Objectives: This external pilot study aimed to evaluate whether a definitive trial of the STAIR OF KNOWLEDGE intervention is warranted. The specific outcomes concerned the trial procedure, including the recruitment, randomisation and retention of nursing homes and the clinical outcomes required for a definitive trial.

Design: The study is an external pilot cluster randomised controlled trial.

Setting: Swedish nursing homes participated.

Participants: The inclusion criteria for participation in the study were nursing homes working with in the Swedish national quality registry Senior Alert. Data from 309 older persons were extracted from the registry. Of these, 214 were women and 95 men, ages 65-102 years.

Intervention: The intervention aims to support nursing staff in providing preventive care regarding pressure ulcers, malnutrition, poor oral health and falls to older persons in nursing homes.

Outcome measures: Following the Medical Research Council and the Knowledge to Action frameworks and guided by predefined progression criteria, we conducted an external pilot study to determine whether to proceed with a definitive trial. The outcome measures concerned testing nursing homes' recruitment and randomisation procedures, their retention and the selection of the most appropriate primary outcome measures.

Results: We recruited eight nursing homes and randomised four to each study arm. All participating nursing homes completed the study, supporting its overall feasibility. The data collection and analysis for the intended clinical outcomes were also feasible. A total of 309 older persons were included in the study sample and were identified as being at risk of pressure ulcers, malnutrition, poor oral health and falls. Among these, actions were planned for 299 (96.8%). Of those for whom actions were planned, actions were implemented on 270 older persons (90.3%). After 12 months, a reduction in implemented actions was observed.

Conclusion: Conducting the current pilot study was a critical step towards preparing for a future definitive trial. The predefined progression criteria were successfully met, demonstrating the feasibility of the specific objectives-including the recruitment, randomisation and retention of nursing homes-as well as the data collection and analysis of intended clinical outcomes. The results of this external pilot study support proceeding with a definitive trial.

Trial registration number: NCT05308862.

Healthy aging implies physical and psychological well-being, maintaining social relationships and engaging in meaningful activities. Thus, socially inclusive initiatives that address loneliness are needed. The aim of this ethnographic study was to describe interpersonal interactions in a community-based activity program targeting loneliness among older adults. Over 10 weeks, 10 participants were observed during interpersonal interactions on 20 occasions, focusing on when, where, and how the interactions occurred. Field and reflective notes were analyzed using an ethnographic approach. The findings show that support was promoted through communication, which created togetherness in the activities by encouraging each other and exchanging knowledge and information. Furthermore, connecting by embracing openness highlighted a willingness and courage to share life experiences and bring memories into conversations. These findings provide valuable insights for designing future activity programs that reduce loneliness and promote social connectedness among older adults.

OBJECTIVES: Interprofessional education (IPE) is a key factor, preparing students for collaboration to improve quality in healthcare. Current literature implies that IPE research needs to be relevant for students, teachers and stakeholders ensuring that research answers the most important research issues. Therefore, the objective of this study was to establish outcomes of a partnership between students, teachers and clinicians to rank the top 10 research priorities for IPE.

DESIGN: James Lind Alliance Priority Setting Partnership (JLA).

SETTING: Higher health education in Sweden.

PARTICIPANTS: Students, teachers and healthcare professionals (clinicians).

METHOD: According to the JLA process, a steering committee was established. A pilot survey to gather research uncertainties highly relevant for participants was performed and tested by the content validity index. The pilot survey was followed by a main survey with 53 participants and a final workshop to determine the top 10 research priorities.

RESULTS: The content validity index was satisfactory for 23 out of 27 research uncertainties, followed by minor changes and removal of three uncertainties. After processing the 24 uncertainties from the main survey, 21 remained in the workshop. The final top 10 research priorities included measurements to evaluate IPE, promoting and hindering factors for IPE, educational models for IPE, longitudinal studies on effects from IPE and implementation of IPE.

CONCLUSION: The priorities represent consensus areas from students, teachers and clinicians to guide future research and justify and inform strategic allocation of research funding.

Background: Patients with intermittent claudication (IC) need lifelong treatment with secondary prevention, including smoking cessation, physical activity, and best medical treatment. The deficiency in existing support indicates a need for new strategies to improve self-management of the disease. However, knowledge of electronic health (e-health) as support for these patients is lacking. The primary aim was to evaluate the effect on secondary prevention outcomes and the usability of a web-based application for patients with IC. The secondary aim was to describe the patients’ experiences of using a web-based application. Patients and methods: Patients with IC (n=34) were recruited from a vascular outpatient clinic to a randomized controlled pilot trial. The study population had a mean age of 73 years and 52.9% were women. For three months, the intervention group (n=18) reported information through/via the application about physical activity, smoking, medication therapy, blood pressure, pain after activity, and quality of life (QoL). Primary outcome was walking distance, and the secondary outcome included ankle brachial index (ABI), blood pressure measurements, lifestyle factors, health education, and QoL. A linear mixed model was used to determine how the intervention affected the progression of walking distance, ABI, blood pressure measurements and BMI and Wilcoxon signed ranked test for QoL. After completing the study, the intervention group was interviewed in focus groups. Results: The reporting adherence was high (86–93%). QoL were improved in the intervention group (p=.049), and the level of insight into their condition increased in both intervention - (p=.016) and control group (p=.014). No significant differences in variables walking distance, ABI, blood pressure or BMI were observed between the groups. The interviews show an overall positive experience of using the application. Some patients experienced that the application increased their motivation to adhere to lifestyle recommendations. Conclusions: High reporting adherence and improved QoL, together with the participants experiences, indicate that using e-health may support adherence to secondary prevention in patients with IC but needs to be further studied in a full-scale randomized controlled trial.

Objective: To synthesize and conceptualize the lived experiences of older adults with chronic low back pain (CLBP) by systematically reviewing qualitative studies. Data Sources: CINAHL, PsycINFO, and PubMed were searched from their inception years (1961, 1967, and 1996, respectively) to September 2023 to identify qualitative studies on the lived experiences of older adults with CLBP. Study Selection: Eligible qualitative studies included published journal article with qualitative design and analysis, and participants aged ≥65 years with chronic nonspecific low back pain (LBP) that lasted for over 3 months. Of 3669 citations screened, 17 studies met the inclusion criteria. Data Extraction: Findings were analyzed using metasynthesis. Two reviewers independently conducted study selection and data extraction, and the methodological quality of each included study was assessed using the Consolidated Criteria for Reporting Qualitative Research framework. Data Synthesis: Six themes emerged from the analysis: (1) perceived causes of CLBP; (2) interference with daily living; (3) family dynamics; (4) social life; (5) emotional responses to CLBP; and (6) coping strategies. Collectively, CLBP negatively affected older adults’ personal, family, and social life to varying extents. Suboptimal LBP management could lead to negative emotions (eg, depression) and avoidance behaviors. Accepting and adapting to the presence of CLBP, along with a clear diagnosis of LBP, might promote self-management. Conversely, comorbidities and rumination might hinder self-management efforts. Conclusions: Given that the acceptance (acknowledging and adapting to the pain) of CLBP improves self-management of pain in older adults, clinicians should pay attention to the concerns of older adults with CLBP, understand the negative effects of CLBP on them, and provide personalized education and management strategies to enhance their self-management and engagement in value-driven actions.

Twenty-first century transformations have taken place within the framework ofglobalisation of the economy, the spread of information technology and global migrationresulting in increased cultural diversity in many societies. This qualitative studyinvestigated perspective transformation in 18 research students, from Australia, HongKong SAR, and Sweden, participating in an international online course by using Mezirow’stheory of perspective transformation and Kiely’s six forms of transformativechange (intellectual, moral, political, cultural, personal, and spiritual). The approach tolearning facilitated global networking and a commitment to support growth in thestudents’ research practice. Validating the link between research students’ learningexperiences and perspective transformation theory encourages educators to developfuture online educational materials to promote cognitive flexibility and reflexivity andincrease students’ cultural awareness to inform their research practices.

Rationale, Aims and Objectives: Colonoscopy, though common, can be uncomfortable, necessitating routine assessment of patient experience per European guidelines. Positive patient experiences are crucial as they influence willingness for repeat procedures. Patient‐reported experience measures (PREMs) effectively capture patient perspectives through surveys, empowering patients to influence healthcare quality. These surveys identify areas for improvement and inform research, enhancing healthcare and its quality. The Patient Experience Colonoscopy Scale (PECS) is a colonoscopy‐specific PREM that measures adult patient experience after an elective colonoscopy. It consists of items derived from the patient's perspective and has been found to be content valid. The PECS is multidimensional and divided into five constructs: health motivation, discomfort, information, a caring relationship, and understanding. The current study aims to evaluate the measurement properties of the new PREM, called the PECS regarding reliability and construct validity.

Method: The sample comprised 331 adult patients who had undergone an elective colonoscopy at a University Hospital in Sweden. The PECS was evaluated using intraclass correlation coefficients, confirmatory factor analysis, and multi‐ and unidimensional Rasch analyses.

Results: The test−retest reliability was acceptable, with an average intraclass correlation coefficient of 0.72. Construct validity was tested with three different techniques. The confirmatory factor analysis revealed that the theoretical bifactor model containing the five constructs was supported. The multi‐ and unidimensional Rasch analyses showed that approximately 60% of the items had acceptable values. Some violation of local independence and some evidence of differential item functioning with respect to age and gender were identified, but they all made subject matter sense. The PECS is well‐targeted to patients with less positive experiences. The overall evaluation of the construct validity showed the PECS has acceptable measurement properties.

Conclusion: The PECS is a reliable and valid 30‐item colonoscopy‐specific PREM that can play an important role in gathering data for research and quality improvement initiatives that seek to incorporate patient perspectives on colonoscopy experiences. Some potential areas for improvement were found, but the PECS is ready to be utilised in clinical practice for the purpose of collecting patient experiences.

Introduction: An increasing population and a lack of identified potential organ donor patients make the waiting list or people needing a new organ constantly growing. Donation after Circulatory Death (DCD) is a method to achieve the demand for transplantable organs. However, it implies new challenges in nursing care and there is a lack of studies investigating nurses’ attitudes and knowledge of DCD.

Method: The study has a cross-sectional, mixed-method design. A convenience sampling method was employed for this case study.

A study-specific 26-item tool with fixed and free-text answers was developed and sent to n=145 intensive care nurses (ICNs) working in four intensive care units in Sweden. Data were analyzed descriptively, and correlation analyses were performed. The free-text answers were qualitatively analysed.

Results: Fifty-three percent of the participants had limited knowledge about the DCD process. Respondents who had previous education on DCD had significantly higher knowledge of DCD (r=.380, p = 0.006), followed the public debate regarding organ donation (r=.423, p=0.002), and thought about ethical perspectives of DCD (r=.386, p= 0.022).

The qualitative analysis resulted in four categories: The importance of the team, Need for ethical discussions, Increased knowledge of DCD, and Unanswered questions and unmet needs. The integrated analysis underscored the need for targeted education, clear guidelines, and ongoing ethical discussions to prepare ICU nurses for DCD.

Conclusion: Nurses with previous education in organ donor care had higher knowledge, displayed a more positive attitude towards implementing DCD in their units and followed the public debate on DCD. The importance of interprofessional teamwork and ethical perspectives were key aspects that were emphasized to facilitate DCD implementation. These findings may lead to higher motivation in identifying DCD donor patients and implementing the DCD process, which is needed due to a global lack of transplantable organs.

Introduction: Participation is one of the core elements of health promotion, which means that approaches and methods should focus on involvement. The process of involving women with a migration background in health promotion needs to be further explored. Thus, the aim of this study was to explore the development process of a type 2 diabetes health-promotive community-based participatory research intervention among Middle Eastern women with a migration background, living in Sweden. Materials and methods: This study was performed within the context of a community-based participatory research program in Sweden. The design of this study followed the development process of a community-based participatory research conceptual model, including three of the original four dimensions, that is, the context, the partnership process, and the intervention and research dimension. Appropriate methods for data collection were used in the various dimensions. Participants from the community, active in the program, conducted dialogue cafés, together with the core partners of the program, to inventory existing needs as well as what actions were needed for promoting health and thereby prevent type 2 diabetes. Results: The two dialogue cafes resulted in one long term and three short term goals. The third short-term goal—create health circles around food and nutrition was decided to be in focus for this study together with cooperation with the local health care center. The partnership process made it possible to involve relevant collaborators, which resulted in a jointly developed nurse-led educational intervention. Participants and stakeholders were also involved in the process of modifying and elaborating evaluation tools appropriate for the intervention. Discussion/conclusions: The community-based participatory research approach enables the acknowledgement and use of the various kinds of knowledge of all stakeholders, including the community members. In this study, the community members’ knowledge was obtained through participation and dialogue, aimed at balancing power between stakeholders. This approach, that is, developing a community-based participatory research intervention, offers a possibility for the primary health care to engage with the community members and for other stakeholders to work in a health-promotive way.