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Lipoedema is a disease in adipose tissue associated with multiple health problems that negatively impact the quality of life. However, due to body appearance, the disease is frequently misunderstood as lifestyle-induced obesity, and the affected women are at risk of being fat-shamed and lacking prerequisite support from healthcare providers and other people. Although the negative impact lipoedema has on health and social life, research from the affected women´s perspective is relatively sparse. Therefore, we conducted a Swedish national survey to explore healthcare experiences, health-related stigma, and social support among women with lipoedema. Methods An online survey with closed and open questions assessing sociodemographic, lipoedema characteristics, health-care experiences, health-related stigma, and perceived social support was sent out to all Lipoedema Association groups across Sweden. Participants In total, 245 women with lipoedema responded to the survey. The majority of participants were aged 40-59, and over half were in lipoedema stage 3. Most of the women had a combination of lipoedema type 3 and type 4. Results The result showed that it often takes decades, including many healthcare visits, from disease onset to diagnosis. Moreover, participants reported an overall significantly lower patient satisfaction with healthcare compared to a general Swedish female population. Especially low scores were found in the dimensions of Emotional support, Continuity and coordination, and Information and knowledge, which related to participants’ dissatisfaction with healthcare providers’ availability, responsiveness, commitment, and compassion for the patient’s worries and needs. Furthermore, compared to a general Swedish female population, women with lipoedema scored significantly more health-related social impairment. When analyzing data for stigma and health-related quality of life, significant correlations across higher levels of stigma and lower physical and so

Objectives Lipedema is associated with multiple health problems which limit daily life. Still, the disease is frequently misunderstood in healthcare, and research from the patient’s perspective is relatively sparse. A Swedish national survey was conducted, to comprehensively examine health and quality of life among women with lipedema. Furthermore, the study explored participants’ self-care, self-reported effects of different treatments, and experiences when seeking healthcare. Results In total, 245 women with lipedema responded to the survey. The majority were 40-59 years old, and over half of the participants were in lipedema stage 3. Overall, in most age groups, women with lipoedema scored approximately 25-35 points lower in their physical and mental health than an age-matched general Swedish female population. Moreover, it often took decades from disease onset, including many healthcare visits, to be correctly diagnosed. Compared to a general female population, women with lipedema scored significantly lower on satisfaction with healthcare in dimensions of availability, information and knowledge, Experiences of emotional support, continuity and coordination, respect and treatment, and participation and involvement. Particularly low scores were recorded in participants’ overall impression of healthcare, including expectations of care, perceived efficiency, being cared for, and accessing information about treatment alternatives. Women with lipedema used several different treatments to manage their health problems. Most common were performing low-intensity exercise and using compression garments, of which approximately half of the participants rated as having a good or a very good effect. Less used, but self-reported as more effective, were conservative and surgical treatments performed by healthcare professionals. Conclusion Lipedema has a significant negative impact on health and quality of life. Still, the diagnosis delay is extensive, and women with lipedema

Introduction: Interventions that support patients to handle the emotional and medical aspects of a long-term health condition is important. One way is to use peer-support groups, to help patients solving problems, increasing their knowledge and making decisions. Aim: was to investigate the impact on shared decision-making, empowerment and coping after participation in group-learning sessions for patients with long-term conditions (N = 42). Design: An intervention following a health education programme based on group-learning sessions was established. Eight different programmes were held in five different departments at a regional county hospital in Sweden. Methods: Questionnaires were analysed using paired-sample t-test. Results: Results showed that patients might have better opportunities to be more active during their patient encounter after attending the group learning sessions. Interventions directed to patient activation may be one key in future healthcare management, especially concerning long-term conditions. Empowering patients is central in healthcare, and using different approaches is important. What does this paper contribute to the wider global clinical community? Patients with long-term conditions should be encouraged to share their knowledge to others, which can give support in managing their disease Group-learning sessions can add a perspective of patients' lived knowledge which is one of the key aspects concerning treatment of patients with long-term conditions

BACKGROUND: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. OBJECTIVE: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. METHODS: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. RESULTS: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers' conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the

Aim: To describe how the nurse anaesthetist empowers the patient in the perioperative dialogue. Design: A qualitative descriptive design with interviews with 12 nurse anaesthetist (NA). Method: A hermeneutic text interpretation with a foundation in Gibson's empowerment model. Result: The results highlight Gibson's nursing domain: Helper, Supporter, Counsellor, Educator, Resource Consultant, Resource Mobilizer, Facilitator, Enabler and Advocate. The overall understanding is revealed as a relationship can be built through closeness between the patient and the NA. The NA helps the patient master the situation by talking to and touching the patient. The patient is helped to find their own strengths and to cope with their fears. The patients decide over their own bodies. When the patients do not want to or cope with protecting themselves, the NA protects and represents the patient.

The extant literature has suggested relationships between an individual's chronotype (in relation to morningness/eveningness) and several outcomes, including addictive disorders, psychological distress and daytime sleepiness. Moreover, sleep quality has been proposed to be a mediator in the aforementioned relationships. Consequently, the aim of the present study was to investigate the complex relationship between morningness/eveningness, problematic social media use, psychological distress and daytime sleepiness, with the potential mediators of sleep quality and insomnia. All participants (N = 1,791 [30.1% males]; mean age = 27.2 years, SD = 10.1) completed a battery of psychometric scales, including a reduced version of the Morningness-Eveningness Questionnaire (at baseline), the Pittsburgh Sleep Quality Index and Insomnia Severity Index (1 month after baseline assessment), the Bergen Social Media Addiction Scale, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale (2 months after baseline assessment). The impacts of morningness-eveningness on problematic social media use, anxiety, depression and daytime sleepiness were found in the mediation models. Furthermore, the mediated effects of insomnia and sleep quality were observed. The present study's results emphasize the importance of promoting healthy sleep habits and sleep hygiene behaviours, and that of early detection of sleep problems among individuals who have the eveningness chronotype, because this would significantly improve their health outcomes.

Objective: Health education programs using group learning sessions for patients with long-term conditions have been tested, but not evaluated. In order to evaluate such sessions, the purpose was to explore experiences from patients with long-term conditions after participating in group learning sessions. Methods: A descriptive design based on qualitative content analysis was used. Interviews were conducted with 19 patients with different long-term conditions, and participants were asked about their experiences after taking part in the group learning sessions. Results: Sharing experiences with one another gave them opportunities for learning. Patients described a metaphorical "expanded window," which opens in the group learning sessions; comparable to encounters during regular visits to health care providers. The nature of the learning environment that follows the educational model, together with describing lived experiences, allowed patients to share capability and resources, which was found to be foundational. Conclusions: The health education program as a format was important for shared learning. The facilitator can support the learning by structuring the format, but most essential was sharing experiences that facilitated each patient's learning that can aid the support of individual self-management.

Purpose: Insomnia has adverse effects on people with epilepsy. We aimed to test a novel cognitive behavioral therapy for insomnia (CBT-I) app-based intervention on insomnia symptoms and social psychological factors in people with epilepsy and to examine the possible mechanisms among the factors. Methods: Participants were recruited from neurology clinics in Iran and comprised individuals diagnosed with epilepsy and having moderate to severe insomnia. A two-arm randomized controlled trial design was used, consisting of a treatment group (CBT-I; n = 160) and control group (patient education; n = 160). Primary outcomes were self-reported sleep quality, insomnia severity, and sleep hygiene behavior and objective sleep characteristics measured by actigraphy. Secondary outcomes were attitude, perceived behavioral control, intention, action planning, coping planning, behavioral automaticity, self-monitoring, anxiety, depression, and quality of life (QoL). All outcomes were measured at baseline, and at one, three, and six months postintervention, except objective sleep, which was assessed at baseline, and one and six months postintervention. Data were analyzed using linear mixed models. Results: Current findings showed that sleep quality, insomnia severity, sleep hygiene behavior, and sleep onset latency were significantly improved in the CBT-I group compared with the patient education group at all measurement points. Also, the CBT-I group had significantly improved anxiety, depression, and QoL compared with the patient education group. Mediation analyses showed that attitude, intention, coping planning, self-monitoring, and behavioral automaticity significantly mediated the effect of the intervention on sleep outcomes. Conclusion: Results support the use of the CBT-I app to improve sleep outcomes among people with epilepsy.

BACKGROUND: Comorbid psychological distress (i.e. insomnia and depression) is experienced by 20-40% of patients with cardiovascular disease. This has a considerable impact on their health and quality of life, leading to frequent re-hospitalisations, higher healthcare costs and a shorter life expectancy. Internet-based cognitive behavioural therapy shows great potential for treating psychological distress in cardiovascular disease. Effective and feasible treatments can, however, only benefit patients if they are fully implemented in clinical care. AIM: This scoping review aimed to explore the literature for internet-based cognitive behavioural therapy in cardiovascular disease and for strategies to implement the intervention. METHODS: We searched electronic databases, journals and internet sources to find original studies about internet-based cognitive behavioural therapy in cardiovascular disease, adhering to scoping methodology guidelines. After identifying 267 titles, we screened 40 abstracts and chose 11 full-text articles for full-text screening. The results sections in four articles were searched for outcomes that related to the effectiveness and implementation of internet-based cognitive behavioural therapy by directed qualitative content analysis using an implementation framework. RESULTS: Three of the four articles fulfilling the inclusion criteria concerned internet-based cognitive behavioural therapy for treating mild to moderate depressive symptoms in cardiovascular disease, and none focused on insomnia. The studies showed evidence for the effectiveness of internet-based cognitive behavioural therapy, and/or described patient factors influencing clinical effectiveness. Our qualitative content analysis showed that many implementation aspects and stakeholder perspectives remain unexplored. CONCLUSIONS: Internet-based cognitive behavioural therapy promises to alleviate patient suffering in cardiovascular disease. There is, however, little research about inte

By educating laymen, survival after cardiac arrest can increase in society. It is difficult to reach the entire population with cardiopulmonary resuscitation (CPR) training. However, if 15% of the population knows how to perform CPR, an increase in short- and long-term survival in patients suffering a cardiac arrest could be seen. To educate youth is a way to reach parts of the population. This study aimed to investigate the effect of a 2-h CPR intervention for youth.

Purpose: To describe the experiences of patients with COPD participating in a health coaching self-management program. Patients and methods: Twenty patients who had participated in a 6-month health coaching self-management program intervention were purposefully selected for a qualitative evaluation of the program using semi-structured interviews. The interviews were analyzed using inductive qualitative content analysis. Results: Four categories and 13 subcategories emerged describing the participants' experiences of the program. Their experiences were expressed as gaining insight into the importance of knowledge and personal responsibilities in the management of COPD, taking action to maintain a healthy lifestyle, feeling supported by the program, and being hindered by individual and program limitations. Conclusion: Iterative interactions between patients and health care professionals together with the content of the program are described as important to develop skills to manage COPD. However, in future self-management programs more awareness of individual prerequisites should be considered.

Background: Mental health (MH) problems such as depression and insomnia are prominent among patients with cardiovascular disease (CVD). They are associated with a negative impact on quality of life, higher health care costs and a poorer prognosis. Despite this most patients with CVD will not receive support or treatment for their MH problems. Studies in other patient groups have described internet based cognitive behavioral treatment (I-CBT) as a promising intervention, but I-CBT has not been tested in CVD patients. The I-CBT HEART research project aims specifically to develop and evaluate I-CBT programs for CVD patients with psychological distress. The programs, both of which are in early stages of clinical evaluation, respectively target patients with depressive symptoms and patients with insomnia. Two randomized controlled trials will be carried out, I-CBT for insomnia (HiT-IT) and I-CBT for depression (DOHART). Implementation research has shown overwhelming evidence of the difficulties that are often encountered in the diffusion and dissemination of novel treatments, such as I-CBT for CVD. To smooth the way for future use of a successful intervention in clinical practice, a better knowledge is needed of the factors that may hinder or support implementation in practice. Purpose: The overall aim of the IMPLEMENT-IT study, a part of the I-CBT HEART project, is to achieve a better understanding of potential future implementation issues by exploring barriers and facilitators from different stakeholder perspectives that may be of importance in future implementation. Methods: Both qualitative and quantitative data will be collected in conjunction with the RCT studies HiT-IT and DOHART. Interviews with stakeholders at different levels focusing on perceptions of the role of eHealth in traditional healthcare in general, and of the I-CBT HEART intervention in particular. Informants are recruited in groups of healthcare-tasked representatives of political parties at the reg

Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We wish to evaluate the impact of a quality improvement regarding PVC treatment for patients with coronary heart diseases. Method: A longitudinal, quantitative observational study was carried out in 2008 and 2013 in a hospital in southern Sweden with 360 consecutive patients suffering from acute chest pain. New routines for PVC treatment were included in the hospital with daily inspection according to a checklist. A structured observation protocol was used to survey the prevalence of thrombophlebitis between 2008 and 2013. Also, we examined the relationship between the location and luminal diameters of PVCs. Results: The student’s t-test showed significant differences between 2008 and 2013 with respect to luminal diameter of PVCs (p = 0.002), prevalence of thrombophlebitis (p = 0.003) and number of days with PVC left in situ (p < 0.001). Conclusion: These findings emphasize the value of using systematic daily inspections and checklists to achieve quality and safety in patients with acute chest pain having PVC-based treatment.

In this paper the nature of user involvement in a co-design process will be explored. The outlines of a research project aiming at developing support systems for self-care inpatients suffering from chronic heart failure will be presented. The project is planned to perform a co-design effort where users (patients and healthcare professionals) will be given the opportunity to influence the development of support systems. We will discuss a number of possibilities and challenges that lie in the design of this kind of project and also some findings from its early stages. This report presents the experiences of users’ input, which are discussed in the context of previous research on benefits of user contributions in systems development., Conference on ENTERprise Information Systems / International Conference on Project MANagement / Conference on Health and Social Care Information Systems and Technologies, CENTERIS / ProjMAN / HCist 2015 October 7-9, 2015

Introduction: Self-care refers to activities performed with the intention of improving or restoring health and well-being. A good understanding of the adaptations needed in daily life is a prerequisite to motivate individuals to implement such changes. Facilitating the person with heart-failure’s (HF) understanding of the diagnosis, how to handle symptoms, and when to seek healthcare, is one way of proactive self-care. Previous Information and communication technology (ICT) support has proved to be effective in younger patients, but the development has not been user-driven, i.e. involving references and experiences from the patient, their family members or healthcare professionals and have rarely been implemented in clinical practice. In addition, disregard of the user hands over control and responsibility to the healthcare professionals and misses the patient’s desires and requirements. Aim: To describe an experience-based co-design of ICT for self-care support in the context of heart failure care Methods: The steps in the process of developing ICT support programs for self-care were guided by an experienced based co-design methodology including: 1) Workshops regarding self-care needs. 2) Workshops regarding self-care support as a means to cope with the phases of the disease. 3) Workshops to assess the usability of the suggested ideas. 4) Workshops to test the different supports in action. The project involved older persons with HF, their family members, healthcare professionals, IT-developers, informatics, development leaders, and researchers. There was also a quality improvement process involved to improve working routines and communication between the person with HF and the healthcare professionals, which in turn, increases the value of the innovation. Data collection include tape- and video recorded workshops and diary notes supplied by the informants. All data are to be analyzed by content analysis to identify needs, opportunities and challenges of self-care., Moderated Poster Session, Psycho-social & Prevention, Sunday 14 June 2015 – 10:00 – 11:00

Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization