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Forming therapeutic relationships is considered important within psychiatric and mental health nursing. One way of achieving this is through social interaction when engaging in joint activities. However, introducing and using nursing interventions based on joint activities in psychiatric inpatient care has proven challenging. Since staff motivation is important, researching the meaning of engaging in joint activities from the nursing professional's point of view can provide information that is relevant in this area. This study aims to illuminate the meaning of participating in joint activities with patients as narrated by nursing professionals in psychiatric inpatient care. Narrative interviews with 14 nursing professionals with experience from psychiatric inpatient care were conducted. Data were analysed using phenomenological hermeneutics and reported following the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results illuminate that engaging in joint activities means being open to a process of learning. Four themes contributed to this understanding: Struggling with uncertainty, discovering aspects of the other, unfolding paths to self-fulfilment and sharing personhood. Being open to a process of learning means being willing to face uncertainty when engaging in activities as well as being open to learning about oneself as well as the other. Through openness to this process of learning, a sharing of personhood can be achieved, where the nursing professional and the patient approach becoming two persons. Illuminating the meaning of joint activities from the nursing professionals' perspective may provide valuable insights related to introducing and using interventions focusing on joint activities.

Introduction: During the last decade, structures for ‘knowledge governance’ as a means of strengthening the quality of social services has been used by the Swedish government and national authorities. In this process, regional collaboration and support structures (RCSSs) have been identified as a key asset as an intermediary link between national and local actors. The aim of this study was to explore the perspectives of these regional actors on expectations associated with being an intermediary support structure in knowledge governance processes in social services in Sweden. Methods: The study uses an abductive, qualitative approach, mainly with open questions in an empirical-driven manner (inductively) and partly in a theory-driven manner (deductively). Interviews with representatives from the RCSSs were used for data collection. Conventional content analysis with elements of directed content analysis of the data material was used. Results: A variety of expectations on RCSSs was reported from the national and local levels. According to the respondents, the feeling of inadequacy in relation to the perceived expectations was recurrent because the expectations were hard to meet. They also experienced role ambiguity and that their mission was unclear. Conclusions: The findings show that RCSSs seem to handle the situation by considering, assessing, and prioritising different actors’ needs and expectations in relation to their own perception of the intermediary mission. The findings also indicate a lack of a collective sense-making process with other key actors on different levels in the knowledge governance system. To reach the core purpose of knowledge governance, it is necessary to establish a common understanding of the relationship between expectations and prerequisites for facilitation between national, regional, and local actors.

Folkhälsomyndigheten (Fohm) har sedan 2018 regeringens uppdrag att bidra med kunskapshöjande insatser för att minska stigmatiseringen av psykisk ohälsa och suicid. Avtal har inledningsvis slutits med tre regioner för att stärka dessas främjande och preventiva arbete för att minska stigmatisering av psykisk ohälsa och suicid.

Umeå universitet har fått uppdraget att genomföra en processutvärderingmed implementeringsperspektiv under 2021. Utvärderingen har syftat till att bidra med en fördjupad förståelse för implementeringen av det regionala utvecklingsarbetet. Utvärderingen vilar på analyser av dokument, enkäter och fokusgruppsintervjuer från de medverkande regionerna. Utvärderingen har delvis tagit sin utgångspunkt i det teoretiska ramverket the Consolidated Framework for Implementation Research (CFIR). CFIR sammanfattar befintlig litteratur om faktorer som påverkar implementeringsprocesser och utfall.

Resultaten visar att de undersökta faktorerna, av de allra flesta medverkande aktörerna, betraktas som viktiga förutsättningar för utvecklingsarbetets implementering. Det råder viss variation i deltagarnas uppfattningar om i vilken utsträckning dessa förutsättningar finns på plats och hur väl de fungerar idag. Förutsättningar och utmaningar har varierat i regionerna. De faktorer som en övervägande del respondenter skattat som extra utmanande i genomförandet av utvecklingsarbetet återfinns i organisationernas inre kontext och utgörs av Utvecklingsarbetets givna prioritet; Målens tydlighet och hur dessa kommunicerats; Utvecklingsarbetets organisering och; Hur kända mottagarkontextens behov är i organisationen.

Gemensamma framgångsfaktorer som beskrivits är en god samverkan mellan olika aktörer; en ökad medvetenhet i regionerna om vikten av att arbeta med stigma av psykisk ohälsa och suicid; ett yttre tryck från nationella aktörer som bidrar till att prioritera dessa frågor; samt att det finns en bred förankring i politisk- och tjänstemannaledning som ger ett tydligt mandat. Man lyfter fram vikten av att utvecklingsarbetet integreras i befintliga strukturer, samtidigt som man ser att själva integreringen också kräver tidför matchning och anpassning. Den pågående pandemin Covid-19 har medfört ytterligare utmaningar och har på ett betydande sätt påverkat såväl planering som genomförande.

Baserat på studiens resultat, föreslås att genomföra en kartläggning av organisationens beredskap för utvecklingsarbetet i utgångsläget, liksom att i ett initialt skede enas om viktiga aspekter som är nödvändiga att vara överens om, till exempel gemensamma och tydliga förväntningar. 

BACKGROUND: Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence-based clinical decision-making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research.

METHODS: A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis.

RESULTS: The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved.

CONCLUSIONS: The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given.

Aim: The aim was to investigate assistant nurses’ perceptions of how working with national quality registries affected their work situation in care of older people.

Design: Qualitative interview study.

Methods: Sixteen semi‐structured interviews were conducted at four special housing units in Sweden, and a conventional content analysis, with elements of thematic analysis, was applied.

Results: The introduction of national quality registries contributed to role clarifications and the development of new formal work procedures in terms of documentation and arenas and routines for communication. The increased systematics and effectiveness gained from these changes had a perceived positive effect on the work situation, workload, work satisfaction, staff interactions and learning and reflection.

For decades, scholars have found significant gaps between the knowledge available and the knowledge applied in healthcare. Many potential benefits of adequate knowledge based interventions are therefore never achieved. A considerable body of knowledge has evolved on how to promote a better uptake of evidence-based knowledge into routine use. Even so, the actual impact and usefulness of implementation research findings among healthcare practitioners have not been extensively studied.

Accordingly, the overall aim of this thesis is to contribute to the understanding of how the implementation of complex interventions into healthcare can be improved. This is done by investigating whether some of these efforts do correspond with available scientific knowledge on implementation.

The thesis is based on three cases contributing to four studies. The cases studied are: the National Perinatal Patient Safety program (NPPS), the Dynamic and Viable Organisation initiative (DVO), and the International Child Development Program (ICDP). All studies focuses on the early stages of implementation.

A mixed methods approach was adopted, involving both qualitative and quantitative methods. Data collection consisted of interviews, questionnaires, observations, and process diaries. Qualitative content analysis (conventional and directed), descriptive and non-parametric statistics were used. The focus was on implementation strategies used by healthcare actors in relation to factors influencing implementation processes and outcomes. More specifically, healthcare actors perspectives on such factors and whether they were addressed by the strategies used, was investigated. A process evaluation of implementation outcomes was also part of the thesis.

The healthcare actors in focus were the adopters, i.e. practitioners expected to change their work practices, and implementation facilitators. The latter refer to actors with a more or less explicit responsibility to implement new practices or interventions aimed at improving the quality and effectiveness of the provided health services.

Variation was found regarding how the implementation strategies used in the three cases corresponded with available scientific knowledge on implementation. In Case NPPS, the implementation facilitators planned, designed, and ensured that the core interventions of the implementation strategy were executed in a rational manner. Several important implementation factors were addressed by the strategy. The process evaluation of effects on readiness for change by the development of a team mental model among adopters showed positive results.

In Case DVO a strategy was used that evolved over time, partly based on raised questions and feedback from staff and managers involved. The strategy can be described as an intuitive ‘socially accomplished activity’. This strategy involved addressing ‘Implementation Process-related factors’ in order to affect motivation and increase the tension for change among adopters.

In Case ICDP, the results reflected a shortage of strategies during the early stage of implementation. The main intervention was the stepwise ICDP-education. A more comprehensive implementation strategy covering implementation factors highlighted as important among adopters was not developed. The process evaluation revealed vague directives on what was expected regarding the use and adaptation of ICDP to current practice versus preservation of fidelity to the original ICDP. This situation resulted in a rather large variation in how the changes in work practices were perceived among the health centres involved. No health centre practiced ICDP in its original form.

A new knowledge-practice gap is discussed based on the findings in this thesis: a gap between the scientific knowledge on implementation and the actual implementation strategies used in practice during improvement efforts initiated by healthcare actors. The findings show that correspondence between scientific knowledge on implementation and what is actually done in order to accomplish change in practice might be more random (or implicit) than systematic. The question of how to transfer scientific knowledge on implementation into user-friendly resources for practitioners is discussed. A tentative model is suggested, which contributes to existing determinant frameworks by focusing on relations among factors. The model may be used in healthcare practice, to guide the design of an implementation strategy (or as a pathway for tailored implementation interventions) and aid the assignment of responsibilities in relation to factors that are known to affect implementation processes and outcomes.

The question of how to transfer models and frameworks into user-friendly resources needs further attention. It is suggested that action oriented research aiming at further developing and establishing the concept of ‘practical implementation science’ should be conducted. This could be a way of bridging the knowledge-practice gap in healthcare.

BACKGROUND: Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed.

AIM: This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them.

DESIGN: A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used.

METHODS: Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors.

FINDINGS: Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices.

CONCLUSIONS: Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness.

Purpose: The purpose of this paper was to investigate the role of an intra-organizational change facilitating function (CFF) in relation to a multi-level development initiative in a health care organization. Involved actors’ views on factors in need of attention and how the CFF related to these factors were studied.

Design/methodology/approach: A longitudinal case study design was used, combining data from questionnaires, process diaries and interviews with employees at the CFF, managers and clinic staff.

Findings: Factors on micro, meso and macro levels, crucial to attend to, were highlighted by respondents at staff and managerial levels. The CFF related to some of these factors by acting upon them, or by developing plans to handle them, while other factors were unattended to. The CFF activities also had indirect influence on other factors. The CFF role and responsibilities were not clearly defined beforehand, and a need to clarify a division of roles and responsibilities is highlighted.

Research limitations/implications: Our study contributes to current knowledge on facilitation of change by relating it to an organizational dimension of implementation.

Practical implications: The description of important factors to handle during a large organizational change process and issues a CFF can encounter may aid others involved in designing and managing large organizational development initiatives.

Originality/value:The study elaborates on less studied functions and roles of an intra-organizational CFF in relation to factors of vital importance for organizational change and development in health-care organizations.