‘Managing pieces of a personal puzzle’ — older people’s experiences of self-management falls prevention exercise guided by a digital program or a booklet

Background: Exercise is effective in order to prevent falls in community-dwelling older people. Self-management programs have the potential to increase access and reduce costs related to exercise-based fall prevention. However, information regarding older people's views of participating in such programs is needed to support implementation. The aim of this study was to explore older people's experiences of a self-management fall prevention exercise routine guided either by a digital program (web-based or mobile) or a paper booklet. Methods: This qualitative study was part of a feasibility study exploring two completely self-managed exercise interventions in which the participants tailored their own program, guided either by a digital program or a paper booklet. Individual face-to-face semi-structured interviews were conducted with a purposeful sample of 28 participants (18 women), mean age 76yrs. Qualitative content analysis was used to analyse the data. Results: Self-managing and self-tailoring these exercise programs was experienced as Managing pieces of a personal puzzle'. To independently being able to create a program and manage exercise was described in the categories Finding my own level' and Programming it into my life'. The participants experienced the flexibility and independence provided by completely self-managed exercise as positive and constructive although it required discipline. Furthermore, different needs and preferences when managing their exercise were described, as well as varying sources of motivation for doing the exercise, as highlighted in the category Defining my source of motivation'. The category Evolving my acquired knowledge' captures the participants' views of building their competence and strategies for maintenance of the exercise. It describes a combined process of learning the program and developing reflection, which was more clearly articulated by participants using the digital program. Conclusions: This study provides new knowledge regarding experiences, preferences and motivations of older people to engage in home-based self-managed fall prevention exercise. They expressed both a capability and willingness to independently manage their exercise. A digital program seems to have strengthened the feeling of support while creating their own exercise program and tailoring it to their preferences and circumstances, which might therefore create better opportunities for adoption and adherence in the long term

Evolving Systems – Engaged Users : Key Principles for Improving Region-wide Health IT Adoption

Many countries have formulated their eHealth visions and billions of dollars have been spent on supporting the eHealth development throughout the world. An important part of the development is the electronic patient record (EPR). To enable sharing and increase cooperation between care providers, most Swedish county councils have decided to use a region-wide EPR. The health professionals often experience numerous problems and consider the region-wide EPR to be too generic and require them to tailor their practices instead of the system evolving towards supporting their needs. The aim of the PhD research is to gain knowledge of adoption when deploying and using region-wide health IT systems. This is accomplished by studying, analysing and reflecting upon what region-wide health IT systems are and how professionals use them in their practice. In the research a grounded theory method has been used, which means that the empirical data, not theories and hypotheses, have driven the research process. The data-gathering methods have been interviews, observations, participating in meetings, questionnaires, seminars and conducting literature reviews. In order to be able to improve the adoption, a set of four key principles has been identified: (1) Evolving systems-Engaged users, (2) Treat IT deployment and usage as part of organisational development, (3) Identify, respect and support differences, and (4) Identify what must be customised and what can be centralised. These four principles challenge the traditional way of developing enterprise-wide IT and emphasise the importance that users must engage in the development, procurement and deployment process to identify their similar and unique needs and procedures. It is crucial that both the similarities and uniqueness are respected and supported. The similarities can be supported by a centralised, standardised solution, while uniqueness requires a customised solution. In order to accomplish that, the IT deployment and usage needs to be treated as an important part of the on-going organisational development, and the IT systems must evolve, i.e., be continuously developed in order to engage the users to participate.

Tailor the system or tailor the user? : How to make better use of electronic patient record systems

Health care organisations are extremely complex because they consist of heterogeneous groups of people (clinical professions, patients, managers), use advanced technology (medical devices and patient record systems), and apply many organisational and clinical routines. When introducing Electronic Patient Record systems (EPR) in health care organisations, all these aspects get affected. Using a sociotechnical perspective is necessary in order to get a "successful" EPR usage. The aim of my PhD studies is to provide health care organisations with knowledge and insights into how they can improve their organisation and practice in relation to usage of EPR systems. In my research I have used a grounded theory methodology for studying, analysing and reflecting on how electronic patient record systems are used by professionals in their practice. Studies have been conducted during a 2.5 years collaborative research project. Within the studied health care organisation there are differing opinions if an EPR system is mainly a technical system or a tool to support the clinical organisation. This conceptual division leads to an uncertainty in who is responsible for the proper function of the EPR system and have a major effect for the clinicians in their clinical practice. During the research seven potential problems areas, mandate, usability, education, participation, improvements, support and evaluation have been identified as crucial for the health care organisation to manage to achieve an effective EPR usage. The main results are 1) The health care organisation needs to establish a problem-solving strategy that questions the reasons behind the problems occurred, 2) The different stakeholder groups need to interact, create a better understanding for each other's perspective and agree on the same goal for the EPR system, 3) The clinical organisation needs help to improve their clinical practice in relation to the EPR system, 4) The EPR deployment and usage affect the clinicians in different ways. Their attitude towards the EPR system is dependent on the usability of the EPR system, the deployment process, their experience of participation, education, support and possibilities to improve the system

Tailor the system or tailor the user? : How to make better use of electronic patient record systems

Health care organisations are extremely complex because they consist of heterogeneous groups of people (clinical professions, patients, managers), use advanced technology (medical devices and patient record systems), and apply many organisational and clinical routines. When introducing Electronic Patient Record systems (EPR) in health care organisations, all these aspects get affected. Using a sociotechnical perspective is necessary in order to get a "successful" EPR usage. The aim of my PhD studies is to provide health care organisations with knowledge and insights into how they can improve their organisation and practice in relation to usage of EPR systems. In my research I have used a grounded theory methodology for studying, analysing and reflecting on how electronic patient record systems are used by professionals in their practice. Studies have been conducted during a 2.5 years collaborative research project. Within the studied health care organisation there are differing opinions if an EPR system is mainly a technical system or a tool to support the clinical organisation. This conceptual division leads to an uncertainty in who is responsible for the proper function of the EPR system and have a major effect for the clinicians in their clinical practice. During the research seven potential problems areas, mandate, usability, education, participation, improvements, support and evaluation have been identified as crucial for the health care organisation to manage to achieve an effective EPR usage. The main results are 1) The health care organisation needs to establish a problem-solving strategy that questions the reasons behind the problems occurred, 2) The different stakeholder groups need to interact, create a better understanding for each other's perspective and agree on the same goal for the EPR system, 3) The clinical organisation needs help to improve their clinical practice in relation to the EPR system, 4) The EPR deployment and usage affect the clinicians in different ways. Their attitude towards the EPR system is dependent on the usability of the EPR system, the deployment process, their experience of participation, education, support and possibilities to improve the system

A Usability Study in Primary Care : Conceptual Design of the Representation of Health Problem in Computer Based Medical

If you ask different kinds of care givers if they work in the same way or if they have the same needs of information when they meet a patient they would say no. In my usability study at Tierp’s health centre I have made contextual interviews with different types of care givers to identify their needs and requirements on the medical record systems. The aim is to make a conceptual design solution for a health issue-orientated medical record system. The different types of care giver think they have different needs. But after analyzing their needs I found out that before they meet a patient they all look into the medical records for patient information. They all want information about earlier diseases, referrals, test results and drugs. Their work is not so different from each others. How they work depends on what kind of health issue the patient has and their individual experience and practice. Some wants to look at many old medical records and other just want to look at their own. I have made a concept that allows the user to make personal settings for some parts in the design. My concept is two different kinds of overviews; one that is a patient overview thats how all present and earlier health issues, drugs and planned contact with the care.The other overview is called health issue overview and shows information about the health issue that the care giver is going to treat

Tailor the system or tailor the user? : How to make better use of electronic patient record systems

Health care organisations are extremely complex because they consist of heterogeneous groups of people (clinical professions, patients, managers), use advanced technology (medical devices and patient record systems), and apply many organisational and clinical routines. When introducing Electronic Patient Record systems (EPR) in health care organisations, all these aspects get affected. Using a sociotechnical perspective is necessary in order to get a "successful" EPR usage. The aim of my PhD studies is to provide health care organisations with knowledge and insights into how they can improve their organisation and practice in relation to usage of EPR systems. In my research I have used a grounded theory methodology for studying, analysing and reflecting on how electronic patient record systems are used by professionals in their practice. Studies have been conducted during a 2.5 years collaborative research project. Within the studied health care organisation there are differing opinions if an EPR system is mainly a technical system or a tool to support the clinical organisation. This conceptual division leads to an uncertainty in who is responsible for the proper function of the EPR system and have a major effect for the clinicians in their clinical practice. During the research seven potential problems areas, mandate, usability, education, participation, improvements, support and evaluation have been identified as crucial for the health care organisation to manage to achieve an effective EPR usage. The main results are 1) The health care organisation needs to establish a problem-solving strategy that questions the reasons behind the problems occurred, 2) The different stakeholder groups need to interact, create a better understanding for each other's perspective and agree on the same goal for the EPR system, 3) The clinical organisation needs help to improve their clinical practice in relation to the EPR system, 4) The EPR deployment and usage affect the clinicians in different ways. Their attitude towards the EPR system is dependent on the usability of the EPR system, the deployment process, their experience of participation, education, support and possibilities to improve the system

Three Key Concerns for a Successful EPR Deployment and Usage

The health care environment is unique because of the large and complex organisation with a traditional hierarchic structure that is governed by laws and regulations. This paper examines how a large Swedish health care organisation work with usability issues regarding Electronic Patient Record (EPR) deployment and usage. EPR systems have great impact on work environment and clinical work routines will not be performed in the same way as before. This paper analyse how the EPR management and core business understand their EPR responsibilities and work with usability aspects at different levels in the organisations. The paper reveals that there is a conflict about responsibility between EPR management and core business management. The reasons for the confusion are contradictive understanding of what an EPR system is, an IT system or a tool for the core business to perform better health care work. This leads to that care staff's experience regarding the EPR system's usability, is not being listened to within the organisation. Three key concerns for a successful EPR deployment and usage are identified and further analysed; education, evaluation and support & improvement ideas