| 1. |
- Albers, Bianca, et al.
(author)
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Tailoring in implementation science
- 2023
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In: FRONTIERS IN HEALTH SERVICES. - : FRONTIERS MEDIA SA. - 2813-0146. ; 3
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Journal article (other academic/artistic)
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| 2. |
- Birken, Sarah A., et al.
(author)
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Toward a more comprehensive understanding of organizational influences on implementation: the organization theory for implementation science framework
- 2023
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In: FRONTIERS IN HEALTH SERVICES. - : FRONTIERS MEDIA SA. - 2813-0146. ; 3
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Journal article (peer-reviewed)abstract
- IntroductionImplementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. To advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework.MethodsThe process of distilling organization theory constructs into domains involved concept mapping and iterative consensus-building. First, we recruited organization and implementation scientists to participate in an online concept mapping exercise in which they sorted organization theory constructs into domains representing similar theoretical concepts. Multidimensional scaling and hierarchical cluster analyses were used to produce visual representations (clusters) of the relationships among constructs in concept maps. Second, to interpret concept maps, we engaged members of the Cancer Prevention and Control Research Network (CPCRN) OTIS workgroup in consensus-building discussions.ResultsTwenty-four experts participated in concept mapping. Based on resulting construct groupings coherence, OTIS workgroup members selected the 10-cluster solution (from options of 7-13 clusters) and then reorganized clusters in consensus-building discussions to increase coherence. This process yielded six final OTIS domains: organizational characteristics (e.g., size; age); governance and operations (e.g., organizational and social subsystems); tasks and processes (e.g., technology cycles; excess capacity); knowledge and learning (e.g., tacit knowledge; sense making); characteristics of a population of organizations (e.g., isomorphism; selection pressure); and interorganizational relationships (e.g., dominance; interdependence).DiscussionOrganizational influences on implementation are poorly understood, in part due to the limitations of extant frameworks. To improve understanding of organizational influences on implementation, we distilled 70 constructs from nine organization theories into six domains. Applications of the OTIS framework will enhance understanding of organizational influences on implementation, promote theory-driven strategies for organizational change, improve understanding of mechanisms underlying relationships between OTIS constructs and implementation, and allow for framework refinement. Next steps include testing the OTIS framework in implementation research and adapting it for use among policymakers and practitioners.
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| 3. |
- Boman, Charlotte, et al.
(author)
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Physical activity on prescription for children with obesity: a focus group study exploring experiences in paediatric healthcare
- 2024
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In: Frontiers in Health Services. - 2813-0146. ; 4
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Journal article (peer-reviewed)abstract
- Background: Insufficient physical activity is a growing public health concern and is closely linked to obesity in both adults and children. Swedish physical activity on prescription (PAP) is effective in increasing physical activity levels in adults, but knowledge about how PAP is used in paediatric healthcare is lacking. Therefore, this study aimed to explore experiences of working with PAP for children with obesity amongst paediatric staff and managers. Methods: Seven focus group discussions with 26 participants from paediatric outpatient clinics in western Sweden were conducted. Data were analysed both inductively and deductively, framed by the Normalization Process Theory's four core constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Results: The PAP work for children with obesity was experienced to be about helping children to become physically active, and less about losing weight. Identified barriers for using PAP were the non-uniform nature of the work and a perceived lack of guidelines. Collaboration with physiotherapists and physical activity organisers outside the organisation was identified as an important facilitator. An important contextual factor for implementing PAP is the collaboration between paediatric clinics and physical activity organisers. In the transition between these stakeholders, maintaining a family-centred approach when working with PAP was experienced as challenging. Conclusions: PAP is a well-known intervention that is inconsistently used for children with obesity. The intervention should include a family-centred approach for this patient group. It also needs to align better with existing collaborations with other healthcare units as well as with new forms of collaboration with physical activity organisers in the community.
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| 4. |
- Boman, Charlotte, et al.
(author)
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Prerequisites for implementing physical activity on prescription for children with obesity in paediatric health care: A cross-sectional survey.
- 2023
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In: Frontiers in Health Services. - : Frontiers Media SA. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- Physical inactivity is a main driver of childhood obesity that tracks into adulthood, making it crucial to address early in life. Swedish physical activity on prescription (PAP) is an effective intervention for increasing physical activity levels in adults and is being implemented in primary care in Sweden. Before implementing PAP for children, both intervention effectiveness and implementation prerequisites need to be examined. Framed by the Normalization Process Theory (NPT) domains, this study aimed to investigate perceptions of PAP amongst paediatric staff and managers working with children with obesity, as well as acceptability, appropriateness, feasibility, and barriers and facilitators for implementing PAP in paediatric health care.Staff and managers in 28 paediatric outpatient clinics in western Sweden were surveyed using validated implementation instruments and open-ended questions. Data were analysed using Mann-Whitney U tests and Kruskal-Wallis tests. Qualitative data were categorised into NPT domains.The survey response rate was 54% (125/229). Most respondents (82%) reported PAP to be familiar and many (56%) perceived it as a normal part of work; nurses and physiotherapists to a greater extent (p<0.001). This was anticipated to increase in the future (82%), especially amongst those with the longest work experience (p=0.012). Respondents reported seeing the potential value in their work with PAP (77%), being open to working in new ways to use PAP (94%), and having confidence in their colleagues' ability to use PAP (77%). Barriers and facilitators were found in all the NPT domains, mainly collective action and reflexive monitoring, where, for example, inadequacies of education, resources, and research on PAP for children were reported as barriers. Most respondents agreed that PAP was acceptable, appropriate, and feasible (71% to 88%).PAP is familiar and perceived as an acceptable, appropriate, and feasible intervention, and by many viewed as a normal part of clinical routines in paediatric outpatient clinics in western Sweden, especially by physiotherapists and nurses. Barriers and faciliators are mainly related to collective action and reflexive monitoring. The wide acceptance demonstrates receptiveness to PAP as an intervention to promote an active lifestyle for children with obesity.
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| 5. |
- Dannapfel, Petra, et al.
(author)
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Implementing smoking cessation in routine primary care-a qualitative study
- 2023
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In: FRONTIERS IN HEALTH SERVICES. - : FRONTIERS MEDIA SA. - 2813-0146. ; 3
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Journal article (peer-reviewed)abstract
- BackgroundThe use of digital tools has been proposed as a solution to some of the challenges of providing preventative services in primary care. Although there is a general acceptance among patients to use digital self-help tools to quit smoking, and healthcare organizations are increasingly urged to incorporate these tools in clinical practice, it is unclear how and for whom these innovations can be incorporated into clinical practice.ObjectivesTo explore health care professionals' perceptions about smoking cessation practice in routine primary care and the use of digital tools in this work.MethodsA qualitative study with nine in-depth telephone interviews with health care professionals working in primary care in Sweden. Convenience sampling and snowball technique was used as recruitment strategy. Informants included registered, district and auxiliary nurses as well as behavioral therapists. All informants were female, between 43 and 57 years old and experience of working with smoking cessation in primary care and possibility to recommend digital interventions to smokers.ResultsInformants described smoking cessation practice in primary care as (i) identifying smoking patients, (ii) pursuing standardized routines for smoking cessation practice and (iii) keeping smoking cessation practice on the agenda. Digital tools were described by informants to be used in different ways: (i) replicating practice, (ii) complementing practice and (iii) enabling access to health care practitioners. Finally, the analysis showed that patients' expectations and behaviors contributed to how and when smoking cessation practice was conducted, including the use of digital tools.ConclusionsImplementing smoking cessation practice in primary care in Sweden encompass continuous work of reaching smoking patients, building buy-in among peers and keeping tobacco on the practice agenda. Digital interventions are used to replicate, complement and enabling access to care. The findings suggest that poor continuity of staff and negative attitudes towards preventative work may challenge smoking cessation practice. However, societal changes in the awareness of the health risks of tobacco use including shifting social norms regarding the acceptance of smoking may contribute to a normalization of speaking about smoking in primary care practice. Increased knowledge is needed on how, and for whom digital tools can be incorporated in clinical practice.
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| 6. |
- Eldh, Ann Catrine, Professor, 1965-, et al.
(author)
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Facilitating facilitators to facilitate : Some general comments on a strategy for knowledge implementation in health services
- 2023
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In: Frontiers Health Services. - : Frontiers Media S.A.. - 2813-0146. ; 3
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Journal article (peer-reviewed)abstract
- Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators' activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks.
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| 7. |
- Ingvarsson, Sara, et al.
(author)
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Strategies to reduce low-value care – An applied behavior analysis using a single-case design
- 2023
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In: Frontiers in Health Services. - : Frontiers Media S.A.. - 2813-0146. ; 3
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Journal article (peer-reviewed)abstract
- Introduction: Implementation science has traditionally focused on the implementation of evidence-based practices, but the field has increasingly recognized the importance of addressing de-implementation (i.e., the process of reducing low-value care). Most studies on de-implementation strategies have used a combination of strategies without addressing factors that sustain the use of LVC and there is a lack of information about which strategies are most effective and what mechanisms of change might underlie these strategies. Applied behavior analysis is an approach that could be a potential method to gain insights into the mechanisms of de-implementation strategies to reduce LVC. Three research questions are addressed in this study: What contingencies (three-term contingencies or rule-governing behavior) related to the use of LVC can be found in a local context and what strategies can be developed based on an analysis of these contingencies?; Do these strategies change targeted behaviors?; How do the participants describe the strategies' contingencies and the feasibility of the applied behavior analysis approach? Materials and methods: In this study, we used applied behavior analysis to analyze contingencies that maintain behaviors related to a chosen LVC, the unnecessary use of x-rays for knee arthrosis within a primary care center. Based on this analysis, strategies were developed and evaluated using a single-case design and a qualitative analysis of interview data. Results: Two strategies were developed: a lecture and feedback meetings. The results from the single-case data were inconclusive but some of the findings may indicate a behavior change in the expected direction. Such a conclusion is supported by interview data showing that participants perceived an effect in response to both strategies. Conclusion: The findings illustrate how applied behavior analysis can be used to analyze contingencies related to the use of LVC and to design strategies for de-implementation. It also shows an effect of the targeted behaviors even though the quantitative results are inconclusive. The strategies used in this study could be further improved to target the contingencies better by structuring the feedback meetings better and including more precise feedback.
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| 8. |
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| 9. |
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| 10. |
- Lundgren, Julie S, et al.
(author)
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Perceptions of facilitators, barriers and solutions when preparing to implement a home visiting program in Sweden: a mixed-methods study.
- 2024
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In: Frontiers in health services. - 2813-0146. ; 4
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Journal article (peer-reviewed)abstract
- Although there is growing awareness that early childhood development programs are important for a sustainable society, there is a knowledge gap about how to implement such programs. Successful implementation requires attention to implementation drivers (competency, organization, and leadership) during all phases of the implementation. The purpose of this study was to describe cross-sectoral operational workgroups' perceptions of facilitators, barriers and solutions related to implementation drivers in the preparationphase of implementing an evidence-based early childhood home visiting program.Quantitative and qualitative data were collected from twenty-four participants, divided into 5 groups, during implementation planning workshops. The workshops were guided by a structured method informed by the principles of Motivational Interviewing and within a framework of implementation drivers. Groups sorted cards with statements representing implementation drivers according to perceptions of facilitators and barriers, and percentages were calculated for each type of implementation determinant, for each type of driver. The groups discussed their card sorting and wrote action plans to address barriers, yielding documentation that was analyzed using deductive qualitative content analysis.A mixed-methods analysis resulted identification of facilitators, barriers, unknowns and solutions in two to three subcategories under each main category of implementation driver. A competent and confident workforce, and enthusiasm and commitment were key facilitators. Key barriers were unclear roles and responsibilities, and insufficient articulation of local vision and goals. Many factors were described as yet unknown. Specific solutions were generated to support the implementation.Our study furthers the scientific understanding of how to take evidence-based early childhood programs from research to practice within an implementation drivers framework. Facilitators, barriers and solutions in key areas during the preparation phase were identified with the help of a novel tool. The results provide useful knowledge for decision makers and organizations preparing similar initiatives in communities striving to attain sustainable development goals.
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| 11. |
- Mkumbo, Elibariki, et al.
(author)
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Same label, different patients : Health-workers' understanding of the label 'critical illness'
- 2023
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In: Frontiers in health services. - : Frontiers Media S.A.. - 2813-0146. ; 3
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Journal article (peer-reviewed)abstract
- BACKGROUND: During the course of patients' sickness, some become critically ill, and identifying them is the first important step to be able to manage the illness. During the course of care provision, health workers sometimes use the term 'critical illness' as a label when referring to their patient's condition, and the label is then used as a basis for communication and care provision. Their understanding of this label will therefore have a profound impact on the identification and management of patients. This study aimed to determine how Kenyan and Tanzanian health workers understand the label 'critical illness'.METHODS: A total of 10 hospitals-five in Kenya and five in Tanzania-were visited. In-depth interviews were conducted with 30 nurses and physicians from different departments in the hospitals who had experience in providing care for sick patients. We conducted a thematic analysis of the translated and transcribed interviews, synthesized findings and developed an overarching set of themes which captured healthcare workers' understandings of the label 'critical illness'.RESULTS: Overall, there does not appear to be a unified understanding of the label 'critical illness' among health workers. Health workers understand the label to refer to patients in four thematic ways: (1) those in a life-threatening state; (2) those with certain diagnoses; (3) those receiving care in certain locations; and (4) those in need of a certain level of care.CONCLUSION: There is a lack of a unified understanding about the label 'critical illness' among health workers in Tanzania and Kenya. This potentially hampers communication and the selection of patients for urgent life-saving care. A recently proposed definition, "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility", could be useful for improving communication and care.
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| 12. |
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| 13. |
- Nilsen, Per, 1960-, et al.
(author)
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Realizing the potential of artificial intelligence in healthcare : Learning from intervention, innovation, implementation and improvement sciences
- 2022
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In: Frontiers in Health Services. - Lausanne : Frontiers Media S.A.. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- Introduction: Artificial intelligence (AI) is widely seen as critical for tackling fundamental challenges faced by health systems. However, research is scant on the factors that influence the implementation and routine use of AI in healthcare, how AI may interact with the context in which it is implemented, and how it can contribute to wider health system goals. We propose that AI development can benefit from knowledge generated in four scientific fields: intervention, innovation, implementation and improvement sciences.Aim: The aim of this paper is to briefly describe the four fields and to identify potentially relevant knowledge from these fields that can be utilized for understanding and/or facilitating the use of AI in healthcare. The paper is based on the authors' experience and expertise in intervention, innovation, implementation, and improvement sciences, and a selective literature review.Utilizing knowledge from the four fields: The four fields have generated a wealth of often-overlapping knowledge, some of which we propose has considerable relevance for understanding and/or facilitating the use of AI in healthcare.Conclusion: Knowledge derived from intervention, innovation, implementation, and improvement sciences provides a head start for research on the use of AI in healthcare, yet the extent to which this knowledge can be repurposed in AI studies cannot be taken for granted. Thus, when taking advantage of insights in the four fields, it is important to also be explorative and use inductive research approaches to generate knowledge that can contribute toward realizing the potential of AI in healthcare. © 2022 Nilsen, Reed, Nair, Savage, Macrae, Barlow, Svedberg, Larsson, Lundgren and Nygren.
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| 14. |
- Nilsen, Per, 1960-, et al.
(author)
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Towards evidence-based practice 2.0 : leveraging artificial intelligence in healthcare
- 2024
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In: Frontiers in Health Services. - Lausanne : Frontiers Media S.A.. - 2813-0146. ; 4
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Research review (peer-reviewed)abstract
- Background: Evidence-based practice (EBP) involves making clinical decisions based on three sources of information: evidence, clinical experience and patient preferences. Despite popularization of EBP, research has shown that there are many barriers to achieving the goals of the EBP model. The use of artificial intelligence (AI) in healthcare has been proposed as a means to improve clinical decision-making. The aim of this paper was to pinpoint key challenges pertaining to the three pillars of EBP and to investigate the potential of AI in surmounting these challenges and contributing to a more evidence-based healthcare practice. We conducted a selective review of the literature on EBP and the integration of AI in healthcare to achieve this.Challenges with the three components of EBP: Clinical decision-making in line with the EBP model presents several challenges. The availability and existence of robust evidence sometimes pose limitations due to slow generation and dissemination processes, as well as the scarcity of high-quality evidence. Direct application of evidence is not always viable because studies often involve patient groups distinct from those encountered in routine healthcare. Clinicians need to rely on their clinical experience to interpret the relevance of evidence and contextualize it within the unique needs of their patients. Moreover, clinical decision-making might be influenced by cognitive and implicit biases. Achieving patient involvement and shared decision-making between clinicians and patients remains challenging in routine healthcare practice due to factors such as low levels of health literacy among patients and their reluctance to actively participate, barriers rooted in clinicians' attitudes, scepticism towards patient knowledge and ineffective communication strategies, busy healthcare environments and limited resources.AI assistance for the three components of EBP: AI presents a promising solution to address several challenges inherent in the research process, from conducting studies, generating evidence, synthesizing findings, and disseminating crucial information to clinicians to implementing these findings into routine practice. AI systems have a distinct advantage over human clinicians in processing specific types of data and information. The use of AI has shown great promise in areas such as image analysis. AI presents promising avenues to enhance patient engagement by saving time for clinicians and has the potential to increase patient autonomy although there is a lack of research on this issue.Conclusion: This review underscores AI's potential to augment evidence-based healthcare practices, potentially marking the emergence of EBP 2.0. However, there are also uncertainties regarding how AI will contribute to a more evidence-based healthcare. Hence, empirical research is essential to validate and substantiate various aspects of AI use in healthcare. ©2024 The Authors
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| 15. |
- Padyab, Mojgan, 1976-, et al.
(author)
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A comparative study of stress experienced by Swedish and Norwegian police officers
- 2023
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In: Frontiers in Health Services. - : Frontiers Media S.A.. - 2813-0146. ; 3
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Journal article (peer-reviewed)abstract
- Introduction: Police officers work in a variable environment under different circumstances and often involves stressful situations. This include working irregular hours, ongoing exposure to critical incidents, confrontations and violence. community police officers are mainly out in the society and have daily contact with the general public. critical incidents can also consist of being criticized and stigmatized as a police officer, both from the public but also lack of support from their own organization. There is evidence on negative impacts of stress on police officers. However, knowledge about the nature of police stress and its various types is insufficient. It is assumed that there are common stress factors which are universal among all police officers in different contexts but there is a lack of comparative studies to provide empirical evidence. The aim of this study is to compare different types of stress among police officers in Norway and Sweden and how the pattern of experiencing stress has changed over time in these countries.Methods: The study population consisted of patrolling police officers from 20 local police districts or units in all seven regions in Sweden (n = 953) and patrolling police officers from four police districts in Norway (n = 678). A 42-item Police Stress Identification Questionnaire was used to measure the stress level.Results: The findings show differences in types of stressful events as well as its severity among police officers in Sweden and Norway. The level of stress decreased over time among Swedish police officers whereas it showed no change or even an increase among the Norwegian participants.Discussion: The results of this study are relevant for policy-makers, police authorities and lay police officers in each country to tailor their efforts to prevent stress among police officers.
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| 16. |
- Pestoff, Rebecka, 1978-, et al.
(author)
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Rapid Implementation of Telegenetic Counseling in the COVID-19 and Swedish Healthcare Context : A Feasibility Study
- 2022
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In: Frontiers in Health Services. - : Frontiers Media S.A.. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- This study reports the process and preliminary findings of rapid implementation oftelegenetic counseling in the context of Swedish healthcare and COVID-19 pandemic,from both a patient and a provider perspective. Fourty-nine patients and 6 healthcareprofessionals were included in this feasibility study of telegenetic counseling in aregional Department of Clinical Genetics in Sweden. Telegenetic counseling is heredefined as providing genetic counseling to patients by video (n =30) or telephone (n= 19) appointments. Four specific feasibility aspects were considered: acceptability,demand, implementation, and preliminary efficacy. Several measures were used includingthe Genetic Counseling Outcome Scale 24 (collected pre- and post-counseling); theTelehealth Usability Questionnaire; a short study specific evaluation and Visiba Careevaluations, all collected post-counseling. The measures were analyzed with descriptivestatistics and the preliminary results show a high level of acceptance and demand, fromboth patients and providers. Results also indicate successful initial implementation in theregional Department of Clinical Genetics and preliminary efficacy, as shown by significantclinically important improvement in patients’ empowerment levels.
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| 17. |
- Pettersson, Kristoffer, et al.
(author)
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Eleven Reasons for Adaptation of Swedish Parenting Programs
- 2022
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In: Frontiers in Health Services. - : Frontiers Media SA. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- While questions about adaptation and fidelity are of great concern in manyimplementation projects, less attention has been paid to reasons for adaptations thatremain when evidence-based interventions (EBIs) are used in clinical and communitysettings. This study aims to explore reasons for adaptations that can arise whenusing parenting programs in a community setting. Seventeen individual interviewswith providers were conducted and analyzed thematically, resulting in 11 reasonsfor adaptations organized into four separate areas: characteristics of group leaders(supplementary skills and knowledge, preferred ways of working), characteristics offamilies (problem complexity, diverse or limited educational experience, non-parentingneeds for support, colliding value systems), group incidents (criticism and challenges,excessive questions or discussions), and didactic challenges (lack of focus orengagement, limitations of the material, language differences). The study shows thatfactors triggering adaptation and fidelity decisions continuously reappear in the provisionof parenting programs in community settings. Knowledge about reasons for adaptationcan be used to inform decision-making during implementation planning, as well as thesustainment of implemented interventions.
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| 18. |
- Steerling, Emilie, Doktorand, 1981-, et al.
(author)
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Implementing AI in healthcare—the relevance of trust : a scoping review
- 2023
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In: Frontiers In Health Services. - Lausanne : Frontiers Media S.A.. - 2813-0146. ; 3
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Research review (peer-reviewed)abstract
- Background: The process of translation of AI and its potential benefits into practice in healthcare services has been slow in spite of its rapid development. Trust in AI in relation to implementation processes is an important aspect. Without a clear understanding, the development of effective implementation strategies will not be possible, nor will AI advance despite the significant investments and possibilities.Objective: This study aimed to explore the scientific literature regarding how trust in AI in relation to implementation in healthcare is conceptualized and what influences trust in AI in relation to implementation in healthcare.Methods: This scoping review included five scientific databases. These were searched to identify publications related to the study aims. Articles were included if they were published in English, after 2012, and peer-reviewed. Two independent reviewers conducted an abstract and full-text review, as well as carrying out a thematic analysis with an inductive approach to address the study aims. The review was reported in accordance with the PRISMA-ScR guidelines.Results: A total of eight studies were included in the final review. We found that trust was conceptualized in different ways. Most empirical studies had an individual perspective where trust was directed toward the technology's capability. Two studies focused on trust as relational between people in the context of the AI application rather than as having trust in the technology itself. Trust was also understood by its determinants and as having a mediating role, positioned between characteristics and AI use. The thematic analysis yielded three themes: individual characteristics, AI characteristics and contextual characteristics, which influence trust in AI in relation to implementation in healthcare.Conclusions: Findings showed that the conceptualization of trust in AI differed between the studies, as well as which determinants they accounted for as influencing trust. Few studies looked beyond individual characteristics and AI characteristics. Future empirical research addressing trust in AI in relation to implementation in healthcare should have a more holistic view of the concept to be able to manage the many challenges, uncertainties, and perceived risks.
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| 19. |
- Thomas, Kristin, 1978-, et al.
(author)
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Mobile phone-based lifestyle support for families with young children in primary health care (MINISTOP 2.0) : Exploring behavioral change determinants for implementation using the COM-B model.
- 2022
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In: Frontiers in health services. - : Frontiers Media S.A.. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- BACKGROUND: Obesity in childhood is a public health concern worldwide and mobile phone-based interventions (mHealth) has shown to facilitate obesity prevention. However, more research is needed on the implementation of digital tools in routine primary care. This study explored behavior change determinants for implementing a health promotion mHealth intervention (MINISTOP 2.0 app) targeting parents of 4-year-olds.METHODS: Secondary data from telephone interviews (n = 15) with child health care nurses working within primary child healthcare in Sweden was analyzed using directed content analysis and the COM-B model.RESULTS: Barriers for implementation included: limited knowledge about using technology and reservations about how and to what extent parents would use mHealth. Potential facilitators included nurses' openness to learn and try new tools, confidence in their role and engagement in reaching parents as well as beliefs that the app could improve practice by prompting dialogue and being a shared platform. Nurses expressed a strong professional identity and shared understanding of their practice, mechanisms that could potentially inhibit or facilitate implementation.CONCLUSIONS: Findings suggest cautious optimism regarding implementing mobile phone-based tools in child primary healthcare in terms of capability, opportunity and motivation among stakeholders. Implementation strategies such as educational outreach visits and making the intervention testable among stakeholders could further facilitate implementation in this clinical context. However, more research is needed on behavior change determinants in different stages of real-world implementation.
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| 20. |
- Thomas, Kristin, 1978-, et al.
(author)
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Organizational readiness to implement a care model in primary care for frail older adults living at home in Sweden.
- 2022
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In: Frontiers in health services. - : Frontiers Media S.A.. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- BACKGROUND: The demographic change of an aging population constitutes a challenge for primary care organizations worldwide. The systematic implementation of preventative and proactive care models is needed to cope with increased care demands.OBJECTIVE: To investigate the organizational readiness in primary care to implement a new care model to prevent hospitalization among frail older adults.METHOD: Individual qualitative interviews with health care staff investigated organizational readiness at seven primary care units in Sweden. A semi-structured interview guide was used during the interviews and included broad questions on individual and collective readiness to change. Directed content analysis and organizational readiness to change theory were used in data analysis.RESULTS: Positive beliefs among staff such as perceived benefits and compatibility with existing values contributed to a strong commitment to implement the new care model. However, perceptions such as unclear task demands, limited resources and concerns about new collaborative structures challenged implementation.CONCLUSIONS: The findings emphasize implementation as an inter-organizational phenomenon, especially for holistic practices that span across multiple health care providers and disciplines. Furthermore, implementing care models in healthcare may require a change of culture as much as a change of practice.
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| 21. |
- Tinghög, Gustav, et al.
(author)
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Public Attitudes Toward Priority Setting Principles in Health Care During COVID-19
- 2022
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In: Frontiers in Health Services. - : Frontiers Media SA. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- What role should cost-effectiveness play in health care priority setting? We assessthe level of acceptance toward different priority setting principles in health care duringCOVID-19 and in general, thereby exploring public support for principles presented atdifferent levels of abstraction. An online survey was distributed to a diverse sample of theSwedish population (n = 1 553). The results show that respondents were generally moresupportive of priority setting principles when expressed in general abstract terms thanwhen expressed in more case specific concrete terms. However, prioritization basedon cost-effectiveness was deemed as more acceptable when expressed in concreteterms related to health maximization rather than as an abstract principle. Respondentshad a general inclination in support of physicians and other health care professionalsthe primary responsibility for the allocation of scarce resources in the healthcare duringCOVID-19, while being less supportive of health economists and politicians beinginvolved in these decisions
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| 22. |
- Vackerberg, Nicoline, et al.
(author)
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Commentary : Bridging the silos. A comparative analysis of Implementation Science and Improvement Science
- 2022
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In: Frontiers in health services. - : Frontiers Media S.A.. - 2813-0146. ; 2
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Journal article (other academic/artistic)abstract
- A Commentary onBridging the silos: A comparative analysis of Implementation Science and Improvement ScienceNilsen, P., Thor, J., Bender, M., Leeman, J., Andersson-Gäre, B., and Sevdalis. N. (2022). Front. Health Serv. 1:817750. doi: 10.3389/frhs.2021.817750
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| 23. |
- Villadsen, Sarah Fredsted, et al.
(author)
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Unlocking the mechanisms of change in the MAMAACT intervention to reduce ethnic disparity in stillbirth and newborns' health : integration of evaluation findings
- 2024
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In: Frontiers in health services. - : Frontiers Media S.A.. - 2813-0146. ; 4
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Journal article (peer-reviewed)abstract
- Ethnic disparities in stillbirth exist in Europe and suboptimal care due to miscommunication is one contributing cause. The MAMAACT intervention aimed to reduce ethnic disparity in stillbirth and newborns' health through improved management of pregnancy complications. The intervention encompassed training of antenatal care midwives in cultural competencies and intercultural communication combined with health education materials for the expecting parents about symptoms of pregnancy complications. The evaluation consisted of a qualitative in-depth implementation analysis and a process evaluation embedded in a cluster randomized trial including 19 of 20 maternity wards in Denmark. In this article, the findings from the different evaluation perspectives are integrated. The integration follows the principles of realist evaluation by analyzing to what extent the MAMAACT activities were generating mechanisms of change in interaction with the context. The integration analysis shows that the health education materials in the MAMAACT intervention contributed to heightened health literacy concerning pregnancy complications among pregnant women. Additionally, the training of midwives in cultural competency and intercultural communication raised awareness among midwives. Nonetheless, the exclusive emphasis on midwives and the inflexibility in care provision hindered them from changing their communication practices. To enhance the cultural competence in maternity care, it is essential to implement more comprehensive initiatives involving healthcare professionals in maternity care at all levels, from pregraduate to postgraduate. Adequate interpreter services and management support should also be ensured. Currently, the Danish antenatal care system faces challenges including inadequate information transfer between healthcare sectors, insufficient differentiation of care, and inflexibility in midwife scheduling. This results in a lack of responsiveness to the individual needs of women with immigrant backgrounds, potentially reproducing health inequities.
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- Zetterlund, Johanna, et al.
(author)
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A Slippery Slope When Using an Evidence-Based Intervention Out of Context. How Professionals Perceive and Navigate the Fidelity-Adaptation Dilemma—A Qualitative Study
- 2022
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In: Frontiers in Health Services. - : Frontiers Media SA. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- Introduction: Adaptations are often necessary to effectively translate evidence-based interventions (EBI) between contexts, but compliance with the EBIs' core components is still important, which is referred to as the fidelity–adaptation dilemma. In the sustainment phase of implementation, it is the professionals delivering the EBIs who are tasked with the decision-making regarding adaptations, but the currently used models and frameworks mostly focus on the initial phases of implementation. To better understand and guide professionals in using EBIs, there is a need to explore professionals' perceptions of the fidelity–adaptation dilemma. The aim of this study is consequently to explore how professionals perceive and navigate the fidelity–adaptation dilemma when using an EBI out of context.Materials and Methods: Semi-structured interviews were held with 19 psychologists working in primary care. The interviews concerned EBIs in general and Cool Kids, an evidence-based parenting education program designed for children with anxiety that is now used for children with lower levels of anxiety in another setting. The data were analyzed using an inductive content analysis method.Results: The analysis resulted in two themes: My standpoint regarding fidelity and adaptation is clear and Managing fidelity and adaptations is complicated. The first theme summarizes the professionals' perceptions of confidence for either favoring fidelity or adaptations, as well as reasons for why they made adaptations. For the second theme, the professionals expressed concern about sometimes meeting difficulties with the dilemma when following their original inclination and having second thoughts about the impact the adaptations have in practice.Conclusion: The professionals generally had strong preferences regarding fidelity and adaptations, but neither preference prevented them from facing difficulties with the dilemma. The results point to a need for better information about possible adaptations from developers but also better support and guidance for professionals when implementing EBIs to ensure quality implementation and facilitate implementation. The results of this study can inform the design of support for professionals in managing the dilemma.
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