Kristin Haraldstad

• Macintyre, Anna Kloster-Jensen; Rendal, Heidi Hesselberg; Helseth, Sølvi; Haraldstad, Kristin & Riiser, Kirsti (2026). Co-creating an action to promote health literacy among parents with immigrant backgrounds. BMC Health Services Research. 26, p. 1–13. doi: 10.1186/s12913-026-14842-2. Full text in Research Archive Show summary

  Background Health literacy is a resource that enables individuals to make health related choices to promote and protect their health and that of those around them. For parents, health literacy is essential to access and use information and services in ways that support their child’s health. Immigrant parents may face health literacy challenges due to language barriers, differing approaches to managing child health and parenting, unfamiliar services, and divergent expectations of services and staff. Since parental health literacy is linked to child health outcomes, addressing the needs of immigrant parents may help prevent avoidable inequities in child health. Few studies have developed and tested interventions to promote health literacy among parents with immigrant backgrounds. Based on results from a needs assessment conducted in a culturally and linguistically diverse population in Oslo, Norway, we aimed to co-create an action to promote parental health literacy. Methods We undertook a two-phase co-creation process drawing on methods from the Optimising Health Literacy and Access (Ophelia) Process and the James Lind Alliance Priority Setting Partnership. In phase one, we collected action ideas from a broad range of stakeholders; analysed and synthesised the ideas; facilitated prioritisation workshops with user representatives; and selected one idea for co-design. In phase two, we co-designed the action with user representatives; and conducted quality-improvement cycles in the clinical setting. Results In phase one, 14 immigrant parents and 59 staff from different disciplines generated 302 action ideas. Analysis reduced these to a short-list of 22 ideas which were prioritised by user representatives (parents and staff) resulting in two Top-10 lists. Five priorities overlapped and one of these was selected for development: improving communication on services provided by the family health clinic. In phase two, we operationalised this idea by co-designing short, multilingual, animated videos about follow-up at the clinic. The videos were refined through five iterative quality improvement cycles with input from 43 end users (parents and staff). Conclusions We successfully engaged user representatives, stakeholders and end users across multiple stages of co-creation and co-designed a health literacy action. The videos developed were completed to the stage of feasibility testing in the clinical setting.

• Moi, Ellen Benestad; Skisland, Anne Valen -Sendstad; Haraldstad, Kristin; Johannessen, Berit; Rohde, Gudrun E. & Flateland, Sylvi Monika (2026). Communication and interaction between native-speaker Norwegian nurses and nurses with Norwegian as a second language in home-based care settings: a qualitative exploratory interpretive study. BMC Nursing. doi: 10.1186/s12912-026-04834-2. Full text in Research Archive Show summary

  Introduction: Language barriers between healthcare personnel can influence patient safety and result in inadequate follow-up and communication of the patient’s needs. Aim: The aim of this study was to explore how nurses with Norwegian as a first language (NFL) and nurses with Norwegian as a second language (NSL) experience communication and interaction with each other in home-based workplace settings. Method: The study involved in-depth interviews with 14 nurses: seven nurses with NFL and seven with NSL, and Braun and Clarke’s framework of reflexive thematic analysis were used. Results: Two main themes were identified: (1) the importance of mutual understanding in professional settings, with subthemes highlighting the need to double-check written communication and clarify oral exchanges; and (2) the value of social interactions among colleagues, emphasizing challenges posed by diverse cultural backgrounds and the necessity for clarification due to different native languages. Conclusion: This study underscores the communication challenges in interactions between nurses with NFL and NSL in home-based care. Misunderstandings related to limited language skills may pose a notable threat to patient safety. However, despite the language barriers, nurses with NFL and NSL show strong commitment to clarity and quality, and to working in a positive psychosocial work environment. These findings emphasize the need for organizational support, such as intercultural competence training and clear communication routines, to enhance collaboration and patient safety.

• 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.

• Enstad, Frøydis; Helseth, Sølvi; Løyland, Borghild; Haraldstad, Kristin & Skarstein, Siv (2025). Use of over-the-counter analgesics in Norwegian children – a national cross-sectional study. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948251328492. Full text in Research Archive Show summary

  Aims: We aimed to examine the proportion of recent use of over-the-counter (OTC) analgesics among Norwegian children aged 10 to 12, and explore the relationship between a wide array of factors, both within and outside the indications for use of the medication and recent use of OTC analgesics in this age group. Methods: Data were drawn from the nationwide, population-based Ungdata Junior study in Norway, encompassing children aged 10 to 12 (N= 102,919). We examined factors both within (recurrent pain in different parts of the body) and beyond (repeated bullying, depressive symptoms, screen time and organised activity frequency) medication indications by means of logistic regression. Covariates and background variables included sleep duration, frequency of sports activities, gender, age and socioeconomic status. Results: The results revealed a high prevalence of recent OTC analgesic use (23.7%). Associations were noted with factors both within and beyond the medication’s indications for use. Specifically, adjusted for all variables, recurrent headache (OR = 2.93, 95% CI = 2.81–3.05) and pain (OR = 1.16, 95% CI = 1.11–1.21), depressive symptoms (OR = 1.19, 95% CI = 1.15–1.22) and repeated bullying (OR = 1.07, 95% CI = 1.02–1.14) were significantly linked with an increased risk of recent OTC analgesic use. Conclusions: Our findings suggest a potential misuse of OTC analgesics early in life and raise concerns about potential overuse and unhealthy coping strategies. Enhancing children’s and parents’ understanding of pain and stress management may improve health behaviours and mitigate potential adverse effects from OTC analgesic use.

• Gjellestad, Marianne; Enehaug, Heidi; Haraldstad, Kristin; Nilsen, Vegard & Helmersen, Migle (2024). Women’s health at work: a qualitative study on women’s health issues in relation to work participation. Experiences and perspectives from female teachers and managers in Norwegian high schools. BMC Public Health. 24(1). doi: 10.1186/s12889-024-19241-y. Full text in Research Archive Show summary

  Background Public health and working life are closely related. Even though Norway is one of the world’s most equality-oriented countries, working life is still divided by gender. Women have a lower rate of participation in working life than men, they work more part-time and they have a higher sickness absence. Research has mostly focused on structural and cultural reasons for gender differences, rather than on the fact that women and men have different biology and face different health challenges. The aim of this project was to explore experienced associations between women’s health and female participation in working life. Methods Qualitative methods were chosen for investigating women’s experiences. We carried out in-depth interviews with 11 female high school teachers and supplemented the material with a focus group with five managers from the same organisation. The interviews were recorded and transcribed verbatim. We used the six steps of reflexive thematic analysis for consistency in the analysis process. Results The teachers shared a variety of experienced health issues within the field of women’s health and perceived barriers in the work environment. Four main themes were identified: (1) invisibility of women’s health at work, (2) complexity and lack of recognition of women’s health at work, (3) women’s health in work environment and (4) women’s health and role conflicts. There were few contradictions between the two informant groups. We found that health, work and total life intertwine and that complexity, lack of recognition and invisibility of women’s health appear at different levels in a mutual influence: for the women themselves, in the organisation and in society. Conclusion Lack of recognition and invisibility of women’s health in the work environment is suggested to influence women’s work participation. The complexity of female health is not captured by gender-neutral structures in the work environment meant to protect and promote employees’ occupational health. Recognition of women’s health in the work context can therefore contribute to a gender-equal, health-promoting and sustainable working life.

• Kleppang, Annette Løvheim; Abildsnes, Eirik; Haraldstad, Kristin & Stea, Tonje Holte (2024). Changes in health‑related quality of life and sleep habits after a 6‑month non‑randomised cluster‑controlled trial among children with overweight or obesity. European Child and Adolescent Psychiatry. ISSN 1018-8827. 33, p. 1–9. doi: 10.1007/s00787-024-02375-0. Full text in Research Archive Show summary

  Being overweight or obese can have severe negative psychological impacts and reduce health-related functioning. To improve health-related quality of life (HRQoL) and sleep habits for children with overweight or obesity, it is important to design and implement effective interventions. The aim of this study was to evaluate the effects of a 6-month family-based lifestyle intervention on HRQoL and sleep habits in Norwegian children with overweight or obesity in a primary-care setting. This 6-month, non-randomised, cluster-controlled trial included Norwegian children aged 5–13 years with overweight or obesity and their parents. A questionnaire was filled out by the parents. A total of 33 and 52 children in the control group and 41 and 78 children in the intervention group answered the HRQoL and sleep habits questions, respectively, and were included. The intervention group received individual family counselling and participated in physical activity groups and nutrition courses. The Children’s Sleep Habits Questionnaire (CSHQ) and Kidscreen-10 index were used to assess sleep habits and HRQoL. At baseline, the mean average scores for HRQoL were 50.0 [standard deviation (SD) 8.1] for the intervention group and 49.0 (SD 10.1) for the control group. For sleep habits at baseline, the mean average scores were 45.2 (SD 11.8) for the intervention group and 46.0 (SD 11.9) for the control group. No significant changes in HRQoL and sleep habits after the intervention were revealed. Overall, the family-based lifestyle intervention targeting overweight and obese children in a primary-care setting showed no significant effect on HRQoL or sleep quality.

• 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.

• Gjellestad, Marianne; Enehaug, Heidi; Haraldstad, Kristin; Nilsen, Vegard & Helmersen, Migle (2024). How does women's health matter? A qualitative study on women's health issues in relation to work participation. Experiences and perspectives from nurses and managers in a Norwegian hospital. Health Care for Women International. ISSN 0739-9332. p. 1–26. doi: 10.1080/07399332.2024.2341002. Full text in Research Archive Show summary

  In this article, we explore associations between women’s health and participation in working life, work ability and sickness absence. Through interviews with nurses and hospital manag- ers, we identified three main occupational barriers connected to biological and physiological sex differences: considerations on women’s health, work organization and work environment as conditions for health, and equality and expectations in soci- ety. We find that individual experiences, job systems, and soci- etal attitudes affect each other negatively, and that systemic problems tend to be individualized. The lack of recognition of women’s health affects work participation, work ability and sickness absence in women, representing a challenge to female occupational health, as well as to gender equality and public health in general.

• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Westergren, Per Christer Thomas; Abildsnes, Eirik & Hagen, Milada [Show all 8 contributors for this article] (2024). Health-related quality of life and its association with socioeconomic status and mental health in 5- to 7-year-old children: a cross-sectional study. Quality of Life Research. ISSN 0962-9343. 34, p. 1–13. doi: 10.1007/s11136-024-03834-6. Full text in Research Archive Show summary

  Purpose Assessing socioeconomic status (SES), mental health, and health-related quality of life (HRQoL) in young children is crucial for making informed health care decisions and identifying areas of intervention. The present study aimed to investigate potential associations between SES, mental health, and HRQoL in 5–7-year-old children. Method The present study included mother-reported health assessments for 621 children aged 5–7 years in Grade 1 collected between 2019 and 2023 as part of the Starting Right™ project. Online questionnaires were used to support public health nurses in assessing children’s health status. HRQoL (KIDSCREEN-27, 5 subscales) and mental health [Strength and Difficulties Questionnaire (SDQ), 4 subscales] were assessed. Sociodemographic characteristics, sex, maternal education, and income were obtained from Statistics Norway. The data were analyzed using multiple robust regression. Results Mother-reported mean scores for the KIDSCREEN-27 were within the normal range compared with European norms (8–11 years). However, for each KIDSCREEN-27 dimension, there were individuals whose mothers reported scores that were substantially lower than average. Having mental health problems, defined as being in the 80th and 90th percentiles of the SDQ Total problem score, was associated with 2.1–10.7-point lower KIDSCREEN-27 scores (p < 0.001–0.021), which was most noticeable in the KIDSCREEN-27 school environment subscale. Weak but significant positive associations were found between SES and HRQoL. Conclusion Our results provide important insights into the associations between SES, mental health, and HRQoL in young children. Given the strong association between mental health problems and HRQoL in Grade 1 children, the assessment of both is essential, so that early interventions, an improved caring environment, and nurturing support can be initiated.

• 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
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Småstuen, Milada Cvancarova; Stea, Tonje Holte & Nolte, Sandra [Show all 7 contributors for this article] (2024). The use of youth healthcare services and its association with health-related quality of life, physical and mental health and over-the-counter analgesics use in 13–19-year-old adolescents: a cross-sectional study. BMC Public Health. 24. doi: 10.1186/s12889-023-17544-0. Full text in Research Archive Show summary

  Background Youth healthcare services in Norway include a public health nurse (PHN) at school and local youth health centres (YHCs). They provide health services for all adolescents free of charge, focusing on health promotion and disease prevention. The present study aimed to assess possible associations between health-related quality of life (HRQoL), physical and mental health, over-the-counter analgesics (OTCA) use and use of youth healthcare services among 13–19-year-old adolescents. Methods This study was based on national, cross-sectional data from the Ungdata Survey conducted in 2022. The sample was comprised of 16 482 adolescents. Multiple logistic regression was used to analyse the associations between HRQoL, headaches, selected physical symptoms, psychological distress, use of OTCA, PHN availability, sociodemographic variables, and use of the PHN at school or at a YHC. The KIDSCREEN-10 was used to measure HRQoL, and the Hopkins Symptoms Checklist 10 was used to measure symptoms of psychological distress. Results Girls used the youth healthcare services more frequently than boys. Better HRQoL was significantly associated with fewer visits to the PHN at school. Girls reported lower HRQoL and mental health, and more pain and frequent OTCA use than boys. When having symptoms of psychological distress, boys had greater odds of visiting the PHN at school than girls. For girls in senior high school, headaches and OTCA use were strongly associated with visiting the PHN at school and the YHC. In senior high school, boys with an immigration background had greater odds of visiting the YHC than native Norwegian boys, while girls with an immigration background were less likely to visit the YHC than native Norwegian girls. Conclusions Our results show that more girls than boys use youth healthcare services. When adolescents experience pain, have mental problems, use OTCA, or report low levels of HRQoL, they have greater odds of using youth healthcare services. Youth healthcare services offer excellent opportunities to support and follow up with adolescents. The findings provide important insights into youth healthcare services used by adolescents for various stakeholders, including PHNs and policy makers, with potential implications for future public health efforts.

• Andreasen, Eva Mari; Berg, Helen; Steinsbekk, Aslak Irgens; Høigaard, Rune & Haraldstad, Kristin (2023). The effect of using desktop VR to practice preoperative handovers with the ISBAR approach: a randomized controlled trial. BMC Medical Education. 23. doi: 10.1186/s12909-023-04966-y. Full text in Research Archive Show summary

  Aim The aim was to investigate whether second-year undergraduate nursing students practicing the Identification-Situation-Background-Assessment-Recommendation (ISBAR) communication approach in a desktop virtual reality (VR) application had a non-inferior learning outcome compared with the traditional paper-based method when sorting patient information correctly based on the ISBAR structure. Methods A non-inferior parallel group assessor blinded randomized controlled trial, conducted in simulation sessions as part of preparation for clinical placements in March and April 2022. After a 20-minute introductory session, the participants were randomized to self-practice the ISBAR approach for 45 minutes in groups of three in either an interactive desktop VR application (intervention) or traditional paper-based (TP) simulation. The primary outcome concerned the proportion of nursing students who sorted all 11 statements of patient information in the correct ISBAR order within a time limit of 5 min. The predefined, one-sided, non-inferiority limit was 13 percentage points in favor of traditional paper-based simulation. Results Of 210 eligible students, 175 (83%) participated and were allocated randomly to the VR (N = 87) or TP (N = 88) group. Practicing in the desktop VR application (36% of everything correct) was non-inferior to the traditional paper-based method (22% everything correct), with a difference of 14.2 percentage points (95% CI 0.7 to 27.1) in favor of VR. The VR group repeated the simulation 0.6 times more (95% CI 0.5 to 0.7). Twenty percent more (95% CI 6.9 to 31.6) of the students in the VR group reported liked how they practiced. All the other outcomes including the System Usability Scale indicated non-inferiority or were in favor of VR. Conclusions Self-practicing with the ISBAR approach in desktop VR was non-inferior to the traditional paper-based method and gave a superior learning outcome.

• Haraldstad, Kristin; Abildsnes, Eirik; Bøe, Tormod; Vigsnes, Kristine Løkås; Wilson, Philip & Mølland, Eirin (2023). Health-related quality of life of children from low-income families: the new patterns study. BMC Public Health. 23(1). doi: 10.1186/s12889-023-17335-7. Full text in Research Archive Show summary

  Background Child poverty has been gradually rising, and about 12% of all Norwegian children are living in a state of relative poverty. This study was part of the New Patterns project, which recruits low-income families requiring long-term welfare services. Included families receive integrated welfare services, with the help of a family coordinator. The current study objectives were to explore the associations between HRQoL, demographic variables (age, gender, immigration status) and leisure activities in children and adolescents in low-income families. Methods A cross-sectional survey was conducted among low-income families. Participating families had children (N = 214) aged 8–18 years.The family had a household income below 60% of the equivalized median population income for three consecutive years and needed long-term welfare services. HRQoL was measured using the KIDSCREEN-27 self-report instrument. Descriptive statistics, including means, standard deviations, and proportions, were calculated, and ordinary least squares regressions were performed, clustering standard errors at the family level. Results Compared with boys, girls reported lower HRQoL on only one out of five dimensions, physical wellbeing. In the regression analysis we found statistically significant positive associations between migrant status and HRQoL on all five dimensions: physical wellbeing, psychological wellbeing, parents and autonomy, peers and social support, and school environment. In addition, age was associated with school environment, and age, gender and participation in leisure activities was associated with better physical wellbeing. Conclusions Baseline results regarding HRQoL among children and adolescents in low-income families indicate that they have overall good HRQoL, though some participants had low HRQoL scores, especially on the physical and social support dimensions. Children with an immigrant background report higher HRQoL than do children without an immigrant background.

• Bøe, Tormod; Ostojic, Helene Angelica; Haraldstad, Kristin; Abildsnes, Eirik; Wilson, Philip & Vigsnes, Kristine Løkås [Show all 7 contributors for this article] (2023). Self-reported and parent-reported mental health in children from low-income families in Agder, Norway: results from baseline measurements of New Patterns project participants. BMJ Open. 13(11). doi: 10.1136/bmjopen-2023-076400. Full text in Research Archive Show summary

  Background Poverty may pose risks to child and adolescent mental health, but few studies have reported on this association among children and adolescents in low-income families in Norway. Methods Based on a sample participating in an intervention for low-income families in Norway, we report data from the survey administered at the start of the intervention. Mental health problems were measured using the Strengths and Difficulties Questionnaire (SDQ; self-report (SR) n = 148; parent/proxy-report (PR) n = 153, mean age = 10.8). Demographic and family characteristics were obtained from parent reported data. Results are presented by gender and migration background. Regression analysis was used to investigate the relative contribution of background factors to mental health symptoms. The distribution of scores is compared to UK norms. Results Participants reported relatively high scores on the Strengths and Difficulties Questionnaire (SDQ) Total Difficulties Scale (parent/proxy-report, PR mean=10.7; self-report, SR mean=10.1). Participants with non-immigrant backgrounds scored considerably higher on the Total Difficulties Scale (PR mean difference=2.9; SR 5.3) and on most other domains measured with the SDQ compared with their peers with immigration backgrounds. Participants generally scored higher than or equal to UK norms. Conclusion Participants in the current study had many symptoms of mental health problems, with large differences between those with and without a migrant background. Interventions for low-income families should be based on detailed knowledge about differences in family risks, resources and needs.

• Gjellestad, Marianne; Haraldstad, Kristin; Enehaug, Heidi & Helmersen, Migle (2023). Women’s Health and Working Life: A Scoping Review. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 20(2). doi: 10.3390/ijerph20021080. Full text in Research Archive Show summary

  Women’s health matters for participation in working life. The objective of this study was to explore female physiology in a work–life context and to investigate possible associations between women’s health, sickness absence and work ability. A scoping review was conducted to develop a systematic overview of the current research and to identify knowledge gaps. The search strategy was developed through a population, concept and context (PCC) model, and three areas of women’s health were identified for investigation in the context of work. A total of 5798 articles were screened by title and abstract and 274 articles were screened by full text; 130 articles were included in the review. The material included research from 19 countries; the majority of the studies used quantitative methods. The results showed an impact on the occupational setting and an association between sickness absence, work ability and all three areas of women’s health, but a holistic and overall perspective on female biology in the work context is missing. This review calls for more knowledge on health and work and possible gender differences in this regard. Women’s health and working life involve a complex connection that has the potential to develop new knowledge.

• Mølland, Eirin; Lundberg, Kjetil; Haraldstad, Kristin; Vigsnes, Kristine Løkås; Bøe, Tormod & Danielsen, Hilde [Show all 9 contributors for this article] (2023). Economic composition and income volatility of Norwegian low-income families – a mixed method study of its implications. Nordic Journal of Social Research. 14(1), p. 1–22. doi: 10.18261/njsr.14.1.2. Full text in Research Archive Show summary

  Background: There is a growing amount of research literature documenting increasing social inequality and an increase in the number of children growing up in families with persistently low income in all Scandinavian countries. However, there is a research gap on the issue of income composition; what the main income sources of low-income families are in relation to the families’ position to the labour market and to the welfare state, and possible implications of this to the families’ potential to escape poverty. The aim of this study was to describe the complexity in income sources experienced by low-income families with and without immigrant backgrounds in Norway. Method: Families with children aged 0–17 years (N = 168 families) with low income and in need of long-standing welfare services participated in the New Patterns project. We used a parallel mixed-methods design with quantitative and qualitative research methods, using questionnaires, register data, individual and focus group interviews, workshops with family coordinators and ethnographic fieldwork. Results: Most parents included in the study had low education (51%) and a low proportion participated in the labour market (21%). Twenty different income sources or benefits that the families received were identified and no clear pattern of type of income sources that families received emerged. Families with immigrant background were more likely to receive basic subsistence benefits than non-immigrant background families, and there were corresponding small differences in employment status upon entering the New Patterns project. Several benefits are reduced if families receive other types of income and the interdependence between the various revenue sources increases the unpredictability of total family income. The families have varying degrees of economic literacy, practical finance skills and competence in managing bureaucracy. Conclusion: Income volatility and mechanisms in the Norwegian welfare system contribute to a poverty trap for low-income families who depend on benefits that are not work-related.

• Befus, Eva-Grethe; Helseth, Sølvi; Mølland, Eirin; Westergren, Per Christer Thomas; Fegran, Liv & Haraldstad, Kristin (2023). Use of KIDSCREEN health-related quality of life instruments in the general population of children and adolescents: a scoping review. Health and Quality of Life Outcomes. 21. doi: 10.1186/s12955-023-02088-z. Full text in Research Archive Show summary

  Purpose Subjectively assessing health related quality of life (HRQoL) in children and adolescents is increasingly important in the public health feld. One valid and widely used generic HRQoL instrument is the KIDSCREEN question‑ naire. The aim of this study was to map all studies using KIDSCREEN instruments in the general population of children and adolescents aged 6–18 years. Methods A scoping review was conducted. The search strategy was formulated according to the Preferred Reporting Items for Systematic Reviews and Scoping Reviews guidelines. The databases Cinahl, socINDEX, Medline, Embase, APA Psychinfo, Scopus, and Eric were searched in October 2021. Results In total, 1365 papers were eligible for screening, 1031 were excluded and 334 reports were read in full. 252 reports were included. KIDSCREEN studies in the general population was predominantly conducted in Europe (n=211). Most studies (n=179) had a cross sectional design, while few experimental studies (n=24) were found. The three KIDSCREEN versions comprising of 10, 27 and 52 items, were equally distributed between studies. The selfreported version (n=225) of the KIDSCREEN instrument was more prevalent than the proxy version, while few studies discussed a cut point. Study contexts refected international trends of public health challenges, commonly including mental- and psychosocial health, physical activity, socioeconomic status, and obesity. Conclusion KIDSCREEN is widely used in cross sectional studies assessing common public health challenges. Experi‑ mental and longitudinal assessments, possibly including relevant cut ofs remain mainly unexplored and are recom‑ mended for future research.

• Andreasen, Eva Mari; Høigaard, Rune; Berg, Helen; Steinsbekk, Aslak Irgens & Haraldstad, Kristin (2023). The perceived usability of desktop VR for practicing preoperative handovers using ISBAR among nursing students. Science Talks. 5. doi: 10.1016/j.sctalk.2023.100140. Full text in Research Archive Show summary

  Virtual reality (VR) is an evolving teaching method (Jacobs et al., 2022). However, there is no VR solution for practicing systematic and precise communication, which is a crucial nursing competence during handovers when patients undergo surgery (Gordon, 2018). It is recommended to use the identification-situation-background-assessment-recommendation (ISBAR) approach, which is evidence-based and recommended for communicating patient information between healthcare providers (Shahid & Thomas, 2018). VR has great potential to improve learning outcomes (Foronda et al., 2020; Kyaw et al., 2019). Therefore, a preoperative ISBAR desktop VR application (henceforth application) was developed for undergraduate nursing students to practice handovers. This study evaluated the perceived usability of this application solution involving nine second-year undergraduate nursing students aged 22–29 years at a university in Norway. The participants completed the System Usability Score (SUS) (Brooke, 1996). The students found the application to be a highly motivational learning tool and said it provided interactive learning experiences that were engaging and close to practice. The mean score on the SUS was 83 out of a possible 100 (standard deviation 18.8), which translates to excellent usability (Fig. 1), which means that nursing students found it easy to complete tasks efficiently and effectively.

• Andresen, Gunvor S.; Johannessen, Berit A. T.; Rohde, Gudrun E.; Haraldstad, Kristin & Skisland, Anne Valen -Sendstad (2023). Læreres erfaringer med veiledning av sykepleierstudenter i kliniske studier gjennom covid-19 pandemien. Sykepleien Forskning. ISSN 1890-2936. 18. doi: 10.4220/Sykepleienf.2023.92297. 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.

• Mølland, Eirin; Haraldstad, Kristin; Abildsnes, Eirik; Håland, Åshild Tellefsen; Köpp, Unni Mette Stamnes & Fegran, Liv [Show all 7 contributors for this article] (2023). Use of the Strengths and Difficulties Questionnaire in child and school health services among children aged 4 and 6 years in Southern Norway: clinical considerations. BMC Pediatrics. 23(30). doi: 10.1186/s12887-023-03837-1. Full text in Research Archive Show summary

  Background Parent reported mental health can be assessed by the Strengths and Difficulties Questionnaire (SDQ). Currently, Norwegian norms for parent-reported SDQ do not exist, whereas Swedish, Danish, and United Kingdom (UK) norms have been published. We aimed to (1) describe parent-reported SDQ among children aged 4 and 6 years in Southern Norway, (2) evaluate empirical cutoff values within the context of the Starting RightTM project in relation to the Swedish, Danish, and UK cutoffs, and (3) evaluate the representativeness of the study sample with regard to parental socioeconomic status. Methods This study included parent-reported observations for 665 children (63% consent rate). Means and standard deviations were calculated for the domains of SDQ, and gender differences were assessed. Based on the Swedish, Danish, and UK cutoffs and the 80th and 90th percentile cutoff values within the study, we calculated the total number of children with borderline and abnormal scores. Results Boys had higher mean total difficulties (7.3 vs 5.6) and impact scores (0.3 vs 0.1) and lower prosocial scores (8.3 vs 8.8) than girls. The differences in means were largest in the case of externalizing symptoms (5.0 vs 3.6) and hyperactivity subscore (3.2 vs 2.3). Using the UK cutoff values, 28 and 25 children had borderline and abnormal total difficulties scores, respectively. The corresponding numbers using the within study or Scandinavian cutoff values were 84–99 and 54–79, respectively. Overall, our study sample was well representative of the target population. Conclusions Our findings consistently indicated that girls had better SDQ scores than boys among children aged 4 and 6 years. Fewer children would be identified as having mental health difficulties using the UK cutoff values than using the Scandinavian age- and gender-relevant cutoff values.

• 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.

• Rohde, Gudrun E.; Johannessen, Berit; Maaseide, Markus; Flateland, Sylvi Monika; Skisland, Anne Valen -Sendstad & Moi, Ellen Benestad [Show all 7 contributors for this article] (2023). Being a nursing student during the coronavirus pandemic: a mixed methods study. BMC Nursing. 22(1). doi: 10.1186/s12912-023-01218-8. Full text in Research Archive Show summary

  Background The COVID-19 pandemic led to major changes in people’s lives via protective strategies aimed at limiting the transmission of COVID-19, including social distancing, lockdowns, cancelled or limited leisure activities and tutorials and supervision for students taking place digital. All of these changes may have influenced students’ health and quality of life. Aim To describe and explore fear of COVID-19 and psychological distress, as well as general health and quality of life, among baccalaureate nursing students at 1 year into the COVID-19 pandemic.

• Johannessen, Berit; Flateland, Sylvi Monika; Haraldstad, Kristin; Skisland, Anne Valen -Sendstad & Rohde, Gudrun E. (2022). Being an ethnic minority nursing student- A meta synthesis. Journal of Professional Nursing. ISSN 8755-7223. 40(May-June), p. 111–121. doi: 10.1016/j.profnurs.2022.03.011. Full text in Research Archive Show summary

  Background Our society is characterized by a general globalization and has become more culturally diverse. This diversity is mirrored in nursing education. Purpose The purpose of the meta-synthesis is to identify and synthesize data from primary, qualitative studies of ethnic minority nursing students' experiences in a nursing program. Method Electronic databases, Medline, Embase, and CINAHL, were searched for studies published in English or Nordic languages from 1980 to February 2020. Results The search generated 1070 unique citations, of which 19 articles met the inclusion criteria. The included studies had a total sample size of 255 students, age range 19–50 years. The participants originated from Asia (65), Africa (53), South America (45), and Eastern Europe (17). Seventy-five students' origins were unknown. The meta-synthesis revealed that participants' experiences were characterized by four main themes: to understand and be understood; the importance of supportive relations; motivated but emotionally distressed; and conflicting cultural expectations. Conclusion Ethnic minority nursing students experienced challenges related to language, socialization, cultural awareness, and relations with educators and other students. To meet the students' needs and increase their graduation rates, educational institutions and supervisors should work to promote and facilitate their integration and provide a good learning environment.

• Robstad, Anja Nastasja; Westergren, Per Christer Thomas; Mølland, Eirin; Abildsnes, Eirik; Haraldstad, Kristin & Køpp, Unni Mette Stamnes [Show all 8 contributors for this article] (2022). Experiences of Norwegian child and school health nurses with the “Starting Right™” child health assessment innovation: a qualitative interview study. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08088-x. Full text in Research Archive Show summary

  Background: Although child health services are well established in Norway, the use of information technology for the systematic collection of evidence-based child- and proxy-reported health measures may be benefcial in the early identifcation of child development problems. The Norwegian “Starting Right™” health service innovation consists of parent- and child-reported online structured health assessments tools, including practical routines for child and school health assessments. The aim of this study was to explore the experiences of child and school health nurses with the Starting Right innovation. Methods: We used a qualitative design and conducted three focus group interviews with 18 child and school health nurses from three child health centres one year after the implementation of the innovation. Results: The experiences of professionals with the Starting Right innovation were captured by three themes: (1) the digital innovation could be used to obtain a good overview of a child’s health and development; (2) interpreting the questionnaires was a challenge; and (3) implementing the new digital innovation was time-consuming. Conclusions: Overall, the child and school health nurses experienced that the Starting Right innovation was useful for providing a comprehensive overview of child development and health. The challenges related to interpreting the parents’ scores and follow-up of children, as well as providing the questionnaires in relevant foreign languages, should be addressed to allow all children and families to be reached

• Moi, Ellen Benestad; Skisland, Anne Valen -Sendstad; Johannessen, Berit; Haraldstad, Kristin; Rohde, Gudrun E. & Flateland, Sylvi Monika (2022). Working as a nurse in community health services during Covid-19: a qualitative study. BMC Nursing. 21(1). doi: 10.1186/s12912-022-01141-4. Full text in Research Archive
• Ebitu, Anne Katrine Sandnes; Fegran, Liv; Haraldstad, Kristin; Johannessen, Berit; Chiduo, Mercy Grace & Hovland, Olav Johannes (2022). The banana project: A qualitative study of caregivers' and teachers' experiences of preschool children participating in a free banana school fruit scheme in rural Tanzania. BMJ Nutrition, Prevention and Health. doi: 10.1136/bmjnph-2021-000403. Full text in Research Archive Show summary

  Introduction Good nutrition is the foundation of sustainable growth and development among children. The United Nations aims to achieve food security and improve nutrition through its Sustainable Development Goal 2 - Zero Hunger. In close collaboration with local communities and authorities, the Tanga International Competence Centre, Tanzania, supports projects aimed at achieving the United Nations Sustainable Development Goals. One of their initiatives, The Banana Project, which is a free school fruit scheme, started in 2011 based on a recognised need for nutritional support among preschool children at a rural school in Tanga District. In the interest of improving nutrition, the free school fruit scheme provides one banana 5 school days a week to each child in the class. This study aimed to explore caregivers’ (parents and/or guardians) and teachers’ experiences with preschool children’s participation in the project, with a specific focus on nutrition and health. Methods This qualitative study was performed in 2017. A total of 16 semistructured indepth interviews with 14 caregivers and 2 teachers of the preschool children participating in the project were conducted. Data were analysed using a hermeneutic perspective. Results Caregivers and teachers of the preschool children participating in the intervention experienced that bananas (1) reduced children’s hunger and nutritional deficiency, (2) increased fruit intake and improved their appetite for other foods, (3) improved their physical health and provided energy, and (4) supported cognitive and socioemotional development. Conclusion These findings indicate that the banana intervention has several benefits to preschool children and has an impact on their families. To improve health and reduce the risk of malnutrition of children in rural Tanzania, The Banana Project can be an recommended as a simple, cost-effective and sustainable health and nutrition promotion initiatives.

• Grasaas, Erik; Helseth, Sølvi; Fegran, Liv; Stinson, Jennifer; Småstuen, Milada Cvancarova & Lalloo, Chitra [Show all 7 contributors for this article] (2022). App-based intervention among adolescents with persistent pain: a pilot feasibility randomized controlled trial. Pilot and Feasibility Studies. 8. doi: 10.1186/s40814-022-01113-0. Full text in Research Archive Show summary

  Background: Persistent pain in adolescence adversely afects everyday life and is an important public health problem. The primary aim was to determine the feasibility of an 8-week app-based self-management intervention to reduce pain and improve health-related quality of life in a community-based population of adolescents with persistent pain. A secondary aim was to explore diferences in health outcomes between the intervention and control groups. Methods: A sample of 73 adolescents aged 16–19 years with persistent pain from a community-based population were randomized into 2 groups. The intervention group received the Norwegian culturally adapted version of the iCanCope with PainTM app, which includes symptom tracking, goal setting, self-management strategies, and social support. The attention control group received a symptom tracking app. Feasibility was assessed as attrition rates and level of engagement (interactions with the app). The secondary outcomes included pain intensity, health-related quality of life, self-efcacy, pain self-efcacy, perceived social support from friends, anxiety and depression, and patient global impression. Statistical analyses were conducted using SPSS. Results: Demographic and baseline outcome variables did not difer between the 2 groups. No diferences were found between the participants completing the study and those who withdrew. Twenty-eight adolescents completed the intervention as planned (62% attrition). Both groups had a low level of app engagement. Intention-to-treat analysis (n = 19 + 14) showed no signifcant diferences in outcomes between groups. However, the large efect size (Cohen’s d = .9) for depression suggested a lower depression score in the intervention group. Conclusions: High treatment attrition and low engagement indicate the need for changes in trial design in a fullscale randomized controlled trial to improve participant retention.

• Rohde, Gudrun E.; Johannessen, Berit; Maaseide, Markus; Flateland, Sylvi Monika; Skisland, Anne Valen -Sendstad & Moi, Ellen Benestad [Show all 7 contributors for this article] (2022). Baccalaureate nursing students’ experiences of how the COVID-19 pandemic influenced learning – a mixed method study. BMC Nursing. 21(1). doi: 10.1186/s12912-022-00955-6. Full text in Research Archive Show summary

  Background The COVID-19 pandemic mandated the reconstruction of educational programs globally. For nursing students in need of practical learning and training as a part of their curriculum, the pandemic also caused restrictions and alterations in practical placements and limited access to simulation training at campuses. The aim of this study is therefore, to describe and explore how the COVID- 19 pandemic influenced baccalaureate nursing students’ experiences of learning and their social life as a student. Method We used a mixed method study design including quantitative data from one of the universities (University of Agder) from a national Norwegian survey of baccalaureate nursing students and qualitative data from focus-group interviews from the same university. The quantitative survey included 396 baccalaureate nursing students (response rate, 46%). We arranged five focus groups with a total of 23 students (15 females and 8 males). The students took part in one of the focus-group interviews. The quantitative data were analyzed using chi-square test for categorical data and ANOVA tests for continuous data, while the qualitative data were analyzed using Systematic Text Condensation and an editing analysis style. Results Most students (70%) were concerned about the quality of the education program. In clinical placement, 83% of students had cared for patients with confirmed COVID-19 or unclear COVID-19 status. The qualitative data revealed three main themes: missing the social dimension of learning; worries and challenges in clinical placement; and experiencing normal instructive days in clinical placement. The general picture emerging from our analysis is the importance of social interactions for learning. Conclusion As the COVID-19 pandemic continues, our findings of students’ worries about the quality of the education program and not reaching learning outcomes must be taken into consideration. Social interaction is considered crucial and fundamental for student learning. A follow-up study following baccalaureate completion is necessary to explore the consequences over time of disrupted education.

• Flølo, Tone Nygaard; Gjeilo, Kari Hanne; Andersen, John Roger; Haraldstad, Kristin; Hjelmeland, Inger Helen Hardeland & Iversen, Marjolein M. [Show all 13 contributors for this article] (2022). The impact of educational concerns and satisfaction on baccalaureate nursing students’ distress and quality of life during the Covid-19 pandemic; a cross-sectional study. BMC Nursing. 21(1). doi: 10.1186/s12912-022-00962-7. Full text in Research Archive Show summary

  Background High levels of psychological distress and poor overall quality of life (QOL) have been identified among nursing students during the COVID-19 pandemic. The pandemic necessitated improvised reconstructions of educational curriculums and restrictions in clinical placement and training at campuses, possibly reducing educational quality. Objectives We explored whether baccalaureate nursing students’ concerns and satisfaction with the educational curriculum, focusing on the conduct of clinical training, were associated with perceived psychological distress and overall QOL. Methods Baccalaureate nursing students (N=6088) from five Norwegian universities were invited to an internet-based, cross-sectional survey during the second wave of the pandemic. The survey included COVID-19 specific questions on health, education and clinical training, the Fear of COVID-19 scale (FCV-19S), The Hopkins Symptom Checklist (SCL-5) and overall QOL. Data from national surveys on satisfaction with the educational curriculum, before and during the pandemic were used for comparison. Results In total, 2605 (43%) students responded, of whom 1591 (61%) had been engaged in clinical training during the pandemic. Overall, 53% were either satisfied or fully satisfied with their educational curriculum, with the level of satisfaction being significantly lower than pre-pandemic reference values. Also, 79% were concerned or highly concerned about the educational quality. In multiple regression analyses for all students, lower levels of satisfaction and higher levels of quality concerns were associated with worse SCL-5 scores. Furthermore, satisfaction with the educational curriculum was positively associated with overall QOL. For students engaged in clinical training, only concerns about infecting others were additionally associated with psychological distress. None of the items related to clinical training were associated with overall QOL. Conclusion Nursing students’ educational satisfaction and quality concerns may significantly impact perceived psychological distress and overall QOL during a pandemic. However, with necessary adaptations implemented, concerns regarding the conduct of clinical training account for little of these associations.

• Riiser, Kirsti; Richardsen, Kåre Rønn; Haraldstad, Kristin; Helseth, Sølvi & Torbjørnsen, Astrid (2022). “It’s hard to keep a distance when you’re with someone you really care about”—A qualitative study of adolescents’ pandemic-related health literacy and how Covid-19 affects their lives. PLOS ONE. 17(4), p. 1–14. doi: 10.1371/journal.pone.0266510. Full text in Research Archive Show summary

  Article Authors Metrics Comments Media Coverage Abstract Introduction Methods Results Discussion Conclusion Supporting information Acknowledgments References Reader Comments Figures Abstract Purpose The aim of this study was to explore how adolescents accessed, understood, appraised, and applied information on pandemic preventive measures, how their lives were impacted by long-lasting regulations and how they described their quality of life. Methods A qualitative design with focus group interviews was used to elaborate on the quantitative survey results obtained and analyzed in a previous survey study from the first phase of the Covid-19 pandemic. Five focus groups with seventeen adolescents were conducted digitally during the second pandemic phase in November and December 2020. The interview data were analyzed with directed content analysis. Results The adolescents reported using traditional media and official websites as sources for Covid-19 information. They engaged in preventive behavior, and washing hands and keeping a distance from strangers had become a habit. However, not being physically close to friends felt strange and unpleasant. The measure most frequently discussed was limiting social contact, which was a constant struggle. No one disputed the authorities’ guidelines and rules, but the social restrictions caused boredom and despair, particularly due to interrupted schooling and missed opportunities to engage in life events, and freely socialize with friends. Conclusion The adolescents gave an overall impression of being health literate, which corresponds well with the results from our previous survey study. Their descriptions of how they translated protective measures into their everyday lives demonstrate that they took responsibility and accepted personal costs for the collective good. However, life with social restrictions decreased their quality of life.

• Andreasen, Eva Mari; Høigaard, Rune; Berg, Helen; Steinsbekk, Aslak & Haraldstad, Kristin (2022). Usability Evaluation of the Preoperative ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Desktop Virtual Reality Application: Qualitative Observational Study. JMIR Human Factors. 9(4). doi: 10.2196/40400. Full text in Research Archive Show summary

  Background: Systematic communication, such as the ISBAR (identification, situation, background, assessment, recommendation) approach, comprises a generic, transferable nontechnical skill. It can be used during the handover of patients set to undergo surgery and can be practiced in various ways, including virtual reality (VR). VR increasingly has been implemented and valued in nursing education as a positive contribution to teach students about pre- and postoperative nursing. A new nonimmersive 3D learning activity called the Preoperative ISBAR Desktop VR Application has been developed for undergraduate nursing students to learn preoperative handover using the ISBAR approach. However, the usability of this learning activity has not been studied. Objective: This study aimed to investigate how second-year undergraduate nursing students evaluated the usability of the Preoperative ISBAR Desktop VR Application. Methods: This was a qualitative study with observation and interviews. The inclusion criteria were undergraduate second-year nursing students of varying ages, gender, and anticipated technological competence. The System Usability Scale (SUS) questionnaire was used to get a score on overall usability. Results: A total of 9 second-year nursing students aged 22-29 years participated in the study. The average score on the SUS was 83 (range 0-100), which equals a “B” on the graded scale and is excellent for an adjective-grade rating. The students expressed increased motivation to learn while working in self-instructed desktop VR. Still, a few technical difficulties occurred, and some students reported that they experienced some problems comprehending the instructions provided in the application. Long written instructions and a lack of self-pacing built into the application were considered limitations. Conclusions:The nursing students found the application to be usable overall, giving it an excellent usability score and noting that the application provided opportunities for active participation, which was motivational and facilitated their perceived learning outcomes. The next version of the application, to be used in a randomized controlled trial, will be upgraded to address technological and comprehension issues.

• 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.

• Fegran, Liv; Johannessen, Berit; Ludvigsen, Mette Spliid; Westergren, Thomas; Høie, Magnhild & Slettebø, Åshild [Show all 9 contributors for this article] (2021). Experiences of a non-clinical set of adolescents and young adults living with persistent pain: a qualitative metasynthesis. BMJ Open. 11(4), p. 1–11. doi: 10.1136/bmjopen-2020-043776. Full text in Research Archive Show summary

  Purpose Around 15%–30% of adolescents and young adults (AYAs) experience persistent or chronic pain. The purpose of this study was to synthesise evidence from qualitative primary studies on how AYAs in a non-clinical population experience living with persistent pain. Method A qualitative metasynthesis guided by Sandelowski and Barroso’s guidelines was used. The databases Medline, Embase, Cinahl, PsycINFO, Mednar and ProQuest were searched for studies from 1 January 2005 to 15 February 2021. Inclusion criteria were AYAs aged 13–24 years with first-hand experience of living with persistent, recurrent or episodic non-clinical pain in any body site. Pain associated with a medical diagnosis, malignant diseases, medical procedures or sport activities was excluded. Results Of 2618 screened records, data from nine studies conducted in a Western cultural context including 184 participants (127 female and 57 male aged 11–28 years) were analysed into metasummaries and a metasynthesis. Headaches was the most focused pain condition (n=5), while three of the studies did not specify type of pain. The participants’ experiences were characterised by (1) juggling pain with everyday life; (2) exploring sources of information to manage pain; (3) AYAs’ use of medication to find relief and (4) non-pharmacological strategies for pain relief. Conclusion These AYAs experience of how pain influences everyday life, and their striving to find relief from pain by support from family, friends, professionals and the Internet should be strongly respected. Public health nurses and other healthcare professionals encountering AYAs need to respect their pain experiences, and to support them in healthy coping strategies. Further studies on this issue are needed, especially research focusing on AYAs pain in exposed populations and AYAs from non-Western cultures.

• Beisland, Elisabeth Grov; Gjeilo, Kari Hanne; Andersen, John Roger; Bratås, Ola; Bø, Bodil & Haraldstad, Kristin [Show all 15 contributors for this article] (2021). Quality of life and fear of COVID-19 in 2600 baccalaureate nursing students at five universities: a cross-sectional study. Health and Quality of Life Outcomes. 19. doi: 10.1186/s12955-021-01837-2. Full text in Research Archive Show summary

  Background The COVID-19 pandemic has caused significant disruptions in the implementation of programs across educational institutions. Nursing students, being both young adults and by practical training, part of the health care system, may be particularly vulnerable during the COVID-19 pandemic. The purpose of this study was to explore the associations between self-reported fear of COVID-19, general health, psychological distress and overall quality of life (QoL) in a sample of Norwegian baccalaureate nursing students compared to reference data. Methods The survey targeted baccalaureate nursing students from five universities in February 2021. An electronic questionnaire consisted of the Fear of COVID-19 Scale (FCV-19S), the Hopkins Symptom Checklist 5 (SCL-5), one general health and one overall QoL question. The respondents’ mean scores were compared to reference data. Hierarchical regression analyses were conducted, and effect sizes (Cohen’s d) were evaluated. Results In total, 2605 out of 6088 (43%) students responded. Their FCV-19S scores (mean 2.45, CI 2.42, 2.48) were significantly higher than those of the reference population (mean 1.8, P < 0.001). Nursing students scores showed significantly lower general health (mean 3.50 ± 0.93 SD, population mean = 3.57, Cohen’s d = 0.07), higher levels of psychological distress (mean 2.68 ± 1.03 SD, population mean = 2.12, Cohen’s d = 0.55) and lower overall QoL (mean 5.50 ± 2.16 SD, population mean = 8.00, Cohen’s d = 1.16) compared to pre-pandemic reference data. FCV-19S scores were significantly associated with levels of general health (Cohen’s d = 0.26), psychological distress (Cohen’s d = 0.76) and overall QoL (Cohen’s d = 0.18). Conclusions Baccalaureate nursing students reported worse outcomes during the Covid-19 pandemic on general health, psychological distress and overall QoL compared to the reference population. Level of fear of Covid-19, however, accounted for few of these differences. Other factors related to the pandemic may have reduced nursing students’ overall QoL.

• Westergren, Thomas; Mølland, Eirin; Haraldstad, Kristin; Håland, Åshild Tellefsen; Køpp, Unni Mette & Fegran, Liv [Show all 7 contributors for this article] (2021). Implementation of the norwegian ‘Starting right’ child health service innovation: implementation adjustments, adoption, and acceptability. BMC Health Services Research. 21. doi: 10.1186/s12913-021-06096-x. Full text in Research Archive Show summary

  Background: An increased and/or stable proportion of the child and adolescent population reports symptoms ofimpaired health, and the symptoms can be identified early. Therefore, structured child- and parent-reportedoutcome measures need to be implemented in child and school health services for decision support andidentification of children at risk. We aimed to (a) qualitatively examine adjustments of active implementation fromthe pilot implementation of the Norwegian‘Starting Right’health service innovation including an online childhealth assessment tool and practical routines, and (b) measure practitioners ́ adoption and parental acceptability. Methods: We used a mixed-methods design to qualitatively examine adjustments from working notes andmeeting memoranda, and quantitatively assess adoption and acceptability from user rates provided by the systemslog. Twenty-one child and school health nurses (CSHNs) from two child health centers participated in theimplementation pilot of online health assessments in children aged 2-, 4- and 6-year. We used a deductive andnarrative analysis approach using Fixsen et al. ́s core implementation components to code and sort adjustments. Results: Core implementation components were adjusted throughout the pilot implementation. Researchers ́increased their availability in reciprocity with staff evaluation to integrate active implementation adjustments. Welaunched a project for improved data systems integration. The overall CSHNs adoption rate was satisfactory andhigher in center A, where a medical secretary supported the nurses through the entire pilot phase, than in center B(96 vs. 55 %). Parental acceptability rate was overall high (77 %) with increased rates among parents of 6-year-oldchildren (98 %) compared with younger ones (78–85 %), and in cases where both parents received thequestionnaires. Conclusions: The ‘Starting Right’ health service innovation implementation was actively adjusted by integration of core implementation components mainly based on staff evaluation. The CSHNs adopted the innovation which was also acceptable to parents.

• Sylte, Mari; Grasaas, Erik & Haraldstad, Kristin (2021). Living with pain in adolescence- a qualitative study. Sykepleien Forskning. ISSN 1890-2936. 16. doi: 10.4220/Sykepleienf.2021.86940en. Full text in Research Archive Show summary

  Background: Pain is a major health concern and increasing numbers of adolescents experience persistent pain. More girls than boys are aected. Living with pain aects a person’s quality of life and is related to sleeplessness, stress, depression, and absence from school. For many, the pain becomes severe and persistent, lasting into adulthood.Objective: To describe how young people experience living with persistent pain, how this aects their everyday life and schoolwork, and what they themselves are doing to cope with their pain. Method: The study has a qualitative design and is based on individual interviews with seven adolescents with persistent pain. Results: One of the study’s main ndings was that the young people experienced a great deal of stress and pressure in their everyday lives, and that they generally linked their pain to this strain. Stress associated with school and schoolwork was of particular concern. The informants did not wish to be absent from school because of their pain, and most of them were not talking to anybody about these problems. The results also showed that most of the informants had no eective strategy for coping with pain. Conclusion: The young informants felt a lack of support and found that they had insucient information and inadequate strategies for coping with pain. Because pain can have serious consequences in the short and long term, it is important that health promoting eorts emphasise pain prevention and strategies for coping with pain, to stop the pain from becoming chronic or persistent. Public health nurses are familiar with ways of coping with pain and stress and have an important role to play in giving information to children and their parents and providing guidance for adolescents in how to cope with pain.

• 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.

• Sylte, Mari; Grasaas, Erik & Haraldstad, Kristin (2021). Å leve med smerter i ungdomstiden- en kvalitativ studie av ungdommers erfaringer. Sykepleien Forskning. ISSN 1890-2936. 16. doi: 10.4220/Sykepleienf.2021.86940. Full text in Research Archive Show summary

  Bakgrunn: Smerter er et av våre store helseproblemer, og stadig ere unge har langvarige smerter. Flere jenter enn gutter er rammet. Det å leve med smerter går ut over livskvaliteten og har sammenheng med søvnproblemer, stress, depresjon og fravær fra skolen. For mange blir smerten alvorlig og langvarig og varer til voksen alder.Hensikt: Å beskrive hvordan ungdommer erfarer å leve med langvarige smerter, hvordan det virker inn på hverdagen og skolen, og hva ungdommene selv gjør for å mestre smertene. Metode: Studien har et kvalitativt design og omfatter individuelle intervjuer med sju ungdommer som har langvarige smerter. Resultat: Et av hovedfunnene i studien var at ungdommene opplevde mye stress og press i hverdagen, og at de knyttet smertene i stor grad til dette. Det gjaldt særlig stress knyttet til skole og skolearbeid. Ungdommene ønsket ikke å være borte fra skolen på grunn av smerter, og de este snakket ikke med andre om disse problemene. Videre viste resultatene at de este ungdommene mangler eektive strategier for smertemestring. Konklusjon: Ungdommene opplevde mangel på støtte, informasjon og eektive strategier for å mestre smertene. Fordi smerter kan ha alvorlige konsekvenser både på kort og lang sikt, er det viktig at man i det helsefremmende arbeidet legger vekt på å forebygge smerter og bidra til mestring, slik at ikke smertene blir kroniske eller langvarige. Helsesykepleiere har kunnskap om mestring av smerte og stress. De har en viktig rolle i å informere både barn og foreldre og veilede ungdommer når det gjelder smertemestring.

• Sylte, Mari; Grasaas, Erik & Haraldstad, Kristin (2021). Ungdommer som lever med smerter opplever mer stress i hverdagen. Forskning.no. ISSN 1891-635X. Full text in Research Archive
• Haraldstad, Kristin & Stea, Tonje Holte (2021). Associations between pain, self-efficacy, sleep duration and symptoms of depression in adolescents: a cross-sectional survey. BMC Public Health. 21(1617). doi: 10.1186/s12889-021-11680-1. Full text in Research Archive
• Dalsmo, Ingrid Espegren; Haraldstad, Kristin; Johannessen, Berit; Hovland, Olav Johannes; Chiduo, Mercy Grace & Fegran, Liv (2021). “Now I Feel That I Can Achieve Something”: Young Tanzanian Women’s Experiences of Empowerment by Participating in Health Promotion Campaigns. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(16). doi: 10.3390/ijerph18168747. Full text in Research Archive
• Riiser, Kirsti; Helseth, Sølvi; Haraldstad, Kristin; Torbjørnsen, Astrid & Richardsen, Kåre Rønn (2020). Adolescents’ health literacy, health protective measures, and health-related quality of life during the Covid-19 pandemic. PLOS ONE. 15(8). doi: 10.1371/journal.pone.0238161. Full text in Research Archive Show summary

  Purpose: First, to describe adolescents’ health information sources and knowledge, health literacy (HL), health protective measures, and health-related quality of life (HRQoL) during the initial phase of the Covid-19 pandemic in Norway. Second, to investigate the association between HL and the knowledge and behavior relevant for preventing spread of the virus. Third, to explore variables associated with HRQoL in a pandemic environment. Methods: This cross-sectional study includes survey data from 2,205 Norwegian adolescents 16–19 years of age. The participants reported on their health information sources, HL, handwashing knowledge and behavior, number of social interactions, and HRQoL. Associations between study variables and specified outcomes were explored using multiple linear and logistic regression analyses. Results: Television (TV) and family were indicated to be the main sources for pandemic-related health information. Handwashing, physical distancing, and limiting the number of social contacts were the most frequently reported measures. HL and handwashing knowledge and HL and handwashing behavior were significantly associated. For each unit increase on the HL scale, the participants were 5% more likely to socialize less with friends in comparison to normal. The mean HRQoL was very poor compared to European norms. Being quarantined or isolated and having confirmed or suspected Covid-19 were significantly negatively associated with HRQoL, but seeing less friends than normal was not associated. HL was significantly positively associated with HRQoL, albeit of minor clinical importance.

View all works in NVA

• Bergsjø, Leonora Onarheim; Ersfjord, Ellen Margrete Iveland; Norekvål, Tone Merete & Haraldstad, Kristin (26). Digitalt beredt: Hva slags ehelsekompetanse trenger vi? doi: https:/www.arendalsuka.no/program/digitalt-beredt-hva-slags-ehelsekompetanse-trenger-vi. Full text in Research Archive
• Befus, Eva-Grethe & Haraldstad, Kristin (2026). Livskvalitet hos barn og unge. doi: https:/www.uia.no/om-uia/fakultet/helse-og-idrettsvitenskap/arrangementer/kurs-konferanse-seminar/26-09-livsforsk.html. Full text in Research Archive Show summary

  Innlegg på Livskforsk 2026 konferansen med tema "Livskvalitetsforskningens posisjon i 2026"

• 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
• Haraldstad, Kristin (2025). Godt Begynt- tidlig innsats for barn og unge i Agder. Full text in Research Archive
• Haraldstad, Kristin (2025). Godt Begynt 2018–2025: Fra idé til innsikt – hvor står vi nå? Full text in Research Archive
• Haraldstad, Kristin; Johannessen, Berit; Gallefoss, Lisbeth; Blørstad, Eyvor & Nygaard, Hanna Skjelbred (2025). Ikke kutt helsesykepleierne i videregående skole. Full text in Research Archive
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Westergren, Per Christer Thomas; Abildsnes, Eirik & Hagen, Milada [Show all 8 contributors for this article] (2025). Health‑related quality of life and its association with socioeconomic status and mental health in 5‑ to 7‑year‑old children: a cross‑sectional study. Full text in Research Archive
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Westergren, Per Christer Thomas; Abildsnes, Eirik & Hagen, Milada [Show all 8 contributors for this article] (2025). Health‑related quality of life and its association with socioeconomic status and mental health in 5‑ to 7‑year‑old children: a cross‑sectional study. Full text in Research Archive
• Macintyre, Anna Kloster-Jensen; Hesselberg, Heidi; Helseth, Sølvi; Haraldstad, Kristin & Riiser, Kirsti (2025). Fra innsikt til tiltak: Kartlegging av helsekompetanse hos småbarnsforeldre med innvandrerbakgrunn i Bydel Bjerke og samskaping av tiltak. Full text in Research Archive
• Macintyre, Anna Kloster-Jensen; Helseth, Sølvi; Haraldstad, Kristin; Hesselberg, Heidi & Riiser, Kirsti (2025). Helsekompetanse blant foreldre med innvandrerbakgrunn (OPAL). Full text in Research Archive
• Haraldstad, Kristin; Westergren, Per Christer Thomas; Abildsnes, Eirik; Håland, Åshild Tellefsen; Köpp, Unni Mette Stamnes & Mølland, Eirin (2025). Godt Begynt- tidlig innsats for barn og unge Kristin Haraldstad, Thomas Westergren, Eirik Abildsnes, Åshild T. Haaland, Unni M. Köpp og Eirin Mølland. Full text in Research Archive
• Haraldstad, Kristin (2025). Presentasjon av LIVSFORSK samarbeidsprosjekt -A systematic review of Quality of Life in medicine and health Sciences. Full text in Research Archive
• Riiser, Kirsti; Macintyre, Anna Kloster-Jensen; Rivelsrud, Silje; Hesselberg, Heidi; Haraldstad, Kristin & Helseth, Sølvi (2025). Helsekompetanse hos foreldre med innvadrerbakgrunn (OPAL). Et inkluderende, behovsidentifisert forskningsprosjekt. Full text in Research Archive
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Småstuen, Milada Cvancarova; Stea, Tonje Holte & Nolte, Sandra [Show all 7 contributors for this article] (2024). Livskvalitet og psykisk helse hos ungdom. 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
• Haraldstad, Kristin; Riiser, Kirsti; Macintyre, Anna Kloster-Jensen & Helseth, Sølvi (2024). Utvikling av helsekompetanse i familier med små barn – et folkehelseperspektiv. In Helseth, Sølvi; Pettersen, Kjell Sverre & Wahl, Astrid Klopstad (Ed.), Helsekompetanse Teori, forskning og praksis. Fagbokforlaget. ISSN 9788245043426. Full text in Research Archive
• Macintyre, Anna Kloster-Jensen; Riiser, Kirsti; Helseth, Sølvi & Haraldstad, Kristin (2024). Kartlegging av helsekompetanse blant foreldre med innvandrerbakgrunn. Full text in Research Archive
• Haraldstad, Kristin; Mølland, Eirin; Abildsnes, Eirik & Westergren, Per Christer Thomas (2024). Starting Right, an evidence-based assessment of childrenin municipalities healthcare center. Full text in Research Archive
• Macintyre, Anna Kloster-Jensen; Riiser, Kirsti; Helseth, Sølvi & Haraldstad, Kristin (2024). Helsekompetanse hos foreldre med innvandrerbakgrunn og erfaring fra samarbeid med Bydel Bjerke. Full text in Research Archive
• Andreasen, Eva Mari; Berg, Helen; Steinsbekk, Aslak Irgens; Høigaard, Rune & Haraldstad, Kristin (2024). Læringseffekt av desktop VR for å øve på overføring av pasientinformasjon før operasjon med ISBAR-metoden: en randomisert kontrollert studie. Full text in Research Archive
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Hagen, Milada; Westergren, Thomas & Abildsnes, Eirik [Show all 8 contributors for this article] (2024). What can we do to improve children's health-related quality of life and mental health? 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
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Hagen, Milada; Stea, Tonje Holte & Nolte, Sandra [Show all 7 contributors for this article] (2024). Lørdagsuniversitetet i Kristiansand: Hva kan vi gjøre for ungdoms psykiske helse? Full text in Research Archive
• Haraldstad, Kristin; Mølland, Eirin; Abildsnes, Eirik; Westergren, Per Christer Thomas & Eva-Grethe, Befus (2024). Starting Right, an evidence-based assessment of children in municipalities healthcare centers. Full text in Research Archive
• Riiser, Kirsti; MacIntyre, A.; Haraldstad, Kristin; Hesselberg, Heidi & Helseth, Sølvi (2024). Inclusive, needs-based research for addressing Health Literacy in Parents with immigrant backgrounds. Full text in Research Archive Show summary

  Research indicates that parental health literacy is associated with child health outcomes. A 2021 study by the Norwegian Public Health Department found that certain immigrant groups struggle with health literacy due to language barriers, cultural differences in understanding of health and illness, and unfamiliarity with the Norwegian health system and services. To reduce differences in health literacy and better support parents with immigrant backgrounds to make health promoting choices for their children, and navigate the Norwegian health and social systems effectively, we need knowledge about their resources, challenges, and needs. This knowledge makes it possible to design strategies to promote parental health literacy and make health services more responsive to the needs of the population. Optimising health literacy amongst parents with immigrant backgrounds (OPAL) is a research collaboration between Oslo Metropolitan University and the Bjerke City District, one of the most culturally and linguistically diverse districts in Oslo. Applying the Optimising Health Literacy and Access (Ophelia) process, parents health professionals, and researchers work systematically together to develop knowledge of parents’ health literacy, identify priority areas for research, design and implement effective solutions in primary health care. In this presentation, we will describe how OPAL is rooted in the strategic priorities of the city district, how the project applies methods for needs identification and involves users and stakeholders at all stages. We will share experiences from planning and conducting inclusive data collection, preliminary results and describe how results will be used in development of targeted health literacy actions.

• Haraldstad, Kristin; Mølland, Eirin; Abildsnes, Eirik & Westergren, Per Christer Thomas (2024). Starting Right, an evidence-based assessment of children in municipalities healthcare centers. Full text in Research Archive Show summary

  During the last century, children’s health has evolved significantly, with mental health issues becoming a prominent public health concern. Childhood health problems profoundly impact quality of life (QoL), development, school functioning, and social interactions, affecting society broadly. In Norway, child and school health services offer free comprehensive care within the municipal primary health care system, prioritizing health promotion and prevention to address social health inequalities. The Norwegian Starting RightTM project recruits’ children aged 6 months to16 years and their parents, emphasizing early intervention and support to reduce health inequalities and promote well-being. In the Starting RightTM project, online proxy- and child-reported questionnaires are used to support public health nurses (PHNs) in assessing children’s health and development in routine follow- up. Parents and children receive an SMS text message asking them to answer an online questionnaire before attending their regular a

• Andenæs, Randi; Andersen, Marit Helen; Helseth, Sølvi; Haraldstad, Kristin; Rohde, Gudrun E. & Rokne, Berit [Show all 7 contributors for this article] (2024). Går vi baklengs inn i fremtiden, minister Hoel? Full text in Research Archive
• Haraldstad, Kristin (2024). Status i Godt begynt og presentasjon av ny studie basert på innsamlede data. Full text in Research Archive
• Haraldstad, Kristin (2024). Presentasjon av forskningsresultater fra Godt Begynt prosjektet. Full text in Research Archive
• Riiser, Kirsti; Haraldstad, Kristin; Helseth, Sølvi & Bjørnsen, Hanne Nissen (2024). Helsekompetanse hos barn og unge. In Helseth, Sølvi; Pettersen, Kjell Sverre & Wahl, Astrid Klopstad (Ed.), Helsekompetanse Teori, forskning og praksis. Fagbokforlaget. ISSN 9788245043426. p. 84–93. Full text in Research Archive
• Riiser, Kirsti; Macintyre, Anna Kloster-Jensen; Haraldstad, Kristin; Hesselberg, Heidi & Helseth, Sølvi (2024). Inclusive, needs-based research for addressing Health Literacy in Parents with immigrant backgrounds. European Journal of Public Health. ISSN 1101-1262. 34, p. iii100–iii101. doi: 10.1093/eurpub/ckae144.254. Full text in Research Archive Show summary

  Research indicates that parental health literacy is associated with child health outcomes. A 2021 study by the Norwegian Public Health Department found that certain immigrant groups struggle with health literacy due to language barriers, cultural differences in understanding of health and illness, and unfamiliarity with the Norwegian health system and services. To reduce differences in health literacy and better support parents with immigrant backgrounds to make health promoting choices for their children, and navigate the Norwegian health and social systems effectively, we need knowledge about their resources, challenges, and needs. This knowledge makes it possible to design strategies to promote parental health literacy and make health services more responsive to the needs of the population. Optimising health literacy amongst parents with immigrant backgrounds (OPAL) is a research collaboration between Oslo Metropolitan University and the Bjerke City District, one of the most culturally and linguistically diverse districts in Oslo. Applying the Optimising Health Literacy and Access (Ophelia) process, parents health professionals, and researchers work systematically together to develop knowledge of parents’ health literacy, identify priority areas for research, design and implement effective solutions in primary health care. In this presentation, we will describe how OPAL is rooted in the strategic priorities of the city district, how the project applies methods for needs identification and involves users and stakeholders at all stages. We will share experiences from planning and conducting inclusive data collection, preliminary results and describe how results will be used in development of targeted health literacy actions.

• Kleppang, Annette Løvheim; Abildsnes, Eirik; Haraldstad, Kristin & Stea, Tonje Holte (2023). Changes in Health-Related Quality of Life and Sleep Habits after a 6-Month Non-Randomised Cluster-Controlled Trial among Children with Overweight or Obesity. Full text in Research Archive
• Haraldstad, Kristin (2023). Urovekkende om unge og smerte, -Et varsel om at noe ikke er bra. [Journal]. VG. Full text in Research Archive
• Macintyre, Anna Kloster-Jensen; Riiser, Kirsti; Helseth, Sølvi & Haraldstad, Kristin (2023). Parental health literacy research with a diverse migrant community:Early reflections on user involvement and multi-lingual data collection. Full text in Research Archive
• Macintyre, Anna Kloster-Jensen; Riiser, Kirsti; Helseth, Sølvi & Haraldstad, Kristin (2023). Community engagement and co-designing solutions for implementation research on parental health literacy using needs-based research methodologies. Full text in Research Archive
• Mølland, Eirin; Bøe, Tormod; Ask, Torunn Alise; Lundberg, Kjetil; Danielsen, Hilde & Abildsnes, Eirik [Show all 8 contributors for this article] (2023). Spør en forsker! Presentasjon og drøfting av funn av fra forskningsprosjektet Nye mønstre på familiekoordinator-samling. Full text in Research Archive
• Haraldstad, Kristin (2023). Generic patient-reported outcome measures (PROMs): conditions for use and usefulness in randomized controlled trials. A systematic review. Full text in Research Archive
• Haraldstad, Kristin (2023). A systematic review of quality of life research in medicine and health sciences. 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
• Macintyre, Anna Kloster-Jensen; Riiser, Kirsti; Helseth, Sølvi & Haraldstad, Kristin (2022). Optimising parental health literacy among immigrants (OPAL): Description of a planned needs led study. Full text in Research Archive
• Hovland, Henriette; Karlsen, Cecilie; Haraldstad, Kristin & Thygesen, Elin (2022). Abstracts presented at the Norwegian Public Health Conference, 18–19 October 2022, Hamar, Norway. Scandinavian Journal of Public Health. ISSN 1403-4948. 50(1). doi: 10.1177/14034948221121568. Full text in Research Archive
• Andreasen, Eva Mari; Høigaard, Rune; Berg, Helen; Steinsbekk, Aslak & Haraldstad, Kristin (2022). Is desktop VR more motivational than traditional practice when learning ISBAR? A usability study of desktop VR for learning ISBAR. Full text in Research Archive
• Andreasen, Eva Mari; Høigaard, Rune & Haraldstad, Kristin (2022). Nursing students’ satisfaction with clinical placements – The importance of the supervisory relationship. Full text in Research Archive
• Lohne-Seiler, Hilde; Lindberg, Kolbjørn Andreas; Fosstveit, Sindre Herskedal; Sibayan, Erlend E.; Fjeller, Joachim S. & Løvold, Sondre [Show all 11 contributors for this article] (2022). Physical function and health-related quality of life in older men after 10-weeks power training – any associations? Full text in Research Archive
• Helseth, Sølvi; Haraldstad, Kristin & Riiser, Kirsti (2021). Helsemyndighetene satser på livskvalitet, men glemmer barna. Full text in Research Archive
• Flølo, Tone Nygaard; Gjeilo, Kari Hanne; Andersen, John Roger; Haraldstad, Kristin; Hjelmeland, Inger Helen Hardeland & Iversen, Marjolein M. [Show all 13 contributors for this article] (2021). Associations between educational concerns and satisfaction, psychological distress and quality of life in baccalaureate nursing students during the COVID-19 pandemic. Full text in Research Archive
• Beisland, Elisabeth Grov; Gjeilo, Kari Hanne; Andersen, John Roger; Bratås, Ola; Bø, Bodil & Haraldstad, Kristin [Show all 15 contributors for this article] (2021). Sykepleierstudentene oppgir lav livskvalitet under pandemien. Sykepleien. ISSN 0039-7628. 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
• Stenberg, Una; Riiser, Kirsti; Bjørnsen, Hanne Nissen; Helseth, Sølvi; Le, Christopher & Haraldstad, Kristin [Show all 9 contributors for this article] (2021). Helsekompetanse i alt vi gjør- også for de unge. Full text in Research Archive
• Haraldstad, Kristin & Rohde, Gudrun E. (2021). Livskvalitet og helse under covid-19, hvordan har sykepleiestudentene hatt det? [Internet]. https://www.uia.no/om-uia/podcast/helse-og-idrettspraten. Full text in Research Archive
• Haraldstad, Kristin (2021). Livskvalitet hos barna i "Nye mønstre". Full text in Research Archive
• Riiser, Kirsti; Richardsen, Kåre Rønn; Haraldstad, Kristin; Helseth, Sølvi & Torbjørnsen, Astrid (2021). “It’s hard to keep a distance when you’re with someone you really care about” — a qualitative study of adolescents’ pandemic-related health literacy and how Covid-19 affects their lives. Full text in Research Archive
• Haraldstad, Kristin (2021). Spør oss hvordan vi har det- Godt Begynt, barn og unge i Agder. Full text in Research Archive

View all works in NVA