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Aim: Health care professionals are tasked with the role of supporting patients in using eHealth services in their personal care and counselling competence in digital environments to ensure appropriate patient care. Our aim was to describe health care professionals’ experiences of counselling competence in Digital Care Pathways. Design: A descriptive qualitative study. Methods: Interviews with semi-structured questions were conducted. Twelve healthcare professionals were interviewed. The data were analysed using inductive content analysis. The results were reported according to the Consolidated Criteria for Reporting Qualitative Research. Results: The analysis revealed eight distinct areas of competence related to counselling in Digital Care Pathways, namely, counselling competences related to the use of Digital Care Pathways, supporting patients’ self-care, information technology competence, competence in creating an interactive counselling relationship on the Digital Care Pathway, information management, ethical competence related to counselling in Digital Care Pathways, competence to developing Digital Care Pathways services, and change competence. No Public or Patient Contribution: Due to the complex and unpredictable circumstances of COVID, people’s strict confinement in the hospital prohibited free access to them and the study environment. Therefore, the professionals involved in the study were interviewed through online systems.

Background: Healthcare professionals’ digital health competence is an important phenomenon to study as healthcare practices are changing globally. Recent research aimed to define this complex phenomenon and identify the current state of healthcare professionals’ competence in digitalisation but did not include an overarching outlook when measuring digital health competence of healthcare professionals. Objectives: The purpose of this study was to develop and psychometrically validate two self-assessed instruments measuring digital health competence and factors associating with it. Methods: The study followed three phases of instrument development and validation: 1) conceptualisation and item pool generation; 2) content validity testing and pilot study; and 3) construct validity and reliability testing. The conceptual background of the instruments was based on individual interviews conducted with healthcare professionals (n = 20) and previous systematic reviews. A total of 17 experts assessed the instrument’s content validity. Face validity was evaluated by a group of healthcare professionals (n = 20). Data collection from 817 professionals took place in spring-summer 2022 in nine organisations. Construct validity was confirmed with exploratory factor analysis. Cronbach’s alpha was used to assess the internal consistency of the instruments. Results: The instrument development and validation process resulted in two instruments: DigiHealthCom and DigiComInf. DigiHealthCom included 42 items in 5 factors related to digital health competence, and DigiComInf included 15 items in 3 factors related to educational and organisational factors associated with digital health competence. The DigiHealthCom instrument explained 68.9 % of the total variance and the factors’ Cronbach alpha values varied between 0.91 and 0.97. The DigiComInf instrument explained 59.6 % of the total variance and the factors’ Cronbach alpha values varied between 0.76 and 0.88. Conclusions: The tw

Purpose: To review and synthesize the available evidence on the effectiveness of preparatory digital counseling for children undergoing diagnostic imaging and their parents in terms of patient-related and imaging outcomes. Methods: Relevant studies were identified by searching databases and gray literature resources. References from full-text articles identified in the initial search were searched manually to identify additional relevant studies. The reviewed literature included studies on children and adolescents aged 3 to 21 years, their parents, or both, who participated in digital counseling interventions before medical imaging examinations. Literature selection and quality appraisal were conducted by 2 independent reviewers. Data were extracted using standardized tools and synthesized using the narrative synthesis approach. This review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Five randomized controlled trials and quasi-experimental studies were included in this review. Digital counseling was provided via multiple approaches with interactive elements. Digital counseling was reported to be effective at reducing anxiety and increasing knowledge and satisfaction among children and their parents. It also appeared to reduce the need for general anesthesia and to improve the success of imaging procedures based on image quality and number of repeated images required. Digital counseling also appeared to increase children’s confidence and help them remain still during the imaging process. Discussion: The increased knowledge from digital counseling can strengthen senses of security and self-efficacy, which are important for successful medical imaging examinations, especially in children. The digital counseling applications used in the included studies are location-independent, and children and their parents can use them as often as they want, which might help ensure the provision of

Background: The number of people with chronic and long-term conditions has increased during recent decades; this has been addressed by leveraging information and communication technology (ICT) to develop new self-care solutions. However, many of the developed technological solutions have not been tested in terms of impact(s) on patients’ quality of care. Objectives: This systematic review aimed to identify the current best evidence on the types of interventions that have been developed to improve the quality of patient care through the clinical application of ICT in primary, tertiary or home care. Design: A systematic review, including a meta-analysis, was conducted according to the JBI Manual for Evidence Synthesis guidelines. Data sources: Relevant data were identified from four electronic databases: CINAHL, PUBMED, SCOPUS and MEDIC. Review methods: The eligibility criteria were formatted according to PICOS inclusion and exclusion criteria. At least two researchers performed the screening process separately, after which they agreed upon the results. The Cochrane Risk of Bias Assessment and JBI Critical Appraisal tool for randomised controlled studies (RCTs) were used to assess research quality. Data were extracted, and a meta-analysis was performed if the research met quantitative requirements. Results: Of the 528 initially identified studies, 11 studies were chosen for final data synthesis. All of the interventions integrated ICT solutions into patient care to improve the quality of care. Patients across all of the RCTs were educated through direct training, the provision of information relevant to their disease or one-to-one educational coaching. The interventions included various interactions, e.g. nurse expert visits and support, and support provided by peers, groups or family members. These interactions occurred through face-to-face coaching, virtual human coaching or virtual coaching that relied on an algorithm. The performed meta-analysis included

Aim: To compare the long-term counselling quality among the patients visited and not visited at cardiac nurse after percutaneous coronary intervention (PCI) and related factors one to two years after PCI. Design: An explorative, register-based cross-sectional study. Methodology methods: A sample was drawn from the one university hospital’s procedure register consisted of the patients undergone a PCI (n = 977). The data was collected by Counselling Quality Instrument (CQI) questionnaire by mail, and analysed by basic and multivariate methods. Findings results: Of the respondents (n = 459), less than half the patients (48.4%) visited at cardiac nurse one to two years after PCI as instructed in the national current care guidelines. Patients, who visited the nurse (n = 194) had higher satisfaction for counselling than the ones not visited (n = 70). Nevertheless, patients, especially those who had no dyslipidemia, had Unstable Angina Pectoris or Non-ST-elevated myocardial infarction or were out of the workforce, were unsatisfied with counselling, and needed more social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. A half of the PCI patients (51.6%) did not visit the cardiac nurse at the primary health care. Patient or public contribution: Cardiac nurses assisted the members of research group by assessing the questionnaire prior sending it to the patients and patients contributed by completing the questionnaires. We thank both parties for their contribution. Implication for profession and patient care: This study demonstrated, that patients out of the workforce and having emergency PCI are in need for better quality counselling, concentrating on social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. Those patients, who did not visit the cardiac nurse, should be offered easier access to cardiac nurse for example, by novel digital solutions.

The purpose of this study was to describe and explain patient participation, adherence, and activation for self-management among adult primary healthcare (PHC) patients with multimorbidity, and the associations between these and patient-related factors, and subsequently to produce a schematic model to describe this phenomenon based on the findings. The study consisted of three phases including four original publications (I–IV) and this summary which also presents additional results. In the first phase, the Patient Participation in Rehabilitation Questionnaire (PPRQ) was translated into Finnish and further tested using psychometric assessment in a cross-sectional study (n=88, I). Basic and multivariate methods were used to perform statistical analysis. In the second phase, a cross-sectional descriptive correlational study was conducted to explore patient participation (n=125, II), adherence (n=124; III), and activation for self-management (n=122, IV) among adult PHC patients with multimorbidity, associations between these and patient-related factors (II–IV, Summary). The data were collected using several instruments, such as the PPRQ, the Adherence of People with Chronic Disease Instrument (ACDI), and the Patient Activation Measure (PAM®). Data were analysed using statistical analyses such as descriptive analysis (II–IV), correlations (III, Summary), t-test or ANOVA (II, IV, Summary), General linear model (II, IV), Binary logistic regression (III, IV) and Multivariable linear regression analysis (Summary). In the third phase, the schematic model was produced to describe the studied phenomenon (Summary). The results supported the validity and reliability of the PPRQ instrument in Finnish PHC settings. Patients generally perceived patient participation as highly important but their accounts of the extent to which this had been realised in healthcare encounters varied. Most patients had good adherence to care regimens, but adherence to healthy lifestyle behavio, Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla ja selittää potilaan osallisuutta, hoitoon sitoutumista ja aktivaatiota omahoitoon monisairailla perusterveydenhuollon potilailla, näiden yhteyttä toisiinsa ja potilaaseen liittyviin tekijöihin; ja tämän perusteella tuottaa skemaattinen malli kuvaamaan tätä ilmiötä. Tutkimus koostui kolmesta vaiheesta sisältäen neljä alkuperäisjulkaisua (I–IV) ja yhteenvedon lisätuloksineen. Ensimmäisessä vaiheessa potilaan osallisuusmittari (PPRQ) käännettiin suomeksi ja sen psykometriset ominaisuudet arvioitiin poikkileikkaustutkimuksella (n=88, I). Tilastollisina menetelminä käytettiin perus- ja monimuuttujamenetelmiä. Toisessa vaiheessa tutkittiin potilaan osallisuutta (n=125, II), hoitoon sitoutumista (n=124; III) ja aktivaatiota (n=122, IV) sekä näiden yhteyttä toisiinsa ja potilaaseen liittyviin tekijöihin (II–IV, yhteenveto) aikuisilla monisairailla perusterveydenhuollon potilailla kuvailevalla korrelaatio poikkileikkaustutkimuksella. Aineisto kerättiin muun muassa Potilaan osallisuus (PPRQ), Kroonisesti sairaan potilaan hoitoon sitoutuminen (ACDI) ja Potilaan aktivaatio -mittarilla (PAM®). Aineisto analysoitiin tilastollisilla menetelmillä, kuten kuvaileva tilastoanalyysi (II–IV), korrelaatio (III, yhteenveto), t-testi, ANOVA (II, IV, yhteenveto), lineaarinen malli (II, IV), binaarinen logistinen regressio (III, IV) ja lineaarinen monimuuttuja regressioanalyysi (yhteenveto). Kolmannessa vaiheessa tuotettiin skemaattinen malli kuvaamaan tutkittua ilmiötä (yhteenveto). Tulokset tukivat PPRQ-instrumentin validiteettia ja luotettavuutta suomalaisessa perusterveydenhuollon kontekstissa. Potilaat pitivät osallisuutta tärkeänä, mutta näkemykset sen toteutumisesta terveydenhuollon kohtaamisissa olivat vaihtelevia. Useimmat potilaat olivat sitoutuneet hoitoonsa hoito-ohjelmien osalta, mutta terveellisten elämäntapojen noudattaminen oli usein riittämätöntä. Tilastollisesti merkitseviä hoitoon sitoutumista selittäviä tekijöitä olivat

Aims and objectives: The study was conducted to describe long-term perceived health among patients after a percutaneous coronary intervention as well as clarify the associations between perceived health and various factors. Background: Perceived health is an important outcome for coronary heart disease patients who have undergone percutaneous coronary intervention. Poor perceived health predicts low adherence to treatment, morbidity and mortality. Design: An explanatory and descriptive survey with a six-year follow-up (STROBE Statement: File S1). Methods: Baseline data (n = 416) were collected in 2013, with follow-up data collected from the same study group in 2019 (n = 154) at two university hospitals and three central hospitals in Finland. The employed self-reported questionnaire was based on the EuroQoL visual analogue scale and EuroQol five-dimensional scale. Data were analysed using descriptive statistics and multivariate methods. Results: Perceived health did not significantly differ four months or six years after percutaneous coronary intervention. The respondents most commonly reported pain and discomfort (62.1%), problems in mobility (50.3%), issues with usual activities (27.5%), and anxiety and depression (24.0%). Managing self-care (8.5%) was least likely to be an issue for the respondents. A majority of the reported problems were of a mild nature. The consumption of an adequate amount of vegetables, lower systolic blood pressure, regular follow-up treatment, lack of prior invasive procedures, and younger age predicted better scores for both perceived health and its separate dimensions. Conclusion: Regular follow-up is important to ensure after percutaneous coronary intervention to identify patients with pain and discomfort, mobility problems, depression and anxiety. Healthcare professionals should pay particular attention to elderly patients, who have undergone severe invasive procedures. Relevance to Clinical Practice: This study confirms the i

Endometriosis is a chronic disease associated with severe, life-impacting pain symptoms and impaired fertility that can affect relationships, sexuality, family life, social relationships, and working life. The aim of the present study was to describe endometriosis patients’ experiences of the counseling they need from the nurses through the digital care pathway. A qualitative descriptive study was conducted; 14 Finnish women with endometriosis were interviewed. Content analysis revealed four main categories related to counseling provided through the digital care pathway: counseling on endometriosis and its role in life; counseling on how to live with endometriosis; comprehensive support for self-care; and patient-oriented counseling. Nurses should provide counseling at different stages of the disease, because the symptoms of endometriosis can change rapidly in a short period of time, and these are the moments when the patient needs support and advice from the nurses. The digital care pathway can provide reliable information to patients at the right time of disease progression. The study was planned and reported using the Consolidated Criteria for Reporting Qualitative Research Checklist.

Aim: Work dissatisfaction, burnout and workforce shortage are major problems in healthcare globally, all of which are associated with QWL. Previous studies have found that the QWL of healthcare professionals is moderate or low. The aim was to describe the quality of working life (QWL) of employees working in public healthcare and describe the association between QWL and background variables. Design: This study had a quantitative cross-sectional survey design. Methods: Data was collected from the employees of a Finnish healthcare organization in autumn 2021 using an online questionnaire (n = 837). Convenience sampling was used in the selection of the healthcare organization. The study was reported according to STROBE guidelines. Results: The QWL was moderate, and the mean QWL index calculated from the questionnaire responses was 0.524. The QWL index was lowest in healthcare professionals and highest in upper management, with some dissatisfaction towards leadership noted.

Health care professionals need continuous education to maintain the competencies required to provide high-quality care; in today’s world, this means an understanding of digital health services. Insight into health care professionals’ experiences of which aspects influence their digital health competence development is therefore highly relevant. The objective of the study was to examine which aspects influence the digital health competence development of health care professionals (nursing workforce and allied health professionals). In-depth, semi-structured interviews were conducted with 20 health care professionals (Finland n=15, Sweden n=5) from various health care settings between May 2019 and July 2020. Interviews were audio-recorded, translated verbatim and analysed with inductive content analysis. Health care professionals perceive that digital health competence development is influenced by aspects related to digital health adoption, co-workers and the work community, their manager, and opportunities for continuous education and orientation. The participants agreed that digital health competence is an important part of a health care professional’s overall clinical competence. Continuous education geared towards digital health competence should be systematically designed, and potentially integrate the resources available on social media platforms. Additionally, managers and supervisors should take a stronger stance towards learning about digital health services so they can serve as role models to their employees and genuinely promote digital health competence development.

Aim: The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. Background: Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients’ lives. Design: A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. Methods: Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari’s FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. Results: Most patients’ responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. Conclusions: Multimorbid patients’ adherence to self-management is not an ‘all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. Relevance to clinical

Aim: To test a model of clinical learning that focuses on the role of the ward manager. Background: The ward manager’s role in supporting clinical learning indirectly focuses on the ward climate connected to students’ clinical placements. In this way, the ward manager influences both nursing care and the pedagogical atmosphere in the ward. Design: Cross-sectional, secondary analysis. Methods: The sample included nursing and midwifery students (N = 5,776, n = 1,900) who had completed their clinical placement. Data were collected with the Clinical Learning Environment, Supervision and Nurse Teacher scale. Structural equation modelling was adopted to test the hypotheses. Results: Estimates of the model parameters demonstrated that a ward manager’s leadership style influences both the premises of nursing at the ward (0.84, p < .001) and the pedagogical atmosphere (0.93, p < .001), although the pedagogical atmosphere affects the mentoring relationship (0.87–0.86, p < .001). Conclusions: Ward managers exert a significant influence on the clinical learning environment via their support for an effective pedagogical atmosphere and, consequently, effective mentoring. Implications for Nursing Management: Leadership style guides both the premises of nursing at the ward and pedagogical atmosphere. These findings recommend that ward managers should be involved in promoting a supportive learning climate, which supports the mentor–student relationship and, eventually, leads to effective clinical learning.

Evidence-based practice (EBP) has been shown to improve patient safety as well as quality of care. Advanced practice nurses (APNs) have a vital role in the implementation of EBP. This study aimed to describe APNs’ experiences of EBP implementation. The study was a descriptive qualitative study and data were collected between May and August 2019 through interviews with APNs (n = 12). The data were analyzed using inductive content analysis. The study was reported according to COREQ guidelines. The responses were divided into four main categories: EBP in clinical nursing; EBP leadership; implementation of supporting structures for EBP; and EBP in APNs’ work. APNs experienced: that the realization of EBP varied in clinical nursing, that there was a need for development in the leadership of EBP, variation in nurse leaders’ competence in EBP leadership, and a lack of resources for EBP.

Aim: To identify current evidence on health care managers’ competence in knowledge management. Background: Although successful knowledge management improves the quality of care and performance of health care organisations, there is limited evidence on health care managers’ competence in knowledge management. Evaluation: A scoping review was conducted by including original published and unpublished studies (qualitative, quantitative, and experimental) and review designs in English, Finnish, or Swedish. The studies were retrieved from six databases (CINAHL, ProQuest, PubMed, Scopus, Mednar, and Finnish database Medic) in November 2020 and then complemented in January 2022. Narrative synthesis was used to synthesize data. Key issues: A total of 21 articles was included in the review. The main themes of managers’ competence in knowledge management presented in these were system management, professional development, and leadership behaviour and attitude. No valid and reliable instruments were described in the included studies. Conclusion: At present, there is a limited understanding of health care managers’ competence in knowledge management. A comprehensive understanding of this topic can provide a direction for future research. Implications for Nursing Management: The results can be utilized in the assessment and development of managers’ competence in knowledge management, as well as the formulation of education and in-service training for health care managers.

Background: Adherence to medication and healthy lifestyle is crucial for preventing secondary strokes and other vascular events. However, there is not enough evidence on the long-term effects of hospital-initiated lifestyle counselling. Aim: To determine the effects of The Risk Factor Targeted Lifestyle Counselling Intervention, which is implemented during acute hospitalisation, on adherence to lifestyle changes 7 years after stroke or TIA. Methods: Quasi-experimental design with 7-year follow-up period. Baseline data (n = 150) were gathered from a neurology unit in Finland between 2010 and 2011. Patients received either the studied intervention (n = 75) or the prevailing form of counselling at the time (n = 75). Data concerning lifestyle and clinical values were measured at the baseline time point, while adherence to lifestyle changes was assessed 7 years later (2017–2018). Analysis of covariance and multivariate ordinal logistic regression were used to describe the mean differences between the intervention and control groups. Results: Several between-group differences were detected, namely, members of the intervention group reported consuming less alcohol and having lost more weight during hospitalisation relative to the control group. No between-group differences in the prevalence of smokers were found, but the intervention group reported a greater number of daily cigarettes than the control group. Adherence to medication, importance of adherence to a healthy lifestyle, support from family and friends, and support from nurses were all significantly higher in the intervention group than in the control group. Conclusions: The results suggest that the lifestyle counselling intervention was effective in decreasing alcohol use and weight, as well as increasing factors that are known to support adherence to a healthy lifestyle. Relevance to clinical practice: The results indicate that the adherence process already begins during acute phase counselling. To ensu

Aims and objectives: This study aims to provide insight into healthcare professionals’ lived experiences of digital health competence with the objective of improving the knowledge of how digital health competence is perceived by healthcare professionals. Background: Healthcare professionals need to adjust to the digital era to provide quality and ethical care. Previous research has rarely adopted a healthcare professional’s standpoint to describe their perceptions of digital health competence, even though their perspective in how new care practices are designed and implemented is vital. Design: A qualitative descriptive study. Methods: Healthcare professionals (nurses and allied health professionals) from versatile healthcare settings were recruited for individual semi-structured interviews in Sweden (n = 5) and Finland (n = 15) (spring 2019-summer 2020). Purposive and convenience sampling was used. Participants’ backgrounds were in the public and private sectors. The interviews were transcribed for inductive content analysis. The SRQR guideline guided the study process. Results: Healthcare professionals’ perceptions of digital health competence are connected to competence to provide patient-centric care through digital channels, using technology and digital health systems, interacting with the patient through digital means, evaluating what digital health is and combining digital and traditional methods. Professionals’ perceptions of their own digital health competence were divided, with the participants either reporting sufficient competence or perceiving a lack of skills in some specific areas. Conclusions: Healthcare professionals’ perceptions of digital health competence focus on the ability to provide patient-centric care by evaluating the need and possibilities for using digital health services jointly with more traditional methods. This study provides a sound basis for digital health research, but future studies should focus on elucidating factors wh

Background/Objectives: Social and healthcare operating environments are constantly evolving, so educators have major responsibility for ensuring that Evidence-Based Healthcare is included in the education of future healthcare professionals and applied in their practice. A holistic understanding and implementation of evidence-based healthcare competence is critical to the delivery of appropriate, relevant, and effective healthcare. Aim: To identify and describe social and healthcare educators’ EBHC competence according to the five main components of the JBI model and associated factors to it. Methods: A mixed-methods systematic review was conducted, with inclusion and exclusion criteria identified according to PICo and PEO inclusion criteria for qualitative and quantitative studies, respectively. Five databases—the CINAHL (EBSCO), PubMed, Scopus, Medic and ProQuest databases— were searched in June 2020. In total, 12 original studies (qualitative and quantitative) were included for quality appraisal, data extraction and narrative synthesis. Results: Key competence areas addressed in the selected studies were integrated into the four components of the JBI model of EBHC (evidence generation, synthesis, transfer, and implementation, and focus on its ultimate goal: global health). In the majority of chosen studies, it was found that educators had a positive attitude towards EBHC and wanted to stay up-to-date in the areas of global health and collaboration. Educators demonstrated their abilities to locate, appraise, and interpret the best current relevant evidence. They knew how to integrate EBHC into their teaching and had strong communication skills in evidence transfer. Their EBHC competence was strongest in the educational context and educators could transfer evidence when teaching but were not able to translate it into how to implement EBHC in clinical care. In addition to higher academic education and work experience, organizational support and continuous ed

Background: Adherence to treatment is a crucial factor in preventing the progression of coronary heart disease. More evidence of the predictors of long-term adherence is needed. Aims: The purpose of this study was to identify the predictive factors of adherence to treatment six years after percutaneous coronary intervention. Methods: Baseline data (n=416) was collected in 2013 and follow-up data in 2019 (n=169) at two university hospitals and three central hospitals in Finland. The self-reported Adherence of Patients with Chronic Disease Instrument was used. Data were analysed using descriptive statistics and binary logistic regression analysis. Results: The respondents reported higher adherence to a healthy lifestyle six years after percutaneous coronary intervention in comparison to four months post-percutaneous coronary intervention; adherence was seen in their healthy behaviour, such as decreased smoking and reduced alcohol consumption. Participating in regular follow-up control predicted adherence. Support from next of kin predicted physical activity and normal cholesterol levels; this outcome was associated with close relationships, which also predicted willingness to be responsible for treatment adherence. Women perceived lower support from nurses and physicians, and they had more fear of complications. Fear was more common among respondents with a longer duration of coronary heart disease. Physical activity and male gender were associated with perceived results of care. Conclusion: Support from next of kin, nurses and physicians, results of care, responsibility, fear of complication and continuum of care predicted adherence to treatment in long term. These issues should be emphasised among women, patients without a close relationship, physically inactive and those with a longer duration of coronary heart disease.

Objective: To identify associations between lifestyle counselling quality and adherence to lifestyle changes during the 12-month period after discharge. Setting: Neurology unit. Subjects: Stroke and transient ischaemic attack (TIA) patients (n = 98). Design: Longitudinal explorative study that utilized data initially collected for quasi-experimental study. Main measures: The exploratory measures of Counselling Quality were collected at the hospital on the day of discharge between January 2010 and October 2011, and the outcome measures of Adherence to Lifestyle Change and clinical values were collected 3, 6 and 12 months after discharge. Results: There were significant associations between the exploratory and outcome measures over time. Three of the counselling quality parameters, counselling interaction, advantages and resources, were found to be significantly associated with adherence to lifestyle change. In particular, counselling interactiveness was positively associated with physical activity at 3 (B = 0.31, SD = 0.10, P = 0.004) and 12 (B = 0.29, SD = 0.13, P = 0.030) months, as was advantages of following the advice at 3 (B = 0.33, SD = 0.11, P = 0.006) and 12 (B = 0.34, SD = 0.14, P = 0.021) months. Counselling resources were associated with lower body mass index throughout the entire follow-up period, that is, at 3 (B = −0.06, SD = 0.02, P = 0.006), 6 (B = −0.05, SD = 0.02, P = 0.040) and 12 months (B = −0.05, SD = 0.02, P = 0.022). Furthermore, all aspects of counselling quality were positively related to support from nurses. Conclusion: Adherence to lifestyle change is more likely to be attained if lifestyle counselling is interactive, the advantages of following the given advice are perceived as beneficial and the counsellor has sufficient resources.

Introduction: Since a history of stroke or transient ischaemic attack is a major risk factor for a recurrent event, lifestyle counselling during the hospital phase is an essential component of treatment and may increase the probability of lifestyle change. Aims and objectives: To study the effect of risk factor‐targeted lifestyle counselling intervention on working‐age stroke patients’ adherence to lifestyle changes. Design: A quasi‐experimental, nonequivalent control group pretest–post‐test design. Methods: Stroke patients in an acute neurological unit were divided into a control group (n = 75) receiving standard counselling and an experimental group (n = 75) receiving risk factor‐targeted counselling. Lifestyle data and clinical outcomes were collected at hospital between January 2010 and October 2011, while data on adherence to lifestyle changes 3, 6, and 12 months after discharge. Results: The baseline lifestyle habits did not differ significantly other than in alcohol behaviour. Both groups increased their intake, but the intervention group to a lesser degree. However, the experimental group significantly lost their weight for the first 3 and 6 months; at 3 months reduction in cigarette consumption and at 6 months significant increases in smoking cessation were also achieved. All improved some of their lifestyle habits. Intervention was associated with support from nurses as well as from family and friends. Adherence scores were higher in the experimental group. Conclusion: Some short‐term advantages in lifestyle habits due to the intervention were noted. Participants in both groups improved some of their lifestyle habits.

Background: Studies have shown that counseling about risk factor-related lifestyle habits can produce significantly beneficial changes in stroke patients’ lifestyle habits. However, it is not sufficient nearly to provide a patient with appropriate information, but the quality of lifestyle counseling is also essential. The aim of the study was to investigate the effects of lifestyle counseling intervention on lifestyle counseling quality in stroke and TIA patients. Methods: Post-test control group design was used. Stroke and TIA patients (n=98), divided into intervention and control group, completed Counseling Quality Questionnaire after receiving lifestyle counseling at the hospital (January 2010–October 2011). Data were analyzed with analysis of variance. Results: The patients rated lifestyle counseling quality quite high in terms of all sum variables except patient centeredness. Counseling quality except for counseling resources was estimated to be significantly better by the intervention group. Conclusion: Lifestyle counseling quality at hospital can be enhanced by counseling intervention. More attention to factors that promote patient centeredness of counseling is required since patient centeredness has repeatedly been recognized as the weakest aspect of counseling by both stroke patients and other patient groups.

The purpose of the study was to explain the effects of risk factor targeted lifestyle counselling intervention on quality of lifestyle counselling and on adherence to lifestyle change in stroke patients. Content and characteristics of stroke patient counselling was described (I) with narrative literature review (n=33). Lifestyle habits of hospital-admitted stroke patients were described and explained (II) with cross-sectional design (n=150). Quasi-experimental, nonequivalent control group pretest-posttest design explained (III) the effects of lifestyle counselling intervention on working-age stroke patients’ adherence to lifestyle change (n=75/group). Cross-sectional, explorative between-groups prospective design explained (IV) associations between the quality of counselling and adherence to lifestyle change during the 12-month follow-up (n=98). The literature data was gathered from the databases and analysed with content analysis (I). The empirical data was collected with Lifestyle (II), Adherence to Lifestyle Change (III, IV) and Counselling Quality (IV) instruments. Descriptive statistics, factor analysis, cross-tabulation of variables, logistic regression, and ANCOVA were used for data analysis. Counselling was described with seven themes: information about the disease and concerns regarding stroke, aims of counselling, counselling methods, interaction as a method for counselling, stroke nurse as a counsellor, emotional support and decision making in patient care (I). Patients were overweight or obese (75%) and 86.7% had high waist circumference levels. They generally had rather unhealthy eating habits, were physically inactive and quite highly stressed, and 33.5% drank to excess every month or every week, and 32.9% were current smokers (II). After intervention the experimental group lost their weight at 3 and 6 months, reduced cigarette consumption at 3 months, and increased smoking cessation at 6 months. The experimental group received more support fr, Tiivistelmä Tutkimuksen tarkoituksena oli selittää aivoverenkiertohäiriöpotilaiden (AVH) riskitekijöihin kohdistuvan elintapaohjausintervention vaikutuksia elintapaohjauksen laatuun ja elintapamuutokseen sitoutumiseen. Ohjauksen sisältöä ja ominaispiirteitä kuvattiin (I) narratiivisen kirjallisuuskatsauksen avulla (n=33). AVH-potilaiden elintapoja (n=150) sairaalaan tulovaiheessa kuvattiin ja selitettiin (II) poikkileikkaustutkimuksella. Kvasikokeellinen tutkimus selitti (III) elintapaintervention vaikutuksia työikäisten AVH-potilaiden elintapamuutokseen sitoutumiseen (n=75/ryhmä). Ohjauksen laadun ja elintapamuutokseen sitoutumisen välistä yhteyttä 12 kuukauden seurannan aikana selitettiin (IV) poikkileikkaus- ja pitkittäistutkimuksen avulla (n=98). Kirjallisuuskatsauksen aineisto kerättiin tietokannoista ja analysoitiin sisällön analyysillä (I). Empiirinen data kerättiin elintapamittarilla (II), elintapamuutokseen sitoutumismittarilla (III, IV) ja ohjauksen laatu mittarilla (IV). Aineisto analysoitiin kuvailevin tilastollisin menetelmin, faktorianalyysillä, ristiintaulukoinnilla, logistisella regressiolla sekä varianssianalyysillä. Seitsemän teemaa kuvasi ohjausta: tieto sairaudesta ja siihen liittyvistä tekijöistä, ohjauksen tavoitteellisuus, ohjausmenetelmät, vuorovaikutus ohjausmenetelmänä, sairaanhoitaja ohjaajana, emotionaalinen tuki, sekä potilaan hoitoon liittyvä päätöksenteko (I). Potilaista 75% oli ylipainoisia tai lihavia ja suurella osalla vyötärönympärys oli liian suuri (86.7%). He söivät jokseenkin epäterveellisesti, liikkuivat liian vähän ja olivat stressaantuneita. Potilaista 33.5% joi humalahakuisesti kuukausittain tai joka viikko ja 32.9% tupakoi (II). Koeryhmän potilaiden paino laski kolmen ja kuuden kuukauden kuluttua kotiutumisesta. Savukkeiden määrä väheni kolmen kuukauden kuluttua kotiutumisesta ja tupakoinnin lopettaminen lisääntyi kuuden kuukauden kuluttua. Koeryhmän potilaat saivat enemmän tukea hoitajilta, perheeltä ja ystäviltä (III). Oh