Hilde Elisabeth Timenes Mikkelsen

• Rohde, Gudrun; Haraldstad, Kristin; Helseth, Sølvi; Hagen, Milada; Skarstein, Siv & Mikkelsen, Hilde Timenes (2026). Health-related quality of life in parents of adolescents in 2019, 2021 and 2023. BMC Pediatrics. 26(1). doi: 10.1186/s12887-026-07115-8. Full text in Research Archive Show summary

  Abstract Purpose The objective of the present study is to describe levels of HRQOL in parents of adolescents over a span of four years (2019, 2021, and 2023) and identify which of selected sociodemographic variables associated with HRQOL over time. In addition, we compared all HRQOL domains with norm data from the general Norwegian population. Methods A longitudinal study involving 556 parents (at baseline) of adolescents from the general Norwegian population was conducted. Data were collected at baseline in 2019, in 2021 (when the COVID-19 pandemic was ongoing) and in 2023. HRQOL was assessed using RAND-36. Data were analysed using independent samples t-tests and linear mixed model for repeated measures. Results During the four-year (2019–2023), we observed a small but statistically significant decline in most HRQOL domains, and no domains increased again after the COVID-19 pandemic. Higher education, being in paid work and having a high household income were the most important associates of high HRQOL scores. We identified some statistical differences in HRQOL between the parents in the current study and Norwegian norms at all time points, although these were of limited clinical relevance. Conclusion Over four years, parents of adolescents experienced a small but persistent decline in HRQOL from before the COVID-19 pandemic through 2023, particularly in mental health domains, with no full return to pre-pandemic levels. Higher education, household income, and paid employment were consistently associated with better HRQOL.

• Mikkelsen, Hilde Timenes; Barken, Tina Lien; Rohde, Gudrun; Helseth, Sølvi; Haraldstad, Kristin & Skarstein, Siv (2026). Parenting late-stage adolescents: a qualitative study of parental roles and quality of life. BMC Psychology. doi: 10.1186/s40359-026-05397-2. Full text in Research Archive Show summary

  Abstract Background Having children in their adolescence can affect parents’ quality of life. Parents must navigate their children’s growing independence and face challenges, as adolescents often experience stronger emotions and tend to distance themselves from their parents. There is a lack of knowledge about quality of life in parents of adolescents in the general population and how they experience their parental role. This study aims to explore how parents of late-stage adolescents experience their parental role and their quality of life, and how these experiences are influenced by the developmental, social, and health-related circumstances of their adolescents. Methods A qualitative design was conducted with individual semi-structured in-depth interviews of 15 Norwegian parents of adolescents aged 16–19 years. Braun and Clarke’s thematic analysis was used to analyze the data. Results Three major themes were identified: (1) Challenging, but mostly joy, (2) If my child is doing well, I am doing well and (3) A process of detachment – you need to let go. Several parents expressed feelings of joy seeing their children become more reflective and independent. However, parents also faced challenges as their adolescents made their own choices. A key aspect of parenting late-stage adolescents involved detachment, balancing giving freedom and responsibility while offering guidance as needed. Parents’ quality of life was closely connected to how their children were coping with challenges in everyday life. When the children were doing well, the parents perceived their own quality of life as good, and it was easier for them to prioritize own needs. Conclusions The parental role changes during adolescence. Adolescents are increasingly becoming more autonomous, and parents must balance between giving freedom, setting boundaries and offering sufficient support to their adolescents. This process can be demanding and affect parents’ quality of life. However, most important to parents is their children’s well-being; thus, parents’ quality of life depends on how well their children are doing. The results indicate that parents need more information on how to prepare for their adolescents’ complex emotions and behavioral changes, along with guidance on fostering healthy autonomy while ensuring open, trusting communication.

• Köpp, Unni Mette Stamnes; Mikkelsen, Hilde E. Timenes & Vistad, Ingvild (2026). Omvendt undervisning – en kvalitativ studie blant medisinstudenter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 146(5). doi: 10.4045/tidsskr.25.0438. Full text in Research Archive Show summary

  Bakgrunn og formål Omvendt undervisning, det vil si at studentene forbereder seg før undervisningen, innebærer at undervisningstiden kan brukes til diskusjon, refleksjon og studentaktiviserende arbeid. Formålet med denne kvalitative studien var å undersøke hvordan forberedelsesoppgaver påvirker medisinstudentenes motivasjon, engasjement og opplevde læring. Materiale og metode To fokusgruppeintervjuer med til sammen 14 medisinstudenter ved Universitetet i Oslo, Campus Sør, ble gjennomført i mai 2024. Studentene hadde erfaring med både tradisjonell og omvendt undervisning. Intervjuene ble analysert med refleksiv tematisk analyse med fokus på studentenes erfaringer med forberedelser og undervisning. Resultater Studentene ga uttrykk for at tydelige forventninger og forberedelser tilpasset undervisningens omfang styrket motivasjonen. De foretrakk kortfattede forberedelsesoppgaver tilgjengelig i god tid. Aktiv bruk av forberedelsesoppgavene i undervisningen gjennom quiz, diskusjoner og kasuistikker fremmet engasjement og opplevd faglig mestring. Studentene erfarte at undervisningsmodellen styrket forståelse av stoffet og trygghet i faglige diskusjoner, særlig ved komplekse temaer. Studentene opplevde også at undervisningsformen støttet utvikling av profesjonell identitet og forberedelse til klinisk arbeid. Fortolkning Kombinasjon av avgrensede forberedelsesoppgaver og aktiv integrering av disse i omvendt undervisning fremmer studentenes motivasjon, engasjement, faglige mestringsfølelse og refleksjon.

• Mikkelsen, Hilde Elisabeth Timenes; Barken, Tina Lien; Rohde, Gudrun E.; Helseth, Sølvi & Skarstein, Siv (2026). Parental health literacy in parents of adolescents aged 16–19: a qualitative study. BMC Public Health. 26(1). doi: 10.1186/s12889-026-26471-9. Full text in Research Archive Show summary

  Background: Parental health literacy is crucial for adolescent health outcomes — particularly during late adolescence, when teenagers take on greater health responsibility. There is a need for further research into parental health literacy and how parents access, understand, appraise, and apply health information, as this is vital for assisting their adolescents in making well-informed health decisions. This study aims to provide a deeper understanding of how parents of late-stage adolescents perceive their parental health literacy and to explore their experiences in transferring responsibility for health-related decisions to their adolescents. Methods: A study with a qualitative design was carried out using individual semi-structured interviews with 15 Norwegian parents of adolescents aged 16–19 years. Braun and Clarke’s reflexive thematic analysis was employed to analyze the data. Results: Three major themes were generated: (1) Transfer of health-related responsibility: from parental oversight to adolescent self-management, (2) parental health literacy and source credibility: navigating trustworthy information, and (3) enhancing parental health literacy to better support adolescents’ informed health decision‑making. Parents experience a shift as they balance their guidance with the adolescents’ growing autonomy. This involves selecting credible health information from digital platforms, healthcare professionals, and personal networks, underscoring the importance of parental health literacy in fostering adolescents’ informed decision-making and self-management of health. Conclusions: Parents of late‑stage adolescents are committed to supporting their children in managing health-related issues and to help develop adolescents’ capacity for autonomous health management, emphasizing the importance of parental health literacy. By facilitating the development of critical appraisal skills, and guiding informed decision-making, parents may contribute to strengthening adolescents’ competence and confidence in handling health-related matters more safely and independently. However, parents reported that losing access to their child’s health information after age 16 may hinder their ability to help. Empowering parents through strengthening their HL may improve individual and family health outcomes.

• Grasaas, Erik; Rohde, Gudrun E.; Mikkelsen, Hilde Elisabeth Timenes; Helseth, Sølvi; Hagen, Milada & Skarstein, Siv [Show all 7 contributors for this article] (2025). The relationship between parental self-efficacy, health-related quality of life, stress and educational level on adolescents’ self-efficacy: a cross-sectional study. Journal of Health, Population and Nutrition. ISSN 1606-0997. 44. doi: 10.1186/s41043-025-01163-z. Full text in Research Archive Show summary

  Background Self-efficacy is a well-known concept often referred to as the belief in the ability to perform in different situations. The concept of self-efficacy is particularly relevant during adolescence, as it serves as a self-regulatory mechanism through which adolescents can be motivated to change their behavior by significant others, such as parents. However, there is little research evidence on how parental factors are associated with adolescents’ self-efficacy. Hence, this current paper aimed to describe parental self-efficacy, health-related quality of life (HRQOL), stress, and educational level and explore associations between the participating parent’s self-efficacy, HRQOL, stress, and educational level on adolescents’ self-efficacy stratified by gender. Methods A cross-sectional study was performed among 508 Norwegian adolescent-parent dyads. Adolescents were 13–15 years old and completed an electronic survey during school hours with teacher and researcher present, whereas the participating parent completed the survey at home. The Survey comprised of a test battery of questionnaires, including sociodemographic data, self-efficacy for both adolescents and parents, and the parental factors: stress, HRQOL, and educational level. Separate multivariable regressions were conducted for the participating parent using STATA software. Results Descriptive analyses revealed a self-efficacy score of (mean/standard deviation (SD), 32.9 (4.0) vs. 34.1 (4.3)), HRQOL (mean/SD, PCS 51.1 (9.5) vs. 53.3 (7.0), MCS 51.9 (8.2) vs. 54.1 (7.2)) and stress (mean/SD, 0.28 (0.24) vs. 0.25 (0.15) among mothers and fathers respectively. Half of the mothers (506%) and 46.1% of the fathers reported ≥ 16 years of education. Multivariable regressions revealed all nonsignificant associations of all parental study variables on adolescents’ self-efficacy (all p > 0.05). Conclusions In this study, the parental factors examined were not associated with adolescents’ self-efficacy. These findings highlight the need for further observational and longitudinal studies with larger samples to better understand how parental factors influence adolescents’ self-efficacy.

• Schuur, Eden Eleanor Van Der & Mikkelsen, Hilde Elisabeth Timenes (2025). Public health nurses’ experiences with work aimed at increasing adolescents’ health literacy: a qualitative study. BMC Nursing. 24(1). doi: 10.1186/s12912-025-03976-z. Full text in Research Archive Show summary

  Abstract Background Health literacy is essential for maintaining good health by enabling individuals to make informed and beneficial health choices in their daily lives. Enhancing health literacy in adolescents is important, because it can empower them to become more engaged with and actively participate in their own health. More knowledge is needed on how public health nurses work to enhance health literacy among adolescents. Therefore, the objective of this study is to explore public health nurses’ experiences with work aimed at enhancing adolescents’ health literacy. Methods The study was inspired by a phenomenological-hermeneutic approach. A qualitative research method was used, in which eight public health nurses from the school health service in the southern part of Norway were interviewed individually. The data were analyzed using Braun and Clarke’s thematic analysis approach. Results Three main themes were identified: (1) Public health nurses use multiple approaches to enhance adolescents’ health literacy; (2) Health information during adolescence is influenced by social media; and (3) Parental involvement is crucial during adolescence. Conclusions This study demonstrates the unique position of public health nurses in enhancing health literacy among adolescents and their parents. A core component of their work is focused on normalizing aspects of adolescents’ everyday lives, such as emotions and body image, which is vital considering adolescents’ exposure to unrealistic social media images and misleading health information found online. Furthermore, public health nurses play an important role in maintaining parental involvement, and they offer reliable, evidence-based guidance and support to adolescents and parents. Clinical trial number Not applicable.

• Skarstein, Siv; Helseth, Sølvi; Hagen, Milada; Haraldstad, Kristin; Rohde, Gudrun Elin & Mikkelsen, Hilde E. Timenes [Show all 7 contributors for this article] (2024). Use of Over-The-Counter Analgesics is Associated with Pain, Stress, and Quality of Life in Norwegian Adolescents: A Cross-Sectional Study. Children. 11(10), p. 1–11. doi: 10.3390/children11101247. Full text in Research Archive Show summary

  Introduction: Approximately 20% of Norwegian adolescents are frequently using Over-the-Counter Analgesics (OTCAs). The WHO emphasizes the need for research to identify the key determinants of health problems in adolescence. Thus, our aim was to describe and explore pain, stress, and Health-Related Quality of Life (HRQOL) in Norwegian adolescents and investigate possible associations upon high/low usage of OTCAs. Methods: This cross-sectional study included 315 adolescents (92 boys, 223 girls) with an average age of 14.1 years (13–15 years). All participants reported using OTCAs. Weekly usage was categorized as high and less than weekly as low. Using a validated questionnaire, we explored the following variables: pain, as measured using the Brief Pain Inventory, stress (Perceived Stress Questionnaire), and HRQOL (KIDSSCREEN-27). Binary logistic regression models were conducted using IBM SPSS Statistics (version 27). Results: Our descriptive findings reveal that high users of OTCAs reported higher pain intensity of 3.4 (SD = 1.9) and perceived stress of 0.38 (SD = 0.18) compared to low users, who reported 2.5 (SD = 1.9) and 0.32 (SD = 0.16), respectively. High OTCA users reported lower average scores than low users across all HRQOL subscales. Binary logistic regression revealed 30% higher odds for higher levels of pain intensity and 14 times higher odds of perceived stress associated with being a high user of OTCAs compared to a low user. Conclusions: Our study shows significantly higher odds for experiencing pain and stress among adolescents using OTCAs daily-to-weekly, compared to those seldom using such medicines. Health professionals should be aware of young people who have a high consumption of OTCAs and investigate whether the use is related to pain or stress. This might be important in designing a personalized and appropriate intervention. Parents and caregivers have an important responsibility in supporting adolescents’ appropriate pain management. Longitudinal studies are needed to better explore predictive factors of OTCA use in adolescents, particularly in relation to psychological variables such as stress and quality of life.

• Rohde, Gudrun E.; Helseth, Sølvi; Småstuen, Milada Cvancarova; Mikkelsen, Hilde Elisabeth Timenes; Skarstein, Siv & Haraldstad, Kristin (2024). The relationship between gender, psychosocial factors, pain, health literacy and health-related quality of life in parents of Norwegian adolescents one year into the COVID-19 pandemic. BMC Public Health. 24(1). doi: 10.1186/s12889-024-18525-7. Full text in Research Archive
• Grasaas, Erik; Mikkelsen, Hilde Elisabeth Timenes; Haraldstad, Kristin; Helseth, Sølvi; Hagen, Milada & Skarstein, Siv [Show all 7 contributors for this article] (2023). Pain in Adolescence: Maternal and Paternal Factors Affecting Adolescents’ Pain in Norway—A Cross-Sectional Study. Children. 10(12). doi: 10.3390/children10121915. Full text in Research Archive Show summary

  Background: Pain in adolescence is considered a worldwide concern. Adolescents’ pain affects family functioning. However, bidirectional associations should be considered as parental determinates such as pain, stress, and sociodemographic factors are also shown to influence pain in adolescence. Objectives: This study explored the associations between maternal and paternal sociodemographic factors, pain, and stress and adolescents’ pain, and stress on adolescents’ pain. Methods: In total, 508 school-based Norwegian adolescents with a corresponding parent were included. All adolescents completed an electronic survey during school hours, and their respective parents responded electronically. The survey included sociodemographic data, the Perceived Stress Questionnaire, and the Brief Pain Inventory. Results: Herein, 385 adolescents reported an average pain of 2.1 (SD, 1.9), and 308 of the participating parents reported an average pain of 1.6 (SD, 1.8). Regressions stratified by parental gender revealed nonsignificant associations in fathers’ study variables predicting adolescents’ pain. However, having the highest maternal educational level (p ≤ 0.01) and working part-time (p ≤ 0.01) were associated with lower pain in adolescents. Conclusions: The findings of this study demonstrated that sociodemographic factors such as high educational status in mothers and mothers working part-time were associated with lower pain in Norwegian adolescents. These findings highlight the importance of a holistic approach to pain management in adolescence.

• Grasaas, Erik; Rohde, Gudrun E.; Haraldstad, Kristin; Helseth, Sølvi; Småstuen, Milada Cvancarova & Skarstein, Siv [Show all 7 contributors for this article] (2023). Sleep duration in schooldays is associated with health-related quality of life in norwegian adolescents: a cross-sectional study. BMC Pediatrics. 23(1). doi: 10.1186/s12887-023-04306-5. Full text in Research Archive Show summary

  Background Insufficient sleep is commonly reported in adolescence and is negatively associated with a wide range of health outcomes. A way to grasp the complicated challenge of how sleep impact different aspects of the adolescents´ everyday life is by examining the relationship between sleep duration in schooldays and weekends on different health-related quality of life (HRQOL) subscales. Furthermore, to expand the understanding of possible underlying mechanisms between sleep and HRQOL, testing for self-efficacy as a possible mediator is of importance. Methods A cross-sectional study was performed among 696 adolescents aged 13–15 years from a schoolbased setting. All participants completed an electronic survey in their respective classrooms. The survey included demographic data, the School Sleep Habits Survey, the KIDSCREEN-27 questionnaire measuring HRQOL, and the General Perceived Self-Efficacy Scale. Statistical analyses were conducted using SPSS Statistics software including PROCESS macro by Andrew Hayes. Results Our findings revealed overall similar sleep patterns in boys and girls including longer sleep duration in the study sample during weekends (10:09 h) than in schooldays (08:36 h). Regression analyses revealed that sleep duration in schooldays was positively and statistically associated with HRQOL subscales psychological well-being (95% CI [0.44 to 1.33]), autonomy and parents (95% CI [0.12 to 1.06]), school environment (95% CI [0.47 to 1.40]), and self-efficacy (95% CI [0.01 to 0.47]). Sleep duration in weekends revealed no associations with the HRQOL subscales, except for the HRQOL subscale psychological well-being (95% CI [0.09 to 0.85]). Mediation analyses revealed that sleep duration in schooldays explained most of the associations (64 −75%) in 4 out 5 HRQOL subscales, except in the association with the HRQOL subscale physical well-being revealing an indirect effect of 71.9%. Conclusions This cross-sectional study described sleep among Norwegian adolescents and demonstrated that sleep durations in weekends and schooldays impact HRQOL and self-efficacy, revealing overall better outcome in HRQOL and self-efficacy with sufficient sleep during schooldays. These findings support the regularity of sleep and highlight the importance of sufficient sleep during schooldays, especially in a school-based sample of adolescents.

• Mikkelsen, Hilde Elisabeth Timenes; Skarstein, Siv; Helseth, Sølvi; Småstuen, Milada Cvancarova; Haraldstad, Kristin & Rohde, Gudrun E. (2022). Health-related quality of life, health literacy and COVID-19-related worries of 16- to 17-year-old adolescents and parents one year into the pandemic: a cross-sectional study. BMC Public Health. 22(22). doi: 10.1186/s12889-022-13737-1. Full text in Research Archive Show summary

  Background: The uncertain and challenging situation caused by the COVID-19 pandemic affects adolescents and their parents in an exceptional way. More knowledge of health-related quality of life (HRQoL), health literacy (HL) and COVID-19-related worries in adolescents and parents 1 year into the pandemic is needed. The present study aimed to describe HRQoL, HL and COVID-19-related worries of 16- to 17-year-old adolescents and parents of adolescents. Further, to assess the strength of associations between gender, HL, COVID-19-related worries and HRQoL. Methods: A cross-sectional study involving 215 adolescents and 320 parents was conducted, exploring HRQoL, HL, COVID-19-related worries and sociodemographic variables. KIDSCREEN-10 and RAND-36 were used to measure HRQoL. Data were analyzed using bivariate methods, multiple linear regression and robust regression. Results: Adolescents’ HRQoL was notably lower compared to previous Norwegian studies and European norms. Parents’ HRQoL was comparable to Norwegian norms. Adolescents and parents reported moderate-to-high HL and high degrees of COVID-19-related worries. Females reported significantly lower HRQoL and more worries compared to males. In adolescents, higher HL was significantly associated with higher HRQoL. COVID-19-related worries were not significantly associated with HRQoL. In parents, higher HL in the “understand health information” domain was significantly associated with higher HRQoL for mental well-being (mental component sum scores [MCS]) and with lower HRQoL for physical well-being (physical component sum scores [PCS]). Being worried a lot about infecting others and about family/friends becoming sick was significantly associated with higher MCS and lower MCS, respectively. COVID-19-related worries were not significantly associated with PCS. Conclusions: Our results indicate that the pandemic has a major negative impact on adolescents’ HRQoL. Parents’ HRQoL remained unchanged and comparable to previous studies. Our study demonstrates that HL, gender and COVID-19-related worries are significantly associated with adolescents’ and parents’ HRQoL, indicating that efforts aimed at increasing their HL might indirectly affect their HRQoL as well and that gender-specific interventions or strategies could be beneficial.

• Rohde, Gudrun E.; Helseth, Sølvi; Skarstein, Siv; Småstuen, Milada Cvancarova; Mikkelsen, Hilde Elisabeth Timenes & Haraldstad, Kristin (2022). Health-related quality of life in parents of adolescents one year into the COVID-19 pandemic: a two-year longitudinal study. Health and Quality of Life Outcomes. 20. doi: 10.1186/s12955-022-02069-8. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes; Småstuen, Milada Cvancarova; Haraldstad, Kristin; Helseth, Sølvi; Skarstein, Siv & Rohde, Gudrun E. (2022). Changes in health-related quality of life in adolescents and the impact of gender and selected variables: a two-year longitudinal study. Health and Quality of Life Outcomes. 20(20). doi: 10.1186/s12955-022-02035-4. Full text in Research Archive Show summary

  Background: Increased knowledge about factors that can impact changes in adolescents’ health-related quality of life (HRQOL) is needed. The present study aimed to investigate possible HRQOL changes in adolescents at 14 and 16 years, and assess the impact of sociodemographic factors, gender, pain, self-esteem, self-efcacy, loneliness, and stress on HRQOL changes over time. Further, to assess HRQOL stratifed by gender. Methods: A longitudinal study involving 211 adolescents was conducted. Sociodemographic variables, pain, selfesteem, self-efcacy, loneliness, and stress were all assessed with well-validated instruments. KIDSCREEN-27 was used to measure HRQOL. Data were analyzed using independent t-tests, paired samples t-tests, and linear mixed models for repeated measures. Results: When all variables were added to the linear mixed models, stress, loneliness, and pain were signifcantly, independently associated with a reduction in HRQOL change scores for four of the fve KIDSCREEN subscales. Time was signifcantly associated with a reduction in physical and psychological well-being. Self-efcacy and self-esteem were signifcantly associated with an increase in HRQOL change scores for four and two subscales, respectively. Male gender was signifcantly negatively associated with changes in social support and peers compared to female gender. Conclusion: Our results demonstrated a signifcant decline in adolescents’ HRQOL regarding physical and psychological well-being for the age range 14–16 years. Furthermore, we found that stress, loneliness, and pain have a signifcant negative impact on HRQOL changes, whereas self-esteem and self-efcacy have a signifcant positive impact. Our results highlight the importance of increased understanding regarding factors associated with changes in adolescents’ HRQOL to enable accurate and strategic interventions.

• Grasaas, Erik; Skarstein, Siv; Mikkelsen, Hilde Elisabeth Timenes; Småstuen, Milada Cvancarova; Rohde, Gudrun E. & Helseth, Sølvi [Show all 7 contributors for this article] (2022). The relationship between stress and health-related quality of life and the mediating role of self-efficacy in Norwegian adolescents: a cross-sectional study. Health and Quality of Life Outcomes. 20, p. 1–9. doi: 10.1186/s12955-022-02075-w. Full text in Research Archive
• Rohde, Gudrun E.; Helseth, Sølvi; Mikkelsen, Hilde Elisabeth Timenes; Skarstein, Siv; Småstuen, Milada Cvancarova & Haraldstad, Kristin (2022). Stress, pain, and work affiliation are strongly associated with health-related quality of life in parents of 14-15-year-old adolescents. Health and Quality of Life Outcomes. 20(1), p. 1–10. doi: 10.1186/s12955-021-01913-7. Full text in Research Archive Show summary

  Background: For many adults, their role as a parent is a vital part of their lives. This role is likely to be associated with a parent’s health-related quality of life (HRQOL). The aim of this study was to explore the associations between gender, demographic and psychosocial variables, pain, and HRQOL in parents of 14–15-year-old adolescents. Methods: This was a cross-sectional study that included 561 parents. Data on demographic, psychosocial variables and pain were collected using validated instruments. HRQOL was assessed using the RAND-36. Data were analysed using univariate and hierarchical multiple linear regression analyses. Results: Four hundred and thirty-six (78%) mothers and 125 (22%) fathers with a mean age of 45 (SD=5) years were included. Eighty-one per cent were married/cohabiting, 74% worked full time, and 50% had university education of more than 4 years. Almost one-third reported daily or weekly pain, and more than half (58%) reported using pain analgesics during the previous 4 weeks. Mothers reported signifcantly lower scores on self-efcacy, self-esteem and for all RAND-36 domains, including the physical component summary (PCS) and mental component summary (MCS) and experienced greater stress than fathers. Hierarchical regression analyses showed that working part-time (beta=0.40) or full time (beta=0.52) (reference: not working) had the strongest positive efect on PCS. Absence from work for >10 days (beta=−0.24) (reference: no absence), short-term pain (beta=−0.14), chronic pain (beta=−0.37) (reference: no pain), and stress (beta=−0.10) had the strongest negative efects on PCS. High self-esteem (beta=0.11) had the strongest positive efect, whereas stress (beta=−0.58) and absence from work for>10 days (beta=−0.11) (reference: no absence) had the strongest negative efects on MCS. Conclusion: Mothers reported signifcantly lower scores on self-efcacy, self-esteem, and HRQOL, and experienced greater stress than the fathers. A high proportion of parents reported pain. Pain, stress, and low work afliation were strongly associated with decreased HRQOL in parents. We recommend that parents of adolescents should be provided guidance about coping with pain and stress, and facilitation of a strong work afliation because these seem to be important to parents’ HRQOL.

• Mikkelsen, Hilde Timenes; Haraldstad, Kristin; Helseth, Sølvi; Skarstein, Siv; Småstuen, Milada Cvancarova & Rohde, Gudrun Elin (2021). Pain and health-related quality of life in adolescents and the mediating role of self-esteem and self-efficacy: a cross-sectional study including adolescents and parents. BMC Psychology. 9(1), p. 1–16. doi: 10.1186/s40359-021-00629-z. Full text in Research Archive Show summary

  Background: To promote health-related quality of life (HRQOL) in adolescents with pain, it is important to study factors associated with pain. This study aimed to describe selected factors and pain in 14–15-year-old adolescents and their parents, to assess how these factors are associated with adolescent pain groups, and to explore whether the relationship between pain intensity and HRQOL in adolescents with persistent pain is mediated by self-esteem and self-efficacy. Methods: A cross-sectional study was performed among 508 dyads of adolescents (14–15 years) and parents in a school-based setting. Among these, 148 adolescents had persistent pain. We explored the following variables: HRQOL, pain, self-efficacy, self-esteem, sleep, loneliness, stress and sociodemographic variables. All variables were assessed with well-validated instruments. HRQOL was measured with KIDSCREEN-27. Analyses included Chi-square, ANOVA, Mann–Whitney U tests, Kruskal–Wallis and the PROCESS macro method for mediation analyses. Results: Adolescents with pain reported significantly higher levels of stress, loneliness and lack of sleep and lower levels of self-efficacy, self-esteem and HRQOL compared to adolescents without pain. More girls than boys reported pain. Adolescents with persistent pain scored significantly worse on self-esteem, stress, loneliness, lack of sleep, school absence, pain and HRQOL compared to adolescents with shorter pain duration. Adolescent pain groups did not differ significantly considering parental factors. However, more adolescents with persistent pain reported that someone in their family had pain. The associations between pain intensity and the HRQOL subscales in adolescents with persistent pain were completely mediated by self-esteem, but not by self-efficacy. The highest degree of mediation was estimated for the HRQOL subscale school environment (indirect effect = 73.5%). Conclusions: Our findings highlight the complexity within adolescent pain, demonstrating that adolescents with pain differ from adolescents without pain when it comes to gender, school absence, factors within-person and between-persons. Longer pain duration makes adolescents more vulnerable. We confirm the importance of resilience factors for HRQOL but indicate that self-esteem is more important than self-efficacy. To promote HRQOL in adolescents with persistent pain, a strengthening of both their self-esteem and self-efficacy is recommended. We highlight the need for an individual, holistic approach to adolescent pain.

• Westergren, Thomas; Fegran, Liv; Antonsen, Anne Jørstad; Mikkelsen, Hilde E. Timenes; Hennig, Camilla Bæck & Køpp, Unni Mette (2021). Prevention of overweight and obesity in a Norwegian public health care context: a mixed-methods study. BMC Public Health. 21. doi: 10.1186/s12889-021-11096-x. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes; Haraldstad, Kristin; Helseth, Sølvi; Skarstein, Siv; Småstuen, Milada Cvancarova & Rohde, Gudrun E. (2020). Health‑related quality of life is strongly associated with self‑efficacy, self‑esteem, loneliness, and stress in 14–15‑year‑old adolescents: a cross‑sectional study. Health and Quality of Life Outcomes. 18. doi: 10.1186/s12955-020-01585-9. Full text in Research Archive Show summary

  Background: To enhance and better understand health-related quality of life (HRQOL) in adolescents, it is important to study factors associated with HRQOL. The present study aimed to assess possible associations between sociodemographic variables, self-efcacy, self-esteem, pain, sleep, loneliness, stress and HRQOL in 14 to 15-year-old adolescents. Methods: A cross-sectional study was performed among 696 adolescents (14–15 years) in a school-based setting. Sociodemographic variables, self-efcacy, self-esteem, pain, sleep, loneliness and stress were analyzed. The variables were all assessed with well-validated instruments. HRQOL was analyzed using KIDSCREEN 27. Analyses included Chisquare, independent t-tests, Mann–Whitney U tests, linear regression analyses and hierarchical regression analyses. The results from linear regression models were expressed as standardized beta. Results: The adolescents generally reported high levels of HRQOL. However, girls scored signifcantly worse on HRQOL, self-efcacy, self-esteem, pain, sleep, loneliness and stress compared to boys. Using hierarchical regression analyses we found that Self-efcacy (beta=0.11–0.24), Self-esteem: (beta=0.12–0.21), Loneliness: (beta=−0.24 to −0.45) and Stress: (beta=−0.26 to −0.34) revealed the strongest associations with the HRQOL dimensions. Sociodemographic-, pain- and sleep related covariates were all signifcantly associated with some of the KIDSCREEN subscales, however their efect on the outcome was smaller than for the psychosocial variables listed above. Being a girl, not living with both parents, not having both parents working, being absent from school more than 4 days, having pain and having lack of enough sleep were all independently negatively associated with HRQOL. Conclusions: HRQOL is strongly associated with self-efcacy, self-esteem, loneliness and stress in 14 to 15-year-old adolescents. Our fndings indicate that positive psychosocial factors such as self-efcacy and self-esteem might play a bufer role for negative psychosocial factors (e.g. stress) in adolescents. Further, our results show that girls score signifcantly worse on factors that are associated to HRQOL compared to boys. To improve HRQOL in school-based populations of adolescents, we suggest that future interventions should aim to strengthen self-efcacy and self-esteem. We recommend gender specifc interventions.

• Mikkelsen, Hilde Elisabeth Timenes; Brovold, Karianne Vassbakk; Antonsen, Anne Jørstad; Berntsen, Sveinung; Kersten, Christian & Fegran, Liv (2018). Cancer Patients' Long-term Experiences of Participating in a Comprehensive Lifestyle Intervention Study While Receiving Chemotherapy. Cancer Nursing. ISSN 0162-220X. doi: 10.1097/NCC.0000000000000650. Full text in Research Archive Show summary

  BACKGROUND: Lifestyle interventions seem promising with regard to cancer patients' potential for physical and psychological health benefits and as an empowerment tool. Nevertheless, there is a lack of knowledge concerning cancer patients' longer-term experiences of participating in comprehensive lifestyle interventions. OBJECTIVE: The aim of this study was to explore cancer patients' long-term experiences of participating in a 12-month individualized comprehensive lifestyle intervention study focusing on physical activity, diet, smoking cessation, and stress management while receiving curative or palliative chemotherapy. METHODS: A qualitative design with semistructured interviews of 7 curative and 7 palliative cancer patients was conducted 12 months after inclusion in lifestyle intervention. Data were analyzed following a phenomenological-hermeneutic approach. RESULTS: Two main themes emerged: (1) awareness of the importance of a healthy lifestyle during cancer treatment and (2) individual follow-up; it's good to have someone to talk to. CONCLUSIONS: Participation in a 12-month comprehensive lifestyle intervention is both feasible and desirable in curative and palliative patients. However, although the curative participants' motivation and perceived ability to adhere to lifestyle recommendations increased during the intervention period, the palliative participants' perceived ability to adhere decreased even though they were overall highly motivated. IMPLICATIONS FOR PRACTICE: Our findings encourage the future implementation of lifestyle interventions during cancer treatment, even in cancer patients with advanced disease. However, when implementing lifestyle interventions, healthcare professionals must keep the patients' motivation, perceived ability to adhere to lifestyle recommendations, and individual needs in mind.

• Mikkelsen, Hilde E. Timenes; Brovold, Karianne Vassbakk; Berntsen, Sveinung; Kersten, Christian & Fegran, Liv (2015). Palliative Cancer Patients' Experiences of Participating in a Lifestyle Intervention Study While Receiving Chemotherapy. Cancer Nursing. ISSN 0162-220X. 38(6). doi: 10.1097/NCC.0000000000000235. Full text in Research Archive

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• Mikkelsen, Hilde Elisabeth Timenes & Skoglund, Jane Terese (2026). Deltakelse på Forskningstorget i Kristiansand. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes (2026). Foreldre mistar oversikta når tenåringen fyller 16 år. [Internet]. Universitetet i Agder, Forskning.no. doi: https:/www.forskning.no/barn-og-ungdom-foreldre-helse/foreldre-mistar-oversikta-nar-tenaringen-fyller-16-ar/2632885. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes (2026). Forsker bak ny studie: – Mange foreldre får et lite sjokk når barna fyller 16. [Journal]. Aftenposten, Bergens tidende, Fvn. Full text in Research Archive
• Befus, Eva-Grethe; Mikkelsen, Hilde Elisabeth Timenes; Senterpartiet, Kjersti Toppe, Stortingsrepresentant, Leder av helse- og omsorgskomiteen,; Bakken, Anders; KrF, Rune Andre Frustøl, Fylkesvaraordfører i Agder, & Berge, Siri Dalsmo [Show all 9 contributors for this article] (2026). Smertestillende i skolesekken: Hva skjer med ungdoms helsevaner? doi: https:/www.arendalsuka.no/program/smertestillende-i-skolesekken-hva-skjer-med-ungdoms-helsevaner. Full text in Research Archive Show summary

  Bruken av smertestillende legemidler som Paracet og Ibux har økt blant ungdom de siste årene. Både forskere og helsepersonell er bekymret for at unge i større grad håndterer hverdagsplager gjennom medikamenter. Dette reiser viktige spørsmål om helsekompetanse, psykososiale belastninger, smerteforståelse og tilgjengeligheten av reseptfrie medikamenter. Forskere ved Universitetet i Agder og OsloMet inviterer til et åpent arrangement hvor vi løfter frem forskningsbasert kunnskap og legger til rette for en samtale om hva som skal til for å styrke ungdoms mestring og fremme trygg bruk av smertestillende medikamenter.

• Haraldstad, Kristin; Mikkelsen, Hilde Elisabeth Timenes & Befus, Eva-Grethe (2026). Smertestillende er blitt en del av hverdagen for ungdom. doi: https:/www.fvn.no/mening/kronikk/i/6qkoe8/smertestillende-er-blitt-en-del-av-hverdagen-for-ungdom. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes (2025). Helserettslig myndig. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes; Blørstad, Eyvor & Nygaard, Hanna Skjelbred (2025). Nei, mamma kan ikke ringe legen for deg. doi: https:/www.fvn.no/mening/kronikk/i/63JJqo/nei-mamma-kan-ikke-ringe-legen-for-deg. Full text in Research Archive
• Reppen, Nils Kristian; Rabben, Jannicke; Rohde, Gudrun E. & Mikkelsen, Hilde Elisabeth Timenes (2024). Nå kan du ta kreftsykepleieutdanning på Sørlandet. [Internet]. Sykepleien.no. doi: https:/sykepleien.no/2024/12/na-kan-du-ta-kreftsykepleie-utdanning-pa-sorlandet. Full text in Research Archive
• Rohde, Gudrun Elin; Haraldstad, Kristin; Hagen, Milada; Mikkelsen, Hilde E. Timenes; Skarstein, Siv & Helseth, Sølvi (2024). Health-related quality of life in parents of adolescents assessed over a four-years period (2019, 2121 and 2023). Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes (2024). Ungdom, smerter og vondter. Full text in Research Archive
• Barken, Tina Lien; Mikkelsen, Hilde Elisabeth Timenes; Gallefoss, Lisbeth; Haraldstad, Kristin & Andreasen, Eva Mari (2024). Ungdom trenger trygge helseråd. Full text in Research Archive
• Rohde, Gudrun E.; Helseth, Sølvi; Småstuen, Milada Cvancarova; Mikkelsen, Hilde Elisabeth Timenes; Skarstein, Siv & Haraldstad, Kristin (2022). Changes in health-related quality of life in parents of adolescents, and the impact of gender, sociodemographic and psychological factors, and pain on the changes: A two-year longitudinal study. Full text in Research Archive
• Mikkelsen, Hilde E. Timenes; Skarstein, Siv; Helseth, Sølvi; Småstuen, Milada Cvancarova; Haraldstad, Kristin & Rohde, Gudrun Elin (2021). Health-related quality of life, health literacy and COVID-19-related worries of 16-17-year-old adolescents and parents, one year into the pandemic. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes (2020). Derfor bør vi hjelpe ungdom med å øke sin selvfølelse og mestringstro. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes; Haraldstad, Kristin; Helseth, Sølvi; Skarstein, Siv; Småstuen, Milada Cvancarova & Rohde, Gudrun E. (2020). Health-related quality of life is strongly associated with self-efficacy, self-esteem, loneliness, and stress in 14–15-year-old adolescents. Full text in Research Archive
• Helseth, Sølvi; Mikkelsen, Hilde Elisabeth Timenes; Skarstein, Siv; Småstuen, Milada Cvancarova & Haraldstad, Kristin (2020). HRQOL of adolescence parents. Full text in Research Archive
• Rohde, Gudrun E.; Helseth, Sølvi; Mikkelsen, Hilde Elisabeth Timenes; Skarstein, Siv; Småstuen, Milada Cvancarova & Haraldstad, Kristin (2020). HRQOL in adolescence parents. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes (2019). Deltakelse på Forskningstorget i Kristiansand. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes (2019). Smerteuttrykk og smertemestring. Full text in Research Archive
• Mikkelsen, Hilde Elisabeth Timenes (2022). The Start Young study. Health-related quality of life and pain in adolescents and associated factors; a prospective cohort study of adolescents and their parents. Universitetet i Agder. ISSN 9788284271040. Full text in Research Archive

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