Stroke is a rapidly increasing disease worldwide, and speech and language impairments are common in stroke patients. A patient’s ability to speak, listen, read and write is reduced after stroke which affects the patient's independently living and quality of life. After an initial evaluation at the hospital, the stroke survivors are referred to the stroke rehabilitation centre where the speech therapists assist them in their challenging and long journey towards speech and language relearning. To enhance the patient's quality of life and to facilitate the speech therapists, technology-enhanced systems can play an important role. However, the currently used software applications such as online speech and language relearning applications are not specifically designed after the user’s need, and the user’s participation and empowerment are compromised. Medical caregivers and stroke patients are the main stakeholders and potential users of these software applications. Therefore, this study is aimed to understand the medical caregivers and the stroke patients’ needs for technology-enhanced speech and language relearning from medical caregivers’ viewpoint.  Design science research strategy was adopted to create, implement and evaluate the artefact. Some important stakeholders such as speech therapists, a stroke specialist doctor, information and technology professionals and one stroke survivor participated in this study. Following the speech therapist’s expert opinion, an application for speech and language assessment was developed as an artefact. The application was then evaluated for technology acceptance with the speech therapists. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used as the theoretical foundation for making the interview questions and data analysis.  The user's requirements for software application differ from one patient to another depending upon the patient's overall health after stroke, their age, social life, the level of speech and language loss, and previous experience with technology use. Stroke is common in adults and adults like to participate in designing their relearning process; therefore, adults should be involved in deciding the learning objectives, and adult learning principles are helpful to understate their needs for speech and language relearning. Due to impaired physical and cognitive conditions, the patients need a bigger interface with larger fonts and pictures and more constructive colours than usual. Tablets with touch pens are preferred hardware. The speech therapist should have the possibility to change the exercises runtime according to the patient's abilities and stamina to do the exercises.  The technology acceptance evaluation showed that the developed application was easy to use and efficient for speech therapists. The study participants also highlighted some critical issues for better usability and technology acceptance. The application should be synchronized with speech therapists’ existing workflow and routines, and it should directly be connected to the hospital records system so that the patients’ data can easily be transferred to their journals.  The role of facilitating conditions such as proper education and training about the system, and personalised support is also important in technology acceptance. The user’s trust in the system’s security and privacy and their personal integrity were also highlighted as main determinants for technology adoption and use. To achieve better coherence between the users and technology, all the tasks/exercises and sub-tasks in the application should be designed in close collaboration with speech therapists and stroke patients. Due to the Covid-19 pandemic, only one stroke survivor was interviewed in this study. However, the patients’ perspective is of utmost importance, and in future research, they will be involved in the design and development of such technology-enhanced systems.

Background: Medications are used to treat, cure, or relieve symptoms of diseases, but there is a risk with the use of medications. Drug-related-problems are known to increase morbidity and mortality. Incorrect medical list and discrepancies in these lists can lead to drug-related problems as side effects, hospitalization, non-compliance, drug interactions and overtreated or undertreated patients. Discrepancies can be for example: more prescriptions than necessary, outdated prescriptions, i.e., medicines that will not be used, prescriptions with incorrect dosing and missing prescriptions i.e., medicines used by patients that cannot be seen in the medication list. Purpose:  The aim of this study was to investigate discrepancies in the Swedish prescription list "My saved prescriptions at the pharmacy". The secondary aim was to investigate how common it is to use this prescription list or the dosage label on the medicine packaging to know which medicines to use and which dosage. Methods: The data collection was performed by four pharmacy students at seven pharmacies in Sweden over a period of three weeks during Jan-Feb. 2021 where the prescription list was investigated together with patients to identify any discrepancies. The study included patients who was over 18 years old, spoke Swedish, had three or more prescribed drugs, and agreed to participate.  Results A total of 215 patients were interviewed, where 61% had one or more discrepancies in their medication list. A total of 1717 prescriptions were analyzed, of which 10% were double prescriptions (n = 167), 8% outdated prescriptions (n = 141) and 3% prescriptions with the wrong dosage (n = 42). When analyzing the primary sources of information used by patients to know which medicine to use, the printout of the list "my saved prescriptions at the pharmacy” dominated (n = 72).  Most used information source to know drug dosage was the dosage label on the medicine packaging (n = 112). Conclusions: It is important to have an updated and correct information in the medication list, to prevent drug-related-problems caused by discrepancies. It becomes even more important when we see that the medication list "My saved prescriptions at the pharmacy" and dosage label (containing the same information in the medication list), are the most used primary sources by patients to know which drug to use and in what dosage. Finally, results show a relationship between the number of prescribed drugs and the number of discrepancies that occur, and therefore we see more discrepancies in elderly patients who are usually ill and are being treated for several diseases.  There are opportunities for further research to study e.g., which drug-related-problems are caused by discrepancies in the medication list as well as the degree of danger in these problems. / Användning av läkemedel som avses behandla, lindra eller bota sjukdomar kan i vissa fall utgöra en risk för patientens hälsa. Läkemedelsrelaterade problem p.g.a. felmedicinering står för en stor andel av morbiditeten och mortaliteten bland patienter. En bidragande orsak är ofullständig information i patientens läkemedelslista.   Syftet med studien var att undersöka antalet avvikelser som förekommer i receptlistan ”Mina sparade recept på apoteket”. Studiens sekundära syfte var att undersöka vilka informationskällor som användes av patienter för att veta vilka läkemedel som ska adminstreras och i vilken dos dosering.  Studiens metod var att intervjua patienter som kom till apoteket för att hämta ut läkemedel till sig själva och uppfyllde inklusionskriterierna för att delta i studien. Studien utfördes av fyra farmaceutstudenter på sju olika apotek i fyra olika städer i Sverige som tillsammans med patienter gick igenom receptlistan för att identifiera avvikelser.  Resultatet blev totalt 1717 recept som studerades varav 21% hade avvikelser. Av recepten var 10% dubbla recept (n = 167), 8% inaktuella recept (n = 141) och 3% recept med fel dosering (n = 42). Vid analys av primära informationskällor som används dominerade utskrift av listan ”Mina sparade recept på apoteket” (n = 72) resp. doseringsetiketten på läkemedelsförpackningen (n = 112).  Resultaten visade även ett samband mellan ökade antal läkemedel och antalet avvikelser.  Avvikelser i läkemedelslistan Mina sparade recept är vanligt förekommande därmed är listan inte alltid aktuell. Det är vanligt att denna lista och doseringsetikett på läkemedels-förpackningar används som primära källor av patienter under deras behandlingstid vilket kan innebära en risk för läkemedelsrelaterade problem. En gemensam nationell läkemedelslista är en möjlig lösning till att förebygga läkemedelsrelaterade problem orskade av infromationsbrist i läkemedelslistor. Det är dock nödvändigt med läkemedelsgenomgångar för att bibehålla uppdateringen av listan.

As a response to the need for efficiency and innovation that modern society hasplaced over healthcare organizations, they are constantly looking for more efficientand innovative tools that facilitate the daily practices for providers. In this context,the use of digital solutions or eHealth arises as an alternative for healthcare.Despite the potential benefits of eHealth solutions, healthcare leaders experiencedifficulties implementing them. For that reason, health services researchersacknowledge the critical role of implementation science in the sector. Seeking tomotivate organizations to embrace eHealth solutions and their benefits, thisresearch identifies the barriers and facilitators experienced by project managersduring the implementation projects of innovations in healthcare. Moreover, itproposes the clarification of concrete criteria to assess success derived from theoutcomes of an implementation project. Starting with a literature review, followedby qualitative research and a data collection through a total of ten semi-structuredinterviews with project managers. Moreover, the data analysis is made based onthematic analysis. The results identify three main facilitators for innovation: 1)maintaining a balanced level of understanding for all stakeholders, 2) to have opencommunication, and 3) to have a high involvement of the top management with theproject. Moreover, the most relevant barrier faced by managers is the lack of skilledand competent people within the organization. Regarding the success ofimplementation projects, the most relevant criteria are: 1) delivering in the righttime, budget, scope and quality (reach the project goals), 2) maintaining thecustomer and user satisfaction, and 3) increase in work efficiency in the healthcareorganizations. To some extent, the mentioned factors contribute to facilitating theimplementation of innovations in healthcare. The role of managers inimplementation is highly valuable since they represent the bridge between topmanagement and front-line employees. This research summarizes the experienceof the managers -from a consultancy company- while working in theimplementation of digital tools in healthcare. Therefore, the research provides abetter understanding regarding the barriers, facilitators and success criteria forimplementation.

Bakgrund: Dietary Approaches to Stop Hypertension (DASH) är en väletablerad icke-farmakologisk behandling vid hypertoni men används sällan inom traditionell hälso-och sjukvård på grund av tids- och resursbrist. Digitala metoder kan vara bättre lämpade för att ge långsiktigt stöd. Denna studie är den första digitala kostinterventionen med DASH-kost i en total digital vårdmiljö. Syfte: Syftet med studien är att undersöka följsamhet till DASH-kost samt upplevelse av digital kostbehandling vid hypertoni. Material och metod: Studien har en experimentell design och utgick från den digitala vårdgivaren Blodtrycksdoktorns plattform. Nitton patienter med lätt förhöjt blodtryck fick digital kostbehandling utifrån DASH-kost under 8 veckor utöver standardbehandling. Videosamtal i kombination med asynkron textkommunikation användes som kommunikationsverktyg. Kostförändring mättes via livsmedelsfrekvensformulär (FFQ) före och efter behandling och sammanställdes i ett DASH-index. Patientupplevelse mättes via enkät efter behandling. Studien undersökte även förändring av vikt, BMI, midjemått och blodtryck. Statistisk analys genomfördes med Parat t-test samt Wilcoxons ranksummetest. Resultat: DASH-index förbättrades med 1,4 poäng (p = <0,001). Patienterna hade i genomsnitt haft diagnosen hypertoni under 6 år ± 8 SD (median 2 år) där endast 2 av 19 tidigare fått kostråd för hypertoni. Patienterna hade överlag en positiv upplevelse av digital kostbehandling. Vikt och BMI minskade med 1,9 kg (p = <0,001) respektive 0,7 kg/m2 ( p = <0,001). Midjemåttet minskade med 3,2 cm för manliga patienter (p = 0,007) och 4 cm för kvinnliga patienter (p = 0,027). Systoliskt blodtryck (SBT) minskade med 8,7 mmHg (p = <0,001) och diastoliskt blodtryck (DBT) med 4,6 mmHg (p = 0,004). Slutsats: Den 8 veckor långa digitala kostinterventionen förbättrade kostvanor hos patienter med hypertoni samt ledde till minskad vikt, BMI, midjemått och blodtryck. Patientupplevelse av behandlingen var god. Digital kostbehandling kan utgöra ett alternativ till traditionell kostbehandling för patienter med hypertoni. / Background: Dietary Approaches to Stop Hypertension (DASH) is a well-established non-pharmacological treatment for hypertension but is rarely used in traditional health care due to lack of time and resources. Digital methods may be better suited to provide long-term support. This study is the first digital nutrition intervention with DASH diet in a total digital health care environment. Aim: The purpose of the current study is to investigate adherence to DASH diet and self-reported experience of a digital nutrition intervention for patients with hypertension. Material and methods: The study has an experimental design and was based on the platform of the digital healthcare provider “Blood Pressure Doctor”. Nineteen patients with primary hypertension received digital nutrition therapy based on the DASH diet for 8 weeks in addition to standard care. Video calls in combination with asynchronous text communication were used as communication tools. Dietary change was measured by food frequency questionnaire (FFQ) at baseline and after treatment and compiled in a DASH index. A questionnaire was used to assess patient experience. Secondary outcomes were changes in body weight, BMI, waist measurement and blood pressure. Statistical analysis was performed with Pared t-test and Wilcoxon signed rank test. Results: DASH index improved by 1,4 points (p = <0,001). The patients had on average been diagnosed with hypertension for 6 years ± 8 SD (median 2 years) where only 2 of 19 had previously received dietary advice for hypertension. The patients generally had a positive experience of the digital nutrition intervention. Body weight and BMI decreased by 1,9 kg (p = <0,001) and 0,7 kg / m2 (<0,001), respectively. Waist decreased by 3,2 cm for male patients (p = 0,007) and 4 cm for female patients (p = 0,027). Systolic blood pressure (SBP) decreased by 8,7 mmHg (p = <0,001) and diastolic blood pressure (DBT) by 4,6 mmHg (p = 0,004). Conclusion: The 8-week digital nutrition intervention improved dietary habits, body weight, BMI, waist and blood pressure of patients with hypertension. Patients were overall satisfied with the treatment. Digital nutritional therapy can be an alternative to traditional nutritional therapy for patients with hypertension.

Pregnancy is a sensitive period in women’s lives; pregnant women encounter various physical changes and emotional challenges during pregnancy. The vision for Sweden’s eHealth initiative is to be the best in the world in using eHealth to make it easier for people to achieve a healthy wellbeing and equal welfare by 2025. However, there is a lack of empirical studies in the area, especially studies associated with both eHealth and pregnancy in a Swedish context. Therefore, the thesis intended to seek the factors that affect a pregnant woman to adopt an eHealth innovation by applying qualitative interviews. Eleven women were selected including both women who are currently pregnant and women who have experienced pregnancy in recent years. Semi-structed interviews were chosen to gain more in-depth insights of the challenges during pregnancy. The data analysis followed the framework of Unified theory of acceptance and use of technology (UTAUT). Rogers’ innovation diffusion theory was discussed in relation to the study as well. The results based on the date from the study showed that the real drive for pregnant women to adopt an eHealth innovation is the dissatisfaction with the current solution, namely prenatal care in the Swedish public health care system. Other moderating factors that affect their intention for adoption are relevant knowledge, expertise support and trialability. The results revealed that women with foreign background were more likely to be dissatisfied with prenatal care in Sweden, and that professionals’ involvement in using the innovation and the possibility of experimenting with it will increase the intention of innovation adoption. Age, experience, and personality were not supported in having an impact on innovation adoption in this study. The limitations of the study are transferability and confirmability, where credibility, dependability and authenticity are high in this study.

Introduktion: Långvarig smärta kostar samhället mycket pengar varje år. Under 2020 och 2021 utvecklades applikationen Vitala som stöd för patienter med behov av fysisk aktivitet i sin rehabilitering av sjukdomar. I applikationen ingår en del som syftar till rehabilitering för personer med muskuloskeletala besvär i nacke, axlar, rygg och höft. Den här studien är den första av sitt slag som utvärderar rehabiliteringsdelen i Vitala. Syftet med denna studie var att undersöka användbarhet, deltagarnas förståelse för applikationens frågor och instruktioner, samt relevansen av Vitalas val av övningar för deras smärtmekanismer. Metod: Tio studiedeltagare med besvär i nacke-/skuldra och ländrygg-/höft sedan ≥4 veckor rekryterades genom en privat fysioterapi- och naprapatklinik i Stockholm. Deltagarna observerades när de använde applikationen för att diagnostisera sina besvär och deras förståelse för appens frågor och tester bedömdes. Efter användning skattades användbarhet genom frågeformulär (Health-ITUES och System Usability Scale). Validitet undersöktes genom att jämföra funktionsdiagnos och övningar som förskrevs av Vitala med en erfaren fysioterapeuts bedömning av funktionsdiagnos och rekommenderade övningar. Resultat: Användbarheten i rehabiliteringsdelen skattades mellan mycket bra och bästa tänkbara. Studiedeltagarna förstod frågor och instruktioner i 88% av fallen. Applikationens funktionsdiagnoser var i linje med fysioterapeutens i 9 av 10 fall. Överensstämmelsen av övningarna var fullständiga för fem av deltagarna, fyra saknade något element och endast en bedömdes bristfällig. Konklusion: Studiedeltagarna visade en god förståelse för Vitalas frågor och instruktioner, vilket var i linje med deras egna skattningar där appen bedömdes vara lätt att använda. En viss svårighet med att förstå vad som menades med begreppen smärta och besvär uppstod hos en del. Vitala hade en god överensstämmelse gällande övningar och funktionsdiagnos, med undantag för deltagare med patoanatomiska förändringar eller nociplastiska smärttillstånd.

This project was initiated due to the need for new manners of taking care of elderly. The purpose was to determine the perception of eHealth within home care. The goal was to analyze the perception of eHealth in order to find factors which may affect the implementation of eHealth services. To distinguish the perception, surveys with health personnel within home care and the general public as well as and interviews with municipalities were performed. An extension of the Technology Acceptance Model was used in order to locate the perception to seven different categories related to eHealth. The results from the surveys were statistically analysed, and a factor analysis was executed on the surveys, in order to find groups with similar perception on eHealth. The surveys showed that the general perception of the usability and ease of use of eHealth is positive, even though one view was that the society needs to invest more money within the area. The factor analysis resulted in six different groups of perceptions for the personnel and three groups for the general public. The interviews demonstrated that a clear and common definition of eHealth is missing. Despite that, a positive perception of eHealth within the municipalities existed. A conclusion made was that with clear guidelines of how to work eHealth, a wider and faster implementation will be easier to accomplish. / Syftet med detta projekt var att undersöka inställningen till eHälsa inom äldrevården. Projektet initierades på grund av att det fanns ett behov av nya tillvägagångssätt för att ta hand om äldre människor. Målet var att analysera inställningen till eHälsa, och om möjligt, finna faktorer som kan påverka implementeringen av eHälsotjänster. För att lokalisera inställningen gjordes enkätundersökningar med personal inom hemtjänsten samt med allmänheten. Även intervjuer med kommuner utfördes. En påbyggnad av Technology Acceptance Model användes för att lokalisera upp- fattningen kring sju kategorier relaterade till eHälsa. Enkätundersökningarnas resultat analyserades statistiskt, samt så utfördes en faktoranalys för att hitta grupper som hade liknande uppfattning gällande eHälsa. Analyserna visade att den allmänna uppfattningen gällande nyttan med, och användarvänligheten av eHälsa är positiv. Majoriteten anser att samhället behöver investera mer pengar i området. Faktoranalysen resulterade i sex olika grupper av inställningar inom personalen samt tre grupper för allmänheten. Intervjuer med kommuner påvisade att en klar och tydlig definition av eHälsa saknas. Trots det, har de i stort en positiv inställning till eHälsa och dess utveckling. En slutsats är att tydligare riktlinjer rörande arbete med eHälsa skulle kunna möjliggöra en smidigare implementering.

E-mental health and home treatment are treatment approaches that have proven to be effective, but are only slowly implemented in the German health care system. This paper explores the attitudes toward these innovative treatment approaches. Data was collected in two large, non-clinical samples representative of the German population in spring 2020 (N = 2,503) and winter 2020/2021 (N = 2,519). Statistical associations between variables were examined using two-tailed tests. Binary and multinomial logistic regressions were performed to predict attitudes toward online-based treatment concepts and home treatment approaches. Only few (<20%) people preferred online-based treatment approaches, while a larger proportion (~50%) could imagine being treated at home. Overall, younger subjects were more open to online-therapy approaches, while people with lower education preferred more often a traditional therapy setting. Acceptance of online-therapy did not raise significantly during the first months of the COVID-19 pandemic. When different online-based treatment options were available, the probability of accepting home treatment significantly increased with increasing levels of therapeutic support. Further promotion of acceptance for online-therapy and home treatment seems to be necessary. In the future, more information on innovative treatment approaches should be actively provided.

Many Syrian refugees residing in Germany have been exposed to traumatizing events, while treatment options are scarce. Therefore, the self-help app “Sanadak” was developed to target post-traumatic stress in Syrian refugees. We aimed to inspect the recruitment and baseline characteristics of the participants in the trial, which is conducted to evaluate the app. Analyses were based on the recruitment sample (n = 170) and the trial sample (n = 133). Data were collected during structured face-to-face interviews in the Arabic language. Targeted outcomes included post-traumatic stress (primary; Post-traumatic Diagnostic Scale for DSM-5/PDS-5) and depressive symptoms, anxiety, resilience, among others (secondary). Recruited individuals were M = 32.8 (SD = 11.2, range = 18–65) years old; 38.8% were women. The average PDS-5 score was 23.6 (SD = 13.2) regarding trauma exposure, which was most frequently related to experiencing military- or combat-related events (32.9%). Moreover, 46.5% had major depression and 51.8% showed low resilience. Anxiety was present in 40.6% of the trial participants. Psychological distress was high in Syrian refugees residing in Germany, enrolled in a trial targeting post-traumatic stress. This underlines the need for intervention. Our results provide important figures on the mental health of a not well-studied population group in Germany.

Background: The world is facing new conditions and people are living longer, therefore an increased need for care and greater challenges for nurses to offer high- quality healthcare. Training and hiring more nurses is not considered an optimal solution, but the application of digital care services seems to respond to the increased need for a functioning care. It is therefore important for the nurse to have competence and continuously develop in digital tools to provide a high-quality nursing care. Purpose: The purpose was to describe nurses' experiences of the application of digital care meetings. Method: The method was designed as a literature study consisting of eight scientific articles. In the analysis, relevant information was color-coded and the data was grouped into subcategories and categories. Results: Four categories were identified, which were “Digital care meetings mean new challenges”, “Digital care meetings contribute to increased accessibility and quality” and “Digital care meetings facilitate a continuous relationship”. All articles discussed the advantages and disadvantages of digital care-services, which turned out to depend on the situation and the participants in a digital care-conversation. Conclusion: The technology is a challenge for nurses whose experience and knowledge can be questioned in the event of an insufficient telehealth-technology. Digital care meetings complement the care the patient already receives but cannot replace physical meetings. / Bakgrund: Världen präglas av nya förutsättningar och människor blir äldre och lever längre, vilket har medfört ett ökat vårdbehov och större utmaningar för sjuksköterskor att erbjuda omvårdnad av hög kvalité. Att utbilda och anställa fler sjuksköterskor anses inte som en optimal lösning utan tillämpningen av digitala vårdtjänster tycks svara på det ökade behovet av en fungerande vård. Det är därför viktigt för sjuksköterskan att ha kompetens samt kontinuerligt utvecklas inom användningen av digitala verktyg för att ge en god och säker vård. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att tillämpa digitala vårdmöten. Metod: Metoden var utformad som en allmän litteraturstudie bestående av åtta vetenskapliga artiklar. I analysen färgkodades relevant information och data grupperades sedan i övergripande underkategorier och kategorier. Resultat: Fyra kategorier identifierades, ”Digitala vårdmöten innebär nya utmaningar”, ”Digitala vårdmöten bidrar till ökad tillgänglighet och kvalitet” samt ”Digitala vårdmöten underlättar en kontinuerlig vårdrelation”. Samtliga artiklar diskuterade både för- och nackdelarna med digitala vårdmöten, vilket visade sig bero på situationen och deltagarna i ett digitalt vårdsamtal. Konklusion: Teknologin är en utmaning för sjuksköterskor vars erfarenheter och kunskaper kan ifrågasättas vid en bristande telehälsoteknik. Digitala vårdmöten kompletterar vården patienten redan får men kan inte ersätta fysiska träffar.