Marie Germund Nielsen

Purpose: There is social inequity in the distribution of digital health literacy (DHL), and patients with chronic disease have also been shown to have lower general health literacy. The study aimed to examine the associations between low socioeconomic status (SES) [measured by self-reported educational level], chronic disease and low DHL and whether chronic disease modifies the effect between SES and DHL. Methods: Cross-sectional study from the Danish HLS ₁₉ survey, a stratified random sample of 3,644 respondents from the Danish population. A questionnaire collected information on educational level and the prevalence of 13 specific chronic diseases. The number of self-reported chronic diseases were counted. DHL was measured using the HLS ₁₉ digital health literacy scale from the WHO-Action Network M-POHL. Linear regression models were used to estimate the association between chronic disease and DHL and between education level and DHL, adjusted for sex and age. The potential effect modification between SES, chronic disease and DHL was analyzed. Results: Having two or more chronic diseases was associated with a lower level of DHL (beta (95%CI)) (-3.88 (-5.68; -2.08)) compared to having no chronic disease. Both bachelor-level education (6.49 (4.68; 8.30)) and master-level or above (9.39 (7.43;11.36)) were associated with a higher DHL than respondents with vocational education. No statistically significant interaction was found between chronic diseases and education level on the level of DHL. Conclusions: SES and the presence of chronic diseases were independently associated with DHL but did not interact.

The purpose of this prospective cohort study was to assess weight loss in kg following orthognathic surgery focusing on gender, type of surgery, employment, and living arrangements, as effect modifiers.

Question: Which domains are important to develop a preliminary item bank for a new patient-reported outcome measure relating to adolescents with non-traumatic anterior knee pain? Design: Multiple methods: semi-structured interviews, Participants: Twenty-one adolescents with anterior knee pain participated in semi-structured interviews which explored their experience of living with knee pain. Following thematic analysis, we generated an item bank based on the domains which emerged from the impact their knee pain had on their daily life. Ten clinical experts provided input on the preliminary item bank via an online survey. Cognitive interviews were conducted using the think-aloud approach with ten adolescents to evaluate the comprehensibility and face validity of the items. Results: From the interviews we identified four overarching domains where adolescents were impacted by their knee pain: knee symptoms, limitations in physical activity/sport, limitations in social activities, and emotional impact of pain. Eighteen items was initially developed and expanded to 23 following clinical expert input. The cognitive interviews with adolescents demonstrated that the items were comprehensive, understandable, and relevant for adolescents. Conclusion: This study developed an item bank of 23 items. These spanned four domains of impact for adolescents with anterior knee pain. The items had good face validity and were deemed relevant and understandable for adolescents with knee pain. Further steps are needed to validate and reduce the items for the non-traumatic anterior knee pain (AKP)-YOUTH scale.

Background: For improving health literacy (HL) by national and international public health policy, measuring population HL by a comprehensive instrument is needed. A short instrument, the HLS₁₉-Q12 based on the HLS-EU-Q47, was developed, translated, applied, and validated in 17 countries in the WHO European Region. Methods: For factorial validity/dimensionality, Cronbach alphas, confirmatory factor analysis (CFA), Rasch model (RM), and Partial Credit Model (PCM) were used. For discriminant validity, correlation analysis, and for concurrent predictive validity, linear regression analysis were carried out. Results: The Cronbach alpha coefficients are above 0.7. The fit indices for the single-factor CFAs indicate a good model fit. Some items show differential item functioning in certain country data sets. The regression analyses demonstrate an association of the HLS₁₉-Q12 score with social determinants and selected consequences of HL. The HLS₁₉-Q12 score correlates sufficiently highly (r ≥ 0.897) with the equivalent score for the HLS₁₉-Q47 long form. Conclusions: The HLS₁₉-Q12, based on a comprehensive understanding of HL, shows acceptable psychometric and validity characteristics for different languages, country contexts, and methods of data collection, and is suitable for measuring HL in general, national, adult populations. There are also indications for further improvement of the instrument.

This study aims to explore how a changed COVID-19 work environment influences nurses’ clinical decision-making. Data were collected via three focus groups totaling 14 nurses working in COVID-19 pandemic wards at a Danish university hospital. The factors influencing decision-making are described in three themes; navigating in a COVID-19 dominated context, recognizing the importance of collegial fellowship, and the complexities of feeling competent. A strong joint commitment among the nurses to manage critical situations fostered a culture of knowledge-sharing and drawing on colleagues’ competencies in clinical decision-making. It is important for nurse leaders to consider multiple factors when preparing nurses not only to work in changing work environments, but also when nurses are asked to work in environments and specialties that deviate from their usual routines.

The maintenance of physical distance, the absence of relatives and the relocation of registered nurses to COVID-19 units presumably affects nursing care at non-COVID-19 units. Using a qualitative design, this study explored registered nurses’ experiences of how COVID-19 influenced nursing care in non-COVID-19 units at a Danish university hospital during the first wave of the virus. The study is reported using the COREQ checklist. The analysis offered two findings: (1) the challenge of an increased workload for registered nurses remaining in non-COVID-19 units and (2) the difficulty of navigating the contradictory needs for both closeness to and distance from patients. The study concluded that several factors challenged nursing care in non-COVID-19 units during the COVID-19 pandemic. These may have decreased the amount of contact between patients and registered nurses, which may have contributed to a task-oriented approach to nursing care, leading to missed nursing care.

This study aims to assess the measurement properties of the Major Depression Inventory (MDI) in a clinical sample of primary care patients. General practitioners (GPs) handed out the MDI to patients aged 18-65 years on clinical suspicion of depression. Thirty-seven general practices in the Central Denmark Region participated in the study. Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis. The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software. Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1-3) and after dichotomization of items according to diagnostic procedure. Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Key points The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice. This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Minor problems with measurement structure should be addressed in future revisions of the MDI.

Depression constitutes a significant part of the global burden of diseases. General practice plays a central role in diagnosing and monitoring depression. A telemedicine solution comprising a web-based psychometric tool may reduce number of visits to general practice and increase patient empowerment. However, the current use of telemedicine solutions in the field of general practice is limited. This study aims to explore barriers and facilitators to using a web-based version of the Major Depression Inventory (eMDI) for psychometric testing of potentially depressive patients in general practice. Semi-structured individual interviews were conducted with nine general practitioners (GPs) from eight general practices in the Central Denmark Region. All interviewees had previous experience in using the eMDI in general practice. Determinants for using the eMDI were identified in relation to the GPs’ capability, opportunity and motivation to change clinical behaviour (the COM-B system). Our results indicate that the main barriers for using the eMDI are related to limitations in the GPs’ opportunity in regards to having the time it takes to introduce change. Further, the use of the eMDI seems to be hampered by the time-consuming login process. Facilitating factors included behavioural aspects of capability, opportunity and motivation. The implementation of the eMDI was facilitated by the interviewees’ previous familiarity with the paper-based version of the tool. Continued use of the eMDI was facilitated by a time-saving documentation process and motivational factors associated with clinical core values. These factors included perceptions of improved consultation quality and services for patients, improved possibilities for GPs to prioritise their patients and improved possibilities for disease monitoring. Furthermore, the flexible nature of the eMDI allowed the GPs to use the paper-based MDI for patients whom the eMDI was not considered appropriate. Implementation of a telemedicine intervention in general practice can be facilitated by resemblance between the intervention and already existing tools as well as the perception among GPs that the intervention is time-saving and improves quality of care for the patients.