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Bakgrund: Antalet fall av kardiovaskulära sjukdomar, där hypertoni ingår, ökar världen över och är de mest dödliga icke smittsamma sjukdomarna. Hälften av alla som är drabbade av högt blodtryck vet inte om att de är det. Behandlingen består bland annat av egenvårdsåtgärder, vilket innefattar farmakologisk behandling och livsstilsförändringar. Det finns ett behov av att beskriva patienters erfarenheter av egenvård vid hypertoni för att öka kunskap och förståelse hos sjuksköterskor. Syfte: Att beskriva patienters erfarenheter av egenvård vid hypertonibehandling.Metod: En litteraturöversikt med kvalitativ metod och induktiv ansats. Litteratursökning gjordes i databaserna CINAHL och PubMed vilket genererade 13 resultatartiklar. Dataanalys av artiklarna genomfördes enligt Fribergs fem steg (2017).  Resultat: Patienter erfor både förutsättningar och begränsningar till att utföra egenvård. Det framkom att få stöd, besitta kunskap och känna motivation var förutsättningar för följsamhet till egenvård. Begränsningar bestod av otillräcklig kunskap, lågt socialt stöd, uppfattade barriärer och låg självförmåga.   Slutsats: Patienter med hypertonidiagnoser erfar hinder att utföra egenvård och behöver stöd från omgivningen eller från vården. Med hjälp av kunskap om sin sjukdom och individuella medel som exempelvis mobilapplikationer blir egenvården mer lätthanterlig. Sjuksköterskan möter dagligen patienter med hypertoni och därför är det viktigt att förstå patienters erfarenheter av behandlingen för att kunna ge en god vård. / Backround: The number of people living with cardiovascular diseases, including hypertension, is increasing worldwide and is the most deadly non communicable disease. Half of the world's population with hypertension is unaware of their condition. Treatments can consist of self-care measures which include both lifestyle changes and medical treatment. To understand and encounter hypertensive patients from a nurse’s perspective, it is important to determine patients’ experiences of self-care.Aim: To describe patients’ experiences of self-care in hypertension treatment.Method: A literature review with a qualitive design and inductive approach was conducted. The databases CINAHL and PubMed were searched to find literature and 13 articles were found. The articles were analysed using Friberg’s five steps (2017).Results: Patients experience both prerequisites and limitations when managing self-care. The results show that receiving support, possessing knowledge, and feeling motivated were prerequisites for compliance to self-care. Limitations were insufficient knowledge, low social support, perceived barriers, and low self-efficacy.  Conclusion: Patients with hypertension experience difficulties in performing self-care and need support from family or healthcare. With the help of individual means such as mobile applications, and knowledge of illness, self-care becomes more manageable. Nurses meet patients with hypertension on daily basis and it is, therefore, important to understand patients' experiences of the treatment to provide good nursing care.

Enligt hälso- och sjukvårdslagen ska vården vara av en god hygienisk standard. Detta innebär att hela verksamheten är utformad så att risken för att patienter drabbas av infektion och smittspridning är så liten som möjligt. För att åstadkomma det är det centralt att använda ett infektionsförebyggande åtgärdsprogram samt att förhindra smittspridning i vården. Trots att kravet på en god hygienisk standard är lagstadgat så saknades ett verktyg för en god hygienisk standard för primärvård i Region Jönköpings län.Förbättringsarbetet handlade om att ta fram och införa en egenkontroll för god hygienisk standard anpassad för primärvård. Målet var att varje vårdcentral skulle arbeta med egenkontrollen och att antalet områden som uppfyllde hygienkraven skulle öka med minst fem procent per vårdcentral i mars 2023 jämfört med baslinjemätning. Kvantitativ metod och Nolans förbättringsmodell med PGSA användes. Förbättringsaktiviteter skapades med inspiration av COM-B. Alla åtta vårdcentraler uppnådde målet inom tidsramen.Studiens syfte var att utvärdera införandet av egenkontrollen vid deltagande vårdcentraler inom ramen av förbättringsarbetet. En kvalitativ innehållsanalys genomfördes och COM-B användes i analysen. Studien identifierade framgångsfaktorer som krävs för att vårdpersonalen ska kunna arbeta med egenkontrollen. Några av dessa var närvarande representant från Vårdhygien vid genomgång av egenkontroll och stöttning av chef för att planera och prioritera arbetet för att lyckas vid tidsbrist.Slutsatsen var att egenkontrollen var ett framgångsrikt sätt att få vårdcentralerna att arbeta mot att säkerställa en god hygienisk standard. Införandet har lett till en ökad patientsäkerhet för patienterna och ökad kunskap och förståelse hos vårdpersonalen. Pilotprojektet ska skalas upp under hösten 2023 och egenkontrollen ska införas på alla 40 vårdcentraler i regionen. / According to the Health Care law, health care must be of a good hygienic standard. This means that the entire health care unit is designed so that the risk of infection is as small as possible. To achieve this, it is central to use a program for infection control. Although the requirement for a good hygienic standard is statutory, the primary care in the region did not have a checklist for this purpose.This improvement work involved introducing a checklist for a good hygienic standard for primary care. The goal was that each primary care unit would use the checklist and the number of areas that met the hygiene requirements should increase by at least five percent in March 2023 compared to the baseline. Quantitative method and Nolan's improvement model with PDSA was used. Improvement activities was created with inspiration from the COM-B model. All eight units achieved the goal.The purpose of the study was to evaluate the introduction of the checklist at the participating health centers within the framework of the improvement work.The study identified success factors that the healthcare staff required to be able to work with the checklist. Some of these were that a representative from the Infection Control unit was present during the review of the checklist and that the manager was supporting in planning and prioritizing the work when there were little time.The conclusion was that the checklist was a successful way to get the primary care units to work towards a good hygienic standard. The introduction of the checklist led to increased patient safety for the patients and increased knowledge and understanding for the health care staff. In the fall of 2023 the checklist will be introduced at all 40 primary care unit in the region.

Detta förbättringsprojekt är både sjukhusövergripande och klinikbaserat och syftar till att på ett nytt sätt ta sig an ett systemproblem, närmare bestämt sjuksköterskebristen. Brister i bemanning och kompetens ger ökad stress, sämre kommunikation och samverkan och i slutändan drabbas patienterna av vårdskador. Konsekvenserna förstärker grundproblemet och leder till en negativ spiral. Detta förbättringsarbete bygger på antagandet att ledarskapsbeteendet är avgörande för hur framgångsrik en organisation är för att bryta denna spiral och med stöd av teoretiskt ramverk (COM-B och CLT) har förbättringsarbete och studie planerats och studerats. Syftet är att skapa förutsättningar för samverkan på mesonivå, öka systemförståelsen och kunskaper i förändringsledning och på mikronivå omsätta denna kunskap, ta tillvara på verksamhetskännedomen och genomföra ett förbättringsarbete för att minska arbetsbelastningen. Nolans förbättringsmodell har använts för att strukturera arbetet.  Resultatet på mesonivå visar att förbättringsarbetets design med verksamhetsövergripande studiegrupper uppskattades mycket och över tid ses en ökad systemförståelse och förbättrad kommunikation i organisationen. På mikronivå genomfördes olika förbättringstester. Minskning av antal patienter per sjuksköterska hade direkt inverkan på upplevelsen av att ha tillräckligt med tid för att utföra sina arbetsuppgifter på ett sätt man var nöjd med och genererade en rimlig arbetsbelastning. Förbättringsarbetet har studerats kvalitativt med reflexiv tematisk analys och beskriver organisationens förmåga, möjlighet och motivation att ta sig an systemproblem utifrån både vårdenhetschefs- och sjuksköterskeperspektiv.  I analysen framkommer antagande om Vem som kan? kontra Vem som får? -förändra i organisationen, vilka kulturella och strukturella möjligheter som inverkar samt hur individuella drivkrafter och organisatoriska arbetssätt påverkar motivationen. Med hjälp av COM-B-modellens komponenter framkom att Möjlighet är den mest avgörande komponenten för att åstadkomma systemförändring. Tillvaratagande av Förmågor och Motivation hos medarbetare och VEC är kulturberoende och en förutsättning för förändring av andra ordningen. För att nå framgång behövs att alla organisationsnivåer involveras och skapar ett gemensamt mål att arbeta mot. / This complex and long-term improvement project aims to address a systemic problem, namely the nursing shortage. Deficiencies in nursing staffing and competence lead to increased stress, poorer communication and collaboration, and ultimately risks for patients. These consequences reinforce the problem, and a negative spiral arises.  With COM-B model and CLT as a theoretical framework, this improvement effort assumes that leadership behaviour is crucial for how successful an organization is at breaking this spiral. Using Nolan´s model for improvement, the purpose is thus to create conditions for collaboration, increase a system-understanding and knowledge about change leadership and put this knowledge into practice and carry out improvement work to reduce the workload. The results at a mesolevel show that the design of the improvement work with hospital wide workshops for first line managers was highly appreciated. Over time, an increased system understanding became visible and the communication was improved. Simultaneously at the microlevel, various improvement tests were carried out, where reducing the patients to nurse ratio had a direct impact on the nurses’ experience of having enough time to perform their tasks and thus provided a reasonable workload.   The qualitative study was carried out by conducting interviews with first line mangers and nurses and was analysed through reflexive thematic analysis. The result of the analysis describes the organization's capability, opportunity and motivation to take on systemic problems. The analysis reveals assumptions about Who can? versus Who gets? to change in the organization, how culture and structure affects, and how individual driving forces and organizational working methods affect motivation.  The conclusion is that opportunity is the most influential component to achieve change in the overall system. The ability to benefit from the capability and motivation from the staff is dependent on the organizational culture. To achieve this, all leadership levels need to be involved with a shared aim.

Multidisciplinary cancer conferences (MCCs) are prospective meetings to discuss diagnoses and treatment plans for patients with cancer. MCCs are typically attended by surgeons, medical and radiation oncologists, pathologists and radiologists. To date, the quality of MCCs, specifically MCC decision making, has not been formally evaluated in a Canadian context. We utilized progressive knowledge translation methodology, specifically the use of theory, models and an integrated knowledge translation approach, to design, implement and evaluate an intervention, titled the KT-MCC Strategy (KT-MCC). The purpose of the KT-MCC is to improve the quality of MCC decision making. This thesis is comprised of four parts. In Part 1, we completed a generalizability study to evaluate the reliability of an MCC assessment tool (MTB-MODe) in an Ontario context. In Part 2, we conducted key informant interviews using the Theoretical Domains Framework (TDF) to identify barriers and facilitators to optimal MCC decision making. In Part 3, we mapped identified TDF barriers and facilitators to the COM-B Behavioural Change Wheel to develop the KT-MCC, an intervention aimed at improving the quality of MCC decision making. In this study, we examined the validity of the key informant findings using focus groups and surveys completed by individual MCC participants. In Part 4, we conducted a before-and-after pilot study to evaluate the feasibility and impact of the KT-MCC on MCC decision making in preparation for a possible randomized controlled trial testing the efficacy of the KT-MCC. There are few examples in the KT literature that provide a complete and detailed description of the design, implementation and evaluation of a complex KT strategy using progressive KT methods such as TDF interviews to identify barriers and facilitators to practice change; the COM-B model to identify potential interventions; and use of integrated KT with front-line workers. We describe in detail our methods to design, implement and evaluate the KT-MCC. This thesis provides a significant contribution to the knowledge translation literature and provides recommendations to improve the quality of MCCs in Ontario. / Thesis / Doctor of Philosophy (PhD) / Multidisciplinary cancer conferences (MCCs) are regular meetings held by health professionals to prospectively discuss diagnoses and treatment plans for patients with cancer. The purpose of MCCs is to facilitate input from numerous experts to ensure that each patient receives an optimal treatment recommendation. To date, the quality of MCCs, specifically MCC decision making, in Ontario has not been formally evaluated. We aimed to identify gaps in Ontario MCC decision making and design an intervention to mitigate these gaps. The intervention was designed using an integrated knowledge translation approach, meaning MCC participants were involved in the design, implementation and evaluation of the intervention. The resulting intervention, called the KT-MCC Strategy, was evaluated at four Ontario MCC sites. This thesis provides a significant contribution to the knowledge translation literature and provides recommendations to improve the quality of MCCs in Ontario.

Food waste is an arguably increasing problem in society, with consumers being responsible for as much as half of all combined food waste. The problem needs to be tackled from all angles, but there is no all encompassing solution for all situations. One context consumers find themselves in is the kitchen at their place of work, where the shared nature of the refrigerator creates situations and problems not found in the home environment. It is for these shared kitchens that this study is focused on providing a physical solution based on The Behavioural Change Wheel (BCW), book providing methods and tools for designing with the goal of behavioural change. The intention of this study was to develop, test and later evaluate a prototype on its behavioural change capacity and potential, using the tools presented in the BCW. The developed prototype took form as an RFID activated labelling system, providing users with the current date and their name on a label to be adhered on the articles they place in the shared refrigerator. After the testing period, an online questionnaire was sent out and was answered by fourteen out of seventeen participants. The two week testing period and subsequent questionnaire provided no conclusive answers regarding detected behavioural change capacity, but the potential is considered high based on participants qualitative comments and attitudes, and their quantitative usage. No measurements of change in food waste is conducted, but the target behavioural changes would provide a positive development resulting in less food waste in the workplace kitchen, if not only a more orderly refrigerator. / Matavfall är ett påtagligt ökande problem i samhället, där konsumenter ansvarar för så mycket som hälften av allt kombinerat matavfall. Problemet bör hanteras från alla möjliga håll, men det finns ingen allmän lösning för alla situationer. Ett sammanhang som konsumenterna befinner sig i är köket på deras arbetsplats, där kylskåpets gemensamma natur skapar situationer och problem som inte återfinns i hemmiljön. Det är för dessa delade kök som denna studie riktar sig på att tillhandahålla en fysisk lösning baserad på The Behavioural Change Wheel (BCW). Den innehåller metoder och verktyg för att designa med beteendeförändring som mål. Syftet med denna studie var att utveckla, testa och senare utvärdera en prototyp angående dess beteendeförändringsförmåga och potential, med hjälp av de verktyg som presenteras i BCW. Den färdigställda prototypen tog form som ett RFID-aktiverat etikettsystem, som gav användarna det aktuella datumet och deras namn på en etikett som ska sättas på artiklarna som de placerar i det delade kylskåpet. Efter testperioden skickades ett frågeformulär ut och fjorton av sjutton deltagare svarade. En testperiod på två veckor och efterföljande frågeformulär gav inga avgörande svar angående påvisad beteendeförändringsförmåga, men potentialen anses vara hög baserad på deltagarnas kvalitativa kommentarer och attityder, och deras kvantitativa användning. Inga mätningar kring mängd matavfall utfördes, men målbeteendeförändringarna skulle ge en positiv utveckling som resulterar i mindre matavfall i arbetsplatsens kök, om inte bara ett mer ordnat kylskåp. / Smart storage solutions in the fridge of the future to reduce food waste

Background: The World Health Organization recommends early breastfeeding initiation, within the first hour of life. Ugandan mothers with no formal schooling appear superior in fulfilling this recommendation compared to mothers with primary, secondary, or higher education. Aim: This secondary analysis of Ugandan Demographic and Health Survey data from 2016 aimed to statistically analyze the association between maternal education and early breastfeeding initiation, to find socio-economic and health care determinants that promote the behavior. Methods: Ugandan mothers (n=9,209, 15 to 49 years) were included in statistical analysis. Chi-squared testing and logistic regression were used to assess associations between maternal education (exposure) and fulfillment of early breastfeeding initiation less than 1 hour after birth (outcome). Results: Out of the eligible mothers in a weighted sample, 68% (n=6,281) fulfilled early breastfeeding initiation and 32% (n=2,928) did not meet the criteria. Maternal primary education significantly predicted the outcome of early breastfeeding initiation (p ≤ 0.05, AOR: 0.80, with 95% CI 0.67-0.95) in a negative direction, compared to uneducated mothers. This result was adjusted for maternal residence, education, occupation, and parity, along with the husband/partner's education. Moreover, educational attainment beyond the primary level indicated a non-significant association to the criteria fulfillment when compared to uneducated mothers. Conclusions: Ugandan maternal education does not seem to significantly promote early BFI behavior. Primary level education only indicated a significantly negative association compared to uneducated Ugandan mothers. Traditional lifestyle factors (lower level education, and corresponding level of occupation, and larger families) appeared to be associated with the desired behavior.

<p>Poor food safety in informal, open-air markets remains a pressing issue in Cambodia, contributing to both foodborne illness and malnutrition. In order to design food safety programs that successfully promote positive food safety practices among the various actors involved in these markets, is important to understand their perceptions of food safety and of their own capability, opportunity, and motivation for adopting positive food safety behaviors. To that end, this research sought to explore and describe the perceptions of vegetable vendors, vegetable distributors, and vegetable growers in the Cambodian provinces of Battambang, Siem Reap, and Phnom Penh regarding food safety and their own personal capability, opportunity, and motivation for implementing specific food safety practices.  To note, this research was made possible by the generous support of the American people through the United States Agency for International Development (USAID) though Cooperative Agreement No. 7200AA19LE00003 to Purdue University as management entity of the Feed the Future Innovation Lab for Food Safety. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. </p> <p>The first portion of the research, which examined levels of perceived capability, opportunity, and motivation for positive food safety practices among actors involved in informal vegetable markets in Cambodia, employed a quantitative questionnaire based on the Capability, Opportunity, Motivation-Behavior model of behavior and the Theoretical Domains Framework. A pilot study using this questionnaire was performed with vegetable vendors in the Province of Phnom Penh (<em>N</em> = 55), after which the questionnaire was revised and implemented in person with vegetable distributors in Battambang Province (<em>n</em> = 37) and vegetable vendors and growers in Battambang (<em>n</em> = 26 and <em>n</em> = 27, respectively) and Siem Reap Provinces (<em>n</em> = 61 and <em>n</em> = 30, respectively). To validate the questionnaire, response data from participants in Battambang and Siem Reap were evaluated using confirmatory factor analysis. The resultant nine-factor model had a comparative fit index of .91, a Tucker-Lewis index of .89, and a root mean square error of approximation of .05. Data analysis proceeded using a fitted general linear mixed model. Results of this analysis suggested that levels of perceived motivation and capability for the target food safety practice were typically significantly higher (<em>p</em> < .05) than levels of perceived opportunity among vegetable vendors and distributors, regardless of location. Levels of perceived opportunity and perceived capability were significantly lower (<em>p</em> < .05) than levels of perceived motivation among vegetable growers in both Battambang and Siem Reap. Significantly higher (<em>p</em> < .05) levels of perceived opportunity and motivation for the target food safety practice were observed among vendors in Battambang in comparison to vendors in Siem Reap; perceptions of all three behavioral determinants were higher among vendors in Battambang than among farmers in either location. </p> <p>Subsequently, a quantitative questionnaire regarding participants’ perceptions of vegetable safety was implemented in person with vegetable growers in Battambang (<em>n </em>= 41) and Siem Reap (<em>n</em> = 28) and vegetable vendors in Phnom Penh (<em>n </em>= 31). Response data were analyzed using a fitted logistic regression model. Nearly all respondents indicated that they were concerned about vegetable safety (overall mean estimate 97.4%, 95% CI = [89.7, 99.4]%), with ≤ 62.7% of respondents in all groups reporting at least moderate concern (lower bounds of 95% confidence intervals 46.2% at the lowest). Across all groups, chemical contamination was perceived as more concerning than microbial contamination (84.9%, 95% CI = [76.0, 90.9]%). The majority of respondents reported that they were familiar with the potential health effects of consuming vegetables contaminated with either chemicals (71.4% [61.5, 79.6]%) or microbes (57.3% [47.2, 66.9]%). Nonetheless, when those who reported familiarity were asked to give examples of such health effects, fewer than 50% (ranging from 7.3% to 48.4%) provided an example of a commonly understood health effect of consuming contaminated vegetables. </p> <p>Both chemical and microbial contamination were most frequently perceived as occurring mainly “at the farm”, regardless of participants’ occupation and location (≥ 76.7%, lower bounds of 95% confidence intervals at least 61.5%, and ≥ 39.3%, lower bounds of 95% confidence intervals at least 21.2%, respectively). Correspondingly, “vegetable farmers’ were most often perceived as having the greatest responsibility for chemical contamination prevention (≥ 51.6% across all groups, lower bounds of 95% confidence intervals at least 34.0%). There were significant between-group differences in participants’ perceptions of microbial contamination prevention responsibility, however (<em>p</em> = .02). With regards to practices intended to prevent vegetable contamination, 22.6% of surveyed vendors in Phnom Penh, 39.0% of surveyed growers in Battambang, and 53.6% of surveyed growers in Siem Reap described at least one commonly accepted contamination prevention practice. </p> <p>Considered as a whole, these findings indicate that food safety practice adoption may be more effectively encouraged among vegetable growers, distributors, and vendors in Phnom Penh, Battambang, and Siem Reap by emphasizing the importance of microbial contamination and integrating educational components regarding the health effects of consuming vegetables contaminated with microbes or chemicals into food safety programs. Such programs should also address the relatively lower levels of perceived opportunity present among all groups; environmental restructuring-based interventions may be one means by which to do so. Programs for vegetable vendors specifically should communicate that microbial contamination of vegetables is common and highlight the significance of the role of vegetable vendors in maintaining a safe vegetable supply. Food safety programs tailored to vegetable growers could draw on growers’ perception of their own responsibility for both vegetable contamination and contamination prevention as well as their perception of contamination as a common occurrence. Programs for vegetable growers also need to incorporate efforts to address the relatively lower levels of perceived capability present within this group. These efforts could include educational programming or hands-on demonstrations that increase participants’ perceptions of their own ability to implement positive food safety practices. </p>

Background The Swedish population is ageing quickly and the system for elderly home care is under increasing pressure. Staff turnover is high, nursing assistants are reporting stress, and employers have to recruit staff lacking sufficient experience. These factors are barriers to empathic care, considered essential to patient health outcomes. Elderly care should rely on cognitive empathy, be other-oriented and improve the client’s situation based on contextual understanding. There is a need for education and support for nursing assistants, so that they can provide empathic care. Purpose The thesis explores empathy as a skill in elderly home care to identify opportunities of promoting empathy in the client-nursing assistant interaction, by means of behaviour change interventions delivered through an mHealth application that nursing assistants already use at work. Method A group interview was conducted with six nursing assistants from four elderly home care organisations in a Swedish municipality, to learn about their experience of empathy at work, and factors affecting their ability to give empathic care. The respondents were using the same mHealth application to get and provide information about client visits. The Behaviour Change Wheel framework was used to analyze behavioural drivers of empathic care in elderly home care. Results Influences on empathic behaviour was identified in all 14 domains in the Theoretical Domains Framework. 13 target behaviours, 7 Intervention Functions and 45 Behaviour Change Techniques were suggested as suitable candidates to investigate for intervention development. Conclusion Empathy seems possible to promote through resource-efficient digital behaviour change interventions. Future studies may use this work as a starting point for development of interventions to promote empathic behaviour in elderly care.