Högskolan i Skövde

Background: Loneliness is recognized as a global health threat. Older adults are vulnerable to loneliness due to life changes common in old age. While individual risk factors for loneliness in old age are well-documented, contextual factors are scarcely explored, such as digitalization. Rapid digitalization underscores the need to explore the long-term association between the use of digital devices and loneliness.

Objective: This study aimed to explore whether and how the use of digital devices is associated with changes in loneliness in a population-based sample of middle-aged and older adults in a context where digital technology and digital environments were introduced and rapidly evolving.

Methods: Data were obtained from the longitudinal cohort study, the Swedish Adoption/Twin Study of Aging (SATSA; N=771; mean age 69.64 years, SD 11.00). Daily digital use and loneliness were assessed across 5 waves between 2004 and 2014. Age, sex, education, living situation, self-rated health, and the personality traits openness and extraversion were assessed at baseline. Growth mixture modeling was used to identify latent trajectories of loneliness, and multinomial logistic regression was used to predict class membership based on baseline daily digital use and covariates.

Results: Three latent loneliness classes were identified: class 1 (10.5%; high intercept and significant increases in loneliness), class 2 (33.2%; intermediate stable loneliness), and class 3 (56.3%; low stable loneliness). Daily digital use at baseline is significantly associated with lower odds of belonging to the high-increasing loneliness group (class 1) compared to the low-stable group (class 3; odds ratio 0.27, 95% CI 0.08-0.90; P=.03). Differences between classes were not explained by the personality traits.

Conclusions: Daily use of digital devices is associated with lower and more stable levels of loneliness over time, compared to not using digital devices daily, which is associated with higher and increasing levels of loneliness. These findings, based on data from early adopters of digital technology, lend further support to the idea that digital use is associated with lower levels of loneliness and less increase in loneliness. Hence, these findings suggest that use of digital devices may represent a noninvasive approach to addressing loneliness in older adults.

Introduction: Loneliness, a global health problem, increases with advancing age. The digitalization of society has the potential to either increase or decrease loneliness. This study aims to investigate the cross-sectional association between digital living and loneliness in the context of other risk factors in a sample of late middle-aged and older adults, using a measure of embracement of digitalization in daily life.

Methods: In total, 441 Swedish adults (response rate 44%) aged 55 to 93 years of age who responded from December 2023 to January 2024. Embracement of digitalization was measured using the Digital Living Index, and loneliness with the UCLA Loneliness Scale.

Results: The mean score for perceived loneliness was 35.64 (SD = 10.55), positioning the participants at the threshold between low and moderate levels of loneliness. In the final multivariate linear regression model, including established risk factors for loneliness, low digital living was estimated to be 3.3 and 4.1 units higher in loneliness compared to mid and high digital living (p = 0.005), respectively. Mental health was estimated to be the strongest predictor of loneliness, with a difference of 14.1 units between bad or very bad mental health and very good (p < 0.001).

Conclusion: Higher digital living appears to be associated with lower levels of loneliness even when other established risk factors for loneliness are controlled for. Supporting late middle-aged and older adults to overcome the digital divide, from access and use to embracement, could potentially be a tool to battle loneliness, and hence to improve public health. 

Background: Healthcare systems struggle with an imbalance between the required resources and existing demand. The number of patients seeking emergency care has increased steadily, placing additional strain on emergency departments, which are also challenged by a high volume of non-urgent visits. When patients perceive a need to seek emergency care, the decision is influenced by various factors, including the availability and quality of support and the information they use to make informed decisions. Digital health support encompasses a range of technologies designed to assist at various stages of the healthcare continuum. They are intended to support patients and personnel, as well as effective resource utilization in healthcare. More knowledge is needed to understand the factors involved when patients decide to seek emergency care, and how digital health support can be introduced to benefit both patients and personnel. This study aims to identify and understand important factors that influence patients’ decisions when seeking emergency care, focusing on the information they gather and various sources of support, especially digital health support.

Methods: This qualitative interview study included 31 participants seeking care at an emergency department in western Sweden. The data were analysed through reflexive thematic analysis.

Results: The analysis resulted in four themes: (1) human support needed; (2) going back and forth about making the right decision; (3) digital reassurance; and (4) digital support with hesitation. The participants based their decisions on various forms of information and support. Patients who used digital health support reported mixed experiences, describing both opportunities and barriers. Some patients mentioned expectations for future digital solutions, mainly expressing a desire to preserve human contact.

Conclusion: Patients strive to make the right decision about whether, when, and where to seek care in perceived urgent situations. In this decision-making process, patients use human and digital support for guidance and to facilitate their decision. However, navigating the healthcare system is challenging for patients, and digital health support provides both enabling opportunities and several obstacles. The results of this study indicate that further development of digital health support for patients seeking emergency care would benefit if end users were included in the co-creating process.

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.

Denna rapport innehåller en kartläggning av digitalisering, ensamhet och hälsa i Skövde kommun. Resultaten baseras på en enkät som skickats ut till 1000 invånare i Skövde kommun som är 55 år eller äldre. Enkäten har tagits fram i samverkan mellan Skövde kommun och Högskolan i Skövde. Rapporten vänder sig främst till politiker, beslutsfattare och handläggare som arbetar med frågor som berör digitalisering, ensamhet och hälsa. Andra målgrupper finns inom civilsamhälle, näringsliv och forskning.

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.