Ulrica von Thiele Schwarz

Introduction: Health and social services face increasing fragmentation and costs, underscoring the need to transition toward more person-centered and integrated care. The Swedish government’s ‘Close Care’ [Nära vård] initiative promotes this transition by encouraging shared regional visions and roadmaps. However, translating a vision into practice remains challenging. This study aimed to explore the experiences of healthcare and social services stakeholders regarding the transition to Close Care, focusing on using a joint roadmap. Methods: This qualitative study included three focus groups with 19 regional healthcare and municipal social service representatives, analyzed using reflexive thematic analysis. Results: Four main themes summarize the findings: 1) A rocky road toward Close Care; 2) A patchwork of Roadmap practices; 3) Navigating ambiguity: defining and positioning the roadmap; 4) Mobilizing shared meaning for Close Care and the roadmap. Discussion: A growing understanding, awareness, and engagement with Close Care is demonstrated, although challenges, including limited cross-organizational leadership and dialogue, remain. Participants reported varied familiarity and strategic document use with the roadmap, which was often considered vague or irrelevant for actionable guidance. Conclusion: Roadmap clarity, linked to measurable indicators, and strategic leadership and dialogue are required to strengthen relational coordination and transition toward more person-centered and integrated care.

Implementation of evidence-based interventions requires professionals to manage fidelity and adaptation in everyday practice. From a deliverer-centered perspective, this work may have implications for professionals’ psychosocial working conditions. This study examined professionals’ perceptions of their psychosocial working conditions when using an evidence-based intervention called “All Children in Focus” under different forms of implementation support targeting fidelity and adaptation. Using a longitudinal within-person repeated-measures design, 25 Swedish professionals were surveyed across three scenarios: (1) practice as usual; (2) after structured reflection on fidelity and adaptation; and (3) after participating in a decision-support intervention about fidelity and adaptation (the Adaptation and Fidelity Tool–A-FiT), designed to facilitate fidelity–adaptation decisions. Psychosocial working conditions were assessed using validated self-report measures, including unreasonable tasks, role conflict, quantitative demands, knowledge, skills, openness, and work-related self-efficacy. Data were analyzed using Friedman’s ANOVA and Wilcoxon signed-rank tests. Across the three scenarios, professionals reported generally favorable psychosocial working conditions, with no statistically significant changes over time on most measures. A statistically significant decrease in perceived skills was observed following structured reflection ( p = 0.024), but this change was not sustained following participation in A-FiT. Overall, the findings indicate that, in this sample, implementation support targeting fidelity and adaptation was not associated with statistically significant deterioration in professionals’ psychosocial working conditions. The findings have implications for deliverer-centered evaluation of implementation strategies and for understanding conditions that may support sustainable use of evidence-based interventions in practice. Larger studies are needed to confirm findings and examine generalizability across other contexts.

Political leadership positions are dominated by men. Arguably the most visible of a society’s positions of power, these positions may be important symbols of women’s ability to lead. If so, levels of female political representation within a society should shape its stereotypes of women’s suitability for political leadership. This project will test this possibility by conducting a secondary analysis of a dataset that measured the stereotypes of women, men and political leaders in 44 countries covering six continents (Nsample = 23,256). Specifically, we will test whether, as a country’s representation of women in political leadership increases, there is a greater increase in the congruence of that country’s stereotypes of political leaders and women than in the congruence of that country’s stereotypes of political leaders and men. We will also conduct exploratory analyses to identity whether other socio-ecological and cultural variables correlate with cross-national heterogeneity in the content and congruence of these stereotypes. This project will shed light on the way in which macro-level variables can shape micro-level gendered leadership beliefs.

This chapter describes how intervention programme theory can inform a proactive plan for adaptation and fidelity. We also describe how adaptation and fidelity can be continuously managed, guided by process evaluation to improve the fit between the intervention and the context. This is vital since the uptake of health interventions in real-world settings depends on how well the intervention creates value for the organisation where it is implemented – in essence, if it supports the achievement of organisational goals – and if it fits well with the local context. Readers will be able to develop a local, proactive plan for adaptation and fidelity based on the intervention programme theory together with local interest-holders, describe how adaptation and fidelity can be continuously monitored and addressed using process evaluation to support the optimal use of an intervention, and critically appraise the role of fidelity and adaptation in the intervention implementation phase in order to integrate process evaluation in the implementation to facilitate real-time change.

Background: Research quality is often discussed in terms of excellence, emphasising replicability and trustworthiness. Practice-based research instead emphasises implementability and practical impact, and thus, may reflect other values and logics and challenge how high-quality practice-based research is defined. The aim of this study is to explore what characterises excellent practice-based research. Method: R&D staff at social and health care organisations in Sweden were invited to participate in a concept mapping study. Forty-eight participants were prompted to finish the sentence: ‘Excellent practice-based research is characterised by …’ in a brainstorming session. Next, participants (n=22) worked individually to sort statements by similarity and rate perceived importance (n=13) and experience (n=10). Data was analysed with multidimensional scaling, cluster analysis and t-tests. Lastly, a digital workshop with 50 participants was conducted to facilitate the interpretation of cluster solutions. Results: Eighty-three statements were distilled into 11 clusters from characteristics typical for traditional academic values (for example, ‘deploying appropriate methods’) and practice-based research (for example, ‘being actionable’) to characteristics emphasising the unique blend between them, such as ‘capturing and conveying reality’ and ‘embracing different agendas and perspectives’, the latter rated as the most important quality of excellent practice-based research, followed by ‘deploying appropriate methods’ and ‘being actionable’. Conclusions: Practice-based research is a complex field, addressing both ‘why things are’ and ‘how they work’. This study offers insights into how excellent practice-based research can be defined, broadening the view of what excellence entails.

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.

Evidence-based interventions have the potential to improve health and well-being, but their effectiveness depends, among other things, on the challenging act of balancing between fidelity and adaptation, referred to as the fidelity-adaptation dilemma. After initial implementation, it is primarily professionals delivering evidence-based interventions to end users that face the dilemma, but research about how professionals relate to and perceive it is limited. This study aims to describe professionals’ attitudes towards the dilemma and investigate the associations between professional attitudes and individual and organisational implementation determinants, individual characteristics, and work-life consequences for the professionals. Using a cross-sectional design, 103 professionals working with an evidence-based parental support programme ABC (All Children in Focus) were surveyed on attitudes towards the fidelity-adaptation dilemma, implementation determinants, and work-life consequences. Data were analysed using two-step cluster analysis. Three profile groups summarize professionals’ attitudes: one preferring fidelity (the adherers, n = 31), one preferring adaptations (the adapters, n = 50), and one with a dual view on fidelity and adaptation (the double-minded, n = 18). The adherers, the ones preferring fidelity, reported higher levels of skills, knowledge, openness, work-related self-efficacy, meaning of work, and possibilities for development, and a lower level of role conflict and unreasonable tasks compared to the adapters. Professionals with a positive attitude towards fidelity reports experiencing more job resources and a lower level of job demands compared to professionals who are more positive towards adaptation. The study shows that the fidelity-adaptation dilemma is at play during the sustainment phase of implementation and suggest that it has consequences for professionals working life.