| 1. |
|
|
| 2. |
- Fridberg, Helena, et al.
(författare)
-
Development and evaluation of the measurement properties of a generic questionnaire measuring patient perceptions of person-centred care
- 2020
-
Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background Implementation of person-centred care (PCC) is a challenging undertaking. Thus, a call has been issued for a robust and generic instrument to measure and enable evaluation of PCC across settings and patient groups. This study aimed to develop a generic questionnaire measuring patients' perceptions of PCC. Further aims were to evaluate its content and measurement properties using a mixed-methods approach entailing Rasch and qualitative content analyses. Methods The study was conducted in three iterative phases. Phase one included six key informants to gain a broad view of the concept. Phase two entailed a Delphi study involving two rounds with eight experts who generated ratings on relevance, readability, comprehensiveness and suggestions for revision. Data were analysed using the Item Content Validity Index in conjunction with qualitative comments to improve the questionnaire. Phase three was performed using a mixed-methods design. Quantitative data were collected from patients (n = 553) responding to the questionnaire who were recruited from six in- and outpatient care units in a health care region in Sweden. Data was analysed using the Rasch measurement model. Qualitative data were based on the respondents' free-text comments, cognitive interviews (n = 10) and field notes, and then analysed with deductive content analysis. Results A questionnaire was developed and operationalised based on the information given by key informants in phase one and then validated for its content by experts in phase two. In phase three Rasch analyses revealed problems with targeting, thresholds and two misfitting items. These problems were corroborated by data from the qualitative analyses, which also revealed some issues of wording and interpretation of items. When thresholds were resolved and two items removed, the questionnaire met the assumptions of the Rasch model. Conclusions Experts gave the questionnaire content high ratings and it met measurement requirements assumed by the Rasch model after revisions. Those problems on targeting that remain need to be addressed in future studies. Meanwhile, we regard the questionnaire as of sufficient quality to be useful in benchmarking PCC.
|
|
| 3. |
|
|
| 4. |
- Fridberg, Helena, et al.
(författare)
-
Operationalisation of person-centred care in a real-world setting: a case study with six embedded units
- 2022
-
Ingår i: Bmc Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although person-centred care (PCC) is growing globally in popularity it is often vague and lacks conceptual clarity and definition. The ambiguity stretches from PCC's underlying philosophical principles and definitions of the concept to how it is operationalised and practised on the ground by health care professionals. We explore how the PCC model by the Gothenburg University Centre for Person-centred Care (GPCC) was operationalised in a real-world setting by using a set of recommendations by Fixsen and others that define and structure the core components of innovations in four distinct but interrelated components: philosophical principles and values, contextual factors, structural elements and core practices. Thus, this study aimed to increase knowledge about core practices in PCC in six health care units in real-world circumstances. METHODS: A case study with six embedded health care units was conducted from 2016 to 2019. We collected data from three sources: interviews (n=12) with change agents, activity logs and written documents. Data were triangulated, and core practices were identified and deductively coded to the PCC model's structural elements: initiating, working and safeguarding the partnership with patients. RESULTS: We identified operationalisations of PCC in line with the three structural elements in the GPCC model at all included health care units. A range of both similarities and dissimilarities between units were identified, including the level of detail in describing PCC practices, when these practices were conducted and by whom at the workplace. The recommendations for describing the core components of PCC also helped us identify how some operationalisations of PCC seemed more driven by contextual factors, including a new regulation for planning and documenting care across health care specialities. CONCLUSIONS: Our findings show how PCC is operationalised in different health care units in a real-world setting based on change agents' understanding of the concept and their unique context. Increased knowledge of PCC and its philosophical principles and values, contextual factors, structural elements and core practices, is necessary to build a common understanding of the PCC-concept. Such knowledge is essential when PCC is operationalised as part of implementation efforts in health care. © 2022. The Author(s).
|
|
| 5. |
- Fridberg, Helena, et al.
(författare)
-
Self-efficacy in activities of daily living and symptom management in people with dizziness : a focus group study
- 2019
-
Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 41:6, s. 705-713
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Self-efficacy is associated with health status, health behaviour and health behaviour change in various chronic health conditions.PURPOSE: To describe self-efficacy in relation to Activities of daily living and symptom management in people with dizziness.MATERIAL AND METHODS: Thirteen women and three men, aged 45-82 years, with persistent dizziness (duration 4 months to 30 years) were recruited from an outpatient physiotherapy unit. A qualitative study was conducted using four focus groups and one individual interview and was then analysed with qualitative content analysis.RESULTS: The participants conveyed, in-depth information concerning two predefined main categories. Self-efficacy in Activities of daily living was related to challenging body positions and motions, environments, social activities, work tasks, and complex cognitive behaviours. Self-efficacy in symptom management was related to distress and aggravated symptoms, unfamiliar environment, and unknown people.CONCLUSIONS: People with dizziness describe how self-efficacy for specific activities varies according to the perceived difficulty of the task, the context of the activity, and day-to-day variations in general wellbeing. The results underscore the importance of targeting self-efficacy in the rehabilitation of people with dizziness. Our findings can guide the rehabilitation process by providing a deeper understanding of self-efficacy judgements in relation to Activities of daily living and symptom management in people with dizziness. Implication for rehabilitation This study adds important in-depth knowledge to the rehabilitation area on self-efficacy beliefs in relation to Activities of daily living and symptom management in people with dizziness. Self-efficacy for specific activities varies according to the perceived difficulty of the task, the context in which the activity takes place and day-to-day variations in perceived general well-being. The results can be used as a topic list to guide rehabilitation efforts in exploring and intervening aspects of people's everyday activities that are affected by low self-efficacy judgements. Activities perceived to be crucial to everyday life and important for well-being should be targeted in rehabilitation to increase self-efficacy and thereby activity performance and participation in people with dizziness.
|
|
| 6. |
- Fridberg, Helena
(författare)
-
The complexities of implementing person-centred care in a real-world setting : A case study with seven embedded units
- 2022
-
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.
|
|
| 7. |
- Fridberg, Helena, et al.
(författare)
-
The innovation characteristics of person-centred care as perceived by healthcare professionals: an interview study employing a deductive-inductive content analysis guided by the consolidated framework for implementation research
- 2021
-
Ingår i: Bmc Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background Person-centred care (PCC) is promoted as an innovation that will improve patients' rights and increase their participation in healthcare. Experience shows that the implementation of PCC is challenging and often results in varying levels of adoption. How health care professionals (HCPs) perceive an innovation such as PCC is an important factor to consider in implementation. Yet, such studies are scarce. Thus, in a sample of healthcare units in a region in Sweden, involved in a transition to PCC, we aimed to investigate HCPs' perceptions of PCC. Methods An interview study was conducted in 2018 during the implementation of PCC with HCPs (n = 97) representing diverse vocational roles in six healthcare contexts. Data were collected via focus groups (n = 15), dyadic interviews (n = 5), and individual interviews (n = 22) and analysed using a deductive-inductive content analysis. The deductive approach was guided by the Consolidated Framework for Implementation Research (CFIR), followed by an inductive analysis to describe HCPs' in-depth perceptions of PCC in relation to each of the CFIR constructs. Results Eight constructs from two of the CFIR domains, Intervention characteristics and Inner setting, were used to code HCPs' perceptions of PCC. One construct, Observability, was added to the coding sheet to fully describe all the data. The constructs Relative advantage, Complexity, Compatibility, Observability, and Available resources were discussed in depth by HCPs and resulted in rich and detailed data in the inductive data analysis. This analysis showed large variations in perceptions of PCC among HCPs, based on factors such as the PCCs ethical underpinnings, its operationalisation into concrete working routines, and each HCPs' unique recognition of PCC and the value they placed on it. Conclusions We identified nine CFIR constructs that seem pertinent to HCPs' perceptions of PCC. HCPs report an array of mixed perceptions of PCC, underlining its complex nature. The perceptions are shaped by a range of factors, such as their individual understandings of the concept and the operationalisation of PCC in their local context. Stakeholders in charge of implementing PCC might use the results as a guide, delineating factors that may be important to consider in a wide range of healthcare contexts.
|
|
| 8. |
- Fridberg, Helena, et al.
(författare)
-
Tracking, naming, specifying, and comparing implementation strategies for person-centred care in a real-world setting: a case study with seven embedded units
- 2022
-
Ingår i: Bmc Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector face two intertwined and complex challenges. First, making sense of PCC as an intervention with complex innovation characteristics and second, staging implementation of PCC by choosing appropriate implementation strategies. We aimed to explore one of these challenges by tracking, naming, specifying, and comparing which strategies and how strategies were enacted to support the implementation of more PCC in a real-world setting represented by one health care region in Sweden. Methods A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification. Results Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%. Conclusions Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.
|
|
| 9. |
|
|
| 10. |
|
|
