https://doi.org/10.14528/snr.2022.56.3.3107
2022. Obzornik zdravstvene nege, 56(3), pp. 209–221.
ABSTRACT 
Introduction: Community health nurses contribute significantly to better health, well-being and independence 
of older adults. The aim of the study is to compare preventive services for older adults in community health 
care between Sweden and Slovenia.
Methods: Literature review and document analysis were used to conduct a qualitative comparative analysis. 
Literature was retrieved from the MEDLINE, CINAHL and COBIB databases. An analysis of documents such 
as sectoral legal bases, guidelines and expert recommendations in Slovenia and Sweden was also conducted. 
The analysis included sources related to preventive services for older adults living at home published between 
January 2000 and December 2020 in Slovene, English or Swedish. 
Results: Twenty units of literature were included in the review. Four comparative factors were identified: 
system and legal basis, organisation and scope, providers, and content. In Slovenia, all older adults are entitled 
to the same range of preventive services. Compared to Sweden, the organisation of community health care in 
Slovenia is more centralised, all older adults are entitled to the same scope of preventive health visits, while the 
level of education and scope of competences of healthcare providers are lower. In both countries, the content 
of preventive home visits to older adults is similar.
Discussion and conclusion: In Slovenia, community health nurses with additional knowledge could prescribe 
medical devices and medications form a limited list, as well as coordinate care. This would allow them to act 
more independently in patients' home environment. Further development of more personalised preventive 
services for older adults depends on research, resource provision and consideration of the organisational 
culture. 
IZVLEČEK
Uvod: Preventivne obravnave v patronažnem varstvu pomembno prispevajo k samostojnosti, boljšemu 
zdravju in dobremu počutju starejših odraslih. Namen raziskave je primerjati preventivne obravnave starejših 
odraslih v patronažnem varstvu med Švedsko in Slovenijo. 
Metode: Na osnovi pregleda literature in analize dokumentov je bila narejena kvalitativna primerjalna analiza. 
Vključena je bila literatura iz podatkovnih bazah MEDLINE, CINAHL in COBIB. Narejena je bila tudi analiza 
dokumentov, kot so področne pravne podlage, smernice ter strokovna priporočila v Sloveniji in na Švedskem. 
Vključeni so bili viri objavljeni med januarjem 2000 in decembrom 2020, so se nanašali na preventivne 
obravnave starejših odraslih, ki živijo doma in so bili napisani v slovenščini, angleščini ali švedščini.
Rezultati: V analizo smo vključili 20 enot literature. Opredeljeni so bili štirje faktorji primerjave: sistem in 
pravne podlage, organiziranost in obseg, izvajalci ter vsebina. V Sloveniji so vsi starejši odrasli upravičeni do 
enakega obsega preventivnih obravnav. V primerjavi s Švedsko je v Sloveniji bolj centralizirana organizacija 
patronažnega varstva, vsi starejši odrasli imajo enak obseg preventivnih obiskov, izobrazba in obseg 
kompetenc izvajalcev pa je v Sloveniji nižja. Vsebina preventivnih patronažnih obiskov starejših odraslih je v 
obeh državah podobna. 
Diskusija in zaključek: V Sloveniji bi lahko medicinske sestre v patronažnem varstvu z dodatnimi znanji 
pridobile tudi kompetence na področju predpisovanja z omejene liste zdravil in medicinskih pripomočkov ter 
koordinacije oskrbe. Tako bi lahko bolj samostojno delovale v domačem okolju pacientov. Za nadaljnji razvoj 
bolj personaliziranih preventivnih obravnav za starejše odrasle je pomembno raziskovanje, zagotavljanje 
virov in skrb za organizacijsko kulturo.
Ključne besede: oskrba; 
preventiva; domače okolje; 
zdravstvena nega 
Key words: care; prevention; 
home environment; nursing
1 University of Ljubljana, 
Faculty of Health Sciences, 
Zdravstvena pot 5, 1000 
Ljubljana, Slovenia
2 Umeå University, Department 
of Nursing, 901 87 Umeå, 
Sweden
* Corresponding author/
Korespondenčni avtor:  
marija milavec@zf.uni-lj.si
Review article/Pregledni znanstveni članek
Comparison of community health nurses' preventive home visits to older adults 
in Sweden and Slovenia: A literature review
Primerjava preventivnih obravnav starejših odraslih v patronažnem varstvu med 
Švedsko in Slovenijo: pregled literature
Marija Milavec Kapun1, *, Nina Meglič, Senada Hajdarevic2
Received/Prejeto: 6. 6. 2021 
Accepted/Sprejeto: 22. 5. 2022
210 Milavec Kapun, M., Meglič, N., & Hajdarevic, S. (2022)/Obzornik zdravstvene nege, 56(3), pp. 209–221.
Introduction
The silvering of the developed world also includes 
Slovenia and Sweden, with both countries facing 
all the challenges of an ageing society. According to 
Eurostat (2020), the proportion of people aged over 
65 in Slovenia has increased over the past decade 
from 16.4% in 2009 to 19.8% in 2019, while Sweden 
has recorded an increase from 17.8% to 19.9% over 
the same period (Table 1). Although this proportion 
is somewhat lower than the European average in both 
countries, these trends point to a more intense ageing 
of the population in the future. 
Available Eurostat data show that the trend in 
population ageing is faster in Slovenia compared 
to Sweden. According to demographic projections, 
Slovenia will be the European Union (EU) country 
with the largest proportion of older adults by 2050 (He, 
Goodkind, & Kowal, 2016). Slovenia and Sweden have 
almost the same life expectancy at age 65 (21.80 vs. 
21.60) (Organisation for Economic Co-operation and 
Development [OECD], 2021a). Slovenia is affected by 
a relatively low health expectancy for people aged 65 
(only 7.4 years), while Sweden (with 15.7 years) ranks 
first in the EU (Statistični urad Republike Slovenije 
[SURS], 2020; OECD, 2021a; Statistiska centralbyrån, 
2021). According to 2010 data, Slovenia and Sweden 
spent 8.3% and 8.5% of their gross domestic product 
(GDP) on health care per year respectively, with 
Sweden increasing its health expenditure over the last 
decade to reach 10.9% of GDP in 2018, while health 
expenditure in Slovenia remained at 8.3% of GDP 
(OECD, 2021b). 
Trends of an ageing population in Slovenia are 
expected to lead to an increase in the need for health 
and social care services (Howdon & Rice, 2018). Our 
contemporary society is characterised by an extremely 
rapid development of societies and thus also of health 
care. At the same time, the morbidity of the ageing 
population is changing towards increasing comorbidity 
and multimorbidity, which is accompanied by constant 
changes in treatment approaches and economic issues 
in health care. As people grow older, their physical 
and mental abilities gradually decline and complex 
health problems increase (Cohen-Mansfield et al., 
2013). Multimorbidity is present in up to 97% of 
older adults in developed societies (Prados-Torres, 
Calderón-Larrañaga, Hancco-Saavedra, Poblador-
Plou, & Van Den Akker, 2014; Nguyen et al., 2019). 
Health and well-being, also in old age, are the key 
factors for independence and good quality of life. 
Therefore, it is very important for older adults to 
be supported by healthcare and other systems. To 
protect the health of older adults, it is also important 
to ensure continuous health monitoring, preventive 
measurements, and timely action. Monaro, White, & 
West (2015) emphasise that it is essential to maintain a 
continuum of care between the hospital and the home. 
Vertical integration between healthcare providers is 
also becoming increasingly important as healthcare 
delivery to patients in the community becomes more 
intensive, calling for a cross-system approach that 
focuses on integration and coordination of services 
(Bryce et al., 2014). 
Nurses working in patients' homes or in community 
services therefore face major challenges (Krajnc, 2013) 
in providing continuous and integrated care with an 
emphasis on preventive activities and the active role 
of patients. An important task for nurses, including 
those working in patients' homes, is to focus on four 
basic tasks: promoting health, preventing illness, 
restoring health, and alleviating patients' suffering, so 
as to help manage diseases and support rehabilitation 
(International Council of Nurses, 2012; World 
Health Organisation [WHO], 2017). Furthermore, 
nurses working in such a demanding and dynamic 
environment need to be available to provide 
continuous support to carers, ensuring quality care 
for people through education, training and leadership 
(Bryce et al., 2014).
Community health nursing is a specific form of 
health care that provides active health and social care 
to individuals, families, and communities (WHO, 
2017). Nurses working in communities and patients' 
homes support a healthy lifestyle and help identify 
risk factors also among older adults (Krajnc, 2016; 
Dravec et al., 2017; WHO, 2017). In Slovenia, nursing 
activities are the responsibility of registered nurses, 
while nursing assistants and nursing aids may also 
be involved in the delivery of curative activities and 
care (Kadivec et al., 2011; Železnik, Horvat, Panikvar 
Žlahtič, Filej, & Vidmar, 2011). Community health 
nursing is characterised by the field concept of 
working in a specific geographical area (WHO, 2017).
Most developed countries support older adults 
to delay their move into nursing homes and to help 
Table 1: Proportion of the population aged 65 and over (Eurostat, 2020)
Tabela 1: Delež populacije nad 65 let (Eurostat, 2020)
Country, year /
Država, leto 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
European Union 17.3 17.5 17.6 17.9 18.2 18.5 18.9 19.2 19.5 19.7 20.0
Slovenia 16.4 16.5 16.5 16.8 17.1 17.5 17.9 18.4 18.9 19.4 19.8
Sweden 17.8 18.1 18.5 18.8 19.1 19.4 19.6 19.8 19.8 19.8 19.9
211Milavec Kapun, M., Meglič, N., & Hajdarevic, S. (2022)/Obzornik zdravstvene nege, 56(3), pp. 209–221.
them continue living in their own homes for as long 
as possible. As a result, the importance of preventive 
home visits (PHVs) has increased in recent decades. 
According to Bannenberg et al. (2021), PHVs have 
an impact on reducing institutionalisation of care 
in Norway. PHVs have also been found to have an 
impact on reducing mortality, hospital admissions 
and improving health status in the population over 80 
years of age. Through their interventions, community 
health nurses encourage older adults to take an active 
role and responsibility for their health and well-being, 
thereby improving their quality of life (Maček, Skela-
Savič, & Zurc, 2011). 
Aims and objectives
The aim of the literature review and document 
analysis conducted in this study is to compare the 
Slovene and Swedish systems of PHVs provision by 
community health nurses to older adults living at 
home. We formulated the following research question: 
According to the analysis of preventive health services 
for older adults in Sweden, how could PHVs to older 
adults living at home be improved in Slovenia? 
Methods
Review methods
The literature review and document analysis relied on 
a qualitative comparative analysis, which focused on the 
macro level (community health nursing) as suggested by 
Esser & Vlieegenthart (2017). This approach provides 
a clearer understanding, description and analysis of 
complex community health nursing (Healy, Tang, 
Patcharanarumol, & Annear, 2018). We reviewed the 
literature on community health nursing for older adults 
between Slovenia and Sweden with a focus on PHVs to 
older adults. We searched for relevant full-text articles 
in the MEDLINE and CINAHL bibliographic databases 
and the COBIB database through the EBSCOhost 
information service. We compiled the search terms 
in text form using the Boolean logical operators, and 
the following keywords: "starostnik", "patronaža", 
"elderly care", "primary health care", "preventive home 
visits", "community nurse", "district nurse", "health 
care system", "Sweden", "Slovenia". We also focused 
on Slovene and Swedish legal sources, guidelines and 
recommendations, which form the basis for conducting 
PHVs to older adults living at home.
The following primary inclusion criteria were 
used: availability of articles in full text published 
in Slovene, English or Swedish between January 
2000 and December 2020, and population aged 65 
years and over. If the record was relevant, we also 
included literature from older publications. Secondary 
inclusion criteria were preventive services, home-
based approach and nursing profession. Our exclusion 
criteria included curative treatment of older adults or 
younger population, treatment in an institution, and 
diploma or master's thesis. 
Results of the review
By searching electronic databases based on our 
inclusion and exclusion criteria, we identified 558 
records and narrowed down the number of sources to be 
included in the final analysis. We also searched websites 
of public health institutions and nursing association 
for additional sources, and included guidelines and 
recommendations. We also included legislation on the 
preventive services provided by nurses in the home 
setting. A total of 20 records were included in the final 
review. Figure 1 shows the systematic nature of the 
literature review process using the Preferred Reporting 
Items for Systematic Review and Meta-Analysis 
(PRISMA) diagram (Page et al., 2021).
Results
We identified differences in the provision of PHVs 
to older adults between the Slovene and Swedish 
healthcare systems. The defined factors for comparison 
were system and legal basis, organisation and scope, 
providers, and content of PHVs (Table 2). 
The following section provides a more detailed 
comparison of the implementation of PHVs to older 
adults between Slovenia and Sweden based on our 
literature review by individual factors.
System and legal basis for preventive home visits
In Slovenia, the health care system is organised at 
tertiary, secondary and primary level (Ministrstvo za 
zdravje, n.d.). Primary health care is provided mostly 
by community health centres, which are owned and 
managed by municipalities, while other healthcare 
providers are privately managed and operate on the 
basis granted concessions, which ensure inclusion into 
the network of publicly financed health care (Pravila 
obveznega zdravstvenega zavarovanja, 2003; Zakon 
o zdravstveni dejavnosti [ZZDej], 2005). In 2019, 
there were almost 729 registered nurses, 105 nursing 
assistants and some other employees working in 212 
municipalities in community health nursing (Renar 
& Zavrl Džananović, 2020). PHVs are part of primary 
health care and are fully covered by compulsory 
health insurance. For persons who are not covered 
by compulsory health insurance, treatment costs are 
covered from other sources (Pravilnik za izvajanje 
preventivnega zdravstvenega varstva na primarni ravni, 
1998; Pravila obveznega zdravstvenega zavarovanja, 
2003). Ensuring the rights and implementation of 
preventive screening programmes and early detection 
of risk factors for chronic non-communicable diseases, 
including screening tests, and health promotion services, 
212 Milavec Kapun, M., Meglič, N., & Hajdarevic, S. (2022)/Obzornik zdravstvene nege, 56(3), pp. 209–221.
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213Milavec Kapun, M., Meglič, N., & Hajdarevic, S. (2022)/Obzornik zdravstvene nege, 56(3), pp. 209–221.
together with guidelines for their implementation, are 
established by the Minister of Health on the proposal of 
the Health Council (Zakon o zdravstvenem varstvu in 
zdravstvenem zavarovanju, 2006). 
According to the current legislation, older adults 
can be included in preventive services provided by 
community health nursing if they are over 65 years of 
age, lonely and socially disadvantaged, or if they are 
patients with chronic diseases and over 25 years of age. 
Community health nurses also visits people who do 
not respond to invitations to participate in national 
prevention programmes (ZORA, DORA, Svit) 
(Pravilnik za izvajanje preventivnega zdravstvenega 
varstva na primarni ravni 1998, 2002, 2007; Pravila 
obveznega zdravstvenega zavarovanja, 2003; Berčan & 
Krajnc, 2016).
The Swedish healthcare system is organised at three 
levels: national, regional, and local. At the regional 
level, 17 district councils and nine regional bodies are 
responsible for financing and providing healthcare 
services to citizens. At the local level, 290 municipalities 
are responsible for the care of older adults and people 
with disabilities (Anell, Glenngård, & Merkur, 
2012). There is no hierarchy between individual 
municipalities, district councils and regions, as they 
have self-governing local authorities responsible for 
various activities in their area, including health care 
(Marczewska, 2011). The local and regional authorities 
are represented by the Swedish Association of Local 
Authorities and Regions (SALAR) (Anell et al., 2012).
Within the Swedish healthcare system, different 
district councils have different forms of health care 
provision. Each district council decides for itself on 
the organisation of primary health care, including the 
implementation of PHVs performed by nurses. One 
of the main changes in recent years has been that the 
responsibility for the care of older adults has been 
transferred from district councils to municipalities. 
According to this, municipalities have to care for 
older adults and support them in maintaining their 
health. In Sweden, if a person needs help to maintain 
a decent standard of living, they are entitled to support, 
regardless of the level of dependency (Anell et al., 2012).
Organisation and scope of preventive home visits 
to older adults
Community health nurses in Slovenia work in 
the field, at the homes of individuals and families, 
and in the local community. Community health 
nursing is provided throughout the country, with 
each nurse covering an area of 2200-2500 inhabitants 
(Šušteršič, Horvat, Cibic, Peternelj, & Brložnik, 
2006). Community nursing services are provided 
by nurses who are employed by primary health care 
centres or self-employed on the basis of a granted 
Table 2: Differences between the two countries in conducting preventive home visits to older adults by selected 
factors 
Tabela 2: Razlike med državama pri izvedbi preventivnih obravnav starejših odraslih v patronažnem varstvu 
po nekaterih izbranih faktorjih 
Factor of comparison/
Faktorji primerjave Slovenia/Slovenija Sweden/Švedska
System and legal basis Mostly centralised approach and financed, but municipally managed. 
Decentralised approach, council/municipality 
managed and financed.
Organisation and scope 
Nurses are employed by community health 
centres or self-employed (concession). Equal 
scope for the entire country.
2 PHVs per year to people aged 65 years and 
over.
Nurses are mainly employed by health centres 
but also by municipalities. 
Age (usually 75+ or older) and frequency (1 
to 5 per year or rarer) of PHVs differ among 
municipalities. 
Providers
Registered nurses (at least higher education – 3 
years). Some nurses have a specialisation in 
community health nursing.
Registered nurses (higher education – 3 years), 
8 weeks of pharmacology course, specialisation 
in primary care – 75 ECTS. 
Content 
Physical examination
Physical, social, and economic assessment
Health education
Medication utilisation
Ensuring continuity and coordination of care
Prevention of violence
Infection prevention
Family support
Collaboration with different professionals.
Information, counselling/guidance on:
− home exercise
− incontinence
− pharmacological counselling
− home care services
− adapting the home environment
− smoke detectors, checking
− municipality services and activities
− legislation and assistance
− public transportation
Fall risk assessment and advice
Driving capacity assessment
Advice and support for family members/carers.
Legend/Legenda: ECTS – European Credit Transfer and Accumulation System/Evropski sistem prenašanja in zbiranja kreditnih točk; 
PHV – preventive home visits/preventivne obravnave v patronažnem varstvu
214 Milavec Kapun, M., Meglič, N., & Hajdarevic, S. (2022)/Obzornik zdravstvene nege, 56(3), pp. 209–221.
concession (ZZDej, 2005; Albreht et al., 2016). 
The rules on compulsory health insurance (Pravila 
obveznega zdravstvenega zavarovanja, 2003, Article 
26) in Slovenia guarantee the right of insured persons 
to access basic healthcare services, which include 
community health care and the right to PHVs (Article 
27) from the nearest community health service 
(Article 160). The rules on the implementation of 
preventive healthcare services at the primary level 
stipulate that in-depth individual and family treatment 
is required, especially for vulnerable groups, including 
older adults and people with chronic diseases. Based 
on these rules, community health nurses may visit 
older adults who are lonely or socially vulnerable or 
persons with chronic diseases twice a year to help 
them maintain their health and provide support to the 
persons and their families for the best possible quality 
of life in the home environment (Pravilnik za izvajanje 
preventivnega zdravstvenega varstva na primarni 
ravni, 1998). The aim of nurses' activities in PHVs 
to older adults is to maintain well-being, promote 
self-care, provide information about various forms 
of assistance and services available in their home 
environment, identify health risk factors, reduce the 
consequences of illness, and implement therapeutic 
programmes as directed by the physician (Berčan & 
Krajnc, 2016).
In Sweden, the primary healthcare system is 
organised by district councils and municipalities. 
Each district council, together with the municipality, 
can decide how to provide medical and nursing 
care (Sherman, 2012). Most municipalities provide 
PHVs to older adults who live at home and do not 
need additional care. Nurses usually visit persons 
over the age of 75 (this varies from municipality to 
municipality), as well as younger people in need. The 
number of visits and the duration of the visit also vary 
from municipality to municipality, with one to five 
visits usually conducted over a period of one year or 
more (Socialstyrelsen, 2019). There are municipalities 
that have restricted eligibility for PHVs in terms of 
age. In Stockholm, for example, the age limit for PHVs 
is 75 years (Sherman, 2012), while in Härryda, a small 
municipality in the southwestern region of Sweden, 
the age limit is 81 years (Härryda Kommun, n.d.). 
Providers of preventive home visits
The provider of nursing activities in Slovenia is a 
person who has completed at least higher education in 
nursing (Skela-Savič, 2015; Ažman & Prestor, 2019). 
The nursing profession is regulated and, in accordance 
with European Union directives, during their studies 
students acquire profession-specific competences for 
independent planning and delivery of nursing care in 
accordance with the nursing process (Železnik et al., 
2011; Skela-Savič, 2015; Ažman & Prestor, 2019). The 
undergraduate nursing degree programme in Slovenia 
lasts three years. After graduation, newly graduated 
nurses can perform nursing activities independently, 
including in community health care. Nurses can also 
call in nursing assistants when curative services are 
needed (Šušteršič et al., 2006; Ažman & Prestor, 2019).
In Sweden, nurses must have a higher education 
degree. To work in community health care, they must 
also complete a specialisation in primary care. As part 
of this requirement, they must complete 50 weeks 
of specialist training, earning 75 credits (European 
Credit Transfer and Accumulation System [ECTS]). 
Since 1994, community health nurses working with 
older adults have been able to prescribe medications 
from a limited list. To be able to do so, they must first 
successfully complete an eight-week pharmacology 
course which is integrated into the specialisation year. 
This provides them with a license to prescribe certain 
medications and medical devices (Mardby, Jakobsson, 
& Hedenrud, 2014).
Content of preventive home visits of older adults
The aim of preventive home visits is to improve the 
quality of life in older people. The tasks of community 
health nurses in Slovenia are described as follows 
(Pravilnik za izvajanje preventivnega zdravstvenega 
varstva na primarni ravni, 1998; Berčan & Krajnc, 
2016):
- Preparing for field work (family documentation, 
health education materials, nursing aids),
- Conducting physical examination of older adults 
(weight, height, mobility, health status, mental state) 
and checking their vital functions, pain assessment,
- Performing health education activities with families 
and older adults (nutrition, care, independence, 
possibility of arranging meals through a service 
provider, health insurance rights, protection of 
older adults, arranging nursing home admission or 
household assistance, support to improve the quality 
of life, education about diseases, referrals for regular 
check-ups, familiarisation with associations and 
non-governmental organisations, health education 
for the family and older adults with a view to 
strengthen and maintain health and prevent illness, 
support for early disease detection, coordination of 
nursing of care at home),
- Ensuring continuity of care,
- Reviewing knowledge and awareness of the use 
of prescribed therapy and other medications and 
dietary supplements,
- Assessing the immediate and wider environment: 
architectural arrangement, hygienic condition,
- Assessing the threats of domestic violence,
- Implementing infection prevention measures,
- Assessing the individual's social and economic 
situation and supporting them in resolving troubled 
215Milavec Kapun, M., Meglič, N., & Hajdarevic, S. (2022)/Obzornik zdravstvene nege, 56(3), pp. 209–221.
situations,
- Supporting family relationships,
- Providing information about other services and 
coordinating care,
- Informing the physician and other agencies as 
necessary.
Providers of PHVs to older adults in Sweden must 
follow a protocol consisting of 12 elements (Behm, 
Ivanoff, & Zidén, 2013):
- Providing information, advice, and guidance on 
a basic (balance) workout programme including 
exercises,
- Performing fall risk assessments, providing 
prevention checklists and information and advice 
on how to identify fall risks and how to stay active 
and safe, 
- Providing information and advice on technical aids 
and housing changes, and, if necessary, information 
on where and to whom to turn for help,
- Providing information and advice about the use of 
smoke detectors, and, if needed checking the smoke 
alarm,
- Providing information on the help and support 
services available in the municipality (volunteers, 
churches, missions, health centres etc.), and on 
who to contact for help in case of health problems 
and illnesses, as well as opening hours and contact 
information,
- Providing information on the possibility of making 
an appointment with a pharmacist to check and 
advise on the patient's medication,
- Providing information and advice on incontinence,
- Presenting and delivering a brochure with 
information on Swedish legislation and the 
possibilities of professional counselling and 
assessment of driving capacity,
- Providing information and advice on what the 
municipality can offer in the form of local meeting 
places, activities run by local associations, such 
as physical exercise for older adults and various 
workshops, different types of help and support 
provided by volunteers or professionals,
- Offering participation in activities, group visits to 
local meeting places, courses in digital technology, 
clubs for seniors, gyms for seniors, Nordic walking 
groups, etc.,
- Providing information on public transport, 
including busses adapted for (older) people with 
disabilities,
- Providing information on the Social Services Act, 
and who to contact in the municipality to apply for 
home care services.
In Sweden, community health nurses provide advice 
and support to patients, families, and other carers 
individually or in groups (Sherman, 2012). They also 
provide information on how older adults can contact 
the appropriate institutions in case of other problems 
(Dahlin-Ivanoff et al., 2010).
Discussion
The comparison of PHV provision between Sweden 
and Slovenia based on our literature review and 
document analysis shows that Slovenia may have 
a better legal basis for a more comprehensive and 
earlier implementation of PHVs, as these are offered 
to people who are ten years or more younger than 
in Sweden, which also means better maintenance of 
well-being and earlier detection and prevention of 
problems and diseases in older adults. In Slovenia, 
older adults are entitled to two PHVs from the age of 
65 onwards. In Sweden, PHVs are generally promoted 
from the age of 75 onwards; however, the entry age 
and the number of PHVs depend on the person's 
region of residence and are based on a decision by the 
district council together with the municipality. With 
the expansion of prevention programmes in Slovenia 
in 2021 (Horvat, Mihevc Ponikvar, & Krajnc, 2021), 
PHVs to older adults are available to all people aged 65 
and over regardless of their social status or presence of 
disease. Community health nurses identify risk factors 
and provide more PHVs if needed. 
Sweden has a different organisation of PHVs and 
more experience in researching, providing, and 
adapting PHVs to older adults and might therefore 
be more successful, as is indicated by its population's 
longer life expectancy and healthy life years. Sweden 
could be more aware of the importance of PHVs 
and seems to provide timely preventive services at 
home, at least in some municipalities. Through the 
municipality-based organisation of preventive services, 
they can adapt interventions to meet people's needs, 
there is perhaps more democracy and opportunities 
for personalisation of PHVs. In Slovenia, primary 
health care is the responsibility of municipalities, but 
they have not been actively involved in the provision 
of PHVs (Albreht et al., 2016). It would therefore be 
sensible to encourage them to take a more active role 
in assessing the needs related to health and well-being 
of all citizens, including older adults.
Activities of Slovene community health nurses 
are primarily focused on prevention. However, it is 
difficult to determine the amount and successfullness 
of the preventive services provided from the available 
data. In practice, preventive and curative services are 
interwoven (Krajnc, 2016), and the preventive part 
of services cannot always be properly documented 
(Hrovatin, Govc-Eržen, Medved, Milavec Kapun, & 
Horvat, 2015). Statistical data for Slovenia (Petrović 
& Zavrl Džananović, 2021) show that in 2019 PHVs 
accounted for only 14.9% of all community health 
nursing services in Slovenia (of which the share of 
PHVs to older adults accounted for only 1.7%). In 
the last decade, there has been a considerable decline 
in PHVs to older adults (by 71%). Other healthcare 
services are characterised by a focus on and rapid 
development of curative services, and therefore also by 
216 Milavec Kapun, M., Meglič, N., & Hajdarevic, S. (2022)/Obzornik zdravstvene nege, 56(3), pp. 209–221.
the provision of better technical and financial support. 
In terms of content, PHVs in Slovenia and Sweden are 
very similar in that their focus is on health education 
of older adults and their families through the provision 
of information about other services, activities, and 
organisations. The content of health education is not 
specified in detail. This could depend on individual 
providers or established doctrine. In Slovenia, the 
content of PHVs focuses more on physiological health 
(e.g., physical examinations, nutrition). In Sweden, a 
slightly more pronounced promotion of social health 
and active living was observed, which is also evident 
from the established protocols (Löfqvist, Eriksson, 
Svensson, & Iwarsson, 2012). The new upgrade of 
PHVs in Slovenia seems to focus more on social health 
(Horvat et al., 2021). According to a study conducted in 
Norway, this focus may be correct, as poorly perceived 
health was associated with health-related risks among 
older adults at home, suggesting that preventive health 
programmes need to focus on social and lifestyle factors 
(Fjell et al., 2018). Health promotion, risk prevention and 
better social participation need to be addressed during 
PHVs (Nivestam, Westergren, Petersson, & Haak, 2020, 
2021). Based on the results of a study conducted in 
Sweden (Sherman, Söderhielm-Blid, Forsberg, Karp, & 
Törnkvist, 2016), it would be useful to examine the effects 
of improved PHVs to older adults and to dynamically 
adjust the scope and content of PHVs in Slovenia as well. 
The new instructions for community health nurses 
in Slovenia highlight the role of different preventive 
services for patients, families and/or significant 
others, which include different tests and assessments 
(Horvat et al., 2021). According to the conclusions of a 
Swedish study (Lannering, Lannering, Ernsth Bravell, 
& Johansson, 2017), a structured preventive process 
only partially facilitates different healthcare providers 
(including nurses) to improve the quality of care. The 
assessment tools were not considered to be close to 
reality. Based on these findings, it would be beneficial 
to investigate the usefulness of the newly included 
assessment tools in PHVs to older adults in Slovenia. 
In Sweden, although community health nurses 
play a significant role in ensuring safe medication 
management for older adults, this role is not 
sufficiently recognised (Lagerin, Törnkvist, Nilsson, 
Johnell, & Fastbom, 2020). In Slovenia, this is part of 
PHVs in relation to adherence to the medication plan 
but not in relation to dealing with polypharmacy and 
inappropriate medication use. Due to the increasing 
multimorbidity and the resulting higher number of 
prescribed medications also in Slovenia, this aspect 
should be included more in PHVs to older adults.
The educational level of Swedish community health 
nurses is higher than that of Slovene community 
health nurses. As a rule, they must complete a one-year 
specialisation for district nurses (primary health care 
specialisation), during which they acquire additional 
knowledge, including that needed to prescribe 
medications and medical devices (Jangland et al., 
2014), which is also the case in 11 EU countries and 
the United Kingdom (Maier, 2019). In Slovenia, there 
is a noticeable lack of specialisation for community 
health nursing, as there are only nine nurses with this 
specialisation (Zavrl Džananović, 2018). Thus, there is a 
clear need to reintroduce it and to determine the content 
and areas of urgently needed specialised knowledge and 
competences for these nurses. Following the example of 
Sweden and other EU countries, Slovene community 
health nursing could also include competences for 
prescribing medical devices and medications from 
a limited list. Therefore, Swedish community health 
nurses are independent and competent providers and 
have the highest competence level among professional 
home care providers (Josefsson & Peltonen, 2015). In 
Slovenia, the transfer of competences from physicians 
to community health nurses would decrease the burden 
on physicians, improve the adaptation of interventions 
to older adults at home and thus reduce the burden on 
the health system. 
According to Slovene documents (Železnik et al., 
2011), community health nurses are coordinators of 
all forms of care and assistance for patients at home. 
They can identify patients' needs for different services, 
make assessments and give advice on finding relevant 
providers. In practice however, they do not have the 
authority to coordinate the work of different providers. 
The importance of integrated and coordinated services 
at home are recognised by the newly adopted Long-
Term Care Act (Zakon o dolgotrajni oskrbi, 2021), 
and now community health nurses have the possibility 
to take the position of coordinators. 
A Swedish study (Brobeck, Odencrants, Bergh, & 
Hildingh, 2013) shows that while community health 
nurses would like to conduct PHVs, especially with 
older adults with or without symptoms of illness, 
they feel that those who are already ill need more of 
their time. For better quality of care, it is necessary to 
identify barriers, facilitators and dilemmas in order to 
improve the training of PHV providers and promote 
the development of this field (Lagerin, Törnkvist, & 
Hylander, 2016). 
In both countries, there is a general awareness of 
the importance and benefits of PHVs for older adults. 
In Sweden, PHVs have been evaluated as a very cost-
effective approach (Sahlen, Löfgren, Mari Hellner, & 
Lindholm, 2008) that promotes health and quality of 
life in old age, as well as patients' feelings of safety and 
being well informed (Gleason, 2017; Nivestam et al., 
2020). Nurses are recognised as suitable professionals 
for health promotion (Kemppainen, Tossavainen, 
& Turunen, 2013), but there is a need to ensure an 
appropriate organisational culture in nursing as an 
important factor for a successful implementation of 
health education and health promotion. Therefore, 
more time and resources are required to develop 
successful health-promotion initiatives. 
217Milavec Kapun, M., Meglič, N., & Hajdarevic, S. (2022)/Obzornik zdravstvene nege, 56(3), pp. 209–221.
PHVs to older adults have a wide range of positive 
effects on patients and their families, which go 
beyond reducing societal costs (Zingmark, Norström, 
Lindholm, Dahlin-Ivanoff, & Gustafsson 2019), 
although some studies (Brettschneider et al., 2015; 
Liimatta, Lampela, Kautiainen, Laitinen-Parkkonen, 
& Pitkala, 2020) argue against their cost-utility. 
According to a Finnish study, PHVs provided by a 
multidisciplinary team have a positive effect only on 
health-related quality of life in older adults (Liimatta et 
al., 2020). For more successful PHVs, comprehensive 
geriatric assessment, follow-up visits, and a focus on 
the younger population are important (Tourigny et 
al., 2015). When developing preventive community/
home-based nursing interventions, aspects such as 
programme duration, frequency of visits, providers 
and age of the target group should be considered. 
Sweden has one of the best healthcare systems in 
the world, and the longest life expectancy and healthy 
life years in Europe (Eurostat, 2021). In 2019, Slovenes 
rated their health significantly worse than their Swedish 
peers (OECD, 2021a). Regardless of community health 
nurses' efforts to improve the health of older adults, a 
culture of health and well-being across the lifespan 
needs to develop among Slovene citizens. There are 
many factors that influence a person's health and well-
being. In Slovenia as well, the sole activity of community 
health nurses might have only a limited impact on the 
health of older adults. 
This qualitative comparative analysis provides an 
opportunity to explore new and diverse possibilities 
for mutual learning through examples of appropriate 
and effective PHVs to older adults. It provides an 
opportunity to reflect on the transformation of existing 
approaches. Through timely preventive services, we 
can repay older adults for their contribution to a better 
society during the active phase of their lives.
The results of this study should be interpreted with 
caution. Nevertheless, the comparison increases the 
explanatory power for inductive conclusions: Would 
preventive services for older adults in Sweden also 
work in Slovenia? This also increases the power of a 
deductive explanation: What are the exceptions to 
the generalisation? It would be particularly useful to 
modify the Swedish examples of good practice before 
successfully transferring them to the Slovene context. 
Conclusion
Our literature review shows that there are several 
levels of differences between the two countries. There 
are significant differences in eligibility requirements 
for PHVs between the countries compared, and clear 
differences between community health nurses who in 
Sweden have higher educational levels and a broader 
range of competences. We see room for improvement 
in Slovene community health nurses' specialisation 
and acquisition of knowledge and competences that 
would allow for their greater independence in working 
and prescribing medical devices and medications 
from a limited list. There are several opportunities for 
further research in Slovenia, including research on the 
impact of PHVs on older adults, the implementation 
of evidence-based prevention interventions, and the 
examination of community health nurses' attitudes 
towards preventive healthcare services.
Conflict of interest/Nasprotje interesov
The authors declare that no conflicts of interest 
exist./Avtorice izjavljajo, da ni nasprotja interesov.
Funding/Financiranje
The study recieved no funding./Raziskava ni bila 
finančno podprta.
Ethical approval/Etika raziskovanja
No approval by the National Medical Ethics 
Committee was necessary to conduct the study due 
to the selected research methodology./Za izvedbo 
raziskave glede na izbrano metodologijo raziskovanja 
dovoljenje ali soglasje Komisije za medicinsko etiko ni 
bilo potrebno. 
Author contributions/Prispevek avtorjev
MMK – introduction, methods, results, discussion, 
and conclusions/uvod, metode, rezultati, diskusija in 
zaključki
NM – research conceptualization, paper review and 
final approval/konceptualizacija raziskave, pregled 
prispevka in končna odobritev
SH – introduction, methods, results, discussion/
uvod, metode, rezultati, diskusija
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