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  • 51.
    Wennberg, Anna-Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Univ Umea Hosp, Dept Publ Hlth & Clin Med, Family Med, SE-90185 Umea, Sweden.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hamberg, Katarina
    Univ Umea Hosp, Dept Publ Hlth & Clin Med, Family Med, SE-90185 Umea, Sweden.
    A questioned authority meets well-informed pregnant women: a qualitative study examining how midwives perceive their role in dietary counselling2015Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, nr 1, artikel-id 88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: During pregnancy and afterward, a healthy diet is beneficial for the expecting mother and her foetus. Midwives in antenatal care have an ideal position for promoting healthy diets. Dietary counselling is however complex and recommendations can be controversial. While pregnant women struggle with dietary recommendations, midwives struggle with a lack of authority. The aim of the study was therefore to describe how midwives perceive their role and their significance in dietary counselling of pregnant women.

    METHODS: An interview study was conducted that involved twenty-one (21) experienced midwives, who worked in the Swedish prenatal health care. A qualitative content analysis was conducted.

    RESULTS: Pregnant women were perceived to be well informed, but they needed guidance to interpret information on the Internet. They were described as rigorous and eager information seekers who needed guidance to interpret information as they were worried and emotional. The midwives saw themselves as a questioned authority who lacked support. This meant being informative and directive though not always updated or listened to. Their impact was uncertain and they could also lack sufficient competence to counsel in delicate issues.

    CONCLUSION: The midwives' directive role may obstruct the women's needs to manage the dietary recommendations and risk evaluation in a women-centred dialogue. Midwives need to acknowledge pregnant women as both well informed and skilled if they are going to develop woman-centred antenatal care. Ongoing training and self-reflection will be needed to make this change.

  • 52.
    Wennberg, Anna-Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsson, Sanna
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Zadik Janke, Josefine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Online Perceptions of Mothers About Breastfeeding and Introducing Formula: Qualitative Study2017Ingår i: JMIR public health and surveillance, ISSN 2369-2960, Vol. 3, nr 4, artikel-id e88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Although the benefits of breastfeeding are well established for babies and their mothers, many women give formula to their infants. Whether to breastfeed or to give infant formula is a complex decision to make. Many parents use the Internet to find information and support that relate to infant feeding decisions.

    OBJECTIVE: The aim of this study was to analyze the perceptions of mothers, who are discussing the topic on Web forums, about introducing infant formula.

    METHODS: This is a qualitative, descriptive, and cross-sectional study on online data from parenting Web forums. The text was analyzed using qualitative content analysis.

    RESULTS: The analysis resulted in 1 main theme, "balancing between social expectations and confidence in your parental ability," which is further divided into 3 themes: "striving to be a good mother," "striving for your own well-being," and "striving to discover your own path."

    CONCLUSIONS: Breastfeeding is complex, and health care personnel can, with a more open approach toward formula, create better support for mothers by helping them to be more confident in their parental ability.

  • 53. Zoffmann, Vibeke
    et al.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Storbaekken, Solveig
    Graue, Marit
    Rasmussen, Bodil
    Wahl, Astrid
    Kirkevold, Marit
    Translating person-centered care into practice: a comparative analysis of motivational interviewing, illness-integration support, and guided self-determination2016Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, nr 3, s. 400-407Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided self-determination [GSD]. Methods: Comparative analysis included eight components: (1) philosophical origin; (2) development in original clinical setting; (3) theoretical underpinnings; (4) overarching goal and supportive processes; (5) general principles, strategies or tools for engaging peoples; (6) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. Results: Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses on managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity tools. Conclusion: Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked. Practice Implications: Professionals must critically consider the context in their choice of approach. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

  • 54.
    Öberg, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    The Self‐Management Assessment Scale: development and psychometric testing of a screening instrument for person‐centred guidance and self‐management support2019Ingår i: Nursing Open, E-ISSN 2054-1058, Vol. 6, s. 504-513Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To develop and psychometrically test the Self‐Management Assessment Scale (SMASc), a screening instrument for person‐centred guidance and self‐management support of persons with type 2 diabetes (T2D).

    Background: T2D is a common and globally increasing chronic condition. Improved self‐management is a vital and integral component of diabetes care to prevent complications from poorly managed diabetes. For diabetes nurses to better understand persons with diabetes experienced challenges and needs regarding self‐management and further for persons with T2D to take an active role in managing their condition, an instrument measuring this is needed.

    Design: Instrument development and psychometric testing of the content and construct validity, factor structure and reliability.

    Method: The SMASc was psychometric tested on a sample of participants (September 2017–November 2017) with a confirmed diagnosis of T2D (N = 104).

    Results: Psychometric findings were satisfactory and supported the scale´s reliability. Cronbach's alpha, CVI and goodness‐of‐fit were acceptable.

    Conclusion: Self‐Management Assessment Scale is a short validated screening instrument, which can indicate possible barriers for self‐management that ought to be approached during the conversation between the person with T2D and the primary healthcare nurses. Therefore, it is a promising instrument to be used to facilitate person‐centred guidance and to improve self‐management of people living with T2D.

  • 55.
    Öberg, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Jutterström, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Orre, Carl-Johan
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support2018Ingår i: JMIR Diabetes, ISSN 2371-4379, Vol. 3, nr 1, artikel-id e7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services.

    Objective: The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care.

    Methods: This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D.

    Results: Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty.

    Conclusions: Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients’ involvement in their own care.

  • 56.
    Öberg, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jutterström, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Orre, Carljohan
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial2019Ingår i: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 8, nr 4, artikel-id e10250Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Type 2 diabetes (T2D) is increasing as the population ages. The development of new medical treatments is promising and important, but the basic treatment remains self-management, even if adherence to lifestyle advice is low. Electronic health (eHealth) or mHealth interventions can increase empowerment among people living with T2D and may compensate for the lack of professional resources and geographical distances. The interactive self-management support (iSMS) project aims at including digital tools to support people living with T2D in their self-management and facilitating their interaction with diabetes specialist nurses (DSNs). This protocol outlines a study with the purpose of developing and evaluating an intervention where people living with T2D can increase self-efficacy and empowerment through digital self-monitoring and interaction with DSNs.

    OBJECTIVE: To develop and evaluate a person-centered iSMS intervention in primary health care for people with T2D in addition to their usual diabetes care.

    METHODS: This study is a 12-month, 3-armed, nonblinded randomized controlled trial (RCT), which will be conducted in 6 primary health care centers (HCCs) in northern Sweden. Eligible participants will be randomized to either an intervention group (n=46), a control group (n=46), or an external group (n=46) for comparison. The intervention group will receive the mobile app, and the control group will receive a minimal intervention (diabetes brochure) and the usual standard of care. Changes in glycated hemoglobin (HbA1c) will be the primary outcome measure.

    RESULTS: This trial is currently open for recruitment. The first results are expected to be submitted for publication in Autumn 2019.

    CONCLUSIONS: This study, with its focus on iSMS, will provide insights regarding suitable ways to promote and develop a person-centered intervention. If successful, the intervention has the potential to become a model for the provision of self-management support to people with T2D.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10250.

  • 57.
    Öberg, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Orre, Carl Johan
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jutterström, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Using the Self‐Management Assessment Scale (SMASc) as an instrument for screening self-management support needs in type 2 diabetes: experiences from nurse-led digital self-management support in Swedish primary health careManuskript (preprint) (Övrigt vetenskapligt)
  • 58.
    Öberg, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Orre, Carl-Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för informatik. Department of Computer Science and Media Technology, Malmö University, Malmö, Sweden.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Schimmer, Robyn
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för informatik.
    Larsson, Håkan
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management2018Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, nr 2, s. 961-970Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Nurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care.

    AIM: The aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management.

    METHODS: Focus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis.

    RESULTS: Three themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes.

    CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care.

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