Mind the gap: analysis of two pilot projects of a home telehealth service for persons with complex conditions in a Swedish hospital.

BACKGROUND: Developing and implementing home telehealth (HTH) services for patients with chronic conditions is a challenge. HTH services provide continuous and integrated care to patients, but very often pilot projects face non-adoption and abandonment issues. Change processes in healthcare are often complex and require learning to adapt to non-linear and unpredictable events. Complexity science can thus provide a complementary view to the predominant Quality Improvement (QI) approach in healthcare. In this study of two pilot projects in a Swedish hospital, we explore how a theory-driven approach can be used (a) to support the development of a self-monitoring HTH service in hospital care and (b) to evaluate staff and patients' experiences from early adoption. METHODS: To plan and evaluate the service for the recipients (i.e., patients and healthcare providers), we used the Plan-Do-Study-Act (PDSA) tool in combination with two complexity-informed frameworks: the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, and the joint Complexity Assessment Tool (CAT). The theory-informed development process led to two pilot projects of an HTH service for patients with heart failure and COVID-19. We collected data from multiple sources (project documents, a survey on readiness for change among staff, and semi-structured interviews with patients and staff) and analyzed the data using descriptive statistics and qualitative content analysis with a deductive approach. RESULTS: Patients and staff perceived the services as valuable as they enabled rapid feedback, and improved communication and collaboration between patients and healthcare providers. Yet, despite the extensive development efforts, there was a perceived gap between how individuals valued the service and the capacity of adopters, the organization, and the wider system to effectively integrate these services into routine care. CONCLUSIONS: The combined use of PDSA, NASSS, and CAT can support the development and evaluation of HTH services that are perceived as valuable by individual patients and staff. For successful adoption, the value for individuals must be supported by organizational efforts to learn how to integrate new routines and tasks into clinical practice and daily life, and how to coordinate multiple providers within and outside the hospital walls.

Stressful situations and coping strategies in relation to age.

Whether people cope differently with negative events at different ages was assessed by relation to age by type of situation perceived as potentially stressful and by type of coping strategy used, and also whether the kind of coping strategy used to reduce the potential stressor was related to type of stressor. To do this the factor structure of the Spanish version of the Ways of Coping Checklist of Lazarus and Folkman was examined in an Argentine sample of 153. The factor analysis of checklist scores identified five factors: Cognitive redefinition, Problem focus, Seeking social support, Wishful thinking, and Avoidance. For two groups, ages 20 to 24 and 40 to 45 years, analysis indicated a significant association of type of situation perceived as potentially stressful with age. The middle-age group (40-45 yr.) chose a way of coping in problem solution but the young adult group (20-24 yr.) seemed more often to elude problems. It appears that the type of stressor influences type of coping.

Adolescent loneliness assessment.

The aim of the present work was to develop a loneliness scale for adolescents in order to assess their perceptions of the quality of their relationships with parents and peers. The scale was administered to 1,233 Argentine secondary school students, aged 13-16 years. Factor analyses (principal axes, oblimin solution) were conducted. Four factors were obtained, which accounted for 43.13% of the variance: Peer Rejection, Family Deficits and Parent Rejection, Personal Inadequacy, and Significant Separation. The internal consistency assessed through Cronbach's alpha was satisfactory. We believe that this proposal, which aims at evaluating the different processes that cause and are caused by a feeling of loneliness, allows for an integral approach to the issue.

Interpersonal Trust in Different Ages

El objetivo de este trabajo es presentar diferentes escalas en español para la evaluación de la confianza interpersonal La calidad de las relaciones establecidas entre los miembros de un grupo social permite el crecimiento de cada integrante y del grupo como conjunto. En la mayoría de los casos, y particularmente en la infancia, las necesidades solamente pueden ser satisfechas a través de la interacción con los demás; esto implica interdependencia y requiere reciprocidad. Por lo tanto es importante prever cómo actuará la otra persona, para anticipar nuestro comportamiento hacia ella. Las expectativas producen cambios en la atribución, según sea interpretada la actitud del otro como beligerante o cooperativa y a la vez modifican el comportamiento hacia los demás

Variables moderadoras del estres / Stress and its moderating variables

El objetivo del presente trabajo es analizar la influencia del estilo atribucional, la confianza interpersonal y el soporte social sobre la percepción de la amenaza. Se administraron la Escala de Estilo Atribucional; la Manheim Interview of Social Support, la Escala de Confianza Interpersonal; y el Inventario de Situa-ciones y Respuestas de Ansiedad, a 260 sujetos de ambos sexos, de 30 años de edad promedio, de nivel socioeconómico medio, residentes en la ciudad de Buenos Aires. El soporte social no demostró influencia significativa sobre la percepción de la amenaza. Con respecto a la influencia del estilo atribucional se puede decir que las personas indefensas perciben mas amenaza, especialmente expresada como ansiedad cognitiva y, en menor grado, como ansiedad motora o conductual. La confianza interpersonal demostro ser una variable importante en la percepción de la amenaza. Los sujetos que presentaron alta desconfianza hacia las personas de su entorno perciben un mundo amenazante, que se manifiesta como ansiedad cognitiva, fisiológica y motora o conductual.

La Escala Revisada de Soledad de UCLA: Una adaptación argentina / UCLA's Revised Scale of Loneliness: An argentinian adaptation

En este trabajo se presenta la adaptación a adultos argentinos de la Escala Revisada de Soledad de Russell, Cutrona y Peplau. La escala traducida fue administrada a 98 sujetos de ambos sexos, de 30 años de edad promedio, estudiantes y profesionales universitarios y no universitarios con diferentes actividades, de nivel socioeconómico medio, residentes en la ciudad de Buenos Aires. Se presentan la media aritmética y desviación estándar, así como las normas percentilares para adultos argentinos. La escala adaptada muestra una adecuada validez factorial ya que los ítems que expresan soledad y los que expresan compañía se separan claramente en dos factores. Es decir que a partir del análisis factorial surge que la soledad, tal como aparece aquí medida, es un concepto unidimensional con dos polos bien separados.

Relacion entre integracion social y personalid

El objetico de esta investigación es describir las características de la personalidad de tres grupos de niños con distintos niveles de integración social. Los tres tipos de grupo fueron prácticamente confundidos con el tipo de escuela a la que concurrián los niños. El primer grupo asistía a escuelas especiales para "villas de emergencia", el segundo, a escuelas comunes de barrios populares; y, el tercero, a escuelas, también comunes pero de barrios residenciales. Se administró la Técnica de Manchas de Tinta de Holtzman en forma grupal. Se realizaron análisis de variancia triple para estudiar cómo influyen la edad, el sexo, la integración social y sus interacciones en las distintas variables de personalidad