| 1. |
- Andersén, Mikael, 1985-, et al.
(author)
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“It’s about how you take in things with your brain” - young people’s perspectives on mental health and help seeking : an interview study
- 2024
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In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1
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Journal article (peer-reviewed)abstract
- Introduction: Poor mental health in young people has become a growing problem globally over the past decades. However, young people have also been shown to underutilize available healthcare resources. The World Health Organisation (WHO) has formulated guidelines for youth-friendly health services (YFHSs) to increase youth participation in healthcare. Still, little is known about how young people using these services perceive mental health, indicating a knowledge gap concerning the subjective evaluation of their mental health.Aim: To investigate how young people visiting youth health clinics (YHC) perceive the concept of mental health and factors they view as central to maintaining mental health.Methods: In total 21 interviews were carried out, 16 in 2018, and 5 in 2023 to assure no changes in findings after the COVID-19 pandemic. Subjects were recruited during visits to youth health clinics (YHCs) in mid-Sweden and were aged 15–23 years. Recruitment strived to achieve heterogeneity in the sample concerning gender, sexual orientation, gender identity and age. Interviews were transcribed and analysed using qualitative content analysis.Findings: Findings of the analysis revealed two themes, “Mental health is helped and hindered by the surroundings” and “Mental health is difficult to understand and difficult to achieve”. The participants described their health as highly dependent on their social surroundings, and that these are important to maintaining health but may also affect health negatively. They described mixed experiences of the health care services and mentioned prerequisites for seeking care for mental health problems such as accessibility and respect for their integrity, including the right to turn down offered treatment. The informants also viewed mental health as an ongoing undertaking that one must work for, and that it is sometimes difficult to know what constitutes mental health. They also expressed a need from healthcare services to enquire about their health, and to show an active interest in how they are doing.Conclusions: Findings underline the need of young people’s individual needs to be met in the healthcare system and their vulnerability to their social surroundings. Health status assessments in young people should consider social and individual factors to fully capture mental health.
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| 2. |
- Ehn, Maria, et al.
(author)
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SALUTOGEN : User-center development and prototype testing of a system supporting seniors’ physical activity for fall prevention
- 2019
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Conference paper (peer-reviewed)abstract
- Background:Physical activity (PA) can contribute to fall prevention among seniors. Many seniors need to increase their PA and regularly perform balance-enhancing activities. Changing behavior is often challenging, especially long-term. Therefore, support for change and long-term maintenance of PA behavior contributing to fall prevention is essential. Technology-based applications are widely exploited to support PA but do not match seniors’ needs. Therefore, new solutions are needed that support seniors’ PA for fall prevention leveraging theory for behavioral change and the specific target user’ needs.Aim, Method:SALUTOGEN is a research and innovation project aiming to develop and test a system prototype of technology-based motivation support for seniors’ PA including balance training. The developed technology includes apps for tablet and mobile phone that together provide seniors with motivation support for PA, activity measurement and video-coaching. The project is based on iterative user-centered methodology including: development of needed app components; evaluation of single apps and their integration; pilot feasibility evaluation with seniors and coaches in real world settings. Results:Valuable feedback from seniors was collected and used in the iterative development, especially from the motivation support perspective. The evaluation showed that the apps must be very intuitive and easy to understand. Preliminary results from the on-going pilot evaluation indicate that the coaching is highly appreciated by seniors and coaches. Moreover, the seniors’ and coaches’ experience in using the technology highly depends on the technology’s usability and reliability. Conclusions:Technology-based interventions can play an important role in supporting seniors’ PA for fall prevention. Results from the project indicate that solution’s key elements are perceived important and appreciated by seniors and coaches. However, it is crucial for the users that the technical applications are light, intuitive and robust.
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| 3. |
- Ehn, Maria, et al.
(author)
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Technology-Based Motivation Support for Seniors' Physical Activity-A Qualitative Study on Seniors' and Health Care Professionals' Views
- 2019
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In: International Journal of Environmental Research and Public Health. - : NLM (Medline). - 1661-7827 .- 1660-4601. ; 16:13
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Journal article (peer-reviewed)abstract
- This paper investigates seniors' and health care professionals' (HCPs) perceptions on needed contributions and qualities of digital technology-based motivation support for seniors' physical activity (PA). Seniors and HCPs expressed their views in focus groups, which were analyzed separately by inductive content analysis. Similarities and differences in seniors' and HCPs' views were identified through thematic analysis of qualitative results from both focus groups. This article's main findings are that both seniors and HCPs believed digital technology should support and make PA more enjoyable in ways to strengthen seniors' control and well-being. However, seniors emphasized support for social interaction, while HCPs also requested support for increasing seniors' insight into PA and for facilitating their dialogue with seniors. Conclusions to be drawn are that seniors and HPCs shared overall views on digital technology's main contributions but had different perspectives on how those contributions could be obtained. This highlights the importance of the early identification of user groups and exploration of their different needs when developing new solutions. Moreover, seniors' and HCPs' perceptions included aspects relevant for personal motivation, technology acceptance, and PA behavioral change according to self-determination theory, unified theory of acceptance and use of technology, and behavioral change techniques for increasing PA.
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| 4. |
- Ehn, Maria, et al.
(author)
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User-centered requirements engineering to manage the fuzzy front-end of open innovation in e-health : A study on support systems for seniors’ physical activity
- 2021
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In: International Journal of Medical Informatics. - : Elsevier Ireland Ltd. - 1386-5056 .- 1872-8243. ; 154
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Journal article (peer-reviewed)abstract
- Background: Although e-health potentials for improving health systems in their safety, quality and efficiency has been acknowledged, a large gap between the postulated and empirically demonstrated benefits of e-health technologies has been ascertained. E-health development has classically been technology-driven, often resulting in the design of devices and applications that ignore the complexity of the real-world setting, thus leading to slow diffusion of innovations to care. Therefore, e-health innovation needs to consider the mentioned complexity already from the start. The early phases of innovation, fuzzy front-end (FFE) defined as “the period between when an opportunity is first considered and when an idea is judged ready for development” has been identified to have the highest impact on the innovation process and its outcome. The FFE has been recognized as the most difficult stage to manage in the innovation process as it involves a high degree of uncertainty. Such a phase becomes even more difficult when different sectors and organizations are involved. Therefore, effective methods for involving different organizations and user groups in the FFE of innovation are needed. Objective: The aim of this study was to manage the FFE of a collaborative, open innovation (OI) process, to define a software system supporting seniors’ physical activity (PA) by applying a framework of methods from software requirements engineering (RE) to elicit and analyze needs and requirements of users and stakeholders, as well as the context in which the system should be used. Methods: Needs and requirements of three future user groups were explored through individual- and focus group interviews. Requirements were categorized and analyzed in a workshop with a multidisciplinary team: a system overview was produced by conceptual modelling using elicited functional requirements; high-level non-functional requirements were negotiated and prioritized. Scenario descriptions of system's supportive roles in different phases of a behavioral change process were developed. Results: User-centered RE methods were successfully used to define a system and a high-level requirements description was developed based on needs and requirements from three identified user groups. The system aimed to support seniors’ motivation for PA and contained four complementary sub-systems. The outcome of the study was a Concept of Operations (ConOps) document that specified the high-level system requirements in a way that was understandable for stakeholders. This document was used both to identify and recruit suitable industrial partners for the following open innovation development and to facilitate communication and collaboration in the innovation process. Conclusions: Applying software RE methods and involving user groups in the early phases of OI can contribute to the development of new concepts that meet complex real-world requirements. Different user groups can complement each other in conveying needs and requirements from which systems can be designed. Empirical studies applying and exploring different methods used to define new e-health solutions can contribute with valuable knowledge about handling innovation FFE.
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| 5. |
- Lostelius, Petra, et al.
(author)
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An electronic patient-reported outcome created based on my needs is worth using : an explorative qualitative study investigating young people's opinions for a health assessment tool
- 2022
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In: Journal of Patient-Reported Outcomes. - : Springer Nature. - 2509-8020. ; 6:1
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Journal article (peer-reviewed)abstract
- BackgroundYoung people in different healthcare settings are positive about using electronic patient-reported outcomes (ePROs), which are meant to increase the effectiveness and safety of interventions from the patient's perspective. Sweden offers free healthcare to young people aged 12-25 years at 275 youth health clinics (YHCs), whose goals are to strengthen young people and promote sexual, physical, and mental health. YHCs need effective ways to identify the overall picture of young people's health and health-related problems. To our knowledge, there is no ePRO for YHCs that provides an overview of young people's health from several health perspectives. The aim of this study was to explore young people's view on content and design of an ePRO to provide an overview of their health and health related problems when visiting a YHC, and their opinion on what healthcare needs to consider when using the ePRO. This was an explorative qualitative study. The participants were included from five YHCs, in different socioeconomic areas in central Sweden. Fifteen participants were included: 10 girls, three boys, and two non-binary participants with an age range of 16-22 years. Data were collected using a semi-structured interview guide and individual interviews, and inductive content analysis was performed.ResultsOne main theme, "ePRO created based on my needs is worth using" and two sub-themes, "Appealing content and design" and "Trusting healthcare", emerged. The participants wanted that an ePRO should include overall questions about mental-, physical-, and sexual health and social support. Participants also believed the ePRO must disclose the risks of self-harm or suicide. The participants noted the importance of emotional and digital security when using the ePRO and having a confidential conversation with a healthcare provider. To share health information means to trust to gain health.ConclusionsThe study participants' views on content and design can form the basis for designing an ePRO for young people. Their thoughts on safety and treatment in healthcare can be considered in the development process. This study is the starting point for developing an ePRO for young people at YHCs.
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| 6. |
- Lostelius, Petra, et al.
(author)
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Identification of health-related problems in youth : a mixed methods feasibility study evaluating the Youth Health Report System
- 2024
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In: BMC Medical Informatics and Decision Making. - : BioMed Central Ltd. - 1472-6947. ; 24:1
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Journal article (peer-reviewed)abstract
- Background: Because poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study. Methods: This mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16–23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants’ quantitative Youth Health Report System data were analyzed for descriptive statistics. Results: Feasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard; Information and routines helped but time was an issue; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility. Conclusions: The process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.
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| 7. |
- Lostelius, Vikman Lostelius, et al.
(author)
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Development and usability evaluation of an electronic health report form to assess health in young people : a mixed-methods approach
- 2023
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In: BMC Medical Informatics and Decision Making. - : BioMed Central Ltd. - 1472-6947. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Electronic Patient-Reported Outcomes (ePROs) have potential to improve health outcomes and healthcare. The development of health-technology applications, such as ePROs, should include the potential users and be theoretically grounded. Swedish Youth Health Clinics (YHCs) offer primarily sexual and psychological healthcare for young people aged 12 to 25 years old. Young people in healthcare settings are considered a vulnerable group. The development of a collection of Patient-Reported Outcomes (PROs) in an Electronic Health Report Form (eHRF) for identifying health and health-related problems in young people, was preceded by a qualitative interview study, exploring young people’s views on using an eHRF at YHCs and which questions about health an eHRF should contain. The aim of the current study was to develop and evaluate the usability of an eHRF prototype for identifying health and health-related problems in young people visiting YHCs. Methods: This study used a participatory design. During the development, an expert panel consisting of eight researchers and one Information Technology worker, participated. A wide literature search was performed to find PROs to construct an eHRF prototype to cover health areas. A mixed methods usability evaluation included 14 participants (young people, healthcare professionals, and an expert panel). Results: The development resulted in an eHRF prototype, containing ten reliable and valid health questionnaires addressing mental-, physical-, and sexual health and social support, a self-efficacy question, and background questions, in total 74 items. The interviews in the usability evaluation resulted in three categories describing the usability of the eHRF: ‘Captures the overall health of young people but needs clarification’, ‘Fun, easy, and optional and will keep young people’s interest’, and ‘Potential contribution to improve the health consultation’. The quantitative results support the usability of the eHRF for YHCs. Conclusions: The participatory approach contributed to development of the eHRF prototype to cover health areas adapted for the target population. The usability evaluation showed that the eHRF was usable and had the potential for self-reflection and contributions to cooperation between young people and healthcare professionals during the health consultation.
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| 8. |
- Lönnberg, Lena, et al.
(author)
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“It’s up to me” : the experience of patients at high risk of cardiovascular disease of lifestyle change
- 2020
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In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 38:3, s. 340-351
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Journal article (peer-reviewed)abstract
- Objective: Despite knowledge of the effect of lifestyle changes in preventing cardiovascular disease, a large proportion of people have unhealthy lifestyle habits. The aim of our study is a) to explore the experiences of participants at high risk of CVD of lifestyle change after participation in a one-year structured lifestyle counselling programme and b) to link the techniques and strategies used by the participants to the processes of the transtheoretical model of behaviour change (TTM). Design: A qualitative explorative design was used to collect data on participants’ experiences. An abductive content analysis was conducted using the processes within TTM for the deductive analysis. Setting: Patients that participated in a one-year lifestyle counselling programme in Swedish primary care, were interviewed. Subjects: Eight men and eight women, aged 51–75 years, diagnosed with hypertension or type 2 diabetes mellitus. Main outcome measures: Experiences of lifestyle change in patients at high cardiovascular risk. Results: The analysis yielded four dimensions that assisted lifestyle change: ‘The value of knowledge’, ‘Taking control’, ‘Gaining trust in oneself’ and ‘Living with a chronic condition’. The theme ‘It’s up to me’ illustrated that lifestyle change was a personal matter and responsibility. Conclusion: Enhanced knowledge, self-efficacy, support from others and the individual’s insight that it was his/her own decisions and actions that mattered were core factors to adopt healthier lifestyle habits. Practice Implications: Although lifestyle change is a personal matter, the support provided by primary healthcare professionals and significant others is essential to increase self-efficacy and motivate lifestyle change.Key Points A large proportion of people persist to have unhealthy lifestyle habits also after receiving a diagnosis of hypertension or diabetes mellitus, type 2. This study contributes to enhanced knowledge of how patients experience lifestyle change after counselling in primary care. Both experiential and behavioural processes as defined by the transtheoretical model of behaviour change were used to make lifestyle changes by the patients in this study.
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| 9. |
- Lönnberg, Lena, et al.
(author)
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Lifestyle counselling – a long-term commitment based on partnership
- 2022
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In: BMC Primary Care. - : BioMed Central Ltd. - 2731-4553. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Lifestyle habits are important factors in the development of non-communicable diseases. Different ways of providing counselling in primary care to promote healthier lifestyle habits have been launched and evaluated in recent years. It is important to provide an insight into what makes lifestyle counselling useful for patients and healthcare providers. Objective: The overall aim of this study was to explore patients´ and community health nurses´(CHNs) experiences of lifestyle counselling in primary care to support healthier lifestyle habits. Methods: Patients and CHNs were interviewed, face to face. Sixteen patients (eight men, eight women, aged 51–75 years) diagnosed with hypertension or type 2 diabetes mellitus and three CHNs participated. Data material was analysed with qualitative content analysis to explore the participants experiences of lifestyle counselling. Results: The theme demonstrates that lifestyle counselling is a long-term commitment based on partnership between patients and CHNs. Five categories describe this partnership: respect and mutual interest, understanding of illness, measurements and goal setting, long-term support, and a structure to support counselling within the primary care unit. Conclusion: The results from this study are consistent with and add to previous understanding of how lifestyle counselling can be performed successfully in the context of primary health care. The results emphasize that lifestyle counselling should encompass a partnership based on mutual respect, recognition of the patient as the expert on his/her current life situation, and the need for both parties to engage in the process of lifestyle change. Practice implications: A structured lifestyle program with five counselling sessions within primary care was experienced as helpful for enhanced lifestyle habits and considered to be feasible by both patients and CHNs.
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| 10. |
- Revenäs, Åsa, et al.
(author)
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A Mobile Internet Service for Self-Management of Physical Activity in People With Rheumatoid Arthritis : Challenges in Advancing the Co-Design Process During the Requirements Specification Phase
- 2015
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In: JMIR Research Protocols. - : JMIR PUBLICATIONS, INC. - 1929-0748. ; 4:3
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Journal article (peer-reviewed)abstract
- Background: User involvement in the development of health care services is important for the viability, usability, and effectiveness of services. This study reports on the second step of the co-design process. Objective: The aim was to explore the significant challenges in advancing the co-design process during the requirements specification phase of a mobile Internet service for the self-management of physical activity (PA) in rheumatoid arthritis (RA). Methods: A participatory action research design was used to involve lead users and stakeholders as co-designers. Lead users (n=5), a clinical physiotherapist (n=1), researchers (n=2) with knowledge in PA in RA and behavioral learning theories, an eHealth strategist (n=1), and an officer from the patient organization (n=1) collaborated in 4 workshops. Data-collection methods included video recordings and naturalistic observations. Results: The inductive qualitative video-based analysis resulted in 1 overarching theme, merging perspectives, and 2 subthemes reflecting different aspects of merging: (1) finding a common starting point and (2) deciding on design solutions. Seven categories illustrated the specific challenges: reaching shared understanding of goals, clarifying and handling the complexity of participants' roles, clarifying terminology related to system development, establishing the rationale for features, negotiating features, transforming ideas into concrete features, and participants' alignment with the agreed goal and task. Conclusions: Co-designing the system requirements of a mobile Internet service including multiple stakeholders was a complex and extensive collaborative decision-making process. Considering, valuing, counterbalancing, and integrating different perspectives into agreements and solutions (ie, the merging of participants' perspectives) were cmcial for moving the process forward and were considered the core challenges of co-design. Further research is needed to replicate the results and to increase knowledge on key factors for a successful co-design of health care services.
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