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Since long-term sickness absence constitutes a problem in most western countries, research that can facilitate return to work (RTW) is important. Today there is evidence that the social context at the workplace has a significant impact on return to work. The dual aims of the study was firstly to investigate the pattern and quality of contact between employees on long-term sick leave and different actors at the workplace, and secondly to investigate whether contacts with the workplace were associated with expectations regarding return to work. An explorative method and descriptive design was used for the first aim. For the second aim, the data was analysed in a multivariate logistic regression model. The results show that employees had frequent and, in most cases, appreciated contact with their supervisor and co-workers. Contact with other workplace actors; that is, the occupational health unit, the union representative, and the human resources department, were less frequent. Employees who experienced the contact as supportive and constructive were far more positive and optimistic than others regarding return to work. It is concluded that supervisors and co-workers should be aware that they play a significant role in the return-to-work process, and that quality of contact is what matters.

Purpose: The objective of this article was to investigate how individual learning emerges among workplace actors during the return-to-work process, and whether the prerequisites for collective learning at the workplace are present and managed by the actors. Learning in this context is viewed as a change in the preconceptions, experience or competence of the individual as a result of interactions in the workplace due to the return-to-work process. Method: A qualitative method was used, consisting of open-ended interviews with 19 individuals across 11 workplaces in the public and private sector. Inductive content analysis was performed. Results: The key findings from this study are that individual learning emerges in the return-to-work process due to previous experience, communication with other workplace actors, or insights into what works for the individual. However, the individual learning that occurs in the return-to-work process is not carried over into workplace learning due to barriers in understanding the needs and opportunities that may be present in the process. Conclusion: Our findings suggest that individual learning occurs within social practices through social interaction between the actors involved (workers on sickness absence supervisors and colleagues) and individual experiences. A greater knowledge of the factors that contribute to workplace learning could facilitate biopsychosocial and ecological return-to-work interventions, which allow workplace actors to draw on previous experiences from one return-to-work process to another.

Background: Despite significant health risks, heavy drinking of alcohol among university students is a widespread problem; excessive drinking is part of the social norm. A growing number of studies indicate that short message service (SMS)-based interventions are cost-effective, accessible, require limited effort by users, and can enable continuous, real-time, brief support in real-world settings. Although there is emerging evidence for the effect of SMS-based interventions in reducing alcohol consumption, more research is needed. This study aims to test the effectiveness of a newly developed SMS-based intervention targeting excessive alcohol consumption among university and college students in Sweden. Methods: The study is a two-arm randomized controlled trial with an intervention (SMS programme) and a control (treatment as usual) group. Outcome measures will be investigated at baseline and at 3-month follow up. The primary outcome is total weekly alcohol consumption. Secondary outcomes are frequency of heavy episodic drinking, highest estimated blood alcohol concentration and number of negative consequences due to excessive drinking. Discussion: This study contributes knowledge on the effect of automatized SMS support to reduce excessive drinking among students compared with existing support such as Student Health Centres. ; Funding Agencies|Public Health Agency of Sweden [03081-2015-6.2]

BackgroundChildhood obesity is still a major health problem in many countries, including Sweden. Childhood obesity and obesity-related behaviours in childhood, such as low physical activity and unhealthy eating habits, tend to track into adulthood, which highlights the need for early prevention. Our aims are to evaluate whether a parent-oriented mobile health app (the MINISTOP 2.0 app) integrated into primary child health care can improve diet and physical activity behaviours and reduce the prevalence of overweight and obesity in preschool-aged children as well as to evaluate the implementation among child health care nurses and parents.MethodsThis trial uses a hybrid type 1 effectiveness-implementation design. Families (n=500) who attend a routine visit to one of 15-20 primary child health care centres throughout Sweden, when their child is 2.5years, are offered participation in a randomised controlled trial (effectiveness evaluation). After acceptance, families will be randomised (1:1) to control or intervention groups. The intervention group receives a 6-month parent-oriented smartphone intervention aimed at improving the dietary and activity behaviours of their child (the MINISTOP 2.0 app) and the control group receives routine child health care. Dietary habits, physical activity and screen time (primary outcomes), body weight and height in children, and parental self-efficacy (secondary outcomes) are measured at baseline and at 6months post randomisation. Implementation outcomes (i.e. perceived acceptability, appropriateness, and feasibility) of the intervention will be assessed among primary child health care nurses and parents in the trial through questionnaires and qualitative interviews.DiscussionThis trial will evaluate whether the MINISTOP 2.0 app can be used in primary child health care to improve diet and physical activity behaviours, and prevent overweight and obesity, in preschool-aged children. If effectiveness is proven, and the MINISTOP 2.0 app is considered acceptable, appropriate and feasible, it can be implemented nationally as part of the preventive strategies to combat childhood obesity provided by routine child health care.Trial registrationThe trial was registered at the Clinicaltrials.gov register platform (ID NCT04147039) on 31 October 2019. ; Funding Agencies|Swedish Research Council for Health, Working Life and Welfare (Forte) [2018-01410]; Region Ostergotland [LIO-893101, LIO-920441]; ALF Grants; Strategic Research Area in Health Care Science; Lions Forskningsfond; Linkoping University Library

Alcohol screening; Brief intervention; Referral to electronic brief advice ; Detección de alcohol; Intervención breve; Remisión a asesoramiento breve electrónico ; Detecció d'alcoholèmia; Intervenció breu; Derivació a assessorament breu electrònic ; Objectives: The objective of the present study was toexplore whether the possibility of offering facilitatedaccess to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increasedthe proportion of consulting adults who were screenedand given brief advice. Design: The study was a 12-week implementationstudy. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands,Poland and Sweden) were asked to screen adults whoattended the PHCU for risky drinking. Setting: A total of 120 primary healthcare centresfrom 5 jurisdictions in Europe. Participants: 746 individual providers (generalpractitioners, nurses or other professionals)participated in the study. Primary outcome: Change in the proportion ofpatients screened and referred to eBI comparing abaseline 4-week preimplementation period with a12-week implementation period. Results: The possibility of referring patients to the eBIwas not found to be associated with any increase in theproportion of patients screened. However, it wasassociated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole(p<0.05), mainly driven by a significant increase in briefintervention rates in England from 87% to 96%(p<0.01). The study indicated that staff displayed a lowlevel of engagement in this new technology. Staffcontinued to offer face-to-face advice to a largerproportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among thereferred patients; on average, 18% of the patientslogged on to the website with a mean log-on rate acrossthe different countries between 0.58% and 36.95%. Conclusions: Referral to eBI takes nearly as muchtime as brief oral advice and might require moreintroduction and training before staff are comfortablewith referring to eBI ; The research leading to these results or outcomes has receivedfunding from the European Union's Seventh Framework Programme forResearch, Technological Development and Demonstration under grantagreement no. 259268—Optimizing Delivery of Health Care Interventions(ODHIN).

Background: Evidence-based practice for healthy lifestyle promotion in primary health care is supported internationally by national policies and guidelines but implementation in routine primary health care has been slow. Referral to digital interventions could lead to a larger proportion of patients accessing structured interventions for healthy lifestyle promotion, but such referral might have unknown implications for clinicians with patients accessing such interventions. This qualitative study aimed to explore the perceptions of clinicians in primary care on healthy lifestyle promotion with or without digital screening and intervention. Methods: Focus group interviews were conducted at 10 primary care clinics in Sweden with clinicians from different health professions. Transcribed interviews were analyzed using content analysis, with inspiration from a phenomenological-hermeneutic method involving naive understanding, structural analysis and comprehensive understanding. Results: Two major themes captured clinicians perceptions on healthy lifestyle promotion: 1) the need for structured professional practice and 2) deficient professional practice as a hinder for implementation. Sub-themes in theme 1 were striving towards professionalism, which for participants meant working in a standardized fashion, with replicable routines regardless of clinic, as well as being able to monitor statistics on individual patient and group levels; and embracing the future with critical optimism, meaning expecting to develop professionally but also being concerned about the consequences of integrating digital tools into primary care, particularly regarding the importance of personal interaction between patient and provider. For theme 2, sub-themes were being in an unmanageable situation, meaning not being able to do what is perceived as best for the patient due to lack of time and resources; and following ones perception, meaning working from a gut feeling, which for our participants also meant deviating from clinical routines. Conclusions: In efforts to increase evidence-based practice and lighten the burden of clinicians in primary care, decision-and policy-makers planning the introduction of digital tools for healthy lifestyle promotion will need to explicitly define their role as complements to face-to-face encounters. Our overriding hope is that this study will contribute to maintaining meaningfulness in the patient-clinician encounter, when digital tools are added to facilitate patient behavior change of unhealthy lifestyle behaviors. ; Funding Agencies|Stockholm County Council (PPG project for patient-focused research and development in Primary Care, Psychiatry and Geriatrics) [20140487]; Swedish Research Council [K2012-61X-22132-01-6, K2012-61P-22131-01-6]; Karolinska Institutet; Stockholm County Council

Background: Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI. Methods: Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method. Results: Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important Tamp;S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro-level such as societal and political culture the effects risks to get nullified. Conclusions: Essential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested. ; Funding Agencies|European Union [259268]; Netherlands Organization for Health Research and Development (ZonMW, Prevention Program), under - ODHIN - Optimizing delivery of healthcare interventions in the Netherlands FP7 EC Grant Agreement [200310017]