Fidelity-consistency and deliberateness of modifications in parenting programs.

BACKGROUND: Evidence-based interventions (EBIs) are frequently modified in practice. It is recommended that decisions to modify EBIs should be made deliberately to ensure fidelity-consistency, yet the relationship between fidelity-consistency and deliberateness is not well understood. This study aims to explore modifications in a sample of practitioners delivering evidence-based parenting programs (i.e., interventions to strengthen parent-child relationships, reduce harmful interactions, and improve child health and well-being). The study investigated three research questions: (1) What kind of modifications are made during the delivery of parenting programs? (2) To what degree are the identified modifications consistent with the core functions of each program? and (3) Is deliberateness associated with the fidelity-consistency of the identified modifications? METHODS: In total, 28 group leaders of five widely disseminated parenting programs in Sweden participated in five focus groups, and two participants from each group also participated in individual interviews (n = 10). A content analysis approach was used where the identification of modifications was directed by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and then assessed for fidelity-consistency and four levels of deliberateness (universal, situational, conditional, and unintentional). Chi-square tests were performed to compare consistent and inconsistent modifications, and logistic regression was performed to explore whether deliberateness predicted consistency. RESULTS: A total of 137 content modifications were identified, covering most of the content modification categories in FRAME. The most common were tailoring/tweaking/refining, adding elements, shortening/condensing, lengthening/extending, and integrating another treatment. Modifications were mostly fidelity-consistent but consistency varied greatly among categories. Furthermore, modifications made unintentionally or situationally were more likely to be fidelity-inconsistent. CONCLUSIONS: These results indicate that explicit consideration of modifications and their impact could be essential for sustaining the fidelity-consistent use of EBIs, even as such interventions are continuously modified.

The adaptation and fidelity tool to support social service practitioners in balancing fidelity and adaptations: Longitudinal, mixed-method evaluation study.

Background: Evidence-based interventions (EBIs) seldom fit seamlessly into a setting and are often adapted. The literature identifies practitioners' management of fidelity and adaptations as problematic but offers little guidance. This study aimed to investigate practitioners' perceptions of the feasibility and usability of an intervention aimed to support them in fidelity and adaptation management when working with EBIs. Methods: The intervention, the adaptation and fidelity tool (A-FiT), was developed based on the literature, along with input from social service practitioners and social services' Research and Development units' personnel. The intervention consisted of two workshops where the participants were guided through a five-step process to manage fidelity and adaptations. It was tested in a longitudinal mixed-method intervention study with 103 practitioners from 19 social service units in Stockholm, Sweden. A multimethod data collection was employed, which included interviews at follow-up, questionnaires at baseline and follow-up (readiness for change and self-rated knowledge), workshop evaluation questionnaires (usability and feasibility) after each workshop, and documentation (participants' notes on worksheets). To analyze the data, qualitative content analysis, Kruskal-Wallis tests, and Wilcoxon rank-sum tests were performed. Results: Overall, the practitioners had a positive perception of the intervention and perceived it as relevant for fidelity and adaptation management (mean ratings over 7.0 on usability and feasibility). The workshops also provided new knowledge and skills to manage fidelity and adaptations. Furthermore, the intervention provided insights into the practitioners' understanding about adaptation and fidelity through a more reflective approach. Conclusion: Practical tools are needed to guide professionals not only to adhere to intervention core elements but also to help them to manage fidelity and adaptation. The proposed A-FiT intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. Potentially, the next step is an evaluation of the intervention's impact in an experimental design.

This study describes practitioners' perceptions of an intervention that aims to support them in fidelity and adaptation management when working with evidence-based interventions (EBIs). This is an important issue because social services practitioners are expected to use EBIs that seldom fit seamlessly into a specific setting and are often adapted. The practitioners perceived the intervention as relevant for their fidelity and adaptation management and states that it helped them develop a plan and increased their knowledge on the topic. Professionals require practical guiding tools not only to adhere to intervention content but also to balance them with fidelity and adaptation. This proposed intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. We propose that researchers further evaluate this intervention as a potential next step.

Strategies to reduce low-value care - An applied behavior analysis using a single-case design.

Introduction: Implementation science has traditionally focused on the implementation of evidence-based practices, but the field has increasingly recognized the importance of addressing de-implementation (i.e., the process of reducing low-value care). Most studies on de-implementation strategies have used a combination of strategies without addressing factors that sustain the use of LVC and there is a lack of information about which strategies are most effective and what mechanisms of change might underlie these strategies. Applied behavior analysis is an approach that could be a potential method to gain insights into the mechanisms of de-implementation strategies to reduce LVC. Three research questions are addressed in this study: What contingencies (three-term contingencies or rule-governing behavior) related to the use of LVC can be found in a local context and what strategies can be developed based on an analysis of these contingencies?; Do these strategies change targeted behaviors?; How do the participants describe the strategies' contingencies and the feasibility of the applied behavior analysis approach? Materials and methods: In this study, we used applied behavior analysis to analyze contingencies that maintain behaviors related to a chosen LVC, the unnecessary use of x-rays for knee arthrosis within a primary care center. Based on this analysis, strategies were developed and evaluated using a single-case design and a qualitative analysis of interview data. Results: Two strategies were developed: a lecture and feedback meetings. The results from the single-case data were inconclusive but some of the findings may indicate a behavior change in the expected direction. Such a conclusion is supported by interview data showing that participants perceived an effect in response to both strategies. Conclusion: The findings illustrate how applied behavior analysis can be used to analyze contingencies related to the use of LVC and to design strategies for de-implementation. It also shows an effect of the targeted behaviors even though the quantitative results are inconclusive. The strategies used in this study could be further improved to target the contingencies better by structuring the feedback meetings better and including more precise feedback.

Job crafting interventions: what works, for whom, why, and in which contexts? Research protocol for a systematic review with coincidence analysis.

BACKGROUND: Recent challenges in the working world that resulted from the pandemic and technological advances have underlined the importance of flexibility in how jobs are designed. Job crafting (JC) refers to self-initiated changes that employees introduce to their jobs to optimize their job design and increase the fit between the job and their needs and preferences. These behaviors can be stimulated by job crafting training interventions, which aim to change how individual employees design, organize, or manage their work. However, since the interventions are implemented in various ways, we do not know which context and intervention factors are necessary or sufficient to achieve desired outcomes. Without this knowledge, benefitting from the potential of job crafting interventions is limited. The overall aim of this project will be to investigate what combinations of context, intervention, and mechanism factors are linked with effective JC interventions. Specifically, we will detect what factors are minimally sufficient and/or necessary to produce a successful JC intervention, how they combine, as well as what are the multiple alternative paths to their success. METHODS: We will perform a systematic review of the JC interventions literature combined with coincidence analysis (CNA). We will search electronic databases of journals and utilize Rayyan software to make decisions regarding inclusion. Data regarding context (e.g., fit), intervention (e.g., types of activities), mechanisms (e.g., intention implementation), and outcomes (e.g., employee well-being, job performance) will be extracted using a pre-piloted form and coded into a crisp-set (factor present vs. absent). Analyses will be carried out using the CNA package in R. DISCUSSION: This review will address gaps in knowledge about the context, intervention, and mechanism-related factors that may impact the effects of JC interventions. Consequently, this review will help develop a program theory for JC interventions that explains what works, how and under which circumstances. Applying CNA to synthesize these complex solutions across multiple studies provides an innovative method that may be used in future review attempts evaluating the implementation of interventions. Finally, our synthesis will provide knowledge relevant to organizational practitioners and scholars who want to implement JC interventions. TRIAL REGISTRATION: https://osf.io/2g6yx.

Bridging HCI and Implementation Science for Innovation Adoption and Public Health Impact.

Human computer interaction (HCI) and implementation science (IS) each have been applied to improve the adoption and delivery of innovative health interventions, and the two fields have complementary goals, foci, and methods. While the IS community increasingly draws on methods from HCI, there are many unrealized opportunities for HCI to draw from IS and to catalyze bidirectional collaborations. This workshop will explore similarities and differences between fields, with a goal of articulating a research agenda at their intersection.

Scaling up evidence-based digital early life nutrition interventions in a county setting: an implementation trial - protocol for Phase 2 of the Nutrition Now project.

Background: Few effective health interventions transition from smaller efficacy or effectiveness studies to real-world implementation at scale, representing a gap between evidence and practice. Recognising this, we have developed Nutrition Now - a tailored digital resource building on four efficacious dietary interventions, aiming to improve nutrition in the important first 1,000 days of life. Nutrition Now targets and guides expectant parents and parents of 0-2 year olds, serves as a reliable source of evidence-based information for midwives and public health nurses at maternal and child healthcare (MCH) centres, and offers pedagogical tools for early childhood education and care (ECEC) staff. The aim of this study is to implement Nutrition Now at scale and evaluate the impact of different sets of multifaceted implementation strategies on implementation outcomes. Methods: A quasi-experimental design with three study arms will be used, providing either low, medium or high implementation support, when rolled out in 50 municipalities in 2 counties in Norway. Nutrition Now will be implemented in MCH and ECEC settings and made available to expectant parents and parents of 0-2 year olds through social media and MCH. The implementation support builds on strategies described in the Expert Recommendations for Implementing Change (ERIC) implementation framework and is informed by dialogues with stakeholders. Impact of the different degree of implementation support will be assessed by examining reach, adoption, fidelity, and sustainability using usage data generated from the Nutrition Now resource, publicly available municipal data and qualitative interviews with MCH and ECEC staff. Discussion: Nutrition Now Phase 2 will break new ground by scaling up successively delivered and complementary dietary interventions in the first 1,000 days of life in a real-life context. The project also seeks to identify what level of implementation support is most effective when implementing digital, scalable, evidence-based early-life nutrition interventions in community settings. The project will inform implementation research and provide knowledge about effective implementation strategies to be used in a national scale-up of Nutrition Now. Trial registration: The study is registered prospectively (submitted 14/06/2022, registration date: 19/06/2022) in the International Standard Randomised Controlled Trial Number registry (ISRCTN): reg. Number: ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967.

How Should Job Crafting Interventions Be Implemented to Make Their Effects Last? Protocol for a Group Concept Mapping Study.

BACKGROUND: By means of job crafting (JC) employees shape and customize their job design to align it with their preferences. Research has so far shown that such bottom-up proactivity can be stimulated via JC interventions. While the overall effectiveness behind these interventions has been supported, it is unclear how to implement these interventions to make their effects lasting. METHODS: The overall aim of this project will be to investigate how to implement JC interventions with lasting effects. We will apply a group concept mapping (GCM) methodology, which is a mixed methods approach of exploratory nature for engaging stakeholder groups in a structured conceptualization process. As part of concept mapping procedures, brainstorming sessions will be conducted with experts in job crafting to identify factors expected to make job crafting intervention effects lasting. These factors will be sorted by similarity and rated by each participant in regard to their perceived importance and feasibility to ensure lasting, sustainable effects. The data will be analyzed using multidimensional scaling (MDS), hierarchical cluster analysis, and descriptive and inferential statistics, resulting in a visual representation of conceptually distinguished clusters representing the factors influencing the sustainability of JC interventions. In the final step, a workshop will be conducted with the participants to facilitate the interpretation of the results. RESULTS AND CONCLUSION: This study will provide knowledge relevant to organizational practitioners and scholars who want to implement JC interventions with lasting effects. Although data collected following the group concept mapping procedure is self-reported and at risk of being simplified, the method allows for a structured conceptualization process integrating different perspectives and uncovering implicit knowledge making it suitable for studying complex phenomena. The results will not only enrich the current literature concerning the effectiveness of JC interventions but also be used to develop a practitioner-oriented toolkit outlining evidence-based recommendations concerning designing and implementing, as well as evaluating JC interventions.

Better self-care through co-care? A latent profile analysis of primary care patients' experiences of e-health-supported chronic care management.

Background: Efficient self-care of chronic conditions requires that an individual's resources be optimally combined with healthcare's resources, sometimes supported by e-health services (i.e., co-care). This calls for a system perspective of self-care to determine to what extent it involves demanding or unnecessary tasks and whether role clarity, needs support, and goal orientation are sufficient. This study aims to explore typical configurations of how the co-care system is experienced by individuals with chronic conditions who used an e-health service supporting self-monitoring and digital communication with primary care. Method: We performed a latent profile analysis using questionnaire data from two waves (7 months apart) involving 180 of 308 eligible patients who pilot-tested an e-health service for co-care at a Swedish primary care center. The five subscales of the Distribution of Co-Care Activities (DoCCA) scale were used to create profiles at Time 1 (T1) and Time 2 (T2). Profiles were described based on sociodemographic variables (age, gender, education level, and health condition) and compared based on exogenous variables (self-rated health, satisfaction with healthcare, self-efficacy in self-care, and perceptions of the e-health service). Results: We identified four typical configurations of co-care experiences at T1: strained, neutral, supportive, and optimal. Patients with optimal and supportive profiles had higher self-rated health, self-efficacy in self-care, and satisfaction with healthcare than patients with strained and neutral profiles. Slightly more than half transitioned to a similar or more positive profile at T2, for which we identified five profiles: unsupportive, strained, neutral, supportive, and optimal. Patients with optimal and supportive profiles at T2 had higher self-efficacy in self-care and satisfaction with healthcare than the other profiles. The optimal profiles also had higher self-rated health than all other profiles. Members of the optimal and supportive profiles perceived the effectiveness of the e-health service as more positive than the unsupportive and strained profile members. Discussion: Primary care patients' co-care profiles were primarily distinguished by their experiences of needs support, goal orientation, and role clarity. Patients with more positive co-care experiences also reported higher self-rated health, self-efficacy in self-care, and satisfaction with healthcare, as well as more positive experiences of the e-health service.

Strategies for de-implementation of low-value care-a scoping review.

BACKGROUND: The use of low-value care (LVC) is a persistent problem that calls for knowledge about strategies for de-implementation. However, studies are dispersed across many clinical fields, and there is no overview of strategies that can be used to support the de-implementation of LVC. The extent to which strategies used for implementation are also used in de-implementing LVC is unknown. The aim of this scoping review is to (1) identify strategies for the de-implementation of LVC described in the scientific literature and (2) compare de-implementation strategies to implementation strategies as specified in the Expert Recommendation for Implementing Change (ERIC) and strategies added by Perry et al. METHOD: A scoping review was conducted according to recommendations outlined by Arksey and O'Malley. Four scientific databases were searched, relevant articles were snowball searched, and the journal Implementation Science was searched manually for peer-reviewed journal articles in English. Articles were included if they were empirical studies of strategies designed to reduce the use of LVC. Two reviewers conducted all abstract and full-text reviews, and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data-charting form. The strategies were first coded inductively and then mapped onto the ERIC compilation of implementation strategies. RESULTS: The scoping review identified a total of 71 unique de-implementation strategies described in the literature. Of these, 62 strategies could be mapped onto ERIC strategies, and four strategies onto one added category. Half (50%) of the 73 ERIC implementation strategies were used for de-implementation purposes. Five identified de-implementation strategies could not be mapped onto any of the existing strategies in ERIC. CONCLUSIONS: Similar strategies are used for de-implementation and implementation. However, only a half of the implementation strategies included in the ERIC compilation were represented in the de-implementation studies, which may imply that some strategies are being underused or that they are not applicable for de-implementation purposes. The strategies assess and redesign workflow (a strategy previously suggested to be added to ERIC), accountability tool, and communication tool (unique new strategies for de-implementation) could complement the existing ERIC compilation when used for de-implementation purposes.

National governance of de-implementation of low-value care: a qualitative study in Sweden.

BACKGROUND: The de-implementation of low-value care (LVC) is important to improving patient and population health, minimizing patient harm and reducing resource waste. However, there is limited knowledge about how the de-implementation of LVC is governed and what challenges might be involved. In this study, we aimed to (1) identify key stakeholders' activities in relation to de-implementing LVC in Sweden at the national governance level and (2) identify challenges involved in the national governance of the de-implementation of LVC. METHODS: We used a purposeful sampling strategy to identify stakeholders in Sweden having a potential role in governing the de-implementation of LVC at a national level. Twelve informants from nine stakeholder agencies/organizations were recruited using snowball sampling. Semi-structured interviews were conducted, transcribed and analysed using inductive thematic analysis. RESULTS: Four potential activities for governing the de-implementation of LVC at a national level were identified: recommendations, health technology assessment, control over pharmaceutical products and a national system for knowledge management. Challenges involved included various vested interests that result in the maintenance of LVC and a low overall priority of working with the de-implementation of LVC compared with the implementation of new evidence. Ambiguous evidence made it difficult to clearly determine whether a practice was LVC. Unclear roles, where none of the stakeholders perceived that they had a formal mandate to govern the de-implementation of LVC, further contributed to the challenges involved in governing that de-implementation. CONCLUSIONS: Various activities were performed to govern the de-implementation of LVC at a national level in Sweden; however, these were limited and had a lower priority relative to the implementation of new methods. Challenges involved relate to unfavourable change incentives, ambiguous evidence, and unclear roles to govern the de-implementation of LVC. Addressing these challenges could make the national-level governance of de-implementation more systematic and thereby help create favourable conditions for reducing LVC in healthcare.

Management strategies to de-implement low-value care-an applied behavior analysis.

BACKGROUND: There is a lack of knowledge about management strategies being used to de-implement low-value care (LVC). Furthermore, it is not clear from the current literature what mechanisms are involved in such strategies and how they can change physicians' behaviors. Understanding the mechanisms is important for determining a strategy's potential impact. Applied behavior analysis focuses on processes involved in increasing and decreasing behaviors. Therefore, the aim of this study is to understand what management strategies are being used to de-implement LVC and the possible mechanisms involved in those strategies, using concepts from applied behavior analysis. METHOD: We applied a qualitative study design using an inductive approach to understand what management strategies are in use and then employed applied behavior analysis concepts to deductively analyze the mechanisms involved in them. RESULTS: We identified eight different management strategies intended to influence LVC. Five of the strategies were developed at a regional level and had the potential to influence physicians' LVC-related behaviors either by functioning as rules on which LVC to de-implement or by initiating local strategies in each health care center that in turn could influence LVC practices. The local strategies had a stronger potential for influencing de-implementation. CONCLUSION: Both strategies at a systemic level (regional) and on a local level (health care centers) must be considered to influence LVC-related behaviors. Strategies at the center level have a specific opportunity to impact LVC-related behaviors because they can be tailored to specific circumstances, even though some of them probably were initiated as an effect of strategies on a regional level. Using applied behavior analysis to understand these circumstances can be helpful for tailoring strategies to reduce LVC use.

Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room-An interview study with registered nurses.

AIM: To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life-threateningly ill patients' care needs from the perspective of a person-centred fundamental care framework. DESIGN: A descriptive, qualitative interview study. METHOD: Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings. RESULTS: Three themes were identified: Task-oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person-centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not. CONCLUSION: From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person-centred care. IMPACT: To date, little is known about registered nurses' work approach and prerequisites in meeting life-threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person-centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person-centred fundamental care and thereby avoid fundamental care being missed.

Eleven Reasons for Adaptation of Swedish Parenting Programs.

While questions about adaptation and fidelity are of great concern in many implementation projects, less attention has been paid to reasons for adaptations that remain when evidence-based interventions (EBIs) are used in clinical and community settings. This study aims to explore reasons for adaptations that can arise when using parenting programs in a community setting. Seventeen individual interviews with providers were conducted and analyzed thematically, resulting in 11 reasons for adaptations organized into four separate areas: characteristics of group leaders (supplementary skills and knowledge, preferred ways of working), characteristics of families (problem complexity, diverse or limited educational experience, non-parenting needs for support, colliding value systems), group incidents (criticism and challenges, excessive questions or discussions), and didactic challenges (lack of focus or engagement, limitations of the material, language differences). The study shows that factors triggering adaptation and fidelity decisions continuously reappear in the provision of parenting programs in community settings. Knowledge about reasons for adaptation can be used to inform decision-making during implementation planning, as well as the sustainment of implemented interventions.

A Slippery Slope When Using an Evidence-Based Intervention Out of Context. How Professionals Perceive and Navigate the Fidelity-Adaptation Dilemma-A Qualitative Study.

Introduction: Adaptations are often necessary to effectively translate evidence-based interventions (EBI) between contexts, but compliance with the EBIs' core components is still important, which is referred to as the fidelity-adaptation dilemma. In the sustainment phase of implementation, it is the professionals delivering the EBIs who are tasked with the decision-making regarding adaptations, but the currently used models and frameworks mostly focus on the initial phases of implementation. To better understand and guide professionals in using EBIs, there is a need to explore professionals' perceptions of the fidelity-adaptation dilemma. The aim of this study is consequently to explore how professionals perceive and navigate the fidelity-adaptation dilemma when using an EBI out of context. Materials and Methods: Semi-structured interviews were held with 19 psychologists working in primary care. The interviews concerned EBIs in general and Cool Kids, an evidence-based parenting education program designed for children with anxiety that is now used for children with lower levels of anxiety in another setting. The data were analyzed using an inductive content analysis method. Results: The analysis resulted in two themes: My standpoint regarding fidelity and adaptation is clear and Managing fidelity and adaptations is complicated. The first theme summarizes the professionals' perceptions of confidence for either favoring fidelity or adaptations, as well as reasons for why they made adaptations. For the second theme, the professionals expressed concern about sometimes meeting difficulties with the dilemma when following their original inclination and having second thoughts about the impact the adaptations have in practice. Conclusion: The professionals generally had strong preferences regarding fidelity and adaptations, but neither preference prevented them from facing difficulties with the dilemma. The results point to a need for better information about possible adaptations from developers but also better support and guidance for professionals when implementing EBIs to ensure quality implementation and facilitate implementation. The results of this study can inform the design of support for professionals in managing the dilemma.

Adaptations to practice and resilience in a paediatric major trauma centre during a mass casualty incident.

BACKGROUND: Innovation and human adaptation in the face of unfolding catastrophe is the cornerstone of an effective systemwide response. Capturing, analysing, and disseminating this is fundamental in developing resilience for future events. The aim of this study was to understand the characteristics of adaptations to practice early in a paediatric major trauma centre during a mass casualty incident. METHODS: A qualitative interview study of 40 healthcare staff at a paediatric major trauma centre in the immediate aftermath of a terrorist bombing was conducted. An inductive thematic analysis approach was used, followed by a deductive analysis of the identified adaptations informed by constructs of resilience engineering. RESULTS: Five themes of adaptations to practice that enhanced the resilient performance of the hospital were identified: teamworking; psychologically supporting patients, families, and staff; reconfiguring infrastructure; working around the hospital electronic systems; and maintaining hospital safety. Examples of resilience potential in terms of respond, monitor, anticipate, and learn are presented. CONCLUSIONS: Our study shows how adaptations to practice sustained the resilient performance of a paediatric major trauma centre during a mass casualty incident. Rapid, early capture of these data during a mass casualty incident provides key insights into enhancing future emergency preparedness, response, and resilience planning.

Beyond the individual: A systematic review of the effects of unit-level demands and resources on employee productivity, health, and well-being.

Creating sustainable employment-that is, a condition in which employees remain productive but also enjoy good health and well-being-is a challenge for many organizations. Work environment factors are major contributors to these employee outcomes. The job demands-resources model categorizes work environment factors into demands versus resources, which are, respectively, detrimental versus beneficial to employee outcomes. Although conceptualized as workplace factors, these job characteristics have been studied mostly at an individual level. Therefore, their roles at the supraindividual level (i.e., any work-unit level above an individual, such as group or organization) for employee productivity, health, and well-being remains unclear. The aim of this systematic review is to synthesize evidence concerning job resources and job demands at the supraindividual level and their relationships to productivity, health, and work-related well-being. The review covers articles published through December 2018. In total, 202 papers met the inclusion criteria. We found stronger support for the beneficial roles of supraindividual job resources than for the detrimental roles of job demands for productivity and work-related well-being. Regarding health, most of the relationships were found to be nonsignificant. To conclude, this review demonstrates that, at the supraindividual level, the motivational path has received more support than the health impairment path. Based on these findings, we provide recommendations for further research and practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Quick and dirty or rapid and informative? Exploring a participatory method to facilitate implementation research and organizational change.

PURPOSE: The purpose is explore an approach to acquire, analyze and report data concerning an organizational change initiative that combines knowledge generation and knowledge use, and contrast that with a method where knowledge generation and use is separated. More specifically, the authors contrast a participatory group workshop with individual interviews analyzed with thematic analysis, focusing on information about the change process and its perceived practical relevance and usefulness. DESIGN/METHODOLOGY/APPROACH: Participants were managers responsible for implementing a broad organizational change aiming to improve service quality (e.g. access and equity) and reduce costs in a mental health service organization in Sweden. Individual interviews were conducted at two points, six months apart (i1: n = 15; i2: n = 18). Between the interviews, a 3.5-h participatory group workshop was conducted, during which participants (n = 15) both generated and analyzed data through a structured process that mixed individual-, small- and whole-group activities. FINDINGS: Both approaches elicited substantive information about the content, purpose and process of change. While the content and purpose findings were similar across the two data sources, the interviews described how to lead a change process, whereas the workshop yielded concrete information about what to do. Benefits of interviews included personal insights about leading change while the workshop provided an opportunity for collective sense-making. ORIGINALITY/VALUE: When organizational stakeholders work through the change process through a participatory workshop, they may get on the same page, but require additional support to take action.

Fundamentals of care in the emergency room - An ethnographic observational study.

BACKGROUND: There is a strong biomedical focus within emergency care. However, while failure to meet patients' fundamental care needs has severe consequences for the patient, there is limited knowledge on how nursing care is provided in emergency rooms and the related implications for patients. AIM: This study aims to explore how fundamental care needs of critically ill patients are met in emergency rooms. METHODS: Non-participant observations at an emergency department in Sweden included 108 observations and field notes (150 h). Data were analysed using descriptive statistics. RESULTS: Observations showed that registered nurses (RN) identified patients' fundamental care needs and provided nursing care. However, the RNs' focus on the patient decreased over time. When the RN communicated with the patient, the patients' physical needs were met to a greater extent. The organisational structure and physical environment of emergency rooms limit RNs' ability to meet patients' fundamental care needs. CONCLUSION: Not all patients had their fundamental care needs optimally met. This study highlights the importance of RNs working in an integrated manner; an RN working bedside is crucial for establishing a patient-nurse relationship to meet the patient's physical, psychosocial, and relational needs.

How to design, implement and evaluate organizational interventions for maximum impact: the Sigtuna Principles.

Research on organizational interventions needs to meet the objectives of both researchers and participating organizations. This duality means that real-world impact has to be considered throughout the research process, simultaneously addressing both scientific rigour and practical relevance. This discussion paper aims to offer a set of principles, grounded in knowledge from various disciplines that can guide researchers in designing, implementing, and evaluating organizational interventions. Inspired by Mode 2 knowledge production, the principles were developed through a transdisciplinary, participatory and iterative process where practitioners and academics were invited to develop, refine and validate the principles. The process resulted in 10 principles: 1) Ensure active engagement and participation among key stakeholders; 2) Understand the situation (starting points and objectives); 3) Align the intervention with existing organizational objectives; 4) Explicate the program logic; 5) Prioritize intervention activities based on effort-gain balance; 6) Work with existing practices, processes, and mindsets; 7) Iteratively observe, reflect, and adapt; 8) Develop organizational learning capabilities; 9) Evaluate the interaction between intervention, process, and context; and 10) Transfer knowledge beyond the specific organization. The principles suggest how the design, implementation, and evaluation of organizational interventions can be researched in a way that maximizes both practical and scientific impact.

Appetite for Destruction: A Psychometric Examination and Prevalence Estimation of Destructive Leadership in Sweden.

There is a growing awareness that destructive leadership has a significant negative impact on employe outcomes. However, little is known about the content and dimensionality of this multidimensional concept, and there are few reliable measures available for organizations and researchers to evaluate these behaviors. Based on a representative sample (N = 1132) of the Swedish workforce, the aim of this study is threefold: first, to examine the factor structure and validity of an easy-to-use multidimensional destructive leadership measure (Destrudo-L)in the general Swedish work context; second, to identify destructive leadership profiles using latent profile analysis (LPA), and determine in what way they are related to employe outcomes; third, to examine the prevalence of destructive leadership using population weights to estimate responses of a population total in the Swedish workforce (N = 3100282). Our analysis supported the structural validity of Destrudo-L, reflecting both a global factor and specific subdimensions. We identified seven unique destructive leadership profiles along a passive and active continuum of destructive leadership behaviors, with the active showing a less favorable relation to employe outcomes. Finally, we found that a substantial proportion of the Swedish workforce report being exposed to destructive leadership (36.4-43.5%, depending on method used). Active destructive leadership was more common in the public sector and passive destructive leadership in the private. Given the potentially severe effects and the commonness of these behaviors, we argue that organizations should work actively with strategies to identify and intervene, to prevent and to handle the manifestation of these harmful behaviors.