PhD (Health Sciences) / Department of Advanced Nursing Science / Disability is the most painful experience for the mother and relatives when a child is born. This is because every parent expects a normal child once a woman conceives. For a mother to be able to cope with their children they need to be supported emotionally, psychologically and physically by the family members, community, and health care professionals and other support service providers.The overall purpose of the study was to develop a model to support mothers of children with intellectual disabilities in selected institutions of Limpopo Province.An exploratory sequential mixed method was employed which includes both qualitative and quantitative approaches to guide the study.Population was all mothers of children with intellectual disabilitiesand health care professionals from the selected institutions where the research was conducted. Health care professionals were purposively selected whereas mothers were conveniently selected. The study was carried out in two phases i.e Phase1(a & b) and Phase 2. Qualitative results were used to build a subsequent quantitative phase. In Phase 1a,a qualitative approach was employed using descriptive and exploratory designs. Qualitative data was collected through individual interviews.Data analyses were done utilising Tesch’s open coding method.In Phase 1b was quantitative approach wherein a cross-sectional descriptive design was used.Questionnaireswere developed and data were collected from the health care professionals in the selected study areas.Data analyses were done using the Statistical Package for the Social Sciences (SPSS) version 24 and the level of statistical difference being set at p<0,05.In Phase 2, concept analysis, model development and validation of the model were performed. Themes and sub- themes were identified from the analysed data. Current study revealed that some mothers were fully supported and some were not supported at all by both the family, friends, relatives, community members and health care professionals. Hence continuous support was seen to be very crucial to them.The study recommendations include: open communication, social, psychological and emotional support, combined available support services, access to special schools and formulation of support groups. / NRF

MCur / Department of Advanced Nursing Science / Background: Doctors and nurses working in ICU are always confronted with ethical dilemmas when caring for critically ill patients no matter where they practice. The ethical dilemmas experienced by ICU nurses and doctors include amongst other: freedom of choice, truth telling, distribution of resources and confidentiality. Purpose: The study sought to explore the ethical dilemmas experienced by healthcare professionals working in ICU, Vhembe district in Limpopo province. Setting: The setting of the study was Tshilidzini hospital, Vhembe district in Limpopo Province Methodology: A qualitative, explorative, descriptive design was used. The population was nurses and doctors working in ICU, Tshilidzini hospital, Vhembe district in Limpopo province. A purposive sampling was used to select the study sample, and the study hospital. Data was collected by means of Semi-structured, in-depth interviews. Data was analyzed using Tesch`s method. Ethical considerations were adhered to. Findings: Participants expressed ethical dilemmas related to lack of resources, unsuitable infrastructure, hospital policies and patient`s decision making. Recommendations: The study recommends better policies by government and critical care societies to help guide resource allocation for ICU services. The number of ICU beds must be allocated according to the population it serves, in-service trainings to be conducted on regular bases in order to equip ICU health care professionals with knowledge of ethics and skills of decision-making, an active ethics committee to be elected to assist ICU practitioners when they encounter ethically challenging situation. / NRF

This thesis explores and evaluates the educational system of certain ambulance service. It's aim is to suggest the recommendations leading to higher efficiency and individualization of the system. This is the way how to address the educational needs of individual employees and help their professional development. Theoretical part of the thesis pays attention to employee's education and describes the specifics of educational cycle in more detail. So far there was no functional educational system in place in explored organization. This is the reason why to make it happen. The change I talk about needs to be prepared, planned and realized. Therefore another theme of theoretical part is devoted to implementation of change in organization. The practical part initially summarizes the attitude of Czech and some foreign ambulance services towards to employee's education, as it appears from their web sides. It also describes the current system of education in explored organization and evaluates it from the change implementation point of view. The attention is also paid to the fulfillment of different parts of educational cycle. Last part of this section is dedicated to research focused on realization of the first phase of cycle - identification of employees' educational needs. The closing part contains all...

Si l’approche par compétences au Canada et aux États-Unis est particulièrement valorisée pour orienter la pratique des professionnels de la santé (PDS) – et en bioéthique clinique –, les travaux permettant de mieux comprendre les fondements psychologiques, ontologiques et philosophiques de ces compétences sont peu présents dans la littérature en bioéthique. Les principaux outils actuellement disponibles se divisent généralement en quatre principales catégories : 1) les documents officiels (codes de déontologie, règlements institutionnels, etc.); 2) les principales théories éthiques (éthique de la discussion, éthique de la vertu, principisme, etc.); 3) les ouvrages de référence scientifiques; 4) les outils de prise de décision éthique. Ces documents sont des incontournables pour les bioéthiciens et les PDS, mais leur disparité, voire leur contenu parfois contradictoire, jumelée à une compréhension limitée de l’éthique, est souvent source de confusion dans les processus décisionnels et peut être la cause de comportements ne répondant pas aux standards éthiques des pratiques professionnelles. Notre recherche constitue une réflexion qui s’inscrit en amont de ces outils dont le caractère pragmatique a le désavantage de simplifier la réflexion théorique au profit de données plus concrètes. Nos travaux visent à développer les bases d’un modèle flexible et inclusif – le modèle de la déontologie réflexive (MDR) – permettant de : 1) poser les principaux repères philosophiques, sociaux et déontologiques des problématiques éthiques rencontrées en pratique; 2) saisir les principales tensions éthiques inhérentes à cette complexité; 3) mieux comprendre, dans une perspective psychologique et développementale, les exigences personnelles et professionnelles qu’impose le statut de professionnel de la santé dans le contexte actuel des soins de santé. Entreprise théorique, ce projet consiste principalement à mettre en relation dynamique un ensemble de dimensions (légale, éthique, clinique, sociale, psychologique) à l’oeuvre dans la rencontre du bioéthicien et du PDS avec la complexité des situations éthiques, en s’inspirant du concept de sensibilité éthique de la « petite éthique » de Paul Ricoeur (1990), du modèle des quatre composantes de Rest (1994) et de la théorie du soi et des modes identitaires d’Augusto Blasi (1993). Ce processus implique trois étapes successives : 1) une mise en ii perspective de la posture épistémologique particulière du bioéthicien et du PDS à la lumière de la « petite éthique » de Ricoeur; 2) une revue de la littérature interdisciplinaire sur le concept de sensibilité éthique afin d’en proposer une définition et de le mettre en perspective avec d’autres compétences éthiques; 3) le développement d’un cadre de référence en matière d’identité éthique professionnelle (professional ethics identity tendencies, PEIT), inspiré de la théorie du soi et des modes identitaires de Blasi. Ces PEIT proposent un repère normatif aux exigences liées à la construction de l'identité en contexte de pratique des PDS et suggèrent des pistes de réflexion quant à la formation et à la recherche en éthique professionnelle. Cette recherche souhaite établir des fondements théoriques pour le développement ultérieur du modèle de la déontologie réflexive (MDR). / If the competency approach seems to be particularly valorised in Canada and in the United States for orienting the practice of health care professionals (HCP) – and in clinical bioethics – material that could provide with a better understanding of the psychological, ontological and philosophical foundations of these competencies seems rather limited in the bioethical literature. The tools that are generally available can be divided into four main categories: 1) official documents (e.g., code of ethics, institutional policies); 2) the main ethical theories (e.g., virtue ethics, theories of justice, principlism); 3) scientific references (e.g., journals, books); 4) decision-making tools. These documents are important for bioethicists and HCPs, but their disparities and even contradictions, coupled with poor knowledge in professional ethics, may be a significant source of confusion in the decision making process and even lead to behaviour that does not meet the ethical standards of HCP. This thesis is an upstream reflection regarding these tools, whose pragmatic character has the disadvantage of simplifying theoretical reflection at the benefit of more concrete evidence useful for practical decision making. This project aims at developing the foundations for a flexible and inclusive model – a model of deontological reflexivity (MDR) – that will: 1) present the main philosophical, psychological, sociological and deontological landmarks characterising ethical issues encountered in practice; 2) understand, from a psychological and developmental perspective, the personal and professional requirements inherent to the status of the health care professional in the current context of health care. A theoretical enterprise, this project primarily consists in relating, in a dynamic manner, a variety of dimensions (legal, ethical, clinical, psychological) at work in complex ethical situations encountered by HCPs and bioethicists, inspired by the concept of ethical sensitivity, the “petite éthique” of Paul Ricoeur (1990), the self theory along with Blasi's Identity modes (Blasi, 1993). The analysis process will consist in three successive phases: 1) a putting into perspective of the bioethicist's and HCPs’ epistemological posture in light of the “petite éthique” of Paul Ricoeur (1990); 2) an interdisciplinary literature review of “ethical sensitivity” in order to propose a definition of the concept and place it into perspective with other ethical competencies; 3) the development of a framework regarding professional ethics iv and identity (professional ethics identity tendencies, PEIT), inspired both by the self theory and Blasi's Identity modes. These PEITs provide a normative benchmark related to the construction of identity in the health care context and suggest some innovative avenues for professional ethics research and education. This research wish to elaborate the theoretical foundations that will be utilised further in the future to develop the model of deontological reflexivity (MDR).

Bakgrund. Föräldrar till barn som har cancer upplever en livssituation som präglas av osäkerhet och oro och de ställs inför sociala och känslo­mässiga utmaningar. Jämfört med föräldrar till friska barn, upplever de också högre stress och drabbas i större utsträckning av posttraumatiska stres­symptom. Trots att information om barnets sjukdom är ett centralt behov för föräldrarna, upplever de otillfredsställelse med den information som ges. Syfte. Syftet med denna avhandling var att inom barnonkologisk vård beskriva vårdares och föräldrars upplevelser av information, studera deras inbördes interaktion samt beskriva upplevelser och effekter av en intervention för personcentrerad information till föräldrar. Metod. I delstudie I–III användes fokusgruppintervjuer (I, II), individ­uella intervjuer (II, III) och deltagande observationer (III). Deltagarna bestod av 20 vårdare (I), 14 föräldrar till barn med cancer (II) respektive 25 vårdare och 25 föräldrar (III). Data analyserades med kvalitativ innehållsanalys (I, II) och diskurspsykologi (III). I delstudie IV testades en intervention för per­son­cen­tre­rad information på åtta föräldrar med hjälp av en experimentell single-case-design. Data samlades in med kvalitativa intervjuer och internetenkäter. Upplevd stress, kroppsliga symptom på stress, ångest, nedstämdhet och tillfredsställelse med information var utfallsmått. Resultat. I delstudie I bestod resultatet av två teman: anpassa mängden information till föräldrarnas behov, som handlade om skillnader i hur mycket information som gavs till föräldrarna utifrån vårdarnas bedömning av föräldrarnas behov, och navigera i en vag struktur, som handlade om brister i ansvar, miljö, tajming och språk när informationen lämnades. I delstudie II konstruerades två teman. Känna sig bekräftad som en viktig person handlade om att föräldrarna kände sig trygga, kunde hålla hoppet uppe och fick stöd från andra föräldrar. Temat var mer framträdande under behandlingens tidiga skeden. Det andra temat var känna sig som en objuden gäst vilket handlade om att kännas övergiven vid viktiga milstolpar, att tvingas tjata sig till information och att belastas av att själv behöva informera andra inom sjukvården. I delstudie III använde vårdarna tolkningsrepertoarer som var barn-, föräldra- eller familjeorienterade, vilket avspeglade deras primära fokus i interaktionen. Föräldrarna använde tolkningsrepertoarer som talesperson, observatör eller familjemedlem. Hur dessa kombinerades inbördes påverkade interaktionen. I delstudie IV erfor föräldrarna stor tillfredsställelse med den per­son­cen­tre­rade informationen och upplevde att de hade nytta av att på egen hand få diskutera barnets sjukdom och ställa frågor de annars inte skulle ställt. Interventionen visade ingen effekt på stress eller kroppsliga symptom på stress, ångest och nedstämdhet. Slutsatser. För att förbättra information till föräldrar som har barn med cancer är det en central uppgift att bedöma hur mycket och vilken information som ska ges vid varje tillfälle, att uppmärksamma att föräldrarna kan ha andra informationsbehov än barnet och att möten med föräldrarna ska ske i lugn och ro samt att organisera vården så att ansvaret är tydligt. I synnerhet bör det ske förbättringar kring det som föräldrarna upplever som viktiga milstolpar under barnets sjukdomstid. Interventionen för per­son­cen­tre­rad information uppskattades av föräldrar som har barn med cancer men effekten på föräldrarnas psykosociala välbefinnande behöver utforskas ytterligare. / Background. Parents of children with cancer experience a life situation characterised by uncertainty and worries, and they face ongoing social and emotional challenges. Compared to parents of healthy children, they also experience increased levels of perceived stress and they suffer to a greater extent from post-traumatic stress symptoms. Even though information about the child’s disease is crucial for parents, they still experience low satis­faction with the information given to them. Aim. The aim of this thesis was to, within the field of paediatric oncology care, describe health care professionals’ and parents’ experiences from infor­mation, study their joint interaction and describe experiences and effects from an intervention based on person-centred information to parents. Methods. For study I–III, focus group interviews (I, II), individual inter­views (II, III), and participant observations (III) were used. Participants were 20 health care professionals (I), 14 parents of children with cancer (II) and 25 health care professionals and 25 parents (III). Data were analysed by qualitative content analysis (I, II) and discursive psychology (III). In study IV, an intervention for person-centred information was tested on 8 parents using a single-case experimental design. Data were collected with qualitative interviews and web questionnaires. Outcome measures were perceived stress, physical symptoms from stress, anxiety, depression, and satisfaction with information. Results. In study I, the analysis resulted in two themes, Matching the amount of information to the parents’ needs, which dealt with differences in the amount of information provided to parents according to the health care professionals’ assess­ment of parental needs, and Navigating through a vague structure, which was about shortcomings in responsibilities, setting, timing, and language when parents were informed. In study II, two themes were constructed. Feeling acknowledged as a person of significance was about feeling safe and secure, having one’s hopes supported and getting relief from other families. This was accentuated early in the treatment trajectory. Feeling like an unwelcome guest was about feeling abandoned at important milestones, feeling forced to nag for information and being burdened by informing others. In study III, the health care professionals used interpretative repertoires that were child, parent, or family oriented, which mirrored the primary focus of the inter­action. Parents used repertoires as a spokesperson, an observer, or a family member. The combination of the repertoires steered the interaction. In study IV, parents reported a high satisfaction with the person-centred information intervention and perceived benefits from having their own time to discuss the child’s disease and pose questions that they otherwise would not have an opportunity to ask. No effects from the intervention were demon­strated on perceived stress, physical symptoms of stress, anxiety, and depressive mood. Conclusion. To improve information to parents of children with cancer, a central task is to assess the amount of and what information given to parents, pay attention to possible differences in infor­mation needs between parents and children, as well as to organise the care so that the respon­si­bilities are clear and that parents are met in a calm setting. Improvements at important milestones during the illness period should be pri­ori­tised. A person-centred information inter­ven­tion is perceived as bene­ficial by parents, however, its effect on perceived parental stress has further to be investigated.

This study used narrative inquiry to answer the question “What are the stories of older adults who choose not to share information with health care professionals?” The study explored the experiences of older adults who did not share information with health care professionals (HCPs), who they defined as doctors. A thematic analysis of five participants’ stories revealed three themes: Illusions of Care, describing the participants’ experiences with doctors before they chose not to share information; The Last Straw, revealing the final incident that caused participants to choose not to share information; and The Mask of the Non-sharing Older Adult, describing how participants interacted with their doctors after they decided not to share information. Relationship development between older adults and their doctors, sensitive topics, issues and perceptions of ageing, and structure of the health care system contribute to the complex issue of older adults not sharing information. The decision not to share information with health care professionals may adversely affect the health and health care of older adults.

This study used narrative inquiry to answer the question “What are the stories of older adults who choose not to share information with health care professionals?” The study explored the experiences of older adults who did not share information with health care professionals (HCPs), who they defined as doctors. A thematic analysis of five participants’ stories revealed three themes: Illusions of Care, describing the participants’ experiences with doctors before they chose not to share information; The Last Straw, revealing the final incident that caused participants to choose not to share information; and The Mask of the Non-sharing Older Adult, describing how participants interacted with their doctors after they decided not to share information. Relationship development between older adults and their doctors, sensitive topics, issues and perceptions of ageing, and structure of the health care system contribute to the complex issue of older adults not sharing information. The decision not to share information with health care professionals may adversely affect the health and health care of older adults.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-05-17T18:44:38Z No. of bitstreams: 1 amandaferreiradearaujo.pdf: 2512560 bytes, checksum: 0250c9fd12a19353bf81c4a48fe0691b (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-05-22T11:37:43Z (GMT) No. of bitstreams: 1 amandaferreiradearaujo.pdf: 2512560 bytes, checksum: 0250c9fd12a19353bf81c4a48fe0691b (MD5) / Made available in DSpace on 2018-05-22T11:37:43Z (GMT). No. of bitstreams: 1 amandaferreiradearaujo.pdf: 2512560 bytes, checksum: 0250c9fd12a19353bf81c4a48fe0691b (MD5) Previous issue date: 2018-04-04 / O Agente Comunitário de Saúde (ACS) é fundamental no contexto da Atenção Primária à Saúde no Brasil e encontra-se envolvido em uma variedade de ambientes de trabalho e peculiaridades que justificam a realização de pesquisas referentes à saúde e condições de trabalho destes profissionais. Assim sendo, o objetivo deste estudo foi analisar e discutir as condições de trabalho dos ACS do município de Juiz de Fora e sua relação com as vivências de prazer, sofrimento e contexto de trabalho. Trata-se de um estudo transversal, quantitativo, realizado com 400 ACS. A coleta de dados foi realizada entre outubro de 2016 e fevereiro de 2017 e foram utilizados como instrumentos dois questionários auto-preenchíveis e duas escalas do Inventário sobre Trabalho e Risco de Adoecimento (ITRA). A população estudada foi predominantemente composta por mulheres (91,2%), com idade média de 46 anos (desvio padrão de 10,22), casadas ou em união estável (57,5%) e com ensino médio completo (76,4%). Nos resultados, a Escala de Avaliação do Contexto de Trabalho (EACT) apresentou os seus três domínios avaliados como crítico, sendo que dois itens relativos às condições de trabalho foram classificados como grave. Na Escala de Indicadores de Prazer e Sofrimento no Trabalho (EIPST), os domínios que avaliam o prazer foram classificados como satisfatório. Dentre os itens destes domínios, ganham destaque os relativos à identificação com o trabalho e o orgulho de exercer a profissão, com médias altas de pontuação positiva, bem como os relativos à confiança entre os colegas, motivação, valorização e reconhecimento, classificados como críticos e sendo, portanto, fatores potencializadores de sofrimento. Os domínios relacionados ao sofrimento no trabalho apresentaram resultado crítico. O domínio Esgotamento Profissional foi o que apresentou a avaliação mais negativa, com todos os itens avaliados como críticos. Com relação às associações os dados sociodemográficos e as condições físico-estruturais do trabalho com os domínios da EACT e EIPST, temos que quanto maior for a idade do ACS, maior é sua realização profissional. Também foi verificado uma associação de vivências de sofrimento e o sexo feminino. Verificamos que a maioria dos itens pesquisados no questionário sobre condições físico-estruturais mostrou associação estatisticamente significativa com a EACT e a EIPST. Isso quer dizer que os ACS consideram suas condições de trabalho inadequadas, insatisfatórias ou ruins e que estas são geradoras de vivências de sofrimento no trabalho. / The Community Health Agent is paramount in the context of Primary Health Care in Brazil and this agent is currently involved in a variety of work environments and specialties that justify a specific research concerning the health and working conditions of these professionals. The aim of this study is to analyze and discuss the working conditions of the “ACS” (Community Health Agent) from the city of Juiz de Fora and the interconnection with their experiences of pleasure and suffering and pain in their work context. It is a cross-sectional, quantitative study with a number of 400 evaluated professionals. Data collection has been performed from October 2016 until February 2017 and two self-fulfilling surveys and two scales of the Work Inventory and Risk of Falling ill (ITRA) were used as instruments for the research. The population of the study is predominantly female (91.2%), around 46 years old in average (standard deviation of 10.22), married or in a stable relationship (57.5%) with a high school degree of education (76.4% %). Regarding the results, the Work Context Assessment Scale (EACT) has presented its three most important indicators as critical; two of them - related to working conditions – have been ranked as severe. Considering the Indicators of Pleasure and Pain at Work (EIPST), the indicators that evaluate pleasure have been ranked as satisfactory. Among all the items, the ones related to work recognition and the pride to work in the designated profession were the ones which have had the highest averages of positive scores. On the other hand, the ones related to trustfulness among work colleagues, work motivation and work recognition by their peers have been ranked as critical, hence, they have been considered as potential indicators of suffering and pain at the work environment. The indicators related to the suffering and pain at work have presented critical results. The indicator regarding Professional Burnout is the one that has presented the most negative evaluation, having had all of its items ranked as critical. Regarding the cross-sectional data, the sociodemographic data and the physical-structural conditions of work with the EACT and EIPST indicators, we understand that the older the ACS gets, the greater is his/her professional fulfillment . It has also been verified an association of experiences of pain and suffering with the female sex. We have noticed that most of the items in the survey concerning physical-structural conditions have shown a statistically significant association with EACT and EIPST. It means that the ACS consider their working conditions inadequate, unsatisfactory or even bad and that these conditions are helping develop experiences of suffering and pain at the work environment.

Background: Patient empowerment is viewed as a priority by policy makers, patients and practitioners worldwide. Although there are a number of measures available, none have been developed specifically for patients in the UK with long-term conditions. It is the aim of this study to report the development and preliminary validation of an empowerment instrument for patients with long-term conditions in primary care.Methods: The study involved three methods. Firstly, a systematic review was conducted to identify existing empowerment instruments, and to describe, compare and appraise their content and quality. The results supported the need for a new instrument. Item content of existing instruments helped support development of the new instrument. Secondly, empowerment was explored in patients with long-term conditions and primary care practitioners using qualitative methods, to explore its meaning and the factors that support or hinder empowerment. This led to the development of a conceptual model to support instrument development. Thirdly, a new instrument for measuring empowerment in patients with long-term conditions in primary care was developed. A cross-sectional survey of patients was conducted to collect preliminary data on acceptability, reliability and validity, using pre-specified hypotheses based on existing theoretical and empirical work. Results: Nine instruments meeting review inclusion criteria were identified. Only one instrument was developed to measure empowerment in long-term conditions in the context of primary care, and that was judged to be insufficient in terms of content and purpose. Five dimensions (‘identity’, ‘knowledge and understanding’, ‘personal control’, personal decision-making’, and ‘enabling other patients’) of empowerment were identified through published literature and the qualitative work and incorporated into a preliminary version of the new instrument. A postal survey achieved 197 responses (response rate 33%). Almost half of the sample reported circulatory, diabetic or musculoskeletal conditions. Exploratory factor analysis suggested a three factor solution (‘identity’, ‘knowledge and understanding’ and ‘enabling’). Two dimensions of empowerment (‘identity’ and ‘enabling’) and total empowerment showed acceptable levels of internal consistency. The measure showed relationships with external measures (including quality of chronic illness care, self-efficacy and educational qualifications) that were generally supportive of its construct validity.Conclusion: Initial analyses suggest that the new measure meets basic psychometric criteria and has potential for the measurement of patient empowerment in long-term conditions in primary care. The scale may have a role in research on quality of care for long-term conditions, and could function as a patient-reported outcome measure. However, further validation is required before more extensive use of the measure.

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.