The recent experience with the 2009 H1N1 pandemic has drawn attention to the need to better understand the public’s response to emergently released vaccines (ERV). This study applied a mixed methods approach to examine the causal pathways underlying the vaccination behaviour during a public health emergency. The integrated evidence from empirical and theoretical-based findings highlights a number of factors to consider in interventions to improve vaccination rates with an ERV. These factors include: 1) providing clear risk messages around the disease and the ERV, 2) improving accessibility to the vaccine, 3) encouraging primary healthcare providers to provide recommendations for vaccination, 4) implementing strategies to increase seasonal influenza vaccination prior to the next public health emergency, 5) developing strategies to target sub-populations more reluctant to accept an ERV. Developing theory-based interventions that are behaviour-specific may be more likely to result in behaviour change within the public in future emergency vaccination campaigns.

After cancer patients have completed active cancer treatment, they have specific follow-up care needs. These needs include ongoing surveillance for new and recurring cancers, managing the side effects of cancer treatment, and psychosocial concerns (Rushton et al., 2015). In the past, cancer centres and oncology specialists provided follow-up care; however, new models of care are needed because cancer centres can no longer provide treatment and follow-up care to all cancer survivors (Jefford et al., 2022). To allocate health care resources, low risk cancer survivors (i.e., breast and colorectal cancer survivors) are being discharged from cancer centres after primary treatment back to their primary care provider (PCP) for follow-up care. Survivorship care plans (SCPs) have been identified as a tool to help survivors and their PCPs with this transition (Rushton et al., 2015). SCPs generally consist of a treatment summary, a schedule for follow-up and surveillance tests, and general health recommendations (i.e., diet and exercise; Howell et al., 2011; Ruston et al., 2015). While SCPs are widely accepted, research on their effectiveness as transition tools has been inconclusive (Hill et al., 2019; Jacobsen et al., 2018). Some studies show positive, neutral, and negative impacts of SCP use, and there are three potential reasons for these mixed findings: 1) there is wide variety in the content, format, delivery, and timing of SCPs which adds considerable variance when studying the impact of SCPs; 2) the use of outcomes to measure the usefulness of SCPs as transition tools that are beyond the scope that information about treatment history and follow-up guidelines could impact and; 3) that SCPs are not effective as transition tools (Hill et al., 2019; Jacobsen et al., 2018). An important first step in clarifying whether SCPs are effective transition tools is to understand how SCPs are being used in real world practice (Hill et al., 2019; Jacobsen et al., 2018). The overall purpose of this study was to develop best practice recommendations for implementing SCPs. This was achieved through three study objectives: 1) to comprehensively identify barriers and facilitators perceived to influence SCP use among cancer survivors and primary care providers (PCPs); 2) to identify evidence-based approaches to address barriers and enhance facilitators of SCP use; and 3) to develop best practice recommendations that can be used by implementors of SCPs that are adaptable across different contexts. Article 1 presents the results of semi-structured interviews with breast and colorectal cancer survivors who had received a SCP at least 12 months prior to the interview. The interviews were based on the Theoretical Domains Framework, version two (TDF-2; Cane et al., 2012) and comprehensively identified barriers and facilitators of SCP use amongst breast and colorectal cancer survivors. Thirty cancer survivors (17 female, 13 male) participated in the 30–45-minute interviews, which were then analyzed using content and thematic analysis. Survivors who had received education about the purpose of SCPs and how to use them reported finding their SCP helpful and that they used it to schedule appointments and communicate with their healthcare providers. Barriers to SCP use that were reported by cancer survivors included having lost or not remembering receiving a SCP, not understanding the importance of their SCP, and wanting information about additional supports to be able to follow the SCP (e.g., regular contact from the cancer centre, avenues for peer support). Overall, study 1 found that in order to SCPs to be used as intended transition tools, survivors benefit from receiving education about how to use them and be informed of the expectation that they be actively involved in their follow-up care. Article 2 presents the TDF-based semi-structured interviews with primary care providers (PCPs). Thirteen PCPs completed 15-20 minute interviews, and content and thematic analysis was conducted. PCPs reported finding SCPs helpful and that they contained relevant information to provide follow-up care. A key facilitator of using the SCP was the table of follow-up tasks (e.g., mammography, colonoscopy) and their frequencies included in the SCP. Two significant barriers for PCPs using SCPs were: a) logistical issues with ordering follow-up tests and receiving results; and b) a lack of clear avenues to consult with oncology specialists (e.g., managing side effects of medications, actions that need to be taken when follow-up tests are abnormal). Overall, article 2 showed that PCPs appreciate and readily use SCPs, and contextual changes to facilitate clear avenues of communication between primary and tertiary care may be beneficial when implementing SCPs. Article 3 is a methodology article that presents a detailed explanation and rationale for the implementation science frameworks used and the data analysis chosen. The TDF-2 and Behaviour Change Techniques Taxonomy (BCTTv1; Michie, et al., 2008; Michie et al., 2013). The Human Behaviour Change Project researchers have empirically linked the 14 TDF domains to behaviour change techniques (BCTs), which allowed for multiple options to be developed to address barriers (and promote facilitators) of SCP use among breast and colorectal cancer survivors and PCPs (https://theoryandtechniquetool.humanbehaviourchange.org/tool; Michie et al., 2021). Using the TDF and BCTTv1 showed a dynamic between oncology specialists (e.g., oncologists, oncology nurses), cancer survivors, and PCPs that is involved in ensuring SCPs are implemented in an optimal way. A logic model was used to organize the barriers and enablers into different phases of SCP development, content, delivery, and use by PCPs and cancer survivors in their follow-up care (Mills et al., 2019). A flowchart organizing the recommendations of implementing SCPs was developed, and comprised 10 steps representing interrelationships between cancer centers, PCPs, and cancer survivors. The detailed methodology article also includes lessons learned and suggestions for implementation science researchers using the TDF and BCTTv1. Finally, article 4 is written for anyone looking for guidance implementing SCPs or improving upon how SCPs have been implemented already. It differs from article 3 in that it provides practical solutions for implementers. Because this work generated many recommendations, article 4 provides a worked example of how to use the results of this study. It is written in a way that outlines who would benefit from using the recommendations, and how to use the flow chart to narrow down the recommendation to those most relevant to implementors. The recommendations are organized into one of the 10 relationships in the flow chart, along with the purpose of the recommendations, how to implement it, to whom the recommendation targets, and those responsible for enacting the recommendations. The core factors associated with facilitating SCP use by PCPs and cancer survivors were: a) a treatment summary and follow-up guidelines included in the SCP; b) SCP provided to both cancer survivors and their PCP; and c) educating cancer survivors about their role as self-managers of their own care and the expectation that they participate in their follow-up cancer care. Future research on the usefulness of SCPs in follow-up care should include detailed information about the content, format, and receivers of SCPs and the outcomes most realistically influenced by the information included in SCPs. Before throwing the proverbial baby out with the bathwater, the implementation of SCPs requires additional standardization before meaningful investigation of their effectiveness as transition tools can be conducted.

Yes / Clinical guidelines are an integral part of healthcare. Whilst much progress has been made in ensuring that guidelines are well developed and disseminated, the gap between routine clinical practice and current guidelines often remains wide. A key reason for this gap is that implementation of guidelines typically requires a change in the behaviour of healthcare professionals – but the behaviour change component is often overlooked. We adopted the Theoretical Domains Framework Implementation (TDFI) approach for supporting behaviour change required for the uptake of a national patient safety guideline to reduce the risk of feeding through misplaced nasogastric tubes.

Bakgrund: Nationellt eftersträvas en digital omställning där digital och fysisk vård integreras inom hälso- och sjukvården. Incitament för denna omställning är att ge invånare ökad tillgänglighet till vård men också att nå en ökad delaktighet för invånare. Den digitala omställningen av vården och därmed integrering av digitala vårdkontakter är inom regionalt driven psykiatri ännu i sin linda. Detta trots växande evidens, framsteg i utveckling och tillgång till digitala verktyg, en pandemi som forcerat barriärer och ökad samhällelig acceptans för vård på distans. En förutsättning för att digitala vårdtjänster integreras som en legitim del av vård och behandling vid psykisk ohälsa är att vårdpersonal integrerar digitala arbetssätt och vårdkontakter i yrkesvardagen.  Idag är lite känt om hur vårdpersonal inom specialiserad öppenvårdspsykiatri i Sverige uppfattar en sådan omställning.   Syfte: Studiens huvudsyfte är att undersöka möjligheter och hinder som vårdpersonal inom regionalt driven öppenvårdspsykiatri upplever vid omställning där patienter erbjuds kombination av fysisk och digital vård.  Metod: Ett webbaserat frågeformulär med öppna och slutna frågor utformades. Insamlade data analyserades med kvalitativ innehållsanalys utifrån en deduktiv ansats utifrån Theoretical Domains Framework (TDF). Deltagare i studien var vårdpersonal verksamma i regionalt driven psykiatrisk öppenvård för vuxna i en region i Södra Sverige. Resultat: Baserat på TDF ramverket identifierades områden som påverkar vårdpersonalen genom att utgöra möjligheter eller hinder för att använda digitala vårdformer som arbetssätt.  Resultatets höga överensstämmelse med tidigare forskning antyder att identifierade TDF- domäner kan användas för att stärka acceptansen och implementeringen av digitala vårdformer inom ramen för psykiatrisk öppenvård. / Background:  In Sweden, a digital transition is sought where digital and physical care, Digi-physical healthcare, are integrated into public health care. A digital transition is one approach to meet the increasing need for health services that significantly challenges the health system but also aims to achieve increased patient participation. The digital transformation of care and the integration of e-mental health is still in its infancy in public psychiatry. This is despite growing evidence, progress in development, and access to digital tools, a pandemic that has pushed through barriers and increased acceptance of Digi-physical healthcare. A prerequisite for the integration of Digi-physical healthcare as a routine in public psychiatry depends on the acceptance of health care professionals. Aim: This study aims to investigate barriers and facilitators, as perceived by health care professionals, for implementing a combination of physical and digital care in Swedish public psychiatry.   Methods: Participants were health care professionals active in public outpatient psychiatry in a region in Southern Sweden. A web-based questionnaire with open and closed questions was designed. Collected data was analyzed with qualitative content analysis based on a deductive approach using the Theoretical Domains Framework (TDF). Results: Based on the TDF framework, barriers and enablers that influence mental health care professionals to apply the distance format as a way of working were identified. The result`s high agreement with previous research, suggests that identified TDF domains can be used to strengthen the acceptance and implementation of Digi-physical healthcare within psychiatric outpatient care.

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.