Publications by authors named "Mette Juel Rothmann"

9 Publications

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Barriers to a healthy postpartum lifestyle and the possibilities of an information technology-based intervention: A qualitative study.

Midwifery 2021 Apr 3;98:102994. Epub 2021 Apr 3.

Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark; Department of Endocrinology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark. Electronic address:

Background: Being overweight or obese is associated with higher risk of adverse maternal and fetal outcomes, including gestational diabetes and childhood obesity. Many women exceed the gestational weight gain recommendations. Thus, it is important to focus on the women's lifestyle between their pregnancies to lower the risk of weight retention before the next pregnancy as well as in a life course perspective.

Objective: The objective of this study was to explore barriers postpartum women experience with respect to a healthy lifestyle during the postpartum period, and to assess whether an IT-based intervention might be a supportive tool to assist and motivate postpartum women to healthy lifestyle.

Method: A systematic text condensation was applied to semi-structured focus groups. Five focus group interviews were carried out with a total of 17 postpartum women and two interviews with a total of six health professionals. Participants were recruited through the municipality in Svendborg, Denmark, and at Odense University Hospital in Odense, Denmark, during a four-month period in early 2018. The results were analysed within the frame of the capability, opportunity, motivation and behaviour model (COM-B).

Results: From the women's perspective, better assistance is needed from the health professionals to obtain or maintain a healthy lifestyle. The women need tools that inform and help them understand and prioritize own health related risks, and to motivate them to plan and take care of their own health. There is room for engaging the partner more in the communication related to the baby and family's lifestyle. Lastly, the women already use audiobooks and podcasts to obtain information.

Conclusion: Postpartum women need tools that inform and motivate for a healthy lifestyle postpartum. The tools should allow access to high quality information from health care professionals when the information is needed and also allow engagement from the partner. An IT-based intervention could be a way to support and motivate postpartum women for a healthy lifestyle.
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April 2021

Self-determination theory interventions versus usual care in people with diabetes: a protocol for a systematic review with meta-analysis and trial sequential analysis.

Syst Rev 2021 Jan 7;10(1):12. Epub 2021 Jan 7.

Department of Anaesthesiology, Herlev University Hospital, Herlev, Denmark.

Background: Existing self-management and behavioural interventions for diabetes vary widely in their content, and their sustained long-term effectiveness is uncertain. Autonomy supporting interventions may be a prerequisite to achieve 'real life' patient engagement and more long-term improvement through shared decision-making and collaborative goal setting. Autonomy supportive interventions aim to promote that the person with diabetes' motivation is autonomous meaning that the person strives for goals they themselves truly believe in and value. This is the goal of self-determination theory and guided self-determination interventions. Self-determination theory has been reviewed but without assessing both benefits and harms and accounting for the risk of random errors using trial sequential analysis. The guided self-determination has not yet been systematically reviewed. The aim of this protocol is to investigate the benefits and harms of self-determination theory-based interventions versus usual care in adults with diabetes.

Methods/design: We will conduct the systematic review following The Cochrane Collaboration guidelines. This protocol is reported according to the PRISMA checklist. A comprehensive search will be undertaken in the CENTRAL, MEDLINE, EMBASE, LILACS, PsycINFO, SCI-EXPANDED, CINAHL, SSCI, CPCI-S and CPCI-SSH to identify relevant trials. We will include randomised clinical trials assessing interventions theoretically based on guided self-determination or self-determination theory provided face-to-face or digitally by any healthcare professional in any setting. The primary outcomes will be quality of life, mortality, and serious adverse events. The secondary will be diabetes distress, depressive symptoms and adverse events not considered serious. Exploratory outcomes will be glycated haemoglobin and motivation. Outcomes will be assessed at the end of the intervention and at maximum follow-up. The analyses will be performed using Stata version 16 and trial sequential analysis. Two authors will independently screen, extract data from and perform risk of bias assessment of included studies using the Cochrane risk of bias tool. Certainty of the evidence will be assessed by GRADE.

Discussion: Self-determination theory interventions aim to promote a more autonomous patient engagement and are commonly used. It is therefore needed to evaluate the benefit and harms according to existing trials.

Systematic Review Registration: PROSPERO CRD42020181144.
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January 2021

The journey to solo motherhood - An explorative study.

Sex Reprod Healthc 2021 Feb 13;27:100586. Epub 2020 Dec 13.

Department of Clinical Research, University of Southern Denmark, Denmark; Department of Endocrinology, Odense University Hospital, Denmark; CIMT Centre for Innovative Medical Technology, Odense University Hospital, Denmark.

Objectives: In high-income countries, the number of women who choose to become single mothers is rising. This trend is also reflected in Denmark. The aim of this study was to explore the decision- making process of becoming a solo mother.

Study Design: This study was designed as an explorative, qualitative study. Semi-structured interviews were conducted face to face or by telephone, to explore women's thoughts and experiences of becoming solo mothers. A systematic text condensation and interpretation were used to analyze the interview material.

Results: Twenty solo mothers-to-be participated in the study and 38 interviews were conducted, before and after pregnancy. Four themes related to the journey of solo motherhood emerged from the data analysis: The dream of motherhood in a nuclear family - a shattered dream, Achieving socio-emotional acceptance, approaching motherhood with a comprehensive plan, and the fatherless child.

Conclusion: The nuclear family was considered as the ideal family among our participants. The decision to become solo mother was characterized by a long process of reorganizing ideas about a family. In the effort to feel more secure about being a solo parent, to control the process and reduce vulnerability, most women drew up a detailed motherhood plan, even before embarking on the project.
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February 2021

Positive facilitators of diabetes management in emerging adults with type 1 diabetes-A qualitative analysis of blogs.

Endocrinol Diabetes Metab 2020 Jul 19;3(3):e00161. Epub 2020 Jun 19.

Steno Diabetes Center Odense Odense University Hospital Odense Denmark.

Introduction: Emerging adults (18-30 years) with type 1 diabetes must manage a demanding chronic illness as well as navigate a life phase full of instability and transitions. Clinical care for this age group remains a challenge. An improved understanding of psychological facilitators of diabetes management may contribute to optimized clinical care to this age group.

Aim: To explore which individual strategies facilitated emerging adults' diabetes management and what kind of support they regard helpful from peers, family and healthcare providers.

Methods: Qualitative analysis of web blogs. We identified personal blogs by emerging adults with type 1 diabetes through a search at the websites for diabetes associations in Denmark, UK and the USA, a snowball search at identified blogs and an internet search (Google). Blog posts from approximately the last year were analysed with thematic analysis as described by Braun and Clarke.

Results: We included 16 blogs from UK, the USA, Australia and Denmark, focusing on blog entries from 2017 to 2018. Several psychological facilitators of management of type 1 diabetes were identified. Positive individual strategies involved: developing a balanced approach to blood glucoses, sharing diabetes with peers and making space for emotional reactions. Supportive involvement from peers, family and health care providers included: normalization, emotional backup and a nonjudgmental attitude.

Conclusion: Diabetes management in emerging adulthood can be facilitated by several individual strategies as well as by supportive involvement from peers, family and health care providers. It is worthwhile to further investigate how individual strategies as well as supportive involvement can be promoted in diabetes care.
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July 2020

The role of parental support for emerging adults with type 1 diabetes: A scoping review.

Pediatr Diabetes 2020 09 14;21(6):995-1030. Epub 2020 Jun 14.

Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.

Background: Emerging adults with type 1 diabetes often have poor diabetes self-care and pose a considerable therapeutic challenge. They simultaneously handle a life phase characterized by instability, identity exploration, and transitions and manage a chronic illness that demands structure, self-discipline, and repeated health care contacts. Relation to parents is often ambivalent but typically remains the most stable social support, so parental support could potentially be helpful for diabetes self-care and wellbeing.

Method: This scoping review aimed to identify, summarize and analyze empirical studies (for instance interview studies, questionnaire studies and intervention studies) exploring parental support for emerging adults with type 1 diabetes. Studies were identified in PsycInfo, PubMed, Scopus, and Google Scholar. Data were extracted by one author and checked by another. Study results were synthesized by a convergent mixed methods approach and qualitative thematic analysis.

Results: We included 26 studies (2829 participants), 16 interview studies, 10 questionnaire studies, and no intervention studies. Five overarching themes were identified: self-care and glycemic control, diabetes-related emotional wellbeing, support characteristics, ambivalence and harms, and core support providers. Parents tended to contribute positively to diabetes self-care, glycemic control, and psychological wellbeing. However, emerging adults did not want to be too dependent on their parents and family, and family could also act unsupportively; when absent, disinterested in diabetes or controlling.

Conclusion: This review underlines that parental support still plays a role for diabetes self-care and wellbeing in emerging adults with type 1 diabetes. Age-appropriate parental support therefore seems a promising path to investigate further.
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September 2020

Lifestyle interventions to maternal weight loss after birth: a systematic review.

Syst Rev 2019 12 16;8(1):327. Epub 2019 Dec 16.

Department of Public Health, University of Southern Denmark, Odense, Denmark.

Background: Over the past decades, there has been an increase in overweight and obesity in women of childbearing age, as well as the general population. Overweight and obesity are related to a later, increased risk of type 2 diabetes and cardiovascular diseases. Increasing weight between pregnancies has a negative impact on the development of the fetus in a subsequent pregnancy. It is also related to long-term obesity and overweight for the woman. Accordingly, weight control in women of the childbearing age is important for both women and their offspring. Information and communication technology (ICT) has become an integrated part of many peoples' lives, and it has the potential to prevent disease. In this systematic review, we summarize the evidence from randomized controlled trials to compare effects of different ICT-based interventions to support postpartum women to achieve weight loss.

Methods: A systematic search was performed in PubMed, Embase, PsycInfo, CINAHL, Web of Science, Scopus, and Cochrane, searching on terms, such as postpartum, weight loss, telemedicine, and randomized controlled trials. Two independent researchers undertook study selection and data extraction. Results were reported narratively. The systematic review only included studies that were randomized controlled trials.

Results: Eight studies were included in the systematic review. All of them were characterized by applying one or more ICT components to assist postpartum women in weight control, and had weight loss as an outcome measure. A significant difference was found in weight loss between control group and intervention group in the majority of the studies. However, five of the studies had a relatively short follow-up period (40 days to 16 weeks), six of the studies had a relatively small sample size (18 to 66 women), and half of the studies indicated challenges with adherence to the interventions over time.

Conclusion: ICT-based interventions can support postpartum women to achieve a healthy lifestyle and weight control. Future studies should focus on larger sample sizes, longer follow-up periods, and adherence to the interventions.

Systematic Review Registration: PROSPERO CRD42018080731.
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December 2019

Usage of an Exercise App in the Care for People With Osteoarthritis: User-Driven Exploratory Study.

JMIR Mhealth Uhealth 2018 Jan 11;6(1):e11. Epub 2018 Jan 11.

Centre for Innovative Medical Technology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.

Background: Exercise has proven to reduce pain and increase quality of life among people living with osteoarthritis (OA). However, one major challenge is adherence to exercise once supervision ends.

Objective: This study aimed to identify mental and physical barriers and motivational and social aspects of training at home, and to test or further develop an exercise app.

Methods: The study was inspired from participatory design, engaging users in the research process. Data were collected through focus groups and workshops, and analyzed by systematic text condensation.

Results: Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training and had knowledge on exercise and pain but found it hard to motivate themselves. They missed the observation, comments, and encouragement by the supervising physiotherapist as well as their peers. Ways to optimize the training app were identified during the workshops as participants shared their experience.

Conclusions: This study concludes that the long-term continuation of exercising for patients with OA could be improved with the use of a technology tailored to users' needs, including motivational and other behavioral factors.
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January 2018

The risk-stratified osteoporosis strategy evaluation study (ROSE): a randomized prospective population-based study. Design and baseline characteristics.

Calcif Tissue Int 2015 Feb 13;96(2):167-79. Epub 2015 Jan 13.

Odense Patient data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3th Floor, 5000, Odense C, Denmark,

The risk-stratified osteoporosis strategy evaluation study (ROSE) is a randomized prospective population-based study investigating the effectiveness of a two-step screening program for osteoporosis in women. This paper reports the study design and baseline characteristics of the study population. 35,000 women aged 65-80 years were selected at random from the population in the Region of Southern Denmark and-before inclusion-randomized to either a screening group or a control group. As first step, a self-administered questionnaire regarding risk factors for osteoporosis based on FRAX(®) was issued to both groups. As second step, subjects in the screening group with a 10-year probability of major osteoporotic fractures ≥15% were offered a DXA scan. Patients diagnosed with osteoporosis from the DXA scan were advised to see their GP and discuss pharmaceutical treatment according to Danish National guidelines. The primary outcome is incident clinical fractures as evaluated through annual follow-up using the Danish National Patient Registry. The secondary outcomes are cost-effectiveness, participation rate, and patient preferences. 20,904 (60%) women participated and included in the baseline analyses (10,411 in screening and 10,949 in control group). The mean age was 71 years. As expected by randomization, the screening and control groups had similar baseline characteristics. Screening for osteoporosis is at present not evidence based according to the WHO screening criteria. The ROSE study is expected to provide knowledge of the effectiveness of a screening strategy that may be implemented in health care systems to prevent fractures.
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February 2015

Women's perspectives and experiences on screening for osteoporosis (Risk-stratified Osteoporosis Strategy Evaluation, ROSE).

Arch Osteoporos 2014 19;9:192. Epub 2014 Aug 19.

Department of Endocrinology, Odense University Hospital, Kloevervaenget 10, 6.sal, 5000, Odense C, Denmark,

Unlabelled: This study aimed to investigate women's perspectives and experiences with screening for osteoporosis. Focus groups and individual interviews were conducted. Three main themes emerged: knowledge about osteoporosis, psychological aspects of screening, and moral duty. Generally, screening was accepted due to life experiences, self-perceived risk, and the preventive nature of screening.

Purpose: The risk-stratified osteoporosis strategy evaluation (ROSE) study is a randomized prospective population-based trial investigating the efficacy of a screening program to prevent fractures in women aged 65-80 years. It is recommended by the World Health Organization that a set of criteria are met before a screening program is implemented. This sub-study aims to investigate women's perspectives and experiences with the ROSE screening program in relation to the patient-related criteria recommended by the World Health Organization.

Methods: A qualitative study was carried out involving 31 women by way of 8 focus group interviews and 11 individual interviews. Principles from critical psychology guided the analysis.

Results: Women's perspectives and experiences with the screening program were described by three main themes: knowledge about osteoporosis, psychological aspects of screening, and moral duty. The women viewed the program in the context of their everyday life and life trajectories. Age, lifestyle, and knowledge about osteoporosis were important to how women ascribed meaning to the program, how they viewed the possibilities and limitations, and how they rationalized their actions and choices. The women displayed limited knowledge about osteoporosis and its risk factors. However, acceptance was based on prior experience, perceived risk, and evaluation of preventive measures. To be reassured or concerned by screening was described as important issues, as well as the responsibility for health-seeking behaviour.

Conclusion: In general, the women accepted the screening program. No major ethical reservations or adverse psychological consequences were detected. Only a minority of women declined screening participation due to a low perceived risk of osteoporosis.
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May 2015