Nursing staff turnover is an increasing problem for healthcare globally. In Sweden, the shortage of nurses in primary healthcare has increased significantly in recent years. This development is alarming because primary healthcare, both in Sweden and internationally, is responsible for a large part of healthcare. The aim of this study was to explore working conditions (change fatigue, leadership climate, and social support from colleagues) and characteristics of primary care nurses who are discontent with their current job, i.e., those with high turnover intentions and poor job satisfaction in Sweden. This was a cross-sectional survey of 466 registered nurses working in Swedish primary healthcare. Data were analyzed using descriptive statistics and logistic regression. The results demonstrate that 21.1% of the responding nurses are discontent with their current job and have considered quitting. Being discontent had significant associations with poor leadership climate (p<0.001), lack of social support from colleagues (p<0.001), change fatigue (p<0.001), poor health (p<0.001), and working more than 40 h per week (p=0.02). The results have implications for how healthcare organizations structure the work of nurses in primary healthcare and how they can attract and retain future staff to these workplaces. © 2024 Elin Karlsson et al.

Implementation science has seen the development of literally hundreds of theoretical approaches in the form of theories, models and frameworks for use by researchers in the field. This chapter provides an overview of the theories, models and frameworks that are available in implementation science, with the aim of describing how these approaches are applied. The chapter presents a taxonomy that distinguishes between different approaches to advance clarity and achieve a common terminology in the field. Knowledge about the theories, models and frameworks facilitates appropriate selection and application of relevant approaches in implementation science studies. © 2024 selection and editorial matter, Per Nilsen; individual chapters, the contributors.

[No abstract available]

Determinant frameworks are used in implementation science to describe and categorize influences (i.e. determinants) on the implementation of evidence-based practices. Determinants are typically divided into barriers (or hindrances) and facilitators (or enablers or drivers) of implementation. Knowledge about implementation determinants is important to develop and select appropriate strategies to overcome barriers and harness facilitators to support the implementation of evidence-based interventions, programmes, services and other practices. This chapter looks at the origins, content and use of six determinant frameworks. © 2024 selection and editorial matter, Per Nilsen; individual chapters, the contributors.

Background: There is overwhelming evidence for the preventive effects of regular physical activity and healthy eating habits on the risk for developing a non-communicable disease (NCD). Increasing attention has been paid to community-wide approaches in the battle against NCDs. Communities can create supportive policies, modify physical environments, and foster local stakeholder engagement through intersectoral collaboration to encourage communities to support healthy lifestyles. The Pep initiative is based on intersectoral community-wide collaboration among Sweden’s municipalities. Primary targets are municipality professionals who work with children and young people as well as parents of children <18 years. The goal is to spread knowledge and create commitment to children’s and young people’s health with a special focus on physical activity and healthy eating habits to facilitate and support a healthy lifestyle. The overarching aim of the research project described in this study protocol is to investigate factors that influence the implementation of the Pep initiative in Sweden, to inform tailored implementation strategies addressing the needs and local prerequisites of the different municipalities. Methods: The project includes a qualitative and a quantitative study and is framed by a theoretical model involving four complementary forms of knowledge, explicitly recognized in the Pep initiative: knowledge about the issue; knowledge about interventions; knowledge about the context; and knowledge about implementation. Study 1 is a focus group study exploring barriers and facilitators for implementing the Pep initiative. The study will be carried out in six municipalities, selected purposively to provide wide variation in municipality characteristics, including population size and geographical location. Data will be analyzed using thematic analysis. Study 2 is a cross-sectional web-based survey investigating the implementability of the Pep initiative in Sweden’s 290 municipalities. Conditions for implementing different areas of the Pep initiative will be examined in terms of the acceptability, appropriateness, and feasibility, three predictors of implementation success. Data will be analyzed using non-parametric statistics. Discussion: The findings of the two studies will increase understanding of the prerequisites for implementing the Pep initiative in Swedish municipalities, which will provide valuable input into how implementation of the Pep initiative can best be facilitated in the different municipality settings. Copyright © 2024 Leijon, Algotson, Bernhardsson, Ekholm, Ersberg, Höök, Klüft, Müssener, Garås and Nilsen.

Background: Implementation science in health is an interdisciplinary field with an emphasis on supporting behavior change required when clinicians and other actors implement evidence-based practices within organizational constraints. Behavioral economics has emerged in parallel and works towards developing realistic models of how humans behave and categorizes a wide range of features of choices that can influence behavior. We argue that implementation science can be enhanced by the incorporation of approaches from behavioral economics. Main body First, we provide a general overview of implementation science and ways in which implementation science has been limited to date. Second, we review principles of behavioral economics and describe how concepts from BE have been successfully applied to healthcare including nudges deployed in the electronic health record. For example, de-implementation of low-value prescribing has been supported by changing the default in the electronic health record. We then describe what a behavioral economics lens offers to existing implementation science theories, models and frameworks, including rich and realistic models of human behavior, additional research methods such as pre-mortems and behavioral design, and low-cost and scalable implementation strategies. We argue that insights from behavioral economics can guide the design of implementation strategies and the interpretation of implementation studies. Key objections to incorporating behavioral economics are addressed, including concerns about sustainment and at what level the strategies work. Conclusion: Scholars should consider augmenting implementation science theories, models, and frameworks with relevant insights from behavioral economics. By drawing on these additional insights, implementation scientists have the potential to boost efforts to expand the provision and availability of high quality care. © The Author(s) 2024.

Conducting implementation science research involves critical decision making on the methods for data collection and analysis as well as the study design that would best answer the research question of interest. This chapter reviews several research methods and study designs used in implementation science research. The chapter begins with an overview of qualitative, quantitative and mixed methods for identifying and/or assessing barriers and facilitators to implementing an evidence-based practice. The second part of the chapter looks at different study designs for carrying out studies to evaluate the effectiveness of different strategies to overcome barriers and harness facilitators. © 2024 selection and editorial matter, Per Nilsen; individual chapters, the contributors.

This core textbook introduces the key concepts, theories, models and frameworks used in implementation science, and supports readers applying them in research projects. The first part of the book focuses on the theory of implementation science, providing a discussion of its emergence from the evidence-based practice movement and its connections to related topics such as innovation research. It includes chapters looking at a wide range of theories, methods and frameworks currently used in implementation science, and a chapter focusing on suitable theories that could be imported from other fields. The first part also addresses strategies and outcomes of implementation and discusses how researchers can build causal pathways adapted to their study. The second part of the book focuses squarely on putting the theory of implementation science to work in practice, with chapters discussing research methods used in the field and how to select the most appropriate approach. This section also features several chapters presenting in-depth case studies of specific applications. This multidisciplinary text is an essential resource for graduate students from a range of healthcare backgrounds taking courses on implementation science, as well as researchers from medicine, nursing, public health, allied health, economics, political science, sociology and engineering. © 2024 selection and editorial matter, Per Nilsen; individual chapters, the contributors.

Implementation strategies have been defined as methods or techniques that are used to enhance the adoption, implementation and sustainability of evidence-based practices in healthcare and other settings. An overview of some taxonomies that categorize different types of implementation strategies is provided. The chapter also deals with the matching of determinants with the appropriate strategies, which represents a considerable challenge in implementation science. Some tools and methods to facilitate this matching process are described. Implementation outcomes, defined as the effects of deliberate and purposive actions to implement evidence-based practices, are also addressed. They are distinct from patient or population outcomes. Two commonly used implementation outcome taxonomies are described. © 2024 selection and editorial matter, Per Nilsen; individual chapters, the contributors.

Theories have been developed by researchers in implementation science to achieve enhanced understanding and explanation of how or why implementation succeeds or fails. These theories specify the causal mechanisms of change. This chapter looks at the concept of theory and examines how implementation science-specific theories are defined. The chapter also clarifies how theories used in implementation science can be distinguished from models and frameworks in the field. Three implementation theories that are used in implementation science are described: Normalization Process Theory (NPT), Organizational Readiness for Change (ORC) and Capability Opportunity Motivation - Behaviour (COM-B). © 2024 selection and editorial matter, Per Nilsen; individual chapters, the contributors.