| 1. |
- Andersson, Peter, et al.
(författare)
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Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care-Study protocol for a multicenter cluster randomized trial
- 2022
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Ingår i: Contemporary Clinical Trials Communications. - : Elsevier. - 2451-8654. ; 27
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants' illness management skills and recovery.Objective: To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual.Method: This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory.Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Registration No. 2020-02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132).
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| 2. |
- Bergstrom, Aileen L., et al.
(författare)
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Perceived occupational gaps one year after stroke : An explorative study
- 2012
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Ingår i: Journal of Rehabilitation Medicine. - Uppsala : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 44:1, s. 36-42
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore and describe factors associated with occupational gaps and to identify factors at 3 months that predict occupational gaps one year post-stroke. A gap, a restriction in participation, is considered to be present when there is a discrepancy between what the individual wants to do and what they actually do in everyday life. Design: Prospective longitudinal study. Subjects: Two hundred persons with stroke. Methods: Data from the Occupational Gaps Questionnaire, one year post-stroke, was used as the dependent variable in 3- and 12-month regression analyses. Domains of the Stroke Impact Scale, global life satisfaction, demographic and medical factors were used as independent variables. Results: At 3 months, activities of daily living abilities, social participation and not being born in Sweden predicted occupational gaps at 12 months. Stroke severity and not being born in Sweden and 3 factors at 12 months: social participation, self-rated recovery, and global life satisfaction were associated with occupational gaps. Conclusion: Activities of daily living ability at 3 months predicted occupational gaps after stroke. Thus, it is possible to identify early on, and provide interventions for, those that risk participation restrictions. Not being born in the country might be an indicator of a risk for participation restrictions.
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| 3. |
- Elf, Marie, et al.
(författare)
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The case of value-based healthcare for people living with complex long-term conditions
- 2017
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 17:1, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient’s experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions.DiscussionAchieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient’s individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation.SummaryThe shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient’s perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.
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| 4. |
- Eriksson, Gunilla, et al.
(författare)
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Occupational gaps in everyday life one year after stroke : association with life satisfaction and impact of stroke
- 2012
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Ingår i: Topics in Stroke Rehabilitation. - Birmingham, USA : Thomas Land Publishers Inc. - 1074-9357 .- 1945-5119. ; 19:3, s. 244-255
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To examine the presence, frequency, and distribution of occupational gaps and to explore whether there are associations between occupational gaps and life satisfaction, self-rated recovery, and functioning and participation in activities of daily living (ADLs) 1 year after stroke.Method: Data were collected at onset and at 12 months after stroke from 161 patients admitted to a stroke unit in central Sweden by using Occupational Gaps Questionnaire, LiSat-11, Stroke Impact Scale, Katz ADL Index, and Barthel Index. Spearman rank correlation and Mann Whitney U test were used in the analyses.Results: Occupational gaps were reported by 87% of the participants. The number of occupational gaps was moderately associated with participation and self-rated recovery. There was a significant difference in the number of occupational gaps between the participants who were independent in ADLs and those who were not, both at baseline and at 12 months after stroke. There was, however, no significant association between occupational gaps and life satisfaction.Conclusions: Occupational gaps 1 year after stroke are very common, particularly among individuals experiencing difficulties in ADLs. Increased efforts are vital to enable individuals to do the activities that are important to them, irrespective of whether these are instrumental ADLs or leisure or social activities. Occupational gaps could be reduced by developing rehabilitation interventions that enable desired activities in different contexts that are crucial for individual patients.
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| 5. |
- Eriksson, Gunilla, et al.
(författare)
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Study protocol of a non-randomised controlled trial evaluating the effectiveness of the F@ce 2.0 programme : a person-centred, ICT-supported and interdisciplinary rehabilitation intervention after stroke
- 2022
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Ingår i: BMJ Open. - : NLM (Medline). - 2044-6055. ; 12:8
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Knowledge is missing on use of information and communication technology (ICT), for example, mobile phones/tablets in rehabilitation after stroke. F@ce 2.0 is a person-centred, interdisciplinary intervention supported by ICT. The components of F@ce 2.0 intend to increase performance in daily activities and participation in everyday life for patients with stroke and their significant others. Based on previous feasibility studies, a full-scale evaluation is planned in Sweden. The aim is to implement and evaluate F@ce 2.0, regarding performance of daily activities and participation in everyday life, in comparison with ordinary rehabilitation among persons who have had stroke and significant others. Second, to increase knowledge about how the programme leads to a potential change by studying the implementation process and mechanisms of impact. METHODS AND ANALYSIS: Twelve rehabilitation teams (intervention n=7; control n=5) will recruit patients (n=160) who receive rehabilitation at home after stroke and their significant others. F@ce 2.0 is an 8-week intervention where patients, together with the team, formulate three activity goals regarding what they need and want to do in daily lives. The patients will receive short messages service (SMS) each morning reminding about goals, and in the evening to rate their performance during the day. Primary outcomes for patients: self-efficacy measured by the Self-Efficacy Scale; perceived performance in daily activities measured by the Canadian Occupational Performance Measure. Significant others: perceived caregiver burden measured by Caregiver Burden Scale. Qualitative interviews with team members delivering, patients receiving intervention and significant others will explore experiences of F@ce 2.0. A process evaluation applying a case-study design using mixed methods will be conducted. ETHICS AND DISSEMINATION: Approved by the Swedish Ethical Review Authority, Stockholm. Knowledge will be created for using ICT for rehabilitation of people after stroke in self-selected activities. Dissemination will include peer-reviewed publications, presentations at conferences, and information to stakeholders. TRIAL REGISTRATION NUMBER DETAILS: NCT04351178 . © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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| 6. |
- Flink, Maria, et al.
(författare)
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Person-centred care transitions for people with stroke : study protocol for a feasibility evaluation of codesigned care transition support.
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Care transitions following stroke should be bridged with collaboration between hospital staff and home rehabilitation teams since well-coordinated transitions can reduce death and disability following a stroke. However, health services are delivered within organisational structures, rather than being based on patients' needs. The aim of this study protocol is to assess the feasibility, operationalised here as fidelity and acceptability, of a codesigned care transition support for people with stroke.METHODS: This study protocol describes the evaluation of a feasibility study using a non-randomised controlled design. The codesigned care transition support includes patient information using videos, leaflets and teach back; what-matters-to me dialogue; a coordinated rehabilitation plan; bridged e-meeting; and a message system for cross-organisational collaboration. Patients with stroke, first time or recurrent, who are to be discharged home from hospital and referred to a rehabilitation team in primary healthcare for continued rehabilitation in the home will be included. One week after stroke, data will be collected on the primary outcome, namely satisfaction with the care transition support, and on the secondary outcome, namely health literacy and medication adherence. Data on use of healthcare will be obtained from a register of healthcare contacts. The outcomes of patients and significant others will be compared with matched controls from other geriatric stroke and acute stroke units, and with matched historic controls from a previous dataset at the intervention and control units. Data on acceptability and fidelity will be assessed through interviews and observations at the intervention units.ETHICS AND DISSEMINATION: Ethical approvals have been obtained from the Swedish Ethical Review Authority. The results will be published open-access in peer-reviewed journals. Dissemination also includes presentation at national and international conferences.DISCUSSION: The care transition support addresses a poorly functioning part of care trajectories in current healthcare. The development of this codesigned care transition support has involved people with stroke, significant other, and healthcare professionals. Such involvement has the potential to better identify and reconceptualise problems, and incorporate user experiences.TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov id: NCT02925871. Date of registration 6 October 2016.PROTOCOL VERSION: 1.
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| 7. |
- Fridberg, Helena, et al.
(författare)
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Development and evaluation of the measurement properties of a generic questionnaire measuring patient perceptions of person-centred care
- 2020
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 20:1
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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.
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| 8. |
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| 9. |
- Fridberg, Helena, et al.
(författare)
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Operationalisation of person-centred care in a real-world setting: a case study with six embedded units
- 2022
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Ingår i: Bmc Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
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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).
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| 10. |
- 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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