scholarly journals The Implementation of Welfare Technology in Municipal Care: A Qualitative Study of Procurement Practices in Sweden

2021 ◽  
Author(s):  
Sanna Kuoppamäki
Keyword(s):  
Ethical Issues ◽  
End Users ◽  
Political Strategy ◽  
Structured Interviews ◽  
Procurement Process ◽  
Ethical Competence ◽  
Care Services ◽  
Qualitative Interview Study ◽  
Welfare Technology ◽  
The Impact

Abstract Background: Welfare technology has been launched as a concept to accelerate digital transformation in care services, but the implementation of these technologies is still hindered by organisational resistance, lack of infrastructure, and juridical and ethical issues. This paper investigates the decision-making among municipal actors in the implementation of welfare technology in a specific task that is procurement. The study explores the perceptions and negotiations in purchasing welfare technology in each stage of the procurement model revealing the impact of technical, economic, juridical and ethical competence on the mapping and planning, procurement, implementation and management of welfare technology. Methods: The study presents empirical findings from a qualitative interview study for municipal actors in Sweden. Semi-structured interviews were gathered among procurement managers, IT managers, and managers in social administrators in three different municipalities in 2020 (N=8). Inductive content analysis and systematic categorisation were employed resulting to 17 sub-categories, 9 generic categories and 3 main categories of procurement practices. Results: Challenges in the procurement practices occur in all stages of the procurement model. In mapping and planning, municipal actors outline barriers the need analysis, requirement specification and market analysis. In procurement stage, economic resources, standardisation and interoperability hinder the procurement process. Implementation and management is complicated by supplier assessment, legislation, cross-organisational collaboration and political strategy. Building on these findings, the study defines the procurement competence to consist of technical, economic, juridical and ethical expertise to assess and evaluate welfare technology. Technical and ethical competence is needed in early stages of the procurement, whereas juridical and economic competence relates to later stages of the model.Conclusions: Procurement competence is associated with the implementation of welfare technology in 1) assessment of the end-users needs, 2) estimation of the costs and benefits of welfare technology, and 3) management of the juridical and legislation issues in data management. Economic and juridical decisions to purchase welfare technology are not value-neutral, but rather associated with socially shared understandings of technological possibilities in care provision. Optimisation of procurement process requires a combination of capabilities to implement welfare technology that meet the demands and needs of end-users.

scholarly journals The application and deployment of welfare technology in Swedish municipal care: a qualitative study of procurement practices among municipal actors

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sanna Kuoppamäki
Keyword(s):  
Ethical Issues ◽  
Qualitative Interviews ◽  
Political Strategy ◽  
Structured Interviews ◽  
Procurement Process ◽  
Ethical Competence ◽  
Care Services ◽  
Welfare Technology ◽  
Process Perspective ◽  
The Impact

Abstract Background Welfare technology has been launched as a concept to accelerate digital transformation in care services, but the deployment of these technologies is still hindered by organisational resistance, lack of infrastructure, and juridical and ethical issues. This paper investigates decision-making among municipal actors in the application and deployment of welfare technology from a procurement process perspective. The study explores the perceptions and negotiations involved in purchasing welfare technology at each stage of the procurement model, revealing the impact of technical, economic, juridical and ethical competence on the mapping, planning, procurement, implementation and management of welfare technology. Methods The study presents empirical findings from qualitative interviews conducted among municipal actors in Sweden. Semi-structured interviews were gathered in 2020 among procurement managers, IT managers, and managers in social administration in three different municipalities (n = 8). Content analysis and systematic categorisation were applied resulting in the division of procurement practices into sub-categories, generic categories and main categories. Results Challenges in the application and deployment of welfare technology occur at all stages of the procurement model. In mapping and planning, barriers are identified in the need analysis, requirement specification and market analysis. In the procurement stage, economic resources, standardisation and interoperability hinder the procurement process. Implementation and management are complicated by supplier assessment, legislation, cross-organisational collaboration and political strategy. Building on these findings, this study defines ‘procurement competence’ as consisting of technical, economic, juridical and ethical expertise in order to assess and evaluate welfare technology. Technical and ethical competence is needed in early stages of procurement, whereas juridical and economic competence relates to later stages of the model. Conclusions Procurement competence is associated with the application and deployment of welfare technology in (1) assessment of the end-user’s needs, (2) estimation of the costs and benefits of welfare technology and (3) management of juridical and legislative issues in data management. Economic and juridical decisions to purchase welfare technology are not value-neutral, but rather associated with socially shared understandings of technological possibilities in care provision. Optimisation of procurement processes requires a combination of capabilities to introduce, apply and deploy welfare technology that meets the demands and needs of end-users.

scholarly journals Swedish primary healthcare practitioners’ perspectives on the impact of arts on prescription for patients and the wider society: a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anita Jensen ◽  
Hilary Bungay
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Primary Healthcare ◽  
Social Issues ◽  
Care Pathway ◽  
Medical Model ◽  
Structured Interviews ◽  
Care Services ◽  
Qualitative Interview Study ◽  
The Impact

Abstract Background There is growing evidence that participating in arts activities are beneficial for mental health and wellbeing. Many patients attending primary care services have mental ill-health or social issues that healthcare practitioners currently do not have adequate ways of supporting. This study set out to explore the perspectives of primary healthcare practitioners on Arts on Prescription (AoP) as an additional referral pathway. Methods A qualitative exploratory descriptive approach within an interpretive framework using semi-structured interviews was used to explore healthcare practitioners’ perspectives and experiences of AoP programmes in Sweden. Ten interviews were conducted with healthcare practitioners in primary care. Data were analysed using an inductive thematic approach. Results The healthcare practitioners interviewed, recognised the need for more holistic approaches to care for those with mental health issues. They perceived that AoP is beneficial for patients in terms of motivation, creating routines, providing social interactions, and increasing self-esteem. In addition, AoP was felt to have the potential to impact upon current service provision and wider society. However, whilst the opportunity to refer patients to AoP in conjunction with conventional treatments was valued, participants reported that time pressures on practitioners and the continuing dominance of the medical model of care were barriers to wider acceptance amongst practitioners at the present time. Conclusions AoP enabled primary healthcare practitioners to offer an additional pathway for patients that is an adjunct to the traditional care pathway. However, the programmes tend to be project-based and often time limited. For programmes to be sustainable and be included as part of a wider range of interventions available to healthcare practitioners’ suitable levels of funding would be required.

scholarly journals How are patients with rare diseases and their carers in the UK impacted by the way care is coordinated? An exploratory qualitative interview study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Amy Simpson ◽  
Lara Bloom ◽  
Naomi J. Fulop ◽  
Emma Hudson ◽  
Kerry Leeson-Beevers ◽  
...  
Keyword(s):  
Care Coordination ◽  
Structured Interviews ◽  
School Work ◽  
Travel Costs ◽  
Care Plans ◽  
Use Of Technology ◽  
Number Of Factors ◽  
Qualitative Interview Study ◽  
The Uk ◽  
The Impact

Abstract Background Care coordination is considered important for patients with rare conditions, yet research addressing the impact of care coordination is limited. This study aimed to explore how care coordination (or lack of) impacts on patients and carers. Semi-structured interviews were conducted with 15 patients and carers/parents in the UK, representing a range of rare conditions (including undiagnosed conditions). Transcripts were analysed thematically in an iterative process. Results Participants described a range of experiences and views in relation to care coordination. Reports of uncoordinated care emerged: appointments were uncoordinated, communication between key stakeholders was ineffective, patients and carers were required to coordinate their own care, and care was not coordinated to meet the changing needs of patients in different scenarios. As a result, participants experienced an additional burden and barriers/delays to accessing care. The impacts described by patients and carers, either attributed to or exacerbated by uncoordinated care, included: impact on physical health (including fatigue), financial impact (including loss of earnings and travel costs), and psychosocial impact (including disruption to school, work and emotional burden). Overall data highlight the importance of flexible care, which meets individual needs throughout patients’/carers’ journeys. Specifically, study participants suggested that the impacts may be addressed by: having support from a professional to coordinate care, changing the approach of clinics and appointments (where they take place, which professionals/services are available and how they are scheduled), and improving communication through the use of technology, care plans, accessible points of contact and multi-disciplinary team working. Conclusion This study provides further evidence of impacts of uncoordinated care; these may be complex and influenced by a number of factors. Approaches to coordination which improve access to care and lessen the time and burden placed on patients and carers may be particularly beneficial. Findings should influence future service developments (and the evaluation of such developments). This will be achieved, in the first instance, by informing the CONCORD Study in the UK.

scholarly journals COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

2021 ◽  
Vol 18 (16) ◽  
pp. 8689
Author(s):  
Claire Norman ◽  
Josephine M. Wildman ◽  
Sarah Sowden
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Care Staff ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Social Prescribing ◽  
Qualitative Interview Study ◽  
The Impact ◽  
Primary Care Staff ◽  
Deprived Areas

COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

scholarly journals The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angelo Ercia
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Health Care Services ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Care Services ◽  
Healthcare Needs ◽  
The Affordable Care Act ◽  
Insured Patients ◽  
The Impact

Abstract Background The Affordable Care Act (ACA) enabled millions of people to gain coverage that was expected to improve access to healthcare services. However, it is unclear the extent of the policy’s impact on Federally Qualified Health Centers (FQHC) and the patients they served. This study sought to understand FQHC administrators’ views on the ACA’s impact on their patient population and organization. It specifically explores FQHC administrators’ perspective on 1) patients’ experience with gaining coverage 2) their ability to meet patients’ healthcare needs. Methods Twenty-two semi-structured interviews were conducted with administrators from FQHCs in urban counties in 2 Medicaid-expanded states (Arizona and California) and 1 non-expanded state (Texas). An inductive thematic analysis approach was used to analyze the interview data. Results All FQHC administrators reported uninsured patients were more likely to gain coverage from Medicaid than from private health insurance. Insured patients generally experienced an improvement in accessing healthcare services but depended on their plan’s covered services, FQHCs’ capacity to meet demand, and specialist providers’ willingness to accept their coverage type. Conclusion Gaining coverage helped improved newly insured patients’ access to care, but limitations remained. Additional policies are required to better address the gaps in the depth of covered services in Medicaid and the most affordable PHI plans and capacity of providers to meet demand to ensure beneficiaries can fully access the health care services they need.

scholarly journals Impact of the COVID-19 pandemic on community antibiotic prescribing and stewardship: a qualitative interview study with general practitioners in England

2021 ◽  
Author(s):  
Aleksandra J Borek ◽  
Katherine Maitland ◽  
Monsey Mcleod ◽  
Anne Campbell ◽  
Benedict Hayhoe ◽  
...  
Keyword(s):  
General Practitioners ◽  
Respiratory Infections ◽  
Qualitative Interview ◽  
Antibiotic Prescribing ◽  
Skin Infections ◽  
Structured Interviews ◽  
Care Services ◽  
Primary Care Services ◽  
Qualitative Interview Study ◽  
Longitudinal Approach

The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners (GPs) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations), and the changing patient presentations and GP workload as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. While the pandemic disrupted the usual ways of working, it also produced opportunities, e.g., for re-organising ways of managing infections and AMS in the future.

scholarly journals Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study

BJGP Open ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. bjgpopen19X101654
Author(s):  
Robert Goldsmith ◽  
Nefyn Howard Williams ◽  
Fiona Wood
Keyword(s):  
Qualitative Interview ◽  
Radicular Pain ◽  
Interview Study ◽  
Structured Interviews ◽  
Treatment Beliefs ◽  
Qualitative Interview Study ◽  
Pathological Model ◽  
Lumbar Radicular Pain ◽  
Credible Information ◽  
The Impact

BackgroundSeveral pathological processes contribute to lumbar radicular pain (LRP), commonly known as sciatica. It is not known how patients rationalise the experience of sciatica or understand the diagnosis. Providing clinicians with a better understanding of how patients conceptualise sciatica will help them to tailor information for patients on the management and treatment of the condition.AimTo understand patients’ beliefs regarding their illness following a diagnosis of LRP, how these beliefs were developed, and the impact of illness beliefs on treatment beliefs.Design & settingQualitative interview study from a single NHS musculoskeletal interface service (in Wales, UK).MethodThirteen patients recently diagnosed with LRP were consecutively recruited. Individual semi-structured interviews were recorded and transcribed. Data were analysed using a thematic approach.ResultsFour main themes were generated: (1) the illness experience (2) the concept of sciatica, (3) treatment beliefs, and (4) the desire for credible information.ConclusionThe diagnosis of LRP is often communicated and understood within a compressive conceptual illness identity. Explaining symptoms with a compressive pathological model is easily understood by patients but may not accurately reflect the spectrum of pathological processes known to contribute to radicular pain. This model appears to inform patient beliefs about treatments. Clinicians should take care to fully explain the pathology prior to shared decision-making with patients.

scholarly journals The impact on emotional well-being of being a palliative care volunteer: An interpretative phenomenological analysis

2021 ◽  
pp. 026921632110647
Author(s):  
Helena Coleman ◽  
Andy Sanderson-Thomas ◽  
Catherine Walshe
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Interpretative Phenomenological Analysis ◽  
Well Being ◽  
Phenomenological Analysis ◽  
Life Care ◽  
Structured Interviews ◽  
Care Services ◽  
The Impact

Background: Much palliative care provision relies on the support of volunteers. Attention is paid to the risks to professionals providing care, such as stress and burnout, but understanding if this is an issue for volunteers is little understood. It is important to understand the impact their role has on volunteers emotional well-being. Aim: To explore the experiences of palliative care volunteers and how the role impacted on their emotional well-being. Design: Interpretative phenomenological analysis, with data collected through semi-structured interviews. Setting/participants: Volunteers in patient-facing roles within palliative and end-of-life care services in the UK. Results: Volunteers ( n = 10) across three palliative and end-of-life care services. Four themes were developed: (1) it can be challenging; (2) it’s where I’m meant to be; (3) managing death; (4) the importance of connection. Challenges included frustrations and questioning themselves. Although difficult at times, volunteers expressed the importance of the role, doing well and that they benefitted too. They also had to manage death and discussed beliefs about life and death, acceptance and managing patients’ fears. Connection with the hospice, patients, staff and other volunteers was important, with a need for everyone to feel valued. Conclusions: Although there are psychosocial benefits for volunteers in their role, it is important to understand the challenges faced and consider ongoing support to help volunteers manage these challenges. This could be addressed through the consideration of coping mechanisms, further training and reflective practice for volunteers.

scholarly journals Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1531
Author(s):  
Aleksandra J. Borek ◽  
Katherine Maitland ◽  
Monsey McLeod ◽  
Anne Campbell ◽  
Benedict Hayhoe ◽  
...  
Keyword(s):  
General Practitioners ◽  
Respiratory Infections ◽  
Qualitative Interview ◽  
Antibiotic Prescribing ◽  
Skin Infections ◽  
Structured Interviews ◽  
Care Services ◽  
Primary Care Services ◽  
Qualitative Interview Study ◽  
Longitudinal Approach

The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived the pandemic as having had less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations) in addition to changing patient presentations and GP workloads as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. The pandemic disrupted, and required adaptations in, the usual ways of working and AMS. It is now important to identify opportunities, e.g., for re-organising ways of managing infections and AMS in the future.

scholarly journals “Out” in the field. Reflecting on the dilemmas of insider status on data collection and conducting interviews with gay men

2014 ◽  
Vol 33 (5) ◽  
pp. 451-461 ◽  
Author(s):  
Simon Roberts
Keyword(s):  
Data Collection ◽  
Gay Men ◽  
Ethical Issues ◽  
Sexual Attraction ◽  
Power Balance ◽  
Structured Interviews ◽  
Content Type ◽  
Data Collection Process ◽  
Wide Range ◽  
The Impact

Purpose – The purpose of this paper is to explore using a reflexive approach the impact of author's personal positioning on issues of power balance between the interviewer and the interviewee, dealing with sensitive stories and concerns of difference and sameness between participants and the researcher in both the data collection process and also during the interviews. Design/methodology/approach – Initial data were gathered from 45 semi-structured interviews with self-identified gay men in a wide range of occupations and ages working in the seaside resort of Bournemouth on the south coast of England. Findings – The paper highlights some of the dilemmas of insider status and doing research on gay men. These include: ethical issues of closeness and involvement with participants, dealing with author's own personal frustrations, tackling the power imbalance between the interviewer and the interviewee and the impact of author's personal positioning on the data collection. Originality/value – Little research has been done on the impact of men doing research on issues of diversity. In particular, this paper re-examines the power balance between the interviewer and interviewee as being one sided as previous studies have suggested in the researcher's favour. It also uncovers ethical dilemmas such as sexual attraction and involvement that has had scant coverage in the literature.

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