Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups

<p>Abstract</p> <p>Background</p> <p>In recent years there has been increasing interest in transferring new knowledge into health care practices, a process often referred to as implementation. The various subcultures that exist among health care workers may be an obstacle in this process. The aim of this study was to explore how professional groups and managers experienced the implementation of a new tool for lifestyle intervention in primary health care (PHC). The computer-based tool was introduced with the intention of facilitating the delivery of preventive services.</p> <p>Methods</p> <p>Focus group interviews with staff and individual interviews with managers at six PHC units in the southeast of Sweden were performed 9 months after the introduction of the new working tool. Staff interviews were conducted in groups according to profession, and were analysed using manifest content analysis. Experiences and opinions from the different staff groups and from managers were analysed.</p> <p>Results</p> <p>Implementation preconditions, opinions about the lifestyle test, and opinions about usage were the main areas identified. In each of the groups, managers and professionals, factors related to the existing subcultures seemed to influence their experiences of the implementation. Managers were visionary, GPs were reluctant, nurses were open, and nurse assistants were indifferent.</p> <p>Conclusion</p> <p>This study indicates that the existing subcultures in PHC influence how the implementation of an innovation is perceived by managers and the different professionals. In PHC, an organization with several subcultures and an established hierarchical structure, an implementation strategy aimed at all groups did not seem to result in a successful uptake of the new method.</p

Relative distancing: a grounded theory of how learners negotiate the interprofessional.

A number of extant educational, psychological and sociological theories have been suggested as possessing utility for interprofessional education (IPE). However, there is limited theory proposed that has been derived directly from data. This article adds to the theoretical toolkit by theorizing from data using constructionist grounded theorizing. This article discusses the grounded theorizing of participants' approaches to IPE and describes the social process of relative distancing, a collection of strategies employed by participants to construct their own professional identities and negotiate their way through interprofessional interactions. The categories of relative distancing are conceptualized as (1) integrating the professional and the interprofessional; (2) constellating and maintaining distance; (3) tensioning and manipulating distance and (4) the dimensions of distance. The first, and most theoretically integrative, category will be discussed in detail here. It was found that participants valued certain learning outcomes over others. They favored learning opportunities that were perceived to be of direct relevance to their own professional development and contributed finite personal resources to these. Resources were committed to those interprofessional learning opportunities where relevance was perceived and the conditions of co-presence (with other professions) and a context for interaction were achieved. The discussion draws links between the data and contemporary discourses of economics and identity