Cette recherche porte sur l’évaluation d’une plateforme numérique, nommée Mylin, relayant des connaissances ainsi que des outils en santé mentale supportés par la science. Les interventions sur la plateforme sont accompagnées d’une description de leurs objectifs et de leur efficacité, qui est évaluée lors de la recension des écrits effectuée par le comité scientifique de Mylin. La plateforme est destinée au grand public et aux professionnels et a l’objectif d’aider ces derniers à prendre des décisions plus éclairées en s'appuyant sur des informations valides. Ce mémoire explore plus particulièrement les retombées associées à l’utilisation de Mylin selon les professionnels et les intervenants s’en servant dans le cadre de leur pratique ainsi que les facteurs pouvant influencer ces retombées. L’utilité de la plateforme a été examinée en fonction des différentes professions et des différents niveaux de littératie numérique en santé. Neuf professionnelles ont été interviewées et ont répondu à l’échelle mesurant le niveau de littératie numérique en contexte de santé (LNS). L’analyse descriptive effectuée sur les réponses à l’échelle mesurant le niveau de LNS a dévoilé que l’échantillon se composait majoritairement de participantes avec un niveau considéré comme élevé de littératie numérique. L’analyse thématique des entrevues a révélé que Mylin pouvait être utilisée pour enrichir son bagage de connaissances, pour prendre des décisions éclairées par la science et pour se développer professionnellement grâce à ces nouveaux acquis. Néanmoins, cette utilité a semblé conditionnelle à plusieurs facteurs liés aux 1) utilisatrices et leurs milieux organisationnels (par exemple, l’intérêt porté aux connaissances issues de la recherche dans leur milieu de travail), 2) au contenu diffusé sur Mylin (par exemple, son adéquation avec les besoins des utilisatrices) et 3) à la convivialité de la plateforme. Comme la plupart des professionnelles de l’échantillon avaient un niveau élevé de LNS, les comparaisons d’expériences entre les professionnelles ayant une littératie plus faible et plus élevée n'ont pas permis d’établir des tendances claires quant au lien entre la LNS et la perception d’utilité de Mylin. / This research assessed a digital platform, named Mylin, disseminating mental health evidence-based knowledge and interventions. The knowledge disseminated is about various adaptation difficulties that can interfere with the well-being and functioning of the neurodivergent population. The interventions on the platform are accompanied by a description of their objectives and their effectiveness, which is evaluated during the literature review carried out by the scientific committee of Mylin. The platform is intended for the public and professionals and aims to help them make more informed decisions based on valid information. This project explores more specifically the benefits associated with the use of Mylin according to the professionals and stakeholders using it in the context of their practice as well as the factors that can influence these benefits. The usefulness of the platform was examined in relation to different professions and different levels of digital health literacy. Nine professionals were interviewed and responded to the scale measuring the level of eHealth literacy. According to the descriptive analysis performed on the responses to the scale measuring the level of eHealth literacy, the sample was composed of a majority of participants with a level considered high in eHealth literacy. The thematic analysis of the interviews revealed that Mylin could be used to, among other things, enrich one's stock of knowledge, to make decisions informed by science and to develop professionally thanks to these new skills. Nevertheless, this usefulness appeared to be conditional on several factors related to 1) the users and their organizational backgrounds (for example, the interest taken in scientific evidence by the workplace), 2) the content disseminated on Mylin (for example, its adequacy with the needs of users) and 3) the user-friendliness of the platform. Since most of the professionals in the sample had a high level of eHealth literacy, comparisons of experiences between professionals with lower and higher literacy do not allow us to establish clear trends as to the link between this factor and Mylin's perception of usefulness.

The future of healthcare is increasingly digital, which includes a shift towards more personalised services that allow for more patient-centred and transparent patient care. These services are defined as PeHS and although there are great potential benefits of these services, there are also challenges regarding infor[1]mation security and privacy related to providing this type of services. This thesis project aims to examine the state of ISMS related to PeHS, which would also involve an examination of considerations taken regarding privacy in PeHS. The data collection methods for this thesis project were a systematic literature review and qualitative interviews.In total 18,667 publications published between 2017 and 2022 were found during the database searches. When the selection criteria had been applied 17 publications from the search process and 1 publication from the backward snowball process were accepted. The accepted publications were analysed by applying thematic analysis. Furthermore, two interviews with three participants were conducted after the literature review had been completed. The interview material was analysed by applying the analysis method of qualitative content analysis. The results showed that there are several challenges regarding ISMS and privacy related to PeHS. For example, there is a lack of knowledge within the organisations on why they should be applying the methods and tools available to ensure the security of the information flow through the healthcare services. Another example is the challenge of keeping up with the pace of digitalisation and adjust the ISMS to ensure sufficient information security of the services.

BACKGROUND: Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. OBJECTIVE: The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. METHODS: A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. RESULTS: Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. CONCLUSIONS: This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers. TRIAL REGISTRATION: ClinicalTrials.gov NCT04004260; https://clinicaltrials.gov/ct2/show/NCT04004260.

Bakgrund: Nya bestämmelser för klagomålshantering togs i bruk 2018 med syfte att stärka patienternas ställning och utveckla det systematiska arbetet med patientsäkerhet. En patient kan rapportera synpunkter och klagomål direkt till sin vårdgivare som är skyldig att ta emot ärendet och utreda vad som har hänt och vidta åtgärder. Forskning har visat att systematik saknas i hur verksamheter tar tillvara innehållet i ärenden som tas emot och det saknas en gemensam kategorisering. En process utvecklades inom Region Stockholm där patienter kan lämna synpunkter och klagomål via en e-tjänst på 1177 som sedan hanteras i regionens IT-stöd för avvikelsehantering. Syfte: Studiens syfte var att på aggregerad nivå undersöka inom vilka problemområden patienter rapporterar synpunkter och klagomål till vårdgivare inom akutsjukvård och primärvård via e-tjänsten samt om dessa ärenden kan bidra till lärande samt kvalitetsförbättring och ökad patientsäkerhet. Metod: Kvantitativ och kvalitativ forskningsansats det vill säga en blandad metod användes. Intervjuer genomfördes med vårdgivare och analyserades med en tematisk innehållsanalys utifrån en induktiv ansats. Problemområden kategoriserades om och jämfördes med Healthcare Complaints Analysis Tool (HCAT). Resultat: De flesta synpunkter och klagomål rapporterades inom problemområdet kommunikation med delproblemet bemötande. Det förelåg ingen markant skillnad i problemområden mellan akutsjukvård och primärvård. Intervjuer visade att vårdgivarna tog tillvara innehållet i synpunkter och klagomål på olika sätt för lärande och i sitt arbete med kvalitet och patientsäkerhet. HCAT-verktyget uppvisade ett överensstämmande resultat vid kategorisering av de tre största problemområdena av klagomål. Slutsats: Genom att systematiskt hantera synpunkter och klagomål på aggregerad nivå kan vårdgivarna få underlag till att bedriva ett ändamålsenligt arbete med kvalitet och patientsäkerhet. Användande av gemensamma kategoriseringar är en förutsättning för regionala och nationella jämförelser. / Background: New regulations for handling complaints were introduced in 2018 with the aim of strengthening the position of patients and developing the systematic work with patient safety. A patient can report complaints directly to their healthcare provider who is required to receive the case and investigate what has happened and act. Research has shown that there is a lack of systematicity in how caregivers make use of the content of cases that are received and there is a lack of common categorization. A process was developed within Region Stockholm where patients can submit complaints via an e-service, which is then handled in the region's IT -system for deviation management. Aim: The aim of the study was to investigate on an aggregated level in which problem areas patients report complaints to care providers in emergency care and primary care via the e-service and in if they can contribute to learning, quality improvement and increased patient safety. Method: A mixed methods approach has been used. Interviews were conducted with caregivers and analyzed with a thematic content analysis based on an inductive approach. Problem areas were recategorized and compared using the Healthcare Complaints Analysis Tool (HCAT). Results: Complaints reported to the caregivers were most common in communication and personal treatment. There was no difference in problem areas between emergency care and primary care. Interviews showed that the caregivers used the content of complaints in different ways for learning and in their work with quality and patient safety. The HCAT-tool showed consistent results in categorizing the top three problem areas of complaints. Conclusion: By the systematically handling of complaints on an aggregated level, the care providers can obtain a basis for carrying out an appropriate work with quality and patient safety. Use of collective categorizations is a prerequisite for regional and national comparisons.

Introduktion: Digitala lösningar ökar inom vården och samhället. Digitala lösningar för vårdkontakt, bokning av tid samt vårdbesök finns idag och ökar i utbredning. I Vision ehälsa 2025 framhålls vikten av att hålla fokus på jämlikhet och jämställdhet när digitala verktyg utformas. Digitala lösningar kan vara en del i omställningen till en mer Nära Vård. För att kunna öka användandet av digitala lösningar inom hälso- och sjukvården kan det vara viktigt att förstå varför befintliga lösningar används eller inte används. Syfte: Syftet med studien var att fördjupa förståelsen kring hur bakomliggande faktorer såsom demografi, erfarenheter, inställningar och attityder påverkat valet av bokningssätt för patienter på Rörelse och Hälsa när de bokat förstagångsbesök till fysioterapeut. Metod: Studien genomfördes med mixad studiedesign. Registerdata användes för demografi och sambandsanalyser och intervjuer genomfördes för att få en fördjupad förståelse kring erfarenheter, inställningar och attityder. Resultat: Kvinnor använde sig i högre utsträckning av Webbtidbok än män. Patienter i ålderskategorin 20-29 år var gruppen som i högst utsträckning använde Webbtidbok, användandet minskade därefter i takt med stigande ålder. Låg ekonomisk standard och låg utbildningsnivå i vårdcentralsområdet korrelerade med lägre användning av Webbtidbok. Olika bokningsalternativ behöver finnas utifrån individers olika behov och förutsättningar. Kunskapen om Webbtidboken som alternativ var lägre än kunskapen om TeleQ. Slutsats: Ålder, kön, ekonomisk standard och utbildningsnivå kan påverka användandet av Webbtidbok. Det är av vikt att olika bokningsalternativ finns och att de är användarvänliga. Information om bokningsalternativ behöver förtydligas. / Introduction: Digital solutions are increasing in healthcare and society. Digital solutions for healthcare contact, appointment booking and healthcare visits exist today and are increasing in prevalence. It is important to maintain focus on equality and equity when digital tools are designed. Digital solutions can be a part of the transition to a more personcentred integrated care. In order to increase the use of digital solutions in healthcare, it may be important to understand why existing solutions are used or not. Aim: The aim of the study was to deepen the understanding of how underlying factors such as demographics, experiences and attitudes influenced the choice of booking method for patients booking their first appointment with a physiotherapist. Methods: The study was conducted with a mixed study design. Register data were used for demographic and correlational analyses, and interviews were conducted to gain a deeper understanding of experiences and attitudes. Results: Women used web-based self-scheduling to a greater extent than men. Patients in the age category 20-29 years used web-based self-scheduling to the highest extent, use subsequently decreased with increasing age. Low economic standard and low level of education in the Health Center area correlated with lower use online-booking. Different booking options need to be available based on individuals' different needs and qualifications. Knowledge of web-based self-scheduling was lacking. Conclusion: Age, gender, economic standard and level of education can affect the use of web-based self-scheduling. It is important that different user-friendly booking options are available. Information about booking options needs to be clarified.

Diabetic ketoacidosis (DKA) is a life-threatening condition that can appear in patients with diabetes. High ketones in the blood lead to acidity of the blood. For DKA diagnosis and management, ketones such as hydroxybutyrate (HB) can be used to quantify the severity of the disease. The fabrication of electrochemical biosensors for the detection of HB is attractive since their capability to deliver fast response, high sensitivity, good selectivity and potential for miniaturisation. In this thesis, an integrated electrode system was prepared for the detection of HB. Laser-induced graphene (LIG) with a 3D porous structure was used as the flexible platform. Poly (toluidine blue O) (PTB) was electro-deposited on LIG (PTB/LIG) under the optimised conduction (pH of 9.7 and from 0.4 to an upper cyclic potential of 0.8 V). The single PTB/LIG working electrode demonstrated excellent performance towards the detection of NADH with a linear range of 6.7 M to 3 mM using chronoamperometry, high sensitivity of detecting NADH and excellent anti-fouling ability (94 % response current retained after 1500 s). Further integration of the 3-electrode system realised the static amperometric detection of NADH over the range of 78 M to 10 mM. Based on the excellent performance of PTB/LIG to NADH sensing, hydroxybutyrate dehydrogenase was immobilised via encapsulation with chitosan and polyvinyl butyral (PVB) which was used for HB biosensing over the linear range of 0.5 M to 1 mM with NAD+ dissolved in solution. In addition, the co-immobilisation of NAD+ and HBD on PTB/LIG was conducted by optimisation of enzyme and NAD+ amount per electrode, which shows excellent reproducibility and satisfactory HB biosensing performance. Further experiments to improve the long-term stability of the enzyme electrode is expected in the future. The proposed integrated electrode system also possesses the potential to extend to a multichannel sensor array for the detection of multiple biomarkers (e.g. pH and glucose) for diagnosis and management of DKA.

Our population is becoming older and with that, the development of chronic diseasesis is also expected to increase. A chronic illness is a long-term illness which lasts throughout a lifetime, or at least for a very long time. A large part of healthcare resources is already devoted to treating chronically ill patients. These patients are often dependent of both care and medication to maintain a meaningful life. To gain a holistic view of these patients health condition by one/two appointments with physicians yearly is not sufficient in order to conclude a certain health-state. The course of disease for these patients changes daily and require follow-up on disease progression continuously to adapt an appropriate treatment plan. Collecting patient-generated health data (PGHD) facilitates in the process of retrieving moreevidence for better assessment of the disease development. While there is obvious importance and benefit of using of PGHD, this data is not commonly used in healthcare.  Further investigation is needed to understand how PGHD can be more useful. This pilot study provides knowledge of the success and failure factors of using PGHD for mainly chronically ill patients, but can be applied to other patient-groups as well. The aim of this thesis work was to collect information about what suppliers, governmental organizations and healthcare professionals require for using PGHD in healthcare setting in a greater extent in the future. Methods used to gather information were participatory interviews in combination with qualitative interview questions. Pattern recognition has been created through a thematic analysis andcluster mapping. The data collection resulted in four areas of improvement; patient behaviour, healthcare organization, digitized health data and equipment. The result shows overall a positive attitude towards the concept of PGHD by all sectors asked in this project. Stakeholders agree on that PGHD can generate positive outcomes for chronically ill patients. The belief of improving workflow in healthcare with PGHD was also positive. The valuable possibilities generated with PGHD are tailored careflows, improved evaluation of disease status and enhanced quality of care and well-being among others. Additionally, several ongoing projects are taking place, which demonstrate great interest in the area. However, before PGHD can be prescribed by healthcare, studies have to be performed including development of national guidelines for reporting PGHD, building a secure infrastructure and introducing new work routines. Future work will be applying AI-analysis of reported PGHD to facilitate the work of caregivers and development of secure storing solutions for instance with block-chain technology. / Vår befolkning blir äldre och med det förväntas utvecklingen av kroniska sjukdomar också att öka. En kronisk sjukdom kallas också för en långvarig sjukdom som varar under hela livet eller åtminstonde under mycket lång tid. En stor del av vårdresurserna ägnas redan åt att behandla kroniskt sjuka patienter. Dessa patienter är ofta beroende av både vård och medicinering för att upprätthålla ett meningsfullt liv. För att få en helhetssyn på dessa patienters hälsotillstånd krävs mer än en eller två möten med sjukvården årligen. Ett fåtal möten per år är inte tillräckligt för att konstatera en rättvis bild av hälsotillståndet. Sjukdomsförloppet för dessa patienter förändras dagligen och kräver fortlöpande uppföljning av sjukdomsutvecklingen för att förstå och anpassa en lämplig behandlingsplan. Insamling av patientgenererad hälsodata (PGHD) underlättar och hjälper till i denna process. Det finns uppenbarliga fördelar med PGHD, men datan används inte vanligtvis i sjukvården. Ytterligare forskning behövs för att förstå hur PGHD kan vara mer användbart. Denna pilotstudie ger kunskap om inflytelserika faktorer för att använda PGHD för huvudsakligen kroniskt sjuka patienter, men kan också tillämpas på andra patientgrupper. Syftet med detta avhandlingsarbete var att samla in information om vad leverantörer, statliga organisationer och vårdpersonal kräver för att använda PGHD i vårdmiljö i framtiden. Metoder som använts för att samla in information var deltagande intervjuer i kombination med kvalitativa intervjufrågor. Resultatet har genomgått en klusterkartläggning och tematisk analys för att skapa mönsterigenkänning. Datainsamlingen resulterade i fyra områden; patientbeteende,vårdorganisation, digitaliserad hälsodata och utrustning. Resultatet visar en positiv inställning till PGHD enligt alla deltagare i studien.Deltagarna är överens om att PGHD kan generera positiva resultat för kroniskt sjuka patienter. Tron att förbättra arbetsflödet inom hälso-och sjukvård med PGHD var också positiv. De värdefulla möjligheterna som genereras med PGHD är bl.a. skräddarsydda vårdflöden, förbättrad utvärdering av sjukdomstatus och förbattradk valitet på vård och välmående bland andra. Dessutom pågår flera pågående projekt som visar stort intresse för området. Innan PGHD kan börja förskrivas av hälsovården måste det utföras fler studier som inkluderar framtagning av nationellariktlinjer för rapportering av PGHD, byggandet av en säker infrastruktur och introduktion av nya arbetsrutiner. Framtida arbete kvarstår dår tillämpning av AI analysmodeller på rapporterad PGHD samt utveckling av säkra lagringslösningar, förslagsvis med blockkedjeteknik, bör vidareutvecklas.

Recent years have seen an influx of medical technologies capable of remotely monitoring the health and behaviours of individuals to detect, manage and prevent health problems. Known collectively as personal health monitoring (PHM), these systems are intended to supplement medical care with health monitoring outside traditional care environments such as hospitals, ranging in complexity from mobile devices to complex networks of sensors measuring physiological parameters and behaviours. This research project assesses the potential ethical implications of PHM as an emerging medical technology, amenable to anticipatory action intended to prevent or mitigate problematic ethical issues in the future. PHM fundamentally changes how medical care can be delivered: patients can be monitored and consulted at a distance, eliminating opportunities for face-to-face actions and potentially undermining the importance of social, emotional and psychological aspects of medical care. The norms evident in this movement may clash with existing standards of 'good' medical practice from the perspective of patients, clinicians and institutions. By relating utilitarianism, virtue ethics and theories of surveillance to Habermas' concept of colonisation of the lifeworld, a conceptual framework is created which can explain how PHM may be allowed to change medicine as a practice in an ethically problematic way. The framework relates the inhibition of virtuous behaviour among practitioners of medicine, understood as a moral practice, to the movement in medicine towards remote monitoring. To assess the explanatory power of the conceptual framework and expand its borders, a qualitative interview empirical study with potential users of PHM in England is carried out. Recognising that the inherent uncertainty of the future undermines the validity of empirical research, a novel epistemological framework based in Habermas' discourse ethics is created to justify the empirical study. By developing Habermas' concept of translation into a procedure for assessing the credibility of uncertain normative claims about the future, a novel methodology for empirical ethical assessment of emerging technologies is created and tested. Various methods of analysis are employed, including review of academic discourses, empirical and theoretical analyses of the moral potential of PHM. Recommendations are made concerning ethical issues in the deployment and design of PHM systems, analysis and application of PHM data, and the shortcomings of existing research and protection mechanisms in responding to potential ethical implications of the technology.

Politikwissenschaftliche Studien der vergangenen Jahre stellen fest, dass das deutsche und österreichische Gesundheitswesen eher reformresistent sind. Anhand der Einführung der elektronischen Kartensysteme im deutschen und österreichischen Gesundheitswesen zeigt diese Dissertation, dass gesundheitspolitische Reformschritte möglich sind. Durch ein vergleichendes Forschungsdesign werden anhand der zwei relativ ähnlich strukturierten Staaten Deutschland und Österreich mit dennoch relevanten Unterschieden im Politikfeld Gesundheit Theorien aus der vergleichenden Policy-Forschung und der Staatstätigkeitsforschung auf ihre Erklärungskraft hin untersucht. Durch eine qualitative Inhaltsanalyse nach Mayring und die Auswertung von Experteninterviews werden die Bestimmungsfaktoren für den gesundheitspolitischen Wandel analysiert. Auf Grund der Abweichung dieser Dissertation (Reformmöglichkeit) von bisherigen empirischen Ergebnissen (Reformresistenz) aus dem Bereich der Gesundheitspolitologie, leistet die in dieser Arbeit vorgenommene Erklärung von politischem Wandel einen Beitrag zur politikwissenschaftlichen Forschung. Die Dissertation zeigt, dass eine Kombination von Theoriemodulen aus der vergleichenden Staatstätigkeitsforschung und der Policy-Forschung die Einführung der elektronischen Kartensysteme im deutschen und österreichischen Gesundheitswesen sinnvoll erklären kann. Die Arbeit stellt dar, dass der politische Wandel vor allem bis zur Phase der Implementation im Politikzyklus in beiden Staaten zügig möglich war. Geänderte Machtverhältnisse, die Verteilung von Machtressourcen zwischen den Interessengruppen im Politikfeld, vormals getroffene politische Entscheidungen und selbstverstärkende Mechanismen, das Engagement "neuer" Akteure im Subsystem, sowie gebundene Rationalitäten der politischen Entscheider sind die maßgeblichen Gründe, welche die Einführung des elektronischen Kartensystems im deutschen und im österreichischen Gesundheitswesen veranlassten.

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