A Model for Reflective Participatory Design - The Role of Participation, Voice and Space

This paper aims to contribute to the participatory tradition in health informatics by presenting a model for reflective participatory design emerging from qualitative fieldwork in a participatory project aimed to improve the health and wellbeing of older people in the northern periphery regions of Europe, through new mobile services. The model brings together two established processes in novel ways: systems development and user participation. Within each process three concepts are presented to facilitate discussion and reflection at the concept level, the process level and the integrated process level

Gender perspective on older people’s exercise preferences and motivators in the context of falls prevention: a qualitative study

Background: Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises. Aim: To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective. Methods: Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Results: Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men. Conclusion: Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women's and men's preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions

Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review

Background: To offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both womens and mens views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older peoples views or preferences regarding uptake and adherence to exercise to prevent falls. Methods: A review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach. Results: Nine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of mens and womens views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies. Conclusion: Although there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older womens and mens views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.Funding Agencies|Swedish Research Council [2015-03481]; Strategic Research Programme in Care Sciences, Umea University; Karolinska Institute, Sweden; Umea University</p

Ageing well : mobile ICT as a tool for empowerment of elderly people in home health care and rehabilitation

The ageing of Europe's population is a crucial challenge for the 21st century. Today, the mean life expectancy in Sweden is 83 years for women and 78 for men. Ageing well is a frequently used process, describing the objectives of future elderly care and rehabilitation. Enabling elderly people to live longer and independently in their homes is one goal for society as a whole. Providing health care of high quality, on equal terms for all citizens, is an important political goal in Sweden. It is a great challenge for providers to achieve elderly care of high quality and to develop products, services and technologies that meet the needs of elderly people. There is an assumption that Information and Communication Technologies (ICT) will enhance quality of life. Additionally "electronic accessibility" is one of the goals for the European Information Society to support and enable self-determination and mobility. Dimensions of empowerment such as participation and ability to influence/control one's life situation imply an approach to health care with the patient/client in focus. The aim of this thesis was to explore different dimensions of empowerment and an empowerment methodology for elderly persons in home health care, and if ICT was a useful tool in this process. A multi-method approach was used that included interviews with patients with experience of rehabilitation, interviews with elderly persons with homecare and safety alarms, exploring their needs in relation to empowerment dimensions such as autonomy, self-determination, participation and mobility, an intervention where a mobile safety alarm was tested by elderly individuals and reflective learning workshops with front line staff in home care. Different methods of analysis were used, including Grounded Theory, Latent Content analysis and Constructivist Grounded Theory together with reflections. One of the overall findings was that all patients/clients that participated in these studies had not reflected upon whether it would be possible or not, to influence care and rehabilitation. The results indicate low patient participation in and influence on, the rehabilitation process. Elderly people perceived freedom of movement as a prerequisite for participation and in one of the studies the elderly participants felt that they could influence care and be participating in one aspect, but they still wanted more support with, for example, being more physically active, like walking out doors. The overall findings show a genuine patient/client desire, but limited possibilities to influence care and rehabilitation. Put another way, patients/clients want to have influence and participate authentically, but they do not exactly know how to achieve this. All patients/clients were positive towards the professionals in care and rehabilitation. They were really grateful and admired the professionals and also identified themselves with how stressed and how overloaded with work the professionals were. This might mean that the concept interdependency is looked upon as more important than real autonomy. The patients/clients tried to be compliant and this can be understood as "learning unpretentiousness". After reflecting upon their situation they were more able to articulate their needs that were not responded to or taken care of. When ICT, as an empowering tool, was implemented, findings showed that elderly people experienced the use of a mobile safety alarm as empowering. The mobile safety alarm gave them the freedom of movement needed to be physically active and still feel safe. The positioning device was not experienced as a threat to their integrity. Mobility and safety were experienced as more important than privacy. The research findings indicate that in order to improve home health care services from the patient's/client's perspective, we need to work with the triads of participation, empowerment and mobile Information and Communication Technology. We need to critically and creatively reflect on what clients say and then try to respond positively to what we learn and shift the focus away from ‘what's life like?' and ‘what should life be like?', towards the explicit action question, ‘what needs to be done to make life as good as it can be?' Real improvement is more likely to be sustained with some changes in accountability.Godkänd; 2008; 20080929 (ysko)e-Home HealthCare @ North Calott

Mobil informations-och kommunikationsteknik (IKT) : en väg till ökad rörelsefrihet för äldre?

Ett gott åldrande är ett generellt mål för samhället. Det ökande antalet äldre i Europa gör det viktigt att utveckla tjänster och produkter som inkluderar äldre och som ökar äldres möjlighet att klara sig själva. Det finns en förväntan om att självbestämmande och rörelsefrihet kan stöttas genom användning av informations- och kommunikationsteknik (IKT). Dimensioner av empowerment som delaktighet, självbestämmande, inflytande och rörelsefrihet är viktiga för ett gott åldrande. Forskning visar att mobil IKT kan stötta äldre genom att bidra till en ökad rörelsefrihet och trygghet. Äldre bör själva medverka i utvecklingen av ny teknik och service för att den skall motsvara deras behov. Mer forskning behövs som identifierar äldres behov, hur IKT kan vara ett stöd för både professionella och patienter/brukare i förbättring av vård och rehabilitering, och som utgår från äldres perspektiv på ett gott åldrande. Den fråga som kan ställas är: "Vad behöver göras för att göra livet så gott som möjligt?"Godkänd; 2009; 20090810 (animel

Project: e-Home HealthCare @ North Calotte

Projektet är en gemensam nordisk ansats för vård i hemmet, i regionerna Kemi-Tornio, Luleå-Boden, Rovaniemi-Ranua och Tromsø. Syfte och mål Projektets syfte var att skapa en bättre och effektivare vård genom att utveckla och testa nya verksamhetsstöd och mobila lösningar till personal som arbetar med vård i hemmet. Till problembilden hör att andelen äldre människor i befolkningen ökar, de stora avstånden i de nordiska länderna och det minskande antalet människor som arbetar med äldrevård. Genomförande Det gjordes olika tester i de olika geografiska områdena. Gemensamt var att man använde bärbara datorer, handterminaler och olika lösningar för kommunikation för överföring av information. Upplägget var också likartat. Man tog fram det system man ville testa, utbildade personalen som skulle använda det och genomförde och utvärderade testerna. Försöken i Luleå bestod dels av en teknisk del och dels en forskardel. Den tekniska delen gick ut på att testa en mobil handenhet medan forskardelen handlade om att studera hur personalen upplever att använda ny teknik i arbetet. Utöver detta skulle förändrade arbetssätt och rutiner utvärderas. Resultat Deltagarna upplever att det förbättrade informationsflödet sparar tid och gör informationen mer tillgänglig, även under hembesöken. Detta förde med sig ökad flexibilitet, säkerhet och kunskap om brukarna. Personalen i Luleå poängterar att det blev betydligt lugnare och mindre stress då arbetsdagen började, tack vara den centraliserade planeringen. Det upptäcktes inga negativa etiska konsekvenser med användandet av ICT i vården. Tvärtom ökas informationssäkerheten tack vare användandet av lösenord och definitionen av yrkesroller som användes för att styra vilken information olika personer skulle ha tillgång till. Vetenskapliga resultat Ett antal vetenskapliga artiklar har publicerats och presentationer av projektet har gjorts vid ett flertal konferenser, bl a the International Telemedicine Conference i Tromsö och the Nordic Conference on Telemedicine i Umeå. Projektet har också senare utmynnat i en licentiatavhandling och doktorsavhandlingen ”Ageing well - Mobile ICT as a tool for empowerment of elderly people in home health care and rehabilitation”, Anita Melander-Wikman.Publikationer: A case study of how knowledge based engineering tools support experience re-use; Value-driven design: a methodology to link expectations to technical requirements in the extended enterprise; Value assessment capabilities in early PSS development: a study in the aerospace industry; Assessing the value of product service systems alternatives: a conceptual framework; Assessing the value of sub-system technologies including life cycle alternatives; Mapping customer needs to engineering characteristics: an aerospace perspective for conceptual design; Value-oriented concept selection in aero-engine sub-systems design: the EVOKE approach; Towards assessing the value of aerospace components: a conceptual scenario; People, product and process perspectives on product/service-system development; Towards sustainability-driven innovation through product-service systems; Measuring innovation capability: assessing collaborative performance in product-service system; Towards a framework for developing product/service systems; Analyzing Product-Service Systems conceptual design: the effect of color-coded 3D representation; Take the knowledge path to support knowledge management in product/service systems; Value visualization in product service systems preliminary design; Communicating the value of PSS design alternatives using color-coded CAD models; Criteria for assessing the value of Product Service System design alternatives: an aerospace investigation; Using 3D CAD models for value visualization: an approach with SIEMENS NX HD3D Visual Reporting; Exploring lightweight knowledge sharing technologies for functional product development; Value creation in PSS design through product and packaging innovation processes; Introducing PSS thinking in product-based organizations: a case study in the Swedish manufacturing industry; Using 3D CAD models for value visualization: an approach with SIEMENS NX HD3D Visual Reporting; Lightweight technology support for product/service systems development; Status: Avslutat; Period: 01/01/2004 → 31/12/2005; Faktiskt slutdatum: 31/12/2005</p

Empowerment in living practice : mobile ICT as a tool for empowerment of elderly people in home health care

The aging of Europe's population is a crucial challenge for the 21st century. Today, the mean life expectancy in Sweden is 83 years for women and 78 for men. Providing health care of high quality on equal terms for all citizens is an important political goal in Sweden. It is a great challenge for providers to achieve elderly care of high quality and to develop products, services and technologies that meet the needs of elderly people. Increased use of various forms of Information and Communication Technology (ICT) can enable the citizens to take more active part in their own health care. Dimensions of empowerment such as participation and ability to influence/control one's life situation imply an approach to health care with the patient/client in focus. The aim of this thesis was to explore different dimensions of empowerment and empowerment methodology for elderly persons in home health care, and if ICT is a useful tool in this process. Methods used included interviews with patients with experience of rehabilitation, reflective learning workshops with first line staff in home care and an intervention where a mobile safety alarm was tested by elderly individuals. Different analysis methods were used, including Grounded Theory, Latent content analysis and constructivist Grounded Theory together with reflections. My findings were that the process of rehabilitation was experienced as a parallel process based on traditional and individual models, implying that a patient copes with a situation by shifting between being compliant and adopting more self-regulatory behaviour. The results indicated low patient participation in and influence on the rehabilitation process in the hospital. When ICT as an empowering tool was implemented, findings showed that elderly people experienced the use of a mobile safety alarm as an empowering tool. The mobile safety alarm gave the freedom of movement needed to be physical active and still feel safe. The positioning device was not experienced as a threat to their integrity. Mobility and safety were experienced as more important than privacy. Freedom of movement and mobility were described as matters of freedom and empowerment. My research findings indicate that in order to improve home health care services from the patient's/client's perspective, we need to work with the triads of participation, empowerment and mobile Information and Communication Technology. We need to critically and creatively reflect on what clients say and then try to respond positively to what we learn. Real improvement might only occur when accountability changes.Godkänd; 2007; 20070220 (ysko

Mobilt larm och rörelsefrihet : upplevelser av ett mobilt trygghetslarm

Den framtida demografiska utvecklingen innebär en allt högre andel äldre i befolkningen i Sverige. En av de största utmaningarna för ett samhälle med en åldrande befolkning är att ordna vården och omsorgen om de äldre i framtiden. Många äldre håller sig aktiva och friska upp i allt högre ålder men en ökad medellivslängd innebär inte detsamma som en ökad hälsa. Oftast har den demografiska utvecklingen framställts som ett stort problem men nu börjar det även komma en diskussion som innebär att äldreboomen, sedd som ett kluster, även kan innebära en möjlighet ett tillväxtområde. Nya tjänster och ny teknik som vänder sig till en växande del äldre i befolkningen utvecklas och testas. Man vet från forskning att faktorer som har med den enskildes upplevelse av egenmakt, integritet och rörelsefrihet, det vill säga empowerment är av stor betydelse för bibehållen hälsa. Trygghet är också av betydelse. För att göra det möjligt att bo kvar så länge som möjligt i hemmet används ofta olika former av teknik. Trygghetslarm är vanligt och används av framförallt äldre men även av funktionshindrade. Syftet med projektet Mobilt larm (MTL CDH) var att undersöka hur dagens trygghetslarm används, utveckla och testa ett mobilt trygghetslarm samt undersöka hur detta larm upplevs utifrån ett empowerment perspektiv. Metoder som använts är analys av alla inkomna larm i Luleå kommun under en 5 dagars period, en intervention i form av ett mobilt larm med fallsensor som testades av 9 äldre personer under 3 veckor, intervju med testpersonerna och två enkäter kring funktion, användarvänlighet samt graden av rörelsefrihet som besvarats av testpersonerna. Resultatet visar att dagens trygghetslarm används förutom till att påkalla hjälp även som kommunikationsmedel för att skapa trygghet. Det testade mobila larmet sågs som en möjlighet till ökad rörelsefrihet. Det faktum att man var positionerad genom larmet upplevdes inte som integritetskränkande så länge man upplevde att det var personen själv som bestämde att använda larmet. Det testade larmet var endast en prototyp under utveckling och testpersonerna bidrog med förslag till förbättringGodkänd; 2006; 20060929 (andbra

Information and communication technology in homecare : care assistants' experiences, opinions and expectations

Godkänd; 2005; Bibliografisk uppgift: Författare till värdpulbikationen: Maria Jonsson; 20071019 (andbra

Mobilt larm och rörelsefrihet : upplevelser av ett mobilt trygghetslarm

Den framtida demografiska utvecklingen innebär en allt högre andel äldre i befolkningen i Sverige. En av de största utmaningarna för ett samhälle med en åldrande befolkning är att ordna vården och omsorgen om de äldre i framtiden. Många äldre håller sig aktiva och friska upp i allt högre ålder men en ökad medellivslängd innebär inte detsamma som en ökad hälsa. Oftast har den demografiska utvecklingen framställts som ett stort problem men nu börjar det även komma en diskussion som innebär att äldreboomen, sedd som ett kluster, även kan innebära en möjlighet ett tillväxtområde. Nya tjänster och ny teknik som vänder sig till en växande del äldre i befolkningen utvecklas och testas. Man vet från forskning att faktorer som har med den enskildes upplevelse av egenmakt, integritet och rörelsefrihet, det vill säga empowerment är av stor betydelse för bibehållen hälsa. Trygghet är också av betydelse. För att göra det möjligt att bo kvar så länge som möjligt i hemmet används ofta olika former av teknik. Trygghetslarm är vanligt och används av framförallt äldre men även av funktionshindrade. Syftet med projektet Mobilt larm (MTL CDH) var att undersöka hur dagens trygghetslarm används, utveckla och testa ett mobilt trygghetslarm samt undersöka hur detta larm upplevs utifrån ett empowerment perspektiv. Metoder som använts är analys av alla inkomna larm i Luleå kommun under en 5 dagars period, en intervention i form av ett mobilt larm med fallsensor som testades av 9 äldre personer under 3 veckor, intervju med testpersonerna och två enkäter kring funktion, användarvänlighet samt graden av rörelsefrihet som besvarats av testpersonerna. Resultatet visar att dagens trygghetslarm används förutom till att påkalla hjälp även som kommunikationsmedel för att skapa trygghet. Det testade mobila larmet sågs som en möjlighet till ökad rörelsefrihet. Det faktum att man var positionerad genom larmet upplevdes inte som integritetskränkande så länge man upplevde att det var personen själv som bestämde att använda larmet. Det testade larmet var endast en prototyp under utveckling och testpersonerna bidrog med förslag till förbättringGodkänd; 2006; 20060929 (andbra