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  • 1.
    Ahlstrand, Inger
    et al.
    Jönköping University, Jönköping, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare.
    Larsson, Margaretha
    University of Skövde, Skövde, Sweden.
    Ekman, Aimée
    Jönköping University, Jönköping, Sweden.
    Hedén, Lena
    University of Borås, Borås, Sweden.
    Laakso, Katja
    University of Gothenburg, Gothenburg, Sweden.
    Lindmark, Ulrika
    Karlstad University, Karlstad, Sweden; Jönköping University, Jönköping, Sweden.
    Nunstedt, Håkan
    University West, Trollhättan, Sweden.
    Oxelmark, Lena
    University of Gothenburg, Gothenburg, Sweden.
    Pennbrant, Sandra
    University West, Trollhättan, Sweden.
    Sundler, Annelie J.
    University of Borås, Borås, Sweden.
    Hallgren, Jenny
    University of Skövde, Skövde, Sweden.
    Health-promoting factors among students in higher education within health care and social work: a cross-sectional analysis of baseline data in a multicentre longitudinal study2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 1314Article in journal (Refereed)
    Abstract [en]

    Background: Educational environments are considered important in strengthening students’ health status andknowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universitiesbased on a salutogenic approach – namely, health promotion. The aim of this study was to describe healthpromotingresources and factors among first-semester students in higher education in healthcare and social work.Methods: This cross-sectional study is based on a survey distributed among all students in seven healthcare andsocial work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a selfreported,web-based questionnaire focussing on general health and well-being, lifestyle factors together with threevalidated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, SalutogenicHealth Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ).Results: Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) wereenrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported goodgeneral health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQwere, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyleswere related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressionsshowed that perceived well-being and no sleeping problems significantly predicted higher general health and higherSOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC.Conclusions: Swedish students in higher education within the healthcare and social work sector report good generalhealth and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), andin some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be ofimportance to both general health and health-promotive resources. This study contributes to knowledge about thehealth promotive characteristics of students in the healthcare and social work fields, which is of importance for planninguniversities with a salutogenic approach. © 2022, The Author(s).

  • 2.
    Aili, Katarina
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden & FoU Spenshult, Halmstad, Sweden.
    Andersson, Maria L.E.
    FoU Spenshult, Halmstad, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). FoU Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). FoU Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). FoU Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    FoU Spenshult, Halmstad, Sweden & Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Sleep problems and fatigue as a predictor for the onset of chronic widespread painover a 5- and 18-year perspective: a 20-year prospective study2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 87-87, article id OP0072Article in journal (Refereed)
    Abstract [en]

    Background: If localised pain represent one end of a pain spectra, with overall better general health, chronic widespread pain (CWP) and fibromyalgia represent the other end of the spectra with worse general health and more comorbidities with other somatic diseases and mental illness. Sleep problems and fatigue are common among individuals reporting CWP and previous research indicate that sleep problems may be an important predictor for pain prognosis.

    Objectives: The aim of this population-based study was to investigate if sleep problems and fatigue predict the onset of CWP 5 and 18 years later.

    Methods: In order to get more stable baseline classifications of CWP, a wash-out period was used, including only individuals who had not reported CWP (according to ACR 1990 criteria for fibromyalgia) at baseline (−98) and three years prior baseline (−95). In all, data from 1249 individuals entered the analyses for the 5 year follow-up (−03) and 791 entered for the 18 year follow-up (−16). Four parameters related to sleep (difficulties initiating sleep, maintaining sleep, early morning awakening and non-restorative sleep), and one parameter related to fatigue (SF-36 vitality scale) were investigated as predictors for CWP. Binary logistic regression analysis were used for analyses.

    Results: All investigated parameters predicted the onset of CWP five years later (problems with initiating sleep (OR 1.91; 1.16–3.14), maintaining sleep (OR 1.85; 1.14–3.01), early awakening (OR 2.0; 1.37–3.75), non-restorative sleep (OR 2.27; 1.37–3.75) and fatigue (OR 3.70; 1.76–7.84)) in a model adjusted for age, gender, socio-economy and mental health. All parameters except problems with early awakening predicted the onset of CWP also 18 years later. In all, 785 individuals did not report any of the sleeping problems at baseline (fatigue not included), 268 reported one of the problems, 167 two, 128 three and 117 subjects reported to have all four sleep problems. Reporting all four sleep problems was significantly associated with CWP at follow-up at both time points when adjusting for age, gender, socio economy and mental health (OR 4.00; 2.03–7.91 and OR 3.95; 1.90–8.20); adjusting for age, gender, socio economy and number of pain regions (OR 2.94; 1.48–5.82 and OR 2.65; 1.24–5.64) and in a model adjusting for age, gender, socio economy and pain severity (OR 2.97;1.53–5.76; and OR 3.02;1.47–6.21) for the 5 year and 18 year follow-up respectively, compared to not reporting any of the sleep problems at baseline.

    Conclusions: Both sleeping problems and fatigue predicts the onset of CWP 5- and 18 years later. The results highlight the importance of the assessment of sleep quality in the clinic.

  • 3.
    Aili, Katarina
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Sport. Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden & Karolinska Institutet, Stockholm, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden & Lunds Universitet, Lund, Sweden.
    Bremander, Ann
    Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden & Lunds Universitet, Lund, Sweden & University of Southern Denmark, Odense, Denmark & Syddansk Universitet, Graasten, Danmark.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Sleep problems and fatigue as predictorsfor the onset of chronic widespread painover a 5- and 18-year perspective2018In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 19, no 1, p. 1-14Article in journal (Refereed)
    Abstract [en]

    Background: Previous research suggests that sleep problems may be an important predictor for chronic widespread pain (CWP). With this study we investigated both sleep problems and fatigue as predictors for the onset of CWP over a 5-year and an 18-year perspective in a population free from CWP at baseline.

    Methods: To get a more stable classification of CWP, we used a wash-out period, including only individuals who had not reported CWP at baseline (1998) and three years prior baseline (1995). In all, data from 1249 individuals entered the analyses for the 5-year follow-up and 791 entered for the 18-year follow-up. Difficulties initiating sleep, maintaining sleep, early morning awakening, non-restorative sleep and fatigue were investigated as predictors separately and simultaneously in binary logistic regression analyses.

    Results: The results showed that problems with initiating sleep, maintaining sleep, early awakening and non-restorative sleep predicted the onset of CWP over a 5-year (OR 1.85 to OR 2.27) and 18-year (OR 1.54 to OR 2.25) perspective irrespective of mental health (assessed by SF-36) at baseline. Also fatigue predicted the onset of CWP over the two-time perspectives (OR 3.70 and OR 2.36 respectively) when adjusting for mental health. Overall the effect of the sleep problems and fatigue on new onset CWP (over a 5-year perspective) was somewhat attenuated when adjusting for pain at baseline but remained significant for problems with early awakening, non-restorative sleep and fatigue. Problems with maintaining sleep predicted CWP 18 years later irrespective of mental health and number of pain regions (OR 1.72). Reporting simultaneous problems with all four aspects of sleep was associated with the onset of CWP over a five-year and 18-yearperspective, irrespective of age, gender, socio economy, mental health and pain at baseline. Sleep problems and fatigue predicted the onset of CWP five years later irrespective of each other.

    Conclusion: Sleep problems and fatigue were both important predictors for the onset of CWP over a five-year perspective. Sleep problems was a stronger predictor in a longer time-perspective. The results highlight the importance of the assessment of sleep quality and fatigue in the clinic. © The Author(s). 2018

  • 4.
    Aili, Katarina
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden & Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bergman, Stefan
    Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Lund University, Department of Clinical Sciences, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden.
    Passive coping strategies but not physical function are associated with worse mental health, in women with chronic widespread pain – a mixed method study2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 2159-2159Article in journal (Refereed)
    Abstract [en]

    Background: Chronic widespread pain (CWP) is a common condition (approximately 10% prevalence), that affects women twice as often as men. There is a lack of knowledge in how different coping strategies relates to health status during CWP development in a general population.

    Objectives: To explore different ways of coping with CWP and to relate the different coping strategies to health-related factors, before and after developing CWP.

    Methods: A sequential explorative mixed methods study including 19 women 45-67 of age, who had reported CWP in a survey 2016, but not in 1995. Individual interviews were analysed with a phenomenographic approach, and resulted in four categories of coping strategies. These categories were further explored with regard to four dimensions of health status (physical function, bodily pain, vitality and mental health) as measured by SF-36 (0-100, a lower score indicates more disability) and sleep problems measured both in 1995, and 2016.

    Results: The qualitative analysis revealed four categories representing different coping strategies, where each woman was labelled by the most dominant category; the mastering woman, the persistent woman, the compliant woman and the conquered woman. The first two categories emerged as being active coping strategies, and the latter two as passive. Women with passive strategies reported significantly lower vitality (median 57.5 vs 75, p=0.007) and worse mental health (median 54 vs 93, p=0.021) in 1995, before they had developed CWP compared with those with active coping strategies. No differences were seen between the groups on physical function, bodily pain or sleep.

    In 2016, there were still a difference between the passive and active group regarding mental health (median 56 vs 80, p=0.022), but not for vitality (median 35 vs 40, p=0.707). No differences were seen between the groups on physical function or bodily pain. All eight women with passive strategies reported problems with sleep in 2016, as compared to 6 of the 11 women with active strategies (p=0.045).

    Conclusion: Women that reported CWP in 2016, but not in 1995, described both active and passive coping strategies. The qualitative findings were associated with differences in vitality and mental health already in 1995, before they had developed CWP. Further, those with passive coping strategies reported worse health with regard to mental health and sleep problems in 2016. Interestingly, the groups did not differ in bodily pain or physical function neither in 1995 nor in 2016, which implicates the importance for the clinician to take the typical coping strategy into consideration, when meeting these patients in clinical settings. © Aili, Bergman, Bremander, Haglund & Larsson 2019. No commercial re-use. See rights and permissions. Published by BMJ.

  • 5.
    Aili, Katarina
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). FoU Spenshult, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). FoU Spenshult, Halmstad, Sweden & Lund University, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). FoU Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). FoU Spenshult, Halmstad, Sweden.
    Women’s experiences of coping with chronic widespread pain – a qualitative study2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 1815-1815, article id FRI10737-HPRArticle in journal (Refereed)
    Abstract [en]

    Background: Approximately ten percent of the population report chronic widespread pain (CWP), the condition is more common among women than men. For most people, the pain interferes with many aspects of every-day life and implies large consequences. However, the group reporting CWP is heterogeneous and there is a need for better understanding of the different strategies used for coping with pain in every-day life.

    Objectives: The purpose of this study was to describe women’s experiences of how to cope with CWP.

    Methods: The study had a descriptive design with a qualitative content analysis approach. Individual interviews were conducted with 19 women, 31–66 of age, who had reported CWP in a survey 2016. CWP was defined according to the 1990 ACR criteria for fibromyalgia. To be considered chronic, the pain should have persisted for more than three months during the last 12 months. A manifest qualitative content analysis was used to analyze the main question “How do you cope with your chronic widespread pain?” The analysis resulted in four categories.

    Results: Women described their coping with CWP in four different ways; to take control, to continue as usual, to follow instructions and to rest. To take control meant to make deliberate decisions to handle everyday day life. It also meant to take care of oneself, to think positive and to exercise at an adequate level. To continue as usual meant not to listen to body signals and either to ignore or accept the pain. To follow instructions meant listening to the health professionals and following advices, but without taking any part of the responsibility for the treatment outcome. To rest meant to perceive an unreasonable need for recovery, to resign and let the pain set the terms for the daily living.

    Conclusions: Women expressed different ways of coping with CWP including both active and passive strategies. The coping strategies included two dimensions, where one ranged from actively taking control over the pain, to passively following instructions and the other from actively continue as usual by either accepting or ignoring the pain to passively rest and being mastered by pain.

  • 6.
    Almgren, Johanna
    et al.
    Halmstad University, School of Health and Welfare.
    Löfström, Emma
    Department of Clinical Microbiology, Hallands Hospital Halmstad, Halmstad, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Malmborg, Julia S
    Halmstad University, School of Health and Welfare.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Undén, Johan
    Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Operation and Intensive Care, Hallands Hospital Halmstad, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden; Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Patients' Health Experiences of Post COVID-19 Condition – A Qualitative Study2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 21, article id 13980Article in journal (Refereed)
    Abstract [en]

    Patients who suffer from long-term symptoms of COVID-19, described as post COVID-19 condition, are a new and large group of patients. There is a lack of knowledge concerning health experiences in this patient group. The aim of this study was to explore patients' health experiences of post COVID-19 condition. Data collection was performed through 14 semi-structured interviews. The qualitative content analysis resulted in six sub-categories, three categories, and an overall theme. Patients experienced symptoms of varying duration-ranging from 5-21 months. The results showed that patients' health experiences of post COVID-19 condition moved between uncertainty and new insights. This was shown by patients experiencing: (1) loss of abilities, including losing smell and taste and lacking energy, (2) loss of control, including being foreign to oneself and seeking answers, and (3) revaluation of life, including accepting the transformed body and prioritizing health. This study illustrates that patients living with post COVID-19 condition need to be treated with flexibility, based on each individual's unique challenges and experiences of the symptoms and the consequences for their health. © 2022 by the authors.

  • 7.
    Andersson, M.
    et al.
    Lund University, Lund, Sweden; Spenshult Research & Development Centre, Halmstad, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden; Spenshult Research & Development Centre, Halmstad, Sweden; University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Sonderborg, Denmark.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research & Development Centre, Halmstad, Sweden.
    Empowerment and Associations to Disease Activity and Pain in Patients with Rheumatoid Arthritis2021In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, no Supplement 1, p. 197-197Article in journal (Refereed)
  • 8.
    Andersson, Maria L.E.
    et al.
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Spenshult Research and Development Center, Oskarström, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden.
    Reasons to stop drinking alcohol among patients with rheumatoid arthritis – a mixed method study2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no Suppl 2, article id 1295Article in journal (Refereed)
    Abstract [en]

    Background: Studies of alcohol use in patients with rheumatoid arthritis are sparse and studies of why patients choose to stop drinking alcohol in particular.

    Objectives: The aim of the current study was twofold: first to identify patients with RA who stopped drinking alcohol and compare those to patients drinking alcohol, and second, to explore reasons to stop drinking alcohol.

    Methods: In 2010 a self-completion postal questionnaire was sent to all 2,102 prevalent patients in the Better anti-rheumatic farmacotherapy (BARFOT) study enquiring about disease severity, physical function (HAQ) and health related quality of life (EQ5D), pain, fatigue, patient global assessment (PatGA) and lifestyle factors e.g. alcohol. The questions assessing alcohol included the question “Have you stopped drinking alcohol?” and an open question “Why have you stopped drinking alcohol?” A mixed method design was used and 1512 patients had answered the alcohol questions and was included in the study of those 86 had stopped drinking alcohol. Seventy-one patients answered the open question and their answers were analyzed with qualitative content analysis (1).

    Results: Comparing patient with RA using alcohol or not, the patients who stopped drinking alcohol was older median age (min-max) 69 (36–90) vs. 66 (23–95), p=0.011, more men 42% vs. 29%, p=0.015, had worse physical function, median HAQ (min-max) 0.50 (0–3.00) vs. 1.00 (0–2.75), p<0.001, worse health related quality of life, median EQ5D (min-max), 0.69 (-0.59–1.00) vs. 0.76 (-0.02–1.00), p<0.001, worse self-perceived health, median PatGA (min-max) 5 (0–10) vs. 3 (0–10), <0.001, more pain, median (min-max) 5 (0–10) vs. 3 (0–10), p<0.001, and more fatigue median (min-max) 6 (0–10) vs 4 (0–10), p<0.001. There were no differences between the groups regarding disease duration, swollen and tender joints. The qualitative content analysis resulted in five categories describing the reasons for patient with RA to stop drinking alcohol: disease and treatment, health and wellbeing, work and family, faith and belief and dependences and abuse.

    Conclusions: Patients with RA who stopped drinking alcohol have a lower physical function, health related quality of life, self-perceived health and more pain and fatigue comparing to patients with RA drinking alcohol. The reasons to stop drinking alcohol were of different nature such as medical, physical, mental, social and spiritual

  • 9.
    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.

  • 10.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Research and Development Center, Spenshult Hospital, Oskarström, Sweden.
    Wikström, Ingegerd
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Larsson, Ingrid
    Research and Development Center, Spenshult Hospital, Oskarström, Sweden.
    Bengtsson, Maria
    Department of Rheumatology, Clinical Sciences Lund and Malmö, Lund University, Lund, Sweden.
    Hagel, Sofia
    Department of Rheumatology, Clinical Sciences Lund and Malmö, Lund University, Lund, Sweden.
    Strömbeck, Britta
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Cultural adaptation, validity, reliability and responsiveness of the Swedish version of the effective musculoskeletal consumer scale (EC-17)2012In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 10, no 1, p. 43-50Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Endorsed by the Outcome MEasures in Rheumatoid Arthritis in Clinical Trials (OMERACT) group, The Effective Consumer Scale (EC-17) was developed in English for patients with musculoskeletal diseases to assess the skills and perceptions important for participating in and managing health care. The objective of this study was culturally to adapt the questionnaire into Swedish and to study its psychometric properties.

    METHODS: After translation of the questionnaire into Swedish, two different groups of outpatients from two specialist rheumatology departments participated in the study. Face validity was assessed, together with internal consistency, test-retest and responsiveness of the questionnaire. Construct validity was assessed using the Arthritis Self-Efficacy Scale (ASES), and responsiveness to a five day educational intervention was analysed using the standardized response mean (SRM).

    RESULTS: Analyses were based on 124 patients with inflammatory rheumatic diseases, of whom 50 attended the intervention. Data quality met the requirements, with missing values <5%, and floor and ceiling effects <15%. Item total correlations were all >0.4, ranging from 0.49 to 0.88. Cronbach's alpha was 0.93 and 0.95 for the two groups. The test-retest correlation (ICC₂.₁) was 0.94, and there was a significant improvement as a result of the intervention, with an SRM of 0.43. However, the questionnaire had a higher construct validity with the ASES subscale 'other symptoms' than hypothesized a priori (r(s) 0.75).

    CONCLUSION: The Swedish version of the EC-17 met the required recommendations for face validity, internal consistency, test-retest reliability and responsiveness. Its construct validity needs to be further established, and the questionnaire needs further testing in different groups of patients and in different interventions. © 2012 John Wiley & Sons, Ltd.

  • 11.
    Carlsson, Ing-Marie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Arvidsson, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Viklund, Åsa
    Department of Social Work, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Birkeland, Anna-Lena
    Department of Social Work, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Creating a communication space in the healthcare context: Children’s perspective of using the eHealth service, Sisom2021In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 25, no 1, p. 31-43Article in journal (Refereed)
    Abstract [en]

    According to the United Nation’s Convention of the Rights of the Child, children have the right to participate in their own healthcare and make their opinions heard. The aim of this study was thus to explore the impact of using an eHealth service, Sisom, to gain the children’s perspectives during their healthcare appointments. Data were gathered through individual interviews with a purposeful sample of 16 children, aged 6–13 years old, treated for different diseases and using the eHealth service, Sisom, during their healthcare appointments. The interviews were analysed using a constructivist grounded theory. The results showed that using Sisom made children’s voice heard by creating a communication space in the healthcare setting. This meant that the children got involved in the communication, were acknowledged as an important person who could give the answers to questions and were given time. Implementing the use of Sisom is a way to make children’s needs and preferences explicitly visible for decision-making in practice and thereby supporting the further development of child-centred care in practice. © The Author(s) 2020.

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  • 12.
    Carlsson, Ing-Marie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Jormfeldt, Henrika
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Place and space in relation to childbirth: a critical interpretive synthesis2020In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 15, no sup1, article id 1667143Article in journal (Refereed)
    Abstract [en]

    Background: In nursing and midwifery, the concept of environment is considered a meta-concept. Research findings suggest that the location is not the only important factor, as both place and space influence the practices of midwives. Moreover, research on the geography of health suggests a connection between place and health that could be extended to reproductive health. Therefore, to move beyond and expand traditional research expressions, it is beneficial to illuminate the concepts of place and space in relation to childbirth.

    Purpose: This study was undertaken to produce a synthesis of previous qualitative research of issues in childbirth in relation to the concepts of place and space.

    Method: In this Critical Interpretive Synthesis (CIS), four electronic databases; CINAHL, Medline, PsycINFO and Sociological abstracts, were used for the literature search. In total 734 papers were screened, and 27 papers met the final inclusion criteria after assessment.

    Results: The synthesis reveals a need to create a space for childbirth underpinned by four aspects; a homely space, a spiritual space, a safe space, and a territorial space.

    Conclusion: Findings from this review will provide a basis for useful dialogue in midwifery education and in clinical settings. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

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  • 13.
    Drake af Hagelsrum, Klara
    et al.
    Halmstad University, School of Health and Welfare.
    Mogard, Elisabeth
    Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Skane University Hospital, Department of Rheumatology, Lund, Sweden.
    Bremander, Ann
    Lund University, Section of Rheumatology, Department of Clinical Sciences Lund, Lund, Sweden; Spenshult, Research and Development Centre, Halmstad, Sweden; University of Southern Denmark, Department of Regional Health Research, Odense, Denmark; University Hospital of Southern Denmark, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.
    Lindqvist, Elisabet
    Lund University, Section of Rheumatology, Department of Clinical Sciences Lund, Lund, Sweden; Skane University Hospital, Department of Rheumatology, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Lund University, Section of Rheumatology, Department of Clinical Sciences Lund, Lund, Sweden; Spenshult, Research and Development Centre, Halmstad, Sweden.
    Healthcare professionals’ experiences of lifestyle management in patients with early rheumatoid arthritis: A qualitative study2022In: Annals of the Rheumatic Diseases, London: BMJ Publishing Group Ltd, 2022, Vol. 81, Suppl 1, p. 239-240Conference paper (Refereed)
    Abstract [en]

    Background: Rheumatoid Arthritis (RA) is a chronic inflammatory systemic disease that mainly affects joints and with symptoms such as stiffness, pain, and increased fatigue. RA also appears to be an independent risk factor for accelerated atherosclerosis with an increased risk of cardiovascular diseases, why national and international guidelines recommend proper pharmacological treatment together with a healthy lifestyle (1). Supporting people with early RA to achieve and maintain a healthy lifestyle is therefore of great importance. However, few studies have explored healthcare professionals’ views of working with lifestyle management. A healthy lifestyle does not only have the potential to lower cardiovascular risk but may also improve a person’s quality of life.

    Objectives: The aim of this study was to explore healthcare professionals´ experiences of lifestyle management in patients with early RA.

    Methods: In this explorative qualitative study, individual interviews were conducted with 20 healthcare professionals who had a mean of 16 years of professional experience in the field of working with patients with RA. An interview guide with open-ended questions was used e.g.: “How do you work with lifestyle changes in patients with RA?” and “What theories do you use to support lifestyle changes?” Qualitative content analysis was used, where three categories emerged: “The importance of a well-functioning organization”, “The importance of teamwork” and “The importance of person-centered care” and nine subcategories, representing the overall content of the interviews ( Table 1 ). 

  • 14.
    Drake af Hagelsrum, Klara
    et al.
    Halmstad University, School of Health and Welfare.
    Mogard, Elisabeth
    Lunds universitet, Lund, Sverige; Skåne University Hospital, Lund, Sweden.
    Bremander, Ann
    Lunds universitet, Lund, Sverige; Spenshult Research and Development Centre, Halmstad, Sweden; University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Sønderborg, Denmark.
    Lindqvist, Elisabet
    Lunds universitet, Lund, Sverige; Skåne University Hospital, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Lunds universitet, Lund, Sverige; Spenshult, Research and Development Centre, Halmstad, Sweden.
    Healthcare Professionals’ Experiences Of Lifestyle management In Patients With Early Rheumatoidarthritis – A Qualitative Study2022In: ReumaBulletinen, ISSN 2000-2246, Vol. 154, no 4, p. 60-61Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatoid Arthritis (RA) is a chronic inflammatory systemicdisease that mainly affects joints and with symptoms such asstiffness, pain, and increased fatigue. RA also appears to be anindependent risk factor for accelerated atherosclerosis withan increased risk of cardiovascular diseases, why national andinternational guidelines recommend proper pharmacologicaltreatment together with a healthy lifestyle (1). Supportingpeople with early RA to achieve and maintain a healthy lifestyleis therefore of great importance. However, few studies haveexplored healthcare professionals’ views of working with lifestylemanagement. A healthy lifestyle does not only have the potential tolower cardiovascular risk but may also improve a person’s qualityof life.

    Objectives: The aim of this study was to explore healthcare professionals´experiences of lifestyle management in patients with early RA.

    Methods: In this explorative qualitative study, individual interviews wereconducted with 20 healthcare professionals who had a mean of 16years of professional experience in the field of working with patientswith RA. An interview guide with open-ended questions was usede.g.: “How do you work with lifestyle changes in patients withRA?“ and “What theories do you use to support lifestyle changes?”Qualitative content analysis was used, where three categoriesemerged: “The importance of a well-functioning organization“,“The importance of teamwork“ and “The importance of personcenteredcare” and nine subcategories, representing the overallcontent of the interviews (table 1).

    Results: Healthcare professionals’ experiences of lifestyle managementin patients with early RA included the importance of a wellfunctioningorganization with supportive leadership, priority oflifestyle management, and competence development in lifestylemanagement. The importance of teamwork was emphasizedincluding interdisciplinary team, professional expertise in lifestylehabits, and structured approach to lifestyle management. The healthcare professionals also highlighted the importance of personcenteredcare with individually tailored lifestyle management,shared decision-making, and patient engagement.

    Conclusion: Healthcare professionals’ experiences of lifestyle managementin patients with early RA reveal that commitment from both themanagement, the team, and the patient is important.

    References: 1. Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendationsfor cardiovascular disease risk management in patients withrheumatoid arthritis and other forms of inflammatory jointdisorders: 2015/2016 update. Ann Rheum Dis 2017;76:17-28.

  • 15.
    Drake af Hagelsrum, Klara
    et al.
    Halmstad University, School of Health and Welfare. Skåne University Hospital, Lund, Sweden.
    Mogard, Elisabeth
    Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Sonderborg, Denmark.
    Lindqvist, Elisabet
    Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Lund University, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden.
    Healthcare professionals' perceptions of working on lifestyle management for patients with early rheumatoid arthritis – a qualitative study2023In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1, article id 2241225Article in journal (Refereed)
    Abstract [en]

    AIM: To explore HPs' perceptions of working on lifestyle management for patients with early rheumatoid arthritis (RA). METHODS: In this qualitative study, individual interviews were conducted with 20 HPs. Qualitative content analysis was used, and three categories and six subcategories were identified. RESULTS: HPs' perceptions of working on lifestyle management for patients with early RA revealed a need for commitment from different levels. This included commitment from healthcare managers and organizations prioritizing work on lifestyle management and providing competence development for HPs. Commitment within the team regarding coordination of interdisciplinary teamwork and development of a structured lifestyle management approach, and commitment to involving patients in lifestyle management, by facilitating patient engagement and a person-centred approach. CONCLUSIONS: HPs' perceptions of working on lifestyle management for patients with early RA revealed that commitment from healthcare managers, organizations, and the interdisciplinary team was essential to facilitate collaboration, patient involvement, and a person-centred approach. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

  • 16.
    Göransson, Carina
    et al.
    Halmstad University, School of Health and Welfare.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare.
    Carlsson, Ing-Marie
    Halmstad University, School of Health and Welfare.
    Art of connectedness: Value-creating care for older persons provided with toileting assistance and containment strategies—A critical interpretive synthesis2023In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 9-10, p. 1806-1820Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    The aim was to conduct a synthesis of the literature on value-creating care for older persons with incontinence provided with toileting assistance and containment strategies, from the perspectives of older persons and healthcare professionals.

    Background

    Incontinence is a health problem for many persons worldwide and the problem will increase as the global population ages. It can have a profound impact on a person's wellbeing, and assistance with toileting and containment strategies is common in home care settings and nursing homes.

    Design

    The design was a literature review with an iterative, reflexive and critical approach.

    Methods

    A critical interpretive synthesis was conducted. Ten papers published between 2011 and 2019 were analysed. The PRISMA -ScR Checklist was used in this review.

    Results

    Based on the findings, the conceptual construct ‘The art of connectedness’ was developed, built on co-created care, personalised care and reflective care between the older person and healthcare professionals. Co-created care is based on establishing a relationship, building trust and respecting preferences. Personalised care consists of meeting the person's needs, promoting comfort and maintaining self-determination. Reflective care entails showing empathy, upholding the person's dignity and developing professional competence.

    Conclusions

    Value-creating care consists conceptually of a connectedness that starts with co-creating the care together with the older person in a close relationship. Assistance is given and received based on the older person's individual needs and is highly valued by the older person as it helps them maintain self-determination. Reflective care is of importance for healthcare professionals.

    Relevance for practice

    The findings are hoped to enhance healthcare professionals’ understanding of how to improve the clinical encounter in nursing when providing assistance. They may also stimulate critical reflection among healthcare professionals on how to improve assistance to meet the older person's values. © 2022 The Authors. 

  • 17.
    Göransson, Carina
    et al.
    Halmstad University, School of Health and Welfare.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare.
    Huige, Nicole
    Essity Hygiene and Health AB.
    Carlsson, Ing-Marie
    Halmstad University, School of Health and Welfare.
    Value-creating continence care for older persons2022In: ICS 2022 Vienna Abstracts, Amsterdam: Elsevier, 2022Conference paper (Refereed)
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  • 18.
    Haglund, Emma
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden & Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Halmstad, Sweden; Lund University, Lund, Sweden & ahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Center, Halmstad, Sweden.
    Educational needs in patients with spondyloarthritis in Sweden - a mixed-methods study2017In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 18, no 1, article id 335Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a demand for a flexible and individually tailored patient education to meet patients' specific needs and priorities, but this area has seldom been studied in patients with spondyloarthritis (SpA), a family of inflammatory rheumatic diseases. The aim of the present study was to identify needs and priorities in patient education in patients with SpA. A second aim was to investigate patients' experiences and preferences of receiving patient education.

    METHODS: Data collection included a questionnaire survey with the Educational Needs Assessment Tool (ENAT) and interviews, using a mixed-methods design. Patients were identified through a specialist clinic register. Descriptive data are presented as mean with standard deviation, or frequencies. Chi-square test and independent-samples t-test were used for group comparisons. A manifest qualitative conventional content analysis was conducted to explore patients' experiences and needs in patient education, based on two focus groups (n = 6) and five individual interviews.

    RESULTS: Almost half (43%) of the 183 SpA patients had educational needs, particularly regarding aspects of self-help, feelings, and the disease process. More educational needs were reported by women and in patients with higher disease activity, while duration of disease did not affect the needs. The qualitative analysis highlighted the importance of obtaining a guiding, reliable, and easily available patient education for management of SpA. Individual contacts with healthcare professionals were of importance, but newer media were also requested.

    CONCLUSION: There are considerable educational needs in patients with SpA, and education concerning self-help, feelings, and the diseases process were raised as important issues. Healthcare professionals need to consider the importance of presenting varied formats of education based on the experiences and preferences of patients with SpA. © 2017 The Author(s).

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  • 19.
    Haglund, Emma
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Spenshult Research and Development Center, Halmstad, Sweden.
    Patient Education in Spondyloarthritis Should be Guiding, Reliable and Available and Presented in Varied Formats2015In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, no Suppl. S10, article id 1196Article in journal (Refereed)
    Abstract [en]

    Background/Purpose:

    The treatment target for axial spondyloarthritis (SpA) is to maximize health-related quality of life (HRQoL) by controlling disease activity and improving functioning. The treatment cornerstones are a combination of patient education, pharmacological and non-pharmacological treatment. Health professionals are familiar with providing patient education but the knowledge is scarce concerning how this education is experienced by the patients.

    The aim was to describe patients’ experiences of education in SpA management.

    Methods:

    The study had a descriptive design with a qualitative conventional content analysis approach performed in seven steps in accordance with Graneheim & Lundman (1). The analysis aimed to describe and preserve contextual meanings. After coding and subgrouping meaningful parts of the text were merged into categories. Eleven interviews were conducted between 2014-2015 in patients with SpA based on a strategic sampling in order to achieve variation with regard to sex (7 men, 4 women), age (38-66 years), subdiagnoses (5 patients with AS, 6 with USpA), quality of life (EQ5D 0.29-1.0), disease activity (BASDAI 1-6), physical function (BASFI 0-5), and global health (BASG 0-7) .

    Results:

    Three categories representing patients’ experiences of patient education in disease management emerged; guiding education, reliable education and available education. Guiding education comprised SpA management including disease knowledge such as symptoms, prognosis, treatment, self-management, climate impact, heredity, and assisting devices. Reliable education meant how and by whom the education was communicated and was considered reliable if it was based on science and communicated by specialists, for example by physician, nurse, PT, dietician and senior patients with experience of rheumatic diseases. The patients experienced difficulties in assessing the large flow of education coming from various sources. Individualized education also increased the reliability. Available education meant that the education can and should be presented in varied formats, and that the amount of information could be chosen. The education could be given orally (through meetings, videos, lectures), in writing (by pamphlets, e-mails, journals, webpages) or obtained through own personal experiences. There were requests to utilize newer media like skype, video and chat forums. Furthermore, individual contacts with healthcare professionals when needed were of importance.

    Conclusion:

    This study highlights the importance of obtaining a guiding, reliable and available patient education for management of SpA. Health care professionals need to consider the importance of presenting varied formats of education based on patients’ experiences and expectations.

    References:

    1.Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today 2004;24(2):105-12.

  • 20.
    Harris, Ulrika
    et al.
    Halmstad University, School of Health and Welfare. Blekinge Centre of Competence, Karlskrona, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    Aili, Katarina
    Halmstad University, School of Health and Welfare.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare.
    Parents’ Experiences of Direct and Indirect Implications of Sleep Quality on the Health of Children with ADHD: A Qualitative Study2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 22, article id 15099Article in journal (Refereed)
    Abstract [en]

    Sleep problems represent a significant challenge for children with ADHD. However, lack of knowledge about how sleep affects children with ADHD in terms of their health and everyday life prevents the development and implementation of interventions to promote sleep. The aim of this study was to explore parents’ experiences of direct and indirect implications of sleep quality onthe health of children with ADHD. The study used an abductive qualitative design, with Tengland’s two-dimensional theory of health as a deductive analysis framework. Semi-structured interviews were conducted with 21 parents of children aged 6–13 with ADHD and sleep problems. The parents experienced that sleep influenced their children’s abilities to control emotional behaviour relatedto ADHD and to manage everyday life. Sleep also had an impact on the children’s well-being,in relation to both vitality and self-esteem. In conclusion, the results show important direct and indirect implications of sleep quality on the health of children with ADHD. This implies a need forgreater focus on sleep, to target both abilities and well-being in promoting health among childrenwith ADHD. © 2022 by the authors

  • 21.
    Holmqvist, Gärd
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Jormfeldt, Henrika
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Lundqvist Persson, Cristina
    Skaraborg Institute for Research and Development, Skövde, Sweden.
    Women’s experiences of change through art therapy2017In: Arts and Health, ISSN 1753-3015, E-ISSN 1753-3023, Vol. 9, no 3, p. 199-212Article in journal (Refereed)
    Abstract [en]

    Background: Art therapy is based on the conception that image making in a therapeutic context may facilitate processes of change.

    Methods: A semi-structured interview with focus on the image was conducted with 17 women in order to explore change, after which a qualitative content analysis was performed.

    Results: The women experienced internal change as a sudden, unexpected turning point or as a more gradual process, although some reported no internal change whatsoever. Five themes reflecting the women’s experiences of what was important for internal change emerged: Trust in the therapist, Belief in the method, Creative impulse, Meaning of the image and The art therapy process.

    Conclusions: Art therapy may contribute to change in the sense of moving from an inadequate to a healthier state. Even when art therapy does not lead to internal change it may be supportive and provide short-term help in everyday life.

    © 2016 Informa UK Limited, trading as Taylor & Francis Group

  • 22. Holmqvist, Gärd
    et al.
    Roxberg, Åsa
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). VID, Specialized University, Bergen, Norway.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Lundqvist-Persson, Cristina
    Skaraborg Institute for Research and Development in Skövde, Skövde, Sweden.
    Expressions of vitality affects and basic affects during art therapy and their meaning for inner change2019In: International Journal of Art Therapy, ISSN 1745-4832, Vol. 24, no 1, p. 30-39Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the occurrence of vitality affects and basic affects and to shed light on their importance in terms of patients’ inner change through art therapy. In an earlier study, where 17 women were interviewed about inner change through art therapy, a secondary deductive content analysis of images and statements was performed exploring the presence of vitality affects and basic affects. Nine of the 17 interviews contained clear descriptions of vitality affects and basic affects in the intersubjective communication between the patient and the therapist; these affects were also mirrored in the patients’ painted images. Three cases are used to illustrate the result and how affects are related to inner change. These three cases differ from each other in that they describe vitality affects either; arising from the art therapist’s empathetic verbal or non-verbal response, from a particular experience in nature, or from the interpreted symbolic language of the image. The common denominator identified as uniting the three cases was the intersubjective communication with the therapist. This study indicates that image making in art therapy gives rise to vitality affects and basic affects that contribute to inner change. It also indicates the importance of having trust in both the method and the art therapist. © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

  • 23.
    Holmqvist, Gärd
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Vuxenpsykiatriska mottagningen i Skövde, Skaraborg's Hospital, Skövde, Sweden & Skaraborg Institute for Research and Development, Skövde, Sweden.
    Roxberg, Åsa
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). VID Specialized University, Bergen, Norway.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Lundqvist-Persson, Cristina
    Skaraborg Institute for Research and Development, Skövde, Sweden & Lund University, Lund, Sweden.
    What art therapists consider to be patients´ inner change and how it may appear during art therapy2017In: The arts in psychotherapy, ISSN 0197-4556, E-ISSN 1873-5878, Vol. 56, p. 45-52Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore what art therapists consider to be patients’ inner change and how it may appear during art therapy. Thirty-eight trained art therapists with experience of using art therapy as a treatment were included in the study. They were asked to describe how they perceived their patients’ inner change and a situation during art therapy when they observed such a change. An inductive thematic analysis resulted in five themes; Therapeutic alliance, describing trust of the therapist and belief in the method, Creating, which concerns the work in the therapeutic process, while Affect consciousness, Self-awareness, and Ego-strength are part of the therapy outcome. The situations in which an inner change can be observed have been presented by means of quotations and discussed in relation to different theories and art therapy research. The participating art therapists formed a heterogeneous group, resulting in an unexpected consistency about what they considered to be an inner change in the patient. The study may be seen as a contribution to further discussion about the benefits of a more common language to describe patients’ inner change in art therapy. © 2017 The Authors. Published by Elsevier Ltd.

  • 24.
    Jones, Bethan
    et al.
    University of the West of England, Bristol, UK; Cardiff University, Cardiff, UK.
    Bennett, Sarah
    University of the West of England, Bristol, UK; University of Bristol, Bristol, UK.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Zangi, Heidi
    Diakonhjemmet Hospital, Oslo, Norway; VID Specialized University, Oslo, Norway.
    Boström, Carina
    Karolinska Institute, Stockholm, Sweden.
    Van der Elst, Kristien
    KU Leuven University Hospitals Leuven, Leuven, Belgium.
    Fayet, Françoise
    Clermont-Ferrand Teaching Hospital, Clermont-Ferrand, France.
    Fusama, Mie
    Takarazuka University, Osaka, Japan.
    Herrero Manso, María del Carmen
    Hospital Universitario 12 de Octubre, Madrid, Spain.
    Hoeper, Juliana Rachel
    Leibniz University Hanover, Hannover, Germany; Hannover Medical School, Hannover, Germany.
    Kukkurainen, Marja Leena
    The Finnish Society of Rheumatology Nurses, Helsinki, Finland.
    Kwok, Suet Kei
    Grantham Hospital, Hong Kong, China.
    Frãzao-Mateus, Elsa
    Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal.
    Minnock, Patricia
    Our Lady's Hospice & Care Services, Dublin, Ireland.
    Nava, Tiziana
    University of Milan–Bicocca, Milano, Italy.
    Pavic Nikolic, Milena
    University Medical Centre Ljubljana, Kamnik, Slovenia.
    Primdahl, Jette
    University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Sønderborg, Denmark.
    Rawat, Roopa
    Indian Spinal Injuries Centre, New Delhi, India.
    Schoenfelder, Mareen
    Österreichische Rheumaliga, Vienna, Austria; Sprachinstitut TREFFPUNKT, Bamberg, Germany.
    Sierakowska, Matylda
    Medical University of Bialystok, Bialystok, Poland.
    Voshaar, Marieke
    Radboud University Medical Center for Infectious Diseases, Nijmegen, The Netherlands.
    Wammervold, Edgar
    Nordlandssykehuset, Bodø, Norway.
    van Tubergen, Astrid
    Maastricht University, Maastricht, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands.
    Ndosi, Mwidimi
    University of the West of England, Bristol, UK; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
    Disseminating and assessing implementation of the EULAR recommendations for patient education in inflammatory arthritis: a mixed-methods study with patients’ perspectives2022In: RMD Open, E-ISSN 2056-5933, Vol. 8, no 1, article id e002256Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore patients’ agreement andreasons for agreement or disagreement with the EULAR recommendations for patient education (PE) for people with inflammatory arthritis (IA). Methods: This mixed-method survey collected data using snowball sampling. The survey had been translated into 20 languages by local healthcare professionals, researchers and patient research partners. It explored the degree towhich patients with IA agreed with each recommendationfor PE (0=do not agree at all and 10=agree completely)and their rationale for their agreement level in free text questions. Descriptive statistics summarised participants’ demographics and agreement levels. Qualitative contentanalysis was used to analyse the free text data. Sixteen subcategories were developed, describing the reasons foragreement or disagreement with the recommendations,which constituted the categories. Results: The sample comprised 2779 participants(79% female), with a mean (SD) age 55.1 (13.1) yearsand disease duration 17.1 (13.3) years. Participants strongly agreed with most recommendations (median10 (IQR: 9–10) for most recommendations). Reasonsfor agreement with the recommendations included thebenefit of using PE to facilitate collaborative care andshared decision making, the value of flexible and tailored PE, and the value of gaining support from other patients.Reasons for disagreement included lack of resources for PE, not wanting informa tion to be tailored by healthcare professionals and a reluctance to use telephone-basedPE. Conclusion: The EULAR recommendations for PE havebeen disseminated among patients with IA. Overall, agreement levels were very high, suggesting that they reflect patients’ preferences for engaging in collaborative clinical care and using PE to facilitate and supplement their own understanding of IA. Reasons for not completely agreeing with the recommendations can inform implementation strategies and education of healthcare professionals. © Author(s) (or their employer(s)) 2022.

  • 25.
    Karnehed, Sara
    et al.
    Halmstad University, School of Health and Welfare.
    Tyskbo, Daniel
    Halmstad University, School of Health and Welfare.
    Petersson, Lena
    Halmstad University, School of Health and Welfare.
    Erlandsson, Lena-Karin
    Halmstad University, School of Health and Welfare.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare.
    Kan samproduktion av framtidens teknik bidra till en hållbar arbetsmiljö för sjuksköterskor?2023Conference paper (Refereed)
    Abstract [sv]

    Svensk primärvård står inför stora utmaningar med en åldrande befolkning och ett ökat antal personer som vårdas i hemmet (Landers et al., 2016). Digital teknik implementeras med förhoppning om att förbättra kommunikationen mellan vårdpersonal och underlätta möjligheterna till egenvård och tillgänglighet för patienter (Socialstyrelsen, 2021). Tidigare studier visar att användningen av digital teknik kan förändra det professionella landskapet (Petersson, 2020) och påverka arbetsmiljö och arbetets innehåll (Ertner, 2019). Trots att teknik som implementeras inom vården bör vara anpassad till hälso- och sjukvårdspersonalens arbete och värderingar (Palmer et al., 2019; Reed et al., 2019) är sjuksköterskor sällan involverade i beslut kring utformning eller implementering av ny teknik (von Gerich et al., 2022). Det behövs mer kunskap om hur digitaliseringen kan ske i samproduktion med sjuksköterskor och utformas så att en god arbetsmiljö bibehålls.

    Presentationen syftar till att beskriva sjuksköterskors arbete och arbetsmiljö inom hemsjukvården och hur dessa kunskaper kan användas vid utvecklingen och implementeringen av framtida digital teknik.

    Individuella semi-strukturerade intervjuer har genomförts med 20 sjuksköterskor som arbetar på vårdcentral och inom hemsjukvård i två halländska kommuner. Intervjuerna har analyserats genom kvalitativ innehållsanalys (Hsieh & Shannon, 2005). Implementeringsteoretiska ramverk används för att undersöka hur kunskapen kan inkorporeras vid innovation och implementering av digitala tekniker inom vårdverksamheter (Nilsen, 2015).

    Preliminära resultat kommer att presenteras vid konferensen.

     

    Referenser

    Ertner, S. M. (2019). Enchanting, evoking, and affecting: the invisible work of technology implementation in homecare. Nordic Journal of Working Life Studies, 9(S5), 33-47.

    Hsieh, H.-F., & Shannon, S. E. (2005). Three Approaches to Qualitative Content Analysis. Qualitative health research, 15(9), 1277-1288.

    Landers, S., Madigan, E., Leff, B., Rosati, R. J., McCann, B. A., Hornbake, R., MacMillan, R., Jones, K., Bowles, K., Dowding, D., Lee, T., Moorhead, T., Rodriguez, S., & Breese, E. (2016). The Future of Home Health Care: A Strategic Framework for Optimizing Value. Home Health Care Management & Practice, 28(4), 262-278.

    Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation science : IS, 10(1), 53-53.

    Palmer, V. J., Weavell, W., Callander, R., Piper, D., Richard, L., Maher, L., Boyd, H., Herrman, H., Furler, J., & Gunn, J. (2019). The Participatory Zeitgeist: an explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement. Medical humanities, 45(3), 247-257.

    Petersson, L. (2020). Paving the way for transparency: How eHealth technology can change boundaries in healthcare Lund University].

    Reed, J. E., Howe, C., Doyle, C., & Bell, D. (2019). Successful healthcare improvements from translating evidence in complex systems (SHIFT-Evidence): simple rules to guide practice and research. International journal for quality in health care, 31(3), 238-244.

    Socialstyrelsen. (2021). E-hälsa och välfärdsteknik i kommunerna 2021. Uppföljning av den digitala utvecklingen i socialtjänsten och den kommunala hälso-och sjukvården.

    von Gerich, H., Moen, H., Block, L. J., Chu, C. H., DeForest, H., Hobensack, M., Michalowski, M., Mitchell, J., Nibber, R., & Olalia, M. A. (2022). Artificial Intelligence-based technologies in nursing: A scoping literature review of the evidence. International Journal of Nursing Studies, 127, 104153.

     

  • 26.
    Kronsell, Lisa
    et al.
    Halmstad University, School of Health and Welfare.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Parents’ Perceptions of the Value of Children’s Participation in Pediatric Rehabilitation Services: A Phenomenographic Study2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 20, article id 10948Article in journal (Refereed)
    Abstract [en]

    Ensuring that children have opportunities to be involved in decision-making regarding their own care is associated with quality improvement in pediatric rehabilitation. The aim of the study was to explore parents’ perceptions of the value of children’s participation in pediatric rehabilitation services. Semi-structured interviews were conducted with 17 parents of children with disabilities who visited pediatric rehabilitation services. A phenomenographic analysis method was used. Three categories developed from the analysis describing how participation generated value in terms of empowerment, self-awareness, and independence. The outcome space describes a hierarchical relationship between the categories and their influence on each other. Independence achieved through participation was a core aspect and is at the highest level in the hierarchy since it includes and depends on the outcomes from both empowerment and self-awareness. Parents’ perceptions of the value of children’s participation in pediatric rehabilitation services include the possibility for the child to use their entire capacity through values created in terms of empowerment, self-awareness, and independence, in order to live the best life possible. Children with disabilities are diverse as a group, and further research to identify barriers and facilitators of participation is needed to adjust interventions within pediatric rehabilitation services to ensure that children with disabilities can be increasingly empowered, self-aware, and independent. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

  • 27.
    Landgren, E.
    et al.
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.
    Lindqvist, E.
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Nylander, M.
    Spenshult Research and Development Centre, Halmstad, Sweden; Swedish Rheumatism Association, Stockholm, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Lund University, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden.
    Patients' Perceptions of Person-Centred Care in Early RA: A Qualitative Study2021In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, no Suppl. 1, p. 1024-1024Article in journal (Refereed)
  • 28.
    Landgren, E.
    et al.
    Lund University, Lund, Sweden; Skåne University Hospital, Malmö, Sweden; Spenshult Research and Development Center, Halmstad, Sweden.
    Mogard, E.
    Lund University, Lund, Sweden; Skåne University Hospital, Malmö, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden; University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Odense, Denmark.
    Nylander, M.
    Spenshult Research and Development Center, Halmstad, Sweden; Swedish Rheumatism Association, Stockholm, Sweden.
    Lindqvist, E.
    Lund University, Lund, Sweden; Skåne University Hospital, Malmö, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden.
    Patients' understanding of health in early rheumatoid arthritis - a qualitative study2023In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 52, p. 49-50Article in journal (Refereed)
  • 29.
    Landgren, Ellen
    et al.
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden ; Department of Rheumatology, Skåne University Hospital, Lund, Sweden ; Spenshult Research and Development Centre, Halmstad, Sweden.
    Bremander, Ann
    Department of Rheumatology, Skåne University Hospital, Lund, Sweden ; Spenshult Research and Development Centre, Halmstad, Sweden ; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark ; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark.
    Lindqvist, Elisabet
    Department of Rheumatology, Skåne University Hospital, Lund, Sweden ; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.
    Nylander, Maria
    Spenshult Research and Development Centre, Halmstad, Sweden ; Swedish Rheumatism Association, Stockholm, Sweden.
    Elst, Kristien Van der
    Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    “Mastering a New Life Situation” – Patients’ Preferences of Treatment Outcomes in Early Rheumatoid Arthritis – A Longitudinal Qualitative Study2020In: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 14, p. 1421-1433Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore patients’ preferred treatment outcomes during their first two years with rheumatoid arthritis (RA). Patients and Methods: A qualitative, longitudinal, multicenter study with interviews at two time points was performed in Sweden. Individual interviews were conducted at time point 1 with 31 patients with RA, defined as disease duration of ≤1 year and treatment for 3–7 months. Seven focus group interviews and five individual interviews were conducted at time point 2 with 22 patients 12–20 months after treatment initiation. The interviews were analyzed using the Qualitative Analysis Guide of Leuven. A core category with four related concepts emerged. Results: The core finding of patient-preferred treatment outcomes was “mastering a new life situation”. Patients preferred to experience control of the disease by controlling the symptoms and by experiencing absence of disease. To experience autonomy by regaining former activity level, experiencing independence, and being empowered was another preferred outcome. Patients preferred to regain identity through being able to participate, experience well-being, and regain former self-image. To experience joy in everyday life through vitality and believing in the future was another preferred outcome. Patients’ preferences developed over time from the acute phase of controlling the symptoms and wanting to return to the life they lived prior to diagnosis, to a more preventive way of self-management and empower-ment to master the new life situation. Conclusion: The patients’ preferred treatment outcomes during the first two years with RA were to master their new life situation and changed from a preference to return to a life lived prior disease onset, to a preference of living with quality of life, despite RA. This study increases the understanding of patients’ preferred treatment outcomes in the early disease course and can be a foundation for tailoring interventions to be more person-centered and to improve long-term treatment outcomes. © 2020 Landgren et al.

  • 30.
    Landgren, Ellen
    et al.
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden.
    Bremander, Ann
    Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden; University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark.
    Lindqvist, Elisabet
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Nylander, Maria
    Spenshult Research and Development Centre, Halmstad, Sweden; Swedish Rheumatism Association, Stockholm, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Patients’ Perceptions of Person‐Centered Care in Early Rheumatoid Arthritis: A Qualitative Study2021In: ACR Open Rheumatology, E-ISSN 2578-5745, Vol. 3, no 11, p. 788-795Article in journal (Refereed)
    Abstract [en]

    Objective: Most research on patient experiences of rheumatoid arthritis (RA) care is performed with patients who have established RA and less often with patients with early RA. Experiences of and expectations about health care may change over time, which is why the aim was to explore patients’ perceptions of person-centered care (PCC) early in the RA disease course.

    Methods: Thirty-one patients with early RA were interviewed in this qualitative study. An abductive qualitative content analysis was conducted based on the framework of McCormack and McCance (1,2). The four constructs, prerequisites, care environment, person-centered processes, and person-centered outcomes, constituted the four categories in the deductive part of the study. An inductive analysis generated 11 subcategories exploring the content of PCC.

    Results: For patients with early RA, PCC was described in terms of 1) prerequisites including being treated with respect, meeting dedicated health care professionals, and meeting professional competence; 2) care environment including having access to a multidisciplinary team, having access to health care, and encountering a supportive organization; 3) person-centered processes including being listened to, being supported, and being involved in decision-making; and 4) person-centered outcomes including being satisfied with received health care and achieving optimal health.

    Conclusion: Genuine PCC is important for patients early in the RA disease course, supporting the implementation of a person-centered approach during all stages in the health care system. This study contributes to information about how to further develop person-centeredness in rheumatology care. © 2021 The Authors.

  • 31.
    Landgren, Ellen
    et al.
    Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden & Lund University, Lund, Sweden.
    Lindqvist, Elisabet
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    van der Elst, Kristien
    University Hospitals Leuven, Leuven, Belgium & KU Leuven, University of Leuven, Leuven, Belgium.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Halmstad, Sweden.
    Patients’ experiences of health in early rheumatoid arthritis – a qualitative study2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 1802-1803, article id FRI10707-HPRArticle in journal (Other academic)
    Abstract [en]

    Background: The World Health Organization defines health as ”a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Health changes dramatically when a person becomes ill in a chronic disease as rheumatoid arthritis (RA). RA is a disease with great impact on all aspects of life. Living with RA affects patients’ health including physical, emotional, psychological and social aspects. The purpose of a person-centered care is to see patients as experts; sharing decisions with them and helping them manage their health. Therefore it is important to understand how patients in early disease stage of RA experience the concept of health.

    Objectives: The purpose of this study was to describe patients’ experiences of health in early RA.

    Methods: The study had a descriptive design with a qualitative content analysis approach. Individual interviews were conducted with 24 patients with early RA. In this study the patients had disease duration less than 12 months. A manifest qualitative content analysis was used to analyze the question: “What does health mean to you?”

    Results: In the early stage of RA, patients experienced health as the most important goal in their life. They described health as well-being, independence, life satisfaction and vitality. Health as well-being meant to feel good, be painless and have a good sleep to feel rested. Health as independence meant to have both physical and financial prerequisites to perform everyday activities, to exercise and being able to travel. Health as life satisfaction meant to feel joy in life, enjoy the family and to believe in the future. Health as vitality meant to have the energy, power and strength to cope with everyday life. The patients expressed that their health had been adversely affected by the RA disease and they had a strong desire for full health including well-being, independence, life satisfaction and vitality.

    Conclusions: Patients in an early stage of RA describe a strong desire to regain health in terms of well-being, independence, life satisfaction and vitality. The concept of health at early RA is similar to health at established RA in terms of well-being, independence and life satisfaction. Unique findings for patients with early RA are the description of health as vitality, and the emphasis of having energy, power and strength to cope with everyday life. Health professionals should have these different ways of experiencing health in mind when providing person-centred care to patients with early RA. Depending on the patients’ perception of health, different support strategies are needed.

  • 32.
    Landgren, Ellen
    et al.
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden & RandD Spenshult, Halmstad, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden & RandD Spenshult, Halmstad, Sweden & Department of Regional Health Research, University of Southern Denmark, Odense, Denmark & Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark.
    Lindqvist, Elisabeth
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Van der Elst, Kristien
    Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium & Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven–University of Leuven, Leuven, Belgium.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden.
    “To regain one’s health” – patients’ preferencesof treatment outcomes in early rheumatoid arthritis – a qualitative study2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 648-648Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatology care strives to identify and meet the needs of the patients, and to understand disease and treatment impact from the patients’ perspective. A better understanding of patients’ expectations from the treatment is needed to enable a patient centered approach in clinical practice and a shared-decision making as recommended in the EULAR treatment recommendations for rheumatoid arthritis (RA). Understanding of patients’ expectations in the early stage of the RA disease may facilitate adherence to treatment, patient independence and prevent unmet needs in the future.

    Objectives: To explore patients’ preferred treatment outcomes in early rheumatoid arthritis (eRA).

    Methods: A qualitative, explorative study. Individual interviews were conducted with 31 patients with eRA, defined as disease duration of ≤ 1 year and disease-modifying antirheumatic drugs (DMARDs) treatment for 3-6 months 1 . Interviews were analyzed using a constant comparison method according to the Qualitative Analysis Guide of Leuven (QUAGOL) and lasted in a core category and four related concepts.

    Results: The patient-preferred treatment outcomes in eRA were described in the core category “to regain one’s health” and the four related concepts: to experience external control of the disease, to experience independence, to regain identity and to experience joy in everyday life. The patients expected to experience external control of the disease by the given treatment to regain one’s health. It was perceived as controlling the symptoms and as absence of disease. Independence was perceived as regaining former activity levels, experiencing autonomy and using active coping strategies. Patients wanted to regain identity through participation, empowerment and their self-image. Joy in everyday life was perceived as vitality and believing in the future.

    Conclusion: Patients’ preferred treatment outcomes in eRA were to regain one’s health including both external and internal control. External control as disease control and independence as well as internal control as identity and joy in everyday life. The results from this study can assist healthcare professionals to better understand patients’ preferred treatment outcomes early in the disease process and to tailor the interventions accordingly to improve long term treatment outcome. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

  • 33.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Nurse-led Care and Patients as Partners Are Essential Aspects of the Future of Rheumatology Care2017In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 44, no 6, p. 720-722Article in journal (Refereed)
  • 34.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Center, Halmstad, Sweden.
    Patients' conceptions of their own influence on good treatment response to biological therapy in chronic inflammatory arthritis2017In: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 11, p. 1057-1067Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Biological therapies are common in the treatment of patients with chronic inflammatory arthritis (CIA). However, despite the fact that many patients respond well to their biological therapies, there are still a number of nonresponders. In order to design the best care for patients, it is important to understand how they conceive their own role in their treatment response.

    OBJECTIVE: To explore how patients with CIA conceive their own influence on a good treatment response to biological therapy.

    METHODS: This study had an exploratory and descriptive design with a phenomenographic approach. Interviews were conducted with 25 patients (11 women and 14 men) aged 17-79 years, with CIA who were undergoing biological therapy and who had low disease activity or were in remission.

    RESULTS: Patients with CIA undergoing biological therapy conceived their own influence on good treatment response in terms of adherence, physical activity, mental attitude, social support, and self-awareness. Adherence was described as the foundation for the patients' own influence on good treatment response. Physical activity, mental attitude, and social support reflected three essential ways of understanding patients' influence on good treatment response where the patients spoke about physical strength, mental strength, and social strength. Self-awareness reflected a comprehensive way of influencing good treatment response in which patients balanced their physical, mental, and social resources in partnership with health care professionals.

    CONCLUSION: Patients conceived that they had a responsibility for adhering to the treatment as well as achieving balance in life in order to ensure good treatment response. Self-awareness was essential for maintaining a good treatment response, and this reflected the patients' awareness of the complexity of living their lives with a chronic illness. © 2017 Larsson.

  • 35.
    Larsson, Ingrid
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Person-centred care in rheumatology nursing in patients undergoing biological therapy2013Conference paper (Refereed)
    Abstract [en]

    Person-centred care in rheumatology nursing in patients undergoing biological therapy

    Background: The life of patients with chronic inflammatory arthritis (CIA) undergoing biological therapy is often lined by regular monitoring of both disease and biological therapy. The rheumatology nurse´s role has developed from that of an expert advisor to a co-actor, where the patients are necessary and equal participants. A rheumatology nurse with a person-centred care approach respects, supports and encourages patients to become co-actors and the rheumatology nurse is a complement to rheumatologists and other professionals in the multidisciplinary team.

    Aim: The overall aim was to explore and evaluate rheumatology nursing from a person-centred care perspective in patients undergoing biological therapy.

    Method: Focuses was on patients with CIA who were undergoing biological therapy at a rheumatology clinic in Sweden. Four studies were conducted and studies I and II had an explorative descriptive design with a phenomenographic approach. Interviews were conducted with 40 participants about their dependence on or independence of a nurse for the administration of their infusions or injections. The objective of the intervention in study III was to replace every second monitoring visit at a rheumatologist-led clinic by a visit to a nurse-led rheumatology clinic, based on person-centred care and had a randomised controlled design involving 107 patients in the trial. The primary outcome was disease activity measured by Disease Activity Score 28. Study IV had an explorative descriptive design with a qualitative content analysis approach. Interviews were conducted with 20 participants who attended the nurse-led rheumatology clinic.

    Findings: Dependence on a rheumatology nurse for administration of intravenous infusions was described as invigorating due to the regular contact with the nurse, which provided security and involvement (study I). Independence of a nurse for subcutaneous injections was achieved by struggling to cope with injecting themselves, learning about and participating in drug treatment (study II). Patients with stable CIA receiving biological therapy were monitored by a nurse-led rheumatology clinic without any difference in outcome when compared to monitoring carried out at a rheumatologist-led clinic. Replacing one of the two annual rheumatologist outpatient follow-up visits by a visit to a nurse-led clinic for the monitoring of biological therapy was found to be safe and effective (study III). A nurse-led rheumatology clinic, based on person-centred care, added value to the follow up care of patients with stable CIA undergoing biological therapy by providing a sense of security, familiarity and participation (study IV).

    Conclusion: Person-centred care is the core of rheumatology nursing in the area of biological therapy. The rheumatology nurse adds value to patient care when she/he gives patients an opportunity to talk about themselves as a person and allow their illness narrative to constitute a starting point for building collaboration, which encourages and empowers patients to play an active part in their biological therapy and become autonomous. A nurse who provides person-centred care and keeps the patients´ resources and needs in focus serves as an important guide during their healthcare journey. Rheumatology nursing will be further developed by a person-centred care approach.

  • 36.
    Larsson, Ingrid
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Person-centred care in rheumatology nursing in patients undergoing biological therapy: An explorative and interventional study2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim was to explore and evaluate rheumatology nursing from a person-centred care perspective in patients undergoing biological therapy.

    Method: This thesis focuses on patients with chronic inflammatory arthritis (CIA) who were undergoing biological therapy at a rheumatology clinic in Sweden. Papers I and II had an explorative descriptive design with a phenomenographic approach. The 40 participants were interviewed about their dependence on or independence of a nurse for the administration of their infusions or injections. Paper III had a randomised controlled design involving 107 patients in the trial.  The objective of the intervention was to replace every second monitoring visit at a rheumatologist-led clinic by a visit to a nurse-led rheumatology clinic, based on person-centred care. Paper IV had an explorative descriptive design with a qualitative content analysis approach. Interviews were conducted with 20 participants who attended the nurse-led rheumatology clinic.

    Findings: Dependence on a rheumatology nurse for administration of intravenous infusions was described as invigorating due to the regular contact with the nurse, which provided security and involvement (paper I). Independence of a nurse for subcutaneous injections was understood by the patients in different ways and was achieved by struggling to cope with injecting themselves, learning about and participating in drug treatment (paper II). Patients with stable CIA receiving biological therapy were monitored by a nurse-led rheumatology clinic without any difference in outcome when compared to monitoring carried out at a rheumatologist-led clinic, as measured by the Disease Activity Score 28. Replacing one of the two annual rheumatologist outpatient follow-up visits by a visit to a nurse-led clinic for the monitoring of biological therapy was found to be safe and effective (paper III). A nurse-led rheumatology clinic, based on person-centred care, added value to the follow up care of patients with stable CIA undergoing biological therapy by providing a sense of security, familiarity and participation (paper IV).

    Conclusion: This thesis contributes a valuable insight into person-centred care as the core of rheumatology nursing in the area of biological therapy. The rheumatology nurse adds value to patient care when she/he gives patients an opportunity to talk about themselves as a person and allow their illness narrative to constitute a starting point for building collaboration, which encourages and empowers patients to play an active part in their biological therapy and become autonomous. A nurse who provides person-centred care and keeps the patients’ resources and needs in focus serves as an important guide during their healthcare journey.

  • 37.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare.
    Sjuksköterskeledda mottagningar2022In: Att våga leda omvårdnad / [ed] Kristina Ziegert, Stockholm: Liber, 2022, p. 152-169Chapter in book (Other academic)
  • 38.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare.
    Aili, Katarina
    Halmstad University, School of Health and Welfare.
    Lönn, Maria
    Halmstad University, School of Health and Welfare. Psychiatry Halland, Halmstad, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Ivarsson, Andreas
    Halmstad University, School of Health and Welfare.
    Johansson, Pia
    Halmstad University, School of Health and Welfare.
    Sleep interventions for children with attention deficit hyperactivity disorder (ADHD): A systematic literature review2023In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 102, p. 64-75Article, review/survey (Refereed)
    Abstract [en]

    Objective/background: Healthy sleep is particularly important for children with attention deficit hyperactivity disorder (ADHD), as sleep disturbances might aggravate disease symptoms. This review aims to synthesize and report evidence on the effectiveness of sleep interventions in increasing sleep, quality of life (QoL), and ADHD symptoms among children with ADHD. Patients/methods: The systematic literature review follows the Cochrane Collaboration methodology recommendations for literature reviews. Four databases were used based on the population, intervention, control and outcome (PICO) framework. Controlled trials with minimum 20 children in each group, aged 6–18, and published from 2005 and onwards were included. Results from the studies were reported in forest plots and three of the seven review outcomes were synthesized in meta-analyses. Results: The search identified 7710 records; of which 4808 abstracts were screened. After fulltext-screening of 99 papers, eight papers from five studies were included. The studies included behavioral sleep interventions and pharmacological interventions using melatonin and eszopiclone. For six of the seven outcomes, the effect sizes were small to moderate and the certainty of the evidence was low. For one outcome, sleep disturbances, the effect size was a moderate −0.49 standardized mean differences (95% confidence interval −0.65;-0.33), with a moderate certainty of evidence for the behavioral interventions for children aged 5–13 years with ADHD. Conclusions: This review identified few and heterogeneous studies. A moderate certainty of evidence for a moderate effect size was only obtained for sleep disturbances from the behavioral interventions. A low certainty of the evidence for a moderate effect size was found for the total sleep time from the pharmacological intervention using melatonin and one behavioral intervention, which indicates that these sleep interventions impact sleep quantity and quality among children with ADHD. © 2022 The Authors

  • 39.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare.
    Aili, Katarina
    Halmstad University, School of Health and Welfare.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Jarbin, Håkan
    Region Halland.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    Parents’ Experiences of Weighted Blankets’ Impact on Children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Problems—A Qualitative Study2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 24, article id 12959Article in journal (Refereed)
    Abstract [en]

    Sleep disturbances are common among children with attention-deficit/hyperactivity disorder (ADHD). While pharmacological treatment has increased dramatically, parents often prefer non-pharmacological interventions. Research on experiences of weighted blankets and their effect in sleep improvement is scarce. The aim of this study was to explore parents’ experiences of weighted blankets for children with ADHD and sleep problems, and the impact on their children’s sleep. The explorative design was based on qualitative content analysis. Interviews were conducted with a purposeful sample of 24 parents of children with ADHD and sleep problems, after completing a sleep intervention with weighted blankets for 16 weeks. Parents reported that children sleeping with weighted blankets: (1) achieved satisfactory sleep, including improved sleep onset latency, sleep continuity, and sleep routines; (2) achieved overall well-being, including improved relaxation and reduced anxiety; and (3) mastered everyday life, including improved balance in life, family function, and participation in school and leisure activities. This study brings forward novel aspects of the effects of improved sleep among children with ADHD. The findings contribute to the understanding of potential positive effects of an intervention with weighted blankets critical for clinical practice to improve sleep, well-being, and everyday life of children with ADHD and their families. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

  • 40.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Aili, Katarina
    Halmstad University, School of Health and Welfare.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Johansson, Pia
    Halmstad University, School of Health and Welfare.
    Jarbin, Håkan
    Faculty of Medicine, Lund University, Lund, Sweden; Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    SLEEP: intervention with weighted blankets for children with attention deficit hyperactivity disorder (ADHD) and sleep problems2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 1, article id e047509Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION AND OBJECTIVES: Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sleep problems. Weighted blankets are one possible non-pharmacological intervention for these problems in this group of children. However, the effectiveness of weighted blankets is insufficiently investigated. This study aims to investigate the effectiveness of weighted blankets in terms of sleep, health-related outcomes and cost-effectiveness as well as to explore children's and parents' experiences of a sleep intervention with weighted blankets.

    METHODS AND ANALYSIS: This study is a randomised placebo-controlled crossover trial comparing the effect of weighted fibre blankets (active) with fibre blankets without weight (control). Children aged 6-13 years, recently diagnosed with uncomplicated ADHD with verified sleep problems, were included in the study. The study period is 4 weeks for each condition, respectively, and then an 8-week follow-up. A total of 100 children diagnosed with ADHD and sleep problems will enter the study. The primary outcomes are sleep and cost per quality-adjusted life years. The secondary outcomes are health-related quality of life, ADHD symptoms, psychological distress and anxiety. Interviews with a subsample of the participating children and parents will be conducted for exploring the experiences of the intervention.

    ETHICS AND DISSEMINATION: Ethical approval of the trial has been obtained from the Swedish Ethical Review Authority (number 2019--2158) and conforms to the principles outlined in the Declaration of Helsinki (WMA, 2013). Results will be reported as presentations at peer-review conferences, in articles in peer-review journals and meetings with healthcare providers.

    TRIAL REGISTRATION NUMBER: NCT04180189. © Author(s) (or their employer(s)) 2022.

  • 41.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Spenshult, Halmstad, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Center, Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Reasons to stop drinking alcohol among patients with rheumatoid arthritis in Sweden: a mixed-methods study2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 12, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Objectives: The aims were to identify patients with rheumatoid arthritis (RA) who had stopped drinking alcohol and compare them with patients drinking alcohol, and to explore reasons for stopping drinking alcohol.

    Design: A sequential explanatory mixed methods design was used.

    Setting: Six rheumatology clinics in Southern Sweden Better Anti-Rheumatic FarmacOTherapy cohort.

    Participants: A total of 1509 patients completed the questions about alcohol and were included in the study. 86 of these had stopped drinking alcohol and 72 responded to the open question and their answers were analysed with qualitative content analysis.

    Outcome measures: The quantitative data were from a cross-sectional survey assessing disease severity, physical function (Health Assessment Questionnaire, HAQ) and health-related quality of life (EuroQol five dimensions, EQ5D), pain, fatigue, patient global assessment (PatGA) and lifestyle factors, for example, alcohol. The questions assessing alcohol included an open question 'Why have you stopped drinking alcohol?' Results: The patients who stopped drinking alcohol were older (median (min-max) 69 (36-90) vs 66 (23-95), p=0.011), had worse HAQ (1.00 (0-2.75) vs 0.50 (0-3.00), p<0.001), worse EQ5D (0.69 (-0.02-1.00) vs 0.76 (-0.58-1.00), p<0.001) worse PatGA (5 (0-10) vs 3 (0-10), p<0.001), more pain (5 (0-10) vs 3 (0-10), p<0.001) and more fatigue (6 (0-10) vs 4 (0-10), p<0.001 compared with patients drinking alcohol. The qualitative content analysis revealed five categories describing reasons for patients with RA to stop drinking alcohol: illness and treatment; health and well-being; work and family; faith and belief; and dependences and abuse.

    Conclusions: The patients who had stopped drinking had worse physical functioning and higher levels in pain-related variables. Most stopped drinking due to their illness or a desire to improve health. © 2018 Author(s).

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  • 42.
    Larsson, Ingrid
    et al.
    Spenshult Hospital, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ dependence on a nurse for the administration of their intravenous anti-TNF therapy: A phenomenographic study2008Conference paper (Refereed)
    Abstract [en]

    Background. Pain, stiffness and functional restrictions of the joints are the main problems for many patients with inflammatory rheumatic conditions. When conventional drugs fail to delay the development of the disease the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of intravenous infusions and thus the patient is obliged to attend a clinic in order to receive his/her medication, which can affect everyday life as well independence. Therefore, it is important that the patient perspective is focused upon in order to improve the care. Aim. To describe variations in how patients with rheumatic conditions perceive their dependence on intravenous anti-TNF therapy provided by a nurse. Method. The study has a descriptive qualitative design and a phenomenographic approach. Interviews were conducted with 20 patients suffering from rheumatoid arthritis and spondyloarthropathies who were treated by means of intravenous anti-TNF therapy. Results. Three descriptive categories and ten sub-categories emerged: Dependence that affords security (encountering continuity, encountering competence, having accessibility and obtaining information); Dependence that creates involvement (being allowed influence and being given freedom); Dependence that invigorates (obtaining relaxation, being seen as an individual, being taken care of and encountering the environment). The patients perceived that the treatment led to feelings of security and involvement and stated that regular encounters with a nurse were invigorating. The patients’ needs should constitute the basis for the nurse’s role in the provision of intravenous anti-TNF therapy in an outpatient clinic

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  • 43.
    Larsson, Ingrid
    et al.
    Jonkoping Univ, Sch Hlth Sci, Jonkoping, Sweden & Spenshult, R&D Ctr, Spenshult, Oskarstrom, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Jonkoping Univ, Sch Hlth Sci, Jonkoping, Sweden.
    Teleman, A.
    Spenshult Hosp, Spenshult Hosp Rheumat Dis, Oskarstrom, Sweden.
    Bergman, Stefan
    Spenshult, R&D Ctr, Spenshult, Oskarstrom, Sweden.
    Nurse-led rheumatology clinic versus rheumatologist clinic in monitoring of biological therapy– a randomised controlled study2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, Vol. 71, no Suppl. 3, p. 121-121Article in journal (Refereed)
    Abstract [en]

    Background: Patients with rheumatic diseases treated with biological therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients with low disease activity or in remission.

    Objectives: To compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients treated with biological therapy with low disease activity or in remission.

    Methods: In a prospective controlled study 107 patients were randomised into two groups with six months follow up to a nurse-led rheumatology clinic (intervention group; n=53) or to a rheumatologist clinic (control group; n=54). Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. In the nurse-led rheumatology clinic the patients´ disease activity was assessed by examination of tender or swollen joints and laboratory tests. The rheumatology nurse also had a dialogue concerning the patient’s needs with regard to drug therapy, smoking habits and psychosocial aspects. Main outcome was disease activity measured by DAS28.

    Results: After 12 months 97 patients completed the study. The patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. In change of DAS28 there were no differences (p=0.66) between the intervention group (0.14) or control group (0.20) from inclusion to 12 months. There were no differences (p>0.05) in mean change after 12 months in ESR, swollen and tender joints, global health and pain visual analogue scales (VAS) or Health Assessment Questionnaire (HAQ) between the patients followed up at the nurse-led rheumatology clinic or the rheumatologist clinic, see table.

     Table. Comparison of the two groups intervention group (Nurse-led rheumatology clinic) and control group (Rheumatologist clinic).

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  • 44.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Arvidsson, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ conceptions of drug information given by a rheumatology nurse - A phenomenographic study2009In: / [ed] Svenska Läkaresällskapet, 2009Conference paper (Refereed)
    Abstract [en]

    Bakgrund Pain, stiffness and functional restriction of the joints are the main problems experienced by patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases require several drugs every day. Adherence is highest among patients who have repeatedly been given drug information by a nurse from the start of the treatment. When developing patient information, it is essential to utilise patients' experiences. The aim of this study was to describe variations in how patients with rheumatic diseases conceive drug information given by a rheumatology nurse.

    Metod Fifteen informants who had been prescribed one or several new drugs during the period of hospitalisation were approached, agreed to take part in the study and were interviewed. Strategic sampling was carried out in order to achieve variation in conceptions of the phenomenon in terms of sex, age, marital status, education, type of rheumatic disease, disease duration and type of new drug

    Resultat Three descriptive categories comprising seven conceptions emerged and revealed how the patients conceived the information about new medication provided by a nurse. Drug information led to Autonomy, Power and Security. Autonomy was based on the patients' experiences of taking responsibility and participating. Power meant gaining knowledge and being motivated to take the drug. Security involved trust, experiencing care and access to a rheumatology nurse.

    Sammanfattning Patients with a rheumatic disease experienced that drug information from a rheumatology nurse gave them autonomy, power and security. These factors could explain why information from a nurse increases drug treatment adherence.

  • 45.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Arvidsson, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ conceptions of drug information given by the rheumatology nurse2009In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 68, no Suppl. 3, p. 781-781Article in journal (Refereed)
    Abstract [en]

    Background: Pain, stiffness and functional restriction of the joints are the main problems for patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases have a need for daily intake of several drugs. Compliance in drug treatment is higher amongst patients that have been given drug information by a nurse at repeated occasions from the start of the treatment. In the development of patient information, it is essential to take advantage of patients' experiences.

    Objectives: The purpose of this study was to describe variations in how patients with rheumatic diseases conceive drug information given by a rheumatology nurse.

    Methods: The study had a descriptive qualitative design with a phenomenographic approach. When employing such an approach, the main aim is to describe how a phenomenon is conceived by different individuals. Fifteen patients with rheumatic diseases who had received a new drug during a hospital visit were approached, agreed to take part in the study and were interviewed. Strategic sampling in terms of sex, age, marital status, education, rheumatic diseases, and illness duration, was carried out in order to achieve variation in conceptions of the phenomenon.

    Results: Three descriptive categories emerged: (1) Autonomy (own responsibility and participation), (2) Power (knowledge and motivation), (3) Security (trust, care and accessibility). Autonomy was based on the patients' experiences from taking their own responsibility and participation. Power meant to gain knowledge and motivation to take the drug. Security was to receive trust, experience care, and to have accessibility to a rheumatology nurse.

    Conclusion: Patients with rheumatic diseases experiences that drug information from a rheumatology nurse gives them autonomy, power and security. These could be essential for the patients to manage their daily life, where drug treatment is one part.

    Disclosure of Interest: None declared

  • 46.
    Larsson, Ingrid
    et al.
    Spenshult hospital, Oskarström, Sweden.
    Arvidsson, Susann
    Spenshult hospital, Oskarström, Sweden.
    Bergman, Stefan
    Spenshult hospital, Oskarström, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients´conceptions of drug information given by a rheumatology nurse: a phenomenographic study2010In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 8, no 1, p. 36-45Article in journal (Refereed)
    Abstract [en]

    Background:

    Pain, stiffness and functional restriction of the joints are the main problems experienced by patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases require several drugs every day. Adherence is highest among patients who have repeatedly been given drug information by a nurse from the start of the treatment. When developing patient information, it is essential to utilize patients' experiences.

    Objectives:

    The purpose of this study was to describe variations in how patients with rheumatic diseases perceive drug information given by a rheumatology nurse.

    Methods:

    The study had a descriptive qualitative design with a phenomenographic approach. Fifteen inpatients with rheumatic diseases who had received a new drug agreed to take part in the study and were interviewed.

    Results:

    Three descriptive categories emerged: autonomy, power and security. Autonomy was based on patients' experiences of taking responsibility and participating. Power meant gaining knowledge and being motivated to take the drug. Security involved trust, experiencing care and access to a rheumatology nurse.

    Conclusions:

    For patients with a rheumatic disease, drug information from a rheumatology nurse gave them autonomy, power and security. These factors could explain why information from a nurse increases adherence to drug treatment.

  • 47.
    Larsson, Ingrid
    et al.
    R&D Centre, Spenshult, Oskarström, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. R&D Centre, Spenshult, Oskarström, Sweden & Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. R&D Centre, Spenshult, Oskarström, Sweden & Lund University, Lund, Sweden.
    OP0094-HPR Person-Centred Care (PCC) May Improve Health Care Consumer Skills More than Regular Care - an RCT in Patients with CIA Undergoing Biological Therapy2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl. 2, p. 104-104Article in journal (Refereed)
    Abstract [en]

    Background: In person-centred care (PCC) a holistic approach, individualized care, empowerment and self-management are cornerstones. Patients are seen as persons with resources and are encouraged to take an active role in their own health care to become skilled or effective consumers of health care. Little is known of the impact of PCC vs. regular care on patients’ skills as health care consumers.

    Objectives: To study the impact on effective consumers’ skills over 12 months in patients undergoing biological therapy and randomly assigned to either a nurse-led rheumatology clinic (NLC) based on PCC or to a rheumatologist-led clinic (RLC) as measured by the Effective Consumer Scale (EC17).

    Methods: A 12 month RCT in 107 patients with chronic inflammatory arthritis.1 Inclusion criteria were ongoing biological therapy and a DAS28 ≤3.2. All patients met a rheumatologist at inclusion and after 12 months, while the 6 month follow-up was performed in the assigned group, either at a NLC (PCC) or at an RLC (regular care). Outcome measure was the EC17, developed and endorsed by the OMERACT to measure skills in decision-making, navigation and negotiation with health care professionals (0-100, worse to best). Minimally Important Difference (MID) of EC17 was calculated (≥ 0.5 SD of the mean baseline score)2 and patients categorized in three EC17 groups: improvement, no change or deterioration of consumer skills. Differences between intervention groups and EC17 groups were calculated with Chi2. Global health, pain and HAQ were measured for descriptive purposes.

    Results: A total of 101 patients completed the EC17 at baseline (mean 84 SD 10) and after 12 months. Twelve patients had baseline scores higher than 95 and a MID in improvement could not be measured why they were excluded, leaving 89 patients in the trial (mean age 53 SD 12 years, mean disease duration 16 SD 11 years, 54% women, RLC n=44, NLC n=45). At baseline mean (SD) DAS28 was 2.05 (0.68), global health 22 (17), pain 23 (18) and HAQ 0.55 (0.51). A larger proportion of patients improved according to EC17 in the NLC compared with the RLC (42% vs. 23%), and a smaller proportion deteriorated (16% vs. 23%; table). The differences were not statistically significant (p=0.14), probably due to a small sample size.

    Table. Proportion of patients who deteriorated (≥5 units), remained stable or improved (≥5 units) in EC17 over 12 months monitored at a NLC or an RLC, total n= 89.

    EC17 deterioration

    NLC 16%   (n=7)

    RLC 23%    (n=10)

    EC17 stable

    NLC 42%   (n=19)

    RCL 54%   (n=24)

    EC17 improvement

    NLC 42%   (n=19)

    RLC 23%   (n=10)

    Conclusions: A nurse-led rheumatology clinic based on person-centred care resulted in a greater proportion of patients who reported a long term improvement in skills as consumers of health services compared with patients monitored by a rheumatologist-led clinic. Larger studies are needed to confirm the result.

    References: 1. Larsson I, et al. Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs 2014;70(1):164-75.

    2. Strand V, et al. It's good to feel better but it's better to feel good and even better to feel good as soon as possible for as long as possible. Response criteria and the importance of change at OMERACT 10. J Rheumatol 2011;38(8):1720-7.

  • 48.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. FoU Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    FoU Spenshult, Halmstad, Sweden; Lund University, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. FoU Spenshult, Halmstad, Sweden & Lund University, Lund, Sweden.
    Person-Centred Care Can Help Patients to Become More Effective Consumers in the Use of Health Information than Regular Care – an RCT in Patients with Arthritis Undergoing Biological Therapy2015In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, no Suppl. S10, article id 1495Article in journal (Refereed)
    Abstract [en]

    Background/Purpose:

    Person-centred care (PCC) is a holistic approach with respectful and individualized care allowing negotiation of care where persons with health problems are empowered to be involved in health decisions. Patients’ illness narratives constitute a starting point for building a collaboration with health care professionals and to empower them to play an active role in their health care. Little is known of the impact of PCC vs. regular care on patients’ skills as health care consumers. The aim was to study the impact on effective consumers’ skills over 6 and 12 months as measured by the Effective Consumer Scale (EC17) in patients undergoing biological therapy and randomly assigned to either a nurse-led rheumatology clinic (NLC) based on PCC or to a rheumatologist-led clinic (RLC) based on regular care.

    Methods:

    A 12 month RCT in 107 patients with chronic inflammatory arthritis1. Inclusion criteria were ongoing biological therapy and a DAS28 ≤3.2. All patients met a rheumatologist at inclusion and after 12 months, while the 6 month follow-up was randomized to either at an NLC (PCC) or at an RLC (regular care). Outcome measure was the EC17, developed and endorsed by the OMERACT, including five subscales; 1. Use of health information, 2. Clarifying personal priorities, 3. Communicating with others, 4. Negotiating roles and 5. Deciding and taking action. EC17 total score ranges from 0-100, worse to best. Differences between and within NLC and RLC were analyzed with Friedmans’ test or Mann Whitney U-test.

    Results:

    After 12 months 97 patients completed the RCT (NLC n=47, RLC n=50), mean (SD) age 55.4 (12.7) years, disease duration 16.7 (11.5) years, DAS28 2.1 (0.7), HAQ 0.54 (0.38), global health 20.4 (17.1), pain 21.1 (18.0) and 56% were women. There were no statistically significant differences within or between the two intervention groups at baseline nor in EC17 total score mean (SD) at baseline (NLC 83.5 (9.4) vs. RLC 83.2 (10.8), 6 months (NLC 85.4 (10.4) vs. RLC 82.9 (10.9) and 12 months (NLC 85.3 (11.1) vs. RLC 82.3 (10.9)). However, in NLC there was a statistically significant improvement in EC17 subscale “1. Use of health information” at both 6 and 12 months (p=0.041 and p=0.004 respectively).

    Conclusion:

    Replacing just one of three visits over 12 months to an NLC based on PCC instead of an RLC based on regular care resulted in more effective consumers concerning the use of health information. Larger studies over longer time frames focusing on PCC are needed to better understand its full impact on effective consumer skills measured by EC17.

    References:

    1. Larsson I, et al. Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs 2014;70:164-75.

  • 49.
    Larsson, Ingrid
    et al.
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients' dependence on a nurse for the administration of their intravenous anti-TNF therapy: A phenomenographic study2009In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 7, no 2, p. 93-105Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pain, stiffness and functional restriction of the joints are the main problems for many patients with inflammatory rheumatic conditions. When conventional drugs fail to delay the development of the disease, the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of intravenous infusions and thus the patient is obliged to attend a clinic in order to receive his/her medication, which can affect everyday life as well as independence. It is therefore important to focus on the patient perspective.

    AIM: The aim of this study was to describe variations in how patients with rheumatic conditions conceive their dependence on a nurse for the administration of their intravenous anti-TNF therapy.

    METHOD: The study had a descriptive qualitative design with a phenomenographic approach. Interviews were conducted with 20 patients.

    RESULT: Three descriptive categories and seven sub-categories emerged: Dependence that affords security (encountering continuity, encountering competence and obtaining information); Dependence that creates involvement (being allowed influence and being given freedom); Dependence that invigorates (obtaining relaxation and encountering the environment).

    CONCLUSION: The patients had not reflected on the fact that they were dependent on a nurse for the administration of their intravenous anti-TNF therapy, which may be due to their possibility to influence the treatment. The patients' needs should constitute the basis for the nurse's role in the provision of care.

  • 50.
    Larsson, Ingrid
    et al.
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ experiences of a nurse-led rheumatology clinic in Sweden: a qualitative study2012In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 14, no 4, p. 501-507Article in journal (Refereed)
    Abstract [en]

    In this study, patients’ experiences of a nurse-led rheumatology clinic for those undergoing biological therapy are discussed. The study had an explorative design, based on a qualitative content analysis with an inductive approach. Strategic sampling was used in order to achieve variations in experiences of a nurse-led clinic. Interviews were conducted with 20 participants, and the analysis resulted in the theme “the nurse-led rheumatology clinic provided added value to patient care”. The participants’ experiences of the encounter with the nurse led to a sense of security (due to competence and accessibility), familiarity (due to confirmation and sensitivity), and participation (due to exchange of information and involvement). Replacing every second visit to a rheumatologist with one to a nurse added value to the rheumatology care,making it more complete. Nurses and rheumatologists complemented each other,as they approached patients from different perspectives. This study suggests that a nurse-led rheumatology clinic adds value to the quality of care for patients inrheumatology units.

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