– More universal design for everyone

In Norway, there is a requirement for universal design in digital services, but during Forhelse’s joint meeting in May, it emerged that there is still a long way to go.

Universal design was one of the topics discussed at Forhelse’s joint meeting in May. The center had invited Kristin Skeide Fuglerud, chief researcher and leader of the subject group for Digital inclusion at the research institute Norsk Regnesentral and Christian Thon, ICT advisor in the Norwegian Association of the Blind, to talk about the challenges of universal design in digital services.

– Universal design is important for everyone to be able to take part in the society of information. It is about self-esteem and self-mastery, says Fuglerud who is also an associate professor at the University of Southeast Norway in the Center for Health and Technology.

– I think universal design is important so that everyone can participate equally. There is already exclusion going on, so people should not have to experience it on digital platforms as well, Thon adds, whom among other things, works with universal design of apps and websites.

–What do you hope to gain from this gathering with focus on universal design?

More universal design for everyone – that is what we should gain from this gathering, says Thon.

– And that it will lead to more sustainable services and increase the quality, so that more people can use the services, Fuglerud adds.

Competence to order and knowledge are some of the barriers

According to Thon, lack of knowledge and experience are some of the reasons why one does not succeed with universal design.

– Another barrier is competence to order. If those who order do not check to see if there is universal design, it can easily be downgraded.

Fuglerud also says that it is important to remember that, as with everything else in ICT, universal design is a continous work that must be maintained and developed.

– Yes, old solutions are often a barrier. One forgets that it needs to be updated. When it comes to barriers for the user, I think that knowledge is central. One is maybe 80 years old and gets a gadget, it is a big challenge for many, says Thon.

The users must be involved

According to Thon and Fuglerud, there are several areas that can create problems for the user. Among other things, login can be a problem as it is difficult to use Bank-ID if one is not a Norwegian citizen or under 16 years of age.

Kristin Fuglerud had a presentation about universal design on Forhelse’s joint gathering

– When working with universal design, involving users is very important. One thing is technical accessibility, if it follows a standard then it is universally designed in theory, but to be truly universal one must involve the user. One should like to have more user representatives on a general basis and collaborate with interest organizations, says Fuglerud.

-I think it is wise to be able to show people how the system is used by those concerned. When designing a store, the store must have a nice flow. But if I have found my way into the store through the warehouse – how user-friendly is the solution then? Seeing the solution being torn to shreds by users can be an eye-opener for many, Thon adds.

They both add that one must not forget honoring the users. They are often expected to work for free, but more people should make it easy for them to get paid for the work they do as they are the experts in their challenges.

Advice from Kristin Fuglerud on how to get started with universal design in research projects: When securing universal design in research projects, it is a good idea to start by checking that you comply with legal requirements, ie WCAG (Web Content Accessibility Guidelines) before consulting with users. WCAG are guidelines for how digital content can be made more easily accessible for people with disabilities, and the elderly with age-related functional challenges. Once you have followed these guidelines, it is important to also get user evaluations to ensure utility. One can get in touch with users through interest groups and councils.

Visit by experts from the Scientific Advisory Council to Forhelse

On May 19th and 20th, Forhelse received a magnificent visit from researchers from the Scientific Advisory Council (SAC). The two days were characterized by useful and good conversations about digital health services.

The three experts were Professor Nick Titov at Macquarie University in Australia, Professor Heleen Riper at the Free University of Amsterdam and Professor Lee Ritterband at the University of Virginia. The purpose of the visit was to get input and professional discussions about the center’s work with various research projects.

– We have been very lucky with our SAC experts who have generously shared their years of experience in the development of, and research, on digital health services, says center manager Tine Nordgreen.

Center leader, Tine Nordgreen, opened the gathering by introducing the researchers to the center and the research, and giving them insight into the challenges Forhelse wanted to get input on.

The research in Forhelse is divided into different work packages and several of these were presented during the meeting.

Read more about the work packages here.

Leaders from the work packages and PhDs attended the gathering and helped present the work packages and the research associated with them. Along the way, they received useful input, questions and feedback from the experts and the other participants.

Day one ended with a panel debate on the themes in the work packages.

On day two, Forhelse had invited a research project related to the work in the center. One of these was the recently started project UngMeistring.

Read more about UngMeistring here.

UngMeistring is a project aimed at young people with various mental disorders and the youth group as users of digital health services were specifically discussed. In addition, Solli DPS participated with its project eMeistring – Health and work, which was presented by Henning Monsen.

The collaboration between SAC and Forhelse will continue closely in the years ahead by SAC following up the center with semi-annual reports and digital meetings, as well as a new physical meeting this year.

See more photos from the day below.

Focuses fully on digital health services for young people

Last week, representatives from UngMeistring were in Oslo to have a workshop with the Norwegian Directorate of Health’s DIGI-UNG. They are one of the partners in UngMeistring and aim to make it easier for young people to access digital health services.

DIGI-UNG wants young people to easily find information and services in one place, rather than looking in a jungle of public enterprises. One of the offers in DIGI-UNG will eventually be the self-help interventions that will be developed by UngMeistring.

Read more about UngMeistring here.

DIGI-UNG currently has seven projects, all of which focus on young people. These are Search, Chat and e-learning which can be found on ung.no, DigiFastlege, DigiHelsestasjon, Rettighetsautomaten, Ungdommens tjenesteportal, Snakk om PSA / SSA and UngMeistring.

Read more about the projects here.

On May 12th, these seven projects came together to get to know each other and learn from each other. UngMeistring competed strongly with three participants; post.doc Thomas Potrebny, PhD student Guri Elise Holgersen and project manager Kristin Hogstad Bruvik.

– We were happy to have the opportunity to meet others who work with digital services aimed at young people, and make contacts that can benefit the project over the next four years, says Kristin Hogstad Bruvik, project manager at UngMeistring.

Post.doc in eMeistring, Thomas Potrebny and project manager Kristin Hogstad Bruvik in the get-to-know-each other-exercise

Visit by the Ministry of Health and Care Services and exciting group exercises

The workshop had a packed and exciting program.

– We had a visit from the Ministry of Health and Care Services, heard about solution architecture in DigiUng and Missions where we were to see where DigiUng is in 10 years, and towards the end of the day a custom-made group exercise where each of the seven project managers were assigned a group of three people from the other projects who knew something that was relevant to a specific problem, says Bruvik.

UngMeistring submitted two issues for this exercise; “What experiences do the projects have with the use of game mechanisms and interaction for young people aged 12-15 and 16-18?” and “what experiences have you had with regard to the storage of personal data and different levels of security?”

– We were so lucky to be assigned three highly competent people for this work: Christian Elvsaas, Morten Nordanger and Robin Føyen. They willingly shared their expertise and experience related to security, privacy, storage of sensitive information, ROS-analyzes and legislation in their own DigiUng projects, says Bruvik.

Further collaboration across Teams

When project manager Bruvik was to present the results of the discussion to the rest of the group, there was only one point under Action points, namely Team meetings.

– The whole day was characterized by openness, warmth and a willingness to share and collaborate on developing good digital services for young people, says Bruvik.

Bruvik says that the project participants from UngMeistring managed to get to know others who have similar issues as themselves, and especially learn from others in the same field.

– We formed networks that we will greatly enjoy further in the project. We greatly appreciate being able to participate in the DIGI-UNG program, says Bruvik.

Two new online treatments for eMeistring in Helse-Bergen

In collaboration with DigiHub in Forhelse, eMeistring has developed two new online treatments for people with insomnia and ADHD.

– We at eMeistring are very pleased with the results of the new programs for Insomnia and ADHD. We are also grateful for the collaboration with Intromat/Forhelse and DigiHub, says section leader in eMeistring, Kjersti Skare

Before Christmas, the work on developing an online treatment program for people with insomnia started. The treatment and the academic content have been developed by Kerstin Blom, sleep expert and researcher at Karolinska Institutet in Stockholm. DigiHub has in collaboration with Blom developed the visual profile and the digital content.

In addition to a strong academic content and method, the program is equipped with a digital sleep diary, a toolbox with information and large amounts of illustrations and interactions that will promote user participation and learning for the patient.

Both treatments are module-based, as you can see an example of here.

After Christmas, the work on an online treatment program for adults with ADHD started. The academic content, and the program, was first developed by psychologist and researcher Robin Kenter, who is also the work package owner in Forhelse.

The treatment which Kenter first created was a self-help program that was used in research into the use of online treatment for adults with ADHD. With feedback from the clinicians in eMeistring, DigiHub has made adjustments and changes to the program so that it can be used with therapist support.

The end product is educational, user-friendly and modern programs that we look forward to using, says Skare.

The ADHD program uses, among other things, videos as a tool.

She says that they are planning a pilot of the insomnia program after the summer vacation and hope they can start using them ordinarily during the autumn of 2022. This also applies to the ADHD program.

-eMeistring is a good offer and we want to reach as many patients as possible with our treatment. Now that we have more treatment programs, we can offer even more patients treatment. Treatment for insomnia and ADHD is in demand in the health service and we have experienced great interest in when programs can be used. We are excited about how the new programs will be received by patients and colleagues.

– It has been very educational and exciting to work with eMeistring in the development of these programs, says team leader in DigiHub, Ingeborg Kløve-Graue.

She says that it as been important in the development to work with eMeistring, who has used online treatment for many years, and to learn from them.

– At the same time, I think they have benefited from our team which has an interdisciplinary background and can help make programs both visually fine, but also user-friendly, says Kløve-Graue.

Both programs are created on business partner Youwell’s platform.

-In addition to a good collaboration with eMeistring, it is also important to have a steady and innovative business partner like Youwell on the team, and I hope and believe this will be a program that is well received, says Kløve-Graue.

Meet the leader of work package 4, Robin Kenter

Forhelse is divided into four work packages; effectiveness, cost-effectiveness, early HTA and implementation. Psychologist Robin Kenter is a researcher and post doc, and the leader of work package 4- Implementation.

We had a chat with Robin about what the responsiblitiy of work package 4 in Forhelse is, and what her thoughts are about health services becoming more digitalized.

What is the goal for the work package you are leading? 

-First of all, the goal is to understand what promotes and inhibits the use and implementation of digital mental health services on different levels, Kenter says.

According to Kenter PhD candidate, Beate Standal in work package 4 is already in the process of qualitative exploration of determinants through interviews and focus groups with participants working with digital health services. From this, they hope to answer what therapist and leaders need to reach a more effective implementation, and increased use of guided internet based treatment.

–We hope that what we find can help make internet treatment available to more people who can benefit from it. Through the interviews, we can also gain knowledge about the future use of tailored -made implementation tools that support the work the district psychiatric centers and hospitals are already doing. By using tailored implementation strategies, and research on the effects of these, we will be able to contribute to more sustainable and efficient implementation. This can lead to online treatment becoming a treatment offered similarly to existing offers, and that we reach more people so that the threshold for seeking help is lower, Kenter says.

What benefit do you think this will have for the health service and the health industry?

As of today, many in Norway are well on their way trying and implementing digital psychological health services. Some get good results while others struggle. Everyone tries on their own, and there is little knowledge about effective implementation strategies when it comes to psychological health services.

Offering a new digital intervention requires a lot. For example, you may need to organize in a new way, relate to new work processes, train personnel, think and act in a new way, and create new activities.  The introduction of digital mental health services is changing the existing way of offering health services and that makes it more complex, Kenter says.

Kenter further explains that in work package 4 they use Normalization Process Theory (NPT) which focuses on the normalization process in the introduction of digital psychological interventions in the health care system. The theory helps them understand digitalization, challenges in introducing digital mental health services and organizational change as a holistic process.

-Digital mental treatments are proving to have good results in research stages, and they are scalable. It can provide more people with a good option, but we must know how to deliver it in the best possible way, and evaluate any errors and pitfalls in the implementation. In addition, collaboration is important, so that more people benefit from the knowledge. The research that takes place in our work package can hopefully streamline the implementation processes and provide a better outcome. Increased knowledge about the introduction of digital interventions in existing health services is relevant for both health workers, the health sector and society, Kenter adds.

What is your hope for the development of digital health service in the years to come?

-I think digitalization and the introduction of new technology are here to stay. I hope we can move towards personalized and adaptive treatment, so that the right treatment is given to the right person, at the right time. I think technology can contribute to that. In addition, I hope that technology can help reduce the impact of treatment, that patients/users are not overloaded with e.g. questionnaire and reporting “homework”, but that the technology can help with the use of sensor data and digital phenotyping. This way it becomes easier for the patient and the therapist to follow the patient’s symptoms and progress in treatment, says Kenter.

What do you think are the biggest challenges with digitalization of health services?

–The major challenges probably lie in the implementation process. We have been quite good at developing psychological interventions, and the way of doing it includes the end user’s needs and preferences from start to finish.

According to Kenter, there are many effective and user-friendly interventions, but a lot of countries are struggling to implement it as an equal service in the health care system. This seems to be a demanding job not only in Norway, but also all over the world. There are different solutions in different countries.

What end result do you hope for in Forhelse?

-The incidence of mental illness exceeds the health services available today. There are far too few who get access to the mental health services they need. I sincerely hope that through Forhelse we can make quality-assured mental health services easily accessible to those who need them, she adds.

You can read more about work package 4 here

Opening seminar for UngMeistring

This week it was time for the opening of UngMeistring. Several of the partners were gathered to get information about the start-up and the way forward.

UngMeistring is a new project in Forhelse in collaboration with several partners. The project’s main goal is to develop and evaluate eight digital online and game-based self-help and treatment programs for young people between 13 and 18 years of age. These programs will address four diagnoses; eating disorders, anxiety, ADHD and depression.

The project was awarded 25 million NOK from the Research Council of Norway under the Pilot Health program. Through its DigiUng project, the Norwegian Directorate of Health has provided additional funding, and is a partner in the project. The project is rented by Helse Bergen and Kristin Bruvik is the project owner.

UngMeistring has an interdisciplinary and broad composition of partners:

  • Helse Bergen HF
  • Helse Fonna HF
  • Helse Stavanger HF
  • Universitetssykehuset Nord-Norge HF
  • Ministry of Health and Care Services
  • Helse Vest IKT (Western Norway Regional Health Authority ICT dept)
  • Sjukehusinnkjøp
  • University of Bergen
  • Bømlo kommune
  • Attensi
  • Youwell
  • SkillUp AS

Project leader Kristin Bruvik was very satisfied with the day;

It was nice to see such great commitment from the partners. This project will challenge new aspects of online treatment that we do not know the answer to, among other things related to how to take care of privacy for young people who do not have a bank ID, says Bruvik.

According to Bruvik, there has been a sharp increase in the need for mental health services for young people in the last two eyars.

It will be interesting to work with user involvement to understand the needs of the young people we want to help. In the project, we will link technology and professional content in a way that engages young people and that has a positive health effect. We will target both digital platforms such as ung.no where young people can find help on their own, we will collaborate with the municipalities to strengthen their services for young people, and we will strengthen specialist health services with digital tools that can help more people more effectively, she says.

The opening seminar was characterized by a committed and competent group with large knowledge in various subject areas. The project will include clinicians from the BUP services, business partners with experience in developing digital health programs and representatives from both primary and specialist health services.

Meet our partner Mage-tarmskolen

Mage-tarmskolen is located at Haukeland University Hospital and was the first in all of Norway to establish a digital treatment offer in somatics for patients with irritable bowel syndrome.

They are in the process of a study where 2000 patients will go through a 12-24 week training and treatment program where the patients are supervised through five inrdteisciplinary digital modules. The aim of the study is to demonstrate beneficial effects in the form of improved quality of life, reduction of abdominal symptoms, provide new knowledge about the interdisciplinary patient approach, and form the basis for a future national project.

Data from this study will also be used in Forhelse to look at predictors of good outcome, which will be important knowledge during implementation.

We talked to the people behind the project and their thoughts on the center.

What was your motivation for joining the center?

Mage-tarmskolen is the first digital health service in somatics. The treatment involves both the physical and the mental aspects of living with chronic stomach ailments. 

For us, this is demand-driven innovation and research with patients in focus. Although this patient group has a great need for health care, this disease is not dangerous or life-threatening. Thus, they are at the bottom of the priority list for the specialist service, and it is challenging for both patients and healthcare professionals.

We want to increase capacity, be able to offer our quality-assured information and health services equally, to everyone in need in Norway, regardless of the patient’s place of residence or their local hospital. We also want to be able to contribute to research on and development of digital health services but also be part of a professional environment.

What is your role/contribution in the work package you participate in?

We are part of work package 4, Implementation with Mage-tarmskolen. This is the only contribution from the somatics in the center. 

In work package 4, the Mage-tarmskolen will research how they/the center can carry out the implementation in a good way, map inhibitors and promoters, and research sustainable implementation.

Read more about work package 4 here.

Read more about work package 4 here.

As there is no other digital solution in somatics, we have not had anything to lean on and much is therefore new. 

It is important to put in place good financing schemes to ensure hospital financial sustainability. New procedure codes were granted in 2021. These are important for providing earnings that are sustainable for hospital operations. This will also be able to contribute to more resources for the project so that the patient receives good follow-up.

A challenge for the project is to identify who our digital health service is best suited for, and especially who gets the best benefit from the treatment. This is a heterogeneous group that will require different and personalized treatment and follow-up. Funds have been set aside for a PhD project to map this. 

In addition, this PhD project will research effective ways to increase the spread of the digital treatment, map barriers and facilitate implementation of the program so that the treatment becomes available to as many people as possible.

Why is digitization important in the health sector?

As the rest of the world digitizes, it will be important for the health sector to also be involved in the development. 

Digitization means that we can offer the same treatment regardless of place of residence. It will also be able to be cost-effective/resource-saving for both the health services and the patients.

What do you want to achieve during the 8 years the center shall exist?

We also want to implement and national broaden Mage-tarmskolen. Out 2023, this is mainly an offer for patients in Helse-Vest. 

Read more about Mage-tarmskolen here.

Annual report 2021

The annual report for 2021 is ready! The report provides a summary of the previous year within central areas in the research center.

You can find the report here.

Meet our partner St.Olavs hospital

St. Olav’s hospital is one of Forhelse’s eMeistring-partners. They have extensive experience with digital health services and have this as one of their main focus areas.

We had a chat with the section manager in Nidaros DPS, Liv Sigrun Sættem Engvik, about their work and why they wanted to be part of Forhelse.

Section manager Liv Sigrun Sættem Engvik

Read more about Senter for eTerapi here.

What was your motivation for joining the center?

Digitization is one of the main focus areas for St. Olav’s hospital. The goal is to develop and use digital health services where it is suited and provides value. Today’s technology has opened up a large opportunity for further development of our health services. Nidaros DPS at St. Olav’s hospital established Senter for eTerapi in collaboration with Helse Bergen in 2018. We want to develop our digital health services and think it is important to have collaboration across various health trusts in that regard. We see Forhelse, with the aim of increasing the use and effect of digital health services, as a good and important partner in this work.

What is your role/contribution to the work package you participate in?

Senter for eTerapi, which offers eMeistring for panic disorder, social phobia and depression, will contribute to work packages 2 and 4. The work packages will look at the extent to which guided internet treatment is cost-effective and experiences and strategies for implementation. There are key professionals associated with the Senter for eTerapi at Nidaros DPS who contribute with experience from the center, from implementation and figures from operations.

Read more about the work packages in Forhelse here.

Why is digitization important in the health sector?

The demand for treatment for mental health problems is increasing in the population and we are challenged to think differently. Technological developments have made it possible to communicate securely with patients in new ways. Digitization is important for developing better and more flexible healthcare services and for providing a more equal healthcare service to patients regardless of where they live. Digitization also increases the patient’s choice, with the opportunity to choose digital solutions if patients want this. Overall, this will increase the quality of the health service, improve resource utilization and increase patient satisfaction.

What do you want to achieve during the eight years the center will exist?

The issues related to cost-benefit and implementation are very relevant in relation to further development of the digital health service. We think that collaboration with the SFI will provide us with valuable information and expertise related to these areas. We want supervised internet treatment, eMeistring, to become a better known treatment-option in the population, and for more patients to be offered this treatment. We also see the opportunity to develop more treatment programs either in the form of guided internet treatment for several conditions or the development of digital tools to support ordinary treatment.

Meet our partner eMeistring – Helse Bergen

Forhelse has three eMestring-partners, and eMeistring in Helse Bergen is one of them. They offer internet-based treatment for anxiety, panic disorder and depression. They are also working on the development of digital treatment programs for patients with insomnia and ADHD.

We have had a chat with the subject manager, Gunn Elise Sætre, about the work they do in eMeistring and why they wanted to be part of the center.

Gunn Elise Sætre, Head of eMeistring Health Bergen

What was your motivation behind joining the center?

eMeistring in Helse-Bergen has used evidence-based digital tools in the treatment of anxiety and depression in the specialist health service since 2013. We receive good feedback from patients who have received treatment from us, and we want our participation in the center to help motivate decision-makers to make use of digital treatment interventions to a greater extent, by providing increased knowledge about how it can be done in a cost-effective way.

eMeistring Helse Bergen is part of two work packages – cost/benefit and implementation. They will contribute with number materials, knowledge and experiences with the use of digital psychological treatment in studies that will examine the extent to which such interventions are cost-effective and that look at the effect of different implementation strategies.

Why is digitization important in the health sector?

The use of digital health services has the potential to reach a larger number of patients than traditional treatment and provide an equal offer regardless of factors such as demographic and social conditions. It can also contribute to the professional resources in the health services being distributed in a better and more efficient way.

What do you want to achieve during the 8 years the center will exist?

We want even more patients to be offered treatment in eMeistring. We also want efforts to be made to develop and facilitate the implementation of treatment programs for more conditions than we currently have.

If you want to read more about eMeistring in Helse-Bergen, you can do so here.