Background First-line managers in healthcare operate in increasingly complex environments marked by high demands, rapid change, and limited resources. These conditions impact their health, leadership capacity, and the sustainability of their roles. While previous research has addressed various aspects of leadership in healthcare, there is a lack of studies focusing specifically on how first-line managers perceive the conditions for sustainable leadership in a changing and resource-demanding organizational context. The aim of this study was to explore the conditions for sustainable leadership among first-line managers in healthcare settings.

Method Using an exploratory qualitative design with an inductive approach, individual interviews were conducted with 25 first-line managers from diverse healthcare areas in southern Sweden between February and July 2024. Three main themes, and nine sub-themes related to sustainable leadership emerged from the qualitative content analysis.

Results Providing resilient organizational structures was characterised by support functions that met operational requirements, adequate resource allocation, and coordinated work routines, enabling managers to carry out leadership tasks over time. Fostering supportive collaborations comprised supervisory and peer support, opportunities for collegial exchange, and access to administrative assistance. These forms of support affected how managers handled their responsibilities and responded to organizational change. Cultivating leadership for innovation included linking leadership tasks to a clear purpose, managing changing expectations, and balancing operational duties with broader development goals.

Conclusion Sustainable leadership among first-line managers depends on the alignment of structural, social, and individual conditions. The findings indicate that resilient organizational systems, accessible support networks, and possibilities to integrate purpose with daily leadership are crucial for maintaining leadership capacity over time. These insights can guide organizational strategies aimed at strengthening managers’ prerequisites for sustainable leadership in complex healthcare settings. © The Author(s) 2026.

Background: Health promotion in higher education may support sustainable health among future healthcare and social work professionals, who face elevated risk of poor health when entering working life. The aim of this study was to describe associations between general health, health-promoting resources, lifestyle factors, and social factors among final-semester students in nursing, healthcare, and social work programs and newly graduated nurses and healthcare and social work professionals. In addition, the study compared groups reporting excellent/very good general health with those reporting good, fair, or poor health.

Methods: Data were collected through a web-based questionnaire, between 2020 and 2023, which included items on health and lifestyle factors, along with validated instruments measuring health-promoting resources (sense of coherence, salutogenic health, emotional intelligence, occupational balance) and social support. Analyses included chi-square tests, non-parametric tests, and logistic regression.

Results:This study included 343 final-semester students in nursing, healthcare, and social work programs and 115 newly graduated professionals. In the final semester, excellent/very good health was most strongly associated with absence of sleep problems (OR 3.3), no oral tobacco use (OR 2.7), and exercising > 60 min/week (OR 2.8). Higher scores in sense of coherence, emotional intelligence, occupational balance were also linked to better health. Among newly graduated professionals, absence of sleep problems (OR 6.8), daily activity > 150 min/week (OR 3.5), and low alcohol use (OR 2.7) were associated with excellent/very good health. At both time points, groups with excellent or very good general health reported higher scores in sense of coherence, salutogenic health, emotional intelligence, and occupational balance. No significant differences in health or health-promoting resources were found between final-semester students and newly graduated professionals.

Conclusion: Participants reporting excellent or very good health had higher health-promoting resources and better sleep during their final semester in nursing, healthcare, and social work programs and as newly graduated professionals. Neither health nor health-promoting resources changed upon entering work-life, however, this observation should be interpreted cautiously given the study's limitations and confirmed in future research. Health promotion during higher education and in early work-life may therefore be crucial for sustainable health. As some of the data were collected during the COVID-19 period, results should be interpreted with awareness that pandemic-related circumstances may have influenced lifestyle and perceived health. © The Author(s) 2026.

Background: Students with foreign backgrounds can face challenges in the study environment linked to language, cultural roles, norms, and ethnicity. It is important to increase knowledge about students' own health-promoting resources and social study factors, to optimize a good study environment. Objective: This study aimed to describe and investigate changes in health-promoting resources and social study factors in, respectively, the first and final semesters, for students with and without foreign backgrounds, in nursing and social work programs in Sweden. Methods: The study had a repeated cross-sectional multicentre design at the group level. Students at six Swedish universities answered a web-based questionnaire in the first (n = 665) and final semester (n = 296) of nursing and social work programs. The questionnaire measured health-promoting resources (SOC-13; SHIS; OBQ), and social study factors (QPSNordic). Statistics were conducted through descriptive, correlation, and multiple linear regression analyses. Results: At baseline, students with foreign backgrounds reported significantly lower health-promoting resources, including SOC total (p < .004), SHIS (p < .004), and social study factors (p < .004), compared to other students. By the final semester, disparities between the two groups persisted in two items of social study factors. In the final semester, students' relationships and the value of group work predicted health-promoting resources for the entire student cohort. Conclusion: Social relationships were central to health-promoting resources for Swedish nursing and social work students. The results indicated the value of targeted actions, in the study environment, especially among students with foreign backgrounds.

© The Author(s) 2025

Background: Artificial intelligence (AI) has the potential to enhance patient safety, particularly in the prevention of in-hospital falls. Recent advances in sensor-based AI systems allow for the analysis of complex, multimodal data to generate real-time alerts, enabling health care professionals to intervene before a fall occurs. By shifting from reactive responses to proactive risk management, these technologies may enable reductions in fall incidence and improvements in care outcomes. As a result, hospitals across Europe are increasingly adopting such systems. Nevertheless, empirical evidence concerning their routine implementation remains limited, particularly concerning their impact on patient safety, clinical workflows, and the usage of health care resources. Addressing these gaps is essential for effective and sustainable integration into hospital care. Objective: This paper outlines the protocol for the multicenter, multimethod project SAFE (Safe AI-Assisted Fall Prevention Through Evidence), which investigates the implementation and impact of AI-assisted fall prevention in Swedish hospitals. Methods: The research project is a collaboration between Halmstad University and hospitals in the V &amp;amp;amp; auml;stra G &amp;amp;amp; ouml;taland Region (VGR) and will, during 2026-2028, investigate an ongoing large-scale AI system implementation in VGR hospitals, covering up to 2400 patient beds. Using surveys, interviews, observations, and a retrospective study, it will track the implementation and impact over time. Two learning laboratories involving patients, their relatives, and health care professionals will be conducted to codevelop strategies for the implementation of AI-assisted fall prevention. Results: The project will provide evidence-based insights and practical guidance on AI-assisted fall prevention. The findings will be relevant not only to patients, health care professionals, and hospital organizations, but also to policymakers and stakeholders involved in the digital transformation of health care. Conclusions: Although VGR serves as the primary research setting, the project's results will inform future similar initiatives in Sweden and offer transferable lessons for other health care systems internationally. This study will contribute to the evidence base on AI-assisted fall prevention in health care, supporting the responsible and scalable integration of such systems across diverse health care environments. © Elin Siira, Anna Gyberg, Ingrid Larsson, Marcus Rosenburg, Petra Svedberg, Kerstin Ulin, Helle Wijk, Thomas Brezicka, Malin Hansson, Jenny Hallgren, Jens Nygren. Originally published in JMIR Research Protocols

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.

Health is multifaceted, with divergent interpretations in diverse cultures and groups of individuals. The ways individuals understand health might aid in developing future interventions. There is scant knowledge on how adolescents with depression conceptualise health. A descriptive qualitative design with a phenomenographic approach was used to describe the different ways adolescents with depression conceptualise health. Interviews were performed with adolescents 13–17 years old (n = 33) who participated in a randomised controlled trial evaluating the effects of aerobic group exercise versus leisure group activities for adolescents with depression. The results were interpreted into four metaphors to embody the understanding of health as described by adolescents with depression: 1) establishing sound routines by managing everyday life, 2) connecting to others by having access to social resources, 3) managing depression symptoms by having control over the mental illness, and 4) attaining inner drive by experiencing joy in everyday life. The various conceptions of health among adolescents with depression provide valuable insights for enhancing evidence-based treatments with person-centred care. Key aspects include establishing routines, fostering connections, finding strategies for symptom control, and incorporating joy through exercise. Given that adolescents highlighted these aspects as essential to health, future research could explore individualised health promotion, particularly focusing on routine-building, social connections, or finding an inner drive as an add-on to evidence-based treatments for adolescent depression. © 2025 Danielsson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 

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.

Background: Physical exercise is part of the recommended treatment for individuals with axial spondyloarthritis (axSpA). High-intensity interval training (HIIT) is an effective way to improve cardiovascular health without risk of increased disease activity. Nevertheless, there is a lack of knowledge regarding facilitating factors for digitally-based HIIT among individuals with axSpA. Objective: This study aimed to explore facilitators influencing participation in a twelve-week digitally-based HIIT intervention among individuals with axSpA. Methods: Individuals with axSpA (9 females/7 males) were recruited from the intervention group of a randomized controlled trial. The intervention included three high-intensity training sessions, two of which would be interval training, weekly for twelve weeks with digitally-based coaching by a physiotherapist. Individual semi-structured interviews were conducted with the participants after completing the intervention. At baseline, the median (min-max) age was 47 (28–65), disease activity (BASDAI) was 2.6 (0.2–5.5) and aerobic capacity was 31 ml O2/kg/min (24–54). A qualitative content analysis was used to bring out manifest content from the interviews. The analysis revealed three categories and eight sub-categories. Results: The participants described that HIIT was facilitated by intervention design, encouragement, and feelings of well-being. The intervention design facilitated HIIT to be feasible to perform, adaptable to everyday life, and by use of digital tools. The importance of inner drive, need for individual coaching, and support of social networks were highlighted as keys for encouragement. Feelings of well-being facilitated HIIT through perceived health effects and improved self-efficacy. Conclusion: A self-managed digitally-based HIIT intervention coached by a physiotherapist but performed outside the healthcare settings could be used as an additional non-pharmacological treatment for individuals with axSpA. © The Author(s) 2025