Bakgrund: Substansberoende är ett globalt problem som inte bara påverkar människan på individnivå utan hela samhället. Den psykosociala omvårdnaden med samtal om livsstilsförändringar blir alltmer viktig. Fysisk aktivitet har visat sig ha positiv effekt för personer med substansbrukssyndrom. Det är betydelsefullt att specialistsjuksköterskan får ökad kunskap och fler redskap för att stödja dessa patienter. Via personcentrad vård och en god vårdrelation som tar tillvara patientens upplevelse kan mer specifikt utformade omvårdnadsåtgärder med fysisk aktivitet utformas. Syfte: Att undersöka patienters upplevelse av fysisk aktivitet vid substansbrukssyndrom. Metod: Litteraturöversikt med systematisk ansats Resultat: Att delta i fysisk aktivitet genererade starka känslor och ledde till beteendeförändringar. Patienterna upplevde att den sociala aspekten av fysisk aktivitet var stödjande. Genom fysisk aktivitet fick patienterna möjlighet att erhålla nya färdigheter. Det simultana och holistiska upplägget av fysisk aktivitet uppskattades. Relationen till FA-ledaren och egenskaperna hos denne upplevdes ha en inverkan på motivationen hos patienterna. Slutsats: Via fysisk aktivitet kan patienter med substansbrukssyndrom uppleva ökad förståelse för den egna kroppens kapacitet, ny upplevd kontroll samt erhålla nya färdigheter som att hantera utmaningar och negativa känslor bättre. Specialistsjuksköterskan har möjlighet att via god personcentrerade vård med motiverande samtalet öka sannolikheten för att fysiska aktivitet som omvårdnadsåtgärd implementeras och har effekt. / Background: Substance use disorder is a global concern that does not only affect the individual negatively but also the society at large. The psychosocial nursing care with dialogue about lifestyle changes is becoming more important. Physical activity has had many confirmed positive effects for patients suffering from substance use disorder. It is important that the specialist nurse is given more knowledge and tools to care for and motivate these patients. Through patient-centered care and a good care relation that takes advantage of the patients' experience more specific care actions with physical activity can be designed to cater for this group's special needs. Aim: To examine patient experience of physical activity while coping with substance use disorder. Method: Literature review Results: Involvement in physical activity generated strong emotions and led to behavior changes. The patients experienced that the social aspect of physical activity was supportive. Through physical activity the patients could obtain new skills. The relation to and the characteristics of the PA-leader had an impact on the patient's motivation. Conclusion: Through physical activity patients with substance use disorder can gain increased understanding of their body’s capacity, new sense of control and new skills such as being able to manage challenges and negative feelings better. The specialist nurse has an opportunity through patient centered care with motivational interviewing to increase the possibility that physical activity is being implemented and has effect.

Bakgrund: Hypertoni är en folksjukdom och är en starkt bidragande orsak till sjukdomar som stroke, hjärtsvikt, kranskärlssjukdom och arterioskleros. En effektiv läkemedelsbehandling mot hypertoni reducerar kraftigt insjuknande och död i dessa sjukdomar. Mer än 50 % av patienterna som behandlas för hypertension, slutar helt sin behandling inom ett år från att diagnos har ställs. Bland de som fortsätter sin behandling är det endast hälften som är följsamma det vill säga tar 80 % av sitt förskrivna antihypertensiva läkemedel. Syfte: Syftet med denna litteraturstudie var att undersöka vilka faktorer som påverkar följsamheten till medicinering hos patienter med diagnosen hypertension. Metod: Metoden som användes var en litteraturstudie med en ansats till innehållsanalys. Tio artiklar från sju kvantitativa studier och tre kvalitativa studier, som svarade på syftet kvalitetsgranskades och inkluderades i litteraturstudien. Resultat: Resultatet visade att anledningen till att inte följa sin läkemedelsordination kan bero på många olika faktorer som grundar sig på patienters attityd till sin sjukdom och medicin, sociala och ekonomiska faktorer, mental påverkan samt vårdgivarens roll och agerande. Konklusion: Att se varje patient som unik och arbeta personcentrerat visade sig förbättra följsamheten till läkemedelsbehandlingen. Detta är ett område där mer forskning krävs. / Background: Hypertension is a common disease and is a major contributor to diseases such as stroke, heart failure, coronary artery disease and atherosclerosis. An effective drug treatment for hypertension greatly reduces illness and death from these diseases. More than 50% of patients being treated for hypertension, stops treatment within a year of the diagnosis. Among those who continue their treatment, only half are compliant i.e., taking 80% of their prescribed antihypertensive medications. Objective: The aim of this study was to investigate the factors that influence adherence to medication in patients with the diagnosis hypertension. Method: The method used was a literature review with an approach to content analysis. Ten articles from seven quantitative studies and three qualitative studies, answering the study aim were reviewed regarding scientific quality and were finally included in the literature review. Results: The results showed that the reason for not being adherent to medication could be caused by many different factors, based on patients' attitudes to their illness and medicine, social and economic factors, mental influence and the caregiver's role and actions. Conclusion: To see each patient as a unique person and give individualized care improved adherence to drug treatment. This is an area where more research is needed.

Bakgrund: Bensår är ett globalt hälsoproblem och befolkningen blir allt äldre. Därmed ökar kroniska sjukdomar och risken att utveckla bensår. De flesta bensåren behandlas inom primärvården där distriktsköterskans roll är central. Det krävs att distriktssköterskan har en helhetsyn i vårdandet och därmed ett personcentrerat arbetsätt. Personcenterad vård är en av distriksköterkans kärnkompetenser varför erfarenheter av personcentrerad vård i mötet med personer med bensår utforskas. Syfte: Att beskriva distriktssköterskors erfarenhet av personcentrerad vård i mötet med personer som har bensår. Metod: Kvalitativ intervjustudie. Nio distriktsköterskor intervjuades genom individuella semistrukturerade intervjuer. Texten bearbetades med kvalitativ innehållsanalys med induktiv ansats. Resultat: Resultatet visade att personcentrerad vård ansågs vara ett naturligt arbetssätt för distriktssköterskorna och innefattade helhetsyn, delaktighet och kontinuitet. Resultatet belyste distriktsköterskans roll att anpassa sitt förhållningsätt, vikten av teamarbete samt att distriksktssköterskorna besitter djupare kunskap i det personcentrerade vårdandet av personer med bensår. Det framkom varierande förutsättningar för personcenterad vård i organsiationer, arbetsplatsen och patientmöten. Slutsats: Distriktssköterskorna har en central roll i den personcentrerade vården genom fördjupade kunskaper. Därför är det viktigt att det finns goda förutsättningar för personcentrerad vård för personer med bensår eftersom det kan öka livskvalitén och minska tiden för sårläkning. Det kan även bidra till större arbetstillfredsställelse för distriktsköterskor och kostnadseffektivitet. / Background: Leg ulcers are a global health problem and the population is getting older. This increases chronic diseases and the risk of developing leg ulcers. Most leg ulcers are treated in primary care where the district nurse's role is central. It is required that the district nurse has a holistic view of care and thus a person-centered way of working. Person-centered care is one of the district nurse's core competencies, which is why experiences of person-centered care when dealing with people with leg ulcers are explored. Aim: To describe district nurses' experience of person-centred care in the meeting with people having leg ulcer. Method: Qualitative interview study. Nine district nurses were interviewed through individual semi-structured interviews. The text was processed with qualitative content analysis using an inductive approach. Results: The result showed that person-centred care was considered a natural way of working for the district nurses and included a holistic view, participation and continuity. The result highlighted the role of the district nurse in adapting their approach, the importance of teamwork and that the district nurses have deeper knowledge in the person-centred care of people with leg ulcers. Various conditions emerged for person-centred care in organisations, the workplace and patient meetings. Conclusions: The district nurses have a central role in person-centred care through in-depth knowledge. Therefore, it is important that there are good conditions for person-centered care for people with leg ulcers because it can increase the quality of life and reduce the time for wound healing. It can also contribute to greater job satisfaction for district nurses and cost efficiency.

Bakgrund: Tarmstomi innebär en öppning på buken där tarmen läggs ut. Det finns flera anledningar till att få tarmstomi. Tarmstomi kan leda till både positiva och negativa förändringar. Förändringarna kan påverka sexualiteten på olika sätt. Sexualiteten är viktig i människans liv och är ett av de främsta grundläggande behoven. Syfte: Att beskriva erfarenheter och upplevelser av sexualitet hos personer med tarmstomi. Metod: En litteraturöversikt med kvalitativ ansats genomfördes där 10 artiklar kvalitetsgranskades som sedan användes till resultatet. Artiklarna analyserades enligt Fribergs 5-stegsmodell. Resultat: Teman som framkom var påverkan på sexuell aktivitet, påverkan på relation och intimitet samt behov av stöd. Resultatet visade att tarmstomin påverkadepersoner psykiskt och fysiskt. Personer med tarmstomi behövde anpassa sig på olika sätt för att få en god sexualitet. Ofta var erfarenheterna och upplevelserna av sexualiteten negativa hos personer med tarmstomi, på grund av känslan av att vara annorlunda och förlorat kontroll över tarmfunktionen. Slutsats: Tarmstomi påverkar sexualiteten på olika sätt. Anpassningar för den nya kroppsbilden behövs. Hur personer med tarmstomi accepterar den nya kroppsuppfattningen har stor betydelse för sexualiteten. Att upprätthålla rutiner och riktlinjer inom hälso-sjukvården är viktigt för att ge rätt stöd till personer med tarmstomi. / Background: An intestinal stoma is an opening in the abdomen where the intestine is laid out. There are several reasons for having an intestinal stoma. Intestinal stomas can lead to both positive and negative changes. The changes can affect sexuality in different ways. Sexuality is important in a human’s life and is one of the main basic needs. Aim: To describe experiences of sexuality in people with intestinal stoma. Method: A literature review with a qualitative approach was carried out where 10 articles were quality controlled, then used for the result. The articles were analyzed according to Friberg's 5-step model. Results: The themes that emerged were the impact on sexual activity, the impact on relationships and intimacy, and the need for support. The results showed that intestinal stoma affects people psychologically and physically. People with intestinal stoma had to adapt in different ways to have a good sexuality. Often, the experiences of sexuality were negative in people with an intestinal stoma because of the feeling of being different and losing control over bowel function. Conclusion: Intestinal stoma affects sexuality in different ways. Adjustments for the new body image are needed. How people with an intestinal stoma accept the new body image has great significance for sexuality. Developing routines and guidelines in healthcare is important to provide the right support for people with intestinal stoma.

BACKGROUND: Contraception is an effective, preference-sensitive intervention that supports quality of life, management of health, and self-determination. Contraception is used by 99% of people assigned female at birth with an average of 3.4 methods used across their lifespan. Providers counsel patients on contraception and patients want to be counselled. Shared decision-making frameworks promote using decision aids (DA) during counseling as best practice. Existing DAs lack transparency in their development methodologies and evaluation results and may not facilitate patient-centered care. AIM: Create a contraception DA and accompanying contraception method information sheets (MIS) that are informed by patients’ values, align with international standards, meet health literacy and accessibility guidelines, and are evaluated by patients and providers to be acceptable, quality, and feasible to use during contraceptive counseling. METHODOLOGY: To create the DA/MIS, (1) literature was reviewed on contraceptive counseling frameworks, DAs, patients’ contraceptive preferences, health literacy, accessibility, user-centered design, and validated patient education material quality measures, (2) results were reviewed from a patient focus group and provider meeting where they defined user requirements, and (3) evidence-based contraceptive information was synthesized. Once created, an exploratory sequential mixed-methods study iteratively refined the DA/MIS after each data collection phase: (1) provider focus groups and survey, (2) patient focus groups and survey, (3) observed patient testing during counseling followed by an interview and survey, (4) expert patient and provider review, and (5) provider field testing in clinic followed by an interview and survey. DA/MIS readability levels were assessed. RESULTS: Quantitatively, the DA/MIS were acceptable, quality, and feasible to use during counseling. Qualitatively, the DA/MIS were preferred to verbal-only counseling and other DA/MIS, centered patients’ preferences, increased knowledge, focused on patient autonomy, challenged bias/coercion, improved counseling satisfaction and quality, offered a novel design, and were appealing, inclusive, and accessible. CONCLUSION: This DA/MIS had positive quantitative and qualitative results, offered a novel design aligned with international standards, and had a transparent, rigorous development process aligned with frameworks and validated tools. Initial results show this DA/MIS can support and improve patient-centered contraceptive counseling. / 2026-08-31T00:00:00Z

No / Person-centred care (PCC) is recommended when working with patients with neurological difficulties. Despite this, to date there has been no appropriate methodology for assessing or developing PCC in neurorehabilitation settings. Dementia Care Mapping (DCM) is a well-established tool for assessing and developing PCC in dementia settings and the current study investigated the feasibility of applying DCM on an acute neurorehabilitation ward. DCM procedure and coding required minor adaptations for use in this setting and further recommended adaptations were subsequently identified. It was found that the DCM coding system was generally suitable and could identify strengths, weaknesses and areas for development in ward care. Q-methodology identified that staff views endorsed the feasibility of using DCM in neurorehabilitation, with staff reporting that they found DCM useful and relevant to their work. DCM could be further developed for this setting by amendments to the behaviour coding system, concept and coding of person-centred care, and a population-specific manual. DCM is a promising methodology to develop and promote PCC in neurorehabilitation.

BACKGROUND:Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews.METHODS:We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire.RESULTS:The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience.CONCLUSIONS:We have placed lay language and direct experience at the center of questionnaire revision and refinement. In so doing, we provide an innovative model for the development of truly patient-centered outcome measures. Although this instrument was designed and tested in a CAM-specific population, it may be useful in assessing multi-dimensional shifts in well-being across a broader patient population.

Adherence is considered a prerequisite for the success of exercise programs for musculoskeletal disorders. The negative effects of non-adherence to exercise recommendations impact the cost of care, and also treatment effectiveness, treatment duration, the therapeutic relationship, waiting times, the efficiency of personnel and use of equipment. Adherence to therapeutic exercise intervention is a multifaceted problem. The World Health Organization (WHO) established the multidimensional adherence model (MAM). The MAM describes five interactive dimensions (socioeconomic, healthcare team and system, condition-related, therapy-related, and patient-related factors) that have an effect on patient adherence. The first purpose of this dissertation was to explore the MAM dimension of condition-related factors to determine the Quick Disabilities of the Arm Shoulder and Hand (QDASH) minimal clinical important difference (MCID) for three distal upper extremity conditions. The second purpose was to explore the MAM dimension of personal factors to learn from individuals who expressed incongruence between their QDASH and GROC scores; how they described their perceived change in therapy. The third purpose was to explore the MAM dimension of therapy-related factors to examine the effect of patient-therapist collaborative goal setting on patient adherence to treatment and QDASH outcomes. Results demonstrated in the first study that diagnosis specific MCID’s differed from the global MCID using multiple diagnoses. In the second study results demonstrated that patients expect to have a dedicated therapist who they can trust to work collaboratively with them to establish goals and spend time with them to achieve these goals. In the third study, our first hypothesis was not supported for all three measures of adherence. The median for home exercise program diary adherence was found to trend towards significance by 8.7 percent favoring the experimental group Mann-Whitney U (p < .100). Our second hypothesis was not supported. The experimental group receiving collaborative goal setting intervention had similar QDASH mean change scores 45.9±27.6 compared to the control group 46.1±23.8, Mann-Whitney U (p < .859).

This thesis reports on research focuses on how to deal with the fact that the organization and processesof today’s health and social care are becoming ever more complex as a consequence of societal trends, including an aging population and an increased reliance on care at home. The overall research goal is to suggest ways in which IT-based solutions can enable and leverage collaboration and coordination insituations where a co-morbid patient is subject to care delivered simultaneously by several different professionals and organizations. Patient-centered care is defined as quality health and social care achieved through a partnership between informed and respected patients, their families, and coordinated health and social care teams who conduct care activities according to jointly determined care plans. Against a background of several years of research on patient-centered collaborative care using adesign science approach, using techniques such as focus groups, interviews, and document studies, the author of the thesis has further pursued the work in a project named CoCare. Results show that the care required in aging societies is both a social and a technical challenge. Meeting this challenge will require a redesign of today's health and social care processes in order to focus more clearly on patient needs and values, and poses demands on information services allowing to share knowledge of the patient’s health and social situation among involved care providers. An important aspect of the increased complexity is that a single patient may need care from several autonomous care providers in parallel, particularly patients with co-morbidities. This clearly requires effective coordination of care activities, which poses further demands on information services to support this task. A set of issues involving patient-centered collaborative care is identified and analyzed. The thesis introduces the notions of the Patient-Centered Care Process (PCCP) and a conglomeration of suchprocesses. A conglomeration comprises a set of PCCPs that concern the same patient, that are overlapping in time, and that share the overall goal of improving and maintaining the health and socialwell-being of the patient. The PCCP is inspired by the well-known PDCA cycle and comprises the four phases of assessing the patient situation (ASSESS), planning care activities (PLAN), performingcare activities (DO) and following up care (CHECK) for the patient. Based on a number of key standards, such as HL7, HISA and CONTsys, the thesis introduces a Patient-Centered Information Model (PCIM). A set of information services, together constituting a Coordination Hub, is proposed. The information services aim to help formal as well as informal carers (including the patient) inconducting care according to the PCCP The thesis contributes to a deeper understanding of care processes and suggests ways to achieve patient-centered collaborative care that better contributes to creating value for the patient as an individual.

Compared to the general population, socially disadvantaged patients have higher rates of chronic illness and require more complex medical care. They also endorse higher levels of psychological distress and tend to engage in behavioral risk factors such as poor diet, physical inactivity, and smoking. These issues are particularly concerning given that this population tends to adhere less to medical recommendations, has limited access to health resources, and receives poorer treatment from providers. In an effort to address this disparity, The Affordable Care Act will expand health care access to an additional 23 million uninsured and 17 million underinsured Americans. However, simply expanding access to health care without examining and improving upon factors related to the physician-patient relationship would not fully address the health care needs of this population. This study sought to improve the quality of care received by socially disadvantaged patients by better understanding the role of race and gender on the physician-patient communication process and patient outcomes in a safety net primary care clinic. The study sample consisted of 330 low-income, uninsured/underinsured African American and White patients and 41 resident physicians. Overall, African American patients and their doctors and White doctors and their patients were viewed as engaging in the highest levels of communication. South Asian physicians, and male South Asian physicians in particular, had the lowest levels of communication and the patients of these providers experienced less improvement in their physical health. Patient education level influenced physicians’ perceptions of their patients to the extent that patients with higher educational levels were viewed as engaging in lower levels of communication. Last, indicators of a good physician-patient relationship were associated with higher levels of patient reported adherence. Practice implications and areas for future research are discussed.