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| 2. |
- Carlfjord, Siw, et al.
(författare)
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Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory
- 2010
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 11:60
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.METHODS: A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.RESULTS: The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.CONCLUSION: When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.
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| 3. |
- Carlfjord, Siw, et al.
(författare)
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Staff perspectives on the use of a computer-based concept for lifestyle intervention implemented in primary health care
- 2010
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Ingår i: HEALTH EDUCATION JOURNAL. - : Health Education Authority. - 0017-8969 .- 1748-8176. ; 69:3, s. 246-256
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to evaluate staff experiences of the use of a computer-based concept for lifestyle testing and tailored advice implemented in routine primary health care (PHC). Design: The design of the study was a cross-sectional, retrospective survey. Setting: The study population consisted of staff at nine PHC units in the county of Ostergotland, Sweden. Method: After a computer-based concept for lifestyle intervention had been in operation for 1 year, a questionnaire was distributed to all staff members. The questions concerned experiences of and attitudes to the concept, and comments on addressing lifestyle issues in PHC. Results: Of the 291 potential respondents, 59 per cent returned the questionnaire. Eighty-five per cent found it positive to refer to the computer-based test, and 93 per cent of those who had read the written advice generated by the computer agreed with the advice provided. Seventy-five per cent thought that the concept could have an effect on a patients lifestyle, and 78 per cent had confidence in the computer-based test. Staff at smaller PHC units had more positive attitudes (p = 0.003) and referred a higher proportion of their patients to the computer-based test than staff at larger units (p = 0.000). Follow-up rates showed no significant differences between the categories. Staff believed that inclusion of more lifestyle areas, e. g. smoking and dietary habits, would make the test more useful. More time, education and the establishment of lifestyle practices were issues suggested in order to enhance the focus on lifestyle factors. Conclusion: Staff members have confidence in the computerized test and consider it a valuable tool. A development towards more lifestyle areas will make it even more useful.
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- Leijon, Matti E., 1970-, et al.
(författare)
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Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care
- 2010
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Ingår i: BMC Family Practice. - London, UK : BioMed Central. - 1471-2296. ; 11:38
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Tidskriftsartikel (refereegranskat)abstract
- Background: Written prescriptions of physical activity, so‐called physical activity referral (PAR) schemes, have increased in popularity in recent years. Such schemes have mostly been evaluated in terms of efficacy. This study reports on a Swedish PAR scheme implemented in routine primary health care (PHC) measuring patients’ self‐reported adherence to physical activity prescriptions. The aim of this study was to evaluate adherence to physical activity prescriptions issued in everyday PHC at 3 and 12 months and to analyse the different characteristics associated with adherence to these prescriptions.Methods: Prospective prescription data were obtained for 37 of the 42 PHC centres in Östergötland County, Sweden, during 2004. The study population consisted of 3300 patients issued PARs by ordinary PHC staff members. Odds ratios were calculated to identify the factors associated with adherence.Results: The average adherence rate was 56% at 3 months and 50% at 12 months. In the descriptive analyses, higher adherence was associated with increased age, higher activity level at baseline, home‐based activities, prescriptions issued by professional groups other than physicians, and among patients issued PARs due to diabetes, high blood pressure and “other PAR reasons”. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline, and to prescriptions including home‐based activities, both at 3 and 12 months.Conclusions: Prescriptions from ordinary staff in routine PHC yielded adherence in 50% of the patients in this routine care PAR scheme follow‐up. Patients’ activity level at baseline (being at least somewhat physically inactive) and being issued homebased activities were associated with higher adherence at both 3 and 12 months.
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| 5. |
- Leijon, Matti, 1970-, et al.
(författare)
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Is there a demand for physical activity interventions from health care providers? : Findings from a population survey
- 2010
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 10:34
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity.Methods: A regional public health survey was mailed to 13 440 adults (aged 18-84 years) living in Östergötland County (Sweden) in 2006. The survey was part of the regular effort by the regional Health Authorities.Results: About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37%) had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity) more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support.Conclusion: These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for their own physical activity levels, but also attribute responsibility for promoting increased physical activity to health care practitioners.
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| 6. |
- Leijon, Matti, et al.
(författare)
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Is there a demand for physical activity interventions provided by the health care sector? Findings from a population survey
- 2010
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity. Methods: A regional public health survey was mailed to 13 440 adults (aged 18-84 years) living in Ostergotland County (Sweden) in 2006. The survey was part of the regular effort by the regional Health Authorities. Results: About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37%) had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity) more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support. Conclusions: These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for their own physical activity levels, but also attribute responsibility for promoting increased physical activity to health care practitioners.
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| 7. |
- Lindhe Söderlund, Lena, 1954-, et al.
(författare)
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Applying motivational interviewing (MI) in counselling obese and overweight children and parents in Swedish child health care
- 2010
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Ingår i: Health Education Journal. - London, UK : Sage Publications. - 0017-8969 .- 1748-8176. ; 69:4, s. 390-400
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate how a motivational interviewing (MI) training course for child healthcare nurses in Sweden affected their work with children’s weight issues and their attitudes to MI.Design: Cross-sectional survey, descriptive design.Setting: Nurses were recruited from 33 different child healthcare centres in Östergötland, Sweden.Method: Seventy-six nurses who had participated in an MI training course (held in 2008) were approached one year later to answer a questionnaire by telephone. Most questions concerned the respondents’ routine use of MI in clinical practice and their attitudes towards MI as a method.Results: The response rate was 82 per cent. Nearly half of the nurses had changed the content and structure of their discussions regarding weight issues. Three-quarters of the nurses stated that they had sufficient time to use MI and that they had support from leadership and colleagues to use MI in their routine practice. The nurses’ attitudes to MI were positive, especially their perception that MI was consistent with their values and was better than traditional advice-giving approaches. Most MI techniques were found to be simple to use: 78 per cent found it very or quite simple to listen actively, 63 per cent believed it was very or quite simple to summarize parents’ opinions, 63 per cent found it very or quite simple to pay attention to parents’ change talk, and 60 per cent said that it was very or quite simple to ask permission before providing information.Conclusion: MI training can have a substantial effect on child healthcare nurses’ clinical work on paediatric weight issues.
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| 8. |
- Lindhe Söderlund, Lena, 1954-
(författare)
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Motivational Interviewing in Theory and Practice
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- An estimated 50% of mortality from the 10 leading causes of death is due to behaviour. Individuals can make important contributions to their own health by adopting health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a counselling approach for behavioural change that builds on a patient empowerment perspective by supporting autonomy and self-efficacy.The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on general health care professionals’ learning and practice of MI. Specific aims are; study I was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies; study II was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services; study III was to evaluate the attitudes towards MI and clinical use of MI with children´s weight issues one year after child health care nurses’ participation in MI training; study IV was to systematically review studies that have evaluated the contents and outcomes of MI training for general health care professionals.Participants in study I were 15 community pharmacy pharmacists in Östergötland, Sweden. Participants in study II were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Data for both studies were obtained through focus group interviews. Study III, participants were 76 nurses from child health care centres in Östergötland, Sweden. 1-year after MI training they answered a survey. Study IV, the material was 10 empirical studies that have evaluated different aspects of MI training.MI training for general health care providers is generally of short duration and tends to focus on specific topics such as diabetes, smoking, and alcohol. The training seems to contain more training on phase I elements, such as clients’ inner motivation, than on phase II, which involves strengthening clients’ commitment to change. MI is seen as practical and useful in work with lifestyle and health promotion issues, especially with issues that may be perceived as sensitive, such as alcohol and obesity. General health care providers have positive attitudes to MI and view MI as being compatible with their values and norms about how they want to work. Clients’ resistance reactions are difficult to handle in the first stages of learning MI, and may lead to frustration. Strategies to avoid resistance are including in the final stages of learning MI. Learning and clinical use of MI for general health care providers is influenced by interactions with their environment (colleagues, staff and organization). Unlearning of old knowledge can be a problem for general health care providers in the learning and clinical use of MI.
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| 9. |
- Nilsen, Per, et al.
(författare)
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Is Questionnaire-Based Alcohol Counseling More Effective for Pregnant Women Than Standard Maternity Care?
- 2010
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Ingår i: JOURNAL OF WOMENS HEALTH. - : Mary Ann Liebert Inc. - 1540-9996 .- 1931-843X. ; 19:1, s. 161-167
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare current standard maternity care in Sweden concerning provision of alcohol advice with a more comprehensive questionnaire-based counseling model. Methods: The study population included pregnant women in Linkoping who were registered at a maternity care center during a 2-year period and whose pregnancies resulted in liveborn infants without birth defects, representing 93% of all pregnant women. Anonymous questionnaires were mailed to the women. The first cohort (registered April 2005 1, to March 31, 2006) received standard care according to a procedure that is common practice in Sweden. The second cohort (April 1, 2006 to March 31, 2007) received alcohol advice based on a comprehensive counseling model, incorporating the use of the three-item Alcohol Use Disorders Identification Test (AUDIT-C) questionnaire and tailored counseling based on the AUDIT-C score. Results: The response rate was 61% in the first cohort (standard care) and 70% in the second cohort (questionnaire-based counseling). The cohorts were similar in sociodemographic variables and prepregnancy drinking characteristics. The proportion of women who continued drinking alcohol during the pregnancy was 6.0% in cohort 1 and 5.8% in cohort 2. Women in cohort 2 were more favorable to the advice and, to a larger extent, perceived the main message to be abstinence from drinking during pregnancy. Conclusions: The questionnaire-based counseling model was more favorably perceived than the standard care model, but the new model was not more effective in terms of its impact on the proportion of women who abstained from drinking during pregnancy.
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| 10. |
- Trinks, Anna, et al.
(författare)
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Reach and effectiveness of a computer-based alcohol intervention in a Swedish emergency room
- 2010
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Ingår i: International emergency nursing. - : Elsevier BV. - 1878-013X .- 1755-599X. ; 18:3, s. 138-146
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study evaluates a computerized alcohol intervention implemented in a Swedish emergency department (ED) with regard to the effectiveness of two different types of tailored brief feedback on patients drinking patterns and the reach of the intervention. METHODS: The study was a prospective, randomized controlled trial of ED patients. The designated target population was the ED population aged 18-69 years who registered at the triage room before receiving care. Patients who were categorized as risky drinkers and completed the computerized test were randomized to either a long or a short feedback. The feedback was tailored on the basis of the individual patients responses to questions on their drinking patterns. RESULTS: The computerized intervention reached 41% of the target population. Those who completed the computerized test and received the feedback were younger than those who did not receive the intervention. Among those who could be followed up, the feedback was effective in reducing the patients weekly alcohol consumption and the number of heavy episodic drinking occasions. The long feedback was slightly more effective than the short feedback, but the differences were not statistically significant.
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