Nurses' Use and Ways of Understanding Web-Based National Guidelines for Child Healthcare.

The national Rikshandboken for child healthcare is both a Web-based guideline containing knowledge and methodological guidance and a national child healthcare program in the process of being implemented in Sweden. The aim of this study was to examine child healthcare nurses' use and ways of understanding the national Web-based Rikshandboken. A mixed-methods study with sequential explanatory design in two phases was used; a Web survey with descriptive statistics was followed with telephone interviews with phenomenographic analysis. The study showed variations in use and contributed deeper knowledge of child healthcare nurses' ways of understanding the unit Rikshandboken whose varied parts interact with each other. To be reliable, useful, and relevant for nurses in their specific contexts, Rikshandboken must be kept updated and involve the end users in the development process. With access to technical devices and optimal use of the possibilities of information and communication technology, Rikshandboken can be a resource for continuing learning, a tool in everyday work, and a possible determinant to equality in child healthcare. The study contributes valuable knowledge for the design of Web-based national guidelines for healthcare, making them useful and relevant for the end users.

Parents' experiences of a health dialogue in the child health services: a qualitative study.

BACKGROUND: The Child Health Services in Sweden is a well-attended health promoting setting, and thereby has an important role in promoting healthy living habits in families with young children. Due to lack of national recommendations for health dialogues, a Child Centred Health Dialogue (CCHD) model was developed and tested in two Swedish municipalities. The aim of this study was to explore parents' experiences of health dialogues based on the CCHD model focusing on food and eating habits during the scheduled child health visit at four years of age. METHODS: A qualitative design with purposeful sampling was used. Twelve individual interviews with parents were conducted and analysed with qualitative content analysis. RESULTS: The analysis resulted in three categories: The health dialogue provides guidance and understanding; Illustrations promote the health dialogue; and Space for children and parents in the health dialogue. In addition, analysis of the latent content resulted in a single theme reflecting the parents' voice on the importance of having a health dialogue on food and eating habits. The health dialogue, promoted by illustrations, provided guidance and understanding, and gave space for children's and parents' involvement. CONCLUSIONS: The results indicate that health dialogues using the CCHD- model create supportive conditions for family members' active participation in the visits, which may strengthen empowerment and health literacy. The study provides knowledge and guidance for further development, evaluation and implementation of the model.

Implementation of a web-based national child health-care programme in a local context: A complex facilitator role.

AIM: The aim of this study was to investigate child health-care coordinators' experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. METHODS: The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. RESULTS: The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme 'Being a facilitator: a complex role' was formed to express the child health-care coordinators' experiences. CONCLUSIONS: Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.

Nurses' Use of a Web-Based National Guide for Child Health Care.

Rikshandboken i Barnhälsovård is a Swedish Web-based guide for child healthcare, providing quality-ensured guidelines and support contributing to equality in child healthcare among all children. In 2015, a new child healthcare program was implemented and made available in this Web-based guide. The aim of this study was to investigate how child healthcare nurses use Rikshandboken i Barnhälsovård and factors affecting its use. The study was a comprehensive Web survey of 2376 child healthcare nurses in Sweden answered by 1309. Statistical processing was performed using descriptive and analytical methods. Rikshandboken i Barnhälsovård was widely used by the respondents, but regional differences and number of years in the profession affected the use. Almost all nurses were satisfied with the usability, content, and design and felt that a national guide for child healthcare is important. This indicates that an established Web-based national guide is an appropriate setting when a new national program is implemented. In order to achieve an equal and equitable child healthcare, it is essential that all nurses use the national guide to provide evidence-based practice. The value of main child healthcare units as regional facilitators in the innovation process of Rikshandboken i Barnhälsovård should not be underestimated.

Health communication in primary health care -a case study of ICT development for health promotion.

BACKGROUND: Developing Information and Communication Technology (ICT) supported health communication in PHC could contribute to increased health literacy and empowerment, which are foundations for enabling people to increase control over their health, as a way to reduce increasing lifestyle related ill health. However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention. The aim of this study was to gain a better understanding of health communication for health promotion in PHC with emphasis on the implications for a planned ICT supported interactive health channel. METHODS: A qualitative case study, with a multi-methods approach was applied. Field notes, document study and focus groups were used for data collection. Data was then analyzed using qualitative content analysis. RESULTS: Health communication is an integral part of health promotion practice in PHC in this case study. However, there was a lack of consensus among health professionals on what a health promotion approach was, causing discrepancy in approaches and practices of health communication. Two themes emerged from the data analysis: Communicating health and environment for health communication. The themes represented individual and organizational factors that affected health communication practice in PHC and thus need to be taken into consideration in the development of the planned health channel. CONCLUSIONS: Health communication practiced in PHC is individual based, preventive and reactive in nature, as opposed to population based, promotive and proactive in line with a health promotion approach. The most significant challenge in developing an ICT supported health communication channel for health promotion identified in this study, is profiling a health promotion approach in PHC. Addressing health promotion values and principles in the design of ICT supported health communication channel could facilitate health communication for promoting health, i.e. 'health promoting communication'.

Health promoting settings in primary health care - "hälsotorg": an implementation analysis.

BACKGROUND: Sweden, like many other western countries, faces increasing rates of lifestyle related diseases and corresponding rise in costs for health care. To meet these challenges, a number of efforts have been introduced at different societal levels. One such effort is "Hälsotorg" (HS). HS is a new health promotion setting that emerged in collaboration between the Swedish County Councils and Apoteket AB, a state-owned pharmacy company. HS's overall aim was to improve population health and facilitate inhabitants' responsibility for self-care. A new National Public Health Policy, introduced in 2008, emphasizes more focus on individual's needs and responsibility as well as strong need for county councils to provide supportive environment for individual-centred health services and increased health literacy among the population. In light of this policy, there is a need to examine existing settings that can provide supportive environment for individuals at community level. The aim of this study was to explore HS's policy implementation at local level and analyse HS's activities, in order to provide a deeper understanding of HS's potential as a health promoting setting. METHODS: Materials included a survey and key documents related to the development and nature of HS on local and national levels. A policy analysis inspired by Walt and Gilson was used in data analysis. In addition, an analysis using the principles of health promotion in relation to HS policy process and activities was also carried out. RESULTS: The analysis illuminated strengths and weaknesses in the policy process, its actors, contextual factors and activities. The health communication approach in the analysed documents contained health promoting intentions but the health promoting approach corresponding to a health promoting setting was neither apparent nor shared among the stakeholders. This influenced the interpretation and implementation of HS negatively. CONCLUSIONS: The analysis indicates that HS has potential to be a valuable health promotion setting for both population and individuals, given the strong intentions for a health and empowerment building approach that is expressed in the documents. However, for a more sustainable implementation of HS, there is need for an in- depth understanding of the health promotion approach among HS stakeholders.

Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study.

BACKGROUND: Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients' experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published. OBJECTIVES: The aim of this study was to explore older persons' common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP. METHODS: A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi's principles of psychological phenomenological analysis. RESULTS: The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises. CONCLUSIONS: It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed.