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  • 1.
    Ahl, Josefin
    et al.
    Halmstad University, School of Information Technology.
    Djurklou, Julia
    Halmstad University, School of Information Technology.
    Ransomware-hotet mot svenska sjukhus: – en intervju- och litteraturstudie2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Statistics show an increase in ransomware activity in recent years. The increase is mainly due to the ongoing Covid-19 pandemic. Cybercriminals take advantage of the fact that hospitals worldwide are overloaded with caring for seriously ill patients in Covid-19 and perform ransomware attacks.

    This thesis examines how Swedish hospitals experience and handle the increased threat of ransomware. The bachelor’s thesis consists of a literature study and some in-depth interviews. The literature study is investigating ransomware as a phenomenon and finding out why it is a successful method for cybercriminals to use in digital extortion.

    The purpose is also to investigate how Swedish hospitals relate to the fact that the healthcare sector has become an attractive target for cyber-attacks. The interview study examines the hospitals' IT security to determine whether they are sufficiently resistant to ransomware attacks. The interview results are discussed and analyzed against the background of the literature. The conclusion of this analysis is the basis for the proposed countermeasure.

    The results show that the hospitals surveyed have suitable IT security. The most central security mechanisms for the hospitals are their backup and recovery routines in the fight against ransomware. The discussion in this work combines the results from the literature and interview studies carried out. Based on the discussion, the conclusion is that the hospitals surveyed have good security and meet most of the recommendations published by Swedish authorities. Still, there is room for some improvement which is indicated.

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  • 2.
    Ali, Ream
    Halmstad University, School of Health and Welfare.
    Digitala vårdmöten: En utmanande utveckling för sjuksköterskor2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The world is facing new conditions and people are living longer, therefore an increased need for care and greater challenges for nurses to offer high- quality healthcare. Training and hiring more nurses is not considered an optimal solution, but the application of digital care services seems to respond to the increased need for a functioning care. It is therefore important for the nurse to have competence and continuously develop in digital tools to provide a high-quality nursing care. Purpose: The purpose was to describe nurses' experiences of the application of digital care meetings. Method: The method was designed as a literature study consisting of eight scientific articles. In the analysis, relevant information was color-coded and the data was grouped into subcategories and categories. Results: Four categories were identified, which were “Digital care meetings mean new challenges”, “Digital care meetings contribute to increased accessibility and quality” and “Digital care meetings facilitate a continuous relationship”. All articles discussed the advantages and disadvantages of digital care-services, which turned out to depend on the situation and the participants in a digital care-conversation. Conclusion: The technology is a challenge for nurses whose experience and knowledge can be questioned in the event of an insufficient telehealth-technology. Digital care meetings complement the care the patient already receives but cannot replace physical meetings. 

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  • 3.
    Amroussia, Nada
    et al.
    Malmö University, Malmö, Sweden; Uppsala University, Uppsala, Sweden.
    Holmström, Charlotta
    Malmö University, Malmö, Sweden.
    Ouis, Pernilla
    Halmstad University, School of Health and Welfare. Malmö University, Malmö, Sweden.
    Migrants in Swedish sexual and reproductive health and rights related policies: a critical discourse analysis2022In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 21, no 1, article id 125Article in journal (Refereed)
    Abstract [en]

    Background: Previous research has shown that migrants in Sweden are disadvantaged in terms of sexual and reproductive health and rights (SRHR). SRHR policies might play a crucial role in shaping migrants’ SRHR outcomes. The purpose of the study was to critically examine: a) how migrants were represented in the discourses embedded within Swedish SRHR-related policies, and b) how migrants’ SRHR-related issues were framed and addressed within these discourses.

    Methods: Critical discourse analysis (CDA) was used to analyze a total of 54 policy documents. Following Jäger’s approach to CDA, discourse strands and entanglements between different discourse strands were examined.

    Results: Our findings consisted of three discourse strands: 1) “Emphasizing vulnerability”, 2) “Constructing otherness”, and 3) “Prioritizing the structural level or the individual level?”. Migrants’ representation in Swedish SRHR-related policies is often associated with the concept of vulnerability, a concept that can hold negative connotations such as reinforcing social control, stigma, and disempowerment. Alongside the discourse of vulnerability, the discourse of otherness appears when framing migrants’ SRHR in relation to what is defined as honor-related violence and oppression. Furthermore, migrant SRHR issues are occasionally conceptualized as structural issues, as suggested by the human rights-based approach embraced by Swedish SRHR-related policies. Relevant structural factors, namely migration laws and regulations, are omitted when addressing, for example, human trafficking and HIV/AIDS.

    Conclusions: We conclude that the dominant discourses favor depictions of migrants as vulnerable and as the Other. Moreover, despite the prevailing human rights-based discourse, structural factors are not always considered when framing and addressing migrants’ SRHR issues. This paper calls for a critical analysis of the concept of vulnerability in relation to migrants’ SRHR. It also highlights the importance of avoiding othering and paying attention to the structural factors when addressing migrants’ SRHR. © 2022, The Author(s).

  • 4.
    Andersson, Elisabet
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Jönsson, Helena
    Halmstad University, School of Social and Health Sciences (HOS).
    Sjuksköterskans förmåga att uppmärksamma och åtgärda malnutrition hos äldre2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    It is the nurse’s responsibility to observe, prevent and treat malnutrition. The reform of geriatric care, where the responsibility for the elderly residents has been moved from county council into municipality, has implied that access to nurses in Home Care Service is deficient in proportion to the amount of residents. This matter together with poor knowledge in nutrition among the nursing care staff, accompanied by high burden of care, have led to deficiencies in nutritional care, which can remain for a long time before revealed. The aim of the literature study was to examine the nurse’s ability to discover and treat malnutrition in elderly Home Care residents. A literature study based on 20 scientific articles was made. The nutritional knowledge among nurses and members of nursing care staff is generally low, only a small amount of the nursing care staff had knowledge in nutritional screening methods and even fewer used screening methods in practice. The individual requirement of energy for the elderly in the studies was in most of the cases not met, but increased energy intake through energy enriched food or supplement drinks, had a positive effect to counteract malnutrition. Further research in Swedish conditions, where the knowledge among the nursing care staff ought to be inventoried, is highly relevant for further development of the Home Care Services.

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  • 5.
    Apeloig, Annelie
    Halmstad University, School of Health and Welfare.
    Stakeholders’ perceptions on potential barriers and facilitators of implementing technology based on Artificial Intelligence for predicting and preventing mental illness among young adults: – a qualitative study applying the NASSS framework2023Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Mental illness is increasing among young adults, and AI-based technology holds the potential to address this by identifying early signs and predicting individuals at risk. Early prediction enables timely, preventive interventions.The use of AI-based technology offers a new possibility to define health and lifestyle as ongoing processes, supported by predictive tools and preventive interventions. Seeking input from healthcare stakeholders is essential to comprehend AI-based technology´s potential applications and facilitating its effective implementation. The aim of this study was to explore stakeholders’ perceptions of implementing AI-based technology for predicting and preventing mental illness among young adults, focusing on barriers and facilitators based on the NASSS framework.  The study collected data through semi-structured interviews with 13 key stakeholders linked to mental healthcare for young adults. The analysis was made with qualitative content analysis with an abductive approach, , with the NASSS framework as the theoretical basis. The findings identified 17 facilitators and 15 barriers. Barriers included resistance to adoption due to Ai-based technologies' perceived inability to replace human expertise, concerns about data bias, and uncertainty related to laws and regulations. Facilitators included implementing pilot projects within innovative organisations led by strategic leadership and creating digital entry points for AI-based technology-supported preventive interventions.

  • 6.
    Arvidsson, Linnea
    et al.
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Hägglund, Benjamin
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Petersson, Lena
    Halmstad University, School of Health and Welfare.
    Arvidsson, Eva
    Futurum, Jönköping, Sweden; Jönköping University, Jönköping, Sweden.
    Tägil, Magnus
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Malmö, Sweden.
    Virtual Follow up After Distal Radius Fracture Surgery — Patient Experiences During the COVID-19 Pandemic2023In: Journal of Patient Experience, ISSN 2374-3735, Vol. 10Article in journal (Refereed)
    Abstract [en]

    The majority of patients with a distal radius fracture (DRF) are elderly, a group known to experience difficulties with new technology, partly due to a low level of digital literacy. At the beginning of the coronavirus disease 2019 pandemic, during the spring 2020, patients that underwent DRF surgery had regular follow-ups replaced by video calls from their surgeon and physiotherapist. Afterward, patients answered questionnaires regarding health and digital literacy and took part in semistructured interviews regarding the experience of the virtual follow-up. By systemic text condensation, 2 major categories were identified: (1) The video call—new, but surprisingly simple: All but 1 found it easier than expected, and (2) Video calls—the patient's choice: All but 1 patient preferred video calls to physical visits for follow-up. This is the first mixed methods study to assess patients’ experiences of digital follow-up after DRF surgery. This study indicates that digital follow-up was highly appreciated, even among patients with low levels of digital literacy. Digital technologies must be made suitable even for patients with inadequate levels of digital literacy. © The Author(s) 2023.

  • 7.
    Ashfaq, Awais
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Predicting clinical outcomes via machine learning on electronic health records2019Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    The rising complexity in healthcare, exacerbated by an ageing population, results in ineffective decision-making leading to detrimental effects on care quality and escalates care costs. Consequently, there is a need for smart decision support systems that can empower clinician's to make better informed care decisions. Decisions, which are not only based on general clinical knowledge and personal experience, but also rest on personalised and precise insights about future patient outcomes. A promising approach is to leverage the ongoing digitization of healthcare that generates unprecedented amounts of clinical data stored in Electronic Health Records (EHRs) and couple it with modern Machine Learning (ML) toolset for clinical decision support, and simultaneously, expand the evidence base of medicine. As promising as it sounds, assimilating complete clinical data that provides a rich perspective of the patient's health state comes with a multitude of data-science challenges that impede efficient learning of ML models. This thesis primarily focuses on learning comprehensive patient representations from EHRs. The key challenges of heterogeneity and temporality in EHR data are addressed using human-derived features appended to contextual embeddings of clinical concepts and Long-Short-Term-Memory networks, respectively. The developed models are empirically evaluated in the context of predicting adverse clinical outcomes such as mortality or hospital readmissions. We also present evidence that, surprisingly, different ML models primarily designed for non-EHR analysis (like language processing and time-series prediction) can be combined and adapted into a single framework to efficiently represent EHR data and predict patient outcomes.

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  • 8.
    Ashfaq, Awais
    et al.
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research. Halland Hospital, Region Halland, Halmstad, Sweden.
    Lönn, Stefan
    Research and Development, Region Halland, Halmstad, Sweden.
    Nilsson, Håkan
    Economic Department, Region Halland, Halmstad, Sweden.
    Eriksson, Jonny
    Halland Hospital, Region Halland, Halmstad, Sweden.
    Kwatra, Japneet
    Brigham and Women’s Hospital, Boston, MA, USA.
    Yasin, Zayed
    Economic Department, Region Halland, Sweden & Harvard Medical School, Boston, MA, USA.
    Slutzman, Jonathan E
    Harvard Medical School, Boston, MA, USA & Massachusetts General Hospital, Boston, MA, USA.
    Wallenfeldt, Thomas
    CGI Group Inc. Consultants to Government and Industries, Halmstad, Sweden.
    Obermeyer, Ziad
    School of Public Health, University of California at Berkeley, Berkeley, CA, USA.
    Anderson, Philip D
    Brigham and Women’s Hospital, Boston, MA, USA & Harvard Medical School, Boston, MA, USA.
    Lingman, Markus
    Halland Hospital, Region Halland, Halmstad, Sweden & Institute of Medicine, Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Data resource profile: Regional healthcare information platform in Halland, Sweden2020In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 49, no 3, p. 738-739fArticle in journal (Refereed)
    Abstract [en]

    Accurate and comprehensive healthcare data coupled with modern analytical tools can play a vital role in enabling care providers to make better-informed decisions, leading to effective and cost-efficient care delivery. This paper describes a novel strategic healthcare analysis and research platform that encapsulates 360-degree pseudo-anonymized data covering clinical, operational capacity and financial data on over 500,000 patients treated since 2009 across all care delivery units in the county of Halland, Sweden. The over-arching goal is to develop a comprehensive healthcare data infrastructure that captures complete care processes at individual, organizational and population levels. These longitudinal linked healthcare data are a valuable tool for research in a broad range of areas including health economy and process development using real world evidence.

    Key messages

    Structured and standardized variables have been linked from different regional healthcare sources into a research information platform including all healthcare visits in the county of Halland in Sweden, from 2009 to date.

    Since 2015, the regional information platform integrates a cost component to each healthcare visit: thus being able to quantify patient level value, safety and cost efficiency across the continuum of care. © The Author(s) 2020; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

  • 9.
    Ashfaq, Awais
    et al.
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research. Halland Hospital, Region Halland, Sweden.
    Pinheiro Sant'Anna, Anita
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Lingman, Markus
    Halland Hospital, Region Halland, Sweden & Institute of Medicine, Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nowaczyk, Sławomir
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Readmission prediction using deep learning on electronic health records2019In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 97, article id 103256Article in journal (Refereed)
    Abstract [en]

    Unscheduled 30-day readmissions are a hallmark of Congestive Heart Failure (CHF) patients that pose significant health risks and escalate care cost. In order to reduce readmissions and curb the cost of care, it is important to initiate targeted intervention programs for patients at risk of readmission. This requires identifying high-risk patients at the time of discharge from hospital. Here, using real data from over 7,500 CHF patients hospitalized between 2012 and 2016 in Sweden, we built and tested a deep learning framework to predict 30-day unscheduled readmission. We present a cost-sensitive formulation of Long Short-Term Memory (LSTM) neural network using expert features and contextual embedding of clinical concepts. This study targets key elements of an Electronic Health Record (EHR) driven prediction model in a single framework: using both expert and machine derived features, incorporating sequential patterns and addressing the class imbalance problem. We show that the model with all key elements achieves a higher discrimination ability (AUC 0.77) compared to the rest. Additionally, we present a simple financial analysis to estimate annual savings if targeted interventions are offered to high risk patients. © 2019 The Authors

  • 10.
    Backman, Linn
    et al.
    Halmstad University, School of Health and Welfare.
    Kleveland, Therese
    Halmstad University, School of Health and Welfare.
    Wetterlöv, Malin
    Halmstad University, School of Health and Welfare.
    Jag älskar mitt jobb men...: Aspekter i sjuksköterskors arbetsmiljö som påverkar omvårdnadskvalitén2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    By findingoutwhich aspectsofnurseworkenvironmentthatmayaffect the qualityofcarenursescanhavegreateropportunity to design their ideal work situation and ultimatelyprovide the best possiblecare. The aimofthisstudywas to investigateaspectsofnurses' workenvironmentthataffectcarequality. The result is based on 20 scientificarticles: bothqualitative and quantitative design. The results show thatifnursesexperience a goodworkingenvironmentthisimprovesnurses' and patients' assessmentofcarequality. Workload has a criticalimpact on the qualityofcare. Nursesareforced to set prioritiesdue to timeconstraints and a heavyworkload, thisnegativelyaffects patients and results in increasedcosts ofcare. Being part of a well-functioning team withgoodcommunicationimprovesnurses' jobsatisfaction. A leadershouldtakenurses' opinions seriously and ensureenoughqualifiedstaff. Salary, careeropportunities, skillsdevelopment, and nurse representation at decision-makinglevelsareseen as importantaspects to raise the profession's status and jobsatisfaction. Implication for further research on the subjectcould be interventional studies thatattempt to improve the revealedaspectsof the workenvironment. Decision-makers, patients and their relatives understandingof the qualityofcarerelated to nurses' workenvironmentare alsoneeded to clearlydescribe the subject.

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  • 11.
    Bennett, Sarah E.
    et al.
    University Of The West Of England, Bristol, United Kingdom; Bristol Medical School, Bristol, United Kingdom.
    Zangi, Heidi A.
    Diakonhjemmet Hospital, Oslo, Norway; Vid Specialized University, Oslo, Norway.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research And Development Centre, Halmstad, Sweden.
    Beauvais, Catherine
    Ap-hp, Paris, France.
    Boström, Carina
    Karolinska Institutet, Stockholm, Sweden.
    Domján, Andrea
    University Of Debrecen, Debrecen, Hungary.
    Van Eijk-Hustings, Yvonne
    Maastricht University, Maastricht, Netherlands; Maastricht University, Maastricht, Netherlands.
    Van Der Elst, Kristien
    University Hospitals Leuven, 3000 Leuven, Belgium.
    Fayet, Françoise
    Chu Clermont-ferrand, Clermont-Ferrand, France.
    Ferreira, Ricardo J.O.
    Nursing School Of Lisbon (esel), Lisbon, Portugal; Centro Hospitalar E Universitário De Coimbra, Coimbra, Portugal.
    Fusama, Mie
    Takarazuka University, Takarazuka, Japan.
    Geneva-Popova, Mariela
    Medical University Of Plovdiv, Plovdiv, Bulgaria.
    Herrero Manso, María Del Carmen
    Hospital Universitario 12 De Octubre, Madrid, Spain.
    Hoeper, Kirsten
    Hannover Medical School, Hannover, Germany.
    Jones, Bethan
    University Of The West Of England, Bristol, United Kingdom.
    Kukkurainen, Marja Leena
    The Finnish Society Of Rheumatology Nurses, Helsinki, Finland.
    Gladys Kwok, Suet Kei
    Grantham Hospital, Hong Kong, China.
    Minnock, Patricia
    Our Lady's Hospice And Care Services, Dublin, Ireland.
    Nava, Tiziana
    University Of Milano-bicocca, Milan, Italy.
    Primdahl, Jette
    University Of Southern Denmark, Odense, Denmark; University Hospital Of Southern Denmark, Sonderborg, Denmark.
    Rawat, Roopa
    Indian Spinal Injuries Centre, New Delhi, India.
    Sierakowska, Matylda
    Medical University Of Bialystok, Bialystok, Poland.
    Stoffer-Marx, Michaela
    Medical University Of Vienna, Vienna, Austria; University Of Applied Sciences, Vienna, Austria.
    Van Tubergen, Astrid
    Maastricht University, Maastricht, Netherlands; Maastricht University, Maastricht, Netherlands.
    Ndosi, Mwidimi
    University Of The West Of England, Bristol, United Kingdom; University Hospitals Bristol Nhs Foundation Trust, Bristol, United Kingdom.
    Assessing acceptability and identifying barriers and facilitators to implementation of the EULAR recommendations for patient education in inflammatory arthritis: a mixed-methods study with rheumatology professionals in 23 European and Asian countries2022In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 81, no 10, p. 1348-1357Article in journal (Refereed)
    Abstract [en]

    Objectives:

    To disseminate and assess the level of acceptability and applicability of the European Alliance of Associations for Rheumatology (EULAR) recommendations for patient education among professionals in rheumatology across Europe and three Asian countries and identify potential barriers and facilitators to their application. Methods: A parallel convergent mixed-methods design with an inductive approach was used. A web-based survey, available in 20 different languages, was distributed to health professionals by non-probability sampling. The level of agreement and applicability of each recommendation was assessed by (0-10) rating scales. Barriers and facilitators to implementation were assessed using free-text responses. Quantitative data were analysed descriptively and qualitative data by content analysis and presented in 16 categories supported by quotes. Results: A total of 1159 completed the survey; 852 (73.5%) were women. Most of the professionals were nurses (n=487), rheumatologists (n=320), physiotherapists (n=158). For all recommendations, the level of agreement was high but applicability was lower. The four most common barriers to application were lack of time, lack of training in how to provide patient education, not having enough staff to perform this task and lack of evaluation tools. The most common facilitators were tailoring patient education to individual patients, using group education, linking patient education with diagnosis and treatment and inviting patients to provide feedback on patient education delivery.

    Conclusions:

    This project has disseminated the EULAR recommendations for patient education to health professionals across 23 countries. Potential barriers to their application were identified and some are amenable to change, namely training patient education providers and developing evaluation tools. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

  • 12.
    Billsten, Johan
    et al.
    Department of Psychology, Linnaeus University, Sweden.
    Fridell, Mats
    Department of Psychology, Lund University, Sweden.
    Holmberg, Robert
    Department of Psychology, Lund University, Sweden.
    Ivarsson, Andreas
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Sport.
    Organizational Readiness for Change (ORC) test used in the implementation of assessment instruments and treatment methods in a Swedish National study2018In: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, Vol. 84, p. 9-16Article in journal (Refereed)
    Abstract [en]

    Organizational climate and related factors are associated with outcome and are as such of vital interest for healthcare organizations. Organizational Readiness for Change (ORC) is the questionnaire used in the present study to assess the influence of organizational factors on implementation success. The respondents were employed in one of 203 Swedish municipalities within social work and psychiatric substance/abuse treatment services. They took part in a nationwide implementation project organized by the Swedish Association of Local Authorities and Regions (SALAR), commissioned by the Swedish National Board of Health and Welfare. Aim The aims were: (a) to identify classes (clusters) of employees with different ORC profiles on the basis of data collected in 2011 and (b) to investigate ORC profiles which predicted the use of assessment instruments, therapy methods and collaborative activities in 2011 and 2013. Design and recruitment The evaluation study applied a naturalistic design with registration of outcome at consecutive assessments. The participants were contacted via official e-mail addresses in their respective healthcare units and were encouraged by their officials to participate on a voluntary basis. Statistics Descriptive statistics were obtained using SPSS version 23. A latent profile analysis (LPA) using Mplus 7.3 was performed with a robust maximum likelihood estimator (MLR) to identify subgroups (clusters) based on the 18 ORC indexes. Results A total of 2402 employees responded to the survey, of whom 1794 (74.7%) completed the ORC scores. Descriptive analysis indicated that the respondents were a homogenous group of employees, where women (72.0%) formed the majority. Cronbach's alpha for the 18 ORC indexes ranged from α = 0.67 to α = 0.78. A principal component analysis yielded a four-factor solution explaining 62% of the variance in total ORC scores. The factors were: motivational readiness (α = 0.64), institutional resources (α = 0.52), staff attributes (α = 0.76), and organizational climate (α = 0.74). An LPA analysis of the four factors with their three distinct profiles provided the best data fit: Profile 3 (n = 614), Profile 2 (n = 934), and Profile 1 (n = 246). Respondents with the most favorable ORC scores (Profile 3) used significantly more instruments and more treatment methods and had a better collaborating network in 2011 as well as in 2013 compared to members in Profile 1, the least successful profile. Conclusion In a large sample of social work and healthcare professionals, ORC scores reflecting higher institutional resources, staff attributes and organizational climate and lower motivational readiness for change were associated with a successful implementation of good practice guidelines for the care and treatment of substance users in Sweden. Low motivational readiness as a construct may indicate satisfaction with the present situation. As ORC proved to be an indicator of successful dissemination of evidence-based guidelines into routine and specialist healthcare, it can be used to tailor interventions to individual employees or services and to improve the dissemination of and compliance with guidelines for the treatment of substance users. © 2017

  • 13.
    Bjurling-Sjöberg, Petronella
    et al.
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Sect Caring Sci, Uppsala, Sweden.;Uppsala Univ, Ctr Clin Res Sormland, Uppsala, Sweden..
    Jansson, Inger
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Wadensten, Barbro
    Uppsala Univ, Sect Caring Sci, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Engström, Gabriella
    Florida Atlantic Univ, Christine E Lynn Coll Nursing, Boca Raton, FL 33431 USA..
    Pöder, Ulrika
    Uppsala Univ, Sect Caring Sci, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Prevalence and quality of clinical pathways in Swedish intensive care units: a national survey2014In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 20, no 1, p. 48-57Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectivesTo identify the prevalence of clinical pathways (CPs) in Swedish intensive care units (ICUs) and to explore the quality, content and evidence base of the documents. MethodsA descriptive and explorative survey of all Swedish ICUs (N84) and a review of submitted examples of CPs (n12) were conducted. ResultsCPs were in use at 20% of the Swedish ICUs. There was a significant geographic variation but no relationship between the use of CPs and category of hospital, type of ICU, size of ICU or type of health record applied. In total, 56 CPs were reported within a range of scopes and extensions. The content of the ICUs' CPs, as well as the degree to which they were interprofessional, evidence based, and renewed varied. ConclusionsProgress has been made in relation to CPs in recent years, but there is potential for further improvements. None of the ICUs had CPs that contained all key characteristics of a high-quality, interprofessional and evidence-based CP identified in the literature. Greater knowledge sharing and cooperation within the field would be beneficial, and further research is needed.

  • 14.
    Brantmark, Anna
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Karlsson, Rebecca
    Halmstad University, School of Social and Health Sciences (HOS).
    Föräldrars påverkan i utvecklingen av övervikt och fetma hos barn2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Overweight and obesity in children are serious conditions, with many negative consequences to the health of individuals and the health care system as a whole. The prevalence is particularly great in certain groups of people and the frequency of these conditions is increasing at an alarming rate. Parents, as the primary caregivers, play a vital role in determining whether or not their children lead a healthy lifestyle. The aim of this literature review was to establish the influence that parents have on the development of overweight and obesity in their children. 19 articles were systematically reviewed and the results showed three main areas of influence; socio-economic factors, factors within the family and the role of the parent. In each of these areas, risk factors of developing overweight and obesity in children were identified. In general, parents lack information about these conditions and are in need of support from nurses and other health care professionals, who in turn carry the responsibility to support the parents, promote good health and prevent disease.

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  • 15.
    Chrisén, Mia
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Holm, Sofia
    Halmstad University, School of Social and Health Sciences (HOS).
    Faktorer som har betydelse för telefonsjuksköterskans triage och rådgivning2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Sjukvårdsrådgivningen via telefon är väl förankrat hos Sveriges befolkning då det varje år rings många samtal dit. Avsaknaden av visuell kontakt och den begränsade tillgången till problemet gör att triage och rådgivning försvåras. Telefonsjuksköterskan kan inte ta del av den icke verbala kommunikationen såsom exempelvis ansiktsuttryck, kroppshållning eller sjukdomstecken på kroppen. Syftet med denna litteraturstudie var att belysa faktorer som har betydelse för telefonsjuksköterskans triage och rådgivning i kontakt med den vårdsökande. I litteraturstudien som grund för resultatet har metoden varit att granska fjorton artiklar med kvalitativ ansats ur ett sjuksköterskeperspektiv. Resultatet visar att telefonsjuksköterskans triage och rådgivning påverkas av olika faktorer som är relaterade till den vårdsökande, telefonsjuksköterskans egna färdigheter och erfarenheter samt faktorer relaterade till organisation. Samtalen som telefonsjuksköterskorna tar emot är varierande till innehåll. Detta ställer krav på telefonsjuksköterskans professionella kompetens. Tidigare klinisk erfarenhet, bred kunskap och en god kommunikativ förmåga är viktiga egenskaper för telefonsjuksköterskan. Omvårdnadssituationen är komplex och för att kompensera för detta använder hon sig av olika strategier. Organisatoriska faktorer som påverkar triage och rådgivning via telefon är tillgången till beslutsstöd och tillgängligheten i vården. Framtida forskning som belyser hur telefonsjuksköterskan kan hantera stress och konfliktsituationer kan underlätta för telefonsjuksköterskan i hennes utsatta arbetssituation. Specialistutbildning till telefonsjuksköterska skulle göra vården säkrare för uppringaren men även förbereda telefonsjuksköterskan inför hennes yrkesroll.

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  • 16.
    Claesson, Hanna
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Sidorson, Maria
    Halmstad University, School of Social and Health Sciences (HOS).
    Äldres syn på förutsättningar för att bibehålla välbefinnandet efter pensioneringen: En kvalitativ studie2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The health of the elderly has improved during the last years, and they have at the same time become more physical active. The aim of the study was to describe the seniors’ views on prerequisites in order to maintain their well-being after retirement. The study was carried out using a qualitive method through semistructured interviews of informants in the age range of 63-84 years. The interviews showed the importance of at least one close friend in order to promote well-being. Interaction between friends and family was another important aspect. Also, maintaining the physical ability counted as important as walking in the nature was a significant aspect of well-being. It also appeared to be of great importance to continue having an active life after reirement. Several of the informants were engaged at no profit to create added value. Avaliability was of a major importance in making the choice of activity, but the informants were to a great deal satisfied by the supply. The study can be used as a foundation for further research in the area of activities, communities and active life among elderly. An important aspect would be to illuminate how people who does not engage in organisationed activities view their well-being and the reason to why they do not participate

     

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  • 17.
    Cregård, Anna
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Halmstad University, School of Business, Engineering and Science, Centre for Innovation, Entrepreneurship and Learning Research (CIEL).
    Inter-occupational cooperation and boundary work in the hospital setting2018In: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 32, no 5, p. 658-673Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to add a little piece to the research on boundary work and inter-occupational cooperation by addressing two questions: how do actors perform boundary work in an inter-occupational cooperation project that seeks to improve the personnel health work in a hospital setting? What impact does the boundary work have on such cooperation in the personnel health project?

    Design/methodology/approach: The study is based on individual, in-depth interviews and participative observations of focus group discussions conducted at a regional municipal organization in Sweden. Respondents are hospital line managers, experts and strategists in the HR departments, and experts from the internal occupational health service.

    Findings: The concepts on boundary work, which include closing/opening boundary strategies, provide the framework for the empirical illustrations. The cooperation runs smoothly in the rehabilitation work because of an agreed upon process in which the professionals’ jurisdictions are preserved through closing strategies. Illness prevention and health promotion are not areas of inter-occupational cooperation because the stronger actors use closing strategies. While the weaker actors, who try to cooperate, use opening boundary strategies in these areas, they are excluded or marginalized.

    Research limitations/implications: The empirical investigation concerns one cooperation project and was completed at one data collection point.

    Originality/value: No similar study of boundary work and inter-occupational cooperation in a hospital setting is available despite the frequency of this professional group configuration in practice. A more inclusive concept of professionalism may facilitate the study of boundary work and inter-occupational cooperation among actors with different professional authority. © Emerald Publishing Limited 2018

  • 18.
    Dahlstrand, Ursula
    et al.
    Karolinska Institutet, Stockholm, Sweden; Enköping Hospital, Enkoping, Sweden.
    Gustafsson, Pontus
    Karolinska Institutet, Stockholm, Sweden; Visby Hospital, Visby, Sweden.
    Näsvall, Pia
    Umeå University, Umea, Sweden.
    Johansson, Jeaneth
    Halmstad University, School of Business, Innovation and Sustainability. Luleå University Of Technology, Lulea, Sweden.
    Gunnarsson, Ulf
    Umeå University, Umea, Sweden.
    Lindforss, Ulrik
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Costs Related to Diverting Ileostomy After Rectal Cancer Surgery: A Population-Based Healthcare Cost Analysis Based on Nationwide Registers2023In: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 60, article id 00469580231212126Article in journal (Refereed)
    Abstract [en]

    Low anterior resection for rectal cancer often includes a diverting loop-ileostomy to avoid the severe consequences of anastomotic leakage. Reversal of the stoma is often delayed, which can incur health-care costs on different levels. The aim is to, on population basis, determine stoma-related costs, and to investigate habitual and socioeconomic factors associated to the level of cost. Multi-register design with data from the Swedish Rectal Cancer Registry, the National Prescribed Drug Register, Statistics Sweden and cost-administrative data from the National Board of Health and Welfare. Data was gathered for 3564 patients with rectal cancer surgery 2007 to 2013, for 3 years following the surgery. Factors influencing the cost of inpatient care and stoma-related consumables were assessed with linear regression analyses. All monthly costs were higher for females (consumables P <.001 and in-patient care P =.031). Post-secondary education (P =.003) and younger age (P =.020) was associated with a higher cost for consumables while suffering a surgical complication was associated with increased cost for inpatient care (P <.001). Patients who had their stoma longer had lower monthly costs (consumables P <.001 and in-patient care P <.001). Female gender, longer duration of stoma, young age, and higher education are associated with higher costs for the care of a diverting stoma after rectal cancer surgery. This study does not allow for analyses of causality but the results together with deepened analyses of underlying reasons form a proper basis for decisions in health care planning and allocation of resources. These findings may have implications on the debate of equal care for all. © The Author(s) 2023.

  • 19.
    Davidge, Jason
    et al.
    Capio Vårdcentral Halmstad, Halmstad, Sweden; Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Halling, Anders
    Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Ashfaq, Awais
    Halmstad University, School of Information Technology.
    Etminani, Kobra
    Halmstad University, School of Information Technology.
    Agvall, Björn
    Halland Regional Hospital, Region Halland, Halmstad, Sweden.
    Clinical characteristics at hospital discharge that predict cardiovascular readmission within 100 days in heart failure patients – An observational study2023In: International Journal of Cardiology Cardiovascular Risk and Prevention, E-ISSN 2772-4875, Vol. 16, article id 200176Article in journal (Refereed)
    Abstract [en]

    Background: After a heart failure (HF) hospital discharge, the risk of a cardiovascular (CV) related event is highest in the following 100 days. It is important to identify factors associated with increased risk of readmission. Method: This retrospective, population-based study examined HF patients in Region Halland (RH), Sweden, hospitalized with a HF diagnosis between 2017 and 2019. Data regarding patient clinical characteristics were retrieved from the Regional healthcare Information Platform from admission until 100 days post-discharge. Primary outcome was readmission due to a CV related event within 100 days. Results: There were 5029 included patients being admitted for HF and discharged and 1966 (39%) were newly diagnosed. Echocardiography was available for 3034 (60%) patients and 1644 (33%) had their first echocardiography while admitted. The distribution of HF-phenotypes was 33% HF with reduced ejection fraction (EF), 29% HF with mildly reduced EF and 38% HF with preserved EF. Within 100 days, 1586 (33%) patients were readmitted, and 614 (12%) died. A Cox regression model showed that advanced age, longer hospital length of stay, renal impairment, high heart rate and elevated NT-proBNP were associated with an increased risk of readmission regardless of HF-phenotype. Women and increased blood pressure are associated with a reduced risk of readmission. Conclusions: One third had a CV-readmission within 100 days. This study found clinical factors already present at discharge that are associated with increased risk of readmission which should be considered at discharge. © 2023 The Authors

  • 20.
    Ekman, Anna
    et al.
    Halmstad University, School of Health and Welfare.
    Kange, Moa
    Halmstad University, School of Health and Welfare.
    ”Vi måste säga att det är fara för hennes liv för hon kommer ju aldrig få någon vård”: En kvalitativ studie om anhörigas upplevelser av delaktighet i vården för närstående personer med diagnosen schizofreni eller schizoaffektivt syndrom2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this bachelor’s thesis was to shed light on how relatives experience their role in contact with psychiatry to a relative with a diagnosis of schizophrenia or schizoaffective syndrome. It also examines what experiences relatives have regarding being included in the process around care interventions. We hope that with this study we can contribute to further sociological knowledge in this subject area to raise the situation of relatives. The thesis is based on a qualitative interview study where eight people were interviewed over the phone and over Zoom. Through a number of articles and a historical review of how psychiatric healthcare in Sweden has developed, the reader gets a deeper understanding of how the role of relatives related to psychiatry has developed and how it looks today. The result is presented by three themes: Relatives' contact with care staff, Present and Future and Improvements regarding relatives' participation. For each theme, the interview results are summarized where differences and similarities are presented and compared with each other. The theoretical framework is based on Melvin Seeman's theory of alienation and Birgitta Andershed’s theory on participation and is used in the analysis to answer the questions. The results of the sociological analysis show that the relatives’ participation in the care of the close relative prevents the relatives' experiences of powerlessness, meaninglessness and social isolation in their everyday life and in their relationship to the care. Participation also contributes to relatives feeling better mentally and that relatives can receive care at an earlier stage.

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  • 21.
    Eliasson, Sofia
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Larsson, Emelie
    Halmstad University, School of Social and Health Sciences (HOS).
    Olne, Karin
    Halmstad University, School of Social and Health Sciences (HOS).
    Sjuksköterskans möte med etiska situationer och problem2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In everyday health care the nurse is constantly confronted with situations presenting ethical issues. A developed personal ethical ability and a good knowledge of one´s own and others´ values is an important part in dealing with such situations. To be able to meet ethical issues the vulnerability of one´s own and of the patients´ must also be noticed and reflected upon. The vulnerability can be seen as an asset, but can also be experienced as a strain which leads to emotional stress. Because of this strain it is important to identify the situations that nurses experience as ethical complicated along with describing the experience of these situations. The aim of this study was to describe the nurse´s experience of ethical situations and issues in nursing practice. The study was conducted as a literature review where 18 research articles were processed and analyzed. The results showed that the nurse is compelled by a desire to do what is best for the patient. When this desire cannot be followed, ethical situations and issues arise. Nurses experienced understaffing, lack of competence and unethical behavior among colleagues as factors leading to ethical situations and issues. Despite a consciousness of what is right and wrong in certain situations, the nurse was limited by different factors in providing quality care with the patient in focus. Reflection of ethical issues and further research on how the nurse uses and applies ethical theories, principles and guidelines in the daily nursing practice, are all needed, in increasing ethical awareness. Awareness, in turn, leads to a “platform of courage” in confronting ethical issues.

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  • 22.
    Emilson, C.
    et al.
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Åsenlöf, Pernilla
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Pettersson, Susanne
    Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden & Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult, Oskarström, Sweden & Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sandborgh, Maria
    School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Martin, Cathrin
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Demmelmaier, Ingrid
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Physical therapists’ assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: direct observations in primary health care2016In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 17, article id 316Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Behavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs' assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain.

    METHODS: A descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs' assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs' clinical practice.

    RESULTS: Red and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs' clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings.

    CONCLUSION: Red and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy. © 2016 The Author(s).

  • 23.
    Engdahl, Birgitta
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Laidler Roslund, Birgitta
    Halmstad University, School of Social and Health Sciences (HOS).
    Höftskydd som prevention2014Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Falls is a major patient safety and socio- economic concern. In Sweden approximately 18 000 persons every year suffer a hip fracture which causes the person major suffering and cost forthe society. The aim of this literature study was to describe the outcome of using hipprotectors as prevention. A literature overview was carried out were twelve scientific articleswere the basis of the result. The result is presented in three categories: effect of hip protectors, compliance to the use of hip protectors and the experiences of hip protectors. The risk of contacting a hip fracture is reducing if the fall occurs when using hip protectors. Compliance to the use of hip protector decreases over time. The result showed that patient and staff both agreed that a large reason for not using hip protectors is that they are uncomfortable. Through education nurses need to increase their awareness about the effect of hip protectors and thereby decrease the amount of hip fractures. Further research to increase compliance and to make the hip protector more comfortable would be desirable to reduce the amount of hip fractures. This will not only reduce suffering for those who contract a hip fracture but also reduce society´s major cost for the care and rehabilitation of a hip fracture.

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  • 24.
    Erlingsdottir, Gudbjörg
    et al.
    Lund University, Lund, Sweden.
    Johansson, Gerd
    Lund University, Lund, Sweden.
    Persson, Johanna
    Lund University, Lund, Sweden.
    Borell, Jonas
    Lund University, Lund, Sweden.
    Petersson, Lena
    Lund University, Lund, Sweden.
    Rydenfält, Christofer
    Lund University, Lund, Sweden.
    How does e-society affect healthcare practice?2014Conference paper (Refereed)
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  • 25.
    Folkhammar Andersson, Siv
    et al.
    Kalmar County Council, Oskarshamn, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Welin Henriksson, Elisabet
    Karolinska Institutet, Huddinge, Sweden & Linköping University, Linköping, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden.
    Arthritis management in primary care – a study of physiotherapists’ current practice, educational needs, and adherence to national guidelines2017In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, no 3, p. 333-340Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: With an increasing number of patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care, our aim was to investigate arthritis-related practice in physiotherapy and to study adherence to evidence-based care.

    METHODS: Seventy physiotherapists (PTs) working in primary care were emailed a questionnaire to investigate current practice and the number of roles assumed by PTs, the degree of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire.

    RESULTS: Sixty-four (91%) PTs responded, and they reported a higher degree of confidence in assessment, treatment and education of patients with OA than for those with RA (p < 0.001). The total number of roles assumed by the PTs was higher in the management of OA than for RA (p < 0.001). PTs who assumed a greater number of roles also reported a stronger degree of confidence in assessing OA (p = 0.036). Those who assumed fewer roles also reported less confidence in RA treatment (p = 0.045). Recommendations in the guidelines were followed by the majority of PTs for eight of 11 treatment modalities in OA and for six of six in RA.

    CONCLUSIONS: PTs reported a lower degree of confidence and the assumption of fewer roles in managing patients with RA compared with OA. There was good adherence to the national guidelines for almost all the treatment modalities listed. Even so, the results indicate a need for education, especially in chronic inflammatory arthritis care.

    Copyright © 2016 John Wiley & Sons, Ltd.

  • 26.
    Forsberg, Elenita
    et al.
    Halmstad University, School of Health and Welfare.
    Regber, Susann
    Halmstad University, School of Health and Welfare.
    Att leda i pediatrisk omvårdnad2022In: Våga leda omvårdnad / [ed] Kristina Ziegert, Stockholm: Liber, 2022, 1, p. 129-151Chapter in book (Other academic)
  • 27.
    Fox, Jackie
    et al.
    National University of Ireland, Galway, Ireland.
    Erlandsson, Lena-Karin
    Halmstad University, School of Health and Welfare. Lund University, Lund, Sweden.
    McSharry, Jenny
    National University of Ireland, Galway, Ireland.
    Shiel, Agnes
    National University of Ireland, Galway, Ireland.
    How does ReDO®-10 work? Understanding the mechanisms of action of an intervention focused on daily activities and health from the perspective of participants2022In: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 92, article id 102092Article in journal (Refereed)
    Abstract [en]

    Evaluation of a complex healthcare intervention should include careful exploration of the mechanisms through which it brings about change. This paper describes a qualitative evaluation of the Redesigning Daily Occupations (ReDO®-10) programme as it was implemented for the first time with women with stress-related issues in a primary care setting in Ireland. The ReDO®-10 is a 10-week group intervention designed to support participants make changes to their daily activity patterns to have a more satisfying and balanced daily life. Fourteen women were interviewed after completing the programme. The aim was to explore changes that participants perceived they experienced and to understand how the content of ReDO®-10 was thought to bring about this change (if it did). Directed content analysis was used to analyse the qualitative data using the Behaviour Change Wheel and Theoretical Domains Framework as a coding framework. Overall, four BCW functions of ReDO® -10 were identified: Education, Persuasion, Modelling and Enablement. Participants described improved belief in their own capabilities, knowledge and goals around life changes. Many behaviour changes were also described, particularly in relation to doing more restorative activities in daily life. Behaviour change techniques that were identified as important for change were practicing new, restorative occupations in group sessions and as homework and the use of self-analysis activities to understand the relationship between activities and health for these participants. Modelling, support and other effects of group dynamics were also vital in changes that occurred. © 2022 The Authors

  • 28.
    Frennert, Susanne
    et al.
    Department of Design Science, Lund University, Lund, Sweden.
    Petersson, Lena
    Halmstad University, School of Health and Welfare.
    Muhic, Mirella
    Department of Informatics, Umeå University, Umeå, Sweden.
    Rydelfält, Christofer
    Department of Design Science, Lund University, Lund, Sweden.
    Nymberg, Veronica Milos
    Department of Clinical Studies, Lund University, Lund, Sweden.
    Ekman, Björn
    Department of Clinical Studies, Lund University, Lund, Sweden.
    Erlingsdottir, Gudbjörg
    Department of Design Science, Lund University, Lund, Sweden.
    Materiality and the mediating roles of eHealth: A qualitative study and comparison of three cases2022In: Digital Health, E-ISSN 2055-2076, Vol. 8Article in journal (Refereed)
    Abstract [en]

    Against the backdrop of eHealth solutions increasingly becoming a part of healthcare professionals’ ways of doing care work, this paper questions how the solutions mediate the experience of healthcare professionals when deployed. We undertook a qualitative study of three eHealth solutions, conducting qualitative interviews with a diverse sample of 102 healthcare professionals from different care settings across the south of Sweden. Materiality and postphenomenology serve as analytic tools for achieving an understanding of the mediating roles of eHealth solutions. The analysis emphasises the mediating roles consisting of interrelated paradoxes: (1) changing and perpetuating boundaries between patients and professional groups, (2) (dis)enabling augmented information and knowledge processes and (3) reconfiguring professional control over work. This contribution provides critical insights into materiality as a category of analysis in studies on the deployment of eHealth solutions, as these technologies have both intended and unintended consequences for care work. Our study identified general positive consequences of all three solutions, such as the increased feeling of closeness to patients and colleagues over time and space; increased ‘understanding’ of patients through patient-generated data; and increased autonomy, due to the fact that asynchronous communication makes it possible to decide when and which patient to attend to. We also identified general unintended consequences of the solutions, such as maintenance of power relations maintained due to organisational structures and professional relations, disabled information and knowledge processes due to the lack of non-verbal clues, reduced professional autonomy due to technical scripts determining what data is collected and how it is categorised, and uneven workload due to the dependency on patient input and compliance. © The Author(s) 2022.

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  • 29.
    Galozy, Alexander
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Data-driven personalized healthcare: Towards personalized interventions via reinforcement learning for Mobile Health2021Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Medical and technological advancement in the last century has led to the unprecedented increase of the populace's quality of life and lifespan. As a result, an ever-increasing number of people live with chronic health conditions that require long-term treatment, resulting in increased healthcare costs and managerial burden to the healthcare provider. This increase in complexity can lead to ineffective decision-making and reduce care quality for the individual while increasing costs. One promising direction to tackle these issues is the active involvement of the patient in managing their care. Particularly for chronic diseases, where ongoing support is often required, patients must understand their illness and be empowered to manage their care. With the advent of smart devices such as smartphones, it is easier than ever to provide personalised digital interventions to patients, help them manage their treatment in their daily lives, and raise awareness about their illness. If such new approaches are to succeed, scalability is necessary, and solutions are needed that can act autonomously without costly human intervention. Furthermore, solutions should exhibit adaptability to the changing circumstances of an individual patient's health, needs and goals. Through the ongoing digitisation of healthcare, we are presented with the unique opportunity to develop cost-effective and scalable solutions through Artificial Intelligence (AI).

    This thesis presents work that we conducted as part of the project improving Medication Adherence through Person-Centered Care and Adaptive Interventions (iMedA) that aims to provide personalised adaptive interventions to hypertensive patients, supporting them in managing their medication regiment. The focus lies on inadequate medication adherence (MA), a pervasive issue where patients do not take their medication as instructed by their physician. The selection of individuals for intervention through secondary database analysis on Electronic Health Records (EHRs) was a key challenge and is addressed through in-depth analysis of common adherence measures, development of prediction models for MA and discussions on limitations of such approaches for analysing MA. Furthermore, providing personalised adaptive interventions is framed in the contextual bandit setting and addresses the challenge of delivering relevant interventions in environments where contextual information is significantly corrupted.       

    The contributions of the thesis can be summarised as follows: (1) Highlighting the issues encountered in measuring MA through secondary database analysis and providing recommendations to address these issues, (2) Investigating machine learning models developed using EHRs for MA prediction and extraction of common refilling patterns through EHRs and (3) formal problem definition for a novel contextual bandit setting with context uncertainty commonly encountered in Mobile Health and development of an algorithm designed for such environments.  

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  • 30.
    Galozy, Alexander
    et al.
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Nowaczyk, Sławomir
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Pinheiro Sant'Anna, Anita
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Towards Understanding ICU Treatments Using Patient Health Trajectories2019In: Artificial Intelligence in Medicine: Knowledge Representation and Transparent and Explainable Systems: Revised Selected Papers, Heidelberg: Springer, 2019, p. 67-81Conference paper (Refereed)
    Abstract [en]

    Overtreatment or mistreatment of patients is a phenomenon commonly encountered in health care and especially in the Intensive Care Unit (ICU) resulting in increased morbidity and mortality. We explore the MIMIC-III intensive care unit database and conduct experiments on an interpretable feature space based on the fusion of severity subscores, commonly used to predict mortality in an ICU setting. Clustering of medication and procedure context vectors based on a semantic representation has been performed to find common and individual treatment patterns. Two-day patient health state trajectories of a cohort of congestive heart failure patients are clustered and correlated with the treatment and evaluated based on an increase or reduction of probability of mortality on the second day of stay. Experimental results show differences in treatments and outcomes and the potential for using patient health state trajectories as a starting point for further evaluation of medical treatments and interventions. © Springer Nature Switzerland AG 2019.

  • 31.
    Gama, Fábio
    et al.
    Halmstad University, School of Business, Innovation and Sustainability. School of Administration and Economic Science, Santa Catarina State University, Florianópolis, Brazil.
    Tyskbo, Daniel
    Halmstad University, School of Health and Welfare.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Barlow, James
    Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom.
    Reed, Julie
    Halmstad University, School of Health and Welfare.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    Implementation Frameworks for Artificial Intelligence Translation Into Health Care Practice: Scoping Review2022In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 24, no 1, article id e32215Article in journal (Refereed)
    Abstract [en]

    Background: Significant efforts have been made to develop artificial intelligence (AI) solutions for health care improvement. Despite the enthusiasm, health care professionals still struggle to implement AI in their daily practice.

    Objective: This paper aims to identify the implementation frameworks used to understand the application of AI in health care practice.

    Methods: A scoping review was conducted using the Cochrane, Evidence Based Medicine Reviews, Embase, MEDLINE, and PsycINFO databases to identify publications that reported frameworks, models, and theories concerning AI implementation in health care. This review focused on studies published in English and investigating AI implementation in health care since 2000. A total of 2541 unique publications were retrieved from the databases and screened on titles and abstracts by 2 independent reviewers. Selected articles were thematically analyzed against the Nilsen taxonomy of implementation frameworks, and the Greenhalgh framework for the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health care technologies.

    Results: In total, 7 articles met all eligibility criteria for inclusion in the review, and 2 articles included formal frameworks that directly addressed AI implementation, whereas the other articles provided limited descriptions of elements influencing implementation. Collectively, the 7 articles identified elements that aligned with all the NASSS domains, but no single article comprehensively considered the factors known to influence technology implementation. New domains were identified, including dependency on data input and existing processes, shared decision-making, the role of human oversight, and ethics of population impact and inequality, suggesting that existing frameworks do not fully consider the unique needs of AI implementation.

    Conclusions: This literature review demonstrates that understanding how to implement AI in health care practice is still in its early stages of development. Our findings suggest that further research is needed to provide the knowledge necessary to develop implementation frameworks to guide the future implementation of AI in clinical practice and highlight the opportunity to draw on existing knowledge from the field of implementation science. ©Fábio Gama, Daniel Tyskbo, Jens Nygren, James Barlow, Julie Reed, Petra Svedberg. 

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  • 32.
    Grönevall, Richard
    et al.
    Halmstad University, School of Business, Engineering and Science, Centre for Innovation, Entrepreneurship and Learning Research (CIEL).
    Danilovic, Mike
    Halmstad University, School of Business, Engineering and Science, Centre for Innovation, Entrepreneurship and Learning Research (CIEL). Shanghai Dianji University, Shanghai, China.
    Designing an integrated project, program and portfolio system: A case study of healthcare2014In: Risk and change management in complex systems: Proceedings of the 16th International DSM Conference, Paris, France, 2-4 July 2014 / [ed] Marija Jankovic, Maik Mauer, Frank Marle, Danilo Marcello Schmidt, Udo Lindemann, München: Carl Hanser Verlag GmbH, 2014, p. 309-318Conference paper (Refereed)
    Abstract [en]

    Healthcare organizations are subject to an increasing complexity in the management of patient information. The modern healthcare system is developed through projects in large scale. The complexity is rapidly increasing and lack of coordination between projects is crucial in relation to performance. The contemporary approach following the traditional project related approach is insufficient and obsolete and the underlying interconnectivity between elements in a multi-project environment can be used to explore new compositions of projects, programs and portfolios. By a systematic approach in managing interdependencies based on exploring the flow of information between projects on three different levels two major outcomes can be concluded. In our systematic DSM/DMM approach we explore how projects can be organized in programs and in portfolios.

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    Grönevall_Danilovic_2014_DSMConference_2014
  • 33.
    Grönevall, Richard
    et al.
    Halmstad University, School of Business, Engineering and Science, Centre for Innovation, Entrepreneurship and Learning Research (CIEL).
    Danilovic, Mike
    Halmstad University, School of Business, Engineering and Science, Centre for Innovation, Entrepreneurship and Learning Research (CIEL). Shanghai Dianji University, Shanghai, China.
    Designing an Integrated Project, Program and Portfolio System: A Case Study of Healthcare2014In: Journal of Modern Project Management, ISSN 2317-3963, E-ISSN 1747-0862, Vol. 2, no 2, p. 78-85Article in journal (Refereed)
    Abstract [en]

    Healthcare organizations are subject to an increasing complexity in the management of patient information. The modern healthcare system is developed through large-scale projects. The complexity is rapidly increasing but the lack of coordination between projects in relation to performance is critical. The contemporary approach following the traditional project related approach is insuffi cient and obsolete and the underlying interconnectivity between elements in a multi-project environment can be used to explore new compositions of projects, programs and portfolios. By a systematic approach in managing interdependencies based on exploring the fl ow of information between projects at three different levels and two major outcomes can be concluded. In our systematic DSM/DMM approach we explore how projects can be organized in programs and in portfolios.

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    Grönevall_Danilovic_2014
  • 34.
    Guo, Xiaoyi
    et al.
    University of Electronic Science and Technology of China, Chengdu, PR China; University of Electronic Science and Technology of China, Quzhou, PR China.
    Tiwari, Prayag
    Halmstad University, School of Information Technology.
    Zhang, Ying
    Beidahuang Industry Group General Hospital, Harbin, PR China.
    Han, Shuguang
    University of Electronic Science and Technology of China, Quzhou, PR China.
    Wang, Yansu
    University of Electronic Science and Technology of China, Chengdu, PR Chin.
    Ding, Yijie
    University of Electronic Science and Technology of China, Quzhou, PR China.
    Random Fourier features-based sparse representation classifier for identifying DNA-binding proteins2022In: Computers in Biology and Medicine, ISSN 0010-4825, E-ISSN 1879-0534, Vol. 151, article id 106268Article in journal (Refereed)
    Abstract [en]

    DNA-binding proteins (DBPs) protect DNA from nuclease hydrolysis, inhibit the action of RNA polymerase,prevents replication and transcription from occurring simultaneously on a piece of DNA. Most of theconventional methods for detecting DBPs are biochemical methods, but the time cost is high. In recent years,a variety of machine learning-based methods that have been used on a large scale for large-scale screeningof DBPs. To improve the prediction performance of DBPs, we propose a random Fourier features-based sparserepresentation classifier (RFF-SRC), which randomly map the features into a high-dimensional space to solvenonlinear classification problems. And 𝐿2,1-matrix norm is introduced to get sparse solution of model. Toevaluate performance, our model is tested on several benchmark data sets of DBPs and 8 UCI data sets. RFF-SRCachieves better performance in experimental results. © 2022 Elsevier Ltd. 

  • 35.
    Göransson, Carina
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Eriksson, I.
    School of Health and Education, University of Skövde, Skövde, Sweden.
    Ziegert, Kristina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Wengström, Y.
    Cancer Theme, Karolinska University Hospital, Stockholm, Sweden.
    Langius-Eklöf, Ann
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Brovall, M.
    School of Health and Education, University of Skövde, Skövde, Sweden.
    Kihlgren, A.
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Blomberg, K.
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Testing an app for reporting health concerns-Experiences from older people and home care nurses2018In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, no 2, article id e12181Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To explore the experiences of using an app among older people with home-based health care and their nurses. Background: Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. Design: Explorative qualitative design. Methods: For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. Results: The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. Conclusions: The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. Implications for practice: The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care. © 2017 John Wiley & Sons Ltd

  • 36.
    Göransson, Patrik
    et al.
    Halmstad University, School of Business, Engineering and Science, Centre for Innovation, Entrepreneurship and Learning Research (CIEL). Hallands Hospital, Halmstad, Sweden.
    Börjesson, Elinore
    Hallands Hospital, Halmstad, Sweden.
    Wahlgren, Birgitta
    Hallands Hospital, Halmstad, Sweden.
    From Vision to Action - Innovation and Implementation of an Integrated Cancer Rehabilitation Within Clinical Practice2013In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no Suppl. s3, p. 79-79, article id X-5Article in journal (Other academic)
  • 37.
    Hagel, Sofia
    et al.
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sweden & Skåne University Hospital, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Lindqvist, Elisabet
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sweden and Skåne University Hospital, Lund, Sweden.
    Bergknut, Charlotte
    Department of Orthopedics, Lund University, Lund, Sweden.
    Englund, Martin
    Department of Orthopedics, Lund University, Lund, Sweden.
    Trends in 21st century Health Care Utilization in a Rheumatoid Arthritis Cohort Compared to the General Population2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no S10, p. S31-S32, article id 73Article in journal (Refereed)
    Abstract [en]

    Statement of purpose: To study twenty-first century trends in health care utilization by rheumatoid arthritis (RA) patients compared to the general population. Methods: Observational cohort study; using Swedish health care register data, we identified 3977 Region Skåne residents (mean age year 2001, 62.7 years and 73% women) consulting for RA (ICD-10 codes M05 or M06) in 1998-2001. We randomly sampled two referents from the general population per RA patient matched for age, sex, and area of residence. We calculated the year 2001-2010 trends for the annual ratio (RA cohort/referents) of the mean number of hospitalizations and outpatient clinic visits. Results: By the end of the 10-year period 62% of RA patients and 74% of referents were still alive and resident in the region. From 2001 to 2010 the ratio (RA cohort/referents) of the mean number of hospitalizations for men and women decreased by 27% (p=0.01) and 28% (p=0.004), respectively. The corresponding decrease was 29% (p=0.005), and 16% (p=0.004) for outpatient physician care, 34% (p=0.009) and 18% (p=0.01) for nurse visits, and 34% (p=0.01) and 28% (p=0.004) for physiotherapy (Figure 1 and 2). Figure 1.Health care utilization during the first decade of the twenty-first century by patients in a closed rheumatoid arthritis cohort and their matched referents from the general population. The y-axes show the mean number of visits per subject per calendar year. Figure 2.Health care utilization during the first decade of the twenty-first century by patients in a closed rheumatoid arthritis cohort and their matched referents from the general population. The y-axes show the mean number of visits per subject per calendar year. Conclusions: During the twenty-first century, coinciding with increasing use of earlier and more active RA treatment including biological treatment, the overall inpatient and outpatient health care utilization by a cohort of RA patients decreased relative to the general population.

  • 38.
    Hazelzet, Jan A.
    et al.
    Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
    Thor, Johan
    The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Andersson Gäre, Boel
    The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Kremer, Jan A.M.
    IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
    van Weert, Nico
    Society Personalized Healthcare, Nijmegen, The Netherlands.
    Savage, Carl
    Medical Management Centre, Department of Learning, Informatics, Management & Ethics, Karolinska Institute, Stockholm, Sweden.
    Elwyn, Glyn
    The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
    Value-based healthcare’s blind spots: call for a dialogue2021In: F1000 Research, E-ISSN 2046-1402, Vol. 10, article id 1314Article in journal (Refereed)
    Abstract [en]

    The value-based healthcare (VBHC) concept was first proposed as a solution to many of the ills of healthcare. Since then, we have seen the term “value” defined, used, confused, and interpreted in multiple ways. While we may disagree that competition based on value will solve healthcare’s complex challenges, value is a concept integral to the future of healthcare. Before VBHC becomes consigned to the long list of quality improvement trends and management fads that have passed through healthcare, we call for a dialogue around the term value and the implications of its different interpretations. The intention is not just to critique, but to facilitate ongoing efforts to substantially improve healthcare in ways that are relevant and sustainable for society at large.

  • 39.
    Hidefjäll, Patrik
    et al.
    Halmstad University, School of Business, Innovation and Sustainability. Karolinska Institutet, Stockholm, Sweden.
    Laurell, Hélène
    Halmstad University, School of Business, Innovation and Sustainability.
    Johansson, Jeaneth
    Halmstad University, School of Business, Innovation and Sustainability. Luleå University Of Technology, Luleå, Sweden.
    Barlow, James
    Halmstad University, School of Business, Innovation and Sustainability. Imperial College Business School, London, United Kingdom.
    Institutional logics and the adoption and implementation of remote patient monitoring2023In: Innovation: Management, Policy & Practice, ISSN 1447-9338, E-ISSN 2204-0226Article in journal (Refereed)
    Abstract [en]

    Remote patient monitoring (RPM) of chronic diseases represents a care modality with great potential to substantially improve outcomes and reduce hospital admission and costs to society. Empirical research has examined the processes of RPM adoption and implementation; however, implementation of RPM–a complex technological and health service innovation–remains challenging. Various analytical frameworks have tried to understand the conditions for successful adoption and implementation of RPM and other complex healthcare innovations. This conceptual study argues that incorporation of lessons from literature on institutional logics could enrich these frameworks. Healthcare is a domain influenced by multiple competing, collaborating or co-existing institutional logics such as professional, state, market, corporate and increasingly a community logic, expressed in patient-centred care principles. We outline the concept of patient-centred care as an emerging institutional logic and explore how to incorporate it into two widely used analytical frameworks, NASSS (‘non-adoption, abandonment, scale-up, spread, and sustainability’) and normalisation process theory (NPT). The main benefit of adding an institutional logics approach to the NPT framework is primarily to increase awareness of how institutional logics at meso-and macro-levels may affect the scope of implementation at a micro-level. In the case of the NASSS framework institutional logics provides a rationale for achieving cross-level alignment between domains. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

  • 40.
    Holmqvist, Gärd
    et al.
    Skaraborg Hospital, Skövde, Sweden & Skaraborg Institute for Research and Development, Skövde, Sweden.
    Lundqvist-Persson, Cristina
    Skaraborg Institute for Research and Development, Skövde, Sweden & Lund University, Lund, Sweden.
    Is there evidence for the use of art therapy in treatment of psychosomatic disorders, eating disorders and crisis?: A comparative study of two different systems for evaluation2012In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 53, no 1, p. 47-53Article in journal (Refereed)
    Abstract [en]

    As with any type of treatment the requirement for evidence based practice (EBP) has also affected art therapy (AT) when used as an intervention. This review evaluates the available evidence for using AT for psychosomatic disorders, eating disorders and crisis. The search in Cochrane, Best Practice, AMED, CINAHL, PION, PsycINFO and PubMed from 1987 until now resulted in a huge number of articles but only 32 articles met our criteria for evaluations. The articles were assessed with two evaluation systems, the GRADE system used by the Swedish Council on Health Technology Assessment (SBU) and the US Preventive Services Task Force (USPSTF/Task Force). When comparing the results we found that the GRADE evaluation system rejected the quality in 84% of the 32 studies and the USPSTF/Task Force 41% of these studies. An evidence base for AT was found only according to the criteria of USPSTF/Task Force. Hence, the evidence concept is not explicit, which means that effective treatments run a risk of not being implemented in health care. We suggest a broader view of what constitutes evidence in order to make it possible to include different types of research designs and methods. © 2011 The Authors. Scandinavian Journal of Psychology © 2011 The Scandinavian Psychological Associations.

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  • 41.
    Huyghebaert-Zouaghi, Tiphaine
    et al.
    Université de Reims Champagne Ardenne, Reims, France.
    Gillet, Nicolas
    Université De Tours, Tours, France; Institut Universitaire De France, Paris, France.
    Fernet, Claude
    Université Du Québec À Trois-rivières, Trois-Rivieres, Canada.
    Thomas, Jérémy
    Université de Reims Champagne Ardenne, Reims, France.
    Ntoumanis, Nikos
    Halmstad University, School of Health and Welfare. University Of Southern Denmark, Odense, Denmark.
    Managerial predictors and motivational outcomes of workers’ psychological need states profiles: A two-wave examination2023In: European Journal of Work and Organizational Psychology, ISSN 1359-432X, E-ISSN 1464-0643, Vol. 32, no 2, p. 216-233Article in journal (Refereed)
    Abstract [en]

    This study addressed the lack, in the work context, of a comprehensive time-lagged examination of the core constructs (interpersonal behaviors, psychological need states, and motivation) underlying Self-Determination Theory (SDT). Specifically, this research relied on person-centered analyses to gain a better understanding of how the distinct components of psychological need states (satisfaction, frustration, and unfulfillment of the needs for autonomy, competence, and relatedness) combine to produce distinct profiles of employees. We also documented the stability of these profiles over time and their associations with theoretically-relevant predictors (supervisors’ supportive, thwarting, and indifferent behaviors) and outcomes (work motivation). Questionnaire surveys were completed twice over the course of three months by a sample of 590 French employees. Six profiles, characterized by distinct configurations of global and specific need constructs were identified and found to be stable over time. Supervisors’ supportive, thwarting, and indifferent behaviors showed well-differentiated patterns of association with these profiles. Finally, employees’ global levels of self-determination and specific levels of motivational regulations differed as a function of profile membership. Altogether, results from this research suggest that SDT’s explanatory framework may be expanded to encompass the key role played by need indifferent behaviors and employees’ experiences of need unfulfillment. © 2022 Informa UK Limited, trading as Taylor & Francis.

  • 42.
    Hägerholt, Natalie
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Pedersén, Caroline
    Halmstad University, School of Social and Health Sciences (HOS).
    Som att andas genom ett sugrör: Patientens upplevelse av att leva med kroniskt obstruktiv lungsjukdom med fokus på ångestsymtom2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Chronic Obstructive Pulmonary disease is an underdiagnosed disease that today affects more and more individuals. The disease appears mainly with smokers but non-smokers can be affected too. The most occurring symptoms at chronic obstructive pulmonary disease are breathlessness and shortness of breath. The symptoms affect one another and can create a feeling of anxiety. The aim of the study was to illuminate the experience of living with chronic obstructive pulmonary disease with focus on the symptom anxiety. The study was conducted as a literature review containing 13 qualitative and quantitative articles. Difficulties to breathe were described as one of the biggest reasons behind anxiety which affected both the physical and psychological well-being of the patients. The limited airflow and symptoms of anxiety involved a feeling of one being suffocated. The breathing was described as a dreadful situation and the patients compared the condition to breathing through a straw. Many of the patients chose to postpone the contact with medical care thinking that the symptoms would moderate. When the symptoms accelerated medical care yet seemed important for the patients. The study can contribute with meaningful information to the care of patients with chronic obstructive pulmonary disease. The study can also give valuable input to further research studies, especially on patients’ view on health related quality of life related to the symptoms of the disease.

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    Som att andas genom ett sugrör
  • 43.
    Irgang dos Santos, Luís Fernando
    Halmstad University, School of Business, Innovation and Sustainability, Centre for Innovation, Entrepreneurship and Learning Research (CIEL). FURB, Blumenau, Brazil.
    Continuous Finding Problems and Implementing Solutions in Health Care-Associated Infections: The Role of Infection Preventionists2020Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    This licentiate thesis aims to understand how infection preventionists (IPs) continuously find problems and implement solutions related to health care-associated infections (HAIs) in hospital settings.

    HAIs are infections acquired by patients during the process of care and are among the main causes of deaths worldwide. Recently, practices for HAIs prevention and control have challenged IPs due to pandemics (e.g. COVID-19), antimicrobial resistance, population aging and limited resources in health care facilities. Such challenges demand actions to find, solve problems and implement solutions. However, IPs often fail to address these problems. The reasons stem from their inability to timely identify valuable problems and implement new solutions. Although the literature on infection prevention and control is well developed, previous studies have largely investigated how IPs implement preconceived practices to solve given problems as a single event, rather than on how to continuously find problems and implement solutions. 

    This licentiate thesis comprises two empirical papers. Paper I investigates how infection prevention and control teams find problems with HAIs, and is based on a multiple case study of three infection prevention and control teams from one Swedish and two Brazilian hospitals. Paper II investigates how IPs continuously implement changes in infection prevention and control practices during pandemics, and is based on a qualitative descriptive study. The data in both papers were collected from 44 semi-structured interviews with health care professionals enrolled as IPs in Brazilian and Swedish hospitals. The key theories and literatures covered include Problem-Finding and Problem-Solving Perspective and Implementation research.

    This licentiate thesis contains three main contributions. First, it advances the Problem-Finding and Problem-Solving Perspective literature by providing empirical evidence on how to create valuable knowledge from ill-structured and complex problems. Second, this licentiate thesis suggests a distinction between HAI prevention and HAI control based on two modes of decision-making for finding valuable problems with HAIs. Third, the licentiate thesis describes and categorizes sets of practices that allow to continuously implement changes of infection prevention and control practices during pandemics. 

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    Licentiate Thesis Luís F. Irgang
  • 44.
    Irgang dos Santos, Luís Fernando
    et al.
    FURB, Blumeanau, Brazil.
    Gama, Fábio
    Holmén, Magnus
    What’s the Problem? How Infection Prevention and Control Teams Find Problems with Health Care-Associated Infections2019Conference paper (Other academic)
    Abstract [en]

    Background: Health care-associated infections (HAIs) are among the major causes of death of hospitalized patients. The ability to find and solve problems relating to HAIs is heavily contingent on infection prevention and control (IPC) teams’ practices. Previous studies provide detailed insights into how IPC teams find appropriate solutions, but they do not addressed how problems are found. This limitation is a severe drawback as IPC teams may focus their attention on the wrong problems that leads to inefficient or suboptimal solutions.

    Purpose: This study aims to understand how IPC teams find problems with HAIs from a Problem-Finding and Problem-Solving perspective.

    Method: We performed a multiple case study of three hospitals located in Brazil and Sweden. We collected data from 3 exploratory interviews and 13 semi-structured interviews with nurses and physicians enrolled in IPC teams. Supplemented documents were used for data triangulation. Data were analyzed using a thematic approach.

    Findings: Results from this study suggest an approach based on two different sets of activities for finding problems: practices for HAI prevention and for HAI control. Practices for HAI prevention comprises routinely and elective actions whereas practices for HAI control involve ad hoc and emergent actions. The practices are organized into problem-detection, -framing, and -formulation activities.

    Conclusion: We identified and detailed practices that guide IPC teams’ attention to find valuable problems relating to HAIs. By detecting, framing and formulating problems, IPC teams can find appropriate solutions.

    Practice Implications: A range of practices are detailed in our study to guide IPC teams’ attention in how to find relevant problems relating to HAI prevention and control as well as the criteria on how to prioritize latent problems to obtain needed solutions. Our study provides a basis for supporting decision makers on how to identify opportunities for improve IPC policies and practices.

  • 45.
    Irgang dos Santos, Luís Fernando
    et al.
    Halmstad University, School of Business, Innovation and Sustainability. FURB, Blumenau, Brazil.
    Holmén, Magnus
    Halmstad University, School of Business, Innovation and Sustainability.
    Gama, Fábio
    Halmstad University, School of Business, Innovation and Sustainability.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    Facilitation activities for change response: a qualitative study on infection prevention and control professionals during a pandemic in Brazil2021In: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 35, no 7, p. 886-903Article in journal (Refereed)
    Abstract [en]

    Purpose: Facilitation activities support implementation of evidence-based interventions within healthcare organizations. Few studies have attempted to understand how facilitation activities are performed to promote the uptake of evidence-based interventions in hospitals from resource-poor countries during crises such as pandemics. This paper aims to explore facilitation activities by infection prevention and control (IPC) professionals in 16 hospitals from 9 states in Brazil during the COVID-19 pandemic.

    Design/methodology/approach: Primary and secondary data were collected between March and December 2020. Semi-structured interviews were conducted with 21 IPC professionals in Brazilian hospitals during the COVID-19 pandemic. Public and internal documents were used for data triangulation. The data were analyzed through thematic analysis technique.

    Findings: Building on the change response theory, this study explores the facilitation activities from the cognitive, behavioral and affective aspects. The facilitation activities are grouped in three overarching dimensions: (1) creating and sustaining legitimacy to continuous and rapid changes, (2) fostering capabilities for continuous changes and (3) accelerating individual commitment. Practical implications: During crises such as pandemics, facilitation activities by IPC professionals need to embrace all the cognitive, behavioral and affective aspects to stimulate positive attitudes of frontline workers toward continuous and urgent changes.

    Originality/value: This study provides unique and timely empirical evidence on the facilitation activities that support the implementation of evidence-based interventions by IPC professionals during crises in hospitals in a resource-poor country.

    © 2021, Luís Irgang, Magnus Holmén, Fábio Gama and Petra Svedberg

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  • 46.
    James, Inger
    et al.
    School of Health Sciences, Department of Nursing Sciences, Örebro University, Örebro, Sweden.
    Norell Pejner, Margaretha
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Kihlgren, Annica
    School of Health Sciences, Department of Nursing Sciences, Örebro University, Örebro, Sweden.
    Creating conditions for a sense of security during evenings and nights among older persons receiving home health care in ordinary housing: a participatory appreciative action and reflection study2019In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, no 1, article id 351Article in journal (Refereed)
    Abstract [en]

    Background: Today many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge.

    Methods: This study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data.

    Results: Five subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person’s identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other’s conditions. The person’s self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed.

    Conclusion: Conditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people’s self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing. © The Author(s). 2019

  • 47.
    Johnsson, Elin
    Halmstad University, School of Social and Health Sciences (HOS).
    Motionärers frivilliga och spontana visualiseringsupplevelser2010Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Exercise is important for our health, but many who start exercise drop out in the near future (Fallon, Hausenblas, & Nigg, 2005). It is therefore important to develop strategies that motivate people to exercise. Imagery has been shown to have a motivating effect on exercisers. Kim and Giacobbi (2009) argue that there is a need to distinguish between content, functions and effects in exercise imagery and that a new instrument therefore is needed. The objectives of this study were therefore to: (1) develop and test the instrument Individual Profile of Imagery Experiences in Exercise (IPIEE; Weibull & Johnsson 2010) and (2) study exercisers’ voluntary and spontaneous imagery experiences. The theoretical frameworks that were used were the Analytic Framework of Imagery Experiences (Weibull, 2009) and An Applied Model of Imagery Use in Exercise (Munroe-Chandler & Gammage, 2005). The result shows that IPIEE worked well, that voluntary imagery was mostly used to increase motivation and the most spontaneous imagery patterns had an effect on motivation. The most common contents were Exercise situations followed by Non-exercise related events/situations. The results are discussed in relation to theoretical frameworks and previous research.

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  • 48.
    Jonnergård, Karin
    et al.
    Lund University, Lund, Sweden.
    Petersson, Lena
    Lund University, Lund, Sweden.
    Erlingsdóttir, Gudbjörg
    Lund University, Lund, Sweden.
    Communicating the Implementation of Open Notes to Health Care Professionals: Mixed Methods Study2021In: JMIR Medical Informatics, E-ISSN 2291-9694, Vol. 9, no 8, article id e22391Article in journal (Refereed)
    Abstract [en]

    Background: The literature on how to communicate reform in organizations has mainly focused on levels of hierarchy and has largely ignored the variety of professions that may be found within an organization. In this study, we focus on the relationship between media type and professional responses.

    Objective: The objective of this study was to investigate whether and how belonging to a profession influences the choice of communication media and the perception of information when a technical innovation is implemented in a health care setting.

    Methods: This study followed a mixed methods design based on observations and participant studies, as well as a survey of professionals in psychiatric health care in Sweden. The χ2 test was used to detect differences in perceptions between professional groups.

    Results: The use of available communication media differed among professions. These differences seem to be related to the status attached to each profession. The sense-making of the information appears to be similar among the professions, but is based on their traditional professional norms rather than on reflection on the reform at hand.

    Conclusions: When communicating about the implementation of a new technology, the choice of media and the message need to be attuned to the employees in both hierarchical and professional terms. This also applies to situations where professional employees are only indirectly affected by the implementation. A differentiated communication strategy is preferred over a downward cascade of information. © Karin Jonnergård, Lena Petersson, Gudbjörg Erlingsdóttir. 

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  • 49.
    Jormfeldt, Henrika
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Supporting positive dimensions of health, challenges in mental health care2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 2, p. 7126-Article in journal (Refereed)
    Abstract [en]

    This paper will explore two contrasting paradigms in mental health care and their relationship to evidence-based practice. The biomedical perspective of pathogenesis and the health perspective of salotogenesis are two major diverse views in mental health care. Positive dimensions of health are traditionally viewed as software not suitable for statistical analysis, while absence of symptoms of disease are regarded as measurable and suitable for statistical analysis and appropriate as a foundation of evidence-based practice. If the main goal of mental health care is to enhance subjectively experienced health among patients, it will not be sufficient to evaluate absence of symptoms of disease as a measure of quality of care. The discussion focuses on the paradox of evidence-based absence of illness and disease versus subjectively experienced health and well-being as criterions of quality of care in mental health care.

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  • 50. Järpe, Eric
    REMIND: Some ideas for improved security for elderly2019Report (Other academic)
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