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Introduction: Hospital care is critical when assessing the overall quality of chronic obstructive pulmonary disease (COPD) care, particularly for people living with severe COPD who are frequently hospitalised due to exacerbations. The hospitalisation experience for people with COPD is often complex, involving various interactions and has been reported to be suboptimal. A comprehensive understanding of these experiences is lacking. With the intention of informing a holistic approach in COPD hospital care, this study aimed to explore the experiences and expectations of individuals with severe COPD regarding hospital care due to exacerbations of COPD.

Methods: Acknowledging the complexity of interactions within the studied scenarios, this research employed a qualitative study design, utilising co-creation workshops for data collection. A total of 13 participants were involved in the data collection process. Five people with severe COPD were recruited using purposive sampling. In addition, one family member, four healthcare practitioners, one digital health program designer, and two hospital managers were recruited through convenience sampling. Data were collected during three co-creation workshops. During each workshop, participants were divided into subgroups focused on specific topics. Relevant transcripts from these subgroup discussions were chosen for analysis, which was conducted using qualitative content analysis.

Results: The analysis resulted in four categories that illustrate both the experiences and expectations of people with COPD regarding hospital care from admission to discharge: lack of trustworthy guidance, increased vulnerability during hospitalisation, discharge issues, and advocacy for COPD recognition. Our findings reveal some deficiencies, particularly in admission procedures, information exchange, healthcare interactions, and transitions from hospital to home. At the same time, patients also expressed appreciation for the continuous support provided by COPD nurses and home care teams.

Conclusion: This study highlights the need for person-centred care in managing COPD exacerbations. It identifies key interventions such as early help-seeking, better patient education, staff training, care continuity, improved discharge services, and public awareness. Emphasising individualised experiences, it calls for familiar care settings, collaborative discharge planning, and integration of home care to enhance hospital care quality.

Background: There is increasing interest in the use of home-based monitoring in people with chronic lung diseases to improve access to care, support patient self-management, and facilitate the collection of information for clinical care and research. However, integration of home-based monitoring into clinical and research settings requires careful consideration of test performance and other attributes. There is no published guidance from professional respiratory societies to advance the science of home-based monitoring for chronic lung disease.

Methods: An international multidisciplinary panel of 32 clinicians, researchers, patients, and caregivers developed a multidimensional framework for the evaluation of home-based monitoring in chronic lung disease developed through consensus using a modified Delphi survey. We also present an example of how the framework could be used to evaluate home-based monitoring using spirometry and pulse oximetry in adults with asthma, bronchiectasis/cystic fibrosis, chronic obstructive pulmonary disease, and interstitial lung disease.

Results: The PANACEA framework includes seven domains (test Performance, disease mANAgement, Cost, patient Experience, clinician Experience, researcher Experience, and Access) to assess the degree to which home-based monitoring assessments meet the conditions for clinical and research use in chronic lung disease. Knowledge gaps and recommendations for future research of home spirometry and pulse oximetry in asthma, bronchiectasis/cystic fibrosis, chronic obstructive pulmonary disease, and interstitial lung disease were identified.

Conclusions: The development of the PANACEA framework allows standardized evaluation of home-based monitoring in chronic lung diseases to support clinical application and future research.

In this study, we introduce a new approach to addressing the complexities of health systems challenges, which we name the Ecology of Design Briefs. This approach offers a structured framework for delivering key leverage points within these challenges and creating a conceptual space for feasible design opportunities. Acknowledging the limited reach of individual design solutions in tackling the complexities of health systems challenges, our approach draws on the ecology concept of Transition Design. The utilisation of the Ecology of Design Briefs results in a collection of interconnected specification documents for design projects that guide the creative process, working together synergistically to tackle the complexities. This approach was applied to enhance hospital care experiences for individuals with acute exacerbations of chronic obstructive pulmonary disease (COPD). Hospitalisations for this group frequently lead to multidimensional negative experiences, and addressing these issues is closely linked to resolving underlying health systems problems. Our findings suggest that the developed briefs provide comprehensive, mutually reinforcing, and detailed insights necessary for understanding these challenges. This study contributes to health systems problem-solving by conceptualising the Ecology of Design Briefs as an approach and documenting its application in a hospital care setting.

This article reflects on how patient education tool design can benefit from a co-creation process with patients and key stakeholders involved, using a case study in chronic obstructive pulmonary disease (COPD) care. Unfavourable hospitalisation experiences for COPD patients are often linked to organisational issues and health literacy challenges. This study presents insights from a year-long co-creation practice involving COPD patients, a family member, healthcare practitioners, and hospital managers, aimed at developing patient education tools to enhance health literacy concerning the hospitalisation process. The primary outcome is a set of patient education infographics that can be integrated into digital platforms or printed formats. For such co-creation practice, we found that setting clear creativity expectations and using methods such as user journey maps empower participants. Balancing the power dynamics between patients and healthcare practitioners enables culturally relevant and patient-centred tools. In addition, family members play a crucial role in both co-creation process and care journey, while hospital managers ensure tools align with clinical practices. We also advocate for an ecological perspective towards intervention development, acknowledging diverse needs emerged from the co-creation process. Future research should implement strategies in further individualising infographics to improve their effectiveness.

Background: There is a growing interest in eHealth solutions to enhance access to and use of pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD).

Objective: This study aims to evaluate the feasibility of a novel eHealth tool (Me&COPD) to support pulmonary rehabilitation concerning usability, exercise adherence, intensity, progression, and adverse events. Moreover, this study aims to evaluate clinical outcome measures to prepare for a future larger trial.

Methods: A multicenter, parallel-group randomized controlled pilot and feasibility trial was conducted in 6 primary health care centers. People with mild to severe COPD were recruited by physiotherapists at the included health care centers and randomized either to the intervention group with access to Me&COPD for 3 months or to the control group receiving usual care. The Me&COPD tool comprised audio-visual and written self-management strategies, including an individually tailored home-based exercise program and interaction with a physiotherapist. The exercise program was prescribed in a face-to-face meeting with a physiotherapist, and thereafter it was regularly reviewed and adjusted through the eHealth tool. The primary outcome, usability, was self-assessed at intervention completion in the intervention group and among participating physiotherapists (n=7) using the Swedish version of the Mobile Health App Usability Questionnaire (S-MAUQ). In addition, use data on exercise adherence, intensity, and progression and adverse events were exported from the eHealth tool. Clinical outcomes, assessed by blinded assessors at baseline and 3 months in the intervention and control groups, included exercise capacity, balance, physical activity level, COPD-related symptoms, and health-related quality of life. Descriptive statistics were used for analysis.

Results: In total, 22 participants (women: n=12, 55%), aged 72.3 (SD 8.4) years on average, were included in the intervention (n=15) and control (n=7) groups. The mean overall S-MAUQ scores out of 7 (highest possible usability) were 4.4 (SD 1.5) for participants and 4.5 (SD 1.2) for physiotherapists. Among the subscales, the highest score was assigned to usefulness among participants (S-MAUQ: mean 4.9, SD 1.3) and physiotherapists (S-MAUQ: mean 5.1, SD 1.7). No severe adverse events were registered, although exercise adherence, intensity, and progression evaluation were limited by incomplete exercise session registration. The test procedures and the clinical outcome measures used were found to be feasible for the participants and the assessors.

Conclusions: The novel eHealth tool, Me&COPD, seemed feasible in terms of safety and had acceptable usability among people with COPD and participating physiotherapists. Usability may be improved by better organization of the information and simplification of the exercise diary to enable collection of data on exercise adherence, intensity, and progression through the eHealth tool. The test procedures seemed feasible, although the recruitment process needs further consideration. The effectiveness of the intervention remains to be evaluated in a future larger trial.

Objectives: Co-creation is recognised as a promising methodology for addressing complex public health issues by leveraging the collective intelligence of multiple stakeholders to develop tailored solutions. However, there is a lack of clarity and significant fragmentation in the concept. This study aims to define the fundamental attributes and guiding principles of co-creation to establish it as a rigorous, evidence-based, and trustworthy methodology.

Study design: A participatory concept mapping process based on the Differentiae Principle was employed.

Methods: The study consisted of four stages: 1) systematic extraction of attributes and their definition from traditional scientific and participatory research methodological literature, 2) screening, 3) semantic analysis and clustering into principles using Natural Language Processing and Large Language Models and 4) selection of a final set of attributes and development of principles. The study involved 50 participants with diverse backgrounds within and outside the Health CASCADE Network over 18 months.

Results: The study identified 105 candidate attributes. A set of 38 was selected from which 10 key principles were derived (open access, recognised contribution, ethics and legal, transparency, rigorous evaluation, clear problem, plural evidence, critical reflection, diversity, and structured and flexible processes) across three domains: Governance, Scientific and Methodological Rigour, and Collective Intelligence Processes.

Conclusions: The attributes and guiding principles provide a comprehensive foundations for evidence-based co-creation, enhancing its trustworthiness, transparency, reliability, and impact in public health and other fields. Future research and practice should use these principles and attributes to refine and implement co-creation effectively.

Introduction: The subjective experiences of healthcare professionals during the COVID-19 pandemic have been extensively studied; however, little research has focused on the experiences and perspectives of physiotherapists’, especially in the Nordic countries. The aim of this study was to explore the lived experiences and perceptions of physiotherapists regarding the rehabilitation of COVID-19 patients in hospital settings during the COVID-19-pandemic in Finland.

Methods: Hermeneutic phenomenology was employed as a methodology. Ten physiotherapists were recruited using purposive and snowball sampling. The data were collected through semi-structured interviews and analysed using thematic analysis.

Results: Four themes were identified: (1) pragmatic development of sensitive rehabilitation practices in a new and confusing working environment; (2) becoming a member of a cohesive team; (3) mixed feelings and reactions when facing the brutality of an unknown disease; and (4) being supported by colleagues but lacking support from the healthcare organisation.

Conclusion: The results may benefit healthcare organisations in improving organisational processes for ensuring the wellbeing of physiotherapists during future crises. Concrete actions to support employees could be developed by arranging resources for professional counselling and reflection during and after such crises, and by developing appropriate systems for recognising professional conduct in spite of difficult circumstances.

Objectives: Co-creation is increasingly applied in public health research, particularly to develop solutions. Due to the unpredictable and 'messy' nature of co-creation, co-creation processes often do not go as planned. To inform facilitators of co-creation research, we aimed to identify critical events in planning, conducting, evaluating and reporting of co-creation and to provide strategies to prevent or mitigate them, by reflecting on co-creation projects within the Health CASCADE project.

Study design: Qualitative study design.

Methods: Online or in-person reflection sessions were held with facilitators of six co-creation projects, across various sectors, in different populations, and addressing diverse topics. Facilitators were asked to reflect on critical events in their project that could have negatively impacted the co-creators, the co-creation process, or the co-created solution, and to identify preventive and mitigating measures. Two researchers analysed meeting summaries using inductive thematic analysis.

Results: We identified 16 overarching themes, representing critical events from planning to reporting, including not recruiting the 'right' participants, low engagement, lack of motivation for implementation, and biased evaluations. These can result in insufficient inclusion of diverse opinions and reduced co-creation time, which in turn can lead to less effective solutions and lack of trust in co-creation. We identified various preventive (e.g., scheduling reflection meetings beforehand) and mitigating (e.g., having a co-facilitator in case of difficulties) strategies.

Conclusions: The results highlight the crucial role of facilitators in making co-creation an effective approach in public health. Allocating ample time for facilitator training beforehand and ongoing reflection during the cocreation project is essential.

Choosing the appropriate design process is critical for the effective implementation and long-term sustainment of interventions aimed at addressing public health challenges. To address this need, we proposed a Transition Design model to identify and deliver sustainable solutions for complex healthcare problems. This model generates system-level health-intervention initiatives that can synergistically function, particularly during the development and implementation phases, to enhance healthcare delivery. Drawing from a case study on addressing the challenges of hospitalisations and early discharge for people with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), we reflected on the process and analysed the outcomes. Although further testing for the initiatives is warranted, this study contributes to the evolving discourse in design research on systems solutioning for public-health challenges.

We aimed to evaluate short-term effects of a web-based self-management support on objectively measured physical activity (PA) compared to usual care in people with chronic obstructive pulmonary disease (COPD). We conducted a pragmatic randomised controlled trial including people with stable COPD within primary healthcare. Participants were randomised to intervention group, IG (access to the COPD Web, an interactive website to support self-management with focus on PA), or to control group, CG (usual care). Primary outcome at 3 months was change in accelerometry-measured daily steps analysed with ANCOVA, and secondary outcomes were self-reported PA, disease-related symptoms, and quality of life. Missing data in intention-to-treat (ITT) analyses were multiply imputed. One hundred and forty-six participants (n = 73/group), mean (SD) age 69.5 (6.7) years, FEV1pred 60.7 (19.1)% were included. The ITT analysis showed no significant difference in steps between the groups: 1295 steps (95% CI: [−365, 2955], p = 0.12), while the complete case analysis (n = 98) revealed a significant difference of 1492 steps (95% CI: [374, 2609], p = 0.01) in favour of IG. A significant increase in self-reported PA was seen in IG in both the ITT and complete case analysis. In summary, access to the COPD Web was insufficient to increase short-term PA level compared to usual care. However, among participants with complete step data, a clinically relevant effect on daily steps exceeding the minimal important difference was observed, partly explained by higher baseline PA than among dropouts. This indicates that access to the COPD Web may increase PA levels for some people with COPD.