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  • 1.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Odontology and Oral Health Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Univ Hosp Linkoping, Dept Clin Neurophysiol, Linkoping, Sweden..
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jonkoping Univ, Sch Hlth & Welf, ADULT, Jonkoping, Sweden..
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karlstad Univ, Dept Hlth Sci, Karlstad, Sweden..
    Oral health-related situations among patients with experience of continuous positive airway pressure treatment: a critical incident analysis of experiences and actions2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no Suppl 1, article id P085Article in journal (Refereed)
  • 2.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Odontology and Oral Health Science. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    “The terrible dryness woke me up, I had some trouble breathing”- critical situations related to oral health as described by CPAP-treated persons with obstructive sleep apnea2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no 6, article id e13670Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.

  • 3.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Odontology and Oral Health Science. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Views about oral health determinants as described by persons with continuous positive airway pressure-treated obstructive sleep apnea: A qualitative studyManuscript (preprint) (Other academic)
  • 4.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Department of Odontology and Oral Health Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Department of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Department of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Department of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Views on oral health determinants as described by persons with continuous positive airway pressure-treated obstructive sleep apnoea: a qualitative study2023In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 23, no 1, article id 407Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Oral diseases have been associated with cardiovascular diseases, and persons with continuous positive airway pressure [CPAP]-treated obstructive sleep apnoea [OSA] have an increased risk for negative consequences for both oral and general health. CPAP treatment is often life-long and adherence to treatment is essential. Xerostomia is a common side-effect which can lead to treatment abandonment. Oral health is a changeable part of our general health and well-being and exploring the views of oral health determinants from persons with experience of CPAP-treatment is important to prevent adverse oral health outcomes. The purpose of this study was to explore what persons with experience of CPAP-treated OSA view as determinants for their oral health.

    METHODS: Eighteen persons with long-term experience of CPAP-treated OSA were purposively selected. Data were collected by semi-structured individual interviews. A code book based on the World Dental Federation's [FDI] theoretical framework for oral health was developed and used to analyse the data using directed content analysis. The domains in the framework's component driving determinants were used as pre-determined categories. Using the description of driving determinants as a guide, meaning units were extracted from the interview transcripts through an inductive approach. Then, by employing a deductive approach the code book was used to categorise the meaning units into the pre-determined categories.

    FINDINGS: The views on oral health determinants described by the informants were compatible with the five domains in the component driving determinants in the FDI's theoretical framework. Ageing, heredity, and salivation (biological and genetic factors), influences from family and the wider society (social environment), location and re-localisation (physical environment), oral hygiene habits, motivation, willingness to change, professional support (health behaviours), and availability, control, finances, and trust (access to care) were viewed as important oral health determinants by the informants.

    CONCLUSION: The study points to a variety of individual oral health-related experiences that oral healthcare professionals could consider when designing interventions to reduce xerostomia and prevent adverse oral health outcomes for persons undergoing long-term CPAP-treatment.

  • 5.
    Neher, Margit
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Landén Ludvigsson, Maria
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Enblom, Anna
    County Council of Östergötland, Linköping, Sweden.
    Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation: Focus Group Interviews Exploring Rehabilitation Professionals' Perceptions2021In: Journal of Cancer Education, ISSN 0885-8195, E-ISSN 1543-0154, Vol. 36, no 4, p. 779-786Article in journal (Refereed)
    Abstract [en]

    To explore primary care professionals' perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals' knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.

  • 6.
    Neher, Margit
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Lundgren, J.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Johansson, P.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study2022In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 24, no 1, article id e28870Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. OBJECTIVE: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. METHODS: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. RESULTS: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers' conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. CONCLUSIONS: Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.

  • 7.
    Neher, Margit
    et al.
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Ståhl, Christian
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Ellström, Per-Erik
    Linköpings universitet, Pedagogik och sociologi.
    Nilsen, Per
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.2015In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 6, p. 661-679Article in journal (Refereed)
    Abstract [en]

    As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

  • 8.
    Neher, Margit
    et al.
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Ståhl, Christian
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Festin, Karin
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Nilsen, Per
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Implementation of Evidence-Based Practice in Rheumatology: What Sociodemographic, Social Cognitive and Contextual Factors Influence Health Professionals’ Use of Research in Practice?2016In: Journal of rheumatic diseases and treatment, ISSN 2469-5726, Vol. 2, no 3, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Objective: Research on the use of research in rheumatology practice is largely lacking. This study attempts to fill this knowledge gap by exploring the degree to which evidence-based practice (EBP) is implemented in clinical rheumatology practice and identifying individual and organizational factors that may potentially affect research use in the clinical environment.

    Methods: A web-based questionnaire was distributed to members of health professional groups in clinical rheumatology by way of publicly available e-mail addresses. Data were collected on sociodemographic, social cognitive, and contextual factors deemed to potentially influence the use of research in practice. The outcome measure was the EBP Implementation Scale.

    Results: A complex range of factors was found to influence the outcome. The factors that were most clearly associated with research use were the perception of personal ability to use research knowledge, years of experience in clinical rheumatology, and experience of research activities.

    Conclusions: Our study results suggest a large variation in levels of implementation of EBP across work units and individuals, and although a low general standard is indicated (even if a gold standard does not exist), there was also a great interest in working according to EBP principles. Potential for change is apparent, but it seems necessary to examine the use of research evidence in rheumatology practice at the individual and work unit levels to accommodate local and individual needs and resources. Future studies are needed to examine the influence of contextual influences by other methods.

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  • 9.
    Neher, Margit
    et al.
    Division of Social Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Ståhl, Christian
    National Centre of Work and Rehabilitation, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Nilsen, Per
    Division of Social Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Learning opportunities in rheumatology practice: A qualitative study2015In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 27, no 4, p. 282-297Article in journal (Refereed)
    Abstract [en]

    Purpose – This paper aims to explore what opportunities for learning practitioners in rheumatology perceive of in their daily practice, using a typology of workplace learning to categorize these opportunities.

    Design/methodology/approach – Thirty-six practitioners from different professions in rheumatology were interviewed. Data were analyzed using conventional qualitative content analysis with a directed approach, and were categorized according to a typology of formal and informal learning.

    Findings – The typology was adjusted to ft the categories resulting from the analysis. Further analysis showed that work processes with learning as a by-product in general, and relationships with other people in the workplace in particular, were perceived as important for learning in the workplace. The use of many recognized learning opportunities was lower. Barriers for learning were a perceived low leadership awareness of learning opportunities and factors relating to workload and the organization of work.

    Research limitations/implications – The generalizability of results from all qualitative inquiries is limited by nature, and the issue of transferability to other contexts is for the reader to decide. Further studies will need to confrm the results of the study, as well as the proposed enhancement of the typology with which the results were categorized.

    Practical implications – The study highlights the importance of relationships in the workplace for informal learning in rheumatology practice. In the clinical context, locally adapted strategies at organizational and individual levels are needed to maximize opportunities for both professional and interprofessional informal learning, taking the importance of personal relationships into account. The fndings also suggest a need for increased continuing professional education in the specialty.

    Originality/value – The workplace learning typology that was used in the study showed good applicability to empirical health-care study data, but may need further development. The study confrmed that informal workplace learning is an important part of learning in rheumatology. Further studies are needed to clarify how informal and formal learning in the rheumatology clinic may be supported in workplaces with different characteristics.

  • 10.
    Nilsen, P.
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Ellström, P. -E
    Linköping University, Sweden.
    Gardner, B.
    King’s College London, United Kingdom.
    A learning perspective on implementation2022In: Implementation Science: The Key Concepts / [ed] F. Rapport, R. Williams and J. Braithwaite, Taylor & Francis, 2022, p. 169-170Chapter in book (Other academic)
    Abstract [en]

    For many healthcare practitioners, implementing an evidence-based practice presents a few interlinked learning challenges: acquiring evidence-based practice skills to be able to problem-solve when faced with clinical uncertainty; adopting specific evidence-based practices, for example, interventions with proven effectiveness; and abandonment of non-evidence-based practices. The essay describes two modes of learning and uses these as lenses for analysing the challenges of implementing an evidence-based practice in healthcare. Adaptive learning involves a gradual shift from slower, deliberate behaviours to faster, smoother, and more efficient behaviours. Developmental learning is conceptualized as a process in the “opposite” direction, whereby more or less automatically enacted behaviours become deliberate and conscious. The mechanisms by which the two modes of learning occur are explained with reference to habit theory.

  • 11.
    Nilsen, Per
    et al.
    Linköpings universitet, Avdelningen för samhälle och hälsa.
    Neher, Margit
    Linköpings universitet, Avdelningen för samhälle och hälsa.
    Ellström, Per-Erik
    Linköpings universitet, Pedagogik och sociologi.
    Gardner, Benjamin
    Department of Psychology, King's college, London, UK.
    Implementation from a learning perspective2020In: Handbook on implementation science / [ed] Per Nilsen, Sarah A. Birken, Cheltenham, UK: Edward Elgar Publishing, 2020, p. 409-421Chapter in book (Refereed)
    Abstract [en]

    The Handbook on Implementation Science provides an overview of the field’s multidisciplinary history, theoretical approaches, key concepts, perspectives, and methods. By drawing on knowledge concerning learning, habits, organizational theory, improvement science, and policy research, the Handbook offers novel perspectives from a broad group of international experts in the field representing diverse disciplines. The editors seek to advance implementation science through careful consideration of current thinking and recommendations for future directions.

  • 12.
    Nilsen, Per
    et al.
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Neher, Margit
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Ellström, Per-Erik
    Linköpings universitet, Pedagogik och sociologi.
    Gardner, Benjamin
    Institute Psychiat Psychol and Neurosci, England.
    Implementation of Evidence-Based Practice From a Learning Perspective2017In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 14, no 3, p. 192-199Article in journal (Refereed)
    Abstract [en]

    Introduction: For many nurses and other health care practitioners, implementing evidence-based practice (EBP) presents two interlinked challenges: acquisition of EBP skills and adoption of evidence-based interventions and abandonment of ingrained non-evidence-based practices.

    Aims: The purpose of this study to describe two modes of learning and use these as lenses for analyzing the challenges of implementing EBP in health care.

    Methods: The article is theoretical, drawing on learning and habit theory.

    Results: Adaptive learning involves a gradual shift from slower, deliberate behaviors to faster, smoother, and more efficient behaviors. Developmental learning is conceptualized as a process in the opposite direction, whereby more or less automatically enacted behaviors become deliberate and conscious.

    Conclusion: Achieving a more EBP depends on both adaptive and developmental learning, which involves both forming EBP-conducive habits and breaking clinical practice habits that do not contribute to realizing the goals of EBP.

    Linking Evidence to Action: From a learning perspective, EBP will be best supported by means of adaptive learning that yields a habitual practice of EBP such that it becomes natural and instinctive to instigate EBP in appropriate contexts by means of seeking out, critiquing, and integrating research into everyday clinical practice as well as learning new interventions best supported by empirical evidence. However, the context must also support developmental learning that facilitates disruption of existing habits to ascertain that the execution of the EBP process or the use of evidence-based interventions in routine practice is carefully and consciously considered to arrive at the most appropriate response.

  • 13.
    Petersson, Lena
    et al.
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Larsson, Ingrid
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Nygren, Jens M.
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Nilsen, Per
    School of Health and Welfare, Halmstad University, Halmstad, Sweden; Department of Health, Medicine and Caring Sciences, Division of Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Reed, Julie E.
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Tyskbo, Daniel
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Svedberg, Petra
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Challenges to implementing artificial intelligence in healthcare: a qualitative interview study with healthcare leaders in Sweden2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 850Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Artificial intelligence (AI) for healthcare presents potential solutions to some of the challenges faced by health systems around the world. However, it is well established in implementation and innovation research that novel technologies are often resisted by healthcare leaders, which contributes to their slow and variable uptake. Although research on various stakeholders' perspectives on AI implementation has been undertaken, very few studies have investigated leaders' perspectives on the issue of AI implementation in healthcare. It is essential to understand the perspectives of healthcare leaders, because they have a key role in the implementation process of new technologies in healthcare. The aim of this study was to explore challenges perceived by leaders in a regional Swedish healthcare setting concerning the implementation of AI in healthcare.

    METHODS: The study takes an explorative qualitative approach. Individual, semi-structured interviews were conducted from October 2020 to May 2021 with 26 healthcare leaders. The analysis was performed using qualitative content analysis, with an inductive approach.

    RESULTS: The analysis yielded three categories, representing three types of challenge perceived to be linked with the implementation of AI in healthcare: 1) Conditions external to the healthcare system; 2) Capacity for strategic change management; 3) Transformation of healthcare professions and healthcare practice.

    CONCLUSIONS: In conclusion, healthcare leaders highlighted several implementation challenges in relation to AI within and beyond the healthcare system in general and their organisations in particular. The challenges comprised conditions external to the healthcare system, internal capacity for strategic change management, along with transformation of healthcare professions and healthcare practice. The results point to the need to develop implementation strategies across healthcare organisations to address challenges to AI-specific capacity building. Laws and policies are needed to regulate the design and execution of effective AI implementation strategies. There is a need to invest time and resources in implementation processes, with collaboration across healthcare, county councils, and industry partnerships.

  • 14.
    von Thiele Schwarz, Ulrica
    et al.
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
    Giannotta, Fabrizia
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Department of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Zetterlund, Johanna
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Hasson, Henna
    Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden; Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Sweden.
    Professionals' management of the fidelity-adaptation dilemma in the use of evidence-based interventions-an intervention study2021In: Implementation Science Communications, E-ISSN 2662-2211, Vol. 2, no 1, article id 31Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and health promotion. However, their implementation often requires a delicate balance between the need to adjust the intervention to the context in which it is implemented and the need to keep the core components that make the intervention effective. This so-called dilemma between fidelity and adaptation is often handled by health professionals in the sustainment phase of an implementation (i.e., once the intervention has been adopted and institutionalized in an organization), but not much is known about how and to what extent health professionals are affected by this dilemma. Focusing on the sustainment phase, this project aims to study (1) how fidelity and adaptation are managed by professionals using an EBI, (2) how the fidelity-adaptation dilemma affects professionals' psychosocial working conditions, and (3) how a structured decision support influences professionals' management of the dilemma and their psychosocial working conditions.

    METHODS: The study is set in Sweden, and the EBI in focus is a parental program (All Children in Focus). A longitudinal within-person intervention design is used, combined with a cross-sectional survey design. Data sources include web-based questionnaires, brief interviews, fidelity ratings, paper-and-pen questionnaires, and written documentation, collected at multiple time points with both group leaders and parents as respondents.

    DISCUSSION: This project approaches fidelity and adaptation from the perspective of the professionals that manage EBIs during the sustainment phase of implementation. Although it is well known that EBIs continue to change over time, it remains to be understood how the fidelity-adaptation dilemma can be managed so that the effectiveness of interventions is retained or improved, not diluted. Moreover, the project adds to the literature by presenting an occupational health perspective on the fidelity-adaptation dilemma. It is acknowledged that fidelity and adaptation may have consequences for not only clients but also the occupational wellbeing of the professionals managing the dilemma, and subsequently, their willingness and ability to deliver EBIs in a sustainable way.

  • 15.
    Westas, M.
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Mourad, G.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Andersson, G.
    Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Lundgren, J.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Johansson, P.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    The experience of participating in an internet-based cognitive behavioral therapy program among patients with cardiovascular disease and depression: a qualitative interview study2022In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 22, no 1, article id 294Article in journal (Refereed)
    Abstract [en]

    Background: Depression in conjunction with cardiovascular disease (CVD) is associated with worsening in CVD, higher mortality, and poorer quality of life. Despite the poor outcomes there is a treatment gap of depression in CVD patients. Recently we found that an Internet-based cognitive behavioral therapy (iCBT) tailored for CVD patients led to reduced symptoms of depression. However, we still have little knowledge about CVD patients’ experiences of working with iCBT. The aim of this study was therefore to explore CVD patients’ experiences of engaging in a tailored iCBT program. Methods: A qualitative interview study using inductive thematic analysis. Data was obtained from 20 patients with CVD and depressive symptoms who had participated in a randomized controlled trial (RCT) evaluating the impact of a nine-week iCBT program on depression. Results: Three main themes emerged: (1) Taking control of the disease, (2) Not just a walk in the park, and (3) Feeling a personal engagement with the iCBT program. The first theme included comments that the tailored program gave the patients a feeling of being active in the treatment process and helped them achieve changes in thoughts and behaviors necessary to take control of their CVD. The second theme showed that patients also experienced the program as demanding and emotionally challenging. However, it was viewed as helpful to challenge negative thinking about living with CVD and to change depressive thoughts. In the third theme patients reported that the structure inherent in the program, in the form of organizing their own health and the scheduled feedback from the therapist created a feeling of being seen as an individual. The feeling of being acknowledged as a person also made it easier to continuously work with the changes necessary to improve their health. Conclusions: Engaging in an iCBT program tailored for patients with CVD and depression was by the patients perceived as helpful in the treatment of depression. They experienced positive changes in emotions, thoughts, and behaviors which a result of learning to take control of their CVD, being confirmed and getting support. The patients considered working with the iCBT program as demanding and emotionally challenging, but necessary to achieve changes in emotions, thoughts, and behaviors.

  • 16.
    Westas, Mats
    et al.
    Linköpings universitet, Avdelningen för omvårdnad.
    Lundgren, Johan
    Linköpings universitet, Avdelningen för omvårdnad.
    Mourad, G.
    Linköpings universitet, Avdelningen för omvårdnad.
    Neher, Margit
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Johansson, Peter
    Linköpings universitet, Avdelningen för omvårdnad.
    Patients with cardiovascular disease and their perceptions on how depression is addressed by health care professionals P98 in cardiac care2019Conference paper (Refereed)
  • 17.
    Westas, Mats
    et al.
    Linköpings universitet, Avdelningen för omvårdnad och reproduktiv hälsa.
    Lundgren, Johan
    Linköpings universitet, Avdelningen för omvårdnad och reproduktiv hälsa.
    Mourad, Ghassan
    Linköpings universitet, Medicinska fakulteten.
    Neher, Margit
    Linköpings universitet, Avdelningen för samhälle och hälsa.
    Johansson, Peter
    Linköpings universitet, Avdelningen för omvårdnad och reproduktiv hälsa.
    How Healthcare Professionals in Cardiac Care Address Depressive Symptoms: Experiences of Patients With Cardiovascular Disease2021In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 36, no 4, p. 340-348Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Depressive symptoms are common in patients with cardiovascular disease (CVD) and are associated with a poorer quality of life and prognosis. Despite the high prevalence and negative consequences, the recognition of depressive symptoms is low. More knowledge about patients' perceptions of how depressive symptoms are addressed by healthcare professionals is therefore needed.

    OBJECTIVES: The aim of this study was to explore the experiences of patients with CVD of how healthcare professionals address and manage depressive symptoms in clinical cardiac care encounters.

    METHODS: A qualitative, semistructured interview study was performed. Data were analyzed using inductive thematic analysis.

    RESULTS: In total, 20 patients with CVD previously treated for depressive symptoms were included (mean age, 62 [range, 34-79] years; 45% women). Three main themes emerged: (1) "not being seen as a whole person," (2) "denying depressive symptoms," and (3) "being provided with help." The patients perceived that healthcare professionals mainly focused on somatic symptoms and disregarded their need for help for depressive symptoms when patients raised the issue. Some patients stated that they received help for depressive symptoms, but this depended on the patients' own ability to communicate their needs and/or having social support that could alert them to the importance of doing so. Patients also described that they downplayed the burden of depressive symptoms and/or did not recognize themselves as having depressive symptoms.

    CONCLUSION: Depressive symptoms were overlooked in patients with CVD, and psychological needs had not been met. A good ability to address needs and having good social support were useful for receiving help with depressive symptoms.

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  • 18.
    Wressle, Ewa
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier.
    Lindstrand, Jane
    Landstinget i Östergötland.
    Neher, Margit
    Landstinget i Östergötland.
    Marcusson, Jan
    Linköpings universitet, Geriatrik.
    Henriksson, Chris
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier.
    The Canadian Occupational Performance Measure as an outcome measure and team tool in a day treatment program2003In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 10, p. 497-506Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the usefulness of the Canadian Occupational Performance Measure (COPM) in a day treatment programme for clients with rheumatoid arthritis.

    Method: The study was conducted in two parts. In the first part rehabilitation without changes in the programme was performed (n = 16). After that the COPM was introduced to all team members. In part two the COPM was used (n = 40). Clients' experiences of participation in the process were studied via a structured interview 2 - 4 weeks after discharge in both parts. Qualitative interviews were conducted with team members before part one and after completion of part two.

    Results: Staff expressed that the COPM improved client participation in the rehabilitation process. Goals were formulated distinctly, and focused on activity and performance rather than function. Team conferences were focused on the client's needs. Outcome was considered clear and evident to the client. The changes in client routines demands thorough introduction, support and involvement, and takes time. Involvement and motivation for changing practice were difficult to obtain, this could be a result of a large staff turnover during the data collection period.

    Conclusions: The COPM should be seen as an aid to ensuring client participation in the goal formulation process, and facilitating treatment planning and evaluation of outcome.

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