Although Sweden is one of the most digitalized countries and the Swedish population’s use of the internet is among the most studied in the world, little is known about how Swedes with disabilities use internet. The purpose of this study is to describe use of and perceived difficulties in use of the internet among people with disabilities and to explore digital divides in-between and within disability groups, and in comparison with the general population. This is a cross-sectional survey targeting the same issues as other nationwide surveys but adapted for people with cognitive disabilities. Participants were recruited from May to October 2017 by adaptive snowball sampling. The survey comprised questions on access to and use of devices, and use of and perceived difficulties in use of internet. A total of 771 people responded to the survey, representing 35 diagnoses/impairments. Larger proportions of people with autism, ADHD and bipolar disorder reported using internet than other disability groups. Women with autism used the internet more than any other disability group, and women with aphasia used the internet the least. People with disabilities related to language and understanding reported more difficulties using internet than other disability groups. Larger proportions of participants than the general Swedish population reported not feeling digitally included. In many but not all disability groups, larger proportions of men than women reported not feeling digitally included. Our findings show that there are differences in digital inclusion between sub-groups of diagnoses/impairments. Thus, disability digital divides are preferably investigated by sub-grouping disabilities, rather than studied as one homogeneous group.

Background: Sustainable and effective eHealth requires accessibility for everyone. Little is known about how accessibility of eHealth is perceived among people with various impairments. The aim of this study was to compare use and perceived difficulty in the use of eHealth among people with and without impairment, and how different types of impairment were associated with perceived difficulty in the use of eHealth.Methods: This study used data collected in a nationwide survey in Sweden. Snowball sampling was used to recruit participants with self-reported impairment, from June to October 2019. In February 2020, the survey was posted to people in the general population who were matched to the participants with impairment by age, gender and county of residence. Multiple logistic regression was used to analyse the use of four eHealth services, and perceived difficulty in the use of six eHealth services.Results: In total, 1631 participants with, and 1084 participants without impairment responded to the survey. Participants with impairment reported less use and more difficulty in the use of all eHealth services as compared to participants without impairment. When comparing types of impairment, booking healthcare appointments online was least used and most avoided by participants with communication, language and calculation impairments (adjusted odds ratio (aOR) use 0.64, 95% confidence interval (95%CI) 0.49–0.83; aOR avoid 1.64, 95%CI 1.19–2.27), and intellectual impairments (aOR use 0.28, 95%CI 0.20–0.39; aOR avoid 2.88, 95%CI 1.86–4.45). The Swedish national web-portal for health information and services, 1177.se, was reported difficult to use the most among participants with communication, language and calculation impairments (aOR 2.24, 95%CI 1.50–3.36), deaf-blindness (aOR 11.24, 95%CI 3.49–36.23) and hearing impairment (aOR 2.50, 95%CI 1.17–5.35).Conclusions: The results confirm the existence of an eHealth disability digital divide. People with impairment were not one homogeneous group, but differed in perceived difficulties in regard to eHealth. Based on a purposeful subgrouping of impairments, we showed that people with communication, language and calculation impairments, and intellectual impairments, reported least use and most difficulty in using eHealth. The findings can guide further research in creating eHealth that is accessible for all, including those with the most significant difficulties.

To evaluate the feasibility of study design and method for evaluating effects of interventions on patients with long-lasting neck pain and to compare treatment effects of: (i) a pain and stress management group intervention with applied relaxation, and (ii) individual physiotherapy treatment as usual. Randomized controlled pilot study. Thirty-seven patients with long-lasting neck pain. The patients were randomly assigned either to applied relaxation or treatment as usual. The applied relaxation group received 7 group sessions over a period of 7 weeks and the treatment as usual group an average of 11 individual sessions spread over 20 weeks following baseline. Twenty-nine participants completed the intervention and filled in a self-assessment questionnaire before treatment, and 7 and 20 weeks after baseline. The questionnaire comprised: Neck Disability Index, Coping Strategies Questionnaire, Hospital Anxiety and Depression Scale, Tampa Scale of Kinesiophobia, and questions regarding neck pain, analgesic use, sleep, sick-leave and utilization of healthcare. The applied relaxation group had better perceived control over pain at the 20 weeks follow-up compared with the treatment as usual group. The design and methods of this pilot study were feasible and will be suitable for a larger randomized controlled study.

Background: The Coronavirus disease 2019 (COVID-19) pandemic has caused overwhelming challenges to healthcare systems worldwide. Healthcare workers (HCWs) have faced particular challenges: being exposed to the coronavirus SARS-CoV-2 and caring for patients having a new and potentially life-threatening disease. The aim of this study was to explore how HCWs in the Swedish healthcare system perceived their work situation during the first phase of the COVID-19 pandemic in 2020. Methods: Focus group discussions and interviews with HCWs were performed from June to October 2020 in one Swedish healthcare region. A purposeful sampling approach was used to select a variety of professions (physicians, nurses, nurse aides and cleaners) and workplaces (hospital inpatient wards, emergency department, nursing home and home care service). Qualitative content analysis was used for data analysis. Results: In total, 51 HCWs participated in eight focus group discussions and one HCW participated in an individual interview. The content analysis identified two main categories: ‘Concerns about the risk of infection and transmission of infection to others’, and ‘Transition from chaos to managing in a new and challenging work situation’. The findings revealed how HCWs perceived working conditions, including experiences of fear for personal health, confusion and uncertainty regarding personal protective equipment and infection prevention and control (PPE/IPC), and fear of infecting others. Both fearful and appreciating attitudes were achieved from the surrounding community. Helpful strategies for transition from chaos to control were lifted i.e. present and supportive leadership, and finding comfort and strength in the working team. Both helplessness and meaningfulness were described when caring for COVID-19 patients. Conclusions: This study provides unique insights into HCWs experiences of an extremely challenging work situation during the first phase of the COVID-19 pandemic, including feelings of stress and insecurity in a chaotic and hazardous working environment. But there is also mitigation of these challenges and even positive experiences including feelings of safety and meaningfulness. To enhance safety among HCWs in healthcare crises such as the COVID-19 pandemic, the findings highlight the importance of avoiding confusion about PPE/IPC, having a supportive healthcare leadership and ensuring accurate information provision about virus transmission to the public.

A 2-year follow-up of a randomized controlled trial. To compare long-term effects of (a) a multicomponent pain and stress self-management group intervention (PASS) and (b) individually administered physical therapy (IAPT) on patients with persistent tension-type neck pain in a primary health care (PHC) setting. In a previously reported short-term follow-up, PASS had better effects on pain control, pain-related self-efficacy, disability, and catastrophizing than IAPT. Long-term effects of self-management interventions for persistent neck pain, for example, maintenance of improvement and adherence to coping skills are sparsely investigated. Persons with persistent tension-type neck pain seeking physical therapy treatment at nine PHC centers in Sweden were randomly assigned to either PASS or IAPT. Before intervention, at 10 and 20 weeks and at 1 and 2 years after the intervention, the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale, and questions regarding neck pain and analgesics. Analyses were performed using linear mixed models for repeated measures. The study included 156 participants (PASS n = 77, IAPT n = 79). Between baseline, 10-week, 20-week, 1-year, and 2-year follow-up, significant time-by-group interaction effects were found in favor of PASS regarding the primary outcomes ability to control pain (P < 0.001) and self-efficacy for performing activities in spite of pain (P = 0.002), and the secondary outcome catastrophic thinking (P < 0.001) but not in neck pain-related disability. The initial treatment effects of a self-management group intervention were largely maintained over a 2-year follow-up period and with a tendency to have superior long-term effects as compared to individually-administered physical therapy, in the treatment of persistent tension-type neck pain with regard to coping with pain, in terms of pain control, self-efficacy, and catastrophizing.