Halmstad University

Background Implementing evidence-based interventions (EBIs) in practice requires balancing fidelity and adaptation to suit new contexts. Careful considerations are needed to maintain the core elements for effectiveness while ensuring fit with new contexts. The Adaptation and Fidelity Tool (A-FiT) intervention addresses this challenge by providing support for professionals using EBIs in the sustainment phase of implementation. This study evaluates the A-FiT intervention and examines how professionals delivering an EBI manage fidelity and adaptation during the sustainment phase of implementation, before and after the intervention. Method Short, structured interviews were repeatedly conducted with 14 professionals delivering an EBI ( n = 127). Data was analyzed using deductive content analysis focusing on adaptation types, planning, intentionality, and fidelity consistency. The adaptations were counted and compared before versus after the A-FiT intervention using a chi ² -test. Results The professionals made about the same number of adaptations before and after the A-FiT intervention. However, after the intervention, significant changes in the type and intentionality of the adaptations were observed. Changes in type consisted of fewer “removing,” “substituting,” and “integrating another framework” adaptations and more “loosening structure” and “departing from the intervention” adaptations. Regarding intentionality, fewer planned adaptations with the intention of improving the EBI effects were made, while adaptations made for practical reasons, both planned and unplanned, increased after the A-FiT intervention. No statistical change was found regarding fidelity consistency. Conclusions The findings indicate increased awareness about fidelity and adaptation among the group leaders, resulting in fewer planned adaptations to enhance program effects and more practical adaptations to address context challenges. The A-FiT intervention appears to help professionals in their management of fidelity and adaptations when delivering EBIs. The study underscores the importance of understanding adaptations in their context, purpose, and impact (intended and unintended) on the outcome/value.

Background Knee pain is often an early sign of knee osteoarthritis (KOA). Physical activities (PA) constitute the recommended regime to those affected. However, knee-loading PA at work is linked to an increased risk for KOA. The primary aim of this study was to investigate associations between knee pain and accelerometer-measured knee-loading PA, at work and leisure respectively. The secondary aim was to investigate knee-related problems in relation to self-reported physical effort at work. Methods This cross-sectional study included 107 working participants (aged 30–67) with knee pain. Knee pain was evaluated using the Knee Injury and Osteoarthritis Outcome Scale (KOOS), subscale Pain. Knee-loading PA (including daily steps, time in upright position, stair walking), and sitting/lying were measured by accelerometer for one week. Each knee-loading PA was analysed separately for the measurement periods: (1) total period, (2) time at work, and (3) leisure on workdays. Knee-related problems were evaluated by the KOOS subscales Symptoms, Activities of Daily Living, Function in Sport and Recreation, and Quality of Life. Analyses were made with linear regression, and stratified by high or low self-reported physical effort at work. Results Participants with more knee pain walked on average fewer steps per day, and spent less time in an upright position during leisure on workdays, unstandardized coefficient (β) = 0.001, p = 0.044, β = 0.075, p = 0.001 respectively, i.e. spent less time in knee-loading PA. The associations were stronger for those reporting high physical effort at work, β = 0.116, p = 0.016. Participants with high physical effort at work rated their (knee-related) quality of life worse. There were no associations between knee pain and knee-loading PA during work hours. Conclusions Participants with more knee pain were less physically active during leisure, with stronger associations among those with higher physical effort at work. Those reporting high physical effort at work had worse (knee-related) quality of life compared to participants reporting low effort at work. This highlights the importance of taking knee-loading PA at work and leisure into account when recommending exercise regimes to individuals with knee pain. Trial registration ClinicalTrials.Gov (NCT04928170), Date of registration: 2017-12-20.

Perception and sensing of the surrounding environment are crucial for ensuring the safety of autonomous driving systems. A key issue is securing sensor reliability from sensors mounted on the vehicle and obtaining accurate raw data. Surface contamination in front of a sensor typically occurs due to adverse weather conditions or particulate matter on the road, which can degrade system reliability depending on sensor placement and surrounding bodywork geometry. Moreover, the moisture content of dust contaminants can cause surface adherence, making it more likely to persist on a vertical sensor surface compared to moisture only. In this work, a 76–81 GHz radar sensor, a 72–82 GHz automotive radome tester, a 60–90 GHz vector network analyzer system, and a 76–81 GHz radar target simulator setup were used in combination with a representative polypropylene plate that was purposefully contaminated with a varying range of water and ISO standard dust combinations; this was used to determine any signal attenuation and subsequent impact on target detection. The results show that the water content in dust contaminants significantly affects radar signal transmission and object detection performance, with higher water content levels causing increased signal attenuation, impacting detection capability across all tested scenarios.

Background There is growing awareness that back pain in adolescent soccer (European football) players is not always related to local tissue damage. Approaches taking into consideration lifestyle factors are needed. This study aimed to investigate the association between psychological distress, skipped meals, and insufficient sleep, and the occurrence of back pain among adolescent female soccer players. Hypothesis Psychological distress, skipped meals, and insufficient sleep are associated with the occurrence of back pain. Study Design Cohort study. Level of Evidence Level 3. Methods Swedish adolescent female soccer players aged 12 to 17 years, without back pain at baseline, were included. The exposures psychological distress, skipped meals, and insufficient sleep were assessed at baseline. The players were followed for 1 year with a weekly web-based survey, where back pain intensity was measured on a numeric rating scale (NRS) ranging from 0 to 10. The outcome back pain was defined as reporting low back pain and/or upper back/neck pain intensity of ≥4 on the NRS. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard rate ratio (HRR) with 95% CI for the association between each exposure and the outcome back pain, adjusted for age at baseline and parents’ education. Results In total, 351 players were included, and 141 players reported back pain at some point during the 1-year follow-up. The adjusted HRR for back pain was 1.79 (95% CI, 1.11-2.91) for insufficient sleep, 1.45 (95% CI, 0.97-2.17) for psychological distress, and 0.98 (95% CI, 0.61-1.59) for skipped meals. Conclusion Insufficient sleep and psychological distress are associated with the occurrence of back pain among female adolescent soccer players. Clinical Relevance Our results contribute to the understanding of what may influence the occurrence of back pain in adolescence, offering potential strategies for the prevention of back pain in adolescent female soccer players.

Background To support and strengthen parenting skills, it is mandatory for municipalities in Sweden to offer parental education programmes to all parents. One such programme is the Circle of Security-Parenting (COS-P), in which parents participate in eight weekly group sessions, each lasting 90 minutes. COS-P helps parents recognise and respond to their child’s emotional needs for attachment. The programme focuses on enhancing parents’ understanding of their child’s behaviour, enabling them to address emotional needs effectively and foster security to benefit the child’s overall development. Objective This study aimed to explore parents’ experiences of participating in COS-P parental education programme from a health-promotive perspective. Design Qualitative design using an inductive approach. Setting The COS-P programme was conducted in a medium-sized town in Sweden. Method Nineteen semi-structured interviews were conducted and analysed using qualitative content analysis. Results The analysis of the data resulted in one latent theme: from uncertainty and chaos to consciously empowering qualities; and five categories with it – parents’ understanding of the child needs developed; parents learned to handle conflicts and set boundaries; parents’ ability to reflect increased; parents’ inner security and calmness was strengthened; and parents’ stress was reduced. Conclusion The findings show that the COS-P is a relevant programme for municipal authorities to offer parents as the result point at the programme’s ability to empower parenting and strengthen the attachment between parent and child. The programme contributed to increased self-efficacy, well-being and confidence in parenting and could therefore be seen as a useful health promotion intervention.

Research suggests that accelerated internationalization is accidental and that a firm-specific business model (BM) determines which firms become accelerated internationalizers and which become gradual internationalizers. However, in analysing entrepreneurs adopting different internationalization types (accelerated and gradual) from Finland, New Zealand and Sweden, we find a complex interplay between entrepreneurs’ mindsets and emerging BM practices with respect to their internationalizing firms. These practices enable small international firms to eliminate the time and cost penalties associated with the triple liabilities of accelerated internationalization (i.e., newness, outsidership and smallness). This study contributes to the literature by reconciling the alternative explanations offered in previous research and reveals how entrepreneurs’ global and regional mindsets affect their BM practices, leading to different international trajectories. It further contributes by showing that the entrepreneur’s role may be more important than that of the BM.

Objectives Sport injuries in youth sports are common, and holistic predictive approaches have been called for to better understand how combinations of risk and protective factors contribute to injury occurrence. This study utilises a person-centred approach to identify how combinations of psychological and physical factors are associated with injuries in youth floorball players. Methods At season start, 222 youth athletes conducted physical field tests and measures of self-reported mental health and demographics. Postseason, participants reported any sustained acute or overuse injuries during the season. Latent profile analysis, using psychological (anxiety and depression) and physical (field test performance) factors, such as input variables, was employed to identify risk profiles. Covariate analysis was conducted with demographic predictors of profile membership. Finally, sport injury occurrence was compared between profiles. Results Three profiles were identified: ‘Moderate mental health/high physical performance’ (profile 1, n=101), ‘Very low mental health/average physical performance’ (profile 2, n=49) and ‘High mental health/low physical performance’ (profile 3, n=72). Athletes injured at baseline were less likely to belong to profile 1. Profile 1 had higher injury occurrence than profile 2 (OR=3.63, 95% CI (1.34 to 9.81)) and profile 3 (OR=2.63, 95% CI (1.06 to 6.47)) during the season. Conclusion Our results indicate that players in the profile characterised by moderate mental health and high physical performance (profile 1) at the start of the season, reported the highest injury occurrence during the season (based on retrospective injury reporting). Future studies should explore factors that can explain this relationship, such as engagement in risk situations, load and recovery.

Purpose The study aimed to explore older people’s experiences of insomnia in nursing homes. Method This qualitative study used an inductive approach with semi-structured interviews involving 19 older people (aged 67–101 years) from nine nursing homes in southwestern Sweden. The older people were purposively selected based on insomnia criteria according to the International Classification of Diseases (ICD-10, G47.0) and cognitive competence according to the Standardized Mini-Mental State Examination (S-MMSE). The interviews were analysed using qualitative content analysis. Results Two categories were identified: Valuing good sleep and Disruptive influence on sleep, with the subcategories of internal and external disturbances. Older people expressed that sleep was crucial to their well-being, and poor sleep quality negatively influenced their mood and physical health. They experienced internal disturbances, such as anxiety and physical discomfort, as causing sleep disturbances, but also external aspects that included environmental disturbances, reduced activity levels, loneliness, and worry about which nursing staff was on duty. Conclusion This study highlights the critical role of sleep in maintaining energy, coping with daily life, and ensuring overall well-being for older people in nursing homes.

Background Patients suffering from treatment-resistant depression may be treated with nasal esketamine. The treatment requires administration in a healthcare facility and monitoring by a nurse. Existing research has mainly focused on the clinical effect of nasal esketamine, while less is known about patients’ experiences of treatment. A person-centred framework provides valuable insights into care and treatment. By using person-centredeness, the patient turns into a respected contributor in the delivery of care, enabling improved outcomes, better use of resources, reduced costs and increased satisfaction with care. Thus, the aim was to explore patients’ experiences of treatment with nasal esketamine utilizing the person-centred nursing framework by McCormack and McCance. Methods The study had a qualitative design with an abductive approach. Twenty patients with treatment-resistant depression who had received at least eight treatments of nasal esketamine were interviewed. A thematic analysis was conducted, based on the four constructs of PCC: prerequisites, care environment, person-centred process and expected outcomes. The analysis generated 11 subthemes, reflecting the contextuality of the PCC nursing framework. Results The results highlighted the importance of working in a person-centred manner to achieve increased patient satisfaction and treatment outcomes. Patients highlighted the importance of relationships with competent and engaged nurses and a supportive care environment for treatment outcomes. The physical care environment influenced patients’ well-being, and organizational aspects, such as continuity of staff, flexibility, and being allowed a private space, were also crucial during esketamine treatment. These aspects fostered feelings of security and contributed to achieving the desired outcome. Conclusion This study identified that key aspects of PCC; competent nurses and respect for the patient, comfort and personalization of the care environment, support and involvement are important in ensuring patient satisfaction, quality and ultimately the desired treatment outcomes in esketamine treatment. By adopting a person-centred approach, nurses can increase patient well-being and the quality of care in nasal esketamine treatment. Clinical trial number Not applicable.

Background : Improving physical activity and sedentary behaviors can maintain and improve cardiovascular, musculoskeletal, and psychosocial function for older adults (≥65 years) but finding acceptable, enjoyable, and safe strategies to achieve this is challenging. The immersive BikeAround technology—which integrates stationary cycling with Google Earth Street View—may be an effective strategy as it enhances acute exercise enjoyment and motivation, but treatment effects, safety, and engagement during prolonged use in free-living environments remain unknown. We evaluated the acceptability of BikeAround among older adults in a retirement village and assessed its preliminary effects on physical activity, cardiorespiratory fitness, blood pressure, cognitive function, perceived exertion, and balance, and mobility. Methods : We conducted a single-arm BikeAround acceptability study among older adults living independently in a retirement village. Descriptive and inferential statistics were performed to evaluate acceptability and treatment effects on physical activity, and health outcomes, respectively. Results : Among 20 older adults, BikeAround was acceptable. More than half of the participants showed their intention to use BikeAround again. Statistically significant improvements were observed in the Mini-Balance Evaluation Systems Test score (Wilcoxon test statistic = 210 and p < .01). There was a positive trend in physical activity participation, but none of the physical activity and sedentary behavior measures showed a statistically significant difference. Conclusion : BikeAround was acceptable to older people for promoting physical activity in a retirement village, which could have a significant role in their health and well-being.

Background Health-promotive interventions targeting older persons are important for active and healthy ageing. Hence, physical group exercises for community-dwelling older persons are arranged by various stakeholders via meeting places within the municipalities. Increased knowledge of how group exercises via meeting places can be arranged to promote health for the older population is needed. Therefore, the aim was to explore involved stakeholders’ experiences of group exercises for older persons arranged via meeting places in municipalities in relation to health promotion. Methods Six focus group interviews were conducted online with 25 stakeholders from seven municipalities in Sweden. The stakeholders were managers of prevention units, municipal coordinators for physical activity, group exercise leaders, stakeholders from study associations, sports associations and private stakeholders, and non-profit stakeholders who arranged group exercises via the meeting places. The data was analysed using focus group methodology, where the focus of the analysis was to obtain the stakeholders’ collective understanding of the topic. Findings The analysis resulted in two main themes and seven categories. In the main theme Strategies to strengthen empowerment and exercise habits among older persons, the stakeholders highlighted strategies on an individual level. Strategies of importance to attract new participants and supporting them in maintaining their exercise habits, empowering them through social belonging, adapting to older persons through responsiveness and evaluation, facilitating participation in decision-making, and enabling older persons to lead group exercises. The other main theme, Strategies to strengthen the arrangement of group exercises over time, highlighted strategies on an organisational level concerning financial resources, supportive environments, the importance of human resources, competence development as well as collaboration. Conclusions Person-centredness emerges in health-promoting strategies both at the individual and organisational level. The study contributes to an understanding of how person-centredness is significant when working with health-promotive interventions for healthy ageing. Thus, a potential implication is to use a person-centred approach in the encounter with older persons and in the organisation when arranging group exercises for community-dwelling older persons.

Background Help-seeking for mental health problems is a complex process that involves handling both personal challenges and dealing with the organizational structure of the healthcare system. The healthcare system is siloed and fragmented, but it is unclear how the challenges are experienced by the young adults and what their healthcare journeys look like. Therefore, the aim of this study was to explore experiences of young adults’ healthcare journeys in the context of help-seeking for common mental health problems. Methods In total, 25 young adults (16 women and 9 men) from a student healthcare centre at a Swedish university seeking help for common mental health problems, such as anxiety and depression, were interviewed. A qualitative thematic analysis with an inductive approach was done, and results were abstracted and presented in terms of journey-related metaphors. Results The healthcare journeys of young adults were described as Taxi Riding, Commuting, Sightseeing, and Backpacking. Taxi riding and Commuting are defined by going in a straightforward and smooth way in the healthcare system, without major obstacles to care. In contrast, Sightseeing and Backpacking are characterized by more diffuse and negative experiences, where the young adults are not satisfied with the help received from healthcare providers. Help-seeking is not conformant with the design of the healthcare system but steered by a range of factors, including individual experiences and young adults’ agency, the available resources at the various healthcare providers, and interaction with healthcare professionals. Conclusions Young adults’ healthcare journeys in the context of help-seeking for common mental health problems are related to individual, relational, and organizational factors. Some journeys run smoothly, epitomizing a functioning healthcare system that accommodates a rational help-seeker. Other journeys depict a rigid healthcare system, where the success and nature of the journey primarily depend on individual agency and on not becoming discouraged by obstacles. There is a need for more knowledge on how to support young adults’ mental health help-seeking. However, we also need more insights into how the healthcare system can become more receptive and accommodating toward the needs of young adults with common mental health problems.

This paper proposes a two‐stage framework that combines uncertainty reduction and predictive modelling to enhance the accuracy of battery Remaining Useful Life (RUL) prediction. In the first stage, a simplified fuzzy optimization learning model is introduced to mitigate uncertainty caused by abnormal capacity fluctuations in battery data. The proposed fuzzy model reconstructs degradation data into a consistent downward trend based on mid‐ and short‐term tendencies of the battery, alleviating abnormal variability and improving suitability for predictive modelling. In the second stage, uncertainty arising during the recursive prediction process of a standalone Transformer model was mitigated through the integration of a particle filter. This approach dynamically manages prediction errors using particles, effectively controlling cumulative errors and enhancing the stability and reliability of long‐term predictions. This methodology can lead to extended battery life and increased operational reliability through accurate RUL prediction. The proposed methodology is validated through experiments using NASA and CALCE battery datasets, demonstrating superior prediction accuracy and stability compared to conventional approaches by systematically reducing uncertainties.

This paper investigates how the coherent integration of three different tools for reflection during a science methods course can contribute to student teachers' planning and enactment of science teaching, that is, their development of pedagogical content knowledge (PCK). The Refined Consensus Model (RCM) is used as a theoretical lens for conceptualizing links between teaching practice and the development of PCK. The results show how the student teachers' initial PCK (pPCK input ) was manifested into ePCK during planning and teaching, and further, through reflection, developed into a new and “richer” PCK (pPCK output ). The three tools encouraged collaborative discussion and reflection about teaching certain big ideas linked to a topic. The case presented in this paper proved to be a coherent way to encourage student teachers to collaborate, reflect, and discuss ideas about their teaching practice and their professional development.