Health Promotion and the Built Environment – Views From Swedish Healthcare Organisations

Objective – The study examined the role and integration of the built environment in health promotion as perceived and described by representatives of Swedish health promotive healthcare organisations (HPHs). Background – A majority of Swedish healthcare organisations have implemented health promotion strategies in their plans and actions. These HPHs engage in an ongoing reorientation from a disease focus to a health focus, which includes a person-centred approach that considers people as active participants controlling their own health and care. Swedish HPHs are supported by the Swedish HPH network in introducing health promotion. The HPH network aims are guided by health promotion standards, which indicate the importance of creating health-promoting environments. These aims are confirmed in a letter of intent and membership contract. The aims are also expected to have implications for the planning of healthcare buildings. However, knowledge of the relationship between HPH strategies and the built environment is limited. Additionally, health promotion, when used by building designers, often seems to be reduced to a focus on the enhancement of health. To continue developing health promotion and fulfilling the intentions of the letter of intent as a driver for HPHs, it is important to understand and actively include the built environment in analysis, planning and design. Research question – How do Swedish HPH representatives perceive and describe the relationship between HPHs and the built environment? Methods – An explorative study including both qualitative and quantitative data was carried out. First, data were collected through a survey with county representatives of Swedish HPHs (n=17). Then, qualitative data were obtained from interviews with the Swedish HPH network committee members. The combined data were analysed through descriptive statistics and content analysis. Results – The results showed varied and limited perspectives on the relationship between the built environment and health promotion and diverse HPH intentions related to health equity, health, empowerment, population health, and preventive measures. The results indicated that the documentation meant to support HPHs was not used or well known. Surprisingly, representatives who worked on healthcare building projects did not necessarily consider the built environment to be related to design strategies or characteristics or to their health promotion work within the framework of their HPHs. Conclusion – The results indicate the need to recognise the diverse dimensions and interpretations of health promotion to be able to integrate the built environment in HPHs.publishedVersio

Acción : diario de Teruel y su provincia: Año II Número 80 - (23/02/33)

Aim: To explore and compare the impact of the physical environment on patients’ activities and care at three newly built stroke units. Background: Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients’ activities in relation to the design of the physical environment of stroke units are scarce. Design: This work is a comparative descriptive case study. Method: Patients (n=55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioral mapping analyzed with descriptive statistics and field note taking analyzed with deductive content analysis. Data were collected from April 2013 to December 2015. Results: The units differed in the patients’ levels of physical activity, the proportion of the day that patients spent with health professionals, and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single room design. Stroke units that were easy to navigate and offered variations in the physical environment impacted patients’ activities and care. Conclusions: Patients’ activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.status: accepte

The physical environment and multi-professional teamwork in three newly built stroke units

Purpose: To explore multi-professional teamwork in relation to the physical environment in three newly built or renovated stroke units. Materials and methods: An observational study was undertaken. The participants were all staff members of a multi-professional team working in the reviewed stroke units. The data were collected using behavioural mapping and semi-structured observations, and they were analysed by content analysis and descriptive statistics. Results: Out of all the observations in the behavioural mapping, very few were of two or more members from the team together with a patient. None of the included stroke units had a co-location for all the members of the multi-professional team. Three main categories emerged from the analysis of the interviews: (i) the hub of the unit; (ii) the division of places; and (iii) power imbalance. All the categories reflected the teamwork in relation to parts of the physical environment. Conclusion: The design of the physical environment is important for multi-professional teamwork. Emphasis must be placed on better understanding the impact of the physical environment and on incorporating the evidence related to multi-professional teamwork during the design of stroke units.IMPLICATIONS FOR REHABILITATION Understanding the link between the physical environment and effective teamwork can lead to more tailored and supportive design solutions. The design of the physical environment should be considered as a vital part of effective teamwork in stroke units. The physical environment should include shared workstations, allowing team members to meet and communicate face to face

Health promotion and the built environment - views from Swedish healthcare organisations

Objective– The study examined the role and integration of the built environment in health promotion as perceived and described by representatives of Swedish health promotive healthcare organisations (HPHs).Background– A majority of Swedish healthcare organisations haveimplemented health promotion strategies in their plans and actions [1]. These HPHs engage in an ongoing reorientation from a disease focus to a health focus,which includes a person-centred approachthatconsiders people as active participants controlling their own health and care [2].Swedish HPHs are supported by the Swedish HPHnetwork in introducing health promotion. The HPH network aims are guided by health promotion standards [3-6], which indicate the importance of creating health-promoting environments [4, 7]. These aims are confirmed in a letter of intent and membership contract. The aims are also expected to have implications for the planning of healthcare buildings [8]. However, knowledge of the relationship between HPH strategies and the built environment is limited [9, 10]. Additionally, health promotion, when used by building designers, often seems to be reduced to a focus on the enhancement of health [11]. To continue developing health promotion and fulfilling the intentions of the letter of intent as a driver for HPHs, it is important to understand and actively include the built environment in analysis, planning and design [12, 13].Research question– How do Swedish HPH representatives perceive and describe the relationship between HPHs and the built environment?Methods– An explorative study including both qualitative and quantitative data was carried out. First, data were collected through a survey with county representatives of Swedish HPHs (n=17). Then,qualitative datawere obtained from interviews with the Swedish HPH network committee members. The combined data wereanalysed through descriptive statistics and content analysis.Results– The resultsshowed varied and limited perspectives on the relationship between the built environment and health promotion and diverse HPH intentions related to health equity, health, empowerment, population health, and preventive measures. The results indicated that the documentation meant to support HPHs was not used or well known. Surprisingly, representatives who worked on healthcare building projects did not necessarily consider the built environment to be related to design strategies or characteristics or to their health promotion work within the framework of their HPHs.Conclusion– The results indicate the need to recognise the diverse dimensions and interpretations of health promotion to be able to integrate the built environment in HPHs

Sustainability in clinical practice: a cross-national comparative study of nursing students

BACKGROUND: Delivering health care negatively influences the environment and contributes to climate change. This study examined how nursing students in England and Sweden can make changes in clinical practice to enhance environmental sustainability. METHOD: Third-year undergraduate nursing students at English and Swedish universities responded to open-ended questions on the Sustainability Attitudes in Nursing Survey. Data were analyzed using inductive content analysis. RESULTS: Students in both countries identified lack of confidence as the main barrier to challenging unsustainable practice, followed by a resistance to change in practice. English students predominantly changed their own behavior or influenced the practice of others. Swedish students either changed their own behavior or their own attitudes to sustainability. CONCLUSION: There is a need to ensure students have confidence to act as change agents to enhance sustainable practice in the clinical environment. [J Nurs Educ. 2022;61(7):390-393.]

Health promotive ambitions related to building design – the case of Angered Nearby Hospital

The healthcare system in Sweden is re-orienting and transforming to embrace a holistic perspective on health, which includes a focus on Health Promotion. This development has led to new ambitions and processes in healthcare and has thus changed the requirements for related building design. This explorative study, based on a content analysis of 9 semi-structured interviews with stakeholders involved in the planning and design process of Angered Nearby Hospital (N\ue4rsjukhus), investigates how the building design was influenced by Health Promotion ambitions. Questions focused on expectations and challenges for the new building. The results illustrate how Health Promotion was interpreted in the design process and how expectations were described, e.g., as a “welcoming environment” or “active environment”. It is found that the understanding of how to interpret Health Promotion in design is vague and performed without any guidelines other than at the policy level. This lack of clarity is also related to the difficulty of finding studies on the topic. The results also point to a need for clarification of how Health Promotion can be interpreted in design, the need for Health Promotion-related design guidelines, and the need for definitions of requirements at the project level to measure health-promotive effects

Self-management from the perspective of people with stroke : an interview study

Objective: Self-management support can improve quality of life, mood, self-efficacy, and physical function following a stroke. Knowledge of how people with stroke understand and experience self-management in different contexts is crucial to developing effective self-management support. This study explored how people with stroke understand and practice self-management during the post-acute phase. Method: A descriptive study using qualitative content analysis to explore data from semistructured interviews Results: Eighteen participants were interviewed. Most participants interpreted self-management as ‘taking care of their business’ and ‘being independent”. However, they encountered difficulties performing daily activities, for which they felt unprepared. Although interest in implementing self-management support increases, participants did not report receiving specific advice from healthcare professionals. Conclusion: People continue to feel unprepared to manage everyday activities after hospital discharge and must largely work things out for themselves. There is an overlooked opportunity to start the process of self-management support earlier in the stroke pathway, with healthcare professionals and people with stroke combining their skills, ideas and expertise. This would enable confidence to self-management to flourish rather than decrease during the transition from hospital to home. Practical implications: Individual tailored self-management support could help people with stroke more successfully manage their daily lives post-stroke. © 2023 The Author

Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making

Objective  To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making. Background  Decision‐making processes and outcomes may be shaped by a range of non‐medical or ‘contextual’ factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide‐ranging research for health decision‐making purposes. Methods  To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision‐making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. Findings  We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide‐ranging contextual factors relevant to health decision making. The BTPW tool encompasses health‐related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided. Conclusions  These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health‐related research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86973/1/j.1369-7625.2010.00618.x.pd