The Challenge of Changing Practice: Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care

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Carlfjord, Siw,1959-Östergötlands Läns Landsting,Linköpings universitet,Socialmedicin och folkhälsovetenskap,Hälsouniversitetet,Primärvården i centrala länsdelen (author)

The Challenge of Changing Practice : Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care

BookEnglish2012

Publisher, publication year, extent ...

Linköping :Linköping University Electronic Press,2012
108 s.
electronicrdacarrier

Numbers

LIBRIS-ID:oai:DiVA.org:liu-73300
ISBN:9789173930390
https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-73300URI

Supplementary language notes

Language:English
Summary in:English

Part of subdatabase

SwePubSwePub

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Subject category:vet swepub-contenttype
Subject category:dok swepub-publicationtype

Series

Linköping University Medical Dissertations,0345-0082 ;1269

Notes

Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Public Health, Global Health, Social Medicine and Epidemiology hsv//eng
Implementation; Primary Health Care; Public Health

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Bendtsen, Preben,ProfessorÖstergötlands Läns Landsting,Linköpings universitet,Socialmedicin och folkhälsovetenskap,Hälsouniversitetet,Akutkliniken(Swepub:liu)prebe15 (thesis advisor)
Lindberg, Malou,PhDÖstergötlands Läns Landsting,Linköpings universitet,Allmänmedicin,Hälsouniversitetet,Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland(Swepub:liu)malli89 (thesis advisor)
Andersson, Agneta,PhDÖstergötlands Läns Landsting,Linköpings universitet,Socialmedicin och folkhälsovetenskap,Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland(Swepub:liu)agnan79 (thesis advisor)
Nilsen, Per,DocentLinköpings universitet,Socialmedicin och folkhälsovetenskap,Hälsouniversitetet(Swepub:liu)perni31 (thesis advisor)
Brommels, Mats,ProfessorInstitutionen för Lärande, Informatik, Management och Etik, Karolinska Institutet, Stockholm (opponent)
Linköpings universitetSocialmedicin och folkhälsovetenskap (creator_code:org_t)

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