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Purpose: This study explored how health professionals experience in what way a digital self-monitoring solution influences their consulting practice targeting individuals with low back pain. Material and Methods: This was a qualitative study adopting a constructivist grounded theory approach. Nineteen health professionals participated in the pilot test of the digital self-monitoring solution BackTrace. Data were collected cross-sectionally and consisted of: (a) audio recordings from focus groups with health professionals, (b) field notes from participant observation of online meetings with health professionals, (c) field notes from participant observations of consultations between health professionals and individuals with low back pain and (d) audio recordings from workshops with health professionals. Results: Two main themes and one sub-theme were identified, describing how BackTrace enabled more focused consulting practices, supported patient-self management and improved the relationship between individuals with low back pain and health professionals. Barriers were identified describing how the implementation of digital health solutions required a change in workflow, resources and culture - as well as management support. Conclusions: Findings indicated a need for a change at the system level, including a changed view of digitisation in healthcare systems containing a more supporting approach. IMPLICATIONS FOR REHABILITATION: Low back pain is a leading cause of disability which not only impacts physically but restricts quality of life. This study shows how health professionals experience in what way digital self-monitoring solutions influence their consulting practices targeting individuals with low back pain. A digital self-monitoring solution may contribute to a more focused consulting practice and improve the quality of the relationship between individuals with low back pain and health professionals but require changes at a system level. A change in workflow and culture is recommended if digital health is to be a success. [ABSTRACT FROM AUTHOR]

Background: Fear-avoidance in COPD can have detrimental effects on pulmonary rehabilitation (PR) outcomes and is therefore important to address. This prospective study examined changes in and management of COPDrelated anxiety symptoms over the course of a PR program. Methods: Patients with COPD referred to 9-weeks of PR in the municipality of Vejle, Denmark from January to December 2022 completed a six-minute walk test (6MWT) and the following questionnaires, both before and after PR: COPD Anxiety Questionnaire 20-item version (CAF-R), measuring COPDrelated anxiety; COPD Assessment Test (CAT), measuring COPD-related disability; 12-Item Short-Form Health Survey (SF-12), measuring health-related quality of life (HR-QoL); sociodemographic and disease-related information. After PR, a subsample of the patients took part in semi-structured interviews exploring their understanding of how they managed COPD-related anxiety during PR. Pre- and post-assessment of COPD-related anxiety and other PR outcomes were analysed with t-tests and correlation analyses. Qualitative interviews were analysed using a thematic analysis approach. Results: A total of 72 patients with COPD (mean ± SD age 71 ± 8, 53% female) were included in the study, and 13 took part in qualitative interviews. A significant decrease in COPD-related anxiety was observed from before to after PR, corresponding to a small effect size (Cohen's d = 0.32; p = 0.018). Reductions in COPD-related anxiety were not associated with improvements in COPD-related disability, HR-QOL, or functional exercise capacity. The qualitative findings identified four anxiety management strategies, i.e., "planning", "problem-solving", "accepting", and "confronting", which were influenced by interactions with healthcare professionals and co-patients as well as patients' own perception. Conclusions: COPD-related anxiety symptoms was reduced after PR, potentially through the use of various management strategies. The strategies appeared to be influenced by interactional factors during the PR program. [ABSTRACT FROM AUTHOR]

In Denmark, 12,000 people live with Parkinson's disease. Parkinson's disease is a chronic neurodegenerative disease that requires specialized interventions based on a coordinated interdisciplinary and intersectoral approach. This study aims to illuminate challenges experienced by professionals related to creating coordinated pathways for people with Parkinson's disease and their relatives in a Danish context. The study is based on ten qualitative interviews with healthcare professionals from different professional backgrounds; the interviews were analyzed using qualitative content analysis. The analysis revealed four themes: Collaboration happens by coincidence; Geography dictates treatment offers; Professionals have no influence over treatment offers; and, Achieving new knowledge can be a challenge.These barriers challenge health care professionals to create a coordinated individualized pathway. Consequently, people living with Parkinson's disease and their relatives must seek and coordinate activities themselves, and ultimately interventions may not target individual needs, risking inequality in treatment and care. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to explore the expectations of and experiences with the public healthcare system of domestic partners of people with Parkinson's disease (PD) in Denmark and Norway. Methods: A qualitative exploratory design was applied. The sample consisted of 14 people from Denmark (n = 9) and Norway (n = 5) living with a partner with PD. Semi-structured individual interviews were conducted between June and September 2020, digitally recorded, transcribed verbatim and analysed using a reflexive thematic analysis approach combining inductive and deductive approaches. Results: The main themes were 'negotiating systems of support' and 'balancing being both a partner and a family carer'. Partners take responsibility for the people with whom they live and attempt to fill gaps in the public healthcare system. The most frequently described needs were more information, service coordination as the illness progressed and acknowledgement of the complex role. Discussion: A recommendation for practice is recognition of the complex roles of partners to people with PD and reaching out to both regularly to determine needs. This may enhance the collaboration between partner carers, people with PD and healthcare providers, ensure sustainability of the system and optimise living with PD in the family. [ABSTRACT FROM AUTHOR]

Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long‐term conditions such as Parkinson's disease. Objective: This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. Methods: A mixed‐methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta‐ethnography approach was used to analyse and synthesize cross‐national findings. Results: A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. Conclusions: Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. Patient or Public Contribution: Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings. [ABSTRACT FROM AUTHOR]

Ethnic minority patients have been discussed and problematised in Western health literature. Drawing on an interpretation of central parts of the French philosopher Michel Foucault's authorship, we analysed a broad selection of materials to identify mechanisms through which the truth about ethnic minority patients is constructed. We identified a single, yet consistent discursive strategy that we termed 'figure of inconvenience' in which ethnic minority patients were classified and assigned a specific subjection illustrating them as 'inconvenient' to the nurse's practice. Concurrently, their relatives were afforded the position of substitutes. The discourse exemplifies how the behaviour or appearances of ethnic minority patients cannot be reconciled with the traits of ethnic Danish patients. Finally, we discussed implications that such a strategy may have for the provision of healthcare services for ethnic minority patients in Denmark. [ABSTRACT FROM AUTHOR]

Aims: To explore the existential significance of living with the risk of being infected with coronavirus in patients with COPD. Background: Distancing measures aim to break the coronavirus transmission chains. Physical separation from social networks and social isolation are correlated with anxiety and depression. People with a chronic obstructive lung disease are particularly vulnerable due to the increased risk of a serious course of illness, so therefore many of them choose self‐isolation to protect themselves from COVID‐19. Design: A qualitative exploratory study using individual semi‐structured interviews. Methods: From June–September 2020, 13 participants were recruited through advertisements on Facebook as a convenience sample for semi‐structured individual interviews. The interviews took place through virtual platforms or in physical meetings. Data were analysed using Ricoeur's phenomenological approach, involving naïve reading, a structural analysis and a critical interpretation strategy. The study has been reported in line with COREQ guidelines. Findings: Living with the threat of being infected with coronavirus has greatly affected everyday life for patients with COPD. The nagging fear of coronavirus as a death threat was a dominant feeling, together with anxiety, loneliness and hope. With self‐isolation, followed concerns of being forgotten and thoughts of the future, balancing between fearing the worst, and hoping the best. Conclusions: Patients with moderate to severe COPD feel compelled to self‐isolate, as they fear dying from COVID‐19. The study revealed a need for proactive contact with health professionals to calm the patients' feelings of deprivation, loneliness, hopelessness and anxiety. Relevance to clinical practice: Information about the patient's perspective may be used to develop targeted interventions aimed at giving adequate information, supporting hope, implementing digital or virtual solutions to keep in contact and avoid the feeling of being alone and forgotten during a pandemic crisis. [ABSTRACT FROM AUTHOR]

To explore hospital and nursing home patients' experiences with delirium assessments and better understand their attitudes, we used a qualitative method to summarise, in everyday terms, specific events observed by researchers and experienced by patients. We performed participant observations of delirium assessments of eight patients and conducted individual semi-structured face-to-face interviews with seven other patients. We carried out content analysis using an inductive approach. Our findings indicate that patients approached delirium assessment with initial scepticism due to a lack of knowledge. Their scepticism changed to complete acceptance after the assessment's purpose was explained. However, some patients gave up on the assessment due to cognitive challenges, lack of energy, fatigue, or language barriers. Patients appreciated that professionals were interested in their mental and physical well-being. Despite initial scepticism, the patients found the delirium assessment valuable when they better understood its purpose. Thus, healthcare professionals should provide patients with relevant information about delirium assessments. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to develop a theoretical account of the behavioural pattern of adherence to home-based inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD), performed as two daily sessions of 30 breaths with mechanical threshold loading. Methods: This was a qualitative study based on the classic grounded theory method. We conducted interviews with people living with COPD recruited after completion of 6 weeks of outpatient pulmonary rehabilitation program in 2015. Concurrently, we generated data and performed analyses by means of constant comparative analysis and theoretical sampling that focused on the behavioural characteristics of adherence to IMT. Results: We achieved theoretical saturation of substantive codes with 33 interviews, nine of which were with men. The participants' mean age and forced expired volume in the first second were 65 (SD 8) years and 59.1 (SD 13.9) percent of predicted, respectively. Seventeen participated in face-to-face interviews, and 16 participated in telephone interviews. The core category "Preserving Integrity" emerged as representative of the primary pattern of behaviour related to the inspiratory muscle-training regimen. Through this pattern, the participants resolved the main concern of losing integrity. Preserving Integrity involved three behavioural modes of adherence to home-based IMT: evading, misgiving, and involving modes. Conclusions: The participants' behavioural modes regarding adherence revealed patterns of both intended and unintended nonadherence. In particular, support offered by healthcare professionals should target people with unintended nonadherence and scepticism about the effects of IMT to maximise the possibility of adherence. When implementing inspiratory muscle training, healthcare professionals should be prepared to spend considerable time providing attention and support to participants who feel challenged during the execution of inspiratory muscle training. Support offered by healthcare professionals should target people with scepticism about the effects of inspiratory muscle training to maximise the possibility of adherence. Intended adherence to inspiratory muscle training appeared to be firmly rooted, which means that healthcare professionals can pay less attention to patients with strong intentions to ensure adherence. [ABSTRACT FROM AUTHOR]

Aims and objectives To present a theoretical account of the pattern of behaviour in patients with acute respiratory failure due to chronic obstructive pulmonary disease while undergoing noninvasive ventilation in a hospital setting. Background Strong evidence supports a positive effect of noninvasive ventilation, but successful treatment remains a challenge. Little attention has been given to patient intolerance to noninvasive ventilation as a cause of treatment failure. A better understanding of the patients' patterns of behaviour during noninvasive ventilation may improve treatment success. Design A constant comparative classic grounded theory study was performed. Methods Data collection consisted of participant observation during the treatment of 21 patients undergoing noninvasive ventilation, followed by interviews with 11 of the patients after treatment completion. Data were collected from December 2009- January 2012. Results A substantive theory of striving for habitual well-being was developed. The theory included three phases: initiation, transition and determination. Each phase contained a set of subcategories to indicate the dimensions of and variations in the participants' behaviour. Conclusions The substantive theory revealed that the patients' behaviour was related to their breathlessness, sensation of being restrained by the mask and head gear, and the side effects of noninvasive ventilation. Relevance to clinical practice This inter-relationship should be addressed in the use of noninvasive ventilation for the treatment of patients with chronic obstructive pulmonary disease to achieve treatment success. [ABSTRACT FROM AUTHOR]