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In the municipality context, the priorities and financial objectives established by boards of directors (‘boards’) may influence the quality of occupational health and safety (OHS) in organizations. Little is known about boards’ discussions of OHS, which is why we set out to investigate vice chairs’ and chairs’ perceptions of facilitating conditions for discussing OHS in municipal boardrooms. Thirty-four participants from 12 randomly selected municipalities were interviewed, and the data were analyzed using template thematic analysis. The results show that facilitating conditions for board OHS discussions can be linked to the individual, group, and organizational levels and that these interplay. The most prominent finding is the considerable influence that the (vice-)chairs have on whether and how OHS is discussed on the board, both in terms of influencing the psychological safety of its members and how OHS information is gathered. Furthermore, high levels of psychological safety among organizational representatives interacting with the board facilitate the acquisition of candid OHS information from the organization. With the high level of employee risk of long-term sickness absence in municipalities and the challenges of attracting employees, OHS could be considered a strategically important part of boards’ meeting agendas. Our findings suggest that OHS governance in municipality administrations and companies can be individual dependent and that the governance structure is inadequate for ensuring that OHS is discussed at the board level. © 2026 The Author(s).

Background: Low-value care (LVC) remains a persistent problem in primary healthcare. While various implementation strategies have been proposed and tested for deimplementation, there is limited knowledge about whether there are strategies uniquely suited to deimplementation. Furthermore, there is limited knowledge about system-level responsibilities for deimplementation. Given that implementation strategies are recommended to be tailored to the specific contextual factors surrounding LVC practices, involving primary care physicians in identifying contextually appropriate strategies holds promise. This study aimed to explore the strategies that primary care physicians suggest could facilitate the deimplementation of LVC and map them to the system levels responsible for initiating and deploying these strategies. Methods: This qualitative study was based on responses to an open-ended survey question asking physicians to suggest strategies that could facilitate the deimplementation of LVC practices within primary healthcare in Sweden. A national sample of 441 primary care physicians responded. Responses were analyzed via deductive content analysis categorized by the Expert Recommendations for Implementing Change (ERIC) compilation. Responses that could not be categorized via ERIC were analyzed inductively. The identified strategies were then mapped to the system levels (individual, group, leader, organization and overarching system) responsible for deploying these strategies. Results: Strategies were identified across all nine original ERIC domains, representing 39 (53%) of the original ERIC strategies, and later additions for deimplementation. Additionally, a set of strategies categorized under a new domain, develop better evidence, was identified. Most strategies were suitable for deployment at the organizational (31 strategies) and overarching (31 strategies) levels. Sixteen strategies were best suited for the group level, thirteen for the leadership level, and two for the individual level. Conclusion: Primary care physicians proposed strategies across all nine ERIC domains, with additional strategies beyond those previously described, including develop better evidence. From the physicians’ perspective, deimplementation cannot rely solely on individuals but requires coordinated action across the organizational and system levels. Broader structural, policy, and cultural changes would support physicians and ensure that responsibility for deimplementation is shared across the healthcare system.

Background Implementing evidence-based interventions (EBIs) in practice requires balancing fidelity and adaptation to suit new contexts. Careful considerations are needed to maintain the core elements for effectiveness while ensuring fit with new contexts. The Adaptation and Fidelity Tool (A-FiT) intervention addresses this challenge by providing support for professionals using EBIs in the sustainment phase of implementation. This study evaluates the A-FiT intervention and examines how professionals delivering an EBI manage fidelity and adaptation during the sustainment phase of implementation, before and after the intervention. Method Short, structured interviews were repeatedly conducted with 14 professionals delivering an EBI (n = 127). Data was analyzed using deductive content analysis focusing on adaptation types, planning, intentionality, and fidelity consistency. The adaptations were counted and compared before versus after the A-FiT intervention using a chi2-test.Results The professionals made about the same number of adaptations before and after the A-FiT intervention. However, after the intervention, significant changes in the type and intentionality of the adaptations were observed. Changes in type consisted of fewer "removing," "substituting," and "integrating another framework" adaptations and more "loosening structure" and "departing from the intervention" adaptations. Regarding intentionality, fewer planned adaptations with the intention of improving the EBI effects were made, while adaptations made for practical reasons, both planned and unplanned, increased after the A-FiT intervention. No statistical change was found regarding fidelity consistency.Conclusions The findings indicate increased awareness about fidelity and adaptation among the group leaders, resulting in fewer planned adaptations to enhance program effects and more practical adaptations to address context challenges. The A-FiT intervention appears to help professionals in their management of fidelity and adaptations when delivering EBIs. The study underscores the importance of understanding adaptations in their context, purpose, and impact (intended and unintended) on the outcome/value.

Although the organizational context has been identified as an important factor contributing to the success or failure of leadership training initiatives, exploration of the interaction between differing contextual perceptions in relation to the transfer of leadership training is lacking. Building on Oc's framework on context and leadership, we examine how the degree of perceptual alignment of leader and teams on two contextual factors, formalization and employee orientation, were related to followers' ratings of transformational leadership after a leadership training in the forest industry (n = 37 leaders). Polynomial regression with response surface analysis revealed that agreement between leaders and their teams on formalization and employee orientation predicted improvements in transformational leadership but only up to a certain point. At high levels of formalization agreement negatively impacted leaders' development of transformational leadership, and at high levels of employee orientation the positive impact of agreement flattened out. Leaders who rated formalization and employee orientation higher than their teams increased their transformational leadership to a lesser extent as rated by their followers. Our findings extend the framework developed by Oc and offer a new perspective on the complex interplay between leader, follower, and contextual factors that all matter for successful leadership training transfer.

Swedish municipal organizations exhibit persistent gender inequalities in working conditions, particularly between female-dominated caring occupations and male-dominated technical occupations. Drawing on devaluation theory and New Public Management (NPM) frameworks, this study investigates how politicians, accountable for the work environment of their employees, understand gender inequalities in the working conditions within municipal organizations. The study further explores what, according to the interviewees, may contribute to the reproduction of gender inequalities. Semi-structured interviews with 18 politicians from caring and technical committees revealed widespread awareness of heavier workloads, limited resources, and lower status in caring professions. However, these issues were primarily attributed to organizational culture and structural constraints seen as beyond politicians' control. While technical sectors generate revenue and enjoy more flexible budgets, caring sectors face stricter financial limits. Emphasis on cost efficiency and hierarchical governance, characteristic of NPM, is cited as a major barrier to substantive reforms, reinforcing systemic undervaluation of women's work. A need for more proactive political leadership and accountability mechanisms is underscored by the findings to mitigate gender-based disparities in public administration. By illuminating how political decision-making intersects with societal norms and management practices, this study provides new insights into the persistent undervaluation of caring labor in public- sector contexts.

BackgroundImplementing evidence-based parenting programs often involves navigating fidelity-adaptation decisions. While research has explored various aspects of this dilemma, little is known about how practitioners' outcome preferences influence their decisions in real-world scenarios.MethodsThis study employed a discrete choice experiment (DCE) to investigate the relative importance of five outcomes (Relationship Quality, Satisfaction, Workload Strain, Value Conflict, and Reach) in fidelity-adaptation decisions among 209 practitioners delivering evidence-based parenting programs in Sweden. The DCE presented 25 choice sets across five contextual scenarios, analyzed using Bayesian hierarchical logistic regression.ResultsAll five outcomes significantly influenced practitioners' choices, with Relationship Quality emerging as the most impactful (log-odds: 4.56, 95% CI [4.16, 4.91]). Satisfaction and minimizing Value Conflict showed similar importance (log odds: 2.45 and -2.40, respectively), while Workload Strain and Reach had slightly less impact (log odds: -2.10 and 1.96, respectively).ConclusionsThis study offers a novel perspective on the role of outcome preference in navigating fidelity-adaptation decisions. The strong preference for improving parent-child relationships aligns with core parenting program goals, while consideration of other outcomes reflects practitioners' holistic approach to implementation. These findings can inform the design of interventions and implementation strategies that balance effectiveness with real-world constraints, potentially enhancing parenting programs' adoption, sustainability, and impact.

Background Low-value care (LVC) describes practices that persist in healthcare, despite being ineffective, inefficient or causing harm. Several determinants for the provision of LVC have been identified, but understanding how these factors influence professionals' decisions, individually and jointly, is a necessary next step to guide deimplementation.Methods A factorial survey experiment was employed using vignettes that presented hypothetical medical scenarios among 593 Swedish primary care physicians. Each vignette varied systematically by factors such as patient age, patient request for the LVC, physician's perception of this practice, practice cost to the primary care centre and time taken to deliver it. For each scenario, we measured the reported likelihood of providing the LVC. We collected information on the physician's worry about missing a serious illness.Results Patient requests and physicians' positive perceptions of the practice were the factors that increased the reported likelihood of providing LVC the most (by 14 and 13 percentage points (pp), respectively). When the LVC was low in cost or not time-consuming, patient requests further boosted the likelihood of provision by 29 and 18 pp. In contrast, credible evidence against the LVC reduced the role of patient requests by 11 pp. Physicians' fear of missing a serious illness was linked with higher reported probability of providing LVC, and the credibility of the evidence against the LVC reduced the role of this concern.Conclusions The findings highlight that patient requests enhance the role of many determinants, while the credibility of evidence diminishes the impact of others. Overall, these findings point to the relevance of increased clinician knowledge about LVC, tools for patient communication and the use of decision support tools to reduce the uncertainty in decision-making.