almgren White, Anette, 1960-
(författare)
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Intermedial narration i den fotolyriska bilderboken : Jean Claude Arnault, Katarina Frostenson och Rut Hillarp
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This bipartite thesis presents and implements an intermedial model for co-reading poems and photographs in paper books, a genre I call photo poetry. A survey of the genre in Sweden was carried out and presented in a selected bibliography in my licentiate thesis.Two well-established poets, Katarina Frostenson and Rut Hillarp, made their debut in the genre in the 1980s and have since produced three books each. Frostenson cooperates with photographer Jean Claude Arnault and Hillarp created the poems as well as the pictures herself. Scholarly studies up to now have focused on the poems, however, and have therefore neglected the impact of the photographic pictures.The first part of the thesis elaborates a model based on the framework of the picture book and adapted to the text genre of poetry and the epistemology of the photographic picture. Two different narrative reading strategies are developed and applied to the material: the metonymical and the metaphorical linking. The metonymical linking implies that the diegesis on the spread is perceived to be part of a larger diegesis and that that diegesis has direct virtual contact with the diegesis on the next spread. The metaphorical linking implies that the diegesis on the single spread is perceived to be part of a larger diegesis, but that that diegesis has no direct virtual spatial contact with the next spread.Whether or not a diegesis is perceived to have direct virtual spatial contact with spreads depends on the story’s display of the contingency of characters, time and place.The model is based on the relations tied to the book’s construction: the schematic, the synchronic and the diachronic relation. The schematic relation concerns meaning created on all spreads, the synchronic relation meaning on a single spread, and the diachronic relation meanings on spreads in a row. The schematic and the diachronic may appear to overlap somewhat but in the schematic relation the focus is on tracing different story schemes, and in the diachronic relation the focus is on how the narration progresses and alternates between different schemes.The findings show that with the co-reading model the impact of the photographs gives a deeper understanding of not only the narrative interplay of word and image but also of semiotic, intermedial and intertextual connections. The reading strategies applied show that Frostenson’s and Arnault’s works gain from a metonymically linked interpretation whereasHillarp’s mainly gain from a metaphorically linked interpretation. The study also discusses the impact of the photographic picture and connects it to the semiotic theory of C. S. Peirce as well as to Western picture practices.
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- Duc, Duong, 1984-
(författare)
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Healthcare context for knowledge translation in Vietnam : Development and application of the Context Assessment for Community Health (COACH) tool
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The failure to translate evidence into clinical practice has been repeatedly highlighted. This failure is partly attributed to disregarding the context within which healthcare is delivered. The aim of this thesis was to develop and psychometrically evaluate the Context Assessment for Community Health (COACH) tool, and, through that process, provide opportunities to measure aspects of context perceived to be important for Knowledge Translation (KT) interventions in low- and middle-income countries (LMIC).All four studies in this thesis were mainly undertaken in Quang Ninh province, Vietnam during 2008–2014. Study II, however, was also conducted in four other LMICs (Bangladesh, Nicaragua, South Africa, and Uganda). Study I employed inductive content analysis of 16 focus group discussions to explore the influence of context in a community-based facilitation intervention in Vietnam. Studies II and III reported on the development of the COACH tool and assessment of its psychometric properties. Study IV used the COACH tool in a survey among health workers in Vietnam.To date, three sources of evidence regarding validity of the COACH tool have been provided, that is, test content, response processes, and internal instrument structure, with promising psychometric characteristics. The COACH tool could be used as means of characterizing aspects of context ahead of KT interventions, for tailoring KT strategies, and for further understanding of the results of KT interventions.
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- Fridberg, Helena
(författare)
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The complexities of implementing person-centred care in a real-world setting : A case study with seven embedded units
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Implementing complex innovations such as person-centred care (PCC) is gaining international momentum. Studies in real-world settings have the potential to designate factors crucial for large-scale implementation.Overall aim: To increase the knowledge about the implementation process of PCC in a real-world setting.Methods: The thesis consists of a case study with seven embedded units conducted between 2016 and 2019. Study I explored the strategies and how they were enacted to support implementation of PCC by triangulating data from activity logs, interviews with change agents, and written documents. Study II explored how the PCC model of the Gothenburg University Centre for Person-centred Care and its underlying philosophical principles were operationalised. Study III explored health care professionals’ perceptions of PCC characteristics by an interview study using focus groups, dyadic interviews, and individual interviews. In study IV a mixed-methods design was applied to develop a generic questionnaire measuring patients’ perceptions of PCC. The study was conducted in three phases and included interviews, a Delphi study and patients responding to the questionnaire, and taking part in cognitive interviews. Data were analysed using Rasch and qualitative content analyses.Results: The overall results of this case study show the complexity of health care and change processes, focusing the implementation of a new care approach. Specifically, study I revealed how 43 discrete strategies were used in the participating units to support implementation of PCC with wide frequency and dose variation of activities. Strategies used to train and educate HCPs and develop interrelationships between stakeholders were most often reported (78%). A limited number of strategies (4.6%) reported using evaluative and iterative strategies. Study II highlights the challenges of operationalising an abstract ethical approach into concrete core practices. Both similarities and dissimilarities between the participating health care units were identified. In study III, nine constructs from the CFIR were identified as pertinent to describe HCPs’ perceptions of PCC and showed how their perceptions were shaped by diverse factors, including local context and individual understanding of PCC. In study IV, a questionnaire measuring patients’ perceptions of PCC was developed and found to be psychometrically satisfactory.Conclusions: This case study contributes to an increased understanding of the complexities of implementing PCC in various health care settings. The complexities are apparent in all aspects of the case and contribute with guidance into the different factors that need to be considered during the change process, preferably before organisations embark on implementation of PCC.
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- 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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