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  • 1.
    Mattisson, Marie
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Börjeson, Sussanne
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Operations management.
    Arestedt, Kristofer
    Reg Kalmar Cty, Sweden; Linnaeus Univ, Sweden.
    Lindberg, Malou
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, 1177 Vårdguiden.
    Interaction between telenurses and callers - A deductive analysis of content and timing in telephone nursing calls2024In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 123, article id 108178Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore the content and timing of verbal interaction between telephone nurses and callers, and to suggest areas for improvement. Methods: Transcribed telephone conversations (n = 30) to a national nurse-led advisory service were analyzed using deductive content analysis. Categorization of data was based on components of interaction in the Interaction Model of Client Heath Behavior (IMCHB): health information, affective support, decisional control, and professional-technical competencies. The content was described both quantitatively, based on word count, and qualitatively, using descriptions and exemplars. Transcripts were also coded according to five phases in the conversation process: opening, listening, analyzing, motivating, and ending. The distribution of interaction components among phases was explored. Results: Interaction primarily focused on health information, particularly during the listening and analyzing phases. Telenurses based their advice on medical facts and guided callers through the conversation process. Callers' emotions and reflections on advice were rarely discussed. Conclusions: Health information dominate conversations. Interaction can be further developed, particularly with respect to acknowledging callers' emotional responses, their reactions to advice, and ensuring clarity in exchange of health information. Practice implications: Findings offer valuable guidance for future development of interaction in telenursing.

  • 2. Order onlineBuy this publication >>
    Mattisson, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    "I'm calling for hope, comfort and maybe some advice...": Interaction and caller satisfaction in telenursing2023Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The provision of nursing over the telephone is an appreciated asset in many parts of the world. Interaction between telenurse and caller is important for caller satisfaction, and satisfaction in turn is positively related to outcomes such as adherence, engagement in self-care and well-being. Despite the long history of telehealth services, research about interaction in telenursing is still in a developmental stage.

    Aim: The overall aim of the thesis was to develop a questionnaire that enables valid and reliable exploration of telenurse–caller interaction, and caller satisfaction with calls, and to explore interaction and its importance for caller satisfaction.

    Methods: The thesis applied a deductive approach based on a theoretical nursing model; the Interaction Model of Client Health Behavior (IMCHB). Interaction in the IMCHB, is divided into four components: health information, affective support, decisional control, and professional-technical competencies. In the first study (I), the Telenursing Interaction and Satisfaction Questionnaire (TISQ) was developed. Variables were identified through a literature review, structured according to the IMCHB, and worded as questionnaire items. Content validity was evaluated with input from cognitive interviews with callers, and professionals using the Content Validity Index (CVI). A consecutive sample of 1,400 callers received the TISQ by post, and test-retest reliability of single items was evaluated. In Study two (II), 25 items from the TISQ focusing on interaction between callers and telenurses were selected to form the Telenursing Interaction and Satisfaction Scale (TISS), a scale for the measurement of caller satisfaction with interaction in four subscales according to the IMCHB. Psychometric properties of the TISS were evaluated with a focus on data quality, factor structure, convergent validity, and reliability. In Study three (III), caller satisfaction with interaction (i.e., TISS scores) and their associations to overall satisfaction with calls were explored using descriptive statistics, repeated measures ANOVA and ordinal logistic regression models. In Study four (IV), 30 transcripts of authentic calls were analysed using content analysis with directed approach. A coding scheme based on the four components of interaction in the IMCHB was developed and applied for deductive categorisation of data. Manifest content of conversations (n = 37,447 words) was presented quantitatively and qualitatively. In addition, data was coded and analysed in relation to phases in the conversation process for telenursing: opening, listening, analysing, motivating, and ending.

    Results: The 60 item TISQ showed good content validity in the telenursing setting (I), with a Scale-CVI of 0.91. Test–retest reliability of single items was moderate to good (I). TISS-data deviated significantly from a normal distribution, but all response options were endorsed (II). The confirmatory factor analysis confirmed the four-factor structure of the TISS, and factor correlations were high (rs = 0.88 to 0.96) (II). A higher order model showed marginally deteriorated model fit values (II). Ordinal alpha, scale reliability, and test–retest reliability were satisfactory for all scales, and convergent validity was satisfactory (II). Callers expressed the highest level of satisfaction with affective support, while their satisfaction with decisional control was comparatively lower (III). Callers’ satisfaction with interaction was positively associated with overall satisfaction with calls, even when considering experienced waiting time, main result of the call, fulfilment of expectations, age, gender, self-rated health status and time of call (III). A total of 97% of manifest words in conversations were identified as nursing interaction based on the IMCHB (IV). Health information was the primary focus, particularly during the listening and analysing phases (IV). Affective support was the least prominent component, and callers’ reactions to advice were seldom discussed (IV). The opening phase was the shortest, and analysing phase the most word consuming (IV).

    Conclusions: The TISQ, including the TISS, provide a valid and reliable questionnaire for the study of telenurse-caller interaction, and caller satisfaction. Caller satisfaction with the interaction can be measured using the four subscales in the TISS. In cases where there is a problem with multicollinearity, a total scale score from the TISS can be utilized. All four components of interaction in the IMCHB play a crucial role in determining overall caller satisfaction with calls. Therefore, the development of interaction in telenursing need to consider all four components. The exchange of health information presents challenges for both telenurses and callers, and affective support can be provided to callers without verbalizing emotions. Among the four components, decisional control may have the largest potential for improvement in the studied setting. This can be achieved by acknowledging callers’ reactions to advice.

    List of papers
    1. Development and content validation of the Telenursing Interaction and Satisfaction Questionnaire (TISQ)
    Open this publication in new window or tab >>Development and content validation of the Telenursing Interaction and Satisfaction Questionnaire (TISQ)
    Show others...
    2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, no 6, p. 1213-1222Article in journal (Refereed) Published
    Abstract [en]

    Background Caller satisfaction with telephone advice nursing (TAN) is generally high, and the interaction is essential. However, a valid questionnaire exploring caller satisfaction in TAN with focus on perceived interaction is lacking. Objective To develop and assess content validity and test-retest reliability of a theoretically anchored questionnaire, the Telenursing Interaction and Satisfaction Questionnaire (TISQ), that explores caller satisfaction in TAN by focusing on perceived interaction between the caller and the telenurse. Methods The study was performed in three stages. First, variables relevant for patient satisfaction in health care were identified through a literature search. Variables were then structured according to the Interaction Model of Client Health Behavior (IMCHB), which provided theoretical guidance. Items relevant for a TAN context were developed through consensus discussions. Then, evaluation and refinement were performed through cognitive interviews with callers and expert ratings of the Content Validity Index (CVI). Finally, test-retest reliability of items was evaluated in a sample of 109 individuals using intraclass correlation coefficients (ICC). Results The TISQ consists of 60 items. Twenty items cover perceived interaction in terms of health information, affective support, decisional control and professional/technical competence. Five items cover satisfaction with interaction and five items overall satisfaction. Remaining items reflect singularity of the caller and descriptive items of the call. The TISQ was found to exhibit good content validity, and test-retest reliability was moderate to good (ICC = 0.39-0.84). Conclusions The items in the TISQ form a comprehensive and theoretically anchored questionnaire with satisfactory content validity and test-retest reliability.

    Place, publisher, year, edition, pages
    WILEY, 2019
    Keywords
    communication; content validity; nurse-patient relations; patient experiences; patient satisfaction; surveys and questionnaires; telenursing
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-161153 (URN)10.1111/hex.12945 (DOI)000486250400001 ()31513328 (PubMedID)
    Note

    Funding Agencies|Ostergotland County Council; Medical Research Council of Southeast Sweden

    Available from: 2019-10-25 Created: 2019-10-25 Last updated: 2023-06-02
    2. Psychometric evaluation of the Telenursing Interaction and Satisfaction Scale
    Open this publication in new window or tab >>Psychometric evaluation of the Telenursing Interaction and Satisfaction Scale
    2023 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, no 3, p. 687-697Article in journal (Refereed) Published
    Abstract [en]

    Aims and Objectives Interaction between caller and telenurse in telenursing is important for caller satisfaction and subsequent compliance. Despite this, satisfaction measures with focus on interaction in telenursing are scarce and rarely anchored in nursing theory. The aim was to evaluate the psychometric properties of the Telenursing Interaction and Satisfaction Scale (TISS) with focus on data quality, factor structure, convergent validity, and reliability.Methodological Design and Justification This psychometric study was based on cross-sectional data.Research Methods, Instruments, and/or Interventions Callers to the National Medical Advisory Service in Sweden (n = 616) completed the 60-item Telenursing Interaction and Satisfaction Questionnaire based on Coxs Interaction Model of Client Health Behavior. Twenty-five of these items were selected to form the TISS in four subscales according to the model. Data quality was evaluated in terms of missing data patterns and score distributions. The factor structure was evaluated with confirmatory factor analysis for ordinal data, convergent validity with Spearman correlations, internal consistency with ordinal alpha, scale reliability with composite reliability coefficients, and test-retest reliability with intraclass correlations.Results The amount of missing data was acceptable and equally distributed. Data deviated significantly from a normal distribution. All response options were endorsed. The factor analysis confirmed the hypothesised four-factor structure; factor loadings ranged from 0.56 to 0.97 and factor correlations were high (0.88-0.96). Internal consistency (ordinal alpha = 0.82-0.97), scale reliability (0.88-0.99), and test-retest reliability (ICC = 0.77-0.86) were satisfactory for all scales.Study Limitations The study design did not allow drop-out analysis.Conclusions The TISS showed satisfactory psychometric properties in the study sample. It provides a measure that enables quantitative measurement of caller satisfaction with interaction in telenursing.

    Place, publisher, year, edition, pages
    WILEY, 2023
    Keywords
    interaction; nurse-patient relations; patient satisfaction; psychometrics; surveys and questionnaires; telenursing; telephone nursing
    National Category
    Other Medical Sciences not elsewhere specified
    Identifiers
    urn:nbn:se:liu:diva-192343 (URN)10.1111/scs.13149 (DOI)000923595200001 ()36718016 (PubMedID)
    Note

    Funding Agencies|Forskningsradet i Sydostra Sverige [FORSS-847311, FORSS-930659]; Region Ostergotland [RO LiO-925191, RO LiO-938203]

    Available from: 2023-03-15 Created: 2023-03-15 Last updated: 2024-05-02Bibliographically approved
    3. Role of interaction for caller satisfaction in telenursing - A cross-sectional survey study
    Open this publication in new window or tab >>Role of interaction for caller satisfaction in telenursing - A cross-sectional survey study
    2023 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 15-16, p. 4752-4761Article in journal (Refereed) Published
    Abstract [en]

    Aims and objectives The aim of this study was to explore caller satisfaction with interaction, and the association to overall satisfaction with calls. Background In the era of expanding healthcare at distance, the telephone remains a common tool for the provision of nursing care. Interaction between telenurse and caller in telenursing is vital for safety, satisfaction and adherence reasons. Few studies have quantitatively explored interaction in calls and how it relates to overall satisfaction with calls. Design Cross-sectional survey study with a deductive approach. Methods A total of 466 callers to the Swedish Medical Advisory Service completed the Telenursing Interaction and Satisfaction Questionnaire. Satisfaction with four theoretically defined components of interaction were compared using repeated measures ANOVA. Associations between satisfaction with interaction and overall satisfaction with calls were evaluated with ordinal logistic regression models with and without adjustment for age, sex, health status, waiting time, time for call, main result of the call and expectations. The study followed the STROBE checklist. Results Callers were most satisfied with affective support, followed by professional-technical competence, health information and decisional control-in that order. A summated score of satisfaction with interaction was positively and significantly associated with overall satisfaction with calls before and after adjustment for waiting time, main result of call and variables related to the individual caller. Conclusions Caller satisfaction with interaction is generally high but can be improved, especially regarding decisional control. Satisfaction with interaction is important for overall satisfaction with calls. Relevance to clinical practice This study provides support for professionals at all levels in telenursing organisations to pay attention to interactional matters. The development of best practice for telenurses needs to consider all four components of interaction to enhance satisfaction with calls.

    Place, publisher, year, edition, pages
    Wiley, 2023
    Keywords
    communication; e-health; interaction; nurse-patient relation; nursing care; patient satisfaction; telenursing; telephone nursing
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-188595 (URN)10.1111/jocn.16524 (DOI)000851437600001 ()36081322 (PubMedID)
    Note

    Funding Agencies|Forskningsradet i Sydostra Sverige [FORSS-847311, FORSS-930659]; Region Ostergotland [LIO-925191, LIO-938203]

    Available from: 2022-09-19 Created: 2022-09-19 Last updated: 2024-05-02Bibliographically approved
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  • 3.
    Mattisson, Marie
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Börjeson, Sussanne
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lindberg, Malou
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, 1177 Vårdguiden.
    Årestedt, Kristofer
    Linnaeus Univ, Sweden; Dept Res Reg Kalmar Cty, Sweden.
    Psychometric evaluation of the Telenursing Interaction and Satisfaction Scale2023In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, no 3, p. 687-697Article in journal (Refereed)
    Abstract [en]

    Aims and Objectives Interaction between caller and telenurse in telenursing is important for caller satisfaction and subsequent compliance. Despite this, satisfaction measures with focus on interaction in telenursing are scarce and rarely anchored in nursing theory. The aim was to evaluate the psychometric properties of the Telenursing Interaction and Satisfaction Scale (TISS) with focus on data quality, factor structure, convergent validity, and reliability.Methodological Design and Justification This psychometric study was based on cross-sectional data.Research Methods, Instruments, and/or Interventions Callers to the National Medical Advisory Service in Sweden (n = 616) completed the 60-item Telenursing Interaction and Satisfaction Questionnaire based on Coxs Interaction Model of Client Health Behavior. Twenty-five of these items were selected to form the TISS in four subscales according to the model. Data quality was evaluated in terms of missing data patterns and score distributions. The factor structure was evaluated with confirmatory factor analysis for ordinal data, convergent validity with Spearman correlations, internal consistency with ordinal alpha, scale reliability with composite reliability coefficients, and test-retest reliability with intraclass correlations.Results The amount of missing data was acceptable and equally distributed. Data deviated significantly from a normal distribution. All response options were endorsed. The factor analysis confirmed the hypothesised four-factor structure; factor loadings ranged from 0.56 to 0.97 and factor correlations were high (0.88-0.96). Internal consistency (ordinal alpha = 0.82-0.97), scale reliability (0.88-0.99), and test-retest reliability (ICC = 0.77-0.86) were satisfactory for all scales.Study Limitations The study design did not allow drop-out analysis.Conclusions The TISS showed satisfactory psychometric properties in the study sample. It provides a measure that enables quantitative measurement of caller satisfaction with interaction in telenursing.

    Download full text (pdf)
    fulltext
  • 4.
    Mattisson, Marie
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Börjeson, Sussanne
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Årestedt, Kristofer
    Linnaeus Univ, Sweden; Res Sect, Sweden.
    Lindberg, Malou
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, 1177 Vårdguiden.
    Role of interaction for caller satisfaction in telenursing - A cross-sectional survey study2023In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 15-16, p. 4752-4761Article in journal (Refereed)
    Abstract [en]

    Aims and objectives The aim of this study was to explore caller satisfaction with interaction, and the association to overall satisfaction with calls. Background In the era of expanding healthcare at distance, the telephone remains a common tool for the provision of nursing care. Interaction between telenurse and caller in telenursing is vital for safety, satisfaction and adherence reasons. Few studies have quantitatively explored interaction in calls and how it relates to overall satisfaction with calls. Design Cross-sectional survey study with a deductive approach. Methods A total of 466 callers to the Swedish Medical Advisory Service completed the Telenursing Interaction and Satisfaction Questionnaire. Satisfaction with four theoretically defined components of interaction were compared using repeated measures ANOVA. Associations between satisfaction with interaction and overall satisfaction with calls were evaluated with ordinal logistic regression models with and without adjustment for age, sex, health status, waiting time, time for call, main result of the call and expectations. The study followed the STROBE checklist. Results Callers were most satisfied with affective support, followed by professional-technical competence, health information and decisional control-in that order. A summated score of satisfaction with interaction was positively and significantly associated with overall satisfaction with calls before and after adjustment for waiting time, main result of call and variables related to the individual caller. Conclusions Caller satisfaction with interaction is generally high but can be improved, especially regarding decisional control. Satisfaction with interaction is important for overall satisfaction with calls. Relevance to clinical practice This study provides support for professionals at all levels in telenursing organisations to pay attention to interactional matters. The development of best practice for telenurses needs to consider all four components of interaction to enhance satisfaction with calls.

    Download full text (pdf)
    fulltext
  • 5.
    Mattisson, Marie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Johnson, Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Kalmar Cty Council, Sweden.
    Lindberg, Malou
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, 1177 Vårdguiden på telefon.
    Development and content validation of the Telenursing Interaction and Satisfaction Questionnaire (TISQ)2019In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, no 6, p. 1213-1222Article in journal (Refereed)
    Abstract [en]

    Background Caller satisfaction with telephone advice nursing (TAN) is generally high, and the interaction is essential. However, a valid questionnaire exploring caller satisfaction in TAN with focus on perceived interaction is lacking. Objective To develop and assess content validity and test-retest reliability of a theoretically anchored questionnaire, the Telenursing Interaction and Satisfaction Questionnaire (TISQ), that explores caller satisfaction in TAN by focusing on perceived interaction between the caller and the telenurse. Methods The study was performed in three stages. First, variables relevant for patient satisfaction in health care were identified through a literature search. Variables were then structured according to the Interaction Model of Client Health Behavior (IMCHB), which provided theoretical guidance. Items relevant for a TAN context were developed through consensus discussions. Then, evaluation and refinement were performed through cognitive interviews with callers and expert ratings of the Content Validity Index (CVI). Finally, test-retest reliability of items was evaluated in a sample of 109 individuals using intraclass correlation coefficients (ICC). Results The TISQ consists of 60 items. Twenty items cover perceived interaction in terms of health information, affective support, decisional control and professional/technical competence. Five items cover satisfaction with interaction and five items overall satisfaction. Remaining items reflect singularity of the caller and descriptive items of the call. The TISQ was found to exhibit good content validity, and test-retest reliability was moderate to good (ICC = 0.39-0.84). Conclusions The items in the TISQ form a comprehensive and theoretically anchored questionnaire with satisfactory content validity and test-retest reliability.

    Download full text (pdf)
    fulltext
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