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INTRODUCTION: Care transitions following a stroke call for integrated care approaches to reduce death and disability. The proposed research described in this study protocol aims to evaluate the effectiveness of a person-centred multicomponent care transition support and the process in terms of contextual moderators, implementation aspects and mechanisms of impact. METHODS: A non-randomized controlled trial design will be used. The intervention includes person-centred dialogue intended to permeate all patient-provider communication, various pedagogical modes of information, a person-centred care and rehabilitation plan, and a bridging e-meeting to prepare patients for homecoming. Patients with stroke or TIA who are to be discharged from the participating hospitals to home and referred to a neurorehabilitation team for continued rehabilitation will be included. Follow-ups will be conducted at one week, 3 months and 12 months. Data will be collected on the primary outcome of perceived quality of the care transition, and on the secondary outcomes of health literacy, medication adherence, and perceived person-centeredness. Data for process evaluation will be collected through semi-structured interviews, focus groups, participatory observations, and the Normalisation Measure Development Questionnaire. DISCUSSION: The study will provide insights on implementation, mechanisms of impact, contextual moderators, and effectiveness of a care transition support, targeting a poorly functioning part of the care trajectory for people with stroke and TIA. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05646589.

The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women.

The expansion of second hand clothing markets has developed through the recent years and the phenomenon has turned into a trend and normalization among fashion companies and consumers, rather than its historical label of being connected to low status. As digitalization has become important for how people consume fashion products, previous research suggests several perceived risks with shopping online. However, the Swedish second hand clothing market in the menswear segment is presented as a rather underdeveloped research area, which allows this study to investigate potential risks and possibilities in an online environment. In addition, we apply a combination of two theories (1) The perceived risk theory and (2) The servicescape theory. The chosen theories have been interpreted and tweaked in order to adapt to this research approach and to further analyze University students at Swedish School of Textiles and their online behavior, but also attitude towards second hand clothing. By applying these theories, a contribution on a deeper understanding was achieved and thereby allowed us to fulfill the purpose of the study, which is to identify how online companies can improve their presentation of product assortment with focus on second hand clothing menswear, using eye tracking technology. Hence, the results provide an increased knowledge from a business perspective and a consumer perspective. The chosen methodology for this study is based on a qualitative approach, primarily a laboratory experiment (eye tracking experiment), followed by a semi-structured interview. The experiment and the interviews took place at Handelslabbet located in Borås and the participants were students from Textile Management Bachelor program year 1. The most prominent perceived possibility was shown to be “Second hand - an increasing assortment” and the most prominent risk was “A hidden assortment”. The perceived risks and possibilities are presented in an online environment based on The servic

The study aimed to investigate whether a structured discharge letter and the use of the person-centred communication method Teach Back for sharing information at hospital discharge could support perceived understanding and knowledge of and adherence to prescribed medication for secondary prevention after stroke. Data from a feasibility study of a codesigned care transition support for people with stroke was used. Patients who at discharge received both a structured discharge letter and participated in the person-centred communication method Teach Back (n = 17) were compared with patients receiving standard discharge procedures (n = 21). Questionnaires were used to compare the groups regarding perceived understanding of information about medical treatment, knowledge of information about medical treatment and medication adherence at 1 week and 3 months. There was a statistically significant difference in perceived understanding of information about medical treatment (p > 0.01) between the groups in favour of those who participated in Teach Back at the discharge encounter. No differences between groups were found regarding understanding health information about medical treatment and medication adherence. The results indicate that the use of Teach Back at the discharge encounter positively impacts perceived understanding of information about medical treatment in people with stroke. However, considering the nonrandomised study design and the small sample size, a large-scale trial is needed.

BACKGROUND: Care transitions following stroke should be bridged with collaboration between hospital staff and home rehabilitation teams since well-coordinated transitions can reduce death and disability following a stroke. However, health services are delivered within organisational structures, rather than being based on patients' needs. The aim of this study protocol is to assess the feasibility, operationalised here as fidelity and acceptability, of a codesigned care transition support for people with stroke. METHODS: This study protocol describes the evaluation of a feasibility study using a non-randomised controlled design. The codesigned care transition support includes patient information using videos, leaflets and teach back; what-matters-to me dialogue; a coordinated rehabilitation plan; bridged e-meeting; and a message system for cross-organisational collaboration. Patients with stroke, first time or recurrent, who are to be discharged home from hospital and referred to a rehabilitation team in primary healthcare for continued rehabilitation in the home will be included. One week after stroke, data will be collected on the primary outcome, namely satisfaction with the care transition support, and on the secondary outcome, namely health literacy and medication adherence. Data on use of healthcare will be obtained from a register of healthcare contacts. The outcomes of patients and significant others will be compared with matched controls from other geriatric stroke and acute stroke units, and with matched historic controls from a previous dataset at the intervention and control units. Data on acceptability and fidelity will be assessed through interviews and observations at the intervention units. ETHICS AND DISSEMINATION: Ethical approvals have been obtained from the Swedish Ethical Review Authority. The results will be published open-access in peer-reviewed journals. Dissemination also includes presentation at national and international conferences. DISCUS

Second hand har genomgått olika faser sedan många år tillbaka och har med tiden ändrat status för konsumenten. Idag kan second han bäras med omtanke för miljön och hållbar konsumtion eller som en modetrend. Idag har det utvecklats fler second hand-verksamheter som möter den allt mer miljömedvetna konsumenten. Tidigare forskning har givit kunskap om olika barriärer och motiv kopplat till second hand, men inte satt dessa barriärer och motiv i relation till köpprocessen. I vår studie tillämpar vi “teorin om planerat beteende” och analyserar gymnasieelevers resonemang kring barriärer och motiv i förhållande till köpprocessens olika steg. Genom att studien tillämpar dessa perspektiv, bidrar det därmed till en djupare förståelse om gymnasieelevers attityder och beteenden. Syftet med studien är att identifiera gymnasieelevers attityder till att handla second hand samt identifiera barriärer och motiv till att konsumera second hand. Resultatet från studien tillhandahåller följaktligen en ökad kunskap till befintliga second hand-verksamheter om gymnasieelevers attityder till att handla second hand i syfte att utveckla verksamheten. Studiens valda metod är en kvalitativ ansats där semi-strukturerade intervjuer genomfördes med gymnasieelever via videoplattformen Zoom. Totalt 18 elever intervjuades i tre olika skolklasser i Västra Götaland. Sex elever från varje klass deltog i studien. De mest framträdande motiven till att gymnasieelever väljer att handla second hand är det “överkomliga priset” samt “omtanke för miljön” och de mest framträdande barriärerna till att inte vilja handla second hand är “kontaminerade kläder”, “begränsat utbud och tillgänglighet”, “oinspirerade butiksmiljöer” samt “grupptryck”. Motiven och barriärerna sätts i relation till köpprocessen och det visar sig att “överkomligt pris” och “kontaminerade kläder” identifieras i samtliga steg i köpprocessen. Studiens slutsatser är att ett attityd-beteendegap har identifierats hos gymnasieelever samt att barriärer, Second hand has undergone several phases historically and has over time changed status due to the consumer perception. These days second hand could be worn with concern for the environment, sustainable consumption or as a fashion trend. More second hand businesses have been developed as a response to the increasingly environmentally conscious consumer. Previous research has provided knowledge about various barriers and motives connected to second hand but did not put these barriers and motives in relation to the buying process. In our study, we apply the “theory of planned behaviour” to analyze high school students’ reasoning about barriers and motives in relation to every step of the buying process. Through these perspectives, the study contributes to a deeper understanding of young consumers’ attitudes and behaviors. The main purpose of this study is to identify high school students’ attitudes towards second hand shopping and to identify barriers and motives for consuming second hand. The result from the study will consequently provide an increased knowledge to existing second hand-retailers about high school students' attitudes toward secondhand-buying, in purpose of a business development. This study’s research design is based on a qualitative approach, where semi-structured interviews were conducted with high school students via the video platform Zoom. A total of18 students were interviewed in three different classes in Västra Götaland. Six students were chosen from each class to participate in this study. The most prominent motives for highschool students to shop second hand are the affordable price and the concern for the environment. Regarding the barriers for not having a willingness to perform a buying were “contaminated clothes”, “limited supply and availability”, “uninspired stores” and “peerpressure”. The motives and the barriers are put in relation to the buying process and it turns out that “affordable price” and “contaminated clothes” are identified

Background: Uncoordinated care transitions are known to be a risk of a substantial burden for patients and significant others with a risk of adverse events, rehospitalisation and dissatisfaction with services. After acute hospital care, people with stroke often need continued rehabilitation which entails a care transition such as from hospital to continued rehabilitation in the home environment. Aims: The overall aims of this thesis were to generate knowledge about and describe the care transition process from hospital to the home from the perspective of people with stroke, significant others and healthcare professionals. In addition, the aim was to investigate the concept of participation in a co-design of person-centred care transitions. Methods and participants: Four papers were included. Paper I and II were based on a prospective observational study including 190 people with stroke and 89 significant others. Data were collected from medical records by standardized questionnaires, performance-based tests, and from the Stockholm Region computerized register of healthcare contacts. Paper I was a prospective observational study where data were analysed with descriptive statistics and regression analysis to explore associations between healthcare utilization and independent variables. Paper II was a cross-sectional study where regression analysis was used to explore associations between perceived quality and independent variables. Paper III was a qualitative grounded theory study of the care transition process including 16 people with stroke, 7 significant others and 48 healthcare professionals. Data was collected through focus group interviews, individual interviews, and interviews in dyads. Paper IV included 3 people with stroke, 1 significant other, 10 healthcare professionals and 1 facilitator. Data was collected using observations, field-notes, interviews and questionnaires and was analysed by qualitative content analysis to investigate how participation manifes

Introduction: Care transitions are a complex set of actions that risk poor quality outcomes for patients and their significant others. This study explored the transition process between hospital and continued rehabilitation in the home. The process is explored from the perspectives of people with stroke, significant others and healthcare professionals in Stockholm, Sweden. Method: Focus group interviews (n = 10), semi-structured individual interviews (n = 23) and interviews in dyad (n = 4) were conducted with healthcare professionals, people with stroke and significant others, altogether 71 participants. Data was collected and analyzed using Grounded Theory. Results: One core category "Perceptive dialogue for a coordinated transition", and two categories "Synthesis of parallel processes for common understanding" and "The forced transformation from passive attendant to uninformed agent" emerged from the analysis. The transition consisted of several parallel processes which made it difficult for the stakeholders to get a common understanding of the transition as a whole. Enabling a perceptive dialogue was as a prerequisite for the creation of a common understanding of the care transition. Conclusion: This study elucidates that a perceptive dialogue with patients/significant others as well as within and across organizations is part of a coordinated and person-centred transition. There is an extensive need for increased involvement of patients and significant others regarding dialogue about health conditions, procedures at the hospital and preparation for self-management after discharge.