Christiaan Vis, a researcher in Forhelse work package 4 – implemetnation, is defending his dissertation 03.11.2022 at 11:45 for his Ph.d-degree at the Vrije Universiteit Amsterdam with the thesis ‘Implementing eMental health services in routine mental health care – from barriers to strategies’.
The work that is presented in the thesis touch on four major and relevant topics for implementing online treatment in routine health service: technology assessment and decision- making process, identifying barriers for implementation, outcome of implementing strategies and development of effective tailored implementation strategies.
The ceremony will be streamed online at VU Beadle’s Office – YouTube. Supervisors are Heleen Riper og Tracy Finch, among others; Opponents bl.a. David Mohr, Trish Greenhalgh og Byron Powell.
The government is betting on youth
In this year’s state budget the government has proposed to allocate extra funds to Digi-Ung – a program that works to gather health-related information and public services in one place to make it easier for adolescence to navigate when needed. The information gathers at Ung.no.
UngMeistring at the research center is one of the projects in Digi-.Ung, and collaborates in the development of digital health services for this user group. In the budget proposal they suggest to give Digi-Ung an additional 5 million NOK to strengthen the digital services, which is great news for the digital health services for the future youth. You can read more about UngMeistring here.
In addition to this, the government has decided that, through Digi-Ung, ung-no will be the state’s primary channel for information, dialogue and services for children and adolescence across different service levels.
You can read more about Digi-Ung and excerpts from the budget proposal here:
In Trondheim, research is being done on the cost-effectiveness of the digital treatment that is under developement in the research centre. It is an important piece of work for the future conditions of the programs being designed. This week we have become a little better acquainted with the everyday working life of post.doc. Jørn Heggelund, who is based at St. Olav’s Hospital.
Heggelund has extensive experience from research in mental healthcare and improvement projects at the hospital. With a doctorate in clinical medicine and 13 years in research, he now works on work package 2 cost-benefit. The aim here is to try to give some answers on how to organize yourself as efficiently as possible when facilitating digital health services. In practice, this is about looking at which organizational and administrative measures are in place to make the service cost-effective.
-Why did you want to be a part of Forhelse?
– The health service is under great pressure and there is a need to rethink and find sustainable solutions. That is why we need knowledge, data and good analyses. Forhelse’s work with digital mental health services has a unique approach by combining innovation-driven research with business and clinical collaboration. Here we have the opportunity to make a difference and I want to be part of that, says Heggelund eagerly.
The daily work of Heggelund and the team currently involves collecting and systematizing the data that has been found. Here, there is good cooperation with the participating DPSs, which in this work package are Nidaros, Bjørgvin, Vestfold and Innlandet.
– What do you think will be important in the digital future?
– The overall goal for the health service will always be to ensure safe and effective health services. There are many indications that the digital services both provide better access to health services, better utilization of resources and patient satisfaction, says Heggelund.
For Heggelund, it is crucial to ensure that all digital measures result in a benefit for the patients and the services. He points out that it is particularly important to look after those citizens who do not have much digital experience, and that people with low health skills do not receive a worse health service.
– I strongly believe in improvement, innovation and development – both for patients and for healthcare services. I am passionate about research-driven innovation and quality assurance of new solutions, adds Heggelund.
– What makes you look forward to going to work?
– There are many good people in the project and everyone willingly shares their experiences. It is really exciting to meet and take part in the experiences of the people who perform the health services on a daily basis and to have the opportunity to analyze and systematize these experiences. Forhelse is a large and forward research centre. It is well run and has a large contact point and expertise, adds Heggelund in conclusion.
There are many indications that the digital services both provide better access to health services, better utilization of resources and patient satisfaction
Post.doc Jørn Heggelund
The first course in DigiflexHelse is now published
Now, the course DIGHEL630 – Digitalisation in health: Individual, organisation and community has started.
DIGHEL630 is the first of a total of four courses that the students will complete until June 2023. The project has brought along a very experienced group of students during the piloting of the digital and asynchronous further education in digitization for the health sector (DigiflexHealth). You can read more about the project here. IGS (UiB), Helse Bergen, ForHelse and partners in i DigiflexHelse are working closely to develop topics that meet new needs and requirements for digitization skills for employees in the health sector.
The road ahead will be exciting for both the partners, professionals and the projects lovely students.
Helse Vest IKT
Norwegian Smart Care Cluster
Read more about the digital further education here:
Forhelse has recently had a number of new PhD-fellows join the various projects. In the autumn of 2021, we had the talented Beate Standal join the team, whom we will now get to know a little better.
She became interested in digital psychological interventions in 2006 and it has followed her throughout her entire study- and working life.
Standal has several years’ experience from both primary and specialist health services and has experienced in various circumstances that it is “tough” to start treatments such as guided self-help. She has been curious about why that is.
-Why did you want to be a part of Forhelse?
– When I saw the advertisement for the research fellow position that dealt with the implementation of digital psychological interventions, I immediately thought that this is a field in which I would like to contribute with research. It is difficult to intuitively understand which factors are important for the implementation of this type of methods, so systematic research is welcome. As long as the extent of mental health problems – and especially the suffering for the individual – is so substantial, I think that the way we prioritize our treatment resources must be an important topic, says Standal. Standal is a psychologist from UIB, a specialist in clinical adult psychology and has further education in cognitive therapy.
– If we, with the help of tailor-made implementation, can increase the likelyhood that knowledge-based methods will be used in the healthcare system, one can perhaps spare others from “tough” implementation processes, and most importantly; make the treatment available more quickly to those who need it, she adds.
The project Standal is a part of, is included in work package 4 and deals with how to best implement the digital interventions which have been developed. You can read more here. The aim of Standal’s PhD project is to try and find out what makes the implementation of digital psychological interventions not go faster.
– Today, we can see that the digital treatments for mental disorders are not used to their full potential, and I will try to figure out why that is, by interviewing therapists, leaders and users of these interventions, adds Standal. Right now she is transcribing interviews that were done this spring with therapists and managers, so that she can analyze them qualitatively.
–What do you think will be important in the digital future?
– We must realize that the future will largely be digital and that we must prepare accordingly. Among other things, this involves doing digitalisation in such a way that everyone is included. There are far too many people who are kept out of the digital world. This includes, among other things, ensuring that digital solutions are adapted to different groups and ensuring that those who need training to be able to use the solutions receive this, says Standal.
-What kind of challenges do you see yourself encountering along the way?
– As in all large and long-term projects, it is almost impossible to envisage all the challenges that one might come across. A challenge for me personally is that it has been a long tim esince I studied, so getting into reading and familiarizing myself with current literature takes some time. Otherwise, I expect that I will periodically feel that the project is not moving forward quickly enough. I also have the additional challenge of keeping in touch with my colleagues as I am mainly based in my home office in Ålesund. Fortunately, digital meetings can largely compensate for this, says Standal.
Standal has gradually gained a lot of faith in digital psychological interventions and has seen the usefulness of this in practice. She believes that it provides a good and accessible treatment to patients and that is motivating for therapists to work with. In addition, she points out that for her it is also about an ethical aspect; insufficient therapist resources make it necessary to offer types of treatment that require little resources to ensure that as many people as possible get access to treatment.
-Few things can beat the feeling you get as a therapist when you meet a patient who has recieved good help from the treatment in a short amount of time. My biggest contribution to the research project will be the great passion I have to help spread the great treatment to those who need it. It feels inspiring to think that I might be able to influence this important part of the research, it is really meaningful, says Standal enthusiastically.
-What makes you look forward to going to work?
– The most wonderful thing about the job as a PhD candidate is the opportunity I have to design my own project and my own working days. I also learn something new every single day, which is incredibly inspiring, says Standal.
– In addition, Forhelse has an exciting environment to which many dedicated and skilled people are connected. There is a lot of important research going on here, she adds in conclusion.
VR-therapy can help young people with performance anxiety
Smiti Kahlon will defend her PhD degree at the University of Bergen on 15 September 2022 with the thesis “Virtual Reality Exposure Therapy for Adolescents with Public Speaking Anxiety”.
The purpose of this PhD project is to help young people deal with presentation anxiety, and as a secondary goal to prevent the anxiety from spreading to other social situations. Presentation anxiety is one of the most common fears among young people and it is believed that approximately 30% experience presentation anxiety to such an extent that it affects everyday school life. A third of these also meet the criteria for generalized social anxiety.
Through two studies, it was investigated whether VR-training for young people is feasible and whether it reduces presentation anxiety. In the first study, 27 young people turned up at the clinic to participate in a 90-minute VR-based training session together with a therapist. The young people reported a large decrease in anxiety symptoms. This meant that we could conclude that VR-training has potential for young people with presentation anxiety. A goal of scaling and easy accessibility laid the foundation for the second study to be self-guided.
The second study was a randomized controlled trial using a home-based and self-guided exercise program. A total of 100 young people were randomized into four different groups; 1) VR training only, 2) VR training with subsequent online exposure program, 3) online psychoeducational program with subsequent online exposure program, and 4) waitlist with subsequent online psychoeducational program.
The findings showed that the young people who received VR-training had a greater reduction in anxiety symptoms compared to those who were only in the waitlist-group in the first part of the intervention. No group differences were found between the VR with subsequent exposure program compared to the other groups in the last part of the intervention.”
More information about the disputation can be found on UiB’s website here.
Meet PhD fellow, Guri-Elise Holgersen
Guri-Elise Holgersen is one of several newly employed research fellows that the section is lucky enough to have on the team. We have had a chat with Holgersen to get to know her better and the work she will be doing in the next three years.
Holgersen is associated with the UngMeistring project, which will develop and research digital treatment for children and young people with ADHD, eating disorders, depression and anxiety. You can read more about UngMeistring here.
-Why did you want to be a part of UngMeistring?
– I applied for a PhD scholarship in UngMeistring because I want to be part of the exciting development in mental healthcare for children and young people. I am looking forward to being involved in developing and researching new forms of treatment that can help young people in everyday life. Holgersen adds that she is passionate about helping vulnerable young people. – Having a serious mental illness in addition to being in a period of life that is itself chaotic, I think most of us cannot imagine the extent of it, says Holgersen.
Holgersen is a trained clinical child welfare officer with special training in children and young people’s mental health. She has many years of experience in clinical mental health care for children and young people and ambulatory services, the Psychosis team at Haukeland.
The anchoring of the research in digital treatment
Holgersen will develop and research the effects of digital treatment of eating disorders. The work belongs to work package 1 in UngMeistring. Holgersen’s knowledge is relevant in the development of forms of treatment for young people, and she also has experience in developing digital tools for treatment. Among other things, VR-treatment has been developed in the Psychosis team.
– What do you think will be important in the digital future?
– I think it will be important that apps and digital treatments that are developed are rooted in research. Downloading an app is something that the vast majority of people have access to do. The commercialization potential may overshadow the quality of the help provided. If a self-help app is not rooted in evidence-based methods, it is not certain that it will provide the “right” help. Something that can in turn reduce the user’s hope, Holgersen points out.
UngMeistring started on 1 April 2022, and Holgersen started at the research center just over the summer. Although it is still early, she is well underway with her work.
– Right now I am writing an application to REK (Regional Committees for Medical and Health Research Ethics) which deals with the development of a digital treatment for young people with eating disorders. The aim here is to involve young people who have experience with treatment of an eating disorder in the development process. The overall aim of the project is to increase access to knowledge-based mental health services for young people with eating disorders, through the use of digital treatment.
– What challenges do you see yourself potentially encountering along the way?
– I can’t think of any specific challenges right now, but everyone tells me that being a PhD student is a challenge in itself, says Holgersen cheerfully.
– And lastly, we wonder what makes you look forward to going to work?
– I look forward to going to work because it is incredibly rewarding to be part of an exciting project, with such a nice group of enjoyable and competent people. The impression of the Research Center is incredibly positive. Everyone is committed, positive and welcoming, Holgersen concludes.
– 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.
– 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.
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.
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.
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.
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.
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.
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