Computerized lifestyle intervention in routine primary health care: Evaluation of usage on provider and responder levels

Carlfjord, Siw; Nilsen, Per; Leijon, Matti; Andersson, Agneta; Johansson, Kjell; Bendtsen, Preben

doi:10.1016/j.pec.2008.10.004

Cited by 21 publications

(45 citation statements)

References 34 publications

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“…Patients who performed the test received a printed test result and tailored advice based on their answers. The computer-based tool test and the scientific basis for using computerized solutions in primary health care has been described previously [18]. …”

Section: Methodsmentioning

confidence: 99%

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Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

et al. 2010

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BackgroundBridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.MethodsA qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.ResultsThe theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.ConclusionWhen implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.

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Section: Methodsmentioning

confidence: 99%

“…For the analysis, the narrative text was read and re-read, and meaning units, that is, words or sentences that are related to each other through content or context [18], were identified throughout the text. The meaning units then were condensed to contain only a few central words, and were labelled with suitable codes.…”

Section: Methodsmentioning

confidence: 99%

Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

et al. 2010

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“…Data obtained in the former study revealed that the three smallest units had the highest referral activity, and the largest unit had the lowest referral activity [19]. One possible explanation for this is that staff in the smaller units felt more involved in the decision to adopt the new working tool.…”

Section: Discussionmentioning

confidence: 86%

“…The test is performed anonymously, and the patients themselves decide whether to discuss the results with a health care provider. The concept and its implementation have been described previously in Carlfjord et al [19]. Analyses of differences between groups were performed using the Kruskal-Wallis test.…”

Section: The Computer-based Lifestyle Intervention Conceptmentioning

confidence: 99%

Staff perspectives on the use of a computer-based concept for lifestyle intervention implemented in primary health care

Carlfjord

Johansson

Bendtsen

et al. 2010

Health Education Journal

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ObjectiveThe aim of this study was to evaluate staff experiences of the usage of a computer-based concept for lifestyle testing and tailored advice implemented in routine primary health care (PHC). DesignThe design of the study was a cross-sectional, retrospective survey. SettingThe study population consisted of staff at nine PHC units in the county of Östergötland, Sweden. MethodAfter a computer-based concept for lifestyle intervention had been in operation for 1 year, a questionnaire was distributed to all staff members. The questions concerned experiences of and attitudes to the concept, and comments on addressing lifestyle issues in PHC. ResultsOf the 291 potential respondents, 59% returned the questionnaire. Eighty-five percent found it positive to refer to the computer-based test, and 93% of those who had read the written advice generated by the computer, agreed with the advice provided. Seventy-five percent thought that the concept could have an effect on a patient's lifestyle, and 78% had confidence in the computer-based test. Staff at smaller PHC units had more positive attitudes (p=0.003) and referred a higher proportion of their patients to the computer-based test than 3 staff at larger units (p=0.000). Follow-up rates showed no significant differences between the categories.Staff believed that inclusion of more lifestyle areas, e.g. smoking and dietary habits, would make the test more useful. More time, education and the establishment of lifestyle practices were issues suggested in order to enhance the focus on lifestyle factors. ConclusionStaff members have confidence in the computerized test and consider it a valuable tool. A development towards more lifestyle areas will make it even more useful.

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“…The tool consists of a touch-screen computer and a printer, placed in a so-called IT kiosk and staff are encouraged to refer their patients to the computer. Patients who perform the test receive a printed test result and tailored advice (Carlfjord et al, 2009).…”

Section: The Innovationmentioning

confidence: 99%

Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care

Carlfjord

Andersson

Bendtsen

et al. 2011

Health Promotion International

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Computerized lifestyle intervention in routine primary health care: Evaluation of usage on provider and responder levels

Cited by 21 publications

References 34 publications

Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

Staff perspectives on the use of a computer-based concept for lifestyle intervention implemented in primary health care

Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care

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