| 1. |
- Dannapfel, Petra, et al.
(författare)
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A Qualitative Study of Individual and Organizational Learning through Physiotherapists’ Participation in a Research Project
- 2014
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Ingår i: International Journal of Clinical Medicine. - : OMICS. - 2158-284X .- 2158-2882. ; 5:9, s. 514-524
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Tidskriftsartikel (refereegranskat)abstract
- The need for evidence-based practice has been recognized by physiotherapy organizations over the past decades. Earlier studies have documented facilitators and barriers that affect the use and implementation of evidence-based practice. Less is known about what kind of interventions might be useful to implement evidence-based practice. This study explores what physiotherapists learn through participation in a research project relevant to their professional development towards achieving a more evidence-based physiotherapy practice. To what extent this learning was transferred to colleagues for organizational learning is also examined. This study was set in Sweden, where health care is publicly funded. Patients do not need a referral from a physician to consult a physiotherapist. Eleven interviews were conducted with physiotherapists who had participated in a randomized, controlled, multicenter, physiotherapy intervention investigating neck-specific exercise for patients with whiplash disorder. Gadamer’s hermeneutics was used to analyze the data. The physiotherapists described a range of learning experiences from their project participation, including instrumental learning (the concrete application of knowledge to achieve changes in practice) and conceptual learning (changes in knowledge, understanding or attitudes). The research project enabled the physiotherapists to develop new treatment techniques for broader application and extend their competence in techniques already known (instrumental learning). The physiotherapists believed that project participation enhanced their overall competence as physiotherapists, increased their job motivation and strengthened their self-confidence and self-efficacy (conceptual learning). Physiotherapists’ participation in the research project yielded many individual learning experiences, fostered positive attitudes to research and was conducive to achieving a more research-informed physiotherapy practice. Participation was associated with a deeper understanding of the challenges involved in conducting research. The transfer from indi-
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| 2. |
- Dannapfel, Petra, et al.
(författare)
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A Self-help Tool to Facilitate Implementation of eHealth Initiatives in Health Care (E-Ready) : Formative Evaluation
- 2022
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Ingår i: JMIR Formative Research. - : JMIR Publications Inc.. - 2561-326X. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: eHealth interventions have the potential to increase the efficiency and effectiveness of health care. However, research has shown that implementing eHealth in routine health care practice is difficult. Organizational readiness to change has been shown to be central to successful implementation. This paper describes the development and formative evaluation of a generic self-help tool, E-Ready, designed to be used by managers, project leaders, or others responsible for implementation in a broad range of health care settings. Objective: The aim of this study is to develop and evaluate a tool that could facilitate eHealth implementation in, for example, health care. Methods: A first version of the tool was generated based on implementation theory (E-Ready 1.0). A formative evaluation was undertaken through expert panels (n=15), cognitive interviews (n=17), and assessment of measurement properties on E-Ready items from 3 different workplaces (n=165) using Rasch analyses. E-Ready 1.0 was also field tested among the target population (n=29). Iterative revisions were conducted during the formative evaluation process, and E-Ready 2.0 was generated. Results: The E-Ready Tool consists of a readiness assessment survey and a hands-on manual. The survey measures perceived readiness for change (willingness and capability) at individual and collective levels: perceived conditions for change at the workplace, perceived individual conditions for change, perceived support and engagement among management, perceived readiness among colleagues, perceived consequences on status quo, and perceived workplace attitudes. The manual contains a brief introduction, instructions on how to use the tool, information on the themes of E-Ready, instructions on how to create an implementation plan, brief advice for success, and tips for further reading on implementation theory. Rasch analyses showed overall acceptable measurement properties in terms of fit validity. The subscale Individual conditions for change (3 items) had the lowest person reliability (0.56), whereas Perceived consequences on status quo (5 items) had the highest person reliability (0.87). Conclusions: E-Ready 2.0 is a new self-help tool to guide implementation targeting health care provider readiness and engagement readiness ahead of eHealth initiatives in, for example, health care settings. E-Ready can be improved further to capture additional aspects of implementation; improvements can also be made by evaluating the tool in a larger sample.
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| 3. |
- Dannapfel, Petra, et al.
(författare)
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Applying self-determination theory for improved understanding of physiotherapists rationale for using research in clinical practice: a qualitative study in Sweden
- 2014
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Ingår i: Physiotherapy Theory and Practice. - : Informa Healthcare. - 0959-3985 .- 1532-5040. ; 30:1, s. 20-28
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Tidskriftsartikel (refereegranskat)abstract
- Physiotherapists are generally positive to evidence-based practice (EBP) and the use of research in clinical practice, yet many still base clinical decisions on knowledge obtained during their initial education and/or personal experience. Our aim was to explore motivations behind physiotherapists use of research in clinical practice. Self-Determination Theory was applied to identify the different types of motivation for use of research. This theory posits that all behaviours lie along a continuum of relative autonomy, reflecting the extent to which a person endorses their actions. Eleven focus group interviews were conducted, involving 45 physiotherapists in various settings in Sweden. Data were analysed using qualitative content analysis and the findings compared with Self-Determination Theory using a deductive approach. Motivations underlying physiotherapists use of research in clinical practice were identified. Most physiotherapists expressed autonomous forms of motivation for research use, but some exhibited more controlled motivation. Several implications about how more evidence-based physiotherapy can be achieved are discussed, including the potential to tailor educational programs on EBP to better account for differences in motivation among participants, using autonomously motivated physiotherapists as change agents and creating favourable conditions to encourage autonomous motivation by way of feelings of competence, autonomy and a sense of relatedness.
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| 4. |
- Dannapfel, Petra, et al.
(författare)
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Dissemination strategy for Lean thinking in health care
- 2014
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Ingår i: International Journal of Health Care Quality Assurance. - 0952-6862 .- 1758-6542. ; 27:5, s. 391-404
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations.Design/methodology/approach – The Östergötland county council, Sweden (CCÖ ) was chosenas a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark.Findings – The Lean improvement programme was introduced to tackle challenges such as anageing society, rising care expectations and budgetary and economic constraints. It was designedas a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCÖ strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHS attempted to address nurses’ needs during dissemination, which questioned whether the CCÖ managers’ dissemination strategy is sustainable.Practical implications – This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations.Originality/value – There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.
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| 5. |
- Dannapfel, Petra, 1978-, et al.
(författare)
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Education to Increase Skills in Research Methods among Clinicians in Health Care
- 2017
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Ingår i: Journal of Health & Medical Informatics. - Los Angeles, United States : Omics Publishing Group. - 2157-7420. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe aim of this study was to evaluate participants’ and managers’ experience of the design and content of an education programme. The Knowledge to Action (KTA) framework was applied to identify the steps of knowledge creation and action in the education programme.MethodsData were collected from 18 participants representing two groups: participants in the intervention and supervisors and managers. Two focus groups took place: two with participants in the intervention (4 and 3 in each) and one with eleven managers.ResultsAll steps in the KTA framework were identified and discussed from several aspects. The importance of selecting projects that were relevant and added value in their clinics was mentioned by all participants. The participants also mentioned that after the education, they had further understanding and increased skills in how to be active and perform continuous improvement projects. The step in the KTA process regarding how to adapt knowledge to local context was not discussed explicitly by the participants or managers.DiscussionEducation in research methods and performing improvement projects to develop the clinic creates a more positive attitude to working with continuous improvement. The participant’s self-esteem and knowledge increased regarding how to work with improvements. It is important to have the manager’s support to perform a project. Emphasis was on knowledge inquiry and synthesis and presenting the results with or without possible solutions. The participants and managers talked about barriers and knowledge use more generally and at an organizational level. This means that the participants did not gain the last bit of nowledge needed to put the action into practice. This implies that the problem regarding lack of implementation skills in health care might remain.
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| 6. |
- Dannapfel, Petra, 1978-, et al.
(författare)
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Evidence-Based Physiotherapy Culture : The Influence of Health Care Leaders in Sweden
- 2016
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Ingår i: Open Journal of Leadership. - Irvine, CA, United States : Scientific Research Publishing. - 2167-7751 .- 2167-7743. ; 5:3, s. 51-69
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Tidskriftsartikel (refereegranskat)abstract
- Research in physiotherapy has increased rapidly over the last decade, yet studies have shown that many practice decisions continue to be based on knowledge obtained during initial physiotherapy education and/or personal experience, rather than findings from research. Both barriers and facilitators to achieving a more evidence-based practice (EBP) in physiotherapy have been identified. Leadership is a facilitator that has been recognized to have an important influence on the implementation of EBP in various settings. Our aim was to explore how physiotherapy leaders in Sweden influence the culture for implementation of evidence-based physiotherapy practice. Nine interviews with managers of physiotherapy clinics were conducted in various settings in Sweden. Data were analysed using qualitative analysis and a framework developed by Schein(Schein, 2010) . Organizational Culture and Leadership (4th ed.). San Francisco, CA: Jossey-Bass) was applied. The framework identifies a number of mechanisms by which leaders can influence the culture of an organization and/or groups within an organization. The mechanisms of paying attention to, measuring and controlling on a regular basis as well as deliberate role modelling, teaching and coaching did have some relevance. However, EBP issues seemed to depend on committed individuals, often younger physiotherapists, who were interested in research. Overall, there was limited relevance for most of the embedding mechanisms. The findings suggest that physiotherapy leaders in Sweden contribute to a modest degree to establishing a culture conducive to implementation of an evidence-based physiotherapy practice.
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| 7. |
- Dannapfel, Petra, 1978-
(författare)
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Evidence-Based Practice in Practice : Exploring Conditions for Using Research in Physiotherapy
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Research developments have led to increased opportunities for the use of improved diagnostic and treatment methods in physiotherapy and other areas of health care. The emergence of the evidence-based practice (EBP) movement has led to higher expectations for a more research-informed health care practice that integrates the best available research evidence with clinical experience and patient priorities and values. Physiotherapy research has grown exponentially, contributing to an increased interest in achieving a more evidence-based physiotherapy practice. However, implementation research has identified many individual and contextual barriers to research use. Strategies to achieve a more EBP tend to narrowly target individual practitioners to influence their knowledge, skills and attitudes concerning research use. However, there is an emerging recognition that contextual conditions such as leadership and culture are critical to successfully implementing EBP.Against this background, the overall aim of this thesis was to explore conditions at different levels, from the individual level to the organizational level and beyond, for the use of research and implementation of an evidence-based physiotherapy practice. The thesis consists of four interrelated papers that address various aspects of the aim. Individual and focus group interviews were conducted with physiotherapists and managers within physiotherapy in various county councils in Sweden between 2011 and 2014. Data were analysed using qualitative content analysis, direct content analysis and hermeneutics.It was found that many different types of motivation underlie physiotherapists’ use of research in their clinical practice, from amotivation (i.e. a lack of intention to engage in research use) to intrinsic motivation (research use is perceived as interesting and satisfying in itself). Most physiotherapists tend to view research use in favourable terms. Physiotherapists’ participation in a research project can yield many individual learning experiences that might contribute to a more research-informed physiotherapy practice. However, organizational learning was more limited. Numerous conditions at different levels (individual, workplace and extra-organizational levels) provide support for physiotherapists’ use of research in their clinical practice. However, physiotherapy leaders appear to contribute to a modest degree to establishing a culture that is conducive to implementing EBP in physiotherapy practice. Instead, EBP issues largely seem to depend on committed individual physiotherapists who keep to up to date with research in physiotherapy and inform colleagues about the latest research findings.
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| 8. |
- Dannapfel, Petra, et al.
(författare)
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Fostering a culture of evidence-based physiotherapy practice : a qualitative analysis of the influence of health care leaders in Sweden
- 2015
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Research in physiotherapy has increased rapidly over the last decade, yet studies have shown that many practice decisions continue to be based on knowledge obtained during initial physiotherapy education and/or personal experience, rather than findings from research. Both barriers and facilitators to achieving a more evidence-based practice (EBP) in physiotherapy have been identified. Leadership is one facilitator that has been recognized to have an important influence on the implementation of EBP in various settings. Our aim was to explore how physiotherapy leaders in Sweden influence the culture for implementation of evidence-based physiotherapy practice.Methods: Nine interviews with managers of physiotherapy clinics were conducted in various settings in Sweden. Data were analysed using qualitative analysis and a framework developed by Schein (Schein EH. Organizational culture and leadership. 4th ed. San Francisco, CA: Jossey-Bass; 2010) was applied.Results: The framework identifies a number mechanisms by which leaders can influence the culture of an organization and/or groups within an organization. The mechanisms of paying attention to, measuring and controlling on a regular basis as well as deliberate role modelling, teaching and coaching did have some relevance. However, EBP issues seemed to depend on committed individuals, often younger physiotherapists, who were interested in research.Conclusions: Overall, there was limited relevance for most of the embedding mechanisms. The findings suggest that physiotherapy leaders in Sweden contribute to a modest degree to establishing a culture conducive to implementation of an evidence-based physiotherapy practice.
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| 9. |
- Dannapfel, Petra, et al.
(författare)
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Implementing smoking cessation in routine primary care-a qualitative study
- 2023
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Ingår i: FRONTIERS IN HEALTH SERVICES. - : FRONTIERS MEDIA SA. - 2813-0146. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe use of digital tools has been proposed as a solution to some of the challenges of providing preventative services in primary care. Although there is a general acceptance among patients to use digital self-help tools to quit smoking, and healthcare organizations are increasingly urged to incorporate these tools in clinical practice, it is unclear how and for whom these innovations can be incorporated into clinical practice.ObjectivesTo explore health care professionals' perceptions about smoking cessation practice in routine primary care and the use of digital tools in this work.MethodsA qualitative study with nine in-depth telephone interviews with health care professionals working in primary care in Sweden. Convenience sampling and snowball technique was used as recruitment strategy. Informants included registered, district and auxiliary nurses as well as behavioral therapists. All informants were female, between 43 and 57 years old and experience of working with smoking cessation in primary care and possibility to recommend digital interventions to smokers.ResultsInformants described smoking cessation practice in primary care as (i) identifying smoking patients, (ii) pursuing standardized routines for smoking cessation practice and (iii) keeping smoking cessation practice on the agenda. Digital tools were described by informants to be used in different ways: (i) replicating practice, (ii) complementing practice and (iii) enabling access to health care practitioners. Finally, the analysis showed that patients' expectations and behaviors contributed to how and when smoking cessation practice was conducted, including the use of digital tools.ConclusionsImplementing smoking cessation practice in primary care in Sweden encompass continuous work of reaching smoking patients, building buy-in among peers and keeping tobacco on the practice agenda. Digital interventions are used to replicate, complement and enabling access to care. The findings suggest that poor continuity of staff and negative attitudes towards preventative work may challenge smoking cessation practice. However, societal changes in the awareness of the health risks of tobacco use including shifting social norms regarding the acceptance of smoking may contribute to a normalization of speaking about smoking in primary care practice. Increased knowledge is needed on how, and for whom digital tools can be incorporated in clinical practice.
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| 10. |
- Dannapfel, Petra, et al.
(författare)
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What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden
- 2013
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Ingår i: Implementation Science. - : BioMed Central. - 1748-5908. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEvidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice.MethodsPatients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis.ResultsAnalysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education).ConclusionsSupportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.
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