Inside the black box of workplace interventions : investigating the influence of context and process on outcomes

Introduction: Staff working in healthcare and residential care for older people are continuously required to learn and develop competencies to keep up with medical, technological and social developments. At the same time, they experience a work situation generally characterized by high demands. Workplace interventions aiming to improve competence and work environment have been highlighted as a way to improve working conditions for staff. However, these interventions are complex and challenging to implement, difficult to evaluate and have resulted in mixed effects. Not only the intervention content but also the context and process factors may influence the outcomes of workplace interventions. Yet, although several factors that may influence implementation have been identified, these factors have rarely been linked to the outcomes of such interventions. Aim: The aim of this thesis was to investigate how factors related to the context and implementation process of workplace interventions in healthcare and residential care for older people influenced the implementation and intervention outcomes. Methods: This thesis is based on the evaluation of three workplace interventions. Both qualitative and quantitative methods were used to study the context, process and outcomes. Study I was a workplace learning intervention conducted in three residential care facilities for older people. Six facilities served as a comparison group. The intervention’s effect on organizational learning was evaluated using questionnaires at baseline and at 6- and 12-month follow-up. Context and process factors influencing outcomes were investigated using semi-structured interviews with line managers on two occasions (6- and 14-month follow-up) and with staff on one occasion (6-month follow-up). Study II was an organizational-level occupational health intervention conducted at a hospital with six departments included in the intervention group and six in a comparison group. Implementation fidelity regarding the two core components in the intervention was evaluated using questionnaires administered to all employees in the intervention departments at 6-month follow-up as well as with an analysis of organizational documents. Context and process factors influencing implementation fidelity were assessed with semi-structured interviews with line managers and key individuals, as well as with questionnaires administered to employees at baseline and at 6-month follow-up. Study III was a workplace learning intervention conducted in 78 primary healthcare centers. Employees’ openness to change, concerning both the process and the content of the change, and the work group’s openness to the content of change were measured with questionnaires at baseline. These were used to predict two types of outcomes, improvements in competence regarding information and communication technologies (ICT) and the use of acquired competence, which were evaluated using questionnaires administered to all staff at baseline and at18-month follow-up. Results: Both context and process factors influenced the implementation and intervention outcomes. More specifically, stakeholders’ low ownership of the intervention, an insufficient learning climate, insufficient prerequisites for change and managers’ attitudes and actions were found to hinder the creation of organizational learning in study I. In study II, implementation fidelity varied between the departments that participated in the intervention. Factors related to the omnibus context (i.e., having a well-established quality improvement system, group collaboration), the discrete context (i.e., changes in management), the intervention and implementation (i.e., line managers’ attitudes and actions, perception of information and communication, level of participation, the roles of the drivers of change), and participants’ mental models (i.e., outcome expectancy, perceptions of the intervention activities) were found to explain the differences in implementation fidelity. In study III, baseline individual-level openness to both change process and change content as well as group-level openness to change content predicted intervention outcomes at the time of the follow-up. Conclusions: Overall, the findings suggest that successful workplace interventions are shaped by several factors related to the intervention’s content, the context in which the intervention takes place and the process by which the intervention is implemented. Thus, rather than waiting until after an intervention to evaluate why it succeeded or not, context and process factors should be taken into account already when planning and implementing an intervention. Workplace interventions in which context and process factors, as well as implementation outcomes, are continuously monitored and used to tailor the intervention may have greater potential to improve employees’ work conditions

Essential Content for Teaching Implementation Practice in Healthcare: A Mixed-Methods Study of Teams Offering Capacity-Building Initiatives

Background Applying the knowledge gained through implementation science can support the uptake of research evidence into practice; however, those doing and supporting implementation (implementation practitioners) may face barriers to applying implementation science in their work. One strategy to enhance individuals’ and teams’ ability to apply implementation science in practice is through training and professional development opportunities (capacity-building initiatives). Although there is an increasing demand for and offerings of implementation practice capacity-building initiatives, there is no universal agreement on what content should be included. In this study we aimed to explore what capacity-building developers and deliverers identify as essential training content for teaching implementation practice. Methods We conducted a convergent mixed-methods study with participants who had developed and/or delivered a capacity-building initiative focused on teaching implementation practice. Participants completed an online questionnaire to provide details on their capacity-building initiatives; took part in an interview or focus group to explore their questionnaire responses in depth; and offered course materials for review. We analyzed a subset of data that focused on the capacity-building initiatives’ content and curriculum. We used descriptive statistics for quantitative data and conventional content analysis for qualitative data, with the data sets merged during the analytic phase. We presented frequency counts for each category to highlight commonalities and differences across capacity-building initiatives. Results Thirty-three individuals representing 20 capacity-building initiatives participated. Study participants identified several core content areas included in their capacity-building initiatives: (1) taking a process approach to implementation; (2) identifying and applying implementation theories, models, frameworks, and approaches; (3) learning implementation steps and skills; (4) developing relational skills. In addition, study participants described offering applied and pragmatic content (e.g., tools and resources), and tailoring and evolving the capacity-building initiative content to address emerging trends in implementation science. Study participants highlighted some challenges learners face when acquiring and applying implementation practice knowledge and skills. Conclusions This study synthesized what experienced capacity-building initiative developers and deliverers identify as essential content for teaching implementation practice. These findings can inform the development, refinement, and delivery of capacity-building initiatives, as well as future research directions, to enhance the translation of implementation science into practice

Ethoexperimental studies of behaviour in wild and laboratory mice

The laboratory mouse is the most frequently used laboratory animal in biomedical research today. This thesis deals with behavioural studies of risk assessment in mice as a means of assessing emotional reactivity. The long-term objective of this work is to find relevant behavioural measures in relation to animal welfare. We were interested in increasing our knowledge about the natural baseline of risk assessment behaviours and therefore the idea of comparing behavioural strategies between wild mice and laboratory mice was realised. A novel environment elicits exploratory motivation in the mouse and entails a trade-off conflict between the possibility of locating important resources and the risk of encountering unidentified dangers. Using a battery of tests, Concentric Square Field, Open Field and Elevated Plus Maze, differences in behavioural strategies of exploration and risk assessment were studied. Wild-derived house mice (Mus musculus musculus) were contrasted with domesticated mice of the inbred strains BALB/c and C57BL/6. Taken together, differences in behavioural strategies between wild and laboratory mice were mainly quantitative, however specific behavioural profiles in relation to risk assessment and emotional reactivity were recorded. Wild mice differed from both laboratory strains mainly in an unwillingness to enter open areas. The BALB/c mice generally avoided risk areas and showed a high risk assessment while C57BL/6 mice were more explorative, demonstrating a higher rate of risk taking and performing little risk assessment. No major sex differences were found in the behaviours related to risk assessment and emotional reactivity. However, sex differences were more pronounced in Wild and C57BL/6 mice than in BALB/c mice. In the Light/Dark test, strain was a greater factor than home cage environment (enriched/non-enriched) in terms of risk assessment, emotional reactivity and inter individual variance . Risk assessment was also investigated in a novel test of predator exposure, the Rat Exposure Test. The results were in contrast to the previous findings, as C57BL/6 mice showed more risk assessment, avoidance behaviour and active defence than BALB/c mice in response to the rat. This discrepancy suggest a difference between the responsiveness to novelty or novel places compared to the anti-predator response, at least in these two inbred strains. Moreover, it supports the notion that the environmental features of the test arena, familiarity of the environment and type of aversive stimuli may have a large impact on emotional reactivity and that the strain of the mouse is an important factor in how the situation is perceived. It is concluded that risk assessment is a sensitive marker for emotional reactivity in laboratory mice but that a multivariate approach is necessary for a thorough characterisation in terms of animal welfare

Service procurement in the public sector : A study of the requirement specification

Bakgrund: De senaste åren har den offentliga upphandlingen ökat i omfattning och utgör nu ca 17 procent av Sveriges BNP. Det är viktigt att de offentliga upphandlingarna utförs effektivt och i detta arbete spelar kravspecifikationen en viktig roll. En bra kravspecifikation är en förutsättning för att den upphandlande myndigheten ska få in anbud som motsvarar det de vill ha medan en bristfällig sådan kan ha stora konsekvenser för resultatet av upphandlingen. Det är dock i mycket en komplicerad uppgift att formulera krav för en tjänst, vars specifika egenskaper gör den mer svårdefinierad än en vara. Syfte: Syftet med studien är att skapa förståelse för kravspecifikationens roll i den offentliga tjänsteupphandlingen. Mer specifikt syftar studien till att undersöka vilka förutsättningarna är för att kunna utforma en bra kravspecifikation och vilka konsekvenser en bristfällig sådan kan ha för resultatet av upphandlingen. Genomförande: Med en kvalitativ ansats och genom personliga intervjuer har upphandlares syn på kravspecifikationens betydelse och svårigheter undersökts. Fyra semistrukturerade personliga intervjuer har genomförts med fyra erfarna upphandlare, från fyra olika offentliga organisationer - två landsting och två kommuner. Slutsats: Studiens resultat visar att det är viktigt med god kunskap om marknaden och medvetenhet om verksamhetens behov för att en relevant kravspecifikation ska kunna utformas. En relevant och bra kravspecifikation motverkar ökade transaktionskostnader och ökar möjligheterna att den tjänst som verksamheten är i behov av levereras. Studiens resultat visar vidare att det är viktigare att kravspecifikationen är relevant och tydlig än att den är detaljrik och att funktionsbaserade kravspecifikationer har många fördelar.Background: In recent years, the public procurement has increased in importance and it now represents about 17 percent of Sweden's GDP. It is important that the public procurement is carried out effectively and due to this the requirement specification plays an important role in the process. A good requirement specification is a condition for that the purchasing authority receives tenders that correspond to what they want; while a lack of such may have major implications for the outcome of the procurement. However, it is a complex task to draw up requirements for a service, whose particular characteristics make it more difficult to define than a commodity. Purpose: The purpose of this study is to create an understanding of the requirement specification's role in the public service procurement. More specifically, the study aims to examine what the conditions are to work out a good requirement specification and the consequences a lack of such may have for the outcome of the procurement. Method: With a qualitative approach and through personal interviews, the purchasers view of the importance and difficulty of the requirement specification has been examined in this study. Four semi-structured personal interviews were conducted with four senior purchasers from four different public organizations - two counties and two municipalities. Results: The findings of this study indicate that good knowledge about the market and awareness of the organization’s needs is important for the formulation of a relevant requirement specification. A relevant and good requirement specification counteract high transaction costs and increase the possibility of delivery of the, by the organization, requested and needed service. Further, this research imply that it is more important for the requirement specification to be relevant and clear than to be detailed, and that function based specifications have many benefits

The Role of Course Books in Learners’ Motivation

Veiktais pētījums aplūko angļu valodas kā svešvalodas apguvēju motivāciju, kuru veido vairāki faktori, tai skaitā mācību grāmatas. Pētījuma teorētiskais pamats ir plašais materiāls par faktoriem, kas ietekmē gan svešvalodas apguvēju, gan skolotāju motivāciju. Pētījumā uzsvērta skolotāja atbildība valodas apguvēju intereses rosināšanā. Valodas apguvēju zināšanu līmenim, vecuma grupai un interesēm atbilstošas mācību grāmatas izvēle ir viens no veidiem, kā radīt un rosināt interesi. Darbs sniedz pārskatu par faktoriem, kuri jāņem vērā, novērtējot mācību grāmatu pirms un pēc lietošanas. Piedāvātā pētījuma mērķis ir pierādīt atbilstošu mācību grāmatu pareizas izvēles nozīmi kā valodas apguvēju, tā skolotāju motivācijas veicināšanā. Aptaujas anketu analīze saista teoriju ar praksi. Mācību grāmatas ir novērtējuši kā skolotāji, tā skolēni, un viņu paustie uzskati ir salīdzināti ar skolotāju-ekspertu uzskatiem. Apkopotie fakti ļauj secināt, kuras ir visbiežāk lietotās mācību grāmatas, kā arī analizē tajās piedāvātās mācīšanas/mācīšanās metodes. Secinājumi ir balstīti uz situācijas izpēti; anketu analīze, intervijas un skolēnu novērošana ir izmantoti kā līdzekļi faktu savākšanai. Veiktā pētījuma rezultātus un secinājumus var izmantot angļu valodas skolotāji mācību procesa efektivitātes paaugstināšanai.The present research investigates EFL (English as a foreign language) learners’ motivation conditioned by several factors – course books being one of them. The theoretical background for the research is the extensive reference material on the factors influencing both learners’ and teachers’ motivation. The paper stresses the teacher’s responsibility in arousing learners’ interest. The right choice of course books relevant to the learners’ level of knowledge, age group and interests might be a means for arousing and increasing learners’ interest. The paper features a survey of the factors which should be taken into account in the process of pre-assessment and evaluation of course books. The research paper aims at proving the importance of the right choice of relevant course books in increasing both learners’ and teachers’ motivation. It relates theory to practice by analyzing questionnaires. Course books are valued both by teachers and learners, their opinions are compared with the opinion of expert teachers. The data obtained indicate the most widely used course books and analyze the teaching/learning methods offered by them. The conclusions drawn are based on the case study type; analyses of questionnaires, interviews as well as classroom observations have been used as a means of data gathering. The results and conclusions of this research can be used by the teachers of English in order to make the teaching/learning process more effective

Kartläggning av studier om nordiska ungdomars psykiska hälsa

I denna forskningsrapport redovisas en kartläggning av studier om nordiska ungdomars psykiska hälsa.Kartläggningen har genomförts av Centrum för forskning om barns och ungdomars psykiska hälsa vid Karlstads universitet på uppdrag av Nordiska högskolan för folkhälsovetenskap (NHV). Kartläggningen har finansierats av Nordiska ministerrådet och ingår som ett delprojekt inom ramen för ministerrådets handlingsplan för psykisk hälsa. Samtliga projekt som ingår i handlingsplanen har initierats av Nordiska Akademin för forskning om psykisk hälsa vid NHV under ledning av docent Lars Fredén.Barns och ungdomars psykiska hälsa är en viktig folkhälsofråga, såväl i de nordiska länderna som i de vidare internationella sammanhangen. Under senare år har området fått en ökad uppmärksamhet. Nordiska ministerrådets handlingsplan för psykisk hälsa är ett uttryck för detta. Ett annat exempel kan hämtas från Sverige. Inspirerade av ett projekt i Kungl. Vetenskapsakademiens regi har de statliga forskningsfinansiärerna riktat totalt 300 miljoner kronor under sex år till forskning om barns och ungdomars psykiska hälsa.Kartläggningen i denna forskningsrapport är gjord med ett systematiskt och vetenskapligt arbetssätt, men kan inte likställas med de systematiska kunskapsöversikter som Kungl. Vetenskapsakademien producerade i tidigare nämnda projekt, eller med de rapporter som Statens beredning för medicinsk utvärdering utarbetar. Föreliggande rapport är gjord med väsentligt mindre resurser och med förenklade arbetsmetoder. En preliminär version av rapporten presenterades vid konferensen Ung och utsatt som den 5-6 maj 2011 anordnades vid NH

The Törneby Primate Facility Optimisation of housing conditions for Rhesus Macaques in Sweden

No abstract availabl

Problematic substance use among patients in a Swedish outpatient psychiatry setting : staff and manager perceptions of digital options for increased intervention access

Background Approximately 50% of the patients who globally seek help in psychiatry have been assessed with problematic substance use or been diagnosed with substance use disorder (SUD). Given the high treatment gap for mental health care, in particular SUD, these individuals risk poorer treatment outcomes in psychiatry. Integrated treatment for psychiatric and SUD disorders has been proposed to reduce the treatment gap for SUD, but access to integrated treatment is low. Digital interventions addressing SUD in psychiatry could potentially make treatment available to patients who otherwise would not have access. In this study “digital interventions” comprise an umbrella term covering all kinds of interventions from minimal motivational app-based interventions to internet-based interventions with and without human guidance, up to remote sessions in telepsychiatry. This study aims to explore healthcare staff perceptions of referring patients to digital interventions for reducing problematic substance use, whether or not diagnosed as SUD, in the psychiatric outpatient setting. Method The study was exploratory with a qualitative design. Data were collected in the Swedish outpatient psychiatry setting, via individual semi-structured interviews with managers, and focus groups with healthcare staff. An adapted form of phenomenological hermeneutical analysis was used to analyze the data. Results Three themes emerged from the analysis. The first theme was Encountering obstacles on the path to future implementation of digital interventions, with sub-themes: Lacking resources and Feeling concerned about technical solutions. The second theme was Searching for ways forward to achieve increased access to care, with sub-themes: Blended care could facilitate integrated care and Addressing variations in patients’ technical skills. The third theme was Taking steps towards the future, with sub-themes: Wanting to know more about digital interventions and Formulating a vision for the future. Conclusions The study reveals a concern that implementing digital interventions in psychiatry will create additional work or be technically challenging. The staff see significant advantages from the patient perspective, but they feel that they themselves need training in implementing digital interventions. In order to establish constructive implementation of digital interventions for SUD in psychiatry, staff attitudes and concerns need to be considered and addressed. This study was conducted within the Swedish healthcare system and the findings may not generalize to other countries with differing healthcare systems

Information and support to patients when the waiting time guarantee cannot be fulfilled : a qualitative study

Background: Long waiting times for health care services are a prominent health policy issue. Waiting time guarantees may limit time to assessment and treatment. Methods: This study aims to investigate the information and support given to patients when the waiting time guarantee cannot be fulfilled from a care provider and administrative management perspective. Semi-structured interviews (N = 28) were conducted with administrative management and care providers (clinic staff and clinic line managers) in specialized clinics in the Stockholm Region, Sweden. Clinics were purposefully sampled for maximum variation in ownership (private, public), complexity of care, geographical location, volume of production, and waiting times. Thematic analysis was applied. Results: Care providers reported that patients received inconsistent information and support with regard to the waiting time guarantee and that information was not adapted to health literacy or individual patient needs. Contrary to local law, they made some patients responsible for finding a new care provider or arranging a new referral. Furthermore, financial interests affected whether patients were referred to other providers. Administrative management steered care providers' informing practices at specific time points (upon establishment of a new unit and after six months of operation). A specific regional support function, Region Stockholm's Care Guarantee Office, helped patients change care providers when long waiting times occurred. However, administrative management perceived that there was no established routine to assist care providers in informing patients. Conclusions: Care providers did not consider patients' health literacy when informing them about the waiting time guarantee. Administrative management's attempts to provide information and support to care providers are not producing the results they expect. Soft-law regulations and care contracts seem insufficient, and economic mechanisms undermine care providers' willingness to inform patients. The described actions are unable to mitigate the inequality in health care that arises from differences in care-seeking behavior