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People with dementia are living longer in the community and reliance on informal caregivers is increasing. Few studies have focused on the experiences of adult-daughter caregivers (daughter caregivers), who may have increased risk of depression and lack of support compared with spousal caregivers. We aimed to explore the experiences of accessing and receiving formal and informal support among daughter caregivers of people living with dementia in Sweden. We conducted semi-structured interviews with 23 daughter caregivers. A topic guide was used to explore experiences of accessing and receiving formal and informal support in their caregiving role. We analyzed the interviews using reflexive thematic analysis. We generated two themes: Types of support, and Mismatched support. The first theme, with subthemes Sharing experiences, Professional support, and Getting some relief, captured the caregiver support context with different types of support accessed and received by daughter caregivers, with peer support and informational support identified as important components of caregiver support. The second theme, with subthemes Lack of tailoring to daughter caregivers’ needs and Difficulties navigating support, captured how daughter caregivers perceived existing support to be inadequate to meet their specific needs and the complex structure of available support limited their opportunities to access support. Daughter caregivers experience a mismatch between the type of support accessed and received and their specific support needs. Support better tailored to the needs and situation of daughter caregivers of people with dementia in Sweden is required. The potential of utilizing peer support for caregivers warrants further research.

Background: The implementation of Internet of Things (IoT) technologies to proactively monitor the functioning of assistive products remains underexplored, particularly in public assistive technology services.

Objective: This qualitative single-case study investigated how a public assistive technology provider in Sweden implemented IoT-equipped assistive products.

Methods: The implementation process was mapped, and a thematic analysis of interviews with 6 participants representing key organizational roles was conducted.

Results: The process comprised 9 major events involving 4 main stakeholders. The findings included 4 themes of facilitators and 5 themes of barriers, which were synthesized into three meta-themes: (1) system-level structures that enable and constrain implementation, (2) tensions between technological potential and the challenges of realizing it, and (3) relational and cultural dynamics that balance trust with caution.

Conclusions: The findings underscore the importance of using a sociotechnical framework to guide the implementation of IoT in assistive technology services. Such a framework supports a holistic approach that integrates user needs, privacy considerations, and regulatory requirements, while drawing on leadership, technical expertise, and collaboration to address legal, organizational, technical, and user-related challenges. The implications for health care technology implementation are that organizations should adopt sociotechnical implementation strategies that account for legal, organizational, technical, and user-related considerations.

Background

Implementing the stepped care model for mental health in primary care organizations is a complex process influenced by various barriers and facilitators. Identifying these barriers and facilitators at the appropriate level is crucial for developing effective implementation strategies. Traditionally, barriers and facilitators are identified at the aggregate level, which may not be optimal due to potential organizational and professional differences. The objectives of this study were to identify the barriers and facilitators to implementing the stepped care model across three primary care organizations in Sweden and to explore differences in barriers and facilitators at the aggregate, organizational, and professional levels.

Methods

An online self-report survey was conducted between January and May 2023 among healthcare professionals (n = 33) in three Swedish primary care organizations implementing the stepped care model for mental health. The survey included two open-ended questions regarding barriers and facilitators. Summative content analysis was used to identify frequent barriers and facilitators at the aggregate, organizational, and professional levels. Given the small sample size and early stage of implementation, the study was designed as an exploratory study.

Results

The findings revealed seven frequent barriers and facilitators to implementation: benefits of the model, information and communication, knowledge of the model, propensity to change, resources, support from management and time to work with implementation. At the aggregate level, two barriers (e.g., time to work on implementation) and five facilitators (e.g., resources) were prevalent. At the organizational level, some frequent barriers and facilitators corresponded with those identified at the aggregate level, but there were notable differences between the three organizations. At the professional level, some similarities were observed among psychologists, but no consistent trends were found across other professions.

Conclusions

The study provides three novel contributions to stepped-care implementation research. First, organizational-level analysis reveals context-specific barriers and facilitators that aggregated data overlook, making the organizational level the most informative for guiding implementation. Second, the time required to work on implementation emerges as a distinct barrier. Third, resources function not only as barriers when lacking but also as facilitators when available.

Introduction: Public contribution is increasingly prioritised by research institutions, funding bodies, and policymakers globally. However, the evidence base for the impact of public contribution remains limited. Researchers and public contributors' experiences of such activities are also rarely reported. We worked alongside a Public Advisory Group (PAG) consisting of informal caregivers of people with dementia during a series of studies to inform the development and adaptation of a guided low-intensity behavioural activation intervention for people with dementia (INVOLVERA). The overall aim of the current study was to explore the experience, process, and impact of involving caregivers of people with dementia as public contributors during the intervention development phase of INVOLVERA.

Methods: Public contribution activities were recorded using impact logs from PAG meetings, from which public contributors' suggestions for the intervention were extracted and categorised, and the implementation rate calculated. Semi-structured interviews were conducted with public contributors (n = 4) and researchers (n = 3), and analysed using manifest content analysis.

Results: Public contributors made 158 suggestions across nine PAG meetings, with 76% of these implemented by the researchers. Analysis of interviews generated three categories: Perceived impacts, Interactions and facilitators, and Future challenges and opportunities. Interviews suggested public contribution activities positively impacted the research (e.g., improving intervention acceptability) and those involved (e.g., new knowledge and skills). Public contributors provided valuable recommendations for involving people with dementia and male caregivers in future activities.

Conclusions: Findings illustrate a positive impact of public contribution activities on the research and those involved. This underscores the important role of public contribution during the development of complex interventions and further emphasises the need for comprehensive reporting on the impact of such activities. We believe this study strengthens the evidence base for public contribution and offers practical insights into fostering effective partnerships with public contributors.

Public Contribution: A PAG consisting of wives and daughters (n = 4) of people with dementia worked alongside the researchers throughout the intervention development phase of the project. Contributions included (1) sense-making and interpreting results from a series of intervention development studies, (2) co-designing the intervention, and (3) disseminating findings, including co-writing the current paper.

Background: The utilization of the Internet of Things (IoT) can significantly enhance health care. However, successful implementation of IoT requires a holistic approach including factors beyond technology alone.

Objective: This paper seeks to advance understanding of the factors influencing the successful implementation of IoT solutions in the health care sector, expanding beyond a purely technological focus.

Methods: Using data from 22 semistructured interviews with a diverse group of stakeholders—including health care professionals, researchers, municipal and regional officials, and private companies—this study examines 5 leading IoT projects in Sweden.

Results: Grounded in sociotechnical systems theory, the research identifies five critical subsystems impacting IoT implementation: (1) laws and regulations, which present challenges due to their complexity and misalignment with rapid technological advances; (2) organizational support, highlighting the essential commitment and resources from management to drive innovation; (3) user focus, emphasizing the importance of engaging end-users—such as patients and health care providers—in the design and implementation of IoT solutions; (4) resources, encompassing both financial investments and human capital needed for effective deployment; and (5) infrastructure, which addresses the technological foundations required to support IoT systems reliably.

Conclusions: By shifting attention from adoption to the complexities of implementation, this study fills a critical gap in the literature, which has largely emphasized adoption and technical aspects over practical implementation challenges. The findings provide a nuanced understanding of the primary factors influencing IoT implementation in health care, illuminating both the challenges and potential avenues for successful integration. Ultimately, this research advances the sociotechnical systems theory and also offers valuable insights for managers and policymakers tasked with driving digital transformation in health care systems.

International Registered Report Identifier (IRRID): RR2-10.2196/44562

Background

The development of effective eHealth strategies is critical to enhancing healthcare systems' efficiency and outcomes. However, there is limited comparative analysis of eHealth strategies across health systems, particularly in terms of their vision, objectives, implementation methods, and follow-up processes. This study compares the eHealth strategies of nine health systems, focusing on three key dimensions: vision and objectives, means to achieve objectives, and structures for follow-up.

Methods

A comparative qualitative analysis was conducted using publicly available eHealth strategy documents from nine health systems: Australia, Denmark, Estonia, Finland, Norway, Sweden, the UK (NHS England), Catalonia (Spain), and the USA (Veterans Affairs). The analysis mapped these systems' visions, objectives, implementation methods, and follow-up structures.

Results

Findings show that most systems articulate clear visions and strategic goals. However, there is considerable variability in the level of detail regarding the means of achieving objectives and structures for follow-up. Australia and Estonia present the most comprehensive strategies, with clear tasks, responsibilities, timelines, and follow-up mechanisms. In contrast, countries like Sweden and Catalonia provide less detailed strategic plans, particularly in terms of follow-up processes.

Conclusions

While most studied health systems include clear visions and strategic goals, there is variability in the detail and comprehensiveness of their implementation and evaluation frameworks. Strategies with detailed implementation plans and follow-up processes, such as those from Australia and Estonia, offer valuable models. Further research is recommended to explore the practical impact of these strategies on healthcare delivery, patient outcomes, and system efficiency. Additionally, the role of stakeholder involvement in shaping these strategies warrants further investigation.

Background: While people with dementia commonly experience depression, access to psychological treatment is low. A guided low-intensity behavioral activation intervention may represent a solution. Considering implementation barriers and facilitators is important during intervention development to increase the future implementation potential of an intervention. However, involving patients and informal caregivers in identifying implementation barriers and facilitators during intervention development is rarely done. Involving patients and informal caregivers may be particularly important for low-intensity interventions, given the active role they are expected to adopt for successful intervention implementation, e.g., they are seen as active agents as opposed to passive recipients. Study aims were to: (1) develop an understanding of the existing healthcare and community support in the Swedish context for people with dementia and informal caregivers, and (2) identify people with dementia and informal caregivers’ perceived barriers and facilitators to intervention uptake informed by Normalization Process Theory (NPT).

Methods: Following an interview guide informed by NPT, semi-structured interviews were held with people with dementia (n = 8) and informal caregivers (n = 19). Interview transcripts were analyzed using the NPT coding manual, with an inductive approach adopted for data related to the core theoretical NPT constructs, but not represented within its sub-constructs.

Results: Nine deductive and three inductive categories related to three core NPT constructs (Coherence, Cognitive Participation, Collective Action) were identified. Barriers included: (1) extensive intervention material, (2) dementia symptoms, and (3) lacking acceptance of the dementia. Facilitators included: (1) intervention having potential to fill a large psychological treatment gap, (2) understanding and agreeing upon the intervention purpose and potential benefits, (3) intervention guide having professional experience in dementia, and (4) a trusting face-to-face relationship with the intervention guide.

Conclusions: Implementation barriers and facilitators were identified alongside evidence-based implementation strategies to be adopted in the future. Additional barriers and facilitators were identified to those recognized by dementia healthcare and community interest-holders, emphasizing the importance of recognizing the potential diversity of perspectives among different groups within the healthcare triad. By integrating these diverse perspectives early in the intervention development, we aim to develop an intervention optimized for implementation within real-world settings, meeting global health priorities to support people with dementia and their families live well with dementia.