This study explores staff perceptions of the organizational and behavioral conditions required to normalize SDM within CIP processes in Sweden. Three focus group interviews were conducted with mental health and social care staff in three sites. Data were analyzed qualitatively, using constructs from Normalization Process Theory. Largely, there was shared validation of SDM-CIP, indicating high coherence. Generally, commitment was expressed to strengthen the conditions for implementation (reflecting the construct cognitive participation), by challenging attitudes and establishing effective roles. Inadequate infrastructure limited conditions for collective action for realizing SDM-CIP. The findings highlight a need for cross-organizational staff training and supportive infrastructure. © 2025 The Author(s). Published with license by Taylor & Francis Group, LLC.

Background: Adequate sleep is crucial for children's health, especially for children with ADHD and concurrent sleep problems. There is a need for more studies focusing on sleep problems in children with ADHD as these problems may exacerbate ADHD symptoms and vice versa, impacting negatively on everyday life. The aim of this study was to investigate the differences in health-related factors between children with ADHD without clinically relevant sleep problems and those with clinically relevant sleep problems after a sleep intervention.

Methods: This cross-sectional study involved 83 children diagnosed with ADHD and sleep problems, 46 boys and 37 girls; aged 6-14 years, divided into two groups after a sleep intervention according to the parent-reported Children's Sleep Habits Questionnaire (CSHQ) and a cut-off for clinically relevant sleep problems. Data from a 16-week follow-up of the sleep intervention were analysed in terms of the following health-related measures: The Insomnia Severity Index (ISI), The short form of State-Trait Anxiety Inventory (Short-STAI), The Child Outcome Rating Scale (CORS), The EQ-5D-Y-3L (child-reported), and The Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) (parent-reported). The Mann-Whitney u-test, Independent samples t-test, and Chi-square/Fisher's exact test were used for the analysis.

Results: Forty-two of the 83 children (50.6%) were grouped as having clinically relevant sleep problems and 41 (49.4%) as being without the same. The results indicated that the group without clinically relevant sleep problems reported less insomnia (ISI, total score p = 0.011), less tension in the anxiety scale (Short-STAI, tense p = 0.047), and their parents reported less ADHD symptoms (SNAP-IV, total score for attention deficit, p < 0.001). No group differences were observed for life functioning (CORS) or health-related quality of life (EQ-5D-Y-3 L).

Conclusions: This study showed that children with ADHD without parent-reported clinically relevant sleep problems had fewer health-related issues after a sleep intervention, including self-reported insomnia, tension, and parent-reported ADHD symptoms, compared to children with clinically relevant sleep problems. Longitudinal studies are necessary to fully comprehend the long-term impact of sleep problems and various health-related factors in this cohort. © 2025. The Author(s).

Introduction Absence of structured guidelines to navigate the complexities of implementing AI-based applications in healthcare is recognized by clinicians, healthcare leaders, and policy makers. AI implementation presents challenges beyond the technology development which necessitates standardized approaches to implementation. This study aims to explore the activities typical to implementation of AI-based systems to develop an AI implementation process framework intended to guide healthcare professionals. The Quality Implementation Framework (QIF) was considered as an initial reference framework.Methods This study employed a qualitative research design and included three components: (1) a review of 30 scientific articles describing differences empirical cases of real-world AI implementation in healthcare, (2) analysis of qualitative interviews with healthcare representatives possessing first-hand experience in planning, running, and sustaining AI implementation projects, (3) analysis of qualitative interviews with members of the research groups network and purposively sampled for their AI literacy and academic, technical or managerial leadership roles.Results The data were deductively mapped onto the steps of QIF using direct qualitative content analysis. All the phases and steps in QIF are relevant to AI implementation in healthcare, but there are specificities in the context of AI that require incorporation of additional activities and phases. To effectively support the AI implementations, the process frameworks should include a dedicated phase to implementation with specific activities that occur after planning, ensuring a smooth transition from AI's design to deployment, and a phase focused on governance and sustainability, aimed at maintaining the AI's long-term impact. The component of continuous engagement of diverse stakeholders should be incorporated throughout the lifecycle of the AI implementation.Conclusion The value of this study is the identified processual phases and activities specific and typical to AI implementations to be carried out by an adopting healthcare organization when AI systems are deployed. The study advances previous research by outlining the types of necessary comprehensive assessments and legal preparations located in the implementation planning phase. It also extends prior understanding of what the staff's training should focus on throughout different phases of implementation. Finally, the overall processual, phased structure is discussed in order to incorporate activities that lead to a successful deployment of AI systems in healthcare. © 2025 Nair, Nygren, Nilsen, Gama, Neher, Larsson and Svedberg.

Background: Despite the evident trend in health research to emphasise co-production approaches, there is a lack of established, comprehensive and concrete strategies and evaluation methods to effectively guide and assess them. This project aimed to develop, validate, and test a toolkit designed to enhance and evaluate co-productions in mental health research. The toolkit includes practical evaluation tools, such as a structured questionnaire and tailored interview guides, to support the initiation of research projects and assess the involvement, process and impact of co-production efforts. Methods: This project used a co-production approach with formative research design to develop a comprehensive toolkit for evaluating the process and impact of co-production in mental health research. Conducted between 2022 and 2024, the project involved iterative engagement with diverse stakeholder groups, providing a dynamic testbed for developing, validating, and field-testing the instruments. The paper outlines the four-phase process: (1) toolkit generation, (2) validation, (3) field-testing, and (4) completion, detailing how the co-production approach shaped the toolkit’s design, relevance, usability, and rigor. Results: The result of this project is a structured, practical, and comprehensive co-production evaluation toolkit designed specifically for mental health research, potentially involving a wide range of partnerships. The toolkit includes a project initiation guide, a process-oriented survey and interview-guide for mid- and post-project evaluations, and an impact-focused post-project group interview guide. Conclusions: The findings address a critical gap in mental health research by developing a structured, practical, and comprehensive co-production evaluation toolkit. The toolkit offers comprehensive strategies for evaluating involvement and both the processes and impacts of co-production throughout a project’s lifecycle. © The Author(s) 2025.

As health care demands rise and resources remain constrained, optimizing health care systems has become critical. Information-driven technologies, such as data analytics and artificial intelligence (AI), offer significant potential to inform and enhance health care delivery at various levels. However, a persistent gap exists between the promise of these technologies and their implementation in routine practice. In this paper, we propose that fragmentation of the innovation ecosystem is behind the failure of new information-driven technologies to be taken up into practice and that these goals can be achieved by increasing the cohesion of the ecosystem. Drawing on our experiences and published literature, we explore five challenges that underlie current ecosystem fragmentation: (1) technology developers often focus narrowly on perfecting the technical specifications of products without sufficiently considering the broader ecosystem in which these innovations will operate; (2) lessons from academic studies on technology implementation are underused, and existing knowledge is not being built upon; (3) the perspectives of healthcare professionals and organizations are frequently overlooked, resulting in misalignment between technology developments and health care needs; (4) ecosystem members lack incentives to collaborate, leading to strong individual efforts but collective ecosystem failure; and (5) investment in enhancing cohesion between ecosystem members is insufficient, with limited recognition of the time and effort required to build effective collaborations. To address these challenges, we propose a series of recommendations: adopting a wide-lens perspective on the ecosystem; developing a shared-value proposition; fostering ecosystem leadership; and promoting local ownership of ecosystem investigation and enhancement. We conclude by proposing practical steps for ecosystem members to self-assess, diagnose, and improve collaboration and knowledge sharing. The recommendations presented in this paper are intended to be broadly applicable across various types of innovation and improvement efforts in diverse ecosystems. © Julie Reed, Petra Svedberg, Jens Nygren.

Background: Children with Attention Deficit Hyperactivity Disorder (ADHD) often experience significant sleep difficulties, which can impair daily functioning and exacerbate ADHD symptoms. Sleep-related challenges, such as difficulties with sleep initiation, not only affect the child but also disrupt family dynamics, thereby impacting general family well-being. Understanding the factors that facilitate better sleep initiation could provide valuable insights to inform the development of targeted interventions to support children with ADHD and associated sleep problems.

Aim: This study aimed to explore the experiences of facilitators supporting sleep initiation among children with ADHD and sleep problems.

Method: An exploratory, inductive qualitative design was used. Individual interviews were conducted with 21 children (11 boys and 10 girls) aged 6–12, diagnosed with ADHD and sleep problems. Data were analyzed through qualitative content analysis, resulting in five subcategories and two main categories.

Results: The findings revealed that children with ADHD and sleep difficulties identified both behavioral and environmental factors that facilitate sleep initiation. Behavioral factors included engaging in physical exercise, regulating digital device use, and maintaining a balance between activity and rest. Environmental facilitators included a calming sleeping environment and the maintenance of consistent evening routines. The children highlighted the importance of individualized approaches to the integration of these strategies, to effectively support sleep initiation.

Conclusions: This study highlights the relevance of both behavioral and environmental aspects in supporting sleep initiation among children with ADHD. These exploratory findings may inform future research and practice by emphasizing the value of integrating children’s own perspectives and preferences when designing supportive strategies. © The Author(s) 2025.

Objectives: First-line managers in healthcare play a pivotal role in shaping sustainable and resilient health systems, yet they often face high workloads, limited resources, and increasing administrative demands. These conditions affect not only their own well-being but also their ability to lead effectively and support healthcare teams. Strengthening conditions for leadership development and organizational support is essential to a resilient healthcare workforce and long-term system performance. This study aims to explore the prerequisites for sustainable leadership among first-line managers in healthcare.

Methods: Using an explorative qualitative design with an inductive approach, individual interviews were conducted with 25 first-line managers from various operational areas in southern Sweden between February and July 2024. The data were analysed through qualitative content analysis, identifying three themes and nine sub-themes.

Results: The findings reveal that sustainable leadership depends on three key areas: effective organizational structures, supportive collaborations, and innovative management skills. Managers emphasized the need for clearer role definitions, ongoing leadership training, and access to both administrative and collegial support. They also highlighted the importance of balancing autonomy with structured support to manage complexity, prevent burnout, and foster meaningful engagement.

Conclusions: Investing in the leadership capacity and well-being of first-line managers is essential to building sustainable health systems. Organizations must prioritize structured onboarding, continuous professional development, and collaborative cultures that empower managers. When healthcare leaders are supported and equipped to lead, they are better able to retain staff, promote positive work environments, and ultimately improve patient care. This study underscores that leadership is a managerial concern and a strategic investment in health system sustainability.

Key messages:

• This study highlights the need for clear roles, support, and training to strengthen first-line managers’ leadership and well-being- key to resilient, sustainable healthcare systems.

• Strong first-line managers create better work environments, reduce burnout, and contribute to a stable healthcare organization with higher quality and safer patient care.

© The Author(s) 2025. Published by Oxford University Press on behalf of the European Public Health Association.

Tyngdtäcke har använts inom vården som ett icke-farmakologiskt behandlingsalternativ. Evidens har dock saknats om effekter av tyngdtäcke på sömnen. En crossover randomiserad kontrollerad studie har genomförts för att utvärdera effekten av tyngdtäcke på sömnbesvär hos barn 6-14 år med ADHD. Resultatet visade på ökad total sömntid, ökad sömneffektivitet och minskad tid i vakenhet under natten, men ingen skillnad i insomning vid användning av tyngdtäcke jämfört med ett lättare kontrolltäcke. Föräldrarna rapporterade att barnens sömnproblem minskade. Barnen rapporterade att sömnkvalitén ökade, däremot sågs ingen skillnad i självrapporterade sömnproblem vid användning av tyngdtäcke jämfört med ett kontrolltäcke. © 2025 Maria Lönn, Katarina Aili, Petra Svedberg, Jens Nygren, Håkan Jarbin, Ingrid Larsson.

Aims: The aim of this study was to explore healthcare leaders' perceptions of the contribution of artificial intelligence (AI) to person-centred care (PCC). Methods: The study had an explorative qualitative approach. Individual interviews were conducted from October 2020 to May 2021 with 26 healthcare leaders in a county council in Sweden. An abductive qualitative content analysis was conducted based on McCormack and McCance's framework of PCC. The four constructs (i.e. prerequisites, care environment, person-centred processes and expected outcomes) constituted the four categories for the deductive analysis. The inductive analysis generated 11 subcategories to the four constructs, representing how AI could contribute to PCC. Results: Healthcare leaders perceived that AI applications could contribute to the four PCC constructs through (a) supporting professional competence and establishing trust among healthcare professionals and patients (prerequisites); (b) including AI's ability to facilitate patient safety, enable proactive care, provide treatment recommendations and prioritise healthcare resources (the care environment); (c) including AI's ability to tailor information and promote the process of shared decision making and self-management (person-centred processes); and (d) including improving care quality and promoting health outcomes (expected outcomes). Conclusions: The healthcare leaders perceived that AI applications could contribute to PCC at different levels of healthcare, thereby enhancing the quality of care and patients' health. © Author(s) 2025.

Background: Hard-to-heal wounds pose a significant challenge to healthcare systems globally. While person-centred care (PCC) has been proposed as a means to improve wound management, there is a scarcity of research examining its practical application in healthcare. An increased understanding of healthcare professionals' perceptions of PCC in wound management and the challenges associated with its application is thus warranted. Such an understanding can facilitate the implementation of PCC and, consequently, enhance the quality of care. Aim: To explore healthcare professionals' perceptions of PCC in wound management in primary care services. Method: The study had an explorative abductive design involving semi-structured interviews with 23 healthcare professionals in primary care working with wound management. An abductive qualitative content analysis was conducted using the PCC framework, incorporating three routines related to, respectively, initiation, working, and safeguarding the partnership. Results: The findings illustrated healthcare professionals' perceptions regarding initiating, practising, and safeguarding PCC in wound management. Initiating such care entailed having a holistic perspective, considering both the patient and the underlying causes of the wound, using the patient's goals and preferences to establish wound management, and motivating them to commit to the care. Practising PCC in wound management involved establishing a relationship of trust with the patient, tailoring wound management to her/his needs and circumstances, and minimising symptoms that had a negative impact on everyday life. Safeguarding PCC in wound management involved documenting continuously, keeping updated on patient medical records, and facilitating the exchange of information between healthcare professionals. Conclusion: Healthcare professionals acknowledge the significance of PCC in wound management. The findings also highlight challenges, particularly in practising shared decision-making, ensuring closeness and continuity of wound management, and documenting person-centred care. These findings offer insights into key factors that support the implementation of PCC. © 2025 The Author(s). Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.