Högskolan i Skövde

Purpose Rectal cancer and its treatment have a negative impact on health-related quality of life (HRQoL). If risk factors for sustained low HRQoL could be identified early, ideally before the start of treatment, individualised interventions could be identified and implemented to maintain or improve HRQoL. The study aimed to develop a multivariable prediction model for global HRQoL 12 months after rectal cancer treatment.

Methods Within COLOR II, a randomised, multicentre, international trial of laparoscopic and open surgery for rectal cancer, a sub-study on HRQoL included 385 patients in 12 hospitals and five countries. The HRQoL study was optional for hospitals in the COLOR II trial. EORTC QLQ-C30 and EORTC QLQ-CR38 were analysed preoperatively and at 1 and 12 months postoperatively. In exploratory analyses, correlations between age, sex, fatigue, pain, ASA classification, complications, and symptoms after surgery to HRQoL were studied. Bivariate initial analyses were followed by multivariate regression models.

Results Patient characteristics and clinical factors explained 4–10% of the variation in global HRQoL. The patient-reported outcomes from EORTC QLQ-C30 explained 55–65% of the variation in global HRQoL. The predominant predictors were fatigue and pain, which significantly impacted global HRQoL at all time points measured.

Conclusion We found that fatigue and pain were two significant factors associated with posttreatment global HRQoL in patients treated for rectal cancer T1-T3 Nx. Interventions to reduce fatigue and pain could enhance global HRQoL after rectal cancer treatment.

The global pandemic, COVID-19 shattered everyday life as we know it and disrupted education globally. In this study, we explore an initiated digital transformation accelerated by the pandemic from school leaders’ perspectives in the context of Swedish high schools. The data consists of a questionnaire with 105 school leaders containing both fixed and open-ended response types. The results reveal significant differences in school leaders’ views on how the transition has worked, whether they and their staff have developed their digital competence, and, how it will affect the school onwards. Contributions include theorising about school leaders’ experiences of navigating an accelerated digital transformation prompted by the pandemic. We introduce four school leader profiles: (a) the enthusiast, (b) the affirmative (c) the skeptical, and (d) the hesitant. These profiles serve to encapsulate the nuanced perspectives of school leaders, thereby enriching our comprehension of their diverse requirements and priorities.

Objective

One crucial prerequisite for increased patient empowerment is the willingness among patients to take a more active role. The aim of this study was to develop questionnaires for measuring a patient’s willingness to be empowered in general and by using e-health.

Methods

The study was based on a random sample from an online panel. The 800 responders were Swedish citizens and reflected the internet-using population in Sweden regarding age, gender, income, and education. The measurement properties were evaluated according to the Rasch Measurement Theory.

Results

The analyses showed two questionnaires with adequate fit to the basic measurement model and with high reliability (PSI 0.84 and 0.89, respectively).

Conclusion

We conclude that this study generated two questionnaires with an intuitive order of items illustrating an understandable progression of willingness to be empowered in general as well as for e-health.

Practice implications

The suggested questionnaires are valuable tools supporting the effort to tailor empowerment strategies to meet the patient’s willingness. Questionnaires will also be valuable for evaluating strategies for supporting willingness, studying factors related to willingness and potential inequalities due to e.g. varying digital literacy, and for enabling identification of patient stereotypes using cluster analyses.

The COVID-19 pandemic, clearly illustrated the magnitude of threat caused by communicable diseases and the importance of public health work. In addition, an aging population, increasing costs of health care, epidemic non-communicable diseases and health issues raised due to climate changes are also present challenges illustrating that the need for a competent public health workforce is greater than ever.

Furthermore, the digitalization that progressively permeates our society also transforms public healthcare profession. For instance, digitalization has the potential to make healthcare systems more efficient; to support a people centered care and increased empowerment, a kind of flipped healthcare is . The digitalization in public health is still in its infancy, and there is a need for how it could be planned, introduced and implemented in an evidence-based manner. Furthermore, digitalization also enables increased cooperation and knowledge sharing and increased access to information, i.e. crucial ingredients in evidence-based work.

The digitalization and the transformation of the public healthcare workers landscape accentuates the need for strong competence in research methodology, theory and how it underpins public health practice i.e. one of the core competencies for public health workers. Public health workers must know how to find information, how to analyze and evaluate evidence from several sources and how this could support evidence-based decisions. Traditionally, public health educational programs include scientific and information literacy as learning outcomes, supported by courses in e.g. research methods, biostatistics and epidemiology. These “methodological courses” are accompanied by “subject courses” with different theoretical aspects of public health. One advantage with separated courses is that students get the chance to fully concentrate on one theory and its complexity, e.g. biostatistics. On the other hand, there is a risk that the relationship to subject courses may be weak. For instance, a course in biostatistics may be focusing on different significance test and how to interpret confidence interval, which are rather complex theory demanding time for reflection and understanding, leaving very little or no time over for putting the analyses in its professional context, discussing how statistical analyses are interpreted and used as support for an evidence based public health decision.

In short, one challenge in an educational program is how to integrate methodological and subject courses in a synergetic way. It is also crucial to consider the progression in scientific method beyond the subject progression in a program. Finally, information literacy, pointed out as one of the 21st century skills in our information society, is also vital for public health workers.

This article describes the method used and findings in a work aiming at developing the progression of scientific literacy, including information literacy, and integration of scientific and subject literacy in a bachelor program in public health. The specific questions addressed in this work was:

- How to increase the integration and synergy between “methodological courses” and “subject courses”

- Evaluate and develop the progression in scientific literary

- Evaluate and develop the progression in information literacy, using library-faculty partnership

In 2020, a global pandemic changed the educational landscape overnight and caused an abrupt transition to virtual classrooms. This study aims to gain increased knowledge of teachers’ experiences of facing such radical digitalization through ideal types. The data include a teacher survey with 1109 respondents from 15 high schools in Sweden, containing both fixed and open-ended response types. Educational affordances and digital competence are used as analytical lenses. The results show distinct differences regarding teachers’ perception of how teaching in a virtual classroom has worked and whether they and their students have developed their digital competence during this period. We present four ideal types: a) the enthusiast, b) the skeptic, c) the pessimist, and d) the affirmative, which capture the essence of teachers’ multifaceted experiences, actions, and affordances perceived in the transition to virtual classrooms. Contributions include theorizing about teachers’ encounters with radical cases of digitalization. © The Author(s) 2022.

The importance of user behaviour in the cybersecurity domain is widely acknowledged. Users face cyberthreats such as phishing and fraud daily, both at work and in their private use of technology. Using training interventions to improve users’ knowledge, awareness, and behaviour is a widely accepted approach to improving the security posture of users. Research into cybersecurity training has traditionally assumed that users are provided such training as members of an organization. However, users in their private capacity are expected to cater for their own security. This research addresses this gap with a survey where 1437 Swedish adults participated. Willingness to adopt and pay for different cybersecurity training types was measured. The included types were; training delivered to users in a context where the training is of direct relevance, eLearning and game-based training. The participants were most willing to adopt and pay for contextual training, while eLearning was the second most favoured training type. We also measured if willingness to pay and adopt cybersecurity training was impacted by the participant’s worry about various cyber threats. Surprisingly, no meaningful correlation was found, suggesting that something else than worry mediates willingness to adopt and pay for cybersecurity training. 

PURPOSE: The number of colorectal cancer patient survivors is increasing. Information and support during and after treatment are requested by patients, but questions remain on what to provide. The aim of this study was to understand what informational needs colorectal cancer patients and survivors have, with a focus on the potential support given by patient peers and the use of blended care.

METHODS: A qualitative study using focus groups was conducted with patients diagnosed at the same hospital at least one year prior to the initiation of the study. The focus group interviews were transcribed verbatim and analyzed using deductive content analysis.

RESULTS: The need for informational support varied over time and depended on individual patient characteristics. Timing was crucial and patients requested options of blended care and informational support after treatment cessation. The patients felt alone after treatment and requested assistance in communication with their next-of-kin. They also identified the value of peer support, especially to contextualize knowledge provided by healthcare.

CONCLUSION: This study showed a need for focus on individualized informational support. Blended care through integrating communication with peers online could be one way to support patients, both to enable shared decision-making as well as to provide person-centered care.

Increased patient engagement and the use of new types of data, such as patient-generated health data (PGHD) is shifting how work is performed in relation to healthcare. This change enables healthcare professionals to delegate parts of work previously conducted by them to patients. There is a consensus regarding the need for nurses and physicians to work seamlessly together to make healthcare flow, but the role and responsibility of patients are less researched. In this paper, we aim to fill that gap by focusing on the shift of work from healthcare professionals to patients from the perspective of i) patients and ii) healthcare professionals. We use infrastructuring as a lens to understand the design of everyday work and actions from both perspectives. The main contribution is an analysis of, and insights into, how the work of patients can support healthcare professionals along with a conceptualization of how infrastructuring processes within and outside of healthcare are interconnected.

BACKGROUND: The use of online resources has changed how people manage health care processes. Patients seek information about health conditions, guidance in treatment, and support from peers online, complementary to traditional health care trajectories. Online communities have the potential to contribute to the quality of care by increasing patient empowerment; however, there is a gap in research regarding in what way online communities contribute to patient empowerment.

OBJECTIVE: We synthesized research regarding how online communities contribute to patient empowerment to address the research question "In what ways can participation in online communities support patient empowerment?" by studying how patient empowerment is operationalized in different studies. The definition of patient empowerment used in this paper is enablement for people to develop mastery over actions and control over decisions that influence their lives. The mastery is both through processes and outcomes of the development.

METHODS: A systematic review was conducted by searching in the following databases: Scopus, ACM Digital Library, EBSCO (CINAHL and MEDLINE), PubMed, and Web of Science. In total, there were 1187 papers after excluding duplicates, and through selection processes using an analytical framework with definitions of patient empowerment and related concepts, 33 peer-reviewed papers were included.

RESULTS: Findings indicated that online communities support patient empowerment both as a process and as outcomes of these processes. Additionally, it was seen as a complement to traditional health care and encouragement for health care professionals to have a more positive attitude toward patients' usage. There was a mix between deductive (19/33, 58%), inductive (11/33, 33%), and a mixed approach (3/33, 9%) of studying patient empowerment in various forms. The online communities in most papers (21/33, 64%) were well-established and represented patients' initiatives.

CONCLUSIONS: There is a need to include professionals' perspectives regarding how health care can embrace patient empowerment through online communities. This systematic review's main contribution is the proposal of a new framework and conceptualization of how patient empowerment in online communities can be understood from different hierarchical levels.