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Implementation and use of Web-based National Guidelines in Child Healthcare
Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In Sweden, child healthcare (CHC) is an important health promotion setting, providing universal and targeted interventions. High demands on child healthcare and the competences of CHC nurses, highlight the importance of access to supportive web-based guidelines in everyday work. The implementation of web-based guidelines is affected by various factors and can be challenging. The Swedish Rikshandbokenis national guidelines for CHC that are in the process of being implemented. The overall aim of this thesis was to investigate the CHC provided in Sweden before the implementation of the national CHC programme, and the implementation and usage of web-based national guidelines for CHC. Study Iaimed to investigate whether the Swedish CHC programme was equal and which methods for health surveillance the county councils offered. A web-survey distributed to CHC coordinators was used, and the data were analyzed with descriptive statistics. Study IIaimed to investigate how nurses in CHC use Rikshandboken and factors affecting its use. A web survey was used and analysed using descriptive and analytical statistics. Study IIIaimed to investigate CHC coordinators´ experiences of being a facilitator in the implementation of a new national CHC programme in the form of a web-based guide. Focus group interviews via Skype for Business were conducted and analyzed using qualitative content analysis. Study IVaimed to examine CHC nurses´ use and ways of understanding the national web-based guidelines, Rikshandboken. A mixed method with sequential explanatory design in two phases was used; a web-survey with descriptive statistics followed by telephone interviews with phenomenographic analysis. Study Vaimed to investigate the usage of the national web-based guidelines, Rikshandboken. The data were collected from Google Analytics, and analyzed using descriptive statistics. The results of the studies show that Rikshandbokenis widely used and that its usage has increased. CHC nurses are generally satisfied with the website and emphasizes the importance of national guidelines for CHC. Factors needed to be developed to improve Rikshandbokenwere suggested as well as prerequisites that are needed in the local context to use Rikshandbokenfully. It must be reliable, useful and relevant why the end users need to be involved in the development. With the right conditions, Rikshandbokencould be a resource for learning and a tool in everyday work for CHC nurses. The result also shows that the CHC is provided unequally, and that the CHC programme is challenging to implement in the local context. The CHC coordinators´ task is to facilitate the implementation of the web-based national guidelines; however, this responsibility is complex. Changing the content, structure and access to Rikshandbokenis not sufficient, in the local context, prerequisites for the use of these web-based national guidelines must exist, and only then can Rikshandbokenbe a contributing determinant to an equal CHC.

Place, publisher, year, edition, pages
Karlskrona: Blekinge Tekniska Högskola, 2019. , p. 77
Series
Blekinge Institute of Technology Doctoral Dissertation Series, ISSN 1653-2090 ; 3
Keywords [en]
Child healthcare, nurses, health promotion, information and communication technology, implementation, applied health technology
National Category
Engineering and Technology
Identifiers
URN: urn:nbn:se:bth-17329OAI: oai:DiVA.org:bth-17329DiVA, id: diva2:1265310
Public defence
2019-01-18, sal G340, Blekinge Tekniska Högskola, 371 79, Karlskrona, 14:00 (Swedish)
Opponent
Supervisors
Note

Filosofie doktorsexamen (gick ej att välja ovan)

Available from: 2018-11-22 Created: 2018-11-22 Last updated: 2018-11-23Bibliographically approved
List of papers
1. Stora skillnader i svensk barnhälsovård: Barnhälsovårdsenheterna avgör själva- oroande att nationellt program saknas
Open this publication in new window or tab >>Stora skillnader i svensk barnhälsovård: Barnhälsovårdsenheterna avgör själva- oroande att nationellt program saknas
2011 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, ISSN 0023-7205, Vol. 108, no 35, p. 1618-1621Article in journal (Refereed) Published
Abstract [sv]

I dag saknas ett nationellt program för barnhälsovården. Professionen har startat ett arbete, och Socialdepartementet har i ett regleringsbrev för 2009 givit Socialstyrelsen i uppdrag att tillse att vägledningar, rekommendationer och kunskapsöversikter för barnhälsovård finns utarbetade, tillgängliga och uppdaterade. 

Våren 2010 skickades ett webbaserat frågeformulär till samtliga barnhälsovårdsenheter i Sverige i syfte att undersöka om barnhälsovårdsprogrammet är jämlikt och vilka metoder för hälso­övervakning som erbjuds i det generella basprogrammet. 

Trots att den svenska barnhälsovården ofta beskrivs som generell och likartad, visar resultatet att det finns stora skillnader i landet vad gäller såväl utbud och metoder som uppföljning.

Place, publisher, year, edition, pages
Stockholm Sweden: , 2011
Keywords
Barnhälsovård
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:bth-17319 (URN)
Available from: 2018-11-20 Created: 2018-11-20 Last updated: 2018-11-22Bibliographically approved
2. Nurses’ Use of a Web-Based National Guide for Child Health Care
Open this publication in new window or tab >>Nurses’ Use of a Web-Based National Guide for Child Health Care
2016 (English)In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 34, no 5, p. 197-205Article in journal (Refereed) Published
Abstract [en]

Rikshandboken i BarnhÀlsovård 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 BarnhÀlsovård 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 BarnhÀlsovård 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 BarnhÀlsovård should not be underestimated.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
Keywords
analytic method; child; child health care; evidence based practice center; human; licence; major clinical study; nurse; occupation; Sweden
National Category
Nursing
Identifiers
urn:nbn:se:bth-11785 (URN)10.1097/CIN.0000000000000229 (DOI)000376462300002 ()2-s2.0-84960172285 (Scopus ID)
Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2018-11-22Bibliographically approved
3. Implementation of a web-based national child health-care programme in a local context: A complex facilitator role
Open this publication in new window or tab >>Implementation of a web-based national child health-care programme in a local context: A complex facilitator role
2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 20_suppl, p. 80-86Article in journal (Refereed) Published
Abstract [en]

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. © 2018, © Author(s) 2018.

Place, publisher, year, edition, pages
SAGE Publications Ltd, 2018
Keywords
Child health care, decision support, facilitators, guidelines, ICT, implementation, child, human, infant, Internet, newborn, organization and management, preschool child, professional standard, psychology, public health, Sweden, Child Health Services, Child, Preschool, Humans, Infant, Newborn, National Health Programs, Professional Role
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:bth-16085 (URN)10.1177/1403494817744119 (DOI)000428758300012 ()2-s2.0-85044172782 (Scopus ID)
Available from: 2018-04-06 Created: 2018-04-06 Last updated: 2018-11-22Bibliographically approved
4. Nurses´ use and ways of understanding web-based national guidelines for child healthcare
Open this publication in new window or tab >>Nurses´ use and ways of understanding web-based national guidelines for child healthcare
(English)In: Article in journal (Refereed) Submitted
Abstract [en]

The national Rikshandbokenfor child healthcare, is a web-based guideline for child health care in Sweden containing knowledge- and methodological guidance and a national child health care program in progress to be implemented. The aim with the study was to examine child health care nurses use and ways of understanding the national web-basedRikshandbokenfor child health care.  Mixed method with sequential explanatory design in two phases was used; a web-survey with descriptive statistic followed by telephone interviews with phenomenographic analysis. The study showed variations in use and contribute with deeper knowledge of child healthcare nurse´s ways of understanding the unit RHB whose varied parts interact with each other. To be reliable, useful and relevant for nurses in their context, Rikshandbokenmust be kept updated and involve the end-users in the development process. Access to technical devices and optimal use of the possibilities with information and communication technology, the national web-based Rikshandbokencan be a resource for continuing learning and a tool in everyday work and a possible determinant to an equal child healthcare. The study contributes with valuable knowledge when designing web-based clinical practice guidelines for healthcare, making them useful and relevant for the end-users

Keywords
Child healthcare nurses, national guidelines, information and communication technology, mixed method, phenomenography
National Category
Engineering and Technology Nursing
Identifiers
urn:nbn:se:bth-17321 (URN)
Available from: 2018-11-20 Created: 2018-11-20 Last updated: 2018-11-23Bibliographically approved
5. The usage of web-based national guidelines for child healthcare: A web analytic study
Open this publication in new window or tab >>The usage of web-based national guidelines for child healthcare: A web analytic study
2018 (English)In: Article in journal (Refereed) Submitted
Abstract [en]

The development and dissemination of information- and communication technologies in healthcare is rapid. The purpose of web-based national guidelines is to support professionals in everyday work providing equivalent, safe and qualitative healthcare. Web-based national guidelines are often not implemented effectively in healthcare why studies reflecting different aspects of use and implementation is needed. The aim of this study was to investigate the usage of web-based national guidelines for child healthcare, Rikshandboken i barnhälsovård. In this case study with cross-sectional design, usage pattern of the web-based guidelineswas studied for one year using the web analytic tool, Google Analytics. The usage data were analysed with descriptive statistics. The study showed the general usage pattern of RHB, changes in usage through the year and various usage pattern in different user groups. The usage of RHB had increased, the web-based guidelines was used in all county councils/regions and the most common visited web-page was the new national child healthcare programme. This tendency suggests a positive direction towards the RHB aim to contribute to equal , equitable and high-qualitative CHC.The result also showed the importance to study different user groups as the usage pattern differs. This provide valuable knowledge in the development of web-based national guidelines making them useful and relevant for all its users. 

Keywords
National guidelines, information and communication technology, child healthcare, user experiences, user engagement, Google Analytics
National Category
Engineering and Technology Nursing
Identifiers
urn:nbn:se:bth-17323 (URN)
Available from: 2018-11-20 Created: 2018-11-20 Last updated: 2018-11-23Bibliographically approved

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