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Additional file 2. Interview Guides.

Background The uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders. Methods We performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis. Results Organisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals. Conclusions Implementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families. Trial registration ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

Additional file 4. Example excerpts illustrating facilitator subcategories.

Additional file 3. Example excerpts illustrating barrier categories.

Additional file 1. Standards for Reporting Qualitative Research (SRQR): 21-item checklist.

Additional file 2. Fidelity scale for Basic Family Involvement and Support (BFIS).

Additional file 1. STROBE Statement—Checklist of items that should be included in reports of cross-sectional studies.

Additional file 1. The IFIP Intervention. Detailed description of the trial’s intervention.

Bakgrunn: Loven pålegger norske leger å vurdere samtykkekompetanse før iverksetting av et medisinsk tiltak. Imidlertid finnes det ingen norske retningslinjer for hvordan dette skal gjennomføres. Fremgangsmåtene varierer og mange opplever slike vurderinger som en utfordring. Dette synliggjør et behov for en retningslinje eller et hjelpemiddel. På bakgrunn av dette foreslår vi innføringen av et slikt hjelpemiddel som et tillegg til klinisk skjønn, for å øke kvaliteten på samtykkekompetansevurderingen. Kunnskapsgrunnlag: Samtykkekompetanse er nødvendig for at det skal kunne foreligge et gyldig samtykke. Dette begrunnes i medisinsk etikk og norsk lovgivning. Kunnskapsgrunnlaget er under utvikling, men blant de ulike verktøyene som finnes for å vurdere samtykkekompetanse anbefales ACE- Aid to Capacity Evaluation. MMSE regnes ikke som egnet til å vurdere pasienters samtykkekompetanse. Dagens praksis: Prosjektet er knyttet til geriatrisk avdeling på Lovisenberg sykehus. Kollegialt samarbeid er grunnsteinen i vurderingen, og en vurdering gjøres først og fremst når pasienten takker nei til et nødvendig tiltak. Tiltak og kvalitetsindikatorer: Vi ønsker å implementere ACE som et hjelpemiddel til samtykkekompetansevurdering, når det foreligger mistanke om manglende samtykkekompetanse. Innføringsperioden går over seks måneder. Tiltaket har et primært mål; å øke kvaliteten på vurderinger av samtykkekompetanse, og et sekundært mål; at antallet samtykkekompetansevurderinger økes, slik at flere med manglende samtykkekompetanse fanges opp. Vi foreslår to kvalitetsindikatorer for å måle kvalitetsforbedring i tråd med både det primære og det sekundære målet. Ledelse, prosess og organisering: Prosjektet forankres i ledelsen, og det nedsettes en tverrfaglig gruppe som får ansvaret for implementeringen av ACE-skjemaet. Prosessen er tenkt organisert via en PUKK-sirkel. Resultatene fra prosjektet bør kunne publiseres og bidra til utforming av en norsk retningslinje for vurdering av samtykkekompetanse. Konklusjon: Innføring av ACE-skjema kan bidra til å øke kvaliteten på samtykkekompetansevurderingen og til at flere med manglende samtykkekompetanse fanges opp. Vi ser for oss at innføringen ikke medfører store kostnader, og at tidsbruken står i forhold til hvilke konsekvenser en samtykkekompetansevurdering har for pasienten. Det tilrådes derfor at prosjektet gjennomføres.

The vaccine is one of medicine s greatest achievements, yet has continuously been met with scepticism and opposition. Many are surprised to find that the arguments against immunisation are practically unchanged for over 200 years. Authors on the subject tend to explain the phenomenon by particularities of the human mind or particularities of a given sociopolitical context, but none of them have looked closely at the particularities of the vaccine itself. The present inquiry aims to identify the properties which distinguish vaccines from other medical interventions to explain why they, specifically, remain controversial. It will be argued that vaccines have a particular mode of administration, a particular mode of distribution and a particular mechanism and effect. While certain traits are shared with other medications, it will be demonstrated how it s the configuration of features which inspire vaccine controversies, where any single aspect might have varying importance. This configuration of properties is inherent to the vaccine and thus universal, but also subject to a variety of interpretations, depending on context. Many such interpretations are considered here in a review of the main arguments against vaccination. Through this analytical review, the following thesis is also an attempt to render vaccine opposition comprehensible. Finally it aims to explain the persistency of the phenomenon, by pointing to the fundamental concerns which are expressed through vaccine opposition. These reflect continuing debates in modern society and are concerns about the body, concerns about the relationship between state and individual and concerns about technology and human intervention.