| 1. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Rehabilitation cooperation and person-centred dialogue meeting for patients sick-listed for common mental disorders: 12 months follow-up of sick leave days, symptoms of depression, anxiety, stress and work ability - a pragmatic cluster randomised controlled trial from the CO-WORK-CARE project.
- 2023
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Ingår i: BMJ open. - 2044-6055. ; 13:6
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Tidskriftsartikel (refereegranskat)abstract
- To study whether early and enhanced cooperation within the primary care centres (PCC) combined with workplace cooperation via a person-centred employer dialogue meeting can reduce days on sick leave compared with usual care manager contact for patients on sick leave because of common mental disorders (CMD). Secondary aim: to study lapse of CMD symptoms, perceived Work Ability Index (WAI) and quality of life (QoL) during 12 months.Pragmatic cluster randomised controlled trial, randomisation at PCC level.28 PCCs in Region Västra Götaland, Sweden, with care manager organisation.30 PCCs were invited, 28 (93%) accepted invitation (14 intervention, 14 control) and recruited 341 patients newly sick-listed because of CMD (n=185 at intervention, n=156 at control PCCs).Complex intervention consisting of (1) early cooperation among general practitioner (GP), care manager and a rehabilitation coordinator, plus (2) a person-centred dialogue meeting between patient and employer within 3 months.regular contact with care manager.12 months net and gross number of sick leave days at group level.12 months depression, anxiety, stress symptoms, perceived WAI and QoL (EuroQoL-5 Dimensional, EQ-5D).No significant differences were found between intervention and control groups concerning days of sick leave (intervention net days of sick leave mean 102.48 (SE 13.76) vs control 96.29 (SE 12.38) p=0.73), return to work (HR 0.881, 95%CI 0.688 to 1.128), or CMD symptoms, WAI or EQ-5D after 12 months.It is not possible to speed up CMD patients' return to work or to reduce sick leave time by early and enhanced coordination among GP, care manager and a rehabilitation coordinator, combined with early workplace contact over and above what 'usual' care manager contact during 3 months provides.NCT03250026.
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| 2. |
- Carlsson, Gunnel, 1950, et al.
(författare)
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Coming home in the context of very early supported discharge after stroke - An interview study of patients' experiences
- 2024
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Ingår i: JOURNAL OF STROKE & CEREBROVASCULAR DISEASES. - 1052-3057 .- 1532-8511. ; 33:9
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore patients' experiences of coming home and managing everyday life within the context of very early supported discharge after stroke (VESD). Study design: An explorative qualitative study using semi structured interviews. Method: This study was nested within a randomised controlled trial,; Gothenburg Very Early Supported Discharge (GOTVED), comparing a home rehabilitation intervention given by a coordinated team (VESD) with conventional care. Eleven participants with a median age 70.0 years (range 63-95) of which nine scoring 0-4 on the NIHSS indicating no symptoms or minor stroke were interviewed on average 12 days after discharge. Data was analysed using thematic analysis. Results: The diversity of patients' experiences was reflected in the overarching main theme Very Early Supported Discharge after stroke - a multifaceted experience, built upon five themes: "Conditions surrounding the discharge", "Concerns about the condition", "Confronting a new everyday life", "Experiences of the intervention" and the "Role of next of kin". Conclusions: The respondents were largely satisfied with the very early supported discharge which might be expected, given that it was well planned regarding timing, individualisation and content. The patients need to be aware of the purpose of the VESD intervention. Due to the unpredictability of the stroke and its consequences, interventions need to be flexible. Goal setting is important but must be comprehensible. The role and burden of next of kin should be addressed and negotiated, and the ending of the intervention must be planned, with seamless transition to further rehabilitation and social support including the issue of participation in everyday life.
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| 3. |
- Engwall, Marie, 1964, et al.
(författare)
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Recovering from COVID-19 - A Process Characterised by Uncertainty: A Qualitative study.
- 2022
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Ingår i: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 54
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Tidskriftsartikel (refereegranskat)abstract
- To obtain a deeper understanding of the lived experiences of patients with COVID-19, the recovery process and consequences for everyday life 6 months after hospital discharge.An explorative qualitative study using individual interviews.A purposive sampling was applied to recruit persons who had received inpatient hospital care, were discharged approximately 6 months previously, were of working age and had persistent self-reported symptoms at a 3-month follow-up appointment.Semi-structured interviews were conducted with 15 participants (10 men, 5 women), which were then transcribed and analysed with inductive thematic analysis.Three themes were identified: "Status of recovery - two steps forward, one step back", "Remaining symptoms caused limitations in everyday life" and "Strategies for recovery". Participants indicated the recovery process through 6 months after discharge was a challenging road, often involving setbacks. A wide range of persistent, fluctuating, or new symptoms negatively impacted many areas of daily life, with fatigue and lack of energy being especially prominent. Participants used a variety of strategies to cope and recover.This study increases our knowledge of the lived experiences of COVID-19 based individual experiences. Unexpected symptoms in the recovery process were described and not always possible to forecast.
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| 4. |
- Larsson, Alexandra C, 1986, et al.
(författare)
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Figuring Out Life After Covid-19 : a Qualitative Study From Sweden
- 2023
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Ingår i: Journal of Rehabilitation Medicine. - 1650-1977 .- 1651-2081. ; 55
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To obtain a deeper understanding of the daily life experiences of working aged people during the year following hospitalization due to SARS-CoV-2 (COVID-19), with a focus on function-ing in daily life and return to work.DESIGN: An explorative qualitative study using individual interviews.SUBJECTS: A purposive sample was selected of persons who had received inpatient hospital care, had been discharged approximately 1 year previously and were of working age.METHODS: Semi-structured interviews were conducted with 11 participants (9 men, 2 women). The interviews were transcribed and analysed with inductive thematic analysis.RESULTS: Four themes were identified. Navigating health, with or without support from healthcare, was described as challenging when managing consequences of COVID-19. Participants struggled with a lack of energy that interfered with daily life. It was a trial-and-error process trying to use familiar strategies in new ways to manage. The return to work process was facilitated by own strategies and support.CONCLUSION: This study contributes increased knowledge of everyday life experiences of people 1 year following hospitalization due to COVID-19. The lack of energy and a struggle to manage health while navigating the healthcare system emphasize the importance of strengthening personal and organizational health literacy to facilitate the recovery process after severe COVID-19.
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| 5. |
- Löfgren, Märit, 1977, et al.
(författare)
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Professionals' experiences of what affects health outcomes in the sick leave and rehabilitation process-A qualitative study from primary care level.
- 2024
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Ingår i: PLOS ONE. - 1932-6203. ; 19:7
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Tidskriftsartikel (refereegranskat)abstract
- To explore frontline employees' experiences of how to create a purposeful sick leave and rehabilitation process (SRP) with the best interest of patients' long-term health in focus.Qualitative design based on focus group interviews in a primary care context in Region Västra Götaland, Sweden. Strategically selected professionals from different SRP organizations discussed sick leave outcomes and the rehabilitation process. Analysis was performed with Systematic text condensation.General practitioners (n = 6), rehabilitation coordinators and/or healthcare professionals from primary healthcare (n = 13), caseworkers from the Social Insurance Agency, the Employment Agency, and Social Services (n = 12).The outcome of the SRP was described to depend upon the extent to which the process meets patients' bio-psycho-social needs. Aspects considered crucial were: 1) early bio-psycho-social assessments, including medical specialist consultations when needed, 2) long-term realistic planning of sick leave and rehabilitation alongside medical treatment, 3) access to a wide range of early rehabilitative and supportive interventions, including situation-based, non-medical practical problem solving, and 4) trusting relationships over time for all involved professions and roles to maximize process quality and person-centeredness. A gap between the desired scope of the SRP and existing guidelines was identified.Interviewees perceived that successful outcomes from the sick leave and rehabilitation process in a primary care context depend on consensus, person-centeredness, and relationship continuity for all involved professions. An extended process scope and relationship continuity for all involved professionals were suggested to improve process outcomes.
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| 6. |
- Nejati, Shabnam, 1972, et al.
(författare)
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How can care managers strengthen health literacy among patients with common mental disorders? A qualitative study
- 2023
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Ingår i: Scandinavian journal of caring sciences. - 1471-6712. ; 37:3
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Tidskriftsartikel (refereegranskat)abstract
- In order for persons with mental illness to be able to promote and preserve their health, sufficient knowledge about health is required. An effective means to improve the health of the patients is to strengthen their health literacy. The aim of this study was to explore how care managers work with health literacy in patients with common mental disorders to help them to better understand and manage their illness.A qualitative study was conducted, using written reports from 25 care managers regarding meetings with patients with common mental disorders in the primary care in a Swedish region. The care managers' reports were coded based on Sörensen's four dimensions for the domain "health care" and analysed deductively through systematic text condensation according to Malterud.The care managers described how they worked strategically and continuously with follow-up and wanted to be responsive to the patients' stories. They confirmed the patients' feelings with the goal of creating increased interaction, thereby involving the patients in their own care. The care managers also worked actively to provide well-balanced care at an early stage. Using various tools such as self-assessment instruments, the care manager started from the patient's basic problem, gave support and discussed strategies based on the patient's condition and situation.The care managers used multifaceted health literacy interventions. They worked in a person-centred, strategic and encouraging manner based on the patient's unique conditions, where sensitivity and adapted information were important aspects. The aim of the interventions was for the patients to become knowledgeable, gain new insights and work independently with their own health.
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| 7. |
- Petersson, Eva-Lisa, et al.
(författare)
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Process evaluation of the CO-WORK-CARE model : Collaboration and a person-centred dialogue meeting for patients with common mental disorder in primary health care
- 2024
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Ingår i: Scandinavian Journal of Caring Sciences. - 0283-9318 .- 1471-6712. ; 38:3, s. 602-613
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: To ensure optimal patient care based on evidence, it is crucial to understand how to implement new methods in practice. However, intervention studies often overlook parts of the implementation process. A comprehensive process evaluation is necessary to understand why interventions succeed or fail in specific contexts and to integrate new knowledge into daily practice. This evaluation examines the full implementation of the Co-Work-Care model in Swedish primary healthcare to identify strengths and weaknesses. Aim: This study aimed to evaluate the process of implementing the CO-WORK-CARE model that focuses on close collaboration and the use of a person-centred dialogue meeting in primary healthcare for patients on sick leave due to common mental disorders. Method: The CO-WORK-CARE model emphasises collaboration among the GP, rehabilitation coordinator and care manager, along with person-centred dialogue meetings involving employers. Following UK Medical Research Council guidelines, we conducted a process evaluation. Data from previous studies were reanalysed. We also analysed field notes and meeting notes using Malterud's qualitative method. Results: The evaluation identified key facilitators for model implementation, including regular visits by facilitators and guidance from the research physician. Peer support meetings also bolstered implementation. However, challenges emerged due to conflicts with existing structures and limitations in person-centred dialogue meetings. Conclusion: Adapting the CO-WORK-CARE model to Swedish primary care is feasible and beneficial, with collaboration among the care manager, rehabilitation coordinator and GP and person-centred dialogue meetings. Thorough preparations, ongoing facilitator and peer support and integrated information enhanced implementation efficiency, despite challenges posed by existing structures.
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| 8. |
- Petersson, Eva-Lisa, et al.
(författare)
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The experiences of care managers and rehabilitation coordinators of a primary care intervention to promote return to work for patients with common mental disorders: a qualitative study.
- 2020
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Ingår i: BMC family practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- In an earlier study, PRIM-CARE RCT, a care manager implementation at the primary care centre showed improved return to work and reduced sick leave for patients with CMD. To further improve return to work, the project Co-Work-Care added a person-centered dialogue meeting between the patient, the employer and the rehabilitation coordinator, preceded by an increased collaboration between care manager, rehabilitation coordinator and GP. In this first qualitative study of the Co-Work-Care project, we explored how care managers and rehabilitation coordinators experienced the Co-Work-Care model. The purpose of this study was to explore care managers' and rehabilitation coordinators' perceptions and experiences of a close collaboration and the use of the person-centred dialogue meeting.From an ongoing RCT with 20 primary care centres, care managers (CMs) (n=13) and rehabilitation coordinators (RCs) (n=12) participated in a qualitative study with focus groups. The study was conducted in the primary health care in a Swedish region. The data was analysed with Systematic Text Condensation by Malterud.Seven codes describing the participants' experiences of the Co-Work-Care model were identified: 1) The importance of collaboration at the primary care centre, 2) Collaboration and division of roles between the RC and the CM, 3) Collaboration with the General practitioner (GP), 4) The person-centred dialogue meeting, 5) Initiating the person-centred dialogue meeting, 6) The person-centred dialogue meeting to improve collaboration with the employer, and 7) The person-centred dialogue meeting to teach about the return to work process.The increased collaboration within the Co-Work-Care model created a common picture and understanding of the patient's situation. The person-centred dialogue meeting in the rehabilitation process became a bridge between the employer and the patient.NCT03250026 (registered August 15, 2017).
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| 9. |
- Saxvik, Ausra, et al.
(författare)
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Experiences of patients with common mental disorders concerning team-based primary care and a person-centered dialogue meeting: An intervention to promote return to work.
- 2022
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 17:7
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Tidskriftsartikel (refereegranskat)abstract
- Common mental disorders in combination with work-related stress are widespread in the western world, not least in Sweden. Various interactive factors, primarily work-related, have impact on the return to work process, for example; a supportive communicative function between the person on sick leave and the employer may facilitate this process. The aim was to investigate experiences of being part of a collaborative care model including a person-centered dialogue meeting with the employer and with a rehabilitation coordinator as the moderator.A qualitative design based on individual interviews with 13 persons diagnosed with common mental disorders who participated in an extensive collaborative care model, called the Co-Work-Care model. Persons were recruited as a heterogeneous sample with respect to age, gender, work background, and time since the intervention. All interviews were analyzed with Systematic Text Condensation.Five codes synthesized the results: 1) A feeling of being taken care of, 2) Collaboration within the team was perceived as supportive, 3) An active and sensitive listener, 4) Structure and planning in the dialogue meeting, 5) The person-centered dialogue meeting was supportive and provided increased understanding.Participants experienced the close collaborative contact with the care manager and the rehabilitation coordinator as highly valuable for their rehabilitation process. Participants valued a well-structured dialogue meeting that included initial planning and a thorough communication involving the patient, the employer, and coordinator. Further, participants appreciated having an active role during the meeting, also empowering the return to work process.
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| 10. |
- Saxvik, Ausra, et al.
(författare)
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"Gaining control through close collaboration" - GPs' experiences of a Collaborative Care Model for patients with Common Mental Disorders who need sick leave certification.
- 2022
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Ingår i: BJGP open. - 2398-3795. ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- General Practitioners (GPs) are an important part of collaboration around patients with common mental disorders in primary care. To further improve collaboration, the model Co-Work-Care was implemented, which emphasised working more closely with patients through active dialogues among care managers, rehabilitation coordinators and GPs. This enhanced collaborative model also included a person-centred dialogue meeting with patients' employers.To explore GPs' experiences of the Co-Work-Care model - a collaborative care organisation at the primary care centre including a person-centred dialogue meeting in the care of patients with common mental disorders who need sick leave certification.Qualitative individual and group interviews among Swedish GPs with experience of the Co-Work-Care trial where the primary care centre (PCC) was an intervention PCC with the enhanced collaboration model.GPs were sampled purposefully from different Co-Work-Care intervention PCCs in Sweden. Focus group and individual in-depth semi-structured interviews were conducted. All interviews were analysed by Systematic Text Condensation according to Malterud.Three codes describing the GPs' experiences of working in the Co-Work-Care model were identified: 1) A structured work approach, 2) Competency of the care manager and the rehabilitation coordinator, and 3) Gaining control through close collaboration.Overall, GPs experienced that the enhanced collaboration reduced their workload and enabled them to focus on the medical care. Patient care was perceived as safer and more effective. These advantages may result in higher quality in medical and rehabilitation decisions, as well as a more sustainable and less stressful work situation for GPs.
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| 11. |
- Törnbom, Karin, 1982, et al.
(författare)
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Back to life: Is it possible to be myself again? A qualitative study with persons initially hospitalised due to COVID-19.
- 2022
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Ingår i: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 54
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Tidskriftsartikel (refereegranskat)abstract
- To gain a deeper understanding of the lived experiences of patients with COVID-19, regarding rehabilitation, work and social life 6 months after hospital discharge.An explorative qualitative study with individual interviews.Patients of working age with persistent self-reported symptoms at a 3-month follow-up who had received inpatient hospital care with discharge approximately 6 months previously were purposively sampled.Semi-structured interviews were performed with 10 men and 5 women. The interviews were transcribed verbatim and analysed with inductive thematic analysis.Four themes were identified: "Social support - crucial, but decreased over time", "Varying needs of, and access to, rehabilitation", "Returning to work after COVID-19 - crucial for future prospects" and "An overwhelming experience that essentially changed one's personality".Rehabilitation provided participants with the valuable tools for recovery, giving them hope for future recovery. Support from next of kin was highly valued, creating stronger family bonds. A new meaning and greater appreciation of life was expressed.
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| 12. |
- Törnbom, Karin, 1982, et al.
(författare)
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Defining the undefined: understanding an ongoing project aimed at formalizing the assignment and use of theory and methods of health social workers
- 2024
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Ingår i: NASSW/FORSA 2024 Research Conference; Social Work as Emancipatory Practice: Creating Pathways towards Social Justice.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This research project focuses on health social workers´ (HSWs) work-methods, theoretical inspiration, and epistemic contribution. The empirical material consists of four focus group interviews with HSWs, and two group interviews with a manager and two HSWs with a specialist function, at a hospital in Sweden. The interviews were held at two occasions, in December 2022 and in April 2023. During this time, the HSWs were active in a project emanating from the managers experience of finding it difficult to answer questions about how the HSWs knew that their work had the desired outcomes. Additionally, there was uncertainty about how to know when work-methods used were supported by research. The analytical focus of this research was directed at gaining a deeper understanding of HSWs' work-methods and theoretical inspirations, as well as to analyze the HSWs' understanding of the project in relation to the theoretical concepts of discretion and epistemic hierarchies. The presentation directs attention to overarching questions of how the HSWs discuss differences and similarities among themselves and explores how they articulate understandings of their work, with an overall focus on the professionalization of this subgroup in social work. This is particularly interesting as HSWs, as the first group of social workers in Sweden, have been granted a professional license requiring a one-year Masters´ level specialist education.
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| 13. |
- Törnbom, Karin, 1982, et al.
(författare)
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Understanding concerns after severe COVID-19: A self-imposed lockdown guarded by anxiety?
- 2023
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Ingår i: PloS one. - : NLM (Medline). - 1932-6203. ; 18:7
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Tidskriftsartikel (refereegranskat)abstract
- Many people are struggling to get back to their lives after severe COVID-19. To facilitate their reintegration into everyday life, we need to understand how the process is experienced. We aimed to gain deeper knowledge about this process by interviewing persons one year after hospitalisation due to COVID-19.The study is based on a qualitative design, with eleven in-depth interviews conducted one year after discharge for COVID-19. Participants were recruited to form a heterogeneous sample with respect to age, gender and socioeconomic background. All interviews were analysed utilising inductive thematic analysis.From the participants' narratives four themes were identified: 'Concerns and worries in everyday life', 'Supportive and concerned relatives', 'A new way of life-sorrows and advantages' and 'Seize the day-a greater awareness of one´s mortality'. Participants described how they tried to create a functioning everyday life. They were generally afraid of getting COVID-19 again and concerned about future life, where their lack of energy played a major role. Narratives were diverse regarding to what extent the struggle to cope was experienced as emotionally challenging or not.Participants described an unpredictable recovery after COVID-19, characterised by ups and downs, which created worries concerning their future. In some cases, the worry of getting COVID-19 again was strong enough to keep participants in their homes, as a self-imposed lockdown guarded by anxiety. However, the narratives also revealed gratitude towards being alive and having coped so well. This led to a more positive outlook on life with a greater focus on intrinsic values, close social relations and the deeper meaning of life.
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| 14. |
- Westerlind, Emma, 1992, et al.
(författare)
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Return to work predicts perceived participation and autonomy by individuals with stroke.
- 2020
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Ingår i: Disability and rehabilitation. - : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 42:25, s. 3673-3678
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Tidskriftsartikel (refereegranskat)abstract
- Participation in activities of everyday life is seen as main goal of rehabilitation after a stroke and return to work is an important factor to consider for the substantial number of persons having a stroke at working age. The current study aims to investigate whether returning to work would predict self-perceived participation and autonomy in everyday life after a stroke, from a long-term perspective.Persons with first-ever stroke at age 18-63years in 2009-2010, Gothenburg, were included. As 5-year follow-up, the Impact on Participation and Autonomy questionnaire was sent out, investigating self-perceived participation/autonomy in five levels, and work status was investigated from national sick-absence registers. Prediction of work on participation/autonomy was investigated with logistic regression.A total of 109 participants (49%) responded to the questionnaire. The majority (69-94%) perceived very good participation/autonomy in all domains and 59% were working 5years after stroke. Working was a significant predictor of high participation/autonomy in all domains of the questionnaire.Being able to return to work after a stroke seems to be important for self-perceived participation/autonomy. This emphasizes the importance of work-oriented information and rehabilitation after a stroke at working age. Implications for rehabilitation The current study shows that the majority report high self-perceived participation and autonomy in everyday life and 59% are working 5 years after a stroke in working age. To work 5 years after a stroke was a significant predictor for self-perceived participation and autonomy in everyday life. Since stroke is becoming more common among working age persons and work seem important for perceived participation and autonomy, to optimize the return to work by for instance work-oriented information and vocational rehabilitation is important.
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