Although mental health service delivery varies between and within European countries, consistent challenges exist in the experiences of mental health professionals delivering services in communities with high proportions of immigrants. Improvements to practice should include training in reaching appropriate diagnoses, a focus on building trusting relationships and measures to counter marginalisation.

The aim of this study was to explore barriers and facilitators in the implementation of a health course for adults with mild or moderate intellectual disabilities. An inductive qualitative design was used. Data were collected from a health course conducted in 16 study groups with 83 participants in Stockholm, Sweden by unstructured observations in course sessions, a group discussion with course leaders and evaluation notes from the course leaders. The data were analysed by qualitative content analysis. Four categories were identified: (i) 'individual characteristics', implying various needs, (ii) 'pedagogical strategies' used to meet those needs, (iii) 'interaction within the course', dealing with active and less active participation and (iv) 'structures', including learning climate and organizing. The overarching theme 'creating an individualized supportive context' describes the challenge of educating people with intellectual disabilities towards an empowered and well informed decision making regarding their own health. Therefore, there is a need for support not only within the course but also from the social and physical environment as well.

BackgroundMany adults with intellectual disabilities have poor dietary habits, low physical activity and weight disturbances. This study protocol describes the design and evaluation of a health intervention aiming to improve diet and physical activity in this target group. In Sweden, adults with intellectual disabilities often live in community residences where the staff has insufficient education regarding the special health needs of residents. No published lifestyle interventions have simultaneously targeted both residents and staff.Methods/DesignThe intervention is designed to suit the ordinary work routines of community residences. It is based on social cognitive theory and takes 12-15 months to complete. The intervention includes three components: 1) Ten health education sessions for residents in their homes; 2) the appointment of a health ambassador among the staff in each residence and formation of a network; and 3) a study circle for staff in each residence. The intervention is implemented by consultation with managers, training of health educators, and coaching of health ambassadors. Fidelity is assessed based on the participation of residents and staff in the intervention activities. The study design is a cluster-randomised trial with physical activity as primary outcome objectively assessed by pedometry. Secondary outcomes are dietary quality assessed by digital photography, measured weight, height and waist circumference, and quality of life assessed by a quality of life scale. Intermediate outcomes are changes in work routines in the residences assessed by a questionnaire to managers. Adults with mild to moderate intellectual disabilities living in community residences in Stockholm County are eligible for inclusion. Multilevel analysis is used to evaluate effects on primary and secondary outcomes. The impact of the intervention on work routines in community residences is analysed by ordinal regression analysis. Barriers and facilitators of implementation are identified in an explorative qualitative study through observations and semi-structured interviews.DiscussionDespite several challenges it is our hope that the results from this intervention will lead to new and improved health promotion programs to the benefit of the target group.Trial registration numberISRCTN33749876

There is a growing interest in both employee-driven innovation (EDI) and innovation in welfare services, but a lack of empirical studies addressing innovation from the employee perspective. Accordingly, this study was designed to contribute with well-grounded empirical knowledge, aiming to explore the barriers to and opportunities for participation in innovation experienced by employees of the Swedish welfare services. In order to reach the aim, a qualitative thematic analysis of 27 semi-structured interviews with employees in four municipalities was performed. The study identified three main themes, with a great impact on the innovative performance of the studied organizations: support, including leadership and innovation processes; development, including creativity and learning; and organizational culture, which includes attitudes and communication, all essential ingredients in EDI. Experienced barriers for innovation were unclear or non-existing innovation processes with ambiguous goals, insufficient learning, and deficient organizational slack, thus creating a tension between day-to-day work and innovation and hindering reflection and exploration. Attitudes of colleagues and lack of communication were also barriers to implementing innovation, suggesting the need for better management support for a communicative and open culture. Opportunities were found, including commitment to innovation and willingness to try new ideas, but the employees must be given the mandate and sufficient time to develop the potential that emerges from continuous learning, time for reflection, and user dialogue. The conclusion was that incremental innovations existed, but the full potential of these did not benefit the entire organization due to inadequate communication and lack of innovation processes. The study improves our understanding of how employees regard their involvement in innovation. It also discusses how to make better use of employees’ resources in innovation processes and contributes to important knowledge about EDI in the public sector. On the basis of our results, we suggest a model of EDI for use in practice.

Research on public sector innovation is still limited, and increased knowledge of innovation processes is needed. This article is a based on a study of the fulfillment of innovation policies in Swedish municipalities and gives a first-hand, empirical view of the complexities of innovation in the public sector. The study took place in four municipalities in central Sweden. The municipalities varied in size and organizational forms. Interviews and policy documents were used for data collection. The results showed that the innovation policies were not followed by action, which may be described as not mobilizing dynamic capabilities to create innovativeness. Thus, dynamic capabilities such as learning and HRM were not used in conjunction with innovation. Particularly amongst senior management there was a negative attitude towards the innovative capacity of their organization. Middle management saw possibilities. However barriers such as extensive control systems removed the focus from innovation. Communication lacked between senior management and middle management regarding innovation. The conclusion was that innovation, as both concept and practice, was not fully embraced by the municipalities. It is suggested that a generative leadership, opening up for communication within the organizations, especially between employees, could be beneficial and that a common understanding and definition of the innovation concept is needed.  Integration of top-down processes with bottom-up processes, such as employee-driven innovation, is also suggested.