Perceived usefulness of regional preparedness plans in Sweden: a mixed-methods study

Background

In the face of overlapping global threats such as pandemics, natural disasters, and armed conflicts, preparedness is essential for strengthening health system resilience. Preparedness plans are designed to guide health system responses during crises, yet their practical usefulness during crises remains uncertain. The COVID-19 pandemic exposed both strengths and weaknesses in preparedness globally, and in Sweden. This study aimed to understand how useful pre-existing regional preparedness plans were in the response to the pandemic in Sweden.

Methods

A sequential explanatory mixed-methods design was used. An online survey assessing preparedness plans was distributed to key informants (preparedness managers, coordinators and decision-makers) in all 21 regions in Sweden. To allow for a more in-depth and comprehensive understanding, the survey was followed up with semi-structured interviews in four different regions to explore perceptions of preparedness and the usefulness of the plans during the pandemic.

Results

In total, 53 respondents from all 21 regions completed the survey, and 17 interviews were conducted in four regions. All regions had preparedness plans in place. Respondents often perceived these plans as static documents, developed outside continuous planning processes and unevenly integrated within organizations. While the plans provided a flexible framework, prior preparedness knowledge appeared to influence how they were interpreted and applied in practice.

Conclusions

The Swedish health system entered the COVID-19 pandemic with preparedness plans in place, but their usefulness was reported by participants in this study to have been limited. Although the plans provided an initial framework, their static nature, weak organizational integration, and inconsistent interpretation reduced their perceived usefulness.

Key messages

• Preparedness plans alone are insufficient; continuous processes and organizational integration are essential for effective crisis response.

• Preparedness plans were underused in practice, highlighting the importance of training and shared knowledge for effective implementation.