Till Örebro universitet

BACKGROUND: Breast cancer is the most diagnosed cancer among women, with survivors often experiencing long-term symptoms such as cancer-related fatigue, which significantly impacts quality of life. Yoga has demonstrated potential in alleviating cancer-related fatigue and enhancing overall health and quality of life. Digital interventions are increasingly recognized as a feasible approach to cancer rehabilitation. However, digitally distributed home-based yoga interventions in breast cancer rehabilitation remain underexplored. More research in this area is essential to achieve a deeper understanding of participants' experiences.

OBJECTIVE: This study aims to explore women's experiences of participating in a digitally distributed, home-based yoga intervention in breast cancer rehabilitation.

METHODS: This qualitative study used an inductive content analysis approach. Semistructured interviews were conducted with 20 women who had undergone breast cancer surgery and participated in a 12-week digitally distributed, home-based yoga intervention as part of the randomized controlled multicenter trial Digital Yoga Intervention in Cancer Rehabilitation (DigiYoga CaRe). The intervention consisted of 2 home-based yoga sessions each week: 1 live-streamed group class led by an experienced yoga instructor and 1 prerecorded self-paced practice video. Interviews were conducted within 1 month of completing the intervention, using a semistructured guide with 12 open-ended questions covering physical and mental experiences, daily life impacts, and reflections on the digital format (live-streamed and prerecorded video). The interview transcripts were analyzed using conventional content analysis to identify subcategories and categories, providing insights into participants' experiences.

RESULTS: The interviewees reported that the home-based yoga intervention helped them to actively manage their illness and treatment-related side effects, promoting mental recovery and relaxation, physical function and activity, and self-care practice and routines. They commented that it fostered resilience and empowerment through increased body awareness and by regaining trust in their bodies, self-confidence, and hope for recovery. It was described as a shift in focus toward progress and well-being, equipping them with new coping strategies for their daily lives. They perceived the telerehabilitation format as a safe and user-friendly rehabilitation option, providing support through manageable digital tools, and with minor technical issues that were subsequently resolved. They described feeling safe and supported in the digital environment, fostering a sense of community and individual focus. The accessibility of home-based participation facilitated adherence, making the intervention a valuable and inclusive rehabilitation option for breast cancer survivors, particularly for those experiencing fatigue, time constraints, or challenges related to traveling.

CONCLUSIONS: The digitally distributed home-based yoga intervention was experienced as an effective and accessible tool for breast cancer rehabilitation, promoting overall well-being. For these participants, it fostered resilience, empowerment, and a sense of community; this highlights its potential as a user-friendly rehabilitation option that could be integrated into cancer care to support recovery and address various patient needs.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04812652; https://clinicaltrials.gov/study/NCT04812652. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2022-065939.

BACKGROUND: People with disabilities experience significant health inequities compared with the general population. Addressing these inequities requires the development and implementation of tailored interventions, but a gap often exists between recommended best practices and the actual care provided. Successful implementation is complex, involving multiple organizational factors. Assessing organizational readiness for change is crucial to overcome barriers and improve health outcomes for people with disabilities. This study aims to examine managers' perceptions of their organization's readiness for change regarding the implementation of interventions within disability healthcare in Sweden.

METHODS: This descriptive cross-sectional study employs an embedded mixed-methods approach. The primary approach for the overall study is based on quantitative data, while qualitative data is analyzed to provide supplementary deepened information. Both types of data were collected simultaneously through a web-based survey. The data analysis involves various statistical techniques for the quantitative data and inductive content analysis for the qualitative data.

RESULTS: Several key factors influence managers' perceptions of their organization's readiness for change, including gender, age, tenure, organizational type, managerial level, and experience. Enabling factors for implementation include trust-based leadership, staff involvement, motivation, and engagement. Barriers include complex processes, lack of support, resistance and fear, and insufficient time and resources.

CONCLUSIONS: This study highlights the complexity of organizational readiness for disability healthcare interventions, shaped by both individual and organizational factors. In particular, managerial characteristics, organizational dynamics, and resource availability play key roles. These findings suggest that a comprehensive strategy can strengthen healthcare organizations' ability to navigate implementation challenges effectively.

To examine the inter-rater agreement between parent- and child-reported measures of somatic distress, gastrointestinal symptoms, mental health, and general health in girls aged 9–13 years with functional abdominal pain disorders (FAPDs). This secondary analysis used data from the Just in TIME randomized controlled trial, including girls aged 9–13 years with FAPDs. Both girls and their parents completed the Children’s Somatic Symptoms Inventory (gastrointestinal distress (CSSI-GI) and somatic distress (CSSI-nonGI) subscales) and answered questions about general health and mental health symptoms, measures at baseline and after 8 months. Agreement was assessed using intra-class correlation (ICC) and linear-weighted Cohen’s kappa. Data from 121 girls (mean age 10.6 years) and their parents were analysed. For CSSI-GI, mean scores were similar at baseline (girls 6.98, parents 7.27; ICC 0.84, p < .001) and follow-up (girls 4.25, parents 4.16; ICC 0.91, p < .001). For CSSI-nonGI, girls reported higher mean scores than parents at baseline (8.75 vs. 6.79; ICC 0.75, p < .001) and follow-up (7.14 vs. 5.43; ICC 0.78, p < .001). Agreement for general health was fair (kappa 0.31 at baseline, 0.41 at follow-up, both p < .001). For mental health symptoms, agreement ranged from slight to moderate (kappa 0.20–0.52 at baseline; 0.11–0.46 at follow-up, all significant).

Conclusion: Findings indicated good parent– and child agreement for gastrointestinal and general somatic symptoms, but lower agreement for mental health and general health.

Aim and hypothesis To explore the agreement between parentand child reported measures of somaticdistress, gastrointestinal symptoms, mentalhealth and self-rated health, in girls 9-13years old with functional abdominal pain.

Methods Secondary analysis of data from aprospective randomized controlled trialcalled the Just in TIME study (1, 2), on girlsaged 9–13 years with FunctionalAbdominal Pain Disorders (FAPDs). Weanalyzed data from instruments that bothgirls and their legal guardians answeredseparately, at study start: Childrenssomatization inventory - gastrointestinaldistress (CSSI-GI) and somatic distress(CSSI-nonGI), Self-rated health (SRH), andMental Health Symptoms (MHS).

Results Data from 121 girls (mean age 10.6 years)were analyzed, including 74 with FAPD and47 with Irritated Bowel Syndrom. For CSSI-GIthe girls reported a mean score of 6.98 (SD4.39) and the guardians 7.27 (4.31) with anintraclass correlation (ICC) of 0.84 (p<0.001).Corresponding numbers for CSSI-nonGI were8.75 (6.51) and 6.79 (5.05), ICC 0.75(p<0.001). The weighted Cohen’s kappa was0.32 (p<0.001) for SRH and for the MHS itemsthe kappa varied from 0.20 to 0.52, allsignificant.

Discussion The findings reveal good agreement forgastrointestinal and general somaticsymptoms but lower agreement whenreporting mental and general health.

Importance Understanding parent-child agreement in self-reported health measures enhances insight intohow symptoms are perceived across informants and contexts. It also informs when and forwhom a child’s self-report may be considered sufficient in clinical or research settings.

Mental health problems are increasing among children and adolescents. School-based mindfulness interventions are gaining popularity worldwide and may be a way to decrease depression and anxiety symptoms in students. However, before introducing large-scale mindfulness interventions in school settings, more research is needed on feasible, easily applicable practices that are possible to fit in the school schedule. In this controlled intervention study, a total of 1399 students aged 9-16 were included. The 10-week classroom-based mindfulness intervention comprised daily, brief mindfulness sessions led by schoolteachers or via audio files. Symptoms of depression and anxiety were evaluated with Beck scales prior to and after the intervention. In addition to whole group analyses, subgroup analyses on age, sex as well as mode of delivery were performed. ClinicalTrials.gov ID: NCT03327714. No significant differences between the intervention and control group in change of depression or anxiety symptoms after the intervention were detected. However, the subgroup of students who received teacher-led mindfulness sessions (16%) had a significant decrease of depression and anxiety symptoms after 10 weeks compared to those who received the sessions via audio files. Brief mindfulness sessions on daily basis did not have any detectable overall effect on depression and anxiety symptoms among schoolchildren. Our findings do not support an introduction of large-scale mindfulness interventions in schools although the potential influence of mode of delivery needs to be further examined.

Clinical trial registration: The study was registered at ClinicalTrials.gov (identifier: NCT03327714).

Background: The implementation of interventions in clinical practices is a challenge across healthcare settings, particularly in the field of habilitation. To improve access to research-based treatment, there is a need to understand and explain factors affecting the implementation of interventions. The purpose of this systematic review is to identify, appraise and synthesise staff experience of the implementation of interventions for adults with congenital disabilities into a comprehensive overview.

Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we conducted a search using the Medline, CINAHL, PsycINFO, Sociological Abstract, Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science databases. To be eligible, studies had to have collected data (qualitative or quantitative) that specifically addressed the implementation process.

Findings: Of the 5430 studies initially retrieved, eight met the inclusion criteria. Staff-identified barriers and facilitators, as well as strategies and outcomes, were grouped into three themes: (1) conditions for implementation, (2) acceptability of interventions and (3) approach for change. The most commonly cited barriers and facilitators were organisation structure and culture, financial and personnel resources, relevance of interventions, and communication and collaboration.

Conclusions: When implementing an intervention, it is necessary to consider barriers and facilitators across all three identified themes to increase the likelihood of implementation success. The compiled results of the included studies provide insights that further our understanding of implementation and our knowledge of the influence of factors on the implementation of interventions within habilitation settings. This review highlights knowledge gaps and areas for future study in the context of habilitation implementation.

Background: Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMDs). Exploring support persons’ and health personnel’s experience of anintervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons’ and health personnel’s experience of contextual factors during involvement in an intervention for people with PIMD.

Method: This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach.

Findings: Three themes emerged from the analysis of the informants’ perspectives on the contextual factors: (1) structure and support enhances intervention feasibility, (2) an intervention’s benefit for people with PIMD increases its acceptability and (3) being engaged and involved increases support persons’ and health personnel’s motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan.

Conclusions: A training programme should be provided for the recipients and providers of the intervention. Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.

Introduction: Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons’ and health personnel’s experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons’ and health personnel’s experience of contextual factors during involvement in an intervention for people with PIMD.

Methods: This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach.

Results: Three themes emerged from the analysis of the informants’ perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention’s benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons’ and health personnel’s motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention.

Discussion: Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.