| 1. |
- Farnsworth von Cederwald, Anneli, et al.
(författare)
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Primary Care Behavioral Health in Sweden - a protocol of a cluster randomized trial evaluating outcomes related to implementation, organization, and patients (KAIROS)
- 2023
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundProviding comprehensive and continuous care for patients whose conditions have mental or behavioral components is a central challenge in primary care and an important part of improving universal health coverage. There is a great need for high and routine availability of psychological interventions, but traditional methods for delivering psychotherapy often result in low reach and long wait times. Primary Care Behavioral Health (PCBH) is a method for organizing primary care in which behavioral health staff provide brief, flexible interventions to a large part of the population in active collaboration with other providers. While PCBH holds promise in addressing important challenges, it has not yet been thoroughly evaluated.MethodsThis cluster randomized trial will assess 17 primary care centers (PCCs) that are starting a PCBH implementation process. The PCCs will be divided into two groups, with one starting immediate implementation and the other acting as a control, implementing six months later. The purpose of the study is to strengthen the evidence base for PCBH regarding implementation-, organization-, and patient-level outcomes, taking into consideration that there is a partially dependent relationship between the three levels. Patient outcomes (such as increased daily functioning and reduction of symptoms) may be dependent on organizational changes (such as availability of treatment, waiting times and interprofessional teamwork), which in turn requires change in implementation outcomes (most notably, model fidelity). In addition to the main analysis, five secondary analyses will compare groups based on different combinations of randomization and time periods, specifically before and after each center achieves sufficient PCBH fidelity.DiscussionA randomized comparison of PCBH and traditional primary care has, to our knowledge, not been made before. While the naturalistic setting and the intricacies of implementation pose certain challenges, we have designed this study in an effort to evaluate the causal effects of PCBH despite these complex aspects. The results of this project will be helpful in guiding decisions on how to organize the delivery of behavioral interventions and psychological treatment within the context of primary care in Sweden and elsewhere.Trial registrationClinicalTrials.gov: NCT05335382. Retrospectively registered on March 13th, 2022.
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| 2. |
- Gervind, Elisabet, et al.
(författare)
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The influence of organizational models on the implementation of internet-based cognitive behavior therapy in primary care: A mixed methods study using the RE-AIM framework
- 2024
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 35
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Tidskriftsartikel (refereegranskat)abstract
- Background: Internet-Based Cognitive Behavioral Therapy (iCBT) holds great potential in addressing mental health issues, yet its real-world implementation poses significant challenges. While prior research has predominantly focused on centralized care models, this study explores the implementation of iCBT in the context of decentralized organizational structures within the Swedish primary care setting, where all interventions traditionally are delivered at local Primary Care Centers (PCCs).Aim: This study aims to enhance our understanding of iCBT implementation in primary care and assess the impact of organizational models on the implementation's outcome using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.Method: A mixed-methods research design was employed to identify the factors influencing iCBT implementation across different levels, involving patients, therapists and managers. Data spanning two years was collected and analyzed through thematic analysis and statistical tests. The study encompassed 104 primary care centers, with patient data (n = 1979) sourced from the Swedish National Quality Register for Internet-Based Psychological Treatment (SibeR). Additionally, 53 iCBT therapists and 50 PCC managers completed the Normalization Measure Development Questionnaire, and 15 leaders participated in interviews.Results: Our investigation identified two implementation approaches, one concentrated and one decentralized. Implementation effectiveness was evident through adherence rates suggesting that iCBT is a promising approach for treating mental ill-health in primary care, although challenges were observed concerning patient assessment and therapist drift towards unstructured treatment. Mandatory implementation, along with managerial and organizational support, positively impacted adoption. Results vary in terms of adherence to established protocols, with therapists working in concentrated model showing a significantly higher percentage of registration in the quality register SibeR (X2 (1, N = 2973) = 430.5774, p = 0.001). They also showed significantly higher means in cognitive participation (Z = - 2.179, p = 0.029) and in reflective monitoring (Z = - 2.548, p = 0.011). Discussion: Overall, the study results demonstrate that iCBT, as a complex and qualitatively different intervention from traditional psychological treatment, can be widely implemented in primary care settings. The study's key finding highlights the substantial advantages of the concentrated organizational model. This model has strengths in sustainability, encourages reflective monitoring among therapists, the use of quality registers, and enforces established protocols.Conclusion: In conclusion, this study significantly contributes to the understanding of the practical aspects associated with the implementation of complex internet interventions, particularly in the context of internetbased cognitive-behavioral therapy (iCBT). The study highlights that effective iCBT integration into primary care requires a multifaceted approach, taking into account organizational models, robust support structures, and a commitment to maintaining quality standards. By emphasizing these factors, our research aims to provide actionable insights that can enhance the practicability and real-world applicability of implementing iCBT in primary care settings.
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| 3. |
- Gervind, Elisabet, et al.
(författare)
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The transference of research results to practise: Organization and implementation outcomes of iCBT in primary care – a mixed methods study using the RE-AIM framework
- 2022
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Ingår i: SWESRII 2022.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Healthcare systems all over the world are working in dynamic and resource-constrained contexts. Implementation science plays a critical role in ensuring that costly research results are implemented and improve public health. Implementation of iCBT in regular care has given mixed results and has rarely been documented on the basis of a scientific framework for implementation research. Aim: The overall aim of the present study is to contribute to knowledge about how iCBT can be implemented and organized in primary care. The current study also explores naturalistic variability in two different organizational formats, concentrated and decentralized. Method: A mixed quantitative-qualitative design was used to identify factors that impact the implementation of iCBT across multiple levels, including patient, therapists, leaders and organization. The scientific framework RE-AIM with the dimensions reach (those in the target group participating in the program), effectiveness (effects after completion of the program), adoption (actors who accept the program), implementation (compliance with the program according to protocol), maintenance (sustainability over time) was used to evaluate the implementation. Results: 104 primary care centres participated in the study. Outcomes on patient-data (n=1979) were gathered between 2018 and 2021 from the quality register SibeR. Fifty-four iCBT-therapists, answered the NoMAD-questionnaire and fifteen leaders were interviewed. The materials are currently being analysed.
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| 4. |
- Giang, K. W., et al.
(författare)
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Strategies for achieving efficiency in the general practitioner's everyday life
- 2022
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 40:2, s. 261-270
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe concrete, effective strategies used by experienced GPs to achieve time efficiency, increase patient satisfaction and maintain high medical quality during patient meetings. Design Qualitative observation yielded field notes for qualitative content analysis according to Graneheim and Lundman. Follow-up telephone interviews were conducted to get feedback from patients. Setting A normal working day with patient meetings in a primary health care center in Sweden. Subjects Five GPs known for being experienced and well-functioning clinicians were strategically chosen to participate in an observational study during patient meetings. Afterwards a random selection of 25 patients (five from each GP) were asked to rate their experience of their meeting. Results Observation and analysis of GPs' work before, during, and after patient meetings revealed several concrete strategies, which we classified into two main categories: Behavioral and Communicative, comprising nine and seven subcategories, respectively. Conclusion Most important behavioral skills for time efficiency were a GP's ability to handle interruptions, and effective administration. Medical quality during patient meetings was most supported by GP continuity and relationship, an exploratory patient-centered approach, a focus on one task at a time, and the ability to acknowledge and learn from medical uncertainty. Patients were most satisfied with GPs who had good communicative skills, good GP continuity and relationship.
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| 5. |
- Karl, J. A., et al.
(författare)
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The Cross-cultural Validity of the Five-Facet Mindfulness Questionnaire Across 16 Countries
- 2020
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Ingår i: Mindfulness. - : Springer Science and Business Media LLC. - 1868-8527 .- 1868-8535. ; 11, s. 1226-1237
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The goal of the current study was to investigate the universality of the five-factor model of mindfulness and the measurement equivalence of the Five-Facet Mindfulness Questionnaire (FFMQ). Methods The study used FFMQ data from published and unpublished research conducted in 16 countries (total N = 8541). Using CFA, different models, proposed in the literature, were fitted. To test the cross-cultural equivalence of the best fitting model, a multi-group confirmatory factor analysis was used. Further, the equivalence of individual facets of the FFMQ and potential sources of non-equivalence was explored. Results The best fitting models in most samples were a five-facet model with a higher-order mindfulness factor and uncorrelated positive and negative item-wording factors and a five-facet model with a correlated facets and uncorrelated positive and negative item-wording factors. These models showed structural equivalence, but did not show metric equivalence (equivalent factor loadings) across cultures. Given this lack of equivalent factor loadings, not even correlations or mean patterns can be compared across cultures. A similar pattern was observed when testing the equivalence of the individual facets; all individual facets failed even tests of metric equivalence. A sample size weighted exploratory factor analysis across cultures indicated that a six-factor solution might provide the best fit across cultures with acting with awareness split into two factors. Finally, both the five- and six-factor solution showed substantially better fit in more individualistic and less tight cultures. Conclusions Overall, the FFMQ has conceptual and measurement problems in a cross-cultural context, raising questions about the validity of the current conceptualization of mindfulness across cultures. The results showed that the fit of the FFMQ was substantially better in individualistic cultures that indicate that further data from non-Western cultures is needed to develop a universal conceptualization and measurement of mindfulness.
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| 6. |
- Larsson, Anna, et al.
(författare)
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IMPACT (Internet-Mediated Psychological treatment - Acceptance and Commitment Therapy) in youths: The role of parental support
- 2022
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Ingår i: SWESRII, 2022.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Internet-delivered cognitive behavioral therapy (iCBT) for youths has not yet been established as an evidence-based method in primary care. Thus, the research project IMPACT (Internet-Mediated Psychological treatment - Acceptance and Commitment Therapy) aims to investigate iCBT for youths between 13-18 years old in primary care compared to treatment as usual (TAU). Method: IMPACT consists of 3 studies: Study 1 is a qualitative thematic analysis of the attitudes and experiences. Study 2 is a mixed-method design investigating the experiences and perceived effects of iCBT and study 3 is a quantitative 1-year follow-up of treatment results of iCBT and TAU. Results: In study 1, the therapists reported positive experiences of using iCBT for youths and considered it a valuable alternative to face-to-face treatment and an appreciated variation in their schedules. Nevertheless, the therapists also reported challenges in selecting, motivating and interacting with the patients and suggested that parental support can increase compliance and improve treatment results. In study 2, the quantitative analysis indicated that iCBT was successful in symptom reduction and underlined that the motivation of the youths was crucial for the treatment outcome. The youths valued independence and freedom in managing the treatment on their own terms whereas the parents expressed uncertainty about their role and how to support their youths. This study further supports the importance of parental involvement in iCBT for youths in supporting and reminding during the course of treatment and collaborating with the therapist. Based on the results in study 1 and 2, a separate parental support programme was developed in the shape of a shorter iCBT programme for the parents to use in parallel with their youths doing iCBT treatment. In study 3, the youths with parental support had significantly higher compliance compared to both TAU and iCBT without parental support. Conclusion: Internet treatment in primary care is accepted by both therapists, youths and their parents in the research project. Furthermore, youth motivation was paramount for treatment outcome and parental support was identified as an important factor.
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| 7. |
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| 8. |
- Lilja, Josefine, et al.
(författare)
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Does the Delivery System Matter? The Scaling-Out of a School-Based Resilience Curriculum to the Social Services Sector
- 2021
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: The context is highly relevant to the implementation of new health-related programs and is an implicit or explicit part of the major implementation models in the literature. The Resilience Curriculum (RESCUR) program was developed to foster the psychosocial development of children in early and primary education. RESCUR seeks specifically to decrease children's vulnerability. It aims to promote the emotional and social learning of children who may be at risk of leaving school pre-maturely, social exclusion and mental-health problems. The program is taught using a teachers' manual to support consistency of delivery, a parents' guide, and a resource package. This study aimed to examine the scaling-out of RESCUR to social services, and specifically to test if implementation differs between the school and social services sectors.Methods: RESCUR was implemented in schools and social services in Sweden 2017–2019. Data were collected via group leaders' self-reports and observation protocols for 3 months after implementation started. There were 34 self-reports from schools, and 12 from the social services sector; 30 observation protocols were collected from schools, and 10 from social services. We examined whether there were differences in implementation outcomes (in, for example, dosage, duration, fidelity, adaptation, quality of delivery) between the two delivery systems. Descriptive statistics were prepared and non-parametric tests of significance conducted to compare implementation-related factors across the two settings.Results: Analyses of both the observation protocols and group leaders' self-reports revealed that RESCUR was well-implemented in both schools and social services. The results showed a few significant differences in the outcomes of implementation between the sectors. First, regarding observations, school staff more often adapted the pace of RESCUR lessons to ensure that the children could understand than did social services staff (p < 0.01). Second, social services staff demonstrated greater interest in students and sensitivity to the needs of individual students than did school staff (p = 0.02). Regarding self-reports, social services staff reported having delivered more (p = 0.4) and longer (p < 0.01) lessons than did school staff. Second, school staff reported greater fidelity to (p = 0.02) and less adaptation of (p < 0.01) the intervention than did social services staff. Both observations and self-reports, however, indicated a high fidelity of implementation.Conclusions: Overall, the findings suggest that the resilience program, designed for delivery in schools, can be scaled-out to social services with its implementation outcomes retained. Further research is needed to test the effectiveness of the program regarding child health-related outcomes.
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| 9. |
- Lilja, Josefine, et al.
(författare)
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Five Facets Mindfulness Questionnaire-Reliability and Factor Structure : A Swedish Version
- 2011
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Ingår i: Cognitive Behaviour Therapy. - Abingdon : Routledge. - 1650-6073 .- 1651-2316. ; 40:4, s. 291-303
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Tidskriftsartikel (refereegranskat)abstract
- Two studies were conducted to assess the Swedish version of the Five Facets Mindfulness Questionnaire (FFMQ), which was originally created by Baer et al. (2006). The aim of Study 1 was to examine the psychometric properties of the FFMQ using data from 495 individuals. Quantitative and qualitative analyses resulted in a reduction of the scale by 10 items. Psychometric properties, including internal consistency of the revised instrument, were examined. The Swedish FFMQ provides results comparable to those obtained by Baer. Cronbach’s alphas were high for all the facets. The Swedish FFMQ appears to be a potentially useful tool in measuring mindfulness among Swedish participants. The aim of Study 2 was to test the suggested hierarchical five-factor solution and construct validity, using a confirmatory factor analysis (CFA). Similar to findings for the English version of the FFMQ, the CFA showed that the Observing facet was not a significant part of an overall self-reported mindfulness structure in a Swedish population with little meditation experience. © 2011 Copyright Swedish Association for Behaviour Therapy.
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| 10. |
- Lilja, Josefine L., et al.
(författare)
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The protective effects of Swedish COVID-19 pandemic strategies on adolescents' mental health : a longitudinal cohort study
- 2024
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905.
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to investigate a cohort of Swedish eighth graders' mental health and experiences during the COVID-19 pandemic.Methods: Participants were 157 eighth graders recruited in junior high schools during 2020 who completed a depression questionnaire and a survey about their psychosocial health in relation to the COVID-19 pandemic, alongside a follow-up assessment in 2021. Analyses were conducted using latent change score and cross-lagged models.Results: Participants' depressive symptoms did not substantially increase during the COVID-19 pandemic. The level of depressive symptoms in 2020 was significantly associated with participants' perceptions of the pandemic in 2020 and spring 2021. Participants with higher depression scores reported worse experiences of the pandemic.Conclusions: The stable level of depressive symptoms among this cohort of eighth graders suggested that keeping schools open during a nationwide lockdown could mitigate some mental health consequences. Adolescents in this study with higher self-assessed depressive symptoms were more likely to experience increased depression after 6 months and had worse experiences during the pandemic than others. This suggests that the pandemic may not immediately affect mental well-being, but those at risk may be affected over time.
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