Mental health problems are an increasing challenge for primary healthcare. It puts strain on the healthcare professionals with limited time and resources. In several countries, healthcare professionals can refer patients with mental health issues to structured arts programmes, namely Arts on Prescription (AoP). This study explores the qualitative findings from a 3-year study on Arts on Prescription. Primary healthcare patients were recruited to participated in a 10-week group-based arts programme, twice a week for 2 h (22 sessions over 10 weeks, comprising a mixture of arts and cultural activities facilitated by arts professionals) referred from 18 different primary healthcare centres. Twenty-eight participants volunteered to be interviewed using a semi-structured one-to-one approach. The transcribed interviews were analysed using a thematic analysis. Three themes were identified as Social community Connectedness, Self-efficacy and Routine Structure. Through the identified themes positive effects of psychosocial wellbeing is described as reported by the participants connecting to their experiences of participating in the Arts on Prescription programme including finding common grounds, feeling healthier and more human, connecting with inner resources, and establishing new routines. The findings highlight the potential of Arts on Prescription programmes to promote holistic psychosocial wellbeing, and to facilitate personal growth through community engagement and structured arts activities with salutogenic approaches.

BACKGROUND:Studies have shown that women are asking for more knowledge and guidance about menopause. The professional competence of midwives encompasses menopause as a potential area of expertise. Midwives have good knowledge of women's health and are used to providing health advice. AIM:The aim was to examine midwives' experiences of working with menopause counselling. METHODS:Data were collected by using semi-structured individual interviews with 14 midwives who had experience in conducting menopause counselling. The data analysis was carried out using Malterud systematic text condensation. FINDINGS:The data analysis yielded four themes: The midwife can fulfil a need for care; Menopause counselling, a midwifery task; Factors that facilitate; Promote equal menopause care. The midwives felt they were addressing a healthcare need that had previously been unmet. They thought midwives were well suited to perform this task, had good knowledge of women's health and were used to working from a holistic and salutogenic perspective. The midwives perceived certain conditions as essential, structured menopausal counselling, support in the organisation, education at advanced level and established cross-professional collaborations. They also thought an investment in menopause care is needed to promote equal care. CONCLUSION:This work indicates that midwives with their skills and working methods are well suited to conduct menopausal counselling and thereby could satisfy a healthcare need. Resources needed are investments in menopausal counselling visits by midwives.

Aim: The aim of this study was to explore the role of managers and employees with an assigned responsibility (i.e. inspirers) when integrating recovery-enhancing activities into everyday work in a primary health care setting.Background: The possibility of recovery during the workday is essential for employee wellbeing. However, the literature on workplace interventions focusing on recovery is scarce. Especially with regard to the importance of local driving forces, like managers and inspirers.Methods: Two focus groups and two individual interviews were conducted in this qualitative interview study. In total, ten managers and inspirers from different primary health care centres were interviewed about their experiences of brief recovery interventions at their workplaces. A semi-structured interview guide was used, and the qualitative analysis was conducted by using systematic text condensation.Findings: From a leadership perspective, two themes with promoting factors for recovery interventions were identified. These were structural promoting factors (including authorisation, communication, and integration) and cultural promoting factors (including attitude, support, and open-mindedness). This knowledge can contribute to future workplace environment development with the focus on recovery during the workday. The results also showed several positive effects of integrated recovery, both on an individual and group level. Hence, this study is a valuable addition to the work recovery research, in terms of understanding the importance of investing in recovery at work.

Background Targeted health dialogues (THDs) have been implemented in primary care in many Swedish regions in an attempt to prevent cardiovascular disease and type 2 diabetes. A THD is a counselling meeting with a specially educated health dialogue coach. It is preceded by blood tests (cholesterol, plasma glucose), blood pressure measuring, anthropometric measures, and a lifestyle questionnaire. Health advice is given based on an illustrative health profile. In southern Sweden, all 40- and 50-year-olds are invited to a THD. Recently, a pilot project with similar THDs for 70-year-olds was performed at 14 healthcare centers. The aim of the present study was to examine the health dialogue coaches’ experiences of THDs in 70-year-olds. Methods Sixteen of 22 coaches consented to participate in the study. Twelve of 14 healthcare centers were represented. Data were collected through three focus groups, and two individual interviews, which were audio-recorded and transcribed verbatim, thereafter analyzed inspired by systematic text condensation. The researchers conducted the analyses separately, whereafter differences were discussed until consensus was reached. Results Support from all co-workers at the healthcare center and time for planning and reflection were mentioned as success factors for the implementation of THDs. The lifestyle questionnaire was perceived to be a bit too extensive for 70-year-olds, especially regarding physical activity and diet. Waist-hip ratio was perceived as a problematic measure. In particular, women often had high values despite a lean body composition and low BMI. Many coaches believed that the 70-year-old participants belonged to the healthier part of the population, and they also had the impression that there was a lower participation rate among immigrants, possibly due to language difficulties. The coaches enjoyed the THDs and believed that the 70-year-olds appreciated them as well. The THDs provided an opportunity to discuss not only cardiovascular risk factors but health issues and life in general. Conclusions The health dialogue coaches valued THDs with 70-year-olds highly, but minor adaptations of the information given, questionnaire and health profile were suggested in what the coaches thought could increase participation and facilitate the dialogues with this age group.

IntroductionDementia with Lewy bodies (DLB) is an incurable form of dementia associated with detriments to the daily life of patients and carers from their family. Symptoms of orthostatic hypotension, syncope, and falls are supportive of DLB diagnosis. These symptoms may also be present among people with sick sinus syndrome (SSS), and subsequent pacemaker treatment to manage bradyarrhythmia is associated with improved cognitive function. The prevalence of SSS seems to be higher among people with underlying Lewy body pathology compared to the general age-matched population (5.2% vs. 0.17%). To our knowledge, how people with DLB and their family carers may experience pacemaker treatment to manage bradyarrhythmia has not been previously reported. Therefore, the aim of this study was to explore how people with DLB experience daily life following a pacemaker implant to manage associated symptoms of bradyarrhythmia.MethodsA qualitative case study design was used. Two men with DLB and their spouse carers were repeatedly interviewed as a dyad within 1 year following implant of a dual-chamber rate-adaptive (DDD-CLS) pacemaker to manage SSS in the men. Content analysis was used to assess the qualitative interview data collected.ResultsThree categories emerged: (1) gaining control, (2) maintaining a social life, and (3) being influenced by concurrent diseases. Less syncope/falls and remote pacemaker monitoring increased a sense of control in everyday life, while perceived physical and/or cognitive improvements influenced social participation. The men were still affected by concurrent diseases, which continuously influenced each couple's daily life.ConclusionIdentifying and managing concurrent bradyarrhythmia through a pacemaker implant could improve well-being for people with DLB.

OBJECTIVE:The aim of this study was to examine women's experience of menopausal transition and their expectations and wishes for support from healthcare. Further, to examine their knowledge about menopause and thoughts about current attitudes in healthcare and in society generally.METHODS:Data was collected through three focus group interviews with 14 women experiencing menopausal symptoms. The qualitative analysis was transacted through systematic text condensation, where categories were derived from data.RESULTS:The women in this study told us about being inadequately prepared for menopause through having insufficient knowledge of the menopausal transition. They experienced lack of clarity about where in the health care system they could get help and that knowledge of menopause varied among healthcare staff. The attitudes to menopause experienced by women in this study were both positive and negative, but they often equated menopause with getting old. To be better prepared for the climacteric transition, the women wanted information from health care professionals and they wanted menopausal care to be easily accessible and local. If needed, it should be possible to access clinics providing specialist care.CONCLUSION:This work indicates that women want more and improved information about menopause in order to be better prepared. Advice and treatment for menopausal healthcare care should be easily accessible for women. Improved education and care guidelines for menopausal problems can be helpful for healthcare staff.

Purpose: This qualitative study aimed to investigate experiences and perceptions of hospital physicians regarding the discharging process, focusing on information transfer regarding medications. Methods: By purposive sampling three focus groups were formed. To facilitate discussions and maintain consistency, a semi-structured interview guide was used. Discussions were audio recorded and transcribed verbatim. Qualitative content analysis was used to analyze the anonymized data. A confirmatory analysis concluded that the main findings were supported by data. Results: Identified obstacles were divided into three categories with two sub-categories each: Infrastructure; IT-systems currently used are suboptimal and complex. Hospital and primary care use different electronic medical records, complicating matters. The work organization is not helping with time scarcity and lack of continuity. Distinct routines could help create continuity but are not always in place, known, and/or followed. Physician: knowledge and education in the systems is not always provided nor prioritized. Understanding the consequences of not following routines and taking responsibility regarding the medications list is important. Not everyone has the self-reliance or willingness to do so. Patient/next of kin: For patients to provide information on medications used is not always easy when hospitalized. Understanding information provided can be hard, especially when medical jargon is used and there is no one available to provide support. A central theme, "We're only human", encompasses how physicians do their best despite difficult conditions. Conclusion: There are several obstacles in transferring information regarding medications at discharge. Issues regarding infrastructure are seldom possible for the individual physician to influence. However, several issues raised by the participating physicians are possible to act upon. In doing so medication errors in care transitions might decrease and information transfer at discharge might improve.

Dementia causes substantial suffering for affected persons and their family caregivers. Because no cure is available, it is important to investigate how alternative therapies can improve life for these individuals. For the current study, persons with dementia (PwD) were recruited from a specialized Memory Clinic in Sweden to engage in a choral singing intervention for 1 hour per week for four semesters. PwD were encouraged to bring a family caregiver to the sessions; both were interviewed and data were analyzed using qualitative content analysis. The choral singing intervention appeared to become an important social context for PwD and family caregivers and had a positive impact on relationship, mental well-being, mood, and memory. The intervention appeared to act as an enriched environment for all participants. Choral singing interventions for PwD and their family caregivers is a simple means to create a social context and improve general well-being. [Journal of Psychosocial Nursing and Mental Health Services, 60(5), 29-36.].

Background The literature on workplace interventions focusing on recovery is scarce; hence this study intends to expand that knowledge. An intervention was run for one year, aiming at increasing the experience of recovery during the workday among primary health care employees. During the intervention, different forms of recovery activities were integrated into the daily work at six primary health care centres. The aim of this study was to explore the intervention process and its effects. Methods After completion of an intervention, 39 employees in seven focus groups were interviewed about their experiences of the intervention. A semi-structured interview guide was used, and the qualitative analysis was conducted by systematic text condensation. Results Despite different conditions and attitudes when the project was launched, the participants portrayed a positive outcome of the intervention at all six workplaces. Four promoting factors for intervention success were identified: support, legitimacy, customization, and simplicity. Also, three areas of improvement during the intervention period were described: the workplace climate, employee well-being, and recovery awareness, which in turn became promoting factors. Conclusions An intervention aiming at increasing workplace recovery can be promoted by support, legitimacy, customization, and simplicity. By using these promoting factors, health care workplaces can implement activity models which could increase employees’ experiences of recovery during the workday. Positive effects on workplace climate and employee well-being can also be achieved.

BACKGROUND: There is a lack of research regarding factors promoting recovery during the workday and effective interventions. OBJECTIVE: To evaluate how different intervention activities may impact employees' experiences of recovery at the workplace. METHODS: Customized intervention activities based on qualitative results and a participatory approach were integrated among the employees at six primary health care centres (PHCCs; n= 166) during one year. Recovery and workplace factors were measured with a questionnaire at the start and end of intervention, and also in a control group (15 PHCCs; n= 328). Group differences were tested (Chi-2) and explanatory factors compared by logistic regression models. RESULTS: The proportion of employees reporting workday recovery increased in the intervention group (19.9% to 29.1%; p = 0.01), whereas the control group showed no significant change. Recovery was explained by self-reflection and reflection with co-workers. After intervention, having influence on work situation, energy-building experience, and opportunity for laughter also contributed significantly to recovery. CONCLUSIONS: The results contribute to work recovery research by confirming that a customized intervention may have an impact on employees' recovery experiences. The study showed that considering the factors of reflection, influence, and companionship can positively impact workplace recovery.

OBJECTIVES:The area of regenerative work is still close to unexplored. The aim was to explore the possibility for employees to gain energy at work.METHODS:Questionnaire to all employees (n = 599) from different professions in public and private primary health care centers in one health care district in Sweden. The questionnaire, which had a salutogenic perspective, included information on self-rated health, psychosocial work environment and experiences, recovery, social climate, and energy. Having an energy-building experience was defined by a positive response to two combined questions regarding energy at work. Analyses were performed with bivariate correlation and multiple logistic regression.RESULTS:The response rate was 84%. Health and energy correlated positively (r = 0.54). In total, 44.5% of the employees reported having an energy-building experience. Predictors for having an energy-building experience were recovery [positive odds ratio (POR) = 2.78], autonomy (POR = 2.26), positive workplace characteristics (POR = 2.09), and internal work experiences (POR = 1.88).CONCLUSIONS:The results support the hypothesis that it is possible to gain energy at work, an area that is still close to unexplored. There is a high correlation between energy and health. Employees' energy-building experiences relate to well-being at work and correlates to recovery, autonomy, positive workplace characteristics, and positive internal work experiences. This knowledge can help in improving future work environment development.

Background: National guidelines are important instruments in reducing inappropriate antibiotic prescriptions. Low adherence to guidelines is an acknowledged problem that needs to be addressed. Method: We evaluated established characteristics for guidelines in the guidelines for lower respiratory tract infection, acute otitis media and pharyngotonsillitis in primary care. We studied how doctors used these guidelines by analysing interviews with 29 general practitioners (GPs) in Sweden. Results: We found important between-guidelines differences, which we believe affects adherence. The GPs reported persistent preconceptions about diagnosis and treatment, which we believe reduces their adherence to the guidelines. Conclusion: To increase adherence, it is important to consider doctors’ preconceptions when creating new guidelines.

BACKGROUND:Lack of recovery from everyday strains and demands is connected to increased levels of stress-related problems and development of ill-health. There is much research on how to handle and prevent fatigue and stress in leisure time, but research on working time is more scarce. A recent study found that employees' experience of recovery during working hours was related to high self-rated health.OBJECTIVE:The aim of this study was to explore the concept of recovery during working hours among primary health care workers.METHODS:Eight focus groups with 50 staff members, men and women, from different professions were conducted in the primary health care sector in southern Sweden. The analysis was inspired by systematic text condensation, a strategy for qualitative analysis.RESULTS:Three main categories were identified as important factors for experiencing recovery during working hours: variation (including changes in location, tasks and tempo) companionship (including helpfulness, appreciation, social chat and laughter) and manageability (including completion, satisfaction, influence, control and reflection).CONCLUSIONS:Recovery during working hours is multifaceted. The categories identified in this study will be further elaborated and tested.

OBJECTIVE:The aim of the study was to describe patients' experience of yoga as a treatment for hypertension, as well as their experience of living with hypertension. DESIGN:Qualitative interview study Method and materials: In 2013-2014, in southern Sweden, patients with hypertension from three health care centres were invited to participate in a randomised controlled trial on yoga for hypertension. After completion of the study, eight women and five men (aged 35-79), who had practiced the yoga intervention, were interviewed about their experiences. We used a semi-structured interview guide according to Kvale. Qualitative analysis was conducted by systematic text condensation inspired by Malterud. RESULTS:Two main themes emerged during the analysis process: Yoga - a laborious way to well-being and hypertension - a silent disease. The positive experiences of doing yoga were described in terms of tranquillity and increased agility. The drawbacks were mainly linked to the time required to perform the exercises. Living with high blood pressure and having to take medication can imply a stigma and cause concerns for future cardiovascular events. Most patients that we interviewed expressed a wish to find alternative ways to treat their high blood pressure. Participating in the yoga study was seen as a good possibility to try such an alternative way. CONCLUSIONS:Many patients with hypertension in Swedish primary care seem to be interested in trying alternative treatments to control blood pressure. The patients in our study experienced several benefits from doing yoga, but they also pointed out difficulties in implementing yoga as a regular and permanent lifestyle change.

BACKGROUND:Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines.METHODS:An interview study was conducted among a strategic sample of 25 general practitioners (GPs).RESULTS:All GPs mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and "Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy "Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis.CONCLUSION:The majority of the GPs avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPs did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.

BACKGROUND:Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care.METHODS:Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners' audit registrations. Qualitative data were collected through observations and semi-structured interviews.RESULTS:From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner's diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual.CONCLUSIONS:Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses' triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge.

Swedish nursing homes (NH) have limited capacity. As a result elderly people living in NH represent the part of the elderly population in most need of care. In Sweden a General Practitioner (GP) is usually responsible for the medical care of all subjects living in a NH. The residents in NH seldom have adequate pharmacological treatment according to diagnosis and often have polypharmacy and/or inappropriate medical treatment regarding concerns of declining renal function. What prevents optimal care for the elderly is multifaceted, but there is limited research on how GPs experience their work with the elderly in NH in Sweden.

OBJECTIVE:To explore experienced general practitioner (GP) tutor perceptions of a skilled GP tutor of medical students.DESIGN:Interview study based on focus groups.SETTING:Twenty GPs experienced in tutoring medical students at primary health care centres in two Swedish regions were interviewed.METHOD:Four focus-group interviews were analysed using qualitative content analysis.SUBJECTS:Twenty GP tutors, median age 50, specifically selected according to age, gender, and location participated in two focus groups in Gothenburg and Malmö, respectively.MAIN OUTCOME MEASURES:Meaning units in the texts were extracted, coded and condensed into categories and themes.RESULTS:Three main themes emerged: "Professional as GP and ambassador to general practice", "Committed and student-centred educator", and "Coordinator of the learning environment".CONCLUSION:Experienced GP tutors describe their skills as a clinical tutor as complex and diversified. A strong professional identity within general practice is vital and GP tutors describe themselves as ambassadors to general practice, essential to the process of recruiting a new generation of general practitioners. Leaders of clinical education and health care planners must understand the complexity in a clinical tutor's assignment and provide adequate support, time, and resources in order to facilitate a sustainable tutorship and a good learning environment, which could also improve the necessary recruitment of future GPs.

BACKGROUND:Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C- reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies.METHODS:From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used.RESULTS:The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases. RADT was not believed to be relevant since it detects only one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection.CONCLUSIONS:Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge. When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.