Her interest in this research was born out of her frustration that, as a physiotherapist, she was often expected to start using new tools, even though basic conditions were not met. Therefore, in her thesis work, she studied how three different digital tools in mobile health, mHealth, are implemented in child healthcare and student health.
One of the tools aims to promote healthy eating habits and physical activity in young children, and is used by their guardians. The other two tools, which deal with lifestyle habits and mental health, are aimed at upper secondary school students. The studies included managers, principals, child healthcare nurses, school nurses and people with responsibility for digital strategy at municipal or regional level.
Unclear governance slows implementation
Maria Fagerström has identified two crucial factors that can make it difficult for healthcare to introduce and start using mHealth tools developed by, for example, researchers.
Charlotte Perhammar
“These apps generate health data that needs to be taken care of securely. In my studies, the people I interviewed found this very difficult. The second important factor is clear governance when it comes to implementation,” says Maria Fagerström, who recently defended her thesis at Linköping University.
Unclear governance meant that many people were uncertain about the role of digital health tools and whether they should be prioritised in the organisation.
The next phase in the introduction of digital tools begins once the decision to start using a health app in the organisation has been made.
“I can see in my studies that when a health app is to be used in the organisation, ongoing governance is very important. Child healthcare nurses and school nurses are very autonomous professional groups, who are expected to both run projects and at the same time do their daily work. They demand more governance from their manager as well as from regional actors,” says Maria Fagerström.
Youths want to discuss the apps
Of course, it is important not to forget the end users: the young people and guardians who will use the tools regularly and hopefully benefit from them. Maria Fagerström has also interviewed young people, and notes that it is not enough to offer them an app and show how it works.
Young people’s attitudes to apps that support mental health, and how well the app matched other things they liked using, influenced how they took to it. They also said they wanted to talk about the app with their friends.
“The young people wanted to discuss mental health and the app in the classroom. This means that a small app, which you might think would be easy to implement, creates ripple effects for how teachers and mentors work with mental health,” says Maria Fagerström.
In other words, implementing a digital tool involves not only introducing a new app, but introducing a new way of working within the organisation.
When digital tools cause cultural clashes
The interviews with staff also showed that they sometimes felt that there were cultural clashes when tools were introduced in their work. Child healthcare nurses and school nurses are used to working with lifestyle changes by building relationships and talking to people. In interviews, they described that the tool could become an obstacle to building relations.
“The introduction of digital mHealth tools can be challenging for staff. At the same time, they say that there is a great need for health promotion work to keep pace with the digitalisation of society. And because health promotion resources are so limited, these tools can be a way to extend support also after the in-person meeting,” says Maria Fagerström.
Dissertation: Getting Dressed for Success: Implementing Health-Promoting mHealth in Swedish Child and School Healthcare Services, Maria Fagerström, Linköping University Medical Dissertations No. 2029
Charlotte Perhammar
