Background: New healthcare programmes that focus on the encounter between patients and healthcare services, such as those advocated for in different forms on “ centredness”, are being pushed to the forefront of the healthcare agenda to, amongst other goals, combat rising costs. However, lack of consensus regarding which outcomes should be evaluated to cover the needs of all stakeholders creates barriers to prioritising between competing alternatives. The aim of this research was to develop a core outcome set (COS) for the evaluation of new healthcare programmes adopting centredness within the encounter between patients and healthcare services.

Methods: A COS was developed according to the Core Outcome Measures in Effectiveness Trials guidelines, using the DelphiManager online platform. A list of outcomes was collected from literature, stakeholder group representatives and patient partners. The outcomes underwent a two-round modified Delphi method with representative groups including managerial decision-makers, researchers, health workers, and patients/patient representatives. Outcomes scored 7–9 ( critical) by 70% or more participants and 1–3 ( limited importance) by no more than 15% were deemed to have reached consensus at the conclusion of round two. The COS was finalised during the consensus meeting, conducted with patient partners and written input from stakeholder representatives.

Results: An initial list of 65 outcomes from literature were refined to 51 items at the end of the pilot phase. At the completion of round two, eight outcomes had been scored critical by all stakeholder groups. A further 28 outcomes scored critical by at least one stakeholder group were included during the consensus meeting. The COS included 36 outcomes divided into six categories, i.e., general health, capabilities and support systems, care processes, organisational, economics, and eHealth.

Conclusion: This was a first attempt at developing a COS for new healthcare programmes that adopt centredness within the encounter between patients and healthcare services, resulting in 36 outcomes divided into six categories judged critical by many of the included stakeholders. While providing a first step towards understanding stakeholder needs for implementing or participating in these healthcare programmes, variation between groups highlights the difficulties in allocating resources and attributing value to healthcare programmes practicing centredness.

Patient and public involvement: Two patient partners formed an integral part of the research team by actively participating in the study design, participant recruitment, result analysis and writing of the final manuscript.

Background:Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses’ experiences using a digitalized scale for measuring patients’ needs for self-management support in primary health care settings has been found.

Objective:This paper describes diabetes specialist nurses’ (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support.

Methods:This qualitative study is based on observations and interviews analyzed using qualitative content analysis.

Results:From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient’s term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration.

Conclusions:Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs.

BACKGROUND: Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce. OBJECTIVE: The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D. METHODS: A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data. RESULTS: Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service. CONCLUSIONS: A total of three overarching challenges-flexible access, reducing administrative tasks, and patient empowerment-each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus.

Background: Type 2 diabetes (T2D) is increasing as the population ages. The development of new medical treatments is promising and important, but the basic treatment remains self-management, even if adherence to lifestyle advice is low. Electronic health (eHealth) or mHealth interventions can increase empowerment among people living with T2D and may compensate for the lack of professional resources and geographical distances. The interactive self-management support (iSMS) project aims at including digital tools to support people living with T2D in their self-management and facilitating their interaction with diabetes specialist nurses (DSNs). This protocol outlines a study with the purpose of developing and evaluating an intervention where people living with T2D can increase self-efficacy and empowerment through digital self-monitoring and interaction with DSNs. Objective: To develop and evaluate a person-centered iSMS intervention in primary health care for people with T2D in addition to their usual diabetes care. Methods: This study is a 12-month, 3-armed, nonblinded randomized controlled trial (RCT), which will be conducted in 6 primary health care centers (HCCs) in northern Sweden. Eligible participants will be randomized to either an intervention group (n=46), a control group (n=46), or an external group (n=46) for comparison. The intervention group will receive the mobile app, and the control group will receive a minimal intervention (diabetes brochure) and the usual standard of care. Changes in glycated hemoglobin (HbA(1c)) will be the primary outcome measure. Results: This trial is currently open for recruitment. The first results are expected to be submitted for publication in Autumn 2019. Conclusions: This study, with its focus on iSMS, will provide insights regarding suitable ways to promote and develop a person-centered intervention. If successful, the intervention has the potential to become a model for the provision of self-management support to people with T2D.

BACKGROUND: Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services. OBJECTIVE: The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care. METHODS: This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D. RESULTS: Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty. CONCLUSIONS: Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients' involvement in their own care.

BackgroundNurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care. AimThe aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management. MethodsFocus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis. ResultsThree themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes. Conclusion and relevance to clinical practiceThe results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care.