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  • 1.
    Aarons, Gregory
    et al.
    Univ Calif San Diego, La Jolla, CA 92093 USA.;Child & Adolescent Serv Res Ctr, San Diego, CA USA..
    Green, Amy
    Univ Calif San Diego, La Jolla, CA 92093 USA..
    Moullin, Joanna
    Univ Calif San Diego, La Jolla, CA 92093 USA.;Univ Technol Sydney, Sydney, NSW, Australia..
    Ehrhart, Mark
    San Diego State Univ, San Diego, CA 92182 USA.;Univ Cent Florida, Orlando, FL 32816 USA..
    Ducarroz, Simon
    Ctr Reg Prevent Canc, Ctr Hygee, St Priest En Jarez, France..
    Sevdalis, Nick
    Kings Coll London, London, England..
    Hasson, Henna
    Karolinska Inst, Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Stockholm, Sweden.
    James, Sigrid
    Univ Kassel, Kassel, Germany..
    Willging, Cathleen
    Pacific Inst Res & Evaluat, Behav Hlth Res Ctr Southwest, Albuquerque, NM USA..
    Fostering international collaborations in implementation science2018In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13Article in journal (Other academic)
  • 2.
    Fritz, Johanna
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wallin, L.
    Dalarna University, Falun, Sweden.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Almqvist, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Implementation of a behavioral medicine approach in physiotherapy: A process evaluation of facilitation methods2019In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, no 1, article id 94Article in journal (Refereed)
    Abstract [en]

    Background: In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. Methods: An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used. Results: The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking. Conclusions: The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time. 

  • 3.
    Hasson, H.
    et al.
    Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    Nilsen, P.
    Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden.
    Augustsson, H.
    Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    Ingvarsson, S.
    Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    Korlén, S.
    Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    To do or not to do - Balancing governance and professional autonomy to abandon low-value practices: A study protocol2019In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, no 1, article id 70Article in journal (Refereed)
    Abstract [en]

    Background: Many interventions used in health care lack evidence of effectiveness and may be unnecessary or even cause harm, and should therefore be de-implemented. Lists of such ineffective, low-value practices are common, but these lists have little chance of leading to improvements without sufficient knowledge regarding how de-implementation can be governed and carried out. However, decisions regarding de-implementation are not only a matter of scientific evidence; the puzzle is far more complex with political, economic, and relational interests play a role. This project aims at exploring the governance of de-implementation of low-value practices from the perspectives of national and regional governments and senior management at provider organizations. Methods: Theories of complexity science and organizational alignment are used, and interviews are conducted with stakeholders involved in the governance of low-value practice de-implementation, including national and regional governments (focusing on two contrasting regions in Sweden) and senior management at provider organizations. In addition, an ongoing process for governing de-implementation in accordance with current recommendations is followed over an 18-month period to explore how governance is conducted in practice. A framework for the governance of de-implementation and policy suggestions will be developed to guide de-implementation governance. Discussion: This study contributes to knowledge about the governance of de-implementation of low-value care practices. The study provides rich empirical data from multiple system levels regarding how de-implementation of low-value practices is currently governed. The study also makes a theoretical contribution by applying the theories of complexity and organizational alignment, which may provide generalizable knowledge about the interplay between stakeholders across system levels and how and why certain factors influence the governance of de-implementation. The project employs a solution-oriented perspective by developing a framework for de-implementation of low-value practices and suggesting practical strategies to improve the governance of de-implementation. The framework and strategies can thereafter be evaluated for validity and impact in future studies. 

  • 4.
    Hasson, Henna
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Procome Res Grp, SE-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, SE-17129 Stockholm, Sweden..
    Nilsen, Per
    Linkoping Univ, Div Community Med, Dept Med & Hlth Sci, Linkoping, Sweden..
    Augustsson, Hanna
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Procome Res Grp, SE-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, SE-17129 Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Stockholm.
    Empirical and conceptual investigation of de-implementation of low-value care from professional and health care system perspectives: a study protocol2018In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, article id 67Article in journal (Refereed)
    Abstract [en]

    Background: A considerable proportion of interventions provided to patients lacks evidence of their effectiveness This implies that patients may receive ineffective, unnecessary, or even harmful care Thus, in addition to implementing evidence based practices, there is also a need to abandon interventions that are not based on best evidence, i e, low value care However, research on de implementation is limited, and there is a lack of knowledge about how effective de implementation processes should be earned out The aim of this project is to explore the phenomenon of the de implementation of low value health care practices from the perspective of professionals and the health care system. Methods: Theories of habits and developmental learning in combination with theories of organizational alignment will be used The project's work will be conducted in five steps Step 1 is a scoping review of the literature, and Step 2 has an explorative design involving interviews with health care stakeholders Step 3 has a prospective design in which workplaces and professionals are shadowed during an ongoing de implementation In Step 4, a conceptual framework for de implementation will be developed based on the previous steps In Step 5, strategies for de implementation are identified using a co design approach. Discussion: This project contributes new knowledge to implementation science consisting of empirical data, a conceptual framework, and strategy suggestions on de implementation of low value care The professionals' perspectives will be highlighted, including insights into how they make decisions, handle de implementation in daily practice, and what consequences it has on their work Furthermore, the health care system perspective will be considered and new knowledge on how de implementation can be understood across health care system levels will be obtained The theories of habits and developmental learning can also offer insights into how context triggers and reinforces certain behaviors and how factors at the individual and the organizational levels interact The project employs a solution oriented perspective by developing a framework for de implementation of low value practices and suggesting practical strategies to improve de implementation processes at all levels of the health care system The framework and the strategies can thereafter be evaluated for their validity and impact in future studies.

  • 5.
    Richter, A.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, U.
    Karolinska Institutet, Stockholm, Sweden.
    Lornudd, C.
    Stockholm University, Stockholm, Sweden.
    Lundmark, R.
    Karolinska Institutet, Stockholm, Sweden.
    Mosson, R.
    Karolinska Institute, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    iLead-a transformational leadership intervention to train healthcare managers' implementation leadership2016In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 11, no 1, article id 108Article in journal (Refereed)
    Abstract [en]

    Background: Leadership is a key feature in implementation efforts, which is highlighted in most implementation frameworks. However, in studying leadership and implementation, only few studies rely on established leadership theory, which makes it difficult to draw conclusions regarding what kinds of leadership managers should perform and under what circumstances. In industrial and organizational psychology, transformational leadership and contingent reward have been identified as effective leadership styles for facilitating change processes, and these styles map well onto the behaviors identified in implementation research. However, it has been questioned whether these general leadership styles are sufficient to foster specific results; it has therefore been suggested that the leadership should be specific to the domain of interest, e.g., implementation. To this end, an intervention specifically involving leadership, which we call implementation leadership, is developed and tested in this project. The aim of the intervention is to increase healthcare managers' generic implementation leadership skills, which they can use for any implementation efforts in the future. Methods/design: The intervention is conducted in healthcare in Stockholm County, Sweden, where first- and second-line managers were invited to participate. Two intervention groups are included, including 52 managers. Intervention group 1 consists of individual managers, and group 2 of managers from one division. A control group of 39 managers is additionally included. The intervention consists of five half-day workshops aiming at increasing the managers' implementation leadership, which is the primary outcome of this intervention. The intervention will be evaluated through a mixed-methods approach. A pre- and post-design applying questionnaires at three time points (pre-, directly after the intervention, and 6 months post-intervention) will be used, in addition to process evaluation questionnaires related to each workshop. In addition, interviews will be conducted over time to evaluate the intervention. Discussion: The proposed intervention represents a novel contribution to the implementation literature, being the first to focus on strengthening healthcare managers' generic skills in implementation leadership. 

  • 6.
    von Thiele Schwarz, Ulrica
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth, S-17177 Stockholm, Sweden..
    Percy-Laurry, Antoinette
    NCI, Div Canc Control & Populat Sci, Rockville, MD 20850 USA..
    Aarons, Gregory A.
    Univ Calif San Diego, Dept Psychiat, San Diego, CA 92093 USA..
    Balancing adaptation and fidelity: Exploring the continuum2017In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 12Article in journal (Other academic)
  • 7.
    von Thiele Schwarz, Ulrica
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Stockholm, Sweden..
    Sundell, Knut
    Karolinska Inst, Stockholm, Sweden..
    Forberg, Ulrika
    Karolinska Inst, Stockholm, Sweden..
    Hasson, Henna
    Karolinska Inst, Stockholm, Sweden..
    When is a replication a replication?: An interview study of how intervention researchers manage adherence and adaptations in the research process2018In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13Article in journal (Other academic)
1 - 7 of 7
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  • en-US
  • fi-FI
  • nn-NO
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