Christine Råheim Borge

• Borge, Christine Råheim; Wahl, Astrid Klopstad; Larsen, Marie Hamilton; Andersen, Marit Helen; Stavdal, Malene & Hermansen, Åsmund (2026). Validation of the Health Literacy Competencies (IOHLC) instrument in Norwegian interdisciplinary health care professionals in specialist health care service. Journal of Interprofessional Education & Practice. 45. doi: 10.1016/j.xjep.2026.100838. Full text in Research Archive Show summary

  Background Few instruments exist to capture interdisciplinary healthcare professionals' (HCPs) health literacy (HL) sensitivity, such as knowledge, skills, and attentive attitudes, to pursue HL when communicating with patients and their caregivers effectively. Objective This study aims to report on the psychometric properties of The Instrument of Health Literacy Competencies (IOHLC) using confirmatory factor analysis (CFA) procedures on data from a sample of HCPs working in specialist healthcare services in Norway. Methods The nine scales of the original Chinese IOHLC were translated and adapted from English into Norwegian using a forward-backward translation procedure and cognitive interviews. For the psychometric evaluation, a cross-sectional survey of 288 HCPs was conducted in a medium-sized hospital in Norway from July 2022 to September 2022. The statistical analysis included correlation analysis (Persons R), internal consistency (Cronbach's alpha), and CFA. Results The cognitive interviews led to changes in wording and the inclusion of an additional item in the survey. Nine one-factor models resulted in an acceptable fit (i.e., >0.6), comprising 36of the 40 items in the original version. Four items were excluded due to a low loading. In the final version, comprising 36 items, the alpha for internal consistency was 0.7 and above. Conclusions The CFA analysis yielded 36 items from the original IOHLC with an acceptable model fit. Further studies on the psychometric properties of the Norwegian version in other settings and with a larger sample are needed.

• Borge, Christine Råheim; Eik, Hedda; Wahl, Astrid Klopstad; Bragstad, Line Kildal; Sylwander, Charlotte & Hjorthaug, Kristin [Show all 26 contributors for this article] (2026). Health literacy research in primary healthcare services – A scoping review. Patient Education and Counseling. ISSN 0738-3991. 149, p. 109675–109675. doi: 10.1016/j.pec.2026.109675. Full text in Research Archive Show summary

  Objective To systematically map existing evidence on health literacy among people with non-communicable diseases (NCDs) in primary healthcare. Methods An interdisciplinary research group conducted a scoping review following the Arksey and O’Malley framework, refined by Levac and Peters, and reported according to PRISMA-ScR. The review was registered in OSF and applied the Population–Concept–Context framework to define inclusion criteria. Searches were conducted in Medline, APA PsycInfo, Scopus, and Cochrane for studies published between 2000–2025. Peer-reviewed studies were screened in Rayyan, and data were charted and thematically analyzed through team-based consensus. Results The search identified 7952 studies, of which 106 studies met the inclusion criteria. Participants’ mean age was 59 years; 56% were female. Studies originated from 29 countries, mainly the USA, China, and Canada, with an increase after 2013. Three main themes were identified: (1) health literacy, social status, and ethnicity, (2) health literacy, disease, and health outcomes, and (3) health literacy, NCD knowledge, and self-management. Many studies reported associations between health literacy, and self-management, quality of life, and some clinical outcomes, but findings across designs and outcomes were heterogeneous and not consistently positive. Conclusions Improved communication, greater cultural competence, and tailored health literacy interventions are associated with better self-management and disease outcomes in non-communicable diseases, but most evidence is associative rather than causal, intervention effects are mixed, and research on health literacy experiences remains limited. Practice Implications More rigorously designed intervention studies and broader conceptualization and measurement of health literacy with multidimensional instruments are needed to strengthen the evidence and clarify how health literacy relates to social status, disease outcomes, and self-management in primary healthcare. Training healthcare professionals to assess and address health literacy is essential to promote equity and effective patient engagement.

• Kvidaland, Haakon Kristian; Iversen, Marjolein M.; Frisk, Bente; Richards, David A; Lomborg, Kirsten & Borge, Christine Råheim [Show all 7 contributors for this article] (2026). Recruitment for a digitally based follow-up program for people with chronic obstructive pulmonary disease: a pilot cluster randomized controlled trial. Pilot and Feasibility Studies. 12, p. 1–12. doi: 10.1186/s40814-026-01832-8. Full text in Research Archive Show summary

  Background Recruiting participants for clinical trials in primary care settings remains challenging, not least for interventions targeting individuals with chronic obstructive pulmonary disease (COPD). Clinical outcomes and the effects of interventions receive considerable attention compared to factors influencing recruitment success. Identifying and addressing possible barriers and facilitators is essential for optimizing recruitment strategies and ensuring the feasibility of trials. Aim This study aimed to assess uncertainties regarding recruitment for a digitally based Guided Self-Determination (GSD) follow-up program for people with COPD, prior to a fully powered cluster randomized controlled trial (cRCT), and to explore characteristics of primary care practices and patients willing to be included in the study. Methods The intervention was a 9-month digitally based follow-up program performed with the GSD counseling method, conducted by nurses in primary care practices. Eligible primary care practices were invited to participate, and participants were recruited through their respective practices. The primary feasibility outcome was recruitment, assessed at both the practice (cluster) and patient (participants) level. Eligible participants were people between 35 and 80 years diagnosed with COPD. Baseline characteristics included demographic data, COPD Assessment Test, Dyspnea-12, WHO-5 Well-being Index, and Health Education Impact Questionnaire domains. Progression criteria Go , Amend , and Stop were applied to assess feasibility. Results Recruitment occurred from May to December 2024. Of 16 eligible practices, 12 (75%) responded, of which ten (83%) agreed to participate, corresponding to 63% of the eligible practices. A total of 64 participants with COPD were recruited, 28 in the intervention and 36 in the control clusters. The overall median recruitment rate was 6.5 participants per cluster, 7 in the intervention clusters and 6 in the control clusters. One of three progression criteria, cluster recruitment, met the target Go, while cluster sizes and participant recruitment met the amended criteria. Conclusion Recruitment was deemed feasible. However, successful cluster-level recruitment does not necessarily ensure effective patient enrollment, highlighting the necessity for amendments before a fully powered cRCT. Future research should integrate qualitative data obtained from patients and primary care practitioners to enhance the understanding of recruitment strategies.

• Leine, Marit; Wahl, Astrid Klopstad; Steindal, Simen Alexander; Hermansen, Åsmund; Lein, Martha Pauline & Hagen, Milada [Show all 9 contributors for this article] (2026). Associations between quality of life and health literacy in a Norwegian urban cancer population—a cross-sectional study. Health Literacy and Communication Open. 4(1). doi: 10.1080/28355245.2026.2652604. Full text in Research Archive Show summary

  Background Cancer presents challenges for patients due to its complexity and treatment demands, resulting in a low quality of life. Patients must manage amounts of information, and make care decisions. Health Literacy (HL) may be key to managing these challenges. Existing research suggests an association between health-related quality of life (HRQOL) and HL in cancer patients. However, there remains a limited understanding of how dimensions of HRQOL associate with aspects of HL. Aims Investigate associations between domains of HRQOL and multidimensional HL in cancer patients while controlling for demographic and clinical variables. Methods A cross‑sectional study was conducted at a hospital in Oslo, Norway (2020 to 2022). Patient‑reported measures included HLQ (HL), FACT‑G (HRQOL), EORTC‑OH15 (oral QOL), and sociodemographic data. Clinical data were obtained from questionnaires and medical records. Multivariable linear regression analyses were performed Results We included 54 men and 63 women with cancer at a hospital outpatient clinic (mean age 61 years). Multivariable analysis on the association between HRQOL and HL, controlling for demographic and clinical variables, was performed. Significant associations were found between multiple HL domains, younger age, and fewer comorbidities (St. β ranged −0.20 to −0.39, p ranged .04 to <.001), explaining 6–20% of the variance. No associations with gender, living arrangements, education level, or treatment setting. Associations were observed between higher social well‑being scores and higher HL scores across most HLQ domains; higher emotional, physical, and functional well‑being scores were also associated with higher scores in several HLQ domains. All HLQ domains except appraisal of health information (HLQ5) were associated with HRQOL, HLQ7 (navigation) showed most associations (St. β ranged 0.19–0.53, p ranged 0.04 to <.001, explaining 11–46% of the variance). No associations between oral HRQOL and HL. Discussion This study reveals insights into how aspects of HRQOL associate with different HL dimensions in cancer patients. Higher scores on multidimensional HL—especially social support, patient–provider communication, information access, and navigation—relates to better social, emotional, physical, and functional QOL. The article highlights the need for clinician engagement, information appraisal, and navigation support to improve outcomes and guide HL interventions, and underscores the need to measure both concepts multidimensionally. Plain Language Summary Cancer can create many problems for people and can lower their quality of life. Patients often have to learn a lot about cancer, and manage their treatment and symptoms. They also have the stress of having cancer. This requires health literacy, which means being able to understand health information. Our study looked at how health literacy relates to quality of life in cancer patients. We found that people with higher health literacy tended to have better quality of life in many areas.

• Valle, Thea Løver; Søraune, Nashia; Lerdal, Anners & Borge, Christine Råheim (2026). Avansert klinisk allmennsykepleier sin funksjon på medisinske sengeposter: en kvalitativ studie av sykepleie-og legeperspektiv. Nordisk sygeplejeforskning. ISSN 1892-2678. 16(1), p. 1–15. doi: 10.18261/nsf.16.1.4. Full text in Research Archive Show summary

  Bakgrunn: Fremtidens økte behov for helse- og omsorgstjenester vil skjerpe kompetansekravene i spesialisthelsetjenesten, der avansert klinisk allmennsykepleier (AKS) kan inngå. Det foreligger begrenset forskning på AKS-funksjonen ved medisinsk sengepostkontekst. Hensikt: Å utforske sykepleiere og legers refleksjoner om AKS sin mulige funksjon ved medisinske sengeposter i møte med pasienter med komplekse helseplager. Metode: Kvalitativ metode med to fokusgrupper (N=15, leger og sykepleiere ved medisinsk sengepost). Braun & Clarke’s refleksive tematiske analyse ble benyttet. Resultat: Analysen identifiserte fire temaer: 1) Komplekse pasientbehov krever avansert sykepleiekompetanse, 2) AKS med en «på topp funksjon» ved medisinske sengeposter, 3) AKS som ressurs for kompetanse og samarbeid, og 4) AKS-funksjonen krever organisatorisk forankring. Konklusjon: AKS kan bidra til håndtering av komplekse pasientsituasjoner ved medisinske sengeposter, styrke fagmiljøet og fremme økt pasientsikkerhet gjennom kompetansebygging. For å realisere dette kreves en presis funksjonsbeskrivelse.

• Stavdal, Malene Nerbøvik; Larsen, Marie Hamilton; Sjetne, Ingeborg Strømseng; Wahl, Astrid Klopstad; Gay, Caryl & Kjetland, Monica Bukkøy [Show all 8 contributors for this article] (2026). A health literacy intervention for registered nurses: Development and feasibility testing. International Journal of Nursing Studies Advances (IJNS Advances). 10, p. 1–14. doi: 10.1016/j.ijnsa.2026.100503. Full text in Research Archive Show summary

  Background: Health literacy is essential for improving long-term health outcomes, enhancing quality of care, and ensuring patient safety in healthcare systems. Thus, supporting registered nurses in applying health literacy in practice is essential. While health literacy research is expanding, limited attention has been paid to how healthcare personnel develop health literacy sensitivity (i.e., knowledge, skills, and attitudes healthcare personnel require to effectively meet patients’ health literacy needs). Objective (1) Develop and assess the feasibility of a health literacy intervention for registered nurses working in a general hospital setting. (2) Explore potential changes in health literacy sensitivity, work-related factors, and mental well-being for registered nurses, following the intervention. (3) Evaluate registered nurses’ experiences with implementing the intervention. Design: Pre-post feasibility study employing qualitative and quantitative approaches. Setting: Medical ward, general hospital. Participants: N=32 registered nurses. Methods: An advisory panel, Magnet4Europe’s gap-analysis tool, and prior research were used to design the intervention. Health literacy sensitivity was measured using the Instrument of Health Literacy Competencies. Work-related factors and mental well-being were measured using four validated surveys. Quantitative data were analyzed using descriptive, non-parametric statistics. Registered nurses’ experiences with implementing the intervention were assessed through individual and group interviews and analyzed using thematic analysis. Results: The final intervention included a dedicated health literacy nurse trained to motivate and guide colleagues in improving patients’ health literacy. During a 6-month intervention period, registered nurses participated in internal health literacy education, project groups, morning briefings, and reflection groups. The intervention targeted all registered nurses (N = 32) working on a medical ward (i.e., cardiovascular, stroke, and geriatric conditions). The pre-post study showed statistically-significant improvements in 7 of the 9 domains measuring registered nurses’ health literacy sensitivity (pre n = 29, post n = 20). Additionally, teamwork scores between registered nurses and physicians showed a statistically-significant improvement. Qualitative (n = 9) analyses of registered nurses’ experiences of the intervention revealed three main themes: (1) “Strengthening health literacy through increased resources, embedded routines, and interdisciplinary collaboration,” (2) “Between support and strain: health literacy sensitivity as a professional challenge,” and (3) “Registered nurses’ increased awareness and understanding of health literacy sensitivity”. Conclusion: Post-intervention measures demonstrated a significant increase in registered nurses’ health literacy sensitivity through structured routines, interdisciplinary collaboration, access to resources, and support from a designated health literacy nurse. However, health literacy sensitivity remained a balance between rewarding engagement and burdensome responsibility.

• Khalid, Saliha; Stub, Trine; Kristoffersen, Agnete Egilsdatter; Borge, Christine Råheim & Alpers, Lise-Merete (2025). Communication between Norwegian Pakistani patients and healthcare providers about traditional and complementary medicine: a qualitative study. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 20(1). doi: 10.1080/17482631.2025.2579389. Full text in Research Archive Show summary

  Purpose Norwegian Pakistanis use traditional and complementary medicines (T&CM) to promote well-being and treat illnesses. Effective communication between T&CM users and healthcare providers (HCPs) about these practices is essential for patient safety. Therefore, this study aimed to explore HCPs’ experiences in discussing T&CM practices with Norwegian Pakistani patients. Methods Four focus group interviews and one individual in-depth interview were conducted with HCPs in Oslo, Norway, between May and October 2024. Braun and Clarke’s reflexive thematic analysis (RTA) was used to generate themes highlighting the shared meanings of the participants’ experiences. Results Two main themes were generated: 1) Complex consultations and 2) Enhancing communication by modifying attitudes, knowledge, and practices. Consultations with immigrant patients were complex due to language barriers, participants’ limited knowledge of T&CM, and various patient-related obstacles. Despite these challenges, participants demonstrated a strong motivation to overcome them. Improving HCPs’ knowledge about T&CM and demonstrating openness and interest in what matters to patients can build trust and promote effective communication about T&CM. Conclusion HCPs lack knowledge about T&CM used by Norwegian Pakistani patients and rarely communicate about this topic in consultations. The results show an urgent need to promote measures that enhance communication for patient safety.

• Stavdal, Malene Nerbøvik; Hermansen, Åsmund; Sjetne, Ingeborg Strømseng; Larsen, Marie Hamilton; Wahl, Astrid Klopstad & Kohnen, Dorothea [Show all 9 contributors for this article] (2025). Associations Between Work-Related Factors, Mental Well-Being, and Health Literacy Sensitivity: A Cross-Sectional Study Among Healthcare Personnel. Journal of Healthcare Leadership. 17, p. 383–394. doi: 10.2147/JHL.S533694. Full text in Research Archive
• Larsen, Marie Hamilton; Wahl, Astrid Klopstad & Borge, Christine Råheim (2025). Patients’ and healthcare personnel’s experiences of a health-literacy intervention in chronic obstructive pulmonary disease - a qualitative study. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-13299-z. Full text in Research Archive Show summary

  Background Chronic obstructive pulmonary disease (COPD) poses challenges to people's self-management, especially after hospital discharge. Few studies have qualitatively examined the experiences of patients and healthcare personnel following a nurse-led health literacy intervention to prevent readmission. Methods This exploratory qualitative process evaluation was conducted within a randomized controlled trial aimed at understanding the perspectives of both patients and professionals following the implementation of a health literacy intervention. The intervention includes home visits conducted by nurses trained in COPD, employing motivational interviewing techniques and supporting the development of individualised treatment plans post-hospital discharge. Eight semi-structured interviews with patients, one focus group, and one individual interview with healthcare providers (n = 6) were analysed using inductive thematic analysis. Results Two main themes arose among patients: “Building health literacy through personalized nursing support” and “From knowledge to action: Strengthening health literacy through motivational support” – and two among healthcare professionals; “Health professionals’ experience of developing health literacy competency” and “Perceived shifts in understanding, roles, and relationships through health literacy awareness”. Conclusion The nurse-led health literacy intervention was perceived as valuable by both patients and healthcare professionals. Patients described how home-based support from competent nurses may have contributed to a better understanding of post-discharge care and fostered a sense of preparedness. Professionals reported gaining insights into patient needs, which they felt enabled more tailored communication and care planning. While the findings are based on a small qualitative sample, they suggest that such interventions may support the transition from hospital to home.

• Stavdal, Malene Nerbøvik; Larsen, Marie Hamilton; Wahl, Astrid Klopstad; Sjetne, Ingeborg Strømseng; Lerdal, Anners & Gay, Caryl [Show all 7 contributors for this article] (2025). Healthcare Personnel Experiences With Health Literacy Sensitivity in Relation to Work Satisfaction and Stress: A Qualitative Study. Journal of Multidisciplinary Healthcare. 18, p. 1269–1280. doi: 10.2147/JMDH.S493548. Full text in Research Archive
• Vidnes, Tone Karine; Wahl, Astrid Klopstad; Larsen, Marie Hamilton; Meyer, Käthe Birgitte; Engebretsen, Eivind & Hermansen, Åsmund [Show all 10 contributors for this article] (2024). Effectiveness of a health communication intervention on health literacy in the first year following kidney transplantation – A randomized controlled study. Patient Education and Counseling. ISSN 0738-3991. 123. doi: 10.1016/j.pec.2024.108207. Full text in Research Archive Show summary

  Objective: This study aimed to evaluate the effect of a new health communication intervention focusing on knowledge management skills on health literacy and medication adherence during the first year following kidney transplantation. Methods: We randomized 195 patients during 2020–2021, to either intervention- or control group. Questionnaires were completed at baseline and at 12 months post-transplantation with a 12-month response rate of 84%. Health literacy was measured by the multidimensional Health Literacy Questionnaire (HLQ) instrument. Medication adherence was measured by the self-reported questionnaire (BAASIS©). Results: Results showed that the intervention group had a significant increase in 2 HLQ domains compared to the control group capturing the “ability to appraise health information” Domain 5, (p-value = 0.002) and the “ability to navigate the healthcare system” Domain 7, (p-value <0.04). The effect sizes of SRM were 0.49 (Domain 5) and 0.33 (Domain 7). Medication adherence was comparable in the groups at any measure points. Conclusions: This study contributes to important knowledge about how a health communication intervention focusing on knowledge translation using motivational interviewing techniques positively strengthens health literacy in kidney transplant recipients. Practical implications: Current patient education practice may benefit from focusing on knowledge translation in combination with motivational interview technique.

• Borge, Christine Råheim; Larsen, Marie Hamilton; Osborne, Richard H.; Aas, Eline; Kolle, Ingrid Tryland & Reinertsen, Rikke [Show all 15 contributors for this article] (2024). Impacts of a health literacy-informed intervention in people with chronic obstructive pulmonary disease (COPD) on hospitalization, health literacy, self-management, quality of life, and health costs – A randomized controlled trial. Patient Education and Counseling. ISSN 0738-3991. 123. doi: 10.1016/j.pec.2024.108220. Full text in Research Archive Show summary

  Objective: To compare the effect of motivational interviewing (MI) and tailored health literacy (HL) follow-up with usual care on hospitalization, costs, HL, self-management, Quality of life (QOL), and psychological stress in people with chronic obstructive pulmonary disease (COPD). Methods: A RCT was undertaken in Norway between March 2018-December 2020 (n = 127). The control group (CG, n = 63) received usual care. The intervention group (IG, n = 64) received tailored HL follow-up from MI-trained COPD nurses with home visits for eight weeks and phone calls for four months after hospitalization. Primary outcomes were hospitalization at eight weeks, six months, and one year from baseline. The trial was registered with ClinicalTrials.gov (NCT03216603) and analysed per protocol. Results: Compared with the IG, the CG had 2.8 higher odds (95% CI [1.3 to 5.8]) of hospitalization and higher hospital health costs (MD=€ −6230, 95% CI [−6510 to −5951]) and lower QALYs (MD=0.1, 95% CI [0.10 to 0.11]) that gives an ICER = − 62,300. The IG reported higher QOL, self-management, and HL (p = 0.02- to <0.01). Conclusion: MI-trained COPD nurses using tailored HL follow-up is cost-effective, reduces hospitalization, and increases QOL, HL, and self-care in COPD. Practice implication: Tailored HL follow-up is beneficial for individuals with COPD and the healthcare system.

• Khalid, Saliha; Kristoffersen, Agnete Egilsdatter; Alpers, Lise-Merete; Borge, Christine Råheim; Qureshi, Samera Azeem & Stub, Trine (2024). Use and perception of risk: traditional medicines of Pakistani immigrants in Norway. BMC Complementary Medicine and Therapies. 24(1). doi: 10.1186/s12906-024-04620-0. Full text in Research Archive Show summary

  Background - Pakistani immigrants are the largest non-Western ethnic minority group in Norway. Traditional medicines (TM) are extensively used in Pakistan, and studies show that ethnic minorities also use them to recover from illness after migration to the Western world. This study aims to explore Pakistani immigrants’ experiences and perceptions of risk regarding the use of TM to treat illnesses.<p> <p>Methods - A qualitative study was conducted through in-depth interviews (n = 24) with Pakistani immigrants in Norway from February to March 2023. Participants were recruited through purposive and snowball sampling methods. The data was analyzed using Braun & Clarke’s reflexive thematic analysis (RTA) using Nvivo.<p> <p>Results - RTA revealed three main themes and six sub-themes. The main themes were: (a) House of knowledge, (b) Choosing the best possible approach for health restoration, and (c) Adverse effects of TM used. A total of 96 different TM were identified, including herbs, food items, animal products, minerals, herbal products, and ritual remedies. All participants used TM to restore health in acute and chronic diseases, and many used TM along with conventional medicines. The participants’ mothers were the primary source of knowledge about TM, and they passed it on to the next generation. They also frequently used religious knowledge to recover from illness. Although TM is considered safe because of its natural origin, some participants experienced adverse effects of TM, but none of them reported it to the health authorities.<p> <p>Conclusion - The study helps to understand the experiences and perceptions of risk of Pakistani immigrants in Norway regarding traditional practices for treating health complaints. Public health policies to improve the health of these immigrants should consider the importance of TM in their lives. Further research is necessary to explore the safety and toxicity of those TM that are common in Pakistani households in Norway.

• Lundereng, Elias David; Nes, Andrea Aparecida Gonçalves; Holmen, Heidi; Winger, Anette; Thygesen, Hilde & Jøranson, Nina [Show all 10 contributors for this article] (2023). Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 25. doi: 10.2196/43429. Full text in Research Archive Show summary

  Background: Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients’ homes, reduce hospital admissions, enhance patients’ feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. Objective: The aim of this review was to systematically map published studies on HCPs’ experiences and perspectives on the use of telehealth in HBPC. Methods: A scoping review was conducted using the methodology of Arksey and O’Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs’ experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. Results: This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. Conclusions: Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs’ point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC.

• Finbråten, Hanne Søberg; Romedal, Signegun; Borge, Christine Råheim & Eie, Anette (2023). Helsekompetanse i pasient- og pårørendeopplæring – en tematisk analyse. Sykepleien Forskning. ISSN 1890-2936. 18(91893). doi: 10.4220/Sykepleienf.2023.91893. Full text in Research Archive Show summary

  Bakgrunn: Pasienters og pårørendes muligheter til best å kunne håndtere sin egen helsetilstand kan påvirkes av i hvilken grad sykepleiere og annet helsepersonell tilpasser helseinformasjon til den enkeltes helsekompetanse. Pasienter og pårørende må dessuten ha tilstrekkelig helsekompetanse for at de skal kunne delta i samvalgsprosesser. I korthet omfatter helsekompetanse den enkeltes kompetanse i å finne, forstå, vurdere og anvende helseinformasjon og helsetjenester for å fremme og bevare god helse. Imidlertid er helsekompetanse et relativt ukjent begrep blant helsepersonell. Mange har uttrykt usikkerhet rundt innholdet i begrepet og en interesse for hvilke konsekvenser helsekompetanse kan ha for pasient- og pårørendeopplæringen. Det er lite forskning på hvordan helsepersonell selv reflekterer over betydningen av helsekompetanse i pasient- og pårørendeopplæring. Hensikt: Hensikten med studien var å beskrive helsepersonells og lederes refleksjoner om betydningen av helsekompetanse i pasient- og pårørendeopplæringen. Metode: Studien er deskriptiv-kvalitativ, der dataene ble innhentet gjennom prosessverktøyet «verdenskafé». Vi gjennomførte datasamlingen på Regional konferanse for pasient- og pårørendeopplæring i Helse Sør-Øst (HSØ) i desember 2021. Totalt deltok 54 tverrfaglige helsepersonell og ledere fra åtte helseforetak med særskilt ansvar for pasient- og pårørendeopplæringen i spesialisthelsetjenesten. I tillegg deltok brukerrepresentanter. For å analysere datamaterialet anvendte vi tematisk analyse etter inspirasjon av Braun og Clarke. Resultat: Vi identifiserte seks hovedtemaer og 27 undertemaer. Hovedtemaene omfattet: 1) Helsepersonells kompetanse, 2) Pasientens og pårørendes kompetanse og preferanser, 3) Interaksjon, 4) Ressurser og rammer, 5) Samhandling og samarbeid, 6) og Konsekvenser av helsekompetanse. Konklusjon: Helsepersonell og ledere rapporterte et behov for økt kompetanse i hvordan de kan følge opp helsekompetansebehov i pasient- og pårørendeopplæringen. Et slikt behov kan relateres til et fokus på organisatorisk helsekompetanse. Tilstrekkelige ressurser og rammer samt økt samhandling og samarbeid kan bidra til mer tilpasset pasient- og pårørendeopplæring. Mer oppmerksomhet rundt helsekompetanse kan muligens også gi styrket pasientsikkerhet.

• Skogestad, Ingrid Johansen; Kottorp, Anders; Larsson, Petra; Moen, Marie Therese Kristine Normann; Gay, Caryl & Borge, Christine Råheim [Show all 7 contributors for this article] (2023). Development and evaluation of the Norwegian Fatigue Characteristics and Interference Measure (FCIM) for stroke survivors: cognitive interviews and Rasch analysis. Quality of Life Research. ISSN 0962-9343. doi: 10.1007/s11136-023-03477-z. Full text in Research Archive Show summary

  Purpose There is need for a comprehensive measure of post-stroke fatigue with sound measurement properties. This study aimed to develop the Norwegian Fatigue Characteristics and Interference Measure (FCIM) and assess its content validity, structural validity, and internal consistency. Method This study consisted of three steps: (1) an expert panel developed version 1.0 of the Norwegian FCIM, (2) its content validity was assessed in cognitive interviews with stroke patients (N = 15), (3) a convenience sample of stroke patients (N = 169) completed an online questionnaire with the FCIM, Fatigue Severity Scale, and sociodemographic information; validity and reliability were assessed using Rasch analysis. Results FCIM version 1.0 included a 10-item characteristics subscale, a 20-item interference subscale, and two pre-stroke fatigue items. The cognitive interviews revealed content validity issues, resulting in two interference items being removed and five items being flagged but retained for Rasch analysis (version 2.0). Rasch analysis led to removal of four items from the characteristics subscale and six more from the interference subscale. The final six-item characteristics subscale and 12-item interference subscale (version 3.0) both showed adequate fit to the Rasch model with indications of unidimensionality and local independence. The interference subscale had a high person separation index. No significant differential item function (DIF) was found in relation to gender, but one item demonstrated DIF in relation to age. Conclusion The cognitive interviews and Rasch analysis demonstrated that the Norwegian version of the FCIM has high content validity, structural validity, and internal consistency. Future research should assess its construct validity, reliability, and responsiveness.

• Kolltveit, Beate-Christin Hope; Graue, Marit; Borge, Christine Råheim & Frisk, Bente (2023). Patients’ experiences with participating in a team‑based person‑centred intervention for patients at risk of or diagnosed with COPD in general practice. Pilot and Feasibility Studies. 9. doi: 10.1186/s40814-023-01398-9. Full text in Research Archive Show summary

  Background Symptoms and complications of chronic obstructive pulmonary disease (COPD) can affect daily activities and quality of life, and patients with COPD require long-term follow-up by their general practitioner. Providing patients with or at risk of COPD practical skills and motivation to improve their self-management is important. On this background, an interdisciplinary follow-up program was designed based on the Guided Self-Determination counselling method to facilitate problem-solving and mutual decision-making between healthcare professionals and patients. The aim of the study was to explore patients and healthcare professionals` experiences with the Guided Self-Determination-program to investigate feasibility issues. Methods A qualitative design was used to get insights in the experiences of receiving the Guided Self-Determination counselling program. In total, 13 patients with COPD (mean age 71.7 ± 7.7 years) 4 were current smokers, and 7 at risk of COPD (mean age 54.1 ± 9.9 years) all current smokers, received the Guided Self-Determination program. The researchers performed individual semi-structured telephone interviews after the 12 months Guided Self-Determination program with two patients at risk of COPD, four patients with COPD, three nurses, and five general practitioners. The intervention consisted of structured consultations with the nurse and patient in collaboration with the general practitioner at baseline and after 3, 6, and 12 months. The Guided Self-Determination method comprised facilitation of a mutual reflection process between the patient and the nurse to enhance self-management skills. Each consultation lasted for 60 min. The interviews were analysed using thematic analyses. Results Two themes were identified: (1) A structured follow-up is challenging but motivating. (2) A counselling method that opens for conversation, but it requires resources. Conclusions The findings indicated that patients with or at risk of COPD experienced enhanced self-management skills after participating in a structured and systematic team-based follow-up in general practice with use of the Guided Self-Determination method. The regularity of the follow-up seemed to be important to succeed to help the patients making lifestyle changes to increase health benefits. However, the Guided Self-Determination method was experienced as time consuming among the general practitioners and nurses, and there are currently no available financial rates for this type of treatment in Norway which may be a barrier to further implementation. Trial registration The trial is registered in ClinicalTrials.gov (ID: NCT04076384).

• Hermansen, Åsmund; Andersen, Marit Helen; Borge, Christine Råheim; Dahl, Kari Gire; Larsen, Marie Hamilton & Lønning, Kjersti [Show all 9 contributors for this article] (2023). Preliminary validity testing of the eHealth Literacy Questionnaire (eHLQ): a Confirmatory Factor Analysis (CFA) in Norwegian hospitalized patients. BMC Psychology. 11(1). doi: 10.1186/s40359-023-01449-z. Full text in Research Archive Show summary

  Aims: To perform the first psychometric analysis of the Norwegian version of the eHLQ using confirmative factor analysis (CFA) procedures in a population of patients admitted to hospital using a cross-sectional design. The eHLQ consists of 35 items capturing the 7-dimensional eHealth Literacy Framework (eHLF) which describes users’ attributes, user’s interaction with technologies and user’s experience with digital health systems. Methods: The 7 independent scales of the eHLQ was translated from Danish and culturally adapted into the Norwegian language following a standardised protocol. Assessment of construct validity of the eHLQ was undertaken using data from a cross-sectional survey of 260 patients hospitalized at a Norwegian University Hospital in the Oslo area during a two-week period in June 2021. The analysis included using correlation analysis (Pearsons R), internal consistency (Cronbach’s alpha) and confirmatory factor analysis (CFA). Results: All factor loadings were high to acceptable (i.e. > 0.6), except for five items which had somewhat lower loadings. Regarding internal consistency, alpha ranged from 0.73 to 0.90. For optimal CFA fit for the different scale models, correlated residuals were required for five of the seven scales. Overall our analysis shows an intermediate fit of the orginal construct. Scale intercorrelations were all below 0.8, indicating an overall acceptable discriminant validity between the 7 dimensions. Conclusions: The results from the CFA analysis indicate that for almost all 7 eHLQ scales, an acceptable model fit was achieved. The 260 hospitalized patients included in this study represented a variety of diagnoses, recruited from a geographically limited area. Further studies on psychometric properties of the Norwegian version of eHLQ in larger samples, diverse settings and by using more comprehensive approaches are warranted.

• Frisk, Bente; Sundør, Ingrid Elise; Dønåsen, Mette Ramstad; Refvem, Olav Kåre & Borge, Christine Råheim (2022). How is the organisational settings, content and availability of comprehensive multidisciplinary pulmonary rehabilitation for people with COPD in primary healthcare in Norway: A cross-sectional study. BMJ Open. 12(2). doi: 10.1136/bmjopen-2021-053503. Full text in Research Archive Show summary

  Objective To examine the organisational settings, content and availability of comprehensive multidisciplinary pulmonary rehabilitation (PR) programmes for people with chronic obstructive pulmonary disease (COPD) in primary healthcare in Norway. Design This was a cross-sectional survey study examining the content, organisational settings and availability of comprehensive multidisciplinary PR for people with COPD. Setting and participants When the survey was conducted, Norway had 436 municipalities/primary healthcare services who were invited to participate. Outcome measures The main outcome was the question related to accessibility to a PR programme in primary healthcare. We also examined in what degree the single interventions which are a part of a PR programme were one of the municipalities services and if there were regional differences regarding PR. Results Of the 436 municipalities, 158 answered the survey (36% response rate), and the survey covered for 45% of the total population in Norway. Five per cent of the responders reported having multidisciplinary PR for patients with COPD. The most frequently reported single interventions that can be a part of a multidisciplinary PR programme were reported as follows: group exercise training for all diagnoses (27%), reablement (25%) and home-care treatment by a physiotherapist and/or occupational therapist (24%). Southern-Eastern Norway had a significantly lower number of these interventions than Western Norway, Central Norway, and Northern Norway (p&lt;0.001). Conclusion Only 5% of the Norwegian primary healthcare services (municipalities) had a multidisciplinary PR programme for patients with COPD. PR is the most important and cost-effective treatment within integrated care of patients with COPD. National strategies are therefore needed to increase the availability of PR for patients with COPD in Norwegian municipalities.

• Borge, Christine Råheim; Larsen, Marie Hamilton; Osborne, Richard H; Engebretsen, Eivind; Andersen, Marit Helen & Holter, Ingrid Asbjørnsen [Show all 7 contributors for this article] (2022). How to co-design a health literacy-informed intervention based on a needs assessment study in chronic obstructive pulmonary disease. BMJ Open. 12(10). doi: 10.1136/bmjopen-2022-063022. Full text in Research Archive Show summary

  Objective To develop a co-designed health literacy (HL)-informed intervention for people with chronic obstructive pulmonary disease (COPD) that enables them to find, understand, remember, use and communicate the health information needed to promote and maintain good health. Design This study used a co-design approach informed by the programme logic of the Ophelia (Optimising Health Literacy and Access) process. The co-design included workshops where possible solutions for an HL-informed intervention were discussed based on an HL needs assessment study. Settings Five workshops were performed in a local community setting in the specialist and municipality healthcare services in Oslo, Norway. Participants People with COPD, multidisciplinary healthcare professionals (HCPs) from the municipality and specialist healthcare services, and researchers (n=19) participated in the workshops. The co-designed HL-informed intervention was based on seven focus groups with people with COPD (n=14) and HCPs (n=21), and a cross-sectional study of people with COPD using the Health Literacy Questionnaire (n=69). Results The workshop co-design process identified 45 action points and 51 description points for possible intervention solutions to meet the HL needs of people with COPD. The final recommendation for an HL-informed intervention focused on tailored follow-up after hospitalisation, which uses motivational interviewing techniques, is based on the individual’s HL, self-management and quality of life needs and is implemented in cooperation with HCPs in both the specialist and municipality healthcare services. Conclusion During the codesign process, the workshop group generated several ideas for how to help patients find, understand, remember, use and communicate health information in order to promote and maintain good health. People with COPD need tailored follow-up based on their individual HL needs by HCPs that have knowledge of COPD and are able to motivate them for self-management tasks and help them to improve their quality of life (QOL) and decrease hospitalisation. Data availability statement No data are available. Norwegian regional ethical guidelines do not give permission to share data from research if they are not anonymous.

• Larsen, Marie Hamilton; Mengshoel, Anne Marit; Andersen, Marit Helen; Borge, Christine Råheim; Ahlsen, Birgitte & Dahl, Kari Gire [Show all 15 contributors for this article] (2022). “A bit of everything”: Health literacy interventions in chronic conditions – a systematic review. Patient Education and Counseling. ISSN 0738-3991. 105(10), p. 2999–3016. doi: 10.1016/j.pec.2022.05.008. Full text in Research Archive Show summary

  Objective: To systematically evaluate health literacy (HL) interventions in chronic conditions by exploring theoretical perspectives, intervention content and effectiveness. Method: We searched MEDLINE, Cochrane, CINAHL, EMBASE, ERIC, Web of Science and PsycINFO. Standardised systematic review methods were used, and sequences informing our research question were extracted and analysed. The study includes a descriptive summary of the included papers. Results: We included 39 unique interventions, with diabetes and heart disease as the most targeted chronic conditions. Fifty-four percent of papers included a definition of HL, but the studies showed significant heterogeneity of theoretical underpinnings, modes, measures and content. We identified 23 HL measures, mostly assessing functional HL. The HL interventions were often more complex than the measures indicated. A significant change in HL was found in 28 studies. Study quality was generally poor. Conclusions: Interventions optimizing HL appear important to improve health outcomes in chronic conditions. To ensure cumulative knowledge development of this field we need theory-based interventions, consistency in methods and more tailored and comprehensive measures to capture the interventions’ complexity. Practice implications: A more valid understanding of HL interventions and measurements is needed to reach an agreed understanding of their components and intentions.

• Urstad, Kristin Hjorthaug; Andersen, Marit Helen; Larsen, Marie Hamilton; Borge, Christine Råheim; Helseth, Sølvi & Wahl, Astrid Klopstad (2022). Definitions and measurement of health literacy in health and medicine research: A systematic review. BMJ Open. 12(2). doi: 10.1136/bmjopen-2021-056294. Full text in Research Archive Show summary

  Objectives The way health literacy is understood (conceptualised) should be closely linked to how it is measured (operationalised). This study aimed to gain insights into how health literacy is defined and measured in current health literacy research and to examine the relationship between health literacy definitions and instruments. Design Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources The MEDLINE, PsycINFO, ERIC and CINAHL databases were searched for articles published during two randomly selected months (March and October) in 2019. Eligibility criteria We included articles with a quantitative design that measured health literacy, were peer-reviewed and original, were published in the English language and included a study population older than 16 years. Data extraction and synthesis Six researchers screened the articles for eligibility and extracted the data independently. All health literacy definitions and instruments were considered in relation to category 1 (describing basic reading and writing skills, disease-specific knowledge and practical skills) and category 2 (social health literacy competence and the ability to interpret and critically assess health information). The categories were inspired by Nutbeam’s descriptions of the different health literacy levels. Results 120 articles were included in the review: 60 within public health and 60 within clinical health. The majority of the articles (n=77) used instruments from category 1. In total, 79 of the studies provided a health literacy definition; of these, 71 were in category 2 and 8 were in category 1. In almost half of the studies (n=38), health literacy was defined in a broad perspective (category 2) but measured with a more narrow focus (category 1). Conclusion Due to the high degree of inconsistency between health literacy definitions and instruments in current health literacy research, there is a risk of missing important information about health literacy considered be important to the initial understanding of the concept recognised in the studies.

• Wahl, Astrid Klopstad; Osborne, Richard H; Larsen, Marie Hamilton; Andersen, Marit Helen; Holter, Ingrid Asbjørnsen & Borge, Christine Råheim (2021). Exploring health literacy needs in chronic obstructive pulmonary disease (COPD): Associations between demographic, clinical variables, psychological well-being and health literacy. Heart & Lung. ISSN 0147-9563. 50(3), p. 417–424. doi: 10.1016/j.hrtlng.2021.02.007. Full text in Research Archive Show summary

  Background The World Health Organization (WHO) points to health literacy as an important factor in prevention and control of non-communicable diseases (NCDs), including COPD. Objective To investigate associations between selected demographic and clinical variables, psychological well-being and health literacy. Methods Health literacy was measured using the nine domain Health Literacy Questionnaire (HLQ) and one domain from the eHealth Literacy Questionnaire (eHLQ). Using data from a cross-sectional sample of 158 people with COPD, recruited from a hospital-based patient list period (2014-2016), multiple regression analyses were performed. Results The strongest associated variables with health literacy were psychological well-being, measured by the WHO-5 well-being index and education, indicating that higher psychological well-being and educational level are associated with higher levels of health literacy. Conclusion The present study highlights the importance of specifically looking to psychological factors in determining potentially health literacy needs among people with COPD.

• Borge, Christine Råheim; Larsen, Marie Hamilton; Osborne, Richard H; Engebretsen, Eivind; Andersen, Marit Helen & Holter, Ingrid Asbjørnsen [Show all 8 contributors for this article] (2021). Exploring patients’ and health professionals’ perspectives on health literacy needs in the context of chronic obstructive pulmonary disease. Chronic Illness. ISSN 1742-3953. doi: 10.1177/1742395321999441. Full text in Research Archive Show summary

  Objective Persons with chronic obstructive pulmonary disease (COPD) require complex follow-up by healthcare professionals (HCPs) and may experience several health literacy (HL) needs. This study aimed to explore such needs in people with COPD and the HCPs who care for them. Methods From October 2016 to August 2017 a qualitative study with four focus groups (FG) were performed in people with COPD (n = 14) and three in multidisciplinary HCPs (n = 21). An inductive thematic analysis was used to investigate HL needs. Results Four HL needs emerged: 1) strengthening the feeling of security; 2) combating the burden of insufficient knowledge on COPD and lack of informational flow; 3) supporting motivation for endurance and self-management; and 4) strengthening dignity. Discussion This study highlights a gap between people with COPD who express important HL needs and HCPs’ capabilities to care for these needs. For HCPs to increase HL in such cases, HCPs need to improve their own HL. It is essential to find solutions on how to improve HL in HCPs who care for people with COPD and to increase the availability of interventions that increase HL in COPD. Education programs, health organizations, and governments should be aware of HL needs in such situations.

• Skogestad, Ingrid Johansen; Kirkevold, Marit; Larsson, Petra; Borge, Christine Råheim; Indredavik, Bent & Gay, Caryl [Show all 7 contributors for this article] (2021). Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure. Journal of Patient-Reported Outcomes. 5(35). doi: 10.1186/s41687-021-00307-z. Full text in Research Archive Show summary

  Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

• Lundereng, Elias David; Nes, Andrea Aparecida Goncalves; Holmen, Heidi; Winger, Anette; Thygesen, Hilde & Jøranson, Nina [Show all 11 contributors for this article] (2021). Health care professionals' experiences and perspectives on using telehealth for home-based palliative care: Protocol for a scoping review. JMIR Research Protocols. 10(10). doi: 10.2196/33305. Full text in Research Archive
• Larsen, Marie Hamilton; Hermansen, Åsmund; Borge, Christine Råheim; Strumse, Yndis A. Staalesen; Andersen, Marit Helen & Wahl, Astrid Klopstad (2021). Health literacy profiling in persons with psoriasis – A cluster analysis. Skin Health and Disease (SHD). 1(2). doi: 10.1002/ski2.17. Full text in Research Archive Show summary

  Objective:To explore health literacy (HL) profiles within a cohort of people with psoriasis. A cluster approach identifies groups of individuals that have similar HL profiles. The method unmasks sub-groups with particular HL strengths, or subgroups with limitations, which require tailored healthcare services to improve. Methods:A cross-sectional sample of 792 patients from the Norwegian Climate Helio Therapy Programme in Gran Canaria participated. The HL questionnaire assessed nine HL dimensions. Using Ward's Hierarchical Clustering Method (Stata version 16), we looked for subgroups of patients across the dimensions. We also explored whether these clusters had specific demographic features and associations to outcomes such as psoriasis knowledge, quality of life and self-management capacity. Result:The analysis revealed four unique clusters identifying clinically meaningful subgroups. Two groups stood out as especially interesting. One cluster representing 26.6% of the sample presented severe HL limitations associated with lower psoriasis knowledge, quality of life, self-management and self-efficacy. HL domains connected to cooperation with healthcare professionals showed deficient scores. The other cluster included a smaller percentage (7.7%) with high HL compared to the total sample. This cluster was associated with higher self-management, quality of life and better self-efficacy. Conclusion:The cluster analysis revealed substantial differences in HL profiles within the sample. These results support the importance of a holistic understanding of the HL needs and the vulnerabilities within a psoriasis cohort. Implementing one size fits all approaches, may not be sufficient in psoriasis context to target HL.

• Holmen, Heidi; Larsen, Marie Hamilton; Sallinen, Merja Helena; Thoresen, Lisbeth; Ahlsen, Birgitte & Andersen, Marit Helen [Show all 10 contributors for this article] (2020). En balansegang: helsepersonells erfaringer med mennesker med kronisk sykdom - en oversiktsartikkel av kvalitative studier. BestPractice nordic. Full text in Research Archive
• Holmen, Heidi; Larsen, Marie Hamilton; Sallinen, Merja Helena; Thoresen, Lisbeth; Ahlsen, Birgitte & Andersen, Marit Helen [Show all 10 contributors for this article] (2020). Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies. BMC Health Services Research. doi: 10.1186/s12913-019-4826-2. Full text in Research Archive Show summary

  Background: The number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs’ experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). Method: A systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs’ experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes. Results: Our comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs’ experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 subcategories that formed three overarching main themes of work experiences: 1) individualizing one’s professional approach within the clinical encounter; 2) managing one’s emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs’ work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one’s own emotions. Conclusion: Few qualitative studies highlighted HCPs’ general working experiences, as they mainly focused on the patients’ experiences or HCPs’ experiences of using particular clinical procedures. This study brings new insights about the complexity embedded in HCPs’ work in terms of weighing different, often contrasting aspects, in order to deliver appropriate practice. Acknowledging, discussing and supporting this complexity can empower HCPs to avoid burning out. Leaders, health organizations, and educational institutions have a particular responsibility to provide HCPs with thorough professional knowledge and systematic support. Trial registration: PROSPERO number: CRD42019119052.

• Larsen, Marie Hamilton; Staalesen, Yndis; Borge, Christine Råheim; Andersen, Marit Helen & Wahl, Astrid Klopstad (2020). Relevant associations between alexithymia and health-literacy in persons with psoriasis. Journal of dermatological treatment (Print). ISSN 0954-6634. doi: 10.1080/09546634.2020.1756204. Full text in Research Archive Show summary

  Strumse heter Staalesen Strumse og P er på Staalesen

• Larsen, Marie Hamilton; Strumse, Yndis A. Staalesen; Andersen, Marit Helen; Borge, Christine Råheim & Wahl, Astrid Klopstad (2019). Associations between disease education, self-management support, and health literacy in psoriasis. Journal of dermatological treatment (Print). ISSN 0954-6634. 2:6, p. 603–609. doi: 10.1080/09546634.2019.1688233. Full text in Research Archive
• Haraldstad, Kristin; Wahl, Astrid Klopstad; Andenæs, Randi; Andersen, John Roger; Andersen, Marit Helen & Beisland, Elisabeth Grov [Show all 24 contributors for this article] (2019). A systematic review of quality of life research in medicine and health sciences. Quality of Life Research. ISSN 0962-9343. 28(10), p. 2641–2650. doi: 10.1007/s11136-019-02214-9. Full text in Research Archive Show summary

  Purpose Quality of life (QOL) is an important concept in the field of health and medicine. QOL is a complex concept that is interpreted and defined differently within and between disciplines, including the fields of health and medicine. The aims of this study were to systematically review the literature on QOL in medicine and health research and to describe the country of origin, target groups, instruments, design, and conceptual issues. Methods A systematic review was conducted to identify research studies on QOL and health-related quality of life (HRQOL). The databases Scopus, which includes Embase and MEDLINE, CINAHL, and PsycINFO were searched for articles published during one random week in November 2016. The ten predefined criteria of Gill and Feinstein were used to evaluate the conceptual and methodological rigor. Results QOL research is international and involves a variety of target groups, research designs, and QOL measures. According to the criteria of Gill and Feinstein, the results show that only 13% provided a definition of QOL, 6% distinguished QOL from HRQOL. The most frequently fulfilled criteria were: (i) stating the domains of QOL to be measured; (ii) giving a reason for choosing the instruments used; and (iii) aggregating the results from multiple items. Conclusion QOL is an important endpoint in medical and health research, and QOL research involves a variety of patient groups and different research designs. Based on the current evaluation of the methodological and conceptual clarity of QOL research, we conclude that the majority QOL studies in health and medicine have conceptual and methodological challenges

• Larsen, Marie Hamilton; Staalesen, Yndis; Borge, Christine Råheim; Osborne, Richard H; Andersen, Marit Helen & Wahl, Astrid Klopstad (2019). Health literacy - a new piece of the puzzle in psoriasis care? - results from a cross-sectional study. British Journal of Dermatology. ISSN 0007-0963. 06(18), p. 1506–1516. doi: 10.1111/bjd.17595. Full text in Research Archive Show summary

  Background: Health literacy (HL) – the ability to seek, understand and utilize health information – is important for good health. Suboptimal HL has been associated with poorer health outcomes in other chronic conditions, although this has not previously been studied in patients with psoriasis. Objectives: To investigate the HL strengths and weaknesses of a cohort of patients with moderate‐to‐severe psoriasis. Another aim was to examine possible associations between patients’ quality of life, their demographic, clinical and self‐management characteristics, and dimensions of HL. Methods: A cross‐sectional study was conducted. Data were collected from a cohort of patients with psoriasis who had received climate helio therapy from 2011 to 2016 (n = 825). HL was assessed by the Health Literacy Questionnaire (HLQ). The association between HL domains, demographic, clinical and self‐management variables were analysed using bivariate correlation and a four‐step linear multiple regression model. Results: The scores on all HLQ dimensions indicated lower health literacy than other populations. The linear regression models showed a significant association between HL, quality of life and self‐management variables, with higher HL predicting higher quality of life, self‐efficacy and psoriasis knowledge. Sex, educational attainment, age and disease severity had less influence on health literacy. Conclusions: Improving HL may be a useful strategy for reducing disparities in self‐management skills for patients with psoriasis. Interventions that aim to reduce disease severity and increase psoriasis knowledge, self‐efficacy and quality of life may positively increase HL.

• Larsson, Petra; Borge, Christine Råheim; Nygren-Bonnier, Malin; Lerdal, Anners & Edvardsen, Anne (2018). An evaluation of the short physical performance battery following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. BMC Research Notes. 11(348). doi: 10.1186/s13104-018-3458-7. Full text in Research Archive Show summary

  Objective There is a need for simple tools to evaluate physical performance in patients with COPD before and after pulmonary rehabilitation. The aims of this study were to evaluate changes in short physical performance battery (SPPB)-scores in patients with COPD after a 4-week pulmonary rehabilitation program; explore possible relationships between SPPB-scores and exercise capacity (6-min walk distance), dyspnea (modified Medical Research Council’s dyspnea scale), disease-specific quality of life (COPD assessment test), and pulmonary function (predicted forced expiratory volume in one second) at baseline; and explore if changes in SPPB-scores are related to changes in exercise capacity, dyspnea, and disease-specific quality of life following pulmonary rehabilitation. Results Forty-five patients with COPD were included in the final analysis. SPPB-scores improved following pulmonary rehabilitation (mean change: 1.2 ± 1.7 points, p < 0.001). There were moderate correlations between SPPB-scores and exercise capacity (r = 0.50, p < 0.001) and dyspnea (r = − 0.45, p = 0.003) at baseline, but not with pulmonary function or disease-specific quality of life. Changes in SPPB-scores were not associated with changes in exercise capacity or dyspnea scores. The SPPB may be a useful tool for evaluating physical performance in COPD Trial registration ClinicalTrials.gov NCT02314338, December 11, 2014.

• Steindal, Simen Alexander; Torheim, Henny; Oksholm, Trine; Christensen, Vivi Lycke; Lee, Kathryn A & Lerdal, Anners [Show all 10 contributors for this article] (2018). The effectiveness of nursing interventions for breathlessness in people with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Journal of Advanced Nursing. ISSN 0309-2402. doi: 10.1111/jan.13902. Full text in Research Archive Show summary

  Aim To critically review and synthesize the findings of studies that evaluated the effectiveness of nursing interventions for improving breathlessness in adults with chronic obstructive pulmonary disease. Background Systematic reviews of nursing interventions for breathlessness in people with chronic obstructive pulmonary disease have not been specifically addressed. Design Systematic review with meta‐analysis. Data sources A systematic search of Medline, CINAHL, PsycINFO and Embase was performed for studies published between January 2000 and June 2017. Review methods Risk of bias, data extraction and meta‐analysis were conducted using Cochrane methodology. The quality of evidence was assessed using the GRADE approach. Results Twenty papers were included. A meta‐analysis of interventions performed at home, including two trials, showed a significant effect in favour of experimental groups for the symptom score of the St. George Respiratory Questionnaire compared with controls. A meta‐analysis of interventions performed in clinics with home follow‐up showed a significant effect in favour of experimental groups for the mastery and fatigue scores of the Chronic Respiratory Questionnaire compared with controls. In this category of intervention, an additional meta‐analysis showed a significant effect in favour of experimental groups for the symptom, activity and total scores of the St. George Respiratory Questionnaire compared with controls. The quality of evidence was assessed to be very low to moderate. Conclusion The results are equivocal as to whether nursing interventions performed at home and nursing interventions performed in hospital with follow‐up improve breathlessness in people with chronic obstructive pulmonary disease.

• Leine, Marit; Wahl, Astrid Klopstad; Borge, Christine Råheim; Hustavenes, Magne Mikal & Bondevik, Hilde (2017). Feeling safe and motivated to achieve better health: Experiences with a partnership-based nursing practice programme for in-home patients with chronic obstructive pulmonary disease. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 26(17-18), p. 2755–2764. doi: 10.1111/jocn.13794. Full text in Research Archive
• Borge, Christine Råheim; Mengshoel, Anne Marit; Moum, Torbjørn Åge & Wahl, Astrid Klopstad (2016). Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease. Quality of Life Research. ISSN 0962-9343. 25, p. 2041–2051. doi: 10.1007/s11136-016-1227-4. Full text in Research Archive
• Borge, Christine Råheim; Mengshoel, Anne Marit; Omenaas, Ernst; Moum, Torbjørn Åge; Ekman, Inger & Lein, Martha Pauline [Show all 8 contributors for this article] (2015). Effect of guided deep breathing on breathlessness and the breathing pattern in chronic obstructive pulmonary disease: A double-blind randomized control trial. Patient Education and Counseling. ISSN 0738-3991. 98(2), p. 182–190. doi: 10.1016/j.pec.2014.10.017. Full text in Research Archive
• Saltnes, Solfrid Sørgjerd; Storhaug, Kari; Borge, Christine Råheim; Enmarker, Ingela & Willumsen, Tiril (2015). Oral health-related quality-of-life and mental health in individuals with chronic obstructive pulmonary disease (COPD). Acta Odontologica Scandinavica. ISSN 0001-6357. 73(1), p. 14–20. doi: 10.3109/00016357.2014.935952. Full text in Research Archive
• Borge, Christine Råheim; Hagen, Kåre Birger; Mengshoel, Anne Marit; Omenaas, Ernst; Moum, Torbjørn Åge & Wahl, Astrid Klopstad (2014). Effects of controlled breathing exercises and respiratory muscle training in people with chronic obstructive pulmonary disease: results from evaluating the quality of evidence in systematic reviews. BMC Pulmonary Medicine. 14:184. doi: 10.1186/1471-2466-14-184. Full text in Research Archive Show summary

  Background This paper reviews evidence and quality of Systematic Reviews (SRs) on the effects of breathing control exercises (BCEs) and respiratory muscle training (RMT) on breathlessness/dyspnea and other symptoms, and quality of life (QOL) for individuals with chronic obstructive pulmonary disease (COPD). Methods A search for BCE and RMT literature in COPD published between January 1, 2002 and December 31, 2013 was performed in the following databases: PubMed, Ovid, CINAHL, PsycINFO, AMED, Cochrane and PEDro. The AMSTAR criteria were used to evaluate quality. Results After reviewing 642 reports, seven SRs were identified on RMT and BCEs. Three SRs were of high quality, three were of moderate quality, and one was of low quality. Two high-quality SRs reported significantly beneficial effects of RMT on dyspnea, and one reported significant effects on disease-specific QOL and fatigue. In these SRs, pooled data analyses were performed with three to fourteen single randomised control trials (RCTs) included in the analysis. In one of the SRs the quality of the single RCTs were rated by the authors to be between 5–7 (with10 best) and in the other one the quality of the single RCTs were rated to be between 30-83% of the maximum score. One high-quality SR found a significant positive effect of BCE based on pooled data analysis with two single RCTs in regard to pursed-lip breathing (PLB) on breathlessness. In this SR, one single RCT on diaphragmatic breathing (DB) and another one on yoga breathing (YB) showed effect on disease-specific QOL. The single RCTs included in the SR were rated by the authors in the SRs to be of low and moderate quality. Conclusions Based on three high-quality SRs performing pooled data analyses, there is evidence that RMT has effect on breathlessness, fatigue and disease-specific QOL and PLB on breathlessness. There is also evidence that single studies on DB and YB has effect on disease-specific QOL. Few RCTs are available and the variable quality of the single RCTs in the SRs, seem to require more RCTs in particular for BCEs, but also RMT before conclusions regarding effects and high quality SRs can be written.

• Borge, Christine Råheim; Moum, Torbjørn Åge; Lein, Martha Pauline; Austegard, Elise Lynn & Wahl, Astrid Klopstad (2014). Illness perception in people with chronic obstructive pulmonary disease. Scandinavian Journal of Psychology. ISSN 0036-5564. 55(5), p. 456–463. doi: 10.1111/sjop.12150. Full text in Research Archive Show summary

  Illness perception (IP) concerns how patients evaluate living with a disease. To get a broader understanding of IP in patients with chronic obstructive pulmonary disease (COPD), we investigated whether breathlessness is an important precursor of IP and whether IP in its turn is related to mental health, physical health and global quality of life (QOL). One hundred and fifty-four patients with COPD participated in a cross-sectional survey. Participants underwent pulmonary function testing, provided socio-demographic and clinical information, and completed the following standardized instruments: Brief Illness Perception Questionnaire, Respiratory Quality of Life Questionnaire, Short-Form 12 Health Survey and the Quality of Life Scale. Multiple regression analyses were performed. A high IP score indicates that a patient believes that his/her illness represents a threat. Participants with a high score on the IP dimensions consequences, identity, concern and emotional representation, experienced more breathlessness. High scores on the IP dimensions consequences, identity and concern were associated with impaired physical health and high scores on the IP dimensions consequences, identity and emotional representation were associated with impaired mental health. Impaired global QOL was associated with high scores on the IP dimensions consequences, identity, concern, coherence and emotional representation. The strength of the associations between breathlessness and physical/mental health and global QOL decreased when certain dimensions of IP were included as predictors, indicating that IP to some extent acts as a mediating factor. These findings may have practical implications of patient counseling by helping COPD patients to cope with their disease by restructuring their personal models of illness.

• Borge, Christine Råheim; Wahl, Astrid Klopstad & Moum, Torbjørn (2011). Pain and quality of life with chronic obstructive pulmonary disease. Heart & Lung. ISSN 0147-9563. 40(3), p. 90–101. doi: 10.1016/j.hrtlng.2010.10.009. Full text in Research Archive
• Hope, Håvar Blich; Medhus, Asle Wilhelm; Sandstad, Olav; Borge, Christine Råheim & Skar, Viggo Øystein (2011). Reduced C-13-D-xylose absorption in alcoholics is more likely caused by alterations in small intestinal mucosa than delayed gastric emptying. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 46(4), p. 414–419. doi: 10.3109/00365521.2010.536252. Full text in Research Archive
• Borge, Christine Råheim; Wahl, Astrid Klopstad & Moum, Torbjørn (2010). Association of breathlessness with multiple symptoms in chronic obstructive pulmonary disease. Journal of Advanced Nursing. ISSN 0309-2402. 66(12), p. 2688–2700. doi: 10.1111/j.1365-2648.2010.05447.x. Full text in Research Archive

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• Oksholm, Trine & Borge, Christine Råheim (2021). Lungesykepleie. Fagbokforlaget. ISBN 9788245033939. 259 p. Full text in Research Archive

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• Seljelid, Berit; Skurdal, Anette; Kongsmo, Anna; Eie, Anette; Borge, Christine Råheim & Morvik, Helene [Show all 16 contributors for this article] (2025). Co-creation of digital courses for patients and family caregivers. Full text in Research Archive
• Kleiven, Anne Louise; Steindal, Simen Alexander; Mariussen, Kari L.; Bove, Dorthe Gaby; Hägi-Pedersen, Mai-Britt & Gregersen, Nanna Vedelbo [Show all 15 contributors for this article] (2025). Nursing interventions for patients with respiratory diseases and syndromes in the Nordic countries: A scoping review. European Respiratory Journal. ISSN 0903-1936. 66(Suppl. 69), p. 2028–2028. doi: 10.1183/13993003.congress-2025.pa2828. Full text in Research Archive Show summary

  Introduction: Chronic respiratory diseases (CRD) are the third leading cause of death globally. In the Nordic countries, COPD alone claims the lives of 9000 each year. CRD affects the lives of patients and their families, but also imposes a significant burden on the healthcare systems. Nurses with knowledge and skills in respiratory care can make a positive impact on both patients and healthcare systems. However, nursing research has often been observational studies to describe practice. Consequently, a collaboration of nurses from Norway and Denmark performed a scoping review aimed to summarizing and characterizing published studies on nursing interventions in respiratory care. Objectives: To map and report the evidence on nursing interventions for patients with respiratory diseases in the Nordic countries and to identify research gaps and future research priorities. Method: The scoping review employed the framework by Arksey and O`Malley. Five databases were searched from inception to December 2024. We included, irrespective of design, studies on nursing interventions on adult patients with respiratory diseases, sleep apnea, chronic respiratory failure, and COPD or asthma exacerbation performed in places other than the emergency room and in intensive care units. Pairs of authors will extract data and evaluate the methodological quality. The data will be descriptively summarized. Results: An amount of 74 studies were eligible for data extraction and critical appraisal. Conclusion: We will present preliminary results. The results can inform future research by identifying research gaps and priorities on nursing interventions in respiratory care. Footnotes Cite this article as Eur Respir J 2025; 66: Suppl. 69, PA2828. This article was presented at the 2025 ERS Congress, in session “Contemporary nursing”. This is an ERS Congress abstract. No full-text version is available. Related materials (such as slides or recordings) will be accessible via the ERS Respiratory Channel at https://channel.ersnet.org/programme-live-418

• Linnestad, Anne-Margrethe; Skogestad, Ingrid Johansen; Gay, Caryl; Borge, Christine Råheim; Indredavik, Bent & Stubberud, Jan Egil [Show all 7 contributors for this article] (2025). E-poster #786_17th World Stroke Congress, 22-24 October 2025, Barcelona, Spain. doi: 10.1177/17474930251371440. Full text in Research Archive
• Linnestad, Anne-Margrethe; Skogestad, Ingrid Johansen; Gay, Caryl; Borge, Christine Råheim; Indredavik, Bent & Stubberud, Jan Egil [Show all 7 contributors for this article] (2025). UNDERSTANDING DIGITAL HEALTH LITERACY AMONG STROKE SURVIVORS: A CLUSTER ANALYSIS APPROACH (NORFAST). Full text in Research Archive
• Seljelid, Berit; Skurdal, Anette; Kongsmo, Anna Seljelid; Eie, Anette; Borge, Christine Råheim & Morvik, Helene [Show all 16 contributors for this article] (2025). Samskaping av digitale kurstilbud for pasienter og pårørende. Full text in Research Archive Show summary

  Lærings- og mestringskurs tilbys over hele landet, og er i stor grad knyttet opp til spesialisthelsetjenesten. Kursene har til hensikt å fremme mestring, helse og livskvalitet for pasienter og pårørende, og har positive effekter for individ, helsetjenesten og samfunn. Det er imidlertid både tilfeldigheter og stor variasjon i hvilke pasienter og pårørende som tilbys kurs, og endringer i samfunn og helsetjenester gjør det nødvendig å utforske om kursene kan tilbys på nye måter. Problemstilling: Hvordan utvikle kurskonsept og innhold for å øke tilgjengelighet og kvalitet for pasienter og pårørende? Metode: Kurskonsept og innhold i kurs er utviklet i en samskapende prosess med mange iterasjoner; 1) intervju med fem lærings- og mestringssenter; 2) workshop med brukere og helsepersonell (n=14); 3) litteratursøk; 4) utviklingsgruppe (n=5) som har sammenfattet funn fra litteratur, intervju og workshop med innspill fra brukere (n=2). Resultat: Det er utviklet to generiske kurskonsept med tema «fatigue og stress»; et digitalt individuelt kurs for pasienter, og et hybrid satellittkurs hvor kurset ledes digitalt av en møteleder, mens pasienter og pårørende møter fysisk ved sitt sykehus. Kursene gjennomføres i to deler, hvor det benyttes korte videoer for å introdusere tema. Kursets første del (3 timer) inneholder erfaringsdeling, årsaksmekanismer, sammenheng mellom fatigue og stress, samt mestringsstrategier. Pasienter og pårørende tilbys app for stressmestring og podcast om fatigue/relasjoner i tiden mellom og etter kurs. Kursets andre del (2 timer): inneholder mestring av utfordringer fra fatigue, erfaringsdeling og veien videre. Kursene kan passe mange grupper med kronisk sykdom.

• Borge, Christine Råheim; Andersen, Marit Helen & Stenberg, Una (2024). Kapittel 2. Hvordan arbeide med helsekompetanse i møte med pasienter og pårørende. In Helseth, Sølvi; Pettersen, Kjell Sverre & Wahl, Astrid Klopstad (Ed.), Helsekompetanse Teori, forskning og praksis. Fagbokforlaget. ISSN 9788245043426. Full text in Research Archive
• Larsen, Marie Hamilton; Wahl, Astrid Klopstad & Borge, Christine Råheim (2024). Kapittel 17. Bruk av Ophelia rammeverket til intervensjonsutvikling innen helsekompetanse (i Helsekompetanse Teori, forskning og praksis. In Helseth, Sølvi; Pettersen, Kjell Sverre & Wahl, Astrid Klopstad (Ed.), Helsekompetanse Teori, forskning og praksis. Fagbokforlaget. ISSN 9788245043426. Full text in Research Archive
• Larsen, Marie Hamilton & Borge, Christine Råheim (2024). Kapittel 9 Kronisk sykdom (i Helsekompetanse Teori, forskning og praksis). In Helseth, Sølvi; Pettersen, Kjell Sverre & Wahl, Astrid Klopstad (Ed.), Helsekompetanse Teori, forskning og praksis. Fagbokforlaget. ISSN 9788245043426. Full text in Research Archive
• Borge, Christine Råheim; Larsen, Marie Hamilton; Osborne, Richard H.; Aas, Eline; Andersen, Marit Helen & Moum, Torbjørn [Show all 7 contributors for this article] (2024). Health literacy-informed intervention reduces hospitalization and health economic costs, while improving health literacy, self-management, and quality of life in Chronic Obstructive Pulmonary Disease (COPD). Full text in Research Archive
• Borge, Christine Råheim; Larsen, Marie Hamilton; Osborne, Richard H; Aas, Eline; Andersen, Marit Helen & Moum, Torbjørn [Show all 7 contributors for this article] (2024). Health literacy-informed intervention reduces hospitalization and health economic costs, while improving health literacy, self-management, and quality of life in COPD. Full text in Research Archive
• Finbråten, Hanne Søberg; Romedal, Signegun; Borge, Christine Råheim & Eie, Anette (2024). Helseinformasjon må tilpasses den enkeltes helsekompetanse. Sykepleien. ISSN 0039-7628. doi: 10.4220/Sykepleiens.2024.95687. Full text in Research Archive
• Khalid, Saliha; Kristoffersen, Agnete Egilsdatter; Stub, Trine; Borge, Christine Råheim; Qureshi, Samera Azeem & Alpers, Lise-Merete (2024). Health and Illness Beliefs and Practices among Pakistani Immigrants in Norway: An Application of The Health Traditions Model. Full text in Research Archive
• Khalid, Saliha; Kristoffersen, Agnete Egilsdatter; Alpers, Lise-Merete; Qureshi, Samera Azeem; Borge, Christine Råheim & Stub, Trine (2023). Tradisjonell medisin brukt blant pakistanske innvandrere i Norge. Full text in Research Archive
• Finbråten, Hanne Søberg; Borge, Christine Råheim; Romedal, Signegun & Eie, Anette (2023). Refleksjoner over betydningen av helsekompetanse i pasient- og pårørendeopplæring. Full text in Research Archive
• Finbråten, Hanne Søberg; Romedal, Signegun; Borge, Christine Råheim & Eie, Anette (2023). Helsepersonell og ledere sine refleksjoner rundt helsekompetanse i pasient- og pårørendeopplæring. Full text in Research Archive
• Seljelid, Berit & Borge, Christine Råheim (2023). Pasient- og pårørendeopplæring - refleksjon over teori og praksis. Full text in Research Archive
• Borge, Christine Råheim & Seljelid, Berit (2023). Helsekompetanse. Full text in Research Archive
• Frisk, Bente; Refvem, Olav Kåre; Sundfør, Ingrid Elise & Borge, Christine Råheim (2022). LUNGEREHABILITERINGSTILBUD I NORSKE KOMMUNER FOR PERSONER MED KRONISK OBSTRUKTIV LUNGESYKDOM - KARTLEGGINGSSTUDIE. Full text in Research Archive
• Torheim, Henny & Borge, Christine Råheim (2021). Kartlegging av symptomer og kliniske tegn. In Oksholm, Trine & Borge, Christine Råheim (Ed.), Lungesykepleie. Fagbokforlaget. ISSN 9788245033939. p. 52–76. Full text in Research Archive
• Holmen, Heidi; Mengshoel, Anne Marit; Thoresen, Lisbeth; Larsen, Marie Hamilton; Eik, Hedda & Borge, Christine Råheim (2021). En ubetydelig brikke. Full text in Research Archive
• Larsen, Marie Hamilton; Strumse, Yndis S.S.; Borge, Christine Råheim; Andersen, Marit Helen & Wahl, Astrid Klopstad (2020). Viktige sammenhenger mellom aleksitymi og helsekompetanse hos pasienter med psoriasis som har deltatt i klimabehandling. BestPractice nordic. Full text in Research Archive
• Bakker, M; Putrik, P; Aaby, A; Debussche, X; Morrissey, J & Borge, Christine Råheim [Show all 10 contributors for this article] (2019). Acting together –WHO National Health literacy demonstration projects (NHLDPs) adress health literacy needs in the Eruopen Region. Public Health Panorama. 5, p. 2–3. Full text in Research Archive
• Mandal, H.T.; Aaby, A; Bonnen, A; Debussche, X; Borge, Christine Råheim & Kolarcik, P [Show all 10 contributors for this article] (2019). Symposium: “WHO National Health Literacy Demonstration Projects (NHLDPs): European Action Network for intervention development and implementation. Full text in Research Archive
• Borge, Christine Råheim (2019). Helsekompetanse. Nøkkelen til helse for personer med kronisk obstruktiv lungesykdom (kols). Et samarbeidsprosjekt mellom Lovisenberg Diakonale Sykehus, Helsekonferansen 9 mai 2019. Presentasjon. Full text in Research Archive
• Larsen, Marie Hamilton; Borge, Christine Råheim; Staalesen, Yndis & Wahl, Astrid Klopstad (2018). Health literacy - a new pierce of The puzzle in psoriasis? Full text in Research Archive
• Steindal, Simen Alexander; Oksholm, Trine; Torheim, Henny; Christensen, Vivi Lycke; Lee, Kathryn & Lerdal, Anners [Show all 10 contributors for this article] (2017). A systematic review of nursing interventions for breathlessness in COPD. European Clinical Respiratory Journal. 50, p. PA2582–PA2582. doi: 10.1183/1393003.congress-2017.PA2582. Full text in Research Archive
• Steindal, Simen Alexander; Oksholm, Trine; Torheim, Henny; Christensen, Vivi Lycke; Lee, Kathryn A & Lerdal, Anners [Show all 10 contributors for this article] (2017). A systematic review of nursing interventions for breathlessness in COPD. Full text in Research Archive
• Borge, Christine Råheim (2016). Pustekontroll hos personer med kronisk obstruktiv lungesykdom. Full text in Research Archive
• Borge, Christine Råheim; Mengshoel, Anne Marit; Omenaas, Ernst; Moum, Torbjørn Åge; Ekman, Inger & Lein, Martha Pauline [Show all 8 contributors for this article] (2016). Effektn på tung pust ved hjelp av pusteveiledning av pasienter med moderat og alvorlig kols -en dobbelblindet, randomisert kontrollstudie. BestPractice. Lungemedisin. Full text in Research Archive
• Borge, Christine Råheim; Moum, Torbjørn Åge; Austegard, Elise Lynn; Lein, Martha Pauline & Wahl, Astrid Klopstad (2013). Illness perception among people with Chronic Obstructive Pulmonary Disease. Full text in Research Archive
• Borge, Christine Råheim; Wahl, Astrid Klopstad & Moum, Torbjørn Åge (2013). Multiple symptoms and quality of life in people with Chronic Obstructive Pulmonary Disease. Full text in Research Archive
• Borge, Christine Råheim; Moum, Torbjørn Åge & Wahl, Astrid Klopstad (2012). Smerter hos personer med KOLS. BestPractice nordic. Full text in Research Archive
• Borge, Christine Råheim; Austegard, Elise Lynn & Wahl, Astrid Klopstad (2010). Compliance to inhalation medication in relation to illness perception, quality of life and predicted pulmonary function in COPD patients. Full text in Research Archive
• Borge, Christine Råheim; Wahl, Astrid Klopstad & Miaskowski, Christine (2009). Subjective symptoms and functional performances in chronic obstructive pulmonary diseases (COPD). Full text in Research Archive
• Borge, Christine Råheim; Wahl, Astrid Klopstad & Miaskowski, Christine (2008). Pain in people with Chronic Obstructive Pulmonary Disease (COPD). Full text in Research Archive
• Stavdal, Malene Nerbøvik; Borge, Christine Råheim; Larsen, Marie Hamilton; Sjetne, Ingeborg Strømseng & Wahl, Astrid Klopstad (2026). Healthcare personnel’s health literacy sensitivity in relation to work-related factors and mental well-being - a multiple methods approach. Universitetet i Oslo. ISSN 9788234808616. Full text in Research Archive Show summary

  In this thesis, healthcare personnel’s well-being and mental health were researched in combination with health literacy sensitivity in clinical practice. Health literacy sensitivity is the knowledge, skills, and attitudes required to effectively meet patients’ health literacy needs (health literacy: how individuals access, understand, and use information in ways that promote and maintain good health). Health literacy-sensitive care plays a critical role in patients’ long-term health outcomes, care quality, and patient safety. The overall aim of this thesis was to explore experiences and potential associations among healthcare personnel’s health literacy sensitivity, work-related factors, and mental well-being in a general hospital setting, and to use this knowledge to develop and evaluate a health literacy intervention. A multi-method sequential design was applied. Paper 1 used focus group interviews with interdisciplinary healthcare personnel, analyzed using thematic analysis. Paper 2 was a cross-sectional study (n=288) examining associations, analysed using hierarchical multiple regression. Paper 3 was a pre–post feasibility study, using quantitative measures and qualitative interviews to evaluate a six-month health literacy intervention for registered nurses. Findings show that higher health literacy sensitivity is associated with better teamwork, higher work engagement, and fewer mental health challenges, and the intervention resulted in statistically significant improvements in 7 of 9 domains of health literacy sensitivity and improved nurse–physician collaboration. Qualitative findings highlighted increased awareness, strengthened routines, and enhanced interdisciplinary collaboration, but also identified health literacy responsibilities as potentially demanding. In conclusion, health literacy sensitivity is closely linked to both organizational conditions and healthcare personnel’s mental well-being. While it can be experienced as demanding, it can be strengthened through structured interventions, improved teamwork, and integration into everyday clinical practice.

• Frisk, Bente; Refvem, Olav Kåre; Sundfør, Ingrid Elise & Borge, Christine Råheim (2021). Lungerehabiliteringstilbud i norske kommuner for personer med kronisk obstruktiv lungesykdom - Kartleggingsstudie. Høgskulen på Vestlandet. ISSN 9788293677604. Full text in Research Archive Show summary

  Bakgrunn: Lungerehabilitering er en tverrfaglig, individuelt tilpasset behandling hvor hensikten er å bedre den fysiske og psykiske tilstanden til personer med kronisk obstruktiv lungesykdom (kols). Dette inkluderer, men er ikke begrenset til, fysisk trening, undervisning, pasientopplæring og råd om livsstil. Målet er å bedre etterlevelse av helsefremmende adferd. Nasjonale og internasjonale retningslinjer anbefaler lungerehabilitering som det viktigste behandlingstilbudet for pasienter med kols. Ved innføring av Samhandlingsreformen i 2012, ble det besluttet at rehabilitering skulle være en del av det kommunale helsetjenestetilbudet. Det er i dag uklart i hvilken grad norske kommuner har etablert tilbud om lungerehabilitering, hvor tilgjengelig dette er og hva tilbudet omfatter. Hensikt: Å undersøke tilbud og tilgjengelighet av lungerehabilitering i kommuner og frisklivssentraler i Norge. Metode: Nasjonalt kolsråd gjennomførte en kartleggingsstudie i perioden februar-april 2019. Et spørreskjema med spørsmål om innhold, organisering og tilgjengelighet til tverrfaglig lungerehabilitering ble sendt elektronisk til alle kommuner og frisklivssentraler. Resultat: Svarresponsen var 36 % og dekket for 45 % av den totale befolkningen i Norge. Behandlingsintervensjoner som inngår i et lungerehabiliteringsprogram for personer med kols ble rapportert som et tilbud i 21% av kommunene, mens 5% rapporterte at de har tverrfaglig lungerehabilitering over flere uker. Flere kommuner hadde tilbud om elementer som inngår i et lungerehabiliteringsprogram som mestringskurs (6 %) og bassengtrening (22 %) for pasienter med kols, mens treningsgrupper uavhengig av diagnose var rapportert hos 27 %, hverdagsrehabilitering hos 25 % og hjemmebehandling av fysioterapeut eller ergoterapeut hos 24 %. Konklusjon og implikasjon: Lungerehabilitering er den viktigste og mest kostnadseffektive behandling ved kols. Resultatene fra denne kartleggingsstudien viser at behandlingen kun er tilgjengelig i et fåtall av norske kommuner. Det er stort behov for å utarbeide nasjonale strategier som sikrer at pasienter med kols får tilgang til den beste og mest effektive behandlingen, lungerehabilitering, som bedrer og styrker fysisk og psykisk helse. Dette kan gi store samfunnsøkonomiske gevinster med redusert bruk av helsetjenester og færre sykehusinnleggelser.

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