Jeanette Wassar Kirk

Introduction: Social prescribing (SP) is increasingly promoted internationally as a cross-sector strategy to address complex health and social needs by linking primary care patients with community-based, non-clinical support. Despite increasing policy uptake and expanding evaluations of outcomes, evidence on how SP models are implemented and become embedded in routine practice across diverse welfare and organizational contexts remains limited and fragmented. Existing studies tend to catalogue implementation activities and contextual barriers without sufficiently explaining how implementation strategies operate through actors, activate underlying mechanisms, and interact with contextual conditions. We aimed to address this gap by developing an empirically grounded, mechanism-based program theory for implementing a Danish SP model. Specifically, we examined which implementation strategies were distributed across key actor groups, and how strategies performed by specific actors were assumed to activate mechanisms under specific contextual conditions to generate implementation outcomes. Methods: We conducted an ethnographic field study of the early implementation phase (from mid-2024 to mid-2025) of a Danish SP model (Southwest CPH) initiated by general practitioners (GPs) in Copenhagen in collaboration with link workers (LWs), a Volunteer Centre, and the DaneAge Association. Data comprised 68 days of participant observations supplemented by documents (e-mails, training materials, and reports). Analysis followed an abductive five-step approach: (1) mapping implementation strategies using the ERIC taxonomy, (2) analysing the distribution of strategies across actors, (3) examining systemic interaction patterns across clinical, community, and governance settings, (4) identifying actor logics and mechanisms informed by cultural models, and (5) synthesizing findings into a mechanism-based program theory drawing on realist evaluation, systems theory, and Proctor's implementation outcomes. Findings were iteratively validated through two rounds of analytic dialogue with all project members. Results: Implementation strategies spanned six ERIC clusters and were distributed across four actor groups in a differentiated yet complementary pattern. GPs primarily led dissemination, policy-related activities, and infrastructural anchoring; LWs concentrated on training, relationship-building, and iterative learning; the Volunteer Centre facilitated local networking and community infrastructure; and the DaneAge Association contributed to national-level advocacy and legitimacy work. Synthesis identified five cross-cutting mechanism families through which strategies were assumed to contribute to implementation outcomes under specific contextual conditions: (1) legitimacy, (2) standardization and normalization, (3) relational sense-making and trust-building, (4) network weaving and coalition formation, and (5) knowledge visibility and mobilization. The resulting program theory specifies how combinations of strategies enacted across actors and system levels are expected to generate key implementation outcomes, including adoption, feasibility, fidelity, acceptability, penetration, and sustainability. Conclusions: Implementation of SP should be understood as a system-embedded, multi-actor process in which strategies generate effects only through actor-specific enactment and the activation of mechanisms under particular contextual conditions, rather than as isolated or transferable techniques. The empirically grounded program theory developed in this study provides an analytically transferable framework for examining and guiding adaptive SP implementation and scale-up in welfare systems characterized by strong professional autonomy and decentralized governance.

Background: Triage is a critical clinical tool in emergency care, ensuring appropriate prioritization of patient care. However, traditional triage systems face challenges such as mistriage, resource misallocation, and overcrowding. Evaluation of triage accuracy also lacks a universal reference standard, making comparisons across studies challenging. Artificial intelligence (AI) has shown potential to enhance triage accuracy, mitigate human limitations, and optimize resource allocation. However, routine integration into clinical workflows remains limited, as uptake depends on staff-related factors such as usability, trust, and organizational readiness. Therefore, there is a need to synthesize evidence on both performance and implementation determinants. Objective: This scoping review compares AI-based triage with conventional/non-AI triage among adults in prehospital and emergency department settings, focusing on implementation determinants as well as performance outcomes. The dual focus on quantitative and qualitative aspects seeks to provide actionable insights for the effective development and integration of AI tools in emergency care. Methods: The review will follow the Joanna Briggs Institute methodology and the PRISMA-ScR reporting guidelines to ensure transparency. We will search PubMed (MEDLINE), Embase (Ovid), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate), Scopus (Elsevier), and grey literature via Google Scholar and ProQuest using four core concepts: AI, triage, emergency medicine, and implementation. We will include studies of adult patients comparing AI-based triage with conventional/non-AI triage in prehospital and emergency department settings. Two reviewers will independently screen titles/abstracts and full-text articles and extract data in Covidence®, with a third reviewer resolving disagreements. Quantitative findings will be summarized descriptively in tables/figures, and heterogeneity in triage accuracy definitions and reference standards will be described explicitly rather than pooling non-comparable measures. Qualitative findings will be synthesized thematically and structured using the Consolidated Framework for Implementation Research (CFIR). Discussion: This review will map AI-based triage models and key gaps in design, clinical effectiveness, and implementation across prehospital and in-hospital emergency care. By integrating quantitative and qualitative insights, it will bridge theory and practice, guide future research, and foster human-AI collaboration. Findings may inform the development of more effective AI tools that can be integrated into clinical workflows and strengthen acute patient care.

Aims and Objectives: To explore the experiences of elderly medical patients shortly after an unplanned emergency department readmission and the perceived value of health care encounters. Background: Elderly medical patients are often frail, have multiple health issues and are at risk for (re)admissions, loss of function, morbidity, and mortality. Elderly people are frequently admitted for a shorter time. Design: This study employed a qualitative design and was conducted at a 700‐bed university hospital in Copenhagen, Denmark. Methods: A purposeful sampling included 10 readmitted medical patients over 65 years, admitted for less than 72 h. In‐depth qualitative study within the phenomenological‐hermeneutical research tradition, drawing analytical inspiration from Interpretative Phenomenological Analysis. Results: The analysis identified three main themes. Patients experience powerlessness and system‐dependence in their attempt to navigate the healthcare system and are in need of clarification in relation to the acute readmissions. Patients described being in a life circumstance where they constantly had to balance acute and chronic disease(s) . Conclusions: Elderly readmitted patients are highly dependent on the randomness of support related to acute healthcare encounters and a supportive network. Lack of health clarification can provoke a negative spiral of disempowerment and lower the threshold for acute health care seeking. Relevance to Clinical Practice: Identifying and understanding the perceived value of a readmission is essential to prevent unplanned readmission and guide healthcare professionals in enhancing the quality of care. Reporting Method: COREQ checklist. Patients or Public Contributing: Elderly readmitted patients were involved in the study as participants providing the research data. What Does This Paper Contribute to the Wider Global Clinical Community?: This study illustrates how the organisation and flow culture in the emergency departments are inadequate to meet the multiple health issues of elderly medical patients, where the separation of acute and chronic illness may be blurred. This study describes the experienced consequences of missed care and how patients are having deep trouble connecting value of the acute hospitalisation to their overall health situation, leaving them in a debilitating dilemma in need of clarification. Elderly medical patients exposed to a varying degree of belonging to a personal network may be vulnerable to disempowerment and dependent on a system that does not accommodate their expectations or needs. Trial Registration: The study was approved by the Danish ethical committee protocol number: 17006481 and the regional governance AHH no. 2017028—is‐suite no. 05367

Background Obesity is associated with increased risk of morbidity, reduced quality of life, and pervasive weight stigma. For patients with severe obesity and multimorbidity who are ineligible for bariatric surgery, effective treatment options remain limited. Recently, glucagon-like peptide 1 receptor agonist-based weight loss medications have shown promise in weight management, but their effects in highly complex patient populations are not well described. Objective This protocol outlines a prospective observational study designed to explore and describe changes in cardiometabolic health, physical activity, physical capacity, and wellbeing among patients with obesity and multimorbidity enrolled in a two-year intensive weight loss program with GLP-1RA medication. Methods The study uses an exploratory prospective longitudinal cohort design and is based on an intensive weight loss program for patients with obesity and multimorbidity at Copenhagen University Hospital - Hvidovre. Approximately 35 patients will be enrolled over a six-month period. Data are collected at baseline, four months, and 24 months. Key outcomes include objectively measured physical activity, health-related quality of life, and 10-year cardiovascular risk. Additional outcomes include anthropometrics, mental health-related quality of life, weight bias internalization, cardiorespiratory fitness, lower body strength, and walking capacity. Data will be analyzed descriptively, and changes will be reported as mean differences with 95% confidence intervals. The study was registered at clinicaltrials.gov prior to recruitment (NCT06234111). Perspectives This study will provide novel insights into the health effects of intensive GLP-1RA-based weight loss program for patients with severe obesity and multimorbidity ineligible for bariatric surgery, thereby addressing an important knowledge gap in obesity management. Registration https://clinicaltrials.gov/study/NCT06234111

Social prescribing connects healthcare with community-based services to address social determinants of health, such as loneliness, social isolation, and low health-related quality of life. Although widely implemented in countries such as the United Kingdom and Australia, social prescribing remains underdeveloped in Denmark. The Social Prescribing Vesterbro-Sydhavnen project is the first attempt to systematically implement a general practice–embedded model of social prescribing within a tax-funded healthcare system. It aims to reduce loneliness and promote well-being among socially vulnerable adults by integrating link workers into the patient pathway, in close collaboration with general practitioners, local authorities, and voluntary organizations. This research programme uses a Hybrid Type II effectiveness-implementation design to evaluate both clinical and implementation outcomes. The programme comprises nine interrelated work packages using mixed methods. Quantitative components include a quasi-experimental study assessing healthcare service use and patient-reported outcomes (loneliness and quality of life) among 350 referred individuals. Qualitative components include ethnographic fieldwork, semi-structured interviews, and realist evaluation to explore implementation strategies, mechanisms of change, and contextual determinants. Two programme theories guide data collection and analysis and are refined iteratively throughout the studies. This study addresses a gap in implementation research by investigating how a complex, socially embedded intervention can be effectively integrated into routine primary care. The use of a Hybrid Type II design enables simultaneous learning about what works and how implementation strategies interact with local contexts. Particular focus is placed on the roles of link workers, intersectoral collaboration, organizational readiness, and the fit between patient needs and community services. The research contributes to the understanding of strategy selection, adaptation, and sustainment across clinical, organizational, and community settings. Findings will inform the scale-up of social prescribing in Denmark and offer transferable insights on implementing person-centred, equity-oriented interventions in other healthcare systems. The effectiveness assessment is registered prospectively at ClinicalTrials.gov (NCT07029334).

It is well-established that mobility is very limited among older hospitalized patients and associated with several negative outcomes. Therefore, this mixed-methods study aimed to quantify 24-hour mobility levels in acutely admitted older adults and simultaneously explore clinical practice with regards to mobilization and mobility through an ethnographic field study. Over a 6-week period, hospital mobility was assessed in 44 geriatric patients by SENS motion® activity sensors that the patients wore continuously for 24 h a day during their hospitalization. An ethnographic field study was conducted alongside the cohort study. It included participant observation on the ward and situated conversations with staff, patients, and relatives 2–3 times a week for 4–5 h at different times of the day. The observations were noted in field notes. Activity data were aggregated into a per day measure based on the mean of all available days for a given patient. Also, the per day measures were stratified by walking dependency (walking with or without a walking aid). The field notes were analyzed through a thematic analysis. During hospitalization, the patients spent most of their time (22.8 h/per day) in sedentary behavior and only 1.2 h/per day in uptime (walking and standing), including 43 min walking, and took less than 1200 steps daily. The field study revealed that most staff consider mobilization and mobility important tasks. However, mobilizing patients to a chair and performing functional level assessments are prioritized over patient mobility. Also, the patients’ perceived mobility opportunities are limited by the physical environment (e.g., congested hallways) and lack of purposeful activities to engage in. This study found low levels of mobility in geriatric inpatients during hospitalization. While mobility is considered important, mobilization to a chair and functional assessments are prioritized over patient mobility, which becomes dependent on the patient’s own initiative. Therefore, environmental adjustment, enhanced interprofessional collaboration, and targeted strategies for integrating mobility into daily care practices are warranted to enhance in-hospital mobility. ClincalTrials.Gov identifier NCT06421246.

In patients hospitalized following hip fracture, basic mobility status early after surgery and at discharge is associated with long-term outcomes. Getting in and out of bed is the basic mobility activity identified as one of the most challenging. Therefore, this study described strategies used by patients when getting in and out of bed early after hip fracture surgery. We conducted an observational cross-sectional study (the HIP-ME-UP cohort; NCT05756517) at Copenhagen University Hospital Hvidovre. We filmed patients getting in and out of bed during physiotherapy sessions on post operative days 3-5 by using an iPad. We analyzed the recordings using a quantitative film analysis with all recordings structured into three phases: preparation, lie-to-sit (out of bed)/sit-to-lie (into bed) and positioning. 42 patients (23 women) with a mean (SD) age of 78.7 (7.6) years were enrolled. For getting out of bed, we identified five strategies in the preparation phase, seven strategies in the lie-to-sit phase, and two strategies in the positioning phase. For getting into bed, we identified five strategies within each of the three phases. The choice of strategies for patients who were independent in getting in/out of bed was similar to patients in need of assistance. Patients hospitalized following hip fracture surgery use different strategies when getting in and out of bed. Patients requiring assistance and those being independent used similar strategies, which suggests that it is important to tailor rehabilitation to each patient's specific needs rather than their level of independence. www.clinicaltrials.gov identifier is NCT05756517.

Background: Physical locations play an essential yet often overlooked role in healthcare implementation processes. Implementation Science frameworks such as the Theoretical Domains Framework, the Consolidated Framework for Implementation Research, and the Implementation in Context framework acknowledge the importance of the physical environment, but they often treat it as a passive backdrop for change. However, from a cultural geographic perspective, spaces and places are dynamic, influencing behavior, social structures, and the acceptance of new practices. This study aims to explore how managers and emloyees develop a sense of place in a new emergency department (ED) and how these spatial dynamics influence the implementation process. Methods: This study used a multi-sited ethnographic design, tracking the implementation process across multiple hospital locations from 2019 to 2023. Fieldwork was conducted in settings such as management meetings, micro-simulation training, and tours of the new ED construction site. A total of 53 participants, including managers, nurses, and physicians from 12 specialized departments, were purposively selected. Data were collected through ethnographic field notes (750 single-spaced pages) and semi-structured interviews averaging 39 min. Analysis was guided by situational analysis and cultural geography, integrating human and nonhuman elements. An overall inductive approach was used to develop theory from observations through analysis, applying a coding system to identify key themes related to spaces, places, traces, and sense of place. Results: Five themes emerged regarding the development of a sense of place: (1) comfort, influenced by physical elements such as daylight and indoor climate; (2) spatial organization, affecting collaboration, workflow, and professional identity; (3) familiarity, highlighting cultural practices and equipment in fostering belonging; (4) time, where construction delays enabled deeper emotional engagement; and (5) involvement, showing that initial criticism transformed into stronger ownership through increased engagement. Conclusion: This study highlights the importance of a sense of place during pre-implementation of new physical locations in healthcare. Factors such as comfort, spatial organization, familiarity, time, and involvement are key to participants’ development of a strong sense of place in the new ED. These insights are crucial for designing implementation processes that address both physical and emotional needs, influencing outcomes such as acceptability, adoption, and sustainability.