Frida Severinsen

• Severinsen, Frida; Varsi, Cecilie; Andersen, Lene Frost; Henriksen, Christine & Paulsen, Mari Mohn (2026). Implementation of Digital Seamless Nutrition Care throughout the Treatment Course for Patients with Head and Neck Cancer: A Process Evaluation. Current Developments in Nutrition (CDN). 10(4), p. 1–13. doi: 10.1016/j.cdnut.2026.107677. Full text in Research Archive Show summary

  Background Nutritional interventions may reduce the prevalence of malnutrition in patients with head and neck cancer; however, implementation often fails due to barriers at various levels. Process evaluations can provide an understanding of implementation outcomes, mechanisms of impact, and context and provide information about feasibility and acceptability. Objectives To perform a process evaluation of the Nutrition Throughout the Treatment Course (NUTREAT) intervention, including use of the MyFood app and web report. Specifically, we aimed to evaluate 1) the acceptability, adoption, appropriateness, feasibility, and fidelity of the intervention, 2) the implementation plan, and 3) patient adherence to the intervention. Methods A mixed methods approach was applied, including individual interviews, a focus group discussion, log data from electronic patient records (EPRs), an experience questionnaire, and information from the MyFood web report. Proctor’s implementation outcomes guided the development of the interview guide and analysis. Themes were deductively established using codebook thematic analysis. The implementation plan was evaluated through logs of completed activities. Log data from EPRs were collected to evaluate fidelity among healthcare professionals (HCPs), and information from the MyFood web report informed patient adherence to the intervention. Results Individual interviews were conducted with patients (n = 8), registered nurses (n = 3), and leaders (n = 2), and a focus group discussion was conducted with registered dietitians (n = 6). Patients, registered nurses, registered dietitians, and leaders found the intervention acceptable, appropriate, and feasible. Patient adherence was high, whereas fidelity among HCPs was low. Conclusions The NUTREAT intervention increased patients’ awareness of their own nutritional requirements and was considered helpful by HCPs in preparing for patient consultations. However, fidelity among HCPs was low. Future efforts should focus on identifying strategies to improve fidelity among HCPs and study the long-term sustainability of the intervention.

• Severinsen, Frida; Varsi, Cecilie; Andersen, Lene Frost; Henriksen, Christine & Paulsen, Mari Mohn (2025). Experiences with nutritional follow-up and barriers and opportunities of implementing digital seamless nutrition care in the head and neck cancer treatment course: a qualitative study from patient, family caregiver, and healthcare professional perspectives. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-13542-7. Full text in Research Archive Show summary

  Introduction Patients with head and neck cancer (HNC) are often malnourished. Despite evidence of beneficial effects of digital health interventions, challenges with implementation into clinical practice have been reported. Objective To investigate the implementation of a seamless nutrition care intervention into the HNC treatment course, this study aimed to (1) explore the experiences with current nutritional follow-up; and (2) identify potential barriers and opportunities associated with future implementation of the Nutrition Throughout the Treatment Course (NUTREAT) intervention. Methods This qualitative study involved semi-structured interviews with patients with HNC, family caregivers, and healthcare professionals (HCPs). The Consolidated Framework for Implementation Research (CFIR) guided the development of the interview guide and analysis. Inductive-deductive analyses were conducted. Results Interviews were conducted with patients (n = 7), family caregivers (n = 4), registered nurses (n = 5), and physicians (n = 2). Themes created to cover experiences with the current nutritional follow-up were: (1) Nutritional challenges; (2) Family caregiver support; and (3) Experience with current nutritional follow-up. Barriers and opportunities for implementing the NUTREAT intervention were analyzed within 20 constructs of CFIR. Patients were satisfied with nutritional follow-up, and spouses served as key emotional support, yet a need for closer monitoring post-treatment was identified. Exhaustion, advanced age, and dementia were potential barriers for implementing NUTREAT. Increased awareness of nutritional requirements for patients, and increased accessibility of dietary recordings for HCPs compared to current practices were opportunities. Conclusion Overall, patients and spouses were satisfied with the nutritional follow-up, though challenges were identified. The identified barriers and opportunities will inform the development of an implementation plan for an effectiveness- and implementation study.

• Varsi, Cecilie; Andersen, Lene Frost; Koksvik, Gunhild Tellebon; Severinsen, Frida & Paulsen, Mari Mohn (2023). Intervention-related, contextual and personal factors affecting the implementation of an evidence-based digital system for prevention and treatment of malnutrition in elderly institutionalized patients: a qualitative study. BMC Health Services Research. 23(1), p. 1–12. doi: 10.1186/s12913-023-09227-8. Full text in Research Archive Show summary

  Background: Malnutrition in elderly institutionalized patients is a significant challenge associated with adverse health outcomes. The ‘MyFood’ decision support system was designed to prevent and treat malnutrition and has previously been studied in a hospital setting. The aim of this study was to explore the experiences of nursing staff regarding the implementation of MyFood in settings treating elderly patients. Methods: The study was conducted in two settings treating elderly patients in Norway. Nursing staff received training in how to follow-up patients with MyFood. Qualitative interviews were conducted with 12 nursing staff. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data collection and the thematic data analysis. Results: The implementation of a digital decision support system to prevent and treat malnutrition into settings treating elderly patients was found to be affected by intervention-related, contextual, and personal factors. Although nursing staff experienced several advantages, the leadership engagement was low and hampered the implementation. Conclusion: Nursing staff experienced several advantages with implementing a digital decision support system for the prevention and treatment of malnutrition in institutionalized elderly patients, including quality improvements and time savings. The results indicate that the leadership engagement was weak and that some nursing staff experienced low self-efficacy in digital competence. Future improvements include increasing the level of training, using MyFood throughout the patient course and involving the patient’s next-of-kin.

• Severinsen, Frida; Andersen, Lene Frost & Paulsen, Mari Mohn (2023). The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study. JMIR mhealth and uhealth. 11. doi: 10.2196/45079. Full text in Research Archive Show summary

  Background The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ≥65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition. Objective This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ≥65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app. Methods Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants’ experiences with the app. Results This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ≥80% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60% of the participants had ≥80% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74% (26/35) of the participants reported that the app was easy to navigate. Conclusions The results showed that the MyFood app tended to underestimate the participants’ dietary intake compared with the 24-hour recalls at both the individual and group levels. The app’s ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake.

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